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NATIONAL AMERICAN UNIVERSITY

BLOOMINGTON CAMPUS

BSN PROGRAM

Nursing 3360: Holistic Nursing Care in Acute Illness I

Spring 2014

Learning Plan 7

Lower and Upper Gastrointestinal Problems

Objectives of the Course:

Upon successful completion of this course, the student will be able to:

1. Demonstrate theoretical principles and ability to perform safe, effective and efficient psychomotor skills.

Knowledge and skills leading to mastery of this competency

a. Explain the interrelationships among theory, practice, and research.

b. Integrate theories and concepts from liberal education into nursing practice.

c. Determine the application of psychomotor skills for the efficient, safe, and compassionate delivery of client care.

d. Maintain optimum level of pain relief, oxygenation, patency of airway, administration of intravenous therapy, and integrity of medical supplies and equipment.

e. Promote respiratory, circulatory, cardiopulmonary, gastrointestinal, genitourinary, integument, and musculoskeletal functioning.

f. Promote the nutrition and fluid balance, elimination, physical activity, restoration or maintenance of physical independence, physical comfort, rest and sleep, and personal hygiene of the client.

3. Explain the purposes, rationales, and indications for various nursing actions.

Knowledge and skills leading to mastery of this competency

a. Incorporate a model of critical thinking when making clinical judgments and decisions.

b. Cite nursing and associated literature that supports the nursing action.

c. Deliver compassionate, client-centered, evidence-based care that respects client and family preferences.

d. Explore phenomena in nursing that relates to the human response to illness.

4. Acquire knowledge from the behavioral, biological and physical sciences necessary to provide simple to intermediate level nursing actions.

Knowledge and skills leading to mastery of this competency

a. Synthesize theories and concepts from liberal education to build an understanding of the human experience

b. Identify sources of information necessary to deliver nursing actions to clients and families who are experiencing illness.

c. Incorporate theories of aging when providing care for gerontological clients.

d. Explore the Patterns of Knowing.

 5. Document pertinent, accurate and complete client care information.

Knowledge and skills leading to mastery of this competency

a. Incorporate a standardized terminology in a care environment that reflects nursing’s unique contribution to patient outcomes.

b. Examine information and electronic medical record systems used to document client information.

c. Explain the use of CIS systems to document interventions related to achieving nurse sensitive outcomes

6. Demonstrate advancing knowledge and skill in implementing the nursing process in client care and critical thinking activities.

Knowledge and skills leading to mastery of this competency

a. Articulate the components of the nursing process: Assessment, diagnosis, outcome identification, planning, implementation, and evaluation.

i. Explain the purposes of implementation and evaluation.

j. Explain activities the nurse carries out to effectively use the nursing process.

Overview:

The main function of the gastrointestinal (GI) system is to supply nutrients to body cells. Factors outside the GI tract can influence its functioning. Both psychological and emotional factors, such as stress and anxiety, influence GI functioning in many people. Stress may be manifested as anorexia, epigastric and abdominal pain, or diarrhea. Factors such as dietary intake, ingestion of alcohol and caffeine-containing products, cigarette smoking, poor sleep, and fatigue may also affect GI function. Some organic diseases of the GI system such as peptic ulcer disease (PUD) may be aggravated by stress. Nausea and vomiting are the most common manifestations of a variety of GI disorders.

The wide variety of intestinal problems presented in this lesson plan include the common dysfunctions of diarrhea, fecal incontinence, and constipation; inflammatory and infectious bowel disorders; bowel trauma; bowel obstructions; abdominal and bowel surgery (including ostomy formation); and malabsorption disorders. Particular emphasis is placed on the nursing management of patients with inflammatory bowel disease and patients undergoing bowel surgery with creation of ostomies.

Theory Learning Activities:

Lewis:

• Chapter 39 (review) Gastrointestinal System

• Chapter 42 Upper Gastrointestinal Problems

• Chapter 43 Lower Gastrointestinal Problems

Potter and Perry

• Chapter 46 Bowel Elimination

ATI Adult Medical-Surgical Nursing:

• Chapter 51 Gastrointestinal Diagnostic Procedures

• Chapter 52 Gastrointestinal Therapeutic Procedures

• Chapter 53 Esophageal Disorders

• Chapter 54 Peptic Ulcer Disease

• Chapter 55 Acute and Chronic Gastritis

• Chapter 56 Appendicitis

• Chapter 57 Intestinal Obstruction

• Chapter 58 Inflammatory Bowel Disease

• Chapter 59 Colorectal Cancer

Review

• United Ostomy Associations of America, Ind.

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• Crohn’s and Colitis Foundation of America

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• International Foundation for Functional Gastrointestinal Disorders

Come to class prepared to discuss:

• Diarrhea

• Fecal Incontinence

• Constipation

• Acute abdominal pain

• Irritable Bowel Syndrome

• Abdominal Trauma

• Inflammatory Disorders

o Appendicitis

o Crohn’s disease

o Ulcerative colitis

• Intestinal obstruction

• Ostomy surgery

• Anal rectal problems

• Abdominal Disorders

o Nausea and vomiting

o Gastroesophageal reflex disease (GERD)

o Hiatal hernia

o Gastritis

o Peptic ulcer disease (PUD)

o GI bleed

Theory Post-class:

• HESI Case Study – Skin Integrity

Learning Objectives

1. Explain the common etiologies, collaborative care, and nursing management of diarrhea, fecal incontinence, and constipation

2. Describe common causes of acute abdominal pain and nursing management of the patient following an exploratory laparotomy.

3. Describe the collaborative care and nursing management of acute appendicitis, peritonitis, and gastroenteritis.

4. Compare and contrast the inflammatory bowel diseases of ulcerative colitis and Crohn’s disease, including pathophysiology, clinical manifestations, complications, collaborative care, and nursing management.

5. Differentiate among mechanical, neurogenic, and vascular bowel obstructions, including causes, collaborative care, and nursing management.

6. Describe the clinical manifestations and collaborative management of colorectal cancer.

7. Explain the anatomic and physiologic changes and nursing management of the patient with an ileostomy and a colostomy.

8. Differentiate between diverticulosis and diverticulitis, including clinical manifestations, collaborative care, and nursing management.

9. Compare and contrast the types of hernias, including etiology and surgical and nursing management.

10. Describe the types of malabsorption syndrome and collaborative care of celiac disease, lactase deficiency, and short bowel syndrome.

11. Describe the types, clinical manifestations, collaborative care, and nursing management of anal rectal conditions.

12. Describe the etiology, complications, collaborative care, and nursing management of nausea and vomiting, and gastritis

13. Explain the etiology, clinical manifestations, collaborative care, and nursing management of upper gastrointestinal bleeding.

14. Explain the types, clinical manifestations, complications, collaborative care, including surgical therapy and nursing management of gastroesophageal reflux disease (GERD) and hiatal hernia.

15. Compare and contrast gastric and duodenal ulcers, including etiology, clinical manifestations, complications, collaborative care, and nursing management.

16. Differentiate between the patterns of pain seen in gastric ulcer and a duodenal ulcer.

17. Describe the clinical manifestations indicative of a perforation.

18. Discuss the rationale behind the ‘triple therapy’ approach to the treatment of peptic ulcer disease.

19. List the tests performed to check for Helicobacter pylori.

20. Identify the classifications of medications used to relieve symptoms of GERD that result from reflux of gastrointestinal contents containing acid.

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