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8/14/2019 Body Metabolism and Nutrition
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Metabolism
Prepared by:
John Gil B. Ricafort, RN
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Objectives:
Review of Digestive System
Common Assessment Findings
Common Diagnostic Tests/Procedures
Disturbances
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c. Intestinal Gas
d. Nausea and vomitinge. Change in bowel habits
and stool characteristics
f. Jaundice
g. Pruritus
h. Increased bleeding
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Common Diagnostic Tests
a. Stool Tests
b. Breath Tests
- Hydrogen Breath Test-used to evaluate CHOabsorption and bacterialovergrowth.
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- Urea Breath Test
- detects the presence of H.
Pylori
Note: The person takes a capsule ofcarbon labeled urea and then
provides breath sample 10 to 20minutes after.
*AVOID antibiotics
*AVOID Sucralfate/ Omeprazole
*AVOID Tagamet/ Pepcid/ Zantac
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c. Abdominal Ultrasonography
d. Upper GI Series (BariumSwallow)
- its a fluoroscopic examinationof the upper GI tract to determinestructural problems and gastricemptying time; Client mustswallow barium sulfate or other
contrast medium.
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- sequential films taken as it movesthrough the system.
Nursing Responsibilities: PRETEST
1. Keep NPO after midnight or 6-8 hours
pretest.
2. Explain that the barium will tastechalky.
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Nursing Responsibility: POSTTEST
1. Administer laxatives to enhance
elimination of barium and preventobstruction or impaction.
e. Lower GI Series ( Barium Enema)- Barium is instilled into the colon byenema; client retains the contrast
while x-rays are taken to identifyabnormalities
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Nursing Responsibilities: PRETEST
1. Keep on NPO for 8 hours pretest
2. Give enemas until clear the morningof test
3. Administer laxative or suppository
4. Explain that cramping may beexperienced during the procedure.
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Nursing Responsibility: POSTTEST
1. Administer laxatives and fluids to
assist in expelling barium.
f. Endoscopic studies
g. Liver Biopsy
- invasive procedure where a needle isinserted into the liver to remove asmall piece of tissue for study.
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Nursing Responsibilities: PRETEST
1. Ensure the client has signed the
consent form.2. Keep NPO 6-8 hours pretest.
3. Instruct the client to HOLD BREATH
during the procedure.
Nursing Responsibilities: POSTTEST
1. VS taking every hour for 8-12 hours
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2. Place client on his RIGHT SIDE for afew hours with a pillow against his
abdomen to provide pressure on theliver.
3. Observe the punctured site for
hemorrhage.4. Assess for complications of shock and
pneumothorax.
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Disturbances:
1. Gastritis
- inflammation of the gastric orstomach mucosa, is a common GIproblem.
Clinical Manifestation:
abdominal discomfortheadache
nausea and vomiting
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Hiccuping
Anorexia
Heartburn
Sour taste in the mouth
Nausea and vomitingAssessment and Diagnostic Findings:
Endoscopy
Upper GI radiographic StudyHistologic Exam
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Medical Management:
The gastric mucosa is capable of healing
itself for about 1 day after gastritis.Ingestion of acid neutralization
Ingestion of alkaline neutralization
NG IntubationAnalgesic Agents/ Sedative
Antacids
AntibioticsModify Diet, STRESS management
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Nursing Diagnoses:
1. Anxiety related to treatment
2. Altered Nutrition: Less than
Body Requirement related toinadequate intake of nutrients.
3. Acute Pain related to irritated
stomach mucosa
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Nursing Interventions
1. Reducing anxiety
2. Promoting optimal nutrition
3. Promoting fluid balance
4. Relieving pain
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2. Peptic Ulcer Disease (PUD)
- is an excavation that forms in themucosal wall of the stomach, in thepylorus, in the duodenum and in theesophagus.
Types:
a. Lower Esophageal Ulcer
b. Gastric Ulcerc. Duodenal Ulcer
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Clinical Manifestations:
Same with gastritis
Burning sensation in themidepigastrium
Pain relived by eating
Pyrosis
Vomiting
Constipation or diarrheaBleeding
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Assessment and Diagnostic Findings
Endoscopy
Breath Test
Stool Exam
Medical Management
Antibiotics
Antacid
Proton Pump InhibitorsHistamine Receptor Antagonist
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Other Managements:
Stress Reduction and Rest
Smoking Cessation
Dietary Modification
SurgeryBillroth 1(Gastroduodenostomy)
Billroth 2(Gastrojejunostomy)
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Nursing Diagnoses:
1. Acute Pain related to the effect ofgastric acid secretion on damaged
tissue.2. Anxiety related to coping with an
acute disease.
3. Imbalance Nutrition related tochanges in diet.
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Nursing Interventions
1. Relieving pain
2. Reducing anxiety
3. Maintaining optimal nutritional status4. Monitoring & managing complications
Hemorrhage
PerforationPyloric Obstruction
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Assessment and Diagnostic Findings
Complete PE
Laboratory Studies
X-ray
Medical Management
Antibiotics
IV administration
Analgesics (after surgery)Surgery (APPENDECTOMY)
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Complications of Appendicitis:
Perforation most commonSepticemia
Abscess formation
4. Inflammatory Bowel Disease
a. Crohns Disease
b. Ulcerative Colitis
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Crohns Disease
- also known as Regional Enteritis
- a chronic inflammatory bowel diseasethat can affect both the large and smallintestines, but most COMMON in the
megacolon area.- UNKNOWN cause
- onset: 20-30 years and 40-60 years
- both sexes are affected
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- characterized by GRANULOMAS thatmay affect all the bowel wall layers with
resultant thickening, narrowing, andscarring of the intestinal wall.
Clinical Manifestations
Right lower quadrant tendernessAbdominal distention
Decrease skin turgor
Dry mucous membrane
Increase peristalsis
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Nausea and Vomiting
3-4 semisoft stools (ribbon-like)/ day
with mucus and pus
Diagnostic Tests
Decreased Hgb and Hct
Barium enema shows narrowing withareas of strictures
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Medical Management
Diet: High Calorie, High vitamin, High
protein, Low residue, Milk free;Supplementary iron
Pharmacologic Agent
Antimicrobials (Sulfasalazine)
Corticosteroids
Antidiarrheals
Anticholinergics
Surgery: Resection of the diseasedportion and ileostomy
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Nursing Interventions
1. Provide appropriate nutrition while
reducing bowel motility.2. Promote comfort/ rest.
3. Provide care for the client with bowel
surgery
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Ulcerative Colitis
- inflammatory bowel disease
characterized by inflammation andulceration that starts in therectosigmoid area and spreads upward.
The mucosa of the bowel becomesedematous, thickened with eventualscar formation. The colon consequentlyloses its elasticity and absorptive
capabilities.
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- UNKNOWN cause- occurs more often in women
- onset is usually 15-40 years
Clinical Manifestations
Severe diarrhea (15-20 liquid stools/day containing mucus, blood andpus)
Severe tenesmus
Weight loss
A i
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Anorexia
Weakness
Crampy discomfortDecreased skin turgor
Dry mucous membrane
Low-grade feverAbdominal tenderness
Diagnostic Tests
Decreased Hgb and HctSigmoidoscopy reveals mucosa thatbleeds easily with ulcer development
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Management
Mild to Moderate from
Diet: Low-roughage diet; NO milkproducts
Pharmacologic Agents
Severe form
Diet: NPO with IVs and electrolytereplacement, NG tube with suction,
Blood transfusion
Surgery
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Factor CROHNS ULCERATIVE
CoursePathology
Early
Late
ManifestationLocation
Bleeding
Fistulas
Diarrhea
Prolonged, variable
Transmural
Deep
Ileum, Right Colon
Usually not
Common
Less severe
Exacerbations
Mucosal
Mucosal
Rectum, Left colon
Common/severe
Rare
Severe
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Nursing Diagnoses
1. Diarrhea related to inflammatoryprocess.
2. Acute Pain related to increasedperistalsis and GI inflammation.
3. Imbalance Nutrition: Less than
body requirements related todietary restrictions, nausea andmalabsorption.
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Nursing Interventions:
1. Maintaining elimination patterns.2. Relieving pain.
3. Maintaining fluid intake.
4. Maintaining optimal nutrition.5. Promoting rest.
6. Reducing anxiety.
7. Monitoring and managing potentialcomplications.
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5. Hemorrhoids
- are dilated portions of veins in the anal
canal usually due to impairment of bloodflow.
- common between 20-50 years old
Types:
a. Internal Hemorrhoids
b. External Hemorrhoids
Manifestations
Pain ProtrusionItching and Bleeding
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Management
Antibiotic
Anti-inflammatory
AnalgesicsStool softeners
SurgeryHemorrhoidectomy
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Clinical Manifestation
Increased abdominal girthRapid weight gain
Shortness of breathStriae
Distended neck veinFluid and electrolyte
imbalances
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Diagnostic Findings
UltrasoundFluid Wave Testing
Medical Management
Dietary ModificationDiuretics
Bed rest
Paracentesis
LeVeen Shunt (Peritoneal-venous Shunt)
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Nursing Interventions
1. Monitor nutritional status/ provide
adequate nutrition with modified diet.Sodium = 200-500mg/day
Fluid = 1000-1500ml/day
Promote high calorie food
2. Monitor/ prevent increasing edema
3. Monitor/ promote skin integrity
4. Promote comfort
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7. Esophageal Varices
- are dilated, tortuous veins usually foundin the submucosa of the loweresophagus, but may develop higher inthe esophagus or extend into the
stomach.- usually caused by portal hypertension
- bleeding varices lead to hemorrhagic
shock, producing decrease cerebral,hepatic and renal perfusion.
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Clinical Manifestation
Hematemesis
Melena
General Disorientation
Signs and symptoms of shock
Diagnostic Findings:
Endoscopy
Ultrasonography
CT Scan
Angiography
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Management
Ice normal saline lavage
Administration of Vit. KBlood transfusion
Oxygen administration
Fluid replacementVasopressin vasoconstriction
Nitroglycerin
Balloon Tamponade
- it controls the bleeding by using adouble-balloon (Sengstaken-Blakemore)
C i f P i i h S k
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Caring for Patient with Sengstaken-Blakemore Tube:
1. Facilitate placement of the tube;check and lubricate tip and elevate thehead of the bed
2. Prevent dislodgement of the tube byplacing the patient in semi-fowlersposition; secure the tube properly
3 K SCISSORS h b d id ll
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3. Keep SCISSORS at the bedside at alltimes
4. Monitor respiratory status5. Label each lumen to avoid confusion
6. Observe nares for skin breakdown and
provide oral and nasal care every 1-2hours.
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Endoscopic Sclerotherapy
-injection of sclerosing agent topromote thrombosis and sclerosis
Esophageal Banding Therapy
8. Hepatic Cirrhosis
- a chronic degenerative disease inthe liver in which the lobes arecovered with fibrous tissue, theparenchyma degenerates and thelobules are infiltrated with fat.
t i i i
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- occurs twice in men in women
- onset: 40-60 years ols
Types:
1. Laennec Cirrhosis
2. Postnecrotic Cirrhosis
3. Cardiac Cirrhosis
4. Biliary Cirrhosis
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Clinical Manifestations
Intermittent feverSpleenomegaly
Vascular spiders Weight loss
Abdominal pain Edema
Firm, enlarged liver Muscle wasting
Ascites Weakness
Jaundice
Epistaxis
Hypotension
Di ti T t
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Diagnostic Test:
Ultrasound
CT ScanMRI
Laboratory Studies
Increased Liver enzymeMedical Management
Management is based on the
presenting symptoms.COLCHICINE
N i g I t ti
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Nursing Interventions
1. Provide sufficient rest and comfort
2. Promote nutritional intakea. encourage small frequent feeding
b. High calorie, low to moderate
protein, high carbohydrate, low-fatdiet, supplemental vitamin
3. Prevent infection
4. Monitor/ prevent bleeding
5. Administer diuretics
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9. Cholelithiasis
- refers to stones in the gallbladder
Risk Factors:
Obesity
Multiple PregnancyRapid weight loss
Estrogen therapy
Cystic FibrosisDiabetes Mellitus
Cli i l M if i
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Clinical Manifestation
Epigastric distress
Abdominal distention
Vague pain in the RUQ of theabdomen
Pain and Biliary Colic
Jaundice
Vitamin Deficiency
Changes in urine and stool color
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Diagnostic Findings:
Ultrasound
Abdominal X-ray
Medical Management
Nutritional and Supportive
Pharmacologic
Ursodeoxycholic AcidChenodeoxycholic Acid
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Nursing Interventions
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Nursing Interventions
1. Administer pain medications as
ordered.2. Administer IV fluids as ordered
3. Provide small frequent meals
4. Provide care to relieve pruritus
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10. Pancreatitis
- refers to inflammation of thepancreas due to self-destruction.
- Severe abdominal pain is themajor symptom of pancreatitis
Diagnostic Finding
Based on historyLaboratory studies
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Medical Management
Directed towards relieving thesymptom.
Parenteral Nutrition
Anti-ulcer drugsPain management (DEMEROL)
Respiratory Care