GIT Nursing
GIT Nursing
GIT Nursing
Gastro-intestinal Disorder
Prepared: Mark Fredderick Abejo RN, MAN
Gastrointestinal System
MS 1 Abejo
Medical and Surgical Nursing
Gastro-intestinal Disorder
Prepared: Mark Fredderick Abejo RN, MAN
Better to have mumps at an early stage,
preferably before puberty may lead to
III. LOWER ALIMENTARY CANAL (Elimination) sterility
A. 2nd half of ascending colon 3. Provide a general liquid to soft diet
B. Transverse colon 4. Apply cold compress or ice pack at affected site
C. Descending colon 5. Prevent complications
D. Sigmoid colon Cervicitis, oophoritis, vaginitis
E. Rectum Meningitis
IV. ACCESSORY ORGANS Orchitis sterility
A. Salivary glands – produces 1.2-1.5 L of saliva per day
1. Parotid – below and in front the ear II. APPENDECITIS – Inflammation of the vermiform appendix
2. Sublingual (located at the R. iliac region, produces WBC during fetal life)
3. Submandibular
B. Vermiform appendix
C. Liver – largest gland, occupies most of R hypochondriac
region
1. Glison’s capsule – covers liver, transparent, brown
2. Liver lobules – functional site
D. Gall bladder
E. Pancreas
A. PREDISPOSING FACTORS
1. Microbial invasion
2. FECALITHS – undigested food particles (tomato,
guava seeds)
3. intestinal obstruction
MS 2 Abejo
Medical and Surgical Nursing
Gastro-intestinal Disorder
Prepared: Mark Fredderick Abejo RN, MAN
NO ANALGESICS! May mask pain which A. PREDISPOSING FACTORS
indicates impending rupture 1. Alcoholism
4. Monitor IO VS and Bowel sounds 2. Malnutrition
5. Avoid heat application rupture 3. Viruses
6. Maintain patent IV line 4. Toxicity
Carbon tetrachloride
E. NURSING MANAGEMENT POST-OP 5. Use of hepatotoxic agent
1. If (+) penrose drain (indicates rupture) – place
patient on affected site for drainage
2. If (-), position is based on pt. comfort
3. Administer medications as ordered
Analgesics
Antibiotics
Antipyretics PRN
4. Maintain patent IV line
5. Monitor VS IO and bowel sounds (N=borborygmi)
2. Late signs
Hematologic changes
Anemia
Leucopenia
Bleeding tendencies
Endocrine changes
Spider angiomas/ telangiectasis
Caput medusae (Varicose veins radiating
from the umbilicus)
Palmar erythema
Gynecomastia
GIT changes
Ascites
Bleeding esophageal varices d/t portal
HPN
Neuro changes
Hepatic encephalopathy
Early Asterixis (flapping hand
tremors)
MS 3 Abejo
Medical and Surgical Nursing
Gastro-intestinal Disorder
Prepared: Mark Fredderick Abejo RN, MAN
Late headache, dizziness,
confusion, irritability, fetor hepaticus,
(ammonia-like breath), decreased
LOC hepatic coma
C. DIAGNOSTICS
1. Liver enzymes
SGPT (ALT) elevated
SGOT (AST) elevated
2. Serum cholesterol
Ammonia elevated
3. Indirect bilirubin / Unconjugated bilirubin elevated
4. CBC low
5. PTT prolonged
6. Hepatic UTZ – fat necrosis of liver lobules
MS 4 Abejo
Medical and Surgical Nursing
Gastro-intestinal Disorder
Prepared: Mark Fredderick Abejo RN, MAN
D. NURSING MGT
1. Narcotic analgesics
Meperidine HCl (Demerol)
2. Anticholinergic agents
Atropine sulfate
3. Anti-emetics
Metoclopramide (Plasil)
Phenergan
4. Diet low in fat, high CHON and CHO
5. Meticulous skin care
6. Assist in surgery: Cholecystectomy
Post-op: maintain patency of tube drain (t-tube)
Monitor for infections
STOMACH
J-shaped structure
Widest section of alimentary canal especially p.c.
A. Parts
1. Antrum
2. Fundus
3. Pylorus
B. Valves - prevents reflux
1. cardiac – between esophagus and stomach
2. pyloric – stomach and duodenum
projectile vomiting
olive shaped belly
C. Cells
1. Chief cells or zymogenic cells
Gastric amylase – digests CHO
Gastric lipase – digests fats
Pepsin – proteins
Rennin – milk and milk products
2. Parietal/augentaffin/oxyntic cells
Produces intrinsic factors reabsorption of B12
(cyanocobalamin) maturation of RBCs
MS 5 Abejo
Medical and Surgical Nursing
Gastro-intestinal Disorder
Prepared: Mark Fredderick Abejo RN, MAN
10. Microbial invasion (Helicobacter pylori)
Produces HCl acid with pH of 1-2 aids in Metronidazole
digestion SE: photosensitivity
3. Endocrine cells Etampicillin
Secretes gastrin stimulates HCl Acid secretion
C. TYPES
D. FUNCTIONS 1. Severity
1. Mechanical and chemical digestion Acute ulcers – submucosal
2. Storage of food Chronic ulcers – deeper underlying tissues; (+)
CHO and CHON – 1-2 hours scar formation
Fats – 2-3 hours 2. Location
Stress (Critically-ill patients)
Curling’s ulcer
Burns and trauma hypovolemia
V. PEPTIC ULCER DISEASE – erosion/excoriation of GIT ischemia decreased resistance
submucosa/mucosal lining d/t of mucosal barrier to HCl acid
Hypersecretion of acid – pepsin secretion
Decreased resistance of mucosal barrier to HCl Cushing’s ulcer
acid secretion (neutralizes acidity) Head trauma
CVA/Stroke increased vagal
stimulation hyperacidity
ulceration
Gastric
Duodenal
D. DIAGNOSTICS
1. Endoscopy
2. (+) Stool occult blood
3. Gastric analysis reveals
A. INCIDENCE RATE
Normal gastric acid secretion if gastric
1. Men
Increased gastric acid secretion if duodenal
2. Aggressive
4. Upper GI series – confirms ulceration
B. PREDISPOSING FACTORS
E. NURSING MANAGEMENT (Diet, Drugs, Surgery)
1. Heredity
1. Bland diet non-irritating, non-spicy
2. Emotional stress
Avoid beverages and foods high in caffeine or
3. Smoking vasoconstriction gastric ischemia
milk and milk containing products
4. Alcoholism release of histamine parietal cells
2. Admin meds as ordered
to secrete gastrin
Antacids
5. Irregular diet
ACA – aluminum containing antacids
6. Rapid eating
7. Ulcerogenic drugs Aluminum OH gel (Ampho gel)
Aspirin SE: constipation, hyperphosphatemia,
Ibuprofen hypoparathyroidism
Indomethacin (SE:corneal cloudiness) MAD – magnesium containing antacids
Steroids Milk of magnesia
NSAIDs SE: diarrhea
8. Foods or beverages rich in caffeine Mg + Al preparations (Maalox) less SE
9. Gastrin producing tumors H2 receptor antagonists
Gastrinoma Zollinger-Ellison’s Syndrome
MS 6 Abejo
Medical and Surgical Nursing
Gastro-intestinal Disorder
Prepared: Mark Fredderick Abejo RN, MAN
Vagotomy (severe vagus nerve) and
Cimetidine (Tagamet) – antagonizes oral pyloroplasty for drainage
anti-coagulant, more SEs Decrease vagal stimulation decrease
Ranitidine (Zantac) – most common, HCl acid secretion prevent hemorrhage
fewer SE
Famotidine (Pepsid)
Give antacids and Cimetidine ONE
HOUR APART decreased antacid
absorption and vise versa
Instruct client to avoid smoking because it
decreases effectiveness of drug
Cytoprotective agents
Sucralfate (Carafate) provides a paste-
like substance that coats the mucosal
lining
Cytotec (Misoprostol) causes severe
spasm (abortifacient) uterine cramping
bleeding
Anticholinergic/Anti-spasmodic agents
Atropine
Propanthelene sulfate (Probanthene)
Sedatives, tranquilizers
3. Assist in surgical procedure: subtotal gastrectomy
Billroth I (removal of 1/3 of stomach)
Gastroduodenostomy gastric stump to
the duodenum
F. NURSING MANAGEMENT POST OP
1. Monitor NGT output that includes:
Immediately after post-op bright red
32-46 hours greenish in color
48h dark red because of influence of HCl
acid
2. Administer medications as ordered
Antimicrobials
Narcotic analgesics
Anti-emetics
3. Maintain a patent IV line
4. Monitor VS, IO, Bowel Sounds
5. Prevent complication
Hemorrhage shock
Paralytic Ileus – most common type of
complication in all abdominal surgery
Peritonitis
Billroth II Septicemia
Gastrojejunostomy gastric stump to Hypokalemia
jejunum Pernicious anemia
Removal of ½ to ¾ of the stomach, DUMPING SYNDROME (Billroth II) – rapid
duodenal valve and anastomosis of gastric emptying of hypertonic food solutions; chyme
stump to jejunum – food and HCl acid from stomach to jejunum
Complic: DUMPING SYNDROME with resultant hypovolemia dizziness,
diaphoresis, palpitation, tachycardia, diarrhea,
weakness
Nursing management for dumping
syndrome:
Provide fluids BEFORE meals
Avoid fluids/chilled solutions
Provide a small frequent feeding or 6
equal divided feeding
Diet low in CHO and sugar moderate
CHON and fats
Instruct pt to lie flat on bed 15-30
minutes after each feeding
MS 7 Abejo
Medical and Surgical Nursing
Gastro-intestinal Disorder
Prepared: Mark Fredderick Abejo RN, MAN
A. PREDISPOSING FACTORS
1. High risk: female
2. Congenital weakness of muscular fibers of intestines
3. Obesity
4. Stress
5. Diet: decrease in roughage
C. DIAGNOSTICS
1. Barium Enema – reveals inflammatory process
2. Decreased hematocrit/hemoglobin (d/t diarrhea)
D. NURSING MANAGEMENT
1. Administer medications as ordered.
Bulk laxatives
Anti-cholinergics
Atropine Sulfate
Propanthelene Bromide
Antibiotics for infection
2. Provide dietary intake:
Diverticulosis – high roughage/fiber with no
seeds
Diverticulitis – low fiber diet
3. Assist in surgical procedure
Bowel resection: removal of diseased portion
of the bowel and creation of colostomy.
MS 8 Abejo