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Chapter 47

Unit 7: Nursing care of clients with gastrointestinal disorders

QuestionAnswer
NG decompression suction applied to relieve abdominal distention -from an intestinal obstruction (either mechanical or functional)
when do you do decompression? when pt is vomiting, BS are absent, abdominal pain, hiccups
Ostomies; permanent or temporary ileostomy qualities -post op amount? -Can be both -surgical opening in ileum; performed when entire colon must be removed d/t disease (crohn's) liquidy, 500-1000ml/day, continuous output, paste like -post op? 1,000 ml/day, bile colored/liquid
transverse colostomy POST OP; small semi-liquid w/ some mucus 2-3 days after surgery, blood after surgery as well can be present -semi formed or formed, output will return to pts normal bowel routine
sigmoid colostomy POST OP; small to moderate amount of mucus w semi-formed stool 4-5 days after surgery -semi formed stool after several days-weeks, output will return to pts normal bowel routine
stoma assessment beefy red and moist
Peristomal care -stoma should appear? -skin barriers & creams ok? -pink & moist (red, beefy) -yes; allow to dry before applying new appliance clean around it with water, make sure the appliance fits properly so there is no skin breakdown
LIS and LCS low intermittent suctioning, low continuous suctioning
NG tube placement *MUST DO ATLEAST 2* inject air into stomach and watch for rise (not really recommended), xray, aspirate and check pH of contents, MUST have xray before you can feed them thru the tube
Pg. 529 Bariatric surgeries -what are they Treatment for morbid obesity when other wt control methods have failed
What do bariatric surgeries do? Reduce the functional size of the stomach(vertical banded gastroplasty)
Different types of laparoscopic procedures 1. Vertical banded gastroplasty -involves Stapling stomach to reduce its functional size
2. adjustable banded gastroplasty -invovles Constricting the functional size of the stomach
3. Intestinal bypass includes bypassing the stomach & part of the small intestine to decrease the absorption of nutrients & calories -removes a portion of the stomach & creates a pouch or sleeve w remaining portion (sleeve gastrectomy)
Indications fro bariatric surgery: history of morbid obesity BMI >40, BMI >35 w/ comorbidities
Post procedure bariatric surgery: -anastomosis -position -meals Monitor for a leak (emergency) -semi fowlers for lung expansion -6 small meals a day when oral nutrients can be resumed -monitor for dumping syndrome
Client education post bariatric surgery: -limitations regarding liquids or pureed foods for the first 6 weeks -walk daily ___ mins -overeating can -30 mins -can dilate surgical pouch causing wt to be regained
Complications of bariatric surgery; -Dehydration, malabsorption/malnutrition -smaller stomach or bypassed portions of the intestinal tract = fewer nutrients ingested & absorbed
When should an ostomy bag be emptied? 1/4 to 1/2 drainage
Dietary changes w ostomies.. -Foods that cause odors? F,E,A,G,B,DGLF -What can help decrease gas? Fish, eggs, asparagus, garlic, beans, dark green leafy vegetables -Yogurt!
What should clients with an ileostomy or small intestine colostomy avoid? High fiber foods for the first 2 months -increase fluids, chew food well
Complications to an ostomy: Stomal ischemia/necrosis: S/S? pale pink or bluish/purple in color & dry -black/purple = serious!
Necrotic stoma nursing actions? VS, notify provider/surgeon
Created by: mary.scott260!