Gastrointestinal Disorders

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Diagnostic Testing

Information will be in Angel in separate GI

Testing folder for all GI conferences

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Peptic Ulcer Disease

Gastroesophageal Reflux

Disease

Peritonitis(review) 3

MEDICATIONS

Review preconference

1. Protonix

2. Prilosec

3. Pepcid

4. Reglan

5. Carafate

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Peptic Ulcer Disease

Gastric Ulcers: in the stomach

Duodenal Ulcers: proximal part of the

duodenum

VIEW VIDEOTAPE

Treating Your Peptic Ulcer - VHS-104

(10 minutes)

Notetaking Guide Provided

Causes of PUD

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

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Assessment Findings: Duodenal

Ulcer

Burning, cramping

pain

Midepigastric

Pain 2-4 hours after

eating

Pain relief with

antacids and food

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Diagnostic Tests for PUD

EGD

Serum Antibody test

for H. Pylori

Urea Breath Test

Review test

information on ANGEL

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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

Nursing Intervention:

Assessment Signs and Symptoms: nausea, vomiting,

timing of symptoms

Pain assessment

Signs of hemorrhage

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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)

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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

Signs & Symptoms to Report

to MD

Increased pain

N/V

Black tarry stools

Bloody emesis

TNI: Teaching: Lifestyle

Changes

Avoiding alcohol

Avoiding tobacco

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Surgical Management of PUD

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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

Common Complications:

PERFORATION Pain

Distention

Temp rise

Vitals

P fast

BP low

RR fast

T elevated

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Common Complications:

Gastric Outlet Obstruction

GERD

VIEW VIDEOTAPE

GERD Gastroesophageal Reflux

Disease - VHS-059 (10 minutes)

GERD: CAUSES

hiatal hernia

incompetent lower

esophageal sphincter

(LES)

decreased

esophageal clearance

decreased gastric

emptying

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

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Diagnostic Tests for GERD

Barium swallow

Endoscopy

Esophageal pH monitoring.

Review Test info on ANGEL

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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

NI: Assessment

Signs and symptoms

Pain assessment

Respiratory

assessment

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NI: Teaching: Medications

Review medication list

Antacid

Antiemetic

Histamine receptor antagonist

Mucosal protectant

Proton pump inhibitor

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NIs - Nutrition

High protein, low fat diet

Small, frequent meals

Avoid chocolate, peppermint, caffeine, alcohol

NI: Teaching: Signs and

Symptoms to Report Chronic heartburn and regurgitation

Persistent dysphagia, epigastric fullness

and bloating

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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

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Surgical Management:

Nissen fundoplication

Wrap top portion of

stomach around LES

to tighten LES

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

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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

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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.

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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

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

Case Study 2

3. What nursing interventions are indicated

for patient?

Review answers: Teaching, Teaching,

Teaching!

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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)

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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

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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

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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.

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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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