nursing: Gastrointestinal Tract Visualization

This Nursing lecture provides a graphical review of the different operations and diagnostic tests used in the study of the Gastrointestinal tract. This nursing lecture includes nursing interventions and management for each particular GIT operation.

GI tract Visualization http://nursinglectures.blogspot.com
GIT Visualization
- Barium Swallow- UGIS
- Pretest: written consent, NPO the night
- Intratest: administer barium orally, then followed by X-ray
- Post-test: Laxative for constipation, increased fluids, assess for intestinal obstruction , warn that stool is light colored!
GIT Visualization
- Barium Enema- LGIS
- Pretest: Informed consent, NPO the night, Enema the morning
- Intratest: Position on LEFT side, administer enema, then X-ray follow
- Post-test: Cleansing enema , Laxative for constipation, assess for intestinal obstruction
Barium Enema
GIT Visualization
- Esophagogastroscopy
- Pretest: Informed consent, NPO for 8 hours, warn that gag reflex is abolished
- Intratest: Position on LEFT side during scope insertion
- Post-test: NPO until gag returns. Monitor for complications
GIT Visualization
- Anoscopy, proctoscopy, proctosigmoidoscopy, colonoscopy
- Pretest: Consent, NPO, and enema administration the morning
- Intratest: Position on the LEFT side during scope insertion
- Post-test: Monitor for complications
Gallbladder
- Oral cholescystogram
- PTC
- ERCP
- Ultrasound
IV Cholecystogram
- X-ray visualization of the gallbladder after administration of contrast media intravenously
- Pre-test: Allergy to iodine and sea-foods
- Intra-test: ensure patent IV line
- Post-test: increase fluid intake to flush out the dye, Assess for delayed hypersensitivity reaction to the dye like chills and N/V
Oral Cholecystogram
- X-ray visualization of the gallbladder after administration of contrast media
- Done 10 hours after ingestion of contrast tablets
- Done to determine the patency of biliary duct
Endoscopic retrograde cholangiopancreatography
- Examination where a flexible endoscope is inserted into the mouth and via the common bile duct and pancreatic duct to visualize the structures
- Iodinated dye can also be injected after for the x-ray procedure
Endoscopic retrograde cholangiopancreatography
- Pre-test: consent, NPO for 12 hours, Allergy to sea-foods, Atropine sulfate
- Intra-test: Gag reflex is abolished, Position on LEFT side
- Post-test: NPO until gag reflex returns, Position side lying and monitor for perforation and hemorrhage
Percutaneous Transhepatic Cholangiogram
- Under fluoroscopy, the bile duct is entered percutaneously and injected with a dye to observe filling of hepatic and biliary ducts
Ultrasound of the liver, gallbladder and pancreas
- Consent MAY be needed
- Place patient on NPO!!!
- Laxative may be given to decrease the bowel gas
- HIATAL HERNIA
- ASSESSMENT
- DIAGNOSTIC TEST
- NURSING INTERVENTIONS
Hiatal hernia – X-ray Hiatal hernia
- Sliding Hiatal Hernia
Sliding Hiatal Hernia
- Paraesophageal / Rolling Hernias
- Management
GASTROESOPHAGEAL REFLUX DISEASE
- Gastro-esophageal reflux (GERD)
- ASSESSMENT (for GERD)
- Diagnostic test
- NURSING INTERVENTION
Gastritis
Conditions of the Stomach
- GASTRITIS
- Inflammation of the gastric mucosa
- May be Acute or Chronic
- Etiology: Acute- bacteria, irritating foods, NSAIDS, alcohol
- Etiology: Chronic- Ulceration, bacteria, Autoimmune disease, diet, alcohol, smoking
Conditions of the Stomach
- PATHOPHYSIOLOGY OF Gastritis
- Insults  cause gastric mucosal damage  inflammation, hyperemia and edema  superficial erosions  decreased gastric secretions, ulcerations and bleeding
Conditions of the Stomach
- ASSESSMENT
- (Acute)
- Dyspepsia
- Headache
- Anorexia
- Nausea/Vomiting
- ASSESSMENT (Chronic)
- Pyrosis
- Singultus
- Sour taste in the mouth
- Dyspepsia
- N/V/anorexia
- Pernicious anemia
Conditions of the Stomach
- DIAGNOSTIC PROCEDURE
- EGD- to visualize the gastric mucosa for inflammation
- Low levels of HCl
- Biopsy to establish correct diagnosis whether acute or chronic
Conditions of the Stomach
- NURSING INTERVENTIONS
- 1. Give BLAND diet
- 2. Monitor for signs of complications like bleeding, obstruction and pernicious anemia
- 3. Instruct to avoid spicy foods, irritating foods, alcohol and caffeine
Conditions of the Stomach
- NURSING INTERVENTIONS
- 4. Administer prescribed medications- H2 blockers, antibiotics, mucosal protectants
- 5. Inform the need for Vitamin B12 injection if deficiency is present
Gastritis
Acute Gastritis Chronic Gastritis
PEPTIC ULCER DISEASE
Conditions of the Stomach
- PEPTIC ULCER DISEASE
- An ulceration of the gastric and duodenal lining
- Gastric ulcer and Duodenal ulcer
- Most common Peptic ulceration: anterior part of the upper duodenum
Conditions of the Stomach
- PATHOPHYSIOLOGY of PUD
- Disturbance in acid secretion and mucosal protection
- Increased acidity or decreased mucosal resistance  erosion and ulceration
Duodenal Ulcer Gastric Ulcer Pain occurs 90 min to 3h after meals; wakes up patient midnight to 3 AM Commonly pain occurs within a short time of food intake Relieved by food, antacids and H2 blockers; is not associated with vomiting (if atypical features occur think of complications) High gastric acid levels Commonly accompanied by nausea, vomiting with food intake and a variable response to medications Low gastric acid levels H. pylori +++ H. pylori +++ Does not represent a malignancy Malignancy + Usually not accompanied by a high complication rate 25% will be accompanied by significant bleeding; higher mortality and morbidity
DUODENAL / GASTRIC ULCER
- Age: 30-60
- M:F: 2-3:1
- 80%- duodenal
- Hypersecretion of HCL
- (+) weight gain
- Pain occurs 2-3 p.c .; often awakened between 1-2 am; ingestion of food relieves pain
- 50 and over
- 1:1
- 15% GU
- N-hyposecretion of HCl
- Weight loss
- Pain occurs ½ hrs pc ; rarely occurs at night; relieved by vomiting ; ingestion of food does not help, sometimes inc pain
DUODENAL / GASTRIC ULCER
- DU
- Vomiting uncommon
- Hge less common; melena more common
- More likely to perforate
- Malignancy rare
- Risk factors:
- a. H. pylori
- b. Alcohol/Smoking
- c. Cirrhosis
- d. Stress
- GU
- Vomiting common
- Hge more likely; hematemesis more common
- Occasionally
- Risk factors
- a. H. pylori
- b. Gastritis
- c. Alcohol/Smoking
- d. NSAIDs
- e. Stress
PUD
- Laboratory:
- CBC
- Endoscopy
- Gastric acid analysis
- UGIS
- Medical management
- Nursing Interventions:
Ulcer Surgery
- Ulcer Surgery
Nursing Interventions
- Relieving pain
- Reducing anxiety
- Maintaining optimal nutritional status
- Monitoring and managing potential complications
Conditions of the Stomach
- SURGICAL PROCEDURES FOR PUD
- Post-operative Nursing management
- 1. Monitor VS
- 2. Post-op position: FOWLER’S
- 3. NPO until peristalsis returns
- 4. Monitor for bowel sounds
- 5. Monitor for complications of surgery
Conditions of the Stomach
- Post-operative Nursing management
- 6. Monitor I and O, IVF
- 7. Maintain NGT
- 8. Diet progress: clear liquid  full liquid  six bland meals
- 9. Manage DUMPING SYNDROME
- DUMPING SYNDROME
- Rapid emptying of hypertonic food from the stomach
- Distention of the jejunum causing early symptoms
- Fluid shift from the bloodstream into the jejunum
- Decreased blood volume
- Shock – like manifestations
Late signs and symptoms (2 to 3 hrs. p.c.) Sudden hyperglycemia Increased insulin secretion Reactive HYPOGLYCEMIA
- MANAGEMENT OF DUMPING SYNDROME
MANAGEMENT OF DUMPING SYNDROME
Inflammatory Bowel Disease: Crohns and Ulcerative colitis
CHRONIC INFLAMMATORY BOWEL DISORDERS A.Regional ENTERITIS (Crohn’s Disease) B. Ulcerative Colitis
- Transmural
- Mucous ulceration
- Ileum/ascending colon
- Rectum/ lower colon
Cause
- Unknown
- Unknown
- Jewish
- Familial
- Environmental
- Jewish
- Emotional stress
Age
- 20-30 years
- 40-60 years
- 15-40 years
Bleeding
-  ; stool with pus and mucus
- Severe; stool with blood, pus and mucus
Perianal involvement
- Severe
- Mild
Fistulas
- Common
- Rare
Rectal involvement
- 20%
- 100%
Diarrhea
- 5-6 soft stool/ day
- 20-30 watery stool/ day
Abdominal pain
- +
- +
Weight loss
- +
- +
Intervention
- TPN
- Steriods
- Azulfidine (Sulfasalazine)
- Ileostomy
- Colectomy
- Diet
- TPN
- Steriods
- Azulfidine (Sulafasalazine)
- Ileostomy/
- Proctocolectomy
- Nursing Interventions for Crohn’s and UC
Crohn’s Disease: Anatomic Distribution Small bowel alone (33%) Colon alone (20%) Ileocolic (45%) Least Most Freq of involvement
Pathophysiology of IBD - pt. 1 fbg06
Pathophysiology of IBD - pt. 2 fbg06
APPENDICITIS
- Appendicitis
PATHOPHYSIOLOGY Obstruction of the appendix lumen Mucosal inflammation and bacterial proliferation Increased intra-luminal Pressure Lymphoid swelling Decreased venous drainage Thrombosis Bacterial invasion Abscess Gangrene Perforation (24 to 36 hours) Peritonitis
- Assessment findings
- Nursing Interventions
- Surgical procedure= APPENDECTOMY
DIVERTICULITIS
- DIVERTICULITIS
Low fecal volume in the colon Increased intraluminal pressure Decreased muscle strength in the colon wall Herniation/Outpoutching of mucous membrane Entrapment of fecal material and bacteria Inflammation and infection Scarring Abscess Bleeding Perforation Peritonitis Decreased muscle strength in the colon wall
CONDITIONS OF THE LARGE INTESTINE
- ASSESSMENT findings for D/D
- 1. Left lower Quadrant pain
- 2. Flatulence
- 3. Bleeding per rectum
- 4. nausea and vomiting
- 5. Fever
- 6. Palpable, tender rectal mass
CONDITIONS OF THE LARGE INTESTINE
- NURSING INTERVENTIONS
- 1. Maintain NPO during acute phase
- 2. Provide bed rest
- 3. Administer antibiotics, analgesics like meperidine (morphine is not used) and anti-spasmodics
- 4. Monitor for potential complications like perforation, hemorrhage and fistula
- 5. Increase fluid intake
CONDITIONS OF THE LARGE INTESTINE
- NURSING INTERVENTIONS
- 6. Avoid gas-forming foods or HIGH-roughage foods containing seeds, nuts to avoid trapping
- 7. introduce soft, high fiber foods ONLY after the inflammation subsides
- 8. Instruct to avoid activities that increase intra-abdominal pressure
INTESTINAL OBSTRUCTION
CONDITIONS OF THE LARGE INTESTINE
- DIAGNOSTIC STUDIES
- 1. If no active inflammation, COLONOSCOPY and Barium Enema
- 2. CT scan is the procedure of choice!
- 3. Abdominal X-ray
Intestinal Obstruction
- 2 Types:
- Mechanical
- Functional
Small Bowel Obstruction
- Intestinal contents, fluid, gas accumulate above the IO abdominal distention & retention of fluid absorption of fluids stimulates more gastric secretion pressure w/n intestinal lumen venous & arteriolar capillary pressure edema, congestion rupture
Nursing Assessment
- Crampy abdominal pain wavelike and colicky
- (+) blood and mucus; (-) fecal (-) flatus
- (+) vomiting
- Obstruction complete reverse peristalsis
- Ileal obstruction fecal vomiting
- Distended abdomen
- Signs of DHN
Medical Management
- NGT
- IVF
- Surgery
LARGE BOWEL OBSTRUCTION
PERITONITIS
- Peritonitis
Inflammation Adhesions Abscess Intestinal Obstruction Fluid shift into abdominal cavity (300-500 ml.)  Peristalsis Bowel distended with gas & fluid
Pathophysiology
- Medical Management
Nursing Management
- Position on side with knees flexed
- Monitor VS; I and O
- Observe drainage
- SIGNS THAT PERITONITIS IS IMPROVING:
- 1. temperature
- 2. pulse
- 3. softening of the abdomen
- 4. (+) bowel sounds (+) bowel movement
- 5. (+) flatus
- Nursing Interventions
HEMORRHOIDS
- HEMORRHOIDS
- Assessment
- Nursing Management
- Surgery
- Anal Fissure
- Anal Absess
- Anal Fistula
Conditions of the Accessory Organs
The Gallbladder Conditions of the Accessory organs
CONDITION OF THE GALLBLADDER
- Cholecystitis
- Inflammation of the gallbladder
- Can be acute or chronic
CONDITION OF THE GALLBLADDER
- Cholecystitis
- Acute cholecystitis usually is due to gallbladder stones
CONDITION OF THE GALLBLADDER
- Cholecystitis
- Chronic cholecystitis is usually due to long standing gall bladder inflammation
Cholelithiasis
- Formation of GALLSTONES in the biliary apparatus
Predisposing FACTORS
- “ F”
- Female
- Fat
- Forty
- Fertile
- Fair
Pathophysiology
- Supersaturated bile, Biliary stasis
- Stone formation
- Blockage of Gallbladder
- Inflammation, Mucosal Damage and WBC infiltration
CONDITION OF THE GALLBLADDER
- ASSESSMENT findings for cholecystitis
- 1. Indigestion, belching and flatulence
- 2. Fatty food intolerance
CONDITION OF THE GALLBLADDER
- ASSESSMENT findings for cholecystitis
- 3. Epigastric pain that radiates to the scapula or localized at the RUQ
- 4. Mass at the RUQ
CONDITION OF THE GALLBLADDER
- ASSESSMENT findings for cholecystitis
- 5. Murphy’s sign
- 6. Jaundice
- 7. dark orange and foamy urine
CONDITION OF THE GALLBLADDER
- DIAGNOSTIC PROCEDURES
- 1. Ultrasonography- can detect the stones
- 2. Abdominal X-ray
- 3. Cholecystography
CONDITION OF THE GALLBLADDER
- DIAGNOSTIC PROCEDURES
- 4. WBC count increased
- 5. Oral cholecystography cannot visualize the gallbladder
- 6. ERCP: reveals inflamed gallbladder with gallstone
CONDITION OF THE GALLBLADDER
- NURSING INTERVENTIONS
- 1. Maintain NPO in the active phase
- 2. Maintain NGT decompression
CONDITION OF THE GALLBLADDER
- NURSING INTERVENTIONS
- 3. Administer prescribed medications to relieve pain. Usually Demerol (MEPERIDINE)
- Codeine and Morphine may cause spasm of the Sphincter  increased pain. Morphine cause MOREPAIN
CONDITION OF THE GALLBLADDER
- 4. Instruct patient to AVOID HIGH- fat diet and GAS-forming foods
- 5. Assist in surgical and non-surgical measures
- 6. Surgical procedures- Cholecystectomy, Choledochotomy, laparoscopy
CONDITION OF THE GALLBLADDER
- PHARMACOLOGIC THERAPY
- Analgesic- Meperidine
- Chenodeoxycholic acid= to dissolve the gallstones
- Antacids
- Anti-emetics
CONDITION OF THE GALLBLADDER
- Post-operative nursing interventions
- 1. Monitor for surgical complications
- 2. Post-operative position after recovery from anesthesia- LOW FOWLER’s
CONDITION OF THE GALLBLADDER
- Post-operative nursing interventions
- 3. Encourage early ambulation
- 4. Administer medication before coughing and deep breathing exercises
- 5. Advise client to splint the abdomen to prevent discomfort during coughing
CONDITION OF THE GALLBLADDER
- Post-operative nursing interventions
- 6. Administer analgesics, antiemetics, antacids
- 7. Care of the biliary drainageor T-tube drainage
- 8. Fat restriction is only limited to 4-6 weeks. Normal diet is resumed
T-tube
Cholecystectomy/ Choledochostomy/ Choledochotomy
- Cholecystectomy/Choledochostomy/Choledochotomy
Pancreatitis
Pancreatic secretions
- 1. Bicarbonate- to neutralize the acidic chyme from the stomach
- 2. Pancreatic amylase- for carbohydrate digestion
Pancreatic secretions
- 3. Pancreatic lipase- for fat digestion
- 4. Trypsin and chymotrypsin- for protein digestion
Fig. 16.22
CONDITION OF THE PANCREAS
- Pancreatitis
- Inflammation of the pancreas
- Can be acute or chronic
CONDITION OF THE PANCREAS
- Pancreatitis
- Etiology and predisposing factors
CONDITION OF THE PANCREAS
- Pancreatitis
- Etiology and predisposing factors
CONDITION OF THE PANCREAS
- PATHOPHYSIOLOGY of acute pancreatitis
- Self-digestion of the pancreas by its own digestive enzymes principally TRYPSIN
CONDITION OF THE PANCREAS
- PATHOPHYSIOLOGY of acute pancreatitis
- Spasm, edema or block in the Ampulla of Vater  reflux of proteolytic enzymes  auto digestion of the pancreas  inflammation
CONDITION OF THE PANCREAS
- PATHOPHYSIOLOGY of acute pancreatitis
- Autodigestion of pancreatic tissue
- Hemorrhage, Necrosis and Inflammation
- KININ ACTIVATION will result to increased permeability
- Loss of Protein-rich fluid into the peritoneum
- HYPOVOLEMIA
CONDITION OF THE PANCREAS
- ASSESSMENT findings
- 1. Abdominal pain- acute onset, occurring after a heavy meal or alcohol intake
- 2. Abdominal guarding
CONDITION OF THE PANCREAS
- ASSESSMENT findings
- 3. Bruising on the flanks and umbilicus
- 4. N/V, jaundice
- 5. Hypotension and hypovolemia
- 6. Signs of shock
CONDITION OF THE PANCREAS
- DIAGNOSTIC TESTS
- 1. Serum amylase and serum lipase
- 2. Ultrasound
- 3. WBC
- 4. Serum calcium
- 5. CT scan
- 6. Hemoglobin and hematocrit
CONDITION OF THE PANCREAS
- NURSING INTERVENTIONS
- 1. Assist in pain management. Usually, Demerol is given . Morphine is AVOIDED
- 2. Assist in correction of Fluid and Blood loss
CONDITION OF THE PANCREAS
- NURSING INTERVENTIONS
- 3. Place patient on NPO to inhibit pancreatic stimulation
- 4. NGT insertion to decompress distention and remove gastric secretions
- 5. Maintain on bed rest
CONDITION OF THE PANCREAS
- NURSING INTERVENTIONS
- 7. Position patient in SEMI-FOWLER’s to decrease pressure on the diaphragm
- 8. Deep breathing and coughing exercises
- 9. Provide parenteral nutrition
CONDITION OF THE PANCREAS
- NURSING INTERVENTIONS
- 10. Introduce oral feedings gradually- HIGH carbo, LOW FAT
- 11. Maintain skin integrity
- 12. Manage shock and other complications
Damage to pancreatic cells Inflammation Edema of the Pancreas and Pancreatic duct Obstruction to the Flow of Pancreatic Enzyme Activation of Pancreatic Enzymes inside Pancreas AUTODIGESTION of the Pancreas Fatty Necrosis, Ulceration, Hemorrhage, Infection Pathophysiology
CHRONIC PANCREATITIS
- NURSING ASSESSMENT:
- Abdominal pain
- LUQ mass
- Steatorrhea and foul smelling stools
- Weight loss
- Muscle wasting
- Jaundice
- S/Sx DM
- NIRSING INTERVENTION
- Diet: fat/CHON limited
- Avoid heavy meals/alcohol
- Supplemental vitamins
- Pancreatic enzyme
- Insulin
- Notify MD: increased steatorrhea, abdominal distention, cramping, and skin breakdown
Hepatitis
- Hepatitis
- Viral Hepatitis A
- Viral Hepatitis B
- Viral Hepatitis C
- Viral Hepatitis D
- Viral Hepatitis E
- Assessment findings
- Pathophysiology of Viral Hepatitis
- There is Diffuse Inflammatory Infiltration of Hepatic Tissue with Mononuclear Cells and local, spotty or single cell necrosis
- Nursing Interventions
- General Preventive Measures
- Preventive Measures Used with Persons with Known Hepatitis
- Summary of Collaborative Management in Viral Hepatitis
Cirrhosis of the Liver
LIVER Normal Function 1. Stores glycogen 2. Synthesizes proteins 3. Synthesizes globulins 4. Synthesizes Clotting factors 5. Secreting bile 6. Converts ammonia to urea 7. Stores Vitamims and minerals 8. Metabolizes estrogen
- Liver function test:
- AST aspartate aminotransferase formerly SGOT 4.8 - 19 U/L
- ALT alanine aminotransferase formerly SGPT 2.4 - 7 U/L highly specific
Liver Biopsy
Jaundice
- a symptom of a disease
- yellow pigmentation of the skin
- due to accumulation of bilirubin pigment
- usually observed first in the sclera
- kernicterus (brain) fatal
Hemolytic Jaundice
- due to:
- rapid RBC destruction increased in indirect, unconjugated or B2
- due to transfusion reaction or EBF
Obstructive Jaundice
- due to:
- biliary atresia
- inflammation of the biliary tract
- tumors
- cholestatic agent
- total bilirubin is increased
- bile is dammed into the liver and reabsorbed into the circulatory
- s/sx:
- deep orange, foamy urine
- dark tea colored urine
- clay colored stool
- severe itchiness
- steatorrhea
Hepatic Jaundice
- due to:
- Diseased liver (hepatitis or cirrhosis)
- Inability of the liver to clear normal amount of bilirubin from the blood
- Increased bilirubin and albumin
Jaundice Management:
- Control pruritus
- calamine
- baking soda
- NaHCO3
- Antihistamine
- Soothing baths
- Drug
- Cholestyramine = it binds bile salts in the intestine and eliminated via feces.
- Look for the cause and manage it
- Cirrhosis of the Liver
Pathogenesis:
- repeated destruction of hepatic cell  scar tissue formation (fibrotic)  regeneration of liver cell follows  another destruction will occur  cycle (scarring and regeneration) will be repeated until hepatocytes becomes fibrotic and liver function is compromised
Pathophysiology Alcohol abuse Leonnec’s Cirrhosis Malnutrition Infection Postnecrotic Cirrhosis Drugs Biliary Obstruction- Biliary Cirrhosis RSCHF- Cardiac Cirrhosis Destruction of HEPATOCYTES FIBROSIS/SCARRING Obstruction of blood flow Increase Pressure in the venous and sinusoidal channels Fatty infiltration FIBROSIS/SCARRING PORTAL HYPERTENSION } }
- Assessment of Liver Cirrhosis
- PORTAL HYPERTENSION
- Esophageal varices
- Fluid extravasation
- Ascites and edema
-  collateral circulation
- vein distention (angioma)
- hemorrhoids
- spiderangioma (red dot)
- palmar erythema
- telangiectasia (permanent)
- esophageal varices
Caput Medusae
ASCITES
Esohageal Varices
- Esophageal Varices
- ASSESSMENT findings for EV
- DIAGNOSTIC PROCEDURE
CONDITION OF THE ESOPHAGUS
- NURSING INTERVENTIONS FOR EV
- 1. Monitor VS strictly. Note for signs of shock
- 2. Monitor for LOC
- 3. Maintain NPO
CONDITION OF THE ESOPHAGUS
- NURSING INTERVENTIONS FOR EV
- 4. Monitor blood studies
- 5. Administer O2
- 6. prepare for blood transfusion
CONDITION OF THE ESOPHAGUS
- INTERVENTIONS FOR EV
- 7. prepare to administer Vasopressin and Nitroglycerin
- 8. Assist in NGT and Sengstaken-Blakemore tube insertion for balloon tamponade
CONDITION OF THE ESOPHAGUS
- NURSING INTERVENTIONS FOR EV
- 9. Prepare to assist in surgical management:
- If bleeding esophageal varices occur:
- Nursing Interventions
Liver physiology and Pathophysiology Normal Function Abnormality in function 1. Stores glycogen = Hypoglycemia 2. Synthesizes proteins = Hypo-proteinemia 3. Synthesizes globulins =Decreased Antibody formation  risk for INFECTION 4. Synthesizes Clotting factors = Bleeding tendencies 5. Secreting bile = Jaundice and pruritus 6. Converts ammonia to urea =Hyper-ammonemia 7. Stores Vitamims and minerals =Deficiencies of Vit and min 8. Metabolizes estrogen = Gynecomastia, testes atrophy
- HEPACTIC ENCEPHALOPATHY
- Is due to increased AMMONIA levels. The liver cannot convert ammonia by products of protein metabolism into Urea Hepatic coma
- The initial manifestations are BEHAVIORAL changes and MENTAL changes.
- Advance Stage :
- Summary of Collaborative Management
Abdominal Paracentesis
- Withdrawal of fluid from the peritonealspace
- Purpose: diagnostic and therapeutic
- Pretest: consent, empty bladder
Abdominal Paracentesis
- Intratest: 1,500 ml maximum amount collected at one time, Monitor VS
- Post-test : monitor VS, bleeding complication
COLORECTAL CANCER
- COLORECTAL CANCER
- Assessment
- Duke’s Classification of Colorectal Cancer
- Guidelines for Early Detection of Colorectal Cancer
- Collaborative Management
- Medical Management: chemotherapy, radiation therapy, bowel surgery
- Type of Colostomies
- Post-op Care
- Colostomy Irrigation
- Managing Odor
- Supporting a Positive Self-Concept
- Home care instructions for colostomy.

nursing

Wednesday, February 18, 2009

Gastrointestinal Tract Visualization

No comments:

Post a Comment