Dx Testing:
Serum electrolytes:
Specimen: venous blood
Pretest/intratest/posr-test – same
Commonly orderd: (meq/L)
Na – 135-145
K – 3.5 – 5.0
Cl – 95-105
Hematologic:
Hgb, hct, PT, WBC
Hgb (M) 14-18/(F) 12-16 mg/dl
Hct (M) 42-52/(F) 33046%
Platelets – 150k-400k
WBC – 5k-10k
Carcieembryonic antigaen (CEA) – a
protein found in the tissue of a developing
baby in the womb. Blood levels of this
CHON disappear or become very low after
birth.
An abnormal amt. of CEA in adult may
be a signs of cancer (avoid smoking
before the test if smoker) NV = 0-25
mcg/L.
Hepa associated antigens, H. Pylori –
antibody test, urea breath test, stool
antigen test (do not take PPI’s for 2 wks
before the test) and stomach biopsy (no
antibiotics for 1 mo. No PPI’s, no H2
blockers 24 hrs. prior to the test).
Urine studies:
Amylase test – most specific for
pancretitis and pancreatic disorder.
Elevated can also indicate PUD,
bowel perforation and other
condition.
Bilirubin Test- to check if it causes
jaundice or bile problem
Fecal Studies
* For blood, fat, infectious organisms
A freshly passed, warm stool is the
best specimen
For fat or infectious organism
collect three separate specimens
GENERAL NURSING CONSIDERATION FOR STOOL
COLLECTION
Pretest: determine purpose/s, obtain
gloves, container and tongue blade
Intratest:
Instruct to defecate in clean bedpan
Void before collection
Do not discard tissue in bedpan
Obtain 2.5 (1inch) formed stool
15-30ml of liquid stool
• Post-test: prompt delivery
OCCULT BLOOD: GUAIAC TEST
• Detect the presence of enzyme:
Peroxidase
• (+) blue color  positive guaiac
• Restrict intake of red meats, some
medications and vitamin C for 3-7 days
• FALSE (+): red meat, raw fruits and
vegetables especially radish, turnip……
ENDOSCOPY
(ESOPHAGOGASTRODUODENUMSCOPY)
- Direct visualization of the esophagus,
stomach and duodenum by insertion of a
lighted fiberscope
- Used to observe structures, ulcerations,
inflammation, tumors, may include a
biopsy
- Explain that a local anesthetic will be used
to ease discomfort ……..
Nursing care: post test
o Keep NPO until return of gag reflex
 o Assess vital signs and for pain,
dysphagia, bleeding
o Administer warm normal saline
gargles for relief of sore throat
COLONOSCOPY
• Endoscopic visualization of the large
intestine- may include biopsy and removal
of foreign substances
Nursing care: pretest
o Keep NPO for 8 hours pretest
o Administer the laxatives for 1-3
days before the exam, and
sometimes enemas until clear the
night before the test
o Ensure consent form has been
signed
o Explain to client that when the
instrument is inserted into the
rectum a feeling of pressure be
experienced.
POST TEST:
OBSERVE FOR RECTAL …….
SIGMOIDOSCOPY
Endoscopic visualization of the sigmoid
colon
- Used to identify inflammation lesion, or
remove foreign bodies LIGHT SUP
- Nursing care: pretest
o Offer light supper and light
breakfast
o Do bowel prep
o Explain to client that the sensation
of an urge to defecate or
abdominal cramping might be
experienced
Nursing care: post test: assess for signs of bowel
perforation
GASTRIC ANALYSIS
- Insertion of a nasogastric tube to examine
fasting gastric contents for acidity and
folume
Nursing care: pretest
o Keep NPO 6-8 hours pretest
o Advise client about no smoking,
anticholinergic medications,
antacids for 24 hours prior to test
o Inform client that tube will be
inserted into the stomach via the
nose, and instruct to expectorate
saliva to prevent buffering of
secretions
Nursing care: post test: provide frequent mouth
care
ORAL CHOLECYSTOGRAM
- Injection of a radiopaque dye and x-ray
examination to visualize the gallbladder
- Used to determine the gallbladder’s ability
to concentrate and store the dye and to
assess patency of the biliary duct system
- Nursing care: pretest
o Offer a low-fat meal the evening
before the test and black coffee,
tea, or water the morning of the
exam
o Check for iodine sensitivity and
administer dye tablets (Telepaque)
as ordered
Nursing care: post test: observe for side effects of
the dye (nausea and vomiting, diarrhea)
LIVER BIOPSY (CLOSED NEEDLE)
- Invasive procedure where a specially
designed needle is inserted into the liver
to removed a small piece of tissue for
study
- A small slender core of tissue is removed
with a biopsy needle
Nursing care: pretest
o Ensure client has signed consent
form
 o Keep NPO 6-8 hours pretest BACK

o Instruct client to hold breath during 1. Pancreatitis

the biopsy
2. Penetrating duodenal ulcer
- Nursing care: post test
3. Pancreatitis, renal colic
o Assess vital signs every hour for 8-
12 hours 4. Rectal

o Place client on right side for a few MAJOR DISORDERS

abdomen to provide pressure on
1. Nausea
the liver
• is a feeling of discomfort in the
o Observe puncture site for
epigastrium with a conscious desire to
hemorrhage
vomit
o Assess for complications of shock
• may occur with or prior to vomiting
and pneumothorax
2. Vomiting
Nursing diagnosis:
• Is a forceful ejection of the stomach
1. Risk for fluid volume def
contents from the upper GI tract
2. Body image disturbance
• The emesis center in the medulla may be
3. Altered nutrition: less than body stimulated
requirements
Other contributing factors:
4. Diarrhea
• Contributing factors include GI disease,
5. Constipation CNS disorders, circulatory problems,
metabolic disorders, side effects of some
6. Pain meds, pain, psychic trauma and motion

7. Ineffective breathing pattern • May have weakness, fatigue, pallor,

possible lethargy & S/S of dehydration
8. Impaired skin integrity
• Increased BUN
Common organs of referred abdominal pain

FRONT • Decreased Na, Ca & K

1. Liver EATING DISORDERS

2. Heart 1. Pica- persistent eating of non-edible

substances such as plaster, paint, or sand
3. Renal colic
2. Bulimia nervosa- binge eating with
4. Biliary colic ingestion of large amounts of food in a
short time and followed by self-induced
5. Appendicitis vomiting
6. Colon pain - May be accompanied by affective
disorders and fear of being unable to stop
7. Small intestine pain
this behavior
8. Ureteral colic
- Manifested by fluctuations in weight
9. Cholecystitis, pancreatitis, duodenal ulcer caused by binges of eating and fasting
 3. Anorexia Nervosa- is the refusal to eat
or an aberration in eating patterns
resulting in severe emaciation which
eventually becomes a life threatening
condition
• Clients have an extreme fear of becoming
fat
• They also have a body image disturbance
where the clients claim to feel fat even if
already extremely thin
• Most common in adolescent and young
adult females
• 20% mortality rate
• With 15% or >weight loss, electrolyte
imbalances, depression & preoccupation
with being thin
• Has an inability to recognize the degree of
his/her own emaciation
• With social withdrawal and poor family
and individual coping skills
• Usually an academic and athletics
achiever
• May also have amenorrhea
Nursing implications
• Monitor VS, electrolytes, I &O
• Weigh at the same time 3x/week
• Avoid comments on the clients weight
• Set limits allotted for eating
• Accurately record the amount of food
eaten and stay with the client during
meals
• Accompany the client at least 30 mins
after eating to prevent self-induced
vomiting
4. Diarrhea- caused by chronic bowel
disorders, malabsorption, intestinal
infections, biliary tract disorders,
hyperthyroidism, saline laxatives, Mg-
based antacids, stress, antibiotics,
neoplasm, and highly seasoned foods
• May have abdominal cramps distention,
foul smelling and water stools, increased
peristalsis, anorexia, thirst, tenesmus and
anxiety
• May have decreased serum K and Na
• Stomatitis- discussed in oncology topic
Nursing Intervention
1. Increase fluid intake- ORESOL
2. Determine and manage the cause
3. Anti-diarrheal drugs
5.Constipation- lengthening of the normal
time period between bowel movements 2o to
decreased motility of the colon or from feces
retention in the colon or rectum 2o to an
inadequate bulk/liquids in the diet, lack of
physical activity, retention of barium after
radiographic exam, prolonged usee of
constipation meds like aluminium-based
meds, anticholinergics, antihistamines,
antidepressants, phenothiazines, Ca & Fe
* Feeling of abdominal fullness, pressure in
the rectum, abdominal distension, dyschezia,
increased flatus and hardened stool on DRE
COMMON GIT SYMPTOMS AND
MANAGEMENT
CONSTIPATION: pathophysiology
• Interference with three functions of the
colon
1. Mucosal transport
2. Myoelectric activity
3. Process of defecation
Nursing interventions:
1. Assist physician in treating the underlying
cause of constipation
2. Encourage to eat high fiber diet to
increase the bulk
3. Increase fluid intake
 4. Administer prescribed laxatives, stool 7. Weakness and dizziness
softeners
8. Hypoglycemia
5. Assist in relieving stress
Nursing interventions:
6. Jaw fractures- may be 2o to trauma from
a VA or an assault 1. Advise px to eat low-CHO, high fat and
high-CHON diet.
• May be accompanied by blow-out
fractures of the orbit 2. Instruct to eat small, frequent meals,
include more dry items.
• Fracture is surgically repaired by wires
3. Instruct to avoid consuming fluids with
and rubber bands or via the use of
meals.
interosseous wires
4. Instruct to lie down after meals
7. CA of the Mouth- may occur on the lips or
within the mouth (tongue, floor of the 5. Administer anti-spasmodic medications to
mouth, buccal mucosa, hard/soft palate, delay gastric emptying.
pharynx and tonsils
• Pernicious anemia
• Most common type is squamous cell CA
o Results from deficiency of vit. B12
COMMON GIT SX’S AND MANAGEMENT: due to autoimmune destruction of
the parietal cells, lack of intrinsic
1. Dumping syndrome
factor.
- A condition of rapid emptying of the
Assessment:
gastric contents into the small intestine
usually after a gastric surgery. - Severe pallor

- Symptoms occur 30 minutes after eating. - Fatigue

Patho: - Weight loss

The rapid influx of the stomach contents  will - Smooth beefy red tongue
cause distension of the jejunum  early
- Mild jaundice
symptoms  the hy pertonic chyme will draw
fluid from the BV’s to dilute the high - Paresthesia of extremities
concentrations of CHO and electrolytes 
hypovolemia  later, there is increased blood - Balance disturbance
glucose stimulating the increased secretion of
Interventions:
insulin  blood glucose will fall  causing
reactive hypoglycaemia. - Lifetime injection of vit. B12 weekly
initially, then monthly.
Assessment:

1. Nausea and vomiting

CONDITIONS OF UGIT:
2. Abdominal fullness
1. Hiatal hernia
3. Abdominal cramping
- Protrusion of the esophagus through an
4. Palpitation
opening.
5. Diaphoresis
Two types:
6. Drowsiness
• Sliding hiatal hernia (most common)
 • Axial hiatal hernia. Interventions:

Assessment: 1. Monitor VS strictly. Note for signs of shock

- Heartburn 2. Monitor for LOC

- Regurgitation 3. Maintain NPO

- Dysphagia 4. Monitor for blood studies

- 50% - without symptoms 5. Administer O2

Dx test: 6. Prepare for blood transfusion

- Barium swallow 7. Prepare to administer vasopressin and

nitroglycerin
Interventions:
8. Assist in NGT and Sengstaken-Blakemore
- Provide small frequent feedings tube insertion for balloon tamponade.

- Avoid supine position for 1 hour after 9. Prepare to assist in surgical management:
eating
a. Endoscopic procedures
- Elevate the head of the bed on 8-inch
block b. Variceal ligation

- Provide pre-op and post-op care. c. Shunt procedures

Gastroesophageal reflux disease (GERD)

2. Esophageal varices - Backflow of gastric contents into the

esophagus.
- Dilation and tortuosity of the
submucosal veins in the distal esophagus. Factors:

- Etiology: commonly caused by portal 1. Usually due to incompetent lower

HPN secondary to liver cirrhosis esophageal sphincter, pyloric stenosis or
motility disorder.
- This is an emergency condition.
2. Sx’s may mimic angina or MI.
Assessment:
Pathophysiology:
- Hematemesis
• Incompetent lower esophageal sphincter
- Melena
 regurgitation of acidic content 
- Ascites erosion of esophageal mucosa 
pain/esophagitis  failure of esophageal
- Jaundice sphincter in closing.

- Hepatomegaly/splenomegaly Assessment:

- Signs of shock: tachycardia, hypotension, - Heartburn

tachypnea, cold clammy skin and
narrowed pulse pressure. - Dyspepsia

Dx procedures: - Regurgitation

- Esophagoscopy - Epigastric pain

 - Difficulty swallowing - Etiology: chronic – ulceration, bacteria,
autoimmune disease, dit, alcohol,
- Ptyalism smoking.

Dx test: Patho:

- Endoscopy Insults  cause gastric mucosal damage 

- Barium swallow inflammation, hyperemia and edema 
superficial erosions  decreased gastric
- Gastric ambulatory pH analysis: secretions, ulcerations and bleeding.

o Note for the pH of the esophagus, Assessment (acute):

usually done for 24 hrs.
- Dyspepsia
o The pH probe is located 5 inches
above the lower esophageal - Headache

- Anorexia

Interventions: - Nausea and vomiting

Assessment (chronic):
1. Instruct to avoid stimulus that increases
stomach pressure and decreases GES - Pyrosis
pressure.
- Singultus (hiccups)
2. Instruct to avoid alcohol, spices, coffee,
tobacco and carbonated drinks. - Sour taste in the mouth

3. Instruct to eat low-fat, high fiber, bland - Dyspepsia

diet.
- N/V/Anorexia
4. Avoid foods and drinks two hours before
bedtime. - Pernicious anemia

5. Elevate the head of the bed within Dx procedure:

approximately 8-inch block.
- EGD – to visualize the gastric mucosa for
6. Administer prescribed H2-blockers (one to inflammation
two hours before or one hour after), PPI
- Low levels of HCl.
(20mg. 2x a day or 40 mg 2x a day
continuously) and prokinetic meds like - Biopsy to establish correct diagnosis
cisapride, metochlopromide. whether acute or chronic.

7. Advise proper weight reduction. Inteventions:

Prevacid – fast dissolving tablet. - Bland diet

- Monitor for signs of complications such as

bleeding, obstruction and pernicious
Gastritis
anemia
- Inflammation of the gastric mucosa
- Instruct to avoid spicy foods, irritating
- May be acute or chronic foods, alcohol and caffeine.

- Etiology: acute – bacteria, irritating foods, - Administer prescribed meds – H2 blockers,

NSAIDS, alcohol, bile and radiation antibiotics, mucosal protectants
 - Inform the need for vit. B12 injection if - Hematemesis
deficiency is present.
- Weight loss
CONDITIONS OF THE STOMACH
Interventions:
Peptic ulcer disease
- Bland diet, small frequent meals during
- An ulceration of the gastric and duodenal the active phase of the dse.
lining
- Administer prescribed medications
- May be referred as to location as gastric
ulcer in the stomach, or duodenal ulcer in - Monitor for complications of bleeding,
the duodenum perforation and intractable pain

- Most common peptic ulceration: anterior - Provide teaching about stress reduction
part of the upper duodenum. and relaxation.

Patho: Surgical procedures:

• Disturbance in acid secretion and mucosal - Total gastrectomy, vagotomy, and gastric
protection resection, Billroth I and II, Pyloroplasty.

Post-op:
• increased acidity or decreased mucosal
resistance  erosion and ulceration 1. Monitor vital signs
• Infection with H. Pylori 2. .

• Ulceration of the gastric mucosa 3. .

Risk factors: 4. .

• Stress, smoking, NSAIDS abuse, alcohol, 5. .

H. Pylori infection, type A personality and
Hx of gastritis 6. Monitor I and O, IVF

• Incidence is high in older adults 7. Maintain NGT

8. Diet progress: clear liquid -> full liquid ->

• Acid secretion is normal
six bland meals
Gastric ulcer patho:
9. Manage DUMPING SYNDROME
1. Decreased mucosal protection
INGESTION PROBLEMS
2. Infection with H. Pylori
CLEFT LIP AND PALATE
3. Decreased blood…
- Congenital defect
Assessment:
- Cleft lip (hare lip) – incomplete fusion of
- Epigastric pain facial process; may be small notch in the
upper lip (incomplete) or extend to nasal
o Characteristic: gnawing, sharp pain septum and dental ridge (complete); may
in the mid-epigastrium 1-2 hours be unilateral or bilateral
after eating, often not relieved with
food intake - Cleft palate – fissures in soft and/or hard
palate and alveolar ridge; may be midline,
- Nausea uni/bilateral.

- Vomiting is more common

 - Cleft lip – if only skin tissue is affected, 3. Risk for infection r/t surgical incision.
one speaks of cleft lip. Cleft lip is formed
in the top of the lip as either a small gap TRACHEOESOPHAGEAL FISTULA
or indentation in the lip or continues into
- Communication of the esophagus and
the nose. Lip cleft can occur as one sided
trachea
or two sided. I
- Maternal hydramnios and prematurity
Cause: unknown, multifactorial inheritance,
chromosomal abnormalities, maternal alcoholism - S/Sx: 3 C’s, dyspnea, excessive secretion,
or drug ingestion, prenatal infection abdominal distension.

ASSESSMENT: DIAGNOSIS:

- Infant’s ability to suck or swallow - Barium swallow

- Nutritional status NURSING CARE:

- Parent’s reaction to birth of an infant with Pre-op:

a facial defect
1. Suction the baby regularly
- Hx of maternal alcohol intake, drug
ingestion and prenatal. 2. Elevate head

NURSING DIAGNOSIS: (Pediatric) 3. Gastrostomy feeding

A. Cleft Lip and Cleft Palate 4. Hydration

1. Risk for imbalanced nutrition less than 5. Oxygen

body requirements related to feeding
problems. Post-op:

2. Risk for ineffective airway clearance 1. Observe for respiratory distress

related to oral surgery.
2. Proper positioning – avoid hyperextension
TRACHEOESOPHAGEAL ATRESIA/FISTULA of neck

- Prematurity due to hydramnios 3. Continue suction

- Excessive salivation 4. Prevent wound infection

- 3 C’s of TEF: coughing, choking, cyanosis 5. Provide pacifier (may develop colic)

- Apnea PYLORIC STENOSIS

- Increased respiratory distress after - Narrowing of the pylorus caused by the

feeding hypertrophy of circular muscle fibers;
more commonly affects first born white
- Abdominal distension males, 2 wks or 3 mos. Of age.

- Vomiting: amount, color and consistency,

time
NURSING DIAGNOSIS:
- Classic signs:
1. Risk for imbalanced nutrition (less)
related to inability for oral intake o Projectile vomiting (not bile-
stained)
2. Risk for infection r/t aspiration/seepage
of stomach secretions into the lungs o Observable left to right gastric
peristaltic waves
 o Palpable, olive-sized mass of life demonstrating steady weight gain
and is free from infection.
- Metabolic alkalosis, caused by the loss of
HCl and K. 2. Cleft palate: usually 12-18 months of age
to allow for bone growth and changes in
- Hypertrophy/hyperplasia of pyloric contour of palate.
sphincter, males
3. TEF: gastrostomy to keep the stomach
SIGNS AND SYMPTOMS: empty of secretions and prevent reflux
into the lungs: closing the fistula and
- Nonbillous vomiting, s/sx of dehydration anastomosing esophageal segments.
and wt. loss, abdominal distention , olive-
sized mass RUQ, visible persitalsis A. Pre-op, child will maintain adequate
nutrition and will not aspirate fluids.
DIAGNOSIS:
1. Feed slowly in upright position; use
- X-ray – string sign, USG, endoscopy one of the ff: soft nipple with large or
cross-cut opening, asepto syringe, cup
TREATMETNT:
for older infant.
- Surgery
2. For infants with cleft palate be careful
NURSING DX: not to place nipple inside cleft.

1. Risk for deficient fluid volume 3. Burp frequently

2. Risk for infection 4. Rinse mouth after feedings to keep

lip/palate cleansed
NURSING CARE:
5. Teach parents how to feed and burp
1. Hydration infant

2. Pacifier 6. Teach parents use and care of palate

prosthesis.
3. May give thickened feedings on upright
position then NPO before surgery B. Post-op, child will maintain patent airway.

4. Monitor I and O, weight and vomiting 1. Observe for respiratory distress; assist
in respiratory effort by positioning
Post-op: child to facilitate breathing; aspirate
oral secretions gently from the sides of
1. Dropper feeding 4-6 hours after surgery
the mouth
45 min – 1 hr. duration; oral rehydration
solution then half strength 2. Cleft palate: place in mist tent
breastmilk/formula at 24 hr. interval.
3. Position infant to provide drainage of
2. Side-lying position mucus and to prevent trauma to
suture lines
3. Monitor wt. and return of peristalsis
- Cleft lip repair: on side or in infant seat
4. Wound care
- Cleft palate repair: on side or abdomen
5. Pacifier for oral needs

PLANNING/INTERVENTION: 4. Keep oxygen and suction equipment at

bedside: suction only if assessment
Surgical treatment: reveals sign of airway obstruction.

1. Cleft palate: z-plasty surirgical technique, C. Post-op, child will be free from trauma and
usually repaired within the first 3 months infection of suture lines
 1. Monitor VS including temp. Q4H. Liver Cirrhosis

2. Minimize crying by holding and - A chronic, progressive disease

soothing infant as needed. Do not use characterized by a diffuse damage to the
pacifiers. hepatic cells

3. Put elbow restraints on child; remove - The liver heals with scarring, fibrosis and
one at a time Q2H for ROM exercises. nodular regeneration

4. Position as stated above - Etiology: post-infection, alcohol, cardiac

diseases, schisostoma, biliary obstruction
5. Maintain Logan bar on upper lip to
decrease tension on suture line. - Liver physiology and pathophysiology

6. Cleanse suture lines after feeding with Normal function Abnormality in

sterile swabs and solution (diluted function
hydrogen peroxide) as ordered to limit 1. Stores =hypoglycemia
crusting and inflammation. glycogen
2. Synthesizes = hypoproteinemia
- Cleft lip: roll applicator without rubbing proteins
3. Synthesizes = decreased
- Cleft palate: rinse with sterile water after globulin antibody formation
feeding 4. Synthesizes = bleeding
clotting factors tendencies
7. Apply antibiotic ointment to lip suture 5. Secreting bile = jaundice and
pruritus
lines as prescribed.
6. Converts = hyperammonemia
ammonia to
8. Encouraged parents to stay with infant
urea
and participate in care.
7. Stores vit and = deficiencies of vit
minerals and min
DIAPHRAGMATIC HERNIA
8. Metabolizes = gynecomastia,
estrogen testes atrophy
- Herniation of intestinal content into the
thoracic cavity
Portal hypertension
- Left side
1. Compression of the intra-liver vessels
SIGNS AND SYMPTOMS:
2. Decreased protein (colloid pressure)
- Respiratory difficulty, cyanosis,
retractions, (-) breath sounds affected 3. Increased hydrostatic pressure
side, scaphoid abdomen.
Assessment findings
COMPLICATION:
1. Anorexia and weight loss
- Pulmonary HPN
2. Jaundice
TREATMENT:
3. Fatigue
- Emergency surgery
4. Early morning nausea and vomiting
CIRRHOSIS
5. RUQ abdominal pain
- Chronic degenerative disease of the liver
causing inflammation, destruction, fibrotic 6. Ascites
regeneration and hepatic insufficiency
7. Signs of portal hypertension
CONDITION OF THE LIVER
Nursing interventions
1. Monitor VS, I and O, abdominal girth, paracentesis abdominal
weight, LOC and bleeding pressure
6. Administer
2. Promote rest. elevated the head of the medications:
bed to minimize dyspnea •Diuretics, neomycin,
lactulose
3. Provide moderate to LOW-protein • Albumin, amino
(1kg/kg/day) and LOW-sodium diet acid Vitamin K

4. Provide supplemental vitamins (especially

K) and minerals Monitor for complications:

5. Administer prescribed: • Hepatic encephalopathy – asterixis (jerky

movements), changes in LOC
a. Diuretics – to reduce scites and
edema • Bleeding

b. Lactulose – to reduce NH4 in the • Infection

bowel o(give at night before
sleeping or early in the morning) GASTROENTERITIS

c. Antacids – to prevent ulcer and ASSESSMENT

bleeding
- Feeding technique and formula
d. Neomycin – to kill bacteria flora preparation
that cause NH production.
- Types of diarrhea:
6. Avoid hepatotoxic drugs:
1. Mild: weight loss of 5% or less; stools
a. Paracetamol are loose, runny, usually brown and
brownish-yellow.
b. Anti-tubercular drugs
2. Severe: explosive, green, watery
7. Reduce the risk of injury: stools, 10-12x/day; weight loss of 10%
or more
a. Side rails reorientation
- Character of stool (ACCT)
b. Assistance in ambulation
1. Amount: measure or estimate
c. Use of electric razor and soft-
bristled toothbrush 2. Color/consistency

8. Keep equipments ready including 3. Time: frequency, precedents

Sengstaken-Blakemore tube, IV fluids, and
medications to treat hemorrhage. - Associated symptoms: anorexia, nausea,
cramping, abdominal pain, fever,
Nursing interventions Rationale headache
1. Low sodium diet To reduce
edema - Signs of dehydration
2. Low protein diet To reduce NH
production - Change in acid-base balance
3. Benadryl and mild To relieve
soap pruritus 1. Vomiting causes loss of HCl, which
results in metabolic alkalosis

2. Diarrhea causes loss of HCO3, which

4. Pressure onto To prevent
results in metabolic acidosis.
injection site bleeding
5. Assist in Done to relieve
3.
DIAGNOSTIC TESTS: • Abdominal distension (sausage shaped
mass)
1. Stool pH and stool glucose with clinitest
Necrosis: fever, tachycardia, rigid
2. Stool blood with Guaiac or hemoccult
abdomen
3. Stool sample for bacteria culture, ova and
DIAGNOSIS:
parasites
• Sonogram “coiled spring”
ABDSORPTION AND ELIMINATION
TREATMENT:
A. REGIONAL ENTERITS (CROHN’S DISEASE)
• Barium enema (reduction by hydrostatic
- an inflammatory disease……
pressure), surgery
- etiology: unknown
NURSING DIAGNOSIS:
- the terminal ileum thickens, with scarring,
1. Pain r/t abnormal abdominal peristalsis
ulcerations, abscess formation and narrowing
of the lumen. 2. Risk for deficient fluid volume

ASSESSMENT: NURSING CARE

1. Fever 1. Provide comfort measures

2. Abdominal distension 2. NPO

3. Diarrhea 3. Adequate hydration via IVT

4. Colicky abdominal pain 4. Promote parent-infant bonding

5. Weight loss

6. Anorexia D. HIRSCHPRUNG DISEASE

7. Anemia
- Congenital absence of parasympathetic
ganglia of distal colon and rectum,
resulting in inadequate…
B. ULCERATIVE COLITIS
- Five times more frequent in males than in
- Large bowel continuous inflammatory females
process of the mucosa, primarily of the
- Children with down syndrome
colon and rectum.
- Genetic
C. INTUSSUSCEPTION
- Inherited
- Telescoping/invagination of one portion of
the intestine into another, usually - 3-12% chance that another baby they
involving ileo-cecal… have will also have the disease.

SIGNS AND SYMPTOMS: In the neonate:

• Intense abdominal pain 1. No meconium passed

• Vomiting 2. Vomiting – bile-stained or fecal

• Blood in stool “currant jelly” 3. Abdominal distention

4. Constipation – occurs in all patients

 5. Overflow type of diarrhea 1. Gluten intolerance

6. Anorexia, poor feeding 2. Immunoglobulin deficiency

7. Temporary relief with enema

In the older child:

1. Hx of constipation at birth PATHOPHYSIOLOGY:

2. Distention of abdomen – progressice Decreased in amount and activity of enzymes in

enlarging the intestinal mucosal cells causes the villi of the
proximal small intestine to atrophy and decreases
3. Thin abdominal wall with observable intestinal absorption.
peristaltic activity
SIGNS AND SYMPTOMS:
4. Constipation – no fecal soiling, relieved
temporarily with enema • Steatorrhea

5. Ribbon-like stool • Chronic diarrhea

TREATMENT: • Failure to thrive

• Enema or colonic • Anorexia

Surgical: initially, a colostomy or ileostomy is • Malnutrition: weight loss

performed to decompress the intestine, divert
fecal stream, and rest the normal bowel. • Coagulation difficulty
Definitive surgery is done to remove the non-
functioning bowel segment. • Pernicious anemia

DIAGNOSIS: • Acute vomiting and diarrhea

• Rectal exam DIAGNOSIS:

• X-rays • IgA antigliadin Ab, gluten free diet

• Radiopaque markers TREATMENT:

• Barium enema • Gluten free diet, vitamin and iron

supplementation
• Rectal bopsy
NURSING DIAGNOSIS:
• Anorectal manometry
• imbalanced nutrition: less than body
• Ultrasound requirements r/t impaired absorption

E. CELIAC DISEASE – a disease of NURSING INTERVENTION:

unknown etiology
- Nutrition counselling
- Permanent inability to tolerate gluten.
- Eliminate gluten from diet: avoid cereals,
- Poor food absorption bread, cake, cookies, spaghetti, pizza,
instant soup, some chocolates.
- Usually becomes apparent bet. Ages 6-18
months - Give the child: corn and rice products, soy
and potato flour, breast milk or soy –
CAUSES: based formula and fresh fruits.
 o Replace vitamins and calories: give
small, frequent meals
o Monitor for steatorrhea
- Excessive bruising
F. APPENDICITIS (epityphlitis)
- Inflammation of the appendix.
- Your appendix is a small, finger-shaped
pouch that projects out from your colon on
the lower-right side your abdomen.
- Is a condition characterized by
inflammation of the appendix. All cases
require removal of the inflamed appendix,
either by laparotomy or laparoscopy.
Untreated, mortality is high, mainly
because of peritonitis.
MAIN SYMPTOM:
• Pain that typically begins around the navel
and then shifts to the lower right
abdomen. The pain usually increases over
a period of 6 to 12 hours, and eventually
may become very severe.
• Anyone can develop appendicitis, but it
most often strikes people between the
ages of 10 and 30 and is one of the most
common reasons for emergency
abdominal surgery.
TREATMENT:
• The standard treatment for appendicitis is
surgical removal of the appendix. In many
cases the surgery is straightforward, and
you recover quickly. But if your appendix
has ruptured, the surgery may be more
complicated and you’ll take longer to heal.
A ruptured appendix that’s not promptly
treated can lead to serious complications
such as infection. In rare instances a
ruptured appendix can be fatal.
CAUSES:
• Not always clear. Sometimes it’s the result
of an obstruction when food waste or a
hard piece of stool becomes trapped in an
orifice of the cavity that runs the length of
your appendix.
• Appendicitis may also follow an infection,
such as a gastrointestinal viral infection,
or it may result from other types of
inflammation. In both cases, bacteria may
subsequently invade rapidly, causing the
appendix to become inflamed and filled
with pus. If not treated promptly, your
appendix eventually may rupture.
SIGNS AND SYMPTOMS:
• Appendicitis can cause a variety of
symptoms that may change over time.
The most common early symptom is an
aching pain around your navel that often
shifts later to your lower-right abdomen.
As the inflammation in your appendix
spreads to nearby tissues, especially the
inner lining of your abdomen, the pain
may become sharper and more severe.
• Nausea and vomiting
• Loss of appetite
• Low-grade fever that starts after other
signs and symptoms appear
• Constipation
• And inability to pass gas
• Diarrhea
• Abdominal swelling
• Fever
SYMPTOMS
Migratory right iliac 1 point
fossa ain
Anorexia 1 point
Nausea and vomiting 1 point
Signs
Right iliac fossa 2 points
tenderness
Rebound tenderness 1 point
Fever 1 point
 • Nursing considerations:

Laboratory o Check renal status

Leucocytosis 2 points o Check elimination pattern

Shift to left (segmented 1 point
o Give antacids ahead before other
neutrophils)
meds, 1 hr before or 2 hrs after
Total 10 points
• Side effects:

o Chalky taste
MANAGEMENT:
o Diarrhea
Post-op:
o Constipation
• Patient in supine position
2. H2 receptor antagonists – Blocks H2
• Most important physical examination receptors to prevent attachment of
finding is right lower quadrant tenderness histamine in the parietal cells
to palpation
• Uses:
• CBC, urinalysis
o To treat GERD
• Acute appendicitis – appendectomy
o Duodenal ulcers
Pre-op:
o Zolinger-Ellison syndrome
• Cefuroxime and metronidazole to kill
bacteria o PUD prophylaxis

• Spinal anesthesia (epidural) 3. PPI – inhibits gastric acid pump of parietal

cells
DRUGS TO TREAT ORAL DISORDERS:
• Uses:
1. Dentifrices “toothpaste”
o Severe esophagitis
- Contains abrasive agents
o GERD
- Foaming agents and flavoring material
o Gastric/duodenal ulcers
- Fluoride
o Zolinger-Ellison syndrome
- Antibacterial agents
o Eradicate H. Pylori together with
- Whiteners antibiotics
2. Mouth wash
4. Coating agents – forms a complex that
- Temporary effective in removing adheres to the crater of an ulcer,
disagreeable tastes and reducing halitosis protecting it from aggravators such as
acid, pepsin and bile salts
DRUGS TO TREAT GERD AND PUD:
• Uses:
1. Antacids – buffers the HCl acid to lower
hydrogen ion concentration o Duodenal ulcers

• Uses: heartburn, excessive eating and

drinking, PUD
 5. GI prostaglandins – Inhibit gastric acid and in neurokinin-1 receptor int the CNS and
pepsin secretion to protect the stomach GIT.
and duodenal lining against ulceration.
• Uses:
• Uses:
o Aprepitant – treatment of acute
o Prevent and treat gastric ulcers and delayed chemotherapy-
induced nausea and vomiting
6. Prokinetic agents – gastric stimulant; caused by highly emetogenic
increases lower esophageal pressure thus antineoplastic agents
reducing reflux, increases stomach
contractions, relaxes the pyloric valve, 5. Dopamine agonists – inhibits dopamine
increases peristalsis. receptors; part of the pathway to the
vomiting center.
• Uses:
• Nursing considerations:
o …
o Watch for the mental status of the
7. Antispasmodic agents – anticholinergic client.
effect
6. Serotonin antagonists – blocks 5-HT3
• Uses: receptor in the medulla and GIT
suppressing N and V.
o To treat colic
• Nursing consideration:
o Bowel syndrome
o Watch for mental status of the
o Biliary spasm client.
o Mild ulcerative colitis 7. Anticholinergic agents – counterbalances
excessive amount of acetylcholine in the
o Diverticulitis…
vomiting center from the vestibular
DRUGS TO TREAT NAUSEA AND VOMITING, network of the inner ear
CONSTIPATION, DIARRHEA
• Uses:
1. Benzodiazepine – act as an antiemetic
o To treat motion sickness
through a combination of effects including
sedation.
8. Corticosteroids – unknown MOA
• Uses:
- Inhibits emesis
o Reduces frequency of vomiting
Examples:
2. Laxatives – 1. Dexamethasone and methylprednisolone
• Uses: “BLAND SAC”
o

3. Anti-diarrheal – absorbs excess water to

form stool and to absorb irritants or
bacteria.

4. Neurokinin 1 receptor antagonist – blocks

the effect of substance p neurotransmitter