Summarized GI Disorders

Module V: Introduction to the Care of the Adult Health Client Experiencing Upper and Lower Gastrointestinal Alterations

Learning Outcomes

  • Identify and address learning needs of clients with select upper and lower gastrointestinal and genitourinary disorders. (SLO #1)

  • Discuss legal and ethical issues related to select upper and lower gastrointestinal and genitourinary disorders as appropriate. (SLO #2)

  • Utilize the EMR and appropriate order entry technology to safely care for clients with select upper and lower gastrointestinal and genitourinary disorders. (SLO #3)

  • Apply the nursing process to safely care for clients with select upper and lower gastrointestinal and genitourinary disorders in a lower acuity medical facility. (SLO #4)

  • Utilize evidence-based approach when developing and/or implementing care for clients with select upper and lower gastrointestinal and genitourinary disorders. (SLO #5)

  • Identify resources for professional development regarding the care of clients with select upper and lower gastrointestinal and genitourinary disorders when applicable. (SLO #6)

Overview

  • This module primarily focuses on the assessment and provision of care for clients with altered gastrointestinal function, bowel elimination patterns, and nutritional disorders.

  • Topics include:

    • Stomatitis

    • Hernia

    • Diverticulitis

    • Gastroesophageal Reflux Disease (GERD)

    • Gastritis

    • Peptic Ulcer Disease (PUD)

    • Irritable Bowel Syndrome (IBS)

    • Intestinal Obstruction

    • Hemorrhoids

    • Disease processes related to the gallbladder.

  • The module also introduces care of clients with genitourinary alterations, specifically urinary tract infections, including pyelonephritis and urinary catheter-associated infections.

Disease Processes

Stomatitis

  • Definition: Inflammation and ulcers of the oral mucosa.

  • Causes:

    • Viral infections

    • Fungal infections

    • Mechanical trauma

    • Nutritional deficiencies

    • Irritants (e.g., chemotherapy, medications)

  • Common populations affected:

    • Immunocompromised individuals

    • Elderly

    • People with cancer

    • End-of-life patients

  • Healing time: 2-4 weeks, may require supportive care.

Signs and Symptoms

  • Vesicular lesions

  • Red, erythematous mucosa

  • Bleeding

  • Halitosis

  • Pain

  • Tissue necrosis

  • May lead to malnutrition, fluid and electrolyte imbalances, sepsis, bacterial endocarditis.

Treatment

  • Oral Hygiene: Meticulous oral hygiene, including brushing and flossing.

  • Mouth Rinses: Saline or sodium bicarbonate after and between meals.

  • Topical Treatments:

    • Viscous lidocaine (anesthetic)

    • Orabase (protective paste)

    • Amphojel/Kaopectate

    • Nystatin (for fungal infections)

    • Acyclovir/Valtrex (for herpes)

    • Oral penicillin (for bacterial infections)

    • Palifermin (to stimulate epithelial growth)

  • Dietary Management: High-calorie, high-protein diets, avoidance of spicy, hot, and acidic foods.

Nursing Care

  • Perform health history and physical exams.

  • Identify clients at risk.

  • Regular assessment of oral mucosa and consistent mouth care.

  • Encourage regular dental appointments.

  • Suggest buttermilk/yogurt if on antibiotics.

  • Limit spicy, hot, acidic foods; avoid alcohol and smoking.

  • Daily weight monitoring.

  • Advise on liquid diets as needed; advance diet as tolerated.

Hiatal Hernia

  • Definition: Occurs when part of the stomach protrudes through the esophageal hiatus of the diaphragm into the thoracic cavity.

  • Incidence: Increases with age, most commonly past age 50.

  • Symptoms: Often asymptomatic until complications arise. Associated primarily with gastroesophageal reflux disease (GERD).

Pathophysiology

  • Sliding Hiatal Hernia: Gastroesophageal junction and fundus slide upwards through the esophageal hiatus.

  • Paraesophageal Hiatal Hernia: Esophageal junction remains in normal position while part of the stomach herniates through the hiatus.

Signs and Symptoms

  • Reflux

  • Heartburn

  • Feeling of fullness

  • Substernal chest pain

  • Dysphagia

  • Occult bleeding

  • Belching and indigestion.

Treatment

  • Often asymptomatic, so no treatment required unless symptomatic.

  • Treatment may involve anti-reflux measures typically used for GERD sufferers.

  • Surgical options include Nissen fundoplication (can be open or laparoscopic).

Nursing Care

  • Monitor symptoms and ensure proper education on dietary habits (e.g., small, frequent meals).

  • Assist in diagnosing with barium swallow or upper gastrointestinal study.

Diverticular Disease

  • Definition: Small outpouchings (diverticula) of the colon that can occur anywhere in the gastrointestinal tract, most commonly in the sigmoid colon.

  • Etiology: Lack of fiber in diet leading to increased intraluminal pressure and straining.

Diverticulosis

  • Nature: Usually asymptomatic but can be associated with episodic left-sided abdominal pain, constipation, or diarrhea.

  • Symptoms: Abdominal cramping, narrow stools, weakness, and fatigue.

  • Complications: Hemorrhage, diverticulitis.

Diverticulitis

  • Definition: Inflammation of one or more diverticula leading to localized infection.

  • Pathophysiology: The diverticulum gets obstructed by undigested food and bacteria, leading to mucosal ischemia or perforation.

Complications

  • Peritonitis

  • Abscess formation

  • Fistula formation

  • Hemorrhage.

Signs and Symptoms

  • Left-sided abdominal pain, severity can range from mild to severe.

  • Constipation or increased frequency of defecation.

  • Nausea and vomiting, low-grade fever.

  • Abdominal distention with possible palpable mass in LLQ.

Therapeutic Management

  • Uncomplicated Diverticulitis: Bowel rest, liquid diet, antibiotics, pain management.

  • Complicated Diverticulitis: NPO status, IV antibiotics, possibly TPN, and surgical interventions as necessary.

Nutrition and Nursing Care

  • High-fiber diet is vital once the inflammation has subsided.

  • Regular vital signs monitoring, abdominal assessments, and monitoring laboratory values.

GERD (Gastroesophageal Reflux Disease)

  • Definition: Backward flow of gastric content into the esophagus causing complications like esophagitis.

  • Prevalence: Affects 15%-20% of adults.

  • Risk Factors: Obesity, smoking, alcohol consumption, certain medications, dietary factors (e.g., caffeine, spicy foods).

Signs and Symptoms

  • Heartburn

  • Dysphagia

  • Pain (may radiate to back and neck)

  • Regurgitation, belching.

  • Aspiration may lead to respiratory symptoms.

Diagnostic Assessments

  • Barium swallow to visualize anatomy.

  • Esophagogastroduodenoscopy (EGD) to acquire tissue samples.

  • Esophageal manometry to measure peristalsis pressures.

  • 24-hour ambulatory pH monitoring for acid reflux episodes.

  • Bernstein test involving administration of hydrochloric acid to confirm diagnosis.

Treatment

  • Lifestyle Modifications: Diet adjustments, avoiding trigger foods, weight management, smoking cessation.

  • Medications:

    • Antacids for symptomatic relief

    • Proton pump inhibitors (PPIs) to reduce acid secretion

    • H2-receptor antagonists as adjunct therapies.

    • Promotility agents (short-term) to enhance gastric clearance.

  • Surgical Options: Consideration for severe cases.

Nursing Care

  • Administer medications as prescribed, educate on dietary adjustments, and encourage remaining upright after meals.

  • Document patient's responses and teach preventive measures against reflux episodes.

Gastritis

  • Definition: Inflammation of the gastric lining.

  • Types: Can be acute or chronic.

Acute Gastritis

  • Pathophysiology: Characterized by disruption of the mucosal barrier by irritants such as NSAIDs, alcohol, and corrosive substances.

  • Signs and Symptoms: Abdominal discomfort, nausea, vomiting, and potential for GI bleeding.

Chronic Gastritis

  • Etiology: Often related to infection by Helicobacter pylori or autoimmune responses.

  • Manifestations: Heartburn, belching, feeling of fullness, and vitamin B12 deficiency indication due to malabsorption.

Diagnostics

  • History, gastric analysis, labs for H&H, RBC, Vitamin B12, and upper endoscopy.

Medical Management

  • Dietary management (non-irritating diet), PPI or H2 blockers, assessment for hemodynamic stability.

Nursing Care

  • Monitor for electrolyte imbalances, dietary intake, and address pain control needs.

  • Provide education on dietary restrictions and signs of complications.

Peptic Ulcer Disease (PUD)

  • Definition: A break in the mucosal lining of the gastrointestinal tract in contact with gastric juice.

  • Types of Ulcers: Gastric or duodenal.

  • Prevalence: Affects approximately 4 million people in America.

Risk Factors

  • H. pylori infection, NSAID use, advanced age, personal/family history, and smoking.

Signs and Symptoms

  • Epigastric pain (gnawing, burning), heartburn, regurgitation, and possible weight loss.

Complications

  • Hemorrhage, obstruction, perforation leading to peritonitis.

Diagnostic Assessments

  • Upper GI series, endoscopy with biopsy, H. pylori testing via breath/stool.

Treatment

  • Triple Therapy: Two antibiotics and a proton pump inhibitor for H. pylori elimination.

  • Medications: H2 receptor antagonists and PPIs for symptomatic relief.

Nursing Care

  • Pain management, emotional support, dietary adjustments, and education on SS of complications.

Irritable Bowel Syndrome (IBS)

  • Definition: A common functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits.

  • Pathophysiology: Dysregulation of CNS regulation and increased motility related to food intake or stress.

Signs and Symptoms

  • Abdominal pain relieved by defecation, altered bowel habits (constipation or diarrhea).

  • Nausea and bloating.

Diagnostics

  • At least one day per week of recurrent abdominal pain associated with changes in stool frequency or form.

  • Stool studies and possible endoscopic examinations.

Treatment

  • Medications for symptom management (laxatives, antidiarrheals).

  • Dietary adjustments (increased fiber, avoidance of irritating foods).

Nursing Care

  • Educate about symptom management strategies, dietary modifications, and recognizing triggers.

Intestinal Obstruction

  • Definition: Inability of intestinal contents to move through the bowel lumen, can be mechanical or functional.

Mechanical vs Functional Obstructions

  • Mechanical: Physical barriers inside or outside the intestine (e.g., adhesions, tumors).

  • Functional: Impaired peristalsis without physical obstruction (e.g., post-surgical ileus).

Signs and Symptoms

  • Abdominal pain, distension, vomiting, constipation, and lack of flatus.

Diagnostics and Management

  • Abdominal X-rays, possibly CT scans. Treatments include NG tube insertion and surgical intervention for severe obstructions.

Nursing Care

  • Monitor vital signs, fluid balance, pain, diet, and bowel sounds. Provide comfort measures and educate on care following surgery.

Hemorrhoids

  • Definition: Swollen veins in the anal canal that may be asymptomatic or symptomatic.

  • Types: Internal (above the dentate line) and external (below the dentate line).

Causes and Risk Factors

  • Straining during defecation, prolonged sitting, low fiber diet, and pregnancy.

Signs and Symptoms

  • Internal: May cause rectal bleeding, sensation of fullness.

  • External: Painless but may cause irritation, itching, and difficulty cleaning.

Diagnostics

  • Physical examination, possibly an anoscopic procedure.

Treatment

  • Increase dietary fiber, stool softeners, topical treatments, local anesthetics, warm sitz baths, and in some cases surgical options.

Nursing Care

  • Educate on dietary modifications, hygiene practices, and signs of complications.

Cholecystitis and Cholelithiasis

  • Cholecystitis Definition: Inflammation of the gallbladder, typically due to obstruction.

  • Cholelithiasis Definition: Formation of gallstones in the biliary tract.

Risk Factors and Pathophysiology

  • Commonly associated with age, gender (female), obesity, and rapid weight loss.

Symptoms

  • Acute RUQ pain, jaundice, nausea, and vomiting following fatty meals.

  • Diagnostics: Ultrasound and HIDA scan to assess gallbladder function.

Management and Treatment

  • Pain management, antibiotics, possible laparoscopic cholecystectomy, and dietary modifications post-operatively.

Nursing Care

  • Monitor vital signs, assess for signs of complications, dietary counseling, and providing post-operative care.

References

  • Hinkle, J. L., & Cheever, K. H. (2021). Brunner & Suddarth's textbook of medical-surgical nursing (14th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

  • Enhanced Course Point Plus

  • Hinds, M. M., Hyland, J. R., Lovric, A., Nibert, A., Upchurch, S. (2011). HESI: Comprehensive review for the NCLEX-RN examination (5th ed.). St. Louis, MO: Elsevier.