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Gastrointestinal 2
- management
- NPO (nothing by mouth)
- nasogastric tube
- antibiotics: clarithromycin (Biaxin); metronidazole (Flagyl)
- H2 receptor antagonists: cimetidine (Tagamet); rantidine hydrochloride (Zantac); famotidine (Pepcid); nizatidine (Axid)
- anticholinergics: dicyclomine hydrochloride (Bentyl)
- antacids; aluminum hydroxide (Amphogel); aluminum-magnesium combinations (Maalox, Mylanta, Gelusil); calcium carbonate (Tums)
- cytoprotective: sucrulfate (Carafate)
- proton pump inhibitors: omeprazole (Prilosec), iansoprazole (Prevacid)
- anxiolytics
- blood administration
- surgical Intervention
- Postoperative complications
- dumping syndrome- from rapid emptying of the stomach
- tachycardia, palpitations, syncope, diaphoresis, diarrhea, nausea, abdominal distention
- more common with Billroth II
- subsides after several months
- decrease with slow eating, low-carbohydrate, high-protein and fat diet
- avoid liquids with meals
- pernicious anemia secondary to loss of intrinsic factor
- Nursing interventions
- pain relief
- assess for bleeding
- discuss life-style changes: stop smoking, decrease stress
- teaching - medications, diet
- assess for post-operative complications - infection, bleeding, respiratory complications
- maintain patency of NG tube
- observe drainage for signs of bleeding (drainage should be dark red after 24 hours)
- mouth care
- Disorders of Intestines
- Inflammatory intestinal diseases - chronic, recurrent inflammation; etiology unknown
- ulcerative colitis
- definition/etiology
- affects young people ages 15 to 40
- pathophysiology
- ulceration and inflammation entire length of colon
- involves mucosaand submucosa
- begins in rectum and extends to distal colon
- abscess and ulcers lead to bleeding and diarrhea
- colon cannot absorb, so fluids and electrolytes go out of balance
- protein is lost in stools
- scarring produces narrowing, thickening, and shortening of colon
- remissions and exacerbations
- findings
- bloody diarrhea ranging from two to three per day to ten to 20 per day
- stools may also contain pus and mucus
- abdominal (tenderness and cramping) pain
- fever, weight loss, anemia, tachycardia, dehydration
- impaired absorption of fat-soluble vitamins such as E, K
- systemic manifestations
- skin lesions - erythema nodosum
- joint inflammation
- inflammation of the eyes - uveitis
- liver disease
- diagnosis
- sigmoidoscopy
- colonoscopy
- barium enema - definition
- complete blood count (CBC)
- management
- rest
- fluid, electrolyte, and blood replacement
- steroidsas anti-inflammatories
- immunosuppressives
- anti-infectives: sulfasalazine (Azulfidine) primary drug of choice
- anticholinergics
- antidiarrheals
- dietary restrictions - high calorie and high protein
- surgical management
- total proctolectomy and ileostomy
- ileorectal anastomosis
- total proctolectomy with continent ileostomy (Kock pouch)
- total colectomywith ileal pouch (reservoir)
complications
- increased risk of colon cancer
- fluid and electrolyte imbalances
- nursing interventions
- manage pain
- manage diarrhea
- teach weight loss and nutrition
- teach coping
- remedy knowledge deficit
- reduce anxiety
- Crohn's disease
- definition/etiology
- young people 15 to 30 years old
- inflammation of segments of bowel, especially ileum, jejunum, and colon, with areas of normal bowel between inflamed bowel - cobblestone appearance
- inflammation involves all layers of bowel wall - transmural
- ulceration, fissures, fistula, and abscess formation
- bowel wall thickens and narrows, producing strictures
- slowly progressive
- findings
- diarrhea with steatorrhea (fats not processed)
- abdominal pain - right lower quadrant (illustration)
- fatigue, weight loss, dehydration, fever
- systemic manifestations
- arthritis, clubbing of fingers
- skin inflammations
- nephrolithiasis
- complications
- obstruction from strictures
- fistulaformation
- bowel may perforate and infect: peritonitis
- medical management
- rest
- nutritional support
- hyperalimentation
- diet high in calories and protein, low in roughage and fat
- steroids as anti-inflammatories
- immunosuppressives
- anti-infectives: sulfasalazine (Azulfidine) primary drug of choice
- anticholinergics
- antidiarrheals
- loperamide (Imodium) drug of choice
- balloon dilation of strictures
- surgery will not cure Crohn's disease; may limit damage
- colectomy with ileostomy
- subtotal colectomy with ileostomy or ileorectal anastomosis
- nursing interventions
- after surgery, monitor
- diarrhea
- fluid balance and nutrition
- skin integrity
- coping and self-care
- sexuality
- medications
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