Gastrointestinal

Stomach
● Temporary storage for food
● Mixing and breakdown of food
● Digestion of food

Gastric ulcer
● Cause
○ H. Pylori
○ Overuse of NSAIDs
● Symptoms
○ Pain 1-2 hours after meal
○ Abdominal pain aggravated by
eating
○ Vomiting
○ Weight loss
○ Hematemesis if hemorrhage
occurs.
● Treatment
○ Treat H. Pylori infection
■ Antibiotics
○ Reduce stomach acid
■ H2-receptor blocker
■ Proton pump inhibitor
Duodenal ulcer
● Cause
○ H. Pylori
○ Overuse of NSAIDs
● Symptoms
○ Pain 2-4 hours after meals
○ Food may relieve pain
○ Weight gain
○ Melena if hemorrhage occurs.
● Treatment
○ Treat H. Pylori infection
■ Antibiotics
○ Reduce stomach acid
■ H2-receptor blocker
■ Proton pump inhibitor

Acid Reducers
H2 Receptor Blockers Proton Pump Inhibitors
famotidine, cimetidine, nizatidine omeprazole, lansoprazole, pantoprazole
● Decrease gastric acid secretion by binding ● Block gastric acid secretion by binding to
to histamine receptors on gastric parietal and inhibiting the hydrogen-potassium
cells. ATPase pump.
● Take with food. ● Take 30 minutes before first meal of the
● Take 30-90 minutes to start working. day.

GI protectant
Sucralfate
● Sticks to damaged ulcer tissue protecting it
against acid and enzymes
● Allow healing to take place
● Take on an empty stomach (2 hours after or 1
before food)
● Take at least 30 minutes apart from antacids
NCLEX Question
The patient is prescribed omeprazole. You know that the intended action of this
medication is to:
A. Enhance intestinal motility
B. Reduce esophageal pressure
C. Eradication of H. pylori growth
D. Increase stomach pH

Answer: D
Choice D is correct. Increase stomach pH. The primary action of the proton pump inhibitors (PPIs) is to
increase stomach pH or decrease the amount of acid in the stomach. The wall of the stomach produces
an enzyme that produces stomach acid. These PPI medications block those enzymes. Although the PPIs
are used in combination with antibiotics to limit H. pylori growth, it is the antibiotic that eradicates the
bacteria. The nurse should warn the patient against long-term use of PPIs since there is evidence that
this may increase the risk for osteoporosis-related fractures, hypomagnesemia, and myocardial
infarctions.

Choices A, B, and C are incorrect.

NCLEX Question
The nurse is teaching a client about the newly prescribed medication,
omeprazole. Which statement, if made by the client, would require further
teaching? Select all that apply.
A. “I should take this medication with meals and with water.”
B. “I should not take this with any other medication or food.”
C. “The medication will coat my ulcer so I can eat without pain.”
D. “I will need frequent laboratory tests while taking this medication.”
E. “I may need to take magnesium supplements while on this medication.”

Answer: A, C, + D
Choices A, C, D are correct. Esomeprazole is a proton pump inhibitor (PPI) indicated in
treating esophageal erosion, GERD, and peptic ulcer disease. The medication should be
taken half an hour before meals and with an ample amount of water. The medication does
not fortify an existing ulcer, like sucralfate. The client does not require frequent laboratory
testing while on this medication.

Choices B and E are incorrect. Correct teaching for a client receiving esomeprazole would
include taking the medication independent of any other food or medicine as it will decrease
its absorption. PPIs have the proclivity of causing hypomagnesemia, and thus, magnesium
supplementation may be recommended by the PHCP.
 Ulcerative Colitis & Crohn's
Disease

Small + Large Intestines

● Small intestines
○ Absorbs nutrients!!
○ Churn and mix ingested food, making it into chyme.
○ Move the food along its entire length (into the colon)
○ Mix ingested food with mucus (making it easier to move)
○ Receive digesting enzymes from the pancreas and liver (via the pancreatic and common bile
ducts)
● Large intestines (colon)
○ Absorbing water and electrolytes
○ Producing and absorbing vitamins
○ Forming and propelling feces toward the rectum for elimination.
What is Ulcerative Colitis?
● Inflammation of the large intestines.

What is Crohn's Disease

● Inflammation AND erosion of the ileum and anywhere throughout the small
and large intestines.
Assessment
● Rebound tenderness
● Cramping
● Diarrhea
● Vomiting
● Dehydration
● Weight loss
● Rectal bleeding
● Bloody stools
● Anemia
● Fever

Treatment
● Low fiber diet
● Avoid cold or hot foods
● No smoking
● Antidiarrheals
● Antibiotics
● Steroids
● In severe cases may end up surgically removing affected portion of the
intestines.
○ Ileostomy
○ Colostomy
 Appendicitis

What is appendicitis?
● Inflammation of the appendix
● Most common age = 10 years
● Most common abdominal surgery in children
● Perforation more common in children
Assessment
● Abdominal pain
○ Usually begins as generalized pain
○ Pain localizes to RLQ - McBurney’s Point
○ Rebound tenderness → indicates peritonitis
○ Sudden relief of the pain indicates perforation
● Nausea
● Vomiting
● Decreased appetite
● Fever
● Labs
○ CBC shows elevated WBC
○ Elevated CRP
● Imaging
○ CT shows inflamed appendix

Treatment
● Treatment - appendectomy
● Pre-op
○ No heat - this can aggravate inflamed appendix and cause rupture
○ Position right side, low Fowler’s for comfort
● Post-op
○ IV Fluids
○ IV antibiotics
○ Pain management
○ NPO until return of bowel sounds
○ Wound care
NCLEX Question
The patient with appendicitis is experiencing discomfort before her
appendectomy. The nurse should avoid which of the following
non-pharmaceutical therapies to relieve this discomfort?
A. Applying ice packs to the abdomen
B. Practicing breathing exercises with the patient
C. Using a heating pad
D. Encouraging rest

Answer: C
Choice C is correct. Heat should not be applied to the abdomen of patients experiencing pain from
appendicitis. Heat may cause a rupture of the appendix, which puts the client at risk for a life-threatening
condition known as peritonitis.

Choice A is incorrect. Applying ice packs to the abdomen of a patient experiencing discomfort related to
appendicitis is an appropriate non-pharmaceutical intervention.

Choice B is incorrect. Using breathing techniques to work through the pain of appendicitis is an
appropriate non-pharmaceutical intervention.

Choice D is incorrect. Encouraging plenty of rest is an excellent way to prevent and manage pain from
appendicitis.
NCLEX Question
The nurse is reassessing their client diagnosed with appendicitis. The client
expressed 8/10 pain at her last assessment, and now states they has no pain.
The nurse did not administer any pain medication. What is the critical nursing
action?

A. Document the pain score

B. Assess the client's abdomen
C. Notify the healthcare provider
D. Palpate McBurney’s point

NCLEX Question
The nurse is reassessing their client diagnosed with appendicitis. The client
expressed 8/10 pain at her last assessment, and now states they has no pain.
The nurse did not administer any pain medication. What is the critical nursing
action?

A. Document the pain score

B. Assess the client's abdomen
C. Notify the healthcare provider
D. Palpate McBurney’s point
Answer: C
A is incorrect. When a client diagnosed with appendicitis has sudden relief of pain, it is a sign of possible rupture
of the appendix. This is a surgical emergency and the client must be taken to the operating room quickly. It is not
appropriate for the nurse to document the pain score without further intervention.

B is incorrect. It is not appropriate to simply assess the client's abdomen without further intervention. Sudden
relief of pain is concerning for rupture of the appendix and requires another action.

C is correct. The nurse should immediately notify the healthcare provider of this change in the client's status. A
sudden change of 8/10 pain to no pain in the client diagnosed with appendicitis could indicate rupture, and the
healthcare provider needs to be immediately notified.

D is incorrect. The client with appendicitis will likely have pain at McBurney’s point, but this client is expressing
a sudden relief of their pain. This needs to be evaluated for possible rupture, and therefore the nurse should
immediately notify the healthcare provider.
NCSBN Client Need:
Topic: Physiological Integrity Subtopic: Physiological adaptation

Reference: Hockenberry, M., Wilson, D. & Rodgers, C. (2017). Wong’s essentials of Pediatric Nursing (10th ed.) St. Louis, MO: Elsevier Limited.

Subject: Pediatric
Lesson: Endocrine

Pancreatitis
Functions of the pancreas
● Endocrine function
○ Regulates blood sugar
■ Releases insulin
■ Releases glucagon
● Exocrine function
○ Plays a big role in digestion
■ Produces and releases digestive enzymes
● Trypsin → Break down proteins
● Amylase → Breaks for carbohydrates
● Lipase → Breaks down fats
■ Enzymes released into the duodenum

What is pancreatitis?
Inflammation of the pancreas.

No. 1 cause = alcoholism

Pathophysiology
● Digestive enzymes
activate inside of the
pancreas.
● This causes
autodigestion of the
pancreas.

Assessment
● Pain ● Labs
○ Increased WBCs
○ Increases with eating due to increased enzymes
○ Increase serum lipase
● Abdominal distention
● Ascites
● Abdominal mass
● Rigid abdomen
● Cullen’s sign
● Gray Turner’s sign
● Fever
● Nausea & vomiting
● Jaundice
● Hypotension
Treatment
● NPO
● NGT to suction
● Bed rest
● Pain medications
● Steroids
● GI protectants
○ PPIs
○ H2 blockers
○ Antacids
● Monitor I&O’s
○ Fluid and electrolyte balances
● Daily weight
● NO ALCOHOL

Antacids
● Neutralize gastric acid by acting as a buffer in the acidic environment of the
stomach.
● Increases the pH in the stomach.

Examples:
Calcium carbonate (alka-seltzer, tums)
Magnesium hydroxide
Bismuth subsalicylate (Pepto-Bismol)
NCLEX Question
A patient is being evaluated in the clinic for pancreatitis. Besides an elevated
white blood cell count and serum lipase levels, which assessment finding
indicates a positive finding for pancreatitis?
A. The discoloration of the abdomen and periumbilical area
B. Overactive bowel sounds
C. Low bilirubin levels
D. Bluish discoloration of the soles of the feet

Answer: A
Choice A is correct. The discoloration of the abdomen and periumbilical area is known as Cullen’s sign
and indicates pancreatitis when it occurs in conjunction with other symptoms. Other findings include
elevated white blood cell count, bilirubin, and urinary amylase levels.

Choice B is incorrect. In pancreatitis, bowel sounds are generally diminished or absent.

Choice C is incorrect. Bilirubin levels are generally elevated in instances of pancreatitis.

Choice D is incorrect. Bluish discoloration of the feet is not associated with pancreatitis. However, bluish
discoloration of the flanks is known as Turner’s sign and is used as an indicator of pancreatitis.
 Hepatitis

Functions of the liver

● Produces bile
● Produces albumin
● Produces cholesterol
● Converts glucose to glycogen for storage
● Conversion of ammonia to urea
● Metabolism of bilirubin in the breakdown of red blood cells
● Metabolism of drugs and toxins
● Production of clotting factors and regulation of blood clotting
What is hepatitis?
● Inflammation of the liver.
● Can progress to cirrhosis
● Types A, B, C, D, and E - caused by different viral infections
● Severe cases can lead to a hepatic coma.
Hepatic coma
● Protein in your diet is broken down into ammonia.
● Liver is supposed to convert the ammonia into urea.
○ Kidneys can excrete urea.
● When there is inflammation of the liver due to hepatitis, the ammonia builds
up instead of being converted to urea
● Increased ammonia levels can cause a hepatic coma.

Assessment
● Altered level of
consciousness
● Difficult to
awake
● Hyperreflexia
● Asterixis
● Fetor
Treatment
● Lactulose
○ Bacteria in the colon digest lactulose into chemicals that bind ammonia
○ The binding of ammonia prevents ammonia from moving from the colon into the blood
○ Allows the ammonia to be excreted decreasing serum ammonia
● Cleansing enema
● Decreased protein
● Monitor serum ammonia

Cirrhosis
What is Cirrhosis?
● A chronic disease of the liver marked by degeneration of cells, inflammation, and fibrous thickening
of tissue.
● Liver cells destroyed and replaced with scar tissue
● This impairs blood flow to the liver causing portal hypertension
● Causes:
○ Alcoholism
○ Hepatitis

Assessment
● Palpable, firm liver
● Abdominal pain
● Dyspepsia
● Decreased serum albumin
● Ascites
● Splenomegaly
● Increased liver enzymes
○ ALT
○ AST
● One of the major functions of the liver is the production of clotting factors.
● Liver damage = bleeding risk
○ Anemia
Treatment
● Antacids
● Vitamins
● Diuretics
● Paracentesis
● Low protein, low sodium diet
● Stricts I&Os
● Daily weights
● Bleeding precautions
● Skin care
● Be very careful with drug doses. The liver cannot metabolize as well; most doses need
to be decreased. Especially important with :
○ Narcotics
○ Acetaminophen (as a rule, avoid in liver clients)