GI Alterations

GASTROINTESTINAL
ALTERATIONS

Poll

Which type of hepatitis is a DNA virus, can be transmitted via exposure to infectious blood or body fluids, is required for HDV to replicate, and increases the risk of the chronic carrier for hepatocellular cancer?

• HAV

• HBV

• HCV

• HEV

Poll

The patient returned from a 6-week mission trip to Somalia with reports of nausea, malaise, fatigue, and achy muscles. Which type of hepatitis is this patient most likely to have contracted?

• Hepatitis B (HBV)

• Hepatitis C (HCV)

• Hepatitis D (HDV)

• Hepatitis E (HEV

Poll

A nurse on a medical-surgical unit is admitting a client who has hepatitis B with ascites. Which of the following actions should the nurse initiate in the plan of care?

• Initiate contact precautions.

• Weigh the client weekly.

• Measure abdominal girth at the base of rib cage.

• Provide a high calorie, high carbohydrate diet.

Poll

The client diagnosed with end-stage liver disease is admitted with esophageal bleeding. The HCP recommends endoscopic treatment. Which nursing interventions should the nurse implement before this treatment? Select all that apply.

• Position the client in lateral position.

• Stay with client at all times.

• Have a suction catheter at the bedside.

• Administer lactulose.

• Monitor the client's oxygen saturation.

Poll

Which etiologic manifestations occur in the patient with cirrhosis related to esophageal varices?

• Jaundice, peripheral edema, and ascites from increased intrahepatic pressure and dysfunction.

• Loss of the small bile ducts and cholestasis and cirrhosis in patients with other autoimmune disorders.

• Development of collateral channels of circulation in inelastic, fragile esophageal veins as a result of portal hypertension.

• Scarring and nodular changes in the liver lead to compression of the veins and sinusoids, causing resistance of blood flow through the liver from the portal vein.

Poll

Duodenal and gastric ulcers have similar as well as differentiating features. What characteristics are unique to duodenal ulcers (select all that apply)?

• Pain is relieved with eating food.

• There is burning and cramping in the midepigastric area.

• Increased gastric acid secretion occurs

• Associated with Helicobacter pylori infection.

• Hemorrhage, perforation, and obstruction may result.

Poll

A 20-year-old patient with a history of Crohn’s disease comes to the clinic with persistent diarrhea. What are common characteristics of Crohn’s disease (select all that apply)?

• Weight loss

• Rectal bleeding

• Abdominal pain

• Toxic megacolon

• Has segmented distribution

Poll

Which clinical manifestation should the nurse expect to find in a client diagnosed with Ulcerative colitis?

• Twenty bloody stools a day.

• Oral temperature of 102 F.

• Hard, rigid abdomen.

• Urinary stress incontinence.

Introduction

C. Difficile Infection

Liver Disease

Gastrointestinal Bleed

2

LET’S
TALK
ABOUT
THE DIFF

Multiple Select

What is the primary function of the liver in the human body? (SATA)

• To pump blood throughout the body.

• To aid in digestion by producing bile.

• To filter toxins from the blood.

• To produce digestive enzymes.

HEPATITIS

5

Clinical Manifestations

Fatigue, Chills, Fever
Dark Color Urine, Pale Stools, Diarrhea,
Jaundice (Eyes/Skin) (Icky phase)

Fever, Loss of appetite, Abdominal Pain,
Nausea & Vomiting, Weakness & Fatigue,
Joint Pain

Sometimes---asymptomatic
Jaundice, Vomiting, Abdominal Pain

--Similar

--Similar

Medications

Hep A Vaccine

Antivirals

HBV Vaccine

Antivirals

No Vaccine

MANAGEMENT OF CARE

o

Standard Precautions & Proper Hand Hygiene

o

Promote consumption of high carbohydrate, high calorie, low-

moderate protein & low-moderate fat diet.

o

Promote small frequent meals to promote nutrition and healing.

o

Promote hepatic rest and the regeneration of tissue.

o

Be mindful of hepatotoxic meds (i.e. ACEI, ARBS…) including OTC &

herbal supplements

o

Avoid alcohol.

o

Limit physical activity

o

Educate the client and family regarding measures to prevent the

transmission of the disease to others at home.

o

Avoid sexual intercourse until hepatitis antibody testing is negative.

7

COMPLICATIONS OF HEPATITIS

• Liver Cirrhosis

• Liver Failure

• Liver Cancer

• Hepatic Encephalopathy

• Bleeding Risk (Increased INR)

6

Multiple Choice

Although HAV antigens are not tested in the blood, they stimulate specific IgM and IgG antibodies. Which antibody indicates there is acute HAV infection?

• Anti-HBc IgG

• Anti-HBc IgM

• Anti-HAV IgG

• Anti-HAV IgM

Multiple Choice

The nurse identifies a need for further teaching when the patient with acute hepatitis B makes which statement?

• “I should avoid alcohol completely for at least a year."

• “I must avoid all physical contact with my family until the jaundice is gone.”

• “I should use a condom to prevent spread of the disease to my sexual partner.”

• “I will need to rest several times a day, gradually increasing my activity as I tolerate it.”

CIRRHOSIS

8

CLINICAL MANIFESTATIONS:
FATIGUE (EARLY)
WEIGHT LOSS
ABD DISTENTION (ASCITES)
PRURITUS (ITCHING)
PORTAL HTN
MENTAL STATUS CHANGES/CONFUSION
DIFFICULTY THINKING
EMOTIONAL CHANGES- EMOTIONAL, DEPRESSION
GASTROESOPHAGEAL BLEEDING
SPLENOMEGALY
ASCITES
JAUNDICE
PETECHIAE
PALMAR ERYTHEMA (REDNESS, WARMTH OF THE PALMS OF
HANDS)
SPIDER ANGIOMAS (VASCULAR- RED LESIONS ON FACE,
SHOULDERS)
PERIPHERAL EDEMA
FECTOR HEPATICAS (LIVER BREATH): FRUIT/MUSTY ODOR

DIAGNOSTIC LABS

ALT / AST

Bilirubin

Ammonia

Albumin

Nursing Management:

Prevent & treat complications
-Management of ascites (fluid
removal, limit sodium intake,

diuretics)

-Monitoring & prevent rupture of

varices

(Betablockers, octreotide,

vasopressin)

-Tx of Hep. Encephalopathy

(Lactulose)

-Diet: high calorie diet, low fat, low

protein

-Monitor for malnutrition

UPPER
GASTROINTESTINAL
BLEEDING
DISORDERS

PEPTIC ULCER DISEASE

12

PEPTIC ULCER DISEASE

•Clinical Manifestations:

•Both—burning/gaseous pain

•Duodenal—back pain can occur

•Nursing Plan of Care:

•Monitor Labs: CBC, Liver enzymes, amylase,
stool exams

•Treatment:

•Conservative, Avoids NSAIDS, ASA,
Smoking, ETOH, Avoid trigger foods

•Use PPIs, H2A, Antacids, Mucosal agents

•Acute tx H. Pylori → Comb. Abx +PPI

•Diagnostics:

•Endoscopy—to note location

•Biopsy for dx H. Pylori & urease test

•Complications:

•Perforations, Bleeding, Obstruction

13

Multiple Choice

What does the nurse include when teaching a patient with newly diagnosed peptic ulcer disease?

• Maintain a bland, soft, low-residue diet

• Use alcohol and caffeine in moderation and always with food.

• Eat as normally as possible, eliminating foods that cause pain or discomfort.

• Avoid milk and milk products because they stimulate gastric acid productio

INFLAMMATORY
BOWEL DISEASE

14

CROHN’S
VS.
ULCERATIVE COLITIS

15

CROHN’S DISEASE

Clinical Manifestations

•Abdominal Pain (Cramping)

•Diarrhea

•Sig. Weight loss (d/t malabsorption)

•Cobblestone appearance of mucosa

Nursing Plan of Care

•Bowel rest

•Hydration

•Reducing/controlling inflammation– (5-ASAs, steroids, immunosuppressants, Biologics)

•Pain management

•Infection prevention—antimicrobials) *Surgical Repair-if needed
*

•Improve QOL

•Monitor Labs: WBC, Hgb, VS (palpitations,hypotn)

•Diagnostics: Colonoscopy/Stool cultures

Complications

•Peritonitis

•Small. Intestinal
cancer/colorectal
cancer

•C-Diff

•Abscesses/fistulas

ULCERATIVE COLITIS

Clinical Manifestations

•Severe Abdominal Pain

•Bloody Diarrhea (10-20/day)

•Rectal Bleeding

Nursing Plan of Care

•Bowel rest

•Hydration

•Reducing/controlling inflammation & Bleeding

•Pain management

•Infection prevention

•Improve QOL

•Monitor Labs: WBC, Hgb, K+, VS (palpitations, hypotn)

•Diagnostics: CT/MRI/Colon Biopsy/ Stool cultures

Complications

•Toxic Megacolon

•C-Diff

•Colon Cancer

•Strictures

Multiple Choice

A patient with inflammatory bowel disease has a nursing diagnosis of impaired nutritional status; etiology: decreased nutritional intake and decreased intestinal absorption. Which assessment data support this nursing diagnosis?

• Pallor and hair loss

• Frequent diarrhea stools

• Anorectal excoriation and pain

• Hypotension and urine output below 30 mL/hr

Multiple Choice

Which type of hepatitis is a DNA virus, can be transmitted via exposure to infectious blood or body fluids, is required for HDV to replicate, and increases the risk of the chronic carrier for hepatocellular cancer?

• HAV

• HBV

• HCV

• HEV

Multiple Choice

The patient returned from a 6-week mission trip to Somalia with reports of nausea, malaise, fatigue, and achy muscles. Which type of hepatitis is this patient most likely to have contracted?

• Hepatitis B (HBV)

• Hepatitis C (HCV)

• Hepatitis D (HDV)

• Hepatitis E (HEV)

Multiple Choice

A nurse on a medical-surgical unit is admitting a client who has hepatitis B with ascites. Which of the following actions should the nurse initiate in the plan of care?

• Initiate contact precautions.

• Weigh the client weekly.

• Measure abdominal girth at the base of rib cage.

• Provide a high calorie, high carbohydrate diet.

Multiple Choice

Which etiologic manifestations occur in the patient with cirrhosis related to esophageal varices?

• Jaundice, peripheral edema, and ascites from increased intrahepatic pressure and dysfunction.

• Loss of the small bile ducts and cholestasis and cirrhosis in patients with other autoimmune disorders.

• Development of collateral channels of circulation in inelastic, fragile esophageal veins as a result of portal hypertension.

• Scarring and nodular changes in the liver lead to compression of the veins and sinusoids, causing resistance of blood flow through the liver from the portal vein.

Multiple Select

The client diagnosed with end-stage liver disease is admitted with esophageal bleeding. The HCP recommends endoscopic treatment. Which nursing interventions should the nurse implement before this treatment? Select all that apply.

• Position the client in a lateral position.

• Stay with the client at all times.

• Have a suction catheter at beside.

• Administer lactulose.

• Monitor the client's oxygen saturation.

Multiple Select

Duodenal and gastric ulcers have similar as well as differentiating features. What characteristics are unique to duodenal ulcers (select all that apply)?

• Pain is relieved with eating food.

• There is burning and cramping in the midepigastric area.

• Increased gastric acid secretion occurs.

• Associated with Helicobacter pylori infection.

• Hemorrhage, perforation, and obstruction may result.

Multiple Select

A 20-year-old patient with a history of Crohn’s disease comes to the clinic with persistent diarrhea. What are common characteristics of Crohn’s disease (select all that apply)?

• Weight loss

• Rectal bleeding

• Abdominal pain

• Toxic megacolon

• Has segmented distribution

Multiple Choice

Which clinical manifestation should the nurse expect to find in a client diagnosed with Ulcerative colitis?

• Twenty bloody stools a day.

• Oral temperature of 102 F.

• Hard, rigid abdomen.

• Urinary stress incontinence.