Caring for Individuals Experiencing Gastrointestinal/Digestive Challenges NURS 2016

Nausea A subjective experience, wavelike sensation in the back of the throat, epigastrium, or abdomen that may lead to the urge or need to vomit A subjective experience, wavelike sensation in the back of the throat, epigastrium, or abdomen that may lead to the urge or need to vomit Increased salivation Increased salivation Aversion toward food Aversion toward food Gagging Gagging Sour taste Sour taste Increased swallowing Increased swallowing

Nursing Management of Nausea Identify cause Identify cause Eliminate or minimize noxious substance or irritants Eliminate or minimize noxious substance or irritants NPO, clear fluids or bland diet NPO, clear fluids or bland diet Antiemetics – dimenhydrinate (caution if cause is not known) Antiemetics – dimenhydrinate (caution if cause is not known)

Vomiting Forceful projection of contents from the stomach Forceful projection of contents from the stomach Symptom of numerous diseases and treatments Symptom of numerous diseases and treatments

Nursing Management of Vomiting Identify cause and eliminate or minimize Identify cause and eliminate or minimize NPO NPO Monitor emesis Monitor emesis Amount, consistency, colour Amount, consistency, colour Triggers and timing Triggers and timing Monitor fluid balance: non-enteral fluid replacement Monitor fluid balance: non-enteral fluid replacement Monitor electrolyte balance: non-enteral electrolyte replacement (Na+ and K+) Monitor electrolyte balance: non-enteral electrolyte replacement (Na+ and K+)

Gastritis Inflammation of gastric mucosa Acute: short infrequent episodes, often related to food or drink Chronic: longer duration – ulcer – may be related to bacterial invasion (helicobacter pylori)

Peptic Ulcers Doudenal Doudenal Mid adulthood Mid adulthood Males more often Males more often Lots of HCL stomach acid Lots of HCL stomach acid Wt gain (feed it) Wt gain (feed it) Pain 2-3 hours pc Pain 2-3 hours pc Bleed rare (melena) Bleed rare (melena) Higher perforation rate Higher perforation rate H.pylori, alcohol, smoking, cirrhosis, stress H.pylori, alcohol, smoking, cirrhosis, stress Gastric Gastric Older adults Even sex ratio Low or normal HCL ½ to 1 hour pc Vomiting common Bleed common (hematemesis) H.pylori, alcohol, smoking, NSAIDs, stree

Nursing Care of Ulcers Relieving pain Relieving pain Reducing anxiety Reducing anxiety Maintaining nutritional status Maintaining nutritional status Monitoring/managing complications Monitoring/managing complications Hemorrhage Hemorrhage Perforation Perforation Pyloric obstruction Pyloric obstruction

Irritable Bowel Syndrome 8-15% of population 8-15% of population Peristaltic waves affected at specific segments of bowel Peristaltic waves affected at specific segments of bowel Bloating, constipation or diarrhea, cramping, gas Bloating, constipation or diarrhea, cramping, gas Quality of Life

Nursing Care of IBS Primarily an educational role regarding monitoring diet and reducing stress Primarily an educational role regarding monitoring diet and reducing stress Hydrophilic colloids (psyllium) Hydrophilic colloids (psyllium) Avoid excess intake of fluids with food Avoid excess intake of fluids with food Study findings Nurses believed pts were demanding and difficult Nurses believed pts were demanding and difficult Low pain tolerance and crave attention Low pain tolerance and crave attention Nurse had insufficient knowledge and not interested in more Nurse had insufficient knowledge and not interested in more

Diverticular Disease Diverticulum Diverticulum Diverticulosus Diverticulosus Diverticulitis DiverticulitisComplications Peritonitis Peritonitis Abscess formation Abscess formation Bleeding Bleeding

Nursing Care Aimed primarily at comfort and rest Aimed primarily at comfort and rest Monitoring development of complications Monitoring development of complications Working with client to identify ‘triggers’ Working with client to identify ‘triggers’

Bowel Obstruction Partial or complete impairment of forward flow of intestinal contents Partial or complete impairment of forward flow of intestinal contents May be small or larg bowel (most often small bowel, ileum). May be small or larg bowel (most often small bowel, ileum). Complete obstruction – surgical emergency – high mortality if not released Complete obstruction – surgical emergency – high mortality if not released

Bowel Obstruction: Clinical manifestations Small bowel Crampy, wave, colicky Crampy, wave, colicky No fecal or flatus No fecal or flatus Peristalsis may reverse --vomiting Peristalsis may reverse --vomiting Large bowel Slower progression Slower progression Crampy lower abd pain Crampy lower abd pain Abd distention:loops of bowel visible Abd distention:loops of bowel visible Fecal emesis Fecal emesis

Treatment of Obstruction Gastric intubation (sump) Gastric intubation (sump) Surgical intervention Surgical intervention NPO NPO Parenteral Hydration Parenteral Hydration Temporary or permanent ostomy Temporary or permanent ostomy

Inflammatory Bowel Disease Crohn’s Ulcerative Colitis Study table on page 1041 Understand Therapeutic management Therapeutic management Systemic complications Systemic complications

Inflammatory Bowel Disease Nutritional therapy Nutritional therapy Low residue, high protein, high calorie Low residue, high protein, high calorie Pharmacological therapy Pharmacological therapy Anti-inflammatory: ASA, corticosteriods Anti-inflammatory: ASA, corticosteriods Immunmodulators Immunmodulators Surgical management Surgical management

Inflammatory Bowel Disease Focus on assisting client to deal with symptoms and treatment modalities Nsg Dx Altered nutrition (less than body requirements) related to restrictive diet, nausea, and malabsorption Altered nutrition (less than body requirements) related to restrictive diet, nausea, and malabsorption

Nursing Role Common to GI Challenges Assessment, planning, intervening and evaluation related to Pain control Pain control Hydration Hydration Nutritional Status Nutritional Status Knowledge and understanding of medication and treatment regime Knowledge and understanding of medication and treatment regime

Nutritional Routes Enteral: all or most of the GI tract is used Traditional Traditional Modified Modified Parenteral: GI tract is not utilized as a nutritional route

Enteral Therapy Nasogastric, gastric intubation Nasogastric, gastric intubation Gastrointestinal tract integrity preserved. Gastrointestinal tract integrity preserved. Normal sequence of intestinal hepatic metabolism preserved. Normal sequence of intestinal hepatic metabolism preserved. Goal: Maintaining nutritional balance

Feeding Solutions Osmolality Osmolality Lactose-free Lactose-free 1cal/ml 1cal/ml Intermittent Intermittent Continuous Continuous

Nursing Considerations Temperature, volume, flow rate Temperature, volume, flow rate Total fluid intake Total fluid intake Residual gastric content Residual gastric content Medication administration Medication administration

TPN Increase nutritional status Increase nutritional status Establish +ve N+ balance Establish +ve N+ balance Maintain muscle mass Maintain muscle mass Promote weight gain Promote weight gain Enhance healing process Enhance healing process

TPN Administration 5-6x the solute [ ] of blood 5-6x the solute [ ] of blood Administer in high flow vessel (subclavian) Administer in high flow vessel (subclavian) Large bore central line Large bore central line

Complications of TPN Pneumothorax Pneumothorax Air embolism Air embolism Clotted catheter line Clotted catheter line Catheter displacement Catheter displacement Sepsis Sepsis Hyperglycemia or rebound hypoglycemia Hyperglycemia or rebound hypoglycemia Fluid overload Fluid overload

A glimpse at Laxatives Bulk forming Saline agent

Management Perforated diverticulum Perforated diverticulum Peritonitis PeritonitisDietPharmacologicalSurgical