Gastrointestinal disorders are among the most commonly encountered conditions in nursing practice — from the medical-surgical floor to the emergency department. This guide covers the essential GI nursing content, with clinical specifics on assessment, high-yield conditions, medications, and NCLEX priorities.
GI Assessment: The Right Order
Abdominal assessment follows a specific sequence: Inspection → Auscultation → Percussion → Palpation. Auscultation comes before percussion and palpation because manipulating the abdomen can alter bowel sounds.
- Inspection: Contour, visible peristalsis, pulsations, skin changes. Cullen’s sign (periumbilical bruising) and Grey Turner’s sign (flank bruising) indicate retroperitoneal hemorrhage
- Auscultation: Bowel sounds in all four quadrants. Normal: 5–30/min. Absent after 5 minutes = hypoactive (ileus, peritonitis). Hyperactive = diarrhea, early obstruction
- Percussion: Tympany over gas (most of abdomen); dullness over solid organs. Shifting dullness suggests ascites
- Palpation: Light palpation first. Rebound tenderness (Blumberg’s sign) = peritoneal irritation → peritonitis. McBurney’s point tenderness = appendicitis
GERD and Peptic Ulcer Disease
GERD
- Signs/symptoms: Heartburn (burning epigastric pain worse after eating and lying down), regurgitation, dysphagia, chronic cough, dental erosion
- Nursing interventions: HOB elevation 30–45°, avoid eating 2–3 hours before bed, small frequent meals, avoid triggers (fatty food, caffeine, alcohol, spicy foods, citrus, chocolate, smoking)
- Medications: Antacids (immediate neutralization), H2 blockers (famotidine — decrease acid production), PPIs (omeprazole, pantoprazole — most effective; take 30–60 minutes before meals)
Peptic Ulcer Disease (PUD)
- Gastric ulcer pain: Worsens with eating → patient avoids food → weight loss
- Duodenal ulcer pain: Relieved by eating (2–3 hours after meals, at night); most common ulcer type
- H. pylori treatment: Triple therapy — PPI + clarithromycin + amoxicillin × 14 days
- Complications: Hemorrhage (hematemesis, melena), perforation (sudden severe rigid abdomen = surgical emergency), pyloric obstruction (vomiting, early satiety)
Inflammatory Bowel Disease: Crohn’s vs Ulcerative Colitis
- Crohn’s disease: Any part of GI tract (mouth to anus). Transmural (full-thickness) inflammation. Skip lesions. Cobblestone appearance. Complications: fistulas, strictures, abscesses
- Ulcerative colitis: Colon and rectum only. Continuous inflammation, mucosal layer only. Primary symptom: bloody diarrhea. Complication: toxic megacolon
- Both treated with: Mesalamine (mild-moderate UC first-line), corticosteroids (acute flares), immunomodulators (azathioprine), biologics (infliximab, adalimumab)
- Surgery: Total colectomy cures UC (disease limited to colon). Surgery does not cure Crohn’s
GI Bleeding: Upper vs Lower
- Upper GI bleed: Above ligament of Treitz. Esophageal varices, PUD, Mallory-Weiss tears. Presents with hematemesis or melena (dark, tarry, malodorous stool)
- Lower GI bleed: Below ligament of Treitz. Diverticulosis (most common), colorectal cancer, hemorrhoids, IBD. Presents with hematochezia (bright red blood per rectum)
Nursing Priorities in Active GI Bleed
- Assess hemodynamic stability: HR, BP, orthostatic changes, skin perfusion
- Large-bore IV access × 2 immediately
- Type and crossmatch, CBC, BMP, coagulation studies
- IV fluid resuscitation; blood transfusion for Hgb <7 g/dL
- NPO until hemostasis achieved or endoscopy performed
- Prepare for emergent upper endoscopy (EGD) or colonoscopy
- Foley catheter for hourly urine output monitoring if hemodynamically unstable
Liver Disease and Cirrhosis Complications
- Ascites: Fluid in peritoneal cavity from portal hypertension + low albumin. Management: sodium restriction (<2 g/day), spironolactone + furosemide, paracentesis for large volume
- Hepatic encephalopathy: Ammonia buildup → neurological dysfunction. Stages 1–4 (mild confusion → coma). Asterixis (flapping tremor) classic sign. Treatment: lactulose (target 2–3 soft BMs/day), rifaximin
- Esophageal varices: Dilated veins from portal hypertension. Prevention: non-selective beta-blockers. Acute bleed: octreotide, IV PPI, endoscopic band ligation, TIPS for refractory
- Coagulopathy: Liver cannot synthesize clotting factors. Monitor INR. FFP for active bleeding
- Spontaneous bacterial peritonitis (SBP): Ascitic fluid infection. Diagnosis: paracentesis (WBC >250 PMNs). Treatment: IV cefotaxime
Acute Pancreatitis: Assessment and Priorities
Caused by gallstones (most common) or alcohol. Pain: severe epigastric, radiating to the back, worse supine, relieved by leaning forward.
- Labs: Serum amylase and lipase elevated (>3× normal). Lipase more specific to the pancreas
- Severe signs: Cullen’s sign (periumbilical bruising) and Grey Turner’s sign (flank bruising) = retroperitoneal hemorrhage
- Nursing priorities: NPO, aggressive IV fluid resuscitation (Lactated Ringer’s preferred), IV opioid analgesia, monitor glucose, monitor for hypocalcemia (calcium binds necrotic fat)
Ostomy Care Essentials
- Colostomy: From colon. More formed output. Descending/sigmoid colostomy = nearly normal consistency
- Ileostomy: From ileum. Liquid to semi-liquid output continuously. High electrolyte loss — monitor sodium, potassium, fluid balance. Output >1,000 mL/day = concerning
- Healthy stoma: Beefy red, moist, slightly raised. Pale = decreased perfusion. Dark/black = ischemia → notify provider immediately
- Appliance care: Cut wafer opening within 1/8 inch of stoma. Change every 3–5 days. Empty pouch when 1/3 full. Avoid soap with moisturizers (weakens adhesive)
NCLEX Tips: GI Nursing
- GI assessment order: Inspection → Auscultation → Percussion → Palpation — always auscultate before touching the abdomen
- Melena = digested blood from upper GI source. Bright red blood per rectum = lower GI source
- Rebound tenderness = peritoneal irritation → surgical emergency
- Lactulose goal: 2–3 soft BMs/day to eliminate ammonia in hepatic encephalopathy
- Dark/black stoma = vascular compromise → report immediately
- Duodenal ulcer pain relieved by eating; gastric ulcer pain worsened by eating
- Ileostomy = continuous liquid output → dehydration and electrolyte imbalance risk
Official Resources and Further Reading
External References
- Crohn’s and Colitis Foundation — IBD pathophysiology, treatment protocols, and clinical resources
- NIDDK: Digestive Diseases — National Institute of Diabetes and Digestive and Kidney Diseases evidence base
Related Articles on Lectures Note
- Liver Disease Nursing Notes — hepatitis, cirrhosis, and acute liver failure NCLEX content
- Nursing Notes Bundles — complete system-based study bundles for NCLEX prep
Frequently Asked Questions: GI Nursing
Why is auscultation performed before palpation in a GI assessment?
Palpation and percussion can stimulate or alter bowel motility. By auscultating first, you get an accurate baseline before any manipulation changes it.
What is the most common cause of acute pancreatitis?
Gallstones and alcohol use account for approximately 80% of cases. A gallstone obstructing the pancreatic duct triggers autodigestion of the pancreas by its own enzymes.
What is Cullen’s sign and what does it indicate?
Periumbilical bruising indicating retroperitoneal hemorrhage — most commonly from severe acute pancreatitis or ruptured ectopic pregnancy. Grey Turner’s sign (flank bruising) indicates the same. Both are late signs of severe hemorrhage.
How do you tell a colostomy from an ileostomy at the bedside?
Output consistency and location. Ileostomy produces liquid to semi-liquid output; typically on the right side of the abdomen. Colostomy output is more formed; typically on the left. Confirm with surgical notes and the chart.