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N300 Final > GI Module > Flashcards

Flashcards in GI Module Deck (22):
1

C-Diff

-long term antibiotic use destroys normal flora.
-Antibiotic resistant gram positive bacteria causes diarrhea.
NURSING CONSIDERATIONS
contact precautions
stool samples
skin integrity
treat with Flagyl

2

GI bleed

CAUSES
-perforation of an ulcer
SYMPTOMS
decreased H/H
tarry stools (melena)
hematemesis
board like stomach

3

General GI post-op care

(?)

4

NG-Tube nursing care

assess nares and provide nasal/oral care
assess placement
secure the tube
assess suction strength
reposition the tube

5

More on NG-tube care

Used most often for decompression
x-ray varification before use for feedings or administering medications.
Aspirate contents and check pH; should be less than 5.0
It is dangerous to check by instilling air into the tube and auscultating with stethoscope because the sound in the lungs may be the same.
Lubricate the nares and look for pressure ulcers in the nares
Tube patency should be checked q 4 hours and irrigate with 20 mL of NS.

6

Tube feeding nursing care

Check proper placement via x-ray
Patient in high fowlers position during feeding
high fowlers for 30 minutes after feeding
Clamp tube when applying syringe or bag so air doesn't get into the patient's stomach
bolus feedings slowly; gravity over 20-30 minutes.
Flush with water to prevent blockage; at least 30 mL water Q 4 hours
Administer medications one by one.
If there is diarrhea, slow the rate
administer free water via orders.

7

Ulcerative Colitis

Chronic inflammation of mucosa and submucosa in the colon and rectum.
Peak incidence is between 15 and 35 years of age with a second peak in people aged 50 to 70.
Characterized by periods of exacerbation and remission.

8

Ulcerative Colitis: Causes

The cause in unknown
May be related to anxiety or stress
genetics, infection, low fiber intake,
antibody formation
Inflammation develops into abscesses that penetrate the mucosa and spreads laterally
Begins in the rectum and can progress proximally, but is usually limited to the sigmoid colon and rectum.

9

Ulcerative Colitis: Manifestations

Diarrhea - 10 to 20 liquid stools a day often containing blood and mucus
Fatigue from blood loss/lack of sleep/fluid imbalance
Psychosocial - pt afraid to go out

10

Ulcerative Colitis: Complications

Hemorrhage
Abscess formation
Toxic megacolon
Bowel obstruction
Bowel perforation
Risk of Colon cancer

11

Ulcerative Colitis: diagnostics

sigmoidoscopy which shows friable mucosa with a granular appearance.
CBC to look for anemia
Surgical treatment is curative.

12

Ulcerative Colitis: Nursing care

Take Medications as ordered
Avoid food that exacerbate the symptoms (avoid dairy if lactose intolerant)
Low residue diet
Call doc if blood in the stool
Avoid stess
Exercise
Rest to decrease intestinal activity
Provide psychosocial support

13

Bowel Obstruction

Failure of bowel contents to move forward
complete or partial

14

Types of bowel obstructions

1. Mechanical obstuction
resulting from forces outside of the intestine such as tumors, hernias, adhesions
blockage of the lumen itself
2. Non mechanical obstruction
impairment of muscle tone or nervous system innervation preventing peristalsis
(e.g., anesthesia, abd surgery, spinal cord injury, peritonitis, vascular insufficiency)

15

Bowel Obstruction facts

Most often occur in the ileum because this is where the diameter is the smallest.
Peristalsis increases in the intestine above the blockage leading to increased secretions, edema, and increased capillary permeability and resulting in fluid and electrolyte imbalances and hypovolemia.

16

Bowel Obstruction: Manifestations

High pitched, tinkling bowel sounds proximal to obstruction and silent distal to obstruction.
Late in obstruction; silent bowel sounds
abdominal pain can be colicky
vomitting with fecal odor; brown/green color.
abdominal distention
vital signs normal early on, but may progress to signs of shock
-tachycardia
-fever
-tachypnea
-hypotension

17

Bowel Obstruction: Diagnosis

H&P
physical and abnormal x-rays showing dilated loops of bowel.

18

Bowel Obstruction: Nursing Care

Prepare pt for possible surgery
Prepare pt for insertion of NG-tube
IV therapy
NPO
Frequent position changes
Vitals frequently
I/Os especially when connected to suction.
Monitor pain levels
Monitor electrolytes

19

Stoma care

Make sure that stoma is beefy red.
If it is blue-puplish, blood flow is inadequate and the surgeon needs to be consulted STAT
Blood may be in the bag, but this is normal
However, the nurse should monitor closely because if the bleeding increases or continues for several days, then something is wrong.

20

General care for GERD

GERD NURSING CARE
Avoid foods or medications that reduce LES tone
Do not eat 2 hours before bedtime
Do not bend over after eating
Avoid restrictive clothing
Avoid large meals - small, more frequent meals
Elevate HOB for sleeping
Stop smoking
Antacids to neutralize stomach acids
H2 receptor antagonists provide longer relief
Proton pump inhibitors for long term treatment

21

General care for Peptic Ulcer Disease

Upper GI series
Endoscopy
Avoid foods that aggravate ulcerations like coffee, colas, teas, chocolate, foods that are high in sodium, spicy foods
Stop smoking
Monitor for signs and symptoms of complications (hemorrhage or perforations)
Antacids
H2 receptor antagonists
Proton pump inhibitors
Treatment for H. pylori
Mucosal barrier fortifiers
prostaglandin analogs

22

Obesity Education

Assist the patient in making the right dietary choices through information and education
Diet therapy; make sure the patient, health care provider, and the dietician work together
-food pyramid
-serving sizes
Behavioral therapy to assist patient to change eating habits
-food diary
-social cues
-physical appearance
Educate the patient on these surgeries
-banding
-gastric bypass
-lipo