GI System Student Version

8/8/2019 GI System Student Version

http://slidepdf.com/reader/full/gi-system-student-version 1/121

Presented by:Presented by:Kymberly McCoy RN MSNKymberly McCoy RN MSNSpring 2010Spring 2010



Gastrointestinal System FunctionGastrointestinal System Function

and Disordersand Disorders

GI Tract includesGI Tract includes::

MouthMouth

EsophagusEsophagus StomachStomach Small IntestineSmall Intestine Large IntestineLarge Intestine RectumRectum





Small Intestine consistSmall Intestine consistof three portions:of three portions:

Duodenum 10Duodenum 10--12in12in

Jejunum 8ft long Jejunum 8ft long Ileum 11ft longIleum 11ft long





Functions of GI Tract:Functions of GI Tract: Breakdown of food forBreakdown of food for

digestiondigestion Absorption of nutrients Absorption of nutrients

into bloodstreaminto bloodstream Elimination of undigestedElimination of undigested

food & other wastefood & other waste

productsproducts

Major enzymes:Major enzymes: MouthMouth--saliva, salivary saliva, salivary

amylaseamylase StomachStomach--hydrochlorichydrochloric

acid, pepsin, intrinsicacid, pepsin, intrinsicfactorfactor

Small IntestineSmall Intestine--amylase,amylase,

lipase, trypsin and bilelipase, trypsin and bile





Sphincters:Sphincters: EsophagealEsophageal-- betweenbetween

esophagus & stomachesophagus & stomach PyloricPyloric-- between stomachbetween stomach

& large intestine& large intestine IleocecalIleocecal-- between small &between small &

large intestinelarge intestine

Anal Anal-- controls passage of controls passage of fluids and fecal materialfluids and fecal material

Assessment: History Assessment: History Abdominal pain Abdominal pain DyspepsiaDyspepsia Gas, Nausea/vomitingGas, Nausea/vomiting Bowel Habits/patternBowel Habits/pattern Stool CharacteristicsStool Characteristics Eating habitsEating habits

Past GI surgeriesPast GI surgeries Nutritional intakeNutritional intake Weight loss Weight loss Diarrhea, constipationDiarrhea, constipation





Assessment: Physical Assessment: Physical Includes mouth, abdomenIncludes mouth, abdomen

& rectum& rectum Abdominal Assessment Abdominal Assessment InspectInspect Auscultate Auscultate PercussPercuss

PalpatePalpate





Diagnostic Evaluation:Diagnostic Evaluation: CBC, CMP, PTT/PT/INR CBC, CMP, PTT/PT/INR TriglyceridesTriglycerides Amylase, Lipase Amylase, Lipase Liver Function PanelLiver Function Panel CarcinoembryonicCarcinoembryonic

Antigen (CEA) Antigen (CEA)

Cancer Antigen (CA 19Cancer Antigen (CA 19--9)9) Stool testStool test

Diagnostic Procedures:Diagnostic Procedures: Abdominal Ultrasound Abdominal Ultrasound ComputedComputed

Tomography(CT)Tomography(CT) Magnetic ResonanceMagnetic Resonance

Imaging (MRI)Imaging (MRI) Positron EmissionPositron Emission

Tomography (PET)Tomography (PET)




and Disordersand Disorders Diagnostic Procedures:Diagnostic Procedures: Upper GI Study (UGI)Upper GI Study (UGI)

diagnose structuraldiagnose structural

abnormalities & problemsabnormalities & problemsof esophagus & stomachof esophagus & stomach

Diagnosis of ulcers,Diagnosis of ulcers, varicies, tumors, varicies, tumors,malabsorption syndromesmalabsorption syndromes

and moreand more Exam may extend toExam may extend to

duodunum & small bowelduodunum & small bowel(SBFT)(SBFT)

NPO after midnightNPO after midnight Drink Barium SulfateDrink Barium Sulfate

morning of testmorning of test

Possibly LaxativesPossibly Laxatives Monitor stoolsMonitor stools Encourage increased oralEncourage increased oral

intake to assist withintake to assist withpassage of bariumpassage of barium

Stool should return toStool should return tonormal within 72 hoursnormal within 72 hours





Diagnostic Procedures:Diagnostic Procedures: Lower GI Study Lower GI Study (Barium(Barium

enema)enema)-- help detect lowerhelp detect lowerGI abnormalities, polyps,GI abnormalities, polyps,tumors or lesionstumors or lesions

Bowel prepBowel prep Low residue diet 1Low residue diet 1--2 days2 days

prior examprior exam NPO after MidnightNPO after Midnight Lower GI study should beLower GI study should be

done first before UGIdone first before UGI

Diagnostic Procedures:Diagnostic Procedures: Gastric Emptying Study Gastric Emptying Study

liquids & solids taggedliquids & solids tagged with radionuclide markers with radionuclide markers

Measures rate of passageMeasures rate of passageof substance from stomachof substance from stomach

Dx disorders of gastricDx disorders of gastric

motility, diabeticmotility, diabeticgastroparesis andgastroparesis anddumping syndromedumping syndrome





Endoscopic Procedures:Endoscopic Procedures: Esophagogastroduodenoscopy Esophagogastroduodenoscopy

(EGD)(EGD)

Direct visualization of theDirect visualization of theesophagus, stomach &esophagus, stomach &duodenum. Able to obtainduodenum. Able to obtainbiopsies.biopsies.

NPO 6NPO 6--8 hrs prior to exam8 hrs prior to examClear liquids 1Clear liquids 1--2 days prior2 days priorObtain ConsentObtain Consent





Endoscopic Procedures:Endoscopic Procedures:EGD (cont)EGD (cont)Maintain NPO until gagMaintain NPO until gag

reflex returnsreflex returnsPosition to preventPosition to prevent

aspirationaspirationObserve for signs of Observe for signs of

aspirationaspiration bleeding,bleeding,fever, difficulty bleeding,fever, difficulty bleeding,epigastric painepigastric pain





Endoscopic Procedures:Endoscopic Procedures:Colonoscopy Colonoscopy --directdirect

visualization exam that visualization exam thatevaluates large intestineevaluates large intestine

Biopsies & polypectomiesBiopsies & polypectomiescan be performedcan be performed

Commonly used as cancerCommonly used as cancer

screeningscreeningEvaluate diarrhea of Evaluate diarrhea of

unknown cause, occultunknown cause, occultbleeding, anemia, etc.bleeding, anemia, etc.





Endoscopic Procedures:Endoscopic Procedures:Colonoscopy Colonoscopy (cont)(cont)Performed w/client lyingPerformed w/client lying

on left sideon left sideBowel prep day beforeBowel prep day beforeClear liquid diet day beforeClear liquid diet day beforeNPO after midnightNPO after midnight

Monitor for s/s bowelMonitor for s/s bowelperforation & peritonitisperforation & peritonitis







Gerontologic Considerations:Gerontologic Considerations:Decreased hydrochloric acid & decreased absorption of Decreased hydrochloric acid & decreased absorption of

vitamins; encourage frequent small meals high in vitamins vitamins; encourage frequent small meals high in vitaminsDecreased peristalsis & decreased sensation to defecate;Decreased peristalsis & decreased sensation to defecate;

encourage diet high in fiber & minimum of 1500ml of fluidencourage diet high in fiber & minimum of 1500ml of fluiddaily; encourage physical activity daily; encourage physical activity

Decrease lipase from pancreas to aid in fat digestionDecrease lipase from pancreas to aid in fat digestion

Decrease liver activity with decreased production of Decrease liver activity with decreased production of enzymes for drug metabolismenzymes for drug metabolism





Oral CancerOral CancerUncontrollable growth of Uncontrollable growth of

abnormal cellsabnormal cells

Can occur in any area of Can occur in any area of the oral cavity the oral cavity

Frequently curable if Frequently curable if discovered early discovered early

yy Types of Oral Cancer:Types of Oral Cancer:

yy Basal Cell CarcinomaBasal Cell Carcinoma

occurs primarily on lips,occurs primarily on lips,from excessive exposure tofrom excessive exposure tosunlightsunlight

yy Squamous Cell CarcinomaSquamous Cell Carcinoma-- most common, usually most common, usually

affects lower lip, tongue &affects lower lip, tongue &floor of mouthfloor of mouth





yy Oral CancerOral Cancer

yy Etiology Etiology

yy Tobacco useTobacco useyy Excessive alcohol intakeExcessive alcohol intake

yy Poor dental carePoor dental care

yy Exposure to ultravioletExposure to ultraviolet

raysrays


yy Clinical manifestations:Clinical manifestations:

yy LeukoplakiaLeukoplakiayy ErythroplakiaErythroplakia

yy Oral lesion may be fixedOral lesion may be fixed& hard& hard

yy Dysphasia (late)Dysphasia (late)yy Pain (late)Pain (late)

yy Neck massNeck mass








yy Surgery Surgery

yy Hemiglossectomy Hemiglossectomy yy Glossectomy Glossectomy

yy Radical neck dissectionRadical neck dissection


yy Nursing ManagementNursing Management

yy Prepare for surgery Prepare for surgery yy Maintain patent airway Maintain patent airway

yy Maintain oral hygieneMaintain oral hygiene

yy Prevent injury & infectionPrevent injury & infection

yy Maintain nutritional statusMaintain nutritional status




and Disordersand Disordersyy Esophageal CancerEsophageal Cancer

yy Malignant neoplasm of theMalignant neoplasm of the

esophagusesophagus

yy Higher incidence inHigher incidence in African Americans & men African Americans & men

yy Types of Esophageal CA:Types of Esophageal CA:

yy Adenocarcinoma Adenocarcinoma

yySquamous CellSquamous Cell

yy Risk FactorsRisk Factors

yy Barretts EsophagusBarretts Esophagus

yy SmokingSmokingyy Excessive alcohol intakeExcessive alcohol intake

yy Diet low in fruits andDiet low in fruits and veggies veggies





yy Clinical Manifestations:Clinical Manifestations:yy

Progressive dysphagiaProgressive dysphagiayy PainPain

yy Weight loss Weight loss

yy Advanced Ulcerated Advanced UlceratedLesionLesion

yy Esophageal CancerEsophageal Cancer

yy Diagnostic StudiesDiagnostic Studies

yyEndoscopy with biopsy Endoscopy with biopsy

yy CT scanCT scan

yy PET ScanPET Scan

yy Bronchoscopy Bronchoscopy





yy ComplicationsComplications

yyPerforationPerforation

yy HemorrhageHemorrhage

yy Aspiration Pneumonia Aspiration Pneumonia

yy Anastomotic leak Anastomotic leak

yy TreatmentTreatmentyy CurativeCurative

yy PalliativePalliative


yy TreatmentTreatmentyy RadiationRadiation

yy Chemotherapy Chemotherapy

yy Surgery Surgery

yy Esophagectomy Esophagectomy

yy Esophagogastrostomy Esophagogastrostomy

yy Esophagoenterostomy Esophagoenterostomy











yy Maintain nutritional statusMaintain nutritional statusyy NPONPO

yy Secure NG tubeSecure NG tube

yy Vigorous pulmonary plan Vigorous pulmonary plan

yy Oral SuctionOral Suctionyy Patient teachingPatient teaching




and Disordersand Disordersyy Radical Neck DissectionRadical Neck Dissection

removal of all cervicalremoval of all cervicallymph nodes from thelymph nodes from the

mandible to clavicle;mandible to clavicle;removal of theremoval of thesternoceidomastoidsternoceidomastoidmuscle, internal jugularmuscle, internal jugular

vein & spinal accessory vein & spinal accessory muscle on one side of themuscle on one side of theneckneck




and Disordersand Disordersyy Radical Neck DissectionRadical Neck Dissection

yy Potential ComplicationsPotential Complications

yyHemorrhageHemorrhage

yy Chyle fistulaChyle fistula

yy Nerve injury Nerve injury

yy Radical Neck DissectionRadical Neck Dissection


yyProvide preProvide pre--op educationop education

yy PostPost--op careop care

yy Maintain airway Maintain airway

yy Relieve painRelieve pain

yy Provide wound careProvide wound careyy Adequate nutrition Adequate nutrition

yy Support coping measuresSupport coping measures

yy Effective communicationEffective communication





yy Gastroesophageal Reflux Disease (GERD)Gastroesophageal Reflux Disease (GERD)yy The backflow of gastric and duodenal contents into theThe backflow of gastric and duodenal contents into the

esophagus.esophagus.yy Caused by an incompetent lower esophageal sphincter,Caused by an incompetent lower esophageal sphincter,

hiatal hernia, pyloric stenosis, or a motility disorder.hiatal hernia, pyloric stenosis, or a motility disorder.

yy Symptoms may mimic those of a heart attackSymptoms may mimic those of a heart attack





y GERD

y Risk Factors

y Obesity y Smoking

y Excess alcohol intake

y High-fat, spicy or acidic

foodsy Caffeine and carbonated

beverages





GERDGERD

yy Clinical ManifestationsClinical Manifestations

yy PyrosisPyrosisyy DyspepsiaDyspepsia

yy RegurgitationRegurgitation

yy Pain and difficulty withPain and difficulty with

swallowingswallowingyy HypersalivationHypersalivation

yy GERDGERD

yy DiagnosticsDiagnostics

yy History and physicalHistory and physicalyy Endoscopy Endoscopy

yy Barium swallowBarium swallow

yy pH monitoringpH monitoring





yy GERDGERD

yy TreatmentTreatment

yy Lifestyle modificationsLifestyle modificationsyy Nutritional therapy Nutritional therapy

yy Drug therapy Drug therapy

yy Surgery Surgery





yy GERDGERD

yy Nursing InterventionNursing Intervention

yy Avoid the use of anticholinergics, which delay stomach Avoid the use of anticholinergics, which delay stomachemptyingemptying

yy Instruct the client regarding prescribed medications,Instruct the client regarding prescribed medications,such as antacids, histamine Hsuch as antacids, histamine H22--receptor antagonists, orreceptor antagonists, or

protein pump inhibitorsprotein pump inhibitorsyy Instruct the client regarding the administration of Instruct the client regarding the administration of

prokinetic medications if prescribed, which accelerateprokinetic medications if prescribed, which accelerategastric emptyinggastric emptying







yy Barretts EsophagusBarretts Esophagusyy Serious complication of Serious complication of

GERDGERDyy Normal tissue lining of Normal tissue lining of

esophagus changes toesophagus changes toresemble tissue lining of resemble tissue lining of intestineintestine

yy Increases risk forIncreases risk foresophageal canceresophageal cancer







yy NonNon--specific to BEspecific to BEyy Treatment regimen sameTreatment regimen same

as GERD to control acidas GERD to control acidrefluxreflux


yy Surgical InterventionSurgical Intervention

yy Photodynamic Therapy Photodynamic Therapy (PDT)(PDT)

yy Endoscopic MucosalEndoscopic MucosalResection (EMR Resection (EMR)




and Disordersand Disordersyy HerniasHernias a protrusion of the intestine through ana protrusion of the intestine through an

abnormal opening or weakened area of the abdominal wallabnormal opening or weakened area of the abdominal wall

yy Usually occur in the abdominal cavity Usually occur in the abdominal cavity

yy Can be reduced manually or may reduce spontaneously Can be reduced manually or may reduce spontaneously when the person lies down when the person lies down




and Disordersand Disordersyy Types of Hernias:Types of Hernias:

yy

Esophageal (Hiatal)Esophageal (Hiatal)

yy InguinalInguinal

yy FemoralFemoral

yy UmbilicalUmbilical

yy Classification:Classification:

yy ReducibleReducible-- may bemay bereplaced by manualreplaced by manualmanipulationmanipulation

yy IncarceratedIncarcerated-- imprisonedimprisonedcan not be pushed backcan not be pushed backinto placeinto place

yy StrangulatedStrangulated-- blood supply blood supply & intestinal flow are& intestinal flow areobstructedobstructed




and Disordersand Disordersyy Risk Factors:Risk Factors:

yy Chronic coughChronic cough

yy

Obesity Obesity yy Weakened musculature Weakened musculature

yy Pregnancy Pregnancy

yy Clinical Manifestations:Clinical Manifestations:

yy Hernia protrudes overHernia protrudes overaffected area whileaffected area whilestandingstanding

yy PainPain

yy HeartburnHeartburn

yy Nausea/vomitingNausea/vomiting

yy Feeling of fullnessFeeling of fullness




and Disordersand Disordersyy Diagnostics:Diagnostics:

yy Complete H & PComplete H & P

yy X X--Ray Ray

yy Nursing Management:Nursing Management:

yy Small frequent mealsSmall frequent meals

yy Do not recline at least 1 hourDo not recline at least 1 hour

after mealsafter mealsyy Elevate HOB while sleepElevate HOB while sleep

yy Avoid anticholinergics, which Avoid anticholinergics, whichdelay stomach emptyingdelay stomach emptying

yy Treatment:Treatment:

yy Antacids Antacids

yy General elective surgery General elective surgery

yy Strangulated hernia may Strangulated hernia may require resection of affectedrequire resection of affectedbowelbowel

yy Types of Surgery:Types of Surgery:yy Herniorrhaphy Herniorrhaphy

yy Hernioplasty Hernioplasty




and Disordersand Disordersyy Peptic Ulcer DiseasePeptic Ulcer Disease

yy An ulceration in the mucosal lining wall of the stomach, An ulceration in the mucosal lining wall of the stomach,pylorus, duodenum, or esophagus. Erosion may extendpylorus, duodenum, or esophagus. Erosion may extendthrough the muscle.through the muscle.

yy May be referred to as gastric, duodenal, or esophageal ulcerMay be referred to as gastric, duodenal, or esophageal ulcerdepending on the location.depending on the location.

yy The most common peptic ulcers are gastric and duodenalThe most common peptic ulcers are gastric and duodenalulcers.ulcers.




and Disordersand Disordersyy Normal Gastric and Duodenal MucosaNormal Gastric and Duodenal Mucosa





yy Pathophysiology:Pathophysiology:

yy Mucosa cannot withstandMucosa cannot withstanddigestive action of HCLdigestive action of HCLand pepsin. Increasedand pepsin. Increasedconcentration of acidconcentration of acid--pepsin or decreasedpepsin or decreasedresistance of mucosa.resistance of mucosa.

yy Types of Peptic Ulcers:Types of Peptic Ulcers:

yy DuodenalDuodenal

yy

GastricGastricyy StressStress--inducedinduced

yy DrugDrug--inducedinduced





yy Common Sites:Common Sites: yy Risk Factors:Risk Factors:

yy H. PyloriH. Pylori

yy

NSAIDSNSAIDSyy MedicationsMedications

yy Physical/PsychosocialPhysical/PsychosocialStressStress

yy

Alcohol Alcoholyy SmokingSmoking





yy Clinical ManifestationsClinical Manifestations Duodenal UlcersDuodenal Ulcers

yy Burning pain in midepigastric region 2Burning pain in midepigastric region 2--3 hours after meal3 hours after mealand during night (awakened by pain)and during night (awakened by pain)

yy Melena more commonMelena more common

yy

Pain often relieved by foodPain often relieved by food






yy Monitor vital signsMonitor vital signs

yy Bland diet, small frequentBland diet, small frequent

mealsmealsyy Provide adequate restProvide adequate rest

yy Avoid alcohol intake, Avoid alcohol intake,caffeine, ASA, NSAIDS &caffeine, ASA, NSAIDS &

corticosteroidscorticosteroids


yy Physical examPhysical exam

yy X X--Ray Ray

yy EGDEGD


yy Antacids Antacids

yy HH22--receptor antagonistreceptor antagonistyy Lifestyle modificationsLifestyle modifications

yy Surgical intervention only Surgical intervention only if unresponsive to medsif unresponsive to meds




and Disordersand Disordersyy Gastric UlcersGastric Ulcers

yy Involves ulceration of the mucosal lining that extends toInvolves ulceration of the mucosal lining that extends to

the sub mucosal layer of the stomachthe sub mucosal layer of the stomach

yy Predisposing factors include stress, smoking, the use of Predisposing factors include stress, smoking, the use of corticosteroids, nonsteroidal anticorticosteroids, nonsteroidal anti--inflammatory drugsinflammatory drugs(NSAIDs), alcohol, a history of gastritis, a family history of (NSAIDs), alcohol, a history of gastritis, a family history of

gastric ulcers, or infection withgastric ulcers, or infection with Helicobacter pyloriHelicobacter pylori

yy Complications include hemorrhage, perforation, andComplications include hemorrhage, perforation, andpyloric obstructionpyloric obstruction





yy Clinical ManifestationsClinical Manifestations Gastric UlcersGastric Ulcers

yy

Gnawing, sharp pain in left midepigastric region 30Gnawing, sharp pain in left midepigastric region 30 6060minutes after mealminutes after meal

yy Hematemesis more commonHematemesis more common

yy Food accentuates painFood accentuates pain







yy Gastric UlcersGastric Ulcers

yy Nursing InterventionNursing Intervention

yy Administer anticholinergics as prescribed to reduce Administer anticholinergics as prescribed to reducegastric motility gastric motility

yy Administer mucosal barrier protectants as prescribed 1 Administer mucosal barrier protectants as prescribed 1hour before each mealhour before each meal

yy Administer prostaglandins as prescribed for their Administer prostaglandins as prescribed for theirprotective and antisecretory actionsprotective and antisecretory actions








yy InterventionIntervention Active Bleeding Active Bleeding

yy

Monitor vital signs closely Monitor vital signs closely yy Assess for signs of dehydration, hypovolemic shock, Assess for signs of dehydration, hypovolemic shock,

sepsis, and respiratory insufficiency sepsis, and respiratory insufficiency

yy Maintain NPO status and administer IV fluidMaintain NPO status and administer IV fluidreplacement as prescribed; monitor I&Oreplacement as prescribed; monitor I&O

yy Monitor hemoglobin and hematocritMonitor hemoglobin and hematocrit






yy InterventionIntervention Active Bleeding Active Bleeding

yy

Administer blood transfusions as prescribed Administer blood transfusions as prescribedyy Assist with the insertion of a nasogastric (NG) tube for Assist with the insertion of a nasogastric (NG) tube for

decompression and for lavage accessdecompression and for lavage access

yy Assist with normal saline or tap water lavage at room Assist with normal saline or tap water lavage at roomtemperature to reduce active bleedingtemperature to reduce active bleeding

yy Prepare to assist with administering vasopressinPrepare to assist with administering vasopressin(Pitressin) by IV as prescribed to induce(Pitressin) by IV as prescribed to induce vasoconstriction and reduce bleeding vasoconstriction and reduce bleeding





yy Surgical InterventionsSurgical Interventionsyy TOTAL GASTRECTOMY TOTAL GASTRECTOMY

yy Also called esophagojejunostomy Also called esophagojejunostomy yy Removal of the stomach with attachment of the esophagus to theRemoval of the stomach with attachment of the esophagus to the

jejunum or duodenum jejunum or duodenumyy VAGOTOMY VAGOTOMY

yy Surgical division of the vagus nerve to eliminate the vagal impulsesSurgical division of the vagus nerve to eliminate the vagal impulsesthat stimulate hydrochloric acid secretion in the stomachthat stimulate hydrochloric acid secretion in the stomach

yy GASTRIC RESECTIONGASTRIC RESECTIONyy Also called antrectomy Also called antrectomy yy Involves removal of the lower half of the stomach and usually Involves removal of the lower half of the stomach and usually

includes a vagotomy includes a vagotomy






yy Surgical InterventionSurgical Interventionyy BILLROTH IBILLROTH I

yy Also called gastroduodenostomy; partial gastrectomy, with Also called gastroduodenostomy; partial gastrectomy, withremaining segment anastomosed to duodenumremaining segment anastomosed to duodenum

yy BILLROTH IIBILLROTH II

yy Also called gastrojejunostomy; partial gastrectomy, with remaining Also called gastrojejunostomy; partial gastrectomy, with remainingsegment anastomosed to jejunumsegment anastomosed to jejunum

yy PYLOROPLASTY PYLOROPLASTY yy Enlarges the pylorus to prevent or decrease pyloric obstruction,Enlarges the pylorus to prevent or decrease pyloric obstruction,

thereby enhancing gastric emptyingthereby enhancing gastric emptying





yy Total Gastrectomy Total Gastrectomy yy Vagotomies Vagotomies





yy Billroth IBillroth I yy Billroth IIBillroth II







Postoperative CarePostoperative CareDo not irrigate or remove the NG tube; assist the physicianDo not irrigate or remove the NG tube; assist the physician

with irrigation or removal with irrigation or removalMaintain NPO status as prescribed for 1 to 3 days untilMaintain NPO status as prescribed for 1 to 3 days untilperistalsis returnsperistalsis returnsProgress the diet from NPO to sips of clear water to 6 small,Progress the diet from NPO to sips of clear water to 6 small,bland meals a day as prescribed when bowel sounds returnbland meals a day as prescribed when bowel sounds return

Monitor for postoperative complications of hemorrhage,Monitor for postoperative complications of hemorrhage,dumping syndrome, diarrhea, hypoglycemia, and vitamindumping syndrome, diarrhea, hypoglycemia, and vitaminBB1212 deficiency deficiency





yy Gastric CancerGastric Cancer

yy Malignant growth of mucosal cells in the lining of theMalignant growth of mucosal cells in the lining of thestomachstomach

yy Most gastric cancers are adenocarcinomasMost gastric cancers are adenocarcinomas

yy Can spread to nearby lymph nodes and organs such as theCan spread to nearby lymph nodes and organs such as theliver, pancreas, and colon.liver, pancreas, and colon.





yy Risk Factors:Risk Factors:

yy H. Pylori infectionH. Pylori infection

yy DietDiet

yy History of gastric ulcersHistory of gastric ulcers

yy Alcohol Alcohol

yy Incidence higher in menIncidence higher in men

yyHigher in persons of Higher in persons of eastern Asian descenteastern Asian descent

yy Clinical Manifestations:Clinical Manifestations:

yy Pain (relieved by Pain (relieved by antacids)antacids)

yy IndigestionIndigestionyy Anorexia (late) Anorexia (late)

yy Weight loss (late) Weight loss (late)

yy Anemia (late) Anemia (late)

yy Fatigue (late)Fatigue (late)yy Malnourishment (late)Malnourishment (late)

yy Palpable mass (late)Palpable mass (late)





yy Gastric CancerGastric Cancer

yy Diagnostic studiesDiagnostic studies

yy Endoscopy with biopsy Endoscopy with biopsy

yy Upper GI (bariumUpper GI (bariumswallow)swallow)

yy CT ScanCT Scan


yy Surgery Surgery

yy RadiationRadiation





and Disordersand Disordersyy Nursing ManagementNursing Management

yy Reduce anxiety Reduce anxiety

yy Promote optimal nutritionPromote optimal nutrition

yy Relieve painRelieve pain

yy Prepare forPrepare forchemo/radiationchemo/radiation

yy Prepare for surgery Prepare for surgery

yy Nursing PostNursing Post--op Careop Care

yy Monitor vital signsMonitor vital signs

yy NPO 1NPO 1--3 days until3 days untilperistalsis returnsperistalsis returns

yy Do not irrigate/remove NGDo not irrigate/remove NGtubetube

yy Monitor for complications,Monitor for complications,

hemorrhage, dumpinghemorrhage, dumpingsyndrome, vitamin Bsyndrome, vitamin Bdeficiency, hypoglycemiadeficiency, hypoglycemia




and Disordersand Disordersyy Irritable Bowel SyndromeIrritable Bowel Syndrome

(IBS)(IBS)

yy Recurrent abdominal painRecurrent abdominal pain

with an alteration in bowel with an alteration in bowelfunction (diarrhea orfunction (diarrhea orconstipation).constipation).

yy Most common GIMost common GI

conditionconditionyy Seen more in womenSeen more in women

yy Cause remains unknownCause remains unknown


yy Heredity Heredity

yy StressStress

yy Diet high in fatDiet high in fat


yy X X--ray ray yy Stool studiesStool studies

yy Protoscopy or Colonoscopy Protoscopy or Colonoscopy





yy Pathophysiology Pathophysiology

yy Functional disorder of Functional disorder of intestinal motility intestinal motility

yy NeuroendocrineNeuroendocrinedsyregulationdsyregulation

yy Peristaltic wave intensity Peristaltic wave intensity




and Disordersand Disordersyy Clinical ManifestationsClinical Manifestations

yy Alteration in bowel pattern Alteration in bowel pattern

yy Constipation/DiarrheaConstipation/Diarrhea

yy FlatulenceFlatulence

yy PainPain

yy BloatingBloating

yy Abdominal distention Abdominal distention

yy Medical ManagementMedical Management

yy ControlControldiarrhea/constipationdiarrhea/constipation

yy Food diary Food diary

yy High fiber dietHigh fiber diet

yy MedicationsMedicationsyy Bentyl (dicyclomine)Bentyl (dicyclomine)

yy Zelnorm (tegaserod)Zelnorm (tegaserod)

yy Antidepressants Antidepressants

yy Anti Anti--diarrhealsdiarrheals






and Disordersand Disordersyy Appendicitis Appendicitis

yy Inflammation of theInflammation of theappendix.appendix.

yy Common causes:Common causes:yy Obstruction of the lumenObstruction of the lumen

with feces, foreign bodies, or with feces, foreign bodies, ortumors.tumors.

yy Obstruction results inObstruction results indistention, venousdistention, venousengorgement, andengorgement, andaccumulation of mucus andaccumulation of mucus andbacteriabacteria




and Disordersand Disordersyy Pathophysiology Pathophysiology

yy Small lumen easily Small lumen easily occluded, becomesoccluded, becomes

inflamed, edematous &inflamed, edematous &eventually fills with pus ineventually fills with pus ina matter of hours.a matter of hours.


yy Periumbilical pain thatPeriumbilical pain thatshifts to the RLQshifts to the RLQ

yy Anorexia Anorexia

yy NauseaNausea

yy Vomiting Vomiting

yy Low grade feverLow grade fever

yy Rebound tendernessRebound tenderness




and Disordersand Disordersyy DiagnosticsDiagnostics

yy History and physicalHistory and physical

yy CBCCBC

yy UltrasoundUltrasound


yy Appendectomy Appendectomy

yy IV therapy IV therapy

yy Antibiotics Antibiotics


yy PerforationPerforation

yy

PeritonitisPeritonitisyy Abscesses Abscesses




and Disordersand Disordersyy Nursing ManagementNursing Management

yy Encourage pt. to avoidEncourage pt. to avoidenemas and laxativesenemas and laxatives

yy NPONPOyy Start IV fluidsStart IV fluids

yy Administer antibiotics Administer antibiotics

yy Encourage ambulation on theEncourage ambulation on thesame day following surgery same day following surgery

or POD#1or POD#1yy Advance diet as tolerated Advance diet as tolerated

yy Resume normal activity 2Resume normal activity 2--44 weeks after surgery weeks after surgery

yy Age Age--relatedrelatedConsiderationsConsiderations

yy Uncommon in elderly Uncommon in elderly

yy S/S altered greatly S/S altered greatly

yy Pain may be absentPain may be absent

yy Symptoms may be vagueSymptoms may be vaguesuggesting bowelsuggesting bowel

obstructionobstruction

yy Fever & leukocytosis may Fever & leukocytosis may be absentbe absent

yy Dont seek health careDont seek health care




and Disordersand Disordersyy Diverticular DiseaseDiverticular Disease

yy Common GI disorder thatCommon GI disorder thataffects increasing # of affects increasing # of

person over age 40.person over age 40.

yy Affects men and women Affects men and womenequally equally

yy Men have a higherMen have a higher

complication ratecomplication rateyy Caused by a deficiency inCaused by a deficiency in

dietary fiberdietary fiber

y

yy Pathophysiology Pathophysiology

yy Occurs when mucosa orOccurs when mucosa orsub mucosal layers of colonsub mucosal layers of colon

herniate through muscularherniate through muscular wall because of: wall because of:

yy Intraluminal pressureIntraluminal pressure

yy Low volume in colonLow volume in colon

yy Decreased muscle strengthDecreased muscle strength





yy DiverticulosisDiverticulosis -- thethepresence of pouch likepresence of pouch like

herniations through theherniations through themuscular wall of the colon.muscular wall of the colon.(sigmoid colon)(sigmoid colon)

yy DiverticulitisDiverticulitis occurs whenoccurs whenone or more of theone or more of thediverticula are inflamed.diverticula are inflamed.





yy DiverticulosisDiverticulosis

yy Can be asymptomaticCan be asymptomatic

yy S/S relatively mildS/S relatively mild

yy Bowel irregularities withBowel irregularities withintervals of diarrheaintervals of diarrhea

yy BloatingBloating

yy Abdominal distention Abdominal distention


yy DiverticulitisDiverticulitis

yy Acute onset LLQ pain Acute onset LLQ pain

yy Nausea/VomitingNausea/Vomiting

yy FeverFever

yy LeukocytosisLeukocytosis

yy

Palpable mass LLQPalpable mass LLQyy Blood in stoolsBlood in stools





yy CT Scan (preferred test of CT Scan (preferred test of choice)choice)

yy

Colonoscopy Colonoscopy yy CBCCBC

yy UA UA

yy Fecal occult blood testFecal occult blood test

yy

*A barium enema should not*A barium enema should notbe performed. Can causebe performed. Can causeperforation and peritonitisperforation and peritonitis



yy PeritonitisPeritonitis

yy Abscess and fistula Abscess and fistulaformationformation

yy Bowel obstructionBowel obstruction

yy bleedingbleeding




and Disordersand Disordersyy Medical ManagementMedical Management

yy RestRest

yy High fiber dietHigh fiber diet

yy Bulk laxativesBulk laxatives(Metamucil)(Metamucil)

yy Anticholinergics Anticholinergics(Bentyl)(Bentyl)


yy Pain managementPain management


yy Patient/family educationPatient/family education

yy Maintain normal bowelMaintain normal bowelpatternpattern

yy Monitor for signs of Monitor for signs of potential complicationspotential complications

yy Prep for surgery if Prep for surgery if

indicatedindicated






and Disordersand Disordersyy Inflammatory Bowel DiseaseInflammatory Bowel Disease refers to two chronicrefers to two chronic

disorders. Cause still unknown, theorize that its triggereddisorders. Cause still unknown, theorize that its triggeredby environmental agents such as pesticides, food additives,by environmental agents such as pesticides, food additives,

tobacco & radiation.tobacco & radiation.yy Ulcerative ColitisUlcerative Colitis

yy Crohns Disease (Regional enteritis)Crohns Disease (Regional enteritis)




and Disordersand Disordersyy Ulcerative ColitisUlcerative Colitisyy Inflammation & ulceration of Inflammation & ulceration of

the colon and rectum thatthe colon and rectum that

results in poor absorption of results in poor absorption of nutrientsnutrients

yy Begins in colon and spreadsBegins in colon and spreadsupwardupward

yy Colon becomes edematous, may Colon becomes edematous, may

develop bleeding lesions, ulcersdevelop bleeding lesions, ulcersyy Scar tissue developsScar tissue develops

yy Periods of exacerbationsPeriods of exacerbations




and Disordersand Disordersyy Ulcerative ColitisUlcerative Colitis

yy Clinical ManifestationsClinical Manifestationsyy Bloody diarrheaBloody diarrhea

yy Abdominal pain (LLQ) Abdominal pain (LLQ)yy MildMild

yy Diarrhea with two semiDiarrhea with two semi--formed stool, small amountsformed stool, small amountsof blood.of blood.

yy ModerateModerateyy 44--5 stools daily, increased5 stools daily, increased

bleedingbleeding

yy Fever, malaise, anorexiaFever, malaise, anorexia

yy Ulcerative ColitisUlcerative Colitis


yy SevereSevereyy Bloody diarrhea; 10Bloody diarrhea; 10--2020

stools/day stools/day

yy Fever, weight loss(10% of Fever, weight loss(10% of TBW)TBW)

yy Anemia, tachycardia, Anemia, tachycardia,

dehydration.dehydration.





yy History and physicalHistory and physical

yy CBC, electrolytesCBC, electrolytes

yy Colonoscopy Colonoscopy yy Sigmoidoscopy Sigmoidoscopy

yy Barium enemaBarium enema

yy Stool cultures, OCBStool cultures, OCB

yy ComplicationsComplicationsyy IntestinalIntestinal


yy perforationperforationyy Toxic megacolon( dilationToxic megacolon( dilation

and paralysis of theand paralysis of thecolon)colon)

yy StricturesStrictures

yy ExtraintestinalExtraintestinalyy MalabsorptionMalabsorption

yy UveitisUveitis

yy Hepatobiliary diseaseHepatobiliary disease






and Disordersand Disordersyy Drug Therapy (cont)Drug Therapy (cont)

yy Antidiarrheals Antidiarrhealsyy LomotilLomotil

yy Hematinics and vitaminsHematinics and vitamins

yy Ferrous sulfate, Folate,Ferrous sulfate, Folate,ZincZinc

yy ImmunomodulatorsImmunomodulators

yy RemicadeRemicade

yy Surgical ManagementSurgical Management

yy Proctocolectomy withProctocolectomy withpermanent ileostomy permanent ileostomy

yy Proctocolectomy withProctocolectomy withcontinent ileostomy continent ileostomy (Kock pouch)(Kock pouch)

yy Total colectomy Total colectomy

yy Preoperative carePreoperative careyy Postoperative carePostoperative care





y Kock Pouch




and Disordersand Disordersyy Preoperative CarePreoperative Care


yy Low residue dietLow residue diet

yy Abdominal markings for Abdominal markings forstomastoma

yy Postoperative CarePostoperative Careyy Assess stoma for color and Assess stoma for color and

sizesize

yy

I&OI&O

yy PostoperativePostoperativecomplicationscomplicationsyy HemorrhageHemorrhage

yy Abdominal abscess Abdominal abscessyy SBOSBO

yy dehydrationdehydration




and Disordersand Disordersyy Nutritional Therapy Nutritional Therapy

--Low residue, highLow residue, high--calorie,calorie,highhigh--protein dietprotein diet

--Low residue diet providesLow residue diet providesfoods that are low in fiber,foods that are low in fiber, which will reduce the which will reduce theamount of fecal material inamount of fecal material in

the lower GI tractthe lower GI tract

yy Nutritional Therapy Nutritional Therapy

yy TPNTPN

yy ParenteralParenteral therapy therapy yy ProcalamineProcalamine

yy IronIron




and Disordersand Disordersyy Crohns Disease (Regional Enteritis)Crohns Disease (Regional Enteritis)

yy Chronic inflammatory disease that can occur anywhere inChronic inflammatory disease that can occur anywhere inGI tract, most often affects distal ileum (small bowel)GI tract, most often affects distal ileum (small bowel)

which leads to thickening, scarring, narrowed lumen, which leads to thickening, scarring, narrowed lumen,fistulas, ulcerations and abscesses.fistulas, ulcerations and abscesses.

yy Cause is unknownCause is unknown

yy Occurs most often between the ages of 15 and 30.Occurs most often between the ages of 15 and 30.

yy High incidence in womenHigh incidence in women






and Disordersand Disordersyy Drug Therapy Drug Therapy

yy SulfasalazineSulfasalazine

yy CorticoidsteroidsCorticoidsteroids

yy Immunosuppressant'sImmunosuppressant's

yy Biaxin (clarithromycin)Biaxin (clarithromycin)

yy Vitamin B12 Vitamin B12

yy Nutritional Therapy Nutritional Therapy

yy Parenteral nutritionParenteral nutrition

yy Diet should be high inDiet should be high incalories and proteins.calories and proteins.

yy Milk, milkMilk, milk--products,products,roughage, and fatty roughage, and fatty foods should befoods should be

avoided.avoided.




and Disordersand Disordersy Surgical Management

y Depends on affected area

y Intestinal resection with

anastomosis

y *Crohns disease not curedby surgery

y Age-relatedConsiderations

y The elderly clients have higher

morbidity with surgicalprocedures. Elderly clients aremore prone to volume depletionand dehydration; especially if they have renal andcardiovascular disorders.

y Drugs such as Allopurinol,NSAIDS, Digoxin, Estrogen canexacerbate colitis




and Disordersand Disordersyy Colorectal CancerColorectal Cancer

yy 33rdrd most common form of cancer and 2most common form of cancer and 2ndnd leading causeleading causeof cancerof cancer--related deaths in the United States.related deaths in the United States.

yy Highly treatable and often curable if found early.Highly treatable and often curable if found early.

yy Half of all colorectal cancers occur in the sigmoidHalf of all colorectal cancers occur in the sigmoidregion of the colon.region of the colon.

yy More common in men than womenMore common in men than women




and Disordersand Disordersyy Pathophysiology Pathophysiology

yy Adenocarcinoma Adenocarcinoma

yy Starts as benign polypStarts as benign polyp

yy Destroys normal tissuesDestroys normal tissues

yy Migrates away fromMigrates away fromprimary tumor (most oftenprimary tumor (most oftenliver)liver)


yy Increasing age > 50Increasing age > 50

yy May be associated withMay be associated withUlcerative ColitisUlcerative Colitis

yy Family hx colon cancer orFamily hx colon cancer orpolypspolyps

yy HighHigh--fat, lowfat, low--residue diet,residue diet,

high proteinhigh proteinyy Crohns diseaseCrohns disease





yy Change in bowel habitsChange in bowel habits

yy HematocheziaHematochezia

yy MelenaMelena

yy Weight loss Weight loss

yy Unexplained anemiaUnexplained anemia


yy Ascending colon Ascending colon diarrheadiarrhea

yy Descending colonDescending colon constipation or diarrhea;constipation or diarrhea;ribbonribbon--like stool r/t partiallike stool r/t partialobstructionobstruction

yy RectalRectal alternatingalternating

constipation and diarrheaconstipation and diarrhea





yy H&PH&P

yy Digital rectal examDigital rectal exam

yy Fecal occult blood testFecal occult blood test

yy Barium enemaBarium enema

yy Sigmoidoscopy Sigmoidoscopy

yy

Colonoscopy Colonoscopy yy CEA testCEA test


yy Partial or completePartial or completeobstructionobstruction

yy UlcerationUlceration



yy Abscess formation Abscess formation




and Disordersand Disordersyy Age Age--relatedrelated

ConsiderationsConsiderations

yy Closely associated withClosely associated with

dietary carcinogensdietary carcinogensyy Lack of fiber (major factor)Lack of fiber (major factor)

yy Elderly have difficulty Elderly have difficulty managing colostomy caremanaging colostomy care

yy Poor vision, decreasedPoor vision, decreasedmotor functionmotor function

yy Skin care major concernSkin care major concern

yy Management & TreatmentManagement & Treatmentyy Surgery Surgery


yy RadiationRadiationyy Preoperative CarePreoperative Care

yy Bowel preparationBowel preparation

yy Antibiotic administration Antibiotic administration

yy

Patient educationPatient education






and Disordersand Disordersyy Ostomy Ostomy

yy An ostomy is a surgical An ostomy is a surgicalprocedure in which anprocedure in which anopening is made to allowopening is made to allowpassage intestinalpassage intestinalcontents from the bowelcontents from the bowelto an incision or stoma.to an incision or stoma.

yy Types of OstomiesTypes of Ostomies

yy Ascending colostomy Ascending colostomy

yy Descending colostomy Descending colostomy

yy Ileostomy Ileostomy

yy Sigmoid colostomy (singleSigmoid colostomy (single--barreled)barreled)

yy Transverse colostomy Transverse colostomy

(double(double--barreled)barreled)




and Disordersand Disordersyy Types of ColostomiesTypes of Colostomies

yy Ascending colon Ascending colonyy Semi liquid stoolSemi liquid stool

yy Transverse colonTransverse colonyy semi liquid to semi formedsemi liquid to semi formed

stoolstool

yy Sigmoid colonSigmoid colon

yy formed stoolformed stoolyy Ileostomy Ileostomy

yy liquid to semi liquidliquid to semi liquid




and Disordersand Disordersyy Ostomy Surgery Ostomy Surgery

yy PrePre--op careop care

yy Colostomy careColostomy care

yy Nutritional therapy Nutritional therapy

yy PostPost--op careop care


yy Provide emotional supportProvide emotional support

yy Maintain optimal nutritionMaintain optimal nutrition

yy Provide wound careProvide wound care

yy Monitor for complicationsMonitor for complications




and Disordersand Disordersy Hemorrhoidsy Dilated veins in the rectum

y May be internal or external

y Etiology y Occurs as a result of

straining during defecation

y Constipation

y Pregnancy y Prolonged standing and

sitting

y Portal Hypertension

y Clinical Manifestationsy Rectal Pain

y Rectal bleeding with

defecationy Rectal Itching

y Burning




and Disordersand Disordersy Diagnostics

y Digital examination

y Sigmoidoscopy

y Visual inspection (externalhemorrhoids)

y Nursing Interventiony Apply icepacks

y Stool softenersy Sitz baths

y Encourage high-fiber diet

Surgical Interventiony Hemorrhoidectomy

y Laser treatments

y Cryotherapy y Rubber-band ligation




and Disordersand Disordersy Postoperative care

y Assist client to side-lying position

y

Maintain ice packs over dressingy Monitor for urinary retention

y Stool softeners as prescribed

y Instructive client to increase fluid intake, high-fiber

diet




and Disordersand Disordersy Abdominal Traumay Injuries to the abdomen that occur as a result of blunt

trauma, penetration injuries.

y Common injuries include laceration of the liver, rupturedspleen, bladder rupture, stomach or intestinal rupture.

y Surgical intervention must be done ASAP to repairdamaged organs and stop bleeding.





yy Guarding and splinting of the abdomenGuarding and splinting of the abdomen

yy *Hard distended abdomen*Hard distended abdomen

yy Decreased or absent bowel soundsDecreased or absent bowel sounds

yy Bruising over the abdomenBruising over the abdomen

yy Abdomen and scapula pain Abdomen and scapula pain

yy

Hematemesis and hematuriaHematemesis and hematuriayy Signs of hypovolemic shockSigns of hypovolemic shock

yy Cullens signCullens sign





yy CBCCBC

yy UA UA

yy Abdominal x Abdominal x--ray ray yy Peritoneal lavagePeritoneal lavage

yy CT scanCT scan

yy Nursing ManagementNursing Managementyy Establish a patentEstablish a patent

airway airway

yy Prevent hypovolemicPrevent hypovolemicshockshock

yy Replace fluidsReplace fluids




and Disordersand Disordersyy Anorexia Nervosa Anorexia Nervosayy Self imposed weight loss, endocrine function, and aSelf imposed weight loss, endocrine function, and a

distorted psychopathologic attitude toward weight anddistorted psychopathologic attitude toward weight and

eating.eating.

yy Abnormal weight loss Abnormal weight loss

yy Deliberate self Deliberate self--starvationstarvation

yy Intense fear of gaining weightIntense fear of gaining weight




and Disordersand Disordersyy Anorexia Nervosa Anorexia Nervosa

yy Whos at Risk? Whos at Risk?

yy Early adolescentEarly adolescent

yy CaucasianCaucasian

yy Middle & upperMiddle & uppersocioeconomicsocioeconomic

yy Models, dancers, actors,Models, dancers, actors,athletesathletes

yy Clinical ManifestationsClinical Manifestationsyy Refusal to eatRefusal to eat

yy Continuous dietingContinuous dieting

yy Hair lossHair lossyy Sensitivity to coldSensitivity to cold

yy Compulsive exerciseCompulsive exercise

yy Dry skinDry skin

yy constipationconstipation




and Disordersand Disordersyy Anorexia Nervosa Anorexia Nervosa


yy Iron deficiency anemiaIron deficiency anemia

yy Elevated BUNElevated BUN


yy Nutritional supportNutritional support

yy

Psychiatric carePsychiatric careyy Weight gain Weight gain




and Disordersand Disordersyy Bulimia NervosaBulimia Nervosa

yy Frequent binge eating andFrequent binge eating andself self--induced vomitinginduced vomiting

yy Persistent concern withPersistent concern withbody imagebody image


yy Frequent vomitingFrequent vomiting

yy Macerated knucklesMacerated knuckles

yy Swollen salivary glandsSwollen salivary glands

yy Broken blood vessels inBroken blood vessels inthe eyesthe eyes

yy Dental problemsDental problems




and Disordersand Disordersyy Bulimia NervosaBulimia Nervosa


yy Acid reflux Acid reflux

yy Dental cavitiesDental cavities

yy Electrolyte imbalanceElectrolyte imbalance


yy PsychologicalPsychologicalcounselingcounseling

yy Diet therapy Diet therapy

yy Emotional supportEmotional support

yy Refer to support groupsRefer to support groups




and Disordersand Disordersyy Nutrional SupportNutrional Support

yy Oral FeedingsOral Feedings

yy Tube FeedingsTube Feedings

yy Total Parenteral NutritionTotal Parenteral Nutrition

yy Tube FeedingsTube Feedings

yy The administration of aThe administration of anutritionally balancednutritionally balanced

liquefied food or formulaliquefied food or formulathrough a tube insertedthrough a tube insertedinto the stomach,into the stomach,duodenum, or jejunumduodenum, or jejunum




and Disordersand Disordersy Types of Feedings

y Bolus

y Continuous

y Cyclical




and Disordersand Disordersyy Bolus FeedingsBolus Feedings

yy Resembles normal meal feeding patternsResembles normal meal feeding patterns

yy Can be administered via a syringe or via an intermittentCan be administered via a syringe or via an intermittent

feedingfeedingyy With an intermittent feeding, approximately 300 to 400 With an intermittent feeding, approximately 300 to 400

ml of formula is administered over a 30ml of formula is administered over a 30-- to 60to 60--minuteminuteperiod every 3 to 6 hoursperiod every 3 to 6 hours




and Disordersand Disordersyy CONTINUOUSCONTINUOUS

yy Administered continuously for 24 hours Administered continuously for 24 hours

yy An infusion pump regulates the flow An infusion pump regulates the flow

yy CYCLICALCYCLICAL

yy Administered either in the daytime or nighttime for 8 to Administered either in the daytime or nighttime for 8 to16 hours16 hours

yy An infusion pump regulates the flow An infusion pump regulates the flow

yy Feedings at night allow for more freedom during the day Feedings at night allow for more freedom during the day




and Disordersand Disordersyy Administering Tube Feedings Administering Tube Feedingsyy Position the client on right side in highPosition the client on right side in high--FowlersFowlersyy Warm feeding to room temperature to prevent diarrhea Warm feeding to room temperature to prevent diarrhea

and crampsand crampsyy Aspirate stomach contents (residual), measure the amount, Aspirate stomach contents (residual), measure the amount,

and return the contents to the stomach to preventand return the contents to the stomach to preventelectrolyte imbalanceselectrolyte imbalances

yy Check physicians order and agency policy regardingCheck physicians order and agency policy regarding

residual amounts; usually if the residual is less than 100 toresidual amounts; usually if the residual is less than 100 to150 ml, feeding is administered; if greater than 200 ml, hold150 ml, feeding is administered; if greater than 200 ml, holdthe feedingthe feeding




and Disordersand Disordersyy Administering Tube Feedings Administering Tube Feedingsyy Assess tube placement by aspirating gastric contents and Assess tube placement by aspirating gastric contents and

measuring the pH (should be 4 or less)measuring the pH (should be 4 or less)

yy Assess bowel sounds; hold feeding and notify the physician Assess bowel sounds; hold feeding and notify the physicianif bowel sounds are absentif bowel sounds are absent

yy Use a feeding pump for continuous or cyclical feedingsUse a feeding pump for continuous or cyclical feedings

yy For bolus feeding, leave the client in a highFor bolus feeding, leave the client in a high--FowlersFowlersposition for 30 minutes after feedingposition for 30 minutes after feeding

yy For a continuous or cyclical feedings, keep the client in aFor a continuous or cyclical feedings, keep the client in asemisemi--Fowlers position at all timesFowlers position at all times




and Disordersand Disordersyy Tube Feeding PrecautionsTube Feeding Precautionsyy If an obstruction occurs, try flushing with water, salineIf an obstruction occurs, try flushing with water, saline

yy Administer feeding at prescribed rate, or via gravity flow Administer feeding at prescribed rate, or via gravity flow(intermittent, bolus feedings) with a 60(intermittent, bolus feedings) with a 60--ml syringe with theml syringe with theplunger removedplunger removed

yy Gently flush with 30 to 50 ml of water or normal salineGently flush with 30 to 50 ml of water or normal saline(depending on agency policy) with the irrigation syringe(depending on agency policy) with the irrigation syringe

after the feedingafter the feeding




and Disordersand Disordersyy Types of TubesTypes of Tubes

yy Nasogastric TubeNasogastric Tube

yy NasointestinalNasointestinal

yy Gastrsotomy TubeGastrsotomy Tube

yy Jejunostomy Tube Jejunostomy Tube


yy DiarrheaDiarrhea

yy Aspiration Aspiration

yy Vomiting Vomiting

yy Tube ObstructionTube Obstruction

yy HyperglycemiaHyperglycemia




and Disordersand Disordersy Total Parenteral Nutritiony Hypertonic solution that consists of glucose, proteins,

minerals, and vitamins that is given intravenously (IV).

y The goal of TPN is to meet the patients nutritional needsand to allow growth of new body tissue.




and Disordersand Disordersyy Total Parental Nutrition: IndicationsTotal Parental Nutrition: Indications

yy Patients intake is insufficient to maintain an anabolicPatients intake is insufficient to maintain an anabolicstate (burns, malnutrition, AIDS)state (burns, malnutrition, AIDS)

yy Patient unable to ingest food orally or by tube impaired.Patient unable to ingest food orally or by tube impaired.(Crohns disease, hyperemesis gravidarium)(Crohns disease, hyperemesis gravidarium)

yy Patient is unwilling to ingest nutrients (anorexiaPatient is unwilling to ingest nutrients (anorexianervosa)nervosa)




and Disordersand Disordersyy CompositionComposition

yy CaloriesCalories

yy ProteinProtein

yy ElectrolytesElectrolytes

yy Trace ElementsTrace Elements

yy Vitamins Vitamins

yy FatsFats

yy Methods of Methods of Administration Administration

yy PICC (Peripherally PICC (Peripherally

Inserted CentralInserted CentralCatheter)Catheter)

yy CVC (Central VenousCVC (Central VenousCatheter)Catheter)




and Disordersand Disordersyy ComplicationsComplications

yy InfectionInfection

yy Metabolic problemsMetabolic problems

yy Mechanical problemsMechanical problems


yy Vital signs Vital signs

yy Daily weightsDaily weights

yy Blood chemistriesBlood chemistries

yy CBCCBC

yy Blood glucose levelsBlood glucose levels



THE END!

Documents

GI System Student Version