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Presented by:Presented by:Kymberly McCoy RN MSNKymberly McCoy RN MSNSpring 2010Spring 2010
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
GI Tract includesGI Tract includes::
MouthMouth
EsophagusEsophagus StomachStomach Small IntestineSmall Intestine Large IntestineLarge Intestine RectumRectum
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
Assessment: Physical Assessment: Physical Includes mouth, abdomenIncludes mouth, abdomen
& rectum& rectum Abdominal Assessment Abdominal Assessment InspectInspect Auscultate Auscultate PercussPercuss
PalpatePalpate
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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)
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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.
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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 Oral CancerOral Cancer
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
yy Oral CancerOral Cancer
yy Surgery Surgery
yy Hemiglossectomy Hemiglossectomy yy Glossectomy Glossectomy
yy Radical neck dissectionRadical neck dissection
yy Oral CancerOral Cancer
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disordersyy Esophageal CancerEsophageal Cancer
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disordersyy Esophageal CancerEsophageal Cancer
yy ComplicationsComplications
yyPerforationPerforation
yy HemorrhageHemorrhage
yy Aspiration Pneumonia Aspiration Pneumonia
yy Anastomotic leak Anastomotic leak
yy TreatmentTreatmentyy CurativeCurative
yy PalliativePalliative
yy Esophageal CancerEsophageal Cancer
yy TreatmentTreatmentyy RadiationRadiation
yy Chemotherapy Chemotherapy
yy Surgery Surgery
yy Esophagectomy Esophagectomy
yy Esophagogastrostomy Esophagogastrostomy
yy Esophagoenterostomy Esophagoenterostomy
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
yy Esophageal CancerEsophageal Cancer
yy Nursing ManagementNursing Management
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
yy Nursing ManagementNursing Management
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
y GERD
y Risk Factors
y Obesity y Smoking
y Excess alcohol intake
y High-fat, spicy or acidic
foodsy Caffeine and carbonated
beverages
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
yy GERDGERD
yy TreatmentTreatment
yy Lifestyle modificationsLifestyle modificationsyy Nutritional therapy Nutritional therapy
yy Drug therapy Drug therapy
yy Surgery Surgery
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
yy Barretts EsophagusBarretts Esophagus
yy Clinical ManifestationsClinical Manifestations
yy NonNon--specific to BEspecific to BEyy Treatment regimen sameTreatment regimen same
as GERD to control acidas GERD to control acidrefluxreflux
yy Barretts EsophagusBarretts Esophagus
yy Surgical InterventionSurgical Intervention
yy Photodynamic Therapy Photodynamic Therapy (PDT)(PDT)
yy Endoscopic MucosalEndoscopic MucosalResection (EMR Resection (EMR)
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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.
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disordersyy Normal Gastric and Duodenal MucosaNormal Gastric and Duodenal Mucosa
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
yy Nursing ManagementNursing Management
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 DiagnosticsDiagnostics
yy Physical examPhysical exam
yy X X--Ray Ray
yy EGDEGD
yy TreatmentTreatment
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
yy Gastric UlcersGastric Ulcers
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
yy Gastric UlcersGastric Ulcers
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disordersyy Gastric UlcersGastric Ulcers
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
yy Gastric UlcersGastric Ulcers
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
yy Total Gastrectomy Total Gastrectomy yy Vagotomies Vagotomies
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
yy Billroth IBillroth I yy Billroth IIBillroth II
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disordersyy Gastric UlcersGastric Ulcers
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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.
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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)
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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 TreatmentTreatment
yy Surgery Surgery
yy RadiationRadiation
yy Chemotherapy Chemotherapy
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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 Risk FactorsRisk Factors
yy Heredity Heredity
yy StressStress
yy Diet high in fatDiet high in fat
yy DiagnosticsDiagnostics
yy X X--ray ray yy Stool studiesStool studies
yy Protoscopy or Colonoscopy Protoscopy or Colonoscopy
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
yy Pathophysiology Pathophysiology
yy Functional disorder of Functional disorder of intestinal motility intestinal motility
yy NeuroendocrineNeuroendocrinedsyregulationdsyregulation
yy Peristaltic wave intensity Peristaltic wave intensity
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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 Clinical ManifestationsClinical Manifestations
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disordersyy DiagnosticsDiagnostics
yy History and physicalHistory and physical
yy CBCCBC
yy UltrasoundUltrasound
yy TreatmentTreatment
yy Appendectomy Appendectomy
yy IV therapy IV therapy
yy Antibiotics Antibiotics
yy ComplicationsComplications
yy PerforationPerforation
yy
PeritonitisPeritonitisyy Abscesses Abscesses
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
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.
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disordersyy Clinical ManifestationsClinical Manifestations
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 Clinical ManifestationsClinical Manifestations
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disordersyy DiagnosticsDiagnostics
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 ComplicationsComplications
yy PerforationPerforation
yy PeritonitisPeritonitis
yy Abscess and fistula Abscess and fistulaformationformation
yy Bowel obstructionBowel obstruction
yy bleedingbleeding
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Gastrointestinal System FunctionGastrointestinal System Function
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 Antibiotics Antibiotics
yy Pain managementPain management
yy Nursing ManagementNursing 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
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Gastrointestinal System FunctionGastrointestinal System Function
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)
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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 Clinical ManifestationsClinical Manifestations
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.
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disordersyy DiagnosticsDiagnostics
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 HemorrhageHemorrhage
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disorders
y Kock Pouch
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disordersyy Preoperative CarePreoperative Care
yy Antibiotics Antibiotics
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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.
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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 Risk FactorsRisk Factors
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disordersyy Clinical ManifestationsClinical Manifestations
yy Change in bowel habitsChange in bowel habits
yy HematocheziaHematochezia
yy MelenaMelena
yy Weight loss Weight loss
yy Unexplained anemiaUnexplained anemia
yy Clinical ManifestationsClinical Manifestations
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disordersyy DiagnosticsDiagnostics
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 ComplicationsComplications
yy Partial or completePartial or completeobstructionobstruction
yy UlcerationUlceration
yy HemorrhageHemorrhage
yy PerforationPerforation
yy Abscess formation Abscess formation
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Gastrointestinal System FunctionGastrointestinal System Function
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 Chemotherapy Chemotherapy
yy RadiationRadiationyy Preoperative CarePreoperative Care
yy Bowel preparationBowel preparation
yy Antibiotic administration Antibiotic administration
yy
Patient educationPatient education
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Gastrointestinal System FunctionGastrointestinal System Function
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)
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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 Nursing ManagementNursing Management
yy Provide emotional supportProvide emotional support
yy Maintain optimal nutritionMaintain optimal nutrition
yy Provide wound careProvide wound care
yy Monitor for complicationsMonitor for complications
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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.
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disordersyy Clinical ManifestationsClinical Manifestations
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disordersyy DiagnosticsDiagnostics
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disordersyy Anorexia Nervosa Anorexia Nervosa
yy DiagnosticsDiagnostics
yy Iron deficiency anemiaIron deficiency anemia
yy Elevated BUNElevated BUN
yy TreatmentTreatment
yy Nutritional supportNutritional support
yy
Psychiatric carePsychiatric careyy Weight gain Weight gain
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Gastrointestinal System FunctionGastrointestinal System Function
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 Clinical ManifestationsClinical Manifestations
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disordersyy Bulimia NervosaBulimia Nervosa
yy ComplicationsComplications
yy Acid reflux Acid reflux
yy Dental cavitiesDental cavities
yy Electrolyte imbalanceElectrolyte imbalance
yy TreatmentTreatment
yy PsychologicalPsychologicalcounselingcounseling
yy Diet therapy Diet therapy
yy Emotional supportEmotional support
yy Refer to support groupsRefer to support groups
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disordersy Types of Feedings
y Bolus
y Continuous
y Cyclical
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
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
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disordersyy Types of TubesTypes of Tubes
yy Nasogastric TubeNasogastric Tube
yy NasointestinalNasointestinal
yy Gastrsotomy TubeGastrsotomy Tube
yy Jejunostomy Tube Jejunostomy Tube
yy ComplicationsComplications
yy DiarrheaDiarrhea
yy Aspiration Aspiration
yy Vomiting Vomiting
yy Tube ObstructionTube Obstruction
yy HyperglycemiaHyperglycemia
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Gastrointestinal System FunctionGastrointestinal System Function
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.
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Gastrointestinal System FunctionGastrointestinal System Function
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)
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Gastrointestinal System FunctionGastrointestinal System Function
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)
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Gastrointestinal System FunctionGastrointestinal System Function
and Disordersand Disordersyy ComplicationsComplications
yy InfectionInfection
yy Metabolic problemsMetabolic problems
yy Mechanical problemsMechanical problems
yy Nursing ManagementNursing Management
yy Vital signs Vital signs
yy Daily weightsDaily weights
yy Blood chemistriesBlood chemistries
yy CBCCBC
yy Blood glucose levelsBlood glucose levels