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Care of patients with
Gastrointestinal system disorders
Outline ;
Endoscopy.
Proctoscopy .
Nasogatric tube.
medications;
* Ranitidine
* Metoclopramide
* Dolcolax
Gastrointestinal system disorders
 Gastrointestinal (GI) tract disorders are disorders of the digestive
tract, which is sometimes called the Digestive diseases .
 The GI system comprises the alimentary canal and its accessory
organs, beginning at the mouth; extending through the pharynx,
esophagus, stomach, small intestine, colon, rectum, and anal
canal; and ending at the anus.
 The GI system is responsible for the following essential bodily
functions: ingestion , absorption of nutrients into the
bloodstream, and elimination of waste products from the
body .
 Some common problems include ;
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Gastroesophageal reflux disease (GERD), peptic ulcer disease.
Rectal problems, such as hemorrhoids.
Liver problems, such as hepatitis B or hepatitis C, liver failure.
Pancreatitis
 Tests for digestive problems can include Proctoscopy, upper
GI endoscopy, cholangiopancreatography .
Endoscopy
Endoscopy procedure
 Endoscopy is a nonsurgical procedure used to examine a person's
digestive tract.
 Endoscopy is the use of a flexible tube with a light and camera
attached to it, to visualize the GI tract and to perform certain
diagnostic and therapeutic procedures.
 Images of digestive tract are produced through a video screen
monitor.
 The endoscope can be inserted through the rectum or mouth,
depending on which portion of the GI tract is to be viewed
 During an upper endoscopy, an endoscope endoscope is
lubricated with
a water-soluble lubricant and passed smoothly and slowly along
the back of the mouth and down into the esophagus allowing
the doctor to view the esophagus, stomach, and upper part of
the small intestine.
 Endoscopes contain multipurpose channels that allow for air
insufflations, irrigation, fluid aspiration, and the passage of
special instruments.
 Therapeutic endoscopy can be used to remove common bile
duct stones, dilate strictures, and treat gastric bleeding and
esophageal varices.
 The patient wears a mouth guard to keep from biting the
scope.
http://www.youtube.com/watch?v=W1faSbFuLl8
Capsule Endoscopy
 Capsule endoscopy utilizes an ingestible camera device rather
than an endoscope.
 The procedure involves swallowing a capsule (camera device),
which passes through the digestive system while taking pictures
of the intestine.
 capsule (About the size of a large vitamin capsule) that takes
multiple digital photos of the small bowel. The images are
transmitted via small sensors attached to the abdomen with
adhesive stickers or transmitted wirelessly from the capsule to
recording device belted to the patient's waist.
Capsule Endoscopy
The small bowel is about 6 meters long and the capsule takes
about 8 hours to travel through it
After approximately 8 hours, the recording device is removed, the
physician downloads image data from the recorder to a PC and
views the images to make a diagnosis. No sedation or anesthetic is
required.
The capsule will be excreted naturally through the digestive tract.
Indications
 Dysphagia.
 Esophageal reflux symptoms that persist or recur despite
appropriate therapy.
 Persistent vomiting of unknown cause.
 For confirmation and specific histologic diagnosis of radiologically
demonstrated lesions
 In patients with active GI bleeding or recent bleeding.
 When sampling of tissue or fluid is indicated.
 Treatment of bleeding lesions such as ulcers, tumors,
 Removal of foreign bodies.
 Placement of feeding or drainage tubes (eg, percutaneous
endoscopic gastrostomy).
Contraindications
Acute MI
Peritonitis
Acute perforation
Patients who are taking anticoagulants
Complications
 Cardiopulmonary complications related to sedation and analgesia are
the most common types of complications seen with diagnostic
endoscopy .
 Aspiration pneumonia ( Aspiration of gastric contents into the lungs is
common, pneumonia and may result in death).
 Infectious complications related to diagnostic endoscopy result either
from the procedure itself or from the use of contaminated equipment.
 Perforation.
 Bleeding can result from injury to gastric or abdominal wall vessels.
Nursing interventions

Before the procedure
1)
Explain the following to the patient:
1)
The type of procedure to be performed on the patient, And advise
that someone must accompany the patient to drive home due to
the patient being sedated.
2)
NPO for 8 to 12 hours before the procedure to prevent aspiration
and allow for complete visualization of the stomach.
3)
Remove dentures and partial plates to facilitate passing the scope
and preventing injury.
4)
Inform the health care provider of any known allergies and current
medications. Medications may be held until after the test is
completed.
 Describe what will occur during and after the procedure to the
patient :
1) The throat will be anesthetized with a spray or gargle.
2) An I.V. sedative will be administered.
3) The patient will be positioned on the left side with a towel
or basin at the mouth to catch secretions and to provide
easy access for the endoscope.
4) A plastic mouthpiece will be used to help relax the jaw
and protect the endoscope. Emphasize that this will not
interfere with breathing.
5) The patient may be asked to swallow once while the
endoscope is being advanced. Then the patient should not
swallow, talk, or move tongue. Secretions should drain from
the side of the mouth, and the mouth may be suctioned.
6) Air is inserted during the procedure to permit better
visualization of the GI tract. Most of the air is removed at the
end of the procedure. The patient may feel bloated, burp, or
pass flatus from remaining air.
After the procedure
1) The nurse instructs the patient not to eat or drink until the
gag reflex returns (in 1 to 2 hours), to prevent aspiration of
food or fluids into the lungs.
2) The nurse assess or test gag reflex by placing a tongue blade
onto the back of the throat to see whether gagging occurs.
3) After the patient’s gag reflex has returned, the nurse can
offer saline gargle, and oral analgesics to relieve minor throat
discomfort.
4) The nurse places the patient in the Simms position until he or
she is awake and then places the patient in the semi-Fowler’s
position until ready for discharge.
5) observing for signs of perforation, such as pain, bleeding,
unusual difficulty swallowing, and an elevated temperature.
6) Patients who were sedated for the procedure must stay on
bed rest until fully alert.
7) he nurse monitors the pulse and blood pressure for changes
that can occur with sedation.
8) The nurse instructs the patient not to drive for 10 to 12 hours
if sedation was used.
Proctoscopy
Proctoscopy
 The lower portion of the colon also can be viewed directly to
evaluate rectal bleeding, acute or chronic diarrhea, or change in
bowel patterns and to observe for ulceration, fissures, abscesses,
tumors, polyps, or other pathologic processes.
• Proctoscopy is a diagnostic procedure used to examine anal cavity,
rectum or sigmoid colon (pelvic colon) through an instrument called
proctoscope.
• Proctoscope is a metal or plastic tube which is approximately 8 inch
in diameter.
• The procedure is usually done to examine hameorrhoids or rectal
polyps (overgrown tissues).
Procedure for proctoscopy
 During the procedure the instrument is lubricated
and is inserted into the rectum and air is gently
pumped in which allows a clearer view of the
interior part of the rectum.
 The complete procedure takes around 5-10
minutes.
 This procedure is usually uncomfortable
Indications:
1)
2)
3)
4)
To confirm radiographic findings.
To obtain biopsy, cytology and culture specimens.
To locate and coagulate bleeding points.
To examine hameorrhoids
Contraindications:
1) Patients with a large aortic aneurysm.
2) Patients with acute myocardial infarction.
3) Patients with abnormal coagulation studies.
Complications that may arise after proctoscopy
 Bleeding .
 Difficulty in urinating.
 Sever pain
Nursing interventions
 These examinations require only limited bowel
preparation, including use an enema or laxative to empty
the colon before the test is done.
During the procedure,
 the nurse monitors vital signs, skin color and
temperature, pain tolerance.
After the procedure,
1) the nurse monitors the patient for rectal bleeding and
signs of intestinal perforation (ie, fever, rectal drainage,
abdominal distention, and pain).
2) On completion of the examination, the patient can
resume regular activities and dietary practices.
Nasogastric tube Feeding
NGT
Nasogastric tube (NGT)
(NGT )refers to the insertion of a tube through the nasopharynx
into the stomach.
Purposes of Nasogastric Intubation
1) Prevent or relieve nausea and vomiting after surgery or
traumatic events by decompressing the stomach.
2) Irrigate the stomach (lavage) for active bleeding or poisoning.
3) Administer medications and feeding (gavage) directly into the
GI tract.
4) Obtain a specimen of gastric contents
Procedure
1)
Gather equipment.
2)
Don non-sterile gloves
3)
Explain the procedure to the patient and show equipment
4)
If possible, sit patient upright for optimal neck/stomach
alignment
5)
Examine nostrils for deformity/obstructions to determine best
side for insertion
6)
Measure tubing from bridge of nose to earlobe, then to the point
halfway between the end of the sternum and the navel
7)
Lubricate 2-4 inches of tube with lubricant. Pass tube via nostrils,
past the pharynx into the esophagus and then the stomach.
Procedure
8)
Instruct the patient to swallowing or sips small of water to enhance
passage of tube into esophagus. If resistance is met, rotate tube slowly
with downward advancement toward closes ear. Do not force.
9)
Check for placement by attaching syringe to free end of the tube,
aspirate sample of gastric contents. Do not inject an air bolus, as the
best practice is to test the pH of the aspirated contents to ensure that
the contents are acidic. The pH should be below 6. Obtain an x-ray to
verify placement before instilling any feedings/medications or if you
have concerns about the placement of the tube.
10) Secure tube with tape or commercially prepared tube holder.
11) Document the reason for the tube insertion, type & size of tube, the
nature and amount of aspirate, the type of suction and pressure setting
if for suction, the nature and amount of drainage, and the effectiveness
of the intervention.
Nursing interventions
1) Assure the patient that most discomfort he feels will
lessen as he gets used to the tube.
2) Irrigate the tube at regular intervals (every 2 hours
unless otherwise indicated) with small volumes of
prescribed fluid (To ensure the tube patency) .
3) Ensure that NGT in correct position through , inject
air or aspirate stomach secretion.
4) Cleanse nares and provide mouth care every shift.
Nursing interventions
5) Apply petroleum jelly to nostrils as needed, and
assess for skin irritation or breakdown.
6) Keep head of bed elevated at least 30 degrees.
7) Record the time, type, and size of tube inserted.
Document placement checks after each
assessment, along with amount, color,
consistency of drainage.
Medications
Ranitidine
Classification:
Histamine
Action:
inhibiting basal gastric acid secretion and gastric acid secretion
that is stimulated by food, insulin, histamine, cholinergic
agonists, gastrin,
Indications
duodenal ulcer
gastric ulcer
Short-term treatment of gastroesophageal reflux disease
(GERD)
esophagitis
Treatment of heartburn.

contraindication allergy to ranitidine,
lactation.
impaired renal or hepatic function, pregnancy.
Side Effects:
CNS: Headache, malaise, dizziness.
CV: Tachycardia, bradycardia.
Dermatologic: Rash, alopecia
GI: Constipation, diarrhea, nausea, vomiting.
Local: Pain at IM site, local burning or itching at IV site
Ranitidine
Nursing
Considerations:
Administer oral drug with meals and at bedtime.
Decrease doses in renal and liver failure.
Administer IM dose undiluted, deep into large muscle group.
Arrange for regular follow-up, including blood tests, to evaluate
effect .
Patient teaching
Take drug with meals and at bedtime.
Have regular medical follow-up care to evaluate your response.
These side effects may occur:
Constipation or diarrhea (request aid from your health care
provider)
nausea, vomiting (take drug with meals)
headache (adjust lights and temperature and avoid noise).
Report fever, unusual bruising or bleeding, severe headache,
muscle or joint pain.
Metoclopramide
Classification:
Antiemetic
Action:
increases lower esophageal sphincter pressure; , accelerates
gastric emptying and intestinal transit.
Indications
Prevention of nausea and vomiting associated
with emetogenic cancer chemotherapy
Prophylaxis of postoperative nausea and vomiting
when nasogastric suction is undesirable
contraindications
Contraindicated with allergy to metoclopramide
GI hemorrhage
Side Effects:
CNS: Restlessness, drowsiness, fatigue, anxiety
CV: Transient hypertension
GI: Nausea, diarrhea
Nursing
Considerations:
Monitor BP carefully during IV administration.
Monitor diabetic patients, arrange for alteration in insulin dose
or Have phentolamine readily available in case of hypertensive
crisis.
Dulcolax
Classification:
laxative
Action:
It acts directly on the bowels, stimulating the bowel muscles
(Perstalsis) to cause a bowel movement and evacuate the colon .
Indications
to treat constipation
contraindications
allergic to any ingredient in Dulcolax.
severe stomach pain; appendicitis.
stomach, intestinal, or rectal bleeding.
Side Effects:
 abdominal cramping, diarrhea, nausea, vomiting
 fluid and electrolyte imbalance.
Nursing
Considerations:
Assess for allergy to the drug, stomach pain, N/V, sudden
change in bowel habits lasting >2 weeks.
Monitor for rectal bleeding, for no bowel movement, stomach
discomfort.
Monitor fluid and electrolyte regularly .