Disorders of

Gastrointestinal System
 Nausea and Vomiting

• Nausea is an unpleasant feeling that vomiting is

imminent.
• Vomiting is the involuntary act in which
stomach contracts and forcefully expels
gastric contents
• Loss of fluid and electrolytes is the primary
consequence of repeated vomiting;
• The very young and the elderly are more
susceptible to the complications of fluid
imbalances.
• Prolonged vomiting will precipitate a metabolic
problem
– Metabolic alkalosis is associated with prolonged
vomiting and loss of hydrochloric acid
– Metabolic acidosis occurs with severe prolonged
vomiting of contents of the small intestine, resulting
a loss of bicarbonate.
 Assessment
a. Precipitating causes

1. Pathogenic: related to a disease process

-intestinal obstruction

-peptic ulcer disease (PUD)

-increased intracranial pressure

-indigestion of toxic substances (food poisoning)

-Vertigo
2. Iatrogenic: resulting from a disease treatment
-chemotherapy/radiation
-medications
-Surgery (postoperative complications)

3. Psychogenic
-Psychosis/neurosis
-Reaction to Psychological Trauma

4. Pregnancy
 Assessment
• Identify precipitating cause

• Assess frequency of vomiting, amount of vomiting, and contents

of vomitus

• Hematemesis: presence of blood in the vomitus

– Bright red blood is indicative of hemorrhage

– Coffee ground material is indicative of blood retained in the
stomach; the digestive process has broken down the
hemoglobin
– Projectile vomiting: vomiting not preceded by nausea in which
vomiting is expelled with excessive force
– Presence of fecal odor and bile in vomitus indicates a
backflow of intestinal contents into stomach
 Treatment

1. Eliminate the precipitating cause

2. Antiemetics
3. Parenteral replacement of fluids
 Nursing Interventions

Goal: To prevent recurrence of nausea and vomiting and

ensuing complications

• Prophylactic antiemetics for the client with tendency to

vomit
• Prompt removal of unpleasant odors, used emesis basin,
used equipment, and soiled linens
• Good oral hygiene
• Place conscious client on side or in semi-fowlers position;
place unconscious client on side with head of bed slightly
elevated to promote drainage of oral cavity.
• Withhold food and beverages initially after
vomiting; begin oral intake slowly with clear liquids
• Assess client who has undergone surgery for bowel
sounds; do not begin oral administration of fluids
until bowel sounds are present
• Support abdominal incisions during prolonged
vomiting
Goal: To relieve nausea and vomiting

• Administer antiemetics, as indicated

• Evaluate precipitating causes; relieve if possible

Goal: To assess client’s response to prolonged

vomiting

• Monitor and maintain fluid and electrolyte status

• Continued presence of gastric distention
• Overall vital sign changes
• Intake and output
• Assess for adequate hydration
• Evaluate weight loss
 Constipation

• Exists when the interval between bowel

movements is longer than normal for the
individual and the stool is dry and hard
Assessment

• Precipitating Causes
– Decreased fiber intake
– Decreased fluid intake, dehydration
– Immobility, inadequate exercise
– Medications, narcotics, antidepressant, iron
supplements, anticonvulsants
– Irritable bowel syndrome
– Advanced age
– Overuse of laxatives
– Ignoring the urge to defecate
– Diverticulosis, tumors, intestinal obstructions
Clinical manifestations

• Abdominal distention
• Decrease in an amount of stool
• Dry, hard stool
• Straining to pass stool
• Grunting, grimacing
Treatment

• Change dietary intake: increase intake of bulk

and fluids
• Bulk laxatives or enemas for occasional
constipation problem
• Instruct client to maintain normal bowel
schedule and not to ignore urge to defecate
• Discourage long term use of laxatives and
enemas
• Encourage regular exercise
Nursing Interventions

Goal: To identify client at risk of developing problems and

institute preventive measures
• Increase intake of high fiber foods: raw vegetables,
whole grain breads and cereals, fresh fruits
• Increase fluid intake
• Maintain regular activity, daily walking
• Discourage use of laxatives and enemas; client may
become dependent on them
• Encourage use of bulk forming products to provide
increased fiber (methylcellulose, psyllium)
• Encourage bowel movement at same time each day
• Try to position client on bedside commode rather than
on bedpan
• If client is experiencing diarrhea, check to see if stool
is oozing around an impaction
Goal: to implement treatment measures for fecal
impaction removal
• Considered an impaction if client has had no bowel
movement for 3 days or has passed only small of
semisoft or liquid stool
• Specific neurological and metabolic diseases
associated with risk for constipation
– Spinal cord injury
– Parkinson’s disease
– Thyroid irregularities
– Diabetes
• Very young and very old are most susceptible to
problems with impaction
• Steps in removing
– Manually check for presence with nonsterile, lubricated
gloved finger
– Gently attempt to break up impaction
– Follow with suppository, enema or laxative as ordered
by physician
– Emphasis is on prevention of impaction
• Evaluate client’s use of home remedies and OTC drugs.
Assess what the client is using to treat constipation;
frequently, the geriatric client is using harsh laxatives
Diarrhea

• Rapid movement of intestinal contents through

the small bowel.
• Significant increase in number of stools
• Decrease in the consistency of the stool. With
an increase in fluid content
• Infants and elderly most susceptible to
complications of diarrhea
• Complications of severe diarrhea
– Dehydration, resulting in hypovolemia
– Metabolic acidosis
Assessment

• Precipitating causes
– Traveler’s diarrhea: bacteria (Escheria Coli,
Salmonella spp.), viruses, and parasites (Giardia
spp).
– Food poisoning
– Medications (antibiotics and antacids)
– Food intolerance (Lactose intolerance)
– Irritable bowel syndrome
– Emotional factors
– Acquired immunodeficiency syndrome (AIDS)
– Colon cancer
– Malabsorption problems
– Rotavirus: most common pathogen in young children
Clinical Manifestation

• Frequent, watery bowel movements

• Stools may contain undigested food, mucus, pus
or blood
• Frequently foul smelling
• Abdominal cramping, distention, and vomiting
frequently occur with diarrhea
• Weight loss
• Hyperactive bowel sounds
• May precipitate dehydration, hypovolemia,
hypokalemia, and shock
 Treatment

• Treat the underlying problem

• Decrease activity and irritation of the GI
tract by decreasing intake
• Parenteral replacement of fluids and
electrolytes, if diarrhea is severe
• Administer antidiarrheal medications
Nursing Intervention
Goal: To decrease diarrhea and prevent complications

• Identify precipitating causes and eliminate, if possible

• Decrease food intake: offer more soft, non irritating
food
• Administer oral rehydrating solutions (Pedialytic,
Rehydrate, Infalyte) and progress fluids and diet as
tolerated
• Administer medication as indicated
• Maintain good hygiene in the rectal area to prevent skin
excoriation
• Decrease activity
Goal: to evaluate client’s response diarrhea

• Evaluate changes in vital signs correlating with

fluid loss
• Evaluate electrolyte changes and urine specific
gravity
• Record intake and output and daily weight if
diarrhea is progressive
• Assess changes in abdominal distention and
cramping
• Continue ongoing evaluation of characteristics
of diarrhea
Goal: To prevent spread of diarrhea

• Good hand washing techniques

• Contact-based precautions
– Proper disposal of diapers and soiled linens close
to bedside
– Instruct family regarding hand washing technique
– Keep bedpans, soiled linens, diapers away from
clean areas
Rotavirus

• Is the most common pathogen in young children

hospitalized for treatment of diarrhea
• Affects all age groups and is most common in
cool weather
• Incubation period is 1-3 days
• Important source of nosocomial infections is
hospitalized
• Is frequently associated with an upper
respiratory tract infection
• Children 6-24 months old are most susceptible
Assessment

• Clinical manifestation
– Abrupt onset
– Nausea and vomiting
– Persistent foul smelling, explosive, diarrhea
– Fever lasts approximately 48 hours
• Diagnostics
– History regarding onset and duration
– Laboratory determination of electrolyte levels to
determine status of hydration
Treatment

• Usually self limiting

• Oral rehydration with glucose, electrolyte
solution
• Intravenous (IV) fluid replacement as needed
• Antidiarrheal medications
• Strict record of intake and output
• Child may begin eating solid food as soon as
tolerated. Soft diet as acceptable
Nursing Intervention

Goal: To maintain fluid and electrolytes balances (nursing

intervention for client with diarrhea)

• Fluid and electrolyte replacement, initially oral rehydration

therapy with solutions to replace electrolyte (oral
rehydration solutions)
• Monitor IV fluids in cases of severe diarrhea
• Administer antidiarrheal medications. Monitor stools child is
at increased risk for developing paralytic ileus
• Strict monitory of hydration status
• May begin providing solid food as soon as child can tolerate;
generally soft, easily digestible food, does no have to be
clear liquids.
 Gastroesophageal Reflux
Disease
• Gastroesophageal reflux disease (GERD) is
caused by the backward flow of GI contents
into the esophageal (esophageal reflux). Reflux
is often associated with a hiatal hernia, the
herniation of the upper portion of the stomach
through the diaphragm into the thoracic cavity.
• Pathophysiology: Gastric volume or
intraabdominal pressure elevated, or LES tone
decreased—frequent episodes of acid reflux—
breakdown of mucosal barrier—esophageal
inflammation, hyperemia, and erosion—fibrotic
tissue formation—esophageal stricture—
impaired swallowing.
Assessment

• Risk factors
– Lifestyle factors: obesity; smoking, excess alcohol
intake; consumption of high fat, spicy, or acidic foods;
consumption of caffeine and carbonated beverages;
stress
– Pathological predisposing factors: PUD, asthma, cystic
fibrosis, cancer
– Medications: acetysalicylic acid and non steroidal
antiinflammatory drugs (NSAIDS), bronchial inhalers,
potassium, iron supplements, nitrates, anticholinergics
– Anatomical factors: eating heavy meal before lying
down, strenuous exercise after eating, scoliosis, poor
esophangeal sphincter tone, consuming an excessive
amount of food and beverage.
– Clients with prolonged GERD are at increased risk for
cancer
Clinical manifestations

• Reflux esophagitis: heartburn, dyspepsia

• Increased pain after meals; may be relieved by
antacids
• Activities that increase intraabdominal
pressure increase esophageal discomfort
• Pain may radiate to back and neck
• Regurgitation not associated with belching or
nausea
• Diagnostics: 24 hour pH monitoring, esophageal
manometry, esophagoscopy
Treatment
• Medical
– Diet therapy: decrease intake of fatty foods,
small frequent feeding
– Medications: histamine receptor antagonist,
antacids, GI stimulants

• Surgical
– Surgical corrections of hernia
Nursing Intervention

Goal: Decrease esophageal reflux

• Drink adequate fluids at meals to increase food passage
• Avoid temperature extremes in foods
• Avoid drinking fluids 3 hours before bedtime
• Elevate the head of the bed on 6-to 8- inch blocks
• Lose weight to decrease abdominal pressure gradient
• Avoid tobacco, alcohol, NSAIDS, and salicylates.
• Decrease intake of highly seasoned foods
• Eat frequent small meals to prevent gastric dilation
• Avoid any food that precipitates discomfort (fats,
caffeine, chocolate, nicotine will decrease esophageal
sphincter tone)
• Do not lie down after eating
Goal: To perform preoperative nursing
interventions

Goal: to provide postoperative nursing care

– If surgical thoracic approach is used, the client
will have a chest tube after surgery
– Client should continue preoperative dietary
restrictions after surgery.
Gastritis

• Gastritis is an inflammation of the gastric

mucosa
• Acute Gastritis is generally self limiting with
no residual damage
• Chronic gastritis is due to repeated irritation
of the gastric mucosa caused by a breakdown
of the normal protective mucosal barrier
• Gastritis is also classified as erosive or non
erosive, depending on the severity of mucosal
injury
Assessment

• Risk factors/etiology
– Often caused by dietary indiscretion (gastric
irritants: coffee, aspirin, alcohol etc)
– Alcohol intake (especially alcoholism)
– Contaminated foods (Staphylococcus or Salmonella
organism)
– Medications causing gastric irritation (aspirin,
corticosteroids, chemotherapy)
– Acute Gastritis is a common problem in intensive
care units because of significant amount of stress.
– Clients with burns, sepsis, shock, mechanical
ventilation, or multiorgan dysfunction who are not
receiving some enteral feeding are at significantly
increased risk.
 Clinical
Manifestations
• Epigastric tenderness
• Nausea and vomiting
• Anorexia
• Chronic gastritis is frequently caused by the presence of
Helicobacter pylori
– May precipitated pernicious anemia
– May be caused by uremia
– May be associated with PUD
• Smoking exacerbates condition

Diagnostics:
– Endoscopic examination of the gastric mucosa with biopsy
– Stool examination for occult blood
– Gastric analysis
Treatment

• Medical management
– Eliminate cause
– Antiemetics, antacids, acid blockers, proton pump
inhibitor
– Treatment for H.pylori with antibiotics plus H2
receptor antagonists, a proton pump inhibitor, and
antacids

• Surgical intervention, if medical treatment

fails or hemorrhage occurs.
Nursing Interventions

Goal: To decrease gastric irritation

• Nothing by mouth (NPO status) initially, with
IV fluid and electrolyte replacement
• Administer medication as prescribed
• Bed rest
• Begin clear liquids when symptoms subside

Goal: To assist client to identify and avoid

precipitating causes
Gastroenteritis

• Gastroenteritis is the irritation and inflammation of

the mucosa of the stomach and small bowel
• This can rapidly progress to dehydration, hypovolemic
shock and severe electrolyte disturbances.
Assessment

• Risk Factors/Etiology

– Equal incidence in men and women but more severe

in infants and elderly
– Salmonella: fecal oral transmission by direct
contact or via contaminated food
– Staphylococcal: transmission via foods that were
handled by contaminated carrier
– Dysentery: E. coli and Shigella spp.
Clinical Manifestations

• Abdominal cramping
• Nausea, vomiting, and diarrhea
• Fever and chills
• Loss of appetite

Diagnostic: identify causative agents

Treatment: appropriate medication for causative

agents
Nursing interventions
Goal: To maintain hydration and electrolyte balance
and to prevent spread of disease
• Maintain NPO status until vomiting cease
• Examine anal area for irritation, apply moisture
barrier
• IV fluid replacement if severe dehydration
occurs
• Begin clear liquids gradually after vomiting cease
• Contact based precautions
• Avoid aspirin and ibuprofen because these
worsen condition
Goal: to provide symptomatic nursing care for
diarrhea, nausea, and vomiting
Peptic ulcer Disease

• PUD refers to an erosion of the GI mucosa by hydrochloric

acid and pepsin
• Locations of ulcers include the lower esophagus, stomach,
pyloric channel, and duodenum (accounts for 80% of all
ulcers), as well as postoperative ulcers near sites of surgical
anastomosis. When the ulcer is located in the duodenum, it
is also known as a duodenal ulcer.

• Types of peptic ulcers

– Duodenal (most common)
– Gastric
– Stress-induced ulcers, drug induced ulcers.
• Histamine release occurs with the erosion of the
gastric mucosa in both duodenal and gastric
ulcers. This stimulates further secretion of
gastric acid and formation of mucosal edema. The
continued erosion will eventually damage the
blood vessels, leading to hemorrhage or erosion
through gastric mucosa.
Pathophysiology
• Failure of the body to regenerate mucous epithelium at a
sufficient rate to counter balance the damage to tissue during the
breakdown of protein;
• Decrease in the quantity and quality of the mucus; poor local
mucosal blood flow, along with individual susceptibility to the
ulceration.
• A peptic ulcer is a hole in the lining of the stomach, duodenum, or
esophagus. This hole occurs when the lining of these organs is
corroded by the acidic digestive juices secreted by the stomach
cells.
• Excess acid is still considered to be significant in ulcer formation.
The leading cause of ulcer disease is currently believed to be
infection of the stomach by Helicobacter pylori (H.pylori).
• Another major cause of ulcers is chronic use of nonsteriodal anti
inflammatory drugs (NSAIDS). Cigarette smoking is also an
important cause of ulcers.
Characteristics
• Risk factors
– H. pylori (causes two thirds of ulcers)
– NSAIDS
– Medications that alter gastric mucosa and secretions
– Increased physical stress (trauma, surgery)
– Psychosocial stress (duodenal ulcers)
– Smoking, Alcohol
• Aggravating factors
– Stress: emotional or physical stress (e.g., surgery)
– Smoking
– Alcohol
– Increased incidence if family member has ulcers
• Clinical manifestations
– Pain: the pain associated with ulcers may be confusing,
and symptoms may overlap from one type of ulcer to
another. Be careful to avoid confusing ulcer pain with
angina
• Peptic (gastric) ulcers: dull, aching; often
aggravated by eating; may awaken patient at night
• Duodenal ulcers: gnawing pain in epigastric (upper
central region of abdomen), worsening several hours
after a meal. Eating may lessen the discomfort
– Significant weight loss
– Nausea and vomiting
– Bleeding when ulcers erodes through vessels
Diagnostics

• All types
• X-ray film of upper GI system
• Esophagogastroduodenoscopy
Treatment
• Medications
– Antacids
– Histamine receptor antagonist
– Anticholinergic medications for duodenal ulcers
– Prostaglandin analogs and acid pump inhibitors
– Medications to eliminate H.pylori bacteria
• Metronidazole (Flagyl)
• Omeprazole (Prilosec)
• Clarithromycin (Biaxin) or Tetracycline
• Lifestyle modifications
– Avoid foods that cause discomfort
– Decrease or stop smoking
– Decrease activity and psychological stress
• Surgical interventions for intractable ulcers
– Partial gastrectomy: removal of majority of stomach (antrum
and pylorus) with anastomosis to either the duodenum or the
jejunum (preferred)
• Vagotomy: denervation of a portion of the stomach to
decrease acid secreting stimulus to gastric cells
• Pyloroplasty: (pyloric stenosis repair) method for
relieving a narrowed pyloric sphincter to allow the
stomach contents to pass more easily into the
duodenum; may be done in combination with vagotomy
• Complications
– Hemorrhage
• Hematemesis, melena or both
• Hypovolemic shock
– Perforation of ulcer into the peritoneal cavity
• Sudden, severe, diffuse upper abdominal pain
• Abdominal muscles contract as abdomen becomes
more rigid
• Bowel sounds are absent
• Respirations become shallow and rapid
• Severity of peritonitis is proportional to size of
perforation and amount of gastric spillage
• Dumping syndrome
– Affects up to half of clients who have undergone
gastrectomy
Nursing Interventions
Goal: To promote health in clients with PUD
– Identify factors in lifestyle contributing to development of ulcer
– Identify factors that precipitate pain and discomfort
– Do not take OTC medications, especially aspirin compounds and
NSAIDS
– Identify stress factors in lifestyle. Counseling may be indicated to
help client improve ability to cope with stress.
Goal: to assess for complications of gastric obstruction
Goal: to assess for complications of hemorrhage
– Assess for symptoms indicating hemorrhage
• Evaluate hemoglobin and hematocrit levels
• Assess for distention, increase in pain, and tenderness
• Correlate vital signs with changes in client’s overall condition
• Assess stools and nasogastric drainage for present of blood.
• If hemorrhage occurs:
– Establish peripheral infusion line, preferably with
large-gauge needle for blood infusion
– Insert indwelling urinary catheter to monitor
urinary output
– Insert nasogastric tube for removal of gastric
contents and maintain gastric suction
– May implement iced saline solution lavage
– Prepare to administer whole blood transfusion
• Position client supine with legs slightly elevated
• Begin oxygen administration
• Initiate preoperative preparation
Goal: To assist client to return to homeostasis after gastric
resection
• Provide general postoperative care as indicated
• Maintain nasogastric suction until peristalsis returns
• After removal of nasogastric tube, assess for
– Increasing abdominal distention
– Nausea, vomiting
– Changes in bowel sounds
• No oral fluids until client is able to tolerate removal of
nasogastric tube
• Begin oral fluids slowly; clear liquids, then progress to bland, soft
diet
• Based on client’s condition, total parenteral nutrition may be
necessary to maintain adequate nutrition
• Encourage ambulation to promote peristalsis

Goal: to prevent the development of pernicious anemia after total

gastric resection
Goal: to identify dumping syndrome

• Dumping syndrome

– Condition occurs when a large bolus of gastric chyme and

hypertonic fluid enter the intestine

Goal: to assess for symptoms of condition

– Weakness, dizziness, tachycardia

– Epigastric fullness and abdominal cramping

– Diaphoresis

– Generally occurs within 30 minutes of eating

– Condition is usually self limiting and resolves in about 6-12

months
Goal: to prevent dumping syndrome
– Decrease amount of food eaten at one meal
– Decrease carbohydrates, decrease salt intake and roughage, increase
proteins and fats as tolerated
– No added fluid with meal or for 1 hour after meal
– No milk, sweets or sugars
– Position client in semi-recumbent position during meals; client should
lie down on the left side for 20-30 minutes after meals to delay
stomach emptying
– Hypoglycemia may occur 2-3 hours after eating, caused by rapid
entry of carbohydrates into jejunum.
– Alert: implement measures to improve client’s nutritional intake.
Prevent dumping syndrome and/or care client experience dumping
syndrome
Appendicitis

• Appendicitis is an obstruction and inflammation

of the appendix, leading to bacterial infection.
If appendicitis is not treated, the appendix can
become gangrenous and burst, causing
peritonitis, septicemia, and potential death. It
is the most common reason for emergency
abdominal surgery in children.
• Obstruction of the blind sac of the appendix
precipitates inflammation, ulceration, and
necrosis.
• Problems arise when the necrotic area
ruptures, spilling intestinal contents into the
peritoneal cavity, causing peritonitis
Assessment
• Risk factors/etiology
– Age: peak at 20-30 years old; rare in children younger than 2 years
– Diet: low-fiber and refined carbohydrate diets
– Viruses: coxsakievirus B, adenovirus
– Amebiasis
– Bacterial gastroenteritis
– Mumps
– Barium ingestion

• Clinical manifestations
– Abdominal cramping and pain, beginning near navel then migrating toward
McBurney’s point (Right Lower quadrant). Pain worsens with time
– Anorexia, nausea, vomiting and constipation
– Elevated temperature and heart rate
– Side lying, fetal position for comfort
– Client complains of pain when asked to cough: asking client to cough is
better assessment method than palpating for rebound tenderness
– Sudden relief from pain may indicate rupture of appendix
Diagnostics
• Clinical manifestations
• Urinalysis to rule out urinary tract infection
• Ultrasonography to identify inflamed appendix
• White blood cell count revealing leukocytosis

Complication
– peritonitis
Treatment

• Laparoscopic appendectomy is the only

effective treatment
• Abdominal laparotomy and peritoneal lavage if
appendix ruptured (less desirable)
• Broad spectrum antibiotic therapy
• Early ambulation after surgery
Nursing Intervention
Goal: to assess clinical manifestation and to prepare for surgery, as
indicated
• Careful nursing assessment for clinical manifestation
• Maintain NPO status until otherwise indicated
• Maintain bed rest in position of comfort
• Do not apply heat to the abdomen; cold applications may provide some
relief or comfort
• Do not administer enemas
• Avoid unnecessary palpation of abdomen

Goal: to maintain homeostasis and healing after appendectomy

Goal: to prevent abdominal distention and to assess bowel function after

abdominal laparatomy
– Maintain NPO status
– Gastric decompression by nasogastric tube; maintain patency and
suction
– Monitor abdomen for distention
– Assess peristaltic activity
– Evaluate and record character of bowel movements
Goal: to decrease infection and promote healing after abdominal
laparatomy
– Place client in semi fowlers position to localize infection and
prevent spread of infection or development of
subdiaphragmatic abscess
– Antibiotics are usually administered via IV infusion; monitor
response to antibiotics and status of IV infusion site.
– Monitor Vital signs frequently (2-4hours) and evaluate for
infection process
– Provide appropriate wound care; evaluate drainage from
abdominal Penrose Drains and incisional area
Goal; to maintain adequate hydration and nutrition and to
promote comfort after abdominal laparatomy
– Maintain adequate hydration via IV infusion
– Evaluate tolerance of oral liquids when nasogastric tube is
removed
– Begin oral administration of clear liquids when peristalsis
returns
– Progress diet tolerated
– Administer analgesics as indicated.
Alerts:
– Determine need for administration of pain medications. Do not give
narcotics for pain control before a diagnosis of appendicitis is
confirmed, because they mask signs if the appendix ruptures
– Determine whether client is prepared for surgery or procedures.
appendicitis is a very common problems; know how to care for client
during diagnostic phase
– Identify infection: peritonitis is common after surgery for a ruptured
appendix.
Undiagnosed Abdominal Pain
– Do Not
• Give anything by mouth
• Put any heat on the abdomen
• Give an enema
• Give Strong Narcotics
• Give a Laxative
– Do
• Maintain bed rest
• Place in a position of comfort
• Assess hydration
• Assess abdominal Status; distention, bowel sounds, passage of
stool or flatus, generalized or local pains
Peritonitis

• Peritonitis is the generalized inflammation of the

peritoneal cavity, leading to intraabdominal
infection
• Intestinal motility is decreased, and fluid
accumulates as a result of the inability of the
intestine to reabsorb fluid
• Fluid will leak into the peritoneal cavity,
precipitating fluid, electrolyte and protein losses,
as well as fluid depletion
Assessment
• Risk factors/etiology
– Chemical peritonitis may result from gastric ulcer perforation or
a ruptured ectopic pregnancy
– Bacterial peritonitis results from traumatic injury (abdominal
trauma, ruptured appendix)
– Chemical peritonitis is rapidly followed by bacterial peritonitis
– Postoperative dehiscence
– Pancreatic necrosis

• Clinical manifestations
– Presence of precipitating cause
– Pain over involved area; rebound tenderness
– Abdominal mass or distention
– Abdominal muscle rigidity (board like abdomen)
– Unexplained persistent or labile fever
– Anorexia, nausea or vomiting
– Increased pulse, decreased blood pressure, shallow respiration
– Decreased or absent bowel sounds
– Hypovolemia, dehydration
– Shallow respiration in attempt to avoid pain
Diagnostics
– Complete blood count for elevated white blood cell
count
– Contrast- enhanced computed tomography
– Ultrasonography may identify mass
– X-ray film of abdomen
– Paracentesis to evaluate abdominal fluid
Treatment
• Identify and treat precipitating cause ( may
require surgical intervention)
• Antibiotics
• IV fluids
• Decrease Abdominal Distention
Nursing Intervention
Goal: To maintain Fluid and Electrolyte Balance and Reduce gastric
Distention
• Maintain nasogastric suction
• Maintain IV fluid replacement usually normal saline or lactated
Ringer’s Solution
• Administer potassium supplements with caution because of the
possible complication of poor renal function
• Evaluate peristalsis and return of bowel function
• Maintain intake and output records
• Assess for problems of dehydration and hypovolemia
• Encourage activities to facilitate return of bowel function
– Encourage ambulation
– Attempt to decrease analgesics and maintain adequate pain control
– Maintain adequate hydration
Goal: To reduce infection process
– Administer antibiotics via IV infusion; assess client’s tolerance of
antibiotics and status of infusion site
– Evaluate vital signs and correlate with progress of infection
– Maintain in semi-fowlers position to enhance respiration, as well as to
localize drainage and prevent formation of subdiaphragmatic abcess.
Diverticular Disease

• When a diverticulum ( a pouch like herniation

of superficial layers of the colon through
weakened bowel wall) becomes inflamed, it is
known as diverticulitis. In diverticulosis, there
are asymptomatic diverticula.
• Meckel’s diverticulum is diverticular disease of
the ileum in children. It is the most common
congenital anomaly of the GI tract in children
• Diverticulum: dilatation or outpouching of a
weakened area in the intestinal wall.
• Diverticulitis: inflammation of the diverticulum
Assessment
• Risk factors/etiology
– Low fiber diet: high intake of processed foods
– Age
• May be due to constipation and low fiber diet
• Indigestible fibers (corn, seeds, etc.,) will precipitate
diverticulitis
• The edema that accompanies the inflammation results in
increased swelling and bowel irritation
• Clinical manifestations
– Diverticulum, including Meckel’s diverticulum, is usually asymptomatic;
symptoms vary with degree of inflammation
– Intermittent left lower quadrant tenderness, abdominal cramping
– Inflammatory changes may precipitate perforation or abscess
formation
– Diverticulitis
• Fever
• Left lower quadrant pain, usually accompanied by nausea and
vomiting
• Abdominal distention
• Frequently constipated
• May progress to intestinal obstruction
Diagnostics (diverticulosis)
– Barium enema to visualize colon
– Sigmoidoscopy or colonoscopy
– Ultrasonography and/ or computed tomography
scan
– Stool examination
– Barium enema and colonoscopy are done after the
acute phase
Treatment
• Management of uncomplicated diverticulum
– High residue diet and fiber supplements
– Avoid laxatives and enemas
• Diverticulosis with pain
– Liquid or bland diet
– Stool softeners or mineral oil
• Diverticulitis without perforation
– Oral antibiotics when symptoms are mild
– Antispasmodic medications
– Liquid or low fiber foods for acute diverticulitis
• Severe diverticulitis
– Hospitalized with IV antibiotic management
– NPO status
– Surgery for obstruction, abscess, hemorrhage or
perforation
Nursing Interventions

Goal: to assist client to understand dietary

implications and maintain prescribed therapy to
prevent exacerbations
– Understand high fiber diet
– Avoid indigestible roughage such as nuts, popcorn,
raw celery corn and seeds
– Maintain high fluid intake
– Avoid large meals
– Avoid alcohol
– Weight reduction, if indicated
– Avoid activities that increase intraabdominal
pressure (e.g., straining at stool, bending and
lifting); avoid wearing tight restrictive clothing
Goal: to decrease colon activity in client with
diverticulitis
– Maintain clear liquids or NPO status
– Bed rest
– Adequate hydration via parenteral fluids
– As attack subsides, introduce oral fluids gradually
• Self care
– High fiber that is low in indigestible fibers
– If client has any abdominal distress, then all fiber
should be avoided until tenderness resolves
– Report fevers, consistent abdominal pain, and dark
tarry stools.
Crohn’s Disease (Ileitis or Enteritis)

• Crohn’s disease is a chronic inflammatory disease of the

intestines that causes ulcerations primarily in the intestines
• The inflammation may extend through every layer of the
affected bowel tissue. Patches of inflammatory occur next
to health bowel tissue
• Most commonly affects the small bowel, especially to the
area of the terminal ileum. Lesions may also arise in the
cecum and ascending colon
• Edema, inflammation, and fibrosis occur—involving all layers
of the bowel wall
• Inflammatory process occurs in patchy segment, separated
by normal tissue
• Client may experience periods of complete remission that
alternate with exacerbations
Assessment
• Risk factors/etiology
– May begin in adolescence; peak incidence occurs between ages 20-
40 years
– Familial tendencies
– Food allergies
– Smoking
– Immune disorders
• Clinical manifestations
– Acute symptoms
• Chronic diarrhea and abdominal pain
• Nausea, cramping, fever, flatulence
– Chronic Symptoms
• Multiple diarrhea stools each day
• Weight loss
• Anemia
• Diagnostic
– Stool analysis to rule out bacterial or parasitic infection
– Barium enema (pretest procedures may be modified for this client,
check with the physician)
– Colonoscopy
Complications

• Perirectal and intraabdominal fistulas and

abscesses
• Inflammation of the intestine, leading to
perforation and generalized peritonitis
• Nutritional deficiencies, especially of fat-
soluble vitamins.
Treatment

• Dietary modifications; increased calories and protein

and decreased fats and residue. Encourage client to eat
small servings several times a day
• Medications
– Corticosteroids to reduce the inflammation
– Sulfasalazine (an antimicrobial agent) to control
inflammation
– Immunosuppressive in long term management of
chronic problems
– Antidiarrheal medications
– Anticholinergics
– Metronidazole (Flagyl)
– Infliximab ( Remicade)
• Surgical intervention, if fistulas, perforation, bleeding,
or intestinal obstruction occur
Nursing Intervention

• Goal (immediate): to decrease inflammatory response

and to promote healing
• Evaluate and maintain adequate hydration status
• NPO status to decrease bowel activity, fluids are
introduced gradually
• IV fluids; may require parenteral hyperalimentation
• Evaluate electrolyte status
• Good skin hygiene around anal area to prevent
excoriation caused by diarrhea
• Antidiarrheal agents
• If fistulas form, the client is most often malnourished,
may require total parenteral nutrition
• Assess characteristics in patterns of stool
Self Care

• Dietary modifications: teach client to eat

small, frequent meals that are high in protein
and calories
• Medication regimen: precautions regarding
steroids or immunosuppressive medication
• Symptoms of reoccurrence of the problem;
when to call the physician
– Continued diarrhea and weight loss
– Chills, fever, malaise
• Dressing and wound care if fistula is present
• Identify appropriate measures to decrease
stress in lifestyle
Ulcerative Colitis

• Ulcerative colitis is an inflammation and ulceration of the colon

and rectum; it is more common than Crohn’s disease
• Area of inflammation is diffuse, involving mucosa and
submucosa of the intestinal wall. Inflammatory process
progresses to scar formation
• Problem frequently begins in the rectum and spreads in a
continuous manner up to the colon; seldom is the small intestine
involved
• Mucosa develops ulcerated areas that can precipitate
hemorrhage
• Condition has periods of exacerbations and remissions: is
frequently associated with psychological factors and stress
• Acute symptoms may be exacerbated or, as disease
progresses, may become chronic
Assessment
• Risk factors/etiology
– May occur at any age; peaks at ages 15 to 25 years and 55-65
years.
– Increased incidence in Jewish population
– Familial tendencies
– Increased incidence in females
– Pyschophysiological characteristics
• Clinical Manifestations
– Diarrhea, frequently bloody; client may have 20 or more stools
per day
– Abdominal pain, rebound tenderness
– Fever
– Rapid depletion of fluid and electrolytes occurs during
exacerbation
– Anorexia, weight loss
– Anemia
• Diagnostic
– Colonoscopy
– Barium enema
– Stool studies
Complications

• Obstruction, perforation, abscess, fistulas

• Increased incidence for development of colon
cancer
Treatment
• Mild to moderate disease
– Sulfasalazine to help control inflammation
– Corticosteriods
– Medicaton for pain, antidiarrheal agents, and
immunosuppressive agents
• Acute or active disease
– Corticosteroids: administered intravenously, if oral
administration is ineffective
– NPO status to rest bowel
– Retention enemas and rectal foams to ease
inflammation
– Immunosuppresive drugs in combination with steroids
• Surgical interventions
– Resection of the diseased portion of the bowel
– Ileostomy
– Ileoanal anastomosis
Nursing interventions

• Nursing goals and activities are essentially the

same as for the client with regional enteritis
(Crohn’s disease)
Hernia
• A hernia is a protrusion of the intestine through an abnormal opening or
weakened area of the abdominal wall
• Types
– Inguinal: a weakness in which the spermatic cord in men and the
round ligament in women passes through the abdominal wall in the
groin area; more common in men
– Femoral: protrusion of the intestine through the femoral ring; more
common in women
– Umbilical: occurs most often in children when the umbilical opening
fails to close adequately; occurs in adults in an area where the rectus
muscle is weak
– Incisional: weakness in the abdominal wall caused by a previous
incision
• Classification
– Reducible: hernia may be replaced into the abdominal cavity by manual
manipulation.
– Incarcerated, irreducible or imprisoned: hernia cannot be pushed
back into place
– Strangulated: blood supply and intestinal flow in the herniated area
are obstructed; strangulated hernia leads to intestinal obstruction
Risk Factors

• Chronic cough, such as smoker’s cough or cough

associated with cystic fibrosis
• Obesity or weakened abdominal musculature
• Straining during bowel movement or lifting
heavy objects
• Pregnancy
Assessment

• Clinical manifestation
• hernia protrudes over the involved are when
the client stands or strains
• Severe pain occurs if hernia becomes
strangulated
• Strangulated hernia occurs with symptoms of
intestinal obstruction
• Diagnostics
– History
– Clinical manifestations
Treatment

• General elective surgery to prevent

complications of strangulation (herniorrhaphy
• Strangulated hernia involves resection of the
involved bowel
Nursing Intervention

• Goal: to prepare client for surgery, if indicated

• Goal: to maintain homeostasis and promote
healing after herniorrhaphy
• General postoperative nursing care
• Repair of an indirect hernia: assess male
clients for development of scrotal edema
• Encourage deep breathing and turning
• If coughing occurs, teach client how to splint
the incision
• Refrain from heavy lifting for approximately 6-
8 weeks after surgery
Intussusception

• Intussusception is the telescoping of one

portion of the intestine into another, which
may result in an intestinal obstruction. The
common site is the ileocecal valve
Assessment
• Risk factors/etiology
– Incidence of problem increases in client with cystic fibrosis
or celiac disease.
– Most common cause of intestinal obstruction in children from
ages 3 months to 3 years
– More common in males
• Clinical manifestations
– Child is healthy with sudden occurrence of acute abdominal
pain
– Pain may be episodic, characterized by periods of absence of
pain
– Vomiting occurs initially
– Child may pass one normal stool, then as condition
deteriorates, he or she may pass a stool described as
“currant jelly” ( a mixture of blood and mucus)
– Abdominal tenderness and distention
– A “sausage-shaped mass may be palpated in the abdomen
• Diagnostics: radiographic studies to assess for
free air in the abdomen before a barium enema
• Treatment
– Initial treatment may consist of administration of
a water-soluble contrast medium and air pressure
to reduce intussusception
– Barium enema may be used for reduction of
intussusception, as well as for the confirmation of
the problem.
– Barium enema is associated with an increased risk
of peritonitis if there is a perforation
Nursing intervention
• Goal: assist in diagnostic evaluation and maintain ongoing
nursing assessment for pertinent data
• Careful assessment of client’s physical and behavioral
symptoms
• Maintain NPO status and assess for electrolyte imbalance
• Nasogastric suctioning may be necessary
• Monitor all stools; passage of normal stool may indicate
reduction of the intussusception
• A barium enema is contraindicated if there is air the
abdomen, high fever, vomiting and/or signs of peritonitis.
• Prepare the child for barium enema as though surgery will
follow: NPO status, nasogastric tube, IV fluids
• Goal: to provide preoperative preparation of client or child
and parents if surgery is indicated
• Goal: to maintain homeostasis and promote healing after
surgery
Pyloric Stenosis

• Pyloric stenosis is the obstruction of the

pyloric sphincter by hypertrophy and
hyperplasia of the circular muscle of the
pylorus
• Assessment
– Risk factors/etiology
• Occurs most often in firstborn, term infants
(infantile hypertrophic pyloric stenosis)
• More common in male infants
• Seen more frequently in white infants
Clinical Manifestations

• Onset of vomiting may be gradual, occurring in first few

weeks; or forceful, projectile vomiting may develop at
4-6 weeks of age
• Emesis is not bile stained by may be curdled from
length of time in stomach
• Vomiting occurs shortly after feeding
• Infant is hungry and nurses well
• Infant does not appear to be in pain or acute distress
• Weight loss occurs, if untreated
• Stools decrease in number and in size
• Dehydration occurs as condition progresses;
hypochloremia and hypokalemia occur as vomiting
continues
• Upper abdomen is distended, and an “olive-shaped” mass
may be palpated in the right epigastric area
• Diagnostics
– Palpation of abdominal mass
– Prolonged vomiting
– X-ray film and ultrasound examination of abdomen
– Treatment: surgical release of the pyloric muscle
(pyloromyotomy)
Nursing Intervention
• Goal: To restore and maintain hydration and electrolyte balance;
initiate appropraite preoperative nursing activities
• If infant is being fed orally
– Feed slowly with infant in upright position
– Frequent burping during feeding to prevent gastric distention
– After feeding, place infant slightly on the right side is high fowler’s
position or in an infant seat
– Minimal handling after feeding
• Monitor vital signs and check for signs of peritonitis
• Assess hydration status and electrolyte balance
• If child is dehydrated, NPO status with continuous IV infusion (most
often saline solutions) may be required
• Accurate intake and output records: complete description of all
vomitus and stools
• Monitor electrolyte balance closely; especially serum calcium, sodium,
and potassium level
• Gastric decompression and suction may be used before surgery;
maintain patency of tube and record type and amount of drainage
• Preoperative teaching for parents
• Goal: To maintain adequate hydration and promote
healing after pyloromyotomy
• Postoperative vomiting in the first 24-48 hours is not
uncommon
• Assess infant’s response to surgery
• Continue to monitor infant in the same manner as in the
preoperative period
• Feedings are initiated early; bottle fed infant may begin
with clear liquids, then diluted formula; gradually
increase length of time nursing for breast fed infants
• Continue feedings in the same manner as before surgery
• Monitor infant’s response to feedings
• Encourage parents to visit and be involve in child’s care
• Goal: To assist parents to provide appropriate home
care after pyloromyotomy
• No residual problems are anticipated after surgery
• Instruct parents regarding care of the incisional area
Oral cancer
• Oral cancer is an uncontrollable growth of abnormal
cells that invade and cause damage to areas around the
mouth including lips, cheek, tongue, soft and hard
palate, the floor of the mouth, tonsils, sinuses, and even
the pharynx. If detected early, it is frequently curable
• May occur in any area of the mouth; frequently curable
if discovered early
• Sites of oral cancer
– Lips
– Tongue
– Salivary glands
– Floor of the mouth
• Types of oral cancer
– Basal cell carcinoma: occurs primarily on the lips results
from excessive exposure to sunlight
– Squamous cell carcinoma: occurs on the lower lip and
the tongue; associated with alcohol intake and tobacco
use
Assessment

• Risk factors/etiology
– Smoking
– Continuous oral irritation caused by poor dental
hygiene
– Chewing tobacco
• Clinical manifestations
– Leukoplakia: whitish patch on oral mucosa or tongue
(premalignant lesion)
– Oral lesions tend to be fixed and hard; may ulcerate
– Pain and dysphagia are late symptoms
• Diagnostic
– Biopsy of the lesion
Treatment

• Surgery
– Surgical resection
– Reconstructive surgery
– Radial Neck dissection is common
• Radiation
– Radioactive seeds may be implanted in the
affected area
• Chemotherapy
Nursing Intervention

• Goal: To prevent oral cancer

– Avoid chemical, physical or thermal trauma to the mouth
– Good oral hygiene, brushing and flossing
– Prevent constant irritation in the mouth; repair dentures
or other dental problems
– See doctor for any oral lesion that does not heal in 2 to 3
weeks
• Goal: To prepare client for surgery
– General preoperative care
– Discuss with physician the anticipated extent of surgery
reinforce information with client
– Emphasize good oral hygiene
– If reconstructive surgery is anticipated, encourage
ventilation of feelings regarding anticipated changes in
body image.
• Goal: To maintain patent airway after surgery
– Elevate head of bed slightly to promote venous and lymphatic
drainage and to promote patent airway
– Evaluate swelling around suture areas
– Evaluate ability of client to handle oral secretions
– Perform respiratory assessment to identify problems of hypoxia
– Client may have a tracheostomy (depends on the extent of surgery)
• Goal: to maintain oral hygiene and prevent injury and infection after
surgery
– Type of oral hygiene is indicated by the extent of the procedure
• Mouth irrigations
• Soothing mouth rinses (cool normal saline or nonirritating
antiseptic solutions)
• If dentures are present, clean mouth well before replacing
• Oral hygiene before and after oral intake
– Avoid using stiff toothbrushes and metal tipped suction catheters
• Goal: To maintain nutrition after surgery
– Monitor return of bowel sounds before beginning
tube feedings or oral intake
– May be necessary to maintain nutrition by total
parenteral nutrition or tube feedings
– Oral intake
• Liquid, soft, nonirritating foods
• No extremes in temperature of food
• Small, frequent feedings
• Provide privacy and do not rush during meals
Self Care

• Assist client to identify community resources

for individual problems in rehabilitation
– Speech therapist
– Dietician
– Counseling
– Home health care agency, if appropriate
• Assist client to decrease or stop smoking
• Assist client to maintain good oral hygiene and
dressing care and to take medications
• Teach client to identify symptoms of
complications and to notify physician
Celiac Disease

• Celiac disease is also known as sprue, gluten

enteropathy, and malabsorption syndrome. This
disease is an inborn error in metabolism of rye,
wheat, barley, and oat products.
• Symptoms generally begin between the ages of 1
year and 5 years, but they may also occur in
those 50-60 years.
• Severe malnutrition results from a loss of
nutrients via the stool
Assessment

• Cause: congenital defect in metabolism

• Clinical manifestations
– Symptoms begin when child has increased intake of
gluten type foods: cereals, breads, pastas etc
– Watery, pale diarrhea, steatorrhea
– Vomiting, anorexia
– Poor weight gain, failure to thrive
– Constipation, vomiting, and abdominal pain may be
the initial presenting signs/symptoms
– Abdominal distention
– Secondary illness such as atopic dermatitis, alopecia,
or oral ulcers may be initial signs/symptoms
• Diagnostic
– Stool analysis
– Jejunal biopsy
• Treatment
– Primarily dietary management, gluten free diet
Nursing Intervention

• Goal: To assist parents and client to understand diet

therapy and promote optimal nutrition intake
• Written information regarding a gluten free diet; corn and
rice may be substituted for grains in diet
• Diet should be high calorie, high protein and low fat
• Teach parents how to read food labels for grain contents
• Important to discuss with parents and older children
necessity of maintaining a lifelong gluten restricted diet,
problems may occur in teenagers who relax their diet and
experience an exacerbation of disease state
• Lack of adherence to dietary restrictions may precipitate
growth retardation, anemia and bone deformities
• Alert: adapt the diet to meet client’s specific needs
Hirschsprung’s disease

• Hirschsprung’s disease (congenital aganglionic

megacolon) is characterized by a congenital
absence of innervation in a segment of the
colon wall
• May precipitate a neurogenic bowel
obstruction; cause of 25% of neonatal
intestinal obstructions
• Most common site is the rectosigmoid colon;
colon proximal to the area dilates (i.e.,
megacolon)
Assessment
• Risk factors/etiology
– Congenital, may be associated with Down syndrome
• Clinical Manifestations
– Varies according to age and amount of colon involved
– Inadequate or absent peristalsis
– Newborn
• Failure to pass meconium within 24 hours to 48
hours after birth
• Vomiting
• Abdominal distention
• Reluctance to take fluids
• Older infant
– Passage of watery stools and diarrhea
– Failure to thrive
– Lack of appetite
– Persistent constipation, impaction
• Diagnostics
– Rectal biopsy
– Barium enema
• Treatment
– Surgical correction usually involves creation of a
temporary colostomy, then a pull-through of the
colon to a point near the rectum. After the
reanastomosis has healed, the temporary
colostomy is closed.
Nursing intervention

• Goal: To promote normal attachment and prepare infant

and parents for surgery
• Allow parents to ventilate feelings regarding congenital
defect of infant
• Foster infant parent attachment
• General preoperative preparation of the infant; neonate
does not require any bowel preparation
• Careful explanation of colostomy to parents
• Goal: To assist parents to understand and provide
appropriate home care for the child after colostomy
• Colostomy is most often temporary
• Parents should be actively involved in colostomy care
before discharge
Intestinal obstruction
• Interference with normal peristalsis and impairment to forward flow
of intestinal contents is known as intestinal obstruction
• Types of obstruction
– Mechanical obstruction
• Strangulated hernia
• Intussusception of the bowel ( common in infants and small
children)
• Volvulus: twisting of the bowel
• Tumors: cancer (most frequent cause of obstruction in the
elderly)
• Adhesions
– Neurogenic: interference with nerve supply in the intestine
• Paralytic ileus or adynamic ileus occuring as a result of
abdominal surgery or inflammatory process
• Potential sequelae from spinal cord injury
– Vascular obstruction: interference with the blood supply to the
bowel
• Infarction of superior mesenteric artery
• Bowel obstruction related to intestinal ischemia may occur
very rapidly and may be life threatening
• Regardless of the precipitating cause, the ensuing problems are a
result of the obstructive process
• The higher the obstruction in the intestine, the more rapidly
symptoms will occur
• Fluid, gas, and intestinal contents accumulate proximal to the
obstruction.
• This causes distention proximal to the obstruction and bowel collapse
distal to the obstruction
• As fluid accumulation increases, so does pressure against the bowel.
This precipitates extravasation of fluids and electrolytes into the
peritoneal cavity.
• Increased pressure may cause the bowel to rupture
• The location of the obstruction determines the extent of fluid and
electrolyte imbalance and acid base imbalance
– Dehydration and electrolyte imbalance do not occur rapidly if obstruction
is in the large intestine
– If obstruction is located high in the intestine, dehydration occurs rapidly
because of the inability of the intestine to reabsorb fluids
– If persistent vomiting is a problem, the client will have metabolic
alkalosis; if contents of the small intestine are lost through vomiting,
metabolic acidosis will occur.
Assessment
• Risk factors/etiology
– Identify type of obstruction and precipitating cause
• Clinical manifestations
– Vomiting occurs early and is more severe if obstruction is
high; may not occur if obstruction is below the ileum
– Abdominal distention
– Bowel sounds initially may be hyperactive proximal to the
obstruction and decreased or absent distal to the
obstruction; eventually, all bowel sounds will be absent
– Colicky type abdominal pain
• Diagnostics
– X-ray film of the abdomen
– Evaluation of history of abdominal problems
– Leukocytosis
– Barium enema
– Computed tomographic scan for clients with abdominal
malignancy and symptoms of obstruction
Complications

• Infection/ septicemia
• Gangrene of the bowel
• Perforation of the bowel
• Fluid imbalances
Treatment

• Mechanical and vascular intestinal obstruction are

generally treated surgically; ileostomy or colostomy
may be necessary
• Treatment of neurogenic obstruction may consist of
intestinal intubation and decompression
• Maintain fluid and electrolytes balances and adequate
nutrition
Nursing Intervention
• Goal: To prepare client for diagnostic evaluation and to maintain ongoing nursing
assessment for pertinent data
• Goal: To decrease gastric distention and to maintain hydration and electrolyte balance
• Maintain NPO status
• Maintain nasogastric suction or intestinal suction
• Maintain IV fluid replacement; most often normal saline or lactated Ringer’s solution
• Administer potassium supplements with caution because of complications of decreased
renal function
• Evaluate peristalsis and return of bowel function
• Maintain accurate intake and output records
• Assess dehydration, hypovolemia, and eletrolyte disturbance
• Measure abdominal girth to determine whether distention is increasing
• Encourage activities to facilitate return of bowel function
– Encourage physical activity, as tolerated
– Attempt to decrease amount of medication required for effective pain control
– Maintain hydration
• Goal : to decrease infection and promote healing after surgery
• Antibiotics are administered via IV infusion. Monitor client’s response to antibiotics, as
well as status of IV infusion site.
• Monitor vital signs frequently and evaluate for presence or escalation of infection process
• Provide wound care. Evaluate drainage and healing from abdominal Penrose or Jackson-
Pratt drains, as well as from abdominal incisional area
• Goal: To reestablish normal nutrition and
promote comfort after abdominal laparotomy
– Evaluate tolerance of liquids when nasogastric
tube is removed
– Begin administration of clear liquids initially and
continue to evaluate presence of peristalsis
– Progress diet as tolerated
– Administer analgesics as indicated
– Promote psychological comfort
• Respond promptly to requests
• Carefully explain procedures
• Encourage questions and ventilation of feelings
regarding status of illness.