Comprehensive GI System: Anatomy, Assessment, Diagnostics, and Nursing Care

Major organs of the alimentary canal

the mouth, esophagus, stomach, duodenum, jejunum, ileum, large intestines, and anus.

Accessory organs of the GI tract

the liver, gallbladder, and pancreas.

Essential nursing assessment questions for GI system

include: when was your last bowel movement and what did it look like, history of GI disorders or abdominal surgeries, medications, changes in appetite, weight, stool, pain details (location, feeling, level, triggers/relief), and socioeconomic status.

Physical examination steps for abdomen

inspect, listen, percuss, and palpate.

Importance of psychosocial concerns in bowel movement discussions

Discussing bowel movements is not an everyday topic for everyone, so nurses need to guide patients in questioning and make it a comfortable environment.

Laboratory studies for GI assessment

include CBC (H&H, platelets, WBCs), liver function tests, carcinoembryonic antigen (CEA) for cancer, serum cholesterol and triglycerides, and urinalysis.

Specific stool tests for GI

hemoccult/occult blood stool tests (hematest) and culture and sensitivity for infection.

Purpose of a hydrogen breath test

used for stomach issues to detect bacterial overgrowth by checking hydrogen ion levels after the patient drinks sugar (fructose or lactose).

Upper GI series

(barium swallow) involves the patient swallowing barium sulfate, which highlights the upper GI tract on X-ray.

Lower GI series

(barium enema) involves administering barium rectally as an enema.

Barium as a contrast agent

Both upper and lower GI series use barium as a contrast agent that appears white on X-rays.

Primary nursing priority for endoscopic procedures with conscious sedation

is always maintaining airway.

Risks for lower socioeconomic populations regarding oral disorders

greater risk for oral disorders due to generally not having dental insurance, leading to issues ranging from cavities to oral cancers.

Stomatitis

inflammation of the mouth, with ulcerations (like canker sores or trauma-induced ulcers) being the most common forms.

Treatment for stomatitis

typically responds to topical treatments like Ambesol, and involves protecting the area from trauma.

Common endoscopic procedures

EGD (esophagogastroduodenoscopy), ERCP (endoscopic retrograde cholangiopancreatography), gastroscopy, colonoscopy, sigmoidoscopy/proctosigmoidoscopy, endoscopic ultrasound (EUS), and a video camera pill.

Common laboratory studies for GI assessment

Common laboratory studies include CBC (H&H, platelets, WBCs), liver function tests, carcinoembryonic antigen (CEA) for cancer, serum cholesterol and triglycerides, and urinalysis.

Common forms of stomatitis

include ulcerations like canker sores or trauma-induced ulcers.

Maintaining airway during conscious sedation

Patients are at high risk for aspiration and should be kept on their side if still sleepy post-procedure.

Nutritional problems in nursing assessment

Nutritional problems, allergies, food tolerance (solid vs. soft), family history, and other health problems are important.

Grieving process in patients with bowel issues

Patients with conditions like colon cancer and a colostomy may experience a grieving process, which requires understanding and considerate questioning.

Assessment for stomatitis

Should include recent infections, nutritional changes, oral hygiene habits, oral trauma, stress levels, medication history (including OTC and herbal supplements), and the frequency and impact of outbreaks on nutrition and communication.

Health promotion for stomatitis

Includes educating patients on the importance of seeing a dentist twice a year, addressing nutritional deficiencies, and avoiding oral irritants.

Treatments for stomatitis

Include systemic Diflucan for severe cases, Nystatin as a first-line medication, rinsing the mouth with warm salt water, and using a soft-bristle toothbrush.

Oral candidiasis risk factors in older adults

Increased due to decreased immunity with age, diabetes, malnutrition, stress, multiple medications causing oral dryness, and poor-fitting dentures.

Hiatal hernia

Occurs when a weakness in the diaphragm allows a portion of the stomach to slip up into the thoracic cavity.

Non-surgical management of hiatal hernia

Includes modifying diet (avoiding caffeinated beverages, irritating foods like tomatoes/citrus), sitting up for one to two hours after eating, taking PPIs (protonix, omeprazole, pantoprazole), and losing weight to decrease abdominal pressure.

Gastroesophageal Reflux Disease (GERD)

A condition where gastric contents move up from the stomach into the esophagus.

Causes of GERD

Include slow motility, dysfunction of the esophageal sphincter, and delayed gastric emptying, leading to inflammation and erosion.

Risk factors for GERD

Include obesity, poor diet, tobacco use, delayed stomach emptying, NSAID use, pregnancy (due to pressure), and caffeine consumption (especially coffee).

Diagnostic approaches for GERD

Include barium swallow, EGD, pH monitoring examination, and gastric emptying study.

Barrett's esophagus

A precancerous condition that can occur due to repeated exposure of the esophagus to stomach acid (from GERD).

Primary risk factors for esophageal tumors

Include smoking, obesity, untreated GERD, and excessive alcohol intake.

Difference between peptic ulcer disease (PUD) and GERD

In PUD, there is too much acid in the stomach; in GERD, the acid level in the stomach is normal, but it moves up into the esophagus.

Signs and symptoms of peptic ulcer disease

Include a feeling of fullness, nausea, and abdominal burning.

Medical emergency sign for peptic ulcer disease

A rigid, board-like abdomen with rebound tenderness and pain indicates a perforation, requiring immediate surgery.

Types of ulcers

Can be gastric (in the stomach) or duodenal (in the duodenum).

Signs and symptoms of an upper GI bleed

Include bright red or coffee ground emesis (vomit), paleness, low blood pressure, weak peripheral pulses, decreased H&H (hemoglobin and hematocrit), tiredness, and dizziness.

Esophageal varices

Enlarged, varicose veins in the esophagus that can be very swollen and prone to bleeding.

Dumping syndrome

A significant post-gastric surgery complication where food passes through the patient's GI tract very quickly, leading to poor nutrient absorption.

Hospice care

For patients with less than six months to live.

Palliative care

Focuses on helping with pain and symptom management, regardless of prognosis.

Main purposes of an NG tube

To prevent gastric dilation, provide gastric suctioning, and can be used for gastric lavage (washing out the stomach).

Salem Sump tube

A larger NG tube (often 14-18 French) primarily used for suction, has an air vent, and is typically inserted by a nurse.

Dohoff tube

A very small feeding tube, inserted by a physician, used only for feeding and water flushes.

Indications for gastric suction

Include obtaining a specimen from the stomach, treating an intestinal obstruction, and preventing or treating post-operative distension.

Immediate post-operative nursing priorities for a patient with an NG tube

Airway is always the priority, head of the bed should be elevated at least 30 degrees, and NG tube placement must be checked every 4 to 8 hours.

Key nursing considerations for patients with gastric surgeries involving an NG tube

Include keeping the patient NPO, NG tube suctioning for 2-3 days for gastric decompression, ensuring the NG tube is patent, maintaining semi-Fowler's position, and observing NG tube drainage color and consistency.

Normal NG tube drainage colors

Green and yellow are normal, bright red indicates bleeding unless immediately post-op.

Assessment of bowel sounds

Should be assessed every shift by clamping the NG tube first to avoid suction noise and to check for nausea, vomiting, or pain.

Common gastric surgery complications

Include dehiscence (wound separation), evisceration (protrusion of organs), infection, and perforation.

Overarching priorities in GI nursing

Highlighted in the lecture.

Alimentary Canal

The alimentary canal, or GI tract, includes the mouth, esophagus, stomach, duodenum, jejunum, ileum, large intestines, and anus.

Accessory Organs

The liver, gallbladder, and pancreas are considered accessory organs in the digestive system.

Essential GI Assessment Questions

Essential questions include bowel movement history, medication history (including OTC and herbal), and history of GI disorders or abdominal surgeries.

Physical Assessment Order

The physical assessment order is inspect, listen (auscultate), percuss, and then palpate.

Comfortable Environment for Patients

Nurses should make the environment comfortable for patients when discussing bowel movements.

Grieving Process in Colostomy Patients

Colon cancer patients with a colostomy may experience a grieving process.

Common GI Laboratory Study

A CBC, including H&H and WBCs, is a common GI laboratory study.

Liver Function Tests

Liver function tests are relevant as the liver is an accessory GI organ.

Hydrogen Breath Test

A hydrogen breath test detects bacterial overgrowth in the stomach.

Sugar Solution for Breath Test

For a hydrogen breath test, patients drink a sugar solution like fructose or lactose.

Bowel Movement Inquiry

When was your last bowel movement and what did it look like?

Auscultation Before Palpation

Auscultate the abdomen before palpation.

Herbal Supplements Inquiry

Are you currently taking any herbal supplements?

History of Abdominal Surgeries

Inquire about any history of abdominal surgeries.

Percussion of Abdomen

Percuss the abdomen to check for density or gas.

Hemoccult Tests

Hemoccult/occult blood stool tests are used to detect blood.

Culture and Sensitivity Tests

Culture and sensitivity tests are used for detecting infections.

Serum Cholesterol and Triglycerides

Serum cholesterol and triglycerides are checked as part of common laboratory studies.

Psychosocial Factors in GI Assessment

When assessing a patient's GI system, the nurse should consider psychosocial factors.

Comfort in Discussing Bowel Movements

Creating a comfortable environment is crucial when discussing bowel movements with patients.

CBC Components

A CBC includes hemoglobin and hematocrit (H&H) and white blood cells (WBCs).

Barium Studies

Barium studies are diagnostic procedures used to visualize the GI tract.

GI Diagnostic Tests

Various GI diagnostic tests include breath tests and barium studies.

Barium sulfate

Barium sulfate is used as a contrast agent in both upper GI (swallow) and lower GI (enema) series, appearing white on X-rays.

Barium swallow

A barium swallow involves the patient receiving barium rectally.

Barium appearance on X-ray

Barium appears dark on X-ray images, highlighting blockages.

Endoscopic procedure

An endoscopic procedure involves the use of a video camera pill to examine the gastrointestinal tract.

Conscious sedation

The priority with conscious sedation is always maintaining airway.

EGD

An EGD examines the esophagus, stomach, and duodenum.

Colonoscopy

A colonoscopy is a secondary prevention procedure for colon cancer.

Canker sores

Ulcerations, like canker sores, are common forms of stomatitis.

Primary stomatitis

Primary stomatitis can include herpes simplex virus and traumatic ulcers.

Ambesol

Ambesol is a common topical treatment for stomatitis.

Nursing priority post-endoscopy

The primary nursing priority post-procedure is pain management.

Aspiration risk

Patients at high risk for aspiration should be kept on their side if still sleepy.

Topical treatments for stomatitis

Stomatitis typically responds well to systemic antibiotic treatment.

Socioeconomic factors in oral disorders

Lower socioeconomic populations are at greater risk of oral disorders due to lack of dental insurance.

Nutritional changes

Inquire about recent infections and nutritional changes when assessing a patient with stomatitis.

Oral hygiene habits

Ask about oral hygiene habits and any history of oral trauma when assessing a patient with stomatitis.

Mouth rinse for stomatitis

Advise the patient to rinse their mouth with warm salt water.

Toothbrush recommendation

Recommend using a soft-bristle toothbrush for patients with stomatitis.

Diflucan

First-line treatment for most cases of stomatitis.

Nystatin

Generally the first-line medication for stomatitis.

Warm salt water rinses

Recommended for oral hygiene.

Soft-bristle toothbrush

Recommended for oral hygiene.

Oral candidiasis

Increased risk in older adults due to decreased immunity.

PPIs like omeprazole

Commonly prescribed for hiatal hernia.

Weight loss

Can help decrease abdominal pressure in patients with hiatal hernia.