GI Disorders Past Paper PDF - Franklin Pierce University

12/8/24 1 Promoting Health in Patients with GI disorders KAYLA GALLAGHER, MSN, RN, CNE FRANKLIN PIERCE UNIVERSITY 2 Objectives Correlate clinical manifestations with pathophysiological process of selected gastrointestinal disorders Discuss the...

12/8/24 1 Promoting Health in Patients with GI disorders KAYLA GALLAGHER, MSN, RN, CNE FRANKLIN PIERCE UNIVERSITY 2 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 3 Oral candidiasis Fungal yeast infection Raised, bright white patches or coatings oTongue, inside of cheeks oIrritation, redness, and mouth pain oWhen white patches removed -> erythema Burning sensation, change in taste, oral bleeding Risks o65 years old or older or very young oWeakened immune system oCorticosteroids oAntibiotics oTobacco oDentures Treatment: antifungal o 4 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 5 1 1 4 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 5 GERD: risks and complications 1 Risks/comorbidities oObesity oSmoking oStress oDiet oDecrease physical activity oAge 50+ oWhite oLow socioeconomic status oLying down after eating oHiatal hernia oPregnancy oStress oMedications 2 Complications oBarrett's esophagus oStrictures oErosive esophagitis oEsophageal adenocarcinoma 6 GERD: manifestations Heartburn symptoms Regurgitation Epigastric pain Sour taste Dysphagia Odynophagia Belching N&V Chest pain 7 1  N&V Chest pain Hoarseness Chronic cough 7 GERD: management 1 Diagnosis oH&P oRule out cardiac origin oEGD oEsophageal pH monitoring Treatment oLifestyle modifications oMedication §Proton pump inhibitors §H2 receptor antagonists §OTC antacids oSymptom and complication management oSurgical §Esophageal dilation §Nissen fundoplication §Gastric bypass 2 Interventions oVital signs oPhysical assessment oStress reduction strategies oWeight loss management oDiet and exercise oAvoid tight fitting clothes oSmoking cessation oFinish meals 2 hours before bedtime oAvoid lying down after eating oRaise HOB oOral hygiene o 8 9  o 8 GERD surgeries 9 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 10 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 11 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 12 Proton pump inhibitors 13 H2 receptor antagonists 14 What do you know about OTC antacids? Tums=calcium hypercalcemia Milk of magnesia=hypermagnesia Neutralize acid 15 12 13 14 Milk of magnesia=hypermagnesia Neutralize acid 15 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 16 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 17 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 18 1 2  requiring surgery 18 Hiatal hernia: risks and comorbidities 1 SLIDING 2 Multiple pregnancies/pregnancy Skeletal disorders w/ bone decalcification and degeneration Chronic constipation COPD Age >50 Obesity GERD 3 PARAESOPHAGEAL 4 Age >50 Central obesity Smoking 19 Hiatal hernia: manifestations 20 Hiatal hernia: complications GERD Esophageal compression Intestinal obstruction GI bleeding Gastric strangulation Ulcers (Cameron lesions) in gastric body Dehydration and nutritional deficiencies 21 Hiatal hernia: management 1 Diagnosis oEGD -nose to stomach oEsophageal motility study oChest x-ray incidental oBarium swallow study-drinking chalk like stomach, glows on imaging, x-ray or CT scan, chalky colored bowel movement oCT scan Treatment oH2-receptor antagonists 2  Treatment oH2-receptor antagonists oPPIs oAntacids oSurgical §Nissen fundoplication 2 Interventions oVital signs oPhysical assessment oSmoking cessation o 22 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 23 Gastroparesis Chronic illness Delay or absence of gastric emptying Thought to be due to damage to vagus nerve and pacemaker cells of stomach Causes oLong term poorly controlled diabetes mellitus oInjury to vagus nerve (i.e. surgery) oAutoimmune disorders oConnective tissue diseases oCVA (stroke) oParkinson's disease o 24 Gastroparesis: manifestations Early satiety 24 Gastroparesis: manifestations Early satiety Nausea, vomiting (recurring) Abdominal pain Bloating Acid reflux Decreased level of energy Lack of appetite Weight loss 25 Tie it together: what concerns do you have for the patient with gastroparesis Weight loss and poor nutrition Risk for gerd, hernia Electrolyte imbalance Severe malnutrition 26 Tie it together: what concerns do you have for the patient with gastroparesis Nutrition – severe protein-calorie malnourishment Dehydration risk Bezoars-bolus of food doesn’t move becomes hard rock (ferments) painful, bloating, belching, Mallory Weiss tears from retching and vomiting (tear in esophagus) Psychological Recurrent hospitalizations Financial burden Pain management 27 Gastroparesis: management 1 Diagnosis oEGD oGastric emptying tests Treatment oMedications §Metoclopramide (Reglan), erythromycin (stimulate muscles of stomach)  1 §Metoclopramide (Reglan), erythromycin (stimulate muscles of stomach) §Ondansetron (Zofran) and prochlorperazine (Compazine) control N&V oNG tube temporary oJejunostomy tube o o 2 Interventions oFluid intake oSmoking cessation oAvoid using opioids oDo not lie down immediately after meals oMonitor labs -nutritional deficit, electrolytes, creatine, bmp (electrolyte and kidney functions) oDiet §Eat small frequent meals §Chew food thoroughly §Low fat food items §Avoid carbonated beverages §Cooked fruits and veggies §Avoid alcohol 28 Tie it together: what do you know about metoclopramide? 29 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 (tardive dysconesia), long term use of medication. Teaching: oTake will full glass of water oTake on empty stomach oDo not take longer than 12 weeks oMonitor for depression or self-harm 30 31 1  oDo not take longer than 12 weeks oMonitor for depression or self-harm oDo not drive if this medication causes drowsiness oNotify provider if you notice any muscle twitching 30 Tie it together: what do you know about erythromycin? 31 Tie it together: what do you know about erythromycin? 1 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 32 Tie it together: ondansetron and prochlorperazine – general info 33 Tie it together: ondansetron and prochlorperazine – general info 1 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: oReport increased dizziness or feeling faint, do not operate machinery if dizzy or faint, monitor potassium and magnesium, limit alcohol 34 Gastritis Inflammation of the gastric mucosa Causes/risk Exposures gastric irritants Aspirin NSAIDs Alcohol Spicy food, fried, acidic food Smoking  Spicy food, fried, acidic food Smoking Caffeine Corticosteroids Helicobacter pylori (H. Pylori)-food contamination, common cause of gastritis. Autoimmune Traumatic injuries Food poisoning Radiation 35 Gastritis: manifestations Epigastric pain Nausea and vomiting Weight loss Decreased appetite Feeling of fullness Bloating Belching Bleeding (emesis or stool) rare 36 Gastritis: management Diagnosis Endoscopy with biopsy Urea breath tests for H. Pylori-breath into machine Labs: CBC, stool sample Treatment Diet modification Medications Proton pump inhibitors H2 receptor antagonists Antacids 37  H2 receptor antagonists Antacids Antibiotic for H. Pylori 37 Gastritis: complications Peptic ulcers Gastric cancer Vitamin B12 deficiency Bleeding Anemia Perforation Dehydration Nutritional deficits 38 Gastritis: interventions Vital signs-monitor hr, pain, bp, temp, anemia Physical assessment-bowel sounds, full pain assessments, Labs H. Pylori Electrolytes-make sure absorbing correctly I&O IVF Administer medications Educate about gastric irritants-caffeine, chocolate, carbonated beverages, nsaids etc. 39 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 40 41 42  PPI and 2 antibiotics 40 What do you remember about PPI's? 41 Let's review: proton pump inhibitors 42 What do you remember about H2 receptor antagonists? 43 Let's review: H2 receptor antagonists 44 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 oH. Pylori oNSAIDs, corticosteroids, other medications oSmoking oAlcohol consumption oHypersecretion environment (i.e. cystic fibrosis, hyperparathyroidism, and Zollinger Ellison syndrome) 45 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 46 Peptic ulcer disease: complication Hemorrhage 46 Peptic ulcer disease: complication Hemorrhage Perforation Obstruction Infection Nutritional and fluid deficits Gastric cancer 47 Peptic ulcer disease: management 1 Diagnostic oEGD oH. Pylori test Treatment oH. Pylori test oMedication §PPIs oSurgery §Partial gastrectomy §Vagotomy 2 Interventions oVital signs oPhysical assessment oMonitor CBC oHand hygiene oDiet modification oSmoking cessation oLimit medications that increase risk/damage 48 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 49  C.Nausea and vomiting D.A rigid, board-like abdomen 49 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 50 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 51 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