Promoting Health in Patients with GI Disorders PDF

Promoting Health in Patients with GI disorders KAYL A GALL AGHER, MSN, RN, CNE FRANKLIN PIERCE UNIVERSITY Objectives Correlate clinical manifestations with pathophysiological process of selected gastrointestinal disorders Discuss the medical and nursing management of selected disorders of the g...

Promoting Health in Patients with GI disorders KAYL A GALL AGHER, MSN, RN, CNE FRANKLIN PIERCE UNIVERSITY Objectives Correlate clinical manifestations with pathophysiological process of selected gastrointestinal disorders Discuss the medical and nursing management of selected disorders of the gastrointestinal system Develop a teaching plan for a patient with gastrointestinal disorders. Discuss potential diagnostic procedures for patients experiencing gastrointestinal disorders  Oral candidiasis Fungal yeast infection Raised, bright white patches or coatings o Tongue, inside of cheeks o Irritation, redness, and mouth pain o When white patches removed -> erythema Burning sensation, change in taste, oral bleeding Risks o 65 years old or older or very young o Weakened immune system o Corticosteroids o Antibiotics o Tobacco o Dentures Treatment: antifungal GERD Regurgitation of gastric contents into the esophagus Causes changes to the esophagus lining Symptoms include burning, irritation, chest pain Can be due to esophageal dysmotility, lower esophageal sphincter tone impairment, transient sphincter tone relaxation, and delayed gastric emptying GERD: risks and complications Risks/comorbidities Complications o Obesity o Barrett's esophagus o Smoking o Strictures o Stress o Erosive esophagitis o Diet o Esophageal adenocarcinoma o Decrease physical activity o Age 50+ o White o Low socioeconomic status o Lying down after eating o Hiatal hernia o Pregnancy o Stress o Medications GERD: manifestations Heartburn symptoms Regurgitation Epigastric pain Sour taste Dysphagia Odynophagia Belching N&V Chest pain Hoarseness Chronic cough GERD: management Diagnosis Interventions o H&P o Vital signs o Rule out cardiac origin o Physical assessment o EGD o Stress reduction strategies o Esophageal pH monitoring o Weight loss management Treatment o Diet and exercise o Lifestyle modifications o Avoid tight fitting clothes o Medication o Smoking cessation  Proton pump inhibitors o Finish meals 2 hours before bedtime  H2 receptor antagonists  OTC antacids o Avoid lying down after eating o Symptom and complication management o Raise HOB o Surgical o Oral hygiene  Esophageal dilation  Nissen fundoplication  Gastric bypass GERD surgeries EGD Flexible endoscope travels through mouth, esophagus, and stomach (sometimes duodenum) Can treat some problems and take biopsies for diagnosis Patient sedated NPO 6-8 hours prior NCLEX question A nurse is planning to teach a client with gastroesophageal reflux disease (GERD) about substances to avoid. Which item should the nurse include on this list? Select all that apply. A. Coffee B. Chocolate C. Nonfat milk D. Fried chicken E. Scrambled eggs F. Seltzer water NCLEX question A client has undergone esophagogastroduodenoscopy. The nurse should place highest priority on which item as part of the client's care plan? A. Monitoring the temperature B. Monitoring complaints of heartburn C. Giving warm gargles for a sore throat D. Assessing return of the gag reflux  Proton pump inhibitors Drug example:​ Pantoprazole, omeprazole Action:​ Binds to an enzyme in the presence of acidic gastric pH -> stopping transport of hydrogen ions into gastric lumen => less acid AKA inhibits secretion of gastric acid Use: GERD, erosive esophagitis, ulcers Adverse reactions:​ HA, C. diff, bone fractures, vitamin B12 deficiency, hypomagnesemia, hypocalcemia, decreased bone density Interventions:​ Monitor bowel function, GI assessment, administer on empty stomach Administration:​ Will decrease absorption of drugs that require acidic pH PO or IV Do not chew medication Client instructions:​ Take on an empty stomach before first meal and/or at bedtime; short term use, monitor symptoms and follow up  H2 receptor antagonists Drug example:​ famotidine Action:​ Inhibits the action of histamine at the H2-receptor site located primarily in gastric parietal cells -> inhibit gastric acid secretion Use: Duodenal and gastric ulcers, GERD, heartburn Adverse reactions:​ HA, arrhythmias, constipation, diarrhea, agranulocytosis, aplastic anemia, drowsiness, muscle aches Interventions:​ GI assessment, monitor CBC Administration:​ GI assessment, neuro assessment, s/s anemia With meals or right after and at bedtime PO or IV Client instructions:​ Take full course, if OTC do not take more than 2 weeks without seeing provider, smoking cessation, can cause drowsiness Contraindications/ Hypersensitivity precautions:​ Renal impairment, liver impairment, pregnancy and lactation What do you know about OTC antacids? What do you know about OTC antacids? Examples: calcium carbonate (Tums), magnesium hydroxide (Milk of magnesia) Neutralizes gastric acid Used: decrease heartburn or esophageal irritation caused by gastric acid Adverse: constipation, decreased appetite, N&V, flatulence, dry mouth OTC – no prescription Chew tablets completely before swallowing Drink fluid after taking Take before meals and before bedtime  Barrett's esophagus Abnormal change in the tissues that line the distal esophagus Precancerous changes in the cells Risks GERD Male Age 50 and up History of smoking Family history Obese White High risk for adenocarcinoma of the esophagus Surveillance through EGD Hiatal hernia Part of the stomach or other internal organ bulges through an opening in the diaphragm Results in lower esophageal sphincter compromise -> reflux Types: sliding and paraesophageal hernia (PEH) PEH can be an emergency can cut off blood supply to organs requiring surgery Hiatal hernia: risks and comorbidities SLIDING PARAESOPHAGEAL Multiple pregnancies/pregnancy Age >50 Skeletal disorders w/ bone Central obesity decalcification and degeneration Smoking Chronic constipation COPD Age >50 Obesity GERD  Heartburn Regurgitation Sour taste Dysphagia Hiatal Odynophagia hernia: Belching manifestatio Nausea Hoarseness ns Chronic cough Bloating Early satiety Postprandial fullness Hiatal hernia: complications GERD Esophageal compression Intestinal obstruction GI bleeding Gastric strangulation Ulcers (Cameron lesions) in gastric body Dehydration and nutritional deficiencies Hiatal hernia: management Diagnosis Interventions o EGD o Vital signs o Esophageal motility study o Physical assessment o Chest x-ray incidental o Smoking cessation o Barium swallow study o CT scan Treatment o H2-receptor antagonists o PPIs o Antacids o Surgical  Nissen fundoplication NCLEX question A client with a hiatal hernia chronically experiences heartburn following meals. The nurse should plan to teach the client to avoid which action because it is contraindicated with a hiatal hernia? A. Lying recumbent following meals B. Consuming small, frequent bland meals C. Taking H2-receptor antagonist medication D. Raising the head of the bed on a 6-inch (15cm) blocks Gastroparesis Chronic illness Delay or absence of gastric emptying Thought to be due to damage to vagus nerve and pacemaker cells Causes o Long term poorly controlled diabetes mellitus o Injury to vagus nerve (i.e. surgery) o Autoimmune disorders o Connective tissue diseases o CVA o Parkinson's disease Gastroparesis: manifestations Early satiety Nausea, vomiting (recurring) Abdominal pain Bloating Acid reflux Decreased level of energy Lack of appetite Weight loss Tie it together: what concerns do you have for the patient with gastroparesis Tie it together: what concerns do you have for the patient with gastroparesis Nutrition – severe protein-calorie malnourishment Dehydration risk Bezoars Mallory Weiss tears from retching and vomiting Psychological Recurrent hospitalizations Financial burden Pain management Gastroparesis: management Diagnosis Interventions o EGD o Fluid intake o Gastric emptying tests o Smoking cessation o Avoid using opioids Treatment o Do not lie down immediately after meals o Medications o Monitor labs  Metoclopramide (Reglan), erythromycin (stimulate muscles of stomach) o Diet  Ondansetron (Zofran) and prochlorperazine  Eat small frequent meals (Compazine) control N&V  Chew food thoroughly o NG tube temporary  Low fat food items o Jejunostomy tube  Avoid carbonated vegetables  Cooked fruits and veggies  Avoid alcohol Tie it together: what do you know about metoclopramide? Tie it together: what do you know about metoclopramide? Class: dopamine receptor antagonist Action: assists in stimulation of muscles in GI tract to move food and liquids Use: delayed gastric motility, N&V Adverse: drowsiness, agitation, extrapyramidal effects Teaching: o Take will full glass of water o Take on empty stomach o Do not take longer than 12 weeks o Monitor for depression or self-harm o Do not drive if this medication causes drowsiness o Notify provider if you notice any muscle twitching Tie it together: what do you know about erythromycin? Tie it together: what do you know about erythromycin? Antibiotic (macrolide antibiotic) Bacteriostatic Action: A motilin agonist that enhances gastric motility and improves gastric emptying; Use: delayed gastric motility; prevent and treat infection Adverse: N&V, abdominal pain, diarrhea, tachycardia, skin rash, and tiredness; QT prolongation Tie it together: ondansetron and prochlorperazine – general info Tie it together: ondansetron and prochlorperazine – general info Antiemetics Blocks action of serotonin that causes N&V Used for nausea and vomiting Adverse: headache, lightheadedness, blurry vision, tiredness, constipation, and prolonged QT Education: o Report increased dizziness or feeling faint, do not operate machinery if dizzy or faint, monitor potassium and magnesium, limit alcohol Gastritis Inflammation of the gastric mucosa Causes/risk Exposures gastric irritants Aspirin NSAIDs Alcohol Spicy food, fried, acidic food Smoking Caffeine Corticosteroids Helicobacter pylori (H. Pylori) Autoimmune Traumatic injuries Food poisoning Gastritis: manifestations Epigastric pain Nausea and vomiting Weight loss Decreased appetite Feeling of fullness Bloating Belching Bleeding (emesis or stool) rare Gastritis: management Diagnosis Endoscopy with biopsy Urea breath tests for H. Pylori Labs: CBC, stool sample Treatment Diet modification Medications Proton pump inhibitors H2 receptor antagonists Antacids Antibiotic for H. Pylori Gastritis: complications Peptic ulcers Gastric cancer Vitamin B12 deficiency Bleeding Anemia Perforation Dehydration Nutritional deficits Gastritis: intervention s Vital signs Physical assessment Labs H. Pylori Electrolytes I&O IVF Administer medications Educate about gastric irritants What is H. Pylori? Helicobacter pylori Bacteria Causes/associations: gastritis, peptic ulcer disease, gastric cancer, dyspepsia, anemia Diagnosis: breath test, stool test, gastric biopsy Treatment if: PUD, gastritis, resent gastric CA, family history of gastric CA Treatment: PPI and 2 antibiotics What do you remember about PPI's?  Let's review: proton pump inhibitors Drug example:​ Pantoprazole, omeprazole Action:​ Binds to an enzyme in the presence of acidic gastric pH -> stopping transport of hydrogen ions into gastric lumen => less acid Use: GERD, erosive esophagitis, ulcers Adverse reactions:​ HA, C. diff, bone fractures, vitamin B12 deficiency, SLE, low magnesium, decreased bone density Interventions:​ Monitor bowel function, GI assessment, administer on empty stomach Administration:​ Will decrease absorption of drugs that require acidic pH PO or IV Do not chew medication Client instructions:​ Take on an empty stomach before meal; short term use, monitor symptoms and follow up Contraindications/ Hypersensitivity What do you remember about H2 receptor antagonists?  Let's review: H2 receptor antagonists Drug example:​ famotidine Action:​ Inhibits the action of histamine at the H2-receptor site located primarily in gastric parietal cells -> inhibit gastric acid secretion Use: Duodenal and gastric ulcers, GERD, heartburn Adverse reactions:​ Arrhythmias, constipation, diarrhea, agranulocytosis, aplastic anemia, confusion, drowsiness Interventions:​ GI assessment, monitor CBC Administration:​ GI assessment, neuro assessment, s/s anemia With meals or right after and at bedtime PO or IV Client instructions:​ Take full course, if OTC do not take more than 2 weeks without seeing provider, smoking cessation, can cause drowsiness Contraindications/ Hypersensitivity precautions:​ Renal impairment, pregnancy and lactation  Peptic ulcer disease Open sores that occur in the inner lining of the stomach = gastric ulcer Due to a defect in protective gastric mucosa and destructive factors (i.e. H. pylori) Protective lining damaged -> acid can eat away at inner layers and cells have trouble secreting bicarbonate Causes o H. Pylori o NSAIDs, corticosteroids, other medications o Smoking o Alcohol consumption o Hypersecretion environment (i.e. cystic fibrosis, hyperparathyroidism, and Zollinger Ellison syndrome) Peptic ulcer disease: manifestations Can be asymptomatic initially Weight loss Decreased appetite Abdominal pain Nausea and vomiting Bloated Early satiety Pain = burning, gnawning sensation after meals and at night Peptic ulcer disease: complication Hemorrhage Perforation Obstruction Infection Nutritional and fluid deficits Gastric cancer Peptic ulcer disease: management Diagnostic Interventions o EGD o Vital signs o H. Pylori test o Physical assessment o Monitor CBC Treatment o Hand hygiene o H. Pylori test o Diet modification o Medication o Smoking cessation  PPIs o Surgery o Limit medications that increase  Partial gastrectomy risk/damage  Vagotomy NCLEX question – let's see how we do The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer? A. Bradycardia B. Numbness in the legs C. Nausea and vomiting D. A rigid, board-like abdomen NCLEX question The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active, the nurse should assess the client for which manifestation of duodenal ulcer? A. Weight loss B. Nausea and vomiting C. Pain relieved by food intake D. Pain radiating down the right arm Celiac disease Autoimmune disorder Due to reaction to gluten Overtime the inner lining of small intestines is damaged -> malabsorption due to ingestion of the protein Risks: family history, type 1 diabetes, Down syndrome, Turner syndrome, autoimmune thyroid disease, microscopic colitis, Addison's disease Manifestations: diarrhea, fatigue, weight loss, bloating, increased flatulence, anemia References ATI Engage Medical-surgical: Alterations in digestion and bowel elimination ATI Medical-surgical nursing: chapters 46, 47, 48, 51 ATI Pharmacology: chapter 28 29 National library of medicine: StatPearls