Nursing Tips: Gastrointestinal

A patient with appendicitis is likely to have RLQ pain at McBurney's Point along with rebound tenderness, nausea/vomiting, and fever.

When caring for a child with appendicitis, report to the provider any sudden relief of pain. This may indicate that the appendix has perforated and requires emergency surgery!

A patient undergoing a paracentesis (drainage of fluid from the peritoneal cavity using a needle) must empty their bladder prior to the procedure.

Ostomy patient teaching: 

• Cut opening in skin barrier ≤ 1/8" bigger than the measured stoma size to prevent skin damage from contact with ostomy output.
• Assess stoma regularly - should be pink/moist. Pale/blue stoma indicates ischemia.

A child with Meckel's Diverticulum is likely to exhibit painless rectal bleeding and stool with the consistency and appearance of "currant jelly."

A major complication of peptic ulcer disease is perforation of an ulcer. Assess for symptoms of perforation such as severe pain, fever, or a rigid/boardlike abdomen.

Celiac disease is the inability to digest gluten. Patients with celiac disease CAN eat: dairy, rice, corn, potatoes, eggs, fruits and vegetables. Foods containing wheat, rye, and barley should be avoided.

A child who is crying without producing tears should be evaluated for severe dehydration.

Best practices for patients with DYSPHAGIA

ANTACIDS: Take 1 hr and 3 hr after meals, and at bedtime. Also take 1 hour before or after other medications (not WITH other medications)

Patients with dysphagia (difficulty swallowing) need to have a swallow evaluation by a speech language pathologist.

Key differences in symptoms for Gastric and Duodenal ulcers: Gastric ulcer: Pain 30-60 minutes after meal, worse in DAY, worse with eating. Duodenal ulcer: Pain 1.5-3 hours after meal, worse at NIGHT, better with eating.

Patient teaching for GERD: Avoid fatty, fried, citrus, spicy foods. Eat smaller meals. Remain upright after meals. Avoid tight-fitting clothing. Lose weight (if applicable). Quit smoking. Elevate HOB with blocks.

Nutrition recommendations to prevent DUMPING syndrome:

• Consume small frequent meals.
• Do not drink liquids with meals.
• Include protein and fat at each meal.
• Avoid dairy products and concentrated sugar.

Patients with Diverticulitis should avoid seeds and husks. Avoid: popcorn, tomatoes, berries.

Patients with cholecystitis should consume a LOW FAT diet.

Omeprazole and Pantoprazole are Proton Pump Inhibitors used to treat duodenal and gastric ulcers, GERD, and Zollinger-Ellison syndrome. HINT: I will take Omeprazole and pray my ulcer pain goes away.

Sucralfate is a Mucosal Protectant used to treat duodenal ulcers. It reacts with stomach acid to form a thick paste that adheres to ulcers. HINT: Sucralfate gets sucked down into ulcers.

Irritable Bowel Syndrome (IBS) Medications: alosetron is used for IBS w/diarrhea.
HINT: You might aloe on your backside from all that diarrhea.  

Lubiprostone is used for IBS w/consipation. 
HINT: Use lubiprostone to "lube up that stone-like stool".

Ondansetron is an antiemetic (used to prevent nausea and vomiting). Hint: "I threw up on DAN. Better get me some ondansetron."

Misoprostol can be used to prevent gastric ulcers in patients taking NSAIDs. Do NOT administer to a patient who might be pregnant (because it can cause a miscarriage). HINT: "Me so pregnant, so no misoprostol for me" or "Misoprostol can cause a Miscarrage".

Histamine 2 receptor antagonists (ex: ranitidine and famotidine) are used to treat ulcers and GERD. These meds will help you feel better when you "dine".

Lactulose is a laxative, but it is primarily used to decrease AMMONIA levels in patients with hepatic encephalopathy.

When administering a misoprostol (for prevention of gastric ulcers) to a person of child-bearing age, be sure to run a PREGNANCY test first as this medication can cause a miscarriage!

The following foods pose a choking hazard for small children: popcorn, raisins, peanuts, grapes, raw carrots, hotdogs, celery, peanut butter, candy, tough meat.

When evaluating a patient's nutritional status, be sure to check: albumin (normal range: 3.5-5) and prealbumin levels (normal range 15-36).