Académique Documents
Professionnel Documents
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Gastro-intestinal Disorder
Prepared: Mark Fredderick Abejo RN, MAN
MS
Abejo
I.
A.
B.
C.
MS
3.
4.
5.
Meningitis
Orchitis sterility
ETIOLOGIC AGENT
1. Paramyxovirus virus
SIGNS AND SYMPTOMS
1. Swollen parotid gland
2. Earache / otalgia
3. Dysphagia
4. Fever, chills, anorexia, generalized body malaise
NURSING MANAGEMENT
1. Strict isolation
2. Meds as ordered
Antipyretics
A.
PREDISPOSING FACTORS
1. Microbial invasion
2. FECALITHS undigested food particles (tomato,
guava seeds)
3. intestinal obstruction
B.
C.
DIAGNOSTICS
1. CBC mild leukocytosis
2. PE (+) rebound tenderness
3. Urinalysis (+) acetone)
D.
NPO
Skin preparation
antipyretics
antibiotics
Abejo
A.
PREDISPOSING FACTORS
1. Alcoholism
2. Malnutrition
3. Viruses
4. Toxicity
Carbon tetrachloride
5. Use of hepatotoxic agent
B.
Anorexia
Amenorrhea
Dyspepsia indigestion
Hepatomegaly
Jaundice
Urticaria/pruritus
Analgesics
Antibiotics
Antipyretics PRN
4. Maintain patent IV line
5. Monitor VS IO and bowel sounds (N=borborygmi)
2.
MS
Late signs
Hematologic changes
Anemia
Leucopenia
Bleeding tendencies
Endocrine changes
Spider angiomas/ telangiectasis
Caput medusae (Varicose veins radiating
from the umbilicus)
Palmar erythema
Gynecomastia
GIT changes
Ascites
Bleeding esophageal varices d/t portal
HPN
Neuro changes
Hepatic encephalopathy
Early Asterixis (flapping hand
tremors)
Abejo
headache,
dizziness,
confusion, irritability, fetor hepaticus,
(ammonia-like breath), decreased
LOC hepatic coma
C.
DIAGNOSTICS
1. Liver enzymes
Ammonia elevated
3. Indirect bilirubin / Unconjugated bilirubin elevated
4. CBC low
5. PTT prolonged
6. Hepatic UTZ fat necrosis of liver lobules
D.
NURSING MANAGEMENT
1. Enforce CBR
2. Monitor strictly VS and IO
3. Weigh pt daily and assess for pitting edema
4. Measure abdominal girth and notify physician
5. Restrict Na and fluids
6. Diet high in CHO, moderate in fat, decreased
CHON, increased vitamins and minerals
7. Meticulous skin care
8. Prevent complications
Ascites
Administer medications as ordered
Loop diuretics (Furosemide)
Assist in abdominal paracentesis
(empty the bladder pre-op)
Hepatic Encephalopathy
Assist in mechanical ventilation
Monitor VS, NVS
Maintain side rails
Administer medications as ordered
Lactulose for ammonia excretion
A.
OCPs
Hyperlipidemia
Hyperparathyroidism
5. Obesity
6. Diet: high in saturated fats
B.
S/Sx
1. Severe abdominal pain radiating from the back (left
upper quadrant), chest and flank area accompanied
by DOB and aggravated by eating (so dapat naka
TPN to, uhm, usually an infusion vamine glucose or
lipofundin, kung may pera ang patient eh di
Nutripak; remember to keep all lines securely taped
to prevent embolism)
2. Shallow respirations
3. Tachycardia and palpitations, hypertension
4. Anorexia, N&V, dyspepsia
5. Decreased bowel sounds
6. (+) Cullens sign ecchymoses around umbilicus
and (+) Grey-turners spots ecchymoses at the
flank area; both are indications of hemorrhage
C.
DIAGNOSTICS
1. Serum amylase (very toxic to the body) and lipase
elevated
2. Serum Ca low (hypocalcemia)
PANCREAS
Both an endocrine (islets of Langerhans) and exocrine gland
(Acinar cells)
D.
NURSING MANAGEMENT
1. Administer meds as ordered
Narcotic analgesics
Meperidine HCl (Demerol) Respiratory
Depression
DO NOT GIVE MORPHINE can
cause spasm of the sphincter of Oddi
Vasodilators
NTG
Antacids (Maalox)
H2 receptor antagonist
MS
Abejo
2.
3.
4.
5.
6.
V.
Ranitidine (Zantac)
Decrease pancreatic stimulation
Calcium gluconate
Phosphate binders
Amphogel
Withhold food and fluids (need to rest the GIT)
Complications of TPN
Infection (so maintain strict asepsis)
Air embolism
Hyperglycemia
Hyponatremia
Instruct pt to assume comfortable position
Shock
Septicemia
Stress management
DBE, biofeedback
A.
PREDISPOSING FACTORS
1. High risk group: women
2. Obesity
3. Post-menopausal women
therapy
4. Diet high in saturated fats
5. Sedentary lifestyle
6. Neoplasm
7. Obstruction
undergoing
estrogen
B.
C.
DIAGNOSTICS
1. Gallbladder series (Oral cholecystogram) confirm
presence of gallstones
2. Serum lipase elevated
3. Indirect bilirubin elevated
4. Alkaline phosphatase elevated
5. Transaminases elevated
D.
NURSING MGT
1. Narcotic analgesics
Atropine sulfate
3. Anti-emetics
Metoclopramide (Plasil)
Phenergan
4. Diet low in fat, high CHON and CHO
5. Meticulous skin care
6. Assist in surgery: Cholecystectomy
CHOLECYSTITIS/CHOLELITHIASIS inflammation of
the gallbladder with gallstone formation
STOMACH
J-shaped structure
B.
C.
MS
Parts
1. Antrum
2. Fundus
3. Pylorus
Valves - prevents reflux
1. cardiac between esophagus and stomach
2. pyloric stomach and duodenum
projectile vomiting
Pepsin proteins
Metronidazole
SE: photosensitivity
Etampicillin
3.
D.
FUNCTIONS
1. Mechanical and chemical digestion
2. Storage of food
V.
TYPES
1. Severity
Gastric
Duodenal
Differences
Location
Pain
Gastric Ulcer
Antrum
30 mins-1hour p.c.
Pain location
Pain
character
Epigastrium
Gaseous and burning, not
relieved by food and
antacids
Normal
Gastric acid
secretion
Weight
Hemorrhage
Complication
s
High risk
MS
A.
INCIDENCE RATE
1. Men
2. Aggressive
B.
PREDISPOSING FACTORS
1. Heredity
2. Emotional stress
3. Smoking vasoconstriction gastric ischemia
4. Alcoholism release of histamine parietal cells
to secrete gastrin
5. Irregular diet
6. Rapid eating
7. Ulcerogenic drugs
Aspirin
Ibuprofen
Steroids
NSAIDs
8. Foods or beverages rich in caffeine
9. Gastrin producing tumors
Loss
Hematemesis
Hemorrhage,
cancer
60 y.o above
stomach
D.
DIAGNOSTICS
1. Endoscopy
2. (+) Stool occult blood
3. Gastric analysis reveals
E.
Antacids
ACA aluminum containing antacids
Aluminum OH gel (Ampho gel)
SE: constipation, hyperphosphatemia,
hypoparathyroidism
MAD magnesium containing antacids
Milk of magnesia
SE: diarrhea
Mg + Al preparations (Maalox) less SE
H2 receptor antagonists
Abejo
3.
Cytoprotective agents
Sucralfate (Carafate) provides a pastelike substance that coats the mucosal
lining
Cytotec (Misoprostol) causes severe
spasm (abortifacient) uterine cramping
bleeding
Anticholinergic/Anti-spasmodic agents
Atropine
Propanthelene sulfate (Probanthene)
Sedatives, tranquilizers
Assist in surgical procedure: subtotal gastrectomy
MS
Billroth II
Gastrojejunostomy gastric stump to
jejunum
Removal of to of the stomach,
duodenal valve and anastomosis of gastric
stump to jejunum
Complic: DUMPING SYNDROME
Antimicrobials
Narcotic analgesics
Anti-emetics
3. Maintain a patent IV line
4. Monitor VS, IO, Bowel Sounds
5. Prevent complication
Hemorrhage shock
Peritonitis
Septicemia
Hypokalemia
Pernicious anemia
Abejo
MS
A.
PREDISPOSING FACTORS
1. High risk: female
2. Congenital weakness of muscular fibers of intestines
3. Obesity
4. Stress
5. Diet: decrease in roughage
B.
C.
DIAGNOSTICS
1. Barium Enema reveals inflammatory process
2. Decreased hematocrit/hemoglobin (d/t diarrhea)
D.
NURSING MANAGEMENT
1. Administer medications as ordered.
Bulk laxatives
Anti-cholinergics
Atropine Sulfate
Propanthelene Bromide
Abejo