Gastrointestinal
System ©
Kingsborough Community
College
Spring 2023 1
Anatomy
■Oropharynx Organs that empty
■Esophagus into GI tract & aid
■Stomach digestion
■Liver
■Small intestine
■Gallbladder
■Large intestine ■Pancreas
■Rectum, anus
* Spring 2023 2
Spring 2023 3
* Spring 2023 4
Anatomy of GI system
■Oropharynx-oral cavity
■salivary glands, mastication
■Esophagus
■tube begins at base of pharynx, ends below
diaphragm
■ transports food to stomach
■prevents reflux of gastric contents
■Stomach-gastric secretions
■ HCL, pepsin, intrinsic factor
* Spring 2023 5
Anatomy cont.
■Small Intestine-20’
■duodenum, jejunum, ileum—
■movement, digestion, absorption
■10L of fluid enter small intestine; <1L
reaches large intestine daily
■Large Intestine-5’
■movement, absorption
* Spring 2023 6
Liver
■ Stores minerals & vitamins
■ Protects against harmful substances,
detoxification
■ Aids in metabolism
■ Breaks down amino acids to remove ammonia
■ Synthesis of plasma proteins
■ Stores & releases glycogen
■ Synthesizes & stores fatty acids & triglycerides
* Spring 2023 7
Gallbladder
■Concentrates & stores bile from
liver
■Releases bile into intestines via
common bile duct when fat is
ingested
* Spring 2023 8
Pancreas
■Exocrine function
■enzymes trypsin, chymotrypsin,
amylase & lipase
■digestion of fats, CHO, &
proteins
■Endocrine function
■islets of Langerhans-insulin
* Spring 2023 9
DISORDERS OF THE
ESOPHAGUS
* Spring 2023 10
Normal Anatomy
* Spring 2023 11
Gastro-Esophageal Reflux
Disease (GERD)
* Spring 2023 12
Gastro-Esophageal Reflux
Disease (GERD)
■Backward flow of gastric
contents into the esophagus
■Breakdown of esophageal
mucosa
■Esophagitis
* Spring 2023 13
GERD
* Spring 2023 14
Pathophysiology
■Incompetent lower esophageal
sphincter
■Irritation of esophagus from gastric
contents
■hyperemia & erosion
■Abnormal esophageal clearance
■Delayed gastric emptying
■Heals with Barrett epithelium instead
of squamous
■increases risk of cancer (premalignant)
* Spring 2023 15
INCIDENCE/PREVALENCE
GERD
■15-20% of population
■10% report daily symptoms
■44% monthly symptoms
■More in Caucasians
* Spring 2023 16
Etiology
■Some correlation with hiatal hernia
■Nighttime reflux
■Recumbent position, decreased
peristalsis
■Large meals
■Delayed stomach emptying times
■Increased intra-abdominal
pressure
*
■Wearing tight belts, obesity, bending
Spring 2023 17
COLLABORATIVE
MANAGEMENT OF
PATIENTS WITH GERD
* Spring 2023 18
Assessment
■History
■Newly diagnosed with with asthma
■S/S
■Heartburn- burning in chest/epigastric area
■Dysphagia, odynophagia, hoarseness
■Regurgitation without nausea or belching
■Pain
■Substernal, retrosternal, burning, radiating to
neck, jaw, back
* Spring 2023 19
Diagnostic Assessment
■Barium swallow
■Evaluates esophagus, stomach, small
intestine
■Endoscopy
■Direct visualization-biopsies may be done
■Monitor for return of gag reflex
■Report complications
■pain & difficulty swallowing, shoulder pain
■24-hr pH monitoring
* Spring 2023 20
* Spring 2023 21
Interventions-Dietary
■Small frequent feedings
■Elevate HOB 30 degrees or at least 6-8
inches
■Avoid acidic foods
■ (tomatoes, spicy foods, citrus foods, coffee,
tea)
■Avoid foods which relax esophageal
sphincter or delay gastric emptying
■ (fatty foods, chocolate, peppermint,
alcohol)
*
■Avoid eating 2 Spring
hours 2023
before bedtime 22
Interventions-Lifestyle
■Avoid medications that lower LES
■Ca channel blockers, theophylline,
anticholinergics
■Elevate HOB on 6-8” blocks
■Avoid recumbent position for 3 hrs post
eating
■Avoid smoking
■Avoid bending & wearing tight clothes
* Spring 2023 23
Interventions-Medications
■Antacids
■Mild to moderate SX
■Elevates gastric pH
■Take 1hr ac or 2h pc
■Aluminum hydroxide
■Aluminum hydroxide/simethicone
* Spring 2023 24
H2 receptor blockers
■Decreases gastric acid
secretion.
■Do not give with high acid
drinks.
■Cimetidine
■Ranitidine
■Nizatidine
* Spring 2023 25
Proton-pump inhibitors
■Reduce gastric secretions
■Promote healing
■Relieve symptoms
■Omeprazole
■Lansoprazole
■Esomeprazole
* Spring 2023 26
Promotility Agents
■Accelerates gastric emptying
■Increases LES
■Bethanechol
■Metoclopramide
■S/E hallucinations, anxiety, ataxia
* Spring 2023 27
Interventions-Surgical
■Laparoscopic procedures to
tighten lower esophageal sphincter
■Open surgical procedure:
■Nissen fundoplication
■Gastric fundus wraps 360 degrees
around lower eophagus to increase
sphincter pressure
■Post-op complications
■dysphagia, bloating, atelectasis,
pneumonia
* Spring 2023 28
* Spring 2023 29
* Spring 2023 30
HIATAL HERNIA
* Spring 2023 31
Hiatal Hernia
(Diaphragmatic)
■Cardiac sphincter becomes
enlarged allowing the stomach
to pass into the thoracic cavity
■Risk factors
■Increased age, congenital
weakness, trauma, obesity
* Spring 2023 32
Hiatal Hernia
■Types
■Sliding (Esophageal)
■Rolling (Paraesophageal)
* Spring 2023 33
Sliding/Esophageal
Hernia
Esophagus & upper stomach slides in &
out of thoracic cavity
■90% of all, F > M
■ S/S
■Heartburn, regurgitation & dysphagia after
eating, chest pain, belching
■ TX
■Small frequent feedings, elevate HOB,
■Do not lie down immediately post meals
* Spring 2023 34
Rolling/Paraesophageal
All parts of stomach push through
diaphragm
■S/S
■Worse lying down, breathlessness after
eating, feelings of suffocation, chest pain
that mimics angina
■ TX
■Same as GERD
■Complications
■Obstruction, strangulation, & volvulus
* Spring 2023 35
Sliding/Rolling Hiatal
Hernias
* Spring 2023 36
GASTRITIS
* Spring 2023 37
Gastritis
■Types - Acute or Chronic
■Refers to pattern of inflammation
rather than specific time course.
■Chronic - increases with age
■Acute M>F - Chronic F>M
■Increased risk :
■ Smokers & heavy alcohol users
* Spring 2023 38
COLLABORATIVE
MANAGEMENT OF
PATIENTS WITH GASTRITIS
* Spring 2023 39
Assessment-Acute/Chronic
■History
■High risk groups
■Lifestyle history-alcohol, tobacco,
caffeine use
■Medications-ASA, NSAIDS, steroid
■Past illness family history
■S/S
■Heartburn, epigastric pain,
indigestion, N/V
* Spring 2023 40
Assessment-Diagnostic
Acute/Chronic
■Esophagogastroduodenoscopy
(EGD)
■Gastric biopsy for type of gastritis
■H pylori
■Upper GI series
■CBC
■Serum vitamin B12 levels
■Gastric Analysis
* Spring 2023 41
Acute Gastritis
■Inflammation of gastric mucosa
■Disruption of gastric mucosa allowing
HCL & pepsin contact with gastric
tissue leading to irritation
■Gastric mucosa rapidly
regenerates
■Self limiting
* Spring 2023 42
Pathophysiology
Acute Gastritis
■Ingestion of corrosives
■lye, drain cleaner
■Ingestion of irritants
■ASA, NSAIDS, steroids, hot food, excessive
coffee, alcohol
■Effects from cytotoxic agents
■chemo or radiation therapy
■Ingestion of infectious substance
■E coli, Salmonella, Staphylococcus
* Spring 2023 43
Symptoms-Acute Gastritis
■May be asymptomatic at first
but then rapid onset
■Anorexia, abdominal discomfort,
belching, N/V
■More severe- abdominal pain,
hematemesis, melena, gastric
hemorrhage
* Spring 2023 44
Nursing Diagnoses/Patient
Problems
* Spring 2023 45
GOAL
■Promote healing through
diet & medication to relieve
pain & reduce stress
* Spring 2023 46
Interventions-Acute
Gastritis
■NPO & IVF prn
■Progress diet as tolerated
■Avoid spicy foods & large meals
■Reduce anxiety
■Teach food safety to prevent food
contamination with bacteria
* Spring 2023 47
Medications
■Phenothiazines - prochlorperazine
■Vomiting
■Antacids
■Buffers gastric acid & raises pH
■Proton-pump inhibitors
■H2 bockers (ranitidine, famotidine,
nizatidine)
■Mucosal barrier (sucralfate)-acts
locally
* Spring 2023 48
Chronic Gastritis
■Progressive disorder beginning
with superficial inflammation which
eventually leads to atrophy of
gastric tissues
* Spring 2023 49
Types of Chronic Gastritis
■Type A-autoimmune
■Loss of HCL & pepsin secretion
■Develops pernicious anemia (B12
deficiency)
■Severe atropic glossitis, painful smooth,
shiny red tongue & tingling of hands and
feet
■Type B- chronic infection of
mucosa
*
■ HelicobacterSpring
pylori
2023 (H. pylori) 50
Symptoms-Chronic
Gastritis
■Vague or absent symptoms
■Anorexia, belching, feeling of
fullness, N/V, dyspepsia
■Vague epigastric heaviness not
relieved by antacids
■Intolerance to fatty or spicy foods
■Weight loss, fatigue
* Spring 2023 51
NSAID induced Gastritis
* Spring 2023 52
Interventions-Chronic
Gastritis
■Usually managed in community
■Bland small frequent meals
■Avoid foods that cause symptoms
■Dietary consult
■Teach-medication use, smoking
cessation, treatment of alcohol
abuse
* Spring 2023 53
Medications
■Antacids
■Anticholinergics
■Type A-Vitamin B12
■Type B- Dual antibiotic therapy
■Tetracycline, amoxicillin,
clarithromycin or metronidazole
■Proton Pump Inhibitors
■Bismuth salts – bismuth subsalicylate
* Spring 2023 54
PEPTIC ULCER DISEASE
* Spring 2023 55
Peptic Ulcer Disease
Definition:
Break in the continuity of the
esophageal, gastric or duodenal
mucosa. It occurs in any part of
the GI tract that comes in contact
with HCL acid and pepsin.
* Spring 2023 56
Etiology
■10% population M>F
■Gastric - age 55-70
■Duodenal- age 30-55
■Stress induced erosive-
complication of life threatening
condition
■Curling’s ulcer with burns
■Cushing ulcer-after CNS damage
* Spring 2023 57
Pathophysiology
■H.pylori
■Damages gastric epithelial cells-
decreases gastric mucous
effectiveness
■ (80% of gastric/nearly all duodenal)
■Ulcerogenic Agents
■NSAIDS, ASA
■Interrupts prostaglandin synthesis which
maintains mucous barrier of gastric
mucosa
■Alcohol, smoking, caffeine
* Spring 2023 58
* Spring 2023 59
COLLABORATIVE
MANAGEMENT OF
PATIENTS WITH PUD
* Spring 2023 60
Assessment
■HISTORY
■Identify high risk groups
■Type A personalities, use of ulcerogenic
agents/medications
■Past medical history
■Burns, arthritis, alcoholism
■Heredity
■Blood type O-35% more susceptible to duodenal
ulcers
■Family history
* Spring 2023 61
Symptoms-Gastric Ulcer
■Pain
■Aching, pressure, heaviness, gnawing
■Mid/left epigastric region or back
■Pain with full stomach ½ -1 h post
meal
■Food increases pain
■Vomiting - hematemesis
■Bleeding-25%
■Bright red to coffee ground
* Spring 2023 62
Physical Assessment
■Abdominal distension
■Bowel sounds
■Epigastric tenderness
■Stools-may be guaiac positive
■Orthostatic hypotension
* Spring 2023 63
Psychosocial Assessment
■Impact on lifestyle
■Work
■Family
■Social
■Leisure activities
* Spring 2023 64
Diagnostic Assessment
■CBC
■Stool for guaiac
■Gastric acid analysis
■Upper GI series
■EGD
■H. pylori testing
* Spring 2023 65
Symptoms-Duodenal Ulcer
■Pain right epigastric area & upper
back
■Occurs 2-3h after meals and at
night
■Food relieves pain
■Appetite wnl
■Vomiting-less than with gastric
■Bleeding
*
■More likely toSpring
perforate
2023
than 66
UPPER GI SERIES
■Barium as contrast medium
■Fluoroscopic visualization of esophagus,
stomach and duodenum
■Contraindicated with active bleeding or
obstruction
■Detects up to 90% of ulcers
■NPO after midnight
■Bowel cleansing
■Must clean out barium
* Spring 2023 67
* Spring 2023 68
* Spring 2023 69
Esophagogastrodudenosco
py
EGD
■Direct visualization of esophagus,
gastric & duodenal mucosa & biopsy
■Conscious (moderate) sedation
■Atropine to decrease secretions
■Position on Left side – facilitates
drainage of secretions
■Post procedure
■Check for gag reflex – keep NPO
■S/S of perforation
■Difficulty swallowing, bleeding and pain
* Spring 2023 70
Nursing Diagnoses/Patient
Problems
* Spring 2023 71
GOAL
Promote healing, relieve pain,
reduce stress & prevent
complications
* Spring 2023 72
Interventions
■Monitor V/S, capillary refill, skin
turgor
■Avoid ulcerogenic medications
■Diet
■Three regular or smaller frequent
feedings
■Avoid coffee, tea, spices fried foods,
carbonated beverages, citrus fruit,
alcohol
■Avoid smoking-inhibits secretion of
*
bicarbonate from pancreas to
Spring 2023 73
Medicaction
■Antacids
■aluminum & Mg hydroxide
■Proton-pump inhibitors
■omeprazole
■H2 blockers
■Ranitidine, famotidine, nizatidine
■Cytoprotective
■Binds to ulcer site to form acid resistant
mucosal barrier - sucralfate, bismuth
subsalicylate
■Antibiotics
* Spring 2023 74
. Stress Reduction
■Biofeedback
■Guided imagery
■Medication
■Exercise
* Spring 2023 75
Complications
■Hemorrhage most common
■Fatigue, weakness, dizziness, change in LOC
■Increase in HR, RR, decrease in B/P
■Minimal-occult
■Massive-shock
■Oral-coffee ground to bright red blood
■Rectal-black tarry stools (melena)
■Pyloric obstruction
■Bowel perforation-peritonitis
■Ulcer perforation-peritonitis
* Spring 2023 76
Complication - Peritonitis
Peritonitis
■Abdominal rigidity, decreased BS
■Upper quadrant pain
■Positive Kehr’s sign (Right shoulder
pain)
■Fever, N/V,
■Hypotension, tachycardia, tachypnea
■TX
■02, IVF, NGT, FC, blood transfusion,
emergency surgery if bleeding not
controlled
* Spring 2023 77
Surgical management
Vagotomy
■Severs vagus nerve
■prevent HCL acid secretion
■Treatment of choice in high-risk Patients
Gastrectomy
■Bilroth I- removes portion of stomach
& remaining portion anastomosed to
duodenum
■Bilroth II-removes portion of stomach
& anatomosed to jejunum-used more in
duodenal ulcers
* ■Requires B12 replacement
Spring 2023 78
Dumping Syndrome
■Occurs after gastrectomy/gastric
bypass
■Rapid emptying of gastric contents
which move to small intestines &
cause distention
■High CHO stimulates fullness
because of osmolality
■H20 moves from intravascular
space to intestines-intestinal
*
fullness Spring 2023 79
S/S - Dumping Syndrome.
■Starts 30 min. after eating
■Weakness
■Palpitations
■Diaphoresis
■Dizziness
■Cramping pain
■Diarrhea
* Spring 2023 80
TX of Dumping
Syndrome
■Small frequent feedings
■High protein, high fat, low CHO
■Delay gastric emptying
■Eliminate fluids with meals
■Lie down after meals for at least 30
min.
■Eat/rest in semi-recumbent position
* Spring 2023 81
Bariatric Surgery
■ Surgical procedures performed to reduce
weight in the morbidly obese patient when
traditional methods have failed
■ Patients must have a BMI of 40 or > or 35 or >
with additional risk factors
■ Two types of procedures
■ Restrictive – Laparoscopic Adjustable Gastric Banding
(LAGB) – limits stomach size but allows for normal
digestion
■ Malabsorptive – the patient’s stomach, duodenum
and part of the jejunum are bypassed (Roux-en-y
Gastric Bypass) so that fewer calories are absorbed.
* Spring 2023 82
Bariatric Surgery
■ Pre-op care - includes many additional
assessments: psychological, motivation,
support systems
■ Post-op care -
■Banding - usually laparoscopic. May only
need 24 hour hospital stay
■Bypass – care similar to patients with
Gastrectomy
■Dumping Syndrome
■ Obese patient may be more prone to
complications
■ Diet – liquids/pureed food in 1 oz. servings X
* Spring 2023 83
DISORDERS OF THE
INTESTINES
IRRITABLE BOWEL SYNDROME
* Spring 2023 84
Irritable Bowel Syndrome
IBS
■Definition: Disorder of intestinal
motility Spastic bowel, functional
colitis
■Non-inflammatory
■Most common digestive disorder of
western society - 20%
■W>M
■Etiology
Heredity, psychological stress
Diet-rich, irritating foods, alcohol
* Spring 2023 85
IBS-Risk Factors
■Coffee consumption
■Gastric stimulants
■Diverticular disease
■Lactose intolerance
* Spring 2023 86
COLLABORATIVE
MANAGEMENT OF
PATIENTS WITH IBS
* Spring 2023 87
Assessment
■History
■S/S
■Altered Bowel habits
■Constipation
■Diarrhea
■Combination of constipation & diarrhea
■Bloating – abdominal distention
■Pain – often LLQ - relieved by
defecation-may be colicky, spasms, dull
or continuous
* Spring 2023 88
Assessment-Diagnostic
■Stool studies-occult blood, O&P,
culture
■Sigmoid/Colonoscopy
■Barium enema
■Small bowel series
* Spring 2023 89
* Spring 2023 90
Interventions-Medication
■Bulk-forming laxatives -
psyllium
■Anticholinergic drugs -
dicyclomine
■Antidiarrheal drugs - loperamide
, diphenoxylate/atropine
* Spring 2023 91
Interventions-Dietary
■Increased fiber
■Adds bulk & water to stool often
reducing diarrhea & constipation
■Limit gas-forming & fried foods
■Increase fluid intake 8-10
glasses/day
■Eat regular meals, chew food
slowly
* ■Eliminate caffeine
Spring 2023 92
Interventions
Stress Management
■Behavior modification programs
■Exercise
Home care
■Teach regarding complications-fecal
impaction/bowel obstruction
■Instruct to keep a food diary to record
intake & bowel patterns (refine diet to
prevent exacerbations)
* Spring 2023 93
DIVERTICULITIS
* Spring 2023 94
Diverticulitis
■Diverticulum
■Diverticulosis
■Diverticulitis
■Most common pathology of colon in US
■Site-sigmoid colon-95%
■Incidence increases with age, 60% >age
80
■Rare in cultures with high fiber diet-
Africans
■Can occur as an acute attack or
* prolonged infection
Spring 2023 95
Pathophysiology
■Mucosal & submucosal layers of colon
herniate through muscular wall due to
increased pressure within bowel lumen
■Outpouchings form & collect
undigested food & bacteria (hard mass)-
irritation
■Hard mass may interefere with blood
supply-can lead to microscopic or
extensive perforation
* Spring 2023 96
* Spring 2023 97
* Spring 2023 98
* Spring 2023 99
* Spring 2023 100
* Spring 2023 101
* Spring 2023 102
COLLABORATIVE
MANAGEMENT OF
PATIENTS WITH
DIVERTICULITIS
* Spring 2023 103
Assessment
■History
■Risk Factors
■Constipation history for several years
■S/S
■Acute-irregular bowel habits
■Constipation/diarrhea
■LLQ crampy pain, palpable mass
■Low grade fever
■N/V
* Spring 2023 104
Assessment-Diagnostic
■Abdominal X-ray
■Abdominal CT
■Sigmoid/colonoscopy
■Ba Enema – not done in acute
stage
■CBC
■Stool for guiac
* Spring 2023 105
Assessment-complications
■Peritonitis
■Abscess formation
■Fistula formation
■Hemorrhage
■Bowel obstruction
* Spring 2023 106
Nursing Diagnoses/Patient
Problems
* Spring 2023 107
Interventions
■V/S –
■Temp 101 & elevated WBC - hospitalization
■NPO initially
■IVF, possibly TPN
■NGT
■Broad spectrum antibiotics
■Analgesics for pain
■Antispasmodics
■Stool softeners
* Spring 2023 108
Interventions cont.
■Diet progresses as symptoms resolve
■Liquid, soft low-fiber
■High fiber diet with full recovery
■Diet modifications decrease risk of
complications
■Avoid foods with small seeds
■Avoid straining, bending, lifting
■Assess for complications
■Peritonitis, Abscess formation
* Spring 2023 109
Interventions-Surgical
■Usually indicated for pt with
generalized peritonitis or
abscesses that do not respond to
treatment
■Bowel resection
■Hartmann’s procedure with
temporary colostomy
* Spring 2023 110
INFLAMMATORY BOWEL
DISEASE
* Spring 2023 111
Inflammatory Bowel
Disease
■ A combination of chronic diseases
■ Similar but distinct pathology &
treatments
■ Affects people of all ages, but
particularly younger populations
Crohn’s disease Ulcerative
colitis
* Spring 2023 112
Incidence/Prevalence
■Chronic disease with
exacerbations
■Incidence greater in in upper
socioeconomic groups
■Incidence among Jewish
populations is 3-4x greater than
general population
■More common in Caucasians
* ■Etiology unknown
Spring 2023 - runs in families
113
Crohn’s Disease
■Occurs anywhere in GI tract but mostly
terminal ileum
■Characterized by chronic
inflammation throughout the entire
bowel wall
■Skips segments of bowel & areas of the
intestine appears normal & healthy
■Bowel develops cobblestone
appearance
■Chronic inflammation causes the
bowel wall to ulcerate and form fistulas
* Spring 2023 114
Crohn’s
* Spring 2023 115
Crohn’s
* Spring 2023 116
Ulcerative Colitis
■Diffuse inflammation of intestinal
mucosa with ulceration & abscess
formation
■Begins in the rectum & proceeds
uniformly toward the cecum
■Bowel - moth-eaten appearance
■Large bowel shortens & narrows
■Periods of remissions &
exacerbations
* Spring 2023 117
Complications of
Ulcerative Colitis
■Hemorrhage
■Colon perforation-rare but
leads to peritonitis-mortality
15%
* Spring 2023 118
colitis
* Spring 2023 119
* Spring 2023 120
* Spring 2023 121
* Spring 2023 122
* Spring 2023 123
Crohn’s Assessment
■Diarrhea-5-6 x/day, may contain blood
■Steatorrhea –fatty bulky stool
■Pain-RLQ unrelieved by defecation
■Pain-crampy, increases after meals
■Palpable RLQ mass often present
■Fever, fatigue, malaise, weight loss,
anorexia, anemia
■Serious nutritional deficiencies
* Spring 2023 124
Ulcerative Colitis-
Assessment
■S/S
■Bloody diarrhea-more than 10-20
X/day
■Pain-LLQ crampy pain unrelieved
by defecation
■Fatigue, anorexia, weakness
■Rebound tenderness - peritonitis
* Spring 2023 125
Psychosocial Assessment
■Assess understanding of illness
■Assess lifestyle impact
■Assess effect of pain & diarrhea on
sleep & social habits
■Assess social support
■Assess family support
* Spring 2023 126
Diagnostic Assessment
■Barium Enema
■Sigmoid/colonoscopy
■CT Scans
■Stool examination
■↑WBC,ESR & Platelet Count
■↓H&H, Albumin, Folic Acid & B12
(Crohn’s)
■Chemistry-albumin, electrolytes
■Serum vitamin levels
* Spring 2023 127
Nursing Diagnoses/Patient
Problems
* Spring 2023 128
Interventions-Medication
■Corticosteroids
■Control inflammation
■Prednisone, hydrocortisone
■Antidiarrheal agents
■loperamide
* Spring 2023 129
Medications
■Antimicrobial
■Inhibits prostaglandin production in
bowel
■Anti-inflammatory
■Sulfasalazine
■GI anti-inflmmatory
■Mezalamine
■Immunosupressive agents
■Azathioprine
* Spring 2023 130
Interventions-Dietary
Acute phase
■NPO
■I & O
■Daily weights
■TPN/PPN
■Enteral Feedings
■Elemental Formulas-Ensure
* Spring 2023 131
Interventions-Dietary
Non-acute phase
■Individualize diet
■Low residue, low fiber diet
■Eliminate
■alcohol,
■fried & highly flavored cheeses,
■tough, fried or highly spiced meats,
■raw or whole cooked vegetables,
■brown rice, whole grain bread or cereal,
■rich pastries, pies, rich gravies
■dried fruit, seeds, nuts, olives, popcorn,
■pepper, spices & vinegar
* Spring 2023 132
CARE OF PATIENTS WITH
TPN/PPN
■Change dressing daily under
sterile technique
■Change IV tubing daily
■Monitor for increased glucose
■Monitor for fluid overload
■If shortage of TPN solution:
■Hang D10W for TPN
■Hang D5W for PPN
* Spring 2023 133
Surgical Management
■Total colectomy (removal of colon)
■Severe, chronic ulcerative colitis
■Total colectomy with an ileal pouch-
anal
anastomosis
■Tx of choice for extensive ulcerative colitis
■Colon & rectum removed, ileal pouch to
anus
■Temporary ileostomy for 2-3 months
* Spring 2023 134
Surgical Management
cont.
Ileostomy-ostomy made into ileum
■Colon, rectum & anus usually removed
■Anal canal closed
Kock’s Ileostomy
■Intra-abdominal reservoir
■Nipple reservoir
■Catheter inserted into pouch to drain
stool
* Spring 2023 135
Discharge Planning
■Home care preparation
■Health Teaching
■Psychosocial preparation
■Sexual Dysfunction
■Referrals
■United Ostomy Foundation
■Crohn’s & Colitis Foundation of
America
* Spring 2023 142
