 At at the end of the third year, given

individuals, families, population groups and

communities with physiologic and
psychological health problems and
maladaptive patterns of behavior in varies
healthcare settings, the learners demonstrate
safe, appropriate and holistic care utilizing
the nursing process and applying research
and evidence-based practice.
1. Apply knowledge of physical, social, natural and health sciences, and humanities in the
practice of nursing.
2. Provide safe, appropriate and holistic care to individuals, families, population groups and
communities utilizing nursing process.
3. Apply guidelines and principles of evidence-based practice in the delivery of care.
4. Practice nursing in accordance with existing laws, legal, ethical and moral principles.
5. Communicate effectively in speaking, writing and presenting using culturally – appropriate
language.
6. Document to include reporting up-to-date client care accurately and comprehensively.’
7. Work effectively in collaboration with inter-, intra-, and multi-disciplinary and multi-cultural
teams.
8. Practice beginning management and leadership skills in the delivery of client care using a
systems approach.
9. Conduct research with an experienced researcher.
10. Engage in lifelong learning with a passion to keep current with national and global
developments in general, and nursing and health developments in particular.
11. Demonstrate responsible citizenship and pride of being a Filipino.
12. Apply techno-intelligent care systems and processes in health care delivery.
13. Adopt the nursing core values in the practice of the profession.
 Nutrition is the selection of foods and
preparation of foods, and their ingestion to
be assimilated by the body. By practicing a
healthy diet, many of the known health issues
can be avoided. The diet of an organism is
what it eats, which is largely determined by
the perceived palatability of foods.
 It is the state of complete physical, mental
and emotional well being and not merely the
absence of disease or infirmity.
 These are the components of food that help
to nourish the body.
 The basic nutrients are
 CHO,
 proteins,
 vitamins,
 lipids
 defined as a pathological state resulting from
a relative or absolute deficiency or excess of
one or more essential nutrients
 condition that results when insufficient food
is consumed over an extended period of time
 pathological state resulting from the
consumption of excessive quantity of food
over an extended time
 pathological state resulting from
disproportion among essential nutrients with
or without the absolute deficiency of any
nutrient
 pathological state resulting from a relative or
absolute lack of specific nutrients
 A nutritional deficiency occurs when the body
doesn’t absorb or get from food the
necessary amount of a nutrient.
 Deficiencies can lead to a variety of health
problems. These can include digestion
problems, skin disorders, stunted or defective
bone growth, and even dementia
 Protein–energy malnutrition (or protein–
calorie malnutrition)
 refers to a form of malnutrition where there is
inadequate protein and calorie intake
 It is considered as the primary nutritional problem
in India
 PEM is due to the “food gap” between the intake
and requirement
 Causes childhood morbidity and mortality
 Endemic fluorosis
 Endemic goiter (Iodine deficiency disorders)
 Lathyrism
 Nutritional anemia
 Keratomalcia
 Xerophthalmia
 Low birth weight
 Protein Energy Malnutrition
 UNDERNUTRITION
 Is defined as a pathological state resulting from an
absolute or relative deficiency of one or more
essential nutrients.
 PROTEIN–ENERGY MALNUTRITION
 refers to a form of malnutrition where there is
inadequate protein and calorie intake
 It is considered as the primary nutritional problem
in India
 Causes childhood morbidity and mortality
 Condition and disease:
▪ Kwashiorkor
▪ Marasmus
 Inadequate intake of food
 Diarrhea
 Respiratory infections
 Measles
 Poor environmental Hygiene
 Large family size
 Poor maternal health
 Failure of lactation
 Premature termination of breast feeding
 Delayed supplementary feeding
 Use of over diluted cow’s milk
 is the most common and widespread
nutritional disorder in developing countries. It
is a form of malnutrition caused by not
getting enough protein in the diet.
 is a severe form of malnutrition that consists
of the chronic wasting away of fat, muscle,
and other tissues in the body.
 Malnutrition occurs when the body does not
get enough protein and calories.
 This lack of nutrition can range from a
shortage of certain vitamins to complete
starvation.
KWASHIORKOR
 Acute illness/infections
prolonged starvation
 measles,trauma,sepsis
 Protein is principal nutrient
 18 months to 3 years
 Rapid, acute onset
 Some weight loss
 High mortality
MARASMUS
 Severe prolonged
 chronic/recurring
 calories and protein
principal nutrients
 6months to 2 years
 chronic and slow onset
 severe weight loss
 low mortality unless
KWASHIORKAR
 Edema, pot belly, swollen
legs
 Mild to moderate growth
retardation
 Weight masked by edema
 Low subcutaneous fat
 Muscle atrophy
MARASMUS
 Weight loss up to 40%
edema
 Severe growth failure
 Severe emaciation
 Severe loss of
subcutaneous fat
 Severe muscle atrophy
KWASHIORKOR
 Anemia, diarrhea, infection
 Mildly enlarged liver
 Common hair changes
 Rare skin changes
 Wrinkled face (old man’s face)
 Severe muscle atrophy
 Severe loss of subcut fat
 Severe emaciation
 Severe growth failure
 Weight loss upto 40%
 Anemia, diarrhea, infection
MARASMUS
 No edema
 Xerophthalmia
 Enlarged liver
 Thin dry easily plucked hair
 Dry, flaky peeling skin
 Round face (moon face)
 Muscle atrophy
 Low subcutaneous fat
 Weight masked by edema
 Mild to moderate growth
retardation
 Edema, pot belly, swollen
legs
 A malnutrition disease, primarily
of children, resulting from the
deficiency of both calories and
protein.
 The condition is characterized by
severe tissue wasting,
dehydration, loss of
subcutaneous fat, lethargy, and
growth retardation
 Weight for age (%) = Weight of child X 100
Wt. of normal child of same age
 Between 90 – 110% Normal Nutritional
Status
 Between 75 – 89% Mild malnutrition (1st
degree)
 Between 60 – 74% Moderate Malnutrition
(2nd degree)
 Oral rehydration therapy helps to prevent
dehydration caused by diarrhea
 Exclusive breast feeding for 6 months thereafter
supplementary foods may be introduced along
with breast feeds
 Immunization for infants and children
 Nutritional supplements
 Early diagnosis and treatment
 Promotion and correction of feeding practices
 Family planning and spacing of birth
 Infant
 Weight (Kg) = Age in months + 9 2
 Pre schooler
 Weight (Kg) = 2 x (Age in years) + 5
 Identification of mothers at risk
 malnutrition, heavy work load, infections,
disease and high BP
 Increasing food intake of mother, supplementary
feeding, distribution of iron and folic acid tablets
 Avoidance if smoking
 Improved sanitation methods
 Improving health and nutrition of young girls
 Controlling infections – UTI, rubella, syphilis,
malaria
 Oral rehydration therapy helps to prevent
dehydration caused by diarrhea
 Exclusive breast feeding for 6 months there after
supplementary foods may be introduced along
with breast feeds
 Immunization for infants and children
 Nutritional supplements
 Early diagnosis and treatment
 Promotion and correction of feeding practices
 Family planning and spacing of birth
 Periodic surveillance
 Nutritional rehabilitation
 An LBW newborn is any newborn with a birth
weight of less than 2.5kg (including 2.499kg)
regardless of gestational age.
 CAUSES/RISK FACTORS
 Illness/infections
 Short maternal stature
 Very young age
 High parity
 Close birth intervals
 Intrauterine growth restriction (IUGR)
 LOW BIRTH WEIGHT
 PRE TERM BABIES
 SGA BABIES
 SPONTANEOUS PRE TERM BIRTH
 PROVIDER INITIATED PRE TERM BIRTH
 Identification of mothers at risk
 malnutrition, heavy work load, infections, disease and
high BP
 Increasing food intake of mother, supplementary
feeding, distribution of iron and folic acid tablets
 Avoidance if smoking
 Improved sanitation methods
 Improving health and nutrition of young girls
 Early detection and treatment of medical
disorders – DM HTN
 Controlling infections – UTI, rubella, syphillis,
malaria
 can be divided into four categories:
 water-soluble vitamins:
 fat-soluble vitamins: Vitamin ADEK
 microminerals, and
 trace minerals.
 Vitamin A deficiency (VAD) or hypovitaminosis A
 is a lack of vitamin A in blood and tissues. It is
common in poorer countries but rarely seen in more
developed countries.
 Nyctalopia (night blindness) is one of the first signs of
VAD.
 Xerophthalmia i.e., dry eyes refers to all the ocular
manifestations of vitamin A deficiency
 It is the most widespread and serious nutritional
disorder
 Reduced vision in the night or dim light
 Dry eyes which could also lead to Xerophthalmia
 corneal inflammation
 The child or adult may experience susceptibility
towards respiratory infection and urinary
infections.
 Growth can be halted in children
 Skin might also show signs of Vitamin A
deficiency. For example it may get rough and/or
dry
 Xerophthalmia
 dry eyes refers to all the ocular manifestations of
vitamin A deficiency in man It is the most
widespread and serious nutritional disorder
leading to blindness
 Bitot spot
 Keratomalacia
 Softening of cornea
 Corneal ulcers
 1-3 years CLINICAL FEATURES
 Infections
 PEM
 Weaning
 Faulty feeding practices
 Poor socio-economic status
 Fortification of certain food with vitamin A –
sugar, salt, tea and skimmed milk
 Regular and adequate intake of vitamin A
 Administering large doses of vitamin A orally
on a periodic basis 
 Administering large doses of vitamin A orally
on a periodic basis
 Regular and adequate intake of vitamin A
 Fortification of certain food with vitamin A
 sugar, salt, tea and skimmed milk
 Also known as cobalamin
 is a nutrient that helps keep the body's nerve
and blood cells healthy and helps make DNA,
the genetic material in all cells.
 also helps prevent a type of anemia called
megaloblastic anemia that makes people
tired and weak.
 Two steps are required for the body to absorb
vitamin B12 from food.
 meat.
 fish.
 milk.
 cheese.
 eggs.
 some
fortified brea
kfast cereals.
 is a condition where the hemoglobin content
of blood is lower than normal as a result of a
deficiency of one or more essential nutrients,
regardless of the cause of such deficiency.
 Inadequate diet
 Insufficient intake of iron
 Iron mal-absorption
 Pregnancy
 Excessive menstrual bleeding
 Hook worm infestation
 Malaria
 Close birth intervals
 GI bleed
 Infants and children
 Pregnant women
 Pre menopausal women
 Pregnancy
 Increases risk of maternal and fetal morbidity and
mortality
 Abortions, premature births, PPH, low birth weight
are associated with anemia during pregnancy
Infection
 Anemia can be aggravated by parasitic
infections like malaria, intestinal parasites
 Iron deficiency may repair cellular response and
immune functions Work capacity
 More severe the anemia, greater the reduction
in work performance
 Blood transfusion in severe cases of anemia
 Estimation of Hb to assess degree of anemia
 Nutritional education and awareness
 Control of parasites
 Changing dietary habits
 Food fortification with iron
 Iron and folic acid supplements 8g/dL
 leads to a much wider spectrum of disorders
commencing with the intrauterine life and
extending through childhood to adult life
with serious health and social implications
 DISORDERS
 Intrauterine death
 Goiter
 Hypothyroidism / Endemic cretinism
 Subnormal intelligence
 Delayed motor milestones
 Mental deficiency
 Hearing defects
 Speech defects
 Mental retardation
 Neuromuscular weakness
 Endemic cretinism
 Iodized salt
 Iodine monitoring
 Public awareness and education
COMPLICATIONS
 Thyrotoxicosis
 Iodide goiter
 Iodinism
 Lymphocytic thyroiditis
 In many parts of the world where drinking
water contains excessive amounts of fluorine
(3- 5mg/L), endemic fluorosis has been
observed.
 Associated with life time daily intake of 3-
6mg/L or more
 Heavy deposition of fluoride in skeleton
 Crippling occurs leading to disability
 It occurs when excess fluoride is ingested
during the years of tooth calcification – first 7
years of life
 Characterized by molting of dental enamel
which has been reported above 1.5mg/L
intake
 Fluorosis seen on the incisors of upper jaw
 Changing the water sources
 Chemical defluorination
 Preventing use of fluoridated toothpaste
 Fluoride supplements not prescribed for
children consuming fluoridated water
 It is a paralyzing disease of human and
animals
 Also referred to as Neurolathyrism as it
affects the nervous system
 Lathyrus Sativus is commonly known as
‘khesari dhal’, a good source of protein but its
toxins affects the nerves
 The toxin present in lathyrus seed has been
identified as BETA OXALYL AMINO ALANINE
(BOAA) which has blood brain barrier
 Latent stage
 No stick stage
 One stick stage
 Two stick stage
 Crawler stage
 Vitamin C prophylaxis
 Banning the crop
 Removal of toxin
 Education and awareness
 Genetic approach – producing low toxin
variety of crop
 Socio economic changes
 Vitamin A Prophylaxis Program
 Prophylaxis against Nutritional Anemia
 IDD Control Program
 Specific Nutrition Program
 Balwadi Nutrition Program
 Integrated Child Development Scheme
 Mid – day Meal Program
 Mid – day Meal Scheme
 is an epidemic diseases, which consists of
body weight that is in excess of that
appropriate for a person’s height and age
standardized to account for differences,
leading to an increased risk to health related
problems
 are defined as abnormal or excessive fat
accumulation that presents a risk to health.
 A crude population measure of obesity is the
body mass index (BMI), a person’s weight (in
kilograms) divided by the square of his or her
height (in metres).
 A person with a BMI of 30 or more is generally
considered obese.
 A person with a BMI equal to or more than 25
is considered overweight.
 BMI = (Weight in Kilograms / (Height in
Meters x Height in Meters)
Anorexia Nervosa
Bulimia Nervosa
 is an eating disorder characterized by
 immoderate food restriction,
 inappropriate eating habits or rituals,
 obsession with having a thin figure, and
 an irrational fear of weight gain,
 as well as a distorted body self- perception.
 is an eating disorder characterized
 by binge eating and purging, or
 consuming a large amount of food in a short amount
of time followed by an attempt to rid oneself of the
food consumed (purging),
 typically by vomiting,
 taking a laxative,
 diuretic, or stimulant, and/or excessive
 exercise, because of an extensive concern for body
weight.
 Bradycardia or tachycardia
 Depression: may frequently be in a sad, lethargic
state
 Solitude: may avoid friends and family; becomes
withdrawn and secretive
 Swollen joints
 Abdominal distension
 Halitosis (from vomiting or starvation-induced
ketosis)
 Dry hair and skin, as well as hair thinning
 Fatigue
 Rapid mood swings
 Amenorrhea
 rapid, dramatic weight loss at least 15% under
normal body weight
 May engage in frequent, strenuous, or
compulsive exercise
 Perception of self as overweight despite being
told by others they are too thin
 Intolerance to cold and frequent complaints of
being cold. Body temperature may lower in an
effort to conserve energy
 Hypotension and/or orthostatic hypotension
 Anorexia Nervosa
 Pharmacotherapy
 Psychological therapies
 Bulimia Nervosa Bulimia Nervosa
 Psychotherapy
 TCA’s or SSRI’s
 Is defined as a pathological state resulting
from an absolute or relative excess of one or
more essential nutrients.
 Nursing diagnosis:
 Imbalanced nutrition less than body requirement
 Muscle weakness
 Activity intolerance
 Impaired fluid and electrolyte balance
 Impaired skin integrity
 Fatigue
 Risk for infection
 Risk for injury
 Protein malnutrition
 Kwashiorkor
 Marasmus
 Calcium  Keshan disease
 Osteoporosis  Iron deficiency
 Rickets  Iron deficiency
 Tetany anemia
 Iodine deficiency  Zinc
 Goiter  Growth
 Selenium retardation
deficiency
 Thiamine (Vitamin  Vitamin D
B1 )  Osteoporosis
 Beriberi  Rickets
 Niacin (Vitamin B3)  Vitamin A
 Pellagra  Night Blindness
 Vitamin C  Vitamin K
 Scurvy  Haemophilia
• Inability to swallow (dysphagia), which may feel like food or drink is stuck in
your throat
• Regurgitating food or saliva (food coming back up)
• Heartburn
• Belching
• Chest pain that comes and goes
• Coughing at night
• Pneumonia (from aspiration of food into the lungs)
• Weight loss
• Vomiting
 DIAGNOSTIC TESTS

Upper endoscopy. Your doctor inserts a thin, flexible tube equipped with a light
and camera (endoscope) down your throat, to examine the inside of your
esophagus and stomach. Endoscopy can be used to define a partial blockage of the
esophagus if your symptoms or results of a barium study indicate that possibility.
 DIAGNOSTIC TESTS

Esophageal manometry. This test measures the rhythmic muscle contractions in

your esophagus when you swallow, the coordination and force exerted by the
esophagus muscles, and how well your lower esophageal sphincter relaxes or
opens during a swallow. This test is the most helpful when determining which type
of motility problem you might have.
 DIAGNOSTIC TESTS
X-rays of your upper digestive system (esophagram). X-rays are taken after you
drink a chalky liquid that coats and fills the inside lining of your digestive tract.
The coating allows your doctor to see a silhouette of your esophagus, stomach
and upper intestine. You may also be asked to swallow a barium pill that can
help to show a blockage of the esophagus.
 TREATMENT

• Achalasia treatment focuses on relaxing or stretching open the lower

esophageal sphincter so that food and liquid can move more easily
through your digestive tract.
• Specific treatment depends on your age, health condition and the
severity of the achalasia.
 NONSURGICAL TREATMENT
• Pneumatic dilation. A balloon is inserted by endoscopy into the center of the
esophageal sphincter and inflated to enlarge the opening. This outpatient
procedure may need to be repeated if the esophageal sphincter doesn't stay
open. Nearly one-third of people treated with balloon dilation need repeat
treatment within five years.
 NONSURGICAL TREATMENT

• Botox (botulinum toxin type A). This muscle relaxant can be injected directly into
the esophageal sphincter with an endoscopic needle. The injections may need to
be repeated, and repeat injections may make it more difficult to perform surgery
later if needed.
 NONSURGICAL TREATMENT

Medication. Your doctor might suggest muscle relaxants such as

nitroglycerin (Nitrostat) or nifedipine (Procardia) before eating. These
medications have limited treatment effect and severe side effects.
Medications are generally considered only if you're not a candidate for
pneumatic dilation or surgery, and Botox hasn't helped. This type of
therapy is rarely indicated.
 SURGICAL TREATMENT
• Heller myotomy. The surgeon cuts the muscle at the lower end of the
esophageal sphincter to allow food to pass more easily into the
stomach.
 SURGICAL TREATMENT

Peroral endoscopic myotomy (POEM). In the POEM procedure, the surgeon uses
an endoscope inserted through your mouth and down your throat to create an
incision in the inside lining of your esophagus. Then, as in a Heller myotomy, the
surgeon cuts the muscle at the lower end of the esophageal sphincter.
APPENDICITIS

BAKAR, MERIAM S.
BALIWAN, AALEHA IZZA P.
 INTODUCTION

What Is Appendicitis?
• The appendix is a small organ
attached to the large intestine in
the lower right side of the belly.
When it gets infected, it's called
appendicitis.
 ANATOMY & PHYSIOLOGY

 The appendix sits

at the junction of
the small intestine
and large
intestine.
 It’s a thin tube
about four inches
long. Normally,
the appendix sits
in the lower right
abdomen.
Appendicitis occurs
when the appendix
becomes inflamed
and filled with pus.
Appendicitis is an
inflammation of the
appendix, a finger-
shaped pouch that
projects from your
colon on the lower
right side of your
abdomen.
Appendicitis causes
pain in your lower
right abdomen.
 ETIOLOGY: OBSTRUCTIVE CAUSES

 Fecalith ( a fecal calculus or stone )

that occlude lumen of the appendix.
 Kinking of the appendix ( Twisting
or curling)
 Swelling of bowel wall
ETIOLOGY: NONOBSTRUCTIVE CAUSES

 Haematogenous spread of infection

 Vascular occlusion
 Trauma
 Diet lacking fibres
 SIGNS AND SYMPTOMS

 Sudden pain that begins on the right

side of the lower abdomen
 Sudden pain that begins around your
navel and often shifts to your lower
right abdomen
 Pain that worsens if you cough, walk
or make other jarring movement.
 SIGNS AND SYMPTOMS

 Nausea and vomiting

 Loss of appetite
 Low-grade fever that may worsen as
the illness progresses
 Constipation or diarrhea
 Abdominal bloating
 Flatulence
 CARDINAL SIGNS

The 5 important cardinal signs of

appendicitis are:
 PSOA’SSIGN
 ROVSING’S SIGN

 OBTURATOR’S SIGN

 BLOOMBERG’S SIGN

 MCBURNEY’S SIGN
DIAGNOSTIC TESTS & LABORATORIES

Blood Test Urine Test Imaging Test

 MEDICAL & PHARMACOLOGIC INTERVENTION

 Appendectomy
 Analgesics such as Morphine sulphate 10
mg/ml
 Antibiotics
 Cefotaxime 250mg, 500mg
 Levofloxacin 500 mg

 Metronidazole 500mg/100ml, 400 mg tablet

 POSSIBLE NURSING DIAGNOSIS

• Acute Pain
• Risk for Deficient Fluid Volume
Risk for Infection
Deficient Knowledge
 NURSING INTERVENTIONS

 Assessing and relieving pain

through medication administration
as well as nonpharmacologic
interventions.
 Important: Do not apply heat to the
appendicitis patient's abdomen.
 Prevent fluid volume deficit.
 NURSING INTERVENTIONS

 Prevent infection.
 Reduce patient anxiety
 Encourage patients to walk as
able/ permitted to maintain
circulation.
 Monitor for adequate bowel
movements.
CELIAC
DISEAS
E
Jophet L. Amar
Mae Joy C. Araneta
What is Celiac
Disease?

Celiac disease, sometimes

called celiac sprue or gluten-
sensitive enteropathy, is an
immune reaction to eating
gluten, a protein found in
wheat, barley and rye.
 What are the symptoms of celiac disease?
Symptoms of celiac disease vary widely, and a person may have multiple
symptoms that come and go. If you have celiac disease, you may have digestive
problems or other symptoms. Digestive symptoms are more common in children
than in adults.
Digestive symptoms of celiac disease may include:

•bloating
•chronic diarrhea
•constipation
•gas
•lactose intolerance due to damage to the small intestine
•loose, greasy, bulky, and bad-smelling stools
•nausea or vomiting
•pain in the abdomen
For children with celiac disease, being unable to absorb nutrients at a time when
they are so important to normal growth and development can lead to

•damage to the permanent teeth’s enamel

•delayed puberty
•failure to thrive, meaning that an infant or a child weighs less or is gaining less
weight than expected for his or her age
•mood changes or feeling annoyed or impatient
•slowed growth and short height
Some people with celiac disease have symptoms that affect other parts of the
body. These symptoms may include

•dermatitis herpetiformis
•fatigue, or feeling tired
•joint or bone pain
•mental health problems, such as depression or anxiety
•reproductive problems in women and girls which may include infertility
•delayed start of menstrual periods missed menstrual periods, or repeated
miscarriages and male infertility symptoms involving the mouth, such as canker
sores a dry mouth; or a red, smooth, shiny tongue
Most people with celiac disease have one or
more symptoms before they are diagnosed and
begin treatment. Symptoms typically improve
and may go away after a person begins eating a
gluten-free diet. Symptoms may return if a
person consumes small amounts of gluten.
 CAUSES
The exact cause of celiac disease is not known

Risk Factors
The list of risk factors mentioned for CeliacDisease in various sources
includes:
•Family history of celiac
•Family history of autoimmune diseases
•Italian race - celiac is common in Italy anddescendents.
 PHARMACOLOGIC INTERVENTION

Medications to control intestinal inflammation

If your small intestine is severely damaged or you have refractory celiac disease, your
doctor might recommend steroids to control inflammation. Steroids can ease severe
signs and symptoms of celiac disease while the intestine heals.

Other drugs, such as azathioprine (Azasan, Imuran) or budesonide (Entocort EC,

Uceris), might be used.
 DIAGNOSTIC LABORATORIES

Two blood tests can be performed to determine the presence

of celiac disease. It is recommended that gluten still be included
in the diet until the diagnosis is made. Removing gluten in the
diet can cause false negative results.
Serology testing- to identify the presence of antibodies
indicating autoimmune reaction to gluten.
Genetic testing – to test for human leukocyte antigen (HLA-
DQ2 and HLA-DQ8) which is helpful in ruling out celiac disease.
If blood tests suggest celiac disease, further diagnostic
procedures are then ordered.
Endoscopy – involves the insertion of a camera to the stomach
and intestines through the mouth. It allows the clinician to
visualize the internal structures. The clinician usually takes a
sample of the intestines to test for the damage to the villi.
Capsule endoscopy – a more sophisticated procedure than
traditional endoscopy; used to visualize the entirety of the
intestines. A capsule containing a camera takes pictures as it is
ingested.
 NURSING DIAGNOSIS

Here are the following nursing diagnoses that would be appropriate for Celiac
Disease:
 Risk for Imbalanced
 Nutrition: less than body requirements
 Risk for Fluid volume deficit
 Anxiety
 Risk for Infection
 Ineffective Coping
The nursing diagnosis that would be most applicable to Celiac Disease is Risk for Fl
Volume Deficit related to poor gastrointestinal absorption of nutrients related to
diarrhea.
 Nursing Intervention
1. Monitor dietary intake, fluid intake and output, weight, serum electrolytes, and hydration status.
2. Make sure that the diet is free from causative agent, but inclusive of essential nutrients, such as
protein, fats, vitamins, and minerals.
3. Maintain NPO status during initial treatment of celiac crisis or during diagnostic testing.
4 Provide parenteral nutrition as prescribed.
5. If patient is having persistent diarrhea, check for skin turgor and dry mucous membrane
6. Encourage small frequent meals, but do not force eating if the child has anorexia.
8. Assess for fever, cough, irritability, or other signs of infection.
9.Teach patient about Celiac Disease and the importance of maintaining a strict gluten free diet. 10.
Stress that the disorder is lifelong; however, changes in the mucosal lining of the intestine and in general
clinical conditions are reversible when dietary gluten is avoided.
CONSTIPATION
 CONSTIPATION
• Constipation is a condition in which you may have fewer
than three bowel movements a week; stools that are hard,
dry, or lumpy stools that are difficult or painful to pass
• A feeling that not all stool has passed
• Constipation most commonly occurs when waste or stool
moves too slowly through the digestive tract or cannot be
eliminated effectively from the rectum, which may cause
the stool to become hard and dry.
 CAUSES
• Physiological factors
• Low-fiber diet
• Inadequate fluid intake
• Decrease gastrointestinal
motility
• Inadequate oral hygiene
• Functional factors
• Insufficient activity;
immobility
• Ignoring the urge to
defecate
• Fear of pain with
defecation
• Abdominal muscle weakn
ess
• Environmental changes
• Lack of privacy
• Psychological factors
Stress
• Confusion
• Depression
• Anxiety
• Pharmacological factors
• Chronic use of laxatives
• Medication use
(e.g., anticholinergics,
opioids, bile acid
sequestrants)
• Mechanical factors
• Pregnancy
• Colon, anal, or rectal
stricture
• Diverticulosis
• Bowel tumors
• Hirschsprung’s disease
 SIGNS & SYMPTOMS
• fewer than three bowel movements a week stools that are hard, dry, or
lumpy stools that are difficult or painful to pass a feeling that not all stool has
passed
• Having lumpy, hard, dry stool that's difficult to pass
• Straining to pass stool
• Feeling like you still need to go after you have a bowel movement (like you
haven't fully emptied your bowels)
• Feeling like there's a blockage in the intestines or rectum Pain or bloating in
the abdomen
• Reduced appetite
• Sluggishness or lethargy
You should see a doctor right away if you have constipation
and any of the following symptoms

• bleeding from your rectum

• blood in your stool
• constant pain in your abdomen
• inability to pass gas
• vomiting
• fever
• lower back pain
• losing weight without trying
 POSSIBLE COMPLICATIONS
• Swollen, inflamed veins in your rectum (a condition called hemorrhoids).
• Tears in the lining of your anus from hardened stool trying to pass through
(called anal fissures).
• An infection in pouches that sometimes form off the colon wall from stool
that has become trapped and infected (a condition called diverticulitis)
• A pile-up of too much stool/poop in the rectum and anus (a condition
called fecal impaction).
• Damage to your pelvic floor muscles from straining to move your bowels.
These muscles help control your bladder. Too much straining for too long a
period of time may cause urine to leak from the bladder (a condition
called stress urinary incontinence).
 RISK FACTORS
Factors that may increase your risk of chronic constipation include:
• Being an older adult
• Being a woman
• Being dehydrated
• Eating a diet that's low in fiber
• Getting little or no physical activity
• Taking certain medications, including sedatives, opioid pain
medications, some antidepressants or medications to lower blood
pressure
• Having a mental health condition such as depression or an eating
disorder
 DIAGNOSTIC LABORATORIES

• LAB TESTS • OTHER BOWEL FUNCTION

• Blood Tests TESTS
• Stool Tests • defecography
• Urine Tests • anorectal manometry
• ENDOSCOPY • balloon expulsion test
• Colonoscopy
• Flexible Sigmoidoscopy
• COLORECTAL TRANSIT STUDIES
• Radiopaque markers
• Scintigraphy
 MEDICINES TO TREAT CONSTIPATION
• OVER-THE-COUNTER
TREATMENTS
• Fiber supplements
• Calcium polycarbophil
(FiberCon)
• Methylcellulose fibe
(Citrucel)
• Psyllium Konsyl (Metamucil)
• Wheat dextrin (Benefiber)
• OSMOTICS
• Magnesium citrate
• Magnesium hydroxide (Milk of
Magnesia
• Lactitol (Pizensy)
• Polyethylene glycol (Miralax)
• STIMULANTS
• Bisacodyl (Correctol &
Dulcolax)
• Sennocides ( Senexon &
Senokot)
• STOOL SOFTENERS • LUBRICANT LAXATIVES
• Docusate sodium • PRESCRIPTION DRUGS
(Colace) • Lactulose (Cephulac,
• SUPPOSITORIES Constulose, Duphalac,
• Glycerin Enulose, Kristalose)
• Bisacodyl • Linaclotide (Linzess)
• ENEMAS • Lubiprostone (Amitiza)
• Bisacodyl enemas • Plecanatide (Trulance)
• Mineral oil enemas
 POSSIBLE NURSING DIAGNOSIS
• Constipation
• Acute Pain
• Risk for Chronic Functional Constipation
• Risk for Dysfunctional Gastrointestinal Motility
• Deficient Knowledge
• Impaired Comfort
• Risk for Injury
• Risk for Deficient Fluid Volume
 NURSING INTERVENTIONS
The following are the therapeutic nursing interventions for constipation.

1. Encourage the patient to increase fluid intake of 1.5 to 2 L/day as

tolerated.

2. Advised patients to take the recommended dose of dietary fiber

of at least 20 to 30 g daily. Encourage intake of prune juice.

3. Assist the patient in doing physical

activity and exercise
4. Institute a toilet schedule or bowel training as appropriate.

5. Digitally eliminate fecal impaction.

6. Advise taking probiotics if indicated.

7. Educate about biofeedback therapy for constipation.

8. Provide warm Sitz baths as indicated

10. Unless contraindicated, encourage the patient to use the

bathroom. For bedridden patients, assist the patient in assuming a
high-Fowler’s position with knees flexed.
11. Close the bathroom door or pull curtains around the bed.

12. Perform digital anorectal stimulation for patients with

neurological problems.

13. Explain the use of pharmacological agents as ordered.

14. Refer the patient for surgery if indicated.

 DIVERTICULITIS
• GEONZON, GENIELOU
• GEONZON, PSALM HERALD
 WHAT IS DIVERTICULITIS?

• Diverticulosis occurs when small, bulging pouches

(diverticula) develop in your digestive tract. When
one or more of these pouches become inflamed or
infected, the condition is called diverticulitis.
Diverticula are small, bulging pouches that can
form in the lining of your digestive system.
• They are found most often in the lower part of the large
intestine (colon). Diverticula are common, especially
after age 40, and seldom cause problems.

• The presence of diverticula is known as diverticulosis

(die-vur-tik-yoo-LOE-sis). When one or more of the
pouches become inflamed, and in some cases infected,
that condition is known as diverticulitis (die-vur-tik-yoo-
LIE-tis). Diverticulitis can cause severe abdominal pain,
fever, nausea and a marked change in your bowel
habits
 MAIN CAUSE OF DIVERTICULITIS

• Diverticulitis is caused by an infection of one

or more of the diverticula. It is thought an
infection develops when a hard piece of stool
or undigested food gets trapped in one of the
pouches. This gives bacteria in the stool the
chance to multiply and spread, triggering an
infection.
 SIGN AND SYMPTOMS

Diverticulitis can cause symptoms ranging from mild to

severe. These symptoms can appear suddenly, or they can
develop gradually over several days.
 Potential symptoms of diverticular disease include Trusted
Source:
pain in your abdomen
bloating
diarrhea
constipation
If you develop diverticulitis, you might
experience:
constant of severe pain in your abdomen
nausea and vomiting
fever and chills
blood in your stool
bleeding from your rectum
Risk factors

• Aging. The incidence of diverticulitis increases with age.

• Obesity. Being seriously overweight increases your odds
of developing diverticulitis.
• Smoking. People who smoke cigarettes are more likely
than nonsmokers to experience diverticulitis.
• Lack of exercise. Vigorous exercise appears to lower
your risk of diverticulitis.
Diagnosis
• Diverticulitis is usually diagnosed during an acute attack.
Because abdominal pain can indicate a number of
problems, your doctor will need to rule out other causes
for your symptoms.
• Your doctor will start with a physical examination, which
will include checking your abdomen for tenderness.
Women generally have a pelvic examination as well to
rule out pelvic disease.
• Doctors often diagnose diverticulitis using a
computed tomography (CT) scan of your
abdomen and pelvis. It is best to perform the
scan with intravenous (IV) contrast when
possible. Many centers will also ask that you
drink a form of oral contrast. Both contrast
materials make the intestinal tract easier to see
Tests
• Blood and urine tests, to
check for signs of
infection.
• A pregnancy test for
women of childbearing
age, to rule out pregnancy
as a cause of abdominal
pain.
• A liver enzyme test, to rule
out liver-related causes of
abdominal pain.
• A stool test, to rule out
infection in people who
have diarrhea.
• A CT scan, which can
identify inflamed or
infected pouches and
confirm a diagnosis of
diverticulitis. CT can also
indicate the severity of
diverticulitis and guide
treatment.
How is diverticulitis diagnosed and evaluated?

• The signs of diverticulitis can resemble those of

colitis (larger segment of colon inflammation).
While appendicitis typically produces pain in the
lower right area of your abdomen, diverticulitis
typically causes discomfort in the lower left. Given
that there are several therapies for these illnesses,
a prompt and proper diagnosis is crucial. Your
condition could be determined by your doctor
using:
• Abdominal and Pelvic CT: A CT scan is the
best test to diagnose diverticulitis. It can also
help determine the severity of the condition and
guide treatment. You may receive
an intravenous (IV) injection of contrast
material. You may also drink an oral contrast
material one hour before your scan. Both
materials help the radiologist to better see your
intestines and abdominal organs.
• Colonoscopy: A small camera views the
colon's interior to see the inflamed, infected
pouches.
• Ultrasound-Pelvis: Ultrasound creates
pictures of the abdominal organs without
using ionizing radiation. However,
ultrasound images lack the detail of CT
images and cannot evaluate the intestines
as well as CT.
• X-ray - Lower GI tract: Your doctor may use x-
ray to assess for complications from diverticulitis.
• Blood and urine tests: Blood tests look for signs
of infection and/or inflammation. These signs
may include high white blood cell counts.
• Pregnancy test: If you are of childbearing age,
your doctor may ask you to take a pregnancy
test. This will help rule out pregnancy as a cause
of abdominal pain.
 BSN 3A

FECAL
INCONTINENCE
Dumaran, R.C
Cuevas, R.M
 BSN 3A

FECAL
INCONTINENCE
Dumaran, R.C
Cuevas, R.M
TOPIC OUTLINE:
Introduction Medical &
Pharmacological
Interventions
Signs &
Symptoms Nursing
Diagnosis
Clinical
Manifestations
Nursing
Diagnostic Interventions
Laboratories
WHAT IS FECAL
INCONTINENCE?
IN YOUR OWN IDEA? WHAT DO YOU
THINK IS FECAL INCONTINENCE ALL
ABOUT? WHAT IS ITS IMPORTANCE
AND WHAT IS THE IMPORTANCE OF
KNOWING SUCH IDEA?
FECAL INCONTINENCE
INTRODUCTION
INTRODUCTION
unintentional loss of solid or liquid stool

- this idea can also depict a flatus (also known as passing

gas), where others are confined to stool.
• Typically, it connotes that when you have this syndrome,
you are not able to control your bowel movements. For
older adults, this is more likely to happen in a sense that
irregular stool leaks while passing gas to a total loss of
control of your bowel.
RISK FACTORS

• AGE
• DIARRHEA
• CHRONIC ILLNESSES
• In women, OBSTETRIC INJURY.
 CAUSES:
• Diarrhea
• Impacted Stool
• Inflammatory Bowel Disease
฀ Crohn’s disease or ulcerative colitis
• Nerve Damages.
• Cognitive (thinking)
• Rectal Prolapse
• Hemorrhoids
• Muscle Damages
• Rectocele
• Loss of stretch of rectum
 SIGNS & SYMPTOMS

• Loose watery stool

• Uncontrolled urges to eliminate
• Constipation
• Bloating or gasses
CLINICAL MANIFESTATION

• Variation between the normal anal splinchter

muscle and severed anal sphincter muscle
• Presence of hemorrhoids
• Behavioral or psychiatric problems
 DIAGNOSTIC LABORATORIES
DEFECOGRAPHY —
functional imaging to the
work-up of fecal
incontinence.

(A) Anatomy before act of defecation; the bladder appears intense on these T2 images, as does the rectum,
which is filled with water-soluble contrast. (B) Internal intussusception as seen as a chevron sign (arrow)
observed during the act of defecation. MRI, magnetic resonance imaging
 ENDOANAL ULTRASOUND

• provides an objective
assessment of sphincter
integrity, and can readily
diagnose injuries or
(A) Proximal anal canal. (B) Mid-anal canal: (C) Distal anal canal:
anatomic deficiencies of the
internal and external anal
sphincters.
MEDICAL AND
PHARMACOLOGICAL
INTERVENTIONS
• Anti-diarrheal drugs
฀ loperamide,
diphenoxylene, and
atropine
• Methylcellulose and psyllium
• Dietary implications and
products to be given
 POSSIBLE NURSING DIAGNOSIS

• Bowel incontinence related to lack of voluntary sphincter control secondary

to cerebrovascular accident as evidence by patient unable to control passage
of stool.
NURSING INTERVENTION
• Encourage bowel elimination
• Provide a high-fiber diet
• Ensure fluid consumption
• Perform removal of fecal impaction manually, if
necessary
• Assist patient for mobility or exercise
• Health education
 SURGICAL OPTIONS

SPHINCTEROPLASTY ACE PROCEDURE

• Anal sphincter muscle is
• small tube is inserted which a
overlapped and stitches are
daily enema/washout is given
used to secure the muscle on
to clean out the stool.
both sides.

COLOSTOMY
• diverts stool through an opening in the abdomen.
 Gastritis is most often the
result of infection with the
same bacterium that
causes most stomach
ulcers or the regular use of
certain pain relievers.
 Gastritis may occur
suddenly or appear slowly
over time. In some cases,
gastritis can lead to ulcer
and an increased risk of
stomach cancer.
 SIGNS AND SYMTOMS OF GASTRITIS

Tummy pain
 Feeling full and bloated
 Burping and Farting
 Indigestion
 Feeling sick
 You feel full after a very small meal
 You’ve lost your appetite
 It feels like you have a lump in your tummy
 It’s painful or difficult to swallow
 You’ve recently lost weight without trying to
 Not feeling as hungry as usual
DIAGNOSTIC LABORATORIES OF GASTRITIS

UPPER GI ENDOSCOPY

 Upper GI endoscopy is a procedure in which a doctor uses an

endoscope a flexible tube with a camera to see the lining of your upper
GI tract, including your esophagus
BLOOD TEST

 May use blood tests to check for other causes

of gastritis or signs of complications.

STOOL TESTS

 May use stool tests to check pylori infection

and for blood in your stool, a sign of bleeding in
your stomach.
NURSING DIAGNOSIS
 Fluid and Electrolyte Imbalances
 Imbalanced Nutrition Less than Body
Requirements
 Impaired Sense of Comfort
 Activity Intolerance
 Knowledge deficit
NURSING INTERVENTION
• Monitor electrolytes closely.
• Assess for signs of dehydration and record I&O.
• Monitor and record the number of vomiting.
• Administer antiemetics as prescribed.
• Monitor the amount of food intake.
• Provide food in small portions but frequently.
• Assess the patients pain level using a pain
assessment tool.
NURSING INTERVENTION
• Teach pain management techniques.
• Encourage client to avoid consuming food and
beverage that contain caffeine.
• Teach the patient no to take additional
medication over the counter.
• Teach about appropriate eating interval and
types of food in case of flare-up.
PHARMACOLOGIC INTERVENTION
Antibiotic
 Clarithromycin (Biaxin XL)
 Amoxicillin (Amoxil, Augmentin, etc.)
 Metronidazole (Flagyl)
Proton Pump Inhibitor
 Omeprazole (Prilosec)
 Lansoprazole (Prevacid)
 Esomeprazole (Nexium)
PHARMACOLOGIC INTERVENTION
H2 Blockers
 Cimetidine (Tagamet)
 Famotidine (Pepcid)
 Nizatidine (Axid)
 Ranitidine (Zantac)
Antacid
 Pepto-Bismol (Bismuth subsalicylate)
THANK YOU.
GASTROINTESTINAL
(GI)
BLEEDING
PREPARED BY:
MAMALO JEHANA A.
MOHAMAD BAI SAMRAH B.
 Gastrointestinal (GI) bleeding is a symptom of a
disorder in your digestive tract. The blood often
appears in stool or vomit but isn't always visible,
though it may cause the stool to look black or
tarry. The level of bleeding can range from mild to
severe and can be life-threatening.
 SIGNS AND SYMPTOMS
 Abdominal cramping.
 Dark colored poop or regular
colored poop with blood in it.
 Pale appearance
 Shortness of breath (dyspnea)
 Tiredness
 Vomit with blood in it or a substance
that looks like coffee grounds.
 Weakness and fatigue
 DIAGNOSTIC LABORATORIES
Endoscopy and Colonoscopy are the most often used of
doctors.
 An “upper GI test” examines your esophagus, stomach, and the
first part of your small intestine (duodenum).
A “lower GI test” examines the lower part of your small intestine
(ileum) and your large intestine, including your colon and
rectum.
 Your doctor will take a medical history, including a
history of previous bleeding, conduct a physical
exam and possibly order tests. Tests might include:
 COMPLETE BLOOD COUNT
=To test how fast your blood clots,
a platelet count and liver
function tests.

 STOOL TESTS.
=Analyzing your stool can help
determine the cause of
occult bleeding.
 NASOGASTRIC LAVAGE.
= A tube is passed through your nose into your
stomach to remove your stomach contents. This
might help determine the source of your bleed.
 UPPER ENDOSCOPY.
= This procedure uses a tiny camera on the end of a
long tube, which is passed through your mouth to
enable your doctor to examine your upper
gastrointestinal tract.
 COLONOSCOPY.
= This procedure uses a tiny camera on the end
of a long tube, which is passed through your
rectum to enable your doctor to examine your
large intestine and rectum.
 CAPSULE ENDOSCOPY.
=In this procedure, you swallow a vitamin-size capsule
with a tiny camera inside. The capsule travels through
your digestive tract taking thousands of pictures that
are sent to a recorder you wear on a belt around your
waist. This enables your doctor to see inside your
small intestine.
 BALLOON-ASSISTED ENTEROSCOPY.
=A specialized scope inspects parts of your
small intestine that other tests using an
endoscope can't reach. Sometimes, the
source of bleeding can be controlled or
treated during this test.
 ANGIOGRAPHY.
=A contrast dye is injected into an artery,
and a series of X-rays are taken to look
for and treat bleeding vessels or other
abnormalities.
 IMAGING TESTS.
=A variety of other imaging tests, such
as an abdominal CT scan, might be
used to find the source of the bleed.
 CAUSES
 Peptic ulcer- This is the most common cause of
upper GI bleeding. Peptic ulcers are sores that
develop on the lining of the stomach and upper
portion of the small intestine. Stomach acid, either
from bacteria or use of anti-inflammatory drugs,
damages the lining, leading to formation of sores.
 Mallory-Weiss tears- Tears in the lining of the
tube that connects your throat to your stomach
(esophagus). They can cause a lot of bleeding.
 These are most common in
people who drink alcohol to
excess.

 Esophageal varices-
Abnormal enlargement of veins
in the esophagus.
 This condition occurs
most often in people
with serious liver disease.
 Inflammatory bowel disease (IBD).
Also known as crohn’s disease.
a chronic inflammation of the
gastrointestinal tract that prolonged
inflammation result damage to the GI tract.

 Colon polyps- Small clumps of cells that

form on the lining of your colon can cause bleeding.
-Most are harmless, but some might be cancerous or can
become cancerous if not removed.
 Hemorrhoids. These are swollen veins in
your anus or lower rectum, similar to
varicose veins.
 INTERVENTION
 If you have an upper GI bleed, you might be given an IV
drug known as a proton pump inhibitor (PPI) to suppress
stomach acid production.
 Administer fluids, blood,
and electrolytes as
prescribed.

 The goal of fluid resuscitation is to improve tissue

perfusion and to make up for blood and fluid loss and to
keep GI circulation and cellular function intact, IV fluids,
blood products, and electrolytes are often required.
 COMPLICATION
A gastrointestinal bleed can cause:
 Shock
 Anemia
 Death
PREVENTION
To help prevent a GI bleed:
 Limit your use of nonsteroidal anti-inflammatory
drugs.
 Limit your use of alcohol.
 If you smoke, quit.
HEMORRHOIDS
PRESENTED BY: JEA JANNEL V. BULAD-ON
& CHARINA JAIRA CORTADO
HEMORRHOIDS
Hemorrhoids are

Jens Martensson
painful, swollen veins
in the lower portion
of the rectum or
anus.
2
 PATHOPHYSIOLOGY
Hemorrhoid cushions are a part
of normal human anatomy and There are three cushions
only become a pathological present in the normal anal

Jens Martensson
disease when they experience canal.
abnormal changes.

They are important for

continence, contributing to at
rest 15-20% of anal closure
pressure and act to protect
the anal sphincter muscles
during the passage of stool.
3
 Types Of Hemorrhoids
Internal hemorrhoids External hemorrhoids
• Occur just inside the anus, at the • Occur at the anal opening and
beginning of the rectum may hang outside the anus

Jens Martensson
4
 CAUSES
Hemorrhoids may be cause by:
• Straining during bowel
movements
• Constipation

Jens Martensson
• Sitting for long periods of time
• Anal infections
• Pregnancy
• Certain diseases such as liver
cirrhosis
• Obesity
• Genetics
• Low fiber diet
5
 SIGNS AND SYMPTOMS

Jens Martensson
One or more
hard tender
Anal Itching Rectal Pain Bleeding
lumps near
the anus

6
Diagnostic Test
• Visual examination

Growth

Jens Martensson
• Anoscopy

Shows
• Endoscopic image

Sales
• Sigmoidoscopy

7
Treatment
Conservative Fixative Procedures Hemorrhoidectomy
Treatment
• Increase Dietary • The goal of • Surgical removal of

Growth

Jens Martensson
Fiber nonsurgical hemorrhoid is
• Oral Fluids procedures used to called
• NSAID( Ibuprofen treat hemorrhoids hemorrhoidectomy
(Motrin) & is called fixative

Shows
Naproxen (Aleve) procedures. It
include tying off the
• Sitz Bath hemorrhoids
• Rest • with a rubber band
• Steriods Ointments

Sales
• Using Heat
or Creams
• Lasers
• Electric Current

8
PREVENTION
Drink plenty of water, at least eight glasses. per day

Jens Martensson
Eat high fiber diet of fruits, vegetables, and whole grains

Empty bowels as soon as possible after the urge occurs

Regular exercise

9
Nursing Diagnosis for Hemorrhoids
• Pain (acute or chronic) related to rectal swelling

Jens Martensson
• Constipation related to ignore the urge to defecate
due to pain during defecation

• Anxiety related to plan surgery

10
• Impaired Urinary Elimination related to the fear of
postoperative pain.

• Risk for infection related to inadequate primary

Jens Martensson
defenses.

• Deficient knowledge related to the lack of

information about home care.
11
Nursing Intervention for Hemorrhoids
• As needed, provide warm sitz baths to reduce local pain
and swelling

Jens Martensson
• Check for signs and symptoms of anal infection, such as
increases pain and foul smelling anal drainage.

• Teach the patient about hemorrhoidal development,

predisposing factors, and tests. 12
• Emphasize the need for good anal hygiene.

• Encourage the use of toilet paper without dyes or perfumes.

• Provide the patient with high fiber diet and encourage adequate

Jens Martensson
fluid intake and exercise to prevent constipation.

• Prepare the patient for surgery if necessary

• Monitor the patient's pain level and the effectiveness of the

prescribed medications. 13
 Medical Management
• High-fiber diet to keep stools soft.

Jens Martensson
• Warm sitz baths to ease pain and
combat swelling.
• Reduction of prolapsed external
hemorrhoid manually
14
 Pharmacologic Intervention
• Stool softeners to keep stools soft and relieve
symptoms.

Jens Martensson
• Topical creams, suppositories or other preparation
such as Anusol, Preparation H, and witch-hazel
compresses to reduce itching and provide comfort.
• Oral analgesics may be needed.duction of prolapsed
external hemorrhoid manually
15
Thank
You
 BSN3-A

HIATAL HERNIA
PREPARED BY:
SITTIE NORHAIDA E. IPON
BAILYN KOLINSO
A hiatal hernia occurs when the upper part of your stomach bulges
through the large muscle separating your abdomen and chest
(diaphragm).Your diaphragm has a small opening (hiatus)
through which your food tube (esophagus) passes before
connecting to your stomach. In a hiatal hernia, the stomach
pushes up through that opening and into your chest.A small
hiatal hernia usually doesn't cause problems. You may never
know you have one unless your doctor discovers it when
checking for another condition.But a large hiatal hernia can allow
food and acid to back up into your esophagus, leading to
heartburn. Self-care measures or medications can usually relieve
these symptoms. A very large hiatal hernia might require surgery

 There are two main types of of hiatal hernias:

1. Sliding
2. Paraesophageal
a condition in which the upper part of the
stomach or other internal organ bulges
through the hiatus of the diaphragm. When
there is laxity in this hiatus, gastric content
can back up into the esophagus and is the
leading cause of gastroesophageal reflux
disease (GERD).
 Heartburn.
 Regurgitation of food or liquids into the
mouth.
 Backflow of stomach acid into the esophagus
(acid reflux)
 Difficulty swallowing.
 Chest or abdominal pain.
 Feeling full soon after you eat.
 Shortness of breath.
 Vomiting of blood or passing of black stools,
which may indicate gastrointestinal bleeding.
 Hiatal hernias are most common in people
who are:
 Age 50 or older
 Obese
 EndoscopyOpen pop-up dialog box
 A hiatal hernia is often discovered during a test
or procedure to determine the cause of heartburn
or chest or upper abdominal pain. These tests or
procedures include:
 X-ray of your upper digestive system. X-rays are
taken after you drink a chalky liquid that coats
and fills the inside lining of your digestive tract.
The coating allows your doctor to see a
silhouette of your esophagus, stomach and upper
intestine.
 us.
 Upper endoscopy. Your doctor inserts a thin,
flexible tube equipped with a light and
camera (endoscope) down your throat, to
examine the inside of your esophagus and
stomach and check for inflammation.
 Esophageal manometry. This test measures
the rhythmic muscle contractions in your
esophagus when you swallow. Esophageal
manometry also measures the coordination
and force exerted by the muscles of your
esophag
 The exact cause of hiatal hernia is not
known. The condition may be due to
weakness of the supporting tissue. Your risk
for the problem goes up with age, obesity,
and smoking. Hiatal hernias are very
common. The problem occurs often in people
over 50 years.
 This condition may be linked
to reflux (backflow) of gastric acid from the
stomach into the esophagus.

 Children with this condition are most often

born with it (congenital). It often occurs
with gastroesophageal reflux in infants.
 Most people with a hiatal hernia don't
experience any signs or symptoms and won't
need treatment. If you experience signs and
symptoms, such as recurrent heartburn and
acid reflux, you may need medication or
surgery.
 ACUTE PAIN
Related Factors
 Chemical burn of gastric mucosa or oral cavity
 Physical response, such as reflex muscle spasm
in the stomach wall
Evidenced by
 Verbalizations of pain
 Abdominal guarding
 Rigid body posture
 Facial grimacing
 Autonomic responses, such as changes in vitals
signs in reaction to acute pain
 Desired Outcomes
 The client will verbalize relief of pain.
 The client will demonstrate a relaxed body
posture and be able to sleep or rest
appropriately.
Assessment
Assess reports of pain, including
location, duration, and intensity.
Note nonverbal pain cues such as
restlessness, reluctance to move,
abdominal guarding, tachycardia,
and diaphoresis.
Identify factors that aggravate or
alleviate the pain.
Rationale
Pain is not always present, but if
present, should be compared with
the client’s previous pain
symptoms. This comparison may
assist in the etiology and
development of complications.
Nonverbal cues may be both
physiological and psychological
and may be used in conjunction
with verbal cues to evaluate the
extent and severity of the problem.
This may be helpful in establishing
diagnosis and treatment needs.
Independent
Provide small, frequent
meals, as indicated for the
individual client.
Identify and limit foods that
create discomfort.
Assist the client with active
and passive range-of-
motion exercises.
Elevate the head of the bed
after meals and avoid eating
3 hours before bedtime.
Provide frequent oral care
and comfort measures
including back rubs and
position changes.
Food has an acid-
neutralizing effect ad dilutes
the gastric contents. Small
meals prevent distention and
the release of gastrin.
Specific foods that cause
distress vary among
individuals. Spicy foods,
alcohol, and coffee can
precipitate dyspepsia..
This reduces joint stiffness,
minimizing pain and
discomfort.
Wait 3 hours after a meal
before lying down and
elevate the head of the bed
by 8 inches to avoid
regurgitation of ingested
food.
Halitosis from stagnant oral
secretions is unappetizing
and can aggravate nausea.
Dependent/Collaborative
Provide and implement prescribed
dietary modifications.
Use regular rather than skim milk, if Fat in regular milk may decrease
milk is allowed.
Administer analgesics as prescribed.
Administer antacids as indicated.
Administer proton pump inhibitors
(PPIs) as prescribed.
Assist in surgical management as
indicated.
The client may receive nothing by
mouth initially. When oral intake is
allowed, food choices depend on the
diagnosis and etiology of the
ulceration.
gastric secretions
Analgesics relieve acute or severe
pain.
Antacids decrease gastric acidity by
absorption or by chemical
neutralization
PPIs are the most powerful
medications available for treating
GERD.
Surgery is only necessary in the
minority o clients with complications
of GERD despite aggressive
treatment with PPIs.
 Medications that block acid production and
heal the esophagus. These medications —
known as proton pump inhibitors — are
stronger acid blockers than H-2-receptor
blockers and allow time for damaged
esophageal tissue to heal.
Drug name Drug OTC Administratio Standar Side
class or Rx n route d dose Effect
Maalox (aluminum Oral liquid 10-20 ml Headache,
hydroxide) Antacid OTC up to 4 nausea,
times a diarrhea,
day constipation
Tums (calcium Antacid OTC Oral tablet 2-4 Dry mouth,
carbonate) tablets as gas, bloating
needed belching,
(not to constipation
exceed 15
tablets in a
24 hr
period)
Pepcid H2 OTC Oral tablet Once or Headache,
(famotidine) Antagonist twice a day nausea,
prior to vomiting,
eating diarrhea
Nexium Proton pump OTCx Oral capsule 20-40 mg Diarrhea,
(esomeprazole inhibitor once daily nausea,
vomiting
Prilosec Proton pump OTC or Oral capsule 20 mg Rash,
(omeprazole) inhibitor Rx once daily itching, joint
pain,
THANK YOU !!!
INSTRUCTOR:
Mr. Sheikh Ortuoste
 INFLAMMATORY BOWEL DISEASE
(ULCERATIVE COLITIS)

ESPINA, ANGELINE
F O R M E N T E R A , C H A R M E N D.
ULCERATIVE COLITIS
• Is a medical condition that involves the inflammation and ulcer formation in the lining of the
colon (large intestine) and rectum.
• A type of inflammatory bowel disease (IBD) that can have progressive symptoms over time and
could be both debilitating and life-threatening if left uncontrolled.
• There is no cure for ulcerative colitis yet, the treatment is aimed at the reduction of signs and
symptoms of this condition, and the prevention of complications.
TYPES OF ULCERATIVE COLITIS
1. PANCOLITIS – affecting the entire colon and includes severe bloody diarrhea and significant
weight loss
2. LEFT-SIDED COLITIS – inflammation extending from the rectum to the sigmoid and
descending colon; includes pain on the left abdominal area
3. PROCTOSIGMOIDITIS – inflammation involving the sigmoid colon and rectum
4. ULCERATIVE PROCTITIS – inflammation that is on the anus and not extending to the rest of
the colon; includes rectal bleeding as the main symptom
 SIGNS AND SYMPTOMS
1. Diarrhea that could have blood or pus
2. Abdominal pain and cramping
3. Rectal bleeding and/or rectal pain
4. Tenesmus- increased urgency to defecate but inability to move bowels; accompanied by cramping
rectal pain
5. Inability to defecate despite urgency
6. Weight loss
7. Fatigue
8. Fever
CAUSES
• The exact cause of ulcerative colitis remains unknown. Previously, diet and stress were
suspected. However, researchers now know that these factors may aggravate but don't cause
ulcerative colitis.
• One possible cause is an immune system malfunction. When your immune system tries to fight
off an invading virus or bacterium, an irregular immune response causes the immune system to
attack the cells in the digestive tract, too.
• Heredity also seems to play a role in that ulcerative colitis is more common in people who have
family members with the disease. However, most people with ulcerative colitis don't have this
family history.
RISK FACTORS
Ulcerative colitis affects about the same number of women and men. Risk factors may include:
Age. Ulcerative colitis usually begins before the age of 30, but it can occur at any age. Some
people may not develop the disease until after age 60.
Race or ethnicity. Although white people have the highest risk of the disease, it can occur in any
race. If you're of Ashkenazi Jewish descent, your risk is even higher.
Family history. You're at higher risk if you have a close relative, such as a parent, sibling or child,
with the disease.
COMPLICATIONS
Possible complications of ulcerative colitis include:
• Severe bleeding
• Severe dehydration
• A rapidly swelling colon, also called a toxic megacolon
• A hole in the colon, also called a perforated colon
• Increased risk of blood clots in veins and arteries
• Inflammation of the skin, joints and eyes
• An increased risk of colon cancer
• Bone loss, also called osteoporosis
DIAGNOSTIC LABORATORIES

Blood test- It may Stool studies- stool Endoscopy- examine

suggest to check for sample can help rule out inside the colon and
Anemia other disorder such as rectum with a lighted
- To check for signs of infection caused by tube inserted.
infection inflammation bacteria, viruses ad
parasites
 DIAGNOSTIC LABORATORIES

X-ray- for severe Chromoendoscopy- a CT Scan- scan of the

symptoms, may use x-ray technique used during abdomen or pelvis .
of your abdominal area colonoscopy to look for It is also reveal how
polyps or precancerous much the colon is
inflamed
DIAGNOSTIC LABORATORIES
Computerized tomography (CT)
enterography and magnetic
resonance (MR) enterography-
These types of noninvasive tests
may be recommended to exclude
any inflammation in the small
intestine.
Colonoscopy- This exam allows
your provider to view your entire
colon using a thin, flexible, lighted
tube with a camera on the end.
Flexible sigmoidoscopy- uses a
slender, flexible, lighted tube to
examine the rectum and sigmoid
colon — the lower end of your
colon. If your colon is severely
inflamed, this test may be
preferred instead of a full
colonoscopy
MEDICAL AND PHARMACOLOGICAL INTERVENTIONS
Ulcerative colitis treatment usually involves either medication therapy or surgery.
Anti-inflammatory medications:

• 5-aminosalicylates
• Corticosteroids
Immune system suppressors:

• Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan)

• Cyclosporine (Gengraf, Neoral, Sandimmune)
• "Small molecule" medications
Biologics:
•Infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi)
•Vedolizumab (Entyvio)
• Ustekinumab (Stelara)
Other medications:
• Anti-diarrheal medications
• Pain relievers
• Antispasmodics
• Iron supplements
Surgery:
• Proctocolectomy
• Ileoanal anastomosis
Cancer surveillance
Diet:
• Limit dairy products.
•Eat small meals
•Drink plenty of liquids
•Talk to a dietitian
Stress:
• Exercise
• Biofeedback
• Regular relaxation and breathing exercises
 POSSIBLE NURSING DIAGNOSIS AND NURSING
INTERVENTIONS
NURSING DIAGNOSIS NURSING INTERVENTIONS
Nursing Diagnosis: • Commence a stool chart. Use a standardized stool
• Acute pain assessment tool such as Bristol stool chart.
• Ineffective Coping • Administer medications for ulcerative colitis as
• Deficient Knowledge prescribed
• Risk for Deficient Fluid Volume • Encourage to increase oral fluid intake as tolerated,
• Anxiety ideally at least 2L per day. Avoid cold drinks. Check if
the patient is in any fluid restriction before doing so.
• Diarrhea related to inflammation of bowel as • Help the patient to select appropriate dietary choices
evidenced by loose, watery stools, abdominal to reduce the intake of milk products, caffeinated
cramping and pain, increased urgency to defecate, drinks, alcohol and avoid high fiber, high fat foods.
tenesmus and increased bowel sounds • Start the patient on a nothing by mouth status and
gradually progress to clear liquids, followed by bland
diet and the low residue diet. The patient can then
have a low fat/residue, low fiber diet on a long-term
basis, as a recommended by the dietitian
 NURSING DIAGNOSIS
• Imbalanced Nutrition : Less than Body
Requirements related to altered absorption
of nutrients secondary to Ulcerative colitis,
as evidenced by diarrhea, abdominal pain
and cramping
NURSING INTERVENTIONS
• Explore the patient’s daily nutritional intake and
food habits (e.g. mealtime, duration of each
meal session, snacking, etc.)
• Create a daily weight chart and a flood and fluid
chart. Discuss with the patient the short term
and long term nutrition and weight goals related
to ulcerative colitis.
• Help the patient to select appropriate dietary
choices to reduce the intake of milk products,
caffeinated drinks, alcohol and high fiber, high
foods.
• Refer the patient to the dietitian
• Start the patient on a nothing by mouth status,
and gradually progress to clear liquids, followed
by bland diet and the low residue diet. The
patient can then have a low fat, low fiber diet on
a long-term basis.
IRRITABLE BOWEL
SYNDROME

GONZALES, CHARLES
GRINO, NIRIE JOY
 IRRITABLE BOWEL SYNDROME (IBS)

• Is a common, long term condition of the digestive

system.
• A common disorder that affects the stomach and
intestines, also called the gastrointestinal tract. It is
also known as spastic colon or irritable colon.
• Affects all ages, females diagnosed two to three
times often than males.
 TYPES OF IBS

• IBS with constipation (IBS-C): Most of your poop is

hard and lumpy.
• IBS with diarrhea (IBS-D): Most of your poop is loose
and watery.
• IBS with mixed bowel habits (IBS-M): You have both
hard and lumpy bowel movements and loose and watery
movements on the same day.
 Diagnosis of IBS
• Medical History
• Physical Exam
• Poops examine
• Computerized tomography (CT) scan- CT scan produce cross-
sectional X-ray images of internal organ.
• Colonoscopy- in some cases, your doctor may perform this
diagnostic test, in which a small, flexible tube is used to examine
the entire length of the colon.
 Signs/Symtoms of IBS

• Symptoms of IBS vary but are usually present

for a long time. The most common include:
• Abdominal pain, usually in the lower half of
the abdomen.
• Stomach Cramps
• bloating
• Changes in appearance of bowel movement.
• Pain, distension or abdominal discomfort.
• Diarrhea or constipation, or both
• Changes in how often you are having a bowel
movement.
• Excess gas
• Mucus in your poop (may look whitish)
 Causes of IBS
• Abnormal gastrointestinal (GI) tract movements.
• A change in the nervous system communication between the
GI and brain.
• Sensory and motor disorder of the colon.
• Dietary allergies or food sensitivities.
• Neurotransmitter imbalance (decreased serotonin levels).
• Stress.
 Treatment of IBS
• Treatment involves a mix of drug, diet, and psychosocial
intervention.
• Avoid food that trigger symptoms
• Change in what you eat and other lifestyle changes, medicines,
probiotics, and mental health therapies.
• Nonpharmacologic: fiber supplementation, regular exercise, low-
FODMAP diet and behavioral therapy.
• Pharmacologic- polyethylene (IBS-C), alosetron (women, IBS-C &
IBS-M), Rifaximin (IBS-D).
• Probiotics may be an option for you.
• Dietary changes:
• Increase fiber in your diet — eat more fruits, vegetables,
grains and nuts.
• Add supplemental fiber to your diet, such as Metamucil or
Citrucel
• Drink plenty of water.
• Avoid caffeine (from coffee, chocolate, teas and sodas).
• Limit cheese and milk.
 Supporting diagnostic features in IBS

• Symptoms > 6 months

• Frequents consultation for non-GI problem.
• Previous medically unexplained symptoms
• Stress worsen symptoms
 Alarm features in IBS

• Age > 50 years, female gender

• Unexplained Weight loss
• Nocturnal symptoms
• Family history of colon cancer
• Anemia
• Rectal bleeding.
 Nursing management
• Reassurance and psychological support
• Dietary advice- patients should avoid dairy products, foods,
beverages, or medications containing fructose or sorbital.
• High fibre diets- high fibre food are needed to relieve
consipations
• Assess the bowel pattern including frequency and
consistency of stool.
• Assess the patients activity level.
• Administer drug as ordered & check for side effects.
 Nursing diagnosis

• Constipation
• Diarrhea related to food intolerance
• Readiness for enhanced self-health management.
• Pain related to abdominal distention.
• Disturbed body image related to bowel incontinence.
THANK YOU!
Gastroesophageal
Reflux Disease
ALAY-AY, JANICE T.
ALCID, MELOREN L.
Definition
 American College of Gastroenterology (ACG )
 - Symptoms or mocusal damage produced by the abnormal reflux
of gastric contents into the esophagus.
Epidemiology

 About44% of the US adult population

have heartburn atleast once a month.
 14% of Americans have symptoms weekly.
 7% have symptoms symptoms daily.
Clinical Manifestations
 Most common symptoms
 - Heartburn
 - Regurgitation
 - Dysphagia
 Other symptoms include:
 - Chest pain, water brash, globus sensation, odynophagia, nausea
 Extraesophageal manifestation
 - Asthma, laryngitis,chronic cough
 Diagnostic Evaluation
 If classic symptoms of heartburn and regurgitation exist in the
absence of “alarm symptoms” the diagnosis of GERD can be made
clinically and treatment can be initiated.

 Alarms signs/symptoms
 Dysphagia
 Early satiety
 GI bleeding
 Odynophagia
 Vomiting
 Weight loss
 Iron deficiency anemia
Etiology of GERD
 Aggravating Foods
 Chocolate
 Medical Conditions
 Caffeine
 Obesity
 Cola
 Pregnancy
 Citrus juices

 Personal Habits
 Alcohol use  Mint

 Smoking  Milk

 Spicy foods
 Fatty foods
Pathophysiology

 GERD occurs when the LES does not close properly, and stomach
content reflux into the esophagus.
 The LES acts as a physical barrier between the esophagus and
stomach.
 When refluxed stomach acid touches the lining of the esophagus, it
causes a burning sensation in the chest or throat called heartburn.
 Ocassional heartburn is common normally. Heartburn that occurs
more than twice a week may be considered GERD.
Trial of Medications

 H2RA or PPI
 Expext response in 2-4weeks
 If no response
-Change from H2RA to PPI
-Maximize dose of PPI
 If PPI response inadequate despite maximal dosage
Confirm diagnosis
-EGD
- 24 hour pH monitoring
Esophagogastrodudenoscopy
 Endoscopy (with biopsy of needed)
 Lacks sensitivity for identifying pathologic reflux
 Absence of endos copic features does not exclude a GERD
diagnosis
 Allows for detection, stratification and management of esophageal
and manifestation or complications of GERD.
Ambulatory pH Testing
 24 hour pH monitoring
 Accepted standard for establishing or excluding presence of GERD
for those patients who do not have mucosal changes.
 Trans-nasal catheter or a wireless, capsule shaped device.
Treatment

 Lifestyle changes

 Medications

 Fundoplication – this is where the

fundus of the stomach is placed
around the lower part of
esophagus.
Medications
 Antacids
 Neutralizes acid
 Provides rapid but temporary relief
 Use on an as needed basis
 Magnesium Hydroxide or Calcium Carbonate

 Histamine H2-Receptor Antagonist

 Blocks the histamine receptors in gastric parietal cells, thereby
preventing acid secretion.
 Provide symptomatic relief
 May require lifelong therapy
1. Ranitidine (Zantac)
2. Famotidine(Pepcid)
 Proton Pump Inhibitor
 If symptoms do not respond to H2-Receptor antagonist, change to a
once-per-day PPI.
 Blocks gastric acid secretion.
1. Omeprazole (Prilosec)
2. Pantoprazole (Protonix)

 H2RAs vs PPIs
 12 weeks freedom from symptom
48% vs 77%
 12 weeks healing rate
52% vs 84%
 Speed of healing
6%/wk vs 12%/wk
 Prokinetics
 Prevents delayed gastric emptying by improving LES pressure and
improve peristalsis
 The most widely studied agents include:
1. Bethanechol
2. Metoclopramide
Nursing Diagnosis

 Imbalanced nutrition: less than body requirements related to

inability to intake enough food because of reflux.
 Acute pain related to irritated esophageal mucosa.
 Imbalanced nutrition: more than body requirements related to
eating to try to assuage pain.
 Risk for aspiration related to esophageal compromise affecting the
lower esophageal sphincter.
 Deficient knowledge related to lack of information regarding
condition/disease process.
 Anxiety related to change in the health status of the infant (possible
surgical intervention).
 Risk for injury related to abnormal blood profile.
Nursing Interventions
 Offer emotional and psychological support to help the patient cope
with pain and discomfort.
 In consultation with a dietitian, develop a diet that takes the
patient’s food preferences into account but at the same time helps
to minimize his reflux symptoms.
- If the patient is obese, place him on a weight reduction diet as
ordered.
 To reduce intra-abdominal pressure have the patient sleep in a
reverse trendelenburg position.
- Head of the bed elevated 6 to 12 inches or 15 to 30 cm.
- Avoid lying down for three hours after meals and eating late night
snacks.
 After surgery provide post laparotomy care.
 Pay particular attention to the patient’s respiratory status because
the surgical procedure is performed close to the diaphragm.
 Administer prescribed analgesics, oxygen, and IV fluids.
 Monitor intake and output.
 Check vital signs.
 If surgery was performed using a thoracic approach, watch and
record chest tube drainage.
 If needed, provide chest physiotherapy.
COLOSTOMY AND
ILEOSTOMY

PREPARED BY: LUMAYON BAI & MACOL SAFFRA

COLOSTOMY
• An opening in the large intestine or
a surgical that brings one end of
the large intestine out through an
opening (stoma) made in the
abdominal wall

•Stools moving through the

intestine drain through the stoma
into a bag attached to the skin of Colostomy bag is
where the feces will
the abdomen collect while you
have your colostomy
•COLOSTOMY IRRIGATION
- A way to remove stool without
wearing a colostomy bag all the
time .
 Why a Colostomy is performed
• Colostomies performed due to
problems with the lower bowel and
create a new pathways for stools to
pass

The conditions that can require a colostmy include certain illness, injuries or
other problems with your digestive tract, including:

• Crohn’s diseases
•Diverticulitis
•An injury to the colon or rectum
•Intestinal obstruction, which is a blockage in the large bowel
• colon cancer
• Hischsprung’s disease
 Crohn’s diseases

Hischsprung’s disease
COLOSTOMY DIET
• a short-term you follow during the days and week after
colostomy surgery.

LOW RESIDUE DIET – leaves minimal material in your gut after

nutrient absorption.

FOODS TO EAT FOOD TO LIMIT

 Cooked, peeled, and seedles  Raw vegetables
vegetable  Raw fruits with skin
 Lean proteins  Nuts
 Refined grains  Seeds
 Low fat dairy  High fat dairy
 Fried food
TYPES
Temporary colostomy
gives part of the bowel Transverse colostomy
time to heal by redirecting - done in the upper abdomen
where stools go - allows the stool to leave
the body before it reaches the
decending colon, and is
 Permanent colostomy
typically temporary, allowing
- when part of the rectum
parts of the colon to heal
becomes diseased such as
with cancer – a permanent
colostomy is done.
Transverse colostomy
• Transverse colostomies are some of the more common
colostomies, and are divided into two part:

 Loop Transverse colostomy  Double-barrel transverse

- Creates two opening in the
abdomen: one opening is for stool,
the other is only for mucos, which is
normal by-product of defecation.
colostomy
- involves dividing the bowel into
two complete parts. Each part has
its own opening or stoma in the
abdomen. Just like with a loop
transverse
Ascending Colostomy
• Only a small portion of the colon stays active,
and the colostomy itself is placed on the right
side of the abdomen
• A drainable pouch has to be worn at all times.

Descending and sigmoid

Colostomy
•Descending Colostomy is placed in the
descending colon, on the lower left side of the
abdomen. Typically, the output can be controlled,
and is firmer
•Sigmoid Colostomy is done on the sigmoid
colon, and is a few inches lower than a
descending colostomy. Allows for a larger part of
the colon to still do its job, so the stool output is
usually more solid and happens on a regular basis
RISK OF COLOSTOMY
NEEDS FOR THE COLOSTOMY CARE:
NURSING DIAGNOSIS
• Comfort alteration in the abdominal pain related to
abdominal incision.
• Impaired skin integrity related to presence of stoma.
• Body image disturbance related to presence of stoma.
• Knowledge deficit related to stoma care and lack of
experience

NURSING MANAGEMENT
• Dress child with loose fitting clothe that does not press on the
colostomy.
• Inform the doctor if there any bleeding from the stoma or the skin
around it.
• Observe any change in the bowel pattern or size of the stoma.
• Check child temperature and report in case of fever
Ileostomy bag collect
poop discharged through
the stoma.
MEDICAL AND PHARMACOLOGICAL
INTERVENTION
• High stoma output is a common problem in
patients with ileostomy and can lead to
dehydration and electrolyte disturbances. The
first drug of choice to reduce stoma output is
often loperamide.
NURSING INTERVENTION
• Nursing intervention of Ileostomy
• 1. Clean and keep dry.
• Keep the area surrounding the stoma free from stool.
• 2. Apply a protective paste.
• Pastes and powders can be used that assist the adhesive
in fitting better to the skin, preventing leakage.
• 3. Measure the wafer.
• The wafer, or skin barrier, attaches the pouch to the skin.
• 4. Provide education on the pouch system.
• Ensure the patient understands that frequent changing
of the pouch is irritating to the skin.
HEMORRHOIDS
PRESENTED BY: JEA JANNEL V. BULAD-ON
& CHARINA JAIRA CORTADO
HEMORRHOIDS
Hemorrhoids are

Jens Martensson
painful, swollen veins
in the lower portion
of the rectum or
anus.
2
 PATHOPHYSIOLOGY
Hemorrhoid cushions are a part
of normal human anatomy and There are three cushions
only become a pathological present in the normal anal

Jens Martensson
disease when they experience canal.
abnormal changes.

They are important for

continence, contributing to at
rest 15-20% of anal closure
pressure and act to protect
the anal sphincter muscles
during the passage of stool.
3
 Types Of Hemorrhoids
Internal hemorrhoids External hemorrhoids
• Occur just inside the anus, at the • Occur at the anal opening and
beginning of the rectum may hang outside the anus

Jens Martensson
4
 CAUSES
Hemorrhoids may be cause by:
• Straining during bowel
movements
• Constipation

Jens Martensson
• Sitting for long periods of time
• Anal infections
• Pregnancy
• Certain diseases such as liver
cirrhosis
• Obesity
• Genetics
• Low fiber diet
5
 SIGNS AND SYMPTOMS

Jens Martensson
One or more
hard tender
Anal Itching Rectal Pain Bleeding
lumps near
the anus

6
Diagnostic Test
• Visual examination

Growth

Jens Martensson
• Anoscopy

Shows
• Endoscopic image

Sales
• Sigmoidoscopy

7
Treatment
Conservative Fixative Procedures Hemorrhoidectomy
Treatment
• Increase Dietary • The goal of • Surgical removal of

Growth

Jens Martensson
Fiber nonsurgical hemorrhoid is
• Oral Fluids procedures used to called
• NSAID( Ibuprofen treat hemorrhoids hemorrhoidectomy
(Motrin) & is called fixative

Shows
Naproxen (Aleve) procedures. It
include tying off the
• Sitz Bath hemorrhoids
• Rest • with a rubber band
• Steriods Ointments

Sales
• Using Heat
or Creams
• Lasers
• Electric Current

8
PREVENTION
Drink plenty of water, at least eight glasses. per day

Jens Martensson
Eat high fiber diet of fruits, vegetables, and whole grains

Empty bowels as soon as possible after the urge occurs

Regular exercise

9
Nursing Diagnosis for Hemorrhoids
• Pain (acute or chronic) related to rectal swelling

Jens Martensson
• Constipation related to ignore the urge to defecate
due to pain during defecation

• Anxiety related to plan surgery

10
• Impaired Urinary Elimination related to the fear of
postoperative pain.

• Risk for infection related to inadequate primary

Jens Martensson
defenses.

• Deficient knowledge related to the lack of

information about home care.
11
Nursing Intervention for Hemorrhoids
• As needed, provide warm sitz baths to reduce local pain
and swelling

Jens Martensson
• Check for signs and symptoms of anal infection, such as
increases pain and foul smelling anal drainage.

• Teach the patient about hemorrhoidal development,

predisposing factors, and tests. 12
• Emphasize the need for good anal hygiene.

• Encourage the use of toilet paper without dyes or perfumes.

• Provide the patient with high fiber diet and encourage adequate

Jens Martensson
fluid intake and exercise to prevent constipation.

• Prepare the patient for surgery if necessary

• Monitor the patient's pain level and the effectiveness of the

prescribed medications. 13
 Medical Management
• High-fiber diet to keep stools soft.

Jens Martensson
• Warm sitz baths to ease pain and
combat swelling.
• Reduction of prolapsed external
hemorrhoid manually
14
 Pharmacologic Intervention
• Stool softeners to keep stools soft and relieve
symptoms.

Jens Martensson
• Topical creams, suppositories or other preparation
such as Anusol, Preparation H, and witch-hazel
compresses to reduce itching and provide comfort.
• Oral analgesics may be needed.duction of prolapsed
external hemorrhoid manually
15
Thank
You
PREPARED BY:
SALIGUMBA, MARISH
SALVAÑA, KEIN KAREN
INTRODUCTION
 Nasogastric Tube
A tube that is inserted through the nose, down
the throat and esophagus, and into the stomach.
It can be used to give drugs, liquids, and liquid
food, or used to remove substances from the
stomach.
SHORT TUBES - Passed
through the nose into the MEDIUM TUBES - tubes are
stomach: range in size from 14 passed through the nose to
to 18 Fr, single lumen made of duodenum and the jejunum.
plastic or rubber with holes
near the tip.
LONG TUBES - passed through the
nose. through the esophagus and
stomach into the intestines. Used for
decompresion of the intestines.
Some conditions that may require NGT
feeding:
• Difficulty swallowing (dysphagia)
• Head and Neck cancers
• Altered mental status/ unconsciousness.
• Malnutrition
• Endotracheal Intubation
 Who needs an NGT?
• Surgical Patients
• Ventilated Patients
• Neuromuscular Impairment
• Patients who are unable to maintain oral
intake to meet metabolic/ nutritional
demands.
• To feed the patient with fluids when oral intake is not
possible.
• To prevent stress on operated site by
decompressing.
• To instill ice cold solution to control gastric bleeding.
• To relieve vomiting and distention.
• To collect gastric juice for diagnostic purposes.
• To collect gastric juice for diagnostic purposes.
Indications of NGT Insertion

• To feed the patient with fluids when oral intake is

not possible.
• To prevent stress on operated site by
decompressing.
• To instill ice cold solution to control gastric
bleeding.
• To relieve vomiting and distention.
• To collect gastric juice for diagnostic purpose
Complications of NGT Insertion

• Gagging or vomiting
• Tissue trauma along the nasal, oropharyngeal or
upper gastrointestinal tract
• Esophageal perforation (rare)
• Incorrect placement leading to respiratory tree
intubation may cause aspiration.
Risk for aspiration related to tube feeding
as evidence by patient having peg tube
with feedings and speech evaluation is
silent aspiration.
• The nurse will check the patients peg tube residual
and document residual amounts every shift.
• Provide oral and skin care. Give mouth rinses and
apply lubricant to the patient's lips and nostril. using
the water soluble lubricant, lubricate the catheter
until where it touches the nostrils because cliets
nose may become irritated and dry.
Thank you for
listening!
Anatomy and Physiology
 Gastric Lavage
commonly called stomach wash
or gastric suction, is the process
of cleaning out the contents of
the stomach. It has been used for
eliminating poisons from the
stomach.
The left lateral decubitus
position is preferred.
NGT Feeding Gavage
Sanchez, John Lloyd
Suwaib, Maisa
INTRODUCTION
• A nasogastric tube is a long, skinny tube that goes through the nose, down
the throat, and into the stomach.

• NG tubes are held in place by pieces of tape on the cheek

• Gavage feeding is an artificial method of giving fluids and nutrients. This is a

process of feeding with the tube (Nasogastric tube) inserted through the
nose, pharynx, and esophagus and into the stomach.

• Gavage feeding is a way to provide breastmilk or formula directly to your

baby’s stomach. A tube placed through your baby’s nose (called Nasogastric
or NG tube) carries breast milk/formula to the stomach.
PURPOSES & INDICATION
• To feed the children who are unable to take feed orally.

• Feed the children who are undergoing oral surgery like - cleft lip or cleft
palate, fracture of jaw, and in condition of difficulty swallowing.

• when patient is unconsciuos or semiconscious

• when the condition is not supportive to take large amount of food orally e.g -
severe burns, malnutrition, prematurity, acute and chronic infections.

• conditions when the patient is unable to retain the food e.g anorexia nervosa
and vomiting.
CONTRAINDICATION
• Loss of airway protective reflexes, such as in a patient with depressed state
of consciousness.

COMPLICATIONS
• nasal airway obstruction
• aspiration pneumonia
• ulceration or stomach perforation
• irritation of the mucous membrane
• incompetence of esophageal-cardiac sphincter
• epistaxis
Differences between Types of Feeding

• usually with syringe and by

gravity
Intermittent • need caution to prevent air
from entering stomach
• also called Gavage

• with pump machine and order

rate and time
Continuos Infusion • air sensor
• also called bolus
ADVANTAGES OF NASOGASTRIC FEEDING

• All types of nutrients including distasteful foods and medications

can be given in adequate amount.

• Without any danger, feeding can be continued for weeks.

• According to need, stomach can be aspirated at any time.

• Large amount of fluids can be given with safety.

PRINCIPALS INVOLVED IN GASTRIC GAVAGE
• Tube feeding is a process og giving liquid nutrients or medications through a tube into the
stomach when the oral intake is inadequate or impossible

• A thorough knowledge of the anatomy and physiology of the digestive tract and respiratory
tract. Ensures safe induction of the tube (avoid misplacement of the tube).

• Micro-organisms enter the body through food and drink

• Introduction of the tube into the mouth or nostrils is a frightening situation and the client will
resist every attempt. Mental and physical preparation of the client facilities introduction of the
tube.

• Systematic ways of working adds to the comfort and safety of the client and help in the
economy of material, time and energy.
POLICY
• 6 fr feeding tube is used for infants <1000 grams.

• 6 fr or # 8 fr feeding tube are used for infants >1000 grams.

• Never force the feeding under pressure.

• If possible, the infant should be held in semi-up-right position during the

feeding; if not possible, position infant on right side or prone as this will
facilitate gastric emptying.

• If respiratory rate >70, check with physician about withholding feeding.

ARTICLES NEEDED
• Mackintosh with towel
• Kidney tray for receiving the waste
• “Cotton tipped” applicators to clean the nostrils
• Ryle’s tube in a bowel
• Lubricant (water soluble jelly/glycerin) to prevent friction
• Gauze pieces to clean the secretions
• Scissors and adhesive plaster or tape
• Measuring cup or glass/ounces glass.
• sterile syringe, about 10-20 ml
• paper bag - to collect the wastes.
• glass of feed in a bowel of warm water to give the feed at
the body temperature
• tongue blade
• suction apparatus - to clear the airway, whenever need.
• bowel with water - to test the location of tube.
• clamp - to clamp the tube to prevent leakage of gastric
contents.
EQUIPMENT
• suction machine and catheter
• stethoscope
• feeding fluid (formula) as prescribed
• clear calibrated reservoir for feeding fluid or
• catheter tip syringe 20 ml
• cup of water
• PH paper
PROCEDURE

• Do the hand washing properly

• Wear the hand gloves

• Identify the patient

• Explain the procedure in the patient (mother, father, relatives)

• Maintain privacy

• Make the patient in comfortable position.

• Make the patient sit on chair or place him in fowlers position.

PROCEDURE (continuation)
• Arrange the meckintosh and face towel across the chest and put under the chin to protect the
garments and bed linens.

• Keep the kidney tray ready for receiving the vomit, if occur

• Remove the dentures and place in a bowl of clean water.

• Clean the nostrils with cotton applicators, if secretions are deposited.

• Arrange all articles near the bed side or on the bed side looker

• Check the patency of the tube

PROCEDURE (continuation)

• Measure the length of the tube by measuring it from the tip of the nose to ear lobe and from
ear lobe to the tip of the xiphoid process of the sternum

• Lubricate the tube with glycerine - or jelly by the piece of gauze. It is start from tip to the 6 to
8 inches long.

• Now insert the tube with the right hand into the left nostril slowly
PROCEDURE (continuation)
• Pass the tube slowly backwards and downwards. When the tube reaches at pharynx, give
patient sips of water and swallow, while swallow insert the tube about 3-4 inches each time.
When it reaches completely till the mark stop to insert.

• Now confirm the placement of tube by aspirating the gastric contents with the syringe. Other
method is to place the tube end in a bowl of water and check the bubbles. If bubbles are
present it indicates position in trachea.

• Examine the mouth of patient with tongue blade and light source.

• After this secure the tube with the adhesive tape at the nasal bridge.

• After some time give some water to expel the air, Give the feed with feeding syringe or
funnel. Give feed slowly; do not push the feeding solution with plunger.
PROCEDURE (continuation)
• When the feeding is completed, pour a little amount of water and clamp the tube firmly to
prevent leakage of fluids

• When any obstructions occurs while feeding, remove the funnel and take a syringe with
sterile water. Push the water slowly, and draw it back from gastric contents. When fluids
starts to enter, connect the feeding funnel with tube.

• Provide oral hygiene every 4 to 6 hours to prevent infections

• Dispose the waste materials and clean the articles properly and replace them.

• Do the hand washing.

• Recording and reporting.

AFTER CARE OF THE CLIENT AND ARTICLES

• Offer a mouth wash. Clean the face and hands and dry them

• Remove the mackintosh and towel

• Make the client comfortable in bed

• In case of unconscious or seriously ill clients, apply suction if

secretions are collected in the mouth.
AFTER CARE OF THE CLIENT AND ARTICLES (continuation)

• Take all articles to the utility room, Discard the waste and clean the articles
with the soap and water. Dry them. Replace them into their proper places

• Wash hands

• Record the time, date, amount of feed, the nature of the feed, the reaction of
the client if any, in the nurses record as well as in the intake and output chart

• Remove the tube when the tube feeding is to be stopped

THANK YOU
Click to edit Master title style

Peptic Ulcer
Disease
By: Francis Aj Belotindos & Michael Bruno

1
Click to edit Master title style
 Peptic ulcer disease occurs when open
sores, or ulcers, form in the stomach
or first part of the small intestine.
 Many cases of peptic ulcer disease
develop because a bacterial infection eats
away the protective lining of the digestive
system. People who frequently take pain
relievers are more likely to develop ulcers.

Ulcer – open sore

Peptic - cause of the problem is due to acid

2
2
 Types ofedit
Click to Peptic Ulcer
Master title style
• The two most common types of peptic ulcer are called
“gastric ulcers” and “duodenal ulcers”. These names refer
to the location where the ulcer is found.

Gastric Ulcer
• Gastric ulcers are located in the stomach

Duodenal Ulcer
• Duodenal ulcers are found at the beginning of the small
intestine (also called the small bowel) known as the
duodenum. A person may have both gastric and duodenal
ulcers at the same time.

3 3
ClickFactors
Risk to edit Master title style
One in 10 people develops an ulcer.

Risk factors that make ulcers more likely include:

Frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs),
a group of common pain relievers that includes ibuprofen
(Advil® or Motrin®).
A family history of ulcers.
Illness such as liver, kidney or lung disease.
Regularly drinking alcohol.
Smoking.

4 4
Click
Causesto edit Master title style
People used to think that stress or certain foods could cause ulcers. But researchers haven’t found
any evidence to support those theories. Instead, studies have revealed two main causes of ulcers:
• Helicobacter pylori (H. pylori) bacteria.
• Pain-relieving NSAID medications.

H. pylori bacteria

• H. pylori commonly infects the stomach. About 50% of the world’s population has an H. pylori
infection, often without any symptoms. Researchers believe people can transmit H. pylori from
person to person, especially during childhood.

• The H. pylori bacteria stick to the layer of mucus in the digestive tract and cause inflammation
(irritation), which can cause this protective lining to break down. This breakdown is a problem
because your stomach contains strong acid intended to digest food. Without the mucus layer to
protect it, the acid can eat into stomach tissue. 5 5
•Click toforedit
However, Master
most people title style
the presence of H. pylori doesn’t have a negative impact. Only 10% to
15% of people with H. pylori end up developing ulcers

Pain relievers
• Another major cause of peptic ulcer disease is the use of NSAIDs, a group of medications used to
relieve pain. NSAIDS can wear away at the mucus layer in the digestive tract.

These medications have the potential to cause peptic ulcers to form:

Aspirin (even those with a special coating).
Naproxen (Aleve®, Anaprox®, Naprosyn® and others).
Ibuprofen (Motrin®, Advil®, Midol® and others).
Prescription NSAIDs (Celebrex®, Cambia® and others).
Acetaminophen (Tylenol®) is not an NSAID and won’t cause damage to your stomach. People
who can’t take NSAIDs are often directed to take acetaminophen.
6 6
Click to edit Master title style
• Not everyone who takes NSAIDs will develop ulcers. NSAID use coupled with an H. pylori
infection is potentially the most dangerous.
• People who have H. pylori and who frequently use NSAIDs are more likely to have damage to
the mucus layer, and their damage can be more severe.

Developing an ulcer from NSAID use also increases if you:

Take high doses of NSAIDs.
Are 70 years or older.
Are female.
Use corticosteroids (drugs your doctor might prescribe for asthma, arthritis or lupus) at the same
time as taking NSAIDs.
Use NSAIDS continuously for a long time.
Have a history of ulcer disease.
7 7
Click to
Signs andedit
Symptoms
Master title style
Some people with ulcers don’t experience any symptoms. But signs of an ulcer can include:
Gnawing or burning pain in your middle or upper stomach between meals or at night.
Pain that temporarily disappears if you eat something or take an antacid.
Bloating.
Heartburn.
Nausea or vomiting.

In severe cases, symptoms can include:

Dark or black stool (due to bleeding).
Vomiting.
Weight loss.
Severe pain in your mid- to upper abdomen. 8 8
Click to edit
Diagnosis andMaster
Tests title style

How are ulcers diagnosed?

• Your healthcare provider may be able to make the diagnosis just by talking with you about your
symptoms. If you develop an ulcer and you’re not taking NSAIDs, the cause is likely an H. pylori
infection.

To confirm the diagnosis, you’ll need one of these tests:

Endoscopy
• If you have severe symptoms, your provider may recommend an upper endoscopy to determine
if you have an ulcer. In this procedure, the doctor inserts an endoscope (a small, lighted tube
with a tiny camera) through your throat and into your stomach to look for abnormalities.

9 9
Click to edit Master title style
H. Pylori tests
• Tests for H. pylori are now widely used and your provider will tailor treatment to reduce your
symptoms and kill the bacteria. A breath test is the easiest way to discover H. pylori. Your
provider can also look for it with a blood or stool test, or by taking a sample during an upper
endoscopy.

Imaging tests
• Less frequently, imaging tests such as X-rays and CT scans are used to detect ulcers. You have
to drink a specific liquid that coats the digestive tract and makes ulcers more visible to the
imaging machines.

1010
Click to Diagnosis
Nursing edit Master
and
title
Intervention
style
Acute Pain
May be related to: Desired Outcomes:
• Abdominal distention • Client will report satisfactory pain
• Abdominal muscle spasm control at a level less than 2 to 4
on a scale of 0 to 10.
• Recent nonsteroidal anti-inflammatory drug
(NSAID) or acetylsalicylic acid (ASA) use • Client uses pharmacological and
nonpharmacological pain relief
measures.
Possibly evidenced by:
• Client will exhibit increased
• Early satiety comfort such as baseline levels
• Nausea and vomiting for HR, BP, and respirations and
relaxed muscle tone for body
• Pain relieved by food or antacid posture.
• Weight loss
1111
 Nursing Intervention Rationale
Click to edit Master title style
 Assess the client’s pain, including the location, • Clients with gastric ulcer typically demonstrate
characteristics, precipitating factors, onset, pain 1 to 2 hours after eating. The client with
duration, frequency, quality, intensity, and severity. duodenal ulcers demonstrate pain 2 to 4 hours
after eating or in the middle of the night. With both
gastric and duodenal ulcers, the pain is located in
the upper abdomen and is intermittent. Client may
report relief after eating or taking an antacid.

 Encourage the use of nonpharmacological pain • Nonpharmacological relaxation techniques will

relief measures: decrease the production of gastric acid, which in
turn will reduce pain.
• Acupressure
• Biofeedback
• Distraction
• Guided imagery
• Massage
• Music therapy

1212
Click to edit
Deficient Master
Knowledge title style
May be related to:
• Lack of recall of previously learned information
• New condition, treatment
• Recurrent episodes of GI bleeding
• Recurrent peptic ulcer disease
Desired Outcomes:
• Client will verbalize understanding of
Possibly evidenced by: the importance of compliance with
• Incorrect responses to questions about peptic medical regimen, knowledge of peptic
ulcer disease ulcer disease, and commitment to
self-care management.
• Inaccurate follow-through with treatment
regimen and lifestyle modifications
• Lack of questions
• Multiple questions
1313
Click to edit Master
Nursing title style
Intervention Rationale
 Assess the client’s knowledge and misconceptions • Clients may have inaccurate information about
regarding peptic ulcer disease, lifestyle behaviors, how lifestyle behaviors contribute to peptic ulcer
and the treatment regimen. disease. The client needs accurate knowledge to
make informed decisions about taking prescribed
medications and modifying behaviors that
contribute to peptic ulcer disease or GI bleeding.

 Explain the pathophysiology of disease and how it • An understanding of the disease process helps to
relates to the functioning of the body. foster the willingness to follow the recommended
treatment plan and modify behaviors to prevent
recurrent episodes or related complications.

 Discuss the therapy options and the rationales for • The correct use of antibiotics and acid
using these options. suppression medications can promote rapid
healing of an ulcer.

1414
Click to edit Master
Management and Treatment
title style

Will ulcers heal on their own?

• Though ulcers can sometimes heal on their own, you shouldn't ignore the warning signs. Without
the right treatment, ulcers can lead to serious health problems, including:
Bleeding.
Perforation (a hole through the wall of the stomach).
Gastric outlet obstruction (from swelling or scarring) that blocks the passageway from the
stomach to the small intestine.

What ulcer treatments are available?

• If your ulcer is bleeding, your doctor may treat it during an endoscopy procedure by injecting
medications into it. Your doctor could also use a clamp or cauterization (burning tissue) to seal
it off and stop the bleeding.
1515
Click to edit Master title style
For most people, doctors treat ulcers with medications, including:

Proton pump inhibitors (PPI)

• These drugs reduce acid, which allows the ulcer to heal. PPIs include Prilosec®, Prevacid®,
Aciphex®, Protonix® and Nexium®.
Histamine receptor blockers (H2 blockers)
• These drugs also reduce acid production and include Tagamet®, Pepcid®, Zantac® and Axid®.
Antibiotics
• These medications kill bacteria. Doctors use them to treat H. pylori.
Protective medications
• Like a liquid bandage, these medications cover the ulcer in a protective layer to prevent further
damage from digestive acids and enzymes. Doctors commonly recommend Carafate® or Pepto-
Bismol®.
1616
Click to edit Master title style
Prevention

How can I prevent ulcers?

You may be able to prevent ulcers from forming if you:

Talk to your doctor about alternatives to NSAID medications (like acetaminophen) to relieve pain.
Discuss protective measures with your doctor, if you can’t stop taking an NSAID.
Opt for the lowest effective dose of NSAID and take it with a meal.
Quit smoking.
Drink alcohol in moderation.

1717
Click to edit Master title style
Prognosis

Are ulcers curable?

• For most people, treatment that targets the underlying cause (usually H. pylori bacterial infection
or NSAID use) is effective at eliminating peptic ulcer disease. Ulcers can reoccur, though,
especially if H. pylori isn’t fully cleared from your system or you continue to smoke or use
NSAIDs.

How long does it take an ulcer to heal?

• It generally takes several weeks of treatment for an ulcer to heal.

1818
Click to edit Master title style

Thank You
for Listening!
19