GI System/GERD/Gastritis Class Notes –Tuesday April 22nd, 2014
GASTROINTESTINAL SYSTEM
Gastrointestinal System Notes:
Think about “what is going on with that particular system?” GI System digests food and excretes it.
With GI issues, always look to prevent peritonitis, which is where intestinal fluids leak out into the perineal cavity causing bacterial sepsis and hypovolemic shock. Assess temperature as the priority!

The type or characteristics of the blood in the stool tells you where the bleeding is occurring, i.e. Lower GI, Upper GI or Hemorrhage.
RED Blood: Bleeding is in the lower GI area.
DARK Blood: Bleeding is in the upper GI area.
The AMOUNT of Blood: Determines if hemorrhaging is occurring.

Nursing Assessment Data for Assessment of the GI System
Weight changes
Bowel habits
Psychosocial or Stress (stress contributes to causing GI problems)
What causes GI problems or what makes the symptoms better or worse?
Past exposure to toxic substances in the workplace
Diet/Caffeine
Drugs/Medications that contribute to GI problems
Smoking/Alcohol use (Alcohol thins the blood and increases risk for bleeding)
Hydration status and habits/Fluid I/O
Sleep habits/quality
Timing and location of pain
NSAID/Aspirin use (NSAID and Aspirin use causes bleeding)
Stool characteristics/Blood color in stool
Social economic status and changes contribute to ability to get treatment

EGD (Esophagogastroduodenoscopy) is a visual examination of the esophagus, stomach, and duodenum.
Assess for bleeding in the GI (see stool characteristics above)
You must obtain a consent form from the patient before this procedure can occur!

Preoperative and Postoperative Patient Management:
Give NPO 6 to 8 hours before the procedure
Avoid anticoagulants, aspirin, and NSAIDS for several days post procedure. (Anticoagulants increase risk for excessive bleeding)
Hold all medications except cardiac medications. (call Dx for permission to hold or give meds)
After surgery, place patient in the left side-lying position with a towel or basin at their mouth to catch excretions.
Assess Vital Signs every 30 minutes postop until sedation wears off.
Raise side rails for patient safety.
Give NPO after surgery until patients gag-reflex returns (may take up to 2 hours to return).

The #1 Nursing Priority is to Prevent Aspiration! Have respiratory support on standby.

Laboratory Tests ordered for GI Assessments (Page 1186, Chart 55-3)

Other Diagnostic Tests that may be ordered:
Endoscopy
ERCP (Endoscope Retrograde Cholangiopancreatography) …not tested on this.
Small Bowel Capsule Endoscopy
Colonoscopy
Virtual Colonoscopy
Sigmoidoscopy
Gastric Analysis
Ultrasonography
(Possibly an MRI/CAT Scan)
You must obtain a consent form from the patient before any of these procedures can occur!

GERD (Gastroesophageal Disease)
GERD is the result of the backward flow (reflux) of the gastrointestinal contents into the esophagus. The sphincter tone of the *lower esophageal sphincter (LES) is decreased, or it in inappropriately relaxed.
Excessive relaxation of the LES is the most common cause of GERD.
Chronic inflammation leads to hyperemia and erosion (ulcers).
Priorities: elevate HOB to avoid aspiration, take V/S, and have Oxygen and Suction available.

Assessment Questions: 24 hour ambulatory esophageal pH monitoring is the most accurate method of diagnosing GERD.
Have you been newly diagnosed with asthma? (There is a correlation between asthma and GERD)
Have any medications caused GI upset? Have you taken medications for GERD in your past?
How long have you been experiencing the symptoms of GERD?
Have you recently traveled out of the country? (Easy to contract bacteria/bugs in foreign countries)

Common Symptoms of GERD: (Heart issues are often mistaken for GERD. Conversely, common symptoms of GERD could be a heart issue.) The 2 main symptoms are heartburn and regurgitation.
Heartburn or esophageal pain
Atypical