GI -A & P Review Mouth Pharynx Esophagus Stomach Small Intestines Large Intestines Liver and Gallbladder Pancreas 8/11/2011

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Dayna Harvey
6 years ago
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collaborative management of: PUD Hernias Cholecystitis and cholelithiasis GI -A & P

1 Lemone and Burke Chapters 21,23-25 ATI M/S Unit 7 Objectives Review A&P Identify diagnostic exams Discuss etiology, pathophysiology, clinical manifestation, and collaborative management of: PUD Hernias Cholecystitis and cholelithiasis GI -A & P Review Mouth Pharynx Esophagus Stomach Small Intestines Large Intestines Liver and Gallbladder Pancreas 1

Peptic Ulcer Disease (PUD) Objectives: Identify different types Gastric Ulcer Duodenal Ulcer Stress Ulcer Etiology and pathophysiology Clinical manifestation Collaborative management Nursing

2 Peptic Ulcer Disease (PUD) Objectives: Identify different types Gastric Ulcer Duodenal Ulcer Stress Ulcer Etiology and pathophysiology Clinical manifestation Collaborative management Nursing diagnosis PUD Breakdown mucous lining in GI tract Duodenal ulcers Gastric ulcers PUD Etiology and Patho Pathophysiology Gastric mucosa protects epithelium Bicarbonates Adequate blood supply Risk factors H. pylori infections, NSAID, Age, Hx of ulcers, family hx of ulcers 2

PUD Manifestation Pain Gnawing, burning, aching Epigastric region radiates to back Dyspepsia Weight loss Anemia PUD Complications Hemorrhage Hematemesis, blood in stool Fatigue, weakness, dizziness

3 PUD Manifestation Pain Gnawing, burning, aching Epigastric region radiates to back Dyspepsia Weight loss Anemia PUD Complications Hemorrhage Hematemesis, blood in stool Fatigue, weakness, dizziness Orthostatic hypotension Hypovolemic shock Narrowing and obstruction (pyloric) Epigastric fullness N/V - Electrolyte imbalance, metabolic alkalosis Perforation Severe pain Rigid abdomen No bowel sounds Peritonitis PUD Diagnosis EGD Visualize erosion Take biopsies UGI series Lab tests IgG Urea breath test Fecal test 3

PUD - Collaborative Management H & P Medication PPI H2

Tx of complications PUD surgeries Pyloriplasty Billroth

stomach Vagotomy Resection of the vagus nerve reduce

4 PUD - Collaborative Management H & P Medication PPI H2 receptor blocker Antacids Antibiotics Nutrition Surgery Tx of complications PUD surgeries Pyloriplasty Billroth I PUD surgeries Antrectomy Removal of lower third of stomach Vagotomy Resection of the vagus nerve reduce acid secretion Gastrectomy Removal of part or all of stomach 4

PUD Nursing Diagnosis Acute Pain Imbalanced nutrition < body requirement Fluid volume deficit Disturbed sleep pattern Hernias Objectives: Identify different types Hiatal Umbilical Femoral

5 PUD Nursing Diagnosis Acute Pain Imbalanced nutrition < body requirement Fluid volume deficit Disturbed sleep pattern Hernias Objectives: Identify different types Hiatal Umbilical Femoral Ventral/incisional Direct/indirect inguinal Identify etiology and pathophysiology, clinical manifestation, and complications Discuss collaborative management Discuss nursing diagnosis and interventions Hiatal Hernia Stomach protrudes through esophageal hiatus into thoracic cavity Usually asymptomatic Incidence increased w age 5

Sliding Hiatal Hernia Gastroesophageal junction and fundus of stomach

Heartburn Belching Regurgitation Paraesophageal Hiatal Hernia Fundus

through the esophageal hiatus and into the thorax beside the esophagus

6 Sliding Hiatal Hernia Gastroesophageal junction and fundus of stomach slide upward into esophageal hiatus Symptoms: Dysphagia Chest pain Heartburn Belching Regurgitation Paraesophageal Hiatal Hernia Fundus and possibly portions of the stomach s greater curvature, rolls through the esophageal hiatus and into the thorax beside the esophagus A Comparison of the normal stomach, sliding hiatal hernia and rolling hiatal hernia 6

7 Hiatal Hernia - Diagnosis Barium Swallow CXR Endoscopy with biopsy CBC Stool for guaiac Hiatal Hernia - Medical Treatment Goals Aimed at relieving symptoms and prevent complications Bleeding Sliding hiatal hernia treatment medically, Large paraesophageal hernia treatment - surgery Reduce regurgitation of stomach contents into esophagus Medications Includes antacids, PPI, and histamine receptor antagonists (Protonix, Pepcid and Reglan) Neutralizes stomach acidity Decrease acid production Types of Abdominal Hernias Indirect inguinal Direct inguinal Femoral Umbilical Incisional 7

Indirect Inguinal Hernia Peritoneal sac w intestine or omentum pushes down into inguinal canal Affect males May descend into the scrotum S/S: pain with straining Soft

abdominal wall Rarely enters the scrotum Most common in men older than 40; rare in women S/S: usually painless, round swelling close to pubis, which is easily reduced

8 Indirect Inguinal Hernia Peritoneal sac w intestine or omentum pushes down into inguinal canal Affect males May descend into the scrotum S/S: pain with straining Soft swelling increases w intraabdominal pressure, may decrease when lying down Direct Inguinal Hernia In contrast, this type of hernia passes through a weak point in the abdominal wall Rarely enters the scrotum Most common in men older than 40; rare in women S/S: usually painless, round swelling close to pubis, which is easily reduced when supine Umbilical Hernia Protrusion of bowel into umbilical ring Most common in women Congenital Infancy Acquired Obesity Multiple pregnancies Ascities Large tumors 8

Incisional or ventral Hernias Occur at previous surgical

incision Risk of incarceration is low Contributing factors:

Protrude through the femoral ring More common in women than men

9 Incisional or ventral Hernias Occur at previous surgical incision Results from inadequate healing of incision Bulge at incision Risk of incarceration is low Contributing factors: Poor wound closure Age Obesity Poor nutrition Femoral Hernia Protrude through the femoral ring More common in women than men S/S: lump in groin; severe pain, may become strangulated Types of Hernias 9

10 Hernia Collaborative Management Diagnosis H & P Surgical repair herniorrhaphy Nursing interventions H & P Post op care Assess incisions Bowel sounds Encourage TCDB + I/S Teaching Muscle strengthen exercise Good body mechanics Hernia Nursing Diagnosis Acute Pain Risk of ineffective tissue perfusion - gastrointestinal Knowledge deficit Gallbladder Disorders Objectives: Identify etiology, pathophysiology, and clinical manifestations of: Cholelithiasis Cholecystitis Discuss nursing care and interventions of these diseases 10

Race/ethnicity Obesity/hyperlipidemia Rapid weight loss Female Biliary stasis Cholelithiasis - patho Gallstones

11 Function on Biliary System Create, store, transport, and release bile into the duodenum to aid in digestion Liver, Gallbladder, Bile ducts Cholelithiasis Most common problem within biliary duct system Risk factors: Age Family history Race/ethnicity Obesity/hyperlipidemia Rapid weight loss Female Biliary stasis Cholelithiasis - patho Gallstones Abnormal bile composition Biliary stasis Increased cholesterol inflammation Manifestation Mild distress Biliary colic w obstruction 11

12 Cholecystitis - Manifestations Acute or chronic disorder resulting in distention and inflammation of gallbladder Most often in association with cholelithiasis (gallstones) obstructing the cystic duct Obstruction can lead to ischemia of gallbladder wall and mucosa Can lead to necrosis Pain RUQ, may radiate to back and right shoulder Chronic disorder results from repeated bouts of acute disease Cholecystitis - Diagnosis LFT BMP CBC Serum bilirubin Serum lipase and amylase if pancreas involved Ultrasound of right upper quadrant Abdominal x-ray HIDA SCAN Cholecystitis Nursing Care H & P Diagnostic tests Pain management Teaching Nutrition 12

Cholecystitis - Interventions Non surgical management Asymptomatic, manage conservatively Low fat diet Medication ursodiol or chenodiol Acute pain - gallstones obstruct cystic or common bile duct

13 Cholecystitis - Interventions Non surgical management Asymptomatic, manage conservatively Low fat diet Medication ursodiol or chenodiol Acute pain - gallstones obstruct cystic or common bile duct Opioid analgesia (Demerol, as morphine can cause biliary spasm) Anti-emetics to control nausea and vomiting Anti-spasmodics to relax smooth muscle (Bentyl, Lomine) NPO, IV fluids, IV ANTIBIOTICS No surgery until acute infection is resolved Cholecytitis Surgical Management Laparoscopic cholecystectomy: Minimally invasive Usually home within 24 hours Most common complication Injury to bile duct Free air pain from carbon dioxide retention May settle on phrenic nerve and cause shoulder pain Cholecystitis surgical Management (cont) Traditional cholecystectoy Removes gallbladder and stones 4-6 inch incision made into the abdomen Usually home in 1-3 days Back to work in 4-6 weeks May have t-tube placed for drainage of bile (If common bile duct is explored) 13

Cholecystectomy Cholecystectomy: Pre-op Nursing Diagnosis Acute pain Alteration in bowel elimination Alteration in comfort Alteration in nutrition Fluid volume deficit Self-care deficit Risk for

14 Cholecystectomy Cholecystectomy: Pre-op Nursing Diagnosis Acute pain Alteration in bowel elimination Alteration in comfort Alteration in nutrition Fluid volume deficit Self-care deficit Risk for injury Cholecystectomy Pre-op nursing interventions Patient teaching Make sure there is order for consent and it is signed by patient or family (informed) Make patient comfortable IV - Hydration NPO Lab work done and in chart Pre-op check list completed Teaching 14

15 Post-op nursing interventions Prevent pulmonary complications: TCDB, I/S w splinting Prevent pain, PCA Care for the incision, surgical drain NPO -clear liquids -advances to regular as tolerated Monitor bowel sounds, watch for post-op ileus Monitor urinary output Prevent DVT s, early ambulation is best Cholecystectomy: Post-op Nursing Diagnosis Acute pain Knowledge deficit Activity intolerance Ineffective breathing pattern Risk for infection Risk for injury Alteration in nutrition Case Studies 35 y/o nursing student, working PT, heart burn for years and takes Prilosec for after dx dudenal ulcer. Now weak, lightheaded, pale admitted for r/o UGIB 15

16 Case Studies Juanita, 49 y/o married mother with 3 children, native of Yucatan region of Mexico works as a checker at a local supermarket. Recently she started to notice a dull pain over her upper abdomen after meals especially on Sundays when all her children come to visit with their families 16

GI -A & P Review PUD. Peptic Ulcer Disease (PUD) Objectives: Identify different types Gastric Ulcer Duodenal Ulcer Stress Ulcer

GI -A & P Review PUD. Peptic Ulcer Disease (PUD) Objectives: Identify different types Gastric Ulcer Duodenal Ulcer Stress Ulcer GI -A & P Review Lemone and Burke Chapters 21-26 Mouth Pharynx Esophagus Stomach Small Intestines Large Intestines Liver and Gallbladder Pancreas Peptic Ulcer Disease (PUD) Objectives: Identify different