Disturbances in nutrition and gastrointestinal tract lecture notes

GI AND NUTRITION PROCEDURES ASSESSMENT SKILLS
ROSELILY COQUILLA 1
DISTURBANCES IN NUTRITION AND GASTROINTESTINAL TRACT
LECTURE NOTES
Overview
A. Review on GI Assessment
B. Review on GI Medication
C. GI Diagnostic Tests
a) Blood Tests
b) Breath Tests
c) Abdominal Sonography
d) DNA Testing
e) Imaging Studies
• Upper Gastrointestinal Tract Studies
• Lower Gastrointestinal Tract Studies
D. Nursing Care for GI Procedures
• TPN
• Gastric Lavage
• Paracentesis
• Colostomy Care
E. Common Nursing Diagnosis for GI Disturbances
F. Diet Therapy
G. Alternative Therapies
A. Review on GI Assessment
1. Health History
- The nurse notes past and current medication use and any previous
treatment or surgery.
- Information pertaining to medications.
- The nurse takes a dietary history to assess nutritional status.
- the use of tobacco and alcohol includes details about type and
amount.
2. Clinical Manifestations – focusing on symptoms common to GI dysfunction.
a) Pain ( major symptom)
✓ The character, duration, pattern, frequency, location,
distribution of referred pain and time of the pain vary greatly
depending on the underlying cause.
✓ Other factors, such as meals, rest, defecation, and vascular
disorders, may directly affect this pain.

ROSELILY COQUILLA 2
b) Indigestion – upper abdominal discomfort or distress associated with
eating. ( most common)
✓ patient’s own gastric peristaltic movements.
✓ Bowel movements may or may not relieve the pain.
✓ Indigestion can result from disturbed nervous system control of
the stomach
✓ Fatty foods because they remain in the stomach longer than
proteins or carbohydrates do.
✓ Coarse vegetables and highly seasoned
c) Intestinal Gas
✓ belching (the expulsion of gas from the stomach through the
mouth)
✓ ﬂatulence (the expulsion of gas from the rectum
✓ Patients often complain of bloating, distention, or being “full
of gas.
* Excessive ﬂatulence may be a symptom of gallbladder
disease or food intolerance.
d) Nausea and Vomiting ( major symptoms)
✓ Vomiting is usually preceded by nausea, which can be
triggered by odors, activity, or food intake.
✓ The emesis, or vomitus, may vary in color and content.
• It may contain undigested food particles or blood
(hematemesis).
• When vomiting occurs soon after hemorrhage, the
emesis is bright red.
• If blood has been retained in the stomach, it takes on
a coffee-ground appearance because of the action of
the digestive enzymes.
e) Change in Bowel habits and Stool Characteristics - may signal colon
disease.
✓ Diarrhea (an abnormal increase in the frequency and liquidity
of the stool or in daily stool weight or volume) commonly
occurs when the contents move so rapidly through the
intestine and colon that there is in- adequate time for the GI
secretions to be absorbed.
✓ Diarrhea is sometimes associated with abdominal pain or
cramping and nausea or vomiting.
✓ Constipation (a decrease in the frequency of stool, or stools
that are hard, dry, and of smaller volume than normal) may
be associated with anal discomfort and rectal bleeding
✓ Stool is normally light to dark brown. However, many
circumstances, including the ingestion of certain foods and
medications, can change the appearance of stool

ROSELILY COQUILLA 3
✓ Blood in the stool can present in various ways and must be
investigated.
• If blood is shed in sufficient quantities into the upper GI
tract, it produces a tarry-black color ( melena)
• Blood entering the lower portion of the GI tract or pass-
ing rapidly through it will appear bright or dark red.
• Lower rectal or anal bleeding is suspected if there is
streaking of blood on the surface of the stool or if blood
is noted on toilet tissue.
- Bulky, greasy, foamy stools that are foul in odor
- Light gray or clay-colored stool, caused by the
absence of urobilin
- Stool with mucus threads or pus that may be
visible on gross inspection of the stool
- Small, dry, rock-hard masses called scybala;
sometimes streaked with blood from rectal
trauma as they pass through the rectum.
- Loose, watery stool that may or may not be
streaked with blood.
3. Physical Assessment
a) assessment of the mouth, abdomen, and rectum.
• The mouth, tongue, buccal mucosa, teeth, and gums are inspected,
and ulcers, nodules, swelling, discoloration, and inflammation are
noted.
b) The patient lies supine with knees flexed slightly for inspection, auscultation,
palpation, and percussion of the abdomen
• The nurse performs auscultation before percussion and palpation
(which can increase intestinal motility and thereby change bowel
sounds) and notes the character, location, and frequency of bowel
sounds.
- The nurse assesses bowel sounds in all four quadrants using the
diaphragm of the stethoscope.
- the high-pitched and gurgling sounds can be heard best in this
manner.
- It is important to document the frequency of the sounds, using
the terms normal (sounds heard about every 5 to 20 seconds),
hypoactive (one or two sounds in 2 minutes), hyperactive (5 to
6 sounds heard in less than 30 seconds), or absent (no sounds
in 3 to 5 minutes).
- The nurse notes tympany or dullness during percussion.
• Light palpation is appropriate for identifying areas of tenderness or
swelling.

ROSELILY COQUILLA 4
- the nurse may use deep palpation to identify masses in any of
the four quadrants.
- If the patient identifies any area of discomfort, the nurse can
assess for rebound tenderness.
- To elicit rebound tenderness, the nurse exerts pressure over the
area and then releases it quickly.
- It is important to note any pain experienced on withdrawal of
the pressure.
- The nurse notes any abnormal finding in relation to the surface
landmarks (xiphoid process, costal margins, anterior iliac spine,
and symphysis pubis) or in relation to the four quadrants
commonly used to describe the abdomen (right upper
quadrant, RUQ; right lower quadrant, RLQ; left upper
quadrant, LUQ; and left lower quadrant, LLQ)
• Inspection of anal and perineal area.
- The nurse should inspect and palpate areas of excoriation or
rash, fissures or fistula openings, or external hemorrhoids.
- A digital rectal examination can be performed to note any
areas of tenderness or mass.
B. Review on GI Medications
I. Antacids
• React with gastric acid to produce neutral salts or salts of low acidity.
• Inactivate pepsin and enhance mucosal protection, but do not coat
the ulcer crater. ( PUD. GERD)
• Should be taken on regular schedule, 1-3 hours after meal and at
bedtime.
• Antacid tablets showed be chewed thoroughly and followed with a
glass of milk or water.
• Liquid preparation should be shaken before dispensing.
* allow 1 hour between antacid administration of other medication
to prevent interaction and interference with other medication
II. Gastric Protectants
a) Misoprostol
- An antisecretory medication that enhances mucosal defenses.
- Suppresses secretion of gastric acid and maintains submucosal
blood flow by promoting vasodilation.
- Administer with meals
- Causes diarrhea and abdominal pain.
- Contraindicated during pregnancy
b) Sucralfate
- Creates a protective barrier against acid and pepsin.
- Should be taken on empty stomach

ROSELILY COQUILLA 5
- May cause constipation
- May impede absorption of warfarin sodium, phenytoin,
theophylline, digoxin, and some antibiotics.
III. Histamine (H2)-Receptor Antagonists
- Suppress secretion of gastric acid.
- Alleviate symptoms of heartburn and assist with preventing
complications associated with peptic ulcer disease.
• Cimetidine
• Ranitidine
• Famotidine
• Nizatidine
IV. Proton Pump Inhibitor
- Suppress gastric acid secretion.
- Common side effects include headache, diarrhea, abdominal
pain, and nausea.
• Pantoprazole, omeprazole
V. Medication Regimens to Treat Helicobacter pylori
- Esomeprazole, amoxicillin, clarithromycin Lansoprazole, amoxicillin,
clarithromycin, Lansoprazole, amoxicillin, levofloxacin
VI. Prokinetic Agent
- Metoclopramide
- Stimulates motility of the upper GIT increases the rate of gastric
emptying without stimulating gastric, biliary, or pancreatic secretions.
- Administered 30 minutes before meals.
- May cause restlessness, drowsiness, EPS, dizziness, insomnia, and
headache.
VII. Antiemetic
- Medications used to control vomiting and motion sickness.
- Antiemetics can cause drowsiness; therefore, a priority intervention is
to protect the client from injury
• Metoclopramide, Phenergan, Domperidone, Motilium.
Bonamine, Dramamine)
VIII. Laxatives
- Absorbs water into the feces and increase bulk to produce large and
soft stools
- Attracts water into the large intestines to produce bulk and stimulate
peristalsis.
- Dependency can occur with chronic use.
- Used to avoid straining.
* The client receiving laxative needs to increase fluid intake to
prevent dehydration
• Bisacodyl, Lactulose, Magnesium Hydroxide, Magnesium
Citrate)

ROSELILY COQUILLA 6
IX. Antidiarrheals
- Reduce the passage of stool by decreasing intestinal motility and
peristalsis.
- When poisons, infection or bacterial toxins are the cause of diarrhea,
opioids worsen the condition by delaying the elimination of toxins.
• Loperamide, Diatabs
X. Medications to treat IBD
- Antimicrobial ( Metronidazole, Cifrofloxacin, Clarithromycin))
- Corticosteroids ( Budesonide, Prednisone, Hydrocortisone))
C. GI Diagnostic Tests
I. Blood Tests
• CBC
• Carcinoembryonic antigen (CEA)
• Liver function Tests
• Serum Cholesterol and triglycerides
• Stool Tests
- Inspecting the specimen for consistency and color
- Testing for occult blood
II. Breath Tests
• Hydrogen Breath Test
- evaluate carbohydrate absorption.
- Aid in the diagnosis of bacterial overgrowth in the intestine
and short bowel syndrome.
• Urea Breath Test
- Detects the presence of Helicobacter Pylori, the bacteria that
can live in the mucosal lining of the stomach and cause peptic
ulcer disease.
- The patient takes a capsule of carbon- labeled urea and then
provides a breath sample 10 to 20 minutes later.
III. Abdominal Sonography ( noninvasive diagnostic Test)
• an image of the abdominal organs and structures is produced on the
oscilloscope.
• useful in the detection of cholelithiasis, cholecystitis, and
appendicitis. Most recently this technique has proven useful in
diagnosing acute colonic diverticulitis.
Advantage:
✓ no ionizing radiation

ROSELILY COQUILLA 7
✓ inexpensive
Disadvantage:
✓ it cannot be used to examine structures that lie behind
bony tissue
a) Endoscopic Ultrasonography
- is a specialized enteroscopic procedure that aids in the
diagnosis of GI disorders by providing direct imaging of a target
area.
- It helps in staging of a tumor, including size, spread, and
whether the tumor is operable.
- It is useful in evaluating
- transmural changes in the bowel wall that occur in ulcerative
- colitis.
Nursing Intervention
- fasting for 8-12 hours before the test.
- For gallbladder studies, the patient should eat a fat free
meal the evening before the test.
IV. DNA testing - allows practitioners to prevent (or minimize) disease, by
intervening before its onset, and to improve therapy.
V. Imaging Studies and Nursing Interventions
• Upper GI Tract Study ( Barium swallow)
- The patient swallows barium under direct ﬂuoroscopic exam-
ination.
- Enteroclysis – is a very detailed, double-contrast study of the
entire small intestine that involves the continuous infusion,
through a duodenal tube, of 500 to 1000 mL of a thin barium
sulfate suspension.
Nursing Interventions
✓ maintain a low-residue diet for several days before the test.
✓ NPO including oral medications
✓ The physician may prescribe a laxative.
✓ Follow up care is needed after the procedure.
✓ Increase fluid intake
✓ Monitoring of patient stools.
• Lower GI Tests ( Barium enema)
- When barium is instilled rectally to visualize the lower GI tract,
the procedure is called a barium enema.
- to detect the presence of polyps, tumors, and other lesions of
the large intestine and to demonstrate any abnormal anatomy
or malfunction of the bowel.
* Barium enema is contraindicated in patients with signs of
perforation/obstruction

ROSELILY COQUILLA 8
Nursing Interventions
✓ Cleansing enema.
✓ Low residue diet for 1-2 days.
✓ a clear liquid diet and a laxative the evening before;
nothing by mouth after midnight.
• Computed Tomography
- provides cross-sectional images of abdominal organs and
structures.
- Indications: abdominal CT scanning are diseases of the liver,
spleen, kidney, pancreas, and pelvic organs.
- Procedure is painless
Nursing Interventions:
✓ The patient should not eat or drink for 6 to 8 hours before
the test.
✓ Since the doctor may prescribe an intravenous or oral
contrast, the nurse should ask the patient about contrast
dye allergy.
*Barium studies should be scheduled after CT scanning so as
not to interfere with imaging.
• MRI
- It is a noninvasive technique that uses magnetic ﬁelds and
radio waves to produce an image of the area being studied.
- Indication: it is useful in evaluating abdominal tissues as well as
blood vessels, abscesses, fistulas, neoplasms and other sources
of bleeding.
* MRI s contraindicated for patients with pacemakers, and
any artificial devices.
✓ The patient should not eat or drink for 6 to 8 hours before
the test.
✓ All jewelry and other metals should be removed.
✓ It is important to warn patients that the close-ﬁtting scanners
used in many MRI facilities may induce feelings of
claustrophobia and that the machine will make a knocking
sound during the procedure.
• Scintigraphy (radionuclide imaging)
- use of radioactive isotopes (ie, technetium, iodine, and
indium) to reveal displaced anatomic structures, changes in
organ size, and the presence of neoplasms or other focal
lesions, such as cysts or abscesses.
• Gastrointestinal Motility Studies
- used to assess gastric emptying and colonic transit time.
VI. Endoscopic Procedures

ROSELILY COQUILLA 9
• Fibroscopy/Esophagogastroduodenoscopy/esophagogastroduode
noscopy.
- Allows direct visualization, of the esophageal, gastric, and
duodenal mucosa through a lighted endoscope (
gastroscope).
- Otherwise known as esophagogastroduodenoscopy (EGD)
- Patient may experience the following:
❖ Nausea
❖ Gagging
❖ Choking
✓ The patient should not eat or drink for 6 to 12 hours
before the examination.
✓ Help the patient spray or gargle with a local
anesthetic, and administering midazolam (Versed)
intravenously just before the scope is introduced.
✓ The nurse positions the patient on the left side to
facilitate saliva drainage and to provide easy access
for the endoscope.
✓ After the procedure, the nurse instructs the patient
not to eat or drink until the gag reﬂex returns (in 1 to 2
hours).
✓ The nurse places the patient in the Simms position
until he or she is awake and then places the patient
in the semi-Fowler’s position until ready for discharge.
✓ observing for signs of perforation, such as pain,
bleeding, unusual difﬁculty swallowing, and an
elevated temperature.
✓ Monitor BP and PR
✓ Instruct the patient not to drive for 10 to 12 hours if
sedation was used.
• Anoscopy, Proctoscopy and Sigmoidoscopy
- The anoscope is a rigid scope that is used to examine the anus
and lower rectum.
- Proctoscope and sigmoidoscopes are rigid scopes that are
used to inspect the rectum and the sigmoid colon.
✓ During the procedure, the nurse monitors vital signs,
skin color and temperature, pain tolerance, and
vagal response.
✓ After the procedure, the nurse monitors the patient
for rectal bleeding and signs of intestinal perforation

ROSELILY COQUILLA 10
(ie, fever, rectal drainage, abdominal distention, and
pain).
• Fiberoptic Colonoscopy
- Direct visual inspection of the colon to the cecum.
- This procedure is used commonly as a diagnostic aid and
screening device.
- Therapeutically, the procedure can be used to remove all visi-
ble polyps with a special snare and cautery through the
colonoscope.
✓ Prepare the patient for the procedure
❖ Cleansing enema.
❖ Clear liquid diet
❖ Nurse may give lavage solution as prescribed.
✓ Cardiac patient with artificial implants should require
cardiac monitoring during the procedure.
* Colonoscopy cannot be performed if there is a
suspected or documented colon perforation, acute
severe diverticulitis, or fulminant colitis.
✓ Obtain informed consent.
✓ Place the patient on NPO after midnight before the test.
✓ During the procedure, the nurse monitors for changes in
the ff:
❖ oxygen saturation
❖ vital signs, color
❖ temperature of the skin
❖ level of consciousness
❖ abdominal distention
❖ vagal response
❖ pain intensity.
✓ Instruct the patient to report any bleeding to the
physician.
• Small Bowel Enteroscopy
- Direct inspection of the wall of the intestine using a small -
caliber transnasal endoscope.
- Method: “ push” and “pull” endoscope methods
- Used for:
❖ evaluation of patients who have continued bleeding
even after extensive diagnostic testing has identiﬁed no
other problem area.
❖ used when biopsy of the small bowel is needed.
• Endoscopy Through Ostomy

- useful for visualizing a segment of the small or large intestine.
- Purpose:
❖ evaluate an anastomosis, to screen for re- current
disease, or to visualize and treat bleeding in a segment
of the bowel.
VII. Manometry and Electrophysiologic Studies
- methods for evaluating patients with GI motility disorders.
- Types:
❖ Esophageal Manometry - used to detect motility
disorders of the esophagus and the lower esophageal
sphincter.
❖ Gastroduodenal Manometry -evaluate delayed gastric
emptying and gastric intestinal motility.
❖ Rectal sensory function - evaluate rectal sensory
function and neuropathy.
❖ Electrogastrography – an electrophysiologic study to
assess gastric motility disturbances.
• Defecography
- Measures anorectal function.
VIII. Gastric Analysis, Gastric Acid Stimulation Test and pH Monitoring
- Analysis of the gastric juice yields information about the
secretory activity of the gastric mucosa and the presence or
degree of gastric retention in patients thought to have pyloric
or duodenal obstruction.
IX. Laparoscopy ( Peritoneoscopy)
- Used for the diagnosis of GI disease.
D. Nursing Care for GI Procedures
• TPN
- Tube feedings are given to meet nutritional needs.
Prior to administration:
✓ Obtain a complete history.
✓ Obtain a complete PE.
✓ Obtain the following laboratory studies:
❖ Total protein/albumin levels, creatinine, BUN, CBC
electrolytes,
❖ lipid profile
❖ serum iron level
Interventions:
✓ Monitor vital signs

✓ Use strict aseptic technique with IV tubings, dressing
changes and TPN solution.
✓ Monitor blood glucose level.
✓ Monitor for signs of overload
✓ Monitor Renal status
✓ Maintain accurate infusion rate with infusion pump.
• Gastric Lavage
- Is a gastrointestinal decontamination techniques that aims
to empty the stomach of toxic substances by the sequential
administration and aspiration of small volumes of fluid via
an orogastric tube.
Nursing Responsibilities:
✓ Assemble the necessary equipment.
✓ Identify the patient and explain what is to be done.
✓ Position the patient and place an emesis basin and paper
tissues within reach.
✓ Drape the patient with towels or paper chux to absorb
any drainage.
✓ Verify tube placement by aspirating stomach contents.
✓ Place the stomach contents in a labeled specimen
container for examination by the physician and/or
laboratory analysis.
✓ Instill lavage solution, continue to lavage until stomach
contents return clear, the prescribed amount of solution
has been used, or as otherwise directed.
• Paracentesis
- Is the transabdominal removal of fluid from the peritoneal
cavity.
Nursing Responsibilities:
✓ Ensure that the client understands the procedure and that
informed consent has been obtained.
✓ Position the client upright.
✓ Assist the physician, monitor vital signs, and provide
comfort and support during the procedure.
✓ Apply a dressing to the site of puncture.
✓ Monitor VS especially BP and pulse because these
parameters provide information on rapid vasodilation post
paracentesis
✓ weigh the client post procedure and maintain the client
on bed rest.

✓ Measure the amount of fluid removed.
✓ Label and send the fluid for laboratory analysis.
✓ Document the event, the client’s response, and
appearance and amount of fluid removed.
✓ Continually observe the patient for cyanosis, increased
respiration’s, gagging, and attempts to vomit. If the
patient vomits, support his chin in hyperextension to keep
the airway open and prevent aspiration.
✓ When lavage is completed, clamp the tube if it is to
remain in place.
✓ If the tube is to be removed, clamp or pinch off the tube
and withdraw it quickly and smoothly. Place it in a basin.
✓ Remove all used equipment from the bedside.
✓ Measure the total lavage return. Estimate the amount of
stomach contents by subtracting the known amount of
solution used from the total. Record on the I&O worksheet.
✓ Discard lavage solution.
✓ Dispose of equipment in accordance with local SOP.
✓ Record the procedure in the patient’s Nursing Notes. Note
the following information.
❖ Type and amount of lavage solution used.
❖ Appearance, odor, color, and amount of gastric
return.
❖ Patient’s tolerance to procedure.
❖ Disposition of specimens.
• Colostomy Care
- Ostomy means an opening which is made during surgery
that brings a piece of the bowel to the outside of the
abdomen.
Nursing Care:
✓ Assess the location of the stoma and the type of
colostomy performed.
✓ Assess stoma appearance and surrounding skin
condition frequently
✓ Position a collection bag or drainable pouch over the
stoma.
✓ When a colostomy irrigation is ordered for a client with
a double-barrel or loop colostomy, irrigate the
proximal stoma.
✓ Empty a drainable pouch or replace the colostomy
bag as
✓ needed or when it is no more than one-third full.

✓ Provide stomal and skin care for the client with a
colostomy as for the client with an ileostomy.
✓ Use caulking agents, such as Stomahesive or karaya
paste, and a skin barrier wafer as needed to maintain
a secure ostomy pouch.
✓ A small needle hole high on the colostomy pouch will
allow flatus to escape.
• Gastrostomy Care
- Gastrostomy tubes are surgically placed in the stomach, with
the stoma in the epigastric region of the abdomen.
Nursing Care:
✓ Assess tube placement by aspirating stomach contents
and
✓ checking the pH of aspirate to determine gastric or
intestinal placement.
✓ Inspect the skin surrounding the insertion site for healing,
redness, swelling, and the presence of any drainage.
✓ Assess the abdomen for distention, bowel sounds, and
tenderness.
✓ Until the stoma is well healed, use sterile technique for
dressing changes and site care. Clean technique is
appropriate for use once healing is complete.
✓ Wearing clean gloves, remove old dressing. Cleanse the
site with saline or soap and water, and rinse as
appropriate.
✓ Irrigate the tube with 30 to 50 mL of water and clean the
tube inside and out as indicated or ordered.
✓ Provide mouth care or remind the client to do so.
✓ If indicated, teach the client and family how to care for
the tube and feedings.
✓ Enhancing body image
✓ Monitoring and managing potential complications.
E. Common Nursing Diagnosis for GI Disturbances
• Acute/Chronic Pain
• Risk for imbalanced nutrition less than body requirements
• Risk for deficient fluid volume
• Impaired skin or tissue integrity
• Risk for infection
• Knowledge deficient (learning need) regarding condition,
prognosis, treatment regimen, self-care, and discharge needs.
• Fear or anxiety
• Body Image, disturbed

F. Diet Therapy
• High Protein diet
• High Fiber diet/low fiber diet
• Elemental diet such as Criticare, Travasorb-HN, and Precision High
Nitrogen
• TPN in severe cases
• Avoid: Lactose-containing foods, brassica vegetables (cabbage,
cauliflower, broccoli, asparagus and brussels sprouts), caffeine,
beer, monosodium glutamate, highly seasoned foods, carbonated
beverages, fatty foods
G. Alternative Therapies
• Herbal Therapy
❖ Ginger: Relieves nausea
❖ Turmeric: Has anti-inflammatory properties
❖ Slippery elm: Soothes acid reflux
❖ Milk thistle: Helps sluggish digestive systems
• Probiotics:
- Regulates digestion. Substances or organisms that contribute
to the balance of bacteria in the intestines.
• Acupuncture
- abdominal pain, bloating, and nausea.
• Hypnotherapy
- has been shown to be effective for IBS in several clinical trials.
- Improvements in overall well-being, quality of life, abdominal
pain, constipation, and bloating have been noted

Disturbances in nutrition and gastrointestinal tract lecture notes

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Disturbances in nutrition and gastrointestinal tract lecture notes

Similar to Disturbances in nutrition and gastrointestinal tract lecture notes (20)

Recently uploaded

Recently uploaded (20)

Disturbances in nutrition and gastrointestinal tract lecture notes