Assessment of Digestive and Gastrointestinal Function

Medical-Surgical Nursing (Lecture)

BS Nursing (Block A) | Taculod | SEM 2 2022

Pyloric Sphincter
ANATOMIC AND PHYSIOLOGIC OVERVIEW
● formed by circular smooth muscle (from the
Gastrointestinal (GI) Tract wall of the pylorus)
● controls the opening between the stomach
● a pathway and the small intestine.
● 7 to 7.9 m (23 to 26 feet) in length
● extends from the mouth to the esophagus,
stomach, small and large intestines, and
rectum, to the terminal structure, the anus
Esophagus

● located in the mediastinum

● anterior to the spine and posterior to the
trachea and heart.
● a hollow muscular tube
● approximately 25 cm (10 inches) in length Small Intestine
Diaphragmatic hiatus (esophageal hiatus)
● passes through the diaphragm at an opening ● longest segment of the GI tract
● folds back and forth on itself
● approx. 70 m (230 feet)

THREE SECTIONS:
1. Duodenum (the most proximal section)
2. Jejunum (middle section)
3. Ileum (distal section)
Absorption
● process by which nutrients enter the
Stomach bloodstream through the intestinal walls
Ileocecal Valve
● left upper portion of the abdomen ● where ileum terminates at the cecum
● under the left lobe of the liver and the Appendix
diaphragm
● overlaying most of the pancreas ● also known as vermiform appendix
● hollow muscular organ (capacity: approx. ● attached to the cecum
1500mL) ● an appendage that has
FUNCTION: little or no physiologic
● stores food during eating function.
● secretes digestive fluids ● The ‘Safe House’ Theory
● propels the partially digested food (chyme) of the Appendix
into the small intestine.
Four anatomic regions Common Bile Duct
1. Cardia (entrance)
2. Fundus ● empties into the duodenum at the ampulla
3. Body of Vater
4. Pylorus (outlet) ● allows for the passage of both bile and
pancreatic secretions.

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Large Intestine

● also called the large bowel or colon Portal Venous System

● where food waste is formed into poop,
stored, and finally excreted. This portal venous system is composed of five large
● It includes the colon, rectum and anus. veins:
consists of: 1. Superior mesenteric veins
a. ascending segment (right side of the 2. Inferior mesenteric veins
abdomen) 3. Gastric veins
b. transverse segment (extends from right to 4. Splenic veins
left in the upper abdomen) 5. Cystic veins eventually form the vena portae
c. descending segment (left side of the that enters the liver.
abdomen) 6. Once in the liver, the blood is distributed
SIGMOID COLON, THE RECTUM, AND THE ANUS throughout and collected into the hepatic
● completes the terminal portion of the large veins that then terminate in the inferior vena
intestine. cava.
● a network of striated muscle that forms both
the internal and the external anal sphincters
regulate the anal outlet.

GI TRACT BLOOD SUPPLY

● RECEIVES: blood from arteries (thoracic and

abdominal aorta)
● RETURNS: blood through veins (from the
digestive organs & the spleen)
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AUTONOMIC NERVOUS SYSTEM stomach – lower esophageal sphincter closes

tightly (prevent reflux of stomach contents
Voluntary Control into the esophagus)

● Sympathetic Nerves
○ exert an inhibitory effect on the GI GASTRIC FUNCTION
tract Stomach
○ decreased gastric secretion and
motility ● stores and mixes food with secretions
○ constriction of sphincters and blood ● secretes a highly acidic fluid (up to 2.4 L/day)
vessels in response to the presence or anticipated
● Parasympathetic Nerves ingestion of food
○ Peristalsis Hydrochloric Acid
○ Increased secretory activities
○ Relaxing of the sphincter ● pH as low as 1
Voluntary Controls ● secreted by the glands of the stomach
● breaks down food into more absorbable
● Upper esophageal sphincter components
● External anal sphincter ● aid in the
destruction of
most ingested
bacteria.
Pepsin

● An enzyme
for protein
digestion
Intrinsic Factor
Functions of the Digestive System
● Digestion ● a protein that helps your intestines absorb
● Absorption vitamin B12.
● Elimination ● absorption site: ileum
Chewing and Swallowing ● secreted by the gastric mucosa
● absence of intrinsic factor – vitamin B12
Chewing cannot be absorbed – pernicious anemia
● first step of the process of digestion results
● Ptyalin, or salivary amylase Chyme
– enzyme that begins the
digestion of starches. ● the partially digested food
Swallowing mixed with gastric secretions
● begins as a voluntary act; SMALL INTESTINE FUNCTION
regulated by the
swallowing center in the ● Digestive continuous in the
medulla oblongata of the duodenum
CNS. Duodenal Secretions
● swallowed food – epiglottis
covers tracheal opening à ● from accessory digestive organs
upper esophagus – – pancreas, liver, and gallbladder,
esophageal peristalsis – intestinal glands
lower esophageal sphincter relaxes – ● These secretions contain
digestive enzymes: amylase, lipase, and bile.
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Pancreatic secretions ● functions to produce digestive enzymes as

well as to absorb nutrients
● Have an alkaline pH (high concentration of ● Absorption is the major function of the small
bicarbonate) intestine.
1. Trypsin ● accomplished by active transport and
○ Aids in digesting protein diffusion across the intestinal wall into the
2. Amylase circulation.
○ Aids in digesting starch ● Vitamin B12 and bile salts are absorbed in
3. Lipase the ileum.
○ aids in digesting fats Colonic Function
Pancreatic secretion flow:
● These secretions drain into the pancreatic ● Within 4 hours after eating – residual waste
duct – which empties into the common bile material passes into the terminal ileum –
duct at the ampulla of Vater. slowly into the proximal portion of the right
colon through the ileocecal valve.
● The ileocecal valve opens briefly and permits
some of the contents to pass into the colon.

Bile

● secreted by the liver

● stored in the gallbladder
aids in emulsifying ingested fats Gut Microbes (Bacteria)
Sphincter of ODI ● a major component of the contents of the
large intestine
● found at the confluence of the common ● assist in completing the breakdown of waste
● bile duct and duodenum material
● controls the flow of bile. Two types of colonic secretions are added to the
Two types of Intestinal Contractions residual material:
● Segmental Contractions ● an electrolyte solution (bicarbonate solution
○ produce mixing waves that move the that acts to neutralize the end products
intestinal contents back and forth in formed by the colonic bacterial action)
a churning motion. ● mucus (protects the colonic mucosa from the
● Intestinal Peristalsis intraluminal contents and provides
○ propels the contents of the small adherence for the fecal mass)
intestine toward the colon. Waste Products of Digestion
Both movements are stimulated by the presence
of chyme. Fecal matter (75% fluid + 25% solid material)
● Brown Color
Villi
○ results from the breakdown of bile by
the intestinal bacteria
● small, fingerlike projections
● Fecal odor
● lines the entire intestine
○ from the chemicals formed by
intestinal bacteria
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○ gases formed contain methane, ● fecal incontinence

hydrogen sulfide, and ammonia à ● jaundice
which are either absorbed into the PAIN
portal circulation and detoxified by
the liver or expelled from the rectum Abdominal pain
as flatus. ● A frequent presenting in general practice
Elimination ○ character
1. begins with distention of the rectum ○ duration
2. initiates reflex contractions of the rectal ○ pattern
musculature ○ frequency
3. relaxes the normally closed internal anal ○ location
sphincter (controlled by ANS - involuntary) ○ distribution of referred abdominal
4. external sphincter (conscious control of the pain
cerebral cortex – voluntary) = DEFECATION ○ time of the pain
● Defecation is seen to be a spinal reflex
(involving the parasympathetic nerve fibers)
that can be inhibited voluntarily by keeping
the external anal sphincter closed.
Gut Microbiome

Gut Microbiota (the complement of microbes on the

GI tract)
a. Role in vitamin synthesis
b. Immune function (protection against
invading pathogens, regulatory influences on DYSPEPSIA
innate and adaptive immune responses, and
inflammation) ● upper abdominal discomfort associated with
Intestinal Epithelium eating (commonly called indigestion)
● the first line of defense against pathogenic ● most common symptom of patients with GI
microbes and microbial agents (contains dysfunction
innate immune cells such as macrophages, Fatty foods (causes the most discomfort because
dendritic cells, granulocytes, and mast cells, they remain in the stomach for digestion longer than
and has a role in T-cell responses) proteins or carbohydrates)
Peyer’s patches (Gut-Associated Lymph Tissue) INTESTINAL GAS
● also have a role in antigen processing and
immune defense accumulation of gas in the GI tract may result in:
● Belching (expulsion of gas from the stomach
ASSESSMENT OF THE GASTROINTESTINAL through the mouth)
SYSTEM ● Flatulence (expulsion of gas from the
rectum)
Health History
NAUSEA & VOMITING
● A focused GI assessment begins with a
complete history.
Nausea
Common Symptoms:
● A vague, uncomfortable sensation of sickness
● abdominal pain
or “queasiness”
● dyspepsia
Vomiting
● gas
● forceful emptying of the stomach and
● nausea and vomiting
intestinal contents through the mouth
● diarrhea
● constipation

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Emesis or Vomitus, may contain: PHYSICAL ASSESSMENT

● undigested food particles
● blood (hematemesis) ORAL CAVITY
● bilious material mixed with gastric juices.
Mallory-Weiss Tear Inspection and Palpation
● acute onset of emesis that appears bright ● remove dentures for good visualization
red or as coffee grounds LIPS
● indicates upper GI bleeding ● check for moisture
GUMS
● check inflammation, bleeding, retraction, &
discoloration
TONGUE
● texture, color, and lesions & cranial nerve XII
ABDOMEN

● INSPECTION, AUSCULTATION, PERCUSSION,

AND PALPATION
○ patient lies supine with knees flexed
slightly
CHANGE IN BOWEL HABITS AND STOOL ○ divide into either four quadrants or
CHARACTERISTICS nine regions

Diarrhea
● an abnormal increase in the frequency and
liquidity of the stool
● commonly occurs when the continents move
so rapidly through the intestine and colon
that there is inadequate time for the GI
secretions and oral contents to be absorbed. INSPECTION
Constipation ● note skin changes, nodules, lesions, scarring,
● a decrease in the frequency of stool, or discolorations, inflammation, bruising, or
stools that are hard, dry, and of smaller striae.
volume than typical ● contour and symmetry
● may be associated with anal discomfort and ● localized bulging, distention, or peristaltic
rectal bleeding waves
Stool Characteristics: Normally light to dark brown Normal Contour: flat, rounded, or scaphoid
● TARRY-BLACK COLOR (MELENA)
○ upper GI tract bleeding
● BRIGHT OR DARK RED (HEMATOCHEZIA)
○ lower GI tract bleeding
● LOWER RECTAL OR ANAL BLEEDING
○ streaking of blood on the surface of
the stool
○ blood is noted on toilet tissue
FOODS AND MEDICATIONS THAT ALTER STOOL AUSCULTATION
COLOR ● always precedes percussion and palpation,
because they may alter sounds.
● Indications: to determine character, location,
and frequency of bowel sounds and to
identify vascular sounds.

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● Use DIAPHRAGM of stethoscope External examination

BOWEL SOUNDS ● inspection for lumps, rashes, inflammation,
● frequency (occur irregularly and range from excoriation, tears, scars, pilonidal dimpling,
5 – 30/min) and tufts of hair at the pilonidal area.
● character of the sounds (clicks and gurgles)
● designated as (normal, hyperactive,
hypoactive, or absent)
AUSCULTATION GUIDE:
● auscultate for a minimum of 5 minutes
● listen for at least 1 minute in each quadrant
(to confirm the absence of bowel sounds)
● Borborygmus (“stomach growling”)
● heard as a loud prolonged gurgle
PERCUSSION
● used to assess the size and density of the
abdominal organs and to detect the
presence of air-filled, fluid-filled, or solid
masses
● can validate palpation findings
● all quadrants are percussed for overall
tympany and dullness.
○ Tympani (sound that results from the
presence of air in the stomach and
small intestines) DIAGNOSTIC EVALUATION
○ Dullness (heard over organs and solid
masses) GENERAL PREPARATION
PALPATION
● Light Palpation (identifying areas of Preparation for many of these studies includes:
tenderness or muscular resistance) ● clear liquid or low residue diet
● Deep Palpation (used to identify masses) ● Fasting
RECTUM ● ingestion of a liquid bowel preparation
● the use of laxatives or enemas
INSPECTION AND PALPATION ● ingestion or injection of a contrast agent or a
● evaluation of the terminal portions of the GI radiopaque dye
tract, the rectum, perianal region, and anus. SERUM LABORATORY STUDIES
Positions for the rectal examination:
● Knee-chest CBC, also known as complete blood count
● left lateral ● Complete Metabolic Panel
with hips and ● Prothrombin time/Partial thromboplastin
knees flexed time
● standing with ● Triglycerides
hips flexed ● Liver function tests
Internal examination ● Amylase, and Lipase
● performed with a gloved lubricated index ● Tumor markers: Carcinoembryonic antigen
finger inserted into the anal canal while the (CEA), cancer antigen (CA) 19-9, and
patient bears down. alpha-fetoprotein – to detect _________ &
● tone of the sphincter is noted, as are any _____ cancer
nodules or irregularities of the anal ring.

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STOOL TESTS

● determines consistency, color, and occult

(not visible) blood.
○ Fecal urobilinogen
○ Fecal fat
○ Clostridium difficile, and other
pathogen/parasites
○ Fecal leukocytes
Guaiac-based fecal occult blood testing (gFOBT) ABDOMINAL ULTRASONOGRAPHY
● most performed stool test
● used to find occult blood (or blood that can't NURSING INTERVENTIONS
be seen with the naked eye) in stool ● patient is instructed to fast for 8 to 12 hours
● contraindication: hemorrhoidal bleeding before ultrasound (decreases the amount of
● avoid: red meats, aspirin, vitamin C, and gas in the bowel)
NSAIDs for 72 hours prior to the study ● gallbladder studies: the patient should eat a
FIT-fecal DNA testing fat-free meal the evening before the test.
● can detect abnormal sections of DNA from IMAGING STUDIES
cancer or polyp cells
BREATH TESTS Upper Gastrointestinal Tract Study
● An upper GI fluoroscopy delineates the
Hydrogen Breath Test entire GI tract after the introduction of a
● determines the amount of hydrogen expelled contrast agent.
in the breath after it has been produced in ● detect or exclude anatomic or functional
the colon (on contact of galactose with disorders of the upper GI organs or
fermenting bacteria) and absorbed into the sphincters.
blood. ● Agent: Radiopaque liquid (barium sulfate)
● developed to evaluate carbohydrate ● Nursing Responsibility: Low residue or clear
absorption, bacterial overgrowth in the liquid diet, and nothing by mouth (NPO)
intestine and short-bowel syndrome before the study
Urea breath tests
● detect the presence of Helicobacter pylori
(H. pylori metabolizes urea rapidly, the
labeled carbon is absorbed quickly)
● After the patient ingests a capsule of
carbon-labeled urea, a breath sample is
obtained 10 to 20 minutes later.
ABDOMINAL ULTRASONOGRAPHY
Upper Gastrointestinal Tract Study: VARIATIONS
● high-frequency sound waves are passed into 1. Double-contrast Studies
internal body structures ○ outlines the stomach and esophageal
● indications: enlarged gallbladder or wall
pancreas, the presence of gallstones, an 2. Enteroclysis
enlarged ovary, an ectopic pregnancy, or ○ study of the entire small intestine
appendicitis. that involves the continuous infusion
Endoscopic ultrasonography (EUS) (through a duodenal tube)
● a specialized enteroscopic procedure that Lower Gastrointestinal Tract Study
aids in the diagnosis of GI disorders by ● visualization of the lower GI tract is obtained
providing direct imaging of a target area. after rectal installation of barium.

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● barium enema: to detect the presence of ● Sigmoidoscopy

polyps, tumors, or other lesions of the large ● Small-bowel enteroscopy
intestine and demonstrate any anatomic ● Endoscopy through an ostomy
abnormalities or malfunctioning of the
bowel.
● patient may feel some cramping or
discomfort
Lower Gastrointestinal Tract Study: Nursing
Responsibilities
● preparation of the patient: emptying and
cleansing the lower bowel.
○ low residue diet 1 to 2 days before
the test
○ clear liquid diet
○ laxative the evening before
○ NPO after midnight
○ cleansing enemas until returns are
clear the following morning.
Computed Tomography (cross-sectional images of
abdominal
● organs and structures)
Magnetic Resonance Imaging (useful in evaluating
abdominal soft
● tissues as well as blood vessels, abscesses,
fistulas, neoplasms, and other sources of
bleeding)
both can be PLAIN & WITH CONTRAST
Positron Emission Tomography (PET Scan)
● scan is an imaging test that can help reveal
the metabolic or biochemical function of
tissues and organs.
● PET scan uses a radioactive drug (tracer) to
show both normal and abnormal metabolic
activity
Scintigraphy
● relies on the use of radioactive isotopes
● to reveal displaced anatomic structures,
changes in organ size, and the presence of
neoplasms or other focal lesions such as
cysts or abscesses.
Gastrointestinal Motility Studies
● used to assess gastric emptying and colonic
transit time.
ENDOSCOPIC PROCEDURES

● Upper GI Fibroscopy or
Esophagogastroduodenoscopy (EGD)
● Colonoscopy
● Anoscopy
● Proctoscopy
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Nursing Interventions: Upper GI Endoscopy ● the presence or degree of gastric retention

● patient should be NPO for 8 hours prior to Important Diagnostic Information:
the examination ● Pernicious anemia: secrete no acid under
● patient is given a local anesthetic gargle or basal conditions or after stimulation.
spray (if endoscope is introduced via mouth) ● Severe chronic atrophic gastritis or gastric
○ Midazolam (a sedative that provides cancer: secrete little or no acid.
moderate sedation with loss of the ● Gastric ulcer: secrete some acid.
gag reflex and relieves anxiety during ● Duodenal ulcers: usually secrete an excess
the procedure) amount of acid.
○ Atropine (to reduce secretions, and GASTRIC ACID STIMULATION TEST
glucagon may be given to relax
smooth muscle) performed in conjunction with gastric analysis
Nursing Interventions: Lower GI Endoscopy (colon ● Histamine or pentagastrin is given
etc.) subcutaneously to stimulate gastric
● Adequate colon cleansing (for optimal secretions.
visualization) pH Monitoring
● Pre-procedure diet: clear liquid or a low
residue diet ● A sensor that measures pH is inserted and
● use of lavage solutions positioned via endoscopy.
● may experience abdominal cramping due to INDICATION:
increased peristalsis ● esophageal reflux of gastric acid (evaluated
● Post-procedure: inspect for signs and by ambulatory pH monitoring)
symptoms of bowel perforation (rectal Laparoscopy (Peritoneoscopy)
bleeding, abdominal pain or distention,
fever, focal peritoneal signs) ● minimally invasive surgery, diagnostic
MANOMETRY TEST laparoscopy
● a very small incision is made - lateral to the
methods for evaluating patients with GI motility umbilicus
disorders. ● permits direct visualization of the organs and
MANOMETRY TEST structures within the abdomen, permitting
● measures changes in intraluminal pressures visualization and identification of any
and the coordination of muscle activity in the growths, anomalies, and inflammatory
GI tract processes.
● Esophageal manometry ● requires general anesthesia and sometimes
● Gastroduodenal, small intestine, and colonic requires that the stomach and bowel be
manometry decompressed
ELECTROPHYSIOLOGIC STUDIES GASTROINTESTINAL TREATMENT MODALITIES

Rectal sensory function studies SPECIAL DIETS

● used to evaluate rectal sensory function and
neuropathy CLEAR LIQUID DIET
● limited to water, tea, coffee, clear broths,
Electrogastrography (electrophysiologic study) ● ginger ale, strained and clear juices and plain
● to assess gastric motility disturbances gelatin
● detects motor or nerve dysfunction in the ● this diet provides the client with fluid and
stomach. carbohydrate in
GASTRIC ANALYSIS ● the form of sugar but does not supplement
adequate protein, fats, vitamins, minerals or
to determine: calories.
● secretory activity of the gastric mucosa ● it is short term diet 24 to 36 hours

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● the major objective of this diet is to relieve intestine) or the jejunum (the second section
thirst, prevent dehydration, minimize of the small intestine).
stimulation of the GIT

FULL LIQUID DIET

● diet contains only liquids or foods that turn ● Decompress the stomach and remove gas
to liquid at body temperature, like: and fluid
○ Ice cream ● Lavage (flush with water or other fluids) the
○ Vegetable juices stomach and remove ingested toxins or
○ Refined or strained cereals other harmful materials
○ Yogurt ● Diagnose GI disorders
○ milk and milk drinks ● Administer tube feedings, fluids, and
medications
● Compress a bleeding site
● Aspirate GI contents for analysis
Tube Types
● Levin Tube
○ single lumen (channel within a tube
or catheter) and is made of plastic or
rubber.
● Salem Sump
DIET AS TOLERATED (DAT) ○ is a radiopaque (easily seen on x-ray),
● is ordered when the client’s appetite, ability clear plastic, double-lumen gastric
to eat and tolerance for certain foods may tube.
change.
● Normal intestinal motility has returned with
active bowel sound and client reports
passing gas
ENTERAL NUTRITION
● NGT feeding
● Gastrostomy feeding (done to clients at risk
for aspiration)
● Decrease level of consciousness
● Poor cough, gag reflex ENTERAL NUTRITION
● Inability to participate in feeding ,
restlessness/agitation ● Enteral nutrition, also known as tube
GASTROINTESTINAL INTUBATION feeding, is a way of delivering nutrition
directly to your stomach or small intestine.
● is the insertion of a flexible tube into the ● Feeding via the enteral route (intestines are
stomach, or beyond the pylorus into the receiving nutrients)
duodenum (the first section of the small

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● Delivering enteral nutrition – refers to Signs and Symptoms:

infusing nutritional formula feedings through ● feelings of fullness
a tube directly into the GI tract. ● nausea, cramping
Types of Tube Feedings ● dizziness, diaphoresis
● Several types of tubes are used for enteral ● osmotic diarrhea
feeding: Can lead to: Dehydration, Hypotension, Tachycardia.
○ Nasogastric tubes (NGT)
○ Nasojejunal tube (NJT)
○ Jejunostomy tubes (JEJ, PEJ or RIJ
tubes)
○ Radiologically inserted gastrostomy
tube (RIG)
○ Percutaneous endoscopic
gastrostomy tubes (PEG tube)
Administering Tube Feedings
● Indication: oral intake is inadequate or not
possible
● Route: delivered to the stomach, duodenum,
or proximal jejunum
● Advantages ADMINISTRATION METHODS
○ lower in cost, safer 1. NASOGASTRIC TUBE (NGT) FEEDING
○ usually well tolerated by the patient ○ short-term feedings, uncomfortable
○ easier to use in extended care 2. BOLUS FEEDINGS
facilities or patient’s homes. ○ given into the stomach through a
Conditions That May Require Enteral Therapy large (50-mL) syringe via gravity
● Alcoholism, chronic depression, anorexia ○ requires dividing the total daily
nervosa feeding volume into 4 to 6 feeds
● Coma (stroke, head injury, neurologic throughout the day
disorder) ○ the typical volume is 200 to 400 mL
● Convalescent care (surgery, injury, severe of feeding
illness) Bolus gastrostomy
● Oropharyngeal or esophageal paralysis feeding by gravity.
● GI problems (mild pancreatitis, Crohn’s Syringe is raised
disease, ulcerative colitis) perpendicular to the
● Maxillofacial or cervical surgery abdomen so that
OSMOLALITY: DUMPING SYNDROME feeding can enter by
● concentrated solution of high osmolality gravity.
(concentration) entering the
● stomach is taken in quickly or in large 3. GRAVITY FEEDINGS
amounts, the small ○ Raising or lowering the syringe above
intestines the abdominal wall regulates the rate
● expand, and water of flow.
moves rapidly into ○ amount and flow rate (determined
the intestinal lumen by the patient’s reaction)(
from fluid ○ If the patient feels full – slow the
● surrounding the delivery time or give smaller volumes
organs and the more frequently
vascular
compartment.

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4. INTERMITTENT GRAVITY DRIP FEEDING KEY NURSING RESPONSIBILITIES:

METHOD ● Assessing Patients Receiving Tube Feedings
○ requires administering feedings over ● Maintaining Feeding Equipment and
30 minutes or longer at designated Nutritional Balance
intervals by a reservoir enteral bag ● Providing Medications by Tube
and tubing ● Maintaining Delivery Systems
○ flow rate regulated by a roller clamp ● Maintaining Normal Bowel Elimination
or automated pump. Pattern
5. CONTINUOUS FEEDING ● Maintaining Adequate Hydration
○ delivery of feedings incrementally by ● Promoting Coping Ability
a slow infusion over long periods ● Preventing Dumping Syndrome
○ Indications: patients who are NOTE:
critically ill patients, high risk for ● For tube feedings longer than 4 weeks,
aspiration, risk for intolerance gastrostomy or jejunostomy tubes are
(pancreatitis), and for small bowel preferred for administration of medications
feedings or nutrition.
○ Enteral feeding pumps control the GASTRONOMY
delivery rate of the formula
● a surgical procedure
● opening (stoma) is created into the stomach
– houses the tube
PURPOSE:
● Administration of nutrition, fluids, and
medications via a feeding tube
● Gastric decompression (gastroparesis,
gastroesophageal reflux disease, or intestinal
obstruction)
6. CYCLING FEEDING TYPES OF GASTROSTOMY TUBE:
○ alternative to the continuous infusion ● PERCUTANEOUS ENDOSCOPIC
method GASTROSTOMY (PEG)
○ Infused feeding is given by an enteral ● RADIOLOGICALLY INSERTED GASTROSTOMY
feeding pump over 8 to 18 hours. TUBE (RIG)
POTENTIAL COMPLICATIONS OF ENTERAL THERAPY
Gastrointestinal:
● Constipation
● Diarrhea
● Gas/bloating/cramping
● Nausea/vomiting
Mechanical:
● Aspiration pneumonia
● Nasopharyngeal irritation JEJUNOSTOMY
● Tube displacement
● Tube obstruction ● a surgical procedure (can be done
Metabolic: endoscopically or radiologically)
● Dehydration and azotemia (excessive urea in ● placed opening into the jejunum
the blood) PURPOSE:
● Hyperglycemia ● administering nutrition, fluids, and
● Refeeding syndrome (due to rapid shifts in medications
intracellular and extracellular electrolytes)

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● decrease aspiration risk (when the stomach Total Parenteral Nutrition

is not functioning adequately to process and ● a feeding technique that avoids the digestive
empty food and fluids) tract.
INDICATION: ● Most of the body's nutritional requirements
● gastric route is not accessible are met by a specific formula administered
intravenously.
Types of Solution:
● Amino acid-dextrose formulas (intralipid –
500 ml of 10% fat emulsions) – fine bacterial
filter used
● Total nutrient admixture (amino
acid-dextrose-lipid) – no bacterial filter used

GASTROJEJUNOSTOMY

● A surgical procedure that connects part of

the stomach to the jejunum (the middle part
of the small intestine).
● allows food and other stomach contents to
pass directly from the stomach to the
jejunum without passing through the first
part of the small intestine called the METHODS OF ADMINISTRATION:
duodenum. 1. PERIPHERAL
○ peripheral parenteral nutrition (PPN)
○ should not administer dextrose
concentrations above 10% due to
irritation of vessel walls, usually used
for less than 2 weeks.
2. CENTRAL
○ central parenteral nutrition
○ catheter is inserted into subclavian
PARENTERAL NUTRITION vein
Central venous access devices (CVADs):
● a method of providing nutrients to the body ● Percutaneous (or nontunneled)
by an IV route. ● Peripherally inserted central catheters
Indications: (PICCs)
● Malnourished ● Surgically placed (or tunneled) catheters
● cannot tolerate receiving nutrition orally or ● Implanted vascular access ports
by the enteral route

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MEDICAL-SURGICAL NURSING | Chapter 38

TOTAL PARENTERAL NUTRITION: INTERVENTIONS

● Initial rate of infusion of 50 ml/hour
gradually increased to 100 to 125ml/hr. as
patient’s fluid and electrolyte permits
● Infuse solution by pump at constant rate to
prevent abrupt change in infusion rate.
● Monitor for signs of complications
○ Sepsis
○ Pneumothorax because of placement
lines
○ Hyperosmolar coma – monitor for
glucose level & serum osmolality
● Change IV tubing and filter every 24 hours
● Keep solutions refrigerated until needed;
allow to warm to room temperature before
use
● If new solution unavailable, use dextrose
10% and water solution until available
● Monitor daily weights, glucose, temperature,
I & O 3x a week
DISCONTINUATION
● gradually tapered – to allow patient to adjust
to decreased levels of glucose
● After discontinuation, isotonic glucose
solution administered to prevent rebound
hypoglycemia; weakness, faintness,
diaphoresis, shakiness, confusion,
tachycardia.

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