Introduction
● Food has many physiologic as well as psyc
hosocial connotations. Any condition that
interferes with ingestion digestion and e
limination can negatively intuence a pers
on's self - perception and overall sense
of well - being.
● Moreover, gastrointestinal disorders may
necessitate treatments like gastric intub
ation, surgeries and special nutritional
modalities
● These and other circumstances surrounding
the client's situation may profoundly aff
ect his entire life and his family.
● Therefore, nurses need to be alert to ind
icators of pathology, since prognosiscan
be influenced by early diagnosis and trea
tment. Covert physiologic symptoms can fr
equently be identified by analyzing psych
osocial behavior. Nursing care plans need
to address a person's total needs, becaus
e the entire body is frequently adversely
affected by localized gastrointestinal di
sorders which may range from mild alterat
ions in bowel function to the acute and c
hronic manifestations of life threatening
disorders, especially carcinoma.
Anatomy and Physiology of the Gastrointestinal S
ystem
The gastrointestinal system is composed of the f
ollowing structures:
1. The Mouth (oral or buccal cavity)
● Digestion starts from the mouth.
● Mechanical digestion occurs through masti
cation (chewing).
● Chemical digestion occurs through the act
ion of salivary amylase (ptyalin), which
breaks down starches to maltoso.
● Deglutition (swallowing) occurs, once the
food is broken down into small pieces and
well mixed with saliva (food bolus).
2. The Esophagus
● It serves as a passage for food bolus fro
m mouth to stomach by peristalsis.
● The distal end of the esophagus is guarde
d by lower esophageal sphincter (LES). It
is also known as cardiac sphincter. It pr
events gastric reflux.
3. The Stomach
● It is located in the left upper quadrant
of the abdomen. It has an approximate cap
acity of 1,500 mis.
● The stomach has the following regions: ca
rdiac region, fundus, body, and antrum or
pyloric region. It has a lesser and great
er curvature.
● The functions of the stomach are as follo
ws:
1) Mechanical Digestion: storage, mixing and
liquefaction of bolus of food into a semi
solid mixture called chyme. The rugae liq
uefy solid food particles through grindin
g motion.
2) Secretion: 1,500 to 3,000 mls. of gastric
juice is secreted by the glands in the ga
stric mucosa. The gastric juice is compos
ed of mucus, HCI (hydrochlorc acid), peps
inogen and water. Gastrin (a hormone) is
secreted directly into the bloodstream.
3) Chemical Digestion: digestion of protein
starts in the stomach through
the action of pepsin, which converts prot
ein into polypeptides.
● Amylase from the salivary glands i
s inactivated by the acidity in th
e stomach so carbohydrate digestio
n stops.
● Pepsinogen (inactive enzyme) is co
nverted into pepsin (active form)
in the presence of HCI.
● Milk is curdled and casein is set
free, through the action of rennin
Digestion of emulsified fats also
starts in the stomach due to the p
resence of small amounts of gastri
c lipase.
4) Protection: The acid medium is also respo
nsible for the reduced activity of harmfu
l bacteria that may have been taken in wi
th food. It also provides a favorable med
ium for the absorption of calcium and oth
er minerals
5) Absorption: Minimal water, alcohol, gluco
se and some drugs are absorbed through th
e gastric mucosa.
6) Controls passage of chyme into duodenum.
Through peristaltic waves, carbohydrates
are emptied within 1 to 2 hours; proteins
within 3 to 4 hours; fat within 4 to 6 ho
urs. Once acidia chyme is formed, slow pe
nstaltic waves travel from the funds to t
he pylorus. Pressure builds up and pylori
c sphincter opens.
4. The Small Intestine
● The small intestine is about 6 meters lon
g (20 to 22 feet). It extends from the py
loric sphincter to the ileocecal valve,
● It is divided into three parts; duodenum,
jejunum and ileum.
● Majority of the digestive process is comp
leted in the duodenum. And absorption of
foods ocour primary in the small intestin
e,
● The functions of the small intestine are
as follows:
1) Mucus secretion
 ● Goblet cells and duodenal (Brunners) glan
ds secrete mucus to protect the mucosa.
2) Secretion of enzymes
● Brush border cells secrete sucrase, malta
se and enterokinase which act on disaccha
rides (carbohydrates),
● Peptidase acts on polypeptides (proteins).
● Enterokinase activates trypsinogen from t
he pancreas,
3) Secretion of hormones
● Endocrine cells secrete cholecystokinin,
secretin, and enterogastrone that regulat
e the secretion of bile, pancreatic juice
and gastric juice.
4) Chemical Digestion
● in the presence of acidic chyme in the du
odenum the following will occur.
(1) the presence of carbohydrates,
fats, and protein stimulate secretion of
pancreozymin. This enzyme stimulates enzy
me secretion of pancreatic amylase, lipas
e and trypsin.
❖ Amylase completes digestion of car
bohydrates; lipase completes diges
tion of fats; trypsin completes di
gestion of protein.
(2) In the presence of fats in the acidic
chyme, the duodenum secretes cholecystoki
nin which causes contraction of the gallb
ladder, relaxation of sphincter of Oddi,
thereby releasing bile.
❖ The bile emulsifies fats, thereby
enabling pancreatic lipase to comp
lete digestion of fats
❖ The bile and pancreatic juice are
alkalino, therefore they neutraliz
e the acidic chyme.
5. Absorption. Nutrient and water move from the
lumen of the small intestine into the blood capi
llaries and lacteals in the villi, Absorption is
by active transport, by osmosis, and by diffusio
n.
6. Motor Activities. Mixing (segmental) movement
s and peristalsis propel the chyme through the s
mall intestine. The chyme remains in the small i
ntestine for 3 to 10 hours. The residua moves in
to the large intestine.
The Large Intestine
● The large intestine extends from the ileo
cecal valve to the anus. It is approximat
ely 1.5 meters (5 to 6 feet) long.
● It is divided into the following parts; c
ecum, colon, rectum, and anus
● The vermiform appendix is attached to the
cecurn.
● The colon is divided into; ascending, tra
nsverse, descending and sigmoid sections
● The final segments of the large intestine
are the rectum and the anus.
● The functions of the large intestine are
as follows:
1. Motor activities: haustral chuming and perist
alsis.
2. Secretion: the mucus protects the mucosa from
injury, binds fecal
particles into a formed mass, lubricates and all
ows passage of fecal
residue and counteracts the effects of acid - fo
rming bacteria.
3. Absorption of water, sodium, and chloride. Ap
proximately, 800 to 1,000 ml. of water is absorb
ed in the large intestine.
4. Vitamin synthesis. Colonic bacterial flora sy
nthesizes vitamin K,
5. Formation of feces. Fecal material is ¾ water
and ¼ solid material.
6. Defecation. The act of expelling feces from t
he body.
Diagnostic Tests
Gastric Analysis
● Measures secretion of HCI and pepsin,
● NPO for 12 hours.
● NGT is inserted, connected to suction,
● Gastric contents are collected every 15 m
inutes to 1 hour.
↑ HCL : Zollinger - Ellison Syndrome
Duodenal Ulcer
↓ HCL : Gastric Ca
Pernicious Anemia
Berstein Test ( Acid Perfusion Test )
● To assess if chest pain is related to gas
troesophageal.reflux
● NPO 6 - 8 hours
● NGT insertion
● Altemate instillation of NSS and 0.1% HCL
● If no pain is experienced (-) for gatroes
ophageal reflux; if pain is experienced
(+) for gatroesophageal reflux.
● Antacid is administered after the procedu
re to relive discomfort
Radiographic Tests
➢ Scout Film / Flat Plate of the Abdomen
● Plain X - ray of the abdomen
● Avoid belts or jewelres. Metals are radio
paque.
● UGIS (Upper G.I. Series / Barium Swallow)
● To visualize the esophagus, stomach, duod
enum and jejunum
● NPO for 6 - 8 hours
 ● Barium Sulfate (BaS04) per orem is admini
stered. Barium sulfate is white, chalky s
ubstance.
● X-rays are taken on standing, lying posit
ion.
● After the procedure:
➔ Laxative is administered. Barium Sulfate
causes constipation.
➔ Increase fluid intake. To prevent constip
ation.
➔ Inform client that the stool is white for
24 - 72 hours. This is due to evacuation
of Banum Sulfate.
➔ Observe for Barium impaction : distended
abdomen, constipation
LGIS (Lower G.I. Series / Barium Enema)
➔ To visualize the colon
➔ Low residue / clear liquid diet for 2 day
s d.
➔ Laxative for cleansing the bowel
➔ Suppository / cleansing enema in AM
➔ BaS04 is adminislered per rectum
➔ Care after the procedure - same as UGIS
Computed Tomography
● Uses beam of radiation to assess cross se
ctions of the body
● Clear liquid diet in the morning
● If the procedure is done with contrast me
dium
● NPO for 2 - 4 hours
● Assess history of allergy to seafoods and
iodine
● Inform the client that the procedure is p
ainless
● Assess for claustrophobia
● Advise the client to remain still during
the entire procedure
Endoscopy
UGI Endoscopy
● Direct visualization of esophagus, stomac
h, and duodenum
● Obtain written consent
● NPO for 6 - 8 hours
● Administer anticholinergic (AISO4) as ord
ered. To reduce mucus secretions and prev
ent aspiration.
● Sedatives, narcotics, tranquilizers. To r
elax the client
● E.g. Diazepam, Meperidine HCI
● Remove dentures, bridges. To prevent airw
ay obstruction.
● Local spray anesthetic (Lidocaine) on pos
terior pharynx is administered to depress
the gag reflex. Instruct the client not t
o swallow saliva. For maximum effect of t
he anesthetic. Lidocaine is unpalatable.
● After the procedure
● o Place the client in side - lying positi
on. To prevent aspiration.
● NPO until qaq reflex returns (2 - 4 hrs).
● NSS gargle; throat lozenges. To soothe th
e throat.
● Monitor VS (vital signs).
● Assess : bleeding, crepitus (neck), fever
neck / throat pain, dyspnea, dysphagia,
back / shoulder pain
● Advise to avoid driving for 12 hours if s
edative was used.
LGI Endoscopy
● Proctosigmoidoscopy (sigmoid, rectum)
● Clear liquid diet 24 hours before the pro
cedure.
● Administer cathartic / laxative as ordere
● Cleansing enema.
● o Intestinal evacuant like GoLytely may b
e administered in place of enema. Instruc
t client to take 240 cc every 10 minutes
up to 2 hours.
● It is expected that the client will have
watery stools (diarrhea).
● Place the client in knee - chest / latera
l position during the procedure.
● Assess for signs of vasovagal stimulation
The Gl tract is supplied by the vagus ne
rve.
● After the procedure
● Supine position for few minutes. To preve
nt postural hypotension.
● Assess for signs of perforation - Bleedin
g, Pain, and Fever.
● Hot Sitz bath to relieve discomfort in th
e anorectal area.
● Colonoscopy
● Preparation of the client is same as in p
roctosigmoidoscopy
● Sedation is done to relax the client.
● Position during the procedure: left side,
knees flexed.
● After the procedure:
● Monitor VS (note for vasovagal response,
• g. Bradycardia, hypotension)
● Assess for signs and symptoms of perforat
ion.
● Ultrasonography of the abdomen
● NPO for 8 - 12 hours
● Laxative as ordered (to reduce bowel gas)
● MRI (Magnetic Resonance Imaging)
● Produces cross - sectional images of orga
ns by using magnetic fields.
● NPO for 6 - 8 hours,
 ● Instruct to remain still during the proce
dure
● Inform that procedure may last for 60 --9
0 minutes.
● Remove jewelnes/metals,
● Contraindications
● Pacemakers
● Aneurysm clips
● Orthopedic screws
Peptic Ulcer Disease (PUD).
● An impairment of the mucosa and deeper st
ructures of the esophagus, stomach, duode
num, The jejunum may be affected if it is
surgically anastomosed to the stomach,
● The cause of peptic ulcer is Helicobacter
pylori infection.
● Helicobacter pylori infection is usually
due to eating raw or improperly cooked me
at.
● The combination of hydrochloric acid (HI)
and pepsin serves as aggressor to Gl muco
sa. Increased secretion of HCI and pepsin
may be caused by stress and stimulants. T
his contributes to formation of PUD.
● The mucus secretion of the Gl tract serve
s as protector. Decreased secretion of mu
cus may be caused by decreased blood flow
and presence of irritanta in the Gl tract.
These factors damage mucous membrane and
thereby, decreasing mucus secretion.
● Increased action of the aggressor or decr
eased action of the protector may lead to
peptic ulcer disease.
The predisposing factors for peptic ulcer diseas
e are as follows:
1. Stress. Initially, in response to stress, the
sympathefic nervous system
(SNS) is triggered. However, if stress is prolon
ged, SNS is exhausted and
the parasympathetic nervous system (PNS) is acti
vated. PNS activation
causes increased gastric motility and hypersecre
tion of hydrochloric acid
(HCI).
2.Cigarette Smoking Nicotine stimulates increase
d HI secretion and
causes vasoconstriction. Irritation and damage t
o Gl mucosa occur.
3. Alcohol. Irritates Gl mucosa. It also causes
vasoconstriction. Beer
increases gastric acid secretion.
4. Caffeine.
Stimulates increased HCI secretion.
It also causes vasoconstriction. Decreased blood
flow to the GI mucosa causes decreased mucous se
cretion.
5. Drugs. Aspirin (ASA), Nonsteroidal anti-infla
mmatory drugs (NSAIDs),.
steroids are ulcerogenic. These drugs should be
taken with food to prevent Gl irritation.
6. Gastritis. This leads to increased HI secreti
on and mucous ulceration.
7. Zollinger - Ellison Syndrome. This is caused
by pancreatic tumor which is
also called gastrinoma. This tumor stimulates in
creased gastrin secretion,
which in turn stimulates increased hydrochloric
acid secretion. Multiple
areas of ulceration in the Gl tract occur.
8. Irregular, hurred meals. This is stressful an
d this leads to increased gastric motility and i
ncreased HI secretion.
9. Fatty, spicy, highly acidic foods. These are
stimulants (increase HCI
secretion) and irritants to Gl mucosa.
10. Type A Personality (Stress Personality). Thi
s personality is characterized by overconscienti
ousness, perfectionism, "workaholism", inability
to concentrate in one task, parsimoniousness, ve
ry punctual. The individual has increased gastri
c motility and HI secretion.
11. Type O blood. Individuals with Type O blood
have higher pesinogen levels. Pepsinogen is acti
vated into pepsin. Pepsin, in combination with H
I acts as aggressor to the Gl mucosa.
12. Genetics. There are individuals who have hig
her parietal call mass than other individuals. T
he following are the differences between Gastric
Ulcers and Duodenal
Ulcers
–
 t comes in contact stric acid into th
with the ulcers e duodenum

Pain is commonly e
xperienced between
Gastric Ulcers Duodenal Ulcers 12MN and 3AM
Also called as “p Also called as exe Characteristic man Characteristic
oor man’s” or cutive ulcer becau ifestations are na
“laborer’s” ulc se it is primarily usea and vomiting
er because the sto stress - related and hematemesis (v
mach is usually em omiting with bloo
pty d)
20% incidence 80% incidence Complications may
be hemorrhage, per
Commonly affects t Commonly affects t foration, peritoni
how sho are 50 yea hose who are 25 to tis
rs olf and above. 50 years of age. T
Older people usual he years of strugg
ly lose interest i les in life Hemorrhage s the most life - threatening complic
n food ation. Blood loss 20 % (1000mls) is fatal. This
leads to hypovolemic shock.
Commonly affects t Usually well-nouri
hose who are malno shed
urished Medications:
a. Antacids - to neutralize hcl. Best admini
Patho: There is an Patho: There is in stered 1 to 2 hours after eating. This is
increased back-dif creased hcl secret the time of peak of HCl secretion.
fusion of HCL into ion Examples:
gastric mucosa
Amphogel (aluminum hydroxide gel)
There is normal ga Basaljel (Aluminum carbonate)
stric empting rate Maalox (Aluminum - magnesium hydroxide)
b. Histamin H2 receptor antagonists - to red
There is normal HC uce HCl secretion. Best taken in the morn
l secretion ing and at bedtime. Food may delay the ra
te of absorption of the medicine
Both types of PUDS Both types of PUDS
are characterized are characterized Side effects: diarrhea, abdominal cramps, confus
by dull, aching gn by dull, aching gn ion, dizziness, weakness.
awing epigastric p awing epigastric p Cimetidine may cause mental confusion, agitation
ain ain psychosis
Cimetidine should be administered 1 hour apart f
Pain radiates to t Pain radiates to t rom each other. Antacids can decrease the absorp
he left side of th he right side of t
e abdomen he abdomen (Duoden tion of oral Cimetidine
um is located in t c. Cytoprotective drug - to coat the ulcers.
he right side of t Enhances prostaglandin synthesis
he abdomen) Ex: Carafate (Sucralfate)
Administer medication on empty stomach (30 to 60
Pain is experience Pain is experience mins before meals)
d ½ to 2 hours aft d 3 to 4 hours aft
er eating or even er eating. This is May cause constipation
during meals. When the time when acid Administer at;east 60 mins after antacid
food comes in cont ic chyme from the
act with exposed n stomach empties in d. Prostaglandin analogue - replaces gastric
erve endings in ar to the duodenu,. T prostaglandin, It suppresses secretion of
eas of ulcers, pai he exposed nerve e gastric acid
n occurs ndings in the duod
Ex: Cytotec (Misoprostol)
enum are irritated
by the acidic chym Administered with meals
e Causes diarrhea and abdominal pain
Abortiufacient. Contraindicated in pregnancy
Pain is not reliev Pain is relieved b
ed by food intake. y food intake Food e. PPI. - SUppress gastric acid secretion
Food may even wors in the stomach del
Side effects: headache, diarrhea, abdominal pain
en the pain when i ays emptying of ga
and nausea (omepron)

f. Anticholinergics - reduce gastric motilit
y (antispasmodic) and hcl acid secretion
Atropine Sulfate
Bentyl
Robinul
Levsin
g. Helicobacter pylori drug treatments
Amoxil (amoxicillin)
Biaxin (Clarithromycin)
Flagyl (metronidazole)
Achromycin (tetracycline)
Nursing intervention
a. Relieve pain by administering antacid as
prescribed
b. Encourage clientto promote a healthy life
style
c. The client may eat anything as tolerated
but asymptomatic
d. Liberal bland diet
e. Advise client to eat slowly and chew food
properly.
f. Small, frequent feeding
g. Avoid fatty foods coffee, tea, chocolate,
cola, drinks, spices, red black pepper, a
lchol BECAUSE there are all irritants and
stimulants
h. Avoid Bedtime snacks (to prevent nighttim
e reflux)
i. Avoid Binge eating to prevent gastric sti
mulation
j. Avoid Large quantities of milk because mi
lk is alkaline thus it stimulates the sto
mach to increase the hcl secretion to neu
tralize it causing rebound acidity
k. Encourage the client to quit smoking
l. Enhance coping through stress therapy
m. Develop recreation and hobbies
n. Have regular pattern and exercise
o. Stress reduction at ghome and at work
Health History B
Health Perception / Health Management
- The purpose of assessing the client's hea
lth Perception health maintenance pattern
is to determine how the client perceives
and manage his/her current and past nursi
ng and, medical recommendations. The clie
nt's ability to perceive the relationship
between activities of daily living and he
alth is also determined
Nutritional - Metabolic
- The purpose of assessing the client's nut
ritional- metabolic pattern is to determi
ne the client dietary habits and metaboli
c needs. The conditions of hair, skin, na
ils, teeth and mucous membranes are asses
sed.
Elimination Pattern
- The purpose of assessing the client's eli
mination pattern is to determine the adeq
uacy of function of the client's bowel an
d bladder for elimination. The client's b
owel and urinary routines and habits are
assessed.In addition, any bowel or urinar
y problems and use of urinary or bowel el
imination devices are examined.
Activity - Exercise Pattern
- The purpose of assessing the client's act
ivity- exercise- pattern is to determine
the client's activities of daily living,
including routines of exercise, leisure,
and recreation. This includes activities
necessary for personal hygiene, cooking,
shopping eating, maintaining the home, an
d working. An assessment is made of any f
actors that affect or interfere with the
client's routine activities of daily livi
ng. Activities are evaluated in reference
to the client's perception of their signi
ficance in his or her life.
Cognitive - Perceptual Pattern
- The purpose of assessing the client's cog
nitive pattern is to determine the clien
t’s ability to understand, communicate,
remember, and make decision.
Sleep - Rest
- The purpose of assessing the client's sle
ep-rest pattern is to determine the clien
t perception of the quality of his or her
relaxation and energy levels Methods used
to promote relaxation and sleep is also a
ssessed. The purpose of assessing the cli
ent's sleep-rest pattern is to determine
the client perception of the quality of h
is or her relaxation and energy levels Me
thods used to promote relaxation and slee
p is also assessed.
Self-Perception/Self Concept
- The purpose of assessing the client's sel
f-perception-self- concept pattern is to
determine the client’s perception of his
or her identity, abilities, body image, a
nd self worth. The client's behavior atti
tude, and emotional patterns are also ass
essed
Role-Relationship
- The purpose of assessing the client's rol
e- relationship pattern is to determine t
he client’s perceptions of responsibilit
 ies and roles in the family, at work, and
in social life. The client's level of sat
isfaction with these is assessed. In addi
tion, any difficulties in the client's re
lationships and interactions with others
are examined.

Sexuality - Reproductive
- The purpose of assessing the client's sex
uality reproductive pattern is to determi
ne the client’s fulfillment of sexual ne
eds and perceived level of satisfaction.
The reproductive pattern and developmenta
l level of the client is determined, and
perceived problems related to sexual acti
vities, relationships, or self-concept ar
e elicited. The physical and psychologica
l effects of the client's current health
status, on his or her sexuality or sexual
expression are examined.

Coping / Stress Tolerance

- The purpose of assessing client’s coping
– stress tolerance pattern is to determi
ne the areas and amount of stress in a cl
ient’s life and the effectiveness if cop
ing methods used to deal with it Availabi
lity and use of support systems such as f
amily, friends, and religious believes ar
e assessed.

Value - Belief
- The purpose of assessing the client's val
ue- belief pattern is to determine the cl
ient’s life values and goals, philosophi
cal, religious beliefs, and spiritual bel
iefs that influence his or her choices an
d decisions. Conflicts between these valu
es, goals, beliefs, and expectations that
are related to health are assessed The pu
rpose of assessing the client's value- be
lief pattern is to determine the client’
s life values and goals, philosophical, r
eligious beliefs, and spiritual beliefs t
hat influence his or her choices and deci
sions. Conflicts between these values, go
als, beliefs, and expectations that are r
elated to health are assessed
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PHYSICAL EXAM
THORAX LUNGS
CARDIO

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NCP
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MEDICAL MANAGEMENT