Sunteți pe pagina 1din 79

CASE STUDY

ON
Non-Ulcer Dyspepsia
I. IN TRO DUCT IO N
Food is one of the physiologic needs of an individual, a
literal requirement for survival. If these requirements are not
met the human body simply cannot continue to function. By
means of ingestion and digestion we are able to satisfy this
need. Our alimentary tract plays a big role to this ingestion-
digestion process.

There are certain diseases that affects alimentary tract.


One of the most familiar and popular is indigestion also
known as dyspepsia. Dyspepsia is derived from greek word
and means “difficult to digest”. Dyspepsia (indigestion) is
best described as a functional disease. Sometimes, it is
called functional dyspepsia. It pertains to the muscular
organs of the alimentary tract-esophagus, stomach, small
intestine, gallbladder, and colon. It is called functional,
because it involves either the muscles of the organs or the
nerves that control the organs are not working normally,
and, as a result, the organs do not function normally.
Non ulcer dyspepsia is a type of indigestion not caused by
peptic ulcer. The symptoms are often similar to dyspepsia
caused by ulcers such as bloating and upper abdominal pain
or discomfort. Often there is no obvious cause for the
discomfort but sometimes it may be result from eating too fast,
overeating or eating while stressed.

Patient Y is a 26 year old Female who is currently residing


at 424 Marulas A., Caloocan City. She is now pregnant with
AOG of 13-14 wks by LMP. She doesn’t perform any proper
exercise even before. She is fun of eating pork, chicken and
junk foods (Oishy) and seldom eats vegetables.

The Group 1 chooses this case study to aim and further


understand the nature and extent of Non-Ulcer Dyspepsia.
They want to enhance their understanding about the
manifestation, complication, disease process, diagnostic
exams, preventive measures as well as the nursing care
management to develop their independent nursing role. They
want to know the improvements and the treatment that would
increase survival rates and chances of people having the
disease.
II. OBJ ECTI VES
General Objectives

To gain knowledge and to further understand


the nature and extent of the disease, so as to
prepare ourselves with knowledge whenever
we encounter the same case in the future.
And also to have a clear and better
understanding in NUD (Non-Ulcer Dyspepsia)
particularly on its disease process, treatment,
diagnostic exams, preventive measures and
nursing care.
Specific Objectives

To know the latest facts and keep ourselves


updated with newest informations about Non-
Ulcer Dyspepsia.

To be familiar with the disease and medical used


that may help us in doing health teaching to
our client.

To let the nursing students and medical staffs be


aware with the manifestations and
complications brought by the disease.
Bio graphic d ata:
Name: Patient Y
Address: 424 Marulas, Caloocan City
Age: 26 years old
Sex: Female
Marital Status: Single
Religion: Roman Catholic
Health Care financing: Phil. Health and SSS
Usual Source of Medical Care: Health Personnel
Chief Complaints: Vomiting and Epigastric pain
Medical Diagnosis: NUD (Non-Ulcer Dyspepsia)
Attending Physician: Dr. Gail Canlas
Hist ory of p rese nt
il ln ess:
2 months prior to admission, Patient Y has a
habit of skipping breakfast and eating a lot at
lunch and dinner.
5 wks prior to admission, she submitted
herself for check up. After urinalysis, she was
diagnosed with UTI and Pregnancy was
revealed. Antibiotic was given by AP. After 1 wk.
of treatment infection subsides.
Few Hours prior to admission patient Y had 6
episodes of vomiting followed by epigastric pain
after eating chicken and rice @ KFC. Together
with her relatives, she consulted Martinez
Memorial Hospital-ER and was admitted.
Pa st h isto ry
According to Patient Y, She had completed her
immunization status. On her elementary days, she
experienced sore eyes, mumps, chicken pox and measles
and relieved without consulting a physician but with
assistance of alternative therapy like using herbal plants.

She was hospitalized in the same institution last 2002


with the same chief complain but a diagnosis of
appendicitis and it was relieved by medication therapy
given by AP.

She is not allergic to drugs, animals, insects, food or


other agents.
Accidents and Injuries:
There were no reports of patient being involved in
major accidents or injuries that might have been fatal.

Family History Illness:


According to Patient Y, Thay have a history of DM and
peptic ulcer. Her grandfather, on her father side, died
because of DM Nephropathy and her father died because
of heart attack. Her Mother have Peptic Ulcer, Asthma and
Hyperthyriodism.

Lifestyle and Personal Habits


Patient Y is a non-smoker and occasionally she
drinks. She drinks soda once in awhile and she is fun of
eating Junk foods specially Oishy. She loves to watch TV.
Social data:
Patient Y has a good relationship with regards to his
family and relatives. She lives with her mother and
youngest brother. Ever since, she is known friendly in their
neighborhood. Other than that, her neighbor hence no
problem about her attitude as verbalized by the patients
relative.

Diet:
Patient Y eats 3-4 times a day. She prefers to eat
Pork, chicken and fish but would sometimes eat
vegetables. She is fun of eating junk foods (Oishy) and
soda for snacks.

Sleep/Rest Pattern:
According to her, she has ample time to rest although
sometimes experienced sleep disruption due to time of
procedure and treatments and stress brought about by her
condition.
Ethnic affiliation:
Even though Patient Y born in an urban
place she still believes in superstition such as
dwarfs, enkantos and aswangs.

Educational History:
She graduated college with a degree of
Business Administration Major in Marketing

Occupational History:
Since her father died. Patient Y is The Bread
Winner of their Family. According to her she was
employed as an inventory agent in Con Court
Corp. and she said that she is a minimum wage
earner. Her salary, approximately ranging
10,000 – 15,000 pesos per month.
Economic Status:
Now that she was lived for work, her
Phil. Health and SSS insurance help her on
hospitalization bills and medication therapy.

Psychological Data:
Patient Y is concerned about their
family’s financial status, now that she was
lived for work. She doesn’t want her family
to suffer because of her condition.
GO RDON ’S
FUNCT IONA L HEAL TH
PAT TERN S
PATTERN OF HEALTH PERCEPTION AND
HEALTH MANAGEMENT
Before, Patient Y was not health
conscious but when her father died
because of heart attack and her grandfather
died because of DM Nephropathy, she
seeks medical help when she felt unusual
or abnormal sensation. And now that she is
pregnant and having this condition, she
follows medical advices.
NUTRITIONAL – METABOLIC PATTERN

Height : 5’3”
TIME FRAME WEIGHT BMI INTERPRETA
TION

Before illness 65 kg 25.39 Overweight

During illness 65 kg 25.39 Overweight

Weight as of July 29, 65 kg 25.39 Overweight


2009
Basis of Interpretation:
BMI of < 18.5 is classified as underweight
BMI of 18.5 to 24.9 is classified as normal
BMI of 25 to 29.9 is classified as overweight
BMI of 30 to 39.9 is classified as obesity

*BODY MASS INDEX (BMI) = weight (kg) /


height (m²)

Patient Y is Overweight according to her


BMI
DIE TARY PA TTERN
BEFORE ILLNESS PRESENT

MEALS AMOUNT FOODS/DRINKS AMOUNT FOODS/DRINKS

Breakfast 1 glasses water 1 glasses water

Lunch 1-2 cups Rice 1-2 pieces Sandwich


1 serving Pork/fish/chicken 2 glasses water
2 glasses water

Snacks 1 pack Potato chips 1 piece Sandwich


1 glass Soda drinks 1 glass water

Dinner 1 cup Rice 1 piece Sandwich


1 serving Pork/Fish/chicken 2 glasses water
2 glasses water
Favorite Foods : More on meat, Dishes
like Adovo and kare-
kare
but some time vegetables

Vitamins : None

VISIT TO FAST FOOD


RESTAURANTS : 3-4 x a week
(Jollibee, and KFC)

Allergies to Foods : None


PAT TERN O F
EL IMIN ATI ON
Bowel Elimination Before illness during

Frequency Once a day Once a day

Character of stool Brownish, solid Brownish, solid

Problem Encountered None None

Urinary Elimination Before illness Present

Frequency 8 -10 x a day 8 -10 x a day

Character of urine Aromatic, pale yellow Aromatic, pale yellow

Problems Encountered None None


PATT ERN OF ACTI VI TY
AND EXE RCI SE
Typical activity for the day prior to admission
Time Activity

6:00 AM > Wakes up

6:00 – 7:00 AM > eat breakfast and prepare for work

8:00 – 11:00 AM > Work

11:00-12:00 NN > Lunch Break (eat lunch and some rest)

1:30 – 5:00 PM > Work

6:00 – 7:00PM > Helps prepare dinner

7:00 - 8:00 PM > Eat dinner with family

8:00 – 11:00PM > Watch TV

11:00 PM > Bed time


COGNITIVE – PERCEPTION PATTERN
The patient is oriented to time, place, self and
situation. Her perception of pain, warm, cold and touch are
good. She can perceived reality and still can remember
past events such as her memory of childhood. She can still
understand and obey instructions.

PATTERN OF SELF PERCEPTION AND SELF CONCEPT


Patient Y is approachable and cooperative but at some
point she is anxious because of her condition.
ROLE RELATIONSHIP PATTERN

Patient Y is Single but have a boyfriend which is the


father of her child. She lives with her mother and youngest
brother. She is close to her mother. Her family, relatives
and her boyfriend are very supportive with what she is
going through.
SEXUALITY PATTERN
She was practicing good genital hygiene. Before she is
sexually active as evidenced of her present gestation and she is
having gymecological and prenatal check-up.

PATTERN OF COPING AND STRESS TOLERANCE


Patient Y views her problems more as test, given by the Lord,
for her to survive rather than a punishment. Even though it affected
her work, she know that she could pass this trial by the help of the
Lord and with her family’s support. But at some times, she’s being
anxious whenever she felt pain or any abnormal sensation but
when her doctor and her nurse assure her condition here
anxiousness relives.

PATTERN OF VALUES AND BELIEFS


She has strong faith in her religion. She attends mass
sometimes whenever she is free. But now, she is not able to attend
because of her present condition. She became more expressive
about her faith to God because she believes that her faith is a big
help to enlighten her feelings about her present condition.
PH YSI CAL ASS ESME NT
GENERAL APPEARANCE
Body Build : Medium Frame
Height and weight : 5’3”; 65 kg
Posture : erect and straight body posture
Hygiene and grooming : clean and neat
Body breath and odor : none
Appearance : appears weak
Mental status : clear and intact memory both recent,
past and remote, oriented to person,
time and place
Attitude : cooperative
Mood and affect : appropriate to situation
Organization of speech : understandable, moderate pace
Relevance and organization: has logical sequence and sense of
reality of thought
VITAL SIGNS
Temperature : 37°C
Pulse Rate : 90 bpm
Respiration Rate : 20 bpm
Blood Pressure : 120/90 mmHg

INTEGUMENT
A. Skin
Color complexion : fair complexion
Skin moisture : moist and smooth
Skin temperature : normal
Skin turgor : good skin turgor
B. Nails
Fingernail plate shape : convex
Texture : smooth
Bed color : pink
Capillary refill : pink in color returns in <3 secs.
- Intact epidermis around the nail
HEAD
A. Hair
Color : black
Distribution : evenly distributed
Texture and oiliness : silky, curly and oily
- Thick strands of hair
B. Scalp
- Absence of drandruff
- No lesions, masses, deformities, swelling and tenderness.
C. Skull
- Normocephalic
- Smooth, uniform consistency; absence of nodules or masses
D. Face - symmetrical facial features and movements
E. Eyes and Vision
Eyebrows : eyebrows are black, evenly distributed and
symmetrically aligned
Eyelashes : equally distributed, slightly curled outward
Eyelids : skin is intact, lids close symmetrically
Bulbar conjunctiva : transparent, capillaries are not evident and
with anicteric sclera
Palpebral conjunctiva : shiny, smooth, and pink
Lacrimal gland : no edema, or tenderness over the
gland
Pupils : black in color
Visual acuity : can read newspaper written in
TNR with in 12 ft.
distance
Visual field : Normal pheriperal vision
Consensual reaction to light and accommodation: normal constriction
of pupil upon the presence of
light ( PERRLA)
-Normal pupils equally round and reactive
to light and accomodation

F. Ears and hearing


Auricles : symmetrical, skin color is same with
facial skin, Not aligned with outer canthus
of the eye; movable, firm and
tender, recoils back after it is
folded
External ear canal : with scant amount of cerumen and few
cilia
Gross hearing acuity test : able to hear normal voice and able to
hear whisper voice within 6
inches (15. 24 cm)
NECK : No area of tenderness
-No masses found
-Muscles are symmetrical
with head in central
position.
-Movement through full range
of motion without complaint
of discomfort or
limitation.
CHEST
-Thorax is in 1:2 in anteroposterior to
transverse diameter chest wall is intact and no
tenderness.
a. Anterior chest : intact skin with uniform color,
-no area of tenderness,
-no mass is found with visible bone
prominence
-Symmetrical chest expansion
b. Posterior Chest : fair complexion
- smooth skin
- no evidence of enlargement
- no area of tenderness
- no mass is found
UPPER EXTREMITIES
a. Shoulder : range of motion on both shoulders are actively
done within normal limits and pain free but assisted in
left shoulder due to IV line.

b. Elbows : range of motion on left elbow is actively


done within normal limits and pain free.
-Right elbow’s range of motion is done
actively with normal limits and pain free.

c. Wrist and hands : range of motion of right wrist and fingers


are actively done within normal limit and pain free.
- Left wrist and fingers are not movable
due to inserted IV line.

d. Muscles : No tenderness found


ABDOMEN : soft abdomen, no masses
and areas of tenderness
-Uniform in color with no
evidence of enlargement of
liver and spleen.
-Umbilicus is in the normal
position between the xiphoid
process and symphysis pubis
with Normal Abdomen Bowel
Sound (NABS)
LOWER EXTREMITIES
: fair complexion, smooth skin,
symmetrical\muscles, intact skin,
warm to touch with good muscle
tone
-Range of motion on joints is done
within normal limits and pain free.
-Toe nails: with good capillary refill
upon blanch tests (<3 secs),
convex, pinkish nail beds with
intact skin around the nails.
REVI EW OF SYSTE MS
1. Hematopoietic system:
Normal Value Result Interpretation

a. Hemoglobin 1.86-2.48 mmol/L 2.2 Normal

b. Hematocrit 0.38-0.47 0.39 Normal

c. RBC 4.2 - 5.6 mill/mcl 4.6 Normal

d. WBC 5-1 x 10’ g/L 9.2 Normal


2. Genito-Urinary System
Urinates 8-10 times per day and 2-3
times at night, having a characteristic of
aromatic pale yellow with no burning
sensation.
3. Respiratory System:

Normal Result

Respiratory rate 12-20 bpm 20 bpm(normal)


4. Cardiovascular system:
Normal Result

Pulse rate 60-100 bpm 90 bpm( normal )

Blood pressure 120/180 mmHg 120/90( normal )

5. Integumentary System:
Normal Result

Temperature 37 °C 37°C( normal)


6. Digestive System:
No constipation, no diarrhea and no
allergies found.
Eliminates once a day (am), having a
characteristic of brownish solid and doesn’t
experience any pain sensation.

7. Reproductive System:
Currently pregnant (G1P0 PU 13-14 wks
AOG by LMP
Reproductive organs are well-functioning.
No inflammations found.
LABORATORIES
Date Taken: July 29, 2009
Hospital: Martinez Memorial Hospital
Creatinine
Normal Result Interpretation
values
Creatine 61.88-123.76 75.23 Normal
umol/L

Na 135-148 141.1 Normal


mmol/L
K 3.5-5.3 3.57 Normal
mmol/L
Hematology Results
CBC
Normal values Result Interpretation

Erythrocyte 4.2 - 5.6 4.6 Normal


count mill/mcl
Hematocrit 0.38-0.47 0.39 Normal
Hemoglobin 1.86-2.48 2.2 Normal
mmol/L
Leukocyte 5-1 x 10’ g/L 9.2 Normal
count

Others:
Result Normal value Interpretation
Hemoglobin: 130g/L 120-160g /L Normal
Leukocyte Differential Count

Normal values Result Interpretation

Segmenters 0.40-.60 0.80 Increase

Lymphocytes 0.20-0.40 0.20 Normal

Date : July 30, 2009


ECG: Sinus Tachycardia
AN ATO MY AN D
PH YSI OL OGY
LES

lower esophageal
sphincter (LES) also
termed cardiac
sphincter
Function
The stomach generates strong acids and enzymes to aid
in food digestion. This digestive mixture is called gastric juice.
The inner lining of the stomach has several mechanisms to
resist the effect of gastric juice on itself, but the mucosa of the
esophagus does not. The esophagus is normally protected
from these acids by a one-way valve mechanism at its junction
with the stomach. This one-way valve is called the esophageal
sphincter (ES), and prevents gastric juice from flowing back into
the esophagus.
During peristalsis, the ES allows the food bolus to pass
into the stomach. It prevents chyme, a mixture of bolus,
stomach acid, and digestive enzymes, from returning up the
esophagus. The ES is aided in the task of keeping the flow of
materials in one direction by the diaphragm.
Th ora cic dia phra gm
Anatomy
The Diaphragm is a dome-shaped musculofibrous septum
that separates the thoracic from the abdominal cavity, its convex
upper surface forming the floor of the former, and its concave under
surface the roof of the latter. Its peripheral part consists of muscular
fibers that take origin from the circumference of the inferior thoracic
aperture and converge to be inserted into a central tendon.

Function
The diaphragm is helpful for breathing and respiration.
During inhalation, the diaphragm contracts, thus enlarging the
thoracic cavity (the external intercostal muscles also participate in
this enlargement). This reduces intra-thoracic pressure: In other
words, enlarging the cavity creates suction that draws air into the
lungs. When the diaphragm relaxes, air is exhaled by elastic recoil
of the lung and the tissues lining the thoracic cavity in conjunction
with the abdominal muscles, which act as an antagonist paired with
the diaphragm's contraction.
The diaphragm is also involved in non-
respiratory functions, helping to expel vomit,
faeces, and urine from the body by
increasing intra-abdominal pressure, and
preventing acid reflux by exerting pressure
on the esophagus as it passes through the
esophageal hiatus.
In veterinary anatomy, the diaphragm is
not necessarily crucial; a cow, for instance,
can survive fairly asymptomatically with
diaphragmatic paralysis as long as no
massive aerobic metabolic demands are
made of her.
Digestive syst em
Mouth
The function of the
mouth and its
associated structures is
to form a receptacle for
food, to begin
mechanical digestion
through chewing
(mastication), to
swallow food, and to
form words in speech. It
can also assist the
respiratory system in
the passage of air.
Tooth
A tooth is a hard structure, set in the
upper or lower jaw, that is used for chewing
food. Teeth also give shape to the face and
aid in the process of speaking clearly. The
enamel that covers the crown (the part above
the gum) in each tooth can be broken down
by acids produced by the mouth for digestive
purposes. This process is called "decay". To
prevent decay, good oral hygiene, consisting
of daily brushing and flossing, is necessary.
The hardest substance in the human body is
one of the four kinds of tissue which make up
the tooth. It is enamel and covers the crown
(area above the gum line) of the tooth. A bony
material called "cementum" covers the root,
which fits into the jaw socket and is joined to it
with membranes. "Dentin" is found under the
enamel and the cementum, and this material
forms the largest part of the tooth. At the
heart of each tooth is living "pulp," which
contains nerves, connective tissues, blood
vessels and lymphatics. When a person gets
a toothache, the pulp is what hurts.
Esophagus
The esophagus is a muscular tube which carries food and liquids from the
throat to the stomach for digestion after it has been chewed and chemically
softened in the mouth. Food is forced downward to the stomach (or upwards, if
one is standing on his head) by powerful waves of muscle contractions passing
through the walls of the esophagus. Because these contractions are so strong in
the throat and the esophagus, we can swallow in any position -- even upside-
down! If the food is bad, poison, or more than we can "stomach," it may travel
back by the same force to be thrown out through the mouth, which is called
vomiting. The esophagus has a ring of muscle at the top and at the bottom. These
rings close or contract after the food passes through and enters the stomach,
where there is an abundance of churning acid waiting to digest the food. If the
bottom muscle weakens, stomach contents, along with the stomach acid, may
return to the esophagus and cause an uncomfortable, burning sensation known as
"heartburn", although it is not connected with the heart at all, but be careful next
time you are forced to swallow your pride.
Stomach
Stomach
A hollow, sac-like organ connected to the esophagus and the duodenum (the
first part of the small intestine), the stomach consists of layers of muscle and
nerves that continue the breakdown of food which begins in the mouth. It is also a
storage compartment, which enables us to eat only two or three meals a day. If
this weren't possible, we would have to eat about every twenty minutes. The
average adult stomach stretches to hold from two to three pints and produces
approximately the same amount of gastric juices every twenty-four hours. The
stomach has several functions: (1) as a storage bin, holding a meal in the upper
portion and releasing it a little at a time into the lower portion for processing; (2)
as a food mixer, the strong muscles contract and mash the food into a sticky,
slushy mass; (3) as a sterilizing system, where the cells in the stomach produce
an acid which kills germs in "bad" food; (4) as a digestive tub, the stomach
produces digestive fluid which splits and cracks the chemicals in food to be
distributed as fuel for the body. The process of digestion is triggered by the sight,
smell or taste of food, so that the stomach is prepared when the food arrives.
Every time you pass a bakery shop or smell your mother's good cooking, the
body begins a digestive process. If the stomach is not filled, these gastric juices
begin eroding the stomach lining itself, so fill 'er up
Liver
is a vital organ present in vertebrates
and some other animals; it has a wide range
of functions, a few of which are
detoxification, protein synthesis, and
production of biochemicals necessary for
digestion. The liver is necessary for survival;
there is currently no way to compensate for
the absence of liver function.
This organ plays a major role in
metabolism and has a number of functions
in the body, including glycogen storage,
decomposition of red blood cells, plasma
protein synthesis, hormnone production,
and detoxification. It lies below the
diaphragm in the thoracic region of the
abdomen. It produces bile, an alkaline
compound which aids in digestion, via the
emulsification of lipids. It also performs and
regulates a wide variety of high-volume
biochemical reactions requiring highly
specialized tissues, including the synthesis
and breakdown of small and complex
molecules, many of which are necessary for
Gallbladder
The gallbladder is an active storage shed, which absorbs mineral salts and
water received from the liver and converts it into a thick, mucus substance called
"bile," to be released when food is present in the stomach. The gallbladder is a
small, pear-shaped sac which is situated just below the liver and is attached to it by
tissues. It stores bile and then releases it when food passes from the stomach to the
duodenum (the first part of the small intestine) to help in the process of digestion. It
has a capacity of around one and one-half fluid ounces. When food leaves the
stomach, a secretion causes the gallbladder to contract and expel its contents into
the duodenum, where the bile disperses the fats in the food into liquid. Pythagoras,
the 6th Century BC Greek mathematician, believed that life is based on the four
elements of earth, air, fire and water which correspond to the body's "humors": blood
(hot and moist), phlegm (cold and moist), yellow bile (hot and dry) and black bile
(cold and dry). The perfect or imperfect balance of these humors supposedly
determined one's health and intelligence. We still speak in terms of "melancholia"
(excess black bile, leading to depression) and "phlegmatic" (sluggish or impassive)
and scientists have named the heavy mucus secreted in the respiratory passages -
phlegm. Pythagoras was kind of a "square". Oh, come on; where's your sense of
"humor"?
Pancreas
is a gland organ in the digestive and endocrine system of vertebrates. It is
both an endocrine gland producing several important hormones, including insulin,
glucagon, and somatostatin, as well as an exocrine gland, secreting pancreatic
juice containing digestive enzymes that pass to the small intestine. These
enzymes help in the further breakdown of the carbohydrates, protein, and fat in
the chime
Duodenum
is largely responsible for the breakdown of food in the
small intestine, using enzymes. Brunner's glands, which
secrete mucus, are found in the duodenum. The duodenum
wall is composed of a very thin layer of cells that form the
muscularis mucosae The duodenum is almost entirely
retroperitoneal
The duodenum also regulates the rate of emptying of the
stomach via hormonal pathways. Secretin and
cholecystokinin are released from cells in the duodenal
epithelium in response to acidic and fatty stimuli present
there when the pyloris opens and releases gastric chyme
into the duodenum for further digestion. These cause the
liver and gall bladder to release bile, and the pancreas to
release bicarbonate and digestive enzymes such as trypsin,
lipase and amylase into the duodenum as they are needed.
Jejunum
The inner surface of the jejunum, its mucous membrane, is
covered in projections called villi, which increase the surface area
of tissue available to absorb nutrients from the gut contents. The
epithelial cells which line these villi possess even larger numbers
of microvilli. The transport of nutrients across epithelial cells
through the jejunum and ileum includes the passive transport of
sugar fructose and the active transport of amino acids, small
peptides, vitamins, and most glucose. The villi in the jejunum are
much longer than in the duodenum or ileum..
The jejunum lies between the duodenum and the ileum. The
change from the duodenum to the jejunum is usually defined as
the ligament of Treitz.In adult humans, the small intestine is
usually between 5.5-6m long, 2.5m of which is the jejunum.The pH
in the jejunum is usually between 7 and 8 (neutral or slightly
alkaline).The jejunum and the ileum are suspended by mesentery
which gives the bowel great mobility within the abdomen. It also
contains muscles to help move the food along which "when struck
with substantial force will cause regurgetation or vomiting
Ileum
is mainly to absorb vitamin B12 and bile salts and whatever
products of digestion were not absorbed by the jejunum. The wall itself
is made up of folds, each of which has many tiny finger-like projections
known as villi on its surface. In turn, the epithelial cells which line these
villi possess even larger numbers of microvilli. Therefore the ileum has
an extremely large surface area both for the adsorption (attachment) of
enzyme molecules and for the absorption of products of digestion. The
DNES (diffuse neuroendocrine system) cells that line the ileum contain
the protease and carbohydrase enzymes (gastrin, secretin,
cholecystokinin) responsible for the final stages of protein and
carbohydrate digestion. These enzymes are present in the cytoplasm of
the epithelial cells. The villi contain large numbers of capillaries which
take the amino acids and glucose produced by digestion to the hepatic
portal vein and the liver.
Lacteals are small lymph vessels, and are present in villi. They
absorb fatty acid and glycerol, the products of fat digestion. Layers of
circular and longitudinal smooth muscle enable the digested food to be
pushed along the ileum by waves of muscle contractions called
peristalsis.
Cecum
or caecum (from the
Latin caecus meaning blind)
is a pouch, connecting the
ileum with the ascending
colon of the large intestine. It
is separated from the ileum
by the ileocecal valve (ICV)
or Bauhin's valve, and is
considered to be the
beginning of the large
intestine. It is also separated
from the colon by the
cecocolic junction.
Appendix
Given the appendix's propensity to cause death by infection, and the general
good health of people who have had their appendix removed or who have a
congenital absence of an appendix, the appendix is traditionally thought to have no
function in the human body. However, new studies propose that the appendix may
harbor and protect bacteria that are beneficial in the function of the human colon.
There have been no reports of impaired immune or gastrointestinal function in
people without an appendix.
Ascending Colon
is smaller in caliber than the cecum, with which it is
contiguous.It passes upward, from its commencement at
the cecum, opposite the colic valve, to the under surface of
the right lobe of the liver, on the right of the gall-bladder,
where it is lodged in a shallow depression, the colic
impression; here it bends abruptly forward and to the left,
forming the right colic flexure (hepatic).
It is retained in contact with the posterior wall of the
abdomen by the peritoneum, which covers its anterior
surface and sides, its posterior surface being connected by
loose areolar tissue with the Iliacus, Quadratus lumborum,
aponeurotic origin of Transversus abdominis, and with the
front of the lower and lateral part of the right kidney.
Sometimes the peritoneum completely invests it, and
forms a distinct but narrow mesocolon.It is in relation, in
front, with the convolutions of the ileum and the abdominal
parietes.
Transverse Colon
the longest and most movable part of the colon, passes with a downward
convexity from the right hypochondrium region across the abdomen, opposite the
confines of the epigastric and umbilical zones, into the left hypochondrium
region, where it curves sharply on itself beneath the lower end of the spleen,
forming the splenic or left colic flexure. The right colic flexure is adjacent to the
liver.
In its course, it describes an arch, the concavity of which is directed
backward and a little upward; toward its splenic end there is often an abrupt U-
shaped curve which may descend lower than the main curve.
It is almost completely invested by peritoneum, and is connected to the
inferior border of the pancreas by a large and wide duplicature of that membrane,
the transverse mesocolon
It is in relation, by its upper surface, with the liver and gall-bladder, the
greater curvature of the stomach, and the lower end of the spleen; by its under
surface, with the small intestine; by its anterior surface, with the anterior layers of
the greater omentum and the abdominal parietes; its posterior surface is in
relation from right to left with the descending portion of the duodenum, the head
of the pancreas, and some of the convolutions of the jejunum and ileum
Descending Colon
of humans passes downward through the left hypochondrium and
lumbar regions, along the lateral border of the left kidney.At the lower end of
the kidney it turns medialward toward the lateral border of the psoas muscle,
and then descends, in the angle between psoas and quadratus lumborum,
to the crest of the ilium, where it ends in the sigmoid colon.
The peritoneum covers its anterior surface and sides, and therefore the
descending colon is described as retroperitoneal. (The transverse colon and
sigmoid colon, which are immediately proximal and distal, are
intraperitoneal). Its posterior surface is connected by areolar tissue with the
lower and lateral part of the left kidney, the aponeurotic origin of the
transversus abdominis, and the quadratus lumborum.It is smaller in caliber
and more deeply placed than the ascending colon. It has a mesentery in
33% of people, and is therefore more frequently covered with peritoneum on
its posterior surface than the ascending colon (which has a mesentery in
25% of people). However, it is less likely to undergo volvulus than the
ascending colon.
Sigmoid Colon
(pelvic colon; sigmoid flexure) forms a loop that
averages about 40 cm. in length, and normally lies within the
pelvis, but on account of its freedom of movement it is liable to
be displaced into the abdominal cavity.

Rectum
(from the Latin rectum intestinum, meaning straight
intestine) is the final straight portion of the large intestine in
some mammals, and the gut in others, terminating in the
anus. The human rectum is about 12 cm long At its
commencement its caliber is similar to that of the sigmoid
colon, but near its termination it is dilated, forming the rectal
ampulla
Uterus

Anatomy
The uterus is located inside the pelvis immediately dorsal (and usually
somewhat rostral) to the urinary bladder and ventral to the rectum. Outside of
pregnancy, its size in humans is several centimeters in diameter. The uterus
is a pear shaped muscular organ which can be divided anatomically into four
segments: The fundus, corpus, cervix and the internal os.
Function
The uterus provides structural integrity and support to the bladder,
bowel, pelvic bones and organs. The uterus helps separate and keep the
bladder in its natural position above the pubic bone and the bowel in its
natural configuration behind the uterus. The uterus is continuous with the
cervix, which is continuous with the vagina, much in the way that the head
is continuous with the neck, which is continuous with the shoulders. It is
attached to bundles of nerves, and networks of arteries and veins, and
broad bands of ligaments such as round ligaments, cardinal ligaments,
broad ligaments, and uterosacral ligaments.
The uterus is essential in sexual responose by directing blood flow to
the pelvis and to the external genitalia, including the ovaries, vagina, labia,
and clitoris. The uterus is needed for uterine orgasm to occur.
The reproductive function of the uterus is to accept a fertilized ovum
which passes through the utero-tubal junction from the fallopian tube. It
then becomes implanted into the endometrium, and derives nourishment
from blood vessels which develop exclusively for this purpose. The
fertilized ovum becomes an embryo, develops into a fetus and gestates
until childbirth. Due to anatomical barriers such as the pelvis, the uterus is
pushed partially into the abdomen due to its expansion during pregnancy.
Even during pregnancy the mass of a human uterus amounts to only
about a kilogram (2.2 pounds).
Regions
From outside to inside, the path to the uterus is as follows:
• Vulva
• Vagina
• Cervix uteri - "neck of uterus"
o External orifice of the uterus
o Canal of the cervix
o Internal orifice of the uterus
• corpus uteri - "Body of uterus"
o Cavity of the body of the uterus
o Fundus (uterus)
Layers
The layers, from innermost to outermost, are as follows:
Endometrium
The lining of the uterine cavity is called the "endometrium." It consists of
the functional endometrium and the basal endometrium from which the
former arises. In most mammals, including humans, the endometrium
builds a lining periodically which is shed or reabsorbed if no pregnancy
occurs. Shedding of the functional endometrial lining in humans is
responsible for menstrual bleeding (known colloquially as a woman's
"period") throughout the fertile years of a female and for some time
beyond. In other mammals there may be cycles set as widely apart as six
months or as frequently as a few days.
Myometrium
The uterus mostly consists of smooth muscle, known as "myometrium."
The innermost layer of myometrium is known as the junctional zone, which
becomes thickened in adenomyosis.
Perimetrium
The loose surrounding tissue is called the "perimetrium."
Peritoneum
The uterus is surrounded by "peritoneum."
Changes occurs in a female reproductive system
during pregnancy:
a. Uterus.
(1) Changes in the uterus are phenomenal. By the
time the pregnancy has reached term, the uterus
will have increased five times its normal size:
(a) In length from 6.5 to 32 cm.
(b) In depth from 2.5 to 22 cm.
(c) In width from 4 to 24 cm.
(d) In weight from 50 to 1000 grams.
(e) In thickness of the walls from 1 to 0.5 cm.
(2) The capacity of the uterus must expand to normally accommodate a
seven-pound fetus and the placenta, the umbilical cord, 500 ml to 1000 ml
of amniotic fluid, and the fetal membranes.
(3) The abdominal contents are displaced to the sides as the uterus grows
in size, which allows for ample space for the uterus within the abdominal
cavity.
(a) Growth of the uterus occurs at a steady, predictable pace.
(b) Measurement of the fundal height during pregnancy is an important
factor that is noted and recorded (see figure 5-1).
(c) Growth that occurs too fast or too slow could be an indication of
problems.
(d) The size of the uterus usually reaches its peak at 38 weeks gestation.
The uterus may drop slightly as the fetal head settles into the pelvis,
preparing for delivery. This dropping is referred to as "lightening." This is
more noticeable in a primigravida than a multigravida.
NOTE: Remember a primigravida is a woman pregnant for the first time. A
multigravida is a woman who has been pregnant more than once.
b. Cervix.
(1) The cervix undergoes a marked softening which is
referred to as the Goodell's sign."
(2) A mucus plug, which is known as "operculum" is
formed in the cervical canal. This is the result of enlarged
and active mucus glands of the cervix. It serves to seal
the uterus and to protect the fetus and fetal membranes
from infection. The mucus plug is expelled at the end of
the pregnancy. This may occur at the onset of labor or
precede labor by a few days. When the mucus is blood-
tinged, it is referred to as a "bloody show."
(3) Additional changes and softening of the cervix occur
prior to the beginning of labor.
c. Vagina. Increased circulation to the vagina early in
pregnancy changes the color from normal light pink to a
purple hue which is known as the "Chadwick's sign."
d. Ovaries.
(1) The follicle-stimulating hormone (FSH) ceases its activity
due to the increased levels of estrogen and progesterone
secreted by the ovaries and corpus luteum. The FSH
prevents ovulation and menstruation.
(2) The corpus luteum enlarges during early pregnancy and
may even form a cyst on the ovary. The corpus luteum
produces progesterone to help maintain the lining of the
endometrium in early pregnancy. It functions until about the
10th to 12th week of pregnancy when the placenta is capable
of producing adequate amounts of progesterone and
estrogen. It slowly decreases in size and function after the
10th to 12th week.
PAT HOPH YSI OLOG Y
PREGNANCY
(AOG G1P0 13 wks.-14 wks.)

Hormonal Changes

Placenta Pituitary Gland Thyroid Gland Parathyroid Gland

↓ production ↑ production
Estrogen Progesterone hCG of FSH & LH of Growth ↑ production of TH ↑ production of TH
hormone

↑ production
Breast & of melanocyte
uterine morning
sickness, stimulating hormone emotional lability
Palmar
erythema nausea
Enlargement & vomiting
skin pigmentation
emotional

Physical
STRESS
Physical
Behavioral

Non ulcerative dyspepsia


somatization
Vomiting
epigastric ampicillin
chest pain radiating to left arm & back
>D5 NM pain
1L
ranitidine sinus tachycardia
>isoxilan
DRUG STUDY
DRUG NURSING
SIDE ADVERSE
DRUG NAME INDICATIONS ACTIONS INTERACTION RESPONSIBILITIE
EFFECTS REACTIONS
S S

Classification: >Heartburn >Competitivel >Headache >confusion >Antacids: may >asses for abdominal
Antiulcer y inhibits >Burning >malaise interfere with pain
H2 hystamine action of sensation at >vertigo ranitidine >monitor GI
antagonist histamine on injection site >blurred vision absorption discomfort
Generic Name: the H2 at >jaundice >Don’t take with other
Ranitidine receptor sites antacids
hydrochloride of parietal >No smoking, alcohol
Brand Name: cells, or NSAIDs
Ranitidine decreasing
Dose: gastric acid
1 amp IV q8 secretion.
DRUG NURSING
SIDE ADVERSE
DRUG NAME INDICATIONS ACTIONS INTERACTION RESPONSIBILITIE
EFFECTS REACTIONS
S S
Classification: >Emesis during >Stimulates >fatigue >seizures >Anticholinergics: >tell patient to avoid
Antiemetic pregnancy motility of >drowsiness >bradycardia May antagonize alcohol, sedatives and
Generic Name: >to reduce and upper GI tract, >anxiety >neutropenia GI motility hypnoyics in take
Metoclopramid prevent nausea increases >Caution patient to
e Hydrochloride and vomitting lower avoid driving
Brand Name: esophageal
Plasil sphincter tone
Dose: and block
1 amp IV q8 dopamine
receptors at
the
chemoreceptor
trigger zone.
DRUG NURSING
SIDE ADVERSE
DRUG NAME INDICATIONS ACTIONS INTERACTION RESPONSIBILITIE
EFFECTS REACTIONS
S S
Classification: >Hyperacidity >Reduces >Constipation >Hypercalcemi >hypersensitivity >Monitor Urinary pH,
Antacid >Heart burn total acid load >Diarrhea a to aluminum Serum Calcium level,
Generic Name: >peptic ulcer in Gi trat, >Hypermagnes products electrolytes and serum
Calcium >reflux elevates emia phosphate level
Carbonate esophagitis gastric pH to >hyperphosphat >record amount and
Brand Name: reduce pepsin emia consistency of stool
Maalox activity, >WOF: GI bleeding;
Dose: strengthens tarry stools or coffee
500 mg 1 tab gastric ground vomitous
mucosal
barrier, and
increases
esophageal
sphincter tone.
DRUG NURSING
SIDE ADVERSE
DRUG NAME INDICATIONS ACTIONS INTERACTION RESPONSIBILITIE
EFFECTS REACTIONS
S S
Classification: >To prevent GI >Inhibits cell- >Nausea, > Pruritus, >Hypersensitivity >Monitor WBC, C and
Antibiotic and GU wall synthesis Vomiting, urticaria, to penicillin ar S report and I and O
Generic Name: infections. during Diarrhea and stomatitis, cephalosphorin >Monitor
Ampicillin bacterial Rash Fatigue and >Caution with seperinfection
Brand Name: multiplication abdominal pain renal failure, GI >Evaluate renal and
omnifen disease and liver function
Dose: Bleeding disorder >ask for drug allergies
500mg IV >Instruct client to take
ANST (-) q6 drug before meals or
with an empty
stomach.
DI SCH ARG E PL AN
MEDICATION: Folic Acid supplements and Maalox
EXERCISE:
•Perform passive ROM exercise like flexion, extention of the extremities.
•Brisk walking every morning.
•Avoid straining, do not lift heavy objects
HEALTH TEACHING:
•Encourage participation in recreation and regular exercise program
•Provide appropriate level of environmental stimulation (e.i; music, TV/ radio, personal possessions and
visitors)
•Suggest use of sleep aid/ promote normal sleep/rest.
OPD: Attend prenatal check-up to obtain information about the development of the baby.
DIET:
•Eat a well balanced diet
•High fiber diet like vegetables and fruits.
•Folic Acid and Iron rich foods such as : leafy green vegetables, asparagus, legumes, oranges and orange
juice, liver, and whole grains
•Avoid gastric stimulants such as: Bell pepper, spicy preservatives ans sauces, caffeine and caffeinated
foods.
SIGNS/SYMPTOMS:
Observe for signs and symptoms such as swelling of face, finger and legs, severe headache,
abdominal and chest pain, vaginal bleeding and persistent vomiting
Pr ognosi s
The prognosis of the patient is expected to
be good and will respond well to treatment.

The client must be instructed about the


medications she must take and reinforce all the
medical advices given by the attending physician.
Diet would play a vital part in her recovery, hence
must be strictly implemented. Although she displayed
willingness to get better, continuous monitoring of her
condition as well as her baby’s condition will help to
maintain her normal condition.
TH ANK YO U!