s/s of gastric ulcers
L epigastric pain
weight loss
HCL- normal or hyposecretion
Pain 1/2-2 hours after meals
vomiting
Eating may Increase Pain
s/s of duodenal ulcers
well nourished
pain 2-3 hours after meals
food may Decrease pain
mid back and mid epigastrium burning cramping pain
Cushings ulcer
brain injury
Curlings ulcer
Extensive burns
Common risk factors of PUD
stress
h pylori
alcohol
smoking
conditions a client might have that can cause n&v
anorexia
gallbladder disease
food poisening
obstruction
PUD
pancreatitis
chemo
Increased ICP
SRA's examples and end in?
zofran
anzemet
kytril
End in SETRON
what do SRA's do?
block effect of serotonin on vagal nerves
Dopamine Antagonist
block dopamine receptors
Dopamine Antagonist drugs examples
and end in ??
Compozine
Phenagren
Reglan
End in ZINE
Antihistamines used for what? and cause what?
motion sickness and cause drowsiness, dry mouth, and protect from sun!
type of antihistamines
dramamine- dimenhydrinate
antivert-meclizine
vistaril-hydroxyzine
benadryl-diphenhydramine
Nonpharmalogical tx for n/v
fluid and electrolyte replacement
ng
guided imagery
music therapy
hypnosis
ginger
accupuncture
alcohol swab to nose
n/v with pain is associated with?
Peritonitis
Acute GI
obstruction
pancreatitis
n/v with out pain is associated with?
food poisoning
infectious gastroentitis
gallbladder disease
ingestion of toxins
What is GERD?
back flow of gastric contents into espophagus
What causes GERD?
relaxation of lower sphincter
incompetent lower esophageal sphincter
increased pressure within stomach
S/S of GERD
Heartburn
dysphagia
regurgitation
chest pain
pain after eating
belching
Endoscopy
Endoscopy- see if tumors, inflammation, or scarring is there. NPO for
atleast 6 hours before test
With barium swallow, what should you ask patient
allergies to shellfish
after barium swallow what should you tell your patient
stools may be chalky white and to drink lots of fluids after test
What is the Esophageal manometry?
It measures lower esophageal sphincter pressure and peristalsis
Most accurate method of testing for GERD?
Ph testing
What foods irritate GERD?
Caffeine
OJ
lemonade
acidic foods
chocolate
peppermint
coffee
alcohol
smoking
What do PPI's do?
& end in ???
reduce gastric secretions
ZOLE
(pantaprozole, omeprazole, esomeprazole, lansoprazole)
What do H2 blockers do?
& end in ??
reduce gastric acid reduction
end in INE
(ranitidine, famotidine, nizatidine) pepcid , zantac
Which med works more rapidly for GERD?
H2 blockers
Anti ulcer agents do what?
when should you take these
coats stomach and allows the mucosa to heal
Take on an EMPTY stomach
pepcid, zantac, prilosec
do not crush!
increase fluids and fiber
CARAFATE
Antacids?
Mallow, mylanta, tums, gaviscon
Primary tx for GERD
no smoking
diet
avoid tight fitting clothes
small meals
sleep on R side
upright for 2 hrs after eating
don't eat 3 hours prior to bedtime
no bedtime snack
With EGD, what do you want to make sure of?
Make sure patients gag response has returned prior to providing oral
fluids or food following the procedure
Long term consequences of GERD
aspiration
upper resp., sinus, or ear infections
barretts esophagus
What is barrets esophagus
gastric fluids that leads to esophagitis
What happens if GERD becomes chronic?
body will continue to heal inflamed tissue eventually replacing
normal esophageal epithelium with pre malignant tissue
common causes of acute gastritis
ingestion of gastric irritants
nsaids
corticosteroids
alcohol
caffeine
acute gastritis is relieved with?
belching
having a bm
common cause of chronic gastritis
irreversible changes of the gastric mucosa
complications of a peptic ulcer
hemorrhage
obstruction
perforation
risk factors of a PUD
smokers and people who take nsaids
S/S of gastritis
Anorexia
n/v
abd pain
melena
hematemesis
MANHA
primary disorders for a GI Bleed
erosive gastritis
PUD
esophageal varicies
PEE
blood in the g i tract stimulates peristalsis leading to what?
hyperactive BS
Diarrhea
Melena
stools may be black and tarry
hemorrhage from PUD s/s
occult stool
coffee ground emesis
anemia
vomiting blood
hyperactive bowels
dizziness
weakness
hypovolemic shock
orthostatic hypotension
COW HAD HVO
obstruction from PUD s/s
epigastric fullness
metabolic acidosis
n/v -projectile
electrolyte imbalances
MEEN
perforation from PUD s/s
rigid abdomen
no bowel sounds
diaphoresis
tachycardia
fever
rapid shallow respirations
severe and sudden abd. pain that radiates to shoulder
what is H pylori?
bacteria that lives in the stomach
What is the treatment for H-pylori?
2 antibiotics & 1 PPI(end in ZOLE)
antibiotics used for H pylori
metronidazole, amoxicillin, clarithromycin, tetracycline
s/s of dumping syndrome
n/v, epigastric pain with cramping, borborygmi(loud hyperactive BS)
diarrhea, dizziness, flushing
How is dumping syndrome managed?
sm. frequent meals
drink at separate times than eating
avoid carbs
increase fat and protein
surgeries to treat GERD, gastritis, PUD
Bilroth 1 & 2
total gastrostomy
causes of dumping syndrome
stomach surgery
Nutritional aspects to assist with IBS
Increase Fiber- add bran
Limit lactose, fructose, gas causing foods, caffeine
Gas causing foods are?
Apple
Beans
Cabbage
grape juices
nuts
raisins
nursing care for fecal incontinence
Bowel training
skin integrity
dietary changes
nursing care for appendicitis
pain
infection
with appendicitis what is the pain?
RLQ pain with rebound tenderness.. when you press on stomach it feels
good but when you let go it hurts
2 major dangers with appendicitis
rupture
sepsis
no lax or enema!
post op care for appendicitis
wound care
no heat to abdomen
nursing care for gastroentreritis
restrict solid intake
hand hygiene
teach about FVD, diarrhea
pre op instructions for colonoscopy
bowel cleansing
npo
clear liquid 24 hours- no red liquids
Ulcerative colitis what do you see
bloody mucus diarrhea
abd. pain
weight loss
Crohns disease what do you see
no blood, slowly progressive
"skip" lesions
cobblestone appearance
For Ulcerative Colitis what area of colon is involved?
Rectum, Sigmoid
For crohns what area of colon is involved?
ileum and ascending colon
complications of crohns disease
obstruction
fistula
abscess formatin
malabsorption
Complications of ulcerative colitis
hemorrhage
toxic megacolon
perforation and colon cancer
what is ulcerative colitis relieved by?
going to the b/r
Normal stoma?
Pink, moist
High residue diet?
cereals
unpeeled raw apples
peaches
pears
oranges
dried beans(navy pinto, kidney)
lima beans
broccoli
peas
corn
squash
raw veggies-carrots celery tomatoes
unpeeled potatoes
brown rice
whole grain bread or crackers
low residue diet
fruit juices
cooked apples, apricots, cherries, peaches pears bananasa
roasted baked or broiled meet
peeled potaties
white rice
cooked or canned veggies
plain chocolates
corn flakes
white bread
crackers
coffee
teas
milk limited to 2 cups per day
carbonated veggies
tapioca
puddings
TX for crohns disease and ulcerative colitis
remicade- infusion
Toxic megacolon
bowel gets really large with little peristalsis. its dilated and
stops moving. get dissension and pain LLQ and change in stools
IBD TX
total colectomy
ileostomy
With ileostomy what should you instruct pt to do
watch for dehydration
skin irritation
chew food well
watch electrolytes
what is a huge factor with ileostomy and what can it lead to?
Hypocalcemia and lead to metabolic acidosis
Functions of the liver
filters blood
coagulation
gets rid of ammonia
What is the most common thing cirrhosis is caused by
Alcohol
what is cirrhosis
Fibrosis of liver tissue leading to decreased mass, impaired liver
function, and altered blood flow
S/S of Cirrhosis
enlarged liver
tender liver
aching pain in epigastric area or RUQ
wt loss
weakness
anorexia
diarrhea or constipation
What is splenomegaly?
enlarged spleen
With splenomegaly what would you see?
Blood cell destruction
Anemia
leuokopenia
thrombocytopenia
What is ascites?
accumulation of plasma rich fluid in the abdominal cavity
S/S of ascites
hypoalbuminemia-decreases colloidal osmotic pressure of plasma
hyperaldosteronism- sodium and water retention
Esophageal varices
enlarged thin walled veins that form in the submucosa of the esophagus
s/s of esophageal varies
eating high roughage foods
thrombocytopenia
platelet deficiency
impaired production of clotting
nausea/vomiting
what are we worried about with esophageal varices
veins rupturing!
portal encephalopathy
loss of brain function when liver doesn't remove toxins from the blood
s/s of portal encephalopathy
asterixis
personality changes
agitation
restlessness
impaired judgement
slurred speech
factors precipitating portal encephalopathy
high serum ammonia level
constipation
blood transfusions
GI bleeding
hypoxia
severe infection
surgery
meds-sedatives, narcotics
hepatorenal syndrome
imbalanced blood flow (renal failure)
s/s hepatorenal syndrome
gi bleeding
sodium retention
oliguria
hypotension
What labs would be associated with cirrhosis
increased ALT,AST, ALP
low rbc, hemoglobin, hematocrit
prolonged ptt time
hyponatremia
hypokalemia
bilirubin levels elevated
hypoalbuminia
what diuretics would they use and for what?
spironolactone(aldactone)- reduce ascites
furosemide(lasix)-promotes excretion of potassium
What laxatives would they use and for what?
Lactulose-reduces the amount of ammonia and pulls water into the
bowel increasing stools
for hepatic encephalopathy
anti infective agents to use and use for what?
neomycin
metronidazole(flagyl)
rifaximin (xifaxan)
they reduce intestinal bacteria and decrease ammonia production in bowel
use for cirrhosis
nutritional aspects that could assist with management of cirrhosis
restrict sodium intake to 2g/day
restrict fluids to 1500 ml/day
diet with adequate calories and protein
vitamin supplements(vit b12, thiamin, folate)
s/s of pancreatitis
develops suddenly
severe epigastric and abdominal pain radiates to back
n/v
abd. distension
decreased bowel sounds
tachycardia
hypotension
elevated temp
cold clammy skin
how is pancreatitis pain relieved by
sitting up and leaning forward
What is pain usually caused by in pancreatitis
fatty meal or excessive alcohol intake
Signs of bleeding in pancreatitis
Turners sign(bruising in the flanks)
bruising around the umbilicus (cullers signs)
TX for pancreatitis
opioid analgesics
pancreatic enzyme replacement- pancrelipase
hold oral food and fluids (ng usually placed)
when can a person return to reg foods after pancreatitis and what
kind of diet
when amylase levels are normal
bs present
pain disapears
low fat diet and no alcohol!
what complementary tx is used for pancreatitis?
low salt, low fat
Qigong- gently exercise, meditation and controlled breathing
magnetic field therapy
fasting
(all therapies should be prescribed by a trained practitioner)
Why is a beta blocker given? and for what?
nadolol- (end in olol) reduce portal hypertension and prevent
bleeding of esophageal varices
LATER s/s of cirrhosis
jaundice
changes in mental responsiveness and memory
esophageal varices
caput medusa
spider angiomas( face neck shoulders)
ascites
collateral veins visible on abd. wall
hepatomegaly
splenomegaly
hemorrhoids
palmar erythema
edema
gynecomastia
hirsuitism
what is gynecomastia
swollen man boobs
what is capet medusa
visible veins of abdomen
what is asterixis
liver flap.. muscle tremor that interferes with ability to maintain a
fixed position of the extremities and causes involuntary jerking movements
s/s of inussusception
abd pain
vomiting
palpable abd mass
currant jelly stools
when should intussusception be treated and how
within 24 hours and treat with barium enema or surgery
s/s of diarrhea in kids
decreased amount of wet diapers
dry mucous membranes
sunken fontanels
thirst
lethargy
tx for diarrhea in kids
rehydration
diet
anti-diarrheal
good handwashing
With bowel training what should you avoid
enemas
With chronic pancreatitis what med do you NOT give
narcotics due to addiction
What is carafate and what is it used for?
It is an Anti ulcer that coats the stomach or ulcer to prevent
further damage
What do antacids do?
buffers that neutralize the stomach acid
Name some antacids
Maalox
mylanta
gaviscon
tums
When do you give antacids?
1-3 hours after meals
What do promotility agents do?
increases upper GI motility and gastric emptying to decrease GERD
example of promotility agent?
Reglan
Side effects of promotility agent in elderly
Confusion
hallucinations
twitching
weakness
tardive dyskinesia symptoms
What do prostaglandin analogs do?
cytoprotective agent that promotes ulcer healing by increasing mucous
production, bicarbonate secretions and inhibits acid secretions
Ex. of prostaglandin analogs?
Misoprostol
end in prostil or prostol
What is Billroth 1?
gastroduodenostomy
lower 2/3rds of stomach attached to duodenum
Billroth 2?
gastrojejunostomy
remove portion of stomach and attach to jujenum
Gastrostomy?
removal of entire stomach
with a GI bleed what levels are increased?
BUN
Meds used to treat gerd, gastritis, and PUD?
PPI's
h2 blockers
antacids
anti ulcer agents
TX of H pylori?
combination of antibiotics and PPI
Dumping syndrome post op care
I&O
vitals
dressings
ambulation
cough deep breathe
iv fluids
post op for dumping syndrome what does ng look like?
bright red at 1st then darkens
1st 36-48 hours yellowish green
pain management for dumping syndrome post op?
demerol
it reduces spasms in the sphincter of ode
Foods high in Fiber?
fruits
veggies
whole grains
normal functions of the liver
Metabolize proteins, carbs and fats Metabolize
drugs Metabolize steroid hormones Glycogen
storage Vitamin and mineral storage Bile production
Fat absorption Bilirubin elimination
Detox Ammonia conversion to urea
Synthesis of blood components Albumin Clotting
factors
s/s of ascites?
Doctor may put hand on stomach to feel a "wave"
- Abdominal Distention - Shortness of breath - S/S of
dehydration - Weight Gain
Tx for Ascites?
Sodium & Fluid restriction - Paracentesis -
Trans-jugular intrahepatic portosystemic shunt (TIPS)
Actions prior to a pt having a parancentisis
#NAME?
Tx for esophageal varices
Restoration of hemodynamic stability always Priority! - Restore
volume - Medications
- Vasoconstrictors ex-Somatostatin -
Endoscopy-banding/ligation - Sclerosing - Balloon
tamponade (Minnesota, Sengstaken-Blakemore)
What is Portal Encephalopathy aka hepatic encephalopathy and
what causes it?
#NAME?
s/s of encephalopathy?
Mental confusion progressing to coma - Muscle tremors -
Asterixis (dorsiflexion movements of hands and feet, or hyperextend
arms & dorsiflex the wrists) - EARLY S/S
-agitated,
- restless,
- impaired judgement,
- slurred speech.
tx for encephalopathy?
Reduce Ammonia - Low protein diet 40-60 grams daily -
Decrease bacterial production of ammonia
What med would you give to decrease bacterial production of ammonia?
Neomycin
What does lactulose do ? and what toxicities can it cause?
reduces ammonia and watch for nephrotoxic and neurotoxic.
monitor renal, hearing and neurological functions
nutritional aspects for hepotorenal?
- Sodium <2 grams /day - Fluid restrict-generally 1500ml /
day - Protein <60 grams/day - Moderate fat -
High carb & calorie-to promote healing - Vitamins-vitamin
b12 might be ordered - Minerals
Hep A
From contaminated food, water, shellfish. Risks -
International travel , close contact with infected person.
2 week incubation. Risk of spread decreases when jaundice
develops.
Hep B
Bloodborne Risks � IV drugs, multiple sex partners,
work with blood can develop acute, chronic, fulminant
(rapid progression) or carrier hepatitis. Carrier more likely if
acquired at birth. Additional prodromal symptoms are
urticarial, arthralgia, serum sickness, glomerularnephritis
Can lead to primary liver cancer
Hep E
Hep E Fecal contamination of water Person to
person transmission rare Causes fulminant, fatal
hepatitis in pregnant women
Nursing Care for Paracentesis?
NURSING CARE FOR PARACENTESIS monitor BP
during procedure weigh before and after
measure abdominal girth at level of umbilicus get
baseline set of vitals have patient void before
procedure to minimize risk of bladder puncture
position: seated, Fowler surgical vitals after
procedure (15 x 4, 30 x 2)
TX for Esophageal Varices
ligation � rubber bands on varices occlude flow
sclerosis � injected agent induces inflammation and
clotting NG tube prior to procedure Lavage with NS
prior to endoscopy improves visualization Balloon tamponade
treatment � balloon at end of NG tube presses on varices
Risk of aspiration Risk of airway obstruction