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 Resultsfrominadequate intake
of nutrients
 Lack of majornutrientsor
micronutrients
 lossof nutrientsdue to
diarrhea,hemorrhage,orrenal
failure;
 impairedabsorptionanduse
of nutrients;increased
metabolicneeds
 Widespreadcause of disease
and mortality;Young,poor,
elderly,homeless,low-income
women,andethnicminorities
 May developwhile
hospitalized
PATHO
 Whendietaryintake of nutrientsdoesnotmeetthe
body’s energydemands,the bodyusesglycogen,
bodyproteins,andlipidstosupportmetabolism
 Acute illnessandstressproducesastate of
hypermetabolismandcatabolism
 Surgeryor illnessmaypromote Protein-Calorie
Malnutriton,adeficiencyof proteinsandcalorie
SIGNS & SYMPTOMS:
 Weight loss
 Body mass reduction
 Wasted appearance;
Weakness
 Dry and brittle hair
 Pale mucous membranes
 Peripheral or abdominal
edema
 May be indicative of a
Diagnostics& Treatment
 Nutritional screeningtool
 Serumalbuminlevel&Prealbuminlevel
 Serumelectrolyte
 Total lymphocyte count
 Total dailyenergyexpenditure

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NursingCare:Healthhistoryandphysical examination
 Provide environmentandnursingmeasurestopromote eating
 Monitor temperature andpointake.
 Teach S/Sof infectionandhandwashing
 Weighdaily
 I& O; Skinturgor; LOC;urine specificgravity
 Turn Q 2 hours;Turn Clock;Draw sheet
 Assessskin integrityqshift
PATHO:
 Excessive caloriesare storedasfat& adipose tissue
 Resultsfromexcessenergyintake,decreasedenergy
 expenditure,ora combinationof both
 Upper bodyobesity:waist-to-hipratioof greaterthan
1 inmenand 0.8 inwomen
 Associatedwithagreaterriskof complicationssuchas
HTN, lipidlevels,heartdisease,stroke,andelevated
Insulinlevels
 Lowerbody obesity:waist-to-hipratio islessthan0.8;
more commonin women
 More difficulttotreat
 BMI 25-29.9kg/m2 overweight;above 30obese
RISKS
1. Genetics
2. Physiologic
3. Psychological
4. Environmental
5. Sociocultural
*most preventable health problems
in US
Diagnostics:
 BMI
 Waist circumference
 Thyroid profile
 Glucose, cholesterol,
EKG

3. Treatment:
 Medications(appetite suppressants;fatabsorptioninhibitors)
 Exercise &Nutrition
 BehaviorModification
 Surgery
NURSINGCARE:
 Establishrealisticweight lossgoals
 Discussbehaviormodificationtechniques
 Assesscurrentactivitylevel
 Regular,graduallyincreasingexerciseplan(after medical
clearance)
 Encourage discussionof feelings
 Encourage decisionmakinginplanof care
 Establishrapport
MEDICATIONS:
*Phentermine
*Meridia
*Xenical
PATHO:
* Inflammationandulcersof the oral mucosa frompersistentdamage tooral
mucosal cells.
* Release of inflammatorymediatorscause tissue damage, progresses from
superficial toulcerationto involvementof the entire epithelium(Healing
beginsin within2-4weeks;mucosadoes notfullyrecover
 Commonlyseeninimmunocompromisedpeople, elderly,
people withcancer,endof life(renal failure,O2therapy),poor
oral hygiene,tobacco,alcohol use
Causes:
1. Viral (most com) Herpes
simplex
2. Fungal (Candida albicans)
3. Mechanical trauma (cheek
biting)
4. Nutritional deficit
5. Irritants (tobacco, non fit
dentures)
MANIFESTATIONS:
Vary according to the cause.
May include:
 Vesicularlesions(fungal- creamy
white curdlike patches)
 Red,erythematousmucosa
 Bleeding,tissue necrosis
 Halitosis
 Pain(viral irritantant)
 Tissue necrosis
DIAGNOSTICS
 Physical exam
 Cultures,smears (as ordered)
 Oral lesion don’t respond to therapy 1-2
weeksneed to be evaluated for
malignancy
TREATMENT:
• Meticulousoral hygiene,withbrushingandflossing
• Solutionof saline/sodiumbicarbonategivenafterand
betweenmeals
• Topical anesthetic-viscouslidocaine
• Orabase-protective paste

4. NURSING:
• HX & physical
• ID clientsatrisk
• Assessoral mucosa;Regularperformance of mouthcare
• RegularDental appointments
• 8 oz buttermilk/yogurtif takingantibiotics
• Limitspicy,hot,acidicfoods,hotbeverages
• AvoidETOHand smoking
• Weighdaily&High-calorie,high-proteindiets
• Analgesicsforpain
PATHO:
Malignancyof oral mucosa,usuallysquamouscell carcinoma (UNCOMMON)
1. Early—Painless,Inflamedareawithirregular,ill definedborders
2. Late—Underlyingtissues,muscles,bonesmaybe involved
3. Frequentlymetastasize toregional lymphnodes
May occur on the lips,tongue,floorof the mouth
Uncommon—only3-5%of all new cancers
Stage of cancer determinesprognosis,treatment anddegree of disability
Risk factors
1. smoking
2. drinking ETOH
3. chewing tobacco
4. marijuana
5. occupationl
exposure to
chemicals &
viruses
MANIFESTATIONS:
 Earliest—Painlessoral ulcerationorlesion
 White Patches—Leukoplakia
 RedPatches-Erythroplakia
 Later—Impairedspeaking,swallowing,chewing;
 swollenlymphnodes;bloodtingedsputum
 pigmentedareas(brownorblack
 masses,ulcers,fissures
 Asymmetryof head,face,neck,jaw
DIAGNOSTICS:
Physical examination
therapy in 1-2 weeks need to be
evaluated for malignancy
Nursingdiagnoses
1. ImpairedOral Mucous
Membrane
2. Imbalance Nutrition:lessthan
bodyrequirements

5. TREATMENT:
 Eliminate causative factors (tobacco,alcohol)
 Radiation/Chemotherapy
 Surgeryisgenerallytreatmentof choice
 Remove lesionandpotentiallycanceroussurrounding tissuesandlymphnodes
 Radical neckdissectionmaybe requiredif advanced(Lymphnodes,musclesof the neck
removed)- ATRACHEOSTOMYIS performedat time of surgery
 Tracheostomymaybe required(Temporpermanent)
NURSING:
• Teachingrelatedtocausative factors,Earlyidentificationand
interventions
• Assessmentof oral mucosa,lipsonphysical exam
• Monitorairway
• Semi fowlers position
• TCDB every2 hours
• Adequate hydration
• Weighdaily
• Soft,blanddiethighincalories/protein
• Feedingtube---interventions??
• Establishcommunicationplan
• Disturbedbodyimage---interventions
PATHO: (commonlyoccurring15-20% adults)
May resultfrom
1. transientrelaxationof the lower esophageal
sphincter
2. an incompetentloweresophagealsphincter
3. increasedpressure withinthe stomach
*Backward flowingof gastriccontentintothe
esophagus&Maydevelopinflammatory esophagitisasa
resultof acidiccontents
FACTORSTHAT CONTRIBUTE:
1. Increasedgastricvolume(aftermeals)
2. bodypositioning
3. increasedgastricpressure( obesity/
tightclothes)
4. hiatal hernia
5. Damage to the esophageal mucosa
occurs due to prolongedexposure to
gastric juices
MANIFESTATIONS:
 Heartburn&indigestion
 Dysphagia
 Regurgitation
 ChestPain
 Painaftereating
 Belching
 Aspirationmaycause hoarsenessand
respiratorysymptoms
DIAGNOSTICS:
-assesses
esophagus stomach, and upper
small intestine.
-
directvisualization…tissue may
be obtained for a biopsy.
monitoring
y
Diagnoses
1. Riskfor IneffectiveAW
Clearance-(Fowler’sposition,
turn coughdeepbreath,
hydration)
2. Imbalance Nutrition:Lessthan
bodyRequirements
3. ImpairedVerbal Comm.
4. DisturbedBodyImage
Stricturesleadto
dysphagia
Barrett’sesophagus
increasedcancerrisk

6. TREATMENT:
 Antacidsmayrelieve mildormoderate symptoms byneutralizingstomachacid.
Maalox, Mylanta, Gaviscon,Tums
 Protonpumpinhibitorsreduce gastricsecretions, promotehealing,andrelieve symptoms.
Nexium,Prevacid,Prilosec,Protonix,Aciphex
 Histamine2–Receptorblockersreduce gastricacid production andtreatGERD symptoms.
Tagament, Pepcid,Zantac, Axid
 Promotilityagentsmaybe orderedtoenhance clearance of the esophagusandstomach
emptying…Notrecommendedforlong-termuse
Reglan
 Nutritionandlifestylemanagement-reduce acidicfoods(tomato,citrus,spicy,coffee),&
fattyfoods,chocolate,peppermint,alcohol
NURSING:
 PerformhealthhistoryandPhysical exam
 Provide small frequentmeals, Restrictfat,acidicfoods,
coffee,andETOH
 Stopsmoking
 Administers medsasordered
 Remainuprightaftermeal
AcutePain
PATHO:
 Occurs whenpart of the stomach protrudes throughthe esophageal hiatusof
the diaphragmintothe thoracic cavity, incidence increaseswithage
Slidinghiatal hernia
Gastroesophageal junctionandthe fundusof the stomachslide upwardthrough
the esophageal hiatus (fewsymptoms)
Paraesophageal hiatal hernia
Junctionbetweenthe esophagusandstomachremainsin itsnormal position
belowthe diaphragmwhileapart of the stomachherniatesthroughthe
esophageal hiatus-maydevelopgastritisorgastrointestinal bleeding.
MANIFESTATIONS:mostpeople asymptomatic
 Reflux,heartburn
 Feelingof fullness
 Substernal chestpain
 Dysphagia
 Occultbleeding
 Belchingindigestion
DIAGNOSTICS
 BARIUM SWALLOW
 UPPER ENDOSCOPY
Surgery-
Laparoscopicfundoplication –
gastric funduswrappedaround
distal esophagus(increase
pressure inthe loweresophagus,
inhibitinggastriccontentreflux)

7. (PEPTIC ULCER DISEASE)
TREATMENT:
 Oftenasymptomatic…Notreatmentrequired.
 Treatmentmeasuressuchasthose for clientswith GERDmay be ordered
 Surgerymay be required
Nissenfundoplication (maybe openor laparoscopicall)-preventsgastroesophageal junction
fromslippingintothoraciccavity
NURSING:
 Similartothat of GERD clients
 If surgeryis performed,nursingcare ispre-opand post-opinterventionsandcomplications.
PATHO
* A break inthe mucosal liningof the GI tract
where itcomesincontact withgastric juice
(hydrochloricacid andpepsinof the mucosa).
Ulcersmay be superficial ordeepaffectingall
layersof the mucosa
*Exacerbationsmayoccur withtrauma,infection,
stress-bothphysical andpsychological
* ChronicProblem ( Affects4millioninUS)
* PepticUlcersmayoccur in the esophagus,
stomachor duodenum(Duodenal mostcommon)
Risks
 H pylori infection
 NSAIDs
 Advanced age
 Personal/family HX of ulcers
 smoking
MANIFESTATIONS:
aching, or hunger-like)
empty (2-3 hours after meals and in the
middle of the night)
DIAGNSOTICS:
- barium contrast
used 1st
*lab values, stool, vomitus, gastric
drainageCOMPLICATIONS:
• Hemorrhage
1. Slow & insidiousbloodloss,withoccultbloodin
stool.
2. Anemia,weakness,dizziness,hypotension mayoccurif
bleedingcontinues.
3. If large vessel isaffected,hematememsis,bloodinthe stool,
signsof hypovolemicshockoccur.
• Obstruction- gradual process
1. Edema,smoothmuscle spasms,orscar tissue

8. TREATMENT:
 H Pylori Eradicationincreasesulcerhealing&reducesrecurrence
 Triple therapy(7-14 daystwice daily) (1.) Full dose PPI (2.) Amoxicilin(3.) Clarithromycin/
Metronidazole (worksin80-85%)
 H2 receptorantagonists
 Protonpumpinhibitors,antacids,sucralfate (bindstoproteinsinulcerbase formprotectivebarrier)
NURSING:
 HX & physical *AssesAb.,girth,bowel sounds,tenderness
 Painmanagement&relaxation techniques *IV therapy,NGtube maintenance
 Nutritional &dietaryconsult *discontinue NSAIDS, STOPSMOKING
PATHO: common(acute or chronic)
 Inflammationof the stomachlining,resultsfrom irritationof the gastricmucosa
ACUTE:
• Characterizedbydisruptionof the mucosal
barrierby a local irritant;hydrochloricacidand
pepsincome incontact withthe gastrictissue
causingirritation,inflammation,andsuperficial
erosions.
• Self limiting,resolvesinseveral days.
• Most commoncause:ASA, NSAIDs,
corticosteroids,ETOH, and caffeine
consumption;accidental/purposeful ingestion
of corrosive materials; chemo/radiation;shock,
severe trauma, major surgery,sepsis,burns
secondary to ischemiafrom vasoconstriction.
 Elderly,smokers,alcoholics
• GI perforation,hemorrhage,andperitonitis
are complication
MANIFESTATIONS:
 Anorexia
 N/V
CHRONIC:
• Progressivedisorderthatbeginswith
superficial inflammationandgraduallyleadto
atrophyof gastrictissues.
ClassifiedasType A and Type B
• Type A: lesscommon;thoughttobe
autoimmune;body producesantibodieswhich
destroy parientalcellsandintrinsicfactor.
• Type B: more common;incidentincreaseswith
age;Chronic infection(H.pylori) isthe cause;
Causesinflammation,outerlayerthinsand
Atrophies
MANIFESTATIONS
 Vague discomfortaftereating
 May be asymptomatic
 Anemia
AcutePain Disturbed Sleep Pattern Imbalanced Nutrition:Less Risk forbleeding

9. DIAGNOSTICS
 Hx & clinical presentation
 Gastric analysis- decreased
hydrochloric acid secretion
 H&H , RBC (elevated if anemia)
 Vitamin B12 levels
 Upper endoscopy
 Test for H pylori
TREATMENT:
*PPI,H2-Receptorblockers, Sucrlfate maybe given
to preventortreat stressgastritis.
* If H. pylori ispresent,combinationtherapyof two
antibioticsandaPPI are used.
Metronidazole (Flagyl),Clarithromycin(Biaxin),or
Tetracycline (Sumycin
NURSING:
• GI tract rest (NPOfor6-12 hours)
• Clearliquids-fullliquids-soft(bland) diet- regulardiet
• Monitorfor F/E imbalance,N/V
• Gastric lavage maybe ordered- washingoutstomachcontents
• Weighdaily&I/O
• Assessskinturgor
• Increase fluidif notcontraindicated
PATHO:
• Increase infrequency,volume,&fluidcontentof stool,watercontentinstool increased
• May resultfromeitherosmoticorsecretoryprocesses
• Watermay be pulledintothe bowel byosmosis
– Laxatives,Stool softeners,E.coli infections,lactoseintolerance,unabsorbeddietaryfat
• Secretorymayinclude inflammationordisease of the colon
– IBS,Bowel resection,Gastricbypass•Increase inthe frequency,volume,andfluid
contentof stool
• Manifestationratherthanadisorder
• May be acute or chronic
– Acute lastslessthana week,due toinfection
– Chronicmaylast longerthan3-4 weeks,due toinflammation,malabsorption,orendocrine
disorders
MANIFESTATIONS:
• Dependoncause,duration,and
severityaswell asthe areaof the
bowel affected
• Several,large waterystoolsdaily
• Veryfrequent,small stools
containingfat,mucous,bloodor
exudates
DIAGNOSTICS:
• Stool culture
• Sigmoidoscopy
• Serum electrolytes- potassium & magnesium lost
• Serum osmolality
• ABGs
TREATMENT:
Antidiarrheal Medications
– NOTuseduntil the cause has beenidentified
– Examples:Pepto-Bismol,Kaopectate,Lomotil
Complimentarytherapy:
Aromatherapy- chamomile tea,
garlic, ginger,mint oil

10. NURSING:
Hx & physical
• Monitorfrequency,characteristicsof bowel movements
• Assessbowel sounds
• Measure abdgirth
• Standardprecautions
• Limitfoodintake if acute (limitfiber,milk,caffeine)
• Monitorlabvalues
• I&O,WeighDaily,Vital Signs
• Assessperineal area
Teach handwashing
PATHO:
• May be a primaryproblemora manifestationof anotherdisease or
condition
• Acute constipation
– Definitechange inbowel patternsthatpersistsorbecomesmore frequent
or severe
• Chronicconstipation
– Functional causesthatimpairstorage,transport,orevacuationmechanisms
• Infrequentordifficultypassage of stool
– Twoor fewerbowel movementsfrequently
CAUSES
1. Decreasedactivity/mobilitystatus
2. Inadequate fluid/fiberintake
3. Medications(Antidepressants,Antacids,Sedatives,
Calciumchannel blockers,Betablockers,Narcotics)
4. Diseasesof the bowel
5. Voluntarysuppressionof urge
6. Others:AdvancedAge;Pregnancy;Chronic laxative use;
7. Neurological changes
MANIFESTATIONS:
• Havingdecreased
bowel movements
than usual pattern
• Frequentflatus
• Abddiscomfort
• Anorexia
• Strainingtohave a
BM
• Passage of hard,dry
stools
• *Fecal Impaction
may develop
DIAGNOSTICS:
• Barium enema
•Sigmoidoscopy/Colonosco
pY
TREATMENT:
1. Laxative- Usedtopromote stool evacuation, shorttermuse,do not administerif clienthasan
undiagnosedobstruction,Abdpain,impaction,fissures,hemorrhoids
• May cause mechanical damage or perforate the bowels
2. BulkingAgents- Onlylaxativesappropriate andsafe forlongterm use– Examples:Psyllium
Diarrhea
Risk forDeficient Fluid Volume
Risk forImpaired Skin Integrity

11. NURSING:
• Performhealthhistory,PE
• Monitorstool consistency/patternof defecation
• Increase intake of fluid
• Consultdietician
• FrequentROM,Ambulation
• Administerlaxatives,stool softeners,enemasasordered
• Provide time andprivacyforbowel elimination
PATHO:
• Motilitydisorderof the lowerGItract- no identifiable cause
• Commonlyoccurring; 20% of people;Youngerpeople;(Womenmore thanmen)
• CNSregulationof the motor& sensoryfunctionsof the bowel isaltered
• Increasedmotorreactivityof the small intestine&bowel inresponse tofood
intake,hormonal influences,physiologicorpsychological stress
• Characterizedwithvisceral hyperactivityandhyperactivityof the GItract,
includingmucusproduction
MANIFESTATIONS:
• Abdominal pain
– May be relievedbydefecation
– May be intermittentandcolicky/dull &continuous
• Alteredbowel elimination
– Constipation
– Diarrhea
– Mucous stools
• Abdominal bloating,flatulence,tenderness(espover
sigmoidcolon)
• N/V
DIAGNOSTICS:
• Based on the presence of
abdominal pain or discomfort
atleast 3 days per month in the
last 3 months that has two of the
three
following characteristics
– Relieved by defecation
– Associated with changes in
frequency of elimination
– Associated with a change in
stool form
• Stools for occult blood, O&P,

12. TREATMENT:
Meds formanagementof manifestations
• Bulkforminglaxativesforconstipation
• Anticholinergicdrugs- Bentyl,Anaspaz- inhibitbowelmotility,relieves
postprandial abpainwhentaken30-60 minsbefore meals
• Antidiarrhealsfordiarrhea- ImodiumorLomotil
• Antidepressants- tricyclisorSSRIs(Zoloft,Prozac)
Nutritionsupport - Additional dietaryfiber;Limitinglactose,fructose,sorbitol;
reducinggasformingfoods; Limitingcaffeineintake
NURSING:
Healthhistory;Physical examination
• Educationisthe key! Reduce stress& anxiety
• Referralstocounselors
• Nursingcare relatedtoconstipationanddiarrhea
*dietary changes
PATHO:
• Inflammationof the vermiformappendix
• Commoncause of acute abdominal pain,mostcommonemergencysurgery(malesmore thanfemale,
young)
• Locatedinthe rightiliacregion…calledMcBurney’spoint
• Most commoncause is secondarytoobstruction
– Feces,Stones,ForeignBody,Inflammation,Tumor,Parasites,Edemaof lymphtissue
• Appendixfillswithfluidsecretedfrommucosa, pressure increases,inflammation,edema,ulceration,
& infectionmay resultas well as purulentexudate
• Within24-48 hours, tissue necrosisand gangrene resultsleadingto perforation
• Classified
1. Simple Appendicitis
2. GangrenousAppendicitis
3. PerforatedAppendicitis
MANIFESTATIONS:
•Continuousmildgeneralizedor
upperabdominal painwithpain
intensifyingandlocalizingat
McBurney’spoint
• Aggravatedbymovement,walking
or coughing
DIAGNOSTICS:
• Rapid diagnosis and treatment is
imperative
• Abdominal ultrasound
• Abdominal X-rays
• IVP

13. TREATMENT:
• IVFsrestore ormaintainvascularvolume,prevent electrolyteimbalance
• Antibiotictherapy(PriortoSurgery&Post-Op)
– Thirdgenerationcephalosporin- Claforan,Fortaz,Rocephin
• Appendectomyisperformed
– Eitherlaproscopicorlaparotom
NURSING:
• HealthHistory;Physical Examination
• KeepNPO AcutePain
• MonitorVS,especiallytemperature
• IVFsas ordered Risk forInfection
• Assesswound,Abdgirth,Post-oppain
• PainManagement
PATHO:
• Inflammationof the stomachandsmall intestine Bacterial orviral
infection,parasitesortoxins producesinflammation,tissuedamage
and manifestationscausedfromtwomechanisms:
(1.) the productionof exotoxins-impairintestinalabsorption&cause
secretionof electrolytes&water(Staph,clostridium,E coli)
(2.) invasionandulcerationof the mucosa- damage tissue more
directly(Shigella,Salmonella)
• “foodpoisoning”
• Causes:Bacteria,Virus,Parasites,Toxins
• Generallymildandself limited
• Debilitatingforveryyoung,veryold,and immunocompromised
MANIFESTATIONS:
• GI Effects:Anorexia,N/V,Abd
pain,Cramping,
Boborygm)(loud hyperactive
bowel sounds), Diarrhea
• General Effects:
Malaise,Weakness,Muscle
aches,H/A,Dry skin,Dry
mucousmembranes,Poorskin
turgor,Orthostatichypotension,
Tachycardia,Fever
DIAGNOSTICS:
• Labs F/E Balance, ABG
• Stool culture
• Stools for occult blood,
O&P, WBCs
• Sigmoidscopy
TREATMENT:
• Nodrug treatmentisrequiredunlessseverlyill or
manifestationsare prolonged.
• Antibiotictherapyspecifictothe organism
• Antidiarrheal maybe prescribed
• Replace fluid&electrolytes
• Oral/IV rehydration-NSorRinger’ssolution;Lactated
Ringer’sif metabolicacidosispresent
• Gastric Lavage-washingoutstomach if Botulism
• Plasmapheresis-plasmaexchangetherapy

14. NURSING:
• HealthHistory;Physical Exam
• Monitorfrequency,characteristicsof bowel
movements
• Assessbowel sounds
• Measure abdgirth
• Standardprecautions
• Limitfoodintake if acute
• Monitorlabvalues
• I&O,WeighDaily,Vital Signs
• Education
PATHO:
• Polyp-Massof tissue arisingfromthe bowel wall andprotrudes intothe lumen
• Most polyps, resultfromsome formof genetic(DNA) mutationinone of the colon
liningcells.
• Healthycellsgrowanddivide inanorderlyway — a processthat's controlledbytwo
broad groupsof genes.
• Mutationsinany of these genescancause cellsto continue dividingevenwhennew
cellsaren'tneeded.Inthe colonandrectum, thisunregulatedgrowthcancause
polypstoform,and overa longperiodof time,some of these polypsmaybecome
malignant
• May developatanyportionof the colon
• Varyinsize;may be single ormultiple
• Approximately30%of people over50have polyps
• Most are benign;Some are malignant
MANIFESTATIONS:
• Most are asymptomatic
• Intermittent,painlessrectal
bleeding,brightordarkred
• Larger polypsmaycause
abdominal cramping,painor
manifestationsof obstruction
• Diarrhea
DIAGNOSTICS:
•
Sigmoidoscopy/Colonoscopy
• Digital Rectal exaM

15. TREATMENT:
• Polypectomy
– May be cauterizedorcompletelyexciseddependingon
the type of polyp
– Some casesa total colectomymaybe performed
• TX alsodependsonhistologicexamof the tissue
removed
• Chemo/Radiationmaybe necessaryif the polypis
malignant
NURSING:
• HealthHistory
• Post-opCare ( Monitor forhemorrhage post-op)
• AdministerCathartics/Cleansingenemasasprescribed
• MonitorF/E Imbalances
• Clienteducation:becausepolypstendtoreoccur,a colonoscopyisrecommendedin3years
and thenevery5 yearsif no polypsare detected.
PATHO:
• Hemorrhoidsare swollenveinsinthe anal canal
• Developwhenvenousreturnfromthe anal canal isimpaired.
• Strainingincreasesvenouspressure and is the mostcommoncause of
distendedhemorrhoids
• Classifiedasinternal orexternal
– Veinscanswell inside the anal canal toforminternal hemorrhoids
– Veinscanswell nearthe openingof the anusto formexternal
hemorrhoids
– May have both typesatthe same time
– May prolapse orprotrude as theyenlarge
Risks
Bouts of diarrhea or
constipation
pregnancy
Obesity
low fiber diet
prolonged sitting
MANIFESTATIONS:
• “Normally”asymptomatic;painless
• Internal Hemorrhoids
– Rectal bleedingispossible;mayeven
cause anemia;mucousdischarge;feelingof
incomplete evacuation
• External Hemorrhoids
– Anal irritationispossible;feelingof
pressure;difficultycleaningperineal area
DIAGNOSTICS:
• Client’s historyand
physical
• External hemorroids
visible
• Anoscopic exam
• Biopsy

16. TREATMENT
• Bulk-forminglaxatives
• Stool softeners
• Suppositoriesorlocal ointments
• Warm sitzbaths
• Bedrest
• Compresses
• Highfiberdiet;increasedwaterintake
• Sclerotherapy-injectingchemical irritant
intotissuesaroundhemorrhoidtoinduce
inflammation,fibrosis,&scarring.Minimal
pain
• Hemorrhoidectomy- hemorrhoidssurgically
excised,few complications(laxeror
conventional)
NURSING:
• Primarypreventionof symptomatic
hemorrhoids
*dietaryfiberintake,fluid,exercise
• Post-OpCare – monitorV/Sq4hrs,
urine op, cleanwithsitzbath after
defacation
– Assessment?
– PainControl?
– Elimination?
• Clientteaching
– Home care?
– OTC Meds?
– Nutrition
PAHTO:
• Formationof stoneswithinthe gallbladderorbiliaryductsystem
• Gallstonesformwhenseveral factors interact:abnormal bile composition,biliarystasis,
and gallbladderinflammation.Mostcomposedof cholesterol &migrate intoducts.
*CAN LEAD TO CHOLECYSTITIS
MANIFESTATIONS:
 epigastricfullnessafteralarge or fatty meal
 distentionmaycause biliarycolic-steady
 severe paininthe epigastricregion (RUQ) radiatingto
the back and shoulderblade (lasts30mins-5hrs)
 Obstructioncancause jaundice,pain,liverenzymes&
pangreatitis
DIAGNOSTICS:
• Serum Bilirubin (reduced)
• CBC (elevated WBC)
• Amylase & Lipase (pancreatitis)
• Flat plate of abdomen (show
AcutePain
Constipation
Risk forInfection

17. TREATMENT:
• Ursodiol (Actigall) andChenodiol (Chenix) reduce
cholesterol contentof stone thus dissolvestones
– Disadvantage-cost,longduration(2yrsor more),high
incidence of reformation,hepatotoxic
• Antibioticsmaybe ordered
• Questran (Cholestyramine)-usedtotreatpruritus(itching)-
accumulationof bile saltsunderthe skin-excretedinfeces
• PainManagement-NarcoticAngalgesicsMorphine
• Laparoscopiccholecystectomy
• Opencholesystectomy–T-Tube Care
• Nutrition
– Eliminate foodintakeduringacute attack;NG tube maybe inserted;
eliminatedietaryfat;Fatsoluble vitaminsif bile flow isobstructed
• Lithotripsy
Nursing:
• HealthHistory/Physical Examination
• Reduce fatintake
• PainManagement
• Fowler’sPosition
• AssessV/S,temp,nutritionalstatus,lab
results
• Dietary/Nutritional consult
• Assessabdomen
• TCDB, IS
• Ambulate astolerated/ordered
PATHO:
INFLAMMATION of gallbladder
 Acute- followsobstructionof cysticductbya stone
*causesischemia
*bacterial/chemical inflammation
*leadsto necrosis &perforationof gallbladderwall
S/S- RUQ paintendertopalpation12-18 hrs/
anorexia/N &V/fever&chills
 Chronic- byrepeatedboutsof acute or persistent
irritation,maybe asymptomatic
Complications:
1. Empyema
2. Gangrene
3. Obstruction
4. Perforation
DIAGNOSTICS:
• Serum Bilirubin
• CBC
• Amylase (0-130 u/L)
Lipase (0-160u/L
• Flat plate of abdomen
• Ultrasound of
gallbladder
• Gallbladder Scan
MANIFESTATIONS:
 Abruptonset,severe &
steady
 RUQ of abdomen,radiate
to back, last12-18 hrs
 Aggravatedbymovement

18. Review of Anatomy of GI
1. LIVER-
Functions-
 makes bile (700-1200mL daily), necessary for fat digestion & absorption & stores it in
the gallbladder; receives nutrients absorbed by small intestine & metabolize them so
can be used by cells of body
 stores fat soluble vitamins A,D, E, K
Location- R side of abdomen, inferior to diaphragm, anterior to stomach
Bile- greenish, watery solution contains bile salts, cholesterol, bilirubin, electrolytes,
water & phospholipids
TREATMENT:
• Ursodiol (Actigall) andChenodiol (Chenix) reduce
cholesterol contentof stone thusdissolvestones
– Disadvantage-cost,longduration(2yrsor more),high
incidence of reformation,hepatotoxic
• Antibioticsmaybe ordered
• Questran (Cholestyramine)-usedtotreatpruritus
(itching)-accumulationof bilesaltsunderthe skin-
excretedinfeces
• PainManagement-NarcoticAngalgesicsMorphine
• Laparoscopiccholecystectomy
• Opencholesystectomy–T-Tube Care
• Nutrition
– Eliminate foodintakeduringacute attack;NG tube
may be inserted;eliminate dietaryfat;Fatsoluble
vitaminsif bile flowisobstructed
• Lithotripsy- shockwavesbyultrasoundbreakup
stones(watchforcolic)

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