Unit 7: Nursing care of clients with gastrointestinal disorders
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| 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
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| Perforation extending through all the layers of the stomach or duodenum can cause... | Peritonitis
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| Individual who has a peptic ulcer has ___ | PUD
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| Different types of ulcers: | Gastric, duodenal, stress
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| Causes: | H.pylori infection, NSAIDs/steroids, stress, hypersecretion, type O blood, excess alcohol, chronic kidney or pulmonary, zollinger-ellison syndrome
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| S/S: dyspepsia, pain, wt, blood | -dyspepsia (heartburn, N/V, bloating)
-pain depends on ulcer
-wt loss, bloody emesis (hematemesis) or stools (melena)
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| Pain w gastric ulcer; | 30-60 mins after a meal, rare at night, food exacerbates
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| Pain w duodenal ulcer; | 1.5 to 3hr after a meal, night, relieved with food ingestion
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| Epigastric pain w/ ulcers, occurs upon ___ | palpation
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| LU épi pain w/ | gastric ulcer
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| RU epi pain w. | duo ulcer
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| 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
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| If H.pylori is present what happens in the C 13 urea test? | Solution will break down & carbon dioxide will be released
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| more lab testing; IgG serologic testing | H.pylori presence based on antibody assays
can do stool samples too
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| Dx procedures; EGD | definitive dx; obtains gastric samples to detect H.pylori as well
Avoid certain meds (Pg. 550)
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| Medications for ulcers: Antibiotics: Metronidazole (Flagyl), amoxicillin (Amoxil), clarithrymycin (Biaxin), tetracycline (Achromycin V) | Eliminates H.pylori
combination of 3-2 abx my be administered
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| 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
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| 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
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| 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
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| Mucosal protectant; sucralfate (carafate) | Give 1 hr before meals & at bedtime
s/e constipation
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| Diet restricting acid producing foods: | milk products, caffeine, decaffeinated coffee, spicy foods, NSAIDs
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| 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)
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| Surgical interventions for peptic ulcers: Vagotomy | severs only the nerve fibers that disrupt acid production
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| Surgical interventions for peptic ulcers: Pyloroplasty | Opening between the stomach & small intestine is enlarged to increase the rate of gastric emptying
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| 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
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