 GASTROINTESTINAL NURSING
 Anatomy & Physiology Review
 Mouth
 Pharynx
 Esophagus
 Stomach
 Small & large intestines
 Anus
 Nursing Assessment and
Health History
 ?? Common complaints of GI system
 Why is past medical history important??
 What family history might be relevant??
 What are some common questions you need to ask in your review of systems???
 Diagnostic Tests & Procedures

Gastrointestinal
 System
 Stool Specimens
 O&P
 OB
 Fecal Fat
 C&S
 RADIOGRAPHIC TESTS

Most common tests:
1) Barium swallow or UGI
2) Small Bowel series
3) Barium enema
Others: CTS,US abd. X-rays
 ENDOSCOPIC TESTS (for upper GI system)
 Esophagoscopy
 Gastroscopy
 Gastroduodenoscopy
 EGD
 ERCP
 ENDOSCOPIC TESTS ( for lower GI system)
 Colonoscopy
 Proctoscopy
 Sigmoidoscopy
 Laboratory Tests
 Gastric Analysis
 CBC
 PT (prothrombin time)
 INR
 PTT (partial thromboplastin time)
 Bilirubin
 Blood proteins
 Alkaline Phosphatase
 LDH
 GGT
 AST
 ALT
 Cholesterol & Triglycerides
 Amylase
 CEA
 Abnormal Assessment Findings
 Distention
 Firmness
 Tenderness
 Altered bowel sounds
 Therapeutic Measures & Related Nursing Interventions
 With GI Patients
 Gastric Decompression
 Types of tubes ( pg. 741 )
 What is the purpose of gastric decompression?
 ??Nursing Interventions??
 Gavage or Enteral Nutrition (Tube Feedings)
 Provide nutritional support through a tube
 Short or long term
 In conditions that prohibit oral nourishment
 Types of Tubes
 Nasogastric - (NG)
 Gastrostomy – (G-tube)
 Jejunal – (J-tube)
 Percutaneous – (PEG)
 Total Parenteral Nutrition – (TPN)
 Nutritionally complete
 Used when GI system not functioning
 Short or long term
 Pre-Op Nursing Interventions
 For GI surgery patients
 GI tract cleansing
 Assess vital signs
 Liquids for 24 hrs. or NPO
 IV
 Antibiotics
 NGT insertion
 Post-Op Nursing Interventions
 For GI surgery patients

Relieve pain

Detect complications

Prevent gastric distention

Replace lost fluids

Maintain urine elimination
 Digestive Disorders
 Anorexia
 Lack of appetite
 Cause: physical or emotional
 Contributing factors:
 Special diet
 Illness
 Unpleasant odors
 Social isolation
 Decreased sense of taste or smell
 Signs & Symptoms
 Glossitis
 cheilosis
 Muscle waisting
 Extreme fatigue
 Lesions of the mouth
 Nursing Interventions
 Oral hygiene, dentures
 Pleasant environment for meals, socialization
 Diet preferences, small servings
 Obesity
 20% over ideal body wt.
 Morbid obesity= 2X normal body wt.
 Complications
 CV disease
 Diabetes
 Respiratory difficulties
 Musculoskeletal problems
 Emotional and social isolation
 Causes
 Caloric intake > expenditure
 Heredity
 Emotional stress/psychosocial factors
 Slowed metabolism
 Medical Management
 Weight reduction diet
 Exercise
 Medication
 Counseling
 Surgical Treatment
 RNYGBP
 VBG
 LBP
 Liposuction
 Dumping Syndrome
 Disorders of the Mouth
 Dental Caries
 Destructive process of tooth decay
 Causes:
 Bacteria
 Poor oral hygiene
 Prevention
 Frequent brushing and flossing
 Dentist visit 2X/yr
 Good nutrition
 Fluoride
 Treatment
 Removal of diseases portion of tooth and filling
 May need dentures
 If untreated, may lead to periodontal disease
 Stomatitis
 Inflammation of the oral mucosa
 Mechanical trauma from dentures
 Excessive tobacco or ETOH use
 Poor oral hygiene
 Inadequate nutrition
 Radiation or drug therapy
 Emotional tension or fatigue
 Treatment
 Determine cause
 ABX if bacterial
 Analgesics
 Topical anesthetics
 Herpes Simplex
 HSV Type 1
 Vesicles around the mouth & lips
 Tx is comfort not curative
 Zovarax ointment (antiviral)
 Apthous Stomatitis
 “canker sores”
 Painful ulcers
 Cause: possible viral, allergic
 Tx topical or systemic steroids
 Candidiasis
 Fungal infection (Thrush)
 Candida Albicans
 White patches in mouth
 Immunosuppression
 Abx therapy
 Periodontal Disease
 Gingivitis(inflammation of gums and supporting tissues)
 Gums are red, swollen, painful and bleed easily
 Cause poor oral hygiene & nutrition
 Treatment
 ABX
 Good oral hygiene
 Surgical scraping
 Extraction
 THINK…
 Assessment…?
 Nursing Diagnosis….?
 Interventions….?
 Oral Cancer

2 types of malignant tumors

Squamous and Basal cell

Early s/s may be ignored

Tongue irritation, loose teeth, pain in ear or in tongue
 Risk Factors
 Tobacco use
 Alcohol use
 Poor nutrition
 Chronic irritation
 Treatment
Surgery
Radiation
Chemo
 Radical Neck
 Post op Nursing Care:
 May have Tracheostomy
 Temps tympanic or rectal
 Control pain
 NGT, PEG, or TPN
 Emotional Support
 Communication board
 High fowlers
 Mouth care
 Incentive spiro. ( no coughing)
 Disorders of Esophagus
 Esophageal Cancer

Not common, poor prognosis

Middle or lower portion of esophagus

No known cause
 Predisposing Factors
 Cigarette smoking
 Excessive alcohol intake
 Poor oral hygiene
 Eating spicy foods
 Signs and Symptoms
 Progressive dysphagia
 Weight loss may be dramatic
 TX  Chemo or surgery
 Esophagectomy, Esophagogastrostomy, or Esophagogastrectomy

Nursing Care of the patient with Esophageal CA
 Assessment….?
 Nursing Diagnosis….?
 Interventions….?
 Nutrition
 Anxiety
 Risk for infection, injury
 Esophageal Diverticulum
 Esophageal out-pouching
 “Bad breath” due to accumulation of food in diverticulum
 Treatment
 Bland diet
 Antacids
 Anti-emetics
 Surgery
 Nursing Measures
 Semi-fowlers
 Small meals
 Loose clothing
 Disorders of the Stomach
 Hiatal Hernia
 Protrusion of the lower esophagus and stomach upward through the diaphragm
 Two types: Sliding and Rolling
 Causes
 Excessive intra-abdominal pressure
 Obesity
 Pregnancy
 Abdominal tumors, ascites or repeated heavy lifting
 Signs and Symptoms
 Feeling of fullness
 Eructation
 Heartburn
 Dysphagia
 Regurgitation
 Medical Treatment
 Avoid increased intra-abdominal pressure
 HOB ^ 6-12 inchesprevents nighttime reflux
 Drug Therapy
 Diet

Surgical Treatment
 Nissen Fundoplication
 Angelchik Prosthesis
 See page 762 figure 38-14 &
38-15
 GERD
 Gastroesophageal Reflux Disease
 Backward flow of stomach contents into the espohagus
 Sometimes occurs with a sliding hiatal hernia
 Signs & Symptoms
 Burning sensation that moves up and down, commonly after meals
 Intermittent dysphagia
 belching
 Diagnosis
 Based on symptoms
 24 hour pH monitoring
 Endoscopy
 Gastric analysis
 Treatment

Same as for hiatal hernia

Drug therapy may include: Zantac, Reglan, Prilosec & antacids

Fundoplication if required
 Patient Teaching
 Avoid ASA and NSAIDS
 Chew food well
 Avoid eating 2 hrs. before bedtime
 Avoid caffeine, ETOH, nicotine
 Supine with HOB ^ 30 degrees
 Gastritis
 Inflammation of the stomach mucosa/lining
 Causes:
 Meds, spicy foods, alcohol, stress, H.pylori
 Signs & Symptoms
 N/V
 Abdominal pain
 Anorexia
 Feeling of fullness
 Treatment
 Meds
 Replacement of fluids after N,V & diarrhea subsides
 Elimination of the cause
 Surgical intervention if all else fails
 THINK…..
 List 3 Nursing Diagnosis and related interventions when caring for the patient with gastritis
 What teaching would you do with this patient???
 Peptic Ulcer
 Lesion on either the mucosa of stomach or duodenum
 80% are in duodenum
 May be acute or chronic
 Classified as gastric or duodenal
 See Table 38-2, pg. 765
 Causes
 Bacterium H. pylori
 Drugs
 Physical trauma (shock,burns)
 Conditions that cause excessive gastric acid secretions
 Gastric S/S
 Epigastric pain 1-2 hrs after a meal
 Pain relieved by food or fluids
 Nausea, anorexia and weight loss
 Duodenal S/S
 Burning or cramping pain 2-4 hrs after a meal
 Pain relieved by antacids or food
 Teach : 1) limit milk products
2) no baking soda
 Complications of Peptic Ulcers

Hemorrhage

Perforation

Peritonitis

Obstruction
 Medical Treatment
 Drug therapy
 Diet therapy
 NGT  hemorrhage
 Lavage
 Surgical intervention (table 38-4)
 Complications after Gastrectomy
 Dumping syndrome pg.772
 Sx occur within 20 min of eating
 Bloating, flatulence, cramps & diarrhea
 Diaphoresis, anxious, shaky
 Malabsorption--> Malnutrition
 THINK…
 What teaching would you provide to the patient experiencing Dumping Syndrome??/
 Stomach Cancer
 “Silent neoplasm”
 Poor prognosis
 No early s/s
 Late s/s: vomiting, ascites, abd. Mass, enlarged liver
 Risk Factors
 H-pylori infection
 Pernicious anemia
 Chronic gastritis
 Lack of HCL
 Family history
 Treatment
 Surgery
 Chemo
 Radiation
 Health Promotion Considerations
 What are some things we can do and or teach others to do which might reduce the risk of
developing several types of Cancer not just stomach Cancer???/
 Malabsorption
 Intestinal absorption of nutrients is reduced
 Two examples are:
1) Celiac sprue
2) Lactase deficiency
 Signs & Symptoms
 Steatorrhea
 Malnutrition & weight loss
 Abdominal pain, cramping
 Bloating
 diarrhea
 Treatment
 Sprue diet and drug therapy, avoid foods w/ gluten(wheat, barley, oats)
 Lactase  avoid milk products & take lactase enzyme ( Lactaid)
 THAT’S IT…
 YOUR DONE WITH UNIT 1 GI
 ON TO UNIT TWO…..