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BASIC ANATOMY




To better understand the gastrointestinal system, it is best to understand the process of digestion.

 

A.  Oral Cavity (Mouth)

·    Food is initially ingested via the oral cavity.

·    It consists of the lips, cheeks, teeth, gums, tongue, palate and salivary glands that are involved in ingestion, mastication, salivation and swallowing of food.

          1.         The salivary glands consist of the following Parotid, Submaxillary, Sublingual, Buccal glands, all of which are responsible for protection of the oral mucosa and the lubrication of food as it passes along the digestive system.  

        2.         The tongue

·              Mainly responsible for speech, taste and mastication.

·              Contains papillae that are able to detect the following distinct tastes:  bitter, sweet, salty and sour.                        

B.  Pharynx

·    The pharynx connects the oral cavity to the esophagus.

·    Food enters the esophagus via the hypopharyngeal sphincter, the superior end of the esophagus.  This sphincter may open during vomiting.

 

C.  Esophagus

·    Food continues down the esophagus via the peristaltic waves that are exerted by the cellular layers of the esophageal wall.

·    Food enters the Stomach via the gastroesophagel sphincter, also called the cardiac sphincter.

·    Achalasia occurs when food is unable to travel down the esophagus due to nonperistaltic movement.

·    The esophagus does not excrete any enzyme that helps in the digestion of food. It secretes mucus that helps protect the mucosa from the “abrasive” form of the food.

 

D.  Stomach

·    Food enters the stomach via the cardiac sphincter, also called the gastroesophageal sphincter, and is converted in the stomach into its chyme state before passage to the duodenum.

·    Has three parts:  fundus, the body, and he pylorus.

·    The phyloric sphincter, similar to the cardiac sphincter in function, opens up to the duodenum

·    Secretes mainly      (a) mucus – to protect the lining of the stomach, from food and hydrochloric acid
                               (b) enzymes – helps in the breakdown of food.

          The common gastric juices excreted in the stomach once the bolus of food enters the stomach are:

          1.     Hydrocholirc acid, the main gastric juice that is excreted in the stomach, is an enzyme that is involved in protein digestion. It also activates other enzymes in the stomach (like the pepsin that also aids in the protein digestion), and aids in killing bacteria.

          2.     Intrinsic factor, a mucoprotein that is important in the absorption of vitamin B12.  When released the intrinsic factor adheres in the epithelial cells in the ileum, which if and when removed, would require a person to take B12 for life.

          3.     Lipase helps in the breakdown of triglycerides to fatty acids and monglycerides.

          4.     Gastrin –a hormone that helps in the breakdown in the digestion of meats.         

 

E.  Small Intestine

·    Consists of the duodenum jejunum, and ileum, the longest section.

·    Majority of food nutrients are absorbed in the small intestine because its surface area consists of villi and microvilli, small fingerlike projections.

·    Once chyme enters the dudodenum, contraction called segmentation occurs allowing the chyme to be moved down.

·    Fat digestion occurs in the small intestine.  

F.  Large Intestine

·    Contains no villi.

·    Mainly responsible for absorption of water and electrolytes and in the elimination of wastes.

·    Consists of the following:

          (a)     Cecum, where the ileum empties its contents. 

          (b)     Appendix is attached to the cecum and it has no known use and must be removed if it gets infected.

          (c)     Colon – has three main parts: the ascending, traverse and the descending and the sigmoid colon (the portion that crosses from the left to the midline to become the rectum). Most of the absorption occurs in the ascending and traverse colons.

          (d)     Rectum and Anus. The rectum has veins and arteries. If the veins get enlarged they form hemorrhoids.

·    Movement of chyme in the large intestine, referred to as either segmentation or haustration, is slow to allow liquid to be absorbed. Movement can be inhibited by cholinergic drugs and / or diets low in bulk.

·    It contains bacteria that help in the formation of gases which in turn helps provide bulk and propel feces, which is ¾ water and ¼ solid matter normally when eliminated. The bacteria also help in the synthesis of Vitamin           K, thiamine, riboflavin, Vitamin B12, folic acid, biotin and nicotinic acid.

   

Other Accessory Organs of Digestion

Pancreas

·    Both an endocrine (secretes insulin and glucagons) and exocrine (the acinar glands secrete digestive enzymes) organ.

·    The main pancreatic duct is the duct of Wirsung, which empties out to the ampulla of Vater, a short segment just before the common bile duct enters the duodenum, via the sphincter of Oddi.

·    Main enzymes released are:

          (a)    Amylase – for hydrolysis of carbohydrates

          (b)    Lipase – helps in the breakdown of triglycerides to fatty acids and monglycerides.

          (C)    Protease  - the main proteolyctic enzyme is Trypsin, which is responsible for amino acid breakdown.

·    Also pancreatic secretions contains sodium bicarbonate which reacts with the HCL that is emptied in the duodenum , thus forming sodium chloride and carbonic acid, which is eventually eliminated in the lungs as CO2.   The release of carbonic acid results in the sodium chloride, a neutral salt, content increase in the intestine. In effect, this pancreatic enzyme neutralizes the acidity of the chyme from the stomach.

 

Liver

·    Provides bile (the green bile that is eventually stored in the gallbladder) for fat digestion and metabolism of carbohydrates, fats and proteins.

·    Removes bilirubin, the by product of the hemoglobin breakdown, from the blood via urine and feces. Jaundice occurs when bilirubin is not eliminated properly.

·    Store glycogen through glycogenesis (glucose to glycogen) and breaks it down via glycogenolysis (glycogen to glucose)

·    A site for synthesis of certain blood clotting factors (I, II, V, VII, and X)

·    Stores the fat soluble vitamins, Vitamin B12 and iron and copper.

·    Aids in the metabolism of hormones and drugs.

 

Gallbladder

·    Bile produced by the liver is stored in the gallbladder. Absence of bile lead to fat malabsorption leading to steatorrhea (fatty stools)

 

 

TOPICS

 

Abdominal Aortic Aneurysm

·    Main objective is to improve blood pressure and blood flow to brain. Thus, repositioning the patient to a lower head position will help.

 

Abdominal Assessment

·    > 30 sounds /min is hyperactive; Normal is 5 - 30 sounds/ min

·    Physical Assessment order: Inspection, Auscultate, Palpation, Percussion

·    NG tube for draining the stomach and T- Tube for the gallbladder  

 

Abdominal Surgery

·    POST – don’t wet the gauze that has dried over the wound, just remove to help get rid of necrotic tissue.

·    Place on low Fowler to reduce stress on suture line, may be placed supine with hips and knees bent

·    For any abdominal surgery, ambulation facilitates flatus. Client is NPO until bowel sounds are heard, thus avoiding distention.

·    Skin can be best protected with petroleum jelly if Patient is incontinent rather than talcum or corn starch

·    Post surgery, a patient is usually put on a clear diet and progress to regular diet.

·    Post surgery, a patient is put on a stool softener to avoid constipation.

 

Achalasia

·    Functional obstruction of the esophagus where the lower esophageal sphincter is not able to relax leading to non-peristaltic spasm like contraction.

 

Anorexia Nervosa

·    Distorted body image.

·    Gaining weight is the first priority.

·    Pectus Carnatum or Pigeon Chest - sternum is visible - is common in girls with Anorxia Nervosa.

·    Patients are usually not allowed to choose their own food since they will only choose food that they want to eat.

·    Make sure you observe the patient taking in food and stay with the patient to avoid any attempt of purging. 

·    Usually not roomed in alone to prevent any possible purging or doing activities that will make the individual loose weight.

·    Patient is asked to avoid participating in extrenuous activities.

 

Appendicitis

·    Pain usually occurs on the right lower quadrant.

·    Pain is similar to Diverticulitis, but the pain for Diverticulitis usually occurs on the left lower quadrant. 

 

Ascites

·    Ascites is best determined by measuring the abdominal girth.  

 

Bulimia  

·    Patient usually has a normal weight but feels hopeless to correct the problem.

·    Dental caries is common since the teeth tend to erode from constant vomiting.

·    Hoarse voice barely audible can be a sign of tracheosesophageal fistula from esophageal tear;  In essence, laryngitis is a danger sign.

·    An adolescent with scars on his/her knuckles may be a sign that the individual is purging food or is inducing vomit after eating.  

 

Cancer

·    Colorectal Cancer -  individuals who are on high protein and refined carbohydrates (like those with Ulcerative Colitis) are at a greater risk of developing colorectal cancer.   

 

Celiac Disease

·    Watch out for food containing gluten. Bread and pasta contain gluten. Flour made from wheat also contains gluten.

 

Cholecystectomy

·    A spike in temperature may be normal.

 

Colonoscopy 

·    For Colonoscopy, it is important to check fluid and electrolyte imbalance.

·    DURING the Procedure, bowel preparation and NPO status puts patient at high risk for electrolyte imbalances.

 

Colostomy Care

·    COLOSTOMY - postoperatviely, stoma should be beefy red, and if irrigation is required, it is done on 4th or 5th day with 500ml at first via a catheter or bulb syringe (750 ml is used instead); Colostomy bag must be   changed at least every 7 days or when at least 1/2 full.

·    One can have a bath with colostomy

·    Leave skin open to air when possible as changing pouch though exposing to air does not necessarily mean prevention of skin breakdown. BEST way to prevent skin breakdown is to have a close fitting bag.

·    Use Nystatin or powder if yeast infection develops.

·    Proximal end of double barrel colostomy ends at the small intestines, on the patient’s right side.

 

Constipation

·    Constipation for one person maybe normal for another but usually defined as such if person passes hard stool at least 3 times a week, straining in every bowel movement, and having abdominal bloating.

·    Taking laxatives often causes constipation since the bowel becomes dependent on it. NOTE: Laxatives can also prevent absorption of needed nutrients.

·    Can lead to hemorrhoids or rectal fissures.

·    Encourage patient to eat foods high in fiber and to drink lots of fluid.

·    Encourage patient to engage in regular physical exercise.

·    If not treated can lead to ulcers and fistulas.  

Crohn

·    Like Ulcerative Colitis, is an Irritable Bowel Disease (IBD)

·    To differentiate from Ulcerative Colitis, the inflammation of Crohns is NOT contiguous

·    Some develop granulomas that appear like cobblestones and this also differentiates it from Ulcerative Colitis.

·    Usually strikes at an early age, 20 – 30 years of age.

·    Common to individuals of Jewish and European background especially if the individual has a close relative who has had the disease.

 

Dehiscence

·    Also referred to as evisceration.

·    Cover the abdominal viscera with asaline soaked gauze and inform the doctor.

·    Put patient in a Fowler position.

 

Diabetes Insipidus  

·    Deficient in ADH by pituitary gland, thus, there is an increase in urine output and very diluted urine.

·    Patients have excessive urine output.

·    Can develop in patients who has had tumors removed from the pituitary gland.

·    Specific gravity is less than 1.005.

·    Patient would require a Desmopressin Acetate intra-nasally or SQ for the rest of life to reduce urine production.

 

Diabetic Ketoacidosis (DKA)

·    Occurs when the body starts breaking down fat instead of glucose needed by the cells of the body. The breakdown of fat releases ketones

·    Person will exhibit fruity breath (similar to acetone or polish remover) and person is restless, having difficulty waking up.

·    Severe DKA leads to cerebral edema or coma and treatment involves giving insulin and fluids.

·    Associated with dehydration so fluids are encouraged.  

 

Diabetes Mellitus

    Types:

            a.    Type 1 Diabetes (also called Juvenile Diabetes)

            b.    Type 2 Diabetes

          c.     Gestattional Diabetes - Occurs during pregnancy where extra glucose produced can cross the placenta and cause the baby pancreas to produce additional insulin but can lead to a large baby (macrosomia). After birth, the baby may be hypoglycemic because it continues to creates its own insulin without the mother’s additional glucose.  

·         Very low glucose puts the patient at high risk for seizures.

·         Garlic can potentiate the action of diabetic drugs.

·         If hypoglycemia, especially if around 40 - 60 mg/dL, occurs give milk and crackers. If orange juice is given it’s good to follow it up with a meal or protein shake.  Note: orange juice should be avoided for those with renal failure since kidneys will not be able to excrete the added potassium.

·         For children, polyuria, polyphagia, polydyspia (3Ps), along with weight loss (even if the person is eating well) suggest Type 1 diabetes. One may see fatigue and bed wetting in children.

·         In adolescents, recurring UTI is an indication of Type 2 diabetes.

·         Watch for SOMOGYI effect - Normal or elevated blood glucose at bedtime but hypoglycemic at 2 - 3 a.m. and a spike in the morning upon waking.

·         Glycosylated Hemoglobin (HBAIC) – level of glucose within a period of at least 3 months.  Normal range is 3 – 6%

·         The best way to diagnose diabetes is the fasting plasma glucose (FPG) test since it is easy to administer, convenient for patients, and less expensive than other tests. FPG measures your blood glucose level after you have fasted or not eaten for 10 to 12 hours. Normal fasting blood glucose is between 70 and 100 mg/dl for people who do not have diabetes. The standard diagnosis of diabetes is made when two blood tests show that your fasting blood glucose level is greater than or equal to 126 mg/dl.  

 

Diarrhea

·    One is loosing bicarbontate resulting in Metabolic Acidotic
 

 
Diverticulitis


·    The lining of the digestive system has small pouches, called diverticula, if inflamed causes Diverticulitis.

·    It usually occurs in the large intestine but can occur anywhere.

·    Board like abdomen is a complication of Diverticulitis. The pain is similar to Appendicitis but the pain usually occurs on the lower left quadrant as oppose to the right lower quadrant.

·    If the pouch ruptures, its contents leaks into the abdominal cavity and can lead to Peritonitis.

 

Electrolytes  

·    Hypernatremia – can lead to mania.

·    Hyponatremia – can lead to muscle cramps and altered LOC

·    Hyperphosphatemia – phosphate produced by in the neck area.

·    Hypomagnesemia - may result in cardiac arrest, manifested in neuromuscular irritability, tremors, tetany, seizures; common in alcoholics.  

 

Encepalopathy

·    Patient may exhibit asterixis (flappin tremors) that are seen on wrists when the arms are extended.

·    A patient experiencing asterixis is a sign of liver failure.

·    Patient usually given lactulose to decrease absorption of ammonia and other toxins.

 

Enema

·    Enema should not be inserted more then 4 inches.

·    Don’t ask the patient to tense to avoid damaging mucosa. Enema should be 12-18 high to avoid rapid entrance of water causing distention and pressure in the intestine and damaging the mucous membranes.

 

Esophageal Varices  

·    Esophageal tamponade is used to control bleeding.

·    Upper bleeding will result in black or tarry stool.

·    Blood in the gastrointestinal tract can cause diarrhea.

·    A patient experiencing  blood loss will have tachycardia.

·    Maintain the pressure of the balloon at 20 – 25mmHg

·    Usually no epigastric pain involved as in Peptic or Gastric Ulcers.

 

Evisceration  

·    Cover the abdominal viscera with a saline soaked gauze and inform the doctor.

·    Also referred to as dehiscence.

·    Put patient in a Fowler position.

 

Gastoresohageal Reflux Disease (GERD)

·    A condition that occurs when the contents of the stomach backs up into the esophagus, via the lower esophageal sphincter.

·    Long term GERD can lead to Barret’s esophagus, where the lining and composition of the esophageal cells change due to repeated exposure to stomach acid.

·    Avoid eating 3-4 hours before bedtime and do not lie down immediately after eating.

·    Avoid carbonated drinks

·    Try to sleep on left side to prevent reflux

·    Avoid spicy, acidic and sodas / colas.  

 

Heartburn

·         Occurs when the acidic content of the stomach backs up into the esophagus via the lower esophageal sphincter.

·         Frequent heartburn can mean GERD.

·         This mimics a heat attack since it causes burning and painful sensation on the chest.

·         To differentiate from a heart attack is difficult but symptoms specific to a heart attack are:

         a.    Sudden chest pressure that is tight and feels like squeezing that lasts for more than a few minutes.

         b.    The pain radiates to the back, neck, jaw and shoulders, especially the left arm.

         c.    Along with the chest paint, the patient is experiencing shortness of breath, sweating, dizziness and nausea.

         d.    Pressure or tightness on the chest during any physical activity.  

 

Hepatitis

·    Symptoms often can be mistaken as intestinal flu (gastroenteritis). The symptoms include:  Malaise, low grade fever, muscle pain, dark urine, itching, loss of appetite, abdominal pain or discomfort especially on the right side.

·    Interferes with the ability of the liver to metabolize bilirubin thus its level is increased.

·    A patient may experience itching because of jaundice. A patient with HEPATITIS can experience pruritis.

·    To help relieve itching, one can use baby oil on bath water. Also, advice patient not to take too many showers or apply powder which both can lead to skin dryness.

·    Jaundice can be best seen in the oral mucosa for dark skinned individuals. The conjuctiva can have fatty deposits that appear yellow.

·    Patient with hepatitis can develop Ascites which is best determined by measuring the abdominal girth.

·    If a liver biopsy is done, patient should be positioned on the right side (the side of the liver) to help apply pressure on the area and prevent bleeding.

 

Types of Hepatitis

  1.     Hepatitis A

·              Transmitted orally via feces and contaminated water. Vaccine is available.

·              Ask patient to practice good handwashing and to properly clean and cook raw food.

·              Communicable 2 -3 weeks before onset of jaundice and about 1 week after. 

  2.     Hepatitis B

·              Transmitted by blood and bodily fluids. Vaccine is available.

  3.     Hepatitis C

·              Transmitted by blood and bodily fluids. No vaccine available.

  4.     Hepatitis D

·              Usually occurs with Hepatitis B.

  5.     Hepatitis E

·              Transmitted via contaminated water and in oral contact with feces.   

 

Hydration

·    Hypotonic solutions are good.  

 

Ileostomy  

·    Proper cleansing of the stoma should be done to prevent skin irritation.  

INSULIN

·         Insulin is used by the body to allow glucose to enter the cells of the body and be used as energy. Without insulin, glucose level can increase in the blood.

·         Insulin is the ONLY medication compatible with TPN.

·         Doesn’t have to be refrigerated.

·         Human Regular insulin is clear and be drawn with NPH, a cloudy, insulin to avoid giving two injections. Be sure to draw the clear insulin first to avoid contaminating the cloudy insulin.

·         Shaking the bottle causes it to form bubbles and foam. Simply rotate the bottle between palms for at least a minute.

·         When doing a needlestick DON’T milk the finger, it can force to mix the interstitial fluid with cap blood.

·         Rotate injection sites. Failure to do so can result in poor absorption, thus, increasing blood glucose level. Use of the same site can result in lipodystrophy a saucer like depression at the site due to the changes in the subcutaneous fat.

 

Irritable Bowel Syndrome (IBS)

·    Symptoms include abdominal cramping, bloating and gas; diarrhea or constipation or both .

·    Does not cause any tissue changes in lining of the stomach like ulcerative colitis or crohns disease.

·    No bloody stool like Ulcerative or Crohns; pattern could be alternating diarrhea and constipation ; Elevated ESR would indicate an inflammatory process  

 

Jackson Pratt

·    Used for wound drainage  

 

NGT / PEG Feedings

·    Check for placement before each use by injecting air and listening for bubbling sounds over the abdominal area

·    Placement can also be checked by aspirating gastric content and checking the pH. Normal  gastric pH is between 1 – 5. The output could be green or brown in color or clear, or colorless. A tan colored output could mean           that the tube is lodged in the lungs.

·    Check for residuals before administration of any medication

·    Flush the tube after each use. Always flush the tube with at least 2 – 4ml of water NOT normal saline before and after administration of medication.  

 

Nontropical Sprue

·    Similar to Celiac Disease. One ought to avoid food with gluten.  

 

LIVER ISSUES  

            A. Cirrhosis

·              Scarring of the liver. When scarred, it will not be able to do its functions.

·              Cirrhosis of the liver can lead to ascites, which can be seen with abdominal enlargement and fluid wave but it is best assessed by measuring abdominal girth daily.

·              Patients with ascites or liver problems require more protein in their diet.

·              Can lead to encepalopathy.

·              Can cause portal hypertension since blood from spleen, pancreas and intestine pass through the large portal vein and if the liver is scarred, blood can back up and cause pressure.

·              Can lead to bleeding since liver is responsible for certain clotting factors.  

            B. Encepalopathy

·              Mental confusion such as forgetfulness or trouble concentrating.

·              Patient may exhibit asterixis (flapping tremors) that are seen on wrists when the arms are extended.

·              A patient experiencing asterixis is a sign of liver failure.

·              Patient is usually given Lactulose to decrease the absorption of ammonia and other toxins in the intestine.   

            C. Jaundice  

·              A patient may experience itching because of jaundice. A patient with HEPATITIS can experience pruritis.

·              To help relieve itching, one can use baby oil on bath water. Also, advice patient not to take too many showers or apply powder which both can lead to skin dryness.    

            D. Liver Biopsy

·              A procedure where a sample of the liver is removed. It is the only definitive way to diagnose cirrhosis but it can cause bleeding.

·              There is a risk of bleeding after biopsy so check patient coagulation problems.

·              After procedure, best if patient lies on right side to prevent bleeding.  

            E. Liver Transplant

·              A patient with liver transplant is on an immunosuppressant such as Cyclosporin, for the rest of life to prevent organ rejection.  

 

Pancreatitis

·         Pancreatic enzymes are given with meals to help in the digestion of meals.

·         Whipple is the head of the pancreas. A whipple procedure would entail the removal of the head of the pancreas including portions of the stomach and jejunum and are all re-anastomosed.

·         After the whipple procedure, nurse should watch out for any clear or bile tinged output which may indicate some kind of leakage in the anastamosed area.

·         An NG tube to bypass the pancreas therefore reducing the secretion of the pancreatic juices and to assist in relieving pain.

·         Viokase, a pancreatic enzyme or a pancrelipase that can facilitate digestion, can be given to a patient BUT is best given during meals.

·         DO NOT give Morphine, can cause spasms  of the sphincter of Oddi; Meperidine is drug of choice; DO nasogastric suctioning to remove gastric secretions and distention since Patient is NPO to decrease secretion of secretin.

·         Diet for a pancreatic patient is high in calorie and low in fat.

·         Patient is usually placed NPO to reduce pancreatic enzyme secretion.

·         ERCP (endoscopic retrograde cholangiopancreatography) is done to help in the diagnosis;  an endoscopy is done down the throat through the stomach up until the opening of the bile and pancreatic ducts in duodenum. A dye passed through a thin, flexible tube (catheter) inside the endoscope allows for X-ray images of the ducts  

 

Paracentisis

·    A procedure that involves inserting a needle through the abdominal wall to remove fluid.

·    Make sure to have BP cuff on to check for shock which may occur after removal of fluid.

·    This procedure is done to help diagnose the cause of fluid buildup in the abdominal cavity.   

 

PEG / NGT Feedings

·    Check for placement before each use by injecting air and listening for bubbling sounds over the abdominal area

·    Placement can also be checked by aspirating gastric content and checking the pH. Normal  gastric pH is between 1 – 5. The output could be green or brown in color or clear, or colorless. A tan colored output could mean that the tube is lodged in the lungs.

·    Check for residuals before administration of any medication

·    Flush the tube after each use. Always flush the tube with at least 2 – 4ml of water NOT normal saline before and after administration of medication.  

 

SIADH

·    Patient is on fluid restriction.

 

SIGNS

·    Cullen's sign- ecchymosis around the umbilicus, seen in hemorraghic pancreatitis and abdominal trauma

·    Murphys sign - noted in Patients with cholecystitis;  unable to take a deep breath when fingers are pressed below the hepatic margin

 

Sickle Cell

·    Expect the patient to experience hypovolemia, decreased BP, increased respiration because of pain.

·    Encourage patient to take enough fluid.  

 

Stools

·         Should be light to dark brown in color

·         Should not contain fat, mucus, pus and pathogens.  

1.  Black

·              Upper GI bleeding

2.  Brown

·              Normal color of stool

3.  Clay Colored

·              Biliary obstruction

4.  Green

·              Sign of infection.   

 

Surgery

·    POST  don,t wet the gauze that has dried over the wound, just remove to help get rid of necrotic tissue.

·    Place on low Fowler to reduce stress on suture line, may be placed supine with hips and knees bent

·    For any abdominal surgery, ambulation facilitates flatus. Client is NPO until bowel sounds are heard, thus avoiding distention.

·    Skin can be best protected with petroleum jelly if PT is incontinent rather than talcum or corn starch

·    Post surgery, a patient is usually put on a clear diet  and progress to regular diet.

·    Post surgery, a patient is put on a stool softener to avoid constipation.

Tenesmus

·    Inability to move a bowel despite the urgency of wanting to.

·    Common to those suffering from Ulcerative Colitis.

 

Thyroid Scan

·    Uses a dye. So ask client for any allergies

 

TPN (Total Parenteral Nurtition)

·    Glucose check is often ordered since TPN solutions have a high glucose content

·    Used to treat negative nitrogen balance

·    Could lead to hypovolemia. TPN is technically a hypertonic solution that can cause water to leave the cells, thus, hypovolemia.

·    Administered via a central line not a peripheral line. 

·    Needle insertion can lead to pneumothorax. If the needle is advanced too far, it can lead to arryhythmias.

·    Glucose monitor is usually done since TPN solutions are usually high in sugar.

·    If TPN bag is empty a temporary replacement solution is D10W.

 

Ulcer

·    Helicobacter pylori is the bacteria often associated with the disease.

·    Duodenal ulcer is relieved by eating. Decreased BP with increase pulse indicated bleeding of the duodenal ulcer. Melena (blood in stool) is common.

·    Gastric ulcer is not relieved by eating. Vomiting and epigastric pain occurs after meals and patient may experience frequent diarrhea.

·    Endoscopy is the most efficient way to diagnose an ulcer.

Ulcerative Colitis

·    Like Crohns, is an Irritable Bowel Disease (IBD).

·    Unlike Crohns Disease that appear in patches, it occurs contiguously and usually in the large intestine through rectum

·    May exhibit blood in stool especially if it is confined to the rectum.

·    Like Crohns Disease, it is common to those in their 30s of age and to those of Jewish or European backgrounds.

·    DIET - Ulcerative colitis (high protein and calorie; low residue)

NOTE:  Colorectal Cancer -  individuals who are on high protein and refined carbohydrates are at a greater risk of developing colorectal cancer.  A diet for patient with Ulcerative Colitis is at risk for colorectal cancer.

 

 

Vomiting

.

·    Prevent aspiration. If client has no head injury put bed high in position but if patient has a head injury, one can put patient on side.

·    Results in Metabolic Alkalosis

·    Inducing vomit should not be done when a patient ingests anything acidic or of petroleum product like gasoline.

·    Clear or ice-cold beverages.

·    Drink beverages slowly.

·    Eat saltine crackers, plain bread and other bland foods.

·    Avoid foods that are fried or sweet.

·    Eat slowly.

·    Eat smaller meals.

·    Wait a while after eating before exercising or doing other vigorous activity.

·    Don't brush your teeth immediately after

 

 

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