Nursing Management and Disorders of the GI Tract

Nursing Management of Patients Receiving Enteral Nutrition

• Nursing Process Framework

  • Assessment of nutritional status is critical.
  • Education on nutrition is paramount, considering cultural competence and social determinants of health.

• Administration Techniques

  • Enteral nutrition can be delivered via tube to the stomach, duodenum, or jejunum.
  • Delivery methods include:
    • Continuous infusion
    • Cyclic feeding
    • Intermittent feeding
    • Bolus feeding

Types of Diets

• Modified Diets: Changes made to a basic diet to meet patient needs.
  • Clear Liquid Diet
  • Full Liquid Diet
  • Pureed Diet
  • Soft Diet: Low-fiber options for easier digestion.
  • Mechanical Soft Diet
  • Dysphagia Diet: Specialized diets for patients with swallowing difficulties.

Enteral Nutrition Complications

• Potential complications include:
  • Aspiration pneumonia
  • Nausea/vomiting and abdominal discomfort
  • Diarrhea or constipation
  • Dumping syndrome
  • Electrolyte imbalances

Parenteral Nutrition

• Indications for Use: When enteral nutrition is insufficient due to conditions like:

  • Severe burns
  • Malnutrition
  • Short-bowel syndrome
  • Cancer or sepsis

• Administration Routes: Nutrition provided via peripheral or central venous access.

• Nursing Considerations: Include:

  • Monitoring for solution integrity and blood glucose levels.
  • Ensuring sterility and managing fluid overload risks.

Peptic Ulcer Disease

• Types:

  • Acute Peptic Ulcer: Short duration, superficial erosion, resolves with removal of cause.
  • Chronic Peptic Ulcer: Long duration with muscular wall erosion and scar tissue formation.

• Etiology: Common causes include:

  • H. pylori infection
  • NSAIDs use
  • Genetic factors

• Clinical Manifestations:

  • Gastric Ulcers: Weight loss, immediate pain, vomiting, high risk for hemorrhage.
  • Duodenal Ulcers: Weight gain, pain 2-3 hours post meal, vomiting, melena.

• Complications: Includes hemorrhage, perforation, and pyloric obstruction.

• Nursing Goals:

  • Ensure no active PUD or H. pylori infection, maintain pain control, educate on prevention of GI bleed.

Inflammatory Bowel Disease (IBD)

• Categories:

  • Crohn’s Disease: Involves all bowel segments; edematous, thickened with cobblestone ulcerations.
  • Ulcerative Colitis: Begins in rectum and moves up the colon, leading to bloody diarrhea and abdominal pain.

• Diagnostic Tests:

  • CBC for anemia, CRP & ESR for inflammation, Endoscopy/Colonoscopy for intra-luminal assessment.

• Management Goals:

  • Reduce inflammation
  • Decrease flare-ups
  • Improve quality of life

• Nursing Implications:

  • Monitor fluids, electrolytes, and I&O.
  • Educate on diet (high protein, high calorie) to address malnutrition risks.
  • Identify symptoms signaling complications and weight regularly.

• Medication Classes:

  • Aminosalicylates: Used for mild disease.
  • Corticosteroids: Treat acute flares, not for long-term use.
  • Immunomodulators: For steroid-dependent patients.

• Surgical Options:

  • Crohn’s: Resection and strictureplasty.
  • Ulcerative Colitis: Colectomy for severe cases.

Evaluation

• Ensure exacerbations are reduced and manageable, monitor for quality of life, maintain effective immune suppression, and ensure maintenance of body image.