Gastrointestinal System

Comprehensive Textbook Chapter β€” Anatomy, Physiology, Disorders & Nursing Care

Table of Contents

  1. Anatomy & Physiology
  2. GI Assessment & Diagnostics
  3. GI Procedures
  4. GI Disorders
  5. GI Medications
  6. Pediatric GI Disorders
  7. NCLEX Priorities

1. Anatomy & Physiology

Overview of the GI System

The gastrointestinal (GI) system consists of the mouth, esophagus, stomach, small intestine, large intestine, and the accessory organs: liver, gallbladder, pancreas, and the ductal system. Its primary function is digestion β€” the mechanical and chemical breakdown of food into absorbable nutrients β€” and elimination of waste.

Mouth

Contains salivary glands that produce saliva (alkaline pH) containing salivary amylase, which begins carbohydrate digestion. The mouth mechanically breaks down food via mastication.

Esophagus

A collapsible muscular tube ~10 inches long with no secretory glands. Alkaline pH from salivary amylase. The lower esophageal sphincter (LES / cardiac sphincter) prevents reflux of gastric contents.

Stomach

Located in the left hypochondriac, epigastric, and umbilical regions. Parts: cardia, fundus, body, antrum. Two sphincters β€” cardiac (prevents reflux) and pyloric (regulates emptying into duodenum).

Gastric secretions:

Phases: Cephalic (smell, taste, chewing) and Gastric (presence of food). Chyme = partially digested food leaving the stomach. The stomach is acidic in pH.

Small Intestine

Includes duodenum, jejunum, and ileum. Extends from pylorus to ileocecal valve. Microscopic structures:

Chyle = fully digested food in absorbable form.

Large Intestine

Divided into cecum, colon (ascending, transverse, descending, sigmoid), rectum, and anus. Appendix attached to cecum. Responsible for water and electrolyte absorption. Normal flora produces vitamin K and ammonia (converted to urea by liver).

Accessory Organs

Liver

Largest internal organ and gland. Located in right hypochondriac and epigastric regions. 4 lobes: right, left, caudate, quadrate. Supplied by portal artery and portal vein. Functional units = lobules formed of hepatic cells.

Functions:

Gallbladder & Biliary System

Stores and concentrates bile. Bile is dark green to yellowish-brown, alkaline (pH), composed of 85% water, 10% bile salts, 3% mucus/pigments, 1% fat, 0.7% inorganic salts, 0.3% cholesterol.

Bile duct: hepatic duct + cystic duct = common bile duct (CBD). CBD joins pancreatic duct = hepatopancreatic duct (HPD). Drains into duodenum via Ampulla of Vater (controlled by sphincter of Oddi). Release stimulated by CCK-PZ (cholecystokinin-pancreozymin) from duodenal mucosa.

Bile acid sequestrants (cholestyramine / Questran, colestipol / Colestid) bind bile acids in intestine, preventing reabsorption and forcing liver to use more cholesterol.

Pancreas

Located in left hypochondriac region (head, body, tail). Both exocrine and endocrine functions.

Exocrine: pancreatic enzymes β€” amylase (carb digestion), lipase (fat digestion), trypsinogen & chymotrypsin (protein digestion). Also secretes sodium bicarbonate to neutralize HCl.

Endocrine: Islets of Langerhans β€” alpha cells (glucagon), beta cells (insulin).

2. GI Assessment & Diagnostics

Health History

Physical Examination

Sequence: Inspection β†’ Auscultation β†’ Percussion β†’ Palpation

Diagnostic Tests

TestNormal Value
Ammonia11–35 ΞΌmol/L
Alkaline phosphatase20–90 U/L
Bilirubin (direct/conjugated)0.1–0.4 mg/dL
Bilirubin (indirect/unconjugated)0.2–0.7 mg/dL
Bilirubin (total)0.3–1.1 mg/dL
SGOT (AST)5–20 U/L
SGPT (ALT)5–35 U/L
Prothrombin Time (PT)12–14 seconds
Serum amylase50–150 U/dL
Serum lipase10–140 U/L
AFP (alpha-fetoprotein)< 10 ng/mL in adults

Stool for Occult Blood (Guaiac / Hemoccult)

Upper GI Series (Barium Swallow)

Lower GI Series (Barium Enema)

EGD (Esophagogastroduodenoscopy)

Colonoscopy

Sigmoidoscopy

Gastric Analysis

Gallbladder Studies

Oral Cholecystography (OCG): Oral iodine dye β†’ X-rays. Pre: check iodine sensitivity, administer dye (Telepaque/Oragrafin) 10–12 hours before, NPO after dye. Post: normal diet high in fat may be given; ↑ fluids; monitor for N/V/D.

ERCP: Dye injected via endoscope into hepatopancreatic duct β†’ fluoroscopic X-ray. Pre: NPO 6–8 hours, local anesthesia/sedation. Post: monitor gag reflex and signs of perforation.

Percutaneous transhepatic cholangiography: Percutaneous dye injection into biliary system. Pre: NPO 6–8 hours, sedation. Post: monitor for perforation, peritonitis, septicemia.

HIDA scan: Nuclear imaging; radioactive tracer injected IV β†’ liver β†’ biliary system. If gallbladder not visualized in 4 hours, indicates cholecystitis/cholelithiasis.

Liver Biopsy

Urea Breath Test

Detects H. pylori. Patient ingests carbon-labeled urea; breath sample 10–20 minutes later detects COβ‚‚ produced by bacterial conversion.

3. GI Procedures

Enema Administration

Procedure: Explain, encourage mouth breathing to relax abdomen. Hang solution 30–45 cm (12–18β€³). Insert lubricated tube 3–4β€³ (7.5–10 cm) without force. Deliver over 5–10 min. Stop for cramping; slow speed. Monitor for cramps, nausea, dizziness, bradycardia.

Nasogastric (NG) Tube

Indications: Feeding, gastric decompression, gastric analysis.

Types: Levin tube (single lumen, non-vented) | Salem-Sump tube (double lumen, vented).

Procedure: Semi-to-high Fowler's. NEX measurement. Lubricated tube into most patent nostril. Sips of water to facilitate swallowing. Initially extend neck slightly; when past oropharynx, bend chin forward. X-ray confirms position + pH of aspirate.

Nursing care: Monitor patency, assess for distention/N/V, turn side-to-side if not draining. Frequent mouth care. Elevate HOB 30–45Β° during and 1–2 hours after feeding. Monitor fluid/electrolyte balance.

Gastrostomy Tube

Catheter through abdominal incision into stomach. Feeding: bolus, continuous (24h), or cyclical (8–16h).

Total Parenteral Nutrition (TPN)

IV administration of complete nutrition (dextrose, amino acids, lipids, electrolytes, vitamins, trace elements) for patients unable to tolerate enteral feeding. Requires central line (PICC or subclavian). Nursing: strict asepsis, monitor blood glucose, daily weights, I&O, check for infection.

Ostomy Care

Types of Bowel Surgery

Preoperative Care for Ostomy

Postoperative Stoma Care

4. GI Disorders

Gastroesophageal Reflux Disease (GERD)

Pathophysiology: Backflow of gastric contents into esophagus due to incompetent LES, pyloric stenosis, or reduced gastric motility.

Signs & Symptoms: Pyrosis (heartburn), dyspepsia, regurgitation, hypersalivation.

Diagnostics: Esophagoscopy, barium swallow, esophageal pH monitoring.

Medical Management:

Nursing Care: Small frequent meals, upright position during and after meals, weight reduction if obese.

Priority: Elevate HOB & avoid recumbency after meals to prevent aspiration.

Gastritis

Pathophysiology: Inflammation and breakdown of gastric protective barriers β†’ HCl diffuses into gastric lumen β†’ hemorrhage, ulceration, adhesions.

S/S: Anorexia, N/V, belching, hematemesis, epigastric tenderness, ↓ Hgb/Hct. Confirmed by endoscopy and gastric analysis.

Management: Antiemetics, antacids. NPO until tolerating, then bland diet. Avoid coffee, spicy foods, alcohol, NSAIDs, steroids.

Peptic Ulcer Disease (PUD)

Pathophysiology: Ulceration of mucosal lining of stomach, duodenum, or esophagus. Causes: smoking, alcohol, stress, NSAIDs/steroids, H. pylori infection.

FeatureGastric UlcerDuodenal Ulcer
LocationUsually in antrumWithin 2 cm of duodenum
AcidityNormal; rapid acid diffusion into mucosaHyperacidity with increased gastric emptying
PainMid/left epigastric, sharp; 1–2 hours after meals; worsened by foodBurning/cramping; 2–4 hours after meals & at night; relieved by food
WeightWeight lossWeight gain

Findings: Epigastric pain, bloating, hematemesis, melena. Complications: perforation, peritonitis, strictures.

Diagnostics: Gastric analysis, endoscopy, urea breath test.

Medical Management:

Surgical Management: Vagotomy, antrectomy, pyloroplasty, Billroth I (gastroduodenostomy), Billroth II (gastrojejunostomy), partial/total gastrectomy.

Nursing Care for Active Bleeding: Monitor VS closely, NPO + IV fluids, NG lavage (NS or tap water), vasopressin as ordered.

Post-Gastrectomy Care: Monitor for B₁₂ deficiency, hemorrhage, postprandial hypoglycemia, dumping syndrome.

Priority: Dumping syndrome β€” avoid simple sugars & salt; high-protein, high-fat, low-carb diet; 6 small meals/day; no fluids 2 hours after meals; lie down Β½ hour after meals.

Gastroenteritis

Pathophysiology: Inflammation of stomach and intestines caused by viral, bacterial, or parasitic infection; food poisoning; or toxins.

S/S: N/V/D, abdominal cramps, fever, dehydration, electrolyte imbalances.

Management: Fluid/electrolyte replacement, antiemetics, antidiarrheals (bismuth subsalicylate, loperamide). Gradual introduction of bland, high-protein, low-fat, low-bulk diet. Avoid milk products. Prevent anal excoriation.

Celiac Disease (Sprue)

Pathophysiology: Autoimmune disorder; chronic inflammation from gluten (protein in barley, rye, oats, wheat) damages small intestinal villi β†’ malabsorption of fat and fat-soluble vitamins (A, D, E, K).

S/S: Steatorrhea, failure to thrive, anemia, distended abdomen, abdominal pain, irritability, vomiting, muscle wasting.

Diagnostics: Jejunal/duodenal biopsy (villous atrophy). Rule out cystic fibrosis.

Management: Lifelong gluten-free diet (no BROW β€” barley, rye, oats, wheat). Can eat rice, millet, corn, soy, potato. Fat-soluble vitamins in water-soluble form. TPN for severe malnourishment.

Priority: Strict gluten-free diet for life; teach patient to read all food labels for hidden gluten.

Crohn's Disease (Regional Enteritis)

Pathophysiology: Chronic inflammatory bowel disease with granuloma formation β†’ thickening, narrowing, scarring of intestinal wall. Lesions are intermittent and transmural. Usually affects terminal ileum, cecum, ascending colon. Remissions and exacerbations.

S/S: 3–4 semi-soft stools with mucus/pus, A/N/V, weight loss, RLQ pain, dehydration, pallor, increased peristalsis, electrolyte imbalance.

Diagnostics: Barium enema, sigmoidoscopy, colonoscopy, video capsule endoscopy (VCE).

Management: Antibiotics, corticosteroids, antidiarrheals, adalimumab (Humira), anticholinergics, iron supplements, TPN. Diet: high-calorie, high-protein, low-residue β€” no milk/milk products, no gas-producing foods (cabbage, broccoli, cauliflower, legumes, onion, corn, nuts). Surgery for severe cases.

Ulcerative Colitis (UC)

Pathophysiology: Inflammation of colon β†’ ulceration, edema, thickening, scarring, ↓ absorptive capacity. Begins in rectum and spreads upward (continuous lesions). Affects mucosal and submucosal layers. Remissions and exacerbations.

S/S: Severe diarrhea (15–20 liquid stools/day with blood, mucus, pus), tenesmus, weight loss, abdominal cramps, anorexia, weakness, dehydration, low-grade fever, colon tenderness.

Management (mild–moderate): Low-residue, high-protein diet; no milk/products or gas-forming foods; antibiotics, corticosteroids, anticholinergics, antidiarrheals, immunosuppressives; 5-ASA compounds (mesalamine / Asacol, sulfasalazine / Azulfidine).

Severe: NPO + IVF, blood transfusions, NG suction, surgery (total proctocolectomy with permanent ileostomy).

Diverticulosis / Diverticulitis

Pathophysiology: Diverticulum = outpouching of intestinal mucosa. Diverticulitis = inflammation of diverticulum. Most frequent in sigmoid colon.

S/S: Intermittent LLQ pain (worse with coughing/straining), alternating constipation/diarrhea with blood/mucus, palpable tender rectal mass, N/V, flatulence, fever, distention.

Management: High-residue diet (diverticulosis), low-residue diet (diverticulitis). Bulk-forming laxatives, anticholinergics, antibiotics. Surgery (temporary/permanent colostomy) for severe cases.

Priority: Diverticulosis = high fiber; Diverticulitis = low fiber (bowel rest). Know the difference!

Appendicitis

Pathophysiology: Inflammation of appendix preventing mucus drainage into cecum β†’ ischemia β†’ gangrene β†’ rupture β†’ peritonitis.

S/S: RLQ pain at McBurney's point (β…“ distance from ASIS to umbilicus). N/V, guarding, walks stooped over, rebound tenderness, decreased bowel sounds. Psoas sign & Rovsing's sign. ↑ WBC, fever.

Management: No enema, laxatives, or heating pad (risk of perforation). Antibiotics, antipyretics. Minimal analgesics until diagnosis confirmed. Surgery: laparoscopic (uncomplicated) or open (if perforation suspected with Penrose drain).

Nursing: Semi-Fowler's or right side to promote drainage. Monitor drain and NG suction.

Priority: NEVER apply heat or give laxatives/enemas β€” increases rupture risk. Analgesics minimized until surgical diagnosis confirmed.

Hepatitis (Viral)

Pathophysiology: Inflammation of liver β†’ hepatic cell degeneration, necrosis, Kupffer cell proliferation β†’ interrupted bile flow β†’ jaundice.

Phases: Preicteric (A/N/V, fatigue, weight loss, hepatomegaly, RUQ discomfort, splenomegaly) β†’ Icteric (jaundice, pruritus, light stool, dark urine) β†’ Posticteric (improving sense of well-being).

TypeTransmissionIncubationPrevention
Hep AFecal-oral; contaminated food/water2–6 weeksVaccine (Havrix); immunoglobulin post-exposure
Hep BBlood/body fluids, sexual, parenteral6–24 weeksVaccine (Engerix B); HBIg post-exposure
Hep CPrimarily blood5–10 weeksNo vaccine available
Hep DBlood (co-infection with Hep B)7–8 weeksHep B vaccine may prevent
Hep EContaminated food/water2–9 weeksHand washing

Nursing Management: Monitor for fulminant hepatitis and hepatocellular carcinoma. High-carb, high-vitamin, moderate-to-high protein, low-fat diet in small frequent meals. Antiemetics 30 min before meals. Pruritus care: no soap, lukewarm baths, emollients, cool clothing, short nails, cool compresses. Discharge: transmission prevention, avoid alcohol/hepatotoxic drugs, balance rest/activity, no blood donation.

Cirrhosis of the Liver

Pathophysiology: Chronic progressive liver disease β€” inflammation, fibrosis, degeneration β†’ scar tissue β†’ malfunction.

Types: Laennec's (alcohol-related), NAFLD, post-necrotic (viral hepatitis), cardiac (R-sided CHF), biliary (CBD obstruction).

S/S: A/N/V, flatulence, indigestion, fatigue, hepatomegaly, RUQ pain, ascites, mental status changes, gynecomastia, ↓ sex hormones, jaundice, pruritus, pancytopenia (↑ infection risk, easy bruising β€” spider angiomas, palmar erythema), muscular atrophy.

Diagnostics: ↑ SGOT, SGPT, LDH, alkaline phosphatase, bilirubin. Prolonged PT. ↓ Hgb, Hct, albumin.

Nursing Care: Small frequent feedings β€” high-calorie, high-carb, low-to-moderate protein, low-fat. Reverse isolation for severe leukopenia. Prevent bleeding: avoid straining, nose blowing, coughing, Valsalva, NG tube. Diuretics for ascites. Avoid hepatotoxic drugs and alcohol.

Ascites

Patho: Hypoalbuminemia + portal hypertension + hyperaldosteronism β†’ fluid leaks into peritoneal cavity. S/S: Shifting dullness, fluid thrill, protruding umbilicus, distention, striae, peripheral edema, SOB. Management: K⁺-sparing diuretics, albumin infusion, paracentesis, LeVeen shunt. Restrict fluid 1000–1500 mL/day, Na⁺ 200–500 mg/day.

Esophageal Varices

Dilated esophageal veins from portal hypertension. S/S: Hematemesis, melena, fatigue, ascites, caput medusae. Management: Iced NS lavage, blood transfusions, vitamin K, octreotide (Sandostatin), sclerotherapy, vasopressin, Sengstaken-Blakemore tube. Nursing: semi-Fowler's, maintain traction, label lumens, deflate balloons as ordered, keep scissors at bedside.

Hepatic Encephalopathy

Terminal complication β€” liver cannot convert ammonia to urea β†’ ammonia diffuses to brain. Early signs: mental status changes (irritability, confusion, insomnia), slurred speech, tremors, hyperactive reflexes, positive Babinski. Progressive: asterixis, disorientation, apraxia, fetor hepaticus (fruity/musty breath). Late: coma, absent reflexes. Management: High-carb, low-fat, protein-free diet; lactulose (decreases ammonia), neomycin. Nursing: protect from injury, eye care, avoid drugs detoxified by liver.

Priority: Hepatic encephalopathy = ↑ ammonia. Lactulose & neomycin to reduce ammonia. Monitor LOC closely.

Pancreatitis

Pathophysiology: Proteolytic/lipolytic enzymes activated in pancreas instead of duodenum β†’ autodigestion. Precipitated by alcoholism, biliary tract disease, cholelithiasis, trauma, viral infection, duodenal ulcer, hyperlipidemia.

S/S: Mid-epigastric or LUQ pain radiating to back/flank/substernal area. Pain aggravated by eating (high-fat or alcohol). Dyspnea, N/V, steatorrhea, ↓/absent bowel sounds, tenderness/guarding. Grey Turner's spots (flank ecchymosis), Cullen's sign (periumbilical ecchymosis). Hypocalcemia. ↑ serum amylase & lipase, ↑ blood sugar.

Management: NPO. Narcotic analgesics (hydromorphone / Dilaudid, fentanyl). Smooth muscle relaxants (nitroglycerine, papaverine). Anticholinergics, antacids, antihistamines, calcium gluconate. Fetal position for comfort. When tolerating: high-carb, high-protein, low-fat diet, small frequent feedings. Avoid caffeine.

Cholecystitis / Cholelithiasis

Pathophysiology: Acute/chronic inflammation of gallbladder, often with gallstones (cholesterol or pigment stones).

Risk factors: Women > 40, Caucasian, obese, post-menopausal on ERT, OCP users.

S/S: Epigastric/RUQ pain radiating to scapula (2–4 hours after meals), fatty food intolerance, positive Murphy's sign, guarding, rigidity, rebound tenderness, fever, tachycardia, pruritus, jaundice, dark urine, clay-colored stool, steatorrhea.

Diagnostics: ↑ amylase, lipase, WBC, alkaline phosphatase, direct bilirubin. OCG, ultrasound, HIDA scan.

Medical Management: Narcotics (hydromorphone, fentanyl), anticholinergics, antiemetics. Bile acid sequestrants for itching. Stone dissolution: ursodiol (Actigall), chenodiol (Chenix). ECSWL.

Surgical: Cholecystectomy (laparoscopic or open). T-tube inserted if CBD explored. Post-op T-tube care: closed gravity drainage, semi-Fowler's, expect 700–1000 mL bile-colored drainage first 24 hours, keep skin clean/dry, t-tube cholangiogram before removal.

Intestinal Obstruction

Mechanical: Volvulus, intussusception, hernias, foreign bodies, neoplasms, fecal impaction.

Neurogenic (paralytic ileus): Abdominal surgery, peritonitis, shock, spinal cord injury, electrolyte imbalance.

Vascular: Embolus, atherosclerosis β†’ ischemia and gangrene.

S/S (small bowel): Colicky intermittent pain, non-fecal vomiting. Large bowel: Cramp-like pain, occasional fecal vomiting, lack of flatus, absolute constipation. General: distention, rigidity, high-pitched bowel sounds above obstruction, ↓/absent below. Diagnosis: flat plate X-ray. Management: decompression, enema, surgery.

GI Bleed

Upper GI bleed: Hematemesis (coffee-ground emesis), melena (tarry black stools). Causes: PUD, gastritis, esophageal varices, Mallory-Weiss tear.

Lower GI bleed: Hematochezia (bright red blood per rectum). Causes: diverticulitis, colitis, colorectal cancer, hemorrhoids.

Nursing: Monitor VS, NPO, IV access, NG tube for lavage/diagnosis, type & crossmatch for transfusion, monitor Hgb/Hct, administer PPIs, vasopressin, octreotide as ordered.

Priority: ABCs first β€” airway, breathing, circulation. Large-bore IV access, type & crossmatch, monitor for hypovolemic shock.

Colorectal Cancer

2nd most common cancer in men & women. Peak age 50–60. Risk factors: chronic IBD (diverticulosis, UC), family history of polyps (FAP).

S/S: Alteration in bowel pattern, abdominal cramps/distention, weight loss, pallor, unexplained anemia. Diagnosis: CEA positive, positive stool OB, ↓ Hgb/Hct, barium enema, digital rectal exam, sigmoidoscopy, biopsy.

Management: Radiation, chemotherapy, surgery.

5. GI Medications

Proton Pump Inhibitors (PPIs)

  • Omeprazole (Prilosec)
  • Pantoprazole (Protonix)
  • Esomeprazole (Nexium)
  • Lansoprazole (Prevacid)
  • Rabeprazole (Aciphex)

Action: ↓ acid production by suppressing parietal cells. Nursing: Take before meals, swallow whole. Antacids may be taken with PPIs.

Hβ‚‚ Receptor Antagonists

  • Cimetidine (Tagamet)
  • Famotidine (Pepcid)
  • Nizatidine (Axid)
  • Ranitidine bismuth citrate (Tritec)

Action: ↓ gastric acid secretion. Nursing: Give Β½ hour before meals & bedtime. Cimetidine: reversible leukopenia, confusion β€” monitor CBC.

Antacids

  • Aluminum-containing: Amphogel (constipation; only antacid for renal failure)
  • Magnesium-containing: MOM (diarrhea)
  • Combination: Maalox, Mylanta
  • Calcium-containing: Tums (hypercalcemia risk)

Nursing: 1–2 hours after meals & bedtime. Separate 1 hour from other drugs.

Antiemetics

  • Phenothiazines: prochlorperazine (Compazine), promethazine (Phenergan)
  • Antihistamines: hydroxyzine (Vistaril), meclizine (Antivert)
  • Other: metoclopramide (Reglan), ondansetron (Zofran), scopolamine

Laxatives

  • Bulk-forming: psyllium (Metamucil), methylcellulose (Citrucel)
  • Stool softeners: docusate sodium (Colace)
  • Stimulant: bisacodyl (Dulcolax), senna (Senokot)
  • Osmotic: lactulose, magnesium citrate, MOM, GoLYTELY, Miralax

Antidiarrheals

  • Bismuth subsalicylate (Pepto-Bismol)
  • Loperamide (Imodium)
  • Lomotil (atropine + diphenoxylate)

Pancreatic Enzymes

Given for pancreatic insufficiency (chronic pancreatitis, cystic fibrosis). Administer with meals/snacks. Do not crush or chew. Monitor for steatorrhea improvement.

6. Pediatric GI Disorders (Summary)

ConditionKey FeaturesManagement
Esophageal Atresia / TEFPolyhydramnios, inability to pass NG tube, drooling, regurgitation, choking/aspiration, distended abdomenSurgical repair; gastrostomy feeding; prevent aspiration
Pyloric StenosisOlive-shaped mass, projectile non-bilious vomiting at 3–4 weeks, visible peristalsis, metabolic alkalosisPyloromyotomy; post-op: glucose water β†’ formula in 24h
IntussusceptionPiercing cry, sausage-shaped mass, currant-jelly stool; peak 6 monthsBarium enema (diagnostic + therapeutic up to 3Γ—); surgical resection if fails
Hirschsprung's DiseaseFailure to pass meconium, ribbon-like stools, bile-stained vomiting, failure to thrive; aganglionic megacolonColostomy (palliative); pull-through procedure (corrective)
Celiac DiseaseGluten intolerance β†’ villous atrophy, steatorrhea, FTT, ADEK deficiencyLifelong gluten-free diet (no BROW)
Cleft Lip/PalateFeeding difficulty, nasal regurgitation, otitis media riskCheiloplasty (~2 months); Palatoplasty (~9–12 months); special feeding techniques

7. NCLEX Priorities β€” GI System

1. GI Bleed: ABCs first. Large-bore IV, type & crossmatch, monitor for hypovolemic shock. NG lavage for upper bleed.
2. Dumping Syndrome: Avoid simple sugars. Lie down after meals. No fluids with meals. Small frequent meals.
3. Appendicitis: No heat, no enemas, no laxatives β€” risk of rupture. Analgesics minimized until diagnosis confirmed.
4. Hepatic Encephalopathy: High ammonia β€” give lactulose and neomycin. Monitor LOC. Protein-free diet.
5. Esophageal Varices: Keep scissors at bedside for SB tube. Deflate balloons as scheduled to prevent necrosis.
6. Diverticulosis vs. Diverticulitis: Diverticulosis = HIGH fiber; Diverticulitis = LOW fiber/residue (bowel rest).
7. Ostomy Assessment: Pink/red stoma = healthy; pale = anemia; purple/black = impaired circulation (emergency).
8. TPN: Strict asepsis, monitor glucose, daily weights. Never abruptly discontinue β€” risk of hypoglycemia.
9. NG Tube Feeding: Verify position by X-ray before use. Elevate HOB 30–45Β°. Check residual before feeding (hold if > 400 mL).
10. Paracentesis: Have patient empty bladder first. Measure abdominal girth & weight before/after. Monitor for hematuria.