Abdominal NCLEX- GI NOTES: DIET FOR BOTH CROHNS AND ULCERATIVE COLITIS- LOW RESIDUE , LOW FIBER AND

HIGH PROTEIN WITH IRON! Medications for both crohns and ulcerative- similar anti-inflammatory, anti-rheumatics, steroids, anti-diarrheals, sedatives Right upper quadrant pain- liver, pancreas and gallbladder diseases. Left upper q mass- chronic pancreatitis Crohns disease is the random inflammations throughout the bowel- swelling , thickening and abscess formation. Diagnostic marker for this is the revelation of STRING SIGN in barium studies. Barium studies is either the swallowing of barium or procedure of barium from the anus to conjure up the images in the GI tract. Risk Factors: Age 10-30 Symptoms are: abdominal cramping, nausea, vomiting, ulcer formation, weight loss, diarrhea Treatment: Low residue diet, vitamin and iron supplements, medications to sedate, reduce diarrhea and steroids to reduce inflammation, antirheumatics to reduce inflammation. Surgery: Colonectomy- is the removal of entire colon. When this is done it is finished with an ileostomy. Ileostomy considerations that must be followed!- prevent skin problems due to the high risk of abrading the skin due to liquid stool. Ulcerative Colitis is a high mortality IBS where inflammation starts from the rectum going upwards and it is continuous as opposed to Crohns disease. The symptoms for this condition are worse that Crohns and are more heavily treated. Symptoms are: Abdominal Pain, Cramping, Bloody Diarrhea, Gas, epigastric pain, Fever, decreased iron absorption, Vomiting, weight loss Diagnotic Tests: Barium Enema and Sigmoidoscopy Treatment : 1) During its episodes, maintain the patient NPO. Then infuse parental nutrition through a tubing. Slowly progress from clear liquid diet to low fiber diet. 2) Monitor abdomen: Monitor the bowel sounds. 3) Monitor for hemorrhage by looking at the stools to see if its still bloody 4) Monitor for Peritonitis/Perforation !!- usually presented with a board-like abdomen that means inflammation 5) medications such as iron supplements, steroids, medications to sedate, anti-diarrheals similar to Crohns D Surgery: 1) Kock Ileostomy- Is when a pouch is created within the ileum to store feces and is excreted through a stoma in the abdomen. It is drained out through a catheter every day. It is also irrigated and flushed. stoma is protected with adhesive bandages.

Ileostomy vs Colostomy Colostomy- is when the colons are re-routed to a stoma near the abdomen. Anus is still intact and present Ileostomy- is the excretion of wastes through a stoma near the abdomen when the anus/colon is removed. Gastritis The inflammation of the gastric mucosa lining either ACUTE or CHRONIC causes. ACUTE: 1) ingesting foods that are irritants to the stomach, overuse of NSAIDS, alcohol, bile reflux, radiation therapy 2) CHRONIC: usually caused by bacteria H. pylori that is produced from over-secretion of stomach acid that facilitated the growth of such pathogen. Symptoms: For ACUTE patients: Abdominal Pain Nausea Cramping Vomiting Heading Hiccuping (trying to get the acid out) Chronic GASTRITIS SYMPTOMS: Belching of abdomen, pain, cramping, nausea, vomiting, acid reflex( Heart burn), b12 deficiency, sour taste in the mouth Interventions - Liquid diet then solid diet - Watch for bloody vomit, increased HR, reduced BP= hemorrhagic gastritis - Do not eat spicy food (irritants) - B12 deficiency Both gastric ulcers and duodena ulcers have the same treatment modalities Gastric Ulcers- hyposecretion of stomach acid- ulcer in the stomach mucosa. Risk factor over age 50 three symptoms to remember for this condition is 1) epigastric pain 30 minutes to 1 hour after meal 2) pain that is NOT relieved by food 3) VOMITING is common. Duodenal ulcers- hypersecretion of stomach acid- ulcer in the duodenum mucosa Three symptoms: 1) pain in the epigastric area 2-3 hours after food 2) pain relieved by food 3) melena- TARRY stools is common

dx-GI studies, barium swallow, gastric analysis, h bylori bacteria presence is identified by C13 urea breath test, blood test, or a stool exam, biopsy tx- histamine 2 receptors, antibiotics, antacids (neutralize acid secretions) , anticholinergics (to reduce gastric motility) , antispasmodics, PPI(reduce secretion of gastric acid) , Cytotec, barrier drugs such as Sucralfate one hour before each meal to protect the lining Client Teaching: do not drink alcohol, spicy food, smoke, take NSAIDS (secret hydrochloric acid) Surgery1) Gastrectomy: removal of the stomach so that the esophagus is attached to either the jejunum or ileum. (the ends of colon) 2) Vagotomy- the removal of vagel nerve to reduce secretions in the stomach 3) Biliroth I partial removal of gastric mucosa and the remaining being attached to the Duodenum 4) Biliroth II- partial removal of gastric mucosa, and remaining being attached to the jejunum Assessment after surgery: 1) Monitor for Hemorrhage, Shock, abdominal distention 2) the first 24 hours drainage should be bright red in small amounts, and proceed to darker colors afterwards. 3) DO NOT IRRIGATE/MOVE THE NG TUBE after surgery unless ordered by physician Interventions during active bleeding: Always assess first- since you know its bleeding, you should look out for signs of hemorrhage which includes Hypovolemia, hypotension, shock, sepsis respiratory insufficiency. Monitor hct,hgb 1) PUT CLIENT ON NPO, monitor intake and output 2) push iv fluids as replacement fluids 3) administer blood transfusion 4) vasoconstricting medications to reduce bleeding

DUMPING SYNDROME A common complication after gastrectomy where one cannot control the emptying of food to the jejunum. Sx1) diarrhea 2) dizziness (from losing feces) and palpitations 3) nausea/vomiting Tx: reducing carbs, reducing fiber, reducing water intake, recumbent position after small frequent meals, Sandostatin! Diverticulitis Inflammation of the diverticulum- outpouchings in the intestines. Usually in elderly females who eat seeds, nuts and that is what the diverticulum Collects which usually leads to inflammation. Diagnostic studiesEndoscopy and barium Studies NOT barium enema. It is contraindicated in people with acute diverticulitis. Symptoms:

Epigastric pain Diarrhea episodes n/v fever malaise lower left quadrant Treatment - NPO first, then gradually to liquid diet, then soft-fiber foods like whole grains. Not high fibermay aggravate the diverticula - Watch out for signs of perforation. Signs of abdominal perforation/peritonitis guarding abdomen (board-like abdomen due to inflammation) and normal signs of infection = fever and tachycardia - Antipyretics, steroids, anti-inflammatory, anticholinergics DIET: Low residue diet, no seeds and nuts, drink fluids! 2k-3k ml per day Hemorrhoids- purpose is to stop bleeding after surgery- so put ice packs on the wound -prevent constricting /constipating, getting angry and getting stressed. Appendicitis Symptoms/diagnostic: Pain is at LOWER RIGHT QUADRANT- Mc Burrys Point Rebound tenderness/rigidity Elevate WBC/ Nausea/ Vomiting Peritonitis Finding client in side lying position with legs flexed, knees to the chest and guarding the abdomen Interventions: Immediate surgery Appendectomy: 1) NPO Status 2) IV fluids 3) IBS- alternation of diarrhea and constipation. The cause is unknown but the patho is that intestinal motility is increased due to stress Notes : FOR GASTROINTESTINAL REFLUX AND HIATAL HERNIA, THEY ARE BOTH VERY SIMILAR IN SYMPTOMS AND MECHANISM OF OBSTRUCTION AND PATIENT SHOULD NOT LAY DOWN AFTER EATING. ELEVATE HEAD OF BED. NO RECUMBENT POSITION AS WELL. Gastrointestinal Reflux the regurgitation of food from the esophagus back into the mouth due to dysfunction of esophageal spinhcter,+ pylorus stenosis (narrowing) Sx1) heart burn- chest pain 2) Indigestion- Dyspepsia 3) nausea/vomiting 4) tachycardia

5) painful swallowing (odynophagia) 6) Gas dx- pH (acidic), barium swallow and endoscopy (Stretta) tx-avoid foods such as chocolate, fatty foods, alcohol ,carbonated drinks fats and acidic food= this constricts the sphincter even more -do not wear tight clothes cause it can constrict sphincter -avoid lying down after eating for 2 hours -6 Inches - 8 inches elevation on the head of bed - small frequent meals Medications Histamine 2 blockers, antacids to balance out acid, ppi to prevent acid. NO anticholinergics Complications of GERD Esophageal Cancer due to acid buildup called Baretts esophagus Surgery Laparoscopic Nissen Fundoplication- wrapping around the gastric fundus to promote an increase of Pressure which helps with GERD Hiatal hernia- when a part of the stomach goes into the thorax- whether it be the diaphragm or the esophagus Symptoms- almost the same as gastric reflex (regurgitation, heart burn, dysphagia, dyspepsia) s InterventionsSit in a high fowlers position .. DO NOT LIE DOWN do not lay down for 1 hour after eating Eat small frequent meals throughout the day Do NOT take anticholinergics- cause that slows down the intestines
COLOSTOMY IRRIGATION
An enema is given through the stoma to stimulate bowel emptying.

Description
Irrigation is performed by instilling 500 to 1000 mL of lukewarm tap water through the stoma and allowing the water and stool to drain into a collection bag.

Procedure
If ambulatory, position the client sitting on the toilet. If on bedrest, position the client on his or her side. Hang the irrigation bag so that the bottom of the bag is at the level of the clients shoulder or slightly higher. Insert the irrigation tube carefully without force. Begin the flow of irrigation. Clamp the tubing if cramping occurs; release the tubing as cramping subsides. Avoid frequent irrigations, which can lead to loss of fluids and electrolytes. Perform irrigation at about the same time each day. Perform irrigation preferably 1 hour after a meal. To enhance effectiveness of the irrigation, massage the abdomen gently.

LIVER PROBLEMS

Hep A and E- FECAL-ORAL and NOT chronic (first and last are similar) Hep B, C and D- prenatal, sexual, blood G- Blood transfusions

Diet is low fat, high calorie, high protein Hepatitis A- Fecal to oral- usually in people who traveled to undeveloped countries, unsanitary areas, healthcare settings and overcrowded areas. It isnt a chronic state of hepatitis and it lasts for 2-6 weeks. Incubation period-2-6 weeks before the symptoms start, and the symptoms only last for 1-3 weeks. The symptoms are: Malaise, Fever, Jaundice, N/V dxstool specimen HAV antigens can be found before symptoms appear and HAV antibodies can be found after symptoms appear Treatment 1) immune-globin after exposure to hepatitis A- gives passive immunity for about 6 weeks. Must be administered within 2 weeks after exposure. 2) two doses of vaccination. 2nd one can be given between 6-12 months after the first dose. The immunity can last for 20 years 3) a hep a and hep b recombinant vaccination can be given = Twinrix is the name of the vaccination and can be given to people over 18 Hepatitis B : transmitted sexually, through infected mothers, IV and blood to blood contact. It is a chronic condition in which HGaAB is present in the body that shows the presence of this illness. If the HGaABs are not resolved at the end of 6 months after its first appearance, the patient is considered contagious/carrier. Incubation period- 1-6 months Symptoms: Same as Hep A but with Pain (Arthritis and abdominal pain)+ Hep A symptoms: fever, malaise, nausea, vomiting, jaundice Treatment 1) Immuno-globin B (HBIG) can be given after exposure. 2) 3 doses of Hep B vaccination. First right after birth, 1st month of age and 6th month of age. (vasarelis lateral(thigh for infants) and in the deltoids in adults. 3) Alpha inteferferon injections sub Q once weekly. Flulike symptoms 3-6 hours after injection. E.g. Pegsays. 4) Antivirals for hepatitis B- Lamivudine, adefovir, entecavir, telbivudine Hepatitis C usually ends up with chronic liver disease or Cirrhosis. It is the worst kind of hepatitis there is because of its complications. Hepatitis without any classification usually falls under Hep C. Symptoms are mild and similar to type B. Diagnosis : HCV presence in serum can be detected. A liver Treatment: COMBINATION THERAPY- interferon and ribavirin. No vaccine. Hepatitis D is a complication of hepatitis B. so it is detected by the presence of hep D in the blood. USUALLY IN IV DRUG USERS, HEMODIALYSIS, BLOOD TRANSFUSION.

Symptoms: Similar to Hep B. Incubation period is 3-20 weeks. Diagnosis: hep d in serum, and anti-delta antibodies can be detected too. Treatment: Hepatitis D includes alpha interferon. Hepatitis E- fecal to oral route Found in people who are from underdeveloped countries , and areas where rain and flooding occurred. Diagnostic. presence of HEV in blood. Treatment- none . can only prevent by washing hands and good hygiene. Hepatitis G Newly identified hepatitis that is common in people who had received blood transfusion.

SYMPTOMS OF HEPATITIS. Prodromal and icteric stages The prodromal and icteric stages of hepatitis depend on the bile accumulation in the bloodstream. As the liver is being affected by the virus, bile is no longer able to pass through the liver. When that happens, we will see symptoms like clay-colored stools, and dark urine, on top of systemic problems such as fever, malaise, nausea, vomiting, abdominal pain . When enough bile is accumulated in the bloodstream to enter the ICTERIC stage, that is when liver specific symptoms appear such as Jaundice, abdominal pain to the upper right quadrant, yellowing of the eyes, Pruritus and elevated liver enymes such as ALT, AST etc Prodromal few days to two weeks Icteric- 5-10 days after prodromal stage starts. Interventions for all hepatitis 1) encourage patients to not share products. They are not necessarily going to be isolated unless they are contaminated with their feces 2) bed rest 3) small and increased meals : DIET IS low fat- because of bile(Fat) impermeability 4) COOL baths for pruritus 5) steroids, anti-inflammatory, immunosuppressive (to avoid the attacking of body) 6) REINFORCE STANDARD PRECAUTIONS HANDWASHING IS IMPORTANT TO HEP. HH= HANDWASING HEPATITIS 7) diapers of infected children should be disinfected with CUP OF BLEACH AND 1 GALLON OF WATER 8) Hep A is no longer contagious 1 week after jaundice appears. Children can return to school

POSIONING Iron poisoning- Desferal antidote

Lead poisoning- toxicity is over 20 Treatment: chelating therapy excretes Iron out of the system via the Kidneys but doesnt counteract it. The medication Medications include calcium disodium edetate (CaNa2EDTA), and succimer (Chemet), an oral preparation; British anti-Lewisite (BAL, dimercaprol) is used in conjunction with EDTA. (via IV or deep IM)

This poisoning can affect the CNS which is severe 1) assess for urinary output before administering the medications 2) assess for nephrotoxicity, hepatic toxicity 3) drink lots of fluids to flush it out 4) educate parents about lead containing substances that should be avoided Acetominophen poisonng antidote is N-acetyl systeine (Mcomyst). Toxicity level is beyond 150. Assessment: 2-4 hours after exposure: FEVER, MALAISE, N/V, SWEATING, PALLOR, WEAKNESS. Latent: hepatic involvement: jaundice, right upper q pain, fever, n/v, malaise, increased liver enzymes 1) dilute the antidote in juice/soda because of its ba taste IF PATIENT IS UNCONSCIOUS: DO NOT USE ANTIDOTE. GO WITH GASTRIC LAVAGE!!! 1) gastric lavage for the excretion of acetaminophen with ACTIVATED CHARCOAL, to reduce the absorption of acetaminophen. Aspirin poisoning antidote: activated charcoal 1) symptoms involve GI, CNS, Renal, and metabolic 2) sodium bicarbonate iv fluids may be administered to correct the acid in the stomach lining 3) vit K, anticonvulsants, oxygen IF UNCONSCIOUS- DIALYSIS Corrosive poisoning Assessment : sore throat, burning throat, vomiting, fever, edematous membranes (lips, tongue and throat) . drooling and inability to clear secretions Interventions: drink 4oz of milk/water. Do not use chelating agent b/c of adverse reaction and do not induce vomiting because of acid on the throat. POISONING CONTROL- all parents should post poison control numbers near each phone in each of emergency Steps in response to poisoned child: (always treat the child first, then poison) 1) assess lung sounds and ensure patent airway, breathing and circulation vital signs 2) STOP the exposure to poison by taking poison out of mouth 3) find out what the poison is from parents 4) implement the antidote procedure for that particular poison 5) documentation

CIRROHSIS (symptoms caused by Ammonia) - A complication of hepatitis , or the result of necrosis of hepatocytes. The death of these liver cells can cause a wide array of problems that involve the nervous system, renal system, liver system and everything else. One of the biggest problems and signs of Cirrhosis, which can be remembered by how it sounds similar to Fibrosis , and necrosis, is ASCITES. It is heavily monitored throughout the disease and aimed to reduce. - Portal hypertension is the increase of pressure in the liver veins that is produced due to destruction of liver blood flow from obstruction/fibrosis/necrosis - Neurological defects- due to ability to detoxify Ammonia which is neurotoxic= hence neurological defects surface such as Axterisis, neurological disturbances, cognition decline

Asterixis is a sign of Cirrhosis which is the involuntary flapping of the wrists in tremors Esophageal varices- are esophageal veins that are distended and ruptured causing hemorrhage. Renal failure associated with Cirrhosis- where kidneys start to fail by decreased I/O, increased urea nitrogen, BUN increased fetor hepaticus fruity and musky odor that indicates liver failure hemorrhage- due to the inability to absorb fat soluble vitamin such as Vitamin K which helps stop bleeding deficient in fat soluble vitamins A, D , E, K other hepatic symptoms- jaundice, pruritis, fever, malaise, upper right quadrant pain, nausea/vomiting, elevated liver enzymes, edema, constipation/diarrhea

Diagnostic Tests: Ct scan Liver enzymes EGD (esophagogastroduodenoscopy) Lab tests with liver enzymes, increased ammonia levels, and PT time is decreased Interventions - raise head of bed to alleviate shortness of breathe 1) lower blood pressure by taking blood pressure medications 2) measure abdominal girth lately- if too much may to paracentesis . measure around umbilicus and make sure its marked on patients abdomen 3) urine and output must be measured. Measure weight and abdominal girth 4) tamponade may be done to stop bleeding 5) diet: high protein, low fat. At end stage liver, protein is restricted 6) restriction of fluids to combat ascites- and administer diuretics to treat ascites . restrict sodium intake 7) tube feedings if necessary 8) monitor level of consciousness and other neuro problems 9) meds: vitamin K- promote bleeding, Lactulose secrets ammonia, antacids- neutralize acid in the stomach (ammonia) , diuretics, cathartics 10) no alcohol 11) after injections or doing anything that penetrates the patients skin, put pressure on it for five minutes due to bleeding tendencies Esophageal varices- distention of esophagus veins due to Cirrhosis and they rupture at times. When they rupture it is an emergency and must be treated immediately. Sx- ascites, hemorrhage, hepatomegaly, splenelomegaly , blood throwing up, blood in stools, tarry, melena Interventions 1) high fowlers position 2) assess lung sounds to make sure no distress 3) airway- administer oxygen - monitor LOC , o2 sat 4) check for hemorrhage, hgb and hct levels should be monitored 5) ng tube

To stop bleeding: 1) tamponade to the varices to stop bleeding 2) clotting factors and blood transfusions are performed Surgeries: 1) sclerotherapy- sclerosis of varices 2) esophageal ligation tying off of varices 3) shunt diverting portal vein away from esophageal, but to systemic vein 4) the ligation of portal and systemic veins in liver

Pancreatitis it is the inflammation of pancreas due to its enzymes attacking itself. The enzymes are known as lipase, amylase, trypsin, and they are elevated during pancreatitis There are two categories of pancreatitisAcute and Chronic Acute is when the pancreas is attacked once, and chronic is when its more than once This inflammation is usually caused by many precursors- most commonly Alcohol but not limited to Biliary Disease, colecysthiasis (gallbladder), bacterial and viral infection, blunt trauma to the abdomen, peptic ulcers, long term use of certain medications such as steroids, thiazide diuretics, oral contraceptives, opiates and sulfonamides, surgery on pancreas and ERCP procedure Dx: Ct scan, MRI scan, ERCP, elevated liver enzymes, Cullens Sign (discoloration straie on the abdomen) and tumers sign is the discoloration on the flanks, ABGs. Symptoms for acute Epigastric pain that radiates to the back Abdominal distention N/V Elevated blood glucose Elevated liver enzymes Pain from fatty meals Weight loss from the absorbing nutrients well Elevated WBC Calcium levels are decreased Symptoms for chronic Left upper quadrant MASS Steorrhea Jaundice from not processing bile and Diabetes m. symptoms!

Interventions 1) NPO - administer iv fluids to inhibit pancreatic enzymes

2) NG tube to prevent the secretions of pancreatic enzymes and to supplement nutrition 2a) Demerol for pain and doesnt aggravate pancreas that much 3) antacids, h2 antagonists, anticholinergics 4) Diet: low protein, low fat 5) make sure client is aware of chronic pancreatitis symptoms: abdominal distention,jaundice and fatty stools 6) do cough/deep breathing to make sure infection doesnt happen 7) put patient in a knee chest position, side lying For chronic pancreatitis 1) everything above plus, administering medications that aid in the digestion of pancreatic enzymes 2)administering pancreatic enzymes 3) must do follow up visits 4) be aware of complications sterrohea, jaundice, ab distention on left up quadrant Medications: narcotic analgesics, histamine 2 blockers, calcium gluconate to increase calcium levels, VIOKASE, vitamins A, D, E, K, antibiotics, insulin Pancreatic Cancer is located in the head of pancreas, deep within tissue which causes obstruction in the common duct. It is the cancer of the epithelium of the ducts known as adenocarcinoma. The pancreas is important to the vitality of the body as it regulates sugar metabolism and digestion. - High malignant The problem with this is that symptoms dont appear until tumor is large- which is why the prognosis is so poor Causes: When your cells in your DNA are mutated The risk factors are: -Ethnicity of African American -Smoking -high fat diet ! -Environmental Toxins -Acute/Chronic Pancreatitis -Hereditary Pancreatitis -Obese -Age over 50 -diabets mellitus dx- ERCP procedure! ** The symptoms are similar to Pancreatitis except there is a tumor in the pancreas. Intervention 1. Radiation 2. Chemotherapy 3. Whipple procedure- where the head of the pancreas is removed (where the tumor is) , the removal of duodenum, and the distal third of the stomach is removed and gallbladder is

removed so that the pancreas so that 1) the pancreatic enzymes can flow directly into the jejunum, and 2) the bile duct is connected straight to the jejunum. 4. Post operative monitoring- like any other gastric surgeries- always monitor for hyper/hypo glycemia. a. Start off with liquid diet on first day, second day can go back to solid foods and second day can start ambulating and transferred onto a regular floor b. Drains are monitored until 4-5 th day after the surgery

CHOLECYSTITIS/COLELITHIASIS Cholecystitis: Is the defined as the inflammation of the gallbladder when gallstones are collected in the duct. Colelithiasis: Gallstones are formed when bile in the gallbladder are formed into hard-like stones which are precipitated by Bilirubin, cholesterol (fat), calcium gluconate. Gallbladder disease is identified with a positive MURPHY sign which is pain when examiners fingers are placed on the gallbladder upon inhalation Causes of these conditions are: 1) genetic history 2) dietary habits of eating foods high in fat 3) drug use such as cholesterol lowering agents 4) conditions such as diabetes, Crohns disease, hemolytic blood diorders Four 4s as for the risk factors for Choleolithias (only gallstones) f- fourty f- female f- fertile f- fat Symptoms PAIN in upper RUQ especially after a fatty meal and can radiate to the RIGHT shoulder The inhibition of bile excretion manifests in jaundice in eyes and on skin, vitamin A, D, E, K deficient, clay colored stools, dark urine , fatty stools, abdominal distention, flatulence, dyspepsia (indigestion), fever Diagnostic Tests: Gallbladder imaging Abdominal X ray ERCP Heptobiliary scan Intervention for Cholecystitis1) NPO, IV fluids, nG suction 2) anti-inflammatory medications, antibiotics, anticholinergics DIET: skim milk, cooked frits, rice tapioca, lean meats, mashed potatoes, nongas-forming vegetables, bread, coffee and tea Not allowed: eggs, cream, pork, fried foods, cheese, gas formin food, alcohol, rich dressings

Intervention for cholecysthias 1)Acidic drugs that aer used to break up the gallstones UDCA or CDCA. 2) ESWL- extracorporeal shock wave lithotripsy- is the emission of electrical waves directed at the patients gallstones in different positions to loosen up the gallstones so they can be passed through the bile duct can return to normal routine in 48 hours Surgeries: 1)laparoscopic- small incisions to remove gallbladder and gallstones- less complications and pain 2) cholecystectomy when stones are too big . the removal of gallbladder and a PENHOSE drain is attached to the drainage to drain out serosanguinous fluid/bile. T tube is inserted in the duct to drain out bile until bile duct does not swell anymore. - Position patient with T tube in a Semi-Fowlers position to facilitate drainage - Note drainage, amount if a sudden increase tell doctor - Keep it below the gallbladder COLOTRIUM DIFICLE - Usually happens after the ingestion of antibiotics - Risk factors are for people who stay at hospitals for too long, elderly clients and immunosuppressive It is when the intestines are infected with this strand Diagnostic stool sampling SymptomsFoul smelling stool, abdominal cramping, diarrhea, fever Treatment -Antibiotics flagyl or vacomcin -STRICT handwashng -isolation of patient -contact precautions Food borne illnesses 1) Botulism- from canned foods and It is a serious illness that can cause death due to the production of a neurotoxin within 24 hours of exposure/ingestion Symptoms- abdominal pain, neurological decline, respiratory decline, N/V Treatment- NPO, antibiotics, anti-toxin and respiratory support, tell client to cook canned foods for 20 minutes 2) e-coli- from uncooked beef, shellfish and food contaminated with fecal matter Symptoms- nausea and diarrhea and can cause death because of the sudden fluid loss Treatment- antibiotics and iv fluid administration 3) Salmonella- raw eggs , contaminated food 4) staphyloccal- from meat, dairy products, human carriers Lots of vomiting and diarrhea- so treatment is to replace iv fluids GI procedures and considerations Endoscopy- check for respiratory depression prior to test Gastroscopy- check for oral reflex before inserting things in there

Liver biopsy- check for risk of bleeding Barium enema Barium swallow Colonoscopy Sigmoidoscopy Endoscopic exams Gallbladder H pylori Liver panel blood tests pH motility studies upper GI studies