Acute – inflammation of the stomach mucosa lasting several hours to a few days

Chronic – prolonged inflammation of the stomach that may be caused by benign or malignant gastric ulcers or bacterial infection, H. Pylori Confirming Diagnostic Procedure - Endoscopy

Acute: Diet, ETOH, Aspirin,

NSAIDS, Bile reflux, Radiation therapy, Strong acid/alkalie solutions

Chronic: Bacteria, Ulcers, Autoimmune disorders, GERD, Smoking/ETOH disuse, Drugs, Hot Drinks

Acute:

• Neutralize acids with common antacids, e.g., aluminum hydroxide
• Neuralize alkalies with lemon juice or diluted vinegar

• Diet modification
• Rest
• Stress reduction therapies
• Pharmacotherpy
• H. pylori - Amoxicillin
• Assess electrolyte values q24 for fluid imbalance
• Use of Aloe vera

• Physical and emotional support
• Avoid po foods/fluids for hours or days until symptoms subside
• IV therapy and monitoring daily lab data
• Offer ice chips and clear fluids PRN
• Encourage client to discuss illness meaning

Physical and emotional support

Avoid po foods/fluids for hours or days until symptoms subside

IV therapy and monitoring daily lab data

Offer ice chips and clear fluids PRN

Encourage client to discuss illness meaning

• Encourage reduction of caffeinated beverages [as caffeine increases pepsin secretion]
• Encourage strategies to reduce smoking [as nicotine inhibits the ability of the duodenum to neutralize gastric acid]
• ETOH counseling/smoking cessation classes as appropriate

• Observe for hemorrhagic gastritis, i.e., increase in hematemesis, tachycardia, hypotension, anxiety and feelings of ‘impending doom’
• Address knowledge deficit regarding foods, patterns of eating, substances to avoid, educating about prescribed drugs, and the need for long-term vitamin B12 injections

• Peptic Ulcer – a deep excavation or erosion formed in the mucosal wall of the stomach, pylorus, duodenum or esophagus
• More common in the duodenum but do occur often in the lesser curvature of the stomach
• Often associated with H. pylori infection [70% - 95% of clients with gastric and duodenal ulcers]
• Age – 40 to 60
• More common in men

• Family history
• Blood type – more common in folks with Type O
• Chronic use of NSAIDS
• ETOH abuse
• Smoking
• Stress

• Zollinger-Ellison Syndrome [gastrinoma]
• Severe peptic ulcer disease often resistant to standard medical therapy
• Extreme gastric hyperacidity [hyper-secretion of gastric juice]; duodenal ulcer, gastrinoma, islet-cell tumors and pancreatic cancer [which are gastrin-secreting organs]
• 90% of tumors are located in the gastric triangle
• Most tumors are classified as malignant
• Diarrhea and Seatorrhea are often present
• Most frequent complaint is epigastric pain

• Curling’s ulcer [Stress ulcer]
• Acute mucosal lining ulceration in stomach or duodenum due to physiologic stressful events
• Burn victims and shock can be predisposing factors
• Often found in ventilator-dependent and posttraumatic or surgical clients

• Confirmed subjectively by client symptoms:
• dull, gnawing pain in the mid-epigastrum or radiating pain to the back
• Pain is relieved by eating or consuming alkali substances
• sharply localized tenderness elicited with gentle palpation of the epigastric area
• Pyrosis [heartburn] and eructation
• Bleeding described in 25% of all cases

Confirmed objectively by:

• Endoscopy
• Hemoccult or Guaiac
• Biopsy and histology of culture taken during endoscopic procedure

Biomedical managment-PUD

• Biofeedback, hypnosis, and behavioral modification therapies
• Small frequent meals with histamine-blocking agents
• Reducing the intake of caffeine and ETOH
• Reduce diets rich in milk and cream
• Smoking cessation
•   Nicotine increases acid production in the duodenum
•   Smoking impairs ulcer repair

Vagotomy - was once popular as a way of treating and preventing PUD and subsequent ulcerative perforations

a way to reduce the acidity of the stomach by denervating peptic cells that produce acid

Billroth I - an operation in which the pylorus is removed involving anastomosis of the distal stomach directly to the duodenum

Billroth II - an operation in which the lower part of the stomach (antrum) is removed and a loop of small bowel (jejunum) is brought up and joined to it in for drainage (gastrojejunostomy)

• Pain related to the effect of gastric acid secretion on damaged tissue
• Anxiety related to coping with acute illness
• Knowledge deficit about prevention of symptoms and life changing events

• Assess family history
• Assess for malnutrition and weight loss [includes evaluating lab data]
• Bowel sounds q4 hours
• NG tube placement [Levine or Salem-Sump] for gastric decompression
• Assess for occult blood in stools
• Assess psychosocial and nutritional concerns [Dumping Syndrome]

• Assess client for hemorrhage, perforation and obstruction
• Pain medications as ordered
• Assess for hypotension
• Assess environment
• Monitor I/O
• IV therapy
• Use of anti-emetics and H2 antagonists

• Develops in any part of the stomach and may spread throughout the stomach and to other organs; particularly the esophagus, lungs, lymph nodes, and the liver

• Causes about 850,000 deaths worldwide per year
• Occurs in most folks older than 40
• Greater incidence in Japan [perhaps due to a larger dietary consumption of smoked meats, nitrates and a diet that may be lacking in vegetables and fruit]

Early stages:

Symptoms may be absent or similar to those with benign ulcers that are relieved with antacids

Progressive stages:

Indigestion, anorexia, dyspepsia [lasting over 3-4 weeks], weight loss, abdominal pain [usually a late sign], constipation, anemia, N/V and ascites [indicating liver metastasis] – prognosis poor

Diagnosis:

Radiographic with UGI barium swallow

CT , liver and bone scan [may evidence metastatic disease]

• Surgical removal; prognosis good if the tumor is still localized
• Billroth I or Billroth II with possible total gastrectomy and anastomosis of the esophagus and jejunum
• Palliative chemotherapy, i.e., 5-FU, Adriamycin, Mitomycin C
• Radiation therapy
• Tumor marker injection to determine effectiveness of ChemTx

• Dietary history
• Identify weight loss; assess appetite, eating habits
• Pain assessement
• Smoking history; ETOH intake
• Family history
• Psychosocial support, e.g. marital status, coping skill, emotional and financial resources
• Complete physical exam

• Anxiety related to . . .
• Altered nutrition: less than body requirements related to . . .
• Pain related to . . .
• Anticipatory grieving related to . . .
• Knowledge deficit related to . . .

• Small frequent meals
• Non-irritating foods
• High calorie diet with Vitamin A, C, and iron
• Parenteral Vitamin B12
• IV therapy
• I/O and daily weights
• Assess for signs of dehydration, e.g., thirst, decrease in urine output, poor skin turgor, tachycardia, dry mucous membranes
• Lab data review
• Anti-emetics PRN

• Diet changes generally consist of 4 stages
• Takes about 8 weeks to go through all 4
• A return to eating many of the foods eaten in the past, but portion sizes must remain under control for best results

Stage 1

a condition of the digestive system in which a person experiences hard feces that is difficult to expel, related to:

the colon absorbing too much water from food due to the lack of water holding capacity of the contents of the bowels

food moving too slowly through the gi tract, the colon may absorb too much water, resulting in feces that are dry and hard

The process of defecation may be extremely painful, and in severe cases (fecal impaction) leads to symptoms of bowel obstruction

• Age
• Body mass
• Dietary
• Heredity, e.g., Hirschsprung’s disease
• Medications, i.e. opiates vs laxatives
• Heavy metals
• Illness or disorder
• Exercise

Abdominal distention

Borborygmus

Pain and pressure

Diagnosis:

Physical assessment

Barium enema*

Sigmoidoscopy

Stool for occult blood

Ano-rectal manometry

• Assess fluid intake
• Exercise and activity routine
• Dietary assessment
• Use of abusive laxatives
• Use of osmotic agents, i.e., Colace; stimulants, i.e. Biscodyl, lubricants, i.e., Glycerin suppositories; prokinetic agents, Cisapride
• Disimpaction

F

rom the Greek word, "diarrhoia" meaning "a flowing through"),

A condition of having three or more loose or liquid bowel movements per day

A common cause of death in developing countries and the second most common cause of infant deaths worldwide

The loss of fluids through diarrhea can cause dehydration and electrolyte imbalances

In 2009, diarrhea was estimated to have caused 1.1 million deaths in people aged 5 and over and 1.5 million deaths in children under the age of 5 years

• Medications
• Tube feedings
• Metabolic and endocrine disorders
• Viral and bacterial infections
• Malabsorption disorders
• AIDS, i.e., opportunistic infection
• Intestinal obstruction

• Increased frequency and fluid content in stool
• Abdominal cramping and distention
• Anorexia and thirst
• Ineffective straining [tenesmus]
• Fluid and electrolyte imbalances

1.

Watery stools – may indicate small bowel disease

2.Loose, semi-solid – disorders of the colon

3.Voluminous and greasy – intestinal malabsorption

4.Muco-purulent – inflammatory enteritis or colitis

5.Oil droplets – pancreatic insufficiency

6.Nocturnal diarrhea – diabetic neuropathy

Complications – cardiac dysrhythmias; dehydration; muscle weakness, paresthesias, hypotension, anorexia, fatigue, death

• Stool cultures
• Ova & Parasite profile
• CBC
• Chemical profile
• Endoscopy/colonoscopy
• Barium enema

• controlling symptoms and preventing complications
• Health history
• Physical assessment; i.e., abdominal and skin
• I/O
• Weight
• Using antibiotics and anti-inflammatory agents
• Increasing oral and IV solutions, i.e., glucose and electrolyte solutions
• Using antidiarrheals, i.e., diphenoxylate [Lomotil]; loperamide [Imodium]
• Using emollients and lotions, saline-based cleansing agents

• Encourage bed rest, liquids, foods low in bulk
• Limit caffeine consumption, carbonated beverages and either hot or cold foods that may stimulate intestinal motility
• Inspect skin and mucous membranes to determine hydration status and for peri-anal irritation
• Restrict milk products, fat, whole grain products, and fresh fruit and vegetables until symptoms decrease or subside

Fluid volume deficit related to . . .

Anxiety related to . . .

Risk for impaired skin integrity related to . . .

Risk for tissue perfusion related to . . .

• A condition characterized by inflammation of the appendix
• Pain generally experience in the RLQ of the abdomen
• It is a medical emergency
• All cases require removal of the inflamed appendix, either by laparotomy or laparoscopy
• Untreated, mortality is high, mainly because of peritonitis and shock

Prevalence higher among males than females

Incidence highest between the ages of 10 and 30

• LRQ abdominal pain [may be experienced as intermittent pain]
• Low grade fever
• Nausea and vomiting
• McBurney’s point [rebound tenderness in RLQ]
• Rovsing’s sign [pain experienced paradoxically in LLQ]
• Leukocyte count greater than 10,000/mm3
• Pelvic ultrasound reveals RLQ density

• Preoperative care
• Surgery
• Postoperative care
• Incision care
• Antibiotics
• Analgesics

• Accumulation of intestinal contents, fluid and gas that develops above the intestinal obstruction
• Most bowel obstructions [85%] originate in the small intestine
• Surgical adhesions account for 60% of all SBO
• Results in decreasing circulation to the bowel leading to edema, congestion, necrosis, and ultimate rupture of the intestinal wall leading to peritonitis

• Cramp-like pain experienced as ‘wave-like’ and colicky
• Peristaltic waves become vigorous assuming a reverse direction and propelling intestinal contents toward the mouth
• If the obstruction is in the ileum, fecal vomiting occurs
• High risk for dehydration
• Tongue and mucous membranes become parched
• If uncorrected, shock occurs due to F/E imbalances

• Symptoms
• Radiologic
• lab studies

• Maintain function of the NG tube
• Assess and record NG outpit
• Ongoing abdominal assessment
• Assess for F/E imbalance
• Monitor nutritional status
• Assess abdominal pain
• Report discrepancies in I/O
• Postoperative care if necessary

• Originates in lower GI tract
• Dehydration occurs more slowly than with SBO
• Strangulation of the bowel can occur leading to necrotic bowel . . . This is an emergency . . .
• Symptoms occur more slowly than SBO

• Constipation may be the only symptom for days
• Obstruction in sigmoid or rectum
• Abdomen becomes markedly distended while loops of bowel can be visibly seen through the abdominal wall
• Use of rectal tube
• Surgical resection with temporary or permanent colostomy or ileo-conduit if entire colon is removed

• KUB
• UGI/LGI studies
• Radiographic and barium studies

• Colonoscopy to try and untwist and decompress the bowel
• Cecostomy
• Rectal tube placement
• Surgical resection
• Nursing Care

• A subacute and chronic inflammation that extends through the entire bowel wall – often in the distal ileum and colon
• Occurs more frequently in adolescents and young adults
• Seen frequently in older populations [50 – 80]

Major concern with Crohn’s disease is the formation of fistulas, fissures and abscesses that can invade the peritoneal cavity . . . Leading to a thickened bowel wall, intestinal fibrosis and a narrowing of the intestinal lumen . . .

• Onset of symptoms is insidious
• Prominent abdominal pain and diarrhea unrelieved by the act of defecation
• Diarrhea present in 90% of the cases and is usually chronic
• Cramp-like pain after meals . . . leading to weight loss, malnutrition, and anemia
• Inflammed intestine often perforates . . . leading to intra-abdominal and anal abscesses

F

ever and leukocytosis

Symptoms may extend beyond the site[s] of inflammation . . . Arthritis, skin lesions [erythema nodosum], ocular disorders, i.e., conjunctivitis, and oral ulcers

• Goals of treatment include:
• Reducing inflammatory process
• Suppressing inappropriate immune responses
• Providing rest for a diseased bowel
• Attainment of ‘normal’ bowel function
• Reduction of abdominal pain and cramping
• Maintenance of optimal nutrition and prevention of weight loss
• Avoiding fatigue and reducing anxiety
• Effective coping; prevention of skin breakdown; addressing knowledge deficits regarding disease process

Goals of treatment include:

Goals of treatment include:

• Health History and Assessment
• Maintaining normal elimination patterns as much as possible
• Relieving pain such as anti-cholinergic agents, e.g., dicyclomine, and analgesics
• Maintaining fluid and electrolyte balance
• Promoting nutritional therapies such as TPN and small frequent feedings
• Reducing physical activities to conserve energy and reduce peristaltic activity

• S
• trategies to reduce anxiety
• Promoting coping skills and psychotherapy
• Preventing skin breakdown
• Preventing potential complications
• Dysrhythmias, changes on LOC, monitor for hemorrhage, perforation
• [diaphoresis, acute increase in abdominal pain, anxiety, rigid abdomen, vomiting, hypotension]
• Toxic megacolon: abdominal distention, decrease or absent BS, changes in LOC, feve, tachycardia, hypotention, dehydration, changes in F/E

• A recurrent ulcerative and inflammatory disease of the mucosal lining of the colon and rectum
• Severe complications
• High mortality rate
• 15 -20% incidence of colon cancer
• More common in Caucasian populations and people with Jewish heritage, peaking in the 30 -50 age range

Nursing and Medical treatment very similar to the management of Crohn’s Disease

The pressure-volume relationship between ICP,

volume of CSF, blood, and brain tissue, and cerebral perfusion pressure (CPP) is known as the Monro-Kellie hypothesis.

The volume inside of the cranium is a fixed

volume. The cranium and its constituents (blood, CSF, and brain tissue) create a state of volume equilibrium, such that any increase in volume of one of the cranial constituents must be compensated by a decrease in volume of another

70 – 90 mm Hg

0 – 10 mm Hg

normal pressure exerted by blood, brain and cerebral spinal fluid within the skull

Results in decreased cerebral circulation and anoxia

The ICP is a symptom of brain pressure

alterations rather than a disease in itself

death

• Maintain ABCs
• Maintain cerebral perfusion
• Reduce intracranial pressure
• Maintain fluid and electrolyte status
• Maintain cognitive functions
• Prevent complications

• Ineffective airway clearance
• Risk for injury
• Potential complications
• Altered nutrition
• Ineffective family coping
• Impaired skin integrit

• • Head injury/trauma
  • Meningitis
  • Brain tumors
  • Brain abscesses
  • Hemorrhage
  • Stroke
  • Hydrocephalus
  • Space-occup

  • ying lesion

• Progressive LOC decline
• Drowiness
• Increased BP and widening pulse pressure
• Pupil changes
• Confusion and disorientation
• Bradycardia
• Restlessness and irritability
• Abnormal posturing
• Altered respirations

• • Elevated temperature
  • Weakness progressing to hemiplegia
  • Blurred vision
  • Headache
  • Vomiting
  • Positive Babinski reflex (

  negative after 2)Seizures

• ICP Measurement

• via ventriculostomy, epidural sensor, and subarachnoid screw
• *** LP contraindicated***
• History and physical
• MRI
• CT and CAT scans
• EEG

• Oxygen therapy
• Intubation, mechanical ventilation
• Semi-Fowler’s positioning
• Aggressive monitoring
• Labs: K+, Na+, Glu, osmololity, BUN, serum

• osmolarity & creatinine
• Diuretics
• CFS drainage via ventriculostomy
• Anticonvulsants
• Glucocorticoids

Assessment

• Respiratory status
• Neurological status
• Posturing
• Decerebrate posturing - an involuntary flexion or extension of the arms and legs, indicating severe brain injury [involves the brain stem]
• Decorticate or mummy baby posturing- arms flexed, or

• bent inward on the chest, hands are clenched into fists, and the legs extended and feet turned inward [severe brain anoxia

Avoiding morphine analgesics

• • Corticosteroids-

  Decadron, hydrocortisone
• Osmotic diuretics-
Mannitol
• Anti-convulsants-
Dilantin
• Anti-hypertensive agents-
• Procardia [nifedipine sl]
• Antipyretics-
Tylenol
• IV fluids (avoid hypotonic solutions)
• Electrolytes-
K+ replacement
• Stool softners-
Dulcolax suppositories

• Brain herniation: Uncal
• Seizures
• Cognitive deficits
• Motor deficits
• Sensory deficits
• Coma
• Death

-fracture

-hemorrhage

-trauma

the brain results in edema or hypoxia

Hemorrhage is not always

associated with head injuries

often present in conjunction with head injury

• Maintain ABCs
• Maintain cerebral perfusion
• Maintain cognitive function
• Maintain fluid and electrolytes
• Prevention of complications

Restricted fluids

replacement

Ineffective airway clearance

Risk for injury

Potential complication

Ineffective family coping

Motor vehicle accidents

Sports injuries

Assaults

Gunshot wounds

Falls

Disorientation to time, place

and person

Decreased LOC

Unequal pupil size

Decreased level of

consciousness

disturbance

Rapid rise in body temperature

pressure

Auditory or visual disturbances

Seizures

Weakness

Paralysis

History and physical

CBC

ABGs

Serum electrolytes

Fasting blood glucose

MRI

EEG

or CAT scans

For cerebral spinal fluid in nose and ears (otorrhea, rhinorrhea)

5. For complications of immobility

6. For pain and restlessness

7. Monitor for diabetes insipidus

reflexes

Maintain

patent airway, oxygen

Activities to

(elevate HOB, no coughing, noise, O2-Co2)

Pain control, avoid opiods

Safety measures

Watch for diabetes insipidus

Check cough and gag

reflexes

Corticosteroids

Osmotic diuretics

Anti-hypertensives

Antipyretics

Anticonvulsants

Analgesics

Cerebral edema

Cerebral hypoxia

Infection

Shock

Motor/sensory deprivation

Coma

CSF flow obstruction

Death

in motor and sensory deficits

Mortality from stroke can be greatly decreased

by rapid assessment and intervention

well as people with atrial dysrythmic activity, and those individuals with HTN and receiving unmonitored anti-coagulant medication

Early recognition and treatment

Maintaining ABCs

Maintaining functional capabilities

Preventing complications

Effective communication

Cerebral hemorrhage

Ischemia

Arteriosclerosis

Hypertension

Smoking

Sedentary lifestyle

Oral contraceptive use

Coagulation disorders

Sickle cell disease

Obesity

Hypothyrodisim

Substance Abuse

Changes in level of consciousness

Paresthesias

Aphasia

Paralysis, hemiplegia

Weakness

Hypertension

Headache

N&V

Weakness or paralysis of face, drooping mouth

Sensory-perceptual disorders

Hemi-anopia

Drowsiness

Urinary incontinence

Dysarthia

Flaccidity. spasticity or rigidity

Behavioral changes, emotional instability

Agnosia

Apraxia

History and physical

MRI

CT and CAT scans

Arteriography

Cerebral angiography

Ultrasound (2D, 3D, Doppler)

CAT scan and MRI

Semi-Fowler’s position

Low-sodium, increased K+ diet

Oxygen therapy

Assessment of neurological signs

Pharmacology

Anticoagulants (

not for a cerebral hemorrhage!)

Anti-platelets (

not for a cerebral hemorrhage !)

not for a cerebral hemorrhage!)

Sensory-perceptual deficits

Aspiration pneumonia, pulmonary embolism

Seizures

Impaired communication

Depression

Constipation/urinary incontinence or stasis

ARDS

Coma

Death

Maintain ABCs

Maintain cerebral perfusion

Maintain fluid and electrolyte status

Maintain cognitive function

Prevent complications

Ineffective airway clearance

Risk for injury

Potential complications

Altered nutrition

Ineffective family coping

Epidural hematoma

Subdural hematoma

Hypertension

Arteriosclerosis/atherosclerosis

Trauma

Obesity

Diabetes Mellitus

Anticoagulant therapy

Genetics

Increased ICP

Hypertension

Dilated pupils or unequal pupil size

Cheyne-Stokes respirations

Nuchal rigidity

Facial drooping

Dysarthia

Ataxia

Paralysis

Dysphagia

Decreased sensation

Hemiplegia

Unequal extremity strength

Decreased urine specific gravity

History and physical

MRI

CT and CAT scans

Glascow Coma Scale

EEG

Cerebral arteriography

Measures to prevent ICP

Seizure precautions

Safety measures

Prevent complications

Emotional support

Prepare for surgery if indicated

Corticosteroids

Osmotic diuretics

Anti-hypertensives

Antipyretics

Anticonvulsants

Analgesics

for subarachnoid hemorrhage )

Hypoxia

Hemiplegia

Aphasia

Bowel/bladder incontinence

Coma

Death

Autoimmune attack of peripheral nerve

myelin

infection 2 weeks before

years

Ascending weakness

Dyskinesia

Hyporeflexia

Parathesis

Respiratory failure

demyelination---cardiac instability

Guillan-Barre DOES NOT

AFFECT COGNITIVE FUNCTION OR LOC