MS 2ND SEM QUIZ Flashcards
5 NURSING MANAGEMENT FOR OSTEORIZE FEEDING
1 Check the swallowing reflexes.
2 Assess peristalsis by auscultating for bowel sounds (25 to 35 per minute), starting in the right lower quadrant and moving clockwise into the left lower quadrant.
3 Use a 50cc syringe to aspirate 20cc of air to the end of the tube and listen for gurgling sounds
= to ensure that the NGT is in the stomach.
4 Place the patient in a high fowler’s position
= to prevent aspiration pneumonia.
5 Ensure that the patient is well-hydrated,
= as enteral feeding contents typically have lower water content.
6 Measure the length of the tube by placing it in the earlobes to the nose and then nose to the xiphoid process.
7 While inserting the tube, advise the patient do swallowing reflexes.
8 Ensure patency of the tube by flushing it with saline water using a 50cc syringe.
❖ MEDICAL MANAGEMENT PUD
→ Triple Therapy
→ Antacids
→ Histamine 2 Blockers (-tidine)
→ Proton Pump Inhibitors (-zole)
→ Triple Therapy Amoxicillin Clarithromycin Omeprazole
▪ 2 Antibiotics and Proton Pump Inhibitors are used as a combination to treat ulcer.
✓ Typically prescribed for 10 to 14 days.
✓ 2 antibiotics are prescribed to prevent bacterial resistance.
→ Antacids
▪ This promotes healing of the ulcer by neutralizing HCl and reducing Pepsinogen activity.
▪ Calcium Carbonate is the most effective in neutralizing acid; however, it can also cause acid rebound.
Side Effects:
* Excessive use can cause Hypercalcemia and Burnett Syndrome (Milk-Alkali Syndrome).
▪ Non-systemic antacids are composed of alkaline salts such as Aluminum Hydroxide, Magnesium Hydroxide, and Magnesium Trisilicate.
✓ Magnesium has greater neutralizing power than Aluminum.
Side Effects:
* Magnesium – constipation
* Aluminum/Calcium – diarrhea
✓ These are given in combination toavoid constipation/diarrhea.
▪ Health Teaching
✓ Advise the patient to avoid taking this drug with other drugs because it will decrease the absorption of the other drugs. Take it 1 hour before and 2 to 3 hours after taking the other medicines.
→ Histamine 2 Blockers (-tidine)
▪ This blocks the H2 receptors of the parietal
cells in the stomach thus reducing gastric
acid secretion.
▪ Drugs:
✓ Ranitidine (expensive)
✓ Cimetidine blocks about 70% of acid secretion for 4 hours.
* Good kidney function is necessary because 50% to 80% of the drug remained unchanged in the urine.
✓ Famotidine and Nizatidine are more potent than Cimetidine.
→ Proton Pump Inhibitors (-zole)
▪ This suppresses gastric acid secretion by inhibiting the hydrogen-potassium ATPase enzyme located in the gastric parietal cells.
✓ More potent than H2 blockers because PPI blocks acid by 95% while H2 blockers only block 60%.
Health Teaching
✓ Advise the patient to avoid taking this drug around 10pm to 2am because that is the time of highest concentration of gastric acids produced. During this time, the presence of food stimulates increased
production of gastric juices by parietal cells and chief cells, which may lead to the degradation of the drug.
→ Mucosal Protective Agents Sucralfate Misoprostol
▪ This drug is taken before meals because it mixes with the gastric juices, resulting in a soft paste that protects the wound.
❖ PREOPERATIVE CARE PUD
partial gastrectomy
→ The surgery is a high abdominal incision. This incision limits ventilation and creates a high risk of post operative respiratory complications.
→ Give opioids before doing coughing and breathing exercises.
→ Teach the patient about splinting the incision.
→ Frequent change of position
→ Use of Incentive spirometry
→ Advise the patient to avoid smoking.
❖ POSTOPERATIVE CARE PUD
partial gastrectomy
→ Nasogastric Tube (NGT) Management
▪ NGT is inserted to decompress the stomach,
facilitating immediate healing of the
wound.
▪ Assess position and patency of NGT by
connecting it to low suction.
✓ NGT should be well secured.
▪ If the patient’s NGT stops draining:
✓ Verify the placement first to ensure
that the tube remains in the stomach.
✓ Verify a prescription for tube irrigation.
✓ Irrigate the tube with 30 to 60 mL of the
fluid per agency procedure.
✓ Immediately notify the physician.
✓ Periodic gentle irrigations with normal
saline solution.
* Physiologic normal saline is used
in gastric instillation to prevent
electrolyte imbalance.
* Because of the fresh gastric
sutures, slow and gentle
instillation of saline should be
performed to reestablish
patency of the tube, then the
tube should be reconnected to
ensure stomach decompression.
✓ To protect the healing suture line, the
nurse does not routinely irrigate or
reposition the NGT.
✓ Advise the patient to speak less and
avoid using a straw when drinking
because these actions allow them to
swallow more air, which can lead to
distention of the stomach. Distention of
the stomach can lead to:
* rupture of the sutures
* leakage of gastric contents into
the peritoneal cavity
* hemorrhage
* abscess formation
▪ Assess color, amount, and odor of gastric
drainage
❖ POSTOPERATIVE CARE PUD
partial gastrectomy
→ Supporting Adequate Nutrition
→ Encourage Ambulation
→ Supporting Adequate Nutrition
▪ NPO until bowel sounds return (usually 24 to
48 hours).
▪ After removal of the NGT tube, clear liquids
may be ordered > full liquids > soft foods.
→ Encourage Ambulation
▪ Provide progressive mobilization.
✓ Assist slowly to sitting position.
✓ Allow client to dangle legs over the
side of the bed for a few minutes
before standing.
✓ Limit time to 15 minutes 3 times a day,
the first few times out of bed.
✓ Increase time out of bed, as tolerated
by 15-minute increments.
❖ COMPLICATION: DUMPING SYNDROME
t results in the
inability to eat three full meals every day due to
the removal of half of the stomach.
▪ The onset of symptoms occurs within 1 hour
of eating and may recur after 2 hours.
→ To control symptoms of the dumping syndrome:
→ To control symptoms of the dumping syndrome:
▪ Meals are divided into 6 small feedings to
avoid overloading intestines at meal time.
▪ Fluids should not be taken with meals but at
least 30 to 45 minutes before or after meals
to prevent feeling of fullness.
✓ Even if you haven’t undergone partial
gastrectomy, avoid drinking water
while taking meals because it can
dilute the stomach acids, which are
necessary to break down the foods.
▪ Eat a moderate fat and high-protein diet.
✓ Meat, cheese, eggs, milk products.
✓ Foods high in protein exit the stomach
more slowly than foods high in fat and
carbohydrates which minimizes the
dumping syndrome.
▪ Limit carbohydrates because this can
cause diarrhea and a sense of fullness.
✓ Carbohydrates can be easily digested
and may cause diarrhea, so it is
advisable to consume more moderate
amounts of fats and proteins.
▪ Avoid concentrated sweets because these
can contribute to the rapid emptying of the
stomach.
▪ Rest on the left side for 20 to 30 minutes
after eating.
✓ When a person lies on their left side,
the stomach outlet (pylorus) is
positioned higher than when lying on
the right side. This position may
potentially slow down the rate at
which the stomach contents empty
into the small intestine.
▪ Don’t allow the patient to ambulate after
eating meals.
✓ Rapid movement or changes in body
position may contribute to the faster
transit of food.
▪ Avoid very hot and very cold foods and
beverages
PERITONITIS
❖ MEDICAL MANAGEMENT
→ Several liters of an Isotonic Solution is prescribed.
▪ Hypovolemia occurs because massive
amounts of fluid move from the intestinal
lumen into the peritoneal cavity.
→ Analgesics are prescribed for pain.
→ Antiemetics are prescribed for nausea and
vomiting.
→ Intestinal intubation and suction assist in relieving
abdominal distention and in promoting intestinal
function.
▪ Fluid in the abdominal cavity can cause
pressure that restricts expansion of the lungs
and causes respiratory distress.
→ Oxygen Therapy promotes adequate
oxygenation.
→ Antibiotic Therapy is initiated early in the
treatment of peritonitis.
INFLAMMATORY BOWEL DISEASE
❖ MEDICAL MANAGEMENT
→ Immunosuppressant Drugs
▪ Reduces immune system activity, resulting
in less inflammation in the GI Tract.
✓ Since IBD is an autoimmune disease,
the immune system is actively
destroying tissues. This drug works by
inactivating the antibodies, preventing
them from damaging the entire
intestine, resulting in prolonged life
without a cure. However, the patient is
at risk of acquiring infections.
▪ Drugs:
✓ Azathioprine (Imuran)
* It can decrease WBCs in the bone
marrow (agranulocytosis).
✓ Methotrexate (Altrex)
* Adverse effect is photosensitivity,
do not expose the px to sunlight.
→ Aminosalicylates
▪ Decrease GI inflammation through direct
contact with bowel mucosa.
✓ Administered rectal suppository
▪ Drugs:
✓ Sulfasalazine (Azulfidine)
* Increase fluid intake to dilute the
drug, preventing crystalluria.
✓ Mesalamine
* The client should empty the
bowel just before inserting the
rectal suppository. If there is a
presence of feces, the drug may
not come into direct contact with
the mucosa.
▪ This tend to be more effective in treating
ulcerative colitis than Crohn’s disease.
→ Antibiotics
▪ This is prescribed as first line agents rather
than aminosalicylates for Crohn’s Disease.
✓ To prevent or treat secondary
infection.
▪ Combination Therapy:
✓ Metronidazole (Flagyl)
✓ Ciprofloxacin (Cipcor, Ciprophil)
→ Corticosteroids
▪ Steroids are prescribed to stop the
inflammation.
✓ PPI is prescribed together with steroids.
▪ Adverse Effects:
✓ GI Irritant – gastric ulcer
✓ Sodium Retention increases blood
volume resulting in Hypertension
✓ Osteoporosis (more than 3 months)
✓ Hyperglycemia
✓ Hypokalemia
→ Antidiarrhea – to decrease GI motility
▪ Loperamide (Imodium)
▪ Diphenoxylate with Atropine (Lomotil)
IBD
❖ NURSING MANAGEMENT
→ Manage the diarrhea.
▪ Low-fiber, High-protein, and High-Caloric
Diet.
▪ Perineal care
▪ Oral Rehydration Solutions, Gatorade
▪ Avoid foods that can trigger diarrhea such
as nuts, raw leafy vegetables, beans,
whole-grain, cereals, popcorn.
✓ High fat foods
✓ Caffeine
✓ Spicy foods
✓ Milk products
▪ Avoid alcohol and caffeine, these can
stimulate intestinal contractions and worsen
diarrhea.
▪ Drink 8 to 10 glasses of water daily to
prevent dehydration.
▪ Avoid carbonated beverages because
they can cause gas which can contribute
to abdominal discomfort, bloating, and
increased bowel activity.
▪ Sip rather than gulp fluid, drink it slowly.
✓ Rapid ingestion of fluids may stimulate
the gastrocolic reflex increasing bowel
activity.
→ Manage fever.
▪ Tepid Sponge Bath
▪ Adjust room temperature (cool)
▪ Increase fluid intake
▪ Dress the patient in light clothing
▪ Administer antipyretics as prescribed.
IBD
❖ COLOSTOMY CARE
→ Changing of the Pouch
▪ Hand hygiene and gloves.
▪ Remove the pouch and discard.
✓ The best time to change is when the
bowel is least active, usually 2 to 4
hours after meals; or before breakfast.
▪ Use wash cloth with warm water, avoid
using soap.
▪ Clean the surrounding skin and stoma
(cleanest to dirtiest).
✓ Stoma can be painful IF inflamed.
▪ Pat dry, avoid friction because the skin is
prone to getting injured.
▪ Measure the stoma and add 1/8 inch
around the stoma.
✓ Too big = leakage
✓ Too small = constrict
▪ Apply new pouch and burp the bag to
remove the air.
IBD
❖ NURSING MANAGEMENT
→ Nutrition and relieve stress
▪ Low-residue, high-protein, high-calorie diet
with supplemental vitamin therapy and iron
replacements.
✓ High-protein is for tissue repair and
healing.
✓ Since the body is under stress,
metabolism increases, making
carbohydrates easily digested.
Therefore, the body demands more
glucose. A high-calorie diet is
recommended to prevent the
conversion of protein into glucose, a
process known as gluconeogenesis in
the liver.
▪ Total parenteral nutrition may be necessary
when the patient is experiencing a severe
flare.
▪ Eat small meals, 5 to 6 small meals.
✓ Large meals can stimulate the
gastrocolic reflex, increasing bowel
activity and potentially exacerbating
diarrhea. Eating smaller meals
throughout the day allows for better
nutrient absorption
▪ Vegetables should be steamed, stewed, or
baked.
✓ Cooking vegetables in these ways
makes them softer and easier to
digest.
✓ Raw or fried vegetables can be harder
to digest and may contribute to
increased bowel activity.
▪ Good hand hygiene to reduce the risk of
developing GI infection and possible flareup.
→ Relieve Stress
▪ Stress causes gastroparesis and
hyperacidity and can either increase or
decrease intestinal motility.
▪ Depression, anger, and hopelessness are
common companions of Ulcerative Colitis.
IBD
❖ COLOSTOMY CARE
→ Colostomy Stoma
▪ A small amount of bleeding at the stoma is
normal.
▪ The ideal stoma protrudes slightly to allow
stool to drain into the pouch.
▪ Stomas shrink within 6 to 8 weeks.
✓ Measure the stoma once weekly for
the first 6 to 8 weeks to ensure proper
fit of the appliance.
▪ Complete healing of the wound may take
6 to 8 months.
▪ Swelling of the stoma is normal for 2 to 3
weeks after surgery.
▪ The stoma is usually placed in the right
lower quadrant of the abdomen below the
belt line.
✓ Stoma below waistline = unrestricted
flow into bag
✓ Stoma above waistline = belt/pants will
restrict flow into the bag
▪ The stoma should be pinkish to cherry red
because it should be receiving an
adequate blood supply.
IBD
❖ COLOSTOMY CARE
→ Postoperative Care
→ Postoperative Care
▪ Monitor Stoma.
✓ If the stoma becomes pale, or
cyanotic notify the physician
immediately.
▪ NGT is in place for several days after
surgery.
✓ To remove gases and fluids that would
increase intestinal distention and put
pressure on the suture line.
✓ To decompress the stomach.
✓ To give rest to the small intestine.
▪ Ileostomy Output
✓ Initially 1500 to 2000 mL per 24 hours.
✓ Increase fluid intake 2 to 3 L of fluid
daily.
✓ Increase additional sodium.
✓ When peristalsis returns, the patient
may experience a period of highvolume output of 1000 to 1800mL/day.
* Peristalsis returns on the 3rd postop
day.
* Later on, the average amount
can be 500mL daily because the
proximal small bowel adapts.
✓ The initial drainage from the ileostomy
appears loose, dark, green, and may
contain some blood. – this is normal
* The stool consistency and color
will change over time to a yellowgreen or brown.
✓ May need emptying every 3 to 4 hours.
▪ Prevent Skin Irritation
✓ Wound drainage must never be
allowed to be in direct contact with
skin because digestive enzymes and
gastric secretions are caustic leading
to skin breakdown or fungal infection.
✓ Place a gauze pad over the exposed
stoma to avoid soiling from leakage.
✓ Use an adhesive remover each time
the pouch is changed.
✓ Towel-or air-dry
IBD
→ Dietary Considerations
▪ Ingested foods pass through the ileostomy
within 4 to 6 hours.
▪ It is not advisable to eat a large meal close
to bedtime.
▪ Eat foods that thicken the effluent such as
pasta or potatoes without fat-filled sauces.
✓ apple sauce, bananas, cheese,
marshmallows, milk, noodles, smooth
creamy peanut butter, rice, tapioca
pudding, toast, potatoes and yogurt
▪ Avoid flatus-producing foods: beans,
onions, broccoli, peas, banana, carrots,
cauliflower, dairy products, eggplant,
cabbage, and carbonated beverage.
▪ Avoid drinking with straws, chewing gum,
smoking, and skipping meals because
these will increase gas formation which can
distend the colostomy bag.
▪ Avoid odor-producing foods: asparagus,
broccoli, beer, fish, garlic, eggs, highly
spiced foods, carbonated beverages
TPN
❖ ROUTES OF ADMINISTRATION
▪ used to provide complete nutritional
support
▪ long-term lasting more than 10 to 12 days
▪ use if calories ordered is more than 5,000
✓ the solution is thick so it can easily
obstruct the peripheral veins
▪ TPN which is a hypertonic solution, is usually
administered through a central vein.
Subclavian vein is the preferred route.
▪ Other common access sites if subclavian
vein is contraindicated:
✓ Basilic Vein
✓ Brachial Vein
✓ Cephalic Vein
▪ The tip of the central vein catheter is
placed in the superior vena cava.
▪ Hypertonic solution must be delivered
centrally in a large diameter vein so that
they can be quickly diluted.
✓ Large vein has a lot of blood which
can quickly dilute the TPN solution
preventing obstruction
→ Central Vein (large vein)
