Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and

coordination (Acute and Chronic)

NCM 116 SKILLS

NUTRITIONAL METABOLIC PATTERN

The ABDOMINAL examination

The sequence to follow is:

• Inspection
• Auscultation
• Percussion
• Palpation

Imaginary division of abdomen

Techniques of Examination

• Good light & a relaxed & well-draped patient with

exposure of the abdomen from just above the
xiphoid process to the symphysis pubis The
groin should be visible.
• The genitalia should remain draped.
• The abdominal muscles should be relaxed to
enhance all aspects of the examination.
• Stand at the patient’s right side & proceed in an
orderly fashion with IAPePa.
• Assess the liver, spleen, kidneys & aorta.

BARRETTA, TRIXIE MAE M. BSN III-B

 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS
Tips for Enhancing Examination of the Abdomen The contour of the abdomen

• The patient has an empty bladder. • Is it flat, rounded, protuberant or scaphoid

• Comfortable in the supine position. (markedly concave or hollowed)?
• Keep the arms at the sides or folded across the • Do the flanks bulge or are there any local
chest. bulges? Also survey the inguinal & femoral
- If the arms above the head, the abdl wall areas.
stretches & tightens, making palpation o Bulging flanks of ascites; suprapubic bulge
difficult. of a distended bladder or preg uterus;
• Before you begin palpation, ask the patient to hernias
point to any areas of pain so you can examine o Is the abdomen symmetric?
these areas LAST. - Assymetry from an enlarged organ or mass
• Warm your hands & stethoscope. • Are there visible organs or masses? Look for an
- Rub them together of place under warm enlarged liver or spleen that has descended
water. below the rib cage.
- Palpate also through the patients gown to o Lower abdl mass of an ovarian or a uterine
absorb warmth from the patient’s body tumor
• Approach the patient calmly & avoid quick,
Peristalsis
unexpected movements.
- Watch the patients face for any signs of pain • Observe for several minutes if you suspect
or discomfort. intestinal obstruction.
• Distract the patient if necessary, with • Peristalsis may be visible normally in very thin
conversation or questions. people.
o Increased peristaltic waves of intestinal
INSPECTION
obstruction.
Inspect the surface, contours, & movements of the
AUSCULTATION
abdomen, including the following:
Provides important information about bowel
The skin. Note:
motility.
• Scars – describe or diagram their location Listen to abdomen before performing
• Striae – old silver or stretch marks are normal percussion or palpation because these
o Pink – purple striae of Cushing’s maneuvers may alter the frequency of bowel
syndrome sounds.
• Dilated veins – a few small veins may be visible May also reveal bruits, or vascular sounds
normally resembling heart murmurs, over the aorta or
o Dilated veins of hepatic cirrhosis or IVC other arteries in the abdomen.
obstruction
o Rashes & lesions
• Inspect the surface, contours, & movements of
the abdomen, including the following:
o The umbilicus - Observe its contour and
location and any inflammation or bulges
suggesting hernia.

BARRETTA, TRIXIE MAE M. BSN III-B

 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS
Abdominal Bruits ⚫ Tympany

– A clear, hollow sound similar to a drum beating

– Occurs when you percuss over hollow organs

such as an empty stomach or bowel.

⚫ Dull sounds

– Solid organs such as liver, kidney or feces-filled

intestines.

Percuss the abdomen lightly in all four quadrants to

assess the distribution of Tympany & dullness.

– Tympany – gas in the GIT

Place the diaphragm of your stet gently on the – Scattered Dullness – fluid & feces
abdomen.
Listen for bowel sounds & note their frequency & – Any large dull areas – might indicate
character. underlying mass or enlarged organ
Normal sounds consists of clicks & gurgles occuring Light palpation
at an estimated frequency of 5 – 34 per minute.
Occasionally you may hear – Helpful for
BORBORYGMI – prolonged gurgles of identifying
hyperperistalsis – the familiar “stomach growling”. abdominal
Listening in one spot such as the right lower tenderness,
quadrant is usually sufficient. muscular
– Bowel sounds may be altered in resistance & some
diarrhea, intestinal obstruction, superficial organs
paralytic ileus and peritonitis. & masses

PERCUSIION – It also serves to

reassure & relax
the patient.

– When moving your

hand from place to place, raise it just off the
skin.

Assessment for Peritoneal Inflammation

⚫ Usually manifested by abdominal pain &

tenderness associated with muscular spasm.

– ask the patient to cough & determine

where the cough produces pain.

– Then, palpate gently with one finger to

map the tender area.
Two sounds can be shared during percussion:

BARRETTA, TRIXIE MAE M. BSN III-B

 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS
⚫ These gentle maneuvers establish an area of o Early voluntary guarding may be
peritoneal inflammation replaced by involuntary
muscular rigidity.
⚫ If not, look for rebound tenderness.
ACUTE APPENDICITIS
o Press down with your fingers firmly & slowly
then withdraw them quickly.
o Ask the patient “Which hurts more, when I
press or let go?”
- Rebound tenderness caused by rapid
movment of an inflamed peritoneum.

Assessing possible ascites

⚫ Ascites from increased hydrostatic pressure in

cirrhosis, congestive heart failure, constrictive
pericarditis, or inferior vena cava or hepatic vein
⚫ Check the tender area for rebound tenderness.
obstruction; from decreased osmotic pressure
in nephrotic syndrome, malnutrition. ⚫ Check for Rovsing’s sign

⚫ In ascites, dullness shifts to the more – Press deeply & evenly in the LLQ then
dependent side, whereas tympany shifts to the quickly withdraw your fingers.
top.
o If with RLQ pain suggests
Appendicitis

⚫ Look for Psoas sign.

– Place your hand just above the patients

right knee & ask the patient to raise that
thigh against your hand.

⚫ Look for Obturator sign.

– Flex the patients right thigh at the hip with

the knee bent, and rotate the leg internally
Assessing possible Appendicitis at the hip.
⚫ Ask to point to where the pain began & where it o R hypogastric pain constitutes a
is now. Ask the patient cough. positive obturator sign suggesting
– Pain begins near the umbilicus then irritation of Obt. Muscle by an
shift RLQ inflamed appendix.

⚫ Search carefully for an area of local tenderness.

– Localized tenderness anywhere in the

RLQ indicate Appendicitis.

– Feel for muscular rigidity

BARRETTA, TRIXIE MAE M. BSN III-B

 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS
Assessing possible Acute Cholecystitis Common laboratory procedures

⚫ Look for Murphy’s sign ➢ Upper GIT study: barium swallow

– Hook your left thumb or the fingers of your ⚫ Pre-test: NPO post-midnight
right hand under the costal margin at the
⚫ Post-test: Laxative is ordered, increase pt fluid
point where the lateral border of the
intake, instruct that stools will turn white,
rectus muscles intersects with the costal
monitor for obstruction
margin.

– Ask the patient to take a deep breath.

– Watch the patient’s breathing & note the

degree of tenderness.

ACUTE CHOLECYSTISIS

ACUTE PANCREATISIS
➢ Lower GIT study: barium enema

⚫ Examines the lower GI tract

⚫ Pre-test: Clear liquid diet and laxatives, NPO

post-midnight, cleansing enema prior to the test

⚫ Post-test: Laxative is ordered, increase patient

fluid intake, instruct that stools will turn white,
monitor for obstruction

ACUTE DIVERTICULITIS

BARRETTA, TRIXIE MAE M. BSN III-B

 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS

➢ Cholecystography

⚫ Examination of the gallbladder to detect

stones, its ability to concentrate, store and
release the bile

⚫ Pre-test: ensure consent, ask allergies to

iodine, seafood and dyes; contrast medium is
administered the night prior, NPO after
contrast administration

⚫ Post-test: Advise that dysuria is common as the

dye is excreted in the urine, resume normal
activities

➢ Paracentesis
⚫ Removal of peritoneal fluid for analysis
⚫ Pre-test: ensure consent, instruct to VOID and
empty bladder, measure abdominal girth
⚫ Intra-test: Upright on the edge of the bed, back
supported and feet resting on a foot stool
➢ Liver biopsy

⚫ Pretest

⚫ Consent

⚫ NPO

⚫ Check for the bleeding parameters

⚫ Intratest

- Position: Semi fowler’s LEFT lateral to expose

right side of abdomen

⚫ Post-test: position on RIGHT lateral with pillow

underneath, monitor VS and complications like

BARRETTA, TRIXIE MAE M. BSN III-B

 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS
bleeding, perforation. Instruct to avoid lifting
objects for 1 week

CONDITION OF THE ESOPHAGUS

ASSESSMENT Findings in Hiatal hernia

1. Heartburn GASTRIC CANCER

2. Regurgitation

3. Dysphagia

4. 50%- without symptoms

DIAGNOSTIC TEST

⚫ Barium swallow and fluoroscopy

NURSING INTERVENTIONS ⚫ Incidence

1. Provide small frequent feedings – Common between 40 to 70 years old

2. AVOID supine position for 1 hour after eating – Higher in men than women

3. Elevate the head of the bed on 8-inch block ⚫ Dietary factors

4. Provide pre-op and post-op care – high in smoked, salted or pickled foods

BARRETTA, TRIXIE MAE M. BSN III-B

 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS
– Low in fruits & vegetables NURSING ASSESSMENT

⚫ Other factors – Dietary Hx

– Chronic inflammation of the stomach – Recent nutritional intake & status

– H. pylori infection – Weight loss? How much & what over period of
time?
– Pernicious anemia
– Changes in eating habits?
– Smoking
– Loss of appetite?
– Achlorydia
– Feel full after eating?
– Gastric ulcers
– Pain?
– SP subtotal gastrectomy (>20years ago)
– Hx of H. pylori infection?
– genetics
– smoking & alcohol consumption
⚫ Occur anywhere in the stomach but mostly
begin on the lesser curvature – Family Hx of CA

⚫ Infiltrates the surrounding mucosa PSYCHOSOCIAL ASSESSMENT

⚫ Then penetrates the wall of the stomach and – Social support

adjacent organs & structures
– Individual & family coping skills
– Liver, Pancreas, Esophagus &
– Financial resources
Duodenum
NURSING DIAGNOSIS
⚫ Metastasis through lymph to the peritoneal
cavity – Anxiety related to the disease and anticipated
treatment
⚫ Early symptoms
– Imbalanced nutrition, less than body
– Epigastric pain
requirements related to early satiety or
⚫ progressive symptoms anorexia

– Dyspepsia (indigestion) – Pain related to tumor mass

– Early satiety – Anticipatory grieving related to the diagnosis

of cancer
– Weight loss
GOALS
– Abdominal pain just above the
umbilicus – Reduced anxiety

– Loss or decrease in appetite – Optimal nutrition

– Bloating after meals – Relief of pain

– N&V – Adjustment to diagnosis

– Anticipated lifestyle changes

BARRETTA, TRIXIE MAE M. BSN III-B

 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS
REDUCING ANXIETY – Maintaining or gaining weight

– A relaxed, nonthreatening atmosphere ⚫ Signs of dehydration

⚫ Express fears, concerns & possibly – Thirst

anger about the diagnosis & prognosis
– Dry mucous membrane
– Encourage the family or significant other to
– Poor skin turgor
support the patient
– Tachycardia
– Advices about any procedures & treatments
– Decreased urine output
– May suggest to talk with social worker or
spiritual advisor ⚫ Relieving pain
PROMOTING OPTIMAL NUTRITION – Assess frequency, intensity & duration of pain
– Eat small, frequent non-irritating foods – Nonpharmacologic methods
– High in calories ⚫ Position changes
– Vitamins A, C & iron ⚫ Distraction
⚫ For tissue repair ⚫ Relaxation exercises
– Post Gastrectomy ⚫ Backrubs
⚫ Dumping syndrome ⚫ Massage
⚫ Six small feedings daily that are – Analgesics
low in CHO & sugar
PROVIDING PSYCHOSOCIAL SUPPORT
⚫ Fluids between meals rather
than with meals – Let Px express fears, concerns & grief

⚫ Symptoms resolved after several – Answer Px questions honestly

months – Encourage to participate in treatment
⚫ Promoting optimal Nutrition decisions

– Eat small, frequent non-irritating foods – Offers emotional support & involves family
members & significant others
– High in calories
– Seeks also services of clergy, social workers,
– Vitamins A, C & iron psychiatrist if needed
⚫ For tissue repair Gastric CA: Medical Management
– Post Gastrectomy ➢ Tumor markers
⚫ Dumping syndrome ➢ Carcinoembryonic antigen (CEA)
⚫ Post Gastrectomy ➢ Carbohydrate Antigen (CA 19-9)
– Vitamin B12 injection for life (total G) ➢ Tissue biopsy
⚫ Monitors intake & output & daily weight
BARRETTA, TRIXIE MAE M. BSN III-B
 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS
➢ No successful Tx for Gastric CA except REMOVAL
OF TUMOR

➢ Gastric surgery

➢ Total Gastrectomy

Anastomose the end of jejunum to the end of the

esophagus (esophagujejunostomy)

➢ Partial Gastrectomy

Billroth I

Limited resection

Billroth II ASSESSMENT ( for

Wider resection GERD)

75% of the stomach ⚫ Heartburn

➢ Chemotherapy ⚫ Regurgitation

➢ 5-Fluorouracil (5-FU) ⚫ Epigastric pain

➢ Cisplatin NURSING
INTERVENTIONS
➢ Doxorubicin
1. Instruct the patient to AVOID stimulus that
➢ Etoposide increases stomach pressure and decreases GES
pressure
➢ Mitomycin – C
2. Instruct to avoid spices, coffee, tobacco and
➢ Radiation therapy carbonated drinks
3. Instruct to eat LOW-FAT, HIGH-FIBER diet
➢ For palliative Tx in Px with obstruction or GI
4. Avoid foods and drinks TWO hours before bedtime
bleeding
5. Elevate the head of the bed with an approximately
8-inch block
6. Administer prescribed H2-blockers, PPI
CONDITION OF THE STOMACH 7. Advise proper weight reduction
Gastro-esophageal reflux

⚫ Backflow of gastric contents into the esophagus GASTRITIS

⚫ Usually due to incompetent lower esophageal ⚫ Inflammation of the gastric mucosa
sphincter , pyloric stenosis or motility disorder
⚫ May be Acute or Chronic
⚫ Symptoms may mimic ANGINA or MI
⚫ Etiology: Acute- bacteria, irritating foods,
NSAIDS, alcohol, bile and radiation

⚫ Etiology: Chronic- Ulceration, bacteria,

Autoimmune disease, diet, alcohol, smoking

BARRETTA, TRIXIE MAE M. BSN III-B

 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS
NURSING INTERVENTIONS

1. Give BLAND diet

2. Monitor for signs of complications like bleeding,
obstruction and pernicious anemia
3. Instruct to avoid spicy foods, irritating foods,
alcohol and caffeine
4. Administer prescribed medications- H2
blockers, antibiotics, mucosal protectants
5. Inform the need for Vitamin B12 injection if
deficiency is present

PATHOPHYSIOLOGY OF GASTRITIS

⚫ Insults→ cause gastric mucosal damage→ PEPTIC ULCER DISEASE

inflammation, hyperemia and edema→
⚫ An ulceration of the
superficial erosions → decreased gastric
gastric and duodenal
secretions, ulcerations and bleeding.
lining

⚫ May be referred as
to location as Gastric
ulcer in the stomach,
or Duodenal ulcer in
the duodenum

⚫ Most common Peptic

ulceration: anterior
part of the upper
duodenum

PATHOPHYSIOLOGY of PUD
ASSESSMENT (Acute)
⚫ Disturbance in acid secretion and mucosal
⚫ Dyspepsia protection

⚫ Headache ⚫ Increased acidity or decreased mucosal

resistance→ erosion and ulceration
⚫ Anorexia

⚫ Nausea/Vomiting

ASSESSMENT (Chronic)

⚫ Sour taste in the mouth

⚫ Dyspepsia

⚫ N/V/anorexia

⚫ Pernicious anemia

BARRETTA, TRIXIE MAE M. BSN III-B

 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS
GASTRIC ULCER ASSESSMENT (Gastric Ulcer)

⚫ Ulceration of the gastric mucosa, submucosa ⚫ Epigastric pain

and rarely the muscularis
– Characteristic: Gnawing, sharp pain in
the mid-epigastrium 1-2 hours AFTER
eating, often NOT RELIEVED by food
intake, sometimes AGGRAVATING the
pain!

⚫ Nausea

⚫ Vomiting is more common

⚫ Hematemesis

⚫ Weight loss

BARRETTA, TRIXIE MAE M. BSN III-B

 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS
NURSING INTERVENTIONS FOR BLEEDING

1. Maintain on NPO
2. Administer IVF and medications
3. Monitor hydration status, hematocrit and
hemoglobin
4. Assist with SALINE lavage
5. Insert NGT for decompression and lavage
6. Prepare to administer blood transfusion
7. Prepare to give VASOPRESSIN to induce
vasoconstriction to reduce bleeding
8. Prepare patient for SURGERY if warranted

SURGICAL PROCEDURES FOR PUD

⚫ Total gastrectomy

⚫ Vagotomy

⚫ Gastric resection

⚫ Billroth I and II

⚫ Pyloroplasty

SURGICAL PROCEDURES FOR PUD

Post-operative Nursing management

1. Monitor VS
2. Post-op position:
FOWLER’S
3. NPO until
peristalsis returns
4. Monitor for bowel
sounds
5. Monitor for
complications of surgery
6. Monitor I and O, IVF
7. Maintain NGT
8. Diet progress: clear liquid→ full liquid→ six bland
meals
9. Manage DUMPING SYNDROME

BARRETTA, TRIXIE MAE M. BSN III-B

 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS
DUODENAL ULCER ULCER

❖ Ulceration of duodenal mucosa and submucosa

❖ Usually due to increased gastric acidity

APPENDICITIS

⚫ Small, finger-like appendage about 10cm long

⚫ Attached to the cecum just below the ileocecal

ASSESSMENT valve
❖ PAIN characteristic: ⚫ With small
lumen
❖ Burning pain in the mid-epigastrium 2-4
HOURS after eating or during the night, ⚫ Prone to
RELIEVED by food intake obstruction

⚫ Most common
emergency
abdominal
surgery

⚫ Common between ages of 10 & 30 years

⚫ Once occluded (fecalith) or kinked

⚫ Intraluminal pressure increases then initiates a

progressive severe periumbilical pain that
becomes localized to the RLQ for 4-6hours

⚫ Inflamed appendix filled with pus

NURSING INTERVENTIONS

1. Same as for gastric ulceration

2. Patient teaching-avoid alcohol, smoking, caffeine
and carbonated drinks

Take NSAIDS with meals

Adhere to medication regimen

BARRETTA, TRIXIE MAE M. BSN III-B

 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS
⚫ Hallmark S/Sx: ⚫ Diagnostic exams

– Vague epigastric or periumbilical pain – CBC

progresses to RLQ
– Urinalysis
– Low grade fever
– Abdominal X-ray films
– N&V
– UTZ studies
– Loss of appetite
– CT scans
– Local tenderness at McBurney’s point
⚫ Complications
– Rebound tenderness
– Perforation
– If appendix curls around behind the
⚫ Occurs 24 hours after the onset of
cecum, pain & tenderness felt in the
pain
lumbar region
– Peritonitis
– If the tip of appendix is in the pelvis,
pain elicited only during DRE – Abscess formation
– If the resting in the rectal area, pain on ⚫ APPENDECTOMY
defecation
– TOC
– Dysuria, if tip near the UB or ureter

– Rovsings sign

– Psoas sign

– Obturator sign

APPENDICITIS: NURSING MANAGEMENT

⚫ Provide emotional support & needs to ventilate

any fear of surgery

⚫ Montior F & E

⚫ Asses for signs of infections

⚫ Semi fowlers to moderate fowlers position

– To help localize infection if the appendix

ruptures

⚫ Prepares for Surgery

– NPO

– Start IVF

– Antibiotics as ordered
BARRETTA, TRIXIE MAE M. BSN III-B
 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS
⚫ Post surgery ➢ Blood cultures

– High fowlers position: reduce tension on ➢ UTZ

the incision site
➢ Abdominal X-rays
– Pain meds as ordered

– Encourage early ambulation

– Assess return of BM, Bowel, sounds, Flatus

PERITONITIS: NURSING MANAGEMENT

⚫ Maintain the semi-fowlers position

– To localize infection in the pelvic area

⚫ Monitor VS

⚫ Monitor IVF & Gastrointestinal decompression

(NGT)
PERITONITIS
⚫ Monitor I & O
⚫ Inflammation of the peritoneum
⚫ Auscultate for bowel sounds
⚫ Caused by
perforation of – Note passage of flatus
GIT or by
chemical stress ⚫ Antibiotics as ordered
like in
Pancreatitis.
DIVERTICULAR DISEASE
⚫ Hallmark S/Sx

⚫ Abdominal pain

⚫ Rebound tenderness

⚫ Nausea & Vomiting

⚫ Fever

⚫ Rigid abdomen

⚫ Elevated WBC

⚫ Diagnostic exams

➢ CBC

BARRETTA, TRIXIE MAE M. BSN III-B

 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS
⚫ Diverticulum ❑ Nausea and anorexia

– A saclike herniation of the lining of the ❑ Cramping, weakness, bloatedness

bowel
❑ Acute onset of mild to moderate pain
– Extend to the muscle layer
❑ LLQ
⚫ Diverticula
❑ Fever & chills
– Most common at Sigmoid colon (95%)
❑ Septicemia if left untreated
⚫ Diverticulosis
NURSING ASSESSMENT
– Multiple diverticula without
– Onset & duration of pain
inflammation or symptoms
– Hx of constipation with periods of diarrhea

– Dietary habits

– Palpation of LLQ

NURSING DIAGNOSIS

– Constipation related to narrowing of the colon

– Acute pain related to inflammation & infection

COMPLICATIONS

– Peritonitis

❑ Low fiber diet – Abscess formation

❑ Asymptomatic – Bleeding

❑ Unknown GOALS
cause
– Maintenance of normal elimination patterns,
❑ Inflamed pain & absence of complications
diverticulum

❑ Food and
NURSING INTERTVENTION
bacteria
entered the diverticulum ❖ Maintaining Normal Elimination Patterns

❑ Impede drainage & lead to perforation or ❖ Increased fluid intake to 2LPD (if no C/I)
abscess formation
❖ High fiber diet
❑ Leads to peritonitis & erosion of the arterial
❖ Regular exercise
blood vessels resulted to bleeding
❖ Opiod analgesics as ordered
❑ Manifestations
❖ Meperidine (Demerol)
❑ Chronic constipation with intervals of
diarrhea ❖ Antispasmodic agents

BARRETTA, TRIXIE MAE M. BSN III-B

 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS
❖ HNBB – Gastrointestinal Diseases

❖ Assess S/Sx of perforation – Hyperthyroidism

❖ Increased abdominal pain with rigidity – Food poisoning

❖ Elevated WBC

❖ Fever NURSING INTERVENTIONS

❖ Tachycardia 1. Increase fluid intake- ORESOL is the most

important treatment!
❖ Hypotension
2. Determine and manage the cause
❖ Perforation is a surgical emergency 3. Anti-diarrheal drugs

INFLAMMATORY BOWEL DISEASE (IBD)

⚫ Refers to 2 chronic inflammatory GI disorders

– Regional enteritis (Crohns disease)

– Ulcerative colitis

⚫ Unknow cause

⚫ Triggered by

CONSTIPATION – Pesticides exposure

⚫ An abnormal infrequency and irregularity of – Food additives

defecation
– Tobacco & radiation
⚫ Multiple causations
– NSAIDs
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 softeners
5. Assist in relieving stress IBD: CROHN’S DISEASE

⚫ Regional enteritis
COMMON GIT SYMPTOMS AND MANAGEMENT ⚫ Common in adolescents or young adults
Diarrhea ⚫ Commonly affects distal ileum & ascd colon but
⚫ Abnormal fluidity of the stool occur anywhere along the GIT

⚫ Multiple causes ⚫ Common to smokers

BARRETTA, TRIXIE MAE M. BSN III-B

 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS
⚫ Begins with edema & thickening of mucosa ⚫ Ulcerations (cobblestone
appearance)
⚫ Lesions are not continuous, separated by
normal tissue – Endoscopy

⚫ Cobblestone appearance – Colonoscopy

– Clusters of ulcers – Intestinal biopsies

⚫ RLQ pain – CBC

⚫ Diarrhea – Albumin

⚫ Crampy abdominal pains after meals ⚫ Recurrent ulcerative & inflammatory disease of
the colon & rectum
– Weight loss
⚫ May cause Colon CA
– Malnutriion
⚫ Multiple ulcerations of the colonic mucosa
– Secondary anemia
⚫ Bleeding due to ulcerations
⚫ Fever & Leukocytosis
⚫ Contiguous lesions, occurring one after the
⚫ Steatorrhea (excessive fat in the feces)
other

⚫ Disease usually starts at rectum & spreads

proximally to involve the entire colon

DIAGNOSTIC FINDINGS

– Proctosigmoidoscopy

⚫ If with inflamed rectosigmoid

area

– Fecalysis

⚫ Positve Occult blood

⚫ Steatorrhea

– Barium study

⚫ Most conclusive

⚫ Shows classic “STRING SIGN” on

an x-ray film of terminal ileum

BARRETTA, TRIXIE MAE M. BSN III-B

 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS
IBD: MEDICAL MANAGEMENT

❖ Adequate fluid

❖ Diet

❖ Low fiber, high protein, high calorie

❖ IVF if admitted

❖ Avoid milk & milk products

❖ Avoid cold foods & smoking

❖ Antidiarrheal & HNBB

❖ Sulfasalazine

❖ Metronidazole

❖ Corticosteroids

❖ Prednisone if OPD

❖ Hydrocortisone if admitted

❖ Immunomodulators

❖ Azathioprine

❖ Methotrexate

❖ Surgical interventions

❖ Strictureplasty

❖ Blocked or narrowed intestines

are widened

❖ Small Bowel resection

❖ Total colectomy & ileostomy

❖ Procedure of choice in severe

crohn’s disease

❖ Ileostomy

❖ Creation of opening or
stoma in the abdominal
wall

❖ Allows drainage of fecal

matter

❖ Intestinal transplant

BARRETTA, TRIXIE MAE M. BSN III-B

 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS
❖ Proctocolectomy with ileostomy ABDOMINAL HERNIA

❖ Complete resection of colon, ⚫ Protrusion of abdominal contents

rectum & anus
⚫ Acquired or congenital weakness or defect in
IBD: NURSING MANAGEMENT the abdominal wall

❖ Maintaining normal elimination patterns ⚫ Common among males

❖ Ready access to bathroom, commode or ⚫ Types

bedpan
– Umbilical hernias
❖ Antidiarrheal as ordered
– Epigastric hernias
❖ Encourage bed rest
– Spigelian hernia
❖ Relieving pain
– Incisional hernia
❖ Nonpharmacologic

❖ Position changes

❖ Warm application

❖ Diversional activities

❖ Analgesic as ordered

❖ Accurate I&O

❖ Daily weights

❖ Replace fluid loss volume per volume

❑ Umbilical hernias
❖ Stress reductions
❑ Protrusions through the umbilical ring
❖ Small frequent meals. Low fiber diet
❑ Mostly congenital

❑ Acquired

❑ Obesity

❑ Ascites

❑ Pregnancy

❑ Chronic peritoneal dialysis

❑ Epigastric hernias

❑ Occur through linea alba

⚫ Spigelian hernia

– Incisional hernia

BARRETTA, TRIXIE MAE M. BSN III-B

 Care of Clients with problems in nutrition, and gastrointestinal metabolism and endocrine, perception and
coordination (Acute and Chronic)
NCM 116 SKILLS
❑ Spigelian hernia

❑ Defects in the transversus abdominis

muscle lateral to the rectus sheath

❑ Below the level of the umbilicus

❑ Incisional hernia

❑ Through incision from previous

abdominal surgery

❑ Signs & Symptoms

❑ Visible bulge especial when in standing

position

❑ If no palpable hernia, ask the patient to

cough or perform Valsalva maneuver

❑ Vague discomfort

❑ Pain persisted if with strangulation

INGUINAL HERNIAS ❑ Treatment
❑ Inguinal Hernia ❑ Trendelenburg position especially for
inguinal hernia
❑ Occur above the inguinal ligament
❑ Surgical repair
❑ Indirect inguinal hernia, traverse the
internal inguinal ring into the inguinal ❑ Herniorrhaphy
canal
❑ returning the displaced
❑ Direct inguinal hernia extend directly tissues to their proper
forward and do not pass through the position
inguinal canal
❑ Hernioplasty
❑ Femoral hernia
❑ Where a mesh patch is
❑ Occur below the inguinal ligament and sewn over the
go into the femoral canal weakened region tissue

BARRETTA, TRIXIE MAE M. BSN III-B