Learning Plan 5 GI-Hepatic Alterations Metabolism (Gastric & duodenal)

Gastritis Inflammation of the stomach A common GI problem Acute: rapid onset of symptoms usually caused by dietary indiscretion. Other causes include medications, alcohol, bile reflux, and radiation therapy. Ingestion of strong acid or alkali may cause serious complications. Chronic: prolonged inflammation due to benign or malignant ulcers of the stomach or by Helicobacter pylori. May also be associated with some autoimmune diseases, dietary factors, medications, alcohol, smoking, or chronic reflux of pancreatic secretions or bile.

Erosive Gastritis

Manifestations of Gastritis Acute: abdominal discomfort, headache, lassitude, nausea, vomiting, hiccupping Chronic: epigastric discomfort, anorexia, heartburn after eating, belching, sour taste in the mouth, nausea and vomiting, intolerance of some foods. May have vitamin deficiency due to malabsorption of B12 May be associated with achlorhydria, hypochlorhydria, or hyperchlorhydria Diagnosis is usually by UGI X-ray or endoscopy and biopsy

Nursing Process: The Care of the Patient With Gastritis—Diagnoses Anxiety Imbalanced nutrition Risk for fluid volume imbalance Deficient knowledge Acute pain

Medical Management of Gastritis Acute Refrain form alcohol and food until symptoms subside If due to strong acid or alkali treatment to neutralize the agent, avoid emetics and lavage due to danger of perforation and damage to esophagus Supportive therapy Chronic Modify diet, promote rest, reduce stress, avoid alcohol and NSAIDs Pharmacologic therapy: similar medications as use for GERD

Interventions Reduce anxiety; use calm approach and explain all procedures and treatments Promote optimal nutrition; for acute gastritis, the patient should take no food or fluids by mouth. Introduce clear liquids and solid foods as prescribed. Evaluate and report symptoms. Discourage caffeinated beverages, alcohol, cigarette smoking. Refer for alcohol counseling and smoking cessation Promote fluid balance; monitor I&O, for signs of dehydration, electrolyte imbalance, and hemorrhage Measures to relieve pain: diet and medications

Peptic Ulcer Erosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum, or esophagus Associated with infection of H. pylori Risk factors include excessive secretion of stomach acid, dietary factors, chronic use of NSAIDs, alcohol, smoking, and familial tendency Manifestations include a dull gnawing pain or burning in the mid-epigastrium; heartburn and vomiting may occur Treatment includes medications, lifestyle changes, and occasionally surgery Deep Peptic Ulcer

Question Is the following statement true or false? The most common site for peptic ulcer formation is the pylorus.

Nursing Process: The Care of the Patient With Peptic Ulcer—Diagnoses Acute pain Anxiety Imbalanced nutrition Deficient knowledge Collaborative Problems and Potential Complications Hemorrhage Perforation Penetration Pyloric obstruction (gastric outlet obstruction)

Interventions Relieve Pain Assess anxiety Treat with prescription medications Avoid aspirin, NSAIDs, and alcohol Assess anxiety Explain all procedures and treatments: Calm manner Help identify stressors Explain various coping and relaxation methods such as biofeedback, hypnosis, and behavior modification Patient Education Medication education Dietary restrictions Lifestyle changes

Management of Potential Complications Management of hemorrhage Assess for evidence of bleeding, hematemesis or melena, and symptoms of shock/impending shock and anemia Treatment includes IV fluids, NG, and saline or water lavage; oxygen, treatment of potential shock including monitoring of VS and UO; may require endoscopic coagulation or surgical intervention Pyloric obstruction Symptoms include nausea and vomiting, constipation, epigastric fullness, anorexia, and (later) weight loss Insert NG tube to decompress the stomach, provide IV fluids and electrolytes. Balloon dilation or surgery may be required

Management of Potential Complications Management of perforation or penetration Signs include severe upper abdominal pain that may be referred to the shoulder, vomiting and collapse, tender board-like abdomen, and symptoms of shock or impending shock Patient requires immediate surgery

Question What is the best time to teach a client to take proton pump inhibitors? 30 minutes before a meal With a meal Immediately after the meal One to three hours after a meal

Metabolism (Obesity) Ch 47

Obesity Obesity is body mass indices (BMI) above 30 mg/m2 66% of all adults are overweight or obese Obesity-related mortality rates are 30% greater for every gain of 5 kg/m2 of body mass beyond a BMI of 25 kg/m2 Increased risk for disease, disorders, low self-esteem, impaired body image, depression, and diminished quality of life Management Lifestyle modifications Pharmacotherapy Bariatric surgery

Bariatric Surgery Morbid obesity: persons more than two times IBW, BMI exceeds 30 kg/m2, or more than 100 pounds greater than IBW; high risk for health complications Surgery is preformed only after nonsurgical methods have failed Selection factors include body weight, patient history, failure to lose weight using other means, absence of endocrine disorders, and psychological stability

Surgical Procedures for Morbid Obesity

Surgical Procedures for Morbid Obesity

Nursing Care of the Patient Undergoing Bariatric Surgery Preoperative care; evaluation and counseling Postoperative care is similar to gastric resection, but the patient is at greater risk for complications because of obesity Patients require psychosocial interventions to modify their eating behaviors Follow-up care Education regarding long-term effects

Post-Op Care Cardiopulmonary complications, thrombus formation, anastomosis leaks, and electrolyte imbalances Risk for re-sedation Risk for infection Diligence with turning and ambulation DVT prophylaxis including Active & Passive ROM Keep skinfolds clean, protect incision If NGT: keep in correct position 30ml water or sugar free clear liquid Q 2hr High-protein liquid diet Slow eating & stop when full Postoperative diet: six small feedings totaling 600 to 800 calories per day Vomiting common complication

Collaborative Problems and Potential Complications Hemorrhage Bile reflux Dumping syndrome Dysphagia Bowel or gastric outlet obstruction

Question Is the following statement true or false? The average weight loss after bariatric surgery is 60% of previous body weight.

Collaborative Problems and Potential Complications Nursing Process: The Care of the Patient With Gastric Surgery—Diagnoses Anxiety Pain Deficient knowledge Imbalanced nutrition Collaborative Problems and Potential Complications Hemorrhage Dietary deficiencies Bile reflux Dumping syndrome

Interventions Provide interventions to reduce anxiety Pain Administer analgesics as prescribed so patient may perform pulmonary care, leg exercises, and ambulation activities Position in Fowler’s position Maintain function of NG tube Patient education Individualized nutritional care and support

Care and Prevention of Complications Gastric retention May require reinstatement of NPO and Ng suction; use low-pressure suction Bile reflux Agents that bind with bile acid: cholestyramine Malabsorption of vitamins and minerals Supplementation of iron and other nutrients Parenteral administration of vitamin B12 because of a lack of intrinsic factor Dumping syndrome Caused by rapid passage of food into the jejunum and drawing of fluid into the jejunum caused by hypertonic intestinal contents Causes vasomotor and GI symptoms with reactive hypoglycemia Avoid fluid with meals Avoid high carbohydrate and sugar intake Steatorrhea Reduce fat intake and administer loperamide

Dietary Self-Management To delay stomach emptying and dumping syndrome, assume low Fowler’s position after meals; lie down for 20 to 30 minutes Take antispasmodics as prescribed Avoid fluid with meals Meals should contain more dry items than liquid items Eat fat as tolerated but keep carbohydrate intake low and avoid concentrated carbohydrates Eat small, frequent meals Take dietary supplements as prescribed; vitamins, medium-chain triglycerides, and B12 injections