Assessment of Digestive and Gastrointestinal Function and

Treatment Modalities

Topic Outline
1. Anatomic and Physiologic Overview of the Gastrointestinal System
2. Assessment of Gastrointestinal System
3. Diagnostic Evaluation of Patients with Gastrointestinal Disorders
4. Purposes, indication for, and the administration technique of enteral and parenteral nutrition support.

Learning Objectives
After studying this topic, you will be able to:
 Describe the structure and function of the organs of the gastrointestinal (GI) tract, the mechanical
and chemical processes involved in digesting and absorbing nutrients, and eliminating waste products.
 Use assessment parameters appropriate for assessing the status of GI function.
 Discriminate between normal and abnormal GI function.
 Identify the appropriate preparation, patient education, and follow-up care for patients who are
undergoing diagnostic evaluation of the GI tract.

Introduction

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Nutrition is the sum total of the processes involved in the taking in and the utilization of food
substances by which growth, repair, and maintenance of the body are accomplished. It involves ingestion,
digestion, absorption/assimilation, and elimination. And gastrointestinal tract is the gateway of nutrients
in the body. For this reason, disorders in the GIT could be dangerous to the body and development. Any
condition that interferes with ingestion, digestion, and elimination can negatively influence a person’s
sense of well-being. Therefore, nurses need to be alert to indicators of pathology, since prognosis can be
influenced by early diagnosis and treatment.

Amazing Facts about the Digestive System

1. Contrary to popular belief, the stomach isn’t the main source of food digestion. While mechanical
digestion occurs in the stomach, most of the work is done by the small intestine.
2. The stomach has to protect itself from acid erosion by lining itself with a layer of mucus. This keeps
the hydrochloric acid that is in the stomach that digests the food from breaking down the stomach as
well. To protect itself from the corrosive acid, the stomach lining has a thick coating of mucus.
3. The digestive system uses enzymes to break down food into different nutrients. The absorbed
nutrients include carbohydrates, protein, fats, minerals, and vitamins. They are processed, then
delivered throughout the body, and used for energy, growth, and cell repair.
4. The small intestine isn’t small at all. If it is stretched out, it would cover space the size of a tennis
court. This is due to the folds in its walls, known as villi and microvilli that provide increased surface
area.
5. Stomach growling is called borborygmi and happens all the time, but it is just louder when your
stomach is empty because there is no food to muffle it.
6. The average person produces one liter of saliva every day. That is 32 ounces or 2 cans of soda.
7. The stomach can stretch and hold up to 4 pounds of food at one time.
8. Cells along the inner wall of the stomach secrete roughly 2 liters (0.5 gallons) of hydrochloric acid
each day, which helps kill bacteria and aids in digestion.
9. Inside your digestive system live trillions of bacteria. These bacteria play a role in developing your
immune system after you’re born and continue to help you stay healthy throughout your life, among
many other functions.
10. When food enters your mouth, the walls of your GI tract use a special layer of muscles to move,
guiding your meal through your system. This process is called peristalsis-movement that can look like
an ocean wave crashing and receding through your digestive system, and it’s the reason you can
digest food while hanging upside down.

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 GASTROINTESTINAL SYSTEM

The GI system consists of the mouth, pharynx, esophagus, stomach, small intestine, large
intestine, and associated structures (teeth, tongue, salivary glands, liver, gallbladder, and pancreas).

 Mouth structures include lips, teeth, gingivae, and oral mucosal, tongue, hard palate, soft palate, and
pharynx.

 Esophagus is a muscular tube extending from the pharynx to the stomach.

 The esophageal opening includes the upper esophageal sphincter (UES), and the lower esophageal
sphincter (LES), or cardiac sphincter, which normally remains closed and opens only to pass food into the
stomach.

 Stomach is a muscular pouch situated in the upper abdomen

under the liver and diaphragm. The stomach consists of three
anatomic areas: the fundus, body (or corpus), and the antrum
(or pylorus). The stomach wall has four tissue layers:
o Mucosal lining: the epithelial lining of the stomach in
longitudinal folds (rugae), which allows distention and
increases the surface area; contains many glands that
secrete gastric juices (mucous cells, chief cells, parietal cell).

o Submucosal coat: contains blood and lymphatic vessels and

nerves that help regulate digestive activity.

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o Muscular coat: contains three layers of smooth muscle –
oblique, circular and longitudinal fibers. Produces peristaltic
activity.

o Fibroserous coat: the outer layer

 The LES or cardiac sphincter relaxes to allow food to enter the

stomach then contract to prevent reflux into the esophagus. The
pyloric sphincter regulates the flow of stomach content (chyme)
into the duodenum.

 The small intestine, a coiled tube approximately 22 ft long and 1 inch in diameter, extends from the pyloric
sphincter to the ileocecal valve at the large intestine; sections include the duodenum, the jejunum, and
the ileum.
o The tissue layers are similar to the stomach. Numerous villi - tiny, finger-like projections in the
mucosal layer- provide a vast surface area for secretion, digestion, and absorption.

 Large Intestine: a shorter, wide tube (5 to 6 ft. long, 2 to2 ½ inches in diameter) beginning at the ileocecal
valve and ending at the anus, the large intestine consists of three sections:

o Cecum: a 2- to 3-in blind pouch, extending from the ileocecal valve to the vermiform appendix.
o Colon: the main portion of the large intestine, divided into four anatomic sections: ascending,
transverse, descending, and sigmoid.
o Rectum: 7 to 8-inch-long, extending from the sigmoid colon to the anus.

The Functions of the Gastrointestinal System

 The GI system performs two major body functions:
o Digestion of food and fluid, with the absorption of nutrients into the bloodstream.
o Elimination of waste products through defecation.
 Digestion begins in the mouth with chewing and the action of ptyalin (salivary amylase), an enzyme
contained in the saliva that breaks down the starch.
 Swallowed food passes through the esophagus to the stomach where digestion continues through several
processes:
o Secretion of gastric juice, containing hydrochloric acid and the enzyme pepsin and lipase.
o Mixing and churning through the peristaltic action.

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  From the pylorus, the mixed stomach content (chyme) passed into the duodenum through the pyloric
valve.

 In the small intestine, food digestion is completed and most nutrients absorption occurs. Digestion results
from the action of numerous pancreatic and intestinal enzymes and bile.
 In the large intestine, the cecum and ascending colon absorb water and electrolytes from the now
completely digested material; the rectum stores feces for elimination.

Assessment
1. Health history should focus on:
a. History of the present illness and chief complaint, which can provide sufficient information for
diagnosis.
b. Appetite and food intolerance; usual food intake with 24-hour recall.
c. Pain: character, location, timing, alleviating measures.
d. Bowel elimination patterns: frequency, color, consistency, & laxative use; change in bowel habits.
e. Presence of any of the following: dark urine, jaundice, weight loss, nausea, and vomiting.
f. Previous GI tract disorders and surgery
2. Physical Assessment (Normal Findings)
a. Mouth: mucosa of mouth smooth, pink, moist; symmetric movement of all the structures
b. Teeth and gingivae: natural teeth present with dental caries filled or well-fitting dentures; no
gingival redness or swelling
c. Tongue: pink and velvety
d. Throat: no redness or swelling
e. Abdomen
i. Patient’s position should be in supine with knees flexed (dorsal recumbent position);

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Sequence in the abdomen: Inspection, Auscultation, Percussion and Palpation
ii. Inspection
o The skin should be smooth and intact
o The contour of the abdomen is flat, concave, rounded, or distended depending on
the client’s body type.
o Inspect umbilicus: shape, position, color (concave, located at midline, the same
color as the abdominal skin)
o Note abdominal movements, pulsations, peristaltic movements. Normally,
peristaltic movements are not visible
iii. Auscultation
o Bowel sound (5-35/min) rapid, high pitch, loud bowel sounds are hyperactive (e.g.
gastroenteritis). Hypoactive bowel sounds occur at a rate of one every minute or
longer (paralytic ileus) or after surgery.
iv. Percussion: to determine the size and location of abdominal organs and to detect fluid,
air, and masses
o Tympanic: high, pitched, loud musical over-air
o Dull: thuds like sound over a fluid or solid organ
v. Palpation
o Palpate abdomen by lightly depressing (1-2 cm) the abdomen on the quadrant to
quadrant manner
o Assess for masses, rebound tenderness, abdominal rigidity.

Major Manifestation of Gastrointestinal Disturbance

1. Anorexia - lack of appetite for food; lack of interest in all food
2. Dyspepsia (Indigestion) - painful, difficult, or disturbed digestion
3. Nausea - the feeling that one is about to vomit
4. Vomiting - sudden forceful expulsion of stomach contents through the mouth
5. Constipation – elimination pattern characterized by hard, dry stools that result from delayed passage of
food residue.
Signs and Symptoms
a. Decrease frequency of defecation
b. Hard, formed stool
c. A reported sensation of rectal fullness
d. Straining at stool
e. Painful defecation
f. Abdominal distention

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 Nursing Interventions
a. Urge the client to increase intake of dietary fibers.
b. Encouraged increase in water or other fluid intakes
c. Recommend regular exercise
d. Advice establishing a regular time for a bowel movement
e. Administer laxative judiciously

6. Diarrhea – frequent passage of loose, fluid, unformed stools

Signs and Symptoms
a. Loose, fluid stools
b. Increase frequency of defecation
c. Additional bowel sounds
d. Increase stool volume
e. Reported abdominal discomfort and cramping
Nursing Interventions
a. Provide instruction on proper and safe preparation and storage of food products
b. Teach the client how to clean cooking utensils and food containers properly to prevent epidemic
diarrhea
c. Assess client for dehydration
d. Increased oral fluid intake
e. Administer antidiarrheal medication like loperamide (Imodium), Diphenoxylate atropine (Lomotil)
as prescribed.

Diagnostic Evaluation
Laboratory Studies

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Fecal Analysis: the stool is examined for its amount, consistency, and color; a screening test for occult blood.
Normal color varies from light to dark brown.
1. Stool for Occult Blood (Guaiac Stool Exam): to detect G.I. bleeding; for colon cancer screening
 High fiber diet 48-72 hour
 Avoid red meats, poultry, fish contains hemoglobin fibers which may be mistaken as blood.
 Avoid foods with a high peroxidase content, such as turnips, cauliflower, broccoli, horseradish, and
melon because it will cause a false-positive result.
 Withhold for 48 hours: iron, steroids, NSAIDs (Indomethacin), colchicine & aspirin
 Collect 3 stool specimens (3 successive days) because of the possibility of intermittent bleeding.
 When hydrogen peroxide (denatured alcohol–stabilizing mixture) is added to samples, any blood cells
present liberate their hemoglobin, and a bluish ring appears on the electrophoretic paper. Read
precisely at 30 seconds.

2. Stool for Ova and Parasites

 Send fresh, warm stool specimens so that the parasites may be observed under a microscope while
viable.

3. Stool culture to identify the presence of viruses and bacteria

 Use a sterile test tube and cotton-tipped applicator to collect the specimen. This ensures that the
specimen is not contaminated

4. Stool for Lipids: assess steatorrhea which can help in the diagnosis of malabsorption syndromes
 High-fat diet
 Avoid alcohol for 3 days because alcohol metabolizes fats that will cause a false-negative test
 72-hour stool specimen (store on ice)

Gastric Analysis: measure secretion of HCL and pepsin

 NPO for 12 hours before the test. Avoid smoking on the morning of the test.
 NGT tube is inserted into the stomach, connected to suction to aspirate specimens to evaluate gastric acidity
 Gastric content collected every 15 minutes to 1 hour
 Interpretation:  HCL: Zollinger - Ellison Syndrome or Duodenal Ulcer
 HCL: Gastric CA or Pernicious Anemia

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Radiologic Studies
1. Flat Plate of the Abdomen: plain x-ray of the abdomen
Nursing Consideration: no belts and jewelry in the area of examination
2. UGIS (Upper G.I. Series/Barium Swallow): fluoroscopic x-ray examination to visualize the esophagus,
stomach, duodenum, and jejunum after the patient ingests barium sulfate. As the barium passes through
the GI tract, fluoroscopy outlines the GI mucosa and organs. It is used to diagnose esophageal varices,
inflammation, ulcerations, hiatal hernia, foreign bodies, polyps, diverticula, and tumors of the esophagus,
stomach, and duodenum.
Nursing Considerations
 Explain the procedure to the patient
 Instruct patient to maintain a low residue diet for 2-3 days before the test and a clear liquid dinner
the night before the procedure.
 NPO for 6-8 hours after midnight before the test.
 Encourage the patient to avoid smoking before the test. All opioids and anticholinergics to be
withheld 24 hours before the test because they interfere with small intestine motility.
 Barium Sulfate (BaSO4) (non-water-soluble chalky liquid) per orem (480 to 600 mL)
 X-ray taken on standing and, lying position
 After the procedure:
o Laxative or cathartic will be prescribed after the procedure to facilitate the expulsion of
barium.
o Increase fluid intake for atleast 2 days.
o Inform the patient that the stool will be white for 2-3 days from the barium.
o Instruct patient to notify health care provider if he has not passed the barium in 2 to 3
days because retention of the barium may cause obstruction or fecal impaction.
o Observe for Ba impaction: distended abdomen, constipation

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3. LGIS (Lower G.I. Series/Barium Enema): fluoroscopic x-ray examination to visualize the colon after the
patient is given an enema of barium sulfate. Can visualize structural changes, such as tumors, polyps,
diverticula, fistulas, obstructions, and ulcerative colitis.
Nursing Considerations
 Explain the procedure to the patient
 Low-fiber, low-fat diet 1 to 3 days before the examination; clear liquid diet a day before the
examination
 NPO after midnight the day of the procedure.
 Laxative for cleansing the bowel
 Cleansing enema in the morning before the procedure
 BaSO4 per rectum
 After the procedure: same with UGIS

4. Computed Tomography: uses a beam of radiation to assess cross-sections of the body provides excellent
anatomic definition and is used to detect tumors, cysts, and abscesses; can also reveal masses, dilated
bile ducts, pancreatic inflammation, and some gallstones; and can identify changes in intestinal wall
thickness and mesenteric abnormalities.
Nursing Considerations
 Clear liquid diet in the morning before the test Commented [RS1]:
 If done with contrast medium
o NPO for 4 hours before the procedure but the patient can take usual medications with a
sip of water
o A pregnancy test should be obtained on females of childbearing potential
o Ask if there are known allergies to iodine or contrast media
o Instruct patient to report symptoms of itching or shortness of breath if receiving contrast
media, and observe the patient closely.

Endoscopic Procedures: endoscopy is the use of a flexible tube (the fiberoptic

endoscope) to visualize the GI tract and to perform certain diagnostic and
therapeutic procedures. Images are produced through a video screen or telescopic
eyepiece.
1. UGIS Endoscopy (esophagogastroduodenoscopy): allow direct visualization
of esophagus, stomach, and duodenum.
Nursing Considerations
 Explain the procedure and obtain written consent

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  NPO for 6-8 hours before the examination prevent aspiration and allow for complete visualization
of the stomach.
 Anticholinergic (AtSO4) to reduce mucus secretions as ordered.
 Sedatives, narcotics, tranquilizers to relax the client via an IV
 Remove dentures to facilitate passing the scope and preventing injury
 Local spray anesthetics on the posterior pharynx
 After the procedure:
o Side-lying position with a towel or basin at the mouth to catch secretions, to prevent
aspiration.
o Keep the patient NPO until gag reflex returns (2-4 hours)
o Warm saline gargle or throat lozenges may be prescribed for comfort.
o Monitor vital signs every 30 minutes for 3 to 4 hours, and keep the side rails up until the
patient is fully alert.
o Monitor patient for abdominal or chest pain, neck pain, dyspnea, fever, hematemesis,
melena, dysphagia, light-headedness, or a firm distended abdomen. These may indicate
perforation of the GI tract.

2. LGI Endoscopy: used to diagnose malignancy, polyps, inflammation, or strictures; perform a biopsy and remove
foreign objects.
a. Proctosigmoidoscopy: visualization of the anal canal, rectum, sigmoid colon, and proximal colon through a
fiberoptic sigmoidoscope.
b. Colonoscopy: is the direct visualization of the large intestine, descending
transverse and ascending colon, cecum, sigmoid colon, rectum, and anal
canal using a fiber optic colonoscope. It is used for surveillance in patients
with a history of chronic ulcerative colitis, previous colon cancer, or colon

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polyps.
Nursing Considerations
 Explain the procedure and obtain written consent
 Clear liquid diet 24 hours before.
 Administer oral cathartics/laxative as ordered
 Cleansing enema before the procedure
 Sedation is done for colonoscopy
 Knee-chest or (L) lateral Sim’s position; (L) side lying with knee flexed
 After the procedure
o Supine position for few minutes, to prevent postural hypotension due to vagal stimulation
o Monitor VS
o Assess for signs of bleeding or perforation.
o Hot sitz bath for discomfort in the anorectal area.

Other Diagnostic Test

1. Ultrasonography (Ultrasound): a noninvasive test that focuses high-frequency sound waves over an
abdominal organ to obtain an image of the structure. It can detect small abdominal masses, fluid-filled
cysts, gallstones, dilated bile ducts, ascites, and vascular abnormalities.
Nursing Consideration: abdominal ultrasound usually requires the patient to be NPO for at least 6 hours
before the test.

2. MRI: produce cross-sectional images of organs by using magnetic radio waves to identify a source of
gastric bleeding, tumors, or cysts.
Nursing Considerations
 NPO for 6-8 hours
 Instruct to remain still during the procedure
 Inform the procedure last for 60-90 minutes
 Remove any metallic objects (such as hair clips, jewelry) and assess for any metallic implants
(such as pacemakers, body piercings, shrapnel, orthopedic screw).

Common Gastrointestinal Interventions

Gastrointestinal Intubation
Gastric and intestinal decompression: removal of fluid and gas, to prevent gastric and intestinal distention.
Nasogastric tubes (NGT) and nasoenteric tubes are used for gastric and intestinal decompression.

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Types of G.I. Intubation
1. Levin Tube: single lumen stomach tube which is primarily used for NGT feeding

2. Salem- Sump tube: double-lumen NGT used for decompression.

 The air vent prevents adherence of the gastric tube to the gastric mucosa. Do not use the vent
for irrigation
 The other lumen is to be connected to low-pressure continuous gastric suction.

3. Dobbhoff or Enteraflo: nasoenteric tubes used for providing nutrients

 After insertion, turn the client to the right side to allow passage of the tube to the duodenum.
 It usually takes 24 hours for the tube to pass through the stomach and into the intestine.

4. Sengstaken-Blakemore tube: quadruple lumen tube. Used to control bleeding esophageal varices (balloon
tamponade)
 It has two balloons:
o Esophageal balloon: to compress the
bleeding esophageal varices, to stop
bleeding
o Gastric balloon: to anchor the
Sengstaken-Blakemore tube to
prevent upward displacement of the
esophageal balloon.
 Sponge rubber is placed near the nares to
serve as traction. It prevents downward

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displacement of the Sengstaken-Blakemore
tube.
 The esophageal balloon is inflated for 48 hours
only to prevent tissue necrosis.
 Nursing Care
a. Prevent ASPIRATION
o Encourage expectoration regularly
o Suction the mouth PRN
b. Observe for signs and symptoms of respiratory obstruction- gastric balloon may rupture and
esophageal balloon may obstruct airway (keep pair of scissors readily available).
c. Provide oronasal care every 1-2 hours
d. To remove the S-B tube, deflate the esophageal balloon before the gastric balloon, this is to
prevent upward displacement of the esophageal balloon into the pharynx, causing airway
obstruction.

Nasogastric Tube (NGT)

Purpose of NGT Insertion
 To provide feeding
 To irrigate the stomach
 For decompression
 To administer medication
 To administer supplemental fluid

Inserting a Nasogastric Tube

1. Inform the client and explain the purpose of the procedure.
2. Measure the length of the NGT to be inserted
 Tip of the NOSE to the tip of the EARLOBE to the XIPHOID PROCESS=50 cm
3. Lubricate the tip of the tube with water-soluble jelly.
4. Hyper extend the neck, gently advance the tube toward the nasopharynx.
5. Tilt the patient’s head forward once the tube reaches the oropharynx and ask to swallow to facilitate
passage of the tube
6. Assess placement of the tube.
7. Secure the NGT by taping it to the bride of the client’s nose.

Administering Nasogastric Tube Feeding (gastric lavage)

1. The feeding formula should be at room temperature

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 2. Assist client to a fowler’s position in bed or sitting position in a chair, or slightly elevated right side-lying
position.
3. Assess tube placement before feeding
a. Introduction of 10-30 ml of air into the NGT & auscultate the epigastric area for a gurgling sound
b. Aspirate gastric content (pH 1-3). Gastric aspirate appears greenish or yellowish.
c. X-ray
4. Assess residual feeding contents, to assess absorption of the last feeding. If 100 ml or more than half of
the last feeding is aspirated, hold the feeding and notify the physician.
5. Introduce feeding slowly, to prevent flatulence, crampy pain, and or reflex vomiting.
6. The height of feeding is 12 inches above the tube’s point of insertion into the client.
7. Instill 60 ml of water into NGT after feeding, to cleanse the lumen of the tube.
8. Clamp the NGT before all of the water is instilled
9. Ask the client to remain in fowler’s position or on a slightly elevated right lateral position for at least 30
minutes to prevent gastric reflux and aspiration of feeding

Administering Gastrostomy or Jejunostomy Feeding

1. The feeding should be at room temperature
2. Assist the client in a semi to high Fowler’s position.
3. Insert feeding tube to the ostomy opening 10-15 cm (4-6 in.) if one is not sutured in place.
4. Check the patency of the tube sutured in place by instilling 15-30 ml of water into the asepto syringe.
5. Check for residual feeding. Hold the feeding if there are more than 100 ml, and recheck in 3-4 hours.
6. Administer feeding slowly. Hold the syringe 7 to 15 cm (3 to 6 inches) above the ostomy opening.
7. Flush the tube with 30 ml of water after feeding
8. Feed the client in Fowler’s position or slightly elevated right lateral for at least 30 min.
9. Assess the status of peristomal skin.

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10. Make relevant documentation.

Administering Enemas

Purpose
1. To relieve constipation by promoting defecation
2. To relieve flatulence (gas)
3. To administer medication into the colon
4. To lower body temperature
5. To evacuate feces in preparation for diagnostic procedure or surgery.

Types of Enema
1. Cleansing Enema: stimulates peristalsis by irrigating the colon and rectum and/ by distending the intestine
with the volume of fluid introduced
 High enema: to clean as much of the colon as possible
o 1,000 ml of solution is introduced to an adult
 Low enema: to clean the rectum and the sigmoid colon only.
o 500 ml of the solution to an adult
2. Carminative Enema: to expel flatus
 60 to 180 ml of fluid is introduced.

3. Retention Enema
 Introduces oil into the rectum and sigmoid colon; oil retained in 1 to 3 hours.
 Acts to soften the feces and to lubricate the rectum and anal canal, facilitating the passage of feces.

4. Return flow enema/ Colonic Irrigation: used to expel flatus

 100-200 ml of fluid is introduced into and out of the large intestines to stimulate peristalsis and
expulsion of flatus.
 The solution container is lowered so that the fluid back out through the rectal tube into the container.
 The inflow-outflow process is repeated 5-6 times.
 Replace the solution several times during the procedure as it becomes thick with feces.

5. Non-retention Enema
 Solutions
o Tap water (500-1,000 ml)
o Soap-suds (20ml of castile soap in 500-1,000 ml of water)
o NSS (9 ml of NaCl to 1,000 ml of water)

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 o Hypertonic solution/ fleet enema (90-120 ml)
 Height of the solution
o 18 inches above the rectum
 Temperature of the solution
o 46 to 51.5 C (115 to 125 F) on preparation. This temperature of the solution stimulates
peristalsis
 Time of retention
o 5 to 10 minutes

6. Retention Enema
 Solutions
o Carminative enema
o Oil (90- 120 ml of mineral oil or cottonseed oil)
 Height of the solution
o 12 inches above the rectum
 Temperature of solution
o 40.5 to 43.5 C (105 to 110F) on preparation. This lower temperature of the solution for
retention enema does not immediately stimulate peristalsis.
 Time of retention
o 1-3 hrs.

Nursing Intervention in Enema Administration

1. Check the physician’s order
2. Provide privacy

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3. Promote relaxation to facilitate the flow of solution by gravity
4. Position:
a. Adult – left lateral position
b. Infant/Small Children – dorsal recumbent
5. Lubricates 5 cm (2in) of the rectal tube to prevent trauma to anorectal mucosa
6. Allow the solution to flow through the connecting tubing and rectal tube to expel air.
7. Insert 3-4 inches of the rectal tube gently, rotating motion.
8. Introduce solution slowly to prevent sudden stimulation of peristalsis.
9. Change position to distribute solution well in the colon (high enema), (if low enema, remain in left lateral
position).
10. If the order is cleansing enema- give the enema 3 times only.
11. If abdominal cramps occur during the introduction of the solution, temporarily stop the flow until peristalsis
relaxes.
12. After the introduction of the solution, press buttocks together to inhibit the urge to defecate.
13. Ask the client who is using the toilet not to flush it to assess the return of the solution.
14. Do perineal care after the procedure
15. Make relevant documentation.

Total Parenteral Nutrition (TPN): indicated on clients who need extensive nutritional support (primarily to
administer glucose) over an extended period of time.
 The subclavian vein is the usual site for catheter insertion. The clavicle provides good support to the
catheter.
 During the catheter insertion into the subclavian vein, the patient will be placed in a Trendelenburg’s
position to engorge the vein and facilitate the insertion of the catheter.
 Administer TPN at room temperature
 Consume TPN formula within 24 hours to prevent contamination.
 Change IV tubing for TPN every 24 hours to prevent bacterial growth
 TPN solution is hypertonic (usually 25 to 35% dextrose). Use infusion pump to maintain a steady infusion
rate to prevent abnormal shifting of fluids from the intracellular compartment to the extracellular
compartment (cell shrink)
 If the infusion is delayed, do not “catch up”.
 Monitor urine and blood glucose levels. If glucosuria occurs, small doses of insulin are given as prescribed
to prevent glucose intolerance.
 If TPN administration is interrupted or discontinued, administer D10W to prevent hypoglycemia.

All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
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 Activity (can also be Critical Thinking and Review Questions)
Written Assignments: 1) Given an unlabeled diagram, label the structures of the GI tract. Identify the
functions of each organ; 2) Prepare a short report that describes the nursing measures used to prevent
complications from enteral and parenteral nutrition support.
Group Assignment: As a group, develop a chart that discriminates between normal and abnormal GI
function.
Web Assignment: Using the Internet, locate information on the appropriate preparation, patient
education, and follow-up care for patients who are undergoing diagnostic evaluation of the GI tract.

Interactive Link
tinyurl.com/3r9glasd (Abdominal Exam Nursing Assessment)
tinyurl.com/o7i3i7xy (Four Abdominal Quadrants and Nine Abdominal Regions - Anatomy and Physiology)
https://tinyurl.com/3ndswbg6 (Administration of Soap Sud Enema)

Case Study
1. Mrs. Santos, 52 years of age, is scheduled for a colonoscopy. She has no symptoms, but her physician
has ordered this procedure as a baseline study based on suggested guidelines for cancer screening by
the American Cancer Society. The patient is instructed to start a clear liquid diet the day before the
exam.
a. Mrs. Santos arrives at the GI clinic. In assessing whether the patient is properly prepared for

NCM-116
the colonoscopy, what questions should the nurse ask her?
b. Immediately after the procedure, what possible complications should the nurse assess for in
Mrs. Santos?

2. The nurse working in a rehabilitation facility receives a patient from the acute care hospital for
management after a severe closed-head injury. The patient is in a semiconscious state and has
impaired swallowing. The admission orders call for the insertion of a nasogastric (NG) tube for feedings
and medication administration.
a. What is the right method for measuring the length of an NG tube for correct placement in the
stomach?
b. You observed that the student caring for the patient is verifying tube placement by listening
when a bolus of air is injected into the NG tube via a syringe. How should you intervene? What
other methods can the student use to verify tube placement? What is the rationale?
c. What is the correct procedure for administering medications via an NG tube that has
continuous feeding infusing?
d. The patient develops diarrhea on the second day at the rehabilitation facility. The nurse
assesses for which electrolyte abnormalities? What actions can the nurse implement to
decrease diarrhea?

Readings and References

Textbook of Medical-Surgical Nursing-13th Edition. Brunner & Suddarth, 2014
Lippincott Manual of Nursing Practice 11th Edition. Nettina et al., 2019
Medical-Surgical Nursing 8th Edition. Joyce Black, 2014
Mosby’s Comprehensive Review of Nursing 20th Edition. Nugent et al., 2014
Assessment & Management of Clinical Problems 9th Edition. Lewis et al., 2014
Medical-Surgical Nursing Concepts and Clinical Application 3rd Edition. Udan, 2017
Anatomy and Physiology. Tortora. 2008.
Pathophysiology Review. Marlene Hurst, 2008

All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
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