1. Gastronintestinal Issues and Management  What are the primary areas of concern for the patient with any stomach disorder?  Major stomach disorders Iggy p. 1126-1128  Gastritis  Peptic ulcer disease  Gastric  Duodenal  Stress 1

2. Gastroesophageal Reflux Disease (GERD)  Esophageal assessment  Evidence-based information  Noninvasive diagnostic procedures  Antacids, histamine antagonists  Priority nursing interventions 2

3. Ulcer Formation 3

4. Peptic Ulcers 4

5. Benign Gastric Ulcer 5

6. Duodenitis 6

7. Duodenal Ulceration 7

8. Irritable Bowel Syndrome Iggy p. 1144  Most common digestive disorder  One in five people in the U.S.  Classifications:  IBS-D (diarrhea)  IBS-C (constipation)  IBS-A (alternating diarrhea/constipation)  IBS-M (mix of diarrhea/constipation)  Etiology: Unclear  Thought to associated with maladaption to stressors 8

9. Irritable Bowel Syndrome (Cont.)  Health teaching  30-40 grams of fiber daily  Promote normal bowel function  Drug therapy  Symptom specific  Stress reduction  Relaxation  Meditation  Yoga 9

10. Common Abdominal Hernias Iggy p. 1146 10

11. Colostomies Iggy p. 1153, HF p. 752 11

12. Colostomy Care  Normal appearance of stoma  Signs and symptoms of complications  Measurement of stoma  Choice, use, care, application of appropriate appliance to cover stoma  Measures to protect skin  Dietary measures to control gas and odor  Resumption of normal activities 12

13. Diarrhea HF. 758  Causes  Spoiled foods or excessively spicy foods  Bacteria (Escherichia coli), virus, toxins (c. diff.)  Drug reactions  Fecal impaction, laxative abuse  Malabsorption disorders, bowel tumor, inflammatory bowel disease  Stress, anxiety

14. Antidiarrheals  Purpose  Decrease hypermotility  Caution  Should not be used for more than 2 days or if fever is present  Types  Opiates and opiate-related agents  Somatostatin analog  Adsorbents

15. Antidiarrheals (cont’d) Iggy p. 1166  Opiates and opiate-related agents  Camporated opium tincture (Paregoric)  Only used with enteral feeding associated diarrhea  Diphenoxylate with atropine (Lomotil)  Loperamide (Imodium)  Opiates decrease GI motility  Opiates may cause respiratory depression  Especially children and older adults  May cause physical dependence  Atropine contraindicated in glaucoma

16. Antidiarrheals (cont’d)  Somatostatin analog  Octreotide (Sandostatin)  Use: for severe diarrhea from cancer or malabsorption disorders  Keep refrigerated  Adsorbents  Bismuth subsalicylate (Pepto-Bismol)  Kaolin-pectin (Kapectolin)  Action: coats GI tract, absorbs bacteria or toxins  Combination agents  Parepectolin (paregoric, Kaolin-pectin)

17. Antidiarrheals (cont’d)  Nursing interventions  Monitor BP, R.  Report more than 10 to 15 mm Hg decrease in BP.  Monitor frequency of bowel movements and bowel sounds.  Assess for evidence of dehydration.  Monitor electrolytes.  Avoid fried and/or spicy foods, milk, and sedatives.  If diarrhea persists after 48 hours, notify healthcare provider (or sooner if chronically ill)

18. Constipation  Causes  Bowel obstruction, fecal impaction  Chronic laxative use, ignoring urge to defecate  Neurologic disorders  Side effect of drugs  Lack of exercise  Insufficient consumption of fiber and/or water

19. Constipation HF p. 749  Laxatives  Laxatives: soft stool  Cathartics: soft to watery stool with cramping  Purgatives: watery stool with cramping  Types of laxatives  Osmotic (saline)  Stimulant (irritants)  Bulk-forming  Emollient (stool softeners)

20. Osmotic (Saline) Laxatives  Polyethylene glycol (Miralax and GoLYTELY)  Used as a prep for colonoscopy  Lactulose (Chronulac)  Action  Hyperosmolar salts pull water into colon and increase water in feces to increase bulk, which stimulates peristalsis.  Draws ammonia out of the blood and dumps it into the gut  Side effects  Fluid and electrolyte imbalances, hypotension, weakness

21. Stimulant (Irritant) Laxatives  Bisacodyl (Dulcolax), Senna (Senokot)  Action  Increase peristalsis by irritating sensory nerve endings in intestinal mucosa  Results  Orally every 6 to 12 hours or daily, suppository until results  Side effects  Abdominal cramps, weakness, reddish brown urine, diarrhea

22. Bulk-Forming Laxatives  Psyllium hydrophilic mucilloid (Metamucil)  Calcium polycarbophil (Fiber-Con)  Action  Absorb water into intestines, increase bulk and peristalsis  Must have sufficient water intake  Results  8 to 12 hours

23. Bulk-Forming Laxatives (cont’d)  Administration  Mix in glass of water or juice.  Stir and drink immediately.  Follow with 1 glass water.  Side effects  Abdominal cramps  Excess laxative  Nausea, vomiting, gas, diarrhea

24. Emollients (Stool Softeners)  Docusate (Colace)  Action  Lowers surface tension  Promotes water accumulation in intestine  Emulsifies and lubricates feces for easier passage

25. Emollients (Stool Softeners) (cont’d)  Use  Prevent constipation  Reduce straining post surgery or myocardial infarction  Side effects  Abdominal cramping, nausea, vomiting, diarrhea

26. Laxatives  Contraindications  Undiagnosed abdominal pain  Inflammatory disorders of the GI tract  Appendicitis, diverticulitis, ulcerative colitis  Spastic colon  Bowel obstruction  Pregnancy

27. Antiulcer Drugs Iggy p. 1133 - 1134  Antacids  Aluminum (Al) hydroxide (Amphojel)  Magnesium (Mg) hydroxide/aluminum hydroxide (Maalox)  Calcium carbonate (Tums)  Sodium bicarbonate (Alka-Seltzer) (systemic)

28. Antiulcer Drugs (cont’d)  Action  Neutralize gastric acid, reduce pepsin activity  Systemic side effects  Sodium excess, water retention, metabolic alkalosis, acid rebound  Nonsystemic side effects  Mg: diarrhea; Al: constipation  Combination: none

29.  Histamine 2 blockers  Cimetidine (Tagamet), Ranitidine (Zantac)  Famotidine (Pepcid)  Action  Reduce gastric acid by blocking H 2 receptors of parietal cells in stomach  Promote healing of ulcer by eliminating cause  Also used to manage allergic reactions with H1 blockers (diphenhydramine)  Side effects  Headaches, dizziness, diarrhea, constipation, reversible impotence, gynecomastia Antiulcer Drugs (cont’d)

30.  Proton pump inhibitors  Esomeprazole (Nexium), Pantoprazole (Protonix)  Omeprazole (Prilosec), Lansoprazole (Prevacid)  Action  Reduce gastric acid by inhibiting hydrogen/potassium ATPase  Side effects  Headache, insomnia, dizziness, dry mouth, flatulence, abdominal pain

31. Antiulcer Drugs (cont’d)  Pepsin inhibitors  Sucralfate (Carafate)  Action  Combines with protein to form thick paste covering ulcer, protects from acid and pepsin  Side effects  Constipation  Nursing interventions  Given 30 minutes before meals and bedtime