Module 1 Gastro

MODULE I
CARE OF CLIENTS WITH PROBLEMS IN

NUTRITION AND GASTROINTESTINAL
(Related Learning Experience)
AUTHOR:
KRISTINE MARIE G. MABANTA
CO AUTHORS:
ENRICO S. DEL ROSARIO
JIMA J. MAMUNGAY
DINA M. ORTEGA
SHELDY M. PERALTA
MAREXIE V. CASTRO
SECOND SEMESTER, SY 2021-2022

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TABLE OF CONTENTS
Content Page
Introduction 3
Learning Outcomes 3
Module Organizer 3
Area of Assignment 4
RLE Guidelines 5
Directions 8
Lesson 1: Abdominal Assessment 9
Lesson 2: Nasogastric Tube 24
Lesson 3: Enema Administration 35
Lesson 4: Bowel Diversion Ostomy 37
Lesson 5: Parenteral Nutrition 40
Module Activities 44
Module Summary 50
References 51
Appendices 52
Module I: Care of Clients with Problems in Gastro-intestinal and Nutrition Page | 2

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MODULE I
Care of Clients with Problems in Gastro-intestinal and Nutrition
INTRODUCTION
This self- learning module on related learning experience presents the principles
and techniques in caring clients with problems in gastro-intestinal, nutrition,
metabolic and endocrine.
The case scenarios are set at Ilocos Training and Regional Medical Center
Medical Ward: Internal Medicine Ward.
Your related learning experience on this topic is composed of 32 hours.
LEARNING OUTCOMES
After studying the module, you should be able to:
1. Explain a physical examination of the abdomen involving visual inspection,

auscultation, percussion and palpation.
2. Explain the procedures involved in gastric and intestinal intubation
3. Understanding enema administration.
4. Define the procedures for performing a gastronomy tube feeding.
5. Explain the procedures involved in ostomy care.
6. Apply knowledge in the care of clients with problem in nutrition and gastro-
intestinal in the case scenario given.
7. Apply bioethical concepts/ principles, core values, and nursing standards
in the care of clients with problem in nutrition and gastro-intestinal.
MODULE ORGANIZER
Hi! My name is Jima J. Mamungay and I am your Clinical Coordinator for this
semester. I will be assigning you your clinical instructor each group. In case you
encounter difficulty, discuss this with me or with your assigned clinical instructor during
the scheduled virtual meeting via google meet or zoom. If not, contact me or your
clinical instructor with the following contact details:
NAME OF FACULTY
MEMBER
jmamungay@dmmmsu.edu.ph Jima Querrer Jose 09178417848
JIMA J. MAMUNGAY
Mamungay
mcastro@dmmmsu.edu.ph Marexie 09959444662
MAREXIE V. CASTRO
Verceles Castro
CHRISTINE O. DELA cjdelacruz@dmmmsu.edu.ph Christine Obena Dela 09318949874
CRUZ Cruz
ENRICO S. DEL ROSARIO edelrosario@dmmmsu.edu.ph Enrico del Rosario 09052124265
NILO N. FABROS nilofabros@dmmmsu.edu.ph River Nile 09568565550
DINA M. ORTEGA dortega@dmmmsu.edu.ph Dina M. Ortega 09981769598
speralta@dmmmsu.edu.ph Sheldy Mangaser- 09178522185/
SHELDY M. PERALTA
Peralta 09073533907

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REA OF ASSIGNMENT
You are assigned to Medical Ward: Internal Medicine Unit. You are
given 4 days to complete this Module (Thursday-Friday). You are also assigned to a
Clinical Instructor whom you can consult and submit your requirements on this module.
Below is the list of groupings with your respective Clinical Instructor in this Clinical
Rotation. Please refer to the color of your group to the color of your Clinical Instructor
from the previous page.
NAME OF STUDENTS/GROUP NO. NAME OF STUDENTS/GROUP NO.
Group 1: Group 5:
Section A Section C
1. Abellera, Demi Alysonn Ildefonso 1. Cariño, Chara Irene Alcantra
2. Alambra, Nica 2. Carreon, Champaigne Rivera
3. Aparicio, Marven Antona 3. Carreon, Angelyn Campos
4. Balan, Elmer Alexandrew Visperas 4. Dacanay, Clarice Panelo
5. Balangue, Jennifer Nidoy 5. Dela Cruz, Penny Raviel Abellera
6. Banan, Claren Albay 6. Doctolero, Jessa Lordel Contreras
7. Bandong, Vanessa Joyce Serafica 7. Estimada, Lyka Garcia
8. Bautista, Mae Gerail Gunda 8. Fajardo, Lyka Rose Quinto
9. Cabilatazan, Liezel Reyes 9. Flores, Paulene Rose Tambong
10. Carandang, Zharina Madriaga 10. Floresca, Hannah Jane Viazon
11. Cariño, Aira Gel Daroy 11. Fontanos, Dana Chelsea Calub
12. Dalit, Kathleen Blaire Fangon 12. Gacusan, Trixie Glece Gutlay
13. Dulay, Violie Cacananta 13. Gajes, Hasmin Faith Ann Madriaga
14. Dulay, Amy Laron 14. Garabiles, Michelle Ann
15. Fangon, Melkisedec Boac 15. Garibay, Patricia Balcita
16. Flores, Joy Jamica Fabiano 16. Gavina, Edgar Jr. Gargoles
17. Flores, Robin Jay Balcita 17. Laron, Jerwin Centino
18. Galace, Guille Nathalia Cabading 18. Lino, Jocelyn Tolentino
19. Galano, Erika Alyssa Salazar 19. Mabanta, Grace Jessica Manzano
20. Garcia, Maureen Joy Quilates 20. Milan, Mildred Cacas
21. Garcia, Clarisse Joy Paneda 21. Nelmida, Czarina Aubrey Ariem
22. Gesell, Kane Zendrick Castro 22. Paculan, Ayesa Llobrera
23. Gravidez, Hannah Revina Estabillo
CLINICAL INSTRUCTOR:
CLINICAL INSTRUCTOR: MS CHRISTINE O. DELA CRUZ
MS MAREXIE V. CASTRO
Group 2: Group 6:
Section A Section C
1. Heruela, Jolina Pagar 1. Panelo, Jashrein Kaye Milan
2. Jacaban, Charlene Mae Manangan 2. Rullan, Jamaica Madriaga
3. Martinez, Erica Maceo 3. Sanchez, Rizza Rivera
4. Nalica, Angelica Obrero 4. Sanchez, Elizah Carel Baniqued
5. Nidoy, Lionel James Madriaga 5. Tumbaga, Mayjorie Grace Oriero
6. Niñalga, Aubrey Pata 6. Villano, Justine Joy Caluza
7. Niro, Cristy-Ann Soler 7. Villanueva, Peter Jerome Soloria
8. Nucus, Zaira Mae Pagaduan 8. Zikmund, Katrina Mae Reyes
9. Ober, Jhea Louisse Bucao
10. Pang-Es, Emeli Pis-Ing Section D
11. Pulmano, Cristy Eslao 1. Ancheta, Kassandra Christine Lacuata
12. Ramos, Cherrilyn Legaspina 2. Banua, Thristan Quares
13. Ramos, Fregie Mae Villaflor 3. Bringas, Klien Amiel Canlas
14. Refuerzo, La Judea Mae Fangaon 4. Cacayuran, Cristabelle Fabros
15. Regacho, Christian Martin Paul Carbonell 5. Cayabyab, Elizabeth Angela Pascua
16. Rivera, Janelle Tomines 6. Cerezo, Rose Ann Quiñones

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17. Santiago, Shemariah Lita Mangaoang 7. Corpuz, Phoebe Therese Isibido

18. Soliven, Nikka Jane Dacanay 8. De Guzman, Deodel Basa
19. Villegas, Cathy-Ann Hubilla 9. Emperador, Criza Caldona
10. Espiritu, Kimberly De Guzman
Section B 11. Estoque, Camille Joy Fuerte
1. Acosta, Cecilia Amor 12. Estorco, Erica Nicole Baligad
2. Adona, Diana Marie N. 13. Felicitas, Crizzle Kaye Tauli
3. Agagas, Marriane Joy M. 14. Fontanilla, Frizza Carrera
4. Bacungan, Jan Raven C.
CLINICAL INSTRUCTOR: MR NILO N. FABROS
MR ENRICO S. DEL ROSARIO
Group 3: Group 7:
Section B Section D
1. Bascos, Chery Rose R. 1. Garibay, Rissa Mae Velasco
2. Bautista, Ricgie Joy M. 2. Genese, Marichu
3. Cabotaje, Jeannasly M. 3. Jallorina, Jenny Rose Trinidad
4. Cacayuran, Marife 4. Locsin, Jennylyn Valdez
5. Cacho, Dianne Ambrossy O. 5. Mangay-Ayam, Janna Dixie Aquino
6. Calderon, Via Jorilyn A. 6. Palma, Jamyca Dela Masa
7. Carandang, Arvin Ivan M. 7. Peria, Ambrose Jan Immanuelle Ceria
8. Casem, Reyes Isabelle N. 8. Pintes, Esther Buac
9. Catbagan, Abbiegly Q. 9. Pulmano, Mhar Joe Bantiyao
10. Cerezo, Ella Grace R. 10. Quiñones, Glaina Palis
11. De Castro, Shiela G. 11. Ramil, Juanito Sabado
12. Dela Cruz, Chinky Nyza M. 12. Refuerzo, Lea Mae Ollero
13. Dela Cruz, Jonelvira C. 13. Regacho, Diana Rose Fontanilla
14. Delfin, Kathleen Aubrey V. 14. Ringor, Jessa Mae Rocapor
15. Doctolero, Jasmine G. 15. Ringor, Vanessa Batrina
16. Dulay, Marvin John T. 16. Sibayan, Mikee Leal
17. Escoto, Eureka Frances 17. Soriano, Trisha Valerie Antonio
18. Espiritu, Janine Rose V. 18. Soriano, Ma. Kathrina Baniqued
19. Estoque, Clarince Joy R. 19. Tabelon, Airen Sicat
20. Gaborro, Julianne R. 20. Viazon, Pauline Joy Baraobadao
21. Gamboa, Jeusa Mae Joy E. 21. Viduya, Angela Padilla
22. Geneta, Aira Mae E. 22. Villanueva, Grace Villanueva
CLINICAL INSTRUCTOR: CLINICAL INSTRUCTOR:

MS JIMA J. MAMUNGAY MS SHELDY M. PERALTA
Group 4:
Section B Section C
1. Hipol, May C. 1. Aspuria, Hannah Ericka Petina
2. Ilarde, Rina Kaye R. 2. Ayom, Patricia Joy Balderas
3. Laroya, Jennifer Ashley J. 3. Balanon, Crystal Mae Refugia
4. Llobrera, Eddie J. 4. Bandarlipe, Alma Velasquez
5. Manrique, Valerie Rose R. 5. Bautista, Jemarose Capistrano
6. Marra, Jhea Angelica B. 6. Belen, Elizabeth Abrigo
7. Nabua, Angielica Amor N. 7. Bianan, Mariz Lumanglas
8. Oribello, Micah Ella B. 8. Boco, Princess Rowena Montiagodo
9. Orine, Rogelyn A. 9. Cagampan, John Paul Echaure
10. Orpilla, Olive A.
11. Panergo, Arianne Keith F. CLINICAL INSTRUCTOR:
12. Siganay, Princess Deizy A. MS DINA M. ORTEGA
13. Tuazon, Liezl B.
14. Ulatan, Darren N.
MS DINA M. ORTEGA

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RELATED LEARNING EXPERIENCE GUIDELINES
General Information
This “RLE Guidelines” is created to direct you amidst the uncertainties brought by COVID 19
pandemic. It will make the most out of your learning experience without compromising your safety
and health. It will give you a brief overview of how we will course through the conduct of your
related learning experience without conceding proper decorum and discipline
Attendance:
You are expected to attend scheduled virtual meetings. If you failed to attend for 3
consecutive virtual meetings, you will be referred to your Program Chair.
Observance of Proper Netiquette

You should always practice appropriate decorum when communicating with your Clinical
Instructor and with your classmates within our educational platform. If you fail to do so, you will be
referred to your Program Chair. There are guidelines that you are expected to know during our
virtual meetings. These guidelines are the following:
1. Avoid typing in ALL CAPS

You can express your emotions, opinions, ideas or feelings in any way you want
HOWEVER IN MOST CONDITIONS, TYPING IN ALL CAPITAL LETTERS IS UNSUITABLE. All caps
may be viewed as shouting, yelling or intensified emotions, opinions, ideas or feelings
which could be misinterpreted by your reader.
2. Be Polite
There are many sources of mistaken arguments in virtual world. Sarcasm is one of the
sources where the commenter’s intent is hard to understand. To avoid misunderstanding,
you should be nice, humble and respectful in giving your remarks or observations online
even if you don’t agree with someone. In addition, don’t use bad words in disagreeing to
the idea of someone. Moreover, besides appropriate punctuation and spelling, you should
give polite greetings and signatures. Don’t forget to use the words “please” and “thank
you” as you always practice in actual conversation.
3. Don’t abuse the chat box

In every online class, chat box serves as a venue for you to share and give thoughts
and ask inquiries related to the lesson. But this chat box depends on how you will use it
to deliver your ideas and questions. It can be a useful resource or be a main disturbance
during discussions. So, do not post unnecessary or unrelated topics such as online selling,
photo liking contest and the like.
4. Read and Think before you ask

Read and understand previous messages, announcements, and discussions. Spend time
to search or figure out questions on your own. But in case you are still unsure, confused
or trapped in one discussion or topic, that is the time you are going to ask your clinical
instructor for clarifications or confirmations.
5. Cyber bullying is NO NO!

Remember that you are communicating to a human person. They also have feelings
like you, so respect them. Don’t be offensive online because it could backfire to you.
Moreover, anything could be saved then sent to anyone who could be use this information
against you.
6. Submit files the right way

Because we are in a new normal where face to face meeting is not allowed, your

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activities will be submitted online. You should be aware on how you will submit your work
to your clinical instructor. In order to have organized file from submitted assignment, you
will be instructed about the ground rules by your clinical instructor. Failure to do these
instructions suggests that you have a bad netiquette.
7. Be on Time, Presentable and Prepared.

Being punctual is very important for online meetings. This will ensure that everyone
can be gathered to start classes on time and utilize limited time wisely. While this set up
is conducted at the comfort of your own home, this is nonetheless similar to a lesson
conducted inside the classroom. Be sure to look presentable and make sure that all the
materials needed for your class are already prepared near you.
8. Be attentive and Participative

Giving your focused attention is one of the best things you can do to learn efficiently
whether learning online or inside the classroom. Stay focus and be attentive always. Be
participative when your teacher is leading the class in a discussion or dialogue where you
should speak up and share your thoughts.
9. RESPECT
You should always give respect to others especially during virtual meetings. If
someone is talking or discussing, listen and do not do anything that could distract the
speaker. Always remember that do unto others what you want others do unto you. So if
you want respect, respect others too.
RELATED LEARNING EXPERIENCE

Bachelor of Science in Nursing- Third Year
SECOND SEMESTER
Clinical • NUPC117 – 153 hours

• NUPC 118 – 153 hours
Skills Laboratory • NUPC117 – 51 hours
• NUPC 118 – 51 hours
Dress Code
During VIRTUAL RLE meetings, consultation and return demonstrations, you are expected to
wear the prescribed related learning experience. Failure to wear the prescribed uniform shall be
considered as unexcused absence from duty. In case that you left your uniform in your respective
boarding house last semester, you are required to wear white polo/ collared shirt. The following are
the description of your prescribed uniform during RLE and CP:
In the clinical setting

• For Females: White dress that is knee level or one inch below the knee.
• For Males: White pants and white polo shirt with plain white undershirt with pin on left
collar
In the community setting (for both men and women)

• Type A (RHU Uniform): White blouse and polo shirt with RHU (dark blue) pants
• Type B: Dark maong pants with CCHAMS T-shirt
• Type C: Any attire appropriate with the activity as prescribed by your Clinical Instructor
Grooming Standard
• For female students who will attend the VIRTUAL RLE meetings, consultation and return
demonstrations, you are required to observe the following:
Hair should not touch the collar. Bangs should not extend below the eyebrow.
Long hair should be braided or secured neatly into a bun.
Black or dark brown hair clips may be used but no fancy clips, ribbons, and
headbands shall be allowed
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Headbands should be flat and black with no more than 1 inch width
Only light make-up is allowed
No colored contact lens is allowed
No polished or colored fingernails is allowed
Hair color should be dark brown and black ONLY.
• For male students who will attend the VIRTUAL RLE meetings, consultation and return
demonstrations, you are required to observe the following:
Haircut should either be high cut, semi-high cut, flat top, crew cut, or semi low
cut. Hair at the back should be barber’s cut.
No spikes, fancy or other very fashionable hairstyle. No dyeing of hair is allowed.
No moustache, beard or sideburns is allowed
No make up
No colored contact lens is allowed
Hair color should be dark brown and black ONLY.
• Accessories
Only the prescribed watch shall be allowed. No accessories or jewelry shall be
worn during VIRTUAL RLE meetings, consultation and return demonstrations.
Married individuals are allowed to wear their wedding rings
Requirements/ Evaluation
At the end of every clinical module, you are being evaluated by your clinical instructor
assigned to you which will be submitted to your respective clinical level coordinator. Requirements
are assigned in each module and deadline of submission is 1 week after the end of each module.
Format and templates for Requirements are still the same. Rubrics will be attached in each module.
Late submission of requirements will be entertained depending on the reason behind it. You are
required to submit a letter of explanation to your clinical instructor assigned to you and he/she will
classify it if excused or unexcused. The equivalent grade of requirements that are submitted late
will be 75%. Meanwhile, those who will not pass their requirements will automatically have a grade
of ZERO. You are still required to have your clinical duty in the area but in case that the current
situation will still the same, your final grade will be marked as IN PROGRESS. Catch up plan will be
created to meet your clinical duty needs.
DIRECTION
DIRECTIONSA
There are five lessons in this module. Read each lesson carefully. After reading
each lesson, you are required to answer the exercises/activities to find out how much you have
benefited from it. Templates are provided and seen at the appendices. Work on these exercises
carefully because they are graded and submit your output to your assigned clinical instructor’s email
given to you. Rubrics will be used to evaluate your outputs that are seen in the appendices section
of this module.
Good luck and happy reading!!!

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Lesson 1
ABDOMINAL ASSESSMENT
When conducting a focused gastrointestinal assessment on your patient, both subjective and
objective data are needed.
Components may include:
• Chief complaint
• Present health status
• Past health history
• Current lifestyle
• Psychosocial status
• Family history
• Physical assessment
* Communication during the history and physical must be respectful and performed in a
culturally-sensitive manner. Privacy is vital, and the nurses need to be aware of posture,
body language, and tone of voice while interviewing the patient. Take into consideration
that a patient’s ethnicity and culture may affect the history that the patient provides
Chief Complaint
It is important to begin by obtaining a thorough history of abdominal or gastrointestinal

complaints. You will need to elicit information about any complaints of gastrointestinal
disease or disorders. Gastrointestinal disease usually manifests as the presence of one or
more of the following:
• Change in appetite
• Weight gain or loss
• Dysphagia
• Intolerance to certain foods
• Nausea and vomiting
• Change in bowel habits
• Abdominal pain
Appetite
Ask your patients if they have had any changes in appetite or food intake. If they have, ask
for more information about the change. Appetite and eating can be influenced by many
factors that may indicate gastrointestinal disease or that can be attributed to
socioeconomic considerations such as food availability, family norms, peers, and cultural
practices. A loss of taste sensation can contribute to loss of appetite and potentially result
in poor nutrition, especially in older individuals. Attempts at voluntary control can be a
factor, such as dieting or eating disorders.
Weight Loss or Gain

Document any change in weight. If weight loss or gain is substantial or has happened
rapidly, investigate further. Dieting to a body weight leaner than recommended health
standards tends to be highly promoted by current fashion trends, sales campaigns for special
foods, and is encouraged in some activities and professions. Young women are especially at
risk for diet related alterations in normal gastrointestinal functions. Weight loss may also be

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associated with illness, while weight gain may be attributed to fluid retention or a mass.
Dysphagia
People with dysphagia have difficulty swallowing and may also experience pain while
swallowing. Some people may be completely unable to swallow or may have trouble
swallowing liquids, foods, or saliva. Eating becomes a challenge, making it difficult to take
in enough calories and fluids to nourish the body. Ask your patient if they have any difficulty
swallowing and when the difficulty first occurred. An infection or irritation can cause
narrowing of the esophagus. People born with abnormalities of the swallowing mechanism
may not be able to swallow normally. In addition, cancer of the head, neck, or esophagus
may cause swallowing problems.
Intolerance to Food
Ask your patient if they have any intolerance to certain foods. If so, ask which foods and the
type of reaction to the food. Food intolerance should not be confused with food allergies.
An intolerance to certain foods is generally based on the presence of a gastrointestinal
imbalance such as having too little of a particular enzyme that can hinder proper breakdown
and use of the food by the body. Food intolerance may be related to disorders such as celiac
disease, insulin-dependent diabetes, and inflammatory bowel disease. Symptoms of
intolerance to a particular food might include stomach discomfort, gas, bloating, burping,
flatulence, abdominal pain, and diarrhea
Nausea and Vomiting

Nausea and vomiting can be side effects of medications, a manifestation of many diseases,
and can occur frequently in early pregnancy. Ask your patients about the frequency of these
symptoms. Nausea and vomiting may also indicate food poisoning. Questions about types of
food eaten in the past 24 hours should be asked to rule out potential poisoning. If vomiting
is present, you will want to ask about the amount, frequency, color, and odor of the
vomitus. Ask if there is any blood in the vomit or if the vomit appears to be like coffee
grounds. Hematemesis, or blood in the vomitus, is a common symptom of gastric or
duodenal ulcers and may also indicate esophageal varices. Coffee ground emesis indicates
an “old” gastrointestinal bleed. The old, partially digested blood appears to look like coffee
grounds
Changes in Bowel Habits

Particular emphasis should be placed on changes in bowel habits, as it is a common
manifestation of gastrointestinal disease. The frequency, color, and consistency of bowel
movements should be assessed. Assess the use of laxatives at this time. Black, tarry stools
may indicate an upper gastrointestinal bleed or may simply be from the ingestion of iron
supplements or over the counter medications for gastrointestinal upset. Bright red blood in
the stools may indicate hemorrhoids or localized lower gastrointestinal bleeding. Currant
jelly stools are usually foul smelling and resemble maroon or purple colored jelly. The
presence of currant jelly stools often indicates a massive bleeding episode and the patient’s
hemodynamic status must be assessed quickly.
History Taking
1. Past Gastrointestinal Disease

Ask about any past history of gastrointestinal disorders such as ulcers, gall bladder
disease, hepatitis, appendicitis, hernias. Ask the patient if they received treatment and if
the treatment was successful. History should also include past abdominal surgeries, any
abdominal problems after the surgery, and abdominal x-rays or tests (including colonoscopy)
and their results.

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2. Medication History
Many medications can produce gastrointestinal symptoms. Almost every class of drugs
has the potential for gastrointestinal side effects. Most of the side effects include nausea,
vomiting, diarrhea, and/or constipation. Aspirin and non-steroidal anti-inflammatory drugs
(NSAIDs) may cause abdominal pain and may increase the likelihood of gastrointestinal
bleeding. Dietary supplements and the use of over the counter medications should also be
included.
3. Social History and Lifestyle Risk Factors

In taking a complete history, it is important to address lifestyle risk factors and social
behaviors that may contribute to unhealthy lifestyles and increase the risk of
gastrointestinal disorders. Ask your patients about the frequency and duration of alcohol
consumption, caffeine intake, and cigarette smoking at this time. Alcohol can cause liver
cirrhosis and esophageal varices. Cigarette smoking and regular ingestion of caffeine can
lead to gastric reflux and gastric ulcers. Also ask about recreational drug use such as
marijuana, opiates, or amphetamines. The use of illicit drugs can increase or suppress
appetite and affect GI function.
Assessing nutritional status of your patients is important for several reasons. A thorough
nutritional assessment will identify individuals at risk for malnutrition and provide baseline
information for nutritional assessments in the future.
Some of your patients that will require a thorough nutritional assessment include those
patients with:
o Recent unintentional weight loss
o Chemotherapy or radiation
o Recent weight gain
o Food allergies or intolerance
o Decreased appetite
o Multiple medications
o Alterations in sense of taste
o Dieting history
o Difficulty chewing or swallowing
o Vomiting
o Mobility problems
o Diarrhea
o Inability to feed self
o Recent surgery or major illness or injury
o Substance abuse
o Chronic conditions
o Potential for social isolation
o Low income

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Physical Assessment
Anatomy of Gastro-intestinal Tract
Systematic Approach

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1. Patient Position
2. General Appearance
3. Vital Signs-Temp, HR, RR and BP
Patients Position
• Lie flat
• One pillow under head
• Arms alongside the body
• Abdomen exposed-above xiphoid process to symphysis pubis
• Can expose the area in stages to preserve patient’s dignity
General Appearance
• Distressed
• Unwell
• Diaphoretic
• Restless or wants to stay still
• Confused
• Jaundice
• Cyanosis
* When documenting, use these to describe the patient’s general appearance. Patients that
lie very still with shallow breathing should be assessed for an acute abdomen.
Pain
Mnemonic for Pain Assessment
In general, the mnemonic, PQRST, is very useful in assessing abdominal pain and
other gastrointestinal symptoms, such as distention, nausea, and vomiting. It provides a
methodology in which communication to other healthcare providers will be efficient and
informative.
After eliciting information about any experienced signs or symptoms of
gastrointestinal disease, ask about your patients past abdominal or gastrointestinal history,
medications, and nutritional status.
P-- Provocative or Palliative: What makes the pain or symptom(s) better or worse?
Q-- Quality: Describe the pain or symptom(s) (burning, dull, sharp)
R-- Region or Radiation: Where in the body does the pain or symptom(s) occur? Is there
radiation or extension or the pain or symptom(s) to another area of the abdomen?

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S-- Severity: On a scale of 1-10, (10 being the worst) how bad is the pain or symptom(s)?
Another visual pain scale may be appropriate for patients that are unable to identify with
this scale.
T-- Timing: Does it occur in association with something else? (e.g. eating, exertion,
movement)
Abdominal Pain Positions

a. Parietal Pain-peritoneal irritation-fetal position
b. Visceral pain-lie supine with legs outstretched-dull, deep, aching
Vital Signs
Assessment of vital signs is important during abdominal assessment. General
examination focuses on vital signs and other indicators of shock or hypovolemia (eg,
tachycardia, tachypnea, pallor, diaphoresis, oliguria, confusion) and anemia (eg, pallor,
diaphoresis). Patients with lesser degrees of bleeding may simply have mild tachycardia
(heart rate > 100).
Orthostatic changes in pulse (a change of > 10 beats/minute) or blood pressure (a
drop of ≥ 10 mm Hg) often develop after acute loss of ≥ 2 units of blood. However,
orthostatic measurements are unwise in patients with severe bleeding (possibly causing
syncope) and generally lack sensitivity and specificity as a measure of intravascular
volume, especially in elderly patients.
External stigmata of bleeding disorders (eg, petechiae, ecchymoses) are sought, as
are signs of chronic liver disease (eg, spider angiomas, ascites, palmar erythema) and
portal hypertension (eg, splenomegaly, dilated abdominal wall veins). Elevated
temperature indicates infection in the gut. It is an important indicator of infectious
process in patients suffering from inflammatory disease and septic shock.
Four Basic Techniques
• Physical examination of the abdomen

involves visual inspection,
auscultation, percussion and
palpation.
It is best to perform this examination while

the patient is resting in a supine position,
knees slightly flexed to relax the abdominal
muscles.
To facilitate the referencing of location, the

abdomen is viewed as four quadrants.
The quadrant division is the most commonly used by nursing personnel, the abdomen is
divided by a vertical midline and a horizontal line through the navel.
• Ask patient about their last about bowel movement and if they have any problems with
urination.

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• If a female patient, ask when their last menstrual period was.

• If an ostomy is present note the type of ostomy,
stoma color (should be pink and shiny),
consistency and color of stool?
Position
Inspection
What to look for?
• Stomach Contour - Scaphoid, Flat, Rounded, Protuberant, symmetrical?

• Noted Movement – Peristaltic, respirations and pulsations at the aorta (noted in thin
patients): The aortic pulsation can be noted above the umbilicus.
• Characteristics of the Skin-scars, striae, discoloration, venous patterns, edema, navel
(invert or everted).
• Masses (check for hernia after auscultation), PEG tube?

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Usual Abnormal Abdominal Findings during Inspection

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Auscultation
• Start in the RIGHT LOWER
QUADRANT and go
clockwise in all the 4
quadrants
o should hear 5 to 30
sounds per minute…if
no, bowel sounds are
noted listen for 5 full
minutes
o Documents as:
normal, hyperactive,
or hypoactive
Auscultate for bruits (vascular sounds) at the following locations using the BELL of the
stethoscope:
• Aorta: slightly below the xiphoid process midline with the umbilicus
• Renal Arteries: go slightly down to the right and left at the aortic site
• Iliac arteries: go few a inches down from the belly button at the right and left sides to
listen
• Femoral arteries: found in the right and left groin.
Check for hernia: have patient raise up a bit and
look for hernia (at stomach area or navel area)
Use the diaphragm of your stethoscope to listen

for these sounds.
• Borborygmi (BOR-boh-RIG-mee) are normal,

loud, and easily audible sounds.
• High-pitched, tinkling sounds are a sign of
early intestinal obstruction.
• A friction rub is a high-pitched sound heard
in association with respiration. Although
friction rubs in the abdomen are rare, they indicate inflammation of the peritoneal
surface of the organ from tumor, infection, or infarct. Listen for them over the liver
and spleen.
Use the bell of your stethoscope to listen for these sounds.
• Aortic bruits are heard in the epigastrium. They may be a sign of abdominal aortic
aneurysm.
• Renal artery bruits are heard in each upper quadrant. They may be a sign of renal
artery stenosis, which is a potentially treatable cause of hypertension.
• Iliac/femoral bruits are in the lower quadrants. They may be a sign of peripheral
atherosclerosis.
• A venous hum is a soft, low-pitched, continuous sound heard in the epigastric region
and around the umbilicus. It occurs with increased collateral circulation between the
portal and systemic venous systems.
Percussion

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Percussion can precede or be interspersed with palpation of each quadrant. It is a useful

technique for:
• Evaluating the size of the liver and
sometimes the spleen.
• Evaluating gas in the abdomen versus solid or
fluid-filled structures.
• Evaluating for focal areas of tenderness and
peritoneal irritation.
• Evaluating for the presence of ascites.
The anterior gas-filled abdomen normally has
a tympanitic sound to percussion, which is replaced
by dullness where solid viscera, fluid, or stool
predominate. The flanks are duller as posterior solid
structures predominate, and the right upper
quadrant is somewhat duller over the liver. In
contrast, the left upper quadrant may be tympanitic
if there is an underlying gastric air bubble or splenic flexure of the colon filled with gas.
There is good inter-rater reliability between clinicians in what represents a tympanitic note
versus dull.
Percussion of the liver/spleen:

Percussion can be used to estimate the vertical span of the liver. In the midclavicular
line, the liver span is generally between six and twelve centimeters. A liver span greater
than 12 cms is generally considered abnormal and consistent with hepatomegaly.
The spleen is a small, generally posterior structure, found just under the diaphragm and is
often difficult to characterize with percussion. Percussion may be helpful
when splenomegaly is suspected although palpation may provide more useful information.
Assessment of abdominal tenderness via percussion:

Percussion is a useful tool for evaluating abdominal tenderness. Lightly percuss the
abdomen to determine the location of the pain. Localized pain is suggestive of peritoneal or
intrabdominal inflammation, and is further discussed in the "Advanced Techniques" section.
Assessment of ascites via percussion:

One technique for evaluating ascites is assessment of shifting dullness. In the ascitic
abdomen, gas-filled bowel loops float to the top while the ascitic fluid falls to the
dependent portion of the abdomen. As a result, percussion notes are tympanitic over the
bowel loops and dull over the surrounding fluid. With the patient lying on his back, map out
these areas of dullness and tympany. Then, ask the patient to roll on his side and re-
percuss. The ascites and thus dullness shift to the side the patient is lying on, while the
tympanitic area shifts to the top.
Palpation
• Warm hands
• Assess painful area last
• Light palpation (2 cm):
should feel soft with no
pain or rigidity
• Deep palpation (4-5 cm):
feel for any masses, lumps,
tenderness

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You can watch on how to do abdominal assessment:
https://www.youtubetrimmer.com/view/?v=1Xc7RYkzCE&start=17&end=378

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Lesson 2
NASOGASTRIC TUBE
What is Nasogastric Tube?
NG Tubes are inserted through the nares to pass through the posterior
oropharynx, down the esophagus, and into the stomach.
Indications for NG tube

1. Feeding purposes – NG tubes should only be used in people who are malnourished or at
risk of malnutrition and have:
o Inadequate or unsafe oral intake, and
o A functional, accessible gastrointestinal
tract.
o Examples where both stipulations are met
include:
▪ Neurological conditions causing
dysphagia/unsafe swallow such as
stroke.
▪ Lowered consciousness level such as
coma or PVS
▪ Following upper gastrointestinal
surgery where a high anastomosis
must be protected in the initial post-operative period
o Occasionally, NG feeding is used to prepare malnourished patients for major
abdominal surgery in the pre-operative period
o In all cases where enteral tube feeding is considered, specialist assessment by
Speech and Language therapists and dieticians is required in order to ascertain
that tube feeding is necessary and safe, as well as to monitor the patient’s
progress once started on enteral feeding in order to determine if and when it
can be stopped and how to proceed.
o In general, enteral tube feeding is only advised for up to 4 weeks. After this
time, the aim would be for the patient to begin feeding orally, or to change to
more long-term measures such as percutaneous endoscopic gastrostomy (PEG).
▪ If the patient’s nutritional needs are not being met or it transpires that
the gastrointestinal tract is not functioning normally, Total Parenteral
Nutrition (TPN) is considered.
2. Medication delivery
* NG tubes can also be used to deliver certain medications directly into the stomach of
patients with the same stipulations as feeding.
3. Removal of Gastric Contents
o NG tubes may also be used for removal of gastric contents. Examples would
include:
o Initial and continued gastric decompression in the endotracheal intubated
patients
o Symptom relief and bowel rest in bowel obstruction (the “drip and suck”
conservative management – aspiration of stomach contents in conjunction with
intravenous fluid administration)
o Aspirating ingested toxic material
4. Diagnostic Uses
➢ Assessment of the presence or volume of upper gastrointestinal bleeding

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➢ Administration of radiographic contrast
Contraindications of NGT Insertion

Absolute contraindications:
➢ Mid face trauma
➢ Recent nasal surgery
Relative contraindications:
➢ Coagulation abnormalities
➢ Recent alkaline ingestion (due to risk of oesophageal rupture)
➢ Esophageal varices (untreated or recently banded/cauterised)
➢ Esophageal strictures
*In the presence of relative contraindications, the advantages and disadvantages of NG
placement will have to be judged against the reason for tubing and the patient’s condition.
Complications of NG placement:
Placement may cause:
1. Gagging or vomiting
2. Tissue trauma along the nasal, oropharyngeal or upper gastrointestinal tract
3. Esophageal perforation (rare)
Incorrect placement leading to respiratory tree intubation may cause aspiration
NGT Tube Insertion

Equipment needed for placement of NG tubes:
1. Nasogastric tube: 16-18 French
2. Cup of water with straw
3. Tape
4. pH indicator
5. Gloves
6. Emesis basin
7. Benzocaine spray (optional)
8. Water-based lubricant (optional)
9. Suction (have on hand in case of vomiting, particularly in patient with reduced
consciousness level)
Positioning for placement of an NG tube:
➢ The patient should be sat upright with the neck slightly flexed (bringing the nasal
canals horizontal) and head supported. For head support, pillows for comfort are
adequate in the conscious patient; an assistant may be needed for the unconscious
patient.
Correct placement of NG tube
Technique for Placement of an NG tube

1. Check physician’s order for insertion of NGT.
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2. Explain procedure to the patient.

3. Gather equipment.
4. If nasogastric tube is rubber, place it in a basin with ice 5 to 10 minutes or place a plastic
tube in a basin of warm water if needed.
5. Assess the patient’s abdomen.
6. Perform hand hygiene. Don disposable gloves.
7. Assist patient to high Fowler’s position or to 45 degrees if unable to maintain upright
position and drape his or her chest with bath towel or disposable pad. Have emesis basin
and tissues handy.
8. Check nares for patency by asking patient to occlude one nostril and breathe normally
through the other. Select the nostril which air passes normally.
9. Measure distance to insert the tube by placing tip of tube at patient’s nostril and
extending to the tip of the earlobe and then tip of the xiphoid process. Mark the tube with
a piece of tape.
10. Lubricate tip of tube (at least 1-2 inches) with water soluble lubricant. Apply topical
analgesic to nostril and oropharynx or ask patient to hold ice chips in his or her mouth for
several minutes (according to physician’s reference)
11. After having the patient lift his or her head, insert tube into nostril while directing tube
downward and backward. Patient may gag when tube reaches the pharynx.
12. Instruct patient to touch his or her chin to chest. Encourage him or her to swallow even
if no fluids are permitted. Advance the tube in a downward-backward direction when the
patient swallows. Stop when the patient breathes. Provide tissues for tearing or watering
of eyes. If gagging persists, check placement of tube with a tongue blade and flashlight.
Keep advancing the tube until tape marking is reached. Do not use force. Rotate tube if it
meets resistance.
13. Discontinue procedure and remove tube if there are signs of distress, such as gasping,
coughing, cyanosis and inability to speak or hum.
14. Determine that tube is in patient’s stomach. Hold tube in place to keep it from
withdrawing while placement is checked.
a. Attach syringe to end of tube and aspirate a small amount of stomach contents.
b. Measure pH of paper or a meter.
c. Visualize aspirated contents, checking for color and consistency.
d. Obtain radiograph of placement of tube (as ordered by physician)
15. Apply tincture of benzoin to tip of nose and allow to dry. Secure tube with tape to
patient’s nose. Be careful not to pull it tightly against the nose.
a. Cut a 4-inch piece of tape and split bottom 2 inches or use packaged nose tape for
NGTs.
b. Place unsplit end over bridge of patient’s nose.
c. Wrap split ends under tubing and up and over onto nose.
16. Attach tube to suction or clamp tube and cap it according to physician’s order.
17. Secure tube to pt’s gown by using a rubber band or tape and a safety pin. If double-
lumen tube is used, secure vent above stomach level. Attach at shoulder level.
18. Assist or provide with oral hygiene at regular intervals.
19. Perform hand hygiene. Remove all equipment and make patient comfortable.
20. Record the insertion skill, type, size of tube and measure tube from tip of nose to end of
tube. Also, document description of gastric contents, which, which naris is used and
patient’s response.

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How to check an NG tube position on X-Ray:
Abnormal X-ray of NG tube Insertion

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Management of an NG tube after Insertion:

1. In the case of NG placement for drainage of stomach contents, the volume and
character of the contents should be monitored regularly and documented.

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a. A standard management protocol is free drainage into bile bag with 4 hourly
aspirations.
2. In the case of NG placement for feeding, the patient’s nutritional and hydration
status should be monitored daily, with particular care to monitor electrolytes
including potassium, calcium and usually magnesium as well as albumin. This is to aid
the dietician in assessing the ongoing needs of the patient and the success or failure
of this feeding modality.
3. The need for the NG tube should be reassessed regularly and it should be removed as
soon as possible, either when symptoms resolve, when clinical decisions render it
defunct (for example the decision for operative intervention for bowel obstruction
instead of “drip and suck”) or after 4 weeks, as per NICE guidelines.
Removing a Nasogastric Tube
Objectives
• To check if the patient can tolerate oral feeding.
Contraindications
• Continuing need for feeding/suction.
Nursing Alert: Removal is easier with the patient in semi-Fowler’s position.
Supplies and Equipment

• Tissues
• Plastic disposable bag
• Bath towel or disposable pad
• Clean disposable glove
Steps in Removing Nasogastric Tube
The following is the step-by-step procedure in removing nasogastric tubes:
1. Check physician’s order for removal of NGT.

2. Explain procedure to patient and assist to semi-Fowler’s position.
4. Perform hand hygiene. Don clean disposable gloves.
5. Place towel or disposable pad across patient’s chest. Give tissues to the patient.
6. Discontinue suction and separate tube from suction. Unpin tube from patient’s gown and
carefully remove adhesive tape from patient’s nose.
7. Attach syringe and flush with 10 ml NSS or clear with 30-50 cc of air (optional)
8. Instruct patient the patient to take a deep breath and hold it.
9. Clamp tube with fingers by doubling tube on itself. Quickly and carefully remove tube
while patient holds breath.
10. Place tube in disposable plastic bag. Remove gloves and place in bag.
11. Offer mouth care to patient and facial tissues to blow nose.
12. Measure nasogastric drainage. Remove all equipment and dispose according to agency
policy. Perform hand hygiene.
13. Record removal of tube, Patient’s response, and measure of drainage. Continue to
monitor patient for 2-4 hours after tube removal for gastric distention, nausea or
vomiting.
Additional Information to add:

• Record date of removal of nasogastric tube.
• Record client’s response.
• Record measurement of drainage.

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After Care
• Discard the disposable equipment used.
• Wash your hands.
• Position the patient in a comfortable or in his desired position.
Refer to this Video: https://www.youtube.com/watch?v=1OakmxZDa5c
Gastric Suction
➢ Also known as gastric lavage, stomach pumping; nasogastric tube suction; bowel
obstruction suction
➢ It is a procedure to empty the contents of your stomach.
Indications
1. Remove poisons, harmful materials, or excess medicines from the stomach
2. Clean the stomach before an upper endoscopy (EGD) if you have been vomiting blood
3. Collect stomach acid
4. Relieve pressure if you have a blockage in the intestines
Risks
1. Breathing in contents from the stomach (this is called aspiration)
2. Hole (perforation) in the esophagus
3. Placing the tube into the airway (windpipe) instead of the esophagus
4. Minor bleeding
Contraindications
Gastric lavage should not be used with toxicants such as the following:
1. Petroleum distillates (e.g., gasoline, furniture polish)
2. Corrosives (strong acids, strong bases) (e.g., drain cleaner)
3. CNS stimulants, because the act of vomiting may trigger convulsions
*Unless a secure (intubated) airway has been established, gastric lavage should not be used
in the following patients:
1. Those who are unconscious
2. Those with impaired airway reflexes
*Although in theory gastric lavage would seem to be the most direct way of removing a
toxicant, the available evidence does not support the routine use of gastric lavage. Gastric
lavage may be useful in cases in which there has been very recent ingestion (30 minutes to
1 hour) of a life-threatening toxicant.
Technique
Assess:
✓ Presence of abdominal distention on palpation
✓ Bowel sounds
✓ Abdominal discomfort
✓ Vital signs for baseline data
✓ Amount and characteristics of drainage
Determine:
1. Whether the suction is continuous or intermittent
2. The ordered suction pressure (a low suction pressure is between 80 and 100 mmHg,
and a high pressure is between 100 and 120 mmHg)

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3. Whether there is an order to irrigate the gastrointestinal tube and, if so, the type of
solution to use.
Assemble Equipment:
Initiating Suction
➢ Gastrointestinal tube in place in the client
➢ Basin
➢ 50-mL syringe with an adapter
➢ Stethoscope
➢ Suction device for either continuous or intermittent suction
➢ Connector and connecting tubing
➢ Clean gloves
Maintaining Suction
➢ Graduated container as required to measure gastric drainage
➢ Basin of water
➢ Cotton-tipped applicators
➢ Ointment or lubricant
➢ Clean gloves
Irrigation
➢ Clean gloves
➢ Stethoscope
➢ Disposable irrigating set containing a sterile 50-mL syringe, moisture-resistant pad,
basin, and graduated container
➢ Sterile normal saline (500 mL) or the ordered solution
PROCEDURE
1. Introduce self and verify the client’s identity using agency protocol. Explain to the
client what you are going to do, why it is necessary, and how he or she can
participate. Discuss the purpose(s) of the gastrointestinal suction.
2. Perform hand hygiene and observe other appropriate infection prevention

procedures.
3. Provide for client privacy.
Initiating Suction
4. Position the client appropriately. Assist the client to a semi-Fowler’s position if it is
not contraindicated.
5. Confirm that the tube is in the stomach.

a. Apply clean gloves.
b. Check agency protocol for preferred methods to verify placement because
clinical practice varies across health regions:
i. The method of inserting air into the tube with the syringe and listening
with a stethoscope over the stomach (just below the xiphoid process)
for a swish of air is often used at the bedside.
ii. Aspirate to obtain stomach contents and check the acidity of gastric
aspirate using a pH test strip.
iii. X-ray examination is considered the gold standard for determining
placement, especially for high-risk clients (e.g., critically ill, dysphagic,
or unconscious).
c. Remove and discard gloves.
d. Perform hand hygiene.

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6. Set and check the suction

✓ Connect the appropriate suction regulator to the wall suction outlet and
the collection device to the regulator. Check the suction level by
occluding the drainage tube and observing the regulator dial during a
suction cycle.
✓ Set continuous suction as ordered by the primary care provider, or at 60
to 120 mmHg.
✓ If using a portable suction machine, turn on the machine and regulate
the suction as above.
✓ Test for proper suctioning by holding the open end of the suction tube
to the ear and listening for a sucking noise or by occluding the end of
the tube with a thumb.
7. Establish gastric suction

a. Connect the gastrointestinal tube to the tubing from the suction by using the
connector.
b. If a Salem sump tube is in place, connect the larger lumen to the suction
equipment. This double-lumen tube has a smaller tube running inside the
primary suction tube.
c. Always keep the air vent tube of a Salem sump tube open and above the level
of the stomach when suction is applied.
d. After suction is applied, watch the tubing for a few minutes until the gastric
contents appear to be running through the tubing into the receptacle.
e. If the suction is not working properly, check that all connections are tight and
that the tubing is not kinked.
f. Coil and pin the tubing to the client’s gown so that it does not loop below the
suction bottle.
8. Assess the drainage

✓ Observe the amount, color, odor, and consistency of the drainage.
✓ Test the gastric drainage for pH and blood when indicated.
Maintaining Suction
9. Assess the client and the suction system regularly

a. Assess the client every 30 minutes until the system is running effectively and
then every 2 hours, or as the client’s health indicates, to ensure that the
suction is functioning properly.
b. Inspect the suction system for patency of the system (e.g., kinks or blockages
in the tubing) and tightness of the connections.
10. Relieve blockages if present

✓ Perform hand hygiene.
✓ Apply clean gloves.
✓ Check the suction equipment. To do this, disconnect the nasogastric tube from
the suction over a collecting basin (to collect gastric drainage), and then, with
the suction on, place the end of the suction tubing in a basin of water. If water
is drawn into the drainage bottle, the suction equipment is functioning
properly, but the nasogastric tube is either blocked or positioned incorrectly.
✓ Reposition the client if permitted.
✓ Rotate the nasogastric tube and reposition it. This step is contraindicated for
clients with gastric surgery.
✓ Irrigate the nasogastric tube as agency protocol states or on the order of the
primary care provider.
✓ Remove and discard gloves.
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11. Prevent reflux into the vent lumen of a Salem sump tube. To prevent reflux:
✓ Place the vent tubing higher than the client’s stomach to prevent gastric fluid
backup into the blue lumen air vent.
✓ Keep the drainage lumen free of particulate matter that may obstruct the
lumen.
12. Ensure client comfort

✓ Clean the client’s nostrils as needed, using the cotton-tipped applicators and
water. Apply a water-soluble lubricant or ointment.
✓ Provide mouth care every 2 to 4 hours and as needed. Some postoperative
clients are permitted to suck ice chips or a moist cloth to maintain the
moisture of the oral mucous membranes.
13. Change the drainage receptacle according to agency policy

✓ Clamp the nasogastric tube and turn off the suction.
✓ If the receptacle is graduated, determine the amount of drainage.
✓ Disconnect the receptacle.
✓ Inspect the drainage carefully for color, consistency, and presence of
substances (e.g., blood clots).
✓ Replace a full receptacle and attach it to the suction. Check agency policy.
✓ Turn on the suction and unclamp the nasogastric tube.
✓ Observe the system for several minutes to make sure
✓ Function is reestablished.
✓ Go to step 17.
Irrigating a Gastrointestinal Tube

14. Prepare the client and the equipment.
✓ Place the moisture-resistant pad under the end of the gastrointestinal tube.
✓ Turn off the suction
✓ Disconnect the gastrointestinal tube from the connector.
✓ Determine that the tube is in the stomach. See step 5.
15. Irrigate the tube.

✓ Draw up the ordered volume of irrigating solution in the syringe; 30 mL of
solution per instillation is usual, but up to 60 mL may be given per instillation
if ordered.
✓ Attach the syringe to the nasogastric tube and slowly inject the solution.
✓ Gently aspirate the solution.
✓ If you encounter difficulty in withdrawing the solution, inject 20 mL of air and
aspirate again, and/or reposition the client or the nasogastric tube.
✓ If aspirating difficulty continues, reattach the tube and set to intermittent low
suction, and notify the nurse in charge or the primary care provider.
✓ Repeat the preceding steps until the ordered amount of solution is used.
✓ Note: A Salem sump tube can also be irrigated through the vent lumen without
interrupting suction. However, only small quantities of irrigant can be injected
via this lumen compared to the drainage lumen.
✓ After irrigating a Salem sump tube, inject 10 to 20 mL of air into the vent
lumen while applying suction to the drainage lumen.
16. Reestablish suction

✓ Reconnect the nasogastric tube to suction.

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✓ If a Salem sump tube is used, inject the air vent lumen with 10 mL of air after
reconnecting the tube to suction.
✓ Observe the system for several minutes to make sure it is functioning.
17. Document all relevant information.

✓ Record the time suction was started. Also record the pressure established, the
color and consistency of the drainage, and nursing assessments.
✓ During maintenance, record assessments, supportive nursing measures, and
data about the suction system.
✓ When irrigating the tube, record verification of tube placement; the time of
the irrigation; the amount and type of irrigating solution used; the amount,
color, and consistency of the returns; the patency of the system following the
irrigation; and nursing assessments.
NG tube Feeding
Supplies and Equipment
1. Gloves Feeding pump (if ordered)
2. Clamp (optional)
3. Feeding solution
4. Large catheter tip syringe (30 mL or larger)
5. Feeding bag with tubing
6. Water
7. Measuring cup
8. Other optional equipment (disposable pad, pH indicator strips, water-soluble
lubricant, paper towels)
Steps in Tube Feeding

1. Explain procedure to the patient. Use stethoscope to assess bowel sounds.
2. Assemble equipment. Check amount, concentration, type, and frequency of tube feeding
on patient’s chart. Check expiration date of formula.
4. Position patient with head of bed elevated at least 30 degrees or as near normal position
for eating as possible.
5. Unpin tube from patient’s gown and check to see that NGT is properly located in the
stomach as explained in the previous checklist.
6. Aspirate all gastric contents with syringe and measure. Return immediately through the
tube, saving small amount to measure gastric ph. Flush tube with 30 ml of sterile water
for irrigation. Proceed with feeding if amount of residual does not exceed policy of
agency or physician’s guideline. Disconnect syringe from tubing.
7. Remove plunger from 30-60 ml syringe.
8. Attach syringe to feeding tube, pour premeasured amount of tube feeding into syringe,
open clamp, and allow feeding to enter tube. Regulate the rate by raising or lowering
height of the syringe. Do not push feeding with syringe plunger.
9. Add 30-60 ml of water for irrigation to syringe when feeding is almost completed and
allow it to run through the tube.
10. When syringe has emptied, hold the syringe high and disconnect from the tube. Clamp
the tube and cover end with a sterile gauze secured with a rubber band or apply a cap.
11. Place the patient on such position for 1-2 hours or when food has been down. Do the
after care. Document the procedure.
Refer to Video:
https://www.sgh.com.sg/patient-care/inpatient-daysurgery/Pages/Nasogastric-Tube-
Feeding.aspx

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Lesson 3
ENEMA ADMINISTRATION
Enema involves inserting fluid into the patient’s rectum to cleanse the lower
intestines and colon to remove accumulated toxins and fecal matter. The entire process
takes 30 minutes to a couple of hours.
Indications of Enema
1. Colon cleansing
2. Constipation treatment
3. Excessive potassium and ammonia removal
4. Medication delivery
5. Alleviate bowel inflammation
6. Bowel preparation for surgery
Types of Enema
1. Cleansing Enema – This type of enema prevents the release of feces while the patient
is in surgery. The process prepares the intestines of the patient for a colonoscopy or
x-ray. This type of enema can be administered as a small volume or large volume
cleansing enema.
2. Carminative Enema – This type of enema releases tension or swelling in the colon and
rectum. When waste builds and sits in the colon, a carminative enema allows the
waste and toxins to leave the body.
3. Retention Enema – This type of enema is used to administer medication and oil into
the patient’s rectum. The types of oil and medications include nutritive, antibiotics,
and anti-helminthic.
4. Return-Flow Enema – This type of enema provides an alternating flow of enema

solutions between 100 and 200 mL into and out of the patient’s colon and rectum to
stimulate peristalsis to propel food along the normal process.
Complications
1. Muscle tone loss
2. Fluid overflow
3. Bowel irritation
4. Internal hemorrhaging caused by an imbalance of electrolyte
Contraindications
1. Rectal bleeding
2. Abdominal pain
3. Prolapsed rectal tissue
4. Myocardial infarction
5. Arrhythmias.
How to Administer Enema

1. Assemble necessary equipment.
2. Warm the solution in amount ordered and checks temperature with bath
thermometer, if available. If tap water is used, adjust temperature as it flows from
the tap.
3. Explain the procedure to the patient and plan where he or she will defecate. Have

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bedpan, commode, or nearby bathroom ready for his or her use.

4. Perform hand hygiene.
5. Add enema solution to container. Release clamp and allow fluid to progress through
tube before re-clamping.
6. Position waterproof pad under patient.
7. Provide privacy. Position and drape patient on the left side (Sim’s position) with anus
exposed or on back, as dictated by patient comfort and condition.
8. Put on disposable gloves.
9. Elevate solution so it is 45 cm (18 inches) above level of patient’s anus. Plan to
administer solution slowly over a period of 5-10 minutes. Container may be hung on IV
pole or held in the nurse’s hands at the proper height.
10. Generously lubricate the last 5-7 cm (2-3 inches) of the rectal tube. A disposable
enema set may have a pre-lubricated rectal tube.
11. Lift buttock to expose anus. Slowly and gently insert rectal tube 7-10 cm (3-4 inches).
Direct it in an angle pointing toward the umbilicus.
12. If the tube meet resistance while inserting it, permit a small amount of solution to
enter, withdraw tube slightly, then continue to insert it. Do not force tube entry. Ask
patient to take several deep breaths.
13. Introduce solution slowly over a period of 5-10 minutes. Hold tubing all the time
solution being instilled.
14. Clamp tubing or lower container if patient has the desire to defecate or cramping
occurs. Patient also may be instructed to take small fast breaths or to pant.
15. After solution has been given, clamp tubing and remove tube. Have paper towel
ready to receive tube as it is withdrawn. Have patient retain solution until the urge
to defecate becomes strong, usually in about 5-15 minutes.
16. Remove disposable gloves from inside out and discard.
17. When patient has a strong urge to defecate, place him or her in sitting position on
bedpan or assist to commode or bathroom.
18. Record character of the stool and patient’s response to the enema, remind patient
not to flush commode before nurse inspects results of enema.
19. Assist patient, if necessary, with cleaning of anal area. Offer washcloth, soap, and
water to wash his or her hands.
20. Leave patient clean and comfortable. Care for equipment properly.

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Lesson 4
BOWEL DIVERSION OSTOMY APPLIANCE
Ostomy is a surgically created opening from the urinary tract or intestines, where effluent
(fecal matter, urine, or mucous) is rerouted to the outside of the body using an artificially
created opening called a stoma.
Stoma typically protrudes above the skin, is pink to red in colour, moist, and round, with no
nerve sensations.
Effluent is the output from the stoma (urine, feces, or mucous) is called
Indications for creation of Ostomy Appliance
1. Inflammatory bowel disease

a. Crohn’s disease
b. Ulcerative colitis
2. Congenital disorders
3. Obstructive disorders
4. Carcinoma of the distal colon, rectum, and occasionally the anus
5. Diverticular disease
6. Infectious enteritis
7. Trauma
8. Pseudomembranous colitis
9. Colonic obstruction
Different Types of Gastrointestinal Ostomies

Colostomy is the surgical operation in which a piece of the colon (large intestine) is
diverted to an artificial opening (called a stoma). A colostomy is created when a portion of
the colon or the rectum is removed and the remaining colon is brought to the abdominal
wall.
Colostomies are either temporary or permanent.
1. A temporary colostomy will allow the lower portion of the colon to rest or heal. It may
have one or two openings (if two, one will discharge only mucus).
2. A permanent colostomy usually involves the loss of part of the colon, most commonly the
rectum. The end of the remaining portion of the colon is brought out to the abdominal wall
to form the stoma.
Types of Colostomies
The name of the type of colostomy is indicative of the location in the colon where the
stoma is formed.
1. Descending Colostomy: The surgical opening created in the descending colon is brought to
the surface of the abdomen. It is usually located on the lower left side of the abdomen.
2. Transverse Colostomy: The surgical opening created in the transverse colon resulting in
one or two openings. It is located in the upper abdomen, middle, or right side.

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3. Ascending Colostomy: A relatively rare opening in the ascending portion of the colon. It is
located on the right side of the abdomen.
4. Cecostomy: The surgical construction of an opening into the cecum. It is performed as a

temporary measure to relieve intestinal obstruction in a patient who cannot tolerate major
surgery.
5. Sigmoidostomy: The most common location of an ostomy is in the sigmoid colon. It is the
surgical construction of an opening into the sigmoid colon, and is commonly referred to as a
sigmoid colostomy.
Location of Colostomies
Ileostomy
Ileostomy diverts the ileum to a stoma. It is a surgically created opening in the small
intestine, usually at the end of the ileum. The intestine is brought through the abdominal
wall to form a stoma. They may involve removal of all or part of the entire colon.
Types of Ileostomies
1. Ileoanal Reservoir (J-Pouch): The colon and most of the rectum are surgically removed
and an internal pouch is formed out of the terminal portion of the ileum. An opening at the
bottom of this pouch is attached to the anus such that the existing anal sphincter muscles
can be used for continence. This procedure should only be performed on patients with
ulcerative colitis or familial polyposis who have not previously lost their anal sphincters. In
addition to the "J" pouch, there are "S" and "W" pouch geometric variants.
2. Continent Ileostomy (Kock Pouch): A reservoir pouch is created inside the abdomen with a
portion of the terminal ileum. A valve is constructed in the pouch and a stoma is brought
through the abdominal wall. A catheter or tube is inserted into the pouch several times a
day to drain feces from the reservoir.

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Care of Stoma
1. Explain the need to change the ostomy appliance.
2. Identify the patient and explain the procedure.
3. Gather materials needed.
4. Perform handwashing and apply clean gloves.
5. Provide the client privacy preferably in the bathroom.
6. Assist the client to a comfortable sitting or standing position.
7. Shave the periostomal skin of well-established ostomies as needed.
8. Remove and Empty the ostomy appliance.
9. Clean and dry the periostomal skin and stoma. Use toilet tissue to remove excess
stool and use warm water, mild soap, and cotton balls or wash towels to clean
the skin of the stoma.
10. Dry the area thoroughly by patting with a towel or cotton balls.
11. Assess the stoma and periostomal skin.
12. Apply paste-type skin barrier if needed.
13. Prepare and apply the skin barrier.
14. Fill in any exposed skin around an irregularly shaped stoma. For the exposed skin,
apply non-alcohol-based products or sprinkle peristomal powder and wipe off
excess and dab the powder with a slightly moist gauze or applicator moistened
with a liquid skin barrier. This creates a barrier seal.
15. Prepare and apply the appliance.
16. Dispose equipment or clean any reusable equipment.
17. Hand wash.
18. Document the procedure and report assessment on the stoma, skin and stool.

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Lesson 5
PARENTERAL NUTRITION
PARENTAL NUTRITION (PN)

➢ is the administration of nutrients directly into the bloodstream.
➢ is used when the GI tract cannot be used for the ingestion, digestion, and absorption
of essential nutrients.
➢ is a relatively safe method of providing complete nutritional support.
COMMON INDICATIONS for PN

• Chronic severe diarrhea and vomiting
• Complicated surgery or trauma
• GI obstruction
• GI tract anomalies and fistulae
• Intractable diarrhea
• Severe anorexia nervosa
• Severe malabsorption
• Short bowel syndrome
COMPOSITION
➢ is reformulated as the patient’s condition changes. This requires you to collaborate
with the interprofessional team in delivering PN to the patient.
a. Calories - mainly come from carbohydrates in the form of dextrose and by fat in the
form of fat emulsion.
b. Protein - is provided at the rate of 1 to 1.5 g/kg/day depending on the patient’s
needs.
c. Electrolytes - The following are ranges for average daily electrolyte requirements for
adult patients without renal or liver impairment: Sodium: 1 to 2 mEq/kg • Potassium:
1 to 2 mEq/kg • Magnesium: 8 to 20 mEq • Calcium: 10 to 15 mEq • Phosphate: 20 to
40 mmol
d. Trace Elements and Vitamins - Zinc, copper, manganese, selenium, and chromium are
added according to the patient’s condition and needs.
TYPES OF ADMINISTRATION
1. PERIPHERAL PARENTERAL NUTRITION
o is given through a peripherally inserted catheter or vascular access device into
a large vein.
o infusion tips reside outside of the superior or inferior vena cava
o is used when:
a. nutritional support is needed for only a short time
b. protein and caloric requirements are not high
c. the risk for a central catheter is too great
d. to supplement inadequate oral intake

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Watch the video using the link below to know more about Peripheral Parenteral Nutrition
with Lipid (Fat) Emulsion.
https://www.youtube.com/watch?v=hXsTTNJM6Dk
2. TOTAL PARENTERAL NUTRITION/ CENTRAL PARENTERAL NUTRITION

o is indicated when long-term support is needed or when the patient has high
protein and caloric requirements
o is given through a central venous catheter or a peripherally inserted central
catheter (PICC) whose tip lies in the superior vena cava
o TPN is usually inserted in the Right internal jugular and left subclavian
veins provide the most direct path to the right atrium and terminate in the
superior vena cava.
o PICC can be inserted into the basilic, cephalic, median cubital or brachial
veins, usually above the antecubital fossa with the tip terminating in the lower
1/3 of the superior vena cava (SVC).
o When the catheter is inserted, it is sutured to the skin and the insertion site is
covered with a sterile dressing. A radiograph is ordered to check placement
before the catheter is used for feedings
COMPLICATION
- Pneumothorax
- air embolism
- a clotted or displaced catheter
- sepsis
- hyperglycemia
- fluid overload

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- rebound hypoglycemia
ENSURING PATIENT SAFETY

• Before starting PN, check label and ingredients in solution to make sure they match
what the HCP ordered.
• A second RN should verify infusion pump settings before beginning PN.
• Trace the administration tubing to the point of origin in the body at the start of the
infusion and at all handoffs.
• Check the solution for leaks, color changes, particulate matter, clarity, and fat
emulsions cracking (separating into layers). If present, promptly return it to the
pharmacy for replacement.
• Discontinue a PN solution and replace it with a new solution if bag is not empty at
the end of 24 hr. At room temperature, the solution (especially when containing fat
emulsion) is a good medium for microorganism growth.
• If fat emulsions are infused separately from the PN solution, the preferred delivery
method is a continuous low volume delivered over 12 hr.
CARE FOR CLIENTS RECEIVING TPN

• Take great care to prevent infection at the insertion site. Always use sterile
technique for site care. The exact procedure should be ordered or written in the
agency’s procedure manual. With each dressing change, inspect the site for the signs
of infection (redness, swelling, foul odor, or purulent drainage. Monitor the patient’s
temperature for elevation.
• Carefully assess the catheter site for signs of inflammation and infection. Phlebitis
can readily occur because of the hypertonic infusion. Catheter-related infection and
septicemia can occur:
- Local manifestations: erythema, tenderness, and exudate at the catheter
insertion site •
- Systemic manifestations: fever, chills, nausea, vomiting, and malaise
* If you suspect an infection during a dressing change, send a culture specimen of the
site and drainage and notify the HCP at once.
• Monitor the flow rate. If the solution is given too rapidly, the patient may have
circulatory overload, changes in blood glucose, or excessive diuresis (urine output). If
the feeding falls behind schedule, do not speed up the rate to catch up.
• Monitor the patient for signs and symptoms of blood glucose changes. The
concentrated glucose solution can raise the blood glucose excessively
(hyperglycemia). Elevated glucose stimulates the pancreas to produce more insulin,
which may then cause a drop in blood glucose (hypoglycemia).
• Label TPN lines and never use the TPN catheter to administer drugs.
• Be sure that all staff who give medications differentiate TPN lines from small-bore
enteral feeding tubes. Patient deaths have occurred because of oral medications
being administered through a TPN line.
NURSING DIAGNOSES
• Imbalanced nutrition: less than body requirements related to inadequate oral intake of
nutrients
• Risk for infection related to contamination of the central catheter site or infusion line
• Risk for imbalanced fluid volume related to altered infusion rate
• Risk for activity intolerance related to restrictions because of the presence of IV access
device

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GOAL
• The major goals for the patient may include optimal level of nutrition, absence of
infection, adequate fluid volume, optimal level of activity (within individual limitations),
knowledge of and skill in self-care, and absence of complications.
Refer to the video on how to safely connect and disconnect TPN.

https://www.youtube.com/watch?v=yxDJLkg9aZk

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MODULE ACTIVITIES: Applying Critical Thinking

There are tasks given to you. You are expected to do these
tasks. Read the situation carefully then answer what is asked.
Write your answer in a separate sheet and send your answer to
your respective Clinical Instructor. Follow the templates provided
and see rubrics located in the appendix on how your activity will
be evaluated. Good luck!
TASK 1
Perform a return DEMO. SELECT ONE ONLY! Send your videos on goggle
classroom
1. NGT insertion
2. Choose on NGT removal/NGT Feeding/NGT suction
3. Enema Administration or Care of Stoma
*You can refer on the Appendix A, B, C, D, and E for the checklist
TASK 2
1. Make at least 3 NCP based on the Case Scenario below. You can refer on the
Appendix F and G for template and rubrics.
Case Scenario
Patient: Mario Dela Fuente
Date of Birth: August 8, 1949
Address: San Antonio, Agoo, La Union
Marital Status: Widowed, Wife died 6 months ago, 5 adult children
Next Keen: Christine-daughter lives in Conscolacion, Agoo, La Union, other children in USA
Social Background: Lives alone in a bungalow house, with small pension from SSS. Claimed
to be a heavy smoker for 10 years but stopped 2 years ago. He drinks often since death of
wife. (C2 Gin or 4x4 gin/Emperador Brandy)
Medication: Amlodipine 5 mg in am, Losartan 50 mg in pm, Atorvastatin 40 mg ODHS
Past Medical History:
August 2019- Regular check-up with GP, Pathology slightly elevated triglycerides but normal
cholesterol level, BP is elevated 150/90 mmHg, Diet and lifestyle modifications advised.
Amlodipine 5mg prescribed.
September 2019- BP is still elevated-150/90mmhg. Losartan added in Meds. Non-compliant

on diet. Pathology Cholesterol and triglycerides-Atorvastatin 40 mg advised.
December 2019- Still non-compliant with diet and lifestyle modifications. GP to continue
medications. Follow-up checkup January. But did not sought consult because of Pandemic.
But continued medications.

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January 28, 2021- Felt pain in joints-took Naproxen as advised by a friend. Afraid to go to
the hospital because maybe considered as Covid patient. Felt sad most of the time because
of quarantine and can’t go back to visit some children in US thus drinking alcohol becomes a
habit. Drinks every day with a bottle of Redhorse.
February 2, 2021- Still taking NAPROXEN. Felt pain in the stomach, self-medication with
Buscopan-still with pain. Continued to drink alcohol even with pain in abdomen. No consult
done.
February 5, 2021- patient defecated watery stool, abdomen feels bloated, and with
vomiting but still afraid to go to the hospital. A friend visited him at home and have drink a
lot because after 10 years they have seen each other. Still with abdominal pain but relieved
with food.
February 6, 2021- with complaint of pain in the abdomen that is not relieved with anything.
Prompt consult to the hospital.
At the Emergency Room:
Chief Complaints
1. Upper abdominal pain X 4 days with score 5/10, upper abdominal quadrant that radiates
to the back.
2. Vomiting X 2 episode (3 days back)
3. Yellowish discoloration of urine and decreased urine output X 2 days
Vitals:
Pulse rate BP RR TPR SpO2
130/90
102/min mmHg 25/min 37.5 95% in RA
General Appearance: agonized, irritable, restless at times
Abdominal Assessment:
• Soft
• No discoloration or protrusion
• Tenderness over epigastrium and right hypochondrium
• Bowel sound present
Chest: Normal chest sounds, bilateral equal air entry, no added sounds
CNS: Grossly Intact

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Laboratory Reports:

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Ultrasound abdomen:

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CT with contrast Abdomen Revealed:
Diagnosis:
Acute Pancreatitis (Alcoholic)
Disposition from ER:

Admitted to Medical ward after under following medications (after consultation from
surgery and nephrology department): Patient is on NPO.
1. Inj. Imipenem 50mg iv stat then 250mg IV every 12 hours

2. Inj. Optineuron 1 ampule to be incorporated in 1-liter PNSS to run in 24 hours
3. Inj. Tramadol 50mg IV every 6 hours RTC or as needed for pain
4. Inj. Plasil 10 mg Iv as needed for vomiting
On your rounds after three days of confinement:
Assessment upon rounds: She is anxious, in pain, looks pale and is clammy to touch.
Patient is alert and orientated.
After two hours, your attention was called by her watcher. Upon assessment,
Patient is alert and can respond to questions, but is in severe pain and is very anxious
• Respiratory rate 28 on air. With accessory muscle use

• Oxygen saturations 92% on air
• With sweating
• Pulse 120 bpm Radial pulse is weak volume, but regular

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• Blood pressure 80/45 mmHg.

• Capillary refill time 2 seconds
• No urine output since midnight.
• Pain score 6 out of 10. Complaining of general pain across her abdomen
• Pupil equal and reacting to light
• Able to move all limbs
• Blood glucose if tested is 5.2 mmols
• With abdominal tenderness.

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MODULE SUMMARY
In this module, you have learned about Care of Clients with Problems in
Gastro-Intestinal and Nutrition. You have learned their meanings and importance. You have
also learned how to assess, plan and implement nursing care to a patient with problems in
Gastro-Intestinal and Nutrition. Always remember to provide safe and quality nursing care to
your patient. Utilize your nursing process in dealing with patient who has problems in
Gastro-Intestinal and Nutrition. Always observe bioethical concepts and principles and
nursing standards to protect and ensure safety not only to your patients but also to yourself.
Practice good and comprehensive documentation. Most importantly, have a good
relationship and rapport between the health care team that caters the needs of your
patient.
To sum it up, this module has five lessons. Lesson 1 discusses how to assess the
abdomen. Lesson 2 deals with the nasogastric tubes. Lesson 3 discusses about enema
administration. Lesson 4 presents bowel diversion ostomy. And lastly, lesson 5 talk about
parenteral nutrition.
Congratulations! You have just studied this Module. You are now ready to evaluate
how much you have benefited from your reading by answering the summative test through
google forms. Good Luck!!!
CONGRATULATIONS!
You are now ready to move on to the next
module! God Bless!

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REFERENCES
Berman, A., Snyder, S., Frandsen, G. (2016). Kozier and Erb’s Fundamentals of Nursing:
Hawks, J.B.N. (2016), Medical-Surgical Nursing: Clinical Management for Positive

Outcomes, 8e (2 Vol Set), Hardcover
Janice L. Hinkle, Kerry H. Cheever (2017), Brunner & Suddarth's Textbook of Medical-
Surgical Nursing
Karch, A. M. RN, MS (2017), Focus on Nursing Pharmacology, 5 th edition, Wolters

Kluwer Health | Lippincott Williams & Wilkins
Harding, M. H., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Lewis's Medical
and Surgical Nursing: Assessment and Management of Clinical Problems. 11th
edition. Missouri: Elsevier.
Medscape. (2020, April 21). Nasogastric Intubation.

https://emedicine.medscape.com/article/80925-overview
NCBI. (2019, December 10). Chapter 93Inspection, Auscultation, Palpation, and Percussion
of the Abdomen. https://www.ncbi.nlm.nih.gov/books/NBK420/

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Appendix A
Inserting a Nasogastric Tube

CHECKLIST
Name:____________________________________Date:_________Section/Group: _______
Legend:
3-Done
2-Done with Supervision
1-Not Done
PROCEDURES 3 2 1
1. Check physician’s order for insertion of NGT.
2. Explain procedure to the patient.
4. If nasogastric tube is rubber, place it in a basin with ice 5to10
minutes or place a plastic tube in a basin of warm water if needed.
5. Assess the patient’s abdomen.
7. Assist patient to high Fowler’s position or to 45 degrees if unable to
maintain upright position and drape his or her chest with bath towel
or disposable pad. Have emesis basin and tissues handy.
8. Check nares for patency by asking patient to occlude one nostril
and breathe normally through the other. Select the nostril which air
passes normally.
9. Measure distance to insert the tube by placing tip of tube at
patient’s nostril and extending to the tip of the earlobe and then tip
of the xiphoid process. Mark the tube with a piece of tape.
10. Lubricate tip of tube (at least 1-2 inches) with water soluble
lubricant. Apply topical analgesic to nostril and oropharynx or ask
patient to hold ice chips in his or her mouth for several minutes
(according to physician’s reference)
11. After having the patient lift his or her head, insert tube into
nostril while directing tube downward and backward. Patient may gag
when tube reaches the pharynx.
12. Instruct patient to touch his or her chin to chest. Encourage him
or her to swallow even if no fluids are permitted. Advance the tube in
a downward-backward direction when the patient swallows. Stop
when the patient breathes. Provide tissues for tearing or watering of
eyes. If gagging persist, check placement of tube with a tongue blade
and flashlight. Keep advancing the tube until tape marking is reached.
Do not use force. Rotate tube if it meets resistance.
13. Discontinue procedure and remove tube if there are signs of
distress, such as gasping, coughing, cyanosis and inability to speak or
hum.
14. Determine that tube is in patient’s stomach. Hold tube in place to
keep it from withdrawing while placement is checked.
a. Attach syringe to end of tube and aspirate a small amount of
stomach contents.
b. Measure pH of paper or a meter.
c. Visualize aspirated contents, checking for color and consistency.
d. Obtain radiograph of placement of tube (as ordered by physician)
15. Apply tincture of benzoin to tip of nose and allow to dry. Secure

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tube with tape to patient’s nose. Be careful not to pull it tightly

against the nose.
a. cut a 4-inch piece of tape and split bottom 2 inches or use
packaged nose tape for NGTs.
b. Place unsplit end over bridge of patient’s nose.
c. Wrap split ends under tubing and up and over onto nose.
16. Attach tube to suction or clamp tube and cap it according to
physician’s order.
17. Secure tube to pt’s gown by using a rubber band or tape and a
safety pin. If double-lumen tube is used, secure vent above stomach
level. Attach at shoulder level.
18. Assist or provide with oral hygiene at regular intervals.
19. Perform hand hygiene. Remove all equipment and make patient
comfortable.
20. Record the insertion skill, type, size of tube and measure tube
from tip of nose to end of tube. Also document description of gastric
contents, which, which naris is used and patient’s response.
For the next items, evaluate the students in general according to the criteria. (5 as
the highest score)
5 4 3 2 1
Mastery
Orderliness
Proper attitude in assessing the client followed.
Ability to answer questions
Proper reporting observed.
Student’s Name and Signature: _____________________________________
Evaluator’s Name and Signature: _____________________________________
Comments:__________________________________________________________________
____________________________________________________________________________
___________________________________________________________________

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Appendix B
Administering a Tube Feeding

CHECKLIST
Name: ____________________________________ Date: _________Section/Group: ______
Legend:
3-Done
1-Not Done
PROCEDURES 3 2 1
1. Explain procedure to the patient. Use stethoscope to assess bowel sounds.
2. Assemble equipment. Check amount, concentration, type, and frequency
of tube feeding on patient’s chart. Check expiration date of formula.
4. Position patient with head of bed elevated at least 30 degrees or as near
normal position for eating as possible.
5. Unpin tube from patient’s gown and check to see that NGT is properly
located in the stomach as explained in the previous checklist.
6. Aspirate all gastric contents with syringe and measure. Return
immediately through the tube, saving small amount to measure gastric ph.
Flush tube with 30 ml of sterile water for irrigation. Proceed with feeding if
amount of residual does not exceed policy of agency or physician’s
guideline. Disconnect syringe from tubing.
7. Remove plunger from 30-60 ml syringe.
8. Attach syringe to feeding tube, pour premeasured amount of tube feeding
into syringe, open clamp, and allow feeding to enter tube. Regulate the rate
by raising or lowering height of the syringe. Do not push feeding with syringe
plunger.
9. Add 30-60 ml of water for irrigation to syringe when feeding is almost
completed and allow it to run through the tube.
10. When syringe has emptied, hold the syringe high and disconnect from
the tube. Clamp the tube and cover end with a sterile gauze secured with a
rubber band or apply a cap.
11. Place the patient on such position for 1-2 hours or when food has been
down. Do the after care. Document the procedure.
Removing a Nasogastric tube

1. Check physician’s order for removal of NGT.
2. Explain procedure to patient and assist to semi-Fowler’s position.
4. Perform hand hygiene. Don clean disposable gloves.
5. Place towel or disposable pad across patient’s chest. Give tissues to the
patient.
6. Discontinue suction and separate tube from suction. Unpin tube from
patient’s gown and carefully remove adhesive tape from patient’s nose.
7. Attach syringe and flush with 10 ml NSS or clear with 30-50 cc of air
(optional)
8. Instruct patient the patient to take a deep breath and hold it.
9. Clamp tube with fingers by doubling tube on itself. Quickly and carefully
remove tube while patient holds breath.
10. Place tube in disposable plastic bag. Remove gloves and place in bag.
11. Offer mouth care to patient and facial tissues to blow nose.
12. Measure nasogastric drainage. Remove all equipment and dispose
according to agency policy. Perform hand hygiene.

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13. Record removal of tube, Pt’s response, and measure of drainage.

Continue to monitor patient for 2-4 hours after tube removal for gastric
distention, nausea or vomiting.
For the next items, evaluate the students in general according to the criteria. (5 as the
highest score)
5 4 3 2 1
Mastery
Orderliness
Comments:_________________________________________________________________________
___________________________________________________________________________________
_____________________________________________________

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Appendix C
Administering a Cleansing Enema

Checklists
Name: ___________________________________Date:_________Section/Group: _______
Legend:
3-Done
1-Not Done
Goal: To introduce solution into the large intestine to promote expulsion of feces.
PROCEDURES 3 2 1
1 Assemble necessary equipment. Warm the solution in amount ordered and
checks temperature with bath thermometer, if available. If tap water is
used, adjust temperature as it flows from the tap.
2. Explain the procedure to the patient and plan where he or she will
defecate. Have bedpan, commode, or nearby bathroom ready for his or her
use.
4. Add enema solution to container. Release clamp and allow fluid to
progress through tube before reclamping.
5. Position waterproof pad under patient.
6. Provide privacy. Position and drape patient on the left side (Sim’s
position) with anus exposed or on back, as dictated by patient comfort and
condition.
7. Put on disposable gloves.
8. Elevate solution so it is 45 cm (18 inches) above level of patient’s anus.
Plan to administer solution slowly over a period of 5-10 minutes. Container
may be hung on IV pole or held in the nurse’s hands at the proper height.
9. Generously lubricate the last 5-7 cm (2-3 inches) of the rectal tube. A
disposable enema set may have a prelubricated rectal tube.
10. Lift buttock to expose anus. Slowly and gently insert rectal tube 7-10 cm
(3-4 inches). Direct it in an angle pointing toward the umbilicus.
11. If the tube meet resistance while inserting it, permit a small amount of
solution to enter, withdraw tube slightly, then continue to insert it. Do not
force tube entry. Ask pt to take several deep breaths.
12. Introduce solution slowly over a period of 5-10 minutes. Hold tubing all
the time solution being instilled.
13. Clamp tubing or lower container if patient has the desire to defecate or
cramping occurs. Patient also may be instructed to take small fast breaths
or to pant.
14. After solution has been given, clamp tubing and remove tube. Have
paper towel ready to receive tube as it is withdrawn. Have patient retain
solution until the urge to defecate becomes strong, usually in about 5-15
minutes.
15. Remove disposable gloves from inside out and discard.
16. When patient has a strong urge to defecta, place him or her in sitting
position on bedpan or assist to commode or bathroom.
17. Record character of the stool and patient’s response to the enema,
Remind patient not to flush commode before nurse inspects results of
enema.
18. Assist patient, if necessary, with cleaning of anal area. Offer washcloth,
soap, and water to wash his or her hands.
19. Leave patient clean and comfortable. Care for equipment properly.

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highest score)
5 4 3 2 1
Mastery
Orderliness
Comments:_________________________________________________________________________
___________________________________________________________________________________
_____________________________________________________

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Appendix D
Changing a Bowel Diversion Ostomy Appliance

CHECKLIST
Name: ___________________________________Date:___________Section/Group: ______
Legend:
3-Done
1-Not Done
PROCEDURES 3 2 1
Explain the need to change the ostomy appliance.
Identify the patient and explain the procedure.
Gather materials needed.
Perform handwashing and apply clean gloves.
Provide the client privacy preferably in the bathroom.
Assist the client to a comfortable sitting or standing position.
Shave the periostomal skin of well-established ostomies as needed.
Remove and Empty the ostomy appliance.
Clean and dry the periostomal skin and stoma. Use toilet tissue to remove
excess stool and use warm water, mild soap, and cotton balls or wash towels
to clean the skin of the stoma.
Dry the area thoroughly by patting with a towel or cotton balls.
Assess the stoma and periostomal skin.
Apply paste-type skin barrier if needed.
Prepare and apply the skin barrier.
Fill in any exposed skin around an irregularly shaped stoma. For the exposed
skin, apply non-alcohol based products or sprinkle periostomal powder and
wipe off excess and dab the powder with a slightly moist gauze or applicator
moistened with a liquid skin barrier. This creates a barrier seal.
Prepare and apply the appliance.
Dispose equipment or clean any reusable equipment.
Hand wash.
Document the procedure and report assessment on the stoma, skin and
stool.
highest score)
5 4 3 2 1
Mastery
Orderliness
Comments:_________________________________________________________________________
___________________________________________________________________________________
_____________________________________________________

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Appendix E
Managing Gastrointestinal Suction

CHECKLIST
Name:_______________________________Date:_____________Section/Group:_____
Legend:
3-Done
1-Not Done
PREPARATION 3 2 1
PURPOSES
• To relieve abdominal distention
• To maintain gastric decompression after surgery
• To remove blood and secretions from the gastrointestinal
tract
• To relieve discomfort (e.g., when a client has a bowel
obstruction)
• To maintain the patency of the nasogastric tube
1 Assess:
• Presence of abdominal distention on palpation
• Bowel sounds
• Abdominal discomfort
• Vital signs for baseline data
• Amount and characteristics of drainage
2 Determine:
• Whether the suction is continuous or intermittent
• The ordered suction pressure (a low suction pressure is
between 80 and 100 mmHg, and a high pressure is between
100 and 120 mmHg)
• Whether there is an order to irrigate the gastrointestinal
tube and, if so, the type of solution to use.
3 Assemble Equipment:
Initiating Suction
• Gastrointestinal tube in place in the client
• Basin
• 50-mL syringe with an adapter
• Stethoscope
• Suction device for either continuous or intermittent
suction
• Connector and connecting tubing
• Clean gloves
Maintaining Suction
• Graduated container as required to measure gastric
drainage
• Basin of water
• Cotton-tipped applicators
• Ointment or lubricant
• Clean gloves
Irrigation
• Clean gloves
• Stethoscope
• Disposable irrigating set containing a sterile 50-mL syringe,
moisture-resistant pad, basin, and graduated container

DMMMSU
• Sterile normal saline (500 mL) or the ordered solution

1 Introduce self and verify the client’s identity using agency
protocol. Explain to the client what you are going to do, why it
is necessary, and how he or she can participate. Discuss the
purpose(s) of the gastrointestinal suction.
2 Perform hand hygiene and observe other appropriate infection
prevention procedures.
3 Provide for client privacy.
4 Assist the client to a semi-Fowler’s position if it is not
contraindicated.
5 Apply clean gloves.
Check agency protocol for preferred methods to verify placement
because clinical practice varies across health regions:
a. The method of inserting air into the tube with the
syringe and listening with a stethoscope over the stomach
(just below the xiphoid process) for a swish of air is often
used at the bedside.
b. Aspirate to obtain stomach contents and check the

acidity of gastric aspirate using a pH test strip.
c. X-ray examination is considered the gold standard for

determining placement, especially for high-risk clients
(e.g., critically ill, dysphagic, or unconscious).
Remove and discard gloves.
Perform hand hygiene.
6 Connect the appropriate suction regulator to the wall suction
outlet and the collection device to the regulator. Check the
suction level by occluding the drainage tube and observing the
regulator dial during a suction cycle.
Set continuous suction as ordered by the primary care provider,
or at 60 to 120 mmHg.
If using a portable suction machine, turn on the machine and
regulate the suction as above.
Test for proper suctioning by holding the open end of the suction
tube to the ear and listening for a sucking noise or by occluding
the end of the tube with a thumb.
7 Connect the gastrointestinal tube to the tubing from the suction
by using the connector.
If a Salem sump tube is in place, connect the larger lumen to the
suction equipment. This double-lumen tube has a smaller tube
running inside the primary suction tube.
Always keep the air vent tube of a Salem sump tube open and
above the level of the stomach when suction is applied.
After suction is applied, watch the tubing for a few minutes until
the gastric contents appear to be running through the tubing into
the receptacle.
If the suction is not working properly, check that all connections
are tight and that the tubing is not kinked.
Coil and pin the tubing to the client’s gown so that it does not
loop below the suction bottle.
8 Observe the amount, color, odor, and consistency of the drainage.
Test the gastric drainage for pH and blood when indicated.
9 Assess the client every 30 minutes until the system is running

effectively and then every 2 hours, or as the client’s health
indicates, to ensure that the suction is functioning properly.
Inspect the suction system for patency of the system (e.g., kinks
or blockages in the tubing) and tightness of the connections.

DMMMSU
10 Perform hand hygiene.

Apply clean gloves.
Check the suction equipment. To do this, disconnect the
nasogastric tube from the suction over a collecting basin (to
collect gastric drainage), and then, with the suction on, place the
end of the suction tubing in a basin of water. If water is drawn
into the drainage bottle, the suction equipment is functioning
properly, but the nasogastric tube is either blocked or positioned
incorrectly.
Reposition the client if permitted.
Rotate the nasogastric tube and reposition it. This step is
contraindicated for clients with gastric surgery.
Irrigate the nasogastric tube as agency protocol states or on the
order of the primary care provider.
11 Place the vent tubing higher than the client’s stomach to prevent
gastric fluid backup into the blue lumen air vent.
Keep the drainage lumen free of particulate matter that may
obstruct the lumen.
12 Clean the client’s nostrils as needed, using the cotton-tipped
applicators and water. Apply a water-soluble lubricant or
ointment.
Provide mouth care every 2 to 4 hours and as needed. Some
postoperative clients are permitted to suck ice chips or a moist
cloth to maintain the moisture of the oral mucous membranes.
13 Clamp the nasogastric tube and turn off the suction.
Apply clean gloves.
If the receptacle is graduated, determine the amount of drainage.
Disconnect the receptacle.
Inspect the drainage carefully for color, consistency, and presence
of substances (e.g., blood clots).
Replace a full receptacle and attach it to the suction. Check
agency policy.
Turn on the suction and unclamp the nasogastric tube.
Observe the system for several minutes to make sure
function is reestablished.
Go to step 17.
14 Place the moisture-resistant pad under the end of the
gastrointestinal tube.
Turn off the suction
Apply clean gloves.
Disconnect the gastrointestinal tube from the connector.
Determine that the tube is in the stomach. See step 5.
15 Draw up the ordered volume of irrigating solution in the syringe;
30 mL of solution per instillation is usual, but up to 60 mL may be
given per instillation if ordered.
Attach the syringe to the nasogastric tube and slowly inject the
solution.
Gently aspirate the solution.
If you encounter difficulty in withdrawing the solution, inject 20
mL of air and aspirate again, and/or reposition the client or the
nasogastric tube.
If aspirating difficulty continues, reattach the tube and set to
intermittent low suction, and notify the nurse in charge or the

DMMMSU
primary care provider.

Repeat the preceding steps until the ordered amount of solution is
used.
Note: A Salem sump tube can also be irrigated through the vent
lumen without interrupting suction. However, only small
quantities of irrigant can be injected via this lumen compared to
the drainage lumen.
After irrigating a Salem sump tube, inject 10 to 20 mL of air into
the vent lumen while applying suction to the drainage lumen.
16 Reconnect the nasogastric tube to suction.
If a Salem sump tube is used, inject the air vent lumen with 10 mL
of air after reconnecting the tube to suction.
Observe the system for several minutes to make sure it is
functioning.
17 Record the time suction was started. Also record the pressure
established, the color and consistency of the drainage, and
nursing assessments.
During maintenance, record assessments, supportive nursing
measures, and data about the suction system.
When irrigating the tube, record verification of tube
placement; the time of the irrigation; the amount and type of
irrigating solution used; the amount, color, and consistency of the
returns; the patency of the system following the irrigation; and
nursing assessments.
highest score)
5 4 3 2 1
Mastery
Orderliness
Student’s Name and Signature: _____________________________________________

Evaluator’s Name and Signature: ___________________________________________

APPENDIX F
TEMPLATE FOR NURSING CARE PLAN

DMMMSU
APPENDIX G
RUBRIC FOR NURSING CARE PLAN
CRITERIA EXCEEDS MEETS NEARLY MEETS DOES NOT MEET SCORE
ECXPECTATIONS EXPECTATION EXPECTATIONS EXPECTATIONS
(8) (6) (4) (2)
Interview Correctly Correctly identifies Correctly Correctly identifies
assessment identifies five four clear, specific, identifies three two clear, specific,
includes clear, specific and relevant clear, specific, and relevant
subjective and and relevant interview and relevant interview
historical data interview (subjective) data interview (subjective) data
that support (subjective) data points. All data are (subjective) points. Data are
nursing diagnosis points. All data organized and/or data points. unorganized, and
are organized are mostly related Data are relevance to
and are related to a nursing marginally nursing diagnosis is
to a nursing diagnosis. organized, and unclear.
diagnosis. relevance to
nursing
diagnosis is
unclear.
Physical Correctly Correctly identifies Correctly Correctly identifies
assessment identifies five four clear, specific, identifies three two clear, specific,
includes objective clear, specific, and relevant clear, specific, and relevant
data that support and relevant physical (objective) and relevant physical (objective)
nursing diagnosis physical data points. All physical data points. Data
(objective) data data are organized (objective) data are unorganized,
points. All data and/or are mostly points. Data are and relevance to
are organized related to a nursing marginally nursing diagnosis is
and are related diagnosis. organized, and unclear.
to a nursing relevance to
diagnosis. nursing
diagnosis is
unclear.
Nursing diagnosis Properly Properly identifies Properly Diagnoses are not
Includes relevant identifies four or three or fewer identifies two NANDA approved,
NANDA approved more nursing nursing diagnoses or fewer nursing appropriate for
diagnoses written diagnoses that that are clearly diagnoses that patient, or not
in proper form are clearly supported by the are clearly prioritized.
(includes stem, supported by the data, and reflect supported by Diagnosis may not
related to (RT), data and reflect accurate clinical the data, and be clearly
and as evidenced accurate clinical judgment. They are reflect accurate supported by
by (AEB) judgment. They appropriate for the clinical assessment data.
are appropriate patient, well judgment. They
for the patient, prioritized, NANDA may not be
well prioritized, approved, and appropriate for
NANDA written in correct the patient,
approved, and format. well prioritized,
written in NANDA
correct format. approved, or
written in
correct format.
Outcomes / At least four Three short- and Two or fewer Goal portion is
planning including short and long- long-term goals are short and long- incomplete or
patient and family term goals are identified that term goals are completely
short- and long- identified that clearly relate to the identified. unrelated to the
term goals based clearly relate to nursing diagnosis, Goals may not nursing diagnosis.
upon the the nursing are written in a relate to the
diagnosis. Goals diagnosis, are patient-focused nursing
must be patient written in a manner, and are diagnosis, may
focused, realistic, patient-focused realistic. Each goal not be written
and have clear manner, and are contains clear in a patient
measurable realistic. Each criteria for focused
criteria with a goal contains measurement and a manner, or are
target date/time. clear criteria for time frame for unrealistic.
measurement evaluation. Each goal is
and a time frame missing clear
for evaluation criteria for

DMMMSU
measurement
and a time
frame for
evaluation.
Implementation Identifies at Identifies fewer Identifies fewer Interventions are
nursing least three than three specific than three unclear or do not
interventions or specific interventions for specific clearly focus on the
actions that interventions for each outcome interventions etiology of the
directly relate to each outcome criterion in order to for each nursing diagnosis or
the etiology of criterion in order help the outcome relate to the
the nursing to help the patient/family criterion patient goals
diagnosis and the patient/family reach the desired related to the outcomes.
patient goal and reach the goal. etiology of the Rationales provided
desired outcome. desired goal. nursing do not demonstrate
Each intervention diagnosis. Not an understanding of
must include all interventions the purpose of the
referenced may be specific. interventions or no
rationale Rationalizations references are
(including source are included but provided.
and page number they may be
if applicable) weak, or
references are
incomplete or
from sources
that may not be
reliable.
Evaluation Evaluation Clearly states how Evaluation Evaluations portion
outlines the portion contains each outcome portion does not is incomplete or
methods to be data that are would be consistently does not relate to
used in evaluating listed as criteria evaluated. Able to contain data diagnosis, goal
outcome criteria, in goal correctly identify that are listed statement, or
expectations for statement and criteria for goal as criteria in interventions.
goals being met, lists expectations being met, partially goal statement.
and what would for meeting the met, or unmet. May also not
determine that goal. Clear Identifies revisions describe goal as
goal is met, explanation of for care plan but met, partially
partially met, or criteria for goals may not include met, or not
unmet. Explain being met, accurate rationale met. May also
how the plan of partially met, or for revision, or not include
care would be not met. references may be revision or new
revised or Includes plan for from sources that evaluation
continued in each continuation or may not be reliable, date/time.
case, including a revision, clearly or a new date is not
new realistic referenced provided for
evaluation rationale for reevaluation.
date/time. revisions from
reliable sources,
and a new
evaluation
date/time.
Identification of Identifies, Identifies, labels, Identifies, Unable to identify,
the main labels, and and understands all labels, and label, and
issues/problems understands all but one or two understands all understand relevant
relevant main relevant main issues but three or main issues and/or
issues and/or and/or problems. four relevant problems.
problems. main issues
and/or
problems.
Linkage of course Excellent inquiry Good inquiry into Limited inquiry Incomplete or no
readings and into the the into the inquiry into
other resources to problems/ problems/questions problems/ problems/questions
problem/question questions with with clearly questions with with clearly
clearly documented clearly documented
documented linkages to the documented linkages to the
linkages to the material read in linkages to the material read in
material read in class, and/or other material read in class, other
class, other assigned resources, class, or other assigned resources,
assigned previously gained assigned previously gained

DMMMSU
resources, knowledge, and/or resources, knowledge, and/or

previously gained outside resources. previously outside resources.
knowledge, and gained
outside knowledge, or
resources. outside
resources.
Formatting, No errors in APA Minimum errors in May have some Multiple errors in
spelling, grammar citations or APA citation and errors in APA APA citations and
references. references. There citations and references. There
There are no are minimal references. are multiple
mechanical mechanical errors There are some mechanical errors
errors such as such as spelling, mechanical such as spelling,
spelling, formatting, and errors such as formatting, and
formatting, and grammar. spelling, grammar.
grammar. formatting, and
grammar.
TOTAL: 72 points

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MODULE I

CARE OF CLIENTS WITH PROBLEMS IN

SECOND SEMESTER, SY 2021-2022

Lesson 1: Abdominal Assessment 9

Lesson 2: Nasogastric Tube 24

Lesson 3: Enema Administration 35

Lesson 4: Bowel Diversion Ostomy 37

Lesson 5: Parenteral Nutrition 40

Module I: Care of Clients with Problems in Gastro-intestinal and Nutrition Page | 2

Your related learning experience on this topic is composed of 32 hours.

1. Explain a physical examination of the abdomen involving visual inspection,

Module I: Care of Clients with Problems in Gastro-intestinal and Nutrition Page | 3

NAME OF STUDENTS/GROUP NO. NAME OF STUDENTS/GROUP NO.

Module I: Care of Clients with Problems in Gastro-intestinal and Nutrition Page | 4

17. Santiago, Shemariah Lita Mangaoang 7. Corpuz, Phoebe Therese Isibido

CLINICAL INSTRUCTOR: CLINICAL INSTRUCTOR:

Module I: Care of Clients with Problems in Gastro-intestinal and Nutrition Page | 5

RELATED LEARNING EXPERIENCE GUIDELINES

Observance of Proper Netiquette

1. Avoid typing in ALL CAPS

3. Don’t abuse the chat box

4. Read and Think before you ask

5. Cyber bullying is NO NO!

6. Submit files the right way

Module I: Care of Clients with Problems in Gastro-intestinal and Nutrition Page | 6

7. Be on Time, Presentable and Prepared.

8. Be attentive and Participative

RELATED LEARNING EXPERIENCE

Clinical • NUPC117 – 153 hours

In the clinical setting

In the community setting (for both men and women)

Good luck and happy reading!!!

Module I: Care of Clients with Problems in Gastro-intestinal and Nutrition Page | 8

It is important to begin by obtaining a thorough history of abdominal or gastrointestinal

Weight Loss or Gain

Module I: Care of Clients with Problems in Gastro-intestinal and Nutrition Page | 9

Nausea and Vomiting

Changes in Bowel Habits

1. Past Gastrointestinal Disease

Module I: Care of Clients with Problems in Gastro-intestinal and Nutrition Page | 10

3. Social History and Lifestyle Risk Factors

Module I: Care of Clients with Problems in Gastro-intestinal and Nutrition Page | 11

Anatomy of Gastro-intestinal Tract

Module I: Care of Clients with Problems in Gastro-intestinal and Nutrition Page | 12

Module I: Care of Clients with Problems in Gastro-intestinal and Nutrition Page | 13

Abdominal Pain Positions

Four Basic Techniques

• Physical examination of the abdomen

It is best to perform this examination while

To facilitate the referencing of location, the

Module I: Care of Clients with Problems in Gastro-intestinal and Nutrition Page | 14

• If a female patient, ask when their last menstrual period was.

What to look for?

• Stomach Contour - Scaphoid, Flat, Rounded, Protuberant, symmetrical?

Module I: Care of Clients with Problems in Gastro-intestinal and Nutrition Page | 15

Module I: Care of Clients with Problems in Gastro-intestinal and Nutrition Page | 16

Usual Abnormal Abdominal Findings during Inspection

Module I: Care of Clients with Problems in Gastro-intestinal and Nutrition Page | 17

Module I: Care of Clients with Problems in Gastro-intestinal and Nutrition Page | 18

Use the diaphragm of your stethoscope to listen

• Borborygmi (BOR-boh-RIG-mee) are normal,

Use the bell of your stethoscope to listen for these sounds.

Module I: Care of Clients with Problems in Gastro-intestinal and Nutrition Page | 19

Percussion can precede or be interspersed with palpation of each quadrant. It is a useful