MEDICAL SURGERY NURSING STUDY GUIDE UPDATED STUDY GUIDE 2024/2025, Study Guides, Projects, Research of General Surgery

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MEDICAL SURGERY NURSING STUDY

GUIDE

UPDATED STUDY GUIDE 2024/

Upper Gastrointestinal problems Gastritis · An inflammation of the gastric mucosa, is one of the most common problems affecting the stomach. · May be acute or chronic · There is two types (A fundal and B antral) Etiology and pathophysiology · Gastritis occurs as the result of a breakdown in the normal gastric mucosal barrier. · This mucosal barrier normally protects the stomach tissue from autodigestion by acid and the enzyme pepsin. · When the barrier is broken, acid can diffuse back into the muscosa. · This allows hydrochloric (HCL) acid to enter. · The HCL acid stimulates the conversion of pepsinogen to pepsin and stimulates the release from Mast cells. Etiology and Patho Continue · The combined result of these occurrence is tissue edema, disruption of capillary walls with loss of plasma into the gastric lumen and possible hemorrhage. Causes of gastritis · Aspirin

· Nonsteriodal anti-inflammatory drugs · Alcohol · radiation · H. Plyori · Salmonella · Smoking

· sepsis · burns · renal failure Chronic Gastritis Type A and B · Type A= Likely to be an autoimmune disorder. · Type B= is related to H. Pylori Clinical Manifestation Acute gastritis · Anorexia · Nausea and vomiting · epigastric tenderness · felling of fullness · Hemorrhage is commonly associated with alcohol abuse · Is self-limiting, lasting from a few hours to a few days, with complete healing of the mucosa expected. Clinical Manifestation of Chronic gastritis · Similar to to those described for acute gastritis. · Anemia (due to acid-secreting cells that are lost or do not function as a result of atrophy, the source of intrinsic factor is lost. · Intrinsic factor combines with B12. When b !2 is unavailable it cannot absorb in the ileum. · The storage of B12 is depleted from the liver and the lack of this is essential for growth and maturation of RBC’s, resulting

in anemia. Diagnostic Studies · Endoscopic exam’ · Biopsy · Breath · Urine

· Serum · CBC (to check for anemia) · Stools are tested for occult blood Collaborative Care · Elimination of the cause and preventing or avoiding it in the future are generally all that is needed to treat acute gastritis. · Bed rest · NPO status · IV fluids · Vomiting · Diarrhea · Severe case an NG tube may be placed to either keep stomach empty or for a lavage. Continue Collaborative Care · Antiemetics (n/v) · Antacids · H2 antagonist (Zantac, Tagment, Prilosec, Prevcaid) This reduces gastric HCL acid secretion. · Chronic Gastritis-antibodies · Patient with pernicious anemia= regular injections of B · bland diet · antacids Nursing Management Nursing Assessment · Dehydration can occur rapidly if patient is vomiting

· Keep patient quiet · Maintain NPO · Monitoring IVF

· Frequent V/S and testing vomit for blood Nursing Diagnosis · Vomiting · Fluid Volume Deficit · Anxiety · Altered nutrition less than body requirements Goals · Experience minimal or no symptoms of gastritis · Have no recurrent episodes of acute gastritis · achieve am optimal pattern of gastric function relative to the state of the disease. Peptic Ulcers Upper Gi Problem Peptic Ulcer · Is an erosion of the GI mucosa resulting from the digestive action of HCL acid and pepsin. · Any portion of the GI tract that comes in contact with gastric secretions is susceptible to ulcer development. · It is estimated that 10% of men and 4% OF WOMEN IN THE us WILL HAVE DUODENAL ULCERS DURING THEIR LIFE TIME. Types · Peptic ulcer can be classified as acute or chronic and to the location.

· ACUTE= is associated with superficial erosion and minimal inflammation. · It is short duration and resolves quickly when the cause is identified and removed. · CHRONIC=is one of long duration, eroding through the muscular wall with the formation of fibrous tissue. · It is present continuously for many months or intermittently throughout a person’s lifetime.

Gastric Ulcers · More prevalent in women than in men. · Mortality rate from gastric ulcers is greater than that form duodenal ulcers because the peak incidence of gastric ulcers occurs in person over 50 years of age. · More prevalent in those with executives or managerial positions. · Persons with socioeconomic class and manual or unskilled workers are more prone to gastric ulcers. H. Pylori · Provides a new understanding of ulcer formation (please read) · It survives in the human upper GI tract for long periods of time as a result of its ability to move in mucus and attach to mucosal cells. · It secretes a substance called urease, which buffers the area around the bacterium and protects it from destruction in an acidic environment. · H. Pylori is more common in low socioeconomic area. · Route of transmission is unknown it is thought that infection occurs during childhood via transmission form family members tot he child, possible through oral-oral route. · Ulcers can develop from medication · Stress Duodenal Ulcers

· Accounts for about 80% of patients. · Steady increase in women. · May be because of overuse of ASA and NSAIDS and increase consumption of alcohol abuse. · H.Pylori has been identified as being a key role. Manifestations · No pain or other symptoms can occur. · When pain does occur it is described as burring or cramplike. · Located in the mid-epigastrium region beneath the xiphoid process.

· Pain can occur when the stomach is empty or when food has been digested. · Gastric ulcer=located high in the epigastrium and occurs spontaneously 1-2 hours after meals. Complications · Hemorrhage (most common) · Perforation · Gastric outlet obstruction Diagnostic Studies · CBC · Urinalysis · Liver enzymes · Serum electrolytes · Endoscopy · Upper GI barium contrast study · gastric analysis · H.pylori testing of breath, urine, blood and stool Collaborative Therapy · Adequate rest · bland diet · cessation of smoking · antacids

· H2 receptor blocking agents · Anticholinergics · Stress reduction

Collaborative care acute exacerbation without complications · NPO · NG suction · Bed rest to moderate light activity · Cessation of smoking · IVF · Antacids · H2 receptor antagonist · Sedatives · Anticholinergic Acute exacerbation with complications (hemorrhage, perforation or obstruction · NPO · NG suction Bed rest · IVF · Blood transfusions · Stomach lavage Surgical Therapy · Perforation · Gastric outlet obstruction Nursing Diagnosis

· Pain · Ineffective management of therapeutic regimen · Vomiti ng Plannin g · Experience reduction or absence of discomfort related to Peptic Ulcer disease · Exhibit no signs of GI complications related to the ulcerative process · Have complete healing of the peptic ulcer · comply with the prescribed therapeutic regimen. Nursing Implementation · Read p. 1119- · Health Promotion · Acute intervention Surgical Therapy for Peptic Ulcers · Approximately 20% of patients with ulcers need surgical intervention · Bilroth I= Partial gastrectomy with removal of the distal two thirds of the stomach and anastomosis of the gastric stump to the duodenum. · Billroth II= Partial gastrectomy with removal of the distal two thirds of the stomach and anastomosis of the gastric stump to the jejunum.

Continue with surgical therapy · Vagotomy=Severing the vagus nerve, either totally or selectively at some point in its innervation to the stomach. · Pyloroplasty=surgical enlargement of the pyloric sphincter to facilitate the easy passage of contents from the stomach. Postoperative Complications · Dumping syndrome · Postprandial hypoglycemia

· bile reflux gastritis Postpranidal hypoglycemia · A variant of dumping syndrome · result of uncontrolled gastric emptying of a bolus of fluid high in carbohydrate in tot he small intestine. · This results in hyperglycemia and the release of excessive amounts on insulin in to the circulation. · Secondary hypoglycemia then occurs, with symptoms appearing about 2 hours after meals. · Symptoms: Sweating, weakness, mental confusion, palpitations, tachycardia and anxiety. Bile Reflux gastritis · Prolonged contact with bile, especially bile salts, causes damage to the gastric mucosa. · Paradoxically, peptic ulcer can reoccur after surgical treatment that was intended as a cure. · Symptoms are continuos epigastric distress that increases after meals. Vomiting relives the distress but only temporarily. · Questran either before or after meals has met with considerable success. Nutritional therapy related to surgical therapy · DC planning and instruction should be started as soon as the immediate postoperative period is successfully passed. · Dietary instructions

· Eliminate drinking fluids with meals · Dry foods with low carbs and moderate protein and fats. This can reduces the likelihood of dumping syndrome.

Inflammatory bowel disease Lower Gastrointestinal problem Inflammatory bowel Disease Ulcerative Colitis and Chrons disease are immunologically related disorders to as IBD · Their has been extensive research on the etiology of IBD, the cause is still unknown. · Possible causes can be: and infection agent Lupus, food allergies and heredity. Ulcerative Colitis · Characterized by inflammation and ulceration of the colon and rectum.It may occur at any age but peaks between the ages of 15-25 years. · There is a second, smaller peak onset between 50-80 years of age. · Can occur in both sexes but has a higher incidence in women. · More common in Jewish and upper-middle class urban populations. Clinical Manifestations · Bloody diarrhea · Abdominal pain · Pain may vary from mild-severe · With mild disease=diarrhea may consist of one or tow semi- formed stools containing amounts of blood per day.

· In moderate= increased stool output (4 to 5 a day), increased bleeding and systemic symptoms (fever, malaise, anorexia) · Severe=10 -20 stools a day. With fever, weight loss and dehydration are present. Complications · Hemorrhage · strictures

· perforation · toxic megacolon (dilation and paralysis of the colon · colon dilation Diagnostic studies · Fiberoptic colonoscopy · Sigmoidoscopy · Barium enema · CBC · Stool for blood, culture and sensitivity Collaborative Care Mild-moderate · Low roughage diet and not milk or milk products · Antimicrobal therapy · Corticosteriods · Anticholinergic therapy · Anti-diarrheal agents Continue collaborative care Severe · IVF with electrolytes · Blood transfusions · NPO status

· NG tube to low suction · Anti-microbial therapy · Corticosteriods · TPN

· Surgery if no improvement Surgical Therapy · Total protocolectomy with permanent ileostomy · Total proctocolectomy with continent ileostomy · Total colectomy and ileal reservoir · Please read p.1156 Nursing Diagnosis · Diarrhea · Aniexty · Altered nutrition: less than body requirements · Impaired skin integrity · Ineffective individual coping · Ineffective management of therapeutic regimen Goals · Experience decrease in number and severity of acute exacerbation’s · Maintain normal fluid and electrolyte balance · be free from pain and discomfort · comply with medical regimens · maintain nutritional balance Chrons Disease

Lower Gastrointestinal Problems Chrons Disease · A chronic, nonspecific inflammatory bowel disorder of unknown origin that can affect any part of the GI tract. · May occur most often between the ages of 15-30 years. · When it occurs in older adults the mortality and morbidity is higher. · Incidence of Chrons is lower than Ulcerative Colitis.