N107 – Nursing Care of Clients with Alterations in the
), frequency of elimination as well as stool
Gastrointestinal Tract (Gaspar, 2/6/17)
P.S – texts from slides were lifted off, and placed with
added info during lec and ‘reading’ assignments by Sir
Aldin.
Review of Anatomy and Physiology (run-through)
- Esophagus --- at the lower end is the cardiac
sphincter which prevents backflow of gastric
contents.
- Diaphragm – Separates the respiratory system
from the digestive system
- Stomach – esophageal sphincter, fundus, body,
pylorus, pyloric sphincter
- Small Intestine – jejunum, duodenum, ileum
- Large Intestine – separated from the small
intestine by the ileoceccal valve. Ascending,
Transverse, Descending and Sigmoid colon.
- Rectum
- Liver, pancreas, gall bladder, appendix
(appendix determined to be a safe house for
good bacteria)
- Messentery (newly considered organ) –
transports blood and lymph from the intestine to
other parts of the body.
Assessment
- Health History – chief complaint of present
illness
o A detailed description of the present
illness
o Complaints of weight changes,
problems with food ingestion,
symptoms of digestive disturbances, or
changes in bowel elimination
N107- Nursing Care of Clients with GI Problems – BAYONITO, K.A.D.
- Diet (!
characteristics
o Brown color – attributed to the
presence of BILE.
o TOO brown color – high protein in the
diet
o White stool – Post Cholecystectomy
OR ingestion of barium sulfate for
laboratory procedures
o Melena – dark-colored, tarry stool;
indicates bleeding in the upper GI tract
o Hematokesia – Fresh blood in stool;
indicates bleeding in lower GIT
- Past Medical History
o Recent Surgery, trauma, burns, or
infections
o Serious illness, such as diabetes,
hepatitis, anemia, peptic ulcers, gall
bladder disease and cancer
o Alternative methods of feeding or fecal
diversion
o Food allergy or intolerance
o IMMUNIZATIONS
- Medications – OTC medications, prescription
drugs, herbal products, nutritional supplements
- Functional assessment
o Health perception and management –
General dietary habits, recent travel,
attitudes, and beliefs about food, and
changes in dietary habits related to
health problems
o Nutritional – metabolic pattern; 24-
hour food recall, allergies, intolerance
o Elimination pattern – changes in
pattern (correlate with nutritional
pattern)
o Activity-exercise pattern – note
whether patient is able to obtain and
prepare food, eat independently,
effects of chief complaint on usual
functioning
o Sleep-rest pattern – changes in quality
of sleep or rest? Individual routines
o Cognitive-perceptual pattern –
changes in taste or smell, vertigo, heat
and cold sensitivity, patient’s
understanding of the illness and its
treatment
o **Self perception and self-concept –
VERY COMMON PROBLEM with
OSTOMY CLIENTS
Page 1
 o Role-relationship pattern – ability to
maintain usual roles and relationships;
support system
o Sexuality-reproductive pattern –
patient’s confidence regarding sexual
activity; effect of ostomy and
alcoholism
o Coping-stress tolerance pattern and
value-belief pattern – spiritual and
cultural beliefs regarding food and
food preparation
- Physical Examination
o Vital signs, and anthropometric
measurements – FILIPINO STANDARDS
 DOST graph maximum
allowance for BMI – 19.0 to
24.8 is the normal range
[walang masyadong
mahanap na specific
standards, pero this will do I
guess].
o Head and neck – inspect mouth
o Abdomen – remember IAPerPal
(Inspection, Auscultation, Percussion,
Palpation)
o Rectum and anus – palpate for lumps
and tenderness in the rectum
o Bimanual Palpation – liver palpation,
upon percussion should be DULL
- Laboratory and Diagnostic Procedures
o CBC – increased WBC indicates
infection; important to note anemia
and other blood dyscrasias
o Fecal Occult Blood test – send certain
amount of stool -> RBC checked in
stool to see probable bleeding -> if (+),
followed up with other diagnostic tests
o CEA (Carcinoembryonic Antigen) – for
detection of colorectal cancer/s =
normal value is less than 3ug/mL
o BUN, Albumin, Gastric Analysis, Liver
Function Tests,
o Stool Exam – DO NOT PERFORM IF
WITH ACTIVE BLEEDING! Will produce
False Positive result
***Intake of Broccoli, salmon, turnip,
horse radish, liver/igado, must be
STOPPED before taking FOBT to prevent
false positive result
***Ferrous sulfate DOES NOT produce a
false positive result
N107- Nursing Care of Clients with GI Problems – BAYONITO, K.A.D.
***Vitamin C – can produce a FALSE
NEGATIVE result
o Radiographic Studies
 Upper GI series – barium
sulfate fluoroscopy – looks
milky, thin or thick, colorless
tasteless, non-granulated.
NOT ABSORBED BY THE
BODY.
 Nursing Responsbilites –
(1) instruct NPO post 12
midnight in prep for
procedure, (2) INCREASE
FLUID INTAKE
 Lower GI tract – No NPO
needed
 Tumors, neoplasms, and
varices are seen / inflamed
lining appearance in film
indicates ULCER, dense white
appearance indicates
possible neoplasm
 15-30 minute procedure
 Need for low-residue diet 2
weeks before procedure
 Usually laxatives are ordered
o CT Scans
 Better anatomic view of GIT
 NPO 6 to 8 hours before
procedure
 Laxatives are administered to
empty the GI tract
 If w/ barium series, CT Scan
is done FIRST and then
barium swallow
o Endoscopic Examinations
 Upper GI
(Esophogastroduodenoscopy
or EGD)
 Lower GI (Colonoscopy,
proctoscopy, sigmoidoscopy)
 ERCD – Endoscopic
retrograde
cholangiopancreatography –
to visualize pancreas as well
as gall bladder through the
ampulla of vater
 NURSING RESPONSIBILITIES
(1) Prevent vomiting /
aspiration – because
sedatives, muscle relaxants,
Page 2
 and topical anesthetics are appear as ulcerations, thickened or
given rough areas, or sore spots /
(2) NO FOOD INTAKE until Leukoplakia: hard, white patches in the
GAG REFLEX RETURNS (1-2 mouth that are premalignant
hours in other references) o Medical Diagnosis and Treatment – A
***ATROPINE is given to decrease secretions, biopsy of suspicious lesions; treatment
GLUCAGON is given as muscle relaxant includes surgery, radiation, or
(Respiratory smooth muscle relaxation) chemotherapy, or combination of
o LIVER BIOPSY these
*** Instruct to INHALE-EXHALE during o ASSESSMENT
puncture  History of prolonged sun
th th
*** Puncture is between the 6 – 7 rib exposure, tobacco use and
***NEED FOR RESPIRATORY alcohol consumption
MANAGEMENT – prepare pulse oximeter,  Assess for difficulty
possible intubation, and thoracoscopy swallowing or chewing,
*** IF RISK FOR PUNCTURING LUNGS – decreased appetite, weight
Biopsy done through right intrajugular vein loss, change in fit of
*** POST-PROCEDURE POSITION – RIGHT dentures, and hemoptysis
SIDE LYING POSITION  PE Should focus on
o Bleeding precautions examination of mouth for
o Remain immobile for 2 hours, avoid lesions
straining, coughing to prevent bleeding  Assess the neck for limitation
st
o Every 15 minutes VS for 1 hour, of movement and enlarged
q30mins for the next 2-3 hours lymph nodes
DISORDERS OF THE ORAL CAVITY (lymphadenopathy in neck
- Sialadenitis – inflammation of salivary glands indicates possible oral or ear
- ORAL CANCER infection)
o Types: oral cavity cancer and o Nursing Diagnosis
oropharyngeal cancer  IF LATE STAGE – PRIORITY
o 2x more in men DIAGNOSIS IS AIRWAY (!!!)
o 5-year survival rate is 59%  Nutrition – possible
o More common after age 35 parenteral nutrition admin
o Common in the lower lip  Psychosocial problems
o NOTE: Documentation of the neoplasm  Pain, Impaired verbal
(e.g. (+) lesion in the right inner buccal communication, Disturbed
mucosa, minimal erythema, with body image, Risk for
yellowish discharge, 2cm in diameter) infection, Ineffective tissue
o RISK FACTORS perfusion
 Smoking, lipsticks because o Collaborative Care
of lead (CHECK FOR LEAD  Elimination of risk factors
CONTENT – ikiskis daw sa (alcoholism, poor dental
piso or sag into) care, infection with HPV)
 Poor nutritional status,  Correct oral hygiene and
chronic irritation, alcohol use preventive dental care
 Cancer of the lip related to  Radical Neck Dissection –
prolonged exposure to surrounding tissues and
irritants, including sun, wind, affected lymph nodes are
and pipe smoking. removed
o Signs and symptoms – tongue ***Nursing Responsibilities (1) Airway, (2) pain
irritation, loose teeth, and pain in the management, (3) wound care, (4) v/s
tongue or ear / Malignant lesions may

N107- Nursing Care of Clients with GI Problems – BAYONITO, K.A.D. Page 3

 monitoring, (5) psychosocial care, (6)
communication, (7) mobility
*** To facilitate better neck mobility –
(1) first 24 hours or until wound is healed,
IMMOBILIZE NECK
(2) 48 hours onwards, teach ROM, practive neck
movement
(3) WOF: Bleeding, infection, cranial nerve
damage (V, IX, XI)
DISORDERS OF THE ESOPHAGUS
- Gastroesophageal Reflux Disease (GERD) -
backward flow of gastric contents from stomach
to esophagus.
o Most common upper GI problem in
adults
o Incidence of 14-16% in Asia
o Pathophysiology – Abnormalities
around the Lower Esophageal
Sphincter, gastric or duodenal ulcer,
gastric oresophageal surgery,
prolonged vomiting, and prolonged
gastric intubation; eventually causes
esophagitis
o Signs and Symptoms – painful burning
sensation that moves up and down,
commonly occurs after meals, and is
relieved by antacids
o Association with Barret’s Esophagus –
lining similar to stomach replaces the
lining of the esophagus
o Diagnostics
 Suggested by signs and
symptoms
 Endoscopy, biopsy, gastric
analysis, esophageal
manometry, 24-hour
monitoring of esophageal
pH, acid perfusion tests
o Collaborative Care
 Drug Therapy –
(1)H2-receptor blockers
(CIMETIDINE, RANITIDINE),
(2)prokinetic agents
(METOCLOPRAMIDE,
ONDANSENTRON), and
(3) proton pump inhibitors
(OMEPRAZOLE)
 Surgical Fundoplication – to
tighten the sphincter
 Lifestyle modifications –
(1) Avoidance of triggers,
N107- Nursing Care of Clients with GI Problems – BAYONITO, K.A.D.
(2) smoking cessation,
(3) avoid chocolate,
peppermint, tomatoes,
coffee, tea, milk, tomato-
based products, orange,
juice, cola, red wine,
(4) small, frequent meals,
(5) avoid late evening meals
and nocturnal snacking,
(6) take fluids in between
rather than with meals,
(7) chewing gum, oral
lozenges
(8) high-protein, low-fat diet
(9) avoid alcohol,
(10) avoid lying down 2-3
hours post meals, wearing of
tight clothing, and bending
over after eating,
(11) sleeping with head of
bed elevated,
(12) weight reduction.
- Hiatal Hernia – Most common abnormality
found on X-ray examination of GI tract; common
in older adults and more common in women
than in men.
o Types
 Sliding – Hernias that move
up and down, in and out of
the chest area (more than
80% are of this type);
heartburn, regurgitation, and
dysphagia are common Sx.
 Paraesopahgeal/rolling –
part of the stomach pushes
up through the hole in the
diaphragm next to the
esophagus ; patient’s usually
feel a sense of fullness or
chest pain after eating
o Pathophysiology
Page 4
  Protrusion of lower
esophagus and stomach up
through the diaphragm and
into the chest
o Causes
 Weakness of diaphragm
muscles where esophagus
and stomach join, but exact
cause is not known
 Factors are excessive intra-
abdominal pressure, trauma,
and long-term bed rest in a
reclining position
o Diagnostics
 Barium swallow examination
with fluoroscopy
 Esophagoscopy
 Esophageal manometry
o Collaborative Care
 Reduction of intraabdominal
pressure
 Drug Therapy, diet, and
measures to avoid increased
intra abdominal pressure
(Head of bed elevation)
 Eating smaller and frequent
meals
 Avoid lying down for three
hours after drinking or eating
 Sugery: fundoplication and
placement of the synthetic
Angelchik prosthesis
DISORDERS OF THE STOMACH
- Peptic Ulcer Disease
N107- Nursing Care of Clients with GI Problems – BAYONITO, K.A.D.
o Patophysiology – loss of tissue from
lining of the digestive tract /classified
as either GASTRIC or DUODENAL
o Causes – contributing factors include
drugs, infection, stress / most ulcers
are caused by H. pylori
o Signs and symptoms - burning pain,
nausea, anorexia, weight loss
o Complications – haemorrhage,
perforation, pyloric obstruction
o Diagnostics –Barium swallow
examination, EGD; H. Pylori detected
by antibiotics in blood or stool and by a
breath test
o Medical/surgical treatment – Drug
Therapy, Diet Therapy, Managing
Complications, Gastroduodenostomy
or Billroth 1 Operation.
***BILLROTH 1 – Antrectomy – portion of the
stomach distal to the antrum is excised. LOWER
RECURRENCE OF PUD.
***BILLROTH 2 – Gastrojejunostomy – 10 to 20%
recurrence of PUD
***VAGOTOMY – removal of partial or complete
Vagus nerve.
o Dumping Syndrome –happens due to a
part of the stomach removed
 Symptoms that may be felt
10-30 minutes after eating:
Nausea, vomiting, abdominal
cramps, diarrhea, flushing,
dizziness, lightheadedness,
rapid heart rate
 HYPOGLYCEMIA due to
pancreas oversecreting
insulin in an attempt to catch
faster flow of food through
the GI tract
Page 5
 o Assessment
 Pain, including location,
aggravating factors, and
measures that bring relief;
relationship between pain
and food intake.
 Recent serious illness,
previous peptic ulcer disease,
and a medication history
 Functional Assessment:
patient’s usual diet, use of
alcohol and tobacco,
activities, sleep patterns and
stressors.
 Vital signs: Height and
weight; skin and mucous
membranes for turgor and
moisture
 Inspect abdomen for
distention and palpate for
tenderness
 Auscultate for bowel sounds
Gastric PUD Duodenal PUD
- More common in ages 50- - more common in ages 30-
60 y/o 50 y/o
- thinner lining of gastric - equal incidence in both
mucosa men and women
- greater in male because of - pain is relived by food
alcohol intake and stress intake (pain 2-3 hours
- pain induced by food, postmeal)
right after eating (15- - clients are not
30minutes) malnourished
- malnourished client,
usually
o Nursing Diagnosis
 Pain
 Imbalanced nutrition: less…
 Ineffective self-health mgt
 Nausea
 PC: Hemorrhage
o Collaborative Care
 Adequate rest
 Drug Therapy: Antacids, PPI,
H2-receptor blockers,
cytoprotective drugs
 Elimination of smoking and
alcoholism
 Dietary modifications if
needed
 NGT placement
 Rehydration
 Blood Transfusion
N107- Nursing Care of Clients with GI Problems – BAYONITO, K.A.D.
 NPO
 Hemodynamic monitoring
- Upper Gastrointestinal Bleeding – Overt
bleeding / Clinically Important bleeding / Occult
bleeding
o Causes
 Drug-induced:
corticosteroids, NSAIDs,
salicylates
 Esophagus: BEV (Bleeding
Esophageal Varices?),
Esophagitis, Mallory-weiss
tear
 Stomach and Duodenum:
Stomach CA, hemorrhagic
gastritis, PUD, stress-related
mucosal disease
 Systemic Diseases: Blood
dyscrasias, renal failure
o Signs/symptoms
 Melena
 Hematemesis
 “coffee-ground” material in
nasogastric aspirate
 Ocasionally hematochezia
 S/sx of hypovolemia
 Tense, board-like abdomen
(perforation and peritonitis)
 Abdominal distention,
guarding
o Diagnostics – Endoscopy
o Medical and surgical treatment –
sugery, PPI, RBL, somatostatin, blood
transfusion, vasopressin
o GASTRIC LAVAGE – cleaning the
stomach through suction.
 MEASURE (!) volume of
blood loss in coffee ground
nasogastric aspirate
 Cold application – to depress
bleeding
 Normal – yellowish to green
aspirate (bilous)
o Nursing Diagnoses
 Risk for aspiration r/t active
bleeding and altered LOC
 Decreased Cardiac output,
r/t blood loss
 Fluid Volume Deficit r/t
blood loss
Page 6
  Ineffective tissue perfusion
r/t loss of circulatory volume
 Anxiety
 Acute pain
o Collaborative Care
 Health and teaching about
gastric irritant drugs
 Avoidance of alcohol and
smoking
 Prompt treatment of URTI to
prevent severe sneezing and
coughing
 Fluid/blood replacement
 Hemodynamic monitoring (I
and O)
 Lavage
 Avoid red meat/chocolates
- Malabsorption - one ormore nutrients are not
digested or absorbed
o Causes: bacteria, deficiencies of bile
salts, or digestive enzymes, alterations
in the intestinal mucosa, and absence
of all or part of the stomach or
intestines.
o Signs and symptoms – Steatorrhea
(fatty stool), weight loss, fatigue,
decreased libido, easy bruising, edema,
anemia, and bone pain;
 bloating, cramping,
abdominal cramps, and
diarrhea are symptoms of
lactase defiency.
o Diagnostics
 Sprue: based on laboratory
studes, endoscopy with
biopsy, and radiologic
imaging studies
 Lactase deficiency: based on
the health history, the
lactose tolerance test, a
breath test for abnormal
hydrogen levels, and if
necessary, biopsy of the
intestinal [lining].
o Medical Treatment
 Celiac Disease, avoid
products that contain gluten
 Lactase Deficiency: eliminate
milk and milk products.
o Collaborative Care
N107- Nursing Care of Clients with GI Problems – BAYONITO, K.A.D.
 Document the patient’s
symptoms
 Note stool characteristics
 In the case of celiac sprue,
teach the patient how to
eliminate gluten from the
diet
 Give antibiotics as ordered
for tropical sprue
 If folic acid therapy
continued, instruct patient in
self-medication
 The effect of therapy is
evaluated by the return of
normal stool consistency
 Advise the patient with
lactase deficiency of dietary
restrictions and alternative
products
***Important to note STOOL
CHARACTERISTICS
***Supplements for Vitamin A, D, E,
and K are recommended
- APPENDICITIS – inflammation of the appendix; a
ruptured appendix allows digestive contents to
enter the abdominal cavity, causing
PERITONITIS.
o Signs and symptoms
 Pain at McBurney’s point,
midway between the
umbilicus and the iliac crest
 Right lower quadrant pain –
rebound tenderness
 Temperature elevation,
nausea, and vomiting
 Elevated WBC count (10,000-
15,000/mm^3) / Neutrophil
count 75% more than normal
 Peritonitis: absence of bowel
sounds, severe abdominal
distention, increased pulse
and temperature,
nausea/vomiting; rigid
abdomen
 ROVSING’S SIGN – Pressure
on the LLQ causes pain in the
RLQ / ACUTE APPENDICITIS
o Medical Treatment
 Nothing by mouth
 A cold pack to the abdomen
may be ordered
Page 7
  Laxatives and heat
applications should never be
used for undiagnosed
abdominal pain
 Immediate surgical
treatment indicated
 Ruptured appendix: surgery
may be delayed 6-8 hours
while antibiotics and IV fluids
are given
o Assessment
 Location, severity, onset,
duration, precipitating
factors and alleviating
measures in relation to the
pain
 Previous abdominal distress,
chronic illnesses, surgeries;
record allergies and
medications
 Temperature; abdominal
pain, distention and
tenderness,; presence and
characteristics of bowel
sounds
o Preoperative interventions
 Semi-fowler or side-lying
position with the hips flexed
 Until physician determines
the diagnosis, analgesics may
be withheld
 If rupture suspected, elevate
patient’s head to localize the
infection
o Postoperative interventions
 Administer antibiotics,
intravenous fluids, and
possibly gastrointestinal
decompression
 Assist the client in turning,
coughing, and DBE; incentive
spirometry.
***Incentive spiromtery done as common PC is
pneumonia due to pain and refusal to breath.
Done every hour, during waking hours, for 10-
20 minutes unless indicated.
 Splint the incision during
deep breathing
 Early ambulation
N107- Nursing Care of Clients with GI Problems – BAYONITO, K.A.D.
 Assess abdominal wound for
redness, swelling and foul
drainage
 Wound care as ordered or
according to agency policy
- PERITONITIS – Inflammation of peritoneum
caused by chemical or bacterial contamination of
the peritoneal cavity
o Risk factors – Abdominal surgery,
ectopic pregnancy, perforation:
trauma, ulcer, appendix rupture,
diverticulum
o Signs and Symptoms – pain over
affected area, rebound tenderness,
abdominal rigidity, and distension,
fever, tachycardia, tachypnea, nausea,
and vomiting, decreased bowel
sounds, board-like abdomen,
hypertension, dehydration.
o Diagnostics – complete blood cell
count, serum electrolyte
measurements, abdominal
radiography, computed tomography,
ultrasound, and Paracentesis (removal
of fluid that accumulated in the
abdominal cavity)
o Medical Treatment – gastrointestinal
decompression, intravenous fluids,
antibiotics, and analgesics; surgery to
close a ruptured structure and remove
foreign material and fluid from the
peritoneal cavity
o Assessment
 Onset and location and
severity of the pain and any
related symptoms
 Record a history of
abdominal trauma including
surgery
 Take and record Vital Signs
 Inspect abdomen for
distention and auscultate for
the presence of bowel
sounds
o Nursing Diagnoses
 Acute pain
 Decreased cardiac output –
due to dehydration
 Imbalanced nutrition: less
than body requirements
 Anxiety
Page 8
 *** If with infection – metabolism is faster and
fluids is not absorbed well
(1) INCREASE OFI
(2) Observe for Na and K effects
*** Paracentesis is done if stomach is large
already
o Nursing Care:
 IVs and electrolyte and fluid
balance and GI distention
 Decrease pain: position with
knees flexed, analgesics, and
quiet environment
 Prevent complications:
immobility, pulmonary, fluid
balance
- Abdominal Hernia – weakness in the abdominal
wall that allows a portion of the large intestine
to push through; weak locations include the
umbilicus and the lower inguinal areas of the
abdomen; may also develop at the site of a
surgical incision.
o Can be classified as reducible or
irreducible.
 Reducible – contents can be
easily returned to their
original compartment
original compartment
 Incarcerated – Cannot easily
returned to its original
compartment; with SEVERE
ABDOMINAL PAIN
 Strangulated – SURGICAL
EMERGENCY; blood supply
to herniated tissue is
compromised
o Signs and Symptoms
 A smooth lump in the
abdomen
 Incarcerated; distention,
vomiting, and cramps
o Medical Treatment
 Surgical repair through –
Herniorraphy (suture of
edges) or Hernioplasty (with
use of mesh)
o Assessment
 Chief Complaint
 Ask about pain or vomiting
 Inspect for abnormalities,
and listen for bowel sounds
in all four quadrants
N107- Nursing Care of Clients with GI Problems – BAYONITO, K.A.D.
o Preoperative interventions
 Risk for injury
 Impaired skin integrity
o Postoperative interventions
 Impaired urinary elimination
 Constipation
 Acute Pain
 Risk for Injury
- INFLAMMATORY BOWEL DISEASE
o Pathophysiology – Ulcerative colitis,
and Crohn’s disease; Inflammation and
ulceration of intestinal tract lining
o Cause - UNKNOWN; possible causes:
infectious agents, autoimmune
reactions, allergies, heredity, and
foreign substances
Ulcerative Colitis Crohn’s Disease
-Diarrhea w/ frequent -Symptoms depend on
bloody stools location
-Rectal bleeding (colon is -Variety of symptoms
the site for water (mentioned after this table)
absorption, diarrhea -Common with females
common symptom) -Common in older adults
-Common in Caucasian and 50-80 y/o; disseminated to
Jewish people different parts of colon
-Common in younger -2x more common in
people smokers
-10-15% colon cancer Location: anywhere along
possibility the Gi tract
Location: colon typically Inflammation: may occur in
the only affected site patches
Inflammation: continuous Pain: commonly
throughout affected areas experienced in the right
Pain: is common in the lower abdomen
lower left part of the Appearance: Thickened,
abdomen rocky colon wall
Appearance: Colon wall is appearance ; ulcers along
thinner and shows the tract are deep and may
continuous inflammation ; extend into all layers of the
mucus lining of colon may bowel wall
Page 9
have ulcers, but they do not Bleeding: bleeding from the
extend beyond the inner rectum during bowel
lining. movements is not common
Bleeding: bleeding from the
rectum during bowel
movements
o Signs and Symptoms (Ulcerative
Colitis)
 Diarrhea w/ frequent bloody
stools, abdominal cramping
o Signs and symptoms (Crohn’s disease)
 If the stomach and
duodenum are involved
symptoms include nausea,
vomiting, and epigastric pain
 Small intestine – produces
pain and abdominal
tenderness and cramping
 Colon – causes abdominal
pain, cramping, rectal
bleeding and diarrhea
 Systemic signs and
symptoms include fever,
night sweats, malaise and
joint pain
o Complications – Hemorrhage,
obstruction, perforation (rupture),
abscesses in the anus or rectum,
fistulas, and megacolon
o Diagnostics –
 Abdominal enema
examination with air
contrast; colonoscopy with
biopsy, ultrasonography, CT
and cell studies
 Video Capsule – some
capsules are affected by HCl;
caution with use
o Medical treatment – Drug therapy,
diet, and rest
o Assessment
 Onset, location, severity, and
duration of pain
 Note factors that continue to
the onset of pain
 Onset and duration of
diarrhea; presence of blood
 Vital signs, height and
weight, measures of
hydration
 Inspect perianal area for
irritation and ulceration
N107- Nursing Care of Clients with GI Problems – BAYONITO, K.A.D.
 Maintain accurate intake and
output records
 Measure diarrhea stools if
possible and count as output
o Nursing Diagnoses
 Acute pain
 Diarrhea
 Deficient fluid volume
 Imbalanced nutrition: Less
than Body Requirements
 Risk for impaired skin
integrity
 Ineffective coping
o Collaborative Care
 Pain Control
 Hemodynamic stability
monitoring
 Monitor frequency and
appearance of stools
 Stress management
 Coping strategies
 Adequate rest
 Keep client clean, dry and
free of odor
 Perianal care
- Diverticulosis – small saclike pouches in
intestinal wall: diverticula ; weak areas of the
intestinal wall allow segments of the mucous
membrane to herniate outward.
o Risk factors - lack of dietary residue,
age, constipation, obesity, emotional
tension
o Signs and symptoms –
 Often asymptomatic, but
may report of constipation,
diarrhea.
 Rectal bleeding, pain in left
lower abdomen, nausea and
vomiting, and urinary
problems
o Complications – bleeding, obstruction,
perforation, peritonitis, and fistula
formation
o Diagnostics – abdominal CT and
barium enema examination
o Asessment
 Patient’s comfort and stool
characteristics, note N/V
 Monitor patient’s temp
 Abdomen for distention and
tenderness
Page 10
 o Medical Treatment
 High-residue diet without
spicy foods
 Stool softeners or bulk-
forming laxatives;
antidiarrheals; broad-
spectrum antibiotics;
anticholinergics
 Surgical intervention
*** Frequency of colonoscopy – EVERY 10 YEARS
o Collaborative Care
 Fluids as permitted; monitor
intake and output
 Antiemetics, analgesics,
anticholinergics as ordered
 Be alert for signs of
perforation
 Teach patient about
diverticulosis, including the
pathopthysiology, treatment,
and sx of inflammation
- Colorectal cancer – people at greater risk for
colorectal cancer are those with history of IBD
(inflammatory bowel disease, or family history of
CA and intestinal polyps.
o Pathophysiology – High fat and low
fiber diet and inadequate intake of
fruits and veggies also contribute to
development ; can develop anywhere
in the colon – ¾ of all Colorectal CAs
are located in the RECTUM or LOWER
SIGMOID COLON
Colostomy / Ostomy care
o Signs and Symptoms
 Right side of the abdomen –
vague cramping until the
N107- Nursing Care of Clients with GI Problems – BAYONITO, K.A.D.
disease is advanced ;
Unexplained anemia,
weakness, and fatigue to
blood loss may be the only
early symptoms
 Left Side or in the rectum –
diarrhea or constipation and
may notice blood in the stool
; stools may become very
narrow causing to be
described as PENCIL-LIKE ;
feeling of fullness or pressure
in the abdomen or rectum
o Medical and Surgical Treatment
 Usually treated surgically
 Combination chemotherapy
postoperatively if tumor
extends through the bowel
wall or if lymph nodes
involved
 Early rectal cancer
sometimes treated with
radiation and surgery
o Assessment
 Vital signs, I/O, breath and
bowel sounds, pain
 Apperance of wounds and
wound drainage
 If with COLOSTOMY,
measure and describe the
fecal drainage
o Nursing Diagnoses
 Diarrhea or constipation r/t
altered bowel elimination
patterns
 Acute pain r/t difficulty in
passing stools because of
partial or complete
obstruction from tumor
 Risk for injury
 Ineffective tissue perfusion
 Sexual Dysfunction
 Ineffective Coping
o Collaborative Care
 Peri-operative Care
 Psychological Support
- Color of stoma should be BEEFY RED, DRY, NO
SURROUNDING LESIONS
- Colostomy Types:
o Ascending Colostomy
Page 11
 o Transverse Colostomy o Do not use moistened wipes, baby
o Descending and Sigmoid Colostomy wipes, or towelettes that contain
lanolin or other oils
o Unless recommended, do not apply
powders or creams to the skin around
the stoma.
o Patient can shower, bathe, swim or
even get in a hot tub with pouching
system on.
o The opening of the skin barrier should
be no more than 1/8 inch away from
the edge of the stoma.
o Eat meals regularly / no overeating /
DO NOT SKIP MEALS

- Nursing diagnoses (Ostomy surgery)

o Risk for deficient fluid volume
o Risk for impaired skin integrity
o Deficient knowledge: ostomy care
o Disturbed Body image
- Ostomy Care
o Stoma is less active before eating or
drinking in the morning
o Empty the pouch when it is one-third
full
o Remove the old pouching in the
direction of hair growth
o Warm water may be used to remove
the old pouching
o IF STOMA RETRACTS – REFER ASAP!!
o Frequency of ostomy bag change –
PRN
 PGH: Reusable, BUT clean
very well, especially the
inside part of the bag
o Foods that can block the stoma site:
 NUTS, BONY FOODS
 Do not eat or just swallow
large green leaf vegetables!
 ADVISE TO CHEW FOOD
WELL
o Clean the area around the stoma with - WATCH OUT FOR:
warm water o Purple, black, or white stoma
o Dry the skin well before putting the o Severe cramps lasting more than 6
new pouch hours
o Use a gentle touch when cleaning o Severe watery discharge from the
around the stoma, do not scrub stoma lasting more than 6 hours
o Do not use alcohol or any other harsh o No output from the colostomy for 3
chemicals to clean the stoma days
o Excessive bleeding from the stoma

N107- Nursing Care of Clients with GI Problems – BAYONITO, K.A.D. Page 12

 o Swelling of the stoma to more than ½-
inch larger than usual
o Pulling inward of stoma below skin
level
o Severe skin irritation or deep ulcers
o Bulging or other changes in the
abdomen
RECTAL DISOREDERS
- HEMORRHOIDS
o Internal or external dilated veins in the
rectum
o Thrombosed – Blood clots form in
external haemorrhoids; become
inflamed and very painful
o Risk Factors
 Constipation, pregnancy,
prolonged sitting, or standing
o Signs and Symptoms
 Rectal pain and itching
 Bleeding with defecation
 External haemorrhoids easy
to see; appear red/bluish
o Medical Diagnosis and Treatment
 Diagnosed visual inspection
 Non Surgical Treatment
(1)Topical Creams, Lotions or
suppositories soothe and
shrink inflamed tissue
(2) Sitz Bath – comforting
(3) Heat and Cold
applications
 Outpatient procedures:
ligation, sclerotherapy,
thermocoagulation/electroco
agulation, laser surgery
 Hemorrhoidectomy –
surgical excision of
haemorrhoid
***INTRA-OP POSITIONING =
Lithotomy or prone
Post-op = INDIVIDUALIZED, kung saan
komportable ang pasyente
***Lessen head of bed from 60
degrees, decrease height on operative
site
o Assessment
 After hemorrhoidectomy,
monitor VS, I/O, and breath
sounds. Assess perianal area
for bleeding and drainage
N107- Nursing Care of Clients with GI Problems – BAYONITO, K.A.D.
o Nursing Diagnosis
 Acute pain
 Impaired Skin Integrity
 Constipation
o Collaborative Care
 Prevention of constipation
 Avoidance of prolonged
standing or sitting
 Sitz Bath 15-20min, 2-3x/day,
for 7-10 days
 Pain
 Stool softener
- ANORECTAL ABSCESS
o An infection in the tissue around the
rectum
o Sx are rectal pain, swelling, redness,
and tenderness
o Treated with antibiotics, followed by
incision and drainage
o Preoperatively, pain is treated with ice
packs, sitz bath, and topical agents as
ordered
o Postoperatively, pain treated with
opiod analgesics
 Patient teaching emphasizes
importance of thorough
cleansing after each bowel
movement
 Advise patient to consume
adequate fluids and a high-
fiber diet to promote soft
stools
- ANAL FISSURE
o Laceration between the anal canal and
the perianal skin
o Develops from anorectal abscesses or
related to inflammatory bowel disease
and tuberculosis
o Patient typically complains of pruritus
and discharge
o Sitz baths provide some comfort
o Surgical treatment is excision of fistula
and surrounding tissue
o Sometimes a temporary colostomy to
allow the surgical site to heal
o Postoperative care: analgesics and sitz
baths for pain
PATIENT EDUCATION TO PROMOTE NORMAL BOWEL
FUNCTION
- Good hand washing and proper food handling
Page 13
 - People who recognize that stress affects their GI
function may benefit from relaxation techniques
and stress management training
- Signs and symptoms of digestive problems
should be reported for prompt diagnosis and
treatment if indicated
- Teaching patients what is normal, how to
promote normal function, and how to detect
problems can help to avoid serious
gastrointestinal dysfunction.
-----------------Nothing Follows--------------------------------

N107- Nursing Care of Clients with GI Problems – BAYONITO, K.A.D. Page 14