Learning Plan 5 GI-Hepatic
Alterations
METABOLISM (GASTRIC & DUODENAL)
Gastritis
•
Inflammation of the stomach
•
A common GI problem
•
Acute: rapid onset of symptoms usually caused by dietary
indiscretion. Other causes include medications, alcohol, bile reflux,
and radiation therapy. Ingestion of strong acid or alkali may cause
serious complications.
•
Chronic: prolonged inflammation due to benign or malignant ulcers
of the stomach or by Helicobacter pylori. May also be associated with
some autoimmune diseases, dietary factors, medications, alcohol,
smoking, or chronic reflux of pancreatic secretions or bile.
Erosive Gastritis
Manifestations of Gastritis
•
Acute: abdominal discomfort, headache, lassitude, nausea, vomiting,
hiccupping
•
Chronic: epigastric discomfort, anorexia, heartburn after eating,
belching, sour taste in the mouth, nausea and vomiting, intolerance
of some foods. May have vitamin deficiency due to malabsorption of
B12
•
May be associated with achlorhydria, hypochlorhydria, or
hyperchlorhydria
•
Diagnosis is usually by UGI X-ray or endoscopy and biopsy
Nursing Process: The Care of the Patient With
Gastritis—Diagnoses
•
Anxiety
•
Imbalanced nutrition
•
Risk for fluid volume imbalance
•
Deficient knowledge
•
Acute pain
Medical Management of Gastritis
•
•
Acute
•
Refrain form alcohol and food until symptoms subside
•
If due to strong acid or alkali treatment to neutralize the agent, avoid
emetics and lavage due to danger of perforation and damage to esophagus
•
Supportive therapy
Chronic
•
Modify diet, promote rest, reduce stress, avoid alcohol and NSAIDs
•
Pharmacologic therapy: similar medications as use for GERD
Interventions
•
Reduce anxiety; use calm approach and explain all procedures and
treatments
•
Promote optimal nutrition; for acute gastritis, the patient should take no
food or fluids by mouth. Introduce clear liquids and solid foods as
prescribed. Evaluate and report symptoms. Discourage caffeinated
beverages, alcohol, cigarette smoking. Refer for alcohol counseling and
smoking cessation
•
Promote fluid balance; monitor I&O, for signs of dehydration, electrolyte
imbalance, and hemorrhage
•
Measures to relieve pain: diet and medications
Peptic Ulcer
•
Erosion of a mucous membrane forms an
excavation in the stomach, pylorus, duodenum, or
esophagus
•
Associated with infection of H. pylori
•
Risk factors include excessive secretion of stomach
acid, dietary factors, chronic use of NSAIDs,
alcohol, smoking, and familial tendency
•
Manifestations include a dull gnawing pain or
burning in the mid-epigastrium; heartburn and
vomiting may occur
•
Treatment includes medications, lifestyle changes,
and occasionally surgery
Deep Peptic Ulcer
Question
Is the following statement true or false?
The most common site for peptic ulcer formation is the pylorus.
Nursing Process: The Care of the Patient With
Peptic Ulcer—Diagnoses
•
Acute pain
•
Anxiety
•
Imbalanced nutrition
•
Deficient knowledge
Collaborative Problems and
Potential Complications
•
Hemorrhage
•
Perforation
•
Penetration
•
Pyloric obstruction (gastric
outlet obstruction)
Interventions
Relieve Pain
•
•
Treat with prescription
medications
Avoid aspirin, NSAIDs,
and alcohol
Assess anxiety
•
Explain all procedures and treatments: Calm manner
•
Help identify stressors
•
Explain various coping and relaxation methods such as
biofeedback, hypnosis, and behavior modification
Patient Education
•
Medication education
•
Dietary restrictions
•
Lifestyle changes
Management of Potential Complications
•
•
Management of hemorrhage
•
Assess for evidence of bleeding, hematemesis or melena, and symptoms of
shock/impending shock and anemia
•
Treatment includes IV fluids, NG, and saline or water lavage; oxygen,
treatment of potential shock including monitoring of VS and UO; may
require endoscopic coagulation or surgical intervention
Pyloric obstruction
•
Symptoms include nausea and vomiting, constipation, epigastric fullness,
anorexia, and (later) weight loss
•
Insert NG tube to decompress the stomach, provide IV fluids and electrolytes.
Balloon dilation or surgery may be required
Management of Potential Complications
•
Management of perforation or penetration
•
Signs include severe upper abdominal pain that may be referred to the shoulder,
vomiting and collapse, tender board-like abdomen, and symptoms of shock or
impending shock
•
Patient requires immediate surgery
Question
What is the best time to teach a client to take proton pump inhibitors?
A.
30 minutes before a meal
B.
With a meal
C.
Immediately after the meal
D.
One to three hours after a meal
Metabolism (Obesity)
CH 47
Obesity
•
Obesity is body mass indices (BMI) above 30 mg/m2
Management
•
66% of all adults are overweight or obese
•
Lifestyle modifications
•
Obesity-related mortality rates are 30% greater for
every gain of 5 kg/m2 of body mass beyond a BMI of 25
kg/m2
•
Pharmacotherapy
•
Bariatric surgery
•
Increased risk for disease, disorders, low self-esteem,
impaired body image, depression, and diminished
quality of life
Bariatric Surgery
•
Morbid obesity: persons more than two times IBW, BMI exceeds 30
kg/m2, or more than 100 pounds greater than IBW; high risk for
health complications
•
Surgery is preformed only after nonsurgical methods have failed
•
Selection factors include body weight, patient history, failure to lose
weight using other means, absence of endocrine disorders, and
psychological stability
Surgical Procedures for Morbid Obesity
Surgical Procedures for Morbid Obesity
Nursing Care of the Patient Undergoing Bariatric
Surgery
•
Preoperative care; evaluation and counseling
•
Postoperative care is similar to gastric resection, but the patient is at
greater risk for complications because of obesity
•
Patients require psychosocial interventions to modify their eating
behaviors
•
Follow-up care
•
Education regarding long-term effects
Post-Op Care
•
Cardiopulmonary complications, thrombus
formation, anastomosis leaks, and electrolyte
imbalances
•
Risk for re-sedation
•
Risk for infection
•
Diligence with turning and ambulation
•
DVT prophylaxis including Active & Passive
ROM
•
Keep skinfolds clean, protect incision
•
If NGT: keep in correct position
•
30ml water or sugar free clear
liquid Q 2hr
•
High-protein liquid diet
•
Slow eating & stop when full
•
Postoperative diet: six small
feedings totaling 600 to 800
calories per day
•
Vomiting common complication
Collaborative Problems and Potential
Complications
•
Hemorrhage
•
Bile reflux
•
Dumping syndrome
•
Dysphagia
•
Bowel or gastric outlet obstruction
Question
Is the following statement true or false?
The average weight loss after bariatric surgery is 60% of previous body
weight.
Nursing Process: The Care of the Patient With
Gastric Surgery—Diagnoses
•
Anxiety
•
Pain
•
Deficient knowledge
•
Imbalanced nutrition
Collaborative Problems and
Potential Complications
•
Hemorrhage
•
Dietary deficiencies
•
Bile reflux
•
Dumping syndrome
Interventions
•
Provide interventions to reduce anxiety
•
Pain
•
Administer analgesics as prescribed so patient may perform pulmonary
care, leg exercises, and ambulation activities
•
Position in Fowler’s position
•
Maintain function of NG tube
•
Patient education
•
Individualized nutritional care and support
Care and Prevention of Complications
•
Gastric retention
•
•
Dumping syndrome
• Caused by rapid passage of food into the
jejunum and drawing of fluid into the
jejunum caused by hypertonic intestinal
contents
• Causes vasomotor and GI symptoms with
reactive hypoglycemia
• Avoid fluid with meals
• Avoid high carbohydrate and sugar
intake
•
Steatorrhea
• Reduce fat intake and administer
loperamide
May require reinstatement of NPO and
Ng suction; use low-pressure suction
Bile reflux
•
•
•
Agents that bind with bile acid:
cholestyramine
Malabsorption of vitamins and minerals
•
•
Supplementation of iron and other
nutrients
Parenteral administration of vitamin B12
because of a lack of intrinsic factor
Dietary Self-Management
•
To delay stomach emptying and dumping syndrome, assume low Fowler’s
position after meals; lie down for 20 to 30 minutes
•
Take antispasmodics as prescribed
•
Avoid fluid with meals
•
Meals should contain more dry items than liquid items
•
Eat fat as tolerated but keep carbohydrate intake low and avoid concentrated
carbohydrates
•
Eat small, frequent meals
•
Take dietary supplements as prescribed; vitamins, medium-chain triglycerides,
and B12 injections