1
Q
Tarry black
A
Melena upper GI Bleed
2
Q
may contain bile
A
yellowish or greenish
3
Q
bright red (arterial)
A
hemorrhage peptic ulcer
4
Q
dark red venous
A
hemorrhage esophageal/gastric varices
5
Q
coffee ground
A
digested blood from slowly bleeding gastric or duodenal ulcer
6
Q
sour or acid
A
gastric contents
7
Q
undigested food
A
gastric tumor, ulcer, obstruction
7
Q
bitter taste
A
bile
8
Q
causes of diarrhea
A
Infectious agents
(Escherichia coli, Salmonella,
Shigella,Campylobacter, Glardia, Amoeba, Clostridium
difficile, Cyclospora, Cryptosporidium, Rotavirus)
● Food poisoning
● Drugs (antibiotics, magnesium)
● Fecal impaction
● Bowel disease (irritable bowel syndrome, ulcerative
colitis)
● Malabsorption syndromes (lactose Intolerance, Celiac
sprue, fat malabsorption)
● Short bowel syndrome
8
Q
color/taste/consistency vomitus
A
yellowish/greenish
bright red arterial blood
dark red venous blood
coffee ground
undigested food
bitter taste
sour or acid
fecal components
8
Q
fecal components
A
intestinal obstruction
9
Q
bright red blood stool
A
lower GI bleed
10
Q
blood streaks on surface of stool
A
lower rectal or anal bleeding
11
Q
Bulky, greasy, foamy, foul smelling, gray with
silvery sheen
A
steatorrhea
12
Q
Light gray “clay colored” (due to absence of bile
pigment, acholic)
A
biliary obstruction
13
Q
Mucus or pus visible
A
chronic ulcerative colitis
14
Q
Small, dry, rocky-hard masses
A
constipation, obstruction
15
Q
Marble-sized stool/ pellets
A
spastic colon syndrome
16
Q
difficulty in swallowing
A
dysphagia
17
Q
types of dysphagia
A
onset ( acute or gradual), intermittent, continuous
18
Q
frequency,
consistency,
color,
blood/mucus,size.
Change in bowel habits, diet.
A
constipation
19
Q
causes of constipation
A
inadequate fluid intake
Electrolyte imbalances
● Hormonal abnormalities
● Mechanical bowel obstruction, ileus
● Drugs (laxative abuse, anticholinergic agents,
opiates)
● Loss of innervation (Hirschsprung’s disease)
● Neuromuscular (paralysis, spinal cord injury or
sacral lesion, multiple sclerosis)
● Anorectal disorders (hemorrhoids, fecal impaction,
cancer, abscess, fissures)
20
Q
inflammation of oral cavities
A
stomatitis
21
Q
types
A
primary
secondary
22
primary stomatitis
APHTHOUS STOMATITIS or canker sores
- Most common type
- Benign and non-contagious
23
secondary stomatitis
Candidiasis or oral thrush
- May be due to overgrowth of normal flora
24
cause of stomatitis
Infection e.g. herpes zoster or cytomegalovirus,
syphilis etc.
● Allergy to coffee, potatoes, cheese, nuts, citrus fruits
● Vitamin deficiency eg. Vitamin B folate, zinc and iron
● Systemic disease e g. HIV chronic renal failure,
inflammatory bowel disease
● Irritants eg. tobacco and alcohol
● Chemotherapy and Radiation
● Trauma
25
pathophysiology of stomatitis
inflammation of oral mucosa leads to ulceration leads to infection, bleeding, pain
26
whitish gray center and
erythematous ring
canker sores
27
common if with candidiasis
Whitish plaque-like lesion, appears red and sore when
wipe away
28
Lab of Stomatitis
CBC
Cytologic Culture and Gram Stain Testing
29
may reveal iNFECTION
CBC
30
to identify the CAUSATIVE
MICROORGANISM
cytologic Culture and gram stain testing
31
Nursing Care of Stomatitis
Provide ORAL CARE EVERY 2 HOURS and twice
at night
●
Use SOFT-BRISTLED TOOTHBRUSH OR FOAM
SWABS to stimulate gums and clean the oral cavity
●
Use SODIUM BICARBONATE solution (baking
soda), WARM SALINE or Chlorhexidine 2%
aqueous mouth wash in rinsing the mouth Avoid
COMMERCIAL MOUTHWASHES
●
Provide SOFT, BLAND and NON ACIDIC foods
● Apply TOPICAL ANALGESICS or ANESTHETICS
as prescribed
● Administer prescribed medication
32
Type of Stomatitis
General
Fungal
Herpes Simplex
33
Drugs for stomatitis with types and considerations
General- tetracycline syrup (250 mg/10ml for 10 days, rinse for 2 minutes then swallow)
Herpes Simplex- acyclovir (5mg/kg for 1 hour IV 8hrs, make sure the client has no renal problem)
Fungal- Nystatin (600,000 units QID oral suspension)
34
Anti-Inflammatory Agents And Immune Modulators for stomatitis
Dexamethasone
Amlexanox
Triamcinolone in Benzocaine
Thialidomide
35
BACKWARD
FLOW
(reflux)
of
gastrointestinal
contents into the esophagus
● MOST COMMON upper GI disorder
● common in PEOPLE OVER AGE 45
● Considered a disease process when acid is excessive
gastroesophageal reflux disease
36
cause of GERD
INAPPROPRIATE RELAXATION of lower esophageal
sphincter or inability of the LES to close fully
37
predisposing factors of GERD
Ingestion of LARGE INTESTINE
● Condition associated with DECREASED GASTRIC
EMPTYING
● Recumbent or SUPINE positioning after eating.
● Insertion of nasogastric tube (NGT)
● INCREASED
INTRAABDOMINAL
and
INTRAGASTRIC PRESSURE e.g. pregnancy, wearing
of tight belts, obesity, bending over, ascites
38
factors that relaxes the LES
● Fatty foods, Chocolates
● Caffeinated beverages
● Citrus fruits, tomatoes and tomato products
● Alcohol
● Nicotine in cigarette smoke
● High levels of estrogen and progesterone
● Medication
e.g
calcium
channel
blockers
(calcibloc,anticholinergic drugs ( AS04)
39
subjective data of GERD
heartburn- reflux
dysphagia- narrowing of lumen
40
objective data of GERD
● Dyspepsia - MOST COMMON SYMPTOM; occurs
30-60 minutes after meals and with reclining position.
● Regurgitation- with sour or bitter taste
● Hypersalivation
● Dysphagia
● Odynophagia- sharp substernal pain on swallowing
● Eructation (belching)
● Pyrosis- burning sensation in the esophagus.
● Chronic cough
● Aspiration pneumonia
● Respiratory Distress
41
most
accurate method allows for observation of the
frequency of reflux episodes and their associated
symptoms
24-hour ambulatory esophageal pH monitoring
42
Diagnostic tests of GERD
24-hour ambulatory esophageal pH monitoring-most
accurate method allows for observation of the
frequency of reflux episodes and their associated
symptoms
● Upper endoscopy
● Esophageal manometry (measures the rhythmic
muscle contractions
● (peristalsis) that occur in esophagus when swallowing)
43
measures the rhythmic
muscle contractions
esophageal manometry
44
Diet therapy of GERD
Avoid CAFFEINATED AND CARBONATED foods.
● Avoid SPICY and ACIDIC FOODS
● SMALL FREQUENT FEEDINGS (4-6 small meals)
● Avoid food 3 hours before going to bed.
● Standing, Sitting or High Fowler’s position after eating
45
lifestyle changes of GERD
ELEVATED HEAD OF THE BED 6-8 inches for sleep
● DO NOT LIE DOWN 3-4 hours after eating.
● Avoid NICOTINE and ALCOHOL
● LOSE WEIGHT- if the patient is obese.
● Avoid CONSTRICTIVE CLOTHING, STRAINING or
BENDING OVER.
46
INDICATION: management of heartburn
ACTION: elevates gastric pH and deactivates pepsin
SIDE EFFECTS: constipation and diarrhea
CLIENT INSTRUCTIONS: take the antacid 1 hour before
and 2-3 hours after meals
Magnesium Hydroxide
47
INDICATION: management of heartburn
ACTION: suppresses secretion of gastric acid by blocking
the histamine receptor sites
DRUG INTERACTION: CIMETIDINE may have significant
interactions with WARFARIN, THEOPHYLLINE,
PHENYTOIN, NIFEDIPINE and PROPRANOLO
Histamine Receptor Antagonist
48
INDICATION: management of heartburn
ACTION: suppresses secretion of gastric acid by blocking
the histamine receptor sites
DRUG INTERACTION: CIMETIDINE may have significant
interactions with WARFARIN, THEOPHYLLINE,
PHENYTOIN, NIFEDIPINE and PROPRANOLO
Histamine Receptor Antagonist
49
drugs of proton pump inhibitors
● omeprazole (Priolosec)
● lansoprazole (Prevacid)
● rabeprazole (Aciphex)
● pantoprazole (Protonix)
● esomeprazole (Nexium)
50
● WRAPPING AND ANCHORING fundus around the
lower esophageal sphincter
LAPAROSCOPIC NISSEN FUNDOPLICATION (LNF)
51
Histamine Receptor Antagonist
Famotidine
Ranitidine
Cimetidine
Nizatidine
52
increase rate of gastric emptying and
relaxation of the pyloric sphincter antiemetic
metoclopramide
53
Nursing care of Laparoscopic Nissen Fundoplication
elevate the head of the bed for 30 degrees
facilitate insertion of NGT
monitor NGT drainage
check placement of NGT every 4-8 hours
monitor for dysphagia
monitor for gas bloat syndrome
administer simethicone 80 mg QID for gas
54
PURPOSE- to inhibit the activity of the vagus nerve.
● use of radiofrequency energy through needles to
induce THERMAL BURN in the gastroesophageal
junction; tiny lesions occur initially and as it heals, it
tightens the tissues and increase muscle mass at the
LES
● Lasts 45 minutes; recovery time is 1-2 days.
Stretta Procedure
55
o tighten the lower esophageal sphincter
● INJECTION OF SOFT, SPONGY PERMANENT
IMPLANT made of liquid polymeric material into the
LES muscle
enteryx procedure
56
endoscopic therapies
Stretta Procedure
Enteryx Procedure
57
nursing care after endoscopic therapies
maintain Clear liquids for 24 hours
shift to soft diet after day 1
avoid NGT insertion for 1 month
avoid NSAIDS and aspirin for 10 days
give liquid medication as much as possible
watch out for abdominal or chest pain, dysphagia, bleeding
58
➔ opening in the diaphragm through which the
esophagus passess becomes enlarged and part of the
upper stomach moves up into the lower portion of the
thorax
➔ Occurs more often in women than in men
hiatal hernia
59
2 types of hiatal hernia
Sliding
Paraesophageal
60
when the upper stomach and
the gastroesophageal junction are displaced upward
and slide in and out of the thorax
Sliding
61
all of the part of the
stomach pushes through the diaphragm beside the
esophagus
paraesophageal
62
clinical manifestations of HH
pyrosis
regurgitation
dysphagia
intermittent epigastric pain
fullness after eating
intolerance to food, nausea, vomiting
63
Diagnostic of HH
Barium Enema
Chest CT scan
esophagogastroduodenoscopy
esophageal manometry
xray
64
management of HH
do not recline 1 hr after eating
elevate the head 4-8 inches
frequent small frequent feedings
surgical hernia repair for patient with gastric outlet obstruction
65
➔ inflammation of the stomach mucosa
gastritis
66
includes erosive gastritis and stress ulcers
acute gastritis
67
includes non- erosive gastritis.
chronic gastritis
68
inflammation of the glands in the fundus and
body
TYPE A
69
inflammation of the
glands from fundus
to antrum
TYPE B
70
diffuse
inflammation and
destruction of
deeply located
glands.
atrophic
71
cause of acute gastritis
local irritants ( drug,
alcohol, corrosive
substances )
● Bacterial invasions by
salmonella, E.Coli and
H.pylori
72
Chronic Gastritis cause
chronic use of irritants
bile acid reflux
73
erosion of GI lining
hermatemesis
74
symptoms of Acute Gastritis
hermatemesis
nausea vomiting
rapid epigastric pain
pain not alleviated by food
anorexia
gastric hemorrhage
dyspepsia
75
chronic gastritis symptoms
vague epigastric pain
pain relieved by food
nausea vomiting
anorexia
intolerance to fatty and spicy food
pernicious anemia
76
diagnostic test for gastritis
esophagogastroduodenoscopy with biopsy
77
drug therapy for gastritis
h2 receptor antagonist
proton pump inhibitors
antacid
vitamin b12
triple theraphy
1 proton pump inhibitor
1 antibiotic metranidazole
1 amoxicillin
78
stress reduction for gastritis
Progressive muscle relaxation
● Cutaneous stimulation
● Guided imagery
● Distraction
79
surgery to widen the opening in the
lower part of the stomach (pylorus) so that the
stomach contents can empty into the small intestine.
pyloroplasty
80
surgical procedure that involves resection
of the vagus nerve to reduce acidity of the stomach.
vagotomy
81
surgical management of Gastritis
partial/total gastrectomy
pyloroplasty
vagotomy
82
Ulceration of the gastric mucosa, duodenum and
rarely the lower esophagus and jejunum
peptic ulcer disease
83
types of ulcer
Gastric ulcer
○ Duodenal ulcers
○ Stress ulcers (Curling’s Ulcer or Cushing's Ulcer)-
result of critical illness and severe physical or
emotional stress
84
due to hypovolemic shock
curling's ulcer
85
sepsis, severe burns, and hypoxia
major surgery
86
aftermath of cerebral trauma which
cause stimulation of vagus and increase Hcl
production
Cushing's ulcer
87
parameter of gastric and duodenal ulcer
age
gender
blood group
pain
general nourishment
stomach acid production
clinical course
88
predisposing factors of PUD
stress
smoking alcoholism
type o blood
type a personality
GI disorders
ulcerative medications
caffeinated, spicy, fatty
89
complication of PUD
hemorrhage
pyloric obstruction
intractable disease
perforation
90
history assessment of PUD
use of aspirin, nsaids, corticosteroids
alcohol and tobacco use
91
clinical manifestations of PUD
diminishing hyperactive bowel sound
rigid board like abdomen with rebound tenderness
epigastric tenderness
dyspepsia
vomiting
92
Dx of PUD
positive occult blood test
low hemoglobin and hematocrit
esophagogastroduodenoscopy
elevated immunoglobulin G antibodies
fecalysis
barium examination
93
triple therapy
proton pump inhibitor omeprazole
metronidazole
amoxicillin tetracycline clarithromycin
94
hyposecretory drugs
histamine receptor antagonists
proton pump inhibitor
prostaglandin analogues
cytotec
95
mucosal barrier fortifiers
sucralfate
96
forms a seal over the ulcer, protecting if from
irritation
● Instruction: take 1 hour before meals and at bedtime
● Side effect: constipation
sucralfate
97
diet therapy for PUD
Bland diet
● Small frequent feedings (6 small meals/day)
● Avoid caffeine-containing foods (coffee, tea, or cola)
● Avoid tobacco and alcohol
98
management for hypervolemia
avoid NSAIDS
monitor vital signs intake and output
monitor serum electrolytes
perform gastric decompression
administer fresh frozen plasma for bleeding
monitor for shock (chills, palpataptions, diaphoresis, weak thready pulse)
99
● Goal: Promote blood clot formation
endoscopic therapy
100
methods of endoscopic therapy
inject bleeding site with diluted epinephrine
mechanical clip
thermal burn
laser therapy
101
client preperation of endoscopy therapy
administer sedatives
place client on NPO 6 HOURS prior
102
perforation management
place on NPO
gastric lavage
administer antibiotic
replace lost fluids, electrolytes
monitor signs of septic shock
103
surgical management of obstruction
partial gastrectomy
gastroduodenostomy
gastrojejunostomy
pyloroplasty enlargement of pyloric sphincter
104
105
post op care of gastro-nostomy
Monitor placement, patency, and drainage of NGT
● Monitor for Dumping Syndrome
106
early signs of dumping syndrome
vertigo
tachycardia
syncope
desire to lie down
pallor
107
late signs of dumping syndrome
dizziness
light headedness
diaphoresis
palpitations
confusion
108
management of dumping syndrome
Small frequent feeding.
● Do not take fluids with meals.
● Advise a high- protein, high- fat, low to moderate
carbohydrate diet.
● Administer pectin to prevent syndrome.
109
Inflammation of the mucous membranes of the
stomach and the intestinal tract.
● CLASSIC MANIFESTATION- increase in the
frequency and water content of the stools or vomiting
gastroenteritis
110
types of gastroenteritis
bacterial- e coli, shigellosis, campylobacter enteritis
virus- norwalk virus, rotavirus
111
assessment of gastroenteritis
ssment
● Nausea and vomiting (first 2 days of illness)
● Diarrhea
● Myalgia
● Headache
● Malaise
● Abdominal tenderness
112
signs of dehydration
Poor skin turgor
● Dry mucous membranes
● Hypotension
● Oliguria
3rd Yr (2nd SEM)- NCM 116
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