DISORDERS OF THE ORAL CAVITY Nursing Management

o Assess oral hygiene practices and educate

the patient on proper brushing and flossing
Dental Plaque and Caries
techniques.
- Dental plaque is a soft, sticky biofilm that o Promote adequate hydration to prevent
forms on teeth due to the accumulation of dry mouth.
bacteria, food particles, and saliva. If not o Encourage regular dental visits for
removed, plaque hardens into tartar and professional cleanings and check-ups.
can lead to dental caries (cavities), which o Administer pain relief measures such as
are the destruction of the tooth enamel warm saline rinses or prescribed analgesics.
and underlying structures due to bacterial o Educate about dietary modifications to
activity. Caries occur when acids reduce sugar intake and increase fluoride
produced by bacteria erode the enamel, consumption.
leading to decay and potential tooth loss. o Refer to a dentist for further evaluation and
treatment if necessary.

Risk Factors
Medical Management
o Poor oral hygiene (infrequent or improper
brushing and flossing) o Professional dental cleaning to remove
o High sugar and carbohydrate diet plaque and tartar buildup.
(encourages bacterial growth) o Fluoride treatments to strengthen enamel
o Inadequate fluoride exposure (fluoride and prevent further decay.
strengthens enamel) o Dental fillings for minor cavities.
o Dry mouth (xerostomia) (reduces saliva, o Root canal therapy if decay reaches the
which neutralizes acids) tooth pulp.
o Smoking and tobacco use o Tooth extraction in severe cases of decay.
o Gastroesophageal reflux disease (GERD) o Antibiotics if there is an infection associated
(acid exposure weakens enamel) with an abscess.
o Genetic predisposition (some people are
more susceptible to cavities)
Periapical Abscess

Assessment - A periapical abscess is a localized

collection of pus at the apex (tip) of a tooth
History: Oral hygiene habits, diet, pain, sensitivity, root, usually caused by a bacterial
and previous dental issues. infection. It often results from untreated
dental caries, trauma, or previous dental
Physical Examination:
procedures that allow bacteria to invade
o Inspect teeth for plaque, discoloration, or the pulp chamber, leading to inflammation
visible cavities. and pus formation.
o Use a dental probe to detect soft spots.
o Check for gum inflammation or bleeding.
o Assess for bad breath (halitosis) Risk Factors

o Poor oral hygiene (infrequent or improper

brushing and flossing)
Signs and Symptoms
o Untreated dental cavities (dental caries)
o White, brown, or black spots on teeth o Dental trauma (e.g., fractures, cracks)
o Tooth sensitivity to hot, cold, or sweet foods o Previous dental procedures (e.g., root
o Tooth pain, especially while chewing canal treatment failure)
o Bad breath (halitosis) o Weakened immune system (e.g., diabetes,
o Visible holes or pits in teeth HIV/AIDS)
o Swollen or bleeding gums (if plaque leads o High-sugar diet, leading to tooth decay
to gingivitis) o Smoking and tobacco use
o Dry mouth (xerostomia), reducing saliva
protection against bacteria
Signs and Symptoms Medications

o Swelling of the face, jaw, or cheek o Antibiotics (e.g., Amoxicillin, Clindamycin,

o Gum redness and swelling around the Metronidazole) for bacterial control.
affected tooth o Pain relievers (e.g., Ibuprofen,
o Presence of pus or drainage from the gum Acetaminophen) for symptom relief.
o Pain radiating to jaw, ear, or neck
Follow-Up Care:
o Lymphadenopathy (swollen lymph nodes)
o Bad breath (halitosis) or foul taste in the o Regular dental check-ups to prevent
mouth recurrence.
o Difficulty chewing or biting o Treatment of underlying causes, such as
o Fever cavities or gum disease.
o Severe, persistent, throbbing toothache

DISORDERS OF THE JAW

Nursing Management
Your jaw is a set of bones that holds your teeth. It
Pain Management:
includes:
o Assess pain intensity using a pain scale.
- The maxilla, which is the upper part of your
o Administer prescribed analgesics
jaw. It holds your top teeth in place and
o Apply cold compresses externally to
doesn't move. It also supports the muscles
reduce swelling and discomfort
involved in chewing and facial expressions.
Infection Control: - The mandible, which is the lower part of
your jaw. You move it when you talk or
o Encourage proper oral hygiene (brushing, chew. It also holds your lower teeth in
flossing, mouth rinses). place.
o Monitor for signs of systemic infection (e.g., - The temporomandibular joints (TMJs),
fever, chills, increasing swelling). which are two joints (one on each side)
o Administer prescribed antibiotics as that connect your mandible to your skull.
needed

Nutritional Support:
Jaw problems can include:
o Encourage soft or liquid diet if chewing is
painful. o Fractures (broken bones).
o Promote adequate fluid intake to prevent o Dislocations, which are joint injuries that
dehydration. force the ends of your bones out of position.
o Temporomandibular disorders (TMDs),
Patient Education: which are conditions that affect your TMJs.
o Teach proper oral hygiene practices to
prevent recurrence.
o Advise patients to avoid chewing on the Temporomandibular disorders (TMDs)
affected side until treated.
o Educate about the importance of seeking - Are conditions affecting your jaw joints and
prompt dental care. surrounding muscles and ligaments.
- These conditions can cause several issues,
including jaw pain, headaches and
difficulty opening and closing your mouth.
Medical Management

Drainage of Abscess
Risk Factors
o Incision and drainage by a dentist to
remove pus and relieve pressure. o Different types of arthritis, such as
o Root canal therapy if the tooth is rheumatoid arthritis or osteoarthritis.
salvageable to remove infected pulp. o Jaw injury.
o Tooth extraction if the infection is severe o Habits such as gum chewing, nail biting,
and the tooth is non-restorable. and grinding or clenching of teeth.
o Certain connective tissue diseases.
 o Stress, post-traumatic stress disorder, Medication
anxiety or depression.
o Pain relievers like acetaminophen.
o Conditions such as fibromyalgia, ankylosing
o Nonsteroidal anti-inflammatory drugs
spondylitis and sleep disturbances.
(NSAIDs) like ibuprofen and naproxen.
o Smoking.
o Muscle relaxers (particularly helpful for
people who clench or grind their teeth).
o Antidepressants (which can change how
Signs and Symptoms
your body interprets pain).
o Jaw pain Nonsurgical TMJ treatments
o Facial pain
o Shoulder or neck pain o Mouth guards.
o Stiffness in your jaw o Physical therapy.
o Difficulty opening or closing your mouth o Trigger point injections.
o Jaw popping or clicking o Ultrasound therapy.
o Headaches o Transcutaneous electrical nerve stimulation
o Migraines (TENS). Behavioral changes.
o Earaches
Surgical TMJ treatments
o Toothaches
o Tinnitus (ringing in your ears) o Arthrocentesis.
o A change in the way your teeth fit together o TMJ arthroscopy.
(malocclusion) o Open-joint surgery.

Diagnostic Test
DISORDER OF THE SALIVARY GLANDS
Healthcare providers can diagnose TMJ disorder
- Salivary glands produce saliva for
during a dental checkup or physical examination.
digestion, lubrication, and protection.
During this visit, they’ll:
- (Major) Parotid Glands, Submandibular
o Observe your range of motion when you Glands, Sublingual Glands.
open and close your mouth. - (Minor) Lips, Buccal mucosa, lining of the
o Press on your face and jaw to find areas of mouth and throat.
discomfort. - Disorders can result from infections,
o Feel around your jaw joints while you open blockages, or tumors.
and close your mouth. - Common disorders: Parotitis, Sialadenitis,
Sialolithiasis, and Neoplasms.
They may also take imaging tests to get a closer
look at your jaw joints and the structures around
them. These imaging tests may include:
Parotitis
o Dental X-rays.
- Inflammation of the parotid gland.
o CT (computed tomography) scans.
- Swells and becomestense and tender.
o MRI (magnetic resonance imaging).
- Pain in the ear, and swollen glands interfere
o TMJ arthroscopy (used for diagnosis and, in
with swallowing. It becomesred and shiny
some cases, treatment).
ifswelling worsen.
- Causes: Viral (mumps)-Epidemic Parotitis,
bacterial (*Staphylococcus aureus*),
Management and Treatment dehydration.
- Providers usually try noninvasive options - Risk Factors: Old, ill person, poor hygiene,
first, like medications or nonsurgical malnutrition, immunosuppression.
treatments. If your symptoms don’t - Signs & Symptoms: Swelling, pain, fever,
improve, you might need jaw surgery. chills, and pus discharge or othersystemic
signs of infections.
- Diagnostic tests: CBC, culture and sensitivity
test, viral serology, ultrasound, CT scan or
MRI (ifsevere or chronic)
- Nursing Management: Hydration, cold
compresses, good oral hygiene, and
 discontinue medications (tranquilizers, Neoplasms (Tumors)
diuretic agents).
- Medical Management: Antibiotics (if - Salivary gland neoplasms (tumors or
bacterial), Analgesics (pain relief),surgical growths).
drainage (ifsevere)-(Parotidectomy) - Abnormal growths, can be benign or
malignant (cancerous).
- Benign – painless swelling of the glands.
- Malignant - tend to have neurologic
Sialadenitis symptoms (weakness or numbness of the
- Inflammation of salivary glands. facial nerve), and persistent facia pain.
- Causes: *Staphylococcus aureus*, - Causes: Radiation exposure, aging, HPV
dehydration, radiation therapy, stress, infection.
malnutrition, salivary gland calculi - Risk Factors: Pre exposure to ionizing
(stones;sialolithiasis) , and poor oral radiation to the head and neeck, older
hygiene. age, and specific carcinogens.
- Risk Factors: Chronic illness, dry mouth, - Signs & Symptoms: Painless lump,
post-surgery. numbness, difficulty swallowing.
- Signs & Symptoms: Pain,swelling, pus - Diagnostic tests: Fine-needle aspiration
discharge, fever. biopsy, PET scan, ultrasound, MRI and CT
- Diagnostic tests: CBC, culture sensitivity test, scan.
ultrasound, sialography, CT scan/MRI (for - Nursing Management: Monitor for growth,
severe or recurrent cases) provide emotional support.
- Nursing Management: Oral hygiene, - Medical Management: Surgery- Dissection
hydration, warm compresses, massage, to preserve the 7th CN (facial nerve),
sialagogues (substance that trigger saliva Radiation therapy, and chemotherapy.
flow like hard candy or lemon juice). - Complications: facial nerve dysfunction,
- Medical Management: Antibiotics, pain and frey syndrome (auriculotemporal
relief, salivary stimulants,surgical drainage. syndrome) - treated with botulinum toxin
- Sialendoscopy - allows for direct type A injections.
visualization of Stensen duct (diagnostic)
and instillation of antibiotics,
corticosteroids, or irrigation (treatment).

Sialolithiasis (Salivary Calculus)

- Salivary calculi (stones), stone formation in
salivary ducts, blocking saliva flow.
- Gland is swollen and quiet tender, the
stone itself may be palpable.
- Formed mainly from calcium phosphate.
- Diagnostic test: Ultrasound, noncontrast CT
scan, orsialography.
- Causes: Swelling, a sudden and local, often
cockily pain
- Risk Factors: Poor hydration, diet, chronic
infections.
- Signs & Symptoms: Pain when
eating,swelling, hard lump.
- Nursing Management: Hydration, massage,
warm compresses.
- Medical Management: Sialagogues
(stimulate saliva), lithotripsy (shock wave
therapy), sialendoscopy or surgical
removal.
ORAL CANCER Nursing Diagnosis

- Oral cancer, also known as mouth cancer, o Impaired oral mucous membrane related
is a type of cancer that occurs in the lips, to tumor growth, surgery or radiation
tongue, cheeks, gums and throat. It is a therapy
type of head and neck cancer. o Impaired nutrition related to difficulty
swallowing, pain, or altered taste.

Risk Factors
Nursing Management
o Tobacco use (smoking)
o Excessive alcohol consumption o Promoting mouth care
o Human papillomavirus (HPV) infection o Ensuring adequate food and fluid intake
o Nicotine use (vaping) o Supporting a positive self-image
o Help to ease pain and discomfort

Assessment
Medical Management
o Medical History: Assess for risk factors, such
as tobacco use, alcohol consumption, and o Management varies with the nature of the
HPV infection. lesion
o Symptoms: Evaluate for symptoms, such as o Surgical resection and chemoradiation
mouth pain, difficulty swallowing, or (CRT)
changes in taste. o Radiation therapy may be more
o Oral Examination: Perform a thorough oral appropriate for larger lesions involving
examination, including: Inspection of the more than one third of the lip because of
lips, tongue, cheeks, gums, and floor of the superior cosmetic results.
mouth. o Chemotherapy
o A combination of radioactive interstitial
implants (surgical implantation of a
radioactive source into the tissue adjacent
Signs and Symptoms
to or at the tumor site) and external-beam
o Many oral cancers produce few or no radiation may be used.
symptoms in the early stages. o Total glossectomy (removal of the tongue)
o Most frequent symptom is a painless sore or o Reconstructive techniques involve the use
lesion that bleeds easily and does not heal. of the traditional pedicled (attached and
o Oral cancer may also present as a red or tunneled) regional tissue flaps (graft of
white patch (leukoplakia) in the mouth or tissue with its own blood supply) or the
throat. current mainstay of free (cut and
o A typical lesion in oral cancer is a painless removed).
indurated (hardened) ulcer with raised o Laryngeal preservation is associated with
edges. better speech and verbal communication,
o Depending on the location (tonsil, base of but swallowing and aspiration issues remain
the tongue, soft palate, or pharyngeal common functional deficits with total
wall), the patient may report tenderness, glossectomy and free flap reconstruction.
difficulty in chewing, swallowing, or
speaking, coughing of blood-tinged
sputum, trismus (limited jaw range of
motion), weight loss, a neck mass, or
enlarged cervical lymph nodes (NCI,
2021c).
HIATAL HERNIA AND Risk Factors

PARAESOPHAGEAL HERNIA o Age >50

o Previous abdominal surgery
- In the condition known as hiatal hernia, the o Obese
opening in the diaphragm through which o Chronic coughing
the esophagus passes becomes enlarged, o Smoking
and part of the upper stomach moves up
into the lower portion of the thorax.
Assessment & Diagnostic Findings
- Hiatal hernia occurs more often in women
than in men. - Diagnosis is typically confirmed by x-ray
- There are two main types of hiatal hernias: studies, barium swallow,
sliding and paraesophageal. esophagogastroduodenoscopy (EGD).
Which is the passage of a fiberoptic tube
through the mouth and throat into the
Sliding, or Type 1, Hiatal Hernia digestive tract for visualization of the
esophagus, stomach, and small intestine;
- Occurs when the upper stomach and the esophageal manometry; or chest CT scan
gastroesophageal junction are displaced (Kohn, Price, Demeester, et al., 2013).
upward and slide in and out of the thorax.
Between 90% and 95% of 3407 patients with
esophageal hiatal hernia have a sliding Nursing Management
hernia. 1. Frequent, small feedings that can pass
easily through the esophagus.
2. The patient is advised not to recline for 1
Paraesophageal Hernia hour after eating, to prevent reflux or
movement of the hernia elevate the head
- A paraesophageal hernia occurs when all
of the bed on 4- to 8- inch (10- to 20-cm)
or part of the stomach pushes through the
blocks to prevent the hernia from sliding
diaphragm beside the esophagus
upward.
paraesophageal hernias are further
3. Advances the diet slowly from liquids to
classified as types II, III, or IV, depending on
solids, while managing nausea and
the extent of herniation. Type IV has the
vomiting, tracking nutritional intake, and
greatest herniation, with other intra-
monitoring weight.
abdominal viscera such as the colon,
4. Monitors for postoperative belching,
omentum, or small bowel present in the
vomiting, gagging, abdominal distention,
hernia sac that is disp.
and epigastric chest pain, which may
indicate the need for surgical revision.

Clinical Manifestations
Medical Management
o Pyrosis
1. Antacids to neutralize stomach acid
o Regurgitation
2. H-2 receptor blockers to reduce acid
o Dysphagia
production
Many patients are asymptomatic. The patient may 3. Proton inhibitors to reduce acid production
present with vague symptoms of intermittent and heal the esophagus
epigastric pain or fullness after eating.

Sliding hiatal hernias are commonly associated Nursing Diagnosis

with GERD. 1. Impaired nutritional intake associated with
Hemorrhage, obstruction, volvulus (bowel difficulty swallowing.
obstruction caused by a twist in the intestines and 2. Risk for aspiration associated with difficulty
supporting mesentery), and strangulation can swallowing or tube feeding.
occur with any type of hernia but are more 3. Acute pain associated with difficulty
common with paraesophageal hernia (Huerta et swallowing, ingestion of an abrasive agent,
al., 2019). tumor, or frequent episodes of gastric
reflux.
ZENKER’S DIVERTICULUM Maintain Nutrition: Provide small, frequent meals
with soft or pureed food as tolerated.
- The most common type of diverticulum is
Monitor for Complications: Watch for signs of
Zenker Diverticulum (ZD). Located in the
aspiration (coughing, choking, respiratory distress)
pharyngoesophageal area, ZD is caused
and infection (fever, swelling, or drainage).
by a dysfunctional sphincter that fails to
open, which leads to increased pressure Educate the Patient: Educate about safe
that forces the mucosa and submucosa to swallowing techniques, dietary modifications, and
herniate through the esophageal the importance of follow-up care.
musculature (called a pulsion
diverticulum).
Medical Management

Risk Factors o Barium Swallow Study

o Endoscopic or Surgical Treatment
o Age: Most cases occur in people over 60 o Medications:
years old. - Proton Pump Inhibitors (PPIs): If
o Gender: Men are more likely to develop GERD is present, to reduce acid
Zenker's diverticulum than women. reflux.
o LIFESTYLE FACTORS - Antibiotics
o Esophageal Conditions: Conditions like o Dietary Modifications
gastroesophageal reflux disease (GERD)
can weaken the esophagus.
o Spinal Surgery

GASTROESOPHAGEAL REFLUX
Signs and Symptoms
DISEASE
o Dysphagia (difficulty swallowing)
- Is a condition in which stomach acid
o Fullness in the neck
repeatedly flows back up into the tube
o Belching
connecting the mouth and stomach,
o Regurgitation of undigested food
called the esophagus. It's often called
o Gurgling noises after eating
GERD for short. This backwash is known as
o Halitosis (foul odor from the mouth)
acid reflux, and it can irritate the lining of
o Sour taste in the mouth
the esophagus.
o Coughing (due to tracheal irritation or
- Excessive reflux may occur because of an
aspiration)
incompetent lower esophageal sphincter.
o Aspiration risk (especially in a recumbent
pyloric stenosis, hiatal hernia, or a motility
position)
disorder.
- The incidence of GERD seems to increase
with aging and is seen in patients with
Nursing Diagnosis irritable bowel syndrome and obstructive
airway disorder exacerbations, peptic ulcer
o Impaired Swallowing related to obstruction
disease, and angina.
caused by the diverticulum as evidenced
- GERD is associated with tobacco use,
by dysphagia and regurgitation of
coffee drinking, alcohol consumption, and
undigested food.
gastric infection with Helicobacter pylori
(Broers & Tack, 2017; Gabel, Galante, &
Freed man, 2019).
Nursing Management

Monitor for Dysphagia: Assess the patient’s ability

to swallow and note any signs of difficulty or
regurgitation.

Prevent Aspiration: Encourage an upright position

while eating and for at least 30 minutes after meals.
Risk Factors Medical Management

o Obesity. Antacids/ Acid neutralizing agents

o Bulging of the top of the stomach up above
o Calcium carbonate
the diaphragm, known as a hiatal hernia.
o Aluminum hydroxide, magnesium
o Pregnancy.
hydroxide, simethicone
o Connective tissue disorders, such as
scleroderma. Histamine-2 receptor antagonist
o Delayed stomach emptying.
o Alcohol use. o Famotidine
o Cimetidine

Proton pump inhibitors

Assessment
o Omeprazole
1. Assess patient’s history aids in obtaining an o Pantoprazol
accurate diagnosis.
2. Diagnostic testing may include ambulatory
pH monitoring.
3. Trans nasal catheter placement or
endoscopic wireless capsule placement for CANCER OF THE ESOPHAGUS
approximately 24 hours. (Patti, 2016)
- Cancer of the esophagus is a disease in
which malignant (cancer) cells form in the
Signs and Symptoms tissues of the esophagus, the muscular tube
that carries food and liquids from the throat
o Heartburn to the stomach.
o Epigastric pain
o Dysphagia
o Sensation of a lump in the throat There are two main types:

1. Squamous cell carcinoma: Starts in the flat

Nursing Diagnosis cells lining the esophagus.
2. Adenocarcinoma: Begins in the cells that
1. Risk for acute pain from GERD related to produce mucus, often linked to Barrett's
reflux symptoms, coughing, and irritated esophagus.
esophageal mucosa as evidenced by:
o Verbalization of pain
o Coughing Why understanding esophageal cancer is
o Heartburn important?
o Atypical chest pain
- Early detection improves survival rates.
- Nurses play a key role in identifying
Nursing Management symptoms and providing care.
- Proper nursing interventions can prevent
1. Educate patient to avoid situations that complications like aspiration pneumonia.
decrease lower esophageal sphincter
pressure or cause esophageal irritation.
2. Limiting alcohol Risk Factors
3. Weight loss
4. Tobacco cessation Tobacco use: Chemicals in tobacco damage the
5. Elevating the head of the bed esophageal lining, leading to cancer over time.
6. Avoid eating before bed
7. Altering the diet Heavy alcohol consumption: Alcohol irritates the
esophagus, especially when combined with
tobacco.

Chronic GERD (Gastroesophageal Reflux Disease):

Ongoing acid reflux can cause cell changes,
increasing cancer risk.
Barrett's esophagus: A complication of GERD Nursing Management
where cells change, increasing the chance of
cancer. o Nutritional support
o Oral care
Obesity: Increases GERD risk and inflammation, o Positioning
which contribute to cancer. o Monitor for aspiration
o Pain management
Poor diet: Lack of protective nutrients weakens the
o Emotional support
body's defenses.
o Patient education
Achalasia: Food stagnation in the esophagus
increases cancer risk.
Medical Management
Chemical exposure: Ingesting harmful substances
causes long-term damage. o Surgery (esophagectomy)
Family history: Genetic factors may predispose o Radiation therapy
individuals to cancer. o Endoscopic treatments
o Targeted therapy/immunotherapy
Age and gender: Men over 60 are at higher risk, o Palliative care
possibly due to longer exposure to risk factors.

Assessment (Signs and Symptoms)

GASTRITIS
Difficulty swallowing (dysphagia): A key early sign,
often overlooked until severe. - A Common condition characterized by
inflammation of the stomach lining, known
Weight loss: Indicates advanced disease due to as the mucosa. This lining serves as a
eating difficulties. protective barrier against the harsh
Chest pain or discomfort: Can signal tumor growth digestive acids and enzymes present in the
or irritation. stomach.

Hoarseness or persistent cough: Suggests tumor

involvement near the vocal cords. Gastritis can be categorized:
Regurgitation: Indicates a blockage or narrowing
1. Acute Gastritis: sudden and temporary,
of the esophagus.
often caused by acute conditions.
Vomiting blood (hematemesis): A sign of bleeding 2. Chronic Gastritis: a long-term condition,
from a tumor. developing gradually due to another
chronic condition.
Persistent hiccups: Caused by nerve irritation from
the tumor.

Fatigue: Due to poor nutrition or anemia from Risk Factors

bleeding.
Overuse of Pain Relievers: Nonsteroidal anti-
inflammatory drugs like aspirin and ibuprofren can
irritate the stomach lining and increase the risk of
Nursing Diagnosis gastritis, especially with regular use.
o Imbalanced nutrition Excessive Alcohol Consumption: Alcohol irritates
o Risk for aspiration the stomach lining, leading to inflammation and
o Risk for dehydration potentially acute gastritis.
o Ineffective coping
o Anxiety Stress: High levels of stress, especially due to illness,
o Acute pain surgery, or sever injury, can contribute to gastritis.

Autoimmune Disorder: occurs when the body

attacks its own stomach lining, leading to
inflammation and damage.
Assessment PEPTIC ULCER
1. Gather information of the patient about - Is an open sore in the stomach or small
their medical history intestine. That break in the lining of the
2. Performing a physical examination digestive tract that can cause stomach
3. Conducting diagnostic test. pain and bleeding.

Signs and Symptoms Types of peptic ulcers:

o Abdominal Pain Gastric Ulcer: a peptic ulcer in the stomach
o Nausea and vomiting
o Indigestion Duodenal ulcer: a peptic ulcer in the duodenum,
o Feeling full and bloated the first part of the small intestine.
o Loss of appetite

Risk Factors
Nursing Diagnosis
- Old age (60 years old and above)
Acute Pain: related to Inflammation of the - High-doses of nsaids
stomach lining. - Smoking
- Alcohol
Risk for fluid and volume deficit: Caused by - Eating spicy foods
vomiting and decreased oral intake - Untreated stress
Anxiety: Related to the discomfort and - Family history of peptic ulcer
uncertainty associated with gastritis.

Knowledge deficit: Regarding gastritis Assessment & Signs and Symptoms

management and lifestyle modifications.
o Taking a detailed medical history
o Perform Physical exam
Nursing Management o Ordering diagnostic tests like:
- Upper Endoscopy
o Pain Management - Biopsy
o Nutritional Support - Histologic Examination
o Fluid Balance - X-Ray
o Anxiety Reduction - CBCs
o Patient Education o The most common symptom of a peptic
o Medication administration ulcer is abdominal pain, specifically in the
o Monitoring for complications upper abdomen between the belly button
and breastbone. This pain can be dull,
gnawing pain or a burning sensation in the
Medical Management mid epigastrium or the back. Other
common symptoms include:
Antibiotics: to eradicate the bacteria - Feeling full too soon while eating a
meal
Acid-reducing medications: Antacids, H2
- Feeling uncomfortably full after
blockers, and proton pump inhibitors are used to
eating a meal
neutralize or reduce stomach acid, relieving
- Nausea and vomiting
symptoms and promoting healing
- Bloating
Cytoprotective drugs: medication to protect the - Indigestion
stomach lining from further damage. - Heartburn
o The pain associated with a peptic ulcer
Lifestyle Modifications may be worse when the stomach is empty
or at night . For some individuals, eating
may temporarily relieve the pain, while for
others, it may exacerbate it.
Nursing Diagnosis GASTRIC ULCER
1. Acute pain associated with the effect of - Gastric cancer, also known as stomach
gastric acid secretion on damaged tissue cancer, occurs when harmful (malignant)
2. Anxiety associated with an acute illness cells form in the lining of the stomach.
3. Impaired nutritional intake associated with Gastric cancer typically progresses slowly
changes in diet over many years, with pre-cancerous
changes often going unnoticed.

Nursing Management
Risk Factors
o Relieving pain
o Reducing anxiety Demographic Risk Factors
o Maintaining optimal nutritional status
o Monitoring and managing potential o Age
o Complications o Sex
o Promoting home, community based and o Geography
o Transitional care o Ethnicity

Dietary Risk Factors

Medical Management o High salt intake:

o Low fruit and vegetable intake
1. Recurrence may develop; however, peptic o High nitrate and nitrite intake
ulcers treated with antibiotics to eradicate
H. pylori have a lower recurrence rate than Infectious Risk Factors
those not treated with antibiotics.
o Helicobacter pylori ([Link]): bacterial
2. The goals are to eradicate H. pylori as
infection that can cause chronic gastritis.
indicated and to manage gastric acidity.
o Epstein-Barr virus(EBV) infection: Viral
Methods used include medications, lifestyle
infection that can increase the risk of
changes, and surgical intervention.
gastric cancer.

Medical Risk Factors

Pharmacological Therapy
o Chronic gastritis: inflammation of the
1. The most commonly used therapy for stomach lining that can increase the risk of
peptic ulcers is a combination of gastric cancer.
antibiotics, proton pump inhibitors, and o Gastroesophageal reflux disease (GERD):
sometimes bismuth salts that suppress or condition in which stomach acid flows
eradicate H. pylori. back into the stomach acid flows back into
2. Recommended combination drug therapy the esophagus.
is typically prescribed for 10 to 14 days and o Intestinal metaplasia: condition in which
may include triple therapy with two the lining of the stomach changes to
antibiotics (e.g., metronidazole or resemble the lining of the intestine
amoxicillin and clarithromycin) plus a o Hereditary diffuse gastric cancer (HDGC):
proton pump inhibitor (e.g., lansoprazole, Genetic disorder that increase the risk of
omeprazole, or rabeprazole), or quadruple diffuse gastric cancer.
therapy with two antibiotics (metronidazole o Familial adenomatous polyposis (FAP):
and tetracycline) plus a proton pump Genetic disorder that increases the risk of
inhibitor and bismuth salts. colon and gastric cancer.
3. Research is currently being conducted to Lifestyle Risk Factors
develop a vaccine against H. pylori (Liu,
Zhong, Chen, et al., 2020). H2 blockers and o Smoking: tobacco use increase the risk of
proton pump inhibitors that reduce gastric gastric cancer.
acid secretion are used to treat ulcers not o Alcohol consumption: heavy drinking
associated with H. pylori infection. increases the risk of gastric cancer.
o Obesity: being overweight or obese
increase the risk of gastric cancer.
Other Risk Factors Nursing Diagnosis

o Previous stomach surgery o Imbalanced Nutrition: Less than Body

o Radiation exposure Requirements
o Family history o Acute Pain
o Anxiety
o Fatigue
Assessment o Risk for Infection
o Impaired Physical Mobility
Medical history: Assess for risk factors, such as o Grieving
family history, smoking, and previous radiation o Deficient knowledge
exposure.

Physical examination: Check for abdominal

tenderness, masses,or ascites. Nursing Management

Laboratory tests: Preoperative Care:

o Complete Blood Count(CBC)to check for 1. Educate the patient about the surgical
anemia. procedure, potential risks, and benefits.
o Liver function tests(LFTs) to assess for liver
2. Assess the patient’s nutritional status and
metastasis.
provide nutritional support as needed
o Tumor markers,such as CEA and CA 19-9.
3. Manage pain, nausea, and vomiting using
Imaging Studies:
pharmacological and non-
o Upper GI series (barium swallow) to visualize pharmacological interventions.
the stomach.
4. Encourage early mobilization and
o Endoscopy with biopsy to confirm
ambulation to prevent complications.
diagnosis.
o CT scan or MRI to assess for metastasis. 5. Provide wound care and dressing changes
as needed.
Staging: Use the TNM system to stage the cancer.
Postoperative Care:

1. Monitor vital signs,pain,and

Signs and Symptoms
nausea/vomiting.
Early symptoms:
2. Assess the surgical site for signs of
o Indigestion or heartburn bleeding,infection,or complications.
o Loss of appetite
3. Manage pain using pharmacological and
o Weight loss
non-pharmacological interventions.
o Abdominal discomfort or pain.
4. Encourage early mobilization and
Advance symptoms:
ambulation to prevent complications.
o Difficulty swallowing (dysphagia)
5. Provide wound care and dressing changes
o Vomiting blood (hematemesis)
as needed.
o Black, tarry stools (melena)
o Abdominal masses or tenderness.
o Ascites (fluid accumulation in the
Medical Management
abdomen)

Other symptoms: Pre-Treatment Evaluation:

o Fatigue 1. Endoscopy and biopsy: confirm diagnosis

o Weakness and determine tumor stage.
o Anemia-related symptoms(pallor,shortness 2. Imaging studies: CT scan,PET scan, or MRI
of breath) to evaluate tumor extent and metastasis.
o Jaundice (yellowing of the skin and eyes) 3. Laboratory test: Complete blood
count,liver function tests, and tumor
markers
Treatment Modalities: Symptoms

o Surgery o Infrequent bowel movements (less than

three times a week)
1. Gastrectomy: Partial or total
o Hard, dry, or lumpy stools
removal of the stomach.
2. Lymphadenectomy: Removal of o Straining during bowel movements
lymph nodes in the abdomen o Feeling of incomplete evacuation
o Bloating and discomfort
o Chemotherapy:

1. Adjuvant chemotherapy:
chemotherapy after surgery to Causes
reduce recurrence risk.
2. Neoadjuvant chemotherapy: o Low fiber diet
Chemotherapy before surger to o Dehydration
shrink the tumor. o Lack of physical activity
3. Palliative chemotherapy: o Medications (opioids, antacids, iron
chemotherapy to relieve symptoms supplements)
and improve quality of life. o Stress or changes in routine
o Medical conditions (hypothyroidism, IBS,
Targeted Therapy
diabetes)
1. Trastuzumab: monoclonal antibody
targeting HER2-positive gastric cancer
cells. Diagnostic Test
2. Ramucirumab: monoclonal antibody
targeting VEGFR2 to inhibit angiogenesis. Imaging Studies

o Abdominal X-ray (Plain KUB - Kidney,

Ureter, Bladder) - Detects stool
accumulation and bowel obstruction.
CONSTIPATION AND DIARRHEA o MRI or CT Scan (Abdomen & Pelvis) - Used
in severe cases to check for tumors,
volvulus, or structural abnormalities.
Constipation
Laboratory Tests
- Diarrhea is the passage of loose or watery
stools, typically occurring more than three o Complete Blood Count (CBC) – Identifies
times a day. anemia, infection, or inflammation
- Can be acute (lasting less than 2 weeks) or
chronic (lasting more than 4 weeks).
Nursing Diagnosis
Risk Factors
1. Constipation related to insufficient dietary
Lifestyle & Dietary Factors fiber and fluid intake as evidenced by
infrequent, hard stools and straining during
o Low fiber diet
defecation.
o Inadequate fluid intake
o Sedentary lifestyle or lack of exercise
o Ignoring the urge to defecate
o Stress and anxiety Nursing Management

Medical & Physiological Factors Health Promotion & Prevention

o Aging (slowed peristalsis in older adults) 1. Educate on the importance of high-fiber

o Pregnancy (hormonal changes and foods (fruits, vegetables, whole grains).
pressure on intestines) 2. Encourage adequate hydration (1.5-
o Neurological disorders (Parkinson’s, stroke, 2L/day unless contraindicated).
spinal cord injury) 3. Promote regular exercise to stimulate
o Endocrine disorders (diabetes, bowel motility.
hypothyroidism) 4. Advise patients not to ignore the urge to
defecate.
Nursing Intervention Causes

1. Monitor bowel movement patterns and o Infections (viruses, bacteria, parasites)

stool characteristics. o Food poisoning
2. Encourage dietary modifications (increase o Lactose intolerance or food allergies
fiber intake gradually). o Certain medications (antibiotics,
3. Promote non-pharmacologic measures like chemotherapy)
warm water, prune juice, and abdominal o Stress or anxiety
massage. o Chronic conditions (IBS, Crohn’s disease)
4. Positioning: Ensure proper toileting posture
(knees higher than hips). Diagnostic Test
5. Educate about avoiding excessive use of
laxatives to prevent dependence. Stool Tests

o Stool Microscopy and Ova & Parasite (O&P)

Test - Identifies parasites and eggs (Giardia,
Treatment
Entamoeba histolytica).
o Increase fiber intake (fruits, vegetables, Blood Tests
whole grains)
o Drink more water o Complete Blood Count (CBC) - Checks for
o Exercise regularly infection (anemia, or inflammation. Helps
o Use stool softeners or laxatives if needed identify conditions like severe bacterial
(short-term) infections or IBD.
o Establish a regular bathroom routine
Imaging Tests

o Abdominal X-ray or CT Scan - Detects

Diarrhea intestinal obstruction, tumors, or bowel
perforation
- Diarrhea is the passage of loose or watery
stools, typically occurring more than three
Nursing Diagnosis
times a day.
- Can be acute (lasting less than 2 weeks) or 1. Deficient Fluid Volume related to excessive
chronic (lasting more than 4 weeks). fluid loss
2. Risk for Electrolyte Imbalance related to
diarrhea
Risk Factors 3. Imbalanced Nutrition: Less than Body
Requirements related to malabsorption
o Bacterial infections 4. Risk for Impaired Skin Integrity related to
o Food intolerance/allergy (lactose frequent stools
intolerance, gluten sensitivity) 5. Anxiety related to discomfort and illness
o Medications (antibiotics, chemotherapy,
laxatives)
Nursing Management
o Gastrointestinal diseases (Crohn’s disease,
irritable bowel syndrome) Hydration and Electrolyte Balance
o Metabolic disorders (hyperthyroidism)
o Psychological factors (e.g., stress, anxiety) o Encourage oral rehydration therapy (ORS)
for mild dehydration.
o Administer IV fluids (e.g., normal saline,
Symptoms Ringer’s lactate) for severe dehydration.
o Monitor electrolyte levels and replace as
o Loose, watery stools needed.
o Frequent bowel movements
Nutritional Support
o Abdominal cramping
o Nausea or vomiting o Encourage small, frequent meals with
o Dehydration (dry mouth, dizziness, dark bland foods (BRAT diet: Bananas, Rice,
urine) Applesauce, Toast).
o Avoid dairy, caffeine, fatty, and spicy foods.
o Encourage probiotics to restore gut flora.
Treatment Symptoms

1. Stay hydrated (water, electrolyte drinks) o Sudden leakage of stool without warning.
2. Eat bland foods (bananas, rice, toast, o Occasional or complete loss of bowel
applesauce) control.
3. Avoid dairy, caffeine, alcohol, and greasy o Minor soiling to frequent accidents.
foods o A sensation of urgency but inability to
4. Use anti-diarrheal medications if necessary reach the toilet in time.
(like loperamide)
5. Seek medical attention if it lasts more than Assessment
a few days or includes fever/blood
o Medical history review, including past
surgeries, illnesses, and medications.
Constipation and diarrhea together
o Physical examination of the anal and rectal
If you experience alternating constipation and area.
diarrhea, it could be linked to: o Diagnostic tests:
- Anorectal Manometry: Measures
o Irritable Bowel Syndrome (IBS-M) muscle strength.
o Food intolerances or sensitivities - Endosonography/MRI: Identifies
o Inflammatory Bowel Disease (IBD) damage to muscles and nerves.
o Hormonal changes - Stool Tests: Detects infections or
o Stress and anxiety digestive disorders.

When to see a doctor: Nursing Diagnosis

1. Symptoms persist for more than a few weeks
1. Bowel Incontinence related to loss of
2. Blood in stool or black/tarry stools
sphincter control.
3. Unexplained weight loss
2. Impaired Skin Integrity related to frequent
4. Severe abdominal pain
soiling.
5. Signs of dehydration
3. Risk for Social Isolation due to
embarrassment.
4. Self-Care Deficit related to inability to
FECAL INCONTINENCE manage incontinence.
5. Anxiety related to fear of accidents in
- Fecal incontinence is the involuntary public.
leakage of stool from the rectum for at least
three months.
Nursing Management
- It results from the inability to control bowel
movements due to weak muscles, nerve Bowel Training Program:
damage, or underlying conditions.
- It significantly impacts the quality of life. o Establish a regular toilet schedule to
improve bowel habits.
Risk Factors o Encourage proper toilet positioning and
use of assistive devices.
Muscle or Nerve Damage: Injury to anal sphincter
Dietary Modifications:
muscles or nerves from childbirth, surgery, or
neurological disorders (e.g., stroke, multiple o Increase fiber intake (e.g., psyllium
sclerosis, diabetes). supplements) to improve stool consistency.
o Avoid foods that cause loose stools (e.g.,
Chronic Diarrhea or Constipation: Can weaken
caffeine, spicy foods).
bowel control.
Pelvic Floor Exercises:
Aging: Common in older adults due to muscle
weakening. o Kegel exercises strengthen the anal
sphincter.
Pelvic Floor Disorders: Conditions like rectal
o Biofeedback therapy helps patients regain
prolapse and history of pelvic surgery.
control.
Inflammatory Bowel Diseases (IBD): Such as
Crohn’s disease or ulcerative colitis.
Skin Care: Assessment

o Maintain perineal hygiene to prevent skin Monitor Gastrointestinal Status

breakdown.
o Use protective barriers (e.g., creams, o Assess bowel movement patterns
incontinence pads). o Document stool characteristics
o Monitor abdominal pain levels
Emotional Support:
Psychological Status
o Encourage patients to express feelings and
concerns. o Assess stress levels
o Provide education on coping strategies o Monitor anxiety symptoms
and available treatments. o Evaluate coping mechanisms
o Document sleep patterns

Assess Nutritional Status

Medical Management
o Monitor food intake
Treat Underlying Causes: o Track weight changes
o Assess for food intolerances
o If due to diarrhea, manage with anti-
o Document fluid intake
diarrheal medications (e.g., loperamide).
o If related to constipation, use laxatives or Monitor for Complications
stool softeners.
o Check for signs of malnutrition
Medications: o Assess for depression
o Monitor for social isolation
o Fiber supplements (e.g., psyllium) to
improve stool consistency.
o Biofeedback therapy to enhance sphincter
Signs and Symptoms
control.

Surgical Interventions (For Severe Cases): o Chronic stress

o Sleep deprivation
o Sphincter repair surgery (if muscles are o Abdominal pain
damaged). o Bloating
o Sacral nerve stimulation (electrical o Diarrhea
stimulation to strengthen nerves). o Constipation
o Colostomy (as a last resort for severe o Food intolerance
cases). o Anxiety

Nursing Diagnosis
IRRITABLE BOWEL SYNDROME
- Irritable bowel syndrome (1BS) is a chronic - IBS is diagnosed by a thorough history
functional disorder characterized by intake and physical examination by the
healthcare provider.
recurrent abdominal pain associated with
disordered bowel movements, which may
include diarrhea, constipation, or both,
without an identifable cause. Nursing Management

1. The nurse's role is to provide patient and

family education and encourage self-care
Risk Factors activities
o Age 2. The nurse may provide education on the
o Gender appropriate use of a bowel habit diary,
o Genetics such as the Bristol Stool Form Scale
o Anxiety or depression 3. The nurse emphasizes and reinforces good
o History of childhood abuse sleep habits and good dietary habits
4. Patients are encouraged to eat at regular
times and to avoid food triggers.
Medical Management o Fat-soluble vitamin deficiencies (A, D, E, K)
→ night blindness, osteoporosis, bleeding
The goals of treatment are to relieve abdominal
disorders.
pain and control diarrhea or constipation. Lifestyle
o Iron deficiency → anemia, fatigue, pallor.
modification, including stress reduction, ensuring
o Protein malabsorption → edema, hair
adequate sleep, and instituting n exercise
thinning.
regimen, can result in symptom improvement.

Management
MALABSORPTION
Nutritional Support
- Malabsorption is a condition in which the
1. Provide enteral nutrition (NGT or PEG tube)
small intestine is unable to absorb nutrients,
if oral intake is insufficient.
vitamins, and minerals from food.
2. Administer total parenteral nutrition (TPN)
- Can result from damage to the intestinal
via a central line for severe cases of
lining, enzyme deficiencies, or underlying
malabsorption.
gastrointestinal diseases.
- Leads to deficiencies in essential nutrients, Pharmacological Treatment
affecting overall health.
1. Pancreatic enzyme replacement therapy
(PERT): Pancrelipase (Creon) for chronic
pancreatitis.
Risk Factors
2. Gluten-free diet & corticosteroids for celiac
- Risk factors for malabsorption syndrome disease.
include: a family history of cystic fibrosis or 3. Antibiotics (rifaximin, metronidazole) for
malabsorption, drinking large amounts of small intestinal bacterial overgrowth (SIBO).
alcohol! intestinal surgery, use of certain 4. Bile acid sequestrants (cholestyramine) if
medications, including laxatives or mineral bile acid diarrhea is present.
oil.
Surgical Intervention
Gastrointestinal Disorders
1. Small bowel resection for severe Crohn’s
- Celiac disease, Crohn’s disease, chronic disease or bowel obstruction.
pancreatitis. 2. Gastric bypass revision if malabsorption is
due to previous bariatric surgery.
Surgical Causes

- Gastric bypass surgery, small bowel

resection.
CELIAC DISEASE
Infections
- Celiac disease is an illness caused by an
- Parasitic infections, bacterial overgrowth,
immune reaction to eating gluten. Gluten is
HIV/AIDS.
a protein found in foods containing wheat,
barley or rye.
- If you have celiac disease, eating gluten
Assessment and Signs and Symptoms triggers an immune response to the gluten
protein in your small intestine. Over time, this
Gastrointestinal Symptoms
reaction damages your small intestine's
o Chronic diarrhea, steatorrhea (fatty stools), lining and prevents it from absorbing
bloating, flatulence. nutrients, a condition called malabsorption.
- Your small intestine is lined with tiny hair like
Neurological Symptoms projections called villi, which absorb sugars,
o Numbness, tingling, confusion (due to B12 fats, proteins, vitamins, minerals and other
deficiency). nutrients from the food you eat. Gluten
exposure in people with celiac disease
Nutritional Deficiencies damages the villi, making it hard for the
body to absorb nutrients necessary for
o Weight loss, muscle wasting.
health and growth.
Risk Factors 3. Risk for Impaired Skin Integrity
- Evidence: Itchy, blistering skin lesions.
Celiac disease tends to be more common in people 4. Chronic Pain
who have: - Evidence: Complaints of pain, discomfort,
distention.
o A family member with celiac disease (parents,
5. Knowledge Deficit
siblings, children) or dermatitis herpetiformis.
- Evidence: Ingestion of gluten-containing
o Type 1diabetes.
foods, uncertainty about food choices.
o Down syndrome, William syndrome or Turner
6. Risk for Impaired Growth and Development(for
syndrome.
pediatric patients)
o Autoimmune thyroid disease.
- Evidence: Delayed growth, failure to
o Microscopic colitis.
thrive, delayed puberty.
o Addison's disease.
o Gluten Consumption–Early or excessive
exposure to glutenin infancy may increase risk. Nursing Management
o Female Sex – Celiac disease is more common in
females than males. 1. Gluten-Free Diet Education
- Patients must completely avoid foods that
contain wheat, barley, rye, and some
Signs and Symptoms oats (unless certified gluten-free).
2. Dining Out Precautions
o Bloating
- Patients should ask restaurant staff if food
o Chronic diarrhea
is truly gluten-free and not prepared near
o Constipation
glutencontaining items
o Gas
3. Cross-Contamination Awareness
o Lactose intolerance due to damage to the small
- Oats: patients should choose certified
intestine
gluten-free oats only.
o Loose, greasy, bulky, and bad smelling stools
- Shared Cooking Spaces: glutenfree food
o Nausea or vomiting
can accidentally get contaminated if
o Abdominal pain
prepared near gluten-containing foods.
For children with celiac disease - Toasters & Kitchenware: patients should
use a separate toaster or toaster bags.
o Damage to the permanent teeth’s enamel
o Delayed puberty NIH external link
o Failure to thrive, meaning that an infant or a Medical Management
child weighs less or is gaining less weight than
1. Lifelong Gluten-Free Diet: The only effective
expected for his or her age
treatment; no drug-induced remission.
o Mood changes or feeling annoyed or impatient
2. Dietitian Consultation: Helps with dietary
o Slowed growth and short height
adjustments and gluten-free alternatives.
o Weight loss
3. Symptom Resolution: May take time; full
intestinal villi recovery can take up to a year.
Assessment and Diagnostic Findings 4. Persistent Symptoms: Can still occur despite a
strict gluten-free diet, affecting quality of life.
o Clinical Assessment: Evaluate symptoms, family
history, and risk factors. Specific Targeted Treatments:
o Serologic Tests:
o Anemia: Supplement with folate, cobalamin
- IgA anti-tissue transglutaminase (tTG):
(B12), or iron.
90% sensitivity, 95% specificity.
o Osteopenia/Osteoporosis: Require bone health
- Other tests: Total IgA, anti-endomysial
management.
antibodies (EMA).
o Endoscopic Biopsy:
- Upper endoscopy with small intestine
biopsy confirms diagnosis.
o Important Note: Patient must consume gluten
before testing to avoid false-negative results.

Nursing Diagnosis

1. Imbalanced Nutrition: Less Than Body

Requirements
- Evidence: Weight loss, fatigue, anemia,
diarrhea, vitamin deficiencies.
2. Risk for Fluid Volume Deficit
- Evidence: Dehydration, electrolyte
imbalances, weakness.
APPENDICITIS Assessment

- An acute or chronic inflammation of the History Taking

appendix, a small, tube-like structure o Onset and duration of pain (typically starts
attached to the cecum of the large intestine. It
as periumbilical pain, then shifts to RLQ).
is one of the most common causes of
o Associated symptoms (nausea, vomiting,
abdominal pain requiring emergency surgery.
The condition occurs when the appendix anorexia).
becomes blocked, leading to bacterial o Previous episodes of similar pain.
overgrowth, swelling, and possible rupture,
Physical Examination
which can result in life-threatening
complications such as peritonitis or sepsis. o McBurney’s point tenderness – Pain
localized in the right lower quadrant.
Risk Factors o Rebound tenderness – Pain worsens when
pressure is released from the abdomen.
Age o Rovsing’s sign – Pain in the RLQ when
- Most common in adolescents and young palpating the LLQ.
adults (10–30 years). o Psoas sign – Pain when extending the right
thigh (suggests retrocecal appendix).
Diet o Obturator sign – Pain with internal rotation
of the flexed right hip.
- Low-fiber, high-refined carbohydrate diets
may contribute to fecalith formation. Diagnostic Tests

Gastrointestinal Infections o Complete Blood Count (CBC)

o Urinalysis
- Can lead to lymphoid hyperplasia and
o Abdominal Ultrasound
obstruction.
o CT Scan (Gold Standard)
Genetics
Nursing Diagnosis
- Family history may increase susceptibility.
1. Acute Pain related to inflammation and
Acute Appendicitis abdominal distension
2. Risk for Infection related to bacterial
- (Acute inflammation of the appendix) invasion and possible perforation
3. Imbalanced Nutrition: Less than Body
Clinical Manifestations
Requirements related to nausea and
o Sudden onset of abdominal pain, starting vomiting
around the umbilicus and migrating to the 4. Risk for Fluid Volume Deficit related to
right lower quadrant (McBurney’s point) fever, vomiting, and decreased oral intake
o Nausea and vomiting 5. Anxiety related to surgical intervention and
o Fever and chills hospitalization
o Loss of appetite
o Rebound tenderness and guarding Nursing Management
o Elevated white blood cell count
(leukocytosis) Preoperative

1. Keep the patient NPO (nothing by mouth)

Chronic Appendicitis to prepare for possible surgery.
2. Administer IV fluids (e.g., normal saline or
- (Appendix is inflamed over a prolonged
Ringer’s lactate) as prescribed.
period)
3. Provide pain management (e.g.,
Clinical Manifestations analgesics as ordered).
4. Administer antibiotics if prescribed to
o Persistent or recurrent right lower quadrant prevent infection.
pain 5. Avoid applying heat to the abdomen (can
o Low-grade fever cause rupture).
o Nausea and digestive issues
o Symptoms may persist for weeks or month
Postoperative (After Appendectomy) DIVERTICULAR DISEASE
1. Monitor vital signs and assess for infection
- Diverticulum - Is a saclike herniation of the
(e.g., fever, increased
lining of the bowel that extends through a
2. WBC count, wound redness/swelling).
defect in the muscle layer. True diverticula
3. Assess surgical site for bleeding, drainage,
are herniations of all layers of the GI wall
or dehiscence.
(mucosa, muscularis propia, and
4. Encourage early ambulation to prevent
adventitia), while pseudo-diverticula only
complications such as deep vein
involve the mucosa and submucosa.
thrombosis (DVT) and pneumonia.
- May occur anywhere in the tract from the
5. Provide pain management with prescribed
esophagus to colon, but mostly occurs in
analgesics.
the colon.
6. Encourage gradual resumption of oral
- Diverticulum - One pouch
intake once bowel sounds return.
- Diverticula - Multiple pouches
7. Educate on wound care and signs of
- Diverticulosis - happens when small
complications (e.g., fever, severe pain,
pouches or sacs, called diverticula,
purulent discharge).
develop in the colon wall. It doesn't
Complication Prevention typically cause symptoms and may go
undetected until a person undergoes
1. Monitor for signs of peritonitis (severe routine imaging tests or a procedure like a
abdominal pain, rigidity, high fever). colonoscopy.
2. Observe for signs of paralytic ileus - Diverticulitis - occurs when diverticula
(absence of bowel sounds, abdominal become inflamed or infected. Diverticulitis
distension, nausea). typically causes sudden, severe abdominal
3. Encourage incentive spirometry and deep symptoms.
breathing exercises to prevent pneumonia.

Discharge Education Risk Factors

1. Advise on proper wound care and Diverticulosis

hygiene.
o Older age; it is present in half of all adults
2. Instruct to avoid heavy lifting or strenuous
over 65 years of age, and 70% of adults
activity for at least 4-6 weeks.
over 80 years of age. (Kryzak &
3. Educate on dietary modifications (light diet
Mulrooney,2019).
initially, high-fiber foods to prevent
o Low intake of dietary fiber
constipation).
o Slow colonic transit time
4. Emphasize the importance of follow-up
o Obesity
appointments
o History of cigarette smoking
o Regular use of NSAIDS
Medical Management o Family history
o Dietary factors (Red meat, Fat, Particularly
Appendectomy (Gold Standard)
dairy fat, & refined sugar)
o Laparoscopic appendectomy (minimally
Diverticulitis
invasive, faster recovery).
o Open appendectomy (preferred in o People with diverticulosis
complicated cases, such as perforation).

Antibiotic Therapy Signs and Symptoms

o Preoperative broad-spectrum antibiotics Diverticulosis

(ceftriaxone + metronidazole).
o The majority of people with diverticula will
o Postoperative antibiotics if perforation or
not have any symptoms.
abscess is present.
Diverticulitis
Pain Management
o Mild to severe cramping pain in the left
o Acetaminophen or NSAIDs.
lower quadrant
o Avoid morphine in undiagnosed cases, as it
o Constipation or obstipation and nausea,
may mask symptoms.
fever, and leucocytosis (High WBC count)
Assessment and Diagnostic Findings Causes of Intestinal Obstruction

1. Colonoscopy (provides visualization of the 1. Mechanical Causes - something is partially

extent of the disease) of fully blocking the bowel.
2. CBC (if blood in stool is noted, o Common causes include:
haemoglobin level should be analyzed) - Adhesions (scar tissue from
3. WBC is frequently elevated but normal previous surgeries)
WBC does not rule out diverticulitis - Hernias
4. Urinalysis and urine cultures - Tumors
5. Abdominal CT scan with contrast agent - Volvulus (twisting of the
6. Abdominal X-ray intestine)
- Intussusception
Nursing Management (telescoping of one intestine
segment into another)
1. Encourage increased fluid intake 2 liters of - Impacted feces
water per day - Foreign bodies
2. Suggest foods that are soft but have - Herniation
increased fiber (berries, banana, apples, - Adhesions
green leafy veggies) preferably soft - Intussusception
cooked veggies to - Volvulus
3. Encourage daily intake of bulk laxatives 2. Functional Causes (Paralytic Ileus) - occurs
4. Avoid food triggers like nuts and popcorn, when the muscles of the intestinal wall fail
milk, and spicy foods to contract normally in the wavelike
sequence (peristalsis) that propels the
Medical Management intestinal contents.
o Causes include:
1. Rest, oral fluids, and analgesic meds are - Postoperative ileus
recommended. - Neuromuscular disorders
2. Initially, clear liquid diet is consumed until - Certain medications (e.g.,
the inflammation subsides; then a high- opioids)
fiber, and low- fat diet is recommended. - Infections such as peritonitis
3. Selective use of antibiotics for acute,
uncomplicated diverticulitis Risk Factor
4. Broad-spectrum antibiotics (Ampicillin/
sulbactam, ticarcillin/ clavulanate) are o Abdominal surgery: Can lead to scar tissue
prescribed to patient who require surgery and adhesions that can block the intestines
and hospitalization. o Inflammatory bowel disease: Conditions
like Crohn's disease and ulcerative colitis
can cause inflammation in the digestive
tract
INTESTINAL OBSTRUCTION o Cancer: Tumors or growths in the intestines
or abdomen can block the intestines
- Bowel obstruction is a blockage that
o Diverticulosis: An irritation of the lining of the
prevents food or liquid from passing
intestine
through your small intestine or large
o Swallowed foreign objects: Objects that
intestine (colon).
are swallowed and block the intestines
o Chronic constipation: Can lead to
Intestinal Obstruction Stages impacted feces that can block the
intestines
1. Partial obstruction: In this stage, there is a
o Age: Older adults are more likely to
partial blockage in the intestine, allowing
develop intestinal obstructions
some food, fluids, and gas to pass through.
o Family history: A history of intestinal
2. Complete obstruction: In this stage, there is
obstructions in your family can increase
a complete blockage in the intestine,
your risk
preventing any passage of food, fluids, and gas.
3. Strangulation: In this stage, the blockage is o Certain medications: Some medications
can cause intestinal obstruction
so severe that it cuts off the blood supply to
the affected area, leading to tissue
damage and even death.
Symptoms Nursing Management

Signs and symptoms of intestinal obstruction - Maintaining fluid and electrolyte balance
include: through IV fluids, decompressing the bowel
with a nasogastric tube, managing pain,
o Crampy abdominal pain that comes and
monitoring vital signs closely, providing
goes
bowel rest, and preparing the patient for
o Loss of appetite
potential surgery, while also providing
o Constipation
emotional support and education about
o Vomiting
the condition and treatment plan.
o Inability to have a bowel movement or pass
gas
o Swelling of the abdomen Medical Management

Supportive care
Diagnostic Test
o Fluids: Intravenous (IV) fluids and
Physical Examination - Assessment of abdominal electrolytes to treat dehydration
distension, bowel sounds, and tenderness. o Nasogastric tube: A tube inserted through
the nose to remove air and fluids from the
Imaging Studies:
blockage
o X-ray: Shows air-fluid levels and dilated o Bowel rest: A soft, low-fiber diet
bowel loops. o Pain medication: To help with discomfort
o CT Scan: Provides a detailed view of o Antibiotics: To treat infection
obstruction location and cause. o Corticosteroids: To reduce inflammation
o Ultrasound: Useful in pediatric cases, and relieve nausea
especially for intussusception. o Electrolyte replacement: To correct
metabolic derangements
Laboratory Tests - Complete blood count (CBC),
electrolytes, and arterial blood gases to assess Surgery
complications.
o In serious cases, surgery may be required to
remove the blockage and repair any
Nursing Diagnosis damage to the intestinal tissue
o Minimally invasive surgery may be
Acute pain:
performed during a colonoscopy
- Pain related to the bowel obstruction o Surgery is indicated if there is evidence of
vascular compromise or perforation
Constipation:
Imaging
- Difficulty having a bowel movement
o Abdominal radiography or computed
Imbalanced nutrition: tomography can confirm the diagnosis
o A barium enema X-ray can be used to
- Not getting enough nutrients
examine the colon
Deficient fluid volume: o An ultrasound can be used to examine the
abdomen
- Loss of fluids due to vomiting, nausea, fever,
and sweating
Dietary Management
Ineffective breathing pattern:
Stage 1: Clear liquids: Water, clear broth, strained
- Difficulty breathing due to abdominal juices without pulp
distention and rigidity
Stage 2: Thin liquids: Smooth soups, yogurt, milk, thin
Anxiety: fruit juices
- Fear or worry related to a change in health Stage 3: Pureed foods: Well-pureed vegetables,
mashed potatoes, smooth pudding

Stage 4: Soft foods: Soft cooked meats, scrambled

eggs, soft cooked vegetables, soft fruits
Foods to avoid with intestinal obstruction: Signs and Symptoms

o Raw vegetables and fruits 1. Diarrhea: Persistent diarrhea is common.

o High-fiber cereals 2. Abdominal Pain and Cramping: Often
o Whole grains experienced in the lower right abdomen.
o Tough meats 3. Fatigue and Fever: General feelings of
o Popcorn tiredness and occasional low-grade fever.
o Nuts and seeds 4. Weight Loss and Reduced Appetite: Due
o Dried fruits to malabsorption and decreased desire
o Carbonated beverages to eat.
5. Mouth Sores: Ulcers can develop in the
mouth.
INFLAMMATORY BOWEL DISEASE 6. Perianal Disease: Pain or drainage near
the anus due to inflammation from a
- Is a group of chronic disorders that cause tunnel into the skin, called a fistula.
inflammation in the gastrointestinal (GI) tract. 7. Blood in Stool: Occasionally, blood may
- The two main types are Crohn’s disease be present in the stool.
and ulcerative colitis. These conditions
lead to persistent inflammation, ulcers, and
damage to the intestinal lining, causing Diagnostic Test
symptoms such as diarrhea, abdominal
pain, and weight loss. Laboratory Tests:

1. Blood Tests: These are conducted to check

Crohn’s Disease (CD) for anemia, which indicates a lack of
healthy red blood cells, and to detect signs
- Is a chronic inflammatory condition that
of infection or inflammation.
can affect any part of the GI tract from the
2. Stool Tests: Stool samples are analyzed to
mouth to the anus, but it most commonly
rule out infections and to check for hidden
affects the ileum and colon. The
(occult) blood or markers of inflammation.
inflammation occurs in a transmural (full-
thickness) pattern and can lead to Endoscopic Procedures:
complications such as fistulas, strictures,
and abscesses. 1. Colonoscopy: This procedure allows for a
visual examination of the entire colon and
the terminal ileum using a flexible tube with
Risk Factors
a camera. During the colonoscopy, tissue
1. Age: CD can occur at any age but is more samples (biopsies) can be taken to look for
commonly diagnosed before the age of clusters of inflammatory cells called
30. granulomas, which are suggestive of CD.
2. Ethnicity: While CD can affect any ethnic 2. Upper Endoscopy: An upper endoscopy
group, white individuals, particularly those examines the upper part of the
gastrointestinal tract, including the
of Eastern European (Ashkenazi) Jewish
esophagus, stomach, and duodenum, to
descent, have a higher risk.
identify areas of inflammation or ulcers.
3. Family History: Having a first-degree
relative (parent, sibling, or child) with CD Imaging Studies:
increases the risk. Approximately 20% of
individuals with CD have a family member 1. CT Enterography and MR Enterography:
with the disease These specialized imaging tests provide
4. Smoking: Cigarette smoking is a significant detailed images of the small intestine and
modifiable risk factor for CD. It not only are more sensitive than standard imaging
increases the risk of developing the disease for detecting inflammation, obstructions, or
but is also associated with more severe other complications.
disease progression and a higher likelihood 2. MRI: Magnetic resonance imaging is
of requiring surgery. particularly useful for evaluating fistulas
5. Nonsteroidal Anti-Inflammatory Drugs around the anal area or the small intestine.
(NSAIDs): While NSAIDs do not cause CD,
their use can lead to bowel inflammation
that may exacerbate the disease.
Nursing Diagnosis Immune System Suppressors:

1. Diarrhea related to intestinal inflammation 1. Azathioprine and Mercaptopurine: These

secondary to Crohn’s disease, as medications suppress the immune
evidenced by frequent loose, watery stools responseto decrease inflammation.
and abdominal cramping. 2. Methotrexate: Sometimes prescribed for
2. Acute Pain related to intestinal patients who don't respond to other
inflammation and abdominal cramping treatments.
secondary to Crohn’s disease, as
Biologic Therapies:
evidenced by verbal reports of pain and
guarding behavior. 1. TNF Inhibitors: Infliximab, adalimumab, and
3. Imbalanced Nutrition: Less Than Body certolizumab pegol target specific proteins
Requirements related to malabsorption involved in inflammation.
and reduced oral intake secondary to
Crohn’s disease, as evidenced by weight Antibiotics
loss and fatigue. - Metronidazole and ciprofloxacin may be
used to treat or prevent infections,
Nursing Management especially in cases of fistulas or abscesses.

Assessment: Nutritional Therapy:

1. Regularly monitor abdominal - Special diets or enteral nutrition can help

characteristics, including contour, manage symptoms and ensure adequate
distention, firmness, and rigidity. nutrient intake.
2. Auscultate bowel sounds for pitch and
Surgery:
frequency.
3. Evaluate stool frequency, characteristics, - Indicated for complications like strictures,
and volume. fistulas, or abscesses, or when medical
4. Assess for signs of dehydration, bleeding, therapy fails.
and infection, such as frequent bloody
diarrhea, poor skin turgor, dry mucous
membranes, and sunken eyes. Ulcerative Colitis (UC)
5. Administer prescribed analgesics and
assess their effectiveness. - Is a chronic inflammatory condition that
6. Collaborate with a dietitian to develop a affects the colon and rectum only. Unlike
balanced diet plan tailored to the patient's Crohn’s disease, UC involves continuous
needs. inflammation rather than patchy areas,
7. Administer IV fluids as prescribed to and it only affects the mucosal and
maintain hydration. submucosal layers (superficial
8. Observe and record stool frequency and inflammation). The main feature of UC is
characteristics. bloody diarrhea, and severe cases may
9. Provide information on symptom lead to life-threatening complications like
prevention and disease management. toxic megacolon.
10. Assess for signs of anxiety or depression and
provide appropriate interventions. Risk Factors

Medical Management 1. Age: UC typically begins before the age of

30 but can occur at any age. Some
Anti-inflammatory Medications: individuals may not develop the disease
until after age 60.
1. Aminosalicylates: Drugs like sulfasalazine
2. Ethnicity: White individuals, especially
and mesalamine help reduce
those of Ashkenazi Jewish descent, have
inflammation in the intestinal lining.
a higher risk of developing UC.
2. Corticosteroids: Prednisone and
3. Family History: A close relative (parent,
budesonide are used for short-term control
sibling, or child) with UC increases one's
of acute flare ups due to their potential side
risk of developing the disease.
effects with long-term use.
Signs and Symptoms Nursing Diagnosis

1. Diarrhea with Blood or Pus 1. Dysfunctional Gastrointestinal Motility

2. Abdominal pain and Cramping related to the inflammatory process of
3. Rectal Pain and Bleeding ulcerative colitis, as evidenced by
4. Urgency to Defecate diarrhea, abdominal pain, and altered
5. Inability to Defecate Despite Urgency bowel sounds.
6. Weight Loss and Fatigue 2. Acute Pain related to inflammation and
7. Fever ulceration in the gastrointestinal tract
secondary to ulcerative colitis.
Diagnostic Test 3. Diarrhea related to inflammation and
altered bowel function in ulcerative colitis.
1. Blood Tests: These tests check for anemia 4. Imbalanced Nutrition: Less Than Body
and signs of infection. Elevated markers of Requirements related to malabsorption
inflammation may also be assessed. and increased metabolic demands in
2. Stool Tests: Stool samples are analyzed to ulcerative colitis.
rule out infections and to detect white 5. Risk for Impaired Skin Integrity related to
blood cells or certain proteins that indicate frequent bowel movements and potential
inflammation. skin irritation in ulcerative colitis.
3. Colonoscopy: This procedure allows for a
comprehensive examination of the entire Nursing Management
colon using a flexible tube with a camera.
During the colonoscopy, tissue samples 1. Monitor stool frequency, consistency, and
(biopsies) can be taken to confirm the presence of blood.
diagnosis of UC. 2. Assess for abdominal pain, cramping, and
4. Flexible Sigmoidoscopy: If the colon is bowel sounds.
severely inflamed, a flexible sigmoidoscopy 3. Evaluate for signs of dehydration and
may be performed instead of a full malnutrition.
colonoscopy. This procedure examines the 4. Administer prescribed analgesics and
rectum and the lower part of the colon. assess their effectiveness.
5. X-ray: In severe cases, an abdominal X-ray 5. Encourage relaxation techniques to
may be done to rule out serious alleviate discomfort.
complications, such as a perforated colon. 6. Work with a dietitian to identify trigger
6. CT Scan: A CT scan of the abdomen or foods and develop a suitable diet plan.
pelvis may be performed if a complication 7. Encourage oral fluid intake to prevent
is suspected or to assess the extent of colon dehydration.
inflammation. 8. Provide information on the disease
7. Capsule Endoscopy: In this test, you process, symptom management, and the
swallow a capsule containing a tiny importance of medication adherence.
camera that takes pictures of your small 9. Assess for signs of anxiety or depression
intestine. This is particularly useful for and provide appropriate interventions.
detecting inflammation or bleeding in
areas not easily reached by other Medical Management
endoscopic procedures.
8. CT Enterography and MR Enterography: 1. Aminosalicylates – First-line treatment for
These specialized imaging tests provide mild to moderate cases.
detailed images of the small intestine and 2. Corticosteroids – Used for acute flares.
are more sensitive than standard imaging 3. Immunosuppressants – Used for long-term
for detecting inflammation, obstructions, or management.
other complications. 4. Biologic therapy – Used in moderate to
severe cases.
5. Surgical intervention (colectomy) –
Curative for ulcerative colitis. Removal of
the colon eliminates the disease, and
patients may undergo ileostomy or ileal
pouch-anal anastomosis (IPAA).
COLORECTAL CANCER o Diet high in red and processed meats
o Low fiber intake
- Colorectal cancer is a type of cancer that o Sedentary lifestyle
affects the colon or rectum, also known as o Obesity
colon cancer. It begins as a polyp, which is o Smoking and excessive alcohol
an abnormal growth in the inner lining of consumption
the colon or rectum. Over time, some o Inflammatory bowel diseases
polyps can develop into cancer if not (Crohn’sdisease, ulcerativecolitis)
detected and removed early. o Race; African American men and women

The Stages of Colon Cancer Assessment

Stage 0 o Family history - Check for hereditary

colorectal cancer syndromes (e.g., Lynch
The cancer has not invaded the wall of the colon
syndrome, FAP).
or rectum. In these cases, the polyp is removed
o Personal history - Previous polyps,
and no further treatment is needed. These pre-
inflammatory bowel disease (IBD), or
invasive lesions are generally not included in
previous cancers.
cancer statistics.
o Diet and lifestyle - High red/processed
Stage 1 meat intake, low fiber, smoking, alcohol
use, and physical inactivity.
The cancer has grown into the inner wall of the o Bowel habit changes - Persistent diarrhea,
colon or rectum, but has not spread beyond that. constipation, or alternating patterns.
These cancers can be treated by removing the o Presence of symptoms - Blood in stool,
polyp or a section of the colon. The five-year weight loss, fatigue, bloating, and
survival rate is about 92 percent. abdominal pain.
Stage 2 Physical Examination
The cancer has penetrated the outer wall of the o Auscultation in the abdomen for bowel
colon or rectum but has not spread beyond that. sounds
Treatment typically involves surgery to remove part o Abdominal palpation - Check for
of the colon and possibly six months of tenderness, mass, or distension.
chemotherapy. The five-year survival rate is about o Lymph node examination - To check for
65 to 87 percent. metastatic spread.
Stage 3
Signs and Symptoms
The cancer has spread through the wall of the
colon or rectum and has invaded nearby tissue or Ascending Colon (Right-Sided) Signs and
lymph nodes. The standard treatment is surgery Symptoms
and chemotherapy. The five-year survival rate is
1. Persistent abdominal pain (right-sided, dull,
about 53 to 72 percent.
or crampy)
Stage 4 2. Unexplained weight loss
3. Fatigue and weakness (due to slow blood
The cancer has spread to other organs, such as the
loss leading to anemia)
liver or lung. Patients have surgery and
4. Occult (hidden) blood in stool - Stool may
chemotherapy and may get other treatments,
appear normal but cause iron-deficiency
such as radiation and/or immunotherapy. The five-
anemia
year survival rate is about 12 percent.
5. Chronic diarrhea or loose stools
6. Bloating and gas due to bacterial
Risk Factors overgrowth
7. Palpable abdominal mass in advanced
o Age (50yearsandolder) cases)
o Family history of colorectal cancer or
polyps
o Genetic syndromes; Lynch syndrome or
Familial Adenomatous
o Polyposis
Descending Colon (Left-Sided) Signs and o Psychosocial support - Address anxiety,
Symptoms body image concerns, and fear.
o Monitor for anemia or bleeding - Check
1. Bright red blood in stool (hematochezia)
hemoglobin levels and assess for occult
2. Changes in bowel habits - Alternating
blood in stool.
constipation and diarrhea
3. Pencil-thin stools - Due to narrowing from a Post-Surgery Care
tumor or inflammation
o Monitor vital signs & assess for
4. Left-sided abdominal pain - Sharp, crampy
complications (e.g., infection, bleeding,
pain
anastomotic leak).
5. Sensation of incomplete bowel movements
o Manage pain effectively - Use prescribed
6. Bloating and excessive gas
analgesics and encourage deep
7. Obstruction symptoms - Severe
breathing exercises.
constipation, nausea, vomiting
o Assess bowel function - Monitor for return of
bowel sounds and normal stool passage.
Nursing Diagnosis o Wound & stoma care - If a colostomy or
ileostomy is placed, provide stoma care
1. Impaired nutritional intake associated with
education.
nausea and anorexia
o Encourage ambulation - Helps prevent
2. Risk for infection associated with surgery on
deep vein thrombosis (DVT) and
bowel and disruption of colonic bacteria
pneumonia.
3. Risk for hypovolaemia associated with
o Nutritional management - Start clear fluids,
vomiting and dehydration
then progress to a low-fiber diet before
4. Lack of knowledge concerning the
resuming normal intake.
diagnosis, the surgical procedure, and self-
care after discharge
5. Anxiety associated with impending surgery Medical Management
and the diagnosis of cancer
Surgery (Main Treatment for Early Stages)
6. Impaired skin integrity associated with the
surgical incisions (abdominal or perianal) - Colectomy - Removes the affect part of the
colon.
Diagnostic Test - Colostomy/lleostomy - If needed, for stool
diversion.
o Fecal Occult Blood Test (FOBT) / Fecal
Immunochemical Test (FIT) Chemotherapy (For Advanced Stages)
o Stool DNA Test
- Used before or after surgery to kill cancer
o Colonoscopy
cells.
o Sigmoidoscopy
- Common drugs: 5-FU, Capecitabine,
o Endoscopic Ultrasound (EUS)
Oxaliplatin, Irinotecan.
o CT Colonography ("Virtual Colonoscopy")
o CT Scan (Abdomen, Pelvis, and Chest) Radiation Therapy (Mainly for Rectal Cancer)
o MRI (Magnetic Resonance Imaging)
- Shrinks tumors before surgery.
o PET Scan (Positron Emission Tomography)
- Reduces recurrence risk.
o Complete Blood Count (CBC)
o Genetic & Molecular Testing Targeted Therapy & Immunotherapy
o Microsatellite Instability (MSI) or Mismatch
Repair (MMR) testing - (For Advanced Cancer)
o Liver Function Tests (LFTs) - Bevacizumab (stops tumor blood supply).
- Cetuximab/Panitumumab (for KRAS wild-
type tumors).
Nursing Management
- Pembrolizumab/Nivolumab (for MSI- high
Pre-Surgery Care: tumors).

o Bowel preparation - Administer laxatives or Palliative Care (For Late-Stage CRC)

enemas as ordered.
- Focuses on pain relief, symptom control,
o Nutritional support - Encourage a low-
and comfort.
residue diet before surgery.
- May involve palliative surgery or hospice
care.
OBESITY Medical Management

- Obesity is defined by the World Health Lifestyle Modification

Organization (WHO) as an “abnormal or Pharmacological Management
excessive fat accumulation that may
impair health.” - Orlistat
- As a response to endorsements by multiple - Liraglutiden
health care organizations and societies, - Phentermine
obesity should be diagnosed and treated
Nonsurgical
as a disease (AMA, 2013).
- Vagal Blocking Therapy
Risk Factors - Intragastric Balloon Therapy
- Bariatric Embolization
Modifiable Risk Factors

o Unhealthy diet
Lack of physical activity
o
LIVER CANCER
o Overeating
o Excessive alcohol consumption - Also known as hepatic cancer, is a type of
cancer that originates in the liver. It occurs
Non-modifiable Risk Factors
when abnormal cells in the liver grow and
o Genetic multiply uncontrollably, forming a tumor.
o Age
o Gender Types of Liver Cancer

1. Hepatocellular carcinoma (HCC) - is the

Assessment
most common type of primary liver cancer,
Health History responsible for 75% of all liver cancers, with
more than half a million cases diagnosed
- Nurses need to approach patients with each year on a worldwide basis.
obesity with the same respectful, 2. Cholangiocarcinoma - A type of cancer
courteous, and empathetic behavior that that arises from the bile ducts within the
they extend to patients without obesity. liver.
Patients with obesity should be assessed to 3. Angiosarcoma - A rare type of liver cancer
see if there have been any recent that originates from the blood vessels.
increases or decreases in body weight. 4. Hepatoblastoma - A rare type of liver
Anthropometric Assessment?? cancer that typically affects children.

- Patient’s height and weight are measured

Risk Factors
to determine the body mass index (BMI).
o Chronic hepatitis B and C: Viral infections
Nursing Diagnosis that cause liver inflammation and scarring.
o Cirrhosis: Scarring of the liver that can
1. Imbalanced Nutrition: More than Body increase the risk of liver cancer.
Requirements o Alcohol consumption: Excessive alcohol
2. Risk for Impaired Skin Integrity consumption can lead to liver damage
3. Activity Intolerance and increase the risk of liver cancer.
4. Risk for Ineffective Coping o Obesity and diabetes: Metabolic disorders
5. Low Self-Esteem that can increase the risk of liver cancer.
o Family history: A family history of liver
Nursing Management cancer can increase an individual's risk.
o Exposure to toxins: Exposure to certain
1. Nutritional Counseling toxins, such as aflatoxins, can increase the
2. Physical Activity Promotion risk of liver cancer.
3. Behavioral Therapy o Smoking: Smoking can increase the risk of
4. Education on Healthy Lifestyle liver cancer.
5. Education on Healthy Lifestyle
6. Encourage Support Systems
Clinical Manifestations Surgical Management

o Pain-- a continuous dull ache in the RUO, Lobectomy

epigastrium, or back.
- Removal of a lobe of the liver is the most
o Weight loss
common surgical procedure for excising a
o loss of strength
liver tumor.
o Anorexia
o Anemia Liver transplantation
o Enlarged and irregular on palpation liver.
o Jaundice - A lifesaving procedure to replace a liver
that has damage from disease with a
healthy, donor liver.
Assessment and Diagnostic Findings
Local Ablation
History and physical examination
- A minimally invasive treatment option that
Imaging studies:
is used to destroy tumors and other
1. X-rays, liver scans, CT scans, ultrasound abnormal tissues in the body.
studies, MRI, arteriography, and
laparoscopy. Nursing Management
2. Positron Emmission Tomography (PET)
scans. I. Pre-surgery Care: Support, Education, and
Encouragement
Laboratory tests: II. Post-Surgery Care:
o Potential Problems:
1. increased serum levels of bilirubin, alkaline
 Cardiopulmonary
phosphatase, AST, CCT, and lactic
involvement (vascular
dehydrogenase.
complications, respiratory
2. Leukocytosis (increased WBC),
issues, liver dysfunction).
erythrocytosis (increased RBC).
 Metabolic abnormalities.
hypercalcemia, hypoglycemia, and
 Extensive blood loss
hypocholesterolemia.
requiring blood and IV fluid
3. Serum level of alpha-fetoprotein, which
infusions.
serves as a tumor marker, is elevated in 80%
o Close Monitoring and Care:
to 90%.
 Intensive monitoring for the
first 2-3 days post-surgery
Medical Management (similar to abdominal/
thoracic care).
Radiation Therapy
III. Chemotherapy/Radiation Therapy (if
- Radiation therapy includes the most applicable)
common type, external beam radiation o May continue at home post-
therapy (EBRT), and internal radiation surgery.
therapy. o Hepatic Artery Catheter or Biliary
Drainage System:
Chemotherapy
 Catheter inserted surgically,
- A common cancer treatment. It uses drugs with a subcutaneous
to destroy cancer cells and prevent tumor infusion pump for
growth. continuous chemotherapy.
 Hepatic artery port for
Immunotherapy intermittent chemotherapy
infusion (not used for
- Immunotherapy for cancer uses your
continuous therapy at home).
body's immune system to find and destroy IV. Education for Patient and Family
cancerous cells. o Care of biliary catheter.
Percutaneous Biliary Drainage o Understanding the effects and side
effects of hepatic artery
- A procedure to drain bile to relieve pressure chemotherapy.
in the bile ducts caused by a blockage. o Importance of family participation
in home care.
ESOPHAGIAL VARICES Diagnostic Test

- Esophageal varices are enlarged veins in o Esophagogastroduodenoscopy (EGD):

the esophagus, the tube that connects the Gold standard for diagnosing varices.
throat and stomach. Esophageal varices o Abdominal Ultrasound/CT Scan: To assess
most often happen in people with serious portal hypertension & liver disease.
liver diseases. Esophageal varices develop o Liver Function Tests (LFTs): Check for
when regular blood flow to the liver is albumin, bilirubin, ALT, AST levels.
blocked by a clot or scar tissue in the liver. o Coagulation Profile: PT/INR (prolonged in
liver disease).
o CBC (Complete Blood Count): May show
Risk Factors
low hemoglobin (anemia) due to bleeding.
o Excessive alcohol consumption
o A diet rich in fatty and fried foods Signs & Symptoms
o A sedentary lifestyle
o Chronic hepatitis B or C infection 1. Early Symptoms (Before Bleeding)
o Nonalcoholic fatty liver disease o Often asymptomatic until rupture
o Genetic factors occurs
o Contributing conditions, such as o Mild dysphagia (difficulty
schistosomiasis or Budd-Chiari syndrome, swallowing) in some cases
which can increase the risk of esophageal o Indigestion or mild epigastric
bleeding discomfort
2. Signs of Bleeding Varices (Emergency)
o Hematemesis (vomiting blood) –
Assessment
May be bright red or "coffee-
- Assessment includes a combination of ground" in color
history-taking, physical examination, and o Melena (black, tarry stools) – Due
diagnostic tests to determine the presence to digested blood in stool
and severity of esophageal varices o Hematochezia (bright red blood
in stool) – If bleeding is severe
o Dizziness, weakness, fainting – Due
History Taking
to blood loss
o Past medical history of liver disease o Shock symptoms (cold skin,
(cirrhosis, hepatitis, alcoholism) confusion, rapid weak pulse) in
o Symptoms of gastrointestinal (GI) bleeding severe cases
(vomiting blood, black stools)
o Signs of liver dysfunction (jaundice, ascites, Nursing Diagnosis
fatigue)
o Alcohol consumption history 1. Risk for Bleeding related to increased
o Medication history (NSAIDs, anticoagulants portal hypertension and fragile varices.
may worsen bleeding) 2. Ineffective Tissue Perfusion related to
gastrointestinal hemorrhage and
hypovolemia.
Physical Examination 3. Risk for Shock related to massive blood loss
o Vital signs: from ruptured varices.
o Hypotension (low blood pressure) 4. Acute Pain related to esophageal
o Tachycardia (rapid heart rate) irritation, variceal bleeding, and
o Pallor (due to blood loss) associated procedures.
o Abdominal examination: 5. Imbalanced Nutrition: Less than Body
o Ascites (fluid accumulation in the Requirements related to decreased oral
abdomen) intake and malabsorption from liver
o Hepatomegaly (enlarged liver) or dysfunction.
splenomegaly (enlarged spleen) 6. Risk for Aspiration related to hematemesis
o Caput medusae (visible abdominal veins (vomiting blood) and potential airway
due to portal hypertension) obstruction.
o Signs of shock (cold, clammy skin, 7. Deficient Knowledge related to lack of
confusion in severe cases) information about esophageal varices,
treatment, and lifestyle modifications.
 8. Anxiety related to the fear of bleeding o Balloon tamponade (Sengstaken-
episodes and possible complications. Blakemore tube) – used in severe
cases to control bleeding
Goal
4. Post-Bleeding Care & Prevention
1. Prevent rupture and bleeding episodes o Maintain NPO (nothing by mouth) until
2. Maintain adequate blood circulation and bleeding is controlled.
oxygenation. o Gradually introduce clear liquids and a
3. Prevent hypovolemic shock and stabilize soft diet after stabilization.
vital signs. o Encourage follow-up endoscopies to
4. Provide pain relief and comfort measures. monitor varices.
5. Improve nutritional status and maintain o Educate patient on medication
adequate caloric intake. adherence, avoiding alcohol, and
6. Maintain a clear airway and prevent proper nutrition.
aspiration pneumonia.
7. Educate the patient on disease Medical Management
management, alcohol avoidance, and
follow-up care. 1. Prevention of Bleeding (For Non-Bleeding
8. Reduce anxiety and provide emotional Varices)
support. o Beta-blockers (e.g., Propranolol,
Nadolol) → Reduce portal
hypertension.
Nursing Management
o Nitrates (e.g., Isosorbide
1. Monitor & Assess Mononitrate) → Used in
o Vital Signs: Monitor BP, HR, RR, and combination with beta-blockers.
oxygen saturation (watch for signs of o Endoscopic Surveillance → Regular
shock). EGD
o Bleeding Signs: Check for hematemesis (esophagogastroduodenoscopy)
(vomiting blood), melena (black stools), to monitor varices
pallor, and dizziness. 2. Emergency Management of Active
o Neurological Status: Assess LOC (level Bleeding
of consciousness) for hepatic o Fluid Resuscitation: IV fluids, blood
encephalopathy. transfusions (to prevent
o Abdominal Examination: Look for hypovolemic shock).
ascites and hepatomegaly o Vasoactive Drugs:
2. Prevent Bleeding & Rupture  Octreotide → Reduces
o Administer beta-blockers (e.g., portal blood flow &
propranolol) to lower portal pressure.
hypertension.  Vasopressin → Constricts
o Encourage lifestyle modifications (e.g., blood vessels to slow
avoid alcohol, NSAIDs, and heavy bleeding.
lifting). o Endoscopic Therapy:
o Monitor lab values: INR, PT, platelets  Endoscopic Band Ligation
(assess bleeding risk). (EBL) → Ties off bleeding
3. Emergency Management of Active varices.
Bleeding  Sclerotherapy → Injection
o Position patient in high Fowler’s of a sclerosing agent to
(prevents aspiration). stop bleeding.
o Administer IV fluids & blood transfusions o Balloon Tamponade (Sengstaken-
to prevent hypovolemia. Blakemore Tube) → Temporary
o Give vasopressors (e.g., octreotide or control of severe bleeding
vasopressin) to reduce portal pressure. 3. Long-Term Management & Secondary
o Endoscopic interventions: Prevention
 Band ligation – ties off varices o Transjugular Intrahepatic
to stop bleeding. Portosystemic Shunt (TIPS) →
 Sclerotherapy – injects Creates a pathway to reduce
medication to shrink varices. portal pressure.
o Liver Transplantation → For patients
with end-stage liver disease (ESLD).
 o Antibiotics (e.g., Ceftriaxone, Nursing Management / Intervention
Norfloxacin) → Prevent infection-
related complications. o Monitor liver function and vital signs.
o Avoidance of Alcohol & o Encourage rest and proper hydration.
Hepatotoxic Drugs → Prevent o Educate on hygiene, vaccination (HBV),
further liver damage and safe practices.
o Educate on transmission prevention.
o Support nutritional intake with small,
frequent meals
HEPATITIS B, C, D, E
Medical Management
1. Hepatitis B (HBV): A viral infection that
affects the liver, transmitted through blood, Non-surgical
bodily fluids, or perinatal transmission.
2. Hepatitis C (HCV): A liver infection mainly o HepB: Antivirals (Tenofovir, Entecavir).
spread through blood-to-blood contact, o HepC: Direct-acting antivirals (Sofosbuvir,
often leading to chronic liver disease. Ledipasvir).
3. Hepatitis D (HDV): A defective virus that o HepD: Pegylated interferon-alpha.
only occurs in individuals infected with HBV, o HepE: Supportive treatment, ribavirin in
worsening liver damage. severe cases.
4. Hepatitis E (HEV): A self-limiting viral Surgical
infection primarily transmitted through
contaminated food and water. o Liver transplant in end-stage liver disease or
liver failure.

Risk Factors
Diagnostic Test
Hepatits B and C:
o Blood Tests: HBsAg (HBV), Anti-HCV, HCV
o Unprotected sex RNA, Anti-HDV, Anti-HEV.
o Sharing needles o Liver Function Tests: ALT, AST, Bilirubin levels.
o Blood transfusion o Imaging: Ultrasound, Fibroscan (for
o Perinatal transmission fibrosis/cirrhosis).
o Liver Biopsy: In chronic or severe cases
Hepatitis D:

o Co-infection with HBV

Hepatitis E:

o Contaminated water
o Poor sanitation
o Travel to endemic area

Signs and Symptoms

o Fatigue, jaundice, dark urine, abdominal

pain, nausea, vomiting, loss of appetite,
fever, joint pain (more common in HBV).
o Chronic cases (HBV, HCV, HDV) can lead to
liver cirrhosis and cancer.

Nursing Diagnosis

o Risk for infection transmission.

o Impaired liver function related to viral
infection.
o Fatigue related to decreased metabolic
function.
o Imbalanced nutrition due to nausea and
poor appetite.