NAUSEA

the subjective feeling of the urge to vomit

the act of expelling stomach contents through the esophagus and mouth

give antiemetics

provide quiet, odor free environment

oral care

place patient on side

IV fluids (isotonic)--D5NS

clear liquids then toast and crackers

daily weights

I/O

vital signs

monitor for hypovolemic shock

monitor for fluid volume overload

MEDICATIONS FOR NAUSEA AND VOMITING

(ANTIEMETICS)

Benadryl

Vistaril

Reglan

Phenergan

Compazine

Zofran

Transderm Scop

Torecan

Tigan

Weakness

Headache

Muscle Cramps

Restlessness

Inability to concentrate

Postural Hypotension

Confusion

Oliguria

Cold, clammy skin

Chest or abdominal pain

Watch for urine decrease

eyes sunken

DEHYDRATION!!!!

cardiac abnormalities

1lb of weight loss=500 mL

Do Electrolyte panel

Notice color, consistancy, amount of emesis

Loss of appetite

age group 12-18

middle to upper class girls with low self esteem

heart problems

kidney failure

diabetes

osteoporosis

severe weight loss

low self-esteem

compulsive dieting

skeleton-waist, face puffy

altered body image

amenorrhea in females

electrolyte imbalances

cardiac dysarrythmias

constipation

dry skin

bradycardia

hypotension

hypothermia

muscle weakness

body hair increases (lanugo)

give 6 small meals per day

get electrolyte panel

vital signs q 4 H

get baseline weight

EKG

IV fluids

can be normal sized person

purge after meals

increase use of laxatives, diet pills

excessive exercise

many same as anorexia

enamel erosion on teeth

locked in bathroom

vomiting

electrolyte imbalances

metabolic aklalosis

d/t loss of gastric contents

decreased potassium levels

monitor weight, v/s, and labs

promote consistant approach

promote pleasant eating environment

record I/O

provide 6 smaller meals and snacks

monitor what patient is saying

asist with referrals to social services

be nonjudgemental

positive praise

EXPECTED OUTCOMES FOR BULIMIC PATIENTS

establish dietary pattern and weight gain toward desired individual weight range

patient verbalized satisfaction with body image

morbid-above 40 on BMI scale

10-20% is overweight

COMORBITIES---diseases that lead to obesity

S/S---alopecia (hair loss)

HTN

heart disease

apnea

cardiac problems

aspiration

erosion of gastric tissue

breakdown of staples

suction at bedside

clear liquid diet--full liquid--pureed--regular

no concentrated sweets

talk with dietician

watch for dehydration-may need IV fluids

teeth begin mechanical digestion

the tongues main function is chewing

saliva is mostly water

amylase is the only digestive enzyme in saliva

parotid

submandibular

sublingual

LUQ

about 10 inches long

peristalsis of the esophagus allows food to reach the stomach

ULQ

left of the liver

in front of the spleen

ROLES:

1.  some digestion

2.  reservoir for food

about 1 inch in diameter and approximately 20 feet long

extends from the stomach to the cecum of the colon

it is here that digestion is complete

extends from the ileum of the small intestines to the anus

about 5 ft long and 2.5 inches in diameter

functions:

1.  stores then eliminates undigestable material

2.  absorbs water, minerals, and vitamins

3.  eliminates feces

STOOL TESTS

used to test for occult blood

3 tests taken

stools must be examined within 30 minutes of obtaining the culture.

an x-ray exam

pt in hospital gown

remove all metal objects

pregnant patients should not have this

x-ray of the esophagus, stomach, duodenum and jejunum using an oral contrast and fluoroscopy to outline contours of these structures.

detects tumors, ulcers, polyps, hiatal hernias, strutures and motility problems

Pt is NPO for 6-8 hours before procedure

Barium will cause the patients stool to be white and should return to normal within 3 days

LOWER GI SERIES WITH BARIUM

go in through the rectum

used to diagnose tumors, diverticula, stenosis, obstructions, inflammation, ulcerative colitis, and polyps.

usually on a clear liquid or low residue diet 2 days before the procedure

Patients with active inflammatory disease or colon perforation should not use a barium

CT SCAN

Consent is required

NPO 2-4 hours prior to procedure

visualizes the esophagus, stomach and duodenum

pt. is NPO 8-12 hours before procedure

may have sedatives like Valium

pt. is placed on left side and the tube is passed orally down the GI tract with photos taken

pt. remains NPO until gag reflex returns

examines the distal sigmoid colon, the rectum and the anal canal

clear liquid diet 24 hours before test

give warm tap water enema or fleet's the morning of the procedure

position in the left lateral knee position

visualization of the lining of the large intestine to identify abnormalities

clear liquid 24 hours before test

conscious sedation is used

positioned on the left side with the knees bent

GASTRIC ANALYSIS

measures the secretions in the stomach

NPO after midnight

avoid taking any drugs that could interfere with gastric acid secretions such as cholinergics, antacids, and antihistamines

stomach contents are collected q 15 minutes X 1 H

GASTROINTESTINAL INTUBATION

MAIN PURPOSES:

remove gas and fluid from stomach or intestines

(drug overdoses)

to diagnose GI motility

to relieve and treat obstructions and GI bleeds

to provide means for nutrition

(TPN)

to remove toxic substances

to promote healing

TUBE FEEDINGS

REASONS:

supply nourishment to patients when oral intake is not possible

1. inability to swallow

2.  severe burns or trauma to the face and the jaw

3.  mental retardation

4.  oropharyngeal or esophageal paralysis

5.  comatose patients

also known as intravenous hyperailimentation

supplying nutrients via IV route

start slow to allow pancreas time to adjust to increasing insulin production for high amounts of glucose in TPN

check glucose levels q 4 H for hyperglycemia

supplying nutrition intravenously othern than a central vein

PPN is used for less than 10 days when the patient does not need more than 2000 calories daily

WHAT IS AN AST?

lab test that diagnose chronic liver failure, viral hepatitis, acute pancreatitis

normal range:  8-20 units/L

serum protein levels

normal range--3.1-4.3 g/L

 decreased with liver disease

used to detect and monitor pancreatitis

increased with pancreatitis and gallstones

normal range  53-123 U/L

to detect level of this intracellular enzyme released with injury or disease

increased with liver disease

HOW LONG MUST A STOOL SAMPLE FOR O&P BE EXAMINED IN?

HOW MANY TEST ARE USUALLY DONE FOR OCCULT BLOOD?

THE PATIENT IS ENCOURAGED TO DRINK AT LEAST  ________ GLASS OF LIQUID Q HOUR FOR THE NEXT 24 HOURS AFTER A BARIUM ENEMA.

one  8 oz glass of liquid per hour

the straightest side

the side the patients breathes easiest from

WHAT TYPE OF SUCTION IS USED?

q 4 H after last feeding

CBC

Albumin

Glucose

Electrolytes

platelet count

PT