Metabolism

Prepared by:
John Gil B. Ricafort, RN
Objectives:
• Review of Digestive System
• Common Assessment Findings
• Common Diagnostic Tests/
Procedures
• Disturbances
1. Review of Digestive System
2. Common Assessment Findings
a. Pain
– a major symptom of GI disease
b. Indigestion
- refers to abdominal discomfort
or distress associated with eating
- most common symptom of GI
dysfunction
 c. Intestinal Gas
d. Nausea and vomiting
e. Change in bowel habits
and stool characteristics
f. Jaundice
g. Pruritus
h. Increased bleeding
Common Diagnostic Tests

a. Stool Tests
b. Breath Tests
- Hydrogen Breath Test
-used to evaluate CHO
absorption and bacterial
overgrowth.
 - Urea Breath Test
- detects the presence of H.
Pylori
Note: The person takes a capsule of
carbon labeled urea and then
provides breath sample 10 to 20
minutes after.
*AVOID antibiotics
*AVOID Sucralfate/ Omeprazole
*AVOID Tagamet/ Pepcid/ Zantac
c. Abdominal Ultrasonography
d. Upper GI Series (Barium
Swallow)
- it’s a fluoroscopic examination
of the upper GI tract to determine
structural problems and gastric
emptying time; Client must
swallow barium sulfate or other
contrast medium.
 - sequential films taken as it moves
through the system.

Nursing Responsibilities: PRETEST

4. Keep NPO after midnight or 6-8 hours
pretest.
5. Explain that the barium will taste
chalky.
Nursing Responsibility: POSTTEST
2. Administer laxatives to enhance
elimination of barium and prevent
obstruction or impaction.

e. Lower GI Series ( Barium Enema)

- Barium is instilled into the colon by
enema; client retains the contrast
while x-rays are taken to identify
abnormalities
Nursing Responsibilities: PRETEST
2. Keep on NPO for 8 hours pretest
3. Give enemas until clear the morning
of test
4. Administer laxative or suppository
5. Explain that cramping may be
experienced during the procedure.
Nursing Responsibility: POSTTEST
2. Administer laxatives and fluids to
assist in expelling barium.

f. Endoscopic studies
g. Liver Biopsy
- invasive procedure where a needle
is inserted into the liver to remove a
small piece of tissue for study.
Nursing Responsibilities: PRETEST
2. Ensure the client has signed the
consent form.
3. Keep NPO 6-8 hours pretest.
4. Instruct the client to HOLD BREATH
during the procedure.

Nursing Responsibilities: POSTTEST

1. VS taking every hour for 8-12 hours
2. Place client on his RIGHT SIDE for a
few hours with a pillow against his
abdomen to provide pressure on the
liver.
3. Observe the punctured site for
hemorrhage.
4. Assess for complications of shock and
pneumothorax.
Disturbances:
1. Gastritis
- inflammation of the gastric or
stomach mucosa, is a common GI
problem.
Clinical Manifestation:
abdominal discomfort
headache
nausea and vomiting
 Hiccuping
Anorexia
Heartburn
Sour taste in the mouth
Nausea and vomiting
Assessment and Diagnostic Findings:
Endoscopy
Upper GI radiographic Study
Histologic Exam
Medical Management:
The gastric mucosa is capable of healing
itself for about 1 day after gastritis.
Ingestion of acid – neutralization
Ingestion of alkaline – neutralization
NG Intubation
Analgesic Agents/ Sedative
Antacids
Antibiotics
Modify Diet, STRESS management
Nursing Diagnoses:

3. Anxiety related to treatment

4. Altered Nutrition: Less than
Body Requirement related to
inadequate intake of nutrients.
5. Acute Pain related to irritated
stomach mucosa
Nursing Interventions
1. Reducing anxiety
2. Promoting optimal nutrition
3. Promoting fluid balance
4. Relieving pain
2. Peptic Ulcer Disease (PUD)
- is an excavation that forms in the
mucosal wall of the stomach, in the
pylorus, in the duodenum and in the
esophagus.
Types:
a. Lower Esophageal Ulcer
b. Gastric Ulcer
c. Duodenal Ulcer
Clinical Manifestations:
Same with gastritis
Burning sensation in the
midepigastrium
Pain relived by eating
Pyrosis
Vomiting
Constipation or diarrhea
Bleeding
Assessment and Diagnostic Findings
Endoscopy
Breath Test
Stool Exam
Medical Management
Antibiotics
Antacid
Proton Pump Inhibitors
Histamine Receptor Antagonist
Other Managements:
Stress Reduction and Rest
Smoking Cessation
Dietary Modification
Surgery
Billroth 1(Gastroduodenostomy)
Billroth 2(Gastrojejunostomy)
Nursing Diagnoses:

3. Acute Pain related to the effect of

gastric acid secretion on damaged
tissue.
4. Anxiety related to coping with an
acute disease.
5. Imbalance Nutrition related to
changes in diet.
 Nursing Interventions
1. Relieving pain
2. Reducing anxiety
3. Maintaining optimal nutritional status
4. Monitoring & managing complications
Hemorrhage
Perforation
Pyloric Obstruction
3. Appendicitis
- inflammation of the appendix due to
intraluminal obstruction with
subsequent bacterial infection.
Clinical Manifestation
Mc Burney Sign
Rovsing’s Sign
Low grade fever
Constipation or Diarrhea
Assessment and Diagnostic Findings
Complete PE
Laboratory Studies
X-ray
Medical Management
Antibiotics
IV administration
Analgesics (after surgery)
Surgery (APPENDECTOMY)
Complications of Appendicitis:
Perforation – most common
Septicemia
Abscess formation
4. Inflammatory Bowel Disease
a. Crohn’s Disease
b. Ulcerative Colitis
Crohn’s Disease
- also known as Regional Enteritis
- a chronic inflammatory bowel disease
that can affect both the large and small
intestines, but most COMMON in the
megacolon area.
- UNKNOWN cause
- onset: 20-30 years and 40-60 years
- both sexes are affected
 - characterized by GRANULOMAS that
may affect all the bowel wall layers with
resultant thickening, narrowing, and
scarring of the intestinal wall.
Clinical Manifestations
Right lower quadrant tenderness
Abdominal distention
Decrease skin turgor
Dry mucous membrane
Increase peristalsis
 Nausea and Vomiting
3-4 semisoft stools (ribbon-like)/ day
with mucus and pus

Diagnostic Tests
Decreased Hgb and Hct
Barium enema shows narrowing with
areas of strictures
Medical Management
Diet: High Calorie, High vitamin, High
protein, Low residue, Milk free;
Supplementary iron
Pharmacologic Agent
Antimicrobials (Sulfasalazine)
Corticosteroids
Antidiarrheals
Anticholinergics
Surgery: Resection of the diseased
portion and ileostomy
Nursing Interventions
2. Provide appropriate nutrition while
reducing bowel motility.
3. Promote comfort/ rest.
4. Provide care for the client with bowel
surgery
Ulcerative Colitis
- inflammatory bowel disease
characterized by inflammation and
ulceration that starts in the
rectosigmoid area and spreads upward.
The mucosa of the bowel becomes
edematous, thickened with eventual
scar formation. The colon
consequently loses its elasticity and
absorptive capabilities.
 - UNKNOWN cause
- occurs more often in women
- onset is usually 15-40 years

Clinical Manifestations
Severe diarrhea (15-20 liquid stools/
day containing mucus, blood and
pus)
Severe tenesmus
Weight loss
 Anorexia
Weakness
Crampy discomfort
Decreased skin turgor
Dry mucous membrane
Low-grade fever
Abdominal tenderness
Diagnostic Tests
Decreased Hgb and Hct
Sigmoidoscopy reveals mucosa that
bleeds easily with ulcer development
Management
Mild to Moderate from
Diet: Low-roughage diet; NO milk
products
Pharmacologic Agents
Severe form
Diet: NPO with IVs and electrolyte
replacement, NG tube with suction,
Blood transfusion
Surgery
 Factor CROHN’S ULCERATIVE
Course Prolonged, variable Exacerbations
Pathology
Early Transmural Mucosal
Late Deep Mucosal
Manifestation
Location Ileum, Right Colon Rectum, Left colon
Bleeding Usually not Common/severe
Fistulas Common Rare
Diarrhea Less severe Severe
Nursing Diagnoses

3. Diarrhea related to inflammatory

process.
4. Acute Pain related to increased
peristalsis and GI inflammation.
5. Imbalance Nutrition: Less than
body requirements related to
dietary restrictions, nausea and
malabsorption.
Nursing Interventions:
2. Maintaining elimination patterns.
3. Relieving pain.
4. Maintaining fluid intake.
5. Maintaining optimal nutrition.
6. Promoting rest.
7. Reducing anxiety.
8. Monitoring and managing potential
complications.
5. Hemorrhoids
- are dilated portions of veins in the anal
canal usually due to impairment of blood
flow.
- common between 20-50 years old
Types:
e. Internal Hemorrhoids
f. External Hemorrhoids
Manifestations
Pain Protrusion
Itching and Bleeding
Management
Antibiotic
Anti-inflammatory
Analgesics
Stool softeners
Surgery
Hemorrhoidectomy
6. Ascites
- accumulation of fluid in the
abdominal cavity
Due to:
a. Portal hypertension
b. Increase capillary
pressure
c. Obstruction in the venous
blood flow
Clinical Manifestation
Increased abdominal girth
Rapid weight gain
Shortness of breath
Striae
Distended neck vein
Fluid and electrolyte
imbalances
Diagnostic Findings
Ultrasound
Fluid Wave Testing
Medical Management
Dietary Modification
Diuretics
Bed rest
Paracentesis
LeVeen Shunt (Peritoneal-venous Shunt)
Nursing Interventions
1. Monitor nutritional status/ provide
adequate nutrition with modified diet.
Sodium = 200-500mg/day
Fluid = 1000-1500ml/day
Promote high calorie food
2. Monitor/ prevent increasing edema
3. Monitor/ promote skin integrity
4. Promote comfort
7. Esophageal Varices
- are dilated, tortuous veins usually found
in the submucosa of the lower
esophagus, but may develop higher in
the esophagus or extend into the
stomach.
- usually caused by portal hypertension
- bleeding varices lead to hemorrhagic
shock, producing decrease cerebral,
hepatic and renal perfusion.
Clinical Manifestation
Hematemesis
Melena
General Disorientation
Signs and symptoms of shock
Diagnostic Findings:
Endoscopy
Ultrasonography
CT Scan
Angiography
Management
Ice normal saline lavage
Administration of Vit. K
Blood transfusion
Oxygen administration
Fluid replacement
Vasopressin – vasoconstriction
Nitroglycerin
Balloon Tamponade
- it controls the bleeding by using a
double-balloon (Sengstaken-Blakemore)
Caring for Patient with Sengstaken-
Blakemore Tube:
2. Facilitate placement of the tube;
check and lubricate tip and elevate
the head of the bed
3. Prevent dislodgement of the tube by
placing the patient in semi-fowler’s
position; secure the tube properly
3. Keep SCISSORS at the bedside at all
times
4. Monitor respiratory status
5. Label each lumen to avoid confusion
6. Observe nares for skin breakdown and
provide oral and nasal care every 1-2
hours.
 Endoscopic Sclerotherapy
-injection of sclerosing agent to
promote thrombosis and sclerosis
Esophageal Banding Therapy
8. Hepatic Cirrhosis
- a chronic degenerative disease in
the liver in which the lobes are
covered with fibrous tissue, the
parenchyma degenerates and the
lobules are infiltrated with fat.
 - occurs twice in men in women
- onset: 40-60 years ols

Types:
5. Laennec Cirrhosis
6. Postnecrotic Cirrhosis
7. Cardiac Cirrhosis
8. Biliary Cirrhosis
Clinical Manifestations
Intermittent fever
Spleenomegaly
Vascular spiders Weight loss
Abdominal pain Edema
Firm, enlarged liver Muscle wasting
Ascites Weakness
Jaundice
Epistaxis
Hypotension
Diagnostic Test:
Ultrasound
CT Scan
MRI
Laboratory Studies
Increased Liver enzyme
Medical Management
Management is based on the
presenting symptoms.
COLCHICINE
Nursing Interventions
1. Provide sufficient rest and comfort
2. Promote nutritional intake
a. encourage small frequent feeding
b. High calorie, low to moderate
protein, high carbohydrate, low-fat
diet, supplemental vitamin
3. Prevent infection
4. Monitor/ prevent bleeding
5. Administer diuretics
9. Cholelithiasis
- refers to stones in the gallbladder
Risk Factors:
Obesity
Multiple Pregnancy
Rapid weight loss
Estrogen therapy
Cystic Fibrosis
Diabetes Mellitus
Clinical Manifestation
Epigastric distress
Abdominal distention
Vague pain in the RUQ of the
abdomen
Pain and Biliary Colic
Jaundice
Vitamin Deficiency
Changes in urine and stool color
Diagnostic Findings:
Ultrasound
Abdominal X-ray

Medical Management
Nutritional and Supportive
Pharmacologic
Ursodeoxycholic Acid
Chenodeoxycholic Acid
Nonsurgical Removal of Stones
Dissolving Stones
(Methyl Tertiary Butyl Ether) MTBE
Lithotripsy

Surgical
Cholecystectomy
Nursing Interventions
2. Administer pain medications as
ordered.
3. Administer IV fluids as ordered
4. Provide small frequent meals
5. Provide care to relieve pruritus
10. Pancreatitis
- refers to inflammation of the
pancreas due to self-destruction.
- Severe abdominal pain is the
major symptom of pancreatitis

Diagnostic Finding
Based on history
Laboratory studies
Medical Management
Directed towards relieving the
symptom.
Parenteral Nutrition
Anti-ulcer drugs
Pain management (DEMEROL)
Respiratory Care