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Chapter 49

Unit 7: Nursing care of clients with gastrointestinal disorders

Peptic ulcer disease (Pg. 549) what is a peptic ulcer? Erosion of the mucosal lining of the stomach or duodenum -mucous membranes can be eroded enough= exposed to gastric acid & pepsid; bleeding and perforation
Perforation extending through all the layers of the stomach or duodenum can cause... Peritonitis
Individual who has a peptic ulcer has ___ PUD
Different types of ulcers: Gastric, duodenal, stress
Causes: H.pylori infection, NSAIDs/steroids, stress, hypersecretion, type O blood, excess alcohol, chronic kidney or pulmonary, zollinger-ellison syndrome
S/S: dyspepsia, pain, wt, blood -dyspepsia (heartburn, N/V, bloating) -pain depends on ulcer -wt loss, bloody emesis (hematemesis) or stools (melena)
Pain w gastric ulcer; 30-60 mins after a meal, rare at night, food exacerbates
Pain w duodenal ulcer; 1.5 to 3hr after a meal, night, relieved with food ingestion
Epigastric pain w/ ulcers, occurs upon ___ palpation
LU ├ępi pain w/ gastric ulcer
RU epi pain w. duo ulcer
Lab testing: H.pylori testing -gastric samples collected through -C 13 urea breath test; how done -Endoscopy to test for H.pylori -client exhales into collection container (baseline), drinks carbon-enriched urea solution, then asked to exhale again *NPO prior to test
If H.pylori is present what happens in the C 13 urea test? Solution will break down & carbon dioxide will be released
more lab testing; IgG serologic testing H.pylori presence based on antibody assays can do stool samples too
Dx procedures; EGD definitive dx; obtains gastric samples to detect H.pylori as well Avoid certain meds (Pg. 550)
Medications for ulcers: Antibiotics: Metronidazole (Flagyl), amoxicillin (Amoxil), clarithrymycin (Biaxin), tetracycline (Achromycin V) Eliminates H.pylori combination of 3-2 abx my be administered
H2 receptor antagonists; Ranitidine hydrochloride (zantac), famotidine (pepcid) suppresses the secretion of gastric acid by blocking h2 receptors in parietal cells lining the stomach -can be used to prevent stress ulcers in client's NPO after major surgery, burns, septic or ^ ICP *IV in acute
PPI's Pantoprazole (protonix), esomeprazole (nexium) Reduce gastric secretion by irreversibly inhibiting the enzyme that produces gastric acid -take omeprazole prior to eating in the morning -avoid alcohol & NSAIDs
Antacids: Aluminum caebonate, magnesium hydroxide (milk of mag) given 1-3 hrs after meals to neutralize gastric acid -give 1 hr apart from other meds to avoid reducing absorption of other meds
Mucosal protectant; sucralfate (carafate) Give 1 hr before meals & at bedtime s/e constipation
Diet restricting acid producing foods: milk products, caffeine, decaffeinated coffee, spicy foods, NSAIDs
Surgical interventions for peptic ulcers: Gastrectomy: antrectomy & gastrojejunostomy All or part of the stomach is removed by laparoscopic or open approach *antrectomy (antrum is removed) *Gastrojejunnostomy (lower portion excised, etc. (pg. 552)
Surgical interventions for peptic ulcers: Vagotomy severs only the nerve fibers that disrupt acid production
Surgical interventions for peptic ulcers: Pyloroplasty Opening between the stomach & small intestine is enlarged to increase the rate of gastric emptying
Nursing monitoring for surgical interventions: semi-fowlers for lung expansion -scant blood may be seen in NG drainage 12-24hr post op -BS -take it and mineral supplements
Created by: mary.scott260!