ESOPHAGEAL

DEFINITION
SIGNS AND SYMPTOMS WITH SCIENTIFIC RATIONALE FOR EACH S/S

ETIOLOGY/CAUSES WITH SCIENTIFIC EXPLANATION FOR EACH

LABORATORY EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC EXPLANATION). HOW IT IS

DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.

DIAGNOSTIC EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC EXPLANATION). HOW IT IS

DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.

PHARMACOLOGIC MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH

MANAGEMENT

SURGICAL MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH MANAGEMENT

Barium esophagram: patient swallows barium sulfate to get a better sense of the anatomy of
the esophagus and stomach

Esophageal manometry: catheter with multiple pressure-sensing regions is introduced via the
nose or mouth into the esophagus to measure swallowing and peristalsis pressures

 senses pressures in the pharynx, upper esophageal sphincter, esophageal body (3 areas), and
the lower esophageal sphincter

NUTRITIONAL MANAGEMENT. INCLUDE NURSING RESPONSIFILITY FOR EACH MANAGEMENT

AT LEAST 5 NURSING CARE PLAN. PRIORITIZE.

HIATAL HERNIA
DEFINITION
SIGNS AND SYMPTOMS WITH SCIENTIFIC RATIONALE FOR EACH S/S
ETIOLOGY/CAUSES WITH SCIENTIFIC EXPLANATION FOR EACH
LABORATORY EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC
EXPLANATION). HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
DIAGNOSTIC EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC EXPLANATION).
HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
PHARMACOLOGIC MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
SURGICAL MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
NUTRITIONAL MANAGEMENT. INCLUDE NURSING RESPONSIFILITY FOR EACH
MANAGEMENT
AT LEAST 5 NURSING CARE PLAN. PRIORITIZE.

GASTROESOPHAGEAL REFLUX DISEASE

DEFINITION
Involves dysfunction of sphincters and reflux of caustic materials (acid, pepsin, bile, pancreatic
enzymes)
SIGNS AND SYMPTOMS WITH SCIENTIFIC RATIONALE FOR EACH S/S
 heartburn 30-60 minutes after a meal
 sour brash
 dysphagia
 relief with antacids
 esophagitis: does not correlate with severity of heartburn complaint
 extra-esophageal manifestations: exacerbation of asthma, cough, non-cardiac chest pain, laryngitis,
hoarseness, loss of dental enamel
ETIOLOGY/CAUSES WITH SCIENTIFIC EXPLANATION FOR EACH
LABORATORY EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC
EXPLANATION). HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
DIAGNOSTIC EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC EXPLANATION).
HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
PHARMACOLOGIC MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
SURGICAL MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
EGD: documents type and extent of tissue damage from GERD, including strictures and
Barrett’s
 will be normal in up to half of patients with reflux symptoms and won’t detect mild disease
o barium studies: limited role in reflux, but will detect strictures, ulceration, and abnormal folds
 reveals abnormal motility or esophageal clearance
Nissen fundoplication: tightens area around sphincter in an attempt to make it close more
tightly
 must screen for Barrett’s with EGD in those with symptoms > 10 years, those over 50, white males
NUTRITIONAL MANAGEMENT. INCLUDE NURSING RESPONSIFILITY FOR EACH
MANAGEMENT
elevate HOB, lose weight, stop tobacco, no late night eating, limit alcohol/fatty
foods/caffeine/chocolate
AT LEAST 5 NURSING CARE PLAN. PRIORITIZE.

INTESTINAL OBSTRUCTION
DEFINITION
SIGNS AND SYMPTOMS WITH SCIENTIFIC RATIONALE FOR EACH S/S
ETIOLOGY/CAUSES WITH SCIENTIFIC EXPLANATION FOR EACH
LABORATORY EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC
EXPLANATION). HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
DIAGNOSTIC EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC EXPLANATION).
HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
PHARMACOLOGIC MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
SURGICAL MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
NUTRITIONAL MANAGEMENT. INCLUDE NURSING RESPONSIFILITY FOR EACH
MANAGEMENT
AT LEAST 5 NURSING CARE PLAN. PRIORITIZE.

ACHALASIA
DEFINITION
absence of normal esophageal peristalsis with increased tone of the lower esophageal
sphincter (won’t relax)
SIGNS AND SYMPTOMS WITH SCIENTIFIC RATIONALE FOR EACH S/S
gradual, progressive dysphagia of both solids and liquids
 regurgitation of undigested foods, sometimes nocturnally
 substernal discomfort or fullness after eating
 poor esophageal emptying
ETIOLOGY/CAUSES WITH SCIENTIFIC EXPLANATION FOR EACH
LABORATORY EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC
EXPLANATION). HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
DIAGNOSTIC EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC EXPLANATION).
HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
manometry is the gold standard o shows complete absence of peristalsis, incomplete or absent
relaxation of LES
 CXR showing air-fluid level in an enlarged, fluid-filled esophagus
 barium swallow: shows “bird’s beak” from acute tapering of LES at gastro-esophageal junction,
esophageal dilation, loss of peristalsis
 EGD to look for cause: stricture, cancer, ring, obstruction
PHARMACOLOGIC MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
meds: smooth muscle relaxers like Ca channel blockers, nitrates
SURGICAL MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
NUTRITIONAL MANAGEMENT. INCLUDE NURSING RESPONSIFILITY FOR EACH
MANAGEMENT
AT LEAST 5 NURSING CARE PLAN. PRIORITIZE.

GASTRITIS
DEFINITION
SIGNS AND SYMPTOMS WITH SCIENTIFIC RATIONALE FOR EACH S/S
ETIOLOGY/CAUSES WITH SCIENTIFIC EXPLANATION FOR EACH
LABORATORY EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC
EXPLANATION). HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
DIAGNOSTIC EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC EXPLANATION).
HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
PHARMACOLOGIC MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
SURGICAL MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
NUTRITIONAL MANAGEMENT. INCLUDE NURSING RESPONSIFILITY FOR EACH
MANAGEMENT
AT LEAST 5 NURSING CARE PLAN. PRIORITIZE.

PEPTIC ULCER
DEFINITION
– erosion/excoriation of submucosa/mucosal lining d/t
 Hypersecretion of acid – pepsin
 Decreased resistance of mucosal barrier to HCl acid secretion (neutralizes acidity)
SIGNS AND SYMPTOMS WITH SCIENTIFIC RATIONALE FOR EACH S/S

ETIOLOGY/CAUSES WITH SCIENTIFIC EXPLANATION FOR EACH

LABORATORY EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC
EXPLANATION). HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
DIAGNOSTIC EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC EXPLANATION).
HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
1. Endoscopy
2. (+) Stool occult blood
3. Gastric analysis reveals
 Normal gastric acid secretion if gastric
 Increased gastric acid secretion if duodenal
4. Upper GI series – confirms ulceration
PHARMACOLOGIC MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
Antacids
 ACA – aluminum containing antacids
 Aluminum OH gel (Ampho gel)
 SE: constipation, hyperphosphatemia,
hypoparathyroidism
 MAD – magnesium containing antacids
 Milk of magnesia
 SE: diarrhea
 Mg + Al preparations (Maalox)  less SE
 H2 receptor antagonists
 Cimetidine (Tagamet) – antagonizes oral
anti-coagulant, more SEs
 Ranitidine (Zantac) – most common, fewer SE
 Famotidine (Pepsid)
 Give antacids and Cimetidine ONE
HOUR APART  decreased antacid absorption and vise versa
 Instruct client to avoid smoking because it decreases effectiveness of drug
 Cytoprotective agents
 Sucralfate (Carafate)  provides a paste- like substance that coats the mucosal lining
 Cytotec (Misoprostol)  causes severe spasm (abortifacient)  uterine cramping
 bleeding
 Anticholinergic/Anti-spasmodic agents
 Atropine
 Propanthelene sulfate (Probanthene)
 Sedatives, tranquilizers
SURGICAL MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
Assist in surgical procedure: subtotal gastrectomy
 Billroth I (removal of 1/3 of stomach)
 Gastroduodenostomy  gastric stump to the duodenum
Billroth II
 Gastrojejunostomy  gastric stump to jejunum
 Removal of 1⁄2 to 3⁄4 of the stomach, duodenal valve and anastomosis of gastric stump to jejunum
NURSING MANAGEMENT POST OP
1. Monitor NGT output that includes:
 Immediately after post-op  bright red
 32-46 hours  greenish in color
 48h  dark red  because of influence of HCl acid
2. Administer medications as ordered
 Antimicrobials
 Narcotic analgesics
 Anti-emetics
3. Maintain a patent IV line
4. Monitor VS, IO, Bowel Sounds
5. Prevent complication
 Hemorrhage  shock
 Paralytic Ileus – most common type of complication in all abdominal surgery
 Peritonitis
 Septicemia
 Hypokalemia
NUTRITIONAL MANAGEMENT. INCLUDE NURSING RESPONSIFILITY FOR EACH
MANAGEMENT
Bland diet  non-irritating, non-spicy
 Avoid beverages and foods high in caffeine or milk and milk containing products
AT LEAST 5 NURSING CARE PLAN. PRIORITIZE.

MALABSORPTION SYNDROME
DEFINITION
SIGNS AND SYMPTOMS WITH SCIENTIFIC RATIONALE FOR EACH S/S
ETIOLOGY/CAUSES WITH SCIENTIFIC EXPLANATION FOR EACH
LABORATORY EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC
EXPLANATION). HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
DIAGNOSTIC EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC EXPLANATION).
HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
PHARMACOLOGIC MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
SURGICAL MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
NUTRITIONAL MANAGEMENT. INCLUDE NURSING RESPONSIFILITY FOR EACH
MANAGEMENT
AT LEAST 5 NURSING CARE PLAN. PRIORITIZE.

APPENDICITIS

SIGNS AND SYMPTOMS WITH SCIENTIFIC RATIONALE FOR EACH

ETIOLOGY/CAUSES WITH SCIENTIFIC EXPLANATION FOR EACH
LABORATORY EXAMS NEEDED AND ITS EXPECTED RESULT WITH SCIENTIFIC
EXPLANATION. HOW IT IS DONE AND NURSING RESPONSIBILITIES
DIAGNOSTIC EXAMS NEEDED AND ITS EXPECTED RESULT WITH SCIENTIFIC
EXPLANATION HOW IT IS DONE AND NURSING RESPONSIBILITIES
PHARMACOLOGIC MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
SURGICAL MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
NUTRITIONAL MANAGEMENT. INCLUDE NURSING RESPONSIFILITY FOR EACH
MANAGEMENT
AT LEAST 5 NURSING CARE PLAN. PRIORITIZE.

DIVERTICULAR DISEASE
DEFINITION
outpouching of the intestinal mucosa particularly the sigmoid colon; DIVERTICULOSIS –
multiple diverticulum; DIVERTICULITIS – inflammation of diverticula
SIGNS AND SYMPTOMS WITH SCIENTIFIC RATIONALE FOR EACH S/S
1. Intermittent pain at LLQ and tenderness at the rectosigmoid area
2. Alternate bouts of diarrhea/constipation with blood and mucosa
3. Decreased hematocrit/hemoglobin  amnesia
ETIOLOGY/CAUSES WITH SCIENTIFIC EXPLANATION FOR EACH
LABORATORY EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC
EXPLANATION). HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
DIAGNOSTIC EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC EXPLANATION).
HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
1. Barium Enema – reveals inflammatory process
2. Decreased hematocrit/hemoglobin (d/t diarrhea)
PHARMACOLOGIC MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
Administer medications as ordered.
 Bulk laxatives
 Anti-cholinergics
 Atropine Sulfate
 Propanthelene Bromide
 Antibiotics for infection
SURGICAL MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
Assist in surgical procedure
 Bowel resection: removal of diseased portion of the bowel and creation of colostomy.
NUTRITIONAL MANAGEMENT. INCLUDE NURSING RESPONSIFILITY FOR EACH
MANAGEMENT
2. Provide dietary intake:
 Diverticulosis – high roughage/fiber with no seeds
 Diverticulitis – low fiber diet
AT LEAST 5 NURSING CARE PLAN. PRIORITIZE.

HEMORRHOIDS
DEFINITION
occur when increased venous pressure (from straining, prolonged sitting or standing,
pregnancy) causes prolapse of the subepithelial pillows of smooth muscle
SIGNS AND SYMPTOMS WITH SCIENTIFIC RATIONALE FOR EACH S/S
ETIOLOGY/CAUSES WITH SCIENTIFIC EXPLANATION FOR EACH
LABORATORY EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC
EXPLANATION). HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
DIAGNOSTIC EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC EXPLANATION).
HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
PHARMACOLOGIC MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
SURGICAL MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
NUTRITIONAL MANAGEMENT. INCLUDE NURSING RESPONSIFILITY FOR EACH
MANAGEMENT
AT LEAST 5 NURSING CARE PLAN. PRIORITIZE.

CHRON’S DISEASE
DEFINITION
SIGNS AND SYMPTOMS WITH SCIENTIFIC RATIONALE FOR EACH S/S
ETIOLOGY/CAUSES WITH SCIENTIFIC EXPLANATION FOR EACH
LABORATORY EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC
EXPLANATION). HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
DIAGNOSTIC EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC EXPLANATION).
HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
PHARMACOLOGIC MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
SURGICAL MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
NUTRITIONAL MANAGEMENT. INCLUDE NURSING RESPONSIFILITY FOR EACH
MANAGEMENT
AT LEAST 5 NURSING CARE PLAN. PRIORITIZE.

ULCERATIVE COLITIS
DEFINITION
defined as defects in the gastric mucosa that result from an imbalance between enzymatic
activity and mucosal injury
SIGNS AND SYMPTOMS WITH SCIENTIFIC RATIONALE FOR EACH S/S
burning pain localized to the epigastrium that is non-radiating
 gastric ulcers are worse after meals, duodenal ulcers are better after meals
 pain that awakens patient from sleep between 2-3am
 can also be asymptomatic
ETIOLOGY/CAUSES WITH SCIENTIFIC EXPLANATION FOR EACH
typically occurs between ages of 25-64
 at risk: previous GI event, old age, use of anticoagulants, corticosteroids, NSAIDs, chronic
diseases
 Causes: H. pylori, NSAIDs, excess acid
LABORATORY EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC
EXPLANATION). HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
EGD to characterize lesions and biopsy
 H. pylori test
DIAGNOSTIC EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC EXPLANATION).
HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
fasting gastrin or secretin test
 secretin should have no effect on gastrin in normal patients but will ↑↑ gastrin in ZE
 endoscopic US + somatostatin-R imaging
PHARMACOLOGIC MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
NSAIDs decrease prostaglandin synthesis decreased mucin production, decreased mucosal blood
flow, decreased bicarb production = loss of protective effects
Cox-2 inhibitors vs NSAIDs, mucosal protection with 33isoprostol, PPIs, high-dose H2
blockers
SURGICAL MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
surgery: rarely indicated
o complete or partial gastrectomy
o vagotomy
NUTRITIONAL MANAGEMENT. INCLUDE NURSING RESPONSIFILITY FOR EACH
MANAGEMENT
AT LEAST 5 NURSING CARE PLAN. PRIORITIZE.

COLOSTOMY CARE
DEFINITION
SIGNS AND SYMPTOMS WITH SCIENTIFIC RATIONALE FOR EACH S/S
ETIOLOGY/CAUSES WITH SCIENTIFIC EXPLANATION FOR EACH
LABORATORY EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC
EXPLANATION). HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
DIAGNOSTIC EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC EXPLANATION).
HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
PHARMACOLOGIC MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
SURGICAL MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
NUTRITIONAL MANAGEMENT. INCLUDE NURSING RESPONSIFILITY FOR EACH
MANAGEMENT
AT LEAST 5 NURSING CARE PLAN. PRIORITIZE.

HEPATITIS
DEFINITION
inflammation of the hepatocytes
o can be viral (most commonly), alcohol-related, metabolic, toxin, or medication-related
o can be acute or chronic
SIGNS AND SYMPTOMS WITH SCIENTIFIC RATIONALE FOR EACH S/S \
jaundice: yellowing of the skin, conjunctiva, and mucous membranes due to increased bilirubin
o clinically apparent when bilirubin > 2.5 mg/dL
o first appears in the eyes and oral mucosa
o may also have dark urine and light stool
o malaise/fatigue
o light stools, dark urine
o pruritus
o GIB
o confusion
o edema
o weight loss or loss of appetite
o nause & vomiting
o fever
ETIOLOGY/CAUSES WITH SCIENTIFIC EXPLANATION FOR EACH
LABORATORY EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC
EXPLANATION). HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
DIAGNOSTIC EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC EXPLANATION).
HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
PHARMACOLOGIC MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
SURGICAL MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
NUTRITIONAL MANAGEMENT. INCLUDE NURSING RESPONSIFILITY FOR EACH
MANAGEMENT
AT LEAST 5 NURSING CARE PLAN. PRIORITIZE.

LIVER CIRRHOSIS
DEFINITION
loss of architectural design of liver leading to fat necrosis and scarring; can lead to liver cancer
SIGNS AND SYMPTOMS WITH SCIENTIFIC RATIONALE FOR EACH S/S
Weakness and fatigue
Anorexia
Nausea and vomiting
Tea-colored urine, clay-colored stool
Decreased sexual urge
Amenorrhea
Dyspepsia – indigestion
Hepatomegaly
Jaundice
Urticaria/pruritus
Loss of pubic/axillary hair
ETIOLOGY/CAUSES WITH SCIENTIFIC EXPLANATION FOR EACH
LABORATORY EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC EXPLANATION). HOW IT IS DONE
AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
bilirubin is a product of RBC breakdown
o normally the heme unconjugated bilirubin by the spleen
 then the bilirubin is further processed by the liver conjugated bilirubin
 enters the bile
o most is excreted in feces
o smaller amount excreted in urine
 blockage of bile duct enters the blood instead
 insoluble bilirubin = unconjugated = indirect
 kidneys won’t filter this!
 soluble bilirubin = conjugated = direct
 kidneys will filter this, so if urine is dark this is why
o total and direct bilirubin is what is measured from the blood, and indirect bilirubin is
calculated from this number
DIAGNOSTIC EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC EXPLANATION).
HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
Liver enzymes
SGPT (ALT) elevated
SGOT (AST) elevated
Serum cholesterol
Ammonia elevated
Indirect bilirubin / Unconjugated bilirubin elevated
CBC low
PTT prolonged

PHARMACOLOGIC MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH

MANAGEMENT
SURGICAL MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
NUTRITIONAL MANAGEMENT. INCLUDE NURSING RESPONSIFILITY FOR EACH
MANAGEMENT
AT LEAST 5 NURSING CARE PLAN. PRIORITIZE.

PANCREATITIS
DEFINITION
an acute or chronic inflammation of the pancreas leading to pancreatic edema, necrosis and
hemorrhage d/t autodigestion; idiopathic; TRYPSIN – kills pancreas
SIGNS AND SYMPTOMS WITH SCIENTIFIC RATIONALE FOR EACH S/S
Severe abdominal pain radiating from the back (left
upper quadrant), chest and flank area accompanied
by DOB and aggravated
tachycardia secondary to hypovolemia from leaky blood vessels and third-spacing
 fever within 1-3 days of onset from retroperitoneal irritation or inflammation
 sepsis
 icterus or jaundice with biliary obstruction
 decreased breath sounds with pleural effusion
 abdominal tenderness with guarding and rebound tenderness
 acute interstitial pancreatitis: mild, with pancreatic edema
ETIOLOGY/CAUSES WITH SCIENTIFIC EXPLANATION FOR EACH
 alcohol use, although temporal relationship is uncertain
 obstructions: gallstones, pancreatic or ampullary tumors, sphincter of Oddi dysfunction, pancreatic
divisum (malformation of pancreatic duct)
 medications: diuretics, azathioprine, 6-mercaptopurine, sulfa drugs, ACE inhibitors, HIV meds
 infections: mumps, rubella, Coxsackie virus, echovirus, EBV, HIV
 metabolic: ↑ TG, hypercalcemia
 toxins: ethanol, methanol, scorpion sting in Trinidad
 vascular: vasculitis, ischemia
 abdominal trauma: pancreatic contusion, pancreatic duct damage
 post-ERCP
 inherited causes: hereditary pancreatitis, cystic fibrosis
LABORATORY EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC
EXPLANATION). HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
elevated amylase:
 problem: not specific, can be elevated in other conditions such as appendicitis,
cholecystitis, perforation, ectopic pregnancy, renal failure
 decreases after the first 24 hours of pancreatitis o elevated lipase:
 more specific for pancreas, but can be elevated in renal failure and other problems
 elevated for 3- days
o elevated amylase or lipase alone without clinical signs are NOT pancreatitis!
 bilirubin will be elevated if there is an obstruction blocking it from leaving the liver
 elevated BUN if there is volume depletion
 increased hematocrit if there is volume depletion
 US showing enlarged, hypoechoic pancreas
o also look for gallstones, biliary duct dilation
 CT scan showing pancreatic enlargement, peripancreatic edema
o imaging of choice for pancreatic parenchyma: can assess necrosis, extrapancreatic fluid,
assess complications
o can be normal in some patients with mild disease
DIAGNOSTIC EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC EXPLANATION).
HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
CBC – mild leukocytosis
PE – (+) rebound tenderness
Urinalysis – (+) acetone)
PHARMACOLOGIC MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
SURGICAL MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH

MANAGEMENT

ERCP with sphincterectomy or stent placement to open up pancreatic duct

o Puestow procedure: filleting the pancreas, then hotdogging the jejunum in between and
connecting it to the pancreatic duct for ease of pancreatic juice flow into the jejunum
NUTRITIONAL MANAGEMENT. INCLUDE NURSING RESPONSIFILITY FOR EACH
MANAGEMENT
AT LEAST 5 NURSING CARE PLAN. PRIORITIZE.
CHOLELITHIASIS
DEFINITION
– inflammation of the gallbladder with gallstone formation
SIGNS AND SYMPTOMS WITH SCIENTIFIC RATIONALE FOR EACH S/S
Severe abdominal pain (RUQ) radiating from the back and chest that usually occurs at night
Fatty intolerance (pain after ingestion of high fat meals) characterized by: Anorexia, nausea and
vomiting
Tea-colored urine and steatorrhea
ETIOLOGY/CAUSES WITH SCIENTIFIC EXPLANATION FOR EACH
the blood flow to the gallbladder may become compromised which in turn will cause problems with
the normal filling and emptying of the gallbladder. A stone may block the cystic duct which will
result in bile becoming trapped within the gallbladder due to inflammation around the stone within
the duct.
LABORATORY EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC
EXPLANATION). HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
DIAGNOSTIC EXAMS NEEDED. EXPECTED RESULT (WITH SCIENTIFIC EXPLANATION).
HOW IT IS DONE AND NURSING RESPONSIBILITY FOR IS LAB EXAM.
1. Gallbladder series (Oral cholecystogram) – confirm presence of gallstones
2. Serum lipase elevated
3. Indirect bilirubin elevated
4. Alkaline phosphatase elevated
5. Transaminases elevated
PHARMACOLOGIC MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
Narcotic analgesics
 Meperidine HCl (Demerol)
2. Anticholinergic agents
 Atropine sulfate
3. Anti-emetics
 Metoclopramide (Plasil)
 Phenergan
SURGICAL MANAGEMENT. INCLUDE NURSING RESPONSIBILITY FOR EACH
MANAGEMENT
NUTRITIONAL MANAGEMENT. INCLUDE NURSING RESPONSIFILITY FOR EACH
MANAGEMENT
Diet low in fat, high CHON and CHO
AT LEAST 5 NURSING CARE PLAN. PRIORITIZE.

Liver Biopsy
 Indicated for evaluation of abnormal LFTs, suspected neoplasm, confirmation of diagnosis
(hepatitis C,
primary biliary cirrhosis, alcoholic cirrhosis, NAFLD), evaluation of granulomatous disease,
unexplained
jaundice or suspected drug reaction, management of post-transplant care
 Percutaneous, laparoscopic, or transjugular
 Gold standard for evaluation of liver inflammation or fibrosis
 Outpatient
 Complications rare but serious
 Contraindications: increased PT, thrombocytopenia, ascites, difficult body habitus,
suspected
Hemangioma
Endoscopies
 esophagogastroduodenoscopy (EGD): goes from mouth up through the duodenum
 colonoscopy: goes from anus to terminal ileum, allows for visualization of entire colon
o study of choice for colorectal screening
o also indicated for eval of anemia, bleeding, assessment of IBD
o extensive patient bowel prep and liquid diet for 24 hours prior to procedure
o requires sedation
 sigmoidoscopy: examines descending colon, sigmoid colon, and rectum
o useful for patients with inflammatory diarrhea who only need a view of the distal colon
o more effective than fecal occult for colorectal cancer screening, but less effective than
colonoscopy
o less patient prep than colonoscopy
 endoscopic US: allows for transluminal imaging
o study of choice for staging of rectal, esophageal, and gastric tumors
o study of choice for identifying pancreatic tumors
o can also be used to do aspiration biopsies through endoscope