Caring for Individuals Experiencing Gastrointestinal/Digestive Challenges

1. Caring for Individuals Experiencing Gastrointestinal/Digestive Challenges NURS 2016

2. 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 • Increased salivation • Aversion toward food • Gagging • Sour taste • Increased swallowing

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

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

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

6. 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)

7. Doudenal Mid adulthood Males more often Lots of HCL stomach acid Wt gain (feed it) Pain 2-3 hours pc Bleed rare (melena) Higher perforation rate H.pylori, alcohol, smoking, cirrhosis, stress 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 Peptic Ulcers

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

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

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

11. Diverticulum Diverticulosus Diverticulitis Complications Peritonitis Abscess formation Bleeding Diverticular Disease

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

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

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

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

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

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

18. 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

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

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

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

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

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

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

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

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

27. A glimpse at Laxatives Bulk forming Saline agent

28. Management • Perforated diverticulum • Peritonitis Diet Pharmacological Surgical