Nursing Guide for Gastrointestinal and Renal Disorders, Study Guides, Projects, Research of Nursing

Download Nursing Guide for Gastrointestinal and Renal Disorders and more Study Guides, Projects, Research Nursing in PDF only on Docsity!

NR 170 week4 2023-2024 Case Study

Care of patients with common GI

problems:

Diarrhea:

• 3 or more loose stools a day
• Acute: less than 14 days
• Persistent: longer than 14 days
• Chronic: 30 days or more Causes:
• Most common is the ingestion of infectious organisms
• Viruses – 24hrs or less
• Bacteria – E. Coli
• Parasites Clinical Manifestations:
• Large volume watery stools: upper GI infection
• Small volume bloody stools: lower GI tract infection
• Cramping
• Abd pain
• Nausea and vomiting
• Fever Severe symptoms- dehydration, hypokalemia, metabolic acidosis Risk Factors:
• Age – older adults can be life threatening
• Gastric acidity
• Immunocompromised
• Antibiotic use- more prone to c- diff Treatment:
• Prevent transmission of causing agent
• Maintain/replace fluid and electrolytes
• Prevent skin breakdown
• Anti-diarrheal medications Diagnosis:
• Stool culture for patients with symptoms lasting longer than 3 days accompanied by a fever - CDIFF Constipation:
• Difficult or infrequent stools
• Hard, dry stool

• Feeling of incomplete voiding

Normal stomach- food is swallowed --> peristalsis occurs to squeeze food into the stomach. LES relaxes, food enters, LES closes In GERD- impaired esophageal motility

1. LES --> weak due to: anticholinergics calcium channel blockers sedatives overeating/ overweig ht smoking pregnancy (increase in pressure) fatty foods
2. Esophageal mucosal lining – cells that line the esophagus get inflamed Risk: bleeding (esophageal cancer)
3. Stomach acid/contents - erodes esophagus Diagnostics: Endoscopy: asses narrowing of ulcers formed PH monitoring: measures amount of acid in the esophagus Signs + symptoms: Most common: heartburn

• Epigastric
• Regurgitation
• Dry cough- worse at night
• Hoarseness
• Nausea
• Dysphagia

• Lung/ear infections --> fluid backtracks upward

Differentiate between heartburn and cardiac chest pain

• Regurgitation
• Dysphagia
• Hiccups & Belching
• Fullness Feel like food gets “stuck”
• Bowel sounds over chest Peristalsis Diagnostics: Barium swallow Endoscop y Therapeutic management:
• Similar to GERD
• Avoid medications that delay gastric emptying (anticholinergics)
• Antacids, H2 Receptor Antagonists, or PPI’s if experiencing reflux
• Weight loss can naturally improve hiatal hernia
• Surgical Repair a. Physically pull stomach from diaphragm b. Nissen Fundoplication Post hernia repair considerations: temporary dysphagia
• risk for aspiration Nursing interventions:
• Comfort

Sleep with HOB elevated Avoid straining Avoid vigorous exercise

• Nutrition Eat small, frequent meals Do not lay down for 1 hour after eating Patient teaching:
• Follow dietary instructions
• Take medications as prescribed

GASTRITIS

What is it? Gastritis is an inflammation of the gastric mucosa, may be acute or chronic. Acute: thickened, reddened mucosa with prominent rugae or folds. Varying degrees of mucosal necrosis and inflammatory reaction. Complete healing usually occurs in within a few days. If stomach is not involved complete recovery usually occurs with no gastric inflammatory reaction. If muscle is affected, hemorrhage may occur during acute. Chronic gastritis: patchy, diffuse inflammation of the

Results in pernicious anemia (a condition in which not enough red blood cells are produced due to deficiency of vitamin B in the body) Associated with an increased risk for gastric cancer. Type A: Nonerosive Type B: Erosive Atrophic Inflammation of the glands and the fundus and body of the stomach Associated with the presence of antibodies to parietal cells and intrinsic factors – autoimmune cause likely. Long term NSAID use ETOH, coffee, caffeine, and corticosteroids Accidental ingestion of erosive chemicals Effects the glands of the antrum but may involve the entire stomach. Caused H.Pylori infection Smoking, ETOH abuse, radiation therapy Pyloroplasty Chrons disease Uremia Type of chronic gastritis that effects the older population Exposure to toxic substances (lead, nickel) in the workplace H.Plyori Autoimmune disorders Associated with gastric cancer and MALT Signs and symptoms: Acute Chronic Rapid onset of pain Pain relieved by food Nausea and vomiting Anorexia Hematemesis Nausea and vomiting Gastric hemorrhage Intolerance to fatty/spicy foods Heartburn Pernicious anemia Anorexia Prevention/patient teaching: Well-balanced diet Avoid ETOH Caution

aspirin, NSAIDS Avoid caffeine

Therapeutic management: Determine cause Diagnostic tests: EGD, Abd XRAY, Abd/pelvic CT Labs: CBC - Hemoglobin: 14-18 M 12-16 F Hematocrit: 42-52% M 37-47% F White Blood Cell: 5- 10mm RBC: 4.7- 6.1mm 4.2-5.4mm Platelet Count: 150- 400mm Liver panel Lipase- 0- 110 IU/L Medications: Symptom manageme nt- Antiemetics Analgesics H2 Receptor Blockers – Famotidine Sulfcrate Antacid

s PPIs

IRRITABLE BOWEL SYNDROME (IBS)

What is it? Functional GI disorder causes chronic or recurrent diarrhea, constipation and LLQ abdominal pain and bloating. Changes in motility and increased or decreased bowel transit times results in changes in normal bowel patterns: IBS- D – diarrhea IBS- C – constipation IBS- A – alternating IBS-M – mix Symptoms appear in young adulthood and continue throughout the patient's life. Etiology & Cause: Unclear etiology Environmental – caffeine, carbonation, dairy, infectious agents. Immunologic, genetic – cytokine genes, IL-6, IL-8, tumor necrosis factor- alpha. Risk factor: Women 2 times more than likely than men (possible hormone related) Mental health disorders – anxiety, depression Pain and disease may lead to secondary mental health disorders Assessment:

Ask patient history -

IBS-C IBS-D

Bulk forming laxative- Metamucil Antidiarrheals – Imodium, psyllium

• At meal time with glass of water Oral laxative for women – Lubiprostone
• Take with food and water Linaclotide
• helps with pain and cramping
• Once a day 30 mins before breakfast Alosteron (5HT3 Antagonist)
• women when traditional treatment isn't working – last resort
• May cause life threatening bowel complications, report constipation and colitis Rifaximin: treats bloating and abdominal distention – antibiotic When pain is a primary symptom-- Tricyclic antidepressants – amitriptyline Pain after eating – take 30- minutes Supplements: Probiotics Peppermint oil Stress management (relaxation techniques, mediation, yoga)

HERNIA

What is it? Weakness in the abdominal muscle wall through which a segment of the bowel or other abdominal structure protrudes. Can also penetrate through other defect in the abdominal wall, diaphragm, and abdominal cavity. Development of a hernia are congenital or acquired muscle weakness and increased intra-abdominal pressure

• obesity, pregnancy, lifting heavy objects.