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Adult Health Nursing Iii (NURS 450) Odu Bleed Blue

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John Marsh
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GI Alterations – Dr. Wiles Lecture

  • Old Dominion University
  • Adult Health Nursing Iii (NURS 450)

GI Alterations
 GI Bleed, Intra-abdominal Hypertension, Pancreatitis, Liver Failure
 GI Review
o GI Function
 Convert ingested nutrients into simpler forms that can be transported from the GI tract to the
portal circulation and then used in metabolic processes
 Detoxify the body by eliminating bacteria, viruses, chemical toxins, and drugs
o Stomach pH 1.0
 When mixed with food can rise to 2-3
o “Yellow feed the fellow”
 Yellow colored enzymes are produced by the duodenum & are required for nutrient digestion
 When seen in the NGT, patient is generally ready to eat
o “Green obstruction is seen”
 Don’t have the bile salts, means there’s an obstruction
GI BLEEDING
 A medical emergency characterized by bleeding anywhere in the GI tract
o Most cases are upper GI bleeding which is more life threatening
o Lower GI bleeding is generally oozing in the colon
 Acuity ranges from out pt. treatment to ICU admission with maximal intervention
 Key to survival is prevention
o Best treated when diagnosed early
 3 main causes in ICU
o Peptic ulcer disease, Stress related erosion, & esophageal varices
 Higher incidence of death occurs when 1+ co-factors exist
o > 55 years old
o Disease in 3+ organs
o Transfusion of 5+ units
o Lung (oxygenation) or liver (clotting factors) disease
o Recent major surgery
o Immunosuppression
o Shock
 Left untreated, GI bleed results in hypovolemic shock, the initiation of the shock response, and the development
of MODS
 The most common cause of death is NOT retractable hypovolemic shock but EXACERBATION of the underlying
disease process
 GI Bleeding: Peptic Ulcer Disease (PUD)
o Result from breakdown of gastric and duodenal mucosal lining
o Leading cause of upper GI bleed in ICU
o Causes
 NSAIDS
 Ibuprofen (Motrin, Advil), naproxen sodium (Aleve), etc.
 Helicobacter pylori bacteria
 Decreased mucosal blood flow
o Gastric & duodenal ulcers
 In addition to the “normal causes” in the ICU the normal protective mechanisms of the GI tract
cease to function if there is not adequate GI mucosal blood flow
 GI Bleeding: Stress Related Mucosal Disease
o Acute erosive gastritis
o Second leading cause of ICU GI bleed—20%
o High Risk Patients
o Prophylaxis / pH testing
 Pharmacologic gastric acid neutralization to maintain pH > 4.0
o Guiac tests
 Checking for occult blood in stool
o Range from superficial oozing to erosive disease

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Adult Health Nursing Iii (NURS 450) Odu Bleed Blue

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