GASTROINTESTINAL SYSTEM

Overview
Functions:

elimination Accessory organs I. Salivary Glands- for mechanical digestion Parotid (below and in front of ears) Saliva produced- 1,200-1,500 ml/day Sublingual Submaxillary

digestion, absorption and

Overview
Nursing Management I. Salivary Glands Strict respiratory isolation Mumps/Parotitis Administer meds as ordered causative agent: Antipyretic Paramyxovirus Analgesic S/Sx: swollen parotid Antibiotics gland Cool pack Dysphagia General liquid to soft diet Fever, chills, Prevent Cx anorexia F- vaginitis, cervicitis, oophoritis N/V, general M- orchitis (during puberty body malaise stage sterility), virus Weight loss attacks the sperms produced

by Leydig cells at seminiferous tubules

APPENDICITIS
Inflammation

of Vermiform Appendix

At R iliac/inguinal region Produces WBC during fetal life, ceases to function once baby is born
Predisposing

Factors

Microbial agents Fecalith (undigested food particles) Intestinal obstruction

APPENDICITIS
S/Sx

(+) rebound tenderness Pain at the R iliac region Low grade fever Anorexia, N/V, diarrhea, constipation Late S/- tachycardia Dx Procedure CBC- mild leukocytosis U/A- acetone Sx: Appendectomy within 24-48 hrs

APPENDICITIS

Nursing Management Informed consent prior to OR Pre-op: NPO, skin preparation, NO ENEMA! Monitor VS, I/O bowel sound Borborygmi- > 60 sounds/min- hyperactive bowel Administer meds as ordered Maintain patent IV access Antibiotic to prevent peritonitis and septicemia Antipyretics No heat application Post-op: if with penrose drain: R side-lying for drainage

LIVER
Largest

gland, occupies most of theR hypochondriac region Covered by fibrous capsule (capsule of Glisson)- makes the liver scarlet brown, transparent in nature Functional unit: liver lobules

LIVER

Functions: Produce bile- to emulsify fats; gives color to urine and stool Vit. ADEK synthesis Detoxify drugs Destroy excess estrogen Metabolize macronutrients: CHO: glycogenesis, glycogenolysis, gluconeogenesis CHON: synthesis of albumin and globulin Synthesis of prothrombin and fibrinogen Conversion of NH4 to urea FATS: synthesis of cholesterol to neutral fats or triglycerides

LIVER DISORDERS
Laenecs

Cirrhosis- loss of architechtural design of liver- fat necrosis and scarring Predisposing Factors Chronic alcoholism Malnutrition- primary reason Viruses Toxicity- CCl4 Hepatotoxic agents

LIVER DISORDERS

S/Sx Early S/Sx

S/Sx Hema changes-Pancytopenia Weakness and fatigue Endocrine changes Anorexia, N/V
Gynecomastia Flatulence Spider angiomas/telangiectasi Jaundice/Icteric sclerae Caput medussae (abdomen)
Indigestion Pruritus Palmar

Late

GIT changes erythema Hepatomegaly Ascites bowel sounds Bleeding esophageal varices Loss of axillary and pubic hair

LIVER DISORDERS
Late

S/Sx CNS changes Hepatic encephalopathy Early S/Sx Asterixis (flapping hand tremors) LOC Late S/Sx headache, confusion Fetor hepaticus

LIVER DISORDERS
Dx

Procedures Liver Enzymes SGPT (ALT) and SGOT (AST) Serum indirect bilirubin Serum cholesterol and NH4 CBC- pancytopenia Prolonged PTT Hepatic UTZ- fat necrosis of liver lobules

LIVER DISORDERS
Nursing

Management

CBR Diet: Ca+2, Vit and min., to moderate

CHON and fats

Meticulous skin care Monitor neuroVS, I/O Weigh and abdominal girth OD Reverse isolation Restrict fluids

LIVER DISORDERS

Nursing Management Prevent Cx: ASCITES- fluid in peritoneal cavity Administer meds as ordered Loop Diuretic K+ supplements Na+ diet Assist in abdominal paracentesis Bleeding esophageal varices Administer meds as ordered Vit. K Vasopressin (Pitressin) NGT decompression via gastric lavage Monitor for NGT output Assist in mechanical decompression Sengstaken Blakemore tube WOF S/ of hemorrhage, prepared at bedside: scissors

LIVER DISORDERS
Nursing

Management Prevent Cx: Hepatic Encephalopathy Assist in mechanical ventilation Monitor VS, neuro VS Side rails up Administer meds as ordered: Laxative- Lactulose to promote excretion of NH4

PANCREATITIS

Pancreas- located behind stomach acute or chronic inflammation of pancreas leading to pancreatic edema, fat necrosis and hemorrhage due to autodigestion Predisposing Factors Alcoholism Hepatobiliary disorder Drugs toxic to pancreas: OCP, thiazide diuretics, Rentam (for AIDS), ASA Metabolic disorders (hyperparathyroidism, hyperlipidemia) Obesity Na+ intake

 S/Sx

PANCREATITIS

Pain at LUQ radiating from back, flank and substernal area accompanied by DOB and aggravated by eating Tachycardia Shallow respiration Anorexia, N/V bowel sounds Weight loss Indigestion/dyspepsia (+) Cullens sign- ecchymosis at umbilicus (+) Gray Turners spot- ecchymosis at flank area hypoCa+2

PANCREATITIS
Dx Procedures serum amylase and lipase serum Ca+2 Nursing Management Administer meds as ordered Narcotic analgesic- Demerol Smooth muscle relaxant Vasodilator- NTG Antacids- Maalox H2 blockers- Ranitidine ( pancreatic stimulation) Ca+2 gluconate

PANCREATITIS
Nursing Management Withhold food and fluids, institute TPN CX: hyperglycemia, air embolism, infection Stress Management Technique: DBE, yoga Assume comfortable position Knee-chest, fetal-like If can ok to eat, CHO, CHON, fats Prevent Cx: chronic hemorrhage, septicemia

GALL BLADDER

Cholecystitis- inflammation Cholelithiasis- stone Predisposing Factors High risk- F- 40 y/o, menopausal, obese S/Sx Pain at RUQ (epigastric pain) after taking heavy meal, usually at night Fatty intolerance, N/V, feeling of fullness Easy bruising Jaundice Pruritus Dark amber urine Steatorrhea Dx Procedures Oral cholecystogram (Gall Bladder Series)- (+) gall stones Serum alkaline phosphatase

GALL BLADDER
Nursing

Management Administer meds as ordered Narcotic analgesic- Demerol Anticholinegrics- Probanthine, AtSO4 Anti-emetic Monitor V/S, bowel sounds CHO, CHON, fats Meticulous skin care Assist in cholecystectomy

STOMACH
J-shape Widest section With valves

of alimentary canal

Cardiac sphincter- bet. esophagus and stomach Pyloric sphincter- bet. stomach and duodenum, olive-shape mass Parts
Antrum Body Fundus

STOMACH
Cells

Chief/zymogenic cells
Gastric Gastric

Parietal/Oxyntic cells
Produces

amylase- digests CHO lipase- digests fats Pepsin- digests CHON Rennin- digests milk products intrinsic factor (glycoprotein) for reabsorption of Vit B12 for RBC maturation Secretes HCl- aids in digestion
Stimulates

Endocrine cells

gastrin (G-cells)

STOMACH
Functions

Mechanical and chemical digestion Storage of food CHO and CHON 2-3 hrs Fats- 3-4 hrs

PEPTIC ULCER
Erosion/excoriation

lining due to Hypersecretion of acid pepsin resistance of mucosal barrier to hyperacidity Incidence Rate
M- 2-3 X higher risk Low income, laborer
Predisposing

of submucosal and mucosal

Factors

Hereditary Emotional stress Smoking Alcoholism

PEPTIC ULCER
Predisposing

Factors

Caffeine Irregular diet Rapid eating Ulcerogenic drugs: ASA, Ibuprofen, Indomethacin, Steroids, Phenylbutazones Gastrin-producing tumors- Zollinger Ellison syndrome Microbial invasion- Helicobacter pylori

PEPTIC ULCER
Types

depending on Severity
Acute- affects submucosal and mucosal linings Chronic- affects deeper tissues heals scars
Location

Stress ulcer Gastric ulcer Duodenal ulcer- 90-95% less Bicarbonate

PEPTIC ULCER
Stress

Ulcer-common among critically-ill pt

Curlings Ulcer- due to trauma and major burns hypovolemia GIT ischemia resistance of mucosal barrier to HCl acid secretion ulceration Cushings Ulcer- due to head trauma/injury (e.g. CVA) Vagal stimulation hyperacidity ulceration

PEPTIC ULCER
GASTRIC ULCER VS. Antrum 30 mins- 1 hr p.c. Epigastric pain Gaseous pain and burning Not relieved by food/antacid N gastric acid secretion Hematemesis Weight loss Stomach CA and hemorrhage 60 y/o and DUODENAL ULCER Duodenal bulb 2-3 hrs p.c. Mid-epigastric pain Cramping and burning Relieved by food/antacid Gastric acid secretion Melena Weight gain Perforation 20 y/o and

PEPTIC ULCER
Dx

Procedure

Endoscopic exam- extent and depth of ulceration Stool- (+) occult blood Upper GI series (Barium swallow)- (+) ulceration

PEPTIC ULCER

Nursing Management No smoking Diet: bland, no caffeine, no milk and its products, give crackers Administer meds as ordered Antacids Maalox- combined with S/E than 2 antacids separately MAD- Mg containing antacid, S/E- diarrhea AAC- Al containing antacid, S/E- constipation H2 blockers Ranitidine (Zantac) Cimetidine (Tagamet) Famotidine (Pepsin)

PEPTIC ULCER
Nursing

Management Administer meds as ordered Cryoprotective agents- creates a paste-like substance that coats the gastric mucosa Sucralfate Cytotec Anticholinergic/Antispasmodic AtSO4, Buscopan Sedatives/Tranquilizer (Valium)

PEPTIC ULCER

Nursing Management Assist in surgical procedure- SUBTOTAL GASTRECTOMY Bilroth I (Gastroduodenostomy) Removal of 1/3 to uppermost stomach and anastomosis of the gastric stump to the duodenum Bilroth II (Gastrojejunostomy) Removal of 2/3 of stomach duodenal walls and anastomosis of the gastric stump to the jejunum
Vagotomy

and Pyloroplasty- prior to surgery to hemorrhage

PEPTIC ULCER

Nursing Management Post-op Monitor NGT output Immediately post-opbright red 12-16 hrs post-opgreenish > 24 hrs- teacolored/dark red Administer meds as ordered Antibiotics Analgesic Anti-emetic Monitor VS, I/O, bowel sound Maintain patent IV line

Monitor for S/Sx of Cx Bleeding Hemorrhage Shock Paralytic ileus Peritonitis Pernicious anemia Thrombophlebitis hypoK+ Dumping Syndome

DUMPING SYNDROME
Rapid

emptying of hypertrophic food solution (chyme) from stomach to jejunum hypovolemia S/Sx Diaphoresis, palpitation, tachycardia, weakness, diarrhea Nursing Management Diet: CHO, moderate CHON Small, frequent meals (divided into 6 equal parts/day) Avoid chilled solution Diarrhea Pt lie flat for 30 mins p.c.

CGFNS/NCLEX Question
A

RN would instruct a pt who had an ileostomy to avoid which of the following food? A. potatoes B. beef C. popcorn D. yogurt

CGFNS/NCLEX Question
Which

of the following observations of a pt who has pernicious anemia would indicate that the goal of care has been achieved? A. pts skin has no petechiae B. tongue has lost its beefy red color C. no dependent edema D. good appetite

CGFNS/NCLEX Question
A

pt is to be transfused with a unit of whole blood. If the pt were to develop an allergic reaction, the RN would expect to administer which of the following drugs? A. Diphenhydramine HCl (Benadryl) B. Metoclopramide (Plasil) C. Pseudoephedrine HCl (Sudafed) D. Promethazine HCl maleate (Phenergan)

CGFNS/NCLEX Question
Which

of the following serum laboratoty results would a RN expect to identify in a pt who has pancreatitis? A. dec. cholesterol B. dec. glucose C. inc. amylase D. inc. creatinine

CGFNS/NCLEX Question
Which

of the following statements, if made by a pt who has iron deficiency anemia, would indicate that the pt understands the meds instructions? A. I will report any clay-colored stools. B. I will the keep the tablets in the ref. C. I will take the pills with orange juice. D. I will expect my urine to become redtinged.

CGFNS/NCLEX Question
A

client who has nutritional anemia has responded satisfactorily to the tx. In an addition to an increased Hgb, improvement in the clients condition would best be indicated by the results of which of these laboratory tests? A. serum protein level B. platelet count C. leukocyte count D. hematocrit determination

CGFNS/NCLEX Question
A

RN should instruct a pt who has a dx of folic acid deficiency anemia to increase intake of which of the following foods? A. dairy products B. green, leafy vegetables C. citrus juices D. fish and poultry * as well as liver, grains, yeasts, legumes

CGFNS/NCLEX Question
A

10-y/o boy is admitted to the hospital with a hx of fever and RLQ abdominal pain. Which of the following comfort measures would be taken until a dx is made? A. maintain the child in recumbent position B. apply warm compress to the affected area C. obtain an order for an age appropriate analgesic D. distract the child with an age appropriate video

CGFNS/NCLEX Question
When

a 12-year old child has a dx of appendicitis, which of the following manifestations would be most important for the RN to follow-up? A. tympanic temp of 101.2 F (38.4 C) B. absence of stool for 24 hrs C. nausea when exposed to food odors D. cessation of abdominal pain