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NUR 315: Exam 3 Study Guide
Gastrointestinal System
Stomach pain, cramps and spasms are some of the
most frequent complaints of patients in the
emergency room departments
The prevalence of GI problems increases with age
Acute Diarrhea
Frequent passage of loose or watery stools
persisting 3-5 days that are not bloody, purulent
(puss= infection), or greasy (patient not
absorbing fat= problem with absorption)
Acute is <2 weeks duration
Most cases are self-limited and brief, and require
only symptomatic management
Large volume
o Viral or bacterial infection of large or distal small intestine
o Can alter volume and electrolyte balance
o Always worry about fluid and electrolyte imbalances
o Usually a viral or bacterial infection
o Fever is not associated with GI symptoms; self-limiting, goes away on
its own
Small volume
o Frequent loss of small amounts of stools
o Characteristic of ulcerative colitis and Crohn’s disease
o Characteristics with problems with absorption of fluids in colon
and/or small bowel
o Indicative of an inflammatory disorder
Other symptoms
o Fever
o Headache
o Vomiting
o Abdominal pain/discomfort
o Malaise
,Constipation
Changes in the frequency, size, and consistency, and ease of stool passage
One or more common and persistent presenting complaints
Among the most frequent reasons for self medication, especially in the
elderly
There is no test for or standard definition of constipation
o Very subjective
Passing the stool or GI discomfort w/ stool passage?
Pt’s might overuse laxatives (become habit forming in peristalsis of bowels)
in order to self medicate
Stools less than once every 3 days
o Frequency is individual
Causes
o Dehydration
o Delayed gastric motility
o Sedentary lifestyle
o Low fiber diet
o Psychogenic
o Drugs side effect, etc.
Treatment
o Check for fecal impaction especially in the elderly
Very difficult stool to pass
o Start treatment with lifestyle changes:
Increase fluid intake to at least six 8-oz. water/day
Optimal intake at least 8 glasses to 2 liters of water
Increase fiber
Regular exercise program
Bowel training/regular bowel habits
o If lifestyle changes don’t work:
Laxatives
Stool softeners
Enemas
Suppository
Anorexia
Loss of appetite or desire for food
Occurs as a symptom of other GI problems
Also present with conditions not associated with the GI tract
Nausea
Subjective, unpleasant sensation that may precede vomiting
Caused by:
o Distention or irritation anywhere in the GI tract
o Stimulated by higher brain center
,Vomiting
Complex reflex mediated by vomiting center in the medulla oblongata of the
brain
Occur in response to:
o Excessive distention or irritation of the stomach or duodenum
o Chemical stimulation
o Pain
Vomiting can be a response to pain (ex. Intracranial pressure
like a tumor, cause projectile vomiting, b/c affecting vomiting
center in the brain)
o Projectile vomiting occurs with direct stimulation of vomiting center-
due to increase ICP
o Chemoreceptors receiving feedback from GI tract from the metobolic
disturbance
o Symptoms that precede vomiting
Nausea
Tachycardia
Sweating
Types of Abdominal Pain (know parietal vs. visceral)
Parietal pain
o Caused by stimulation of pain receptors in the parietal
peritoneum or abdominal wall. The pain is localized, sharp, intense,
and one-sided (lateralized)
Visceral Pain
o Caused by stimulation of abdominal organs; pain is vague, diffuse
(non localized), and dull
Referred Pain
o Is felt at a distance from the affected tissue or organ; is localized at
some point along the afferent nerve pathway of the organ or tissue
o Gallbladder pain usually presents as right shoulder pain
Intestinal Obstruction
Impaired movement of intestinal contents
Mechanical obstruction
o Caused by any condition that affects the patency of the bowel lumen
o Tumor
o Adhesion
Scar tissue formation that blocks flow of gas or stool through
the gut
o Severe constipation
Can lead to abdominal distention, and alteration of fluid and electrolytes
In severe cases can lead to ischemia of bowel, acidosis, perforation, shock,
sepsis, and death
o Bugs can migrate into the blood stream= shock, sepsis, death
, o Strangulated bowel= NO FLOW- ISCHEMIC
Signs and Symptoms of an Intestinal Obstruction
Pain
o Peristaltic pain
Distention of the bowel
o Some push-back abdomen after palpated
Nausea and vomiting
Anorexia
Diarrhea
Reduced or absent bowel sounds (pt’s intestines ruptured b/c of
obstruction… dangerous, stool released into vascular space), or
borborygmus (3-5 sounds/min)
Abdominal tenderness, rigidity
Fever
Vomiting
o BAD sign b/c of backflow (pt may vomit stool)
Rigidity- gas has escaped causing intestines to be rough
Pt will become septic
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