Care of Clients with
Gastrointestinal Disorders
Abdominal Pain
O Onset: “When did the pain begin?”
Location: “Please point where exactly you
L fee the pain.”
Duration: “How long does the pain last?”
D emptying the stomach contents and secretions
Characteristic: “Please describe the pain
C you feel in your abdomen.”
A Aggravating: “What triggers the pain?”
R Relieving: “What relieves the pain?”
T Timing: “When does the pain occur?”
S Severity: “Please rate your pain from 1-10”
Dyspepsia
Upper abdominal discomfort associated with
eating
Most common symptom of patients with GI
dysfunction
Typically caused by fatty foods, salads,
coarse vegetables, and highly seasoned foods
Intestinal Gas
Accumulation of gas in GI tract
Belching: expulsion of gas from stomach
through the mouth
Flatulence: expulsion of gas from the rectum
May indicate food intolerance or gallbladder
disease
Latent phase
Nausea and Vomiting
Nausea is a vague, uncomfortable sensation of
sickness that may or may not be followed by
vomiting
Vomiting is a physiologic protective response
that limits the effects of noxious agents by
of small intestine
Triggers: odors, activity, medications, food
intake
Change in Bowel Habits
Diarrhea: an abnormal increase in frequency
and liquidity of stool or in daily stool weight or
volume
Commonly occurs when the contents move
so rapidly through the intestine and colon that
there is inadequate time for the GI secretions
and oral contents to be absorbed.
Constipation: a decrease in frequency of
stool, or stools that are hard, dry, and of
smaller volume than typical
Change in Stool
Characteristics
Normal stool
light to dark brown
Melena
Black tarry stool indicative of upper GI
bleeding
Hematochezia
Bright red blood in stool
Steatorrhea
Fatty stool
Alcoholic stool
light- gray or clay- colored stool resulting
from decreased or absent conjugated bilirubin
 Diagnostic Tests for GI UGI Tract Study (Barium Swallow)
Visualizes esophagus, stomach, duodenum, and
Disorders jejunum
Contrast medium: Barium sulfate – white,
chalky substance
Fecal Occult Blood Test (FOBT)/ Guaiac Test X-rays are taken on standing and lying position
Stool for occult blood Nursing interventions:
Done to detect GI bleeding Pre-procedure:
Preparation: • NPO 6-8 hours
• High fiber diet for 48-72 hours Post-procedure:
• Avoid red meat, poultry, turnips, horse radish, • Laxatives, as ordered
cauliflower, and melon – false positive result • Increase OFI
• Avoid vitamin C – false negative result • Inform client that stool may become white
• Hold 48hrs prior: steroids, iron, indomethacin, for 24-72 hours
colchicine LGI Tract Study (Barium Enema)
3 stool specimens will be collected for three Visualization of colon through x- rays after
consecutive days rectal installation of barium
Stool for Ova, Parasites, and E. histolytica (OPEH) Barium enema is C/I for patients with active
Clean technique inflammatory diseases, fistula, or suspected
Send fresh, warm specimen (within 30 mins) perforation of colon.
• Diatrizoic acid is used instead (watersoluble
Stool for Culture and Sensitivity iodinated contrast medium)
Nursing interventions:
Identifies microorganism and determines • Low- residue diet 1 to 2 days before
appropriate antibiotic therapy • Clear liquid diet and laxative the evening
Sterile technique before
Use sterile collection tube and sterile cotton- • NPO post-midnight
tipped applicator to collect specimen • Cleansing enema until clear in AM of
Abdominal Ultrasound (UTZ) procedure
• Schedule before any upper GI studies
Ultrasonography is a noninvasive diagnostic
technique in which high- frequency sound Computed Tomography (CT) Scan
waves are passed into the internal body Provides cross- sectional images of abdominal
structures, and the ultrasonic echoes are organs and structures.
recorded on an oscilloscope as they strike Used to detect and localize many inflammatory
tissues of different densities. conditions in the colon (appendicitis,
Used to detect: diverticulitis, regional enteritis, and ulcerative
• Enlargement of gallbladder, pancreas, colitis)
presence of gallstones, ectopic pregnancy, Painless procedure, but uses radiation
appendicitis Nursing interventions:
Sound waves cannot travel through bones, gas, • Clear liquid diet in AM
or fluid • If using contrast medium:
Nursing interventions: • NPO 2-4 hours
• NPO 8 to 12 hours prior to UTZ • Check for allergies to seafood and iodine
• If for gallbladder studies, fat-free meal the • Assess for claustrophobia
evening before • Instruct client to remain still during entire
• Schedule barium studies after ultrasonography procedure
since barium interferes with sound wave
transmission
 Magnetic Resonance Imaging (MRI)
Noninvasive technique that uses magnetic fields
and radiowaves to produce images of area
being studied
Used to evaluate abdominal soft tissues as well
as blood vessels, abscesses, fistulas,
neoplasms, and other sources of bleeding
Nursing Interventions:
• Pre- procedure:
• NPO 6-8 hours
• Remove all jewelries and other metals
• Inform patient and family that procedure
lasts for 60 to 90 minutes, inform that the MRI
machine will make a knocking sound during the
procedure
• Assess for claustrophobia
Contraindications:
• Pacemakers
• Aneurysm clips
• Orthopedic screws
Upper GI Endoscopy
Direct visualization of esophagus, stomach, and
duodenum
Nursing interventions (Pre op):
• Obtain written consent
• NPO 6-8 hours
• Administer Atropine sulfate, as ordered
• Administer sedatives/narcotics/tranquilizers,
as ordered
• Remove dentures or bridges
• Lidocaine spray is applied to the posterior
pharynx to depress gag reflex.
• Instruct not to swallow saliva
Nursing Interventions (Post op):
• Position to side- lying position
• NPO until gag reflex returns
• NSS gargle
• Monitor VS
• Assess: bleeding, crepitus, fever, neck/throat
pain, dyspnea, dysphagia, back/shoulder pain
Lower GI Endoscopy
Proctosigmoidoscopy
Direct visualization of sigmoid and rectum
Colonoscopy
Direct visualization of the colon
Nursing Interventions (Pre op)
• Obtain written consent
• Clear liquid diet 24 hours before procedure
• Administer laxative/cathartic, as ordered
• Cleansing enema until clear
• Position to knee-chest/lateral position during
procedure
• Assess for vasovagal stimulation
Nursing Interventions (Post op):
• Position to supine for a few minutes
• Assess for signs of perforation – bleeding,
pain, fever
• Hot Sitz bath to relieve discomfort in
anorectal area
Common Nursing Procedures
for Clients with GI Disorders
Gastrointestinal Decompression
Enteral Feeding (NGT, PEG/PEJ)
Parenteral Nutrition
Gastric and Intestinal Decompression
The removal of gas or fluid to prevent
gastric and intestinal distention
Achieved through the use of nasogastric
tubes (NGT) or nasoenteric tubes
Nasoenteric Tubes
Nursing interventions:
After insertion of nasoenteric tubes, turn
patient to the RIGHT side. This facilitates
passage of tube to the duodenum.
Shortening of length of tube from the outside
indicates passage of tube to duodenum
Enteral Feeding
Nasogastric Tube Feeding
Also called gastric gavage
Feeding formula should be at ROOM
TEMPERATURE. Cold formula causes cramps.
Position: semi- fowler’s to high- fowler’s
Check NGT placement:
• BEST- x-ray
• Check pH of Gastric secretions (Should
be acidic with pH of 1-3)
• Note color of aspirate (greenish or
yellowish)
• Introduce 10 mL of air into NGT and
auscultate epigastric area for gurgling sounds
After each feeding, instill 30 to 60 mL of
water
Have the client remain in semi- to high-
fowler’s position for 30 to 60 minutes after
feeding
 Gastrostomy/Jejunostomy Feeding
Gastrostomy
stoma is in the stomach
A procedure in which an opening is created
into the stomach either for the purpose of
administering nutrition, fluids, and medications
via a feeding tube, or for gastric
decompression.
Preferred way of enteral feeding for
nutritional support of greater than 4 weeks
Jejunostomy
stoma is in the jejunum
A surgically placed opening in the jejunum for
the purpose of administering nutrition, fluids,
and medications
Indicated when gastric route is not accessible,
or to decrease aspiration risk when stomach
is not functioning adequately to process and
empty food or fluids
Gastrostomy Jejunostomy
Gastrostomy/Jejunostomy Feeding
Feeding should be at ROOM temperature
Position: semi- to high- fowler’s position
Check patency:
• Instill 15 to 30 ml of water
Have the client remain in semi- to high fowler's
position for 30 to 60 mins after feeding
Parenteral Nutrition
A method of providing nutrients to the body
by an IV route
Goals:
• To improve nutritional status
• Establish a positive nitrogen balance
• Maintain muscle mass
• Promote weight maintenance or gain
• Enhance healing process
Positive Nitrogen Balance
Positive nitrogen balance is necessary to
create an anabolic environment, allowing the
body to build new muscle
Total Parenteral Nutrition (TPN)
Primary purpose: to administer glucose
Indications:
• Clients who need extensive nutritional support
over an extended period of time
• Site of catheter insertion: SUBCLAVIAN vein
• Type of solution: hypertonic (25% to 35%
dextrose)
Nursing interventions:
• Administer TPN at ROOM TEMPERATURE •
Consume TPN within 24 hours
• Change IV tubing every 24 hours
• Use an infusion pump to maintain a steady
infusion rate
• If infusion is delayed, DO NOT catch up.
Notify physician.
• Monitor urine and blood glucose levels.
• Provide skin care on the catheter insertion
site
The removal of gas or fluid to prevent
gastric and intestinal distention
Achieved through the use of nasogastric
tubes (NGT) or nasoenteric tubes
Nasoenteric Tubes
Nursing interventions:
After insertion of nasoenteric tubes, turn
patient to the RIGHT side. This facilitates
passage of tube to the duodenum.
Shortening of length of tube from the outside
indicates passage of tube to duodenum
Enteral Feeding
Nasogastric Tube Feeding
Also called gastric gavage
Feeding formula should be at ROOM
TEMPERATURE. Cold formula causes cramps.
Position: semi- fowler’s to high- fowler’s
Check NGT placement:
• BEST- x-ray
• Check pH of Gastric secretions (Should
be acidic with pH of 1-3)
• Note color of aspirate (greenish or
yellowish)
• Introduce 10 mL of air into NGT and
auscultate epigastric area for gurgling sounds
After each feeding, instill 30 to 60 mL of
water
Have the client remain in semi- to high-
fowler’s position for 30 to 60 minutes after
feeding