Week One (GI)

Inflammation of the inner tissue lining of the stomach that causes the integrity of the gastric mucosal lining to become compromised and exposed to viral, fungal, and bacterial infections. Can be acute or chronic

-Acute and chronic gastritis can be caused by over consumption of alcohol; eating spicy, fried, or acidic foods; taking NSAIDs; food poisoning; varying infections; acute stress; or smoking
-H. pylori is a common cause for chronic gastritis

-Loss of appetite
-Bloating
-Increased belching
-Nausea/vomiting
-Abdominal pain of the epigastric region
-Some will present with black, tarry stools and blood in their vomit

-CBC to check for anemia (bleeding ulcers)
-Stool sample to assess for GI bleeding
-EGD
-Urea breath test
-CT

-Frequent hand washing to prevent the transmission of H. pylori
-Methods to decrease stress
-Avoid or reduce the use of alcohol or NSAIDs
-Do not lie flat for 2-3 hours following meals

-H2 blockers (cimetidine, famotidine)
-PPIs (lansoprazone, omeprazole)
-Antacids (TUMS)
-Antibiotics if bacterial infection is present

Inflammation of the liver that can occure due to an injury sustained via acute or chronic infection from exposure to a specific hepatitis viral strain, excessive alcohol consumption, or through the accumulation of fat in the liver

Late-stage condition that presents with advanced fibrosis or scarring of the liver. Classified as either compensated or decompensated.

Fluid accumulation in the peritoneal space that causes the abdomen to be distended

-A and E are spread via contact with contaminated food or water
-B and D are spread through contact with blood or bodily fluids
-C is only spread through blood

-Occurs due to a defect in the protective gastric mucosa and destructive factors such as H. pylori
-Once the mucosa integrity is damaged, acid from gastric juices can eat away at the inner layers

-H. pylori infection
-Long-term use of NSAIDs
-Smoking
-Alcohol consumption

-Abdominal pain described as a burning or gnawing sensation noted most frequently after meals or at night
-Weight loss
-Nausea
-Vomiting
-Feeling bloated
-Early satiety

-Hypotension
-Tachycardia
-Dizziness
-Lightheadedness
-Weakness
-Elevated temperature
-Shortness of breath
-Blood in emesis or stool

A condition where one part of the intestine telescopes (slides) into another part, causing an obstruction

Swollen, fragile blood vessels that are generally found in the submucosa of the lower esophagus, but can develop higher in the esophagus or extend into the stomach

Can occur as a result of portal hypertension usually due to cirrhosis of the liver
-Viral hepatitis
-Frequently in older adult clients, depressed immune function, decreased liver function, and cardiac disorders can make them especially vulnerable to bleeding

Avoid alcohol consumption

-Typically won't experience manifestations until they begin to bleed
-Hematemesis (vomiting blood)
-Melena (black, tarry stools)
-General deterioration of the client's physical and mental status

-Valsalva maneuver
-Lifting heavy objects
-Coughing
-Sneezing
-Alcohol consumption

-Endoscopic variceal ligation (esophageal banding therapy) can be used for acute bleeding
-Endoscopic sclerotherapy: A sclerosing agent is injected into the varices, resulting in thrombosis of the varicosity
-Transjugular intrahepatic portal-systemic shunt (TIPS) can be used to rapidly lower portal pressure
-Last resort: surgical interventions

-Occurs when the bowel is blocked by something outside or inside the intestines (adhesions, fecal impactions)
-Complete mechanical obstructions should be addressed surgically

-Caused by diminished peristalsis within the bowel (paralytic ileus)
-Can occur postoperatively due to the handling of the intestines during surgery

-Fluid and electrolyte balance
-Decompressing the bowel
-Relief or removal of the obstruction

-Obstipatioin: the inability to pass a stool and/or flatus for more than 8 hours despite feeling the urge to defecate
-Abdominal distention
-High-pitched bowel sounds above site of obstruction (borborygmi) with hypoactive bowel sounds below, or overall hypoactive; absent bowel sounds later in process
-Diarrhea or ribbon-like stools around the impaction with a large intestine obstruction

-Severe fluid and electrolyte imbalance
-Metabolic alkalosis
-Visible peristaltic waves (possible)
-Epigastric or upper abdominal distention
-Abdominal pain, discomfort
-Profuse, sudden projectile vomiting with fecal odor

-NPO with bowel rest
-Check bowel sounds
-Provide oral hygiene
-Ensure IV fluids and electrolyte replacement (particularly potassium) are administered
-Manage pain
-Encourage ambulation
-Place in semi-Fowler's position

-Prepare for surgery and assist with providing preoperative nursing care
-Withhold intake until peristalsis resumes

Influenza-like manifestations
-Fatigue
-Decreased appetite with nausea and vomiting
-Abdominal and/or joint pain
-Fever
-Dark-colored urine
-Clay-colored stool
-Jaundice

-Alanine aminotransferase (ALT): elevated
-Liver function test: elevated
-Prothrombin time: elevated PT/INR
-Bilirubin: elevated
-Aspartate aminotransferase (AST): elevated

-Serotonin 5-HT3 Antagonists
-Antihistamines (anticholinergics)
-Dopamine antagonists
-Other (glucocorticoids, cannabinoids, substance P/neurokinin antagonists, and benzodiazepines)

Examples: odansetron, granisetron, and palonosetron
-Used to treat nausea and vomiting that occurs secondary to chemotherapy and radiation therapy and during the postoperative recovery period

Examples: odansetron, granisetron, and palonosetron
-Blocks serotonin receptors located in the chemoreceptor trigger zone in the brain and on the nerve terminals in the stomach and small intestine, leading to a decrease in nausea and vomiting

Examples: odansetron, granisetron, and palonosetron
-Serotonin syndrome
-Torsade de pointes
-Stevens-Johnson syndrome
-Common reactions include headache, dizziness, constipation, and diarrhea

Examples: odansetron, granisetron, and palonosetron
-Monitor for headache and report to the provider if the client is experiencing severe or persistent headaches
-Administer analgesics for relief of mild headaches
-Monitor for dizziness
-If diarrhea occurs, monitor severity and watch for manifestations of dehydration

Examples: odansetron, granisetron, and palonosetron
-Oral disintegrating tablets should not be used for clients with phenylketonuria
-Used with caution in clients who have hepatic disease, recent abdominal surgery, or in clients who are pregnant or lactating
-SSRIs, SNRIs, tricyclic antidepressants, MAOIs, fentanyl, lithium, buspirone, tramadol, methylene blue, and triptans increase the risk of serotonin syndroms
-Concurrent use with apomorphinen increases the risk of loss of consciousness and severe hypotension

Example: Dimenhydrinate
-Can be given for antiemetic effects
-Counteracts vertigo that accompanies motion sickness

Example: Dimenhydrinate
-Blocks the release of H1 receptors in the inner ear preventing vertigo, nausea, and vomiting

Example: Dimenhydrinate
-Sedation and drowsiness
-Dizziness
-Anticholinergic effects including dry mouth, constipation, and urinary retention

Example: Dimenhydrinate
-Monitor for sedation while ambulating
-Take small frequent sips of water or suck on hard candy to combat dry mouth
-Recommend a high-fiber diet to prevent constipation
-Monitor for urinary retention
-Monitor pulse and BP both prior and during therapy if administered via IV
-Assess for allergic reactions such as pruritis, rhinitis, and hives

Example: Dimenhydrinate
-Instruct client to avoid taking medication prior to driving or activities that require mental alertness
-Educate client to change positions slowly to decrease risk of falls
-Educate client to report any undesirable changes in urinary elimination

Example: Dimenhydrinate
-Contraindicated for clients who have hypersensitivity, angle-closure glaucoma, and premature or newborn infants
-Use with caution in older adult clients or clients with hyperthyroidism, cardiovascular disease, hepatic disease, pyloric obstruction, prostatic hypertrophy, and in clients who are pregnant or lactating

Example: Dimenhydrinate
-Other CNS depressants can increase sedative effects
-MAO inhibitors can increase anticholinergic effects

Example: Metoclopramide
-Treats nausea and vomiting associated with chemotherapy, opioids, and radiation therapy
-Can also be used to increase GI motility for clients with gastroesophageal reflux and diabetic gastroparesis

Example: Metoclopramide
-GERD: increases tone of the lower esophageal sphincter
-Diabetic gastroparesis: increases peristalsis in both the stomach and intestines
-Nausea and vomiting: increases the threshold of the chemoreceptor trigger zone in the brain (CTZ)

Example: Metoclopramide
-Sedation, extrapyramidal reactions, restlessness, and neuroleptic malignant syndrome
-Diarrhea

Example: Metoclopramide
-Contraindicated for clients with gastrointestinal obstruction, hemorrhage, perforation, an uncontrolled seizure disorder, pheochromocytoma, or breast cancer
-Used with caution in older adult clients who have heart failure, hypertension, asthma, Parkinson's disease, hypokalemia, porphyria, seizure disorders, or kidney dysfunction

Example: Metoclopramide
-CNS depressants increases sedative effects
-Opioids and anticholinergics will decrease therapeutic effects
-Medications that can cause extrapyramidal effects can worsen symptoms
-Metoclopramide can negatively affect the absorption of many medications including acetaminophen, aspirin, diazepam, tetracycline, digoxin, and lithium

Examples: Diphenoxylate with atropine and loperamide
-Decreases intestinal peristalsis which increases transit time through the intestinal tract allowing for increased absorption of water from the feces, resulting in smaller and harder feces as well as fewer bowel movements

Examples: Diphenoxylate with atropine and loperamide
-Cardiac arrest and cardiac arrhythmias
-Drowsiness and constipation
-Anticholinergic effects such as dry mouth (side effect of atropine)

Examples: Diphenoxylate with atropine and loperamide
-Monitor for sedation, dizziness, lightheadedness, and drowsiness when ambulating
-Recommend the lowest effective dose and for the shortest period of time
-Monitor for anticholinergic effects
-Monitor for urinary retention

Examples: Diphenoxylate with atropine and loperamide
-Instruct patient to avoid taking medication before driving or participating in activities that require mental alertness
-Recommend changing positions gradually to prevent falls
-Instruct client to report any undesirable changes in urinary elimination patterns

Examples: Diphenoxylate with atropine and loperamide
-Do not use in children younger than 2 years of age or for clients who have advanced hepatic disease, glaucoma, severe fluid and electrolyte imbalance, diarrhea due to poisoning, ileus or gastrointestinal bleeding
-Use with caution in clients with IBD, renal or liver dysfunction, a history of chemical toxicity, and prostatic hypertrophy

Examples: Diphenoxylate with atropine and loperamide
-Other CNS depressants increases CNS depression
-If given with MAOI, increased risk of hypertensive crisis
-Concurrent use of cimetidine, erythromycin, and quinine may increase the risk of cardiac arrhythmias

-Nausea
-Bloating
-Abdominal pain
-Headache
-Changes in appetite and frequency of stools

-H2 Receptor Antagonist: inhibits gastric acid secretion by blocking H2 receptors on gastric parietal cells
-Proton Pump Inhibitors (PPIs): binds to an enzyme in the presence of acidic gastric pH, preventing final transport of hydrogen ions into the gastric lumen
-Antacids: increases gastric pH to reduce pepsin activity and strengthens gastric mucosal barrier and esophageal sphincter tone
-Mucosal Barrier Fortifiers: in presence of mild acid condition, forms viscid and sticky gel and adheres to ulcer surface, forming a protective layer

-Treatment of constipation
-Preventing and treating portal-systemic encephalopathy

-Increases the amount of water your intestines absorb leading to softer stool and easier bowel movements
-Reduces production and absorption of ammonia through acidification of the colon

-Monitor fluid and electrolyte imbalances as this medication can disrupt them (hypernatremia is most common)
-Monitor for diarrhea and subsequent dehydration

(Imodium)
-Treatment of diarrhea
-Reduce stool amount for clients with ileostomy

(Imodium)
-Binds to opioid receptors in the gut to slow down movement allowing more time for fluids and nutrients to be absorbed. This causes a reduction in water stools and a decrease in frequency of bowel movements

(Imodium)
-Health history: this medication should not be used for patients with ulcerative colitis
-Health history: this medication should be used with caution for clients with heart rhythm disorders due to possible cardiac effects
-Patient education: Stop taking and immediately notify provider if patient develops diarrhea that is watery or bloody

(Zofran)
-Treatment of nausea and vomiting that may be associated with surgery or cancer treatment

(Zofran)
-Blocks serotonin receptors located in the chemoreceptor trigger zone in the brain and on the nerve terminals in the stomach and small intestine, leading to a decrease in nausea and vomiting

(Zofran)
-Patient education: This medication may impair cognition and reaction time; advise patient to be careful driving or doing anything that requires mental alertness
-Medication reconciliation: This medication should not be taken with apomorphine

-Treatment of duodenal or benign gastric ulcers
-Treatment of GERD
-Treatment of Zollinger-Ellison Syndrome

Inhibits gastric acid secretion by blocking H2 receptors in gastric parietal cells

-Patient education: avoid drinking alcohol as it can increase risk of damage to stomach
-Patient education: Instruct patient to stop taking this medication if they develop any of these symptoms: confusion, hallucinations, agitation, lack of energy, seizure, fast or pounding heartbeats, sudden dizziness, or unexplained muscle pain, tenderness, or weakness, especially with a fever

-Treatment of stomach ulcers
-Treatment for GERD
-Treatment of active duodenal ulcers
-Treatment of Zollinger-Ellison syndrome

Binds to an enzyme in the presence of acidic gastric pH, preventing final transport of hydrogen ions into the gastric lumen

-Patient education: this medication should be taken 30-60 minutes before meals
-Monitor INR and prothrombin time in patients taking warfarin and omeprazole
-Monitor for C. diff.-associated diarrhea and hypomagnesemia if using long-term

-Medication reconciliation: this medication should not be administered with other drugs known to decrease its absorption, such as H2 receptor antagonists, glucocorticoids, and thiazide diuretics
-Monitor for signs of hypercalcemia including intense thirst and frequent urination, stomach pain, vomiting, constipation, bone pain, muscle weakness, confusion, and drowsiness and fatigue

-Treatment of duodenal ulcers for up to 8 weeks
-Off-label uses: dyspepsia, epithelial wounds, and prevention of ulceration of diversion colitis

-Antipeptic: absorbs pepsin and decreases its concentration
-Site-Protective: forms a polyanion gel that acts as a physical barrier between luminal contents and mucosa, protecting ulcers from acid and pepsin
-Effects on tissues: Binds epidermal growth and tissue growsn factors to tissues and facilitates repair

-Monitor patient for constipation
-For diabetic patients, monitor for hyperglycemia
-Should be used with caution or avoided for patients with end-stage renal disease to prevent aluminum intoxication
-Medication reconciliation: Sucralfate can decrease serum concentrations of digoxin, levothyroxine, furosemide, quinolones, oral phosphate supplements, and warfarin. Administer sucralfate two hours before or after any of the previously mentioned medications