CARE OF THE CLIENTS WITH GASTROINTESTINAL DISORDERS

Diagnostic Test

Laboratory Tests

1. CEA (Carcinoembryonic Antigen)

2. D-xylose Absorption Test
3. Exfoliative Cytology
4. Fecal Analysis
- Stool for Occult Blood
- Stool for Ova and Parasites
- Stool Culture
- Stool for Lipids
5. Gastric Analysis
6. Bernstein Test

Radiographic Tests

1. Flat Plate of the Abdomen

2. UGIS
3. LGIS
4. CT scan
5. Ultrasound
6. MRI

Endoscopy

1. UGI Endoscopy
2. LGI Endoscopy
3. Colonoscopy

Gastrointestinal Interventions

Gastrointestinal Intubation
Purposes of NGT Insertion

1. Feeding
2. Irrigate stomach
3. Decompression
4. Medication administration
5. Administration of supplemental fluids

Administering Tube Feeding

1. Fowler’s position or sitting position

2. Assess tube placement and patency
3. Assess residual feeding contents
4. Introduce feeding slowly
5. Height of feeding is 12 inches above the tube’s point
6. Instill 60 ml of water
7. Clamp the NGT before all of the water is instilled
8. Placed client in the same position for at least 30 minutes
9. Do after care
10. Document
Common Problems

- Constipation/ Diarrhea
- Hyperglycemia
- Abdominal distention
- Vomiting
- Aspiration

Administering Gastrostomy or Jejunostomy Feeding

1. Verify order
2. Assist on Fowler’s position
3. Insert feeding tube into the ostomy opening 10-15 cm
4. Check the patency
5. Check the residual feeding
6. Administer feeding slowly
7. Flush the tube with 30 ml of water
8. Keep the client in Fowler’s position for at least 30 minutes
9. Assess status of peristomal skin
10. Document

Administering TPN
1. Indications:
- Major GI diseases
- Severe trauma or burns
- Severe GI side effects
- Severe malnutrition
- Need extensive support
2. Usual site: Subclavian vein
3. Position: Trendelenburg during insertion
4. Primary purpose: administer glucose
5. Administer TPN at room temperature
6. Consume prepared formula within 24 hours
7. Maintain a steady infusion rate
8. Monitor urine and blood glucose levels
 9. Care of catheter insertion site
10. Provide good oral hygiene

Administering Enema

1. Purposes:
- Relieve constipation
- Relieve flatulence
- Administer medication
- Lower body temperature
- Evacuate feces in preparation for diagnostic procedure or surgery
2. Types of Enema
- Cleansing Enema- stimulates peristalsis by irrigating the colon and rectum.
● High Enema
● Low Enema
- Carminative Enema- expel flatus
- Return Flow Enema/ Harris Flush/ Colonic Irrigation- used to expel flatus. Replace the
solution several times during the procedure as it becomes thick with feces
- Retention Enema- acts to soften the feces and to lubricate the rectum, anal canal, and
facilitate passage of feces
● Solution: Oil (90-120 ml)
● Height: 12 inches
 ● Temperature: 105-110-degree Fahrenheit
● Time of retention: 1-3 hours
- Non-Retention Enema- soften the feces and facilitate passage of feces
● Solution: Water/ Soap suds/ NSS/ Fleet enema
● Height: 18 inches
● Temperature: 115-125-degree Fahrenheit
● Time of retention: 5 to 10 minutes
3. Nursing Intervention
- Check doctor’s order
- Provide privacy
- Promote relaxation
- Position depends on the age
- Allow solution to flow through the connecting tubing and rectal tube to expel air
- Insert 7 to 10 cm of the rectal tube gently
- Introduce solution slowly
- Change the position to distribute solution well in the colon
- If cleansing enema: give the enema 3x
- Alternate hypotonic solution with isotonic solution
- If abdominal cramps occur stop temporarily
- After introduction of the solution, press the buttocks together to inhibit the urge to defecate
- Ask the client to not flush the toilet
- Do perineal care
- Document
4. Siphoning an Enema
- Solution: Water at 105-degree Fahrenheit
- Position: Right side lying position
- Height: 10 cm
- Quickly lower enema container after introduction of solution
- Document