Flashcards in GI Module Deck (22):
-long term antibiotic use destroys normal flora.
-Antibiotic resistant gram positive bacteria causes diarrhea.
treat with Flagyl
-perforation of an ulcer
tarry stools (melena)
board like stomach
General GI post-op care
NG-Tube nursing care
assess nares and provide nasal/oral care
secure the tube
assess suction strength
reposition the tube
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.
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.
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.
Ulcerative Colitis: Causes
The cause in unknown
May be related to anxiety or stress
genetics, infection, low fiber intake,
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.
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
Ulcerative Colitis: Complications
Risk of Colon cancer
Ulcerative Colitis: diagnostics
sigmoidoscopy which shows friable mucosa with a granular appearance.
CBC to look for anemia
Surgical treatment is curative.
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
Rest to decrease intestinal activity
Provide psychosocial support
Failure of bowel contents to move forward
complete or partial
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)
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.
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.
vital signs normal early on, but may progress to signs of shock
Bowel Obstruction: Diagnosis
physical and abnormal x-rays showing dilated loops of bowel.
Bowel Obstruction: Nursing Care
Prepare pt for possible surgery
Prepare pt for insertion of NG-tube
Frequent position changes
I/Os especially when connected to suction.
Monitor pain levels
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.
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
Antacids to neutralize stomach acids
H2 receptor antagonists provide longer relief
Proton pump inhibitors for long term treatment
General care for Peptic Ulcer Disease
Upper GI series
Avoid foods that aggravate ulcerations like coffee, colas, teas, chocolate, foods that are high in sodium, spicy foods
Monitor for signs and symptoms of complications (hemorrhage or perforations)
H2 receptor antagonists
Proton pump inhibitors
Treatment for H. pylori
Mucosal barrier fortifiers