GERD/Peritonitis
What are S/S of peritonitis?
Rigid abdomen, abdominal distension, fever, sepsis S/S (hypotension, tachycardia, dyspnea), nausea and vomiting
What is the initial treatment of gastritis?
NPO
IV hydration
Avoiding NSAIDs and alcohol use
Antiemetics
What procedures are not indicated during acute diverticulitis attack?
Endoscopy (upper) and colonoscopy (lower) scopes
- enemas (barium enema: lower GI series)
What are the enzymes produced by the pancreas
Amylase (breaks down carbohydrates) and lipase (breaks down fats)
What is cobblestone appearance in the GI tract?
- cobblestone appearance visible on colonoscopy
What is the priority intervention for peritonitis?
IV fluid replacement (isotonic fluids: NS, LR)
Risk for hypovolemia
What are the differences between a gastric and duodenal ulcer?
Gastric ulcer: pain right after eating, eating makes pain worse (risk for malnutrition)
Duodenal ulcer: pain 2-3 hrs after meals, waking up with pain at night, pain relieved by eating/taking antacids
What GI abnormality puts someone at risk for diverticulosis/itis?
Constipation
- stool low in fiber
- hardened fecal mass
- straining to have a BM
- older adults
Review the type of pain associated with acute and chronic pancreatitis
Acute: SEVERE abdominal pain (radiates to the back, left flank, left shoulder: retroperitoneal location).
- aggravated by eating, lying flat
Chronic: less severe pain, gnawing constant pain
Discuss GI S/S present with CD and UC
CD: 5 loose stools per day with mucus/pus, high pitched bowel sounds, abd distension, firmness, crampy abdominal pain (occurs after meals), steattorhea
UC: 10-20 bloody diarrheal stools, bowel urgency, abdominal cramping, intermittent tenesmus
What are S/S of GERD?
Pyrosis, dyspepsia, regurgitation, dental erosion, chest pain (feels like an MI), laryngitis, dysphagia, bitter taste
Priority: aspiration risk
What is included with triple and quadruple drug therapy for PUD?
Triple drug therapy: PPI, two ABX
Quadruple drug therapy: PPI, two ABX, GI protectant (carafate)
What is the procedure used to confirm diverticulosis and diverticulitis?
Diverticulosis: colonoscopy and barium enema (lower GI series)
Diverticulitis: CT scan (AP)
Chronic pancreatitis places a client at risk for which chronic complication and why does it cause that?
Diabetes Mellitus (loss of pancreatic beta cells, inability to produce insulin to manage blood sugars
- cannot manage blood sugar because the pancreas is damaged and can't secretes appropriate insulin
What lab testing should be completed for Chron's disease?
Stool testing, CBC, ESR elevation, albumin, total protein
- risk for what?: malnutrition
Avoiding trigger foods (what are they?)
Decaf beverages
Smoking cessation
Stress management
Reduce alcohol usage
Elevate HOB on 4-6 inch blocks or pillows
small frequent meals (4-6)
avoid eating/drinking before bed (how long before?)
What are S/S or hemorrhage caused by PUD?
Hematemesis, melena, dizziness, pale, weakness, VS changes (?), urinary output (?)
What is included in diet teaching for a patient with diverticulitis?
Initially NPO until inflammation subsides (IVF)
- diet: high fiber, low-fat
What nursing interventions are used for medical management of pancreatitis?
-Pain medicine (IV morphine/IV dilaudid/IV fentanyl)
- Bed rest (why?)
- IV ABX
- Positioning (fetal, side-lying, leaning up, sitting forward)
- correction of fluid and electrolyte
What is toxic megacolon and what is the treatment?
Toxic megacolon: colonic distension occurs, inability for the colon muscle to contract
- S/S: fever, abd pain/distension, vomiting, fatigue
Total colectomy
- patient has to have an ileostomy
What are the different medications used to treat GERD and give me one example from each?
PPI's: "zole"
decrease gastric secretions
H2-receptor blockers: "dine"
decrease HCL acid production
What are the treatments for hemorrhage?
IV fluid replacement (including blood transfusions), EGD (cauterize the bleeder), surgery, catheter arterial embolization, NGT insertion (suction and irrigation)
What medication are indicated for diverticulitis, and which are contraindicated?
Opioids and acetaminophen
-contraindicated: NSAIDS (increased risk or perforation)
Discuss pancreatic enzyme replacement therapy
Pancreatic enzyme replacement therapy
- pancrealipase: creon
- caused by pancreatic insufficiency: when the pancreas doesn't produce enough digestion enzymes to break down food in the intestine
used to replace deficient pancreatic enzymes
What are the medications to treat CD and UC
5-ASA (Sulfasalazine, mesalamine)
Corticosteroids (prednisone, hydrocortisone)
Immunosuppressants (cyclosporine, methotrexate)
Anti-diarrheal (loperamide: Imodium)
Antibiotics: metronidazole (Flagyl)