ANEURYSM  Diuretics

 Localized sac or dilation formed at a weak  Beta blockers

point in the wall of artery  Ace inhibitors
 Common aneurysm: saccular & fusiform  ARBS
THORACIC AORTIC ANEURYSM NURSING MANAGEMENT
 Caused by atherosclerosis  Vital signs and Doppler assessment every
 Ages of 50 to 70 15 minutes
 Common site for dissecting aneurysm  Assess for bleeding, pulsation, swelling,
 High morbidity pain, hematoma formation
 High mortality  Skin changes of the lower extremity,
Clinical Manifestations lumbar area or buttocks
 Some patients are asymptomatic
 Pain is the prominent symptom DISSECTING AORTA
Assessment & Diagnostic Findings  Occasionally in an aorta disease by
 Chest xray artheriosclerosis, a tear develops in the
 Computed tomography angiography intima or the media degenerates.
 MRA Causes:
 Transesophageal echocardiography  Stress
Medical Management  Increase blood pressure
 Controlling blood pressure Clinical Manifestations
 Beta blockers (metropolol, atenolol,  Pain: anterior chest, shoulders, epigastric
carvedilol) area, abdomen.
 Angiotensin receptor blockers (losartan, Diagnostic Finding
valsartan, irbesartan)  Arteriography
 Sodium nitroprusside (most established  Multidetector-Computed Tomography
drug) Angiography
 TEE
ABDOMINAL AORTIC ANEURYSM  Duplex ultrasonography
 Common cause artherosclerosis  MRA
 More common in men 65 years of age ARTERIAL EMBOLISM AND ARTERIAL
PATHOPHYSIOLOGY THROMBOSIS
 Damaged media layer of vessel  Acute vascular occlusion caused by an
 Caused by congenital weakness, trauma, embolus or acute thrombosis
or disease Clinical Manifestations
 Risk factors: nicotine use, hypertension,  Pain, pallor, pulselessness, paresthesia,
genetic predisposition poikilothermia, paralysis
CLINICAL MANIFESTATIONS Diagnostic Findings
 Patients feel their heart beating in their  ECG
abdomen when lying down  Chest xray
 Pulsating mass in the abdomen, with or  TEE
w/o pain, followed by abdominal pain and  Noninvasive duplex
back.  Doppler ultrasonography
 Cool, cyanotic extremities and mottling Medical Management
ASSESSMENT  Heparin therapy an initial bolus of 60 U/kg
 Pulsatile mass in middle & upper abdomen body weight is given, followed by
 Systolic bruit maybe heard over the mass continuous infusion of 12 U/kg/h
DIAGNOSTIC FINDINGS Nursing Management
 Duplex ultrasonography  Patients remains on bed rest
 Computed tomography angiogram  Vital signs taken initially every 15 minutes
PHARMACOLOGIC THERAPY
 Antihypertensive drugs
HYPERTENSIVE CRISIS  Bowel habit training, increase fiber,
 Sudden, severe increase blood pressure increase fluid intake, avoid laxative abuse
 BP reading 180-120 DIARRHEA
 It can lead to heart attack, stroke or  Increased frequency of bowel movements
death (more than three per day)
 Increase amount of stool
HYPERTENSIVE EMERGENCY  Altered consistency
 Severely elevated BP with evidence of Types
target organ injury  SECRETORY high volume diarrhea caused
 Targeted organs: CNS, heart, kidney, eye by increased production and secretion of
 Decrease BP immediately water and electrolytes
 Conditions associated: hypertension,  OSMOTIC occurs when water is pulled
pregnancy, acute myocardial infarction, into the intestine by osmotic pressure
intracranial hemorrhage.  MALABSORPTIVE inhibiting effective
THERAPEUTIC GOALS absorption of nutrients
 Reduction of blood pressure by 20-25%  EXUDATIVE caused by changes in
within the first hour of treatment. mucosal integrity
PHARMACOLOGIC THERAPY Complications
 Intravenous vasodilators  Cardiac dysrhythmias
 Sodium nitroprusside (nitropress)  Loss of bicarbonate
 Nicardipine hydrochloride (cardene)  Urine output less than 0.5ml for 2 to 3
 Clevidipine 9ckeviprex) consecutive hours
 Fenoldopam mesylate (corlopam)  Chronic diarrhea
 Enalaprilat Management
 Nitroglycerin  Drug of choice: loperamide
 Pharmacologic antibiotics, anti-
HYPERTENSIVE URGENCY inflammatory agents, antidiarrheals
 Severely elevated BP with no current (loperamide, diphenoxylate)
evidence of secondary organ damage. Nursing Management
 Decrease BP soon  Bed rest
 Associated with: severe headaches,  Bland diet
nosebleeds, or anxiety  Avoid caffeine, carbonated beverages
 Goal: normalizing blood pressure within  Restrict milk products, fat, whole-grain
24 to 48 hours
PHARMACOLOGIC THERAPY IRRITABLE BOWEL SYNDROME
 Oral doses: beta-adrenergic blockers  Recurrent abdominal pain at least 3 days
(labetalol) ACE inhibitors (captopril) a month
alpha2-agonists (clonidine)  Change in frequent stool
 Change in appearance of stool
Nursing Management Management
 Relieving abdominal pain, controlling
 Hemodynamic monitoring
diarrhea, reducing stress
 Taking vital signs every 5 minutes
 Lubiprostone a chloride regulator in the
gut
CONSTIPATION
 Alosteron
 Abnormal infrequency or irregularity of
 Probiotics (lactobacillus, bifidobacterium)
defecation
complementary medicine
Complications
 Hypertension, fecal impaction,
APPENDICITIS
hemorrhoids, fissures, valsalva maneuver
 Inflammation in the appendix
Management
 Common cause acute surgical abdomen
  Commonly occurs between the ages of 10  Can be treated on an outpatient basis with
and 30 diet and mediction
Clinical Manifestations  If symptoms occur, rest, analgesics, and
 Vague epigastric or periumbilical pain antispasmodics are recommended
(visceral pain that is dull and poorly  Diet: clear liquid diet, high fiber, low fat
localized) diet
 Right lower quadrant pain (parietal pain  Broad spectrum antibiotics are prescribed
that is sharp, discrete and well localized) for 7 to 10 days
 Low grade fever and nausea sometimes  An opioid
vomiting and loss of appetite.  Antispasmodics such as propantheline
 Local tenderness at McBurney’s point bromide and oxyphencyclimine may be
 Rebound tenderness rovsing sign prescribed.
 Deep palpation of the left iliac fossa Surgical Management
causes pain in the right iliac fossa  One stage resection in which the
 Psoas sign inflamed area is removed
 Obturators sign or copes sign  Multi stage procedure for complications
Assessment and Diagnostic findings such as obstruction or perforation
 History and physical exam
 CBC INFLAMMATORY BOWEL DISEASES
 Imaging studies  Refers to two chronic GI disorders
 Diagnostic laparoscopy
Medical Management CROHN’S DISEASE
 Appendectomy to decrease risk of  Is a subacute and chronic inflammation of
perforation the GI tract
Nursing Management CLINICAL MANIFESTATIONS
 Iv infusion to replace fluid loss  Onset: insidious
 Nasogastric tube is inserted  Prominent right lower quadrant abdominal
 Place in high fowlers position pain and diarrhea unrelieved by diarrhea
 Food is tolerated
 Oral fluids are administered ULCERATIVE COLITIS
 Is a recurrent ulcerative and inflammatory
DIVERTICULAR DISEASES disease of the mucosal and submucosal
 Diverticulum is a saclike herniation of layers of the colon and rectum
the lining of the bowel that extends Diagnostic and Findings
through defect in the muscle layer  Barium study of upper GI Tract, shows a
 Diverticulosis exists when multiple string sign on an xray film of the
diverticula are present without terminal ileum
inflammation  Confirm diagnosis: endoscopy,
 Diverticulitis results when food and colonoscopy, intestinal biopsies, ct scan,
bacteria retained in diverticulum produce barium enema
infection and inflammation INTESTINAL OBSTRUCTION
Causes  Exists when blockage prevents the normal
 Mucosa and submucosal layers of the flow of intestinal contents through
colon herniate through the muscular wall intestinal tract.
Assessment and Diagnostic Findings Two Types of Processes
 Diagnostic Test: CT with contrast  Mechanical Obstruction caused from
 Colonoscopy pressure of the intestinal wall
 Barium enema if with peritoneal irritation  Functional Obstruction intestinal
 Abdominal xrays musculature cannot propel the contents
 Laboratory test: complete blood cell count along the bowel.
Medical Management
SMALL BOWEL OBSTRUCTION: clinical DIABETIC KETOACIDOSIS
manifestations  Life threatening complication in patients
 Initial: crampy pain, wavelike colicky with IDDM type 2 DM
 Vomiting, passing of blood mucus, reverse Definition
peristalsis.  Hyperglycemia
 Signs of dehydration: intense thirst,  Dehydration and electrolyte loss
drowsiness, arched tongue and mucous  Acidosis
membranes Clinical Manifestations
Assessment & Diagnostic Findings  Polyuria
 Based on symptoms and imaging studies  Polydipsia (increased thirst)
 Imaging studies: abdominal xray, ct scan  Fatigue
 Laboratory studies: dehydration, loss of  Blurred vision
plasma volume, possible infection  Weakness
Medical Management  Headache
 Decompression of bowel thru NGT Gastrointestinal symptoms
 Monitoring for bowel ischemia  Anorexia
 Surgical intervention  Nausea & vomiting
Nursing Management  Abdominal pain
 Maintaining the function of nasogastric  Acetone breath
tube  Hyperventilation
 Assessing and measuring the nasogastric  Kussmaul respirations
output Assessment and Diagnostic Findings
 Assessing for fluid and electrolyte  Blood glucose levels may vary between
imbalance 300 and 800
 Monitoring nutritional status  Evidence of ketoacidosis is reflected in low
serum bicarbonate (0 to 15) and low ph
LARGE BOWEL OBSTRUCTION (6.8 to 7-3) values
 Clinical Manifestations relatively slower  Low partial pressure of carbon dioxide (
occurrence of symptoms PCO2 10 to 30 mm hg)
 Diagnostic findings abdominal xray and  Sodium and potassium concentrations
abdominal CT or MRI: distended colon and may be low
pinpoint sight of obstruction  Increased levels of creatinine, blood
 Barium studies are contraindicated. urea nitrogen, hematocrit
Medical Management Management
 Restoration of intravascular volume  Correcting dehydration, electrolyte loss,
 Correction of electrolyte abnormalities and acidosis
 And nasogastric aspiration and  IV fluid replacement 0.9% sodium chloride
decompression  Fluid volume status monitoring (plasma
Surgical Management expanders)
 Colonoscopy (to untwist and decompress  Monitor potassium levels
bowel)  Potassium replacement
 Cecostomy (surgical opening of cecum) Reversing acidosis
 Rectal tube placement (decompress  IV infusion of insulin (regular insulin)
area lower in the bowel)
 Colonic stent (as palliative intervention HYPERGLYCEMIC HYPEROSMOLAR
or as bridge for definitive surgery) SYNDROME
 Surgical resection, colostomy,  Is a life threatening resulting from a lack
ileostomy of effective insulin, or severe insulin
resistance, causing extreme
hyperglycemia
  Precipitated by stressor: trauma, injury,  Physical examination
or infection that increases insulin demand.  Monitor intake & output
 Serum glucose: more than 600mg/dl Nursing interventions: hypokalemia
Pathophysiology  Replacement of potassium
 There is enough insulin to prevent acidosis  Monitoring cardiac rate, cardiac rhythm,
and the formation of ketone bodies at the ECG, and serum potassium
cellular level, but there is not enough Nursing interventions: cerebral edema
insulin to facilitate the transportation of all  Monitoring blood glucose level, serum
glucose into the cells electrolytes level.
 Glucose molecules accumulate in the
blood stream: sodium, potassium, GASTROESOPHAGEAL REFLUX DISEASE
phosphate. (GERD)
 Patient may lose up to 25% of their total  Excessive reflux may occur because of an
body water. incompetent esophageal sphincter, pyloric
 Increasing hyper osmolality stenosis, or mortality disorder.
Assessment and Diagnostic Findings Clinical Manifestations
 Blood glucose  Pyrosis (burning sensation in the
 Serum electrolytes esophagus)
 BUN  Dyspepsia (indigestion)
 CBC  Regurgitation
 ABG  Dysphagia or odynophagia
Management  Hypersalivation
 Fluid replacement  Esophagitis
 Correction of electrolyte imbalances Assessment & Diagnostic Findings
 Insulin administration  Endoscopy
Nursing Diagnosis  Barium swallow
 Risk for deficient fluid volume related to  Ambulatory 12 to 36 hour ph monitoring
polyuria and dehydration Management
 Risk for electrolyte imbalance related to  Eat low fat diet
fluid loss or shifts  Avoid caffeine, tobacco, beer, milk
 Deficient knowledge about diabetes self-  Avoid eating or drinking 2 hours before
care skills or information bedtime
 Anxiety related to loss of control, fear of  Maintain normal body weight
inability to manage diabetes.  Elevate the head of the bed by at least 30
Nursing Interventions: maintaining fluid and degrees
electrolyte balance Surgical Management
 Intake and output are measured  Nissen fundoplication wrapping of a
 Laboratory values of serum electrolytes portion of the gastric fundus around the
 Vital signs are monitored hourly for signs sphincter area of the esophagus
of dehydration
 Assessment of breath sounds BARRETT’S ESOPHAGUS
 Level of consciousness  A condition in which the lining of the
Nursing interventions: decreasing anxiety esophageal mucosa is altered.
 Imagery  Cause: reflux changing the cells lining the
 Distraction lower esophagus
 Optimistic self-recitation  Signs & symptoms: similar with GERD
 Music ASSESSMENT
Nursing interventions: fluid overload Esophagogastroduodenoscopy
 Measuring vital signs  Expected finding: esophageal lining that is
 Central venous pressure and red rather than pink
hemodynamic monitoring
Biopsies  Injury to small vessels
 Expected finding: high grade dysplasia,  Oedema, haemorrhage, and possible ulcer
columnar epithelium replacing squamous formation
epithelium Manifestation: Acute Gastritis
Management  Epigastric pain or discomfort
 Follow up endoscopy within 6 months  Dyspepsia
 Intensive surveillance biopsies  Anorexia
Surgical Management  Hiccups
 Endoscopic resection  Nausea & vomiting
 Radiofrequency ablation  Erosive gastritis
Nursing diagnosis  Hematemesis
 Imbalanced nutrition less than body  Melena
requirements related to difficulty  Hematochezia
swallowing Manifestation: Chronic Gastritis
 Risk for aspiration related to difficulty  Fatigue
swallowing  Pyrosis after eating
 Acute pain related to difficulty swallowing  Belching a sour taste in the mouth
 Deficient knowledge about the esophageal  Early satiety
disorder  Anorexia
Nursing Management  Nausea & vomiting
 Encouraging adequate nutritional intake  Mild epigastric discomfort or report
 Decreasing risk of aspiration intolerance to spicy or fatty foods
 Relieving pain Assessment and Diagnostic Findings
 Endoscopy and histologic examination
GASTROINTESTINAL BLEEDING  A complete blood count
 Also known as gastrointestinal  H.pylori test: Urea Breath Test
hemorrhage is all forms of bleeding in the Medical Management
GI tract.  Refrain from alcohol
 A nonirritating diet
Upper Gastrointestinal Bleeding  Nasogastric intubation
Gastritis Pharmacologic
 Inflammation of the gastric or stomach  Antacids
mucosa  Histamine 2 receptor antagonist
Acute Gastritis  Proton pump inhibitor
 May be classified as erosive or nonerosive Surgical Management:
 Caused by the ingestion of strong acid or  Gastrojejunostomy a surgical procedure
alkali which may cause the mucosa to that creates an anastomosis between the
become gangrenous or to perforate. stomach and the jejunum.
Chronic Gastritis Nursing management
 Is often classified according to the  Reducing anxiety
underlying causative mechanism  Promoting optimal nutrition
 Cause by H.pylori is implicated in the  Promoting fluid balance
development of peptic ulcers,  Relieving pain
 Autoimmune disorders such as Hashimoto
thyroiditis, Addison disease, Graves PEPTIC ULCER DISEASE
disease  May be referred to as a gastric, duodenal
Pathophysiology or esophageal ulcer
 Due to any cause  Excavation that forms in the mucosa of
 Gastric mucosal barrier is penetrated the stomach in the pylorus, in the
 Hydrochloric acid comes into contact with duodenum or in the esophagus.
the mucosa 