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Preface
Gastrointestinal Issues and
Complications

Deborah Weatherspoon, Debra Sullivan, PhD,

PhD, MSN, RN, CRNA, COI MSN, RN, CNE, COI
Editors

Gastrointestinal (GI) dysfunction and failure are common problems in the critically ill
patient, as a primary reason for admission or developing as part of multiple organ
dysfunction syndrome. Delayed gastric emptying, abnormal motility patterns, and
impaired intestinal barrier integrity are commonly observed in the critical care unit
and are associated with complications and morbidities that may affect survival. In
this issue of Critical Care Nursing Clinics of North America, a wide variety of primary
and secondary causes of GI dysfunction are discussed.
Complications related to inflammation and infection, either as a primary or as a
secondary outcome, cause serious morbidity in both adults and pediatric popula-
tions. The epidemic proportion of Clostridium difficile infection gives cause for
concern, especially for vulnerable populations as adults over age 65; further C diffi-
cile infection is described by the Centers for Disease Control and Prevention as an
urgent threat that is very difficult to manage in any population and more so in pa-
tients with critical illness. Moore reviews clinical manifestations of the infection,
outlines both medical and surgical treatment options, and discusses risk factors,
diagnostics, and ways to improve prevention strategies. Squellati reviews the
role of antibiotics leading to C difficile infection and reviews the pros and cons of
probiotics as a potential treatment. Yet another pathogenic GI infection is shiga
toxin–producing E coli. While this is a significant threat to all age groups, it is espe-
cially dangerous for young children, who are prone to develop a more severe
illness, hemolytic uremic syndrome (HUS). Puentes and Dunstan focus on the pe-
diatric population and the potentially life-threatening complication of HUS. In their
review, a summary of pathogenesis, clinical presentation, diagnosis, and symptom
management is discussed.

Crit Care Nurs Clin N Am - (2017) -–-

https://doi.org/10.1016/j.cnc.2017.10.016 ccnursing.theclinics.com
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Ellison provides insight into the diagnosis, treatment, and management of acute
diverticulitis and potential complication and provides a case study that is interesting
and informative. Cooper and Urso review the signs and symptoms of gastroesopha-
geal reflux and provide the latest evidence-based practice for the treatment and
care in the adult population. Ferguson brings information regarding reflux and regur-
gitation in the infant population.
Revell, Pugh, and McGhee review traumatic injuries that directly or indirectly lead
to bowel injuries and include management of hemodynamic unstable patients and
its effect on the bowel. GI bleeding in both the upper and lower GI system is a
frequent problem seen in critical care patients. Farrar reviews various disorders
leading to GI bleeds and treatment options. Lawson reports specifically on compli-
cations associated with decreased circulation to the GI system and mesenteric
ischemia.
Conditions that affect the immune system and the medications used to treat auto-
immune disease can disrupt GI integrity. Collins-Yoder looks at autoimmune diseases
and the medications often prescribed and potential GI complications. Hall focuses on
HIV patients who are on antiviral medication as well as those living with AIDS who pre-
sent with GI complications. Updated information is presented for both these patient
populations.
The critical care nurse has excellent assessment and monitoring skills; however,
GI issues can be more complex, often presenting with vague yet serious issues. This
issue includes three articles related to assessment and management of GI issues.
Bond and Hallmark discuss nursing education, or skills training, in a simulated
setting using an algorithm that incorporates the Sequential Organ Failure Tool and
the Gastrointestinal Failure Tool. According to recent research, almost half of all
hospitalized patients are not fed, are underfed, or are malnourished while in the hos-
pital due to increased metabolic needs while hospitalized. Welch addresses the
importance of early feedings while in critical care, and the available options,
including enteral and parenteral feedings, that support initiation and management
of early feedings. Frazer, Hussey, and Bemker discuss the critical care patient at
risk of GI complications due to motility disorders. These patients require close moni-
toring and an acute awareness of the causation, symptoms, and treatment of
various GI motility disorders, including gastroparesis, ileus, and toxic megacolon.
Another group requiring specialized critical care is patients experiencing end-stage
liver failure or those preparing for a liver transplant. Hays and McGinnis describe the
vital role nurses play caring this population prior to, and immediately after,
transplantation.
We hope that this update on GI complications increases awareness of the potential
problems, either as a primary concern or as a comorbid one, in the critical care patient.
The authors for each article have provided an updated review of literature and pre-
sented the current evidence-based care evidence to inform nursing practice for the
critical care population.

Deborah Weatherspoon, PhD, MSN, RN, CRNA, COI

College of Health Science
School of Nursing MSN Leadership and Management Program
Walden University
100 Washington Avenue South, Suite 900
Minneapolis, MN 55401, USA
 Preface iii

Debra Sullivan, PhD, MSN, RN, CNE, COI

College of Health Science
School of Nursing Core MSN Program
Walden University
100 Washington Avenue South, Suite 900
Minneapolis, MN 55401, USA
E-mail addresses:
Deborah.Weatherspoon@waldenu.edu (D. Weatherspoon)
Debra.Sullivan@waldenu.edu (D. Sullivan)