logging in or signing up digestive system disorders gbjamindang Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 452 Category: Science & Tech.. License: All Rights Reserved Like it (3) Dislike it (0) Added: October 09, 2010 This Presentation is Public Favorites: 0 Presentation Description Consists of Anatomy and physiology, assessments, nursing diagnoses, nursing interventions, and medical and surgical managements of digestive system disorders Comments Posting comment... By: gbjamindang (16 month(s) ago) Ok Suhir I will share with my powerpoint but the last few slides of this presentation was not finished or done. Are you a nurse or a doctor? nor a student or a teacher? Saving..... Post Reply Close Saving..... Edit Comment Close By: suhir (16 month(s) ago) please let me down load it Saving..... Post Reply Close By: gbjamindang (16 month(s) ago) May I know your email address so I can send u my presentation Saving..... Edit Comment Close Premium member Presentation Transcript GASTROINTESTINAL SYSTEM : GASTROINTESTINAL SYSTEM Slide 2: Functions of the gastrointestinal (GI) system Process food substances Absorb the products of digestion into the blood Excrete unabsorbed materials Provide an environment for microorganisms to synthesize nutrients, such as Vitamin K the : the Mouth Contains the lips, cheeks, palate, tongue, teeth, salivary glands, muscles, and maxillary bones Saliva contains the amylase enzyme (pytalin) that aids in digestion Esophagus A collapsible muscular tube, about 10 inches long Carries food from the pharynx to the stomach Slide 4: Stomach: Contains the cardia, the fundus, the body, and the pylorus Mucous glands Prevent autodigestion by providing an alkaline protective covering Lower esophageal (cardiac) sphincter: Prevents reflux of gastric contents into the esophagus Pyloric sphincter: Regulates the rate of stomach emptying into the small intestine Hydrochloric acid: Kills microorganisms, breaks food into small particles, and provides a chemical environment that is required by the gastric enzymes Pepsin: The chief coenzyme of gastric juice, which converts proteins into proteases and peptones Intrinsic factor: Necessary for the absorption of the vitamin B12 Gastrin : Controls gastric acidity Slide 6: Small intestine Duodenum: Contains the openings of the bile and pancreatic ducts Jejunum: Approximately 8 feet long Ileum: Approximately 12 feet long The small intestine terminates into the cecum Slide 8: Large intestine Approximately 5 feet long Absorbs water and eliminates wastes Manufacture of vitamins, including some B vitamins and vitamin K Colon Ascending Transverse Descending Sigmoid Rectum Slide 9: Liver The largest gland in the body, weighing 3 to 4 pounds Contains Kupffler’s cells, which remove bacteria in the potatal venous blood Removes excess glucose and amino acids from the portal blood Synthesizes glucose, amino acids, and fats Aids in the digestion of fats, carbohydrates, and proteins Stores and filters blood (200 to 400 ml of blood stored) Stores vitamin A, D, and B12 and iron Secretes bile to emulsify fats (500 to 1000 ml of bile a day) Slide 11: 9. Hepatic ducts Deliver bile to the gallbladder via the cystic duct and to the duodenum via the common bile duct The common bile duct opens into the duodenum, which the pancreatic duct at the ampulla of Vater The sphincter prevents the reflux of intestinal contents into the common bile duct and pancreatic duct Slide 12: GALLBLADDER Stores and concentrates bile Contracts to force bile into the duodenum during digestion of fats The cystic duct joins the hepatic duct to form the common bile duct The sphincter of Oddi guards the entrance into the duodenum The presence of fatty materials in the duodenum stimulates the liberation of cholecystokin, which causes contraction of the gallbladder and relaxation of the sphincter of Oddi Slide 13: PANCREAS B. Exocrine gland Secretes sodium bicarbonate to neutralize the acidity of the stomach contents as hey enter the duodenum Pancreatic juices contain enzymes for digesting carbohydrates, fats, and proteins Slide 14: Pancreatic intestinal juice enzymes Amylase digests starch to maltose Maltase reduces maltose to monosaccharide glucose Lactase splits lactose into galactose and glucose Sucrase reduces sucrose to fructose and glucose Nucleoses split nucleic acids to nucleotides Entorokinase activates trysinogen to trypsin Slide 16: A. Endocrine gland Insulin secretion is produced by the islets of Langerhans Insulin is secreted into the bloodstream and is important for carbohydrate metabolism Secretes glucagon to raise blood glucose levels Secretes somatostatin to exert a hypoglycemic effect DIAGNOSTIC PROCEDURES : DIAGNOSTIC PROCEDURES Upper GI tract study (Barium swallow) : Upper GI tract study (Barium swallow) Description: An examination of the upper GI tract under fluoroscopy after the client drinks barium sulfate. Preprocedure: NPO after midnight prior to the day of the test Slide 19: Postprocedure A laxative may be prescribed Instruct the client to drink increased oral fluids to help pass the barium Monitor stools for the passage of barium (stool will appear chalky white) because barium can cause a bowel obstruction Lower GI tract study (Barium enema) : Lower GI tract study (Barium enema) Description - A fluoroscopic and radiographic examination of the large intestine after rectal instillation of barium sulfate Slide 21: Preprocedure A low-residue diet for 1 to 2 days prior to the test A clear liquid diet and a laxative the evening before the test NPO after midnight prior to the day of the test Cleansing enemas on the morning of the test Slide 22: Postprocedure Instruct the client to drink increased oral fluids to help pass the barium Administer a mild laxative as prescribed to facilitate emptying of the barium Monitor stools for the passage of barium Notify the physician if a bowel movement does not occur within 2 days Upper GI fiberoscopy : Upper GI fiberoscopy Description aka esophagogastroduodenoscopy Following sedation, an endoscope is passed down the esophagus to view the gastric wall, sphincters, and duodenum; tissue specimens can be obtained Slide 24: Tu tumors Preprocedure : Preprocedure NPO for 6 to 12 hours prior to the test A local anesthetic (spray or gargle) is administered along with Midazolam (Versed) IV (provides conscious sedation and relieves anxiety just before the scope is inserted Atropine may be administered to reduce secretions, and glucagon may be administered to relax smooth muscle Client is positioned on the left side to facilitate saliva drainage and to provide easy access of the endoscope Postprocedure : Postprocedure NPO until the gag reflex return (1 to 2 hours) Monitor for signs of perforation (pain, bleeding, unusual difficulty in swallowing, elevated temperature) Maintain bed rest for the sedated client until alert Lozenges, saline gargles, or oral analgesics can relieve minor sore throat, after the gag reflex returns Anoscopy, proctoscopy, and sigmoidscopy : Anoscopy, proctoscopy, and sigmoidscopy Description Anoscopy: Use of a rigid scope to examine the anal canal; client is placed in the knee-chest position with the back inclined a 45-degree angle Proctoscopy and sigmoidoscopy: Use of a flexible scope to examine the rectum and sigmoid colon; client is placed on the left side with the right leg bent and placed anteriorly Biopsies and polypectomies can be performed Slide 28: Preprocedure: Enemas until the returns are clear Postprocedure: Monitor for rectal bleeding and signs of perforation Endoscopic retrograde : Endoscopic retrograde CHOLANGIOPANCREATOGRAPHY (ERCP) Description Examination of the hepatobiliary system via a flexible endoscope inserted into the esophagus to the descending duodenum; multiple positions are required during the procedure to pass the endoscope If medication is administered prior to the procedure, the client is monitored closely for signs of respiratory and central nervous system depression, hypotension, oversedation, and vomiting Slide 30: Preprocedure Client is NPO for several hours prior to the procedure Sedation is administered prior to the procedure Postprocedure Monitor vital signs Monitor for the return of the gag reflex Monitor for signs of perforation or infection Paracentesis : Paracentesis Description: Transabdominal removal of fluid from the peritoneal cavity for analysis Preprocedure Obtain informed consent Void prior to the start of procedure to empty bladder and to move bladder out of the way of the paracentesis needle Measure abdominal girth, weight, and baseline vital signs Note that the client is positioned upright on the edge of the bed with the back supported and the feet resting on a stool (Fowler’s position is used for the client confined to bed) Slide 32: Postprocedure Monitor vital signs Monitor for the return of the gag reflex Monitor for signs of perforation or infection Paracentesis : Paracentesis Description: Transabdominal removal of fluid from the peritoneal cavity for analysis Preprocedure Obtain informed consent Void prior to the start of procedure to empty bladder and to move bladder out of the way of the paracentesis needle Measure abdominal girth, weight, and baseline vital signs Note that the client is positioned upright on the edge of the bed with the back supported and the feet resting on a stool (Fowler’s position is used for the client confined to bed) Slide 34: Postprocedure Monitor vital signs Measure fluid collected, describe, and record Label fluid samples and send to the laboratory for analysis Apply a dry sterile dressing to the insertion site; monitor site for bleeding Measure abdominal girth and weight Monitor for hypovolemia, electrolyte loss, mental status changes, or encephalopathy Monitor for hematuria resulting from bladder trauma Instruct the client to notify the physician if the urine becomes bloody, pink or red Liver biopsy : Liver biopsy Description: A needle is inserted through the abdominal wall to the liver to obtain a tissue sample for biopsy and microscopic examination Slide 36: Preprocedure Assess results of coagulation tests (prothrombin time, partial thromboplastin time, platelet count) Administer a sedative as prescribed Note that the client is placed in the supine or left lateral position during the procedure to expose the right side of the upper abdomen Postprocedure : Postprocedure Assess biopsy site for bleeding Monitor for peritonitis Maintain bed rest for several hours Place client on the right side with a pillow under the costal margin to decrease the risk of hemorrhage, and instruct the client to avoid coughing and straining Instruct the client to avoid heavy lifting and strenuous exercise for 1 week Stool specimens : Stool specimens Includes inspecting the specimen for consistency and color and testing for occult blood Tests for fecal urobilinogen, fat, nitrogen, parasites, pathogens, food substances, and other substances; these tests require that the specimen be sent to the laboratory Quantitative 24 to 72 hour collections must be kept refrigerated until they are taken to the laboratory Some specimens require that a certain diet be followed or that certain medications be withheld; check agency guidelines regarding specific procedures PEPTIC ULCER DISEASE : PEPTIC ULCER DISEASE PEPTIC ULCER DISEASE : PEPTIC ULCER DISEASE is an excavation that forms in the mucosal wall of the stomach, in the pylorus, in the duodenum or in the esophagus. The erosion may extend as deeply as the muscle layers or through the muscle to the peritoneum Peptic ulcers are more likely in the duodenum than in the stomach PUD occurs with greatest frequency in people between 40-50 years old men. In the past, stress and anxiety were thought to be causes of ulcers, research had identified that peptic ulcers results from infection with Helicobacter pylori PREDISPOSING RISK FACTORS : PREDISPOSING RISK FACTORS Helicobacter pylori infection NSAIDs, Aspirin Gastritis, Hyperacidity Alcohol ingestion Smoking Blood Type O Type A Personality Brain Trauma (Cushing’s Ulcer) Extensive Burns (Curling’s Ulcer) Slide 42: Duodenal Ulcer Gastric Ulcer Incidence Age 30-60 Usually 50 and M:F 3:1 1:1 80% of PUD 15% of PUD S/Sx Hypersecretion of HCl Normal; hyposecretion of HCl Pain occurs 2-3 hrs after a Pain occurs ½ to 1 hour meal; often awakened after a meal; rarely occurs between 1-2 AM; at night; ingestion of food food relieves pain worsens pain Most likely to perforate Hemorrhage more likely Malignancy Rare Occasionally Risk Factors H. pylori, alcohol, H. pylori, gastritis, alcohol Smoking, stress smoking, NSAIDS, stress Slide 43: Nursing Diagnoses Acute pain related to the effect of gastric acid secretion on damaged mucosa Imbalance nutrition related to changes in diet Deficient knowledge about prevention of symptoms and management of condition. Slide 44: Clinical Manifestation Gnawing, sharp pain in or left of the midepigastric region, abdominal tenderness Heartburn (sour taste, burping when stomach is empty), diarrhea, bleeding Nausea and vomiting (obstruction) Hematemesis, melena Endoscopy: ulcer Nursing Interventions : Nursing Interventions A.Relieve pain Administer prescribed antibiotics, proton pump inhibitors, histamine (H2) blockers, cytoprotective medications and bismuth Antibiotics: Tetracycline, Amoxycillin + Clarithromycin, Metronidazole + Clarithromycin, Histamine (H2) blockers: Cimetidine (Tagamet), Ranitidine (Zantac), Famotidine (Pepcid) Proton Pump Inhibitor: Omeprazole (Prilosec), Lansoprazole (Prevacid) Cytoprotective medications: Misoprostol (Cytotec), Sucralfate (Carafate) Administer anticholinergics as prescribed to reduce gastric motility Slide 46: B. Dietary modifications Advise to eat three regular meals per day and avoid skipping meals Avoid spicy foods, caffeine (including decaffeinated beverages), alcohol, chocolate, C. Prevention of recurrence of symptoms Avoid smoking Avoid aspirin or NSAIDs Obtain adequate rest and reduce stress Slide 47: D. Surgical implementation Billroth I: Gastroduodenostomy; partial gastrectomy, with remaining segment anastomosed to duodenum Billroth II: Gastrojejunostomy; partial gastrectomy, with remaining segment anastomosed to jejunum Total Gastrectomy: Esophagojejunostomy; removal of the stomach with attachment of the esophagus to the jejunum or duodenum Slide 48: Total gastrestomy Dumping syndrome : Dumping syndrome Rapid emptying of the gastric contents into the small intestine that occurs following gastric resection Rapid emptying of the gastric contents into the small intestine rapid distention of S.I. hypertonic intestinal contents draw ECF and ingestion of fluids during mealtime stomach empties rapidly Slide 51: Clinical Manifestations Symptoms occurring 30 minutes after eating Early S/Sx: Nausea and vomiting; feelings of abdominal fullness and abdominal cramping; diarrhea Later S/Sx: reactive hypoglycemia; pallor, weakness, dizziness, palpitations, tachycardia, Slide 52: Nursing Interventions Eat a high-protein, high-fat, low-carbohydrate diet; avoid sugar and salt. Eat small meals and avoid consuming fluids with meals; fluids may be consumed 1 hours before or 1 hour after mealtime Lie down after meals for 20-30 minutes Take antispasmodic medications as prescribed to delay gastric emptying APPENDICITIS : APPENDICITIS small, finger-like appendage about 10 cm (4 inches) long that is attached to the cecum just below the ileocecal valve. It empties to the cecum regularly but inefficiently, so is vulnerable to obstruction and infection. When the appendix becomes inflamed or infected, rupture may occur within a matter of hours, leading to peritonitis and sepsis. Most common reason for emergency abdominal surgery Males are affected more frequently between the ages of 10-30 years old. Clinical Manifestation : Clinical Manifestation Anorexia, nausea, vomiting Low grade fever, Elevate WBC count Pain in the periumbical area that descends to the right lower quadrant (most intense at McBurney’s point ) Rebound tenderness Lumbar pain, pain during rectal examination, Rovsing sign (pain Right Lower Quadrant upon palpation of Left Lower Quadrant) Client in side-lying position, with abdominal guarding and legs flexed Constipation or diarrhea Slide 57: Diagnosis Complete physical examination (Iliopsoas Test, Obturator Test) CBC, Flat plate abdomen Management: Appendectomy DIVERTICULAR DISEASE : DIVERTICULAR DISEASE Slide 60: Diverticulosis Outpouching or herniations of the intestinal mucosa without inflammation or symptoms They can occur in any part of the intestine but are most common in the sigmoid colon Slide 61: DIVERTICULITIS Inflammation of one or more diverticuli that results when food and bacteria retained produces infection and inflammation and lead to perforation and abscess formation Most common in the sigmoid colon Most patients remain assymptomatic; predisposing factors: low dietary intake of fiber Chronic constipation often precedes diverticultis by many years HARTMAN’S PROCEDURE : HARTMAN’S PROCEDURE CIRRHOSIS OF THE LIVER : CIRRHOSIS OF THE LIVER Represents the end stage of liver disease in which much of the liver tissue has been replaced by fibrous tissue. It is characterized by diffuse fibrosis and conversion of normal liver architecture into structurally abnormal nodular regeneration The fibrous tissue forms constrictive bands that disrupt flow in the vascular channel and biliary duct systems of the liver Usually associated with alcoholism, it can develop in the course of viral hepatitis, toxic reactions to drug, mineral deposits (hemochromatosis, Wilson’s Disease) biliary obstruction and cardiac disease You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
digestive system disorders gbjamindang Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 452 Category: Science & Tech.. License: All Rights Reserved Like it (3) Dislike it (0) Added: October 09, 2010 This Presentation is Public Favorites: 0 Presentation Description Consists of Anatomy and physiology, assessments, nursing diagnoses, nursing interventions, and medical and surgical managements of digestive system disorders Comments Posting comment... By: gbjamindang (16 month(s) ago) Ok Suhir I will share with my powerpoint but the last few slides of this presentation was not finished or done. Are you a nurse or a doctor? nor a student or a teacher? Saving..... Post Reply Close Saving..... Edit Comment Close By: suhir (16 month(s) ago) please let me down load it Saving..... Post Reply Close By: gbjamindang (16 month(s) ago) May I know your email address so I can send u my presentation Saving..... Edit Comment Close Premium member Presentation Transcript GASTROINTESTINAL SYSTEM : GASTROINTESTINAL SYSTEM Slide 2: Functions of the gastrointestinal (GI) system Process food substances Absorb the products of digestion into the blood Excrete unabsorbed materials Provide an environment for microorganisms to synthesize nutrients, such as Vitamin K the : the Mouth Contains the lips, cheeks, palate, tongue, teeth, salivary glands, muscles, and maxillary bones Saliva contains the amylase enzyme (pytalin) that aids in digestion Esophagus A collapsible muscular tube, about 10 inches long Carries food from the pharynx to the stomach Slide 4: Stomach: Contains the cardia, the fundus, the body, and the pylorus Mucous glands Prevent autodigestion by providing an alkaline protective covering Lower esophageal (cardiac) sphincter: Prevents reflux of gastric contents into the esophagus Pyloric sphincter: Regulates the rate of stomach emptying into the small intestine Hydrochloric acid: Kills microorganisms, breaks food into small particles, and provides a chemical environment that is required by the gastric enzymes Pepsin: The chief coenzyme of gastric juice, which converts proteins into proteases and peptones Intrinsic factor: Necessary for the absorption of the vitamin B12 Gastrin : Controls gastric acidity Slide 6: Small intestine Duodenum: Contains the openings of the bile and pancreatic ducts Jejunum: Approximately 8 feet long Ileum: Approximately 12 feet long The small intestine terminates into the cecum Slide 8: Large intestine Approximately 5 feet long Absorbs water and eliminates wastes Manufacture of vitamins, including some B vitamins and vitamin K Colon Ascending Transverse Descending Sigmoid Rectum Slide 9: Liver The largest gland in the body, weighing 3 to 4 pounds Contains Kupffler’s cells, which remove bacteria in the potatal venous blood Removes excess glucose and amino acids from the portal blood Synthesizes glucose, amino acids, and fats Aids in the digestion of fats, carbohydrates, and proteins Stores and filters blood (200 to 400 ml of blood stored) Stores vitamin A, D, and B12 and iron Secretes bile to emulsify fats (500 to 1000 ml of bile a day) Slide 11: 9. Hepatic ducts Deliver bile to the gallbladder via the cystic duct and to the duodenum via the common bile duct The common bile duct opens into the duodenum, which the pancreatic duct at the ampulla of Vater The sphincter prevents the reflux of intestinal contents into the common bile duct and pancreatic duct Slide 12: GALLBLADDER Stores and concentrates bile Contracts to force bile into the duodenum during digestion of fats The cystic duct joins the hepatic duct to form the common bile duct The sphincter of Oddi guards the entrance into the duodenum The presence of fatty materials in the duodenum stimulates the liberation of cholecystokin, which causes contraction of the gallbladder and relaxation of the sphincter of Oddi Slide 13: PANCREAS B. Exocrine gland Secretes sodium bicarbonate to neutralize the acidity of the stomach contents as hey enter the duodenum Pancreatic juices contain enzymes for digesting carbohydrates, fats, and proteins Slide 14: Pancreatic intestinal juice enzymes Amylase digests starch to maltose Maltase reduces maltose to monosaccharide glucose Lactase splits lactose into galactose and glucose Sucrase reduces sucrose to fructose and glucose Nucleoses split nucleic acids to nucleotides Entorokinase activates trysinogen to trypsin Slide 16: A. Endocrine gland Insulin secretion is produced by the islets of Langerhans Insulin is secreted into the bloodstream and is important for carbohydrate metabolism Secretes glucagon to raise blood glucose levels Secretes somatostatin to exert a hypoglycemic effect DIAGNOSTIC PROCEDURES : DIAGNOSTIC PROCEDURES Upper GI tract study (Barium swallow) : Upper GI tract study (Barium swallow) Description: An examination of the upper GI tract under fluoroscopy after the client drinks barium sulfate. Preprocedure: NPO after midnight prior to the day of the test Slide 19: Postprocedure A laxative may be prescribed Instruct the client to drink increased oral fluids to help pass the barium Monitor stools for the passage of barium (stool will appear chalky white) because barium can cause a bowel obstruction Lower GI tract study (Barium enema) : Lower GI tract study (Barium enema) Description - A fluoroscopic and radiographic examination of the large intestine after rectal instillation of barium sulfate Slide 21: Preprocedure A low-residue diet for 1 to 2 days prior to the test A clear liquid diet and a laxative the evening before the test NPO after midnight prior to the day of the test Cleansing enemas on the morning of the test Slide 22: Postprocedure Instruct the client to drink increased oral fluids to help pass the barium Administer a mild laxative as prescribed to facilitate emptying of the barium Monitor stools for the passage of barium Notify the physician if a bowel movement does not occur within 2 days Upper GI fiberoscopy : Upper GI fiberoscopy Description aka esophagogastroduodenoscopy Following sedation, an endoscope is passed down the esophagus to view the gastric wall, sphincters, and duodenum; tissue specimens can be obtained Slide 24: Tu tumors Preprocedure : Preprocedure NPO for 6 to 12 hours prior to the test A local anesthetic (spray or gargle) is administered along with Midazolam (Versed) IV (provides conscious sedation and relieves anxiety just before the scope is inserted Atropine may be administered to reduce secretions, and glucagon may be administered to relax smooth muscle Client is positioned on the left side to facilitate saliva drainage and to provide easy access of the endoscope Postprocedure : Postprocedure NPO until the gag reflex return (1 to 2 hours) Monitor for signs of perforation (pain, bleeding, unusual difficulty in swallowing, elevated temperature) Maintain bed rest for the sedated client until alert Lozenges, saline gargles, or oral analgesics can relieve minor sore throat, after the gag reflex returns Anoscopy, proctoscopy, and sigmoidscopy : Anoscopy, proctoscopy, and sigmoidscopy Description Anoscopy: Use of a rigid scope to examine the anal canal; client is placed in the knee-chest position with the back inclined a 45-degree angle Proctoscopy and sigmoidoscopy: Use of a flexible scope to examine the rectum and sigmoid colon; client is placed on the left side with the right leg bent and placed anteriorly Biopsies and polypectomies can be performed Slide 28: Preprocedure: Enemas until the returns are clear Postprocedure: Monitor for rectal bleeding and signs of perforation Endoscopic retrograde : Endoscopic retrograde CHOLANGIOPANCREATOGRAPHY (ERCP) Description Examination of the hepatobiliary system via a flexible endoscope inserted into the esophagus to the descending duodenum; multiple positions are required during the procedure to pass the endoscope If medication is administered prior to the procedure, the client is monitored closely for signs of respiratory and central nervous system depression, hypotension, oversedation, and vomiting Slide 30: Preprocedure Client is NPO for several hours prior to the procedure Sedation is administered prior to the procedure Postprocedure Monitor vital signs Monitor for the return of the gag reflex Monitor for signs of perforation or infection Paracentesis : Paracentesis Description: Transabdominal removal of fluid from the peritoneal cavity for analysis Preprocedure Obtain informed consent Void prior to the start of procedure to empty bladder and to move bladder out of the way of the paracentesis needle Measure abdominal girth, weight, and baseline vital signs Note that the client is positioned upright on the edge of the bed with the back supported and the feet resting on a stool (Fowler’s position is used for the client confined to bed) Slide 32: Postprocedure Monitor vital signs Monitor for the return of the gag reflex Monitor for signs of perforation or infection Paracentesis : Paracentesis Description: Transabdominal removal of fluid from the peritoneal cavity for analysis Preprocedure Obtain informed consent Void prior to the start of procedure to empty bladder and to move bladder out of the way of the paracentesis needle Measure abdominal girth, weight, and baseline vital signs Note that the client is positioned upright on the edge of the bed with the back supported and the feet resting on a stool (Fowler’s position is used for the client confined to bed) Slide 34: Postprocedure Monitor vital signs Measure fluid collected, describe, and record Label fluid samples and send to the laboratory for analysis Apply a dry sterile dressing to the insertion site; monitor site for bleeding Measure abdominal girth and weight Monitor for hypovolemia, electrolyte loss, mental status changes, or encephalopathy Monitor for hematuria resulting from bladder trauma Instruct the client to notify the physician if the urine becomes bloody, pink or red Liver biopsy : Liver biopsy Description: A needle is inserted through the abdominal wall to the liver to obtain a tissue sample for biopsy and microscopic examination Slide 36: Preprocedure Assess results of coagulation tests (prothrombin time, partial thromboplastin time, platelet count) Administer a sedative as prescribed Note that the client is placed in the supine or left lateral position during the procedure to expose the right side of the upper abdomen Postprocedure : Postprocedure Assess biopsy site for bleeding Monitor for peritonitis Maintain bed rest for several hours Place client on the right side with a pillow under the costal margin to decrease the risk of hemorrhage, and instruct the client to avoid coughing and straining Instruct the client to avoid heavy lifting and strenuous exercise for 1 week Stool specimens : Stool specimens Includes inspecting the specimen for consistency and color and testing for occult blood Tests for fecal urobilinogen, fat, nitrogen, parasites, pathogens, food substances, and other substances; these tests require that the specimen be sent to the laboratory Quantitative 24 to 72 hour collections must be kept refrigerated until they are taken to the laboratory Some specimens require that a certain diet be followed or that certain medications be withheld; check agency guidelines regarding specific procedures PEPTIC ULCER DISEASE : PEPTIC ULCER DISEASE PEPTIC ULCER DISEASE : PEPTIC ULCER DISEASE is an excavation that forms in the mucosal wall of the stomach, in the pylorus, in the duodenum or in the esophagus. The erosion may extend as deeply as the muscle layers or through the muscle to the peritoneum Peptic ulcers are more likely in the duodenum than in the stomach PUD occurs with greatest frequency in people between 40-50 years old men. In the past, stress and anxiety were thought to be causes of ulcers, research had identified that peptic ulcers results from infection with Helicobacter pylori PREDISPOSING RISK FACTORS : PREDISPOSING RISK FACTORS Helicobacter pylori infection NSAIDs, Aspirin Gastritis, Hyperacidity Alcohol ingestion Smoking Blood Type O Type A Personality Brain Trauma (Cushing’s Ulcer) Extensive Burns (Curling’s Ulcer) Slide 42: Duodenal Ulcer Gastric Ulcer Incidence Age 30-60 Usually 50 and M:F 3:1 1:1 80% of PUD 15% of PUD S/Sx Hypersecretion of HCl Normal; hyposecretion of HCl Pain occurs 2-3 hrs after a Pain occurs ½ to 1 hour meal; often awakened after a meal; rarely occurs between 1-2 AM; at night; ingestion of food food relieves pain worsens pain Most likely to perforate Hemorrhage more likely Malignancy Rare Occasionally Risk Factors H. pylori, alcohol, H. pylori, gastritis, alcohol Smoking, stress smoking, NSAIDS, stress Slide 43: Nursing Diagnoses Acute pain related to the effect of gastric acid secretion on damaged mucosa Imbalance nutrition related to changes in diet Deficient knowledge about prevention of symptoms and management of condition. Slide 44: Clinical Manifestation Gnawing, sharp pain in or left of the midepigastric region, abdominal tenderness Heartburn (sour taste, burping when stomach is empty), diarrhea, bleeding Nausea and vomiting (obstruction) Hematemesis, melena Endoscopy: ulcer Nursing Interventions : Nursing Interventions A.Relieve pain Administer prescribed antibiotics, proton pump inhibitors, histamine (H2) blockers, cytoprotective medications and bismuth Antibiotics: Tetracycline, Amoxycillin + Clarithromycin, Metronidazole + Clarithromycin, Histamine (H2) blockers: Cimetidine (Tagamet), Ranitidine (Zantac), Famotidine (Pepcid) Proton Pump Inhibitor: Omeprazole (Prilosec), Lansoprazole (Prevacid) Cytoprotective medications: Misoprostol (Cytotec), Sucralfate (Carafate) Administer anticholinergics as prescribed to reduce gastric motility Slide 46: B. Dietary modifications Advise to eat three regular meals per day and avoid skipping meals Avoid spicy foods, caffeine (including decaffeinated beverages), alcohol, chocolate, C. Prevention of recurrence of symptoms Avoid smoking Avoid aspirin or NSAIDs Obtain adequate rest and reduce stress Slide 47: D. Surgical implementation Billroth I: Gastroduodenostomy; partial gastrectomy, with remaining segment anastomosed to duodenum Billroth II: Gastrojejunostomy; partial gastrectomy, with remaining segment anastomosed to jejunum Total Gastrectomy: Esophagojejunostomy; removal of the stomach with attachment of the esophagus to the jejunum or duodenum Slide 48: Total gastrestomy Dumping syndrome : Dumping syndrome Rapid emptying of the gastric contents into the small intestine that occurs following gastric resection Rapid emptying of the gastric contents into the small intestine rapid distention of S.I. hypertonic intestinal contents draw ECF and ingestion of fluids during mealtime stomach empties rapidly Slide 51: Clinical Manifestations Symptoms occurring 30 minutes after eating Early S/Sx: Nausea and vomiting; feelings of abdominal fullness and abdominal cramping; diarrhea Later S/Sx: reactive hypoglycemia; pallor, weakness, dizziness, palpitations, tachycardia, Slide 52: Nursing Interventions Eat a high-protein, high-fat, low-carbohydrate diet; avoid sugar and salt. Eat small meals and avoid consuming fluids with meals; fluids may be consumed 1 hours before or 1 hour after mealtime Lie down after meals for 20-30 minutes Take antispasmodic medications as prescribed to delay gastric emptying APPENDICITIS : APPENDICITIS small, finger-like appendage about 10 cm (4 inches) long that is attached to the cecum just below the ileocecal valve. It empties to the cecum regularly but inefficiently, so is vulnerable to obstruction and infection. When the appendix becomes inflamed or infected, rupture may occur within a matter of hours, leading to peritonitis and sepsis. Most common reason for emergency abdominal surgery Males are affected more frequently between the ages of 10-30 years old. Clinical Manifestation : Clinical Manifestation Anorexia, nausea, vomiting Low grade fever, Elevate WBC count Pain in the periumbical area that descends to the right lower quadrant (most intense at McBurney’s point ) Rebound tenderness Lumbar pain, pain during rectal examination, Rovsing sign (pain Right Lower Quadrant upon palpation of Left Lower Quadrant) Client in side-lying position, with abdominal guarding and legs flexed Constipation or diarrhea Slide 57: Diagnosis Complete physical examination (Iliopsoas Test, Obturator Test) CBC, Flat plate abdomen Management: Appendectomy DIVERTICULAR DISEASE : DIVERTICULAR DISEASE Slide 60: Diverticulosis Outpouching or herniations of the intestinal mucosa without inflammation or symptoms They can occur in any part of the intestine but are most common in the sigmoid colon Slide 61: DIVERTICULITIS Inflammation of one or more diverticuli that results when food and bacteria retained produces infection and inflammation and lead to perforation and abscess formation Most common in the sigmoid colon Most patients remain assymptomatic; predisposing factors: low dietary intake of fiber Chronic constipation often precedes diverticultis by many years HARTMAN’S PROCEDURE : HARTMAN’S PROCEDURE CIRRHOSIS OF THE LIVER : CIRRHOSIS OF THE LIVER Represents the end stage of liver disease in which much of the liver tissue has been replaced by fibrous tissue. It is characterized by diffuse fibrosis and conversion of normal liver architecture into structurally abnormal nodular regeneration The fibrous tissue forms constrictive bands that disrupt flow in the vascular channel and biliary duct systems of the liver Usually associated with alcoholism, it can develop in the course of viral hepatitis, toxic reactions to drug, mineral deposits (hemochromatosis, Wilson’s Disease) biliary obstruction and cardiac disease