Gastrointestinal Disorders

Normally, the liver performs many metabolic functions that provide energy for the body. In cirrhosis, the liver's metabolic function is compromised, increasing the client's need for dietary carbohydrates and other energy sources to provide for cellular metabolism. The nurse should limit the client's fat intake to prevent satiation and should restrict protein intake because a cirrhotic liver can't metabolize protein efficiently. Increasing fiber intake isn't significant for a client with cirrhosis.

 Protecting the client from aspiration is essential because aspiration can cause pneumonia, a potentially life-threatening disorder. Gastric ulcers aren't a common complication of tube feeding in clients with endotracheal or tracheostomytubes. Abdominal distention and diarrhea can both be associated with tube feeding but neither is immediately life-threatening.

A normal potassium level is 3.8 to 5.5mEq/L. Severe hypokalemia can cause cardiac and respiratory arrest, possibly leading to death. Hypokalemia also depresses the release of insulin and results in glucose intolerance. The glucose level is above normal (normal is 75 to 110 mg/dL) and the chloride level is a bit low (normal is 100 to 110 mEq/L). Although these levels should be reported, neither is life-threatening. The BUN (normal is 8 to 26 mg/dL) and creatinine (normal is 0.8 to 1.4 mg/dL) are within normal range.

Acute pancreatitis can cause decreased urine output, which results from the renal failure that sometimes accompanies this condition. Intracranial pressure neither increases nor decreases in a client with pancreatitis. Tachycardia, notbradycardia, usually is associated with pulmonary or hypovolemic complications of pancreatitis. Hypotension can be caused by a hypovolemic complication, but hypertension usually isn't related to acute pancreatitis.

Adverse reactions to gentamicin include ototoxicity and nephrotoxicity. The nurse must monitor the client's hearing and instruct him to report any hearing loss or tinnitus. Signs of nephrotoxicity include decreased urine output and elevated BUN and creatinine levels. Gentamicin doesn't affect the serum calcium level or HCT.

opantheline bromide is used to reduce secretions and spasms of the GI tract in clients with diverticulitis, a condition characterized by bowel inflammation and colonic irritability and spasticity. The nurse should instruct the client to take the drug 30 minutes before meals and at bedtime to reduce GI motility, thus relieving spasticity. Taking it with a meal, immediately before a meal, or 1 hour after a meal would interfere with the drug's action and absorption, thereby reducing its effectiveness.

n NG tube that fails to drain during the postoperative period should be reported to the physician immediately. It may be clogged, which could increase pressure on the suture site because fluid isn't draining adequately. Repositioning or irrigating an NG tube in a client who has undergone gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI mucosa or the suture line.

Hypothermia is a common effect of inhalation anesthetics, and shivering is normal during postoperative recovery. The nurse should administer oxygen, as prescribed, to compensate for the increased oxygen demand caused by shivering. Notifying the physician would be appropriate only if the client had other signs and symptoms, such as respiratory distress or changes in skin color or vital signs. Increasing the I.V. fluid infusion rate could cause fluid overload. The nurse should monitor the fluid intake and output of all postoperative clients, not just those who are shivering or who received an inhalation anesthetic.

 If abdominal distention is accompanied by nausea, the nurse must first auscultate bowel sounds. If bowel sounds are absent, the nurse should suspect gastric or small intestine dilation and these findings must be reported to the physician. Palpation should be avoided postoperatively with abdominal distention. If peristalsis is absent, changing positions and inserting a rectal tube won't relieve the client's discomfort.

Docusate sodium, a laxative, is used to treat constipation. It softens the stool by stimulating the secretion of intestinal fluid into the stool. Lorazepam, an antianxiety agent, has no laxative effect. Administering loperamide, an antidiarrheal agent, could cause the constipation to worsen. Flurbiprofen is a nonsteroidal anti-inflammatory agent with no laxative effect.

The nurse should place the client with acute pancreatitis in a side-lying position with knees flexed; this position promotes comfort by decreasing pressure on the abdominal muscles. The nurse should administer an analgesic, as needed and prescribed, before pain becomes severe, rather than once each shift. Because the client needs a quiet, restful environment during the acute disease stage, the nurse should discourage frequent visits from family and friends. Frequent oral feedings are contraindicated during the acute stage to allow the pancreas to rest.

n ascites, accumulation of large amounts of fluid causes extreme abdominal distention, which may put pressure on the diaphragm and interfere with respiration. If uncorrected, this may lead to atelectasis or pneumonia. Although fluid volume excess is present, the diagnosis Ineffective breathing pattern takes precedence because it can lead more quickly to life-threatening consequences. The nurse can deal with fatigue and altered nutrition after the client establishes and maintains an effective breathing pattern.

The nurse should read the consent form to the client and make sure that he understands what was read to him. The physician and nurse should answer any questions the client has before he signs the consent form. The client's family doesn't need to be present. The legally blind client can sign the consent form.

Feces, fluid, and gas accumulate above a bowel obstruction. Then the absorption of fluids decreases and gastric secretions increase. This process leads to a loss of fluids and electrolytes in circulation.

In acute liver failure, serum ammonia levels increase because the liver can't adequately detoxify the ammonia produced in the GI tract. In addition, serum glucose levels decline because the liver isn't capable of releasing stored glucose. Both elevated serum ammonia and subnormal serum glucose levels depress the level of a client's consciousness. The other diagnostic values aren't as directly related to the client's level of consciousness. 

When used as preanesthesia medications, atropine and other cholinergic blocking agents reduce salivation and gastric secretions, thus helping to prevent aspiration of secretions during surgery. Atropine increases the heart rate and cardiac contractility, decreases bronchial secretions, and causes bronchodilation. No evidence indicates that the drug enhances the effect of anesthetic agents.


Daily weight measurement is the most accurate indicator of fluid status; a loss of 2.2 lb (1 kg) indicates loss of 1 L of fluid. Because spironolactone is a diuretic, weight loss is the best indicator of its effectiveness. This client's serum potassium and sodium levels are normal. A blood pH of 7.25 indicates acidosis, an adverse reaction to spironolactone.

Daily weight measurement is the most accurate indicator of fluid status; a loss of 2.2 lb (1 kg) indicates loss of 1 L of fluid. Because spironolactone is a diuretic, weight loss is the best indicator of its effectiveness. This client's serum potassium and sodium levels are normal. A blood pH of 7.25 indicates acidosis, an adverse reaction to spironolactone.


Cirrhosis causes muscle wasting, a decrease in chest and axillary hair, testicular atrophy, and an increased bleeding tendency.

Elevation of serum lipase is the most reliable indicator of pancreatitis because this enzyme is produced solely by the pancreas. A client's BUN is typically elevated in relation to renal dysfunction; the AST, in relation to liver dysfunction; and LD, in relation to damaged cardiac muscle.

With a sigmoid colostomy, the feces are solid; therefore, the client may eventually gain enough control that he would not need to wear a colostomy bag. With a descending colostomy, the feces are semi-mushy. With a transverse colostomy, the feces are mushy. With an ascending colostomy, the feces are fluid. In these three latter cases, it is unlikely that the client could gain control of elimination; consequently, wearing an ostomy bag would be necessary.

 Hyperglycemia may occur if TPN is administered too rapidly, exceeding the client's glucose metabolism rate. With hyperglycemia, the renal threshold for glucose reabsorption is exceeded and osmotic diuresis occurs, leading to dehydration and electrolyte depletion. Although air embolism may occur during TPN administration, this problem results from faulty catheter insertion, not overly rapid administration. TPN may cause diarrhea, not constipation, especially if administered too rapidly.Dumping syndrome results from food moving through the GI tract too quickly; because TPN is given I.V., it can't cause dumping syndrome.

he Hemovac must be compressed to establish suction. If the Hemovac is allowed to fully expand suction is no longer present causing the drain to malfunction. The client who requires major abdominal surgery typically produces abdominal drainage despite the client's position. An NG tube drains stomach contents, not incisional contents. Therefore, the NG tube drainage of 400 ml is normal in this client and is not related to the absence of Hemovac drainage. Dry drainage on the dressing indicates leakage from the incision; it isn't related to the Hemovac drainage.

he nurse can gently irrigate the tube if ordered, but must be careful not to reposition it. Repositioning can cause bleeding. Suction should be applied continuously — not every hour. The NG tube shouldn't be clamped postoperatively because secretions and gas will accumulate, stressing the suture line.

Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other conditions are less likely to exhibit fluid volume deficit.


A Bernstein test reveals whether a client's chest pain results from acid perfusion of the esophageal mucosa. It's performed by inserting an NG tube and aspirating the gastric contents. (Alternatively, normal saline solution and 0.1% hydrochloric acid may be instilled into the lower esophagus.) If the client doesn't experience pain, the test is negative. A Bernstein test doesn't locate an esophageal mass, evaluate competency of the lower esophageal sphincter, or detect esophageal inflammation.

emoglobin and hematocrit are typically performed first in clients with upper GI bleeding to evaluate the extent of blood loss. Endoscopy is then performed to directly visualize the upper GI tract and locate the source of bleeding. An upper GI series, or barium study, usually isn't the diagnostic method of choice, especially in a client with acute active bleeding who's vomiting and unstable. An upper GI series is also less accurate than endoscopy. Although an upper GI series might confirm the presence of a lesion, it wouldn't necessarily reveal whether the lesion is bleeding. Arteriography is an invasive study associated with life-threatening complications and wouldn't be used for an initial evaluation.



he client diagnosed with Clostridium difficile diarrhea requires contact isolation. Contact isolation precautions require the use of glove and a gown if soiling is likely. 

For a colonoscopy, the nurse initially should position the client on the left side with knees bent. Placing the client on the right side with legs straight, prone with the torso elevated, or bent over with hands touching the floor wouldn't allow proper visualization of the large intestine.



The nurse should make sure the client's bladder is empty before auscultating because a full bladder may interfere with bowel sounds. To auscultate bowel sounds, the nurse uses the diaphragm of the stethoscope. (The nurse uses the bell to auscultate vascular sounds.) To confirm absence of bowel sounds, the nurse must listen in each quadrant for at least 5 minutes. The nurse should press the stethoscope lightly, not deeply, on the abdominal wall in all four quadrants.

he onset of action of kaolin and pectin occurs within 30 minutes after oral administration. Duration of action is 4 to 6 hours.

he nurse must continue enteric precautions for a client with gastroenteritis caused by the Norwalk virus because this virus is transmitted by the fecal-oral route. No safe and effective antiviral agent is available specifically for treating viral gastroenteritis. The Norwalk virus isn't transmitted by droplets.


Pseudomembranous colitis may result from a superinfection with C. difficile during clindamycin therapy. Clindamycin-induced pseudomembranous colitis isn't caused by S. aureus, B. fragilis, or E. coli. 

 Because antacids can interact with ranitidine and interfere with its absorption, the client shouldn't take these drugs together. Ranitidine doesn't interact with antibiotic, antipsychotic, or antiarrhythmic agents.


Peritonitis decreases intestinal motility and causes intestinal distention. A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (such as appendicitis,diverticulitis, ulcerative colitis, or a strangulated obstruction). The client also has direct or rebound tenderness. Tenderness and pain in the right upper abdominal quadrant suggest cholecystitis. Jaundice and vomiting are signs of cirrhosis of the liver. Rectal bleeding or a change in bowel habits may indicate colorectal cancer.


Paregoric has an additive effect of constipation when used with anticholinergic drugs. Antiarrhythmics, anticoagulants, and antihypertensives aren't known to interact with paregoric.

ecause of the short duration of action, frequent doses of antacids are needed. Antacids usually provide a rapid to immediate onset of action, don't have prolonged half-lives, and aren't highly metabolized.

Of the choices listed, aspiration is the most serious potential complication of tube feedings. Dehydration — not fluid volume excess — is a concern because of decreased free water intake. Hyperglycemia is a complication secondary to carbohydrate load of enteral feeding solutions. Constipation is a problem, but it usually isn't a serious one. The client would most likely experience diarrhea.

During passage of the bougies used to dilate the esophagus, the client should take long, slow breaths to minimize the vomiting urge. Having the client hold the breath, bear down as if having a bowel movement, or pant like a dog is neither required nor helpful.

To maintain a gastric pH of 3.0 to 3.5 throughout each 24-hour period, regular (not as needed) doses of an antacid are needed to treat peptic ulcer disease. Frequent administration of an antacid tends to decrease client compliance. Antacids don't regulate bowel patterns, and they decrease pepsin activity.

 Cyanosis, coughing, and choking occur when fluid from the blind pouch is aspirated into the trachea. Saliva production doesn't decrease in neonates born with esophageal atresia. The ability to swallow isn't affected by this disorder.