Gastrointestinal Disorders

By: Keith Kainne “D” Garino, RN, LPT, MAEd

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 Gastroesophageal Reflux Disease
Cause:
•
•
•

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 Clinical Manifestations:
“Indigestion Burns your throat, larynx and esophagus”

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 Interventions: “Food should go down”
Diet
• Fluids
• Fiber
• Meal

Position
• HOB
• Turned to

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 Interventions: “Food should go down”
Medications:
•
•
•
•

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 Interventions: “Food should go down”
• Avoid “5CAFPS”

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 Interventions: “Food should go down”
Avoid
• IAP
•Medications:
•A
•N
•A
•C
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 • High fat
• Semi-fowlers
• High fiber
• 3 meals per day
• Atropine
• Spicy foods
• Avoid coffee
• Fluids in between meals
• Turn to right side
• Tight clothing
• Aspirin

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 Peptic Ulcer Disease
Factors:
• Stress
• Drinks
• Vices
• Drugs
• Infection

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 Clinical Manifestations:

Gastric Duodenal
Epigastric Pain
Time
Relief of pain
Bleeding

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 Interventions:
1. Meal
2. Diet
•
• Chew
• Milk
• Active phase
3. Avoid Factors
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 Medications:
1. Antacids
• Action
• Time
•S

•C

•A

•M

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 Medications:
2. Gastric Protectants/Cytoprotective
• Sucralfate
• Time
• Action

• Misoprostol
• Time
• Action
• Contraindication

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 Medications:
3. Histamine-2 Receptor Antagonist
• Action
• Time

4. Proton Pump Inhibitors

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 A.Antacid
B.Histamine 2 receptor blocker
C.Proton pump inhibitor
D.Cytoprotective

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 1. Removal of the stomach with attachment of the esophagus to the jejunum
or duodenum
2. Surgical division of the vagus nerve.
3. Removal of the lower portion of the stomach.
4. Partial gastrectomy with the remaining segment anastomosed to the
duodenum.
5. Enlargement of the pylorus to prevent or decrease pyloric obstruction.
6. Partial gastrectomy with the remaining segment anastomosed to the
jejunum.

A. Vagotomy
B. Total Gastrectomy
C. Pyloroplasty
D. Antrectomy
E. Billroth I
F. Billroth II

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 Dumping Syndrome

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 • Pallor
• Decreased bowel sound
• Bradycardia
• Hypotension
• Weakness
• Flat abdomen
• Diaphoresis
• Constipation
• Light headedness
• Nausea and vomiting

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 Management
1. Diet:
• protein
• carbohydrate
• fiber
• Meals
• fluids
• Avoid:
2. Position
3. Medication

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 Diverticulosis
• Outpouching of intestinal mucosa
• Common site:
• Factor:

Diverticulitis
• Inflammation of diverticula.
• Cause:

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 Clinical Manifestations:
1. Inflammation
• Abdominal pain
2. Infection
• Body temperature
• WBC
3. Injury
• Stool
4. Obstruction
• Gas

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 Interventions:
Diverticulosis
1. Fiber
2. Fluids
3. Medication

Diverticulitis
1. Fiber
2. Fluids
3. Medication
4. WOF:

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 Appendicitis

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 • McBurney’s point • Blumberg’s sign
Clinical • Rovsing’s sign • WBC
Manifestation
• Dunphy’s sign • Bowel sound

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 Psoas sign

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 Obturator sign

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 A. Dunphy
B. McBurney
C. Obturator
D. Rovsing
E. Blumberg
F. Psoa

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 Management:
1. “Suspected Appendicitis”
• Analgesics
2. “Refer to acute phase”
3. Avoid:
•
•
•
4. Compress
• Cold
• Hot

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 Renal Disorders
By: Keith Kainne “D” Garino, RN, LPT, MAEd

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 Acute Kidney Injury
• Sudden or Progressive loss of kidney function.
• Reversible or irreversible.

Causes:
1. Prerenal
2. Intrarenal/intrinsic
3. Postrenal

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 • Renal calculi
• Dehydration
• Bladder cancer
• Liver cirrhosis
• Antineoplastic medications
• Hemorrhage
• Heart failure
• Glomerulonephritis
• Burns
• Nephritis
• BPH
• Rhabdomyolysis

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 Phases of AKI:
1. Onset/Initiation
2. Oliguric phase (8-15 days)

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 Phases of AKI:
3. Diuretic phase (4-5L/day)

4. Recovery/Convalescent (1-2 years)

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 Findings Oliguric Diuretic
Elevated BUN and Creatinine
Hypokalemia
Hypervolemia
Hyperphosphatemia
Hyponatremia
Hypocalcemia
Metabolic acidosis

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 Chronic Kidney Disease
• Sudden or progressive loss of function of the kidneys.
• Reversible or irreversible.
• GFR –
• Duration –
Stages Estimated GFR
Risk >90 mL/min
Mild CKD 60-90 mL/min
Moderate CKD 30-60 mL/min
Sever CKD 15-30 mL/min
ESRD <15 mL/min
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 Stages Estimated GFR
mL/min
mL/min
mL/min
mL/min
mL/min

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 Clinical Manifestations:

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 Management:
1. FVE
• Monitor
•
•
•
• Auscultate
• Fluid intake
• Diet
• Medication

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 Management:
2. FVD
• Monitor
•
•
•
• Assess
• Fluid intake

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 Management:
3. Hyperkalemia
• Monitor
• Diet
• Medication
•D
•I
•S
•C
•S

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 Management:
4. Hypermagnesemia
• Monitor
•
•
• Diet
• Medications
•C
•A
•D

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 Management:
4. Hyperphosphatemia
• Diet
• Medication

5. Hypocalcemia
• Diet
• Supplement

6. Metabolic Acidosis
• Medication

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 Management:
7. Anemia
• Laboratory
• Medication
• Supplements
• Procedure

8. Uremia and Azotemia

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 Renal Calculi
Causes:
• Diet
• C
•
• O
• P
• Activity
• Fluid
• Infection
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 Clinical Manifestation
Renal colic Ureteral colic
• Pain • Pain
• Location • Location
• Radiating • Radiating
• Male •
• Female •

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 Clinical Manifestation
“The client peed, then was shocked and disgusted.”
Peed
•
•

Shocked
•
•

Disgusted
•

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 Management:
1. Monitor
• V/S
• I&O
• Strain

2. Pain
•
•

3. Promote Passage of stone

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 Management:
4. Diet
• Purine
• Calcium
• Oxalate

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 Urinary Tract Infection
Causes & Factors:
1. Bacteria
•
2. Gender
•
3. Disease
•
4. Procedures
•

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 Sites Upper UTI Lower UTI
Cystitis
Pyelonephritis
Renal abscesses
Prostatitis
Urethritis
Interstitial
nephritis

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 Clinical Manifestations:
Pain:
• GIT symptom:
• Upper UTI:
• Lower UTI:

Inflammation:
•
•

Infection & Injury:

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 Management:
1. Fluid intake: 5. Avoid:
2. Urine pH:
3. “Wash, wear & wipe”
•
•
•
4. Empty bladder:
•
•
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 Medications:
1. Analgesic
•
•

2. Antibiotics
•
•

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 • It is okay to take a bath in a tub.
• I will drink 12 8-ounce cups per day.
• Phenazopyridine will kill the bacteria in my bladder.
• I need to drink plenty of fluids when taking ciprofloxacin.
• I will eat a lot of citrus to acidify my urine.
• It will be better if I wear a tight jeans to prevent UTI.
• Wiping the perineum from front to back.
• Holding in urine to prevent dysuria.
• From now on, I will wear synthetic underwear.
• I will empty my bladder before and after sexual intercourse.

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