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Gastrointestinal Disorders
1
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Diagnostic Testing
Information will be in Angel in separate GI
Testing folder for all GI conferences
2
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Peptic Ulcer Disease
Gastroesophageal Reflux
Disease
Peritonitis(review) 3
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MEDICATIONS
Review preconference
1. Protonix
2. Prilosec
3. Pepcid
4. Reglan
5. Carafate
4
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Peptic Ulcer Disease
Gastric Ulcers: in the stomach
Duodenal Ulcers: proximal part of the
duodenum
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VIEW VIDEOTAPE
Treating Your Peptic Ulcer - VHS-104
(10 minutes)
Notetaking Guide Provided
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Causes of PUD
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Assessment Findings: Gastric
Ulcer
Burning or gaseous
pain in L epigastric
Pain 1-2 hours after
meals
If deep ulcer pain
with food
Occasional N/V
8
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Assessment Findings: Duodenal
Ulcer
Burning, cramping
pain
Midepigastric
Pain 2-4 hours after
eating
Pain relief with
antacids and food
9
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Diagnostic Tests for PUD
EGD
Serum Antibody test
for H. Pylori
Urea Breath Test
Review test
information on ANGEL
10
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Common Nursing Dx
Acute pain r/t gastric inflammation & irritation
Deficient fluid volume r/t bleeding, vomiting
Nausea r/t acute exacerbation of disease
Deficient knowledge (specify) r/t lack of exposure
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Nursing Intervention:
Assessment Signs and Symptoms: nausea, vomiting,
timing of symptoms
Pain assessment
Signs of hemorrhage
12
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NI: Teaching: Medications
Review written list of medications including use,
action, side effects, dose, frequency
Antacids
Histamine H2 Receptor Blockers
Mucosal protective
Antibiotics
Proton pump inhibitors
Antibiotic (if H. Pylori)
13
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NI: Teaching: Nutrition
No specific diet restrictions Eliminate foods that cause
discomfort & symptoms Foods known to irritate gastric
mucosa hot, spicy foods alcohol carbonated beverages caffeine
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Signs & Symptoms to Report
to MD
Increased pain
N/V
Black tarry stools
Bloody emesis
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TNI: Teaching: Lifestyle
Changes
Avoiding alcohol
Avoiding tobacco
16
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Surgical Management of PUD
17
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PUD VIDEO CLIP
http://video.about.com/ibdcrohns/Gastric-Ulcers.htm
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Common Complications:
Hemorrhage
Vital Sign Changes?
Pulse fast
BP low
RR fast
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Common Complications:
PERFORATION Pain
Distention
Temp rise
Vitals
P fast
BP low
RR fast
T elevated
20
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Common Complications:
Gastric Outlet Obstruction
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GERD
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VIEW VIDEOTAPE
GERD Gastroesophageal Reflux
Disease - VHS-059 (10 minutes)
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GERD: CAUSES
hiatal hernia
incompetent lower
esophageal sphincter
(LES)
decreased
esophageal clearance
decreased gastric
emptying
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Assessment of GERD
Heartburn
Heartburn (pyrosis)
burning sensation
beneath lower
sternum
Pulmonary
Symptoms
wheezing, coughing,
dyspnea
Children:
Recurrent vomiting
Regurgitation
Dysphagia
Abdominal pain
Heartburn
Refusal to eat/Poor
weight gain
Hoarseness
Chronic cough
25
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Diagnostic Tests for GERD
Barium swallow
Endoscopy
Esophageal pH monitoring.
Review Test info on ANGEL
26
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GERD Common Nursing Dx
Acute pain r/t irritation of esophagus from
gastric acids
Risk for aspiration r/t entry of gastric
contents in tracheal or bronchial tree
Deficient knowledge (specify) r/t lack of
exposure
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NI: Assessment
Signs and symptoms
Pain assessment
Respiratory
assessment
28
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NI: Teaching: Medications
Review medication list
Antacid
Antiemetic
Histamine receptor antagonist
Mucosal protectant
Proton pump inhibitor
29
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NIs - Nutrition
High protein, low fat diet
Small, frequent meals
Avoid chocolate, peppermint, caffeine, alcohol
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NI: Teaching: Signs and
Symptoms to Report Chronic heartburn and regurgitation
Persistent dysphagia, epigastric fullness
and bloating
31
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NI: Teaching: Prevention
Instruct patient to keep HOB elevated for
2-3 hours after eating
Eat small, frequent meals to prevent
gastric distention
Sleep with HOB elevated on 4-6 inch
blocks
32
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Surgical Management:
Nissen fundoplication
Wrap top portion of
stomach around LES
to tighten LES
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PERITONITIS(post conference
review)
Common Causes of
Peritonitis
Ruptured appendix
Perforated ulcer
Postoperative
rupture or breakage
of anastomosis in
abdominal/pelvic
cavity
Perforation from
endoscopic
procedures
Penetrating trauma
to abdomen
34
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Peritonitis: Assessment
Abdominal pain
Rebound tenderness
Muscular rigidity
Spasms
Shallow respirations
due to pain
Abdominal distention
Fever
n/v
tachypnea,
tachycardia
Review NIs,
diagnostic
testing in guide
and textbook
35
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Critical Thinking Case Study 1:
PUD You are visiting a resident of a retirement
community. She tells you that she has
begun to have symptoms of a peptic ulcer
just like she had many years ago and that
she is treating the ulcer as she did before,
with a bland diet and antacids.
36
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Critical Thinking: Case Study 1:
PUD 1. Based on your knowledge of peptic
ulcers, how would you advise patient?
Most peptic ulcers are caused by H.
Pylori. Pt. should be advised to see
provider for testing for H. Pylori! If
untreated 95% will recur. Requires
antibiotics for treatment
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Case Study 2
A young female comes to the health clinic
with complaints of epigastric pain and
malaise. She works under stress and
smokes heavily. She is in a hurry and wants
quick action. The physician recommends
famotidine (Pepcid) and an upper
gastrointestinal x-ray to rule out duodenal
ulcer.
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Case Study 2
1. What risk factors for a duodenal ulcer
does the patient display?
Under stress
Smokes
2. What further nursing assessment is
needed?
P-A-I-N assessment
Dietary habits
S+S bleeding 39
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Case Study 2
3. What nursing interventions are indicated
for patient?
Review answers: Teaching, Teaching,
Teaching!
40
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Case Study 3
A 43-year-old male patient is being evaluated for peptic
ulcer disease (PUD). He has a history of recurrent
duodenal ulcers. Last night he awakened at 0200 and
requested an antacid. This morning after breakfast, he
passed a large, dark, liquid stool that tested positive for
occult blood. Just before 1100, he turns on his call light.
When the RN enters the room, he is lying on his side with
his knees drawn up, moaning and holding his pillow against
his abdomen. He is diaphoretic, pale, and breathing rapidly
and shallowly. The patient states, Its never hurt like this
before. I feel as though Ive been stabbed.
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Case Study 3
1. What has likely happened to patient?
Perforation!
2. What should RNs actions be?
Obtain VS and pain assessment
Call MD(emergency situation)
42
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Case Study 4
A 61-year-old woman is being treated as an
outpatient for gastroesophageal reflux
disease (GERD). She tells the nurse that
the doctor told her to take Carafate but
did not tell her how else to treat her
condition.
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Case Study 4
1. What should RN teach client?
High protein, low fat diet
Small frequent meals
HOB up 4-6 inches
Ideal body weight
Do not lie down 2-3 hours pc
Avoid tight clothing around waist
Avoid smoking
Medication teaching
44
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Critical Thinking Question:
Peritonitis A client with suspected PUD undergoes an EGD
procedure. Post procedure the nurse is
conducting an abdominal assessment. The
following finding is indicative of a possible
perforation with early signs of peritonitis:
a. Diarrhea and hyperactive bowel sounds
b. Nausea and vomiting
c. Guarding and rebound tenderness
d. Redness and warmth of the abdominal skin
45
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ANSWER
Answer: C
Rationale: Stomach or bowel
perforation is a possible result of and
endoscopic procedure. Perforation
could lead to signs of peritonitis such
as guarding and rebound tenderness of
the abdomen.
46
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ADPIE for PUD Work in pairs and go through the nursing
process for a patient with PUD
Return to large group to discuss and
write answers on the board
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