Digestive Functions
- Prepares food to be used by the cells by
breaking it down
- Passage of food until its eliminated
Gastrointestinal Tract
- 7 to 7.9m (23 to 26 feet) in length that extent
from the mouth to the esophagus, stomach,
small and large intestines, and rectum to the
terminal structure, the anus
Functions:
1. Breakdown of food particles int the molecular
form for digestion
2. Absorption into the bloodstream of small
nutrient molecules produced by digestion
3. Elimination of undigested unabsorbed
foodstuffs and other waste products
- Is an out-pouching of mucosa and submucosa
that protrudes through a weak portion of the
musculature of the esophagus.
Types:
1. Paraesophageal Diverticulum
- Upper area of the esophagus;
- Zenker diverticulum – aka pharyngoesophageal
pulsion diverticulum;
- Most common type located in the
cricopharyngeal muscle (midline of the neck);
- Increase incidence in men >60 y.o
s/s: dysphagia, fullness on the neck, regurgitation
of undigested food, gurgling noise after eating,
coughing, Halitosis and sour taste in the mouth
2. Midesophageal
- Middle area;
- Uncommon with less acute symptoms
s/s: less acute difficulty in swallowing
3. Epiphrenic
- Lower area just above the diaphragm;
- Larger diverticula
s/s: one third are asymptomatic; two third complain
of dysphagia and chest pain
4. Intramural Border of the esophagus
- Numerous small diverticula associated w/
structure of the upper esophagus
s/s: dysphagia
Assessment and Diagnostic Findings:
▪ Barium Swallow
- X-ray with contract dye
- NPO 8hrs / NPO – PM
- During: drink thru a straw & swallow
contrast medium (barium sulfate –
milkshake substance); 15-30 mins; no
discomfort
- C/I: bowel obstruction (store like impaction)
▪ Monometric Studies (Esophageal Function
Studies / Esophageal Monometry /
Esophageal Motility Studies)
- N ° = lower esophageal sphincter pressure
10 – 20 mmHg
- Graphic recording of swallowing waves
(motility
- Before: NPO 8hrs
- During: Swallow 2 or 3 very tiny tubes (for
pressure measurements) attached to a
pressure transducer; 30 mins
- After: Mild sore throat
▪ Monometric Studies
- Usually contraindicated
- d/t possible perforation 2-4hrs
- Before: NPO – PM; remove dentures and
eyewear; instruct not to bite endoscope; oral
hygiene
- During: lateral position; anesthesia to throat
(topical or spray – xylocaine); sedatives; 20
– 30 mins
Management:
• Zenker’s – Diverticulectomy: surgical removal
of the diverticulum
• Myotomy of the cricopharyngeal muscle –
remove spasticity of muscle
• Epiphrenic and Midesophageal – surgery is
only indicated if symptoms are troublesome
- Backflow of the gastric or duodenal contents
into the esophagus which may be due to:
▪ incompetent lower esophageal sphincter,
▪ pyloric stenosis, or
▪ mortality disorder
Clinical Manifestations:
• Pyrosis ● Esophagitis
• Dyspepsia ● Hypersalivation
• Regurgitation or dynophagia
Assessment and Diagnostic Findings:
▪ Endoscopy or Barium swallow with contrast
dye
▪ Ambulatory 12 – 36 hours esophageal pH
monitoring – determine the degree of acid
reflux
▪ Bilirubin monitoring (Bilitec) – measure bile
reflux patterns
Management:
- Teach client to avoid situations that decreases
LES pressure or cause esophageal irritation
➢ Low fat diet
➢ Avoid caffeine, tobacco, beer, milk,
carbonated beverages
➢ Avoid eating or drinking 2 hours prior
bedtime
➢ Maintain normal body weight
➢ Avoid tight fitting clotting
➢ Elevate head part of bed 6 – 8inch blocks
➢ Elevate upper body on pillow
- Antacids or H2 receptor antagonists
(Famotidine, Nizatidine, Ranitidine)
- Proton Pump Inhibitors (decrease release of
gastric acid) – lansoprazole, rabeprazole,
esomeprazole
- Prokinetic agents (accelerate gastric emptying)
– Bethanechol (Urecholine), Domperidone
(Motilium), Metoclopramide (Maxolon)
- Surgery ( Nissen Fundoplication)
- A condition characterized by an opening in the
diaphragm through which the esophagus
passes becomes enlarged, and
- part of the upper stomach moves up into the
lower portion of the thorax
- more common in women
Types:
1. Sliding (Type I) or Hiatal Hernia
- 90% of patients with esophageal hiatal hernia
have a sliding hernia;
- Upper stomach and the gastroesophageal
junction are displaced upward and slide in and
out of the thorax
2. Paraesophageal Hernia (Type II, III, or IV)
- All or part of the stomach pushes through the
diaphragm beside the esophagus
▪ Type IV has the greatest herniation
Clinical Manifestations:
Sliding Hernia
- (50%) asymptomatic
• Pyrosis / Heart Burn
• Regurgitation
• Dysphagia
Paraesophageal Hernia
- Maybe asymptomatic
- Sense of fullness or chest pain after eating
• Hemorrhage
• Obstruction
• Strangulation
Assessment and Diagnostic Findings:
• X-ray
• Barium swallow
• Fluoroscopy
Management:
1. Frequent and small feeding that can pass freely
through the esophagus
2. Advice not to recline for 1 hour after eating
3. Elevate the head of the bed 4-8 inch (10 – 20
cm blocks
4. Surgical hernia repair is indicated in patients
who are symptomatic; 15% of patients
5. Paraesophageal hernia: same medical and
surgical management with GERD however they
may require emergency surgery to correct
torsion (twisting) of the stomach or other body
organ that leads to restriction of blood flow to
that area
_________________________________________
DISTURBANCES OF ABSORPTION
SPRUE
- A chronic degenerative disorder resulting from
malabsorption of nutrients from the small
intestine
- Is a disorder of malabsorption caused by an
autoimmune response to consumption of
products that contain the protein gluten.
- aka gluten sensitive enteropathy gluten –
induced enteropathy
- genetic chronic malabsorption disorder that
results from a sensitive or abnormal
immunologic
Gluten – is most commonly found in wheat,
barley, rye, and other grains, malt, dextrin, and
brewer’s yeast.
- Upon indigestion of foods contain gluten,
changes occur in the intestinal mucosa or villi
that prevent the absorption of foods
Causes:
• Immunological responses to an environmental
factor (gluten)
• Genetic factors (Children of North European
background; Down Syndrome)
Clinical manifestations:
(Noticeable between 6 – 18 months old)
▪ Steatorrhea
▪ Deficiency of vitamin A, D, E, & K
▪ Malnutrition
▪ Distended abdomen
▪ Ricket and hypoprothrombinemia may occur
▪ IDA and hypoalbuminemia
▪ Anorexia, irritability, poor weight, and height
gain
▪ Skinny, with spindly extremities and wasted
buttocks but face may be plump and well
appearing
Diagnosis:
- Serum analysis of and antibodies against gluten
(IgA antigliadin antibodies)
- Biopsy of intestinal mucosa (via endoscopy)
- Oral glucose tolerance test
- Stool – tested for increase fat content
- Observing response to a gluten – free diet:
begins to gain weight steatorrhea improved,
irritability false
Management:
- Gluten – free diet for life
- Avoid BROW!
• Wheat flour, gravy, soups, sauces
• Packaged and frozen foods usually contain
gluten as fillers
• Favorite school – age foods; spaghetti,
pizza, hotdogs, cake, cookies
• Birthday cake, turkey stuffing
- Nutritional counseling for parents:
• Be careful shoppers and read food labels
• Small servings
• Create incentives to eat
- Administration of water – soluble forms or
vitamins A & D
- Iron & folate supplementation
The disappearance of steatorrhea is a good
indicator that child’s ability to absorb nutrient is
improving.
a) Chron’s Disease
b) Ulcerative Colitis
- A group of bowel disorders resulting in
inflammation or ulceration of the bowel lining
- Cause: unknown
- Triggered by environmental agent, NSAIDS,
allergies, immune d/o
- Predisposing factors:
➢ 15 – 30 y.o; 50 – 70 y.o
➢ Genetic
- Is characterized by a subacute and chronic
inflammation of the GI tract wall that extends
through all layers
- Prevalence: adolescence or young adult
smokers
Assessment and Diagnostic findings:
- Proctosigmoidoscopy (recto – sigmoid area
inflammation)
- Stool examination
• (+) occult blood
• (+) steatorrhea
- Barium swallow (most conclusive) classic
“string sign” on x-ray
- Endoscopy, Colonoscopy, Intestinal Biopsies
- Barium edema: ulcerations, fissures and fistulas
- CT scan: bowel wall thickening and fistula
formation
- Decrease Hct and Hgb
- Increase WBC and ESR
- Decrease albumin and protein levels
Surgical Management:
- Laparascope – guided stricture plasty – blocked
or narrowed sections of the intestines are
widened, leaving the intestine intact
- Small bowel resection
- Total colectomy with ileostomy
- Intestinal transplant
- A chronic ulcerative and inflammatory disease
of the mucosal and submucosal layers of the
colon and rectum that is characterized by
unpredictable periods of remission and
exacerbation with bouts of abdominal cramps
and bloody or purulent diarrhea.
- Prevalence: Caucasians, Jews
Assessment and Diagnostic findings:
- Systemic manifestations: tachycardia,
hypotension, tachypnea, fever, and pallor
- Stool: (+) for blood
- CBC: low Hct & Hgb, increase WBC
 - Low albumin - Iron replacement
- Sigmoidoscopy, colonoscopy: inflamed mucosa - Avoids food / activities that exacerbate diarrhea
w/ exudate and ulcerations - Parenteral nutrition
- Barium enema: shortening of bowel ➢ Pharmacologic Therapy
- CT scan, MRI, ultrasound, abscesses and - Sedatives and anti – diarrhea agent
perirectal involvement ▪ ↓ peristalsis (rest the bowel)
- Amino salicylates: sulfasalazine to decrease
Surgical Management: inflammation
- Total colectomy with ileostomy - Prednisone; hydrocortisone; Budesonide
- Proctolectomy (Entocort Ec): if severe and
- Immunomodulators
CHRON’S ULCERATIVE
DISEASE COLITIS Nursing Management:
Part affected Ileum, ascending Rectum, colon a. Maintain normal elimination pattern
colon (transmural (mucosal and • Ready access to bathroom, commode or
inflammation) submucosal bed pan
inflammation • CFAC of stool
Characteristic Discontinuous Continuous • Bed pan
of lesion • Administer anticholinegic agents 30 mins
Predominant Crampy RLQ Diarrhea, passage before a meal
symptoms abdominal pain, of mucus and pus, b. Relieve pain
diarrhea LLQ pain, • Pain assessment
steatorrhea, intermittent • Intervention for pain
anorexia, weight tenesmus, rectal c. Maintain fluid intake
loss, malnutrition, bleeding, anorexia, • Accurate I&O
anemia weight loss, • Monitor daily weight
anemia, fever, • Assess for s/s of FVD
vomiting d. Maintain optimal nutrition
Complications Intestinal Anemia, abscesses • Small frequent feeding
obstruction toxic megacolon, • Parenteral nutrition
perineal disease, perforation, • Glucose monitoring
F&E imbalances, bleeding e. Promote rest
fistulas, fissures,
• Activity restriction
abscesses
• Active or passive rom exercise
Risk of
f. Reduce anxiety
developing Increased Increased
g. Enhance coping measures
colon cancer
• Stress reduction techniques
Other Accompanied by
• Counseling
characteristics systemic
h. Prevent skin breakdown
manifestation high
mortality rate • Perineal care
• Relieve pressure on bony prominences
Management of IDB: i. Monitor and manage potential complication
Goals j. Patient techniques
- Reduce inflammation
- Suppress inappropriate immune response
- Provide rest to the bowel
_________________________________________
- Improve quality of life
- Prevent on minimize
DISTURBANCES OF ANORECTUM
Medical management:
➢ Nutritional Therapy
- Oral fluids - Dilated portion of veins n the anal canal
- Lower residue, high protein, high – calorie diet - Bright red bleeding
- Vitamin supplementation
What causes hemorrhoids? - Stapled hemorrhoidopexy – use of surgical
- Chronic constipation or diarrhea staples for prolapsing hemorrhoids
- Straining during bond movements - Hemorrhoidectomy
- Prolonged sitting / standing
- Lack of fiber in the diet Care of client undergoing hemorrhoidectomy
- Weakening of the connective tissue in the ➢ PRE OP
rectum and anus that occurs with age - Low residue diet – to reduce bulk of feces
- Pregnancy - Stool softeners
- Wearing constriction clothing
- Liver cirrhosis, right sided heart failure ➢ POST OP
- Promote comfort – analgesics as prescribed
Types: - Side – lying or prone position
▪ Internal hemorrhoids - Apply ice packs over dressing for its first 12
- Not pain hours post op (best time: after BM)
▪ External hemorrhoids - Stool softeners, increase fluids, high fibers
- Severe pain fluids
- Itchy, painful
▪ Prolapse hemorrhoids can become inflamed
and thrombosed - An excavation (hollowed – out area) that forms
in the mucosal wall
Interventions:
- Cause: Erosion of the circumscribed area (may
- Good personal hygiene extend as deeply as the muscle layers or
- Avoid excessive straining upon defecation though the muscle to the peritoneum)
- To promote passage of soft, bulky stools: - Prevalence: 40 – 60 years old, males, infants
• High residue diet and children; post – menopausal stage
• Increase fluid intake
• Hydrophilic bulk – forming agents: Psyllium Types:
(Metamucil) 1. Gastric
- To reduce engorgement 2. Duodenal
• Apply cold packs followed by warm sitz bath 3. Esophageal
to relieve soreness and pain by relaxing
sphincter spasm. Significant Predisposing Factors:
- Analgesic ointments 1. Increased secretion of HCI acid – may be
- Suppositories associated with:
- Astringents (calamine, witch hazel, and zinc • Stress and Anxiety
oxide) – cause coagulation (chipping of • Indigestion of milk and caffeinated
proteins) beverages
• Smoking
Patient teaching: • Alcohol
- Set aside a time for bond movement • Spicy foods
- Heed urged to defecate ASAP 2. Familial tendency – Type O blood
- Prevent constipation 3. Co – morbid states – COPD, CKD, ZES
- Moderate exercise ▪ ZES – Zollinger Ellison Syndrome (gastrin –
producing malignant or benign tumors of the
Non – surgical treatment: pancreas)
- Infrared photocoagulation – use of heat to 4. Infection – H. pylori; acquired through ingestion
shrink hemorrhoids of food and water, direct contact or exposure to
- Bipolar diathermy – use of heat emesis
- Laser therapy - use of heat 5. Medication – NSAIDs, corticosteroids
- Injection of sclerosis agents
Pathophysiology
Surgical treatment: Increase concentration or activity of acid – pepsin
- Rubber – band ligation or decrease resistance of the mucosa
- Cryosurgical hemorrhoidectomy – freezing to
Erosion and damage to gastroduodenal mucosa
cause necrosis
 3. Pyrosis with sour eructation or burning
Decrease resistance to mucosa (common w/ empty stomach)
4. Vomiting – rare in uncomplicated duodenal
Possible infection to H. pylori ulcer but may indicate obstruction on the pyloric
orifice
Stress ulcers – acute mucosal ulceration of • Emesis often has undigested food
duodenal or gastric area that occurs after • Follows a severe bout of pain and bloating
physiologically stressful events such as burns, (abdominal distention)
shocks, severe sepsis 5. Constipation or diarrhea
6. 15% of PUD has GI bleeding – melena
Shock
Assessment and Diagnostic Findings
Decrease mucosal blood flow (ischemia) + reflux or ▪ PE (Physical Education)
duodenal contents into the stomach + increase ▪ Barium study of upper GIT – studies x – ray
release of pepsin ▪ Endoscopy – procedure of choice
▪ Stool exam for occult blood
Ulceration ▪ Gastric secretory studies – endoscopy and
histologic examination of tissue specimen
Comparison of Duodenal Ulcer & Gastric Ulcer obtain by biopsy
Incidence ▪ Serologic testing for H. pylori, urea breath test,
Age 30 -60 Usually, 50 and over tool antigen test
Male: Female = 2 – 3: 1 Male: Female = 1:1
80% of peptic ulcers are 15% of peptic ulcers and Urea – Breath Test
duodenal gastric - To determine presence of H. pylori (which
metabolizes urea rapidly)
Signs, Symptoms and 1. Ingest a capsule of carbon – labeled urea
Clinical Findings (radioactive carbon 13c)
• Hypersecretions of • Normal – hyposecretion 2. Breath sample obtained 10 – 20 min after (30 –
stomach acid (HCI) of stomach acid (HCI) 2hrs)
• May have weight gain • weight loss may occur 3. Carbon – labeled urea – absorbed quickly (+)
• Pain occurs 2 – 3 after a • Pain occurs ½ to 1 hour H. pylori
meal; after awakened after a meal; rarely occur
between 1 – 2 AM; ingestion at night, may be received Medical Management
of food relieves pain by vomiting; ingestion of ➢ Pharmacologic Therapy
• Vomiting uncommon food does not help; • For ulcer healing: H2 receptor antagonist and
• Hemorrhage less likely sometimes increase pain proton pump inhibitors (for NSAID) – induced
than with gastric ulcer, but if • vomiting common and non – H. pylori associated PUD)
present melena more • Hemorrhage more likely • H2 blockers – Ranitidine, Cimetidine,
common than hematemesis to occur then duodenal Famotidine, Nizatidine
• More likely to perforate ulcer; hematemesis more • PPIs: Omeprazole, Lansoprazole
than gastric ulcers common than melena • Initial Treatment for H. pylori
- 1st line: Triple therapy = PPI 2x/day +
Malignant Possibility Clarithromycin 2x/day or Metronidazole 2x/day
Rare Occasionally for 10 – 14 days
- 2nd line: Pepto – bismol 2 tabs 4x/day +
Risk Factors Tetracycline 4x/day for 14 days
H. pylori, alcohol, smoking, H. pylori, gastritis, alcohol, • ZES – high dose of H2 blockers + octreotide
cirrhosis, stress smoking use of NSAIDS, (Sandostatin)
stress ➢ Stress Reduction and rest
➢ Smoking cessation
Clinical Manifestation: ➢ Dietary modification – avoid extremes of
1. Pain: dull, gnawing or burning sensation in the temperature of food and beverages, diet milk
midepigastrium or back and cream
2. Sharp tenderness w/ gentle pressure at the ➢ Eat 3 regular meals per day
epigastrium or slightly right of midline ➢ Small frequent feedings are unnecessary to
client is taking antacid or H2 blockers
Surgical Management
- Indicated for patients with intractable ulcers, life
– threatening hemorrhages, perforation or
obstruction; and for those with ZES
unresponsive to treatment
• Vagotomy with or without pyloroplasty
• Antrectomy – removal of the pyloric (antrum)
portion of the stomach with anastomosis
• Billroth
Types:
I. Billroth I – Gastroduodenostomy
II. Billroth II – Gastrojejunostomy
• Total Gastrectomy
- a.k.a Esophagojejunostomy
Pre – Op care
- Provide psychosocial support
- Teach deep breathing exercises and coughing
technique (high abdominal incision cause
respiratory complications)
- Provide nutritional support (TPN
- Inform about post – op measures
• NGT
• TPN until peristalsis return
Post – Op Care
- Promote patient airway and ventilation
• Semi – Fowler position
• Reinforce deep breathing and coughing
exercise, incentive spirometry
• Administer analgesic before activities
• Splint incision before patient coughs
• Encourage early ambulation
• Promote adequate nutrition
• NPO until peristalsis return
• Measure NG drainage accurately (reddish
for first 12hrs)
• Monitor for signs of leakage of anastomosis
(dyspnea, pain, fever, when oral fluids are
initiated)
• Small, frequent feedings
• Monitor for early safety and regurgitation
• Eat less food at a slower pace
• Monitor weight regularly
Potential COMPLICATIONS
1. BLEEDING - first 24 hours, 4th to 7th day post-
op d/t non-healing
• Monitor NG drainage for blood
• Avoid unnecessary irrigation or
repositioning of NGT
2. PERFORATION
• Erosion of the ulcer through the gastric
serosa into the peritoneal cavity without
warning
• Requires immediate surgery!
• s/s: sudden, sever upper abdominal pain
radiating to the right shoulder; board-like
abdomen
• Monitor for signs of peritonitis: severe
abdominal pain, rigidity, fever
3. DUMPING SYNDROME
- a group of unpleasant vasomotor and GI s/s
caused by rapid emptying of gastric content into
the jejunum
Rapid emptying of hypertonic food from the
stomach
Jejunum
Fluid shift from the bloodstream into jejunum
Decreased blood volume
Shock-like manifestations
- Early s/s occur 5-30 min after eating:
• weakness, tachycardia, dizziness, diaphoresis,
pallor, feeling of fullness or discomfort, nausea,
abdominal cramps and diarrhea
- Late s/s: occur 2-3 hrs after
• initially hyperglycemia then hypoglycemia
- Measures that slow gastric emptying:
• Eat in lying position
• Left-side lying position after meals
• SFF
- High protein diet (CHON empties stomach
slowly in 3-4 hrs after eating)
- Limit CHO, no simple sugars
- Administer anticholinergics or antispasmodics
30 min before meals
Nursing Diagnoses
• Acute Pain r/t the effect of gastric acid secretion
on damaged tissue
• Anxiety r/t to an acute illness
• Altered Nutrition: Less than Body
Requirements, r/t changes in diet
• Knowledge Deficit about prevention of
symptoms and management of the condition
• Fluid Volume Deficit r/t hemorrhage
Implementation
1. Relieving pain
▪ Administer prescribed meds.
▪ Advise patient about irritating effects of certain
drugs and foods
▪ Eat meals regularly at paced intervals
▪ Relaxation techniques
2. Reduce anxiety
▪ Give information Chronic:
▪ Relaxed manner 1. Anorexia
▪ Identify stressors, coping and relaxation 2. Heartburn after eating
methods 3. Belching
▪ Family participation 4. Sour taste in the mouth
3. Maintain optimal nutritional status 5. Nausea and vomiting
▪ Assess for malnutrition and weight loss 6. Some: mild epigastric discomfort or report
intolerance to spicy or fatty foods or slight pain
that is relieved by eating
7. Some: asymptomatic
- Inflammation of the gastric or stomach mucosa
ASSESSMENT AND DIAGNOSTIC FINDINGS
- Acute (hours to days) or chronic (resulting from ▪ Achlorhydria or hypochlorhydria (absence or
repeated exposure to irritating agents or low levels of HCl) or hyperchlorhydria (high
recurring episodes of acute gastritis levels of HCl)
▪ Upper GI x-ray series
Causes: ▪ Endoscopy
1. Acute ▪ Histologic examination of a tissue specimen
• dietary indiscretion (irritating, too highly obtained by biopsy
seasoned, contaminated with disease-causing ▪ H.pylori detection
microorganisms)
• overuse of aspirin/ NSAIDs
• excessive alcohol intake
• bile reflux
• radiation therapy
• ingestion of strong acid or alkali
• traumatic injuries, burns, severe infection,
hepatic, renal, or respiratory failure; major
surgery
2. Chronic
• Benign or malignant ulcers of the stomach
• H.pylori infection
• Autoimmune diseases i.e. Pernecious anemia
• Diet: caffeine
• Medications: NSAIDs; biphosphonates
• Alcohol and smoking
• Chronic reflux of pancreatic secretions and bile
into the stomach

PATHOPHYSIOLOGY
Causative factors

Gangrenous mucosa

Edematous & hyperemic

Superficial erosion hemorrhage

Decreased secretion of gastric juice (less acid but

much mucus)

CLINICAL MANIFESTATIONS
Acute: (hours to days)
1. Abdominal discomfort 4. Nausea, anorexia
2. Headache and vomiting
3. Lassitude 5. Hiccupping
MEDICAL MANAGEMENT
Acute:
• Capable of repairing itself (1 day)
• Refrain from alcohol and food until symptoms
subside
• Diet: non-irritating
• If symptoms persist: IVF
• If caused by strong acid/alkali: dilute &
neutralize the offending agent (aluminum
hydroxide for acids and diluted lemon juice or
diluted vinegar for alkalis); if severe: avoid
emetics and lavage
• NG intubation
• Analgesic agents, sedatives, antacids, IV fluids
• Extreme cases: emergency surgery to remove
gangrenous or perforated tissue
Chronic:
• Modify diet
• Promote rest
• Reduce stress
• Avoids alcohol and NSAIDs
• Initiate pharmacotherapy
• Treat H.pylori infection

NURSING MANAGEMENT
1. Reducing Anxiety
• Offers supportive therapy
• Prepare patient for additional diagnostic studies
• Use calm approach in assessing patient and
answering questions
• Explain all procedures
2. Promoting Optimal Nutrition
• No foods or fluids by mouth until acute
symptoms subside
• Monitor I/O and serum electrolyte levels
• Ice chips then clear liquid then solid foods
• Discourage caffeinated beverages, alcohol and
smoking
3. Promoting Fluid Balance
• Monitor I/O and electrolytes
• Monitor for hemorrhagic gastritis (inform AP
immediately)
- Hematemesis
- Tachycardia
- Hypotension
4. Relieving Pain
• Avoid irritating foods
• Correct use of medications