how is a Fowler or semi-Fowler position helpful?
-reduces amount of regurgitation
-prevs encroachment of stomach tissue up through opening in diaphragm
risk factors for peptic ulcers
-drugs (NSAIDs, corticosteroids)
-alcohol
-cig smoking
-acute med crisis or trauma
causes of peptic ulcers
-H pylori
-unknown
symptoms of peptic ulcers
-belching
-bloating
-epigastric pain radiating to back (not associated with type of food eaten); relieved by antacids
what can cause or exacerbate ulcers?
-stress!
-teach stress-reduction methods
-encourage those w/ a fam hx of ulcers to obtain med surveillance for ulcer formation
manifs of GI bleeding
-pallor: conjunctival, mucous membranes, nail beds
-dark, tarry stools
-bright-red or coffee-ground emesis
-abdom mass or bruit
-dec BP, rapid pulse
-cool extremities (shock)
-inc RR
how much fluid loss is lost through GI tract?
-only 100-200 mL/day
-filters up to 8 L/day
-more if diarrhea or vom occurs
opiate fx on GI system
-depress gastric motility
-closely monitor pts on these drugs
-distended intestinal wall with dec muscle tone may lead to intestinal perforation
diverticulosis
-pouches in intestinal wall
-no discomfort, usually
-problem goes unnoticed unless seen on radiologic exam
-usually prompted by some other condition
diverticulitis
inflammation of diverticula (pouches)
-can lead to bowel perforation
nutritional needs for pt with acute phase diverticulitis
NPO
graduating to liquids
nutritional needs for pt with recovery phase diverticulitis
no fiber foods or foods that irritate the bowel
nutritional needs for pt with maintenance phase diverticulitis
high-fiber diet with bulk-forming laxatives to prev pooling of foods in pouches where they can become inflamed
-avoid small, poorly digested foods like popcorn, nuts, seeds, etc.
mechanical bowel obstruction
due to disorders OUTSIDE the bowel (hernia, adhesions) c/b disorders within the bowel (tumors, diverticulitis)
-or by blockage of intestinal lumen (intussusception, gallstone)
nonmechanical bowel obstruction
due to paralytic ileus, which does not involve any actual phys obstruction, but results from inability of bowel itself to function
if bowel obstruction is high in small intestine, what will ABGs show?
-alkalotic state
-if high in small intest where gastric acid is secreted
if bowel obstruction is lower bowel, ABGs?
-acidic
-low where base solns are secreted
nsg priorities for pt who presents with constipation, thready stools, rectal bleeding past few months, dx with rectal mass?
-NPO
-NG tube (possibly intestinal tube)
-IV fluids
-surgical preps of bowel (if obstruction is complete)
-restrict food/fluids 8-10 before surg if poss
-contraindicate bowel cleansing
-oral erythro and neomycin to dec amt of colonic and rectal bacteria
-
how to prevent bowel cancer
-eat more cruciferous veggies (from cabbage family, broccoli, cauliflower, Brussels sprouts, cabbage, kale)
-inc fiber intake
-maintain avg body weight
-eat less animal fat
ACS recs for early detection of colon cancer
-digital rectal exam every year after 40
-stool blood test every year after 50
-colonoscopy or sigmoidoscopy exam q3-5 years after 50, based on advice of doc
early sign of colon cancer?
-rectal bleeding
-encourage pts 50 and older and those with inc risk factors to be screened annually with fecal occult blood testing
-also, routine colonoscopy starting at 50
manifs of jaundice
-yellow skin, sclera, or mucous membranes (bilirubin in skin)
-dark-colored urine (bilirubin in urine)
-chalky or clay-colored stools (absence of bilirubin in stools)
fetor hepaticus
distinctive breath odor in chronic liver disease
-fruity or musty
-results from liver's inability to metabolize and detoxify mercaptan, which is prod by bacterial degradation of methionine, and sulfurous amino acid
tx of ascites
-paracentesis
-peritoneovenous shunt (La Veen and Denver shunts)
esophageal varices may rupture and cause?
-hemorrhage
immediate mgmt of ruptured esoph varices
-insert esophagogastric balloon tamponade
-vasopressors
-vit K
-coag factors
-blood transfusion
what levels rise bc they are not broken down by the damaged liver?
-ammonia
-metab of drugs (Remain in system longer)
environment to provide for clients who are anorexic or nauseated
-remove strong odors
-encourage client to sit up for meals, can dec propensity to vomit
-serve small, freq meals
-give antiemetic before meals
what are necessary for regeneration of liver tissue that is destroyed by hepatitis?
-rest and adequate nutrition
-scrutinize drug therapy carefully
-previously taken drugs or OTC drugs should not be resumed w/o doc's directions
where is acute pancreatic pain located?
-retroperitoneally
-any enlargement of the pancreas causes the peritoneum to stretch tightly
-sitting up or leaning fwd reduces pain
cholecystits
acute infl of gallbladder
cholelithiasis
formation or presence of stones in gallbladder
pts who have ERCP to have gallstones removed may be prone to...
pancreatitis
nonsurgical management of a pt with cholecystitis
-low fat diet
-meds for pain and clotting if needed
-decompression of stomach via NG tube