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Dalhousie University
NURS 2280
Shauna Houk

Gastrointestinal & Genitourinary Alterations in Health Objectives  Understand the signs and symptoms of gastrointestinal disease  Awareness of the nursing assessment (examination of the abdomen, auscultation, palpation) and diagnostic procedures (radiology, stool exam, endoscopy, blood tests)  Describe gastrointestinal procedures (types of intubation, Gastrostomy, Colostomy, Ileostomy)  Explain the role of the nursing in caring for patients with nasogastric tubes and ostomy appliances (handling of medications and drainage, suction procedures, irrigation, dressing procedures)  Describe the importance of proper urinary function related to the nursing role  Identify signs and symptoms associated with urinary disease  Discuss current treatments and tests used for urinary disorders and their role in caring for them (catheters (Foley, suprapubic), ileal conduit  Discuss potential self-image and social issues that may arise and the nurses role relating to them  Identify factors to include teaching and self-management to patients living with an ostomy Purpose of the GI Tract  Breakdown food particle into molecular form for digestion  Absorption into the bloodstream of small nutrient molecules  Elimination of undigested unabsorbed foodstuffs and other waste products  Gastric function-breakdown food  Small intestine function-absorption of nutrients, minerals  Colonic function-extracts water and salts Gastric Alterations 1. Gastro-esophageal Reflux Disease (GERD) 2. Gastritis 3. Peptic ulcers 4. Cancer- esophagus, stomach, liver, pancreas 1. Gastro-Esophageal Reflux (Gerd)  Reflux of stomach acid into esophagus Causes: relaxed sphincter, pregnancy, obesity, smoking, ETOH, dietary( spicy, citrus, caffeine) Symptoms:GI burning, coughing Dx: based on symptoms, Ususally give OTC drugs, Can do GI swallow, which takes pictures to see if anything comes back up, endoscopy is used to look at sphincter tone Treatment:  Diet (avoid spicy, citrus, caffeine. Not all affect the same),  lifestyle modifications (smoking, wt loss, alcohol),  drugs- antacids, PPI’s, H2 antagonists  surgery (sx) is used if there is a floppy sphincter Nursing Care: Education on importance of prophylactic regime, diet and lifestyle changes 2. Gastritis:  Inflammation of the gastric mucosa  Acute: usually due to poor diet or alcohol abuse  Chronic Causes: dietary, ETOH, NSAIDS, bile reflux (GERD), smoking, bacteria- helicobacter pylori Symptoms: pain burning, nausea, belching, loss of appetite, wt loss Dx: CBC, H pylori, scope, bx (biopsy) Treatments: Antacids, PPI’s, H2 antagonists, antibiotics (same as GERD) Complications: Ulcers Nursing Care: Same as GERD, elevate HOB 20/ 30 degrees 3. Peptic Ulcer Disease (PUD): Evacuation of mucosa 1. Gastric, 2. duodenal 3. esophageal ulcers Causes: untreated gastritis, H. pylor ( 80%), NSAIDS, smoking, ETOH, stress Symptoms: abd pain bloating, hematemesis, melena, same as GERD Dx: symptoms, barium swallow (to see movement/ what gets left behind, scopes, Urea breath test- for H pylori Treatment: lifestyle, PPI’s, H2 antagonists, Sx Complications: GI bleed, perforation- peritonitis, 4. Gastric Cancers  Cancer of stomach- 90% adenocarcinmoa & lymphoma  High incidence & death rate, 80-90% metastases Causes: untreated h pylori, smoking, ETOH Symptoms: asymptomatic until late same as GERD, PUD Dx: XR’s, CT scans, Ba studies, scope Treatment: individualized, sx, chemotherapy, radiation Nursing Care:  Dietary modification,  Lifestyle modification  Pharmacologic therapy- antibiotics, proton pump inhibitors, histimine -2 receptor antagonists  Surgical management  Patient education  Prevention screening- early diagnosis Intestinal Alterations 1. Constipation 2. Diarrhea 3. Diverticulitis 4. Colorectal Cancer 5. Irritable Bowel Syndrome (IBS) 6. Inflammatory Bowel Disease: Ulcerative Colitis, Crohns Constipation: Less than 3 stools per week Causes: drugs, anal/rectal disorders, neurogenic/neuromuscular, weakness, immobility, diet, age, S/S: distention, bloating, dec appetite, Dx: hx, exam, abd xr Tx: fluids & fiber, exercise, po & pr meds, enemas education Complications: obstruction, hemorroids, tears/ulcerations, vasovagal episodes, megacolon, perforation PREVENTION Diarrhea: More than 3 stools per day Causes: drugs, intestinal disorders, tube feedings, bacteria/viruses, S/S urgency, cramps, perianal discomfort, incontinence, anorexia, Dx: CBC, stool exams, endocoscpy, ba enema Tx: cause, managing symptoms, preventing complications Complications: dehydration, fluid & elyte imbalance (K+ <3.5mmol/L), Diverticulitis: Saclike herniation of lining of bowel (95% sigmoid colon), Food & bacteria retained in diverticuli = inflammation, infection Causes: genetic predisposition, S/S: pain, bloating, bowel irregularity Dx: CBC, abd xr, exam, Tx: diet, antispasmodics, analagesics, antibiotics, IV fluids, GI decompression, surgery Complications: peritonitis, abcess , formation, rectal bleeding Colorectal Cancer Leading cancer Cause: adenocarcinoma (95%) S/S: most asymptomatic Dx: abd & rectal exam, xr, ct, colonscopy and bx Tx: depends on staging, sx resection, chemo, radiation, Complications: PREVENTION: Screening colonoscopy IBD Comparison Crohns Ulcerative Colitis Prolonged episodes Exacerb. & remissions Deep penetrating granulomas Mucosal ulcerations Ileum , ascending colon Rectum, descending colon No bleeding ++ bleeding Fistulas No fistulas Mod diarrhea Severe diarrhea Tx steroids, antibiotics, TPN, colectomy Tx steroids, antibiotics, surgery, ** recurrence common ** cured with total colectomy GI Assessment  Health history and clinical manifestation  Pain, dyspepsia, intestinal gas, nausea & vomiting, bowel habits, stool characteristics  Physical assessment- abd auscultation, percussion, palpation Diagnostics 1. Se
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