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Small Bowel obstruction: intentional contents, fluid, and gas accumulate above the intestinal obstruction. Increased in intestinal lumen pressure cause occlusion of capillary blood flow and compromise of venous return and arterial flow.

Large Bowel obstruction: an accumulation of intestinal contents, fluid, and gas proximal to the obstruction. If the blood supply is cut off, intentional strangulation and necrosis can occur (life threatening)

S/S:

Abdominal pain and cramping (often colicky), abdominal distention, N/V (may be feces in extreme cases), constipation or obstipation, hyperactive then hypoactive or absent sounds, signs of dehydration (dry mucous membranes, tachycardia)

Diagnostic Tests:

Abdominal X-ray- to show bowel loops and air/fluid levels.

CT scan- identifies location and cause

Ultrasound- more commonly used for children and pregnant women.

CBC and BMP- checking for infection, electrolyte imbalance, and dehydration

Interventions:

NPO- to rest the bowel or create a larger obstruction/more damage

NG tube placement- used for decompression/suction

IV fluids- to maintain hydration and electrolyte balance

Monitor I&Os- to manage care along with VS and abdominal girth

Surgical intervention- if obstruction is complete and does not resolve with other interventions

Encourage ambulation- if possible to encourage motility

Medications:

IV fluids- NS or LR for rehydration and electrolyte replacement

Analgesics- as prescribed as we would not want to cause further damage

Antiemetics- such as ondansetron for N/V

Antibiotics- as prescribed if infection or perforation is suspected

Education:

Report signs of worsening symptoms (severe pain, no bowel movements, vomiting), educate on the importance of early intervention and f/u, postoperative care if surgery (wound care, activity restriction), prevention measures (adequate diet/fiber intake, hydration, and regular activity)

Complications:

Bowel perforation, sepsis, peritonitis, electrolyte imbalance, shock, strangulation/necrosis

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Ulcerative Colitis and Chron Disease (Christina)

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Ulcerative Colitis and Chron Disease (Christina)

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UC vs Chron Disease S/S:

UC:

Exacerbations and remissions

Bright red blood in stool

Severe diarrhea

Affects only the colon

Continuous snake-like ulceration pattern

High colorectal cancer risk

Chron’s Disease (Regional Enteritis):

Prolonged, variable course

Malnutrition

Deep, penetrating granulomas

Fistulas common

Weight loss

May have occult blood, melena (if upper GI affected), or non-bloody diarrhea

Can affect any part of the GI tract (mouth to anus)

Cobblestone appearance due to transmural inflammation

Patchy inflammation (skip lesions)

Diagnostic Tests:

Barium series

Sigmoidoscopy

Colonoscopy

CT scan

CT/MRI enterography

Stool samples (rule out infections, check for blood/inflammation)

CBC (check for anemia, infection)

CRP/ESR (inflammatory markers)

Interventions:

Dietary modifications
Promote hydration and electrolyte balance
Parenteral nutrition
Assess for signs and symptoms of anemia
Monitor laboratory values
Monitor intake and output
Assess stool quality, volume, and frequency
Monitor vital signs

Medications:

Antibiotics
Sulfonamides
Corticosteroids
Bulk hydrophilic agents

Education:

Avoid triggering foods (spicy foods, alcohol, dairy)
Consume a low-residue diet, limiting high-fiber foods during flare-ups
Adhere to prescribed medications
Understand the importance of regular screenings (e.g., colonoscopy for cancer surveillance)

Complications:

Toxic megacolon
Perforation
Small bowel obstruction
Perianal disease
Fluid and electrolyte imbalances
Malnutrition from malabsorption
Fistulas
Abscesses
Severe gastrointestinal hemorrhage
Sepsis

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Diverticulosis vs. Diverticulitis:

Diverticulosis

Presence of pouch-like herniations (diverticula) in the colon wall. Often asymptomatic. Found incidentally during colonoscopy or imaging. Managed with dietary fiber and lifestyle changes

Diverticulitis

Inflammation and infection of one or more diverticula.

Symptomatic: pain, fever, GI issues. Often presents acutely and may require medical intervention. Requires medical treatment (and sometimes surgery)

S/S:

·      Left lower quadrant (LLQ) abdominal pain (most common)

·        Fever and chills

·        Nausea and vomiting

·        Constipation or diarrhea

·        Abdominal tenderness

·        Bloating

·        Leukocytosis (elevated WBC count)

Diagnostic Tests:

CT scan of the abdomen and pelvis (most accurate)

CBC (elevated WBCs indicating infection)

C-reactive protein (CRP) (elevated in inflammation)

Abdominal X-ray (to check for perforation)

Colonoscopy (deferred during acute phase due to risk of perforation)

Interventions:

Bowel rest (NPO → clear liquids → low-residue diet)

IV fluids if hospitalized

Antibiotics (oral or IV depending on severity)

Pain management (typically acetaminophen)

Surgical intervention for complications (e.g., abscess, perforation, recurrent episodes)

Drainage of abscess if needed

Medications:

Antibiotics:

Metronidazole (Flagyl) + Ciprofloxacin or Trimethoprim-sulfamethoxazole (Bactrim)

Alternatives: Amoxicillin-clavulanate (Augmentin)

Pain relievers:

Acetaminophen (preferred to avoid NSAIDs which increase risk of bleeding)

Education:

Diet:

During acute phase: low-fiber or clear liquid diet

After recovery: transition to high-fiber diet

Avoid seeds, nuts, popcorn (historically advised, though evidence is mixed)

Hydration: drink plenty of fluids

Avoid straining during bowel movements

Prevent constipation: regular exercise, fiber supplements if needed

Know when to seek help: worsening pain, fever, or signs of bleeding

Complications:

Abscess formation

Bowel perforation

Peritonitis

Fistula formation (e.g., colovesical)

Bowel obstruction

Recurrent episodes requiring surgical intervention

Sepsis in severe cases

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Acute vs Chronic Pancreatitis S/S:

Acute(symptoms are typically sudden and reversible)-inflammation, severe upper abdominal pain, pain that worsens after eating, N/V, fever, increased HR, abdominal tenderness, elevated lipase and amylase

Chronic(long-standing inflammation that causes permanent damage)- persistent or recurrent pain, weight loss, steatorrhea, possible development of diabetes, fatigue, enzyme levels may be slightly elevated or appear normal in some cases due to compensation

Similar- N/V, fatigue, digestive indigestion, elevated pancreatic enzymes

Diagnostic Tests: Serum lipase and amylase, liver function tests, abdominal ultrasound or CT, MRI, CBC and CRP testing, ERCP or MRCP, blood glucose testing

Interventions:

Acute: NPO, IV fluids, pain management, NG tube if necessary, treat underlying causes(gallstones), monitor for systemic complications (sepsis, etc.), pancreatic enzyme replacement if needed

Chronic: pain control, pancreatic enzyme replacement if needed, low-fat/ high protein diet, alcohol cessation, blood sugar management, may require surgical interventions

Medications: analgesics, antiemetics, antibiotics if infection is present, iv fluids, insulin if needed for control of blood sugar levels, pancreatic enzyme replacement

Education: avoid alcohol, avoid fatty foods, report any signs of infection or worsening of pain, cessation of smoking, adherence to medications and diet, monitor blood sugar levels, teach the importance of nutrition and signs and symptoms of malabsorption

Complications: pancreatic necrosis, pseudocysts, organ failure, hypovolemic shock, sepsis, malabsorption, malnutrition, chronic pain, diabetes mellitus, bile duct obstruction.

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Cholelithiasis:

S/S:

Mild GI symptoms

Epigastric distress

Abdominal distention

Vauge RUQ pain

May be asymptomatic

pain after fatty foods

Diagnostic Tests:

Abdominal ultrasound

CT scan of abdomen

MRCP

AST, ALT, ALP, WBC, bilirubin, amylase

Interventions:

Asymptomatic- no treatment needed

Symptomatic

Pain relief

Dietary modification- low fat diet, small frequent meals

Surgical intervention- removal

Symptom management

Medications:

pain management

antibiotics if needed

surgical interventions

Education:

dietary changes- avoid high fat foods, avoid greasy foods

medications

disease process

surgery education if applicable

Complications:

Cholecystitis

Choledocholithiasis

Cholangitis

gallstone pancreatitis

Cholecystitis:

Inflammation of gallbladder which is caused by a blockage of the cystic duct which affects the gallbladder bladder from draining

Acalculous cholecystitis can occur when patients are on TPN

Complication of Cholelithiasis

S/S:

Severe upper right quadrant pain- radiates to shoulder or back

Murphy's sign: pain on deep inspiration when palpating the right upper quadrant

Fever

Nausea/vomiting

Jaundice

Tachycardia

RUQ tenderness

Diagnostic Tests:

Elevated inflammatory markers

Elevated WBC

Abdominal ultrasound

MRCP

Interventions:

NPO- rest gallbladder

IV fluids

IV antibiotics

NG tube to help drain stomach

ERCP- endoscopic retrograde cholangiopancreatography (removes stones)

Cholesectectomy

Medications:

Antibiotics

NSAIDs- pain

Antiemetics

IV fluids

Education:

Medications

Disease process

When to call doctor or go to ER (jaundice, fever, worsening abdominal pain signs of dehydration)

Diet- avoid heavy meals, stay hydrated, healthy, low-fat meals)

Signs and symptoms of infection

Complications:

Sepsis

Gangrenous gallbladder

Perforation of gallbladder

Gallbladder emphyema

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Hepatitis A–E- Inflammation of the liver

Can be caused by viruses, alcohol, toxins, drugs, or autoimmune diseases.

Transmission

A- Fecal-oral (contaminated food/water, poor hygiene)

E- Fecal-oral (especially in developing countries)

B- Blood, body fluids (sex, IV drugs, childbirth)

C- Blood only (IV drugs, healthcare, old transfusions)

D- Blood/body fluids – but requires Hep B to infect

Signs & Symptoms
- Fatigue
- Nausea, vomiting
- Abdominal pain (RUQ)
- Jaundice (yellow skin/eyes)
- Dark urine, pale stool
- Loss of appetite
- Joint pain (common in B)

Diagnostic Tests
- Liver enzymes: ↑ AST, ALT
- Bilirubin: ↑ (causes jaundice)
- PT/INR: ↑ if liver is damaged
- Serologic tests (to identify virus type):
- Hep A: Anti-HAV IgM/IgG
- Hep B: HBsAg, Anti-HBc, Anti-HBs
- Hep C: Anti-HCV, HCV RNA
- Hep D: Anti-HDV
- Hep E: Anti-HEV IgM

Interventions
- Rest the liver: No alcohol, avoid hepatotoxic meds (like acetaminophen)
- Monitor liver function

Medications

A and E- None – self-limiting

B- Antivirals (e.g., tenofovir, entecavir)

C- Direct-acting antivirals (e.g., sofosbuvir) – may cure

D- no specific D treatment

Education
- Vaccines: Available for A & B (and D by preventing B)
- Handwashing (A & E)
- Safe sex, no needle sharing (B, C, D)
- Avoid alcohol and liver-toxic meds
- Regular follow-up for chronic B/C

Complications
- Chronic hepatitis (B, C, D)
- Liver cirrhosis
- Liver failure
- Hepatocellular carcinoma
- Fulminant hepatitis (rare, sudden liver failure)
- Anemia and bleeding problems

Cirrhosis- Long-term liver damage → Scarring (fibrosis)

Signs & Symptoms
- Fatigue
- Jaundice

-Portal hypertension and esophageal varices (risk for bleeding)

-Hypotension/Cardiovascular issues due to low albumin levels
- Ascites (belly fluid due to third spacing)
- Peripheral edema (swollen legs)
- Itchy skin
- Bruising/bleeding easily
- Spider angiomas
- Confusion (hepatic encephalopathy due to high ammonia levels)
- Dark urine, pale stool
- Anorexia, weight loss

Diagnostic Tests
- Liver enzymes: AST, ALT may be ↑ early, ↓ late stage
- ↑ Bilirubin
- ↓ Albumin
- ↑ PT/INR
- Ammonia ↑ (in encephalopathy)
- Ultrasound, CT, MRI: Assess liver structure
- Liver biopsy: Confirms diagnosis
- FibroScan: Measures liver stiffness

Interventions
- Avoid alcohol & hepatotoxic meds
- Sodium restriction (ascites)
- Monitor I&O, daily weights
- Paracentesis (remove ascites)
- Nutrition support
- Fall risk precautions (encephalopathy)

Medications
- Diuretics (spironolactone, furosemide) for ascites
- Lactulose (↓ ammonia for confusion)
- Rifaximin (antibiotic for encephalopathy)
- Beta-blockers (propranolol) for varices
- Vitamin supplements (esp. B vitamins)

Education
- No alcohol
- Low sodium diet
- Take lactulose as prescribed
- Monitor mental status (report confusion)
- Avoid NSAIDs (↑ bleeding risk)
- Regular follow-up & screening for liver cancer

Complications
- Hepatic encephalopathy (confusion/coma)
- Variceal bleeding (esophageal bleeding)
- Ascites & spontaneous bacterial peritonitis (SBP)
- Hepatorenal syndrome
- Liver cancer (HCC)
- Portal hypertension
- Death without transplant (end-stage)

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The Bristol Stool Chart categorizes fecal matter into seven distinct types, ranging from 1 to 7. Type 1 is characterized by hard lumps, which are indicative of constipation, whereas Type 7 is classified as watery, suggesting the presence of diarrhea. Conversely, Types 3 and 4 are regarded as optimal forms of stool consistency. (McLean, 2022)

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Diarrhea (D)

Patho:

Diarrhea is characterized by an increased frequency of bowel movements exceeding three times per day, an elevated stool volume surpassing 200 grams per day, or the presence of stools that exhibit abnormal liquidity. It is usually linked to increased urgency, pain in the perianal area, or episodes of incontinence.

Diarrhea that persists for less than two weeks is classified as acute, whereas diarrhea that extends beyond four weeks is categorized as chronic.

There are different types of diarrhea, specifically secretory, osmotic, and mixed diarrhea.

Characterized by the release of large quantities of fluid, secretory diarrhea stems from heightened synthesis and secretion of water and electrolytes by the intestinal lining into the digestive tract.

Osmotic diarrhea is characterized by the influx of water into the intestines driven by the osmotic pressure exerted by unabsorbed solutes, which subsequently hinders the reabsorption of water.

Characterized by a blend of heightened secretion and impaired absorption, mixed diarrhea occurs due to increased peristalsis, a phenomenon often linked with inflammatory bowel diseases (IBD)

(Honan, 2024, pp. 780–781)

S/S:

Besides having more regular and fluid-like bowel movements, the patient commonly faces issues such as stomach cramps, swelling, intestinal noises (borborygmus), decreased appetite, and increased thirst.

Defecation may be accompanied by painful spasmodic contractions of the anal sphincter and ineffective straining, a condition known as tenesmus.

Additional symptoms are contingent upon the underlying etiology and severity of diarrhea; however, they are predominantly associated with dehydration and disturbances in fluid and electrolyte balance.

Watery stools are indicative of pathological conditions affecting the small intestine, whereas loose, semisolid stools more frequently correlate with disorders of the large intestine. The observation of bulky, lipid-rich stools may indicate the presence of intestinal malabsorption. Furthermore, the detection of mucus and pus within the stool samples may be indicative of inflammatory enteritis or colitis.

The presence of oil droplets within the toilet water is frequently indicative of pancreatic insufficiency.

Nocturnal diarrhea may be an indicative manifestation of diabetic neuropathy.

In instances where the etiology of diarrhea remains indeterminate, a series of diagnostic evaluations may be conducted. These assessments typically include a complete blood cell count (CBC), serum chemistry analyses, urinalysis, routine stool examinations, and targeted stool analyses to identify the presence of infectious or parasitic organisms, bacterial toxins, blood, fat, and electrolytes. Endoscopic procedures or barium enema evaluations may facilitate the identification of the underlying cause.

(Honan, 2024, pp. 780–781)

Diagnostic Tests:

Blood test

CBC

CMP or an Electrolyte Panel

RFT

Stool Test

C&S

Hydrogen Breath Test

Determines lactose intolerance

Endoscopy ( see constipation for more info)

(Mayo Clinic, 2025)

Interventions:

Primary management focuses on the regulation of symptoms, the prevention of complications, and the eradication or treatment of the underlying disease.

Pharmacological interventions, including antibiotics—specifically designated for instances of bacterial overgrowth—and anti-inflammatory agents, may be employed to mitigate the severity of diarrhea and address the underlying pathological condition.

The primary intervention for the management of diarrhea in most cases is oral rehydration.

However, in instances of severe dehydration or when symptoms are pronounced, intravenous rehydration is recommended. Part of a nurse's duties involves assessing and tracking the features and behaviors linked to diarrhea.

A comprehensive health history must encompass an analysis of the patient's medication therapy, as well as a detailed examination of their medical and surgical history, alongside an assessment of dietary patterns and dietary intake.

Recent reports of exposure to acute illnesses or travel to different geographical regions are significant, as they may influence treatment protocols based on the patient’s medical condition and travel history.

The assessment process encompasses abdominal inspection, auscultation to detect hyperactive bowel sounds, and palpation to evaluate for the presence of abdominal tenderness.

Vital signs are evaluated for indications of fever and the presence of fluid volume deficit, which may be characterized by a weak pulse, hypotension, and a narrow pulse pressure.

The assessment of mucous membranes and cutaneous surfaces is critical for evaluating an individual's hydration status.

Stool samples are collected for analytical testing.

During an episode of acute diarrhea, it is recommended that the nurse advises patients to engage in bed rest and to consume fluids and low-bulk foods until the acute symptoms resolve.

Upon the patient's attainment of sufficient tolerance for food intake, the nursing professional advocates for the adoption of a bland diet comprising semisolid and solid food items.

The patient should refrain from the consumption of caffeine, carbonated beverages, and foods that are either excessively hot or cold, as these substances may stimulate intestinal motility.

It may be necessary to impose limitations on the consumption of dairy products, fats, whole-grain foods, as well as fresh fruits and vegetables for several days.

(Honan, 2024, pp. 780–781)

Medications:

Doctors might recommend antidiarrheal drugs like diphenoxylate and loperamide to reduce the number and amount of bowel movements.

Intravenous fluid therapy may be essential for the prompt rehydration of certain patients, particularly among older individuals and those with pre-existing gastrointestinal conditions, such as inflammatory bowel disease (IBD).

(Honan, 2024, pp. 780–781)

Education:

Diet & Lifestyle changes

Exercise

increases motility

Hydration

softens stool

High fiber diet

fruits, veggies, cereal, rice, whole grain bread, and beans.

Prunes are a high source of fiber and can assist with constipation.

Healthy bowel routine

Educate on the pharmacological option

laxatives

enemas and suppositories

prescription meds

Lubiprostone (Amitiza).

Linaclotide (Linzess).

Plecanatide (Trulance).

Prucalopride (Motegrity).

used in opioid-induced constipation

blocks the effect of opioids depression on stool motility.

Methylnaltrexone (Relistor).

Naldemedine (Symproic).

Naloxegol (Movantik).

Educate on Pelvic muscle training

Surgical option

To fix damage/irregularities in nerves/tissues of the colon/rectum.

(Mayo Clinic, 2025)

Complications:

Fluid Volume Deficit (FVD)

Electrolyte imbalance

Infection risk

Systemic effects (r/t spread of infection)

IBS

Lactose intolerance

Haemolytic uraemic syndrome

Medication Effectiveness May Be Reduced

(McKechnie, 2023)

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Definition

Ostomies are surgical openings created on the surface of the abdomen to allow stool (or urine) to exit the body when the normal route through the rectum (or bladder) is not possible.

Can be permanent or temporary depending on the underlying condition and surgical goals.

Ileostomy

Connection between the ileum (last part of small intestine) and the abdominal wall (usually RLQ).

Stool is liquid and rich in digestive enzymes, water, and electrolytes.

High risk for:

Dehydration

Electrolyte imbalance (especially Na⁺, K⁺)

Skin breakdown around the stoma due to enzyme-rich output

Colostomy

Connection from the colon (large intestine) to the abdomen.

Can be in 4 locations:

Ascending – liquid stool

Transverse – loose to partly formed

Descending/Sigmoid – formed, more like normal stool

Sigmoid colostomies may be trained for regular bowel movements through irrigation

Indications

Crohn’s disease

Ulcerative colitis

Diverticulitis/diverticulosis with complications

GI infection or perforation

Colorectal cancer

Colon or rectal trauma

Bowel obstruction

Nursing Interventions

Assess how clients perform stoma care at home if skin breakdown is noted

Empty pouch when 1/3–1/2 full to avoid leaking or bursting

Change the pouch system every 3–5 days (label with date/time)

Change when bowel is least active (best in morning before breakfast)

Use skin barrier to protect peristomal skin from stool

Cut skin barrier opening 1/8 inch larger than stoma to avoid constriction or leaks

Avoid crushing enteric-coated or sustained-release meds (won’t absorb properly)

Monitor electrolytes & fluid status (especially with ileostomies)

Post-op:

Watch for signs of dehydration: dry mouth, low UOP, tachycardia, hypotension, dizziness

Monitor stoma: should be red/pink, moist, and protrude slightly

Abnormal stoma: dusky, dark red, black = ischemia; pale = low Hgb/Hct

Diet Education

First 6 weeks: low-fiber, soft, small meals

Chew thoroughly to avoid obstruction

Avoid stoma-blocking foods: corn, peas, coleslaw, popcorn, nuts, seeds, raisins, fruit skins, raw mushrooms

Avoid gas-causing or odorous foods: beans, eggs, broccoli, cabbage, onions, garlic, fish, alcohol

Hydration is key, especially with ileostomies

Educate on:

Stoma location and expected appearance

Pouching system

Diet progression and fluid needs

May receive:

Oral antibiotics (↓ bacterial load)

Soft/low-residue diet 2–3 days pre-op

Colon prep/cleansing (can cause dehydration → IV fluids may be needed)

Post-Op Care

Monitor:

Electrolytes, hydration, stoma color/size, output type

Ileostomy output:

Dark green → yellowish once patient starts eating

Colostomy output:

May start as mucous or liquid, then form over time

No stool in 2+ days = assess for obstruction

Use moist sterile petroleum gauze or dry dressing until pouching begins

Complications

Stoma ischemia/necrosis (dusky, black)

Retraction or prolapse

Parastomal hernia

Peristomal skin breakdown

Dehydration and electrolyte imbalance

Bowel obstruction or blockage

Body image disturbance, depression, or anxiety

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Colorectal Cancer Screening and Endoscopy (Wyndell)

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Colorectal Cancer Screening and Endoscopy (Wyndell)

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Indication: Patients with GI disorders and individuals over the age of 45 or 50

Diagnostic Tests: Endoscopy (provides visual inspection of the colon & rectum, assesses for lesions, polyps, and signs of cancer): colonoscopy, flexible sigmoidoscopy or contrast barium enema. Fecal blood test

Interventions:

1) Provide sedation and keep patient NPO after midnight

2) Administer bowel preparation and notify the provider if the patient does not complete bowel prep, if bowel prep is indicated

3) Asses for allergies if contrast is indicated

4) Assess presence of gag reflex and ensure that a diet is ordered before PO administration

5) Assess for complications (acute pain, perforation, bleeding, which are not expected) and report immediately after procedure

Education: After the age of 45, patients should adhere to at least one of test screening schedules:

Annual fecal occult blood test

Flexible sigmoidoscopy or contrast barium enema every 5 years

Colonoscopy every 10 years or CT Colonoscopy every 5 years

Testing may be more frequent if the patient has a history of inflammatory bowel disease or family history of colorectal cancer.

Teach patient about condition prevention or management:

Healthy, balanced diet (high-fiber, hydration)

Physical activity

Smoking cessation

Medication adherence

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S/S: Hoarseness, laryngitis, coughing & wheezing, heartburn, dysphagia, chronic pain that radiates to neck, jaws, and arms, none in most cases

Diagnostic Tests: Esophageal acidity test, Gastroesophageal scintillation, barium swallow test

Interventions: Elevating the head of the bed (8"), removing tight clothing, administer parenteral nutrition, tube feedings, Esophagectomy, hiatal hernia repair, vagotomy

Medications: Antacids (aluminum hydroxide), proton pump inhibitors (lansoprazole and rabeprazole sodium), histamine-2 receptor antagonists (cimetidine)

Education: Educate patient about foods to avoid (fatty foods, whole milk, caffeine, citrus, chocolate), avoid carbonated beverages, avoid eating 2-3 hours before sleep or lying down, eating more protein, carbohydrates, nonfat milk to increase esophageal sphincter pressure, upright after meals and small frequent meals

Complications: Esophageal ulcer or stricture, Reflux esophagitis, peptic stricture, Barrett esophagus

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Type 1: autoimmune condition where the immune system destroys the insulin-producing beta cells, no insulin is produced, life-long, no cure

Type 2: insulin resistance and insulin deficiency; insulin is still produced, but less is produced and it is less effective, can be cured with lifestyle changes

S/S: increased thirst (polydipsia), increased urination (polyuria), excessive hunger (polyphagia), anorexia, fatigue, blurred vision, slow healing sores and increased risk of wounds, infection, cardiovascular disease, fruity smelling breath

Hyperglycemia: "3 P's": polyphagia, polydipsia, polyuria

Hypoglycemia: shakiness, diaphoresis, headache, hunger, nausea, fatigue irritability confusion

Extreme Hypoglycemia: seizures or loss of consciousness

Diagnostic Tests:

Fasting Blood Glucose

normal: 65-110

pre-diabetic: 100-125

diabetic: 126+

HGB A1C (blood glucose trend over 3 months)

normal: below 5.7%

pre-diabetic: 5.7%-6.4%

diabetic: 6.5%+

Oral Glucose Tolerance Test (OGTT)

normal: less than 140

pre-diabetic: 140-199

diabetic: 200+

Interventions:

close monitoring of blood glucose in periods of stress, illness, hormonal changes. Do not stop taking insulin even when ill, administer insulin based on blood glucose levels.

administer insulin, rotate sites, monitor for injection site reactions- monitor K, especially before giving IV insulin

administer glucose (fast-acting 15g), if not too low should be oral carbs, if very low/pt unconscious should be IV dextrose or IM glucagon if no IV line is present- recheck blood glucose in 15 minutes

check feet for injuries

encourage hydration

Medications:

Insulin: rapid (onset within 15 min), short (onset and peak within 30 min-hour), intermediate, long-acting; regular insulin is the only type that can be given IV

Metformin: T2DM, improves insulin sensitivity, reduces glucose absorption in GI, reduces glucose production in the liver, watch for renal toxicity and do NOT give with contrast or other nephrotoxic medications, like antibiotics.

Sulfonylureas (glipizide): T2DM, stimulates insulin release from the pancreas, cannot be given to type 1

DPP-4 Inhibitors: T2DM, increase insulin release, decrease glucagon levels, cannot be given to type 1

SGLT2 Inhibitors: T2DM, prevent glucose reabsorption in kidneys

GLP-1 receptor agonists: T2DM, enhance insulin secretion, inhibit glucagon release, cannot be given to type 1

Education:

Diet: low glycemic index foods (don't want foods that quickly spike blood glucose), whole food sources of protein, fats, and carbs, count carbohydrates with each meal

Blood glucose monitoring: CGM (continuous glucose monitoring), regular monitoring before bed, before meals, after meals, before and after exercise, when feeling sick, more frequent monitoring when sick or stressed

Insulin administration: as needed based on their scale and blood glucose, usually before meals, don't administer rapid acting insulin before a meal if you aren't going to eat, rotate sites

Encourage exercise

Check feet

Regular eye exams

Complications: acute hypo/hyperglycemia, diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar nonketotic syndrome (HHNS), neuropathy, nephropathy and proteinuria, retinopathy/blindness, seizures, infection, amputation

HHNS: usually T2DM, >600 blood glucose

hyperglycemia, dehydration, increased serum osmolality, altered mental status, elevated BUN & creatinine, decreased urine osmolality

fluid & electrolyte replacement, IV insulin, electrolyte monitoring (especially K)

DKA: usually T1DM, >250 blood glucose

hyperglycemia, ketonuria, increased or decreased serum osmolality, metabolic acidosis, altered mental status, increased serum & urine ketones, acidosis= low pH, elevated BUN & creatinine, N/V, abdominal pain, Kussmaul respirations (fast, deep breathing), decreased urine osmolality

fluid & electrolyte replacement, IV insulin, electrolyte monitoring (especially K, must check before giving insulin IV), acidosis management (bicarb)

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Indications:

TPN (Total Parenteral Nutrition)

Used when the GI tract is non- functional.

Indicated for long-term nutritional support (weeks to years, requires a central IV line).

Glucose concentration >15%

Common in patients with bowel obstruction, severe pancreatitis, or short bowel syndrome.

PPN (Peripheral Parenteral Nutrition)

Used when the patient can still eat or receive some enteral nutrition, but needs supplemental support.

Indicated for short-term use (usually less than 2 weeks, does not require a central line).

Used during or after acute events when the patient is expected to resume normal eating soon.

Glucose concentrations </=10%

Education:

For both TPN and PPN...

Explain the purpose of therapy to the patient and their family.

Describe the procedure (central line for TPN, peripheral line for PPN).

Discuss potential complications, including infection, metabolic imbalances, and catheter- related issues.

Monitor for signs of hyper and hypoglycemia

Reassure the patient about monitoring protocols to keep them safe.

Complications:

Shared Complications (TPN and PPN)

infection at catheter site

metabolic imbalances

liver dysfunctions

thrombophlebitis (more for PPN)

TPN- Specific Considerations

Must be given via a central line due to high dextrose concentration

Do not administer TPN through a peripheral line or through the same lumen as other fluids or meds.

PPN- Specific Considerations

Administered through a peripheral vein, so solutions bust be less concentrated to prevent vein irritation.

Generally less risk of central line infections, but monitor for peripheral line issues like phlebitis.

Do not administer through the same lumen as other fluids or meds

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Constipation (C)

Patho:

A common sign of constipation is having fewer than three bowel movements per week, frequently accompanied by the presence of hard stools.

(Honan, 2024, pp. 777–780)

S/S:

The clinical manifestations of constipation are characterized by a frequency of bowel movements less than three per week.

Along with these, individuals might experience abdominal swelling, discomfort, reduced appetite, headaches, tiredness, and digestive issues. Patients might feel as though they haven't fully emptied their bowels, leading to straining during defecation, and they may produce small, lumpy, hard, dry stools.

(Honan, 2024, pp. 777–780)

Diagnostic Tests:

Abdominal Assessment (Mayo Clinic, 2025)

Rectal Exam / Assessment (Mayo Clinic, 2025)

Stool Analysis (color, shape, size, consistency, Length of time, and Frequency) (Rekstis, 2021)

Endoscopy

A slim tube fitted with a camera is inserted into the colon for inspection. This approach can clarify the state of the colon and detect any unusual tissue. Before undergoing this procedure, patients might need to follow a limited diet, use an enema, or take solutions meant to cleanse the colon. (Mayo Clinic, 2025)

There are two types of endoscopy tests (Mayo Clinic, 2025)

Sigmoidoscopy: Exam of the Sigmoid / Descending colon and rectum.

Colonoscopy: Exam of the entire colon as well as the rectum.

Xray

Presents the possibility to see where the stool is present and if it is impacted or causing blockage. (Mayo Clinic, 2025)

CT Scan

Diagnostic assessments may be warranted to identify underlying conditions contributing to constipation. (Mayo Clinic, 2025)

MRI

Diagnostic assessments may be warranted to identify underlying conditions contributing to constipation. (Mayo Clinic, 2025)

Colorectal transit study

Radiopaque Marker Study

This X-ray examination demonstrates the extent to which small pellets, derived from a pharmaceutical tablet, have traversed the colon over a specified duration. (Mayo Clinic, 2025)

Scintigraphy

This examination focuses on the consumption of a meal that includes minimal levels of radioactive materials, which are monitored with sophisticated technological methods as they travel through the colon. (Mayo Clinic, 2025)

Anorectal manometry

A slender, flexible catheter is inserted into the anal canal and rectum. After the inflation of a small balloon-like device, it is withdrawn from the anal canal. The process evaluates how well the muscles involved in defecation work together. (Mayo Clinic, 2025)

Balloon expulsion test

This assessment measures the duration required to expel a small, water-filled balloon from the rectal cavity. This provides an assessment of muscular function and control. (Mayo Clinic, 2025)

Defecography

This assessment is intended to replicate the physiological process of defecation. A viscous material capable of being monitored through imaging technology is introduced into the rectal cavity. X-ray and magnetic resonance imaging (MRI) techniques offer important information regarding the functional performance of the rectum and anus as substances like fecal matter pass through them. (Mayo Clinic, 2025)

Interventions:

Educate on medications

Administer antidiarrheals

Assess and treat electrolyte imbalances.

Consider rehydration

Promote relacation

Promote skin integrity

Lifestyle changes

Post-surgery education

Diarrhea is common following GI surgeries

For days to weeks

Diet Changes

Encourage a Clear/full liquid diet

Bland Low Fiber Diet

(Wagner, 2025)

Medications:

Laxatives

Bulk-Forming

Psyllium hydrophilic mucilloid

Polysaccharides and cellulose derivatives interact with intestinal fluids, resulting in swelling and the subsequent stimulation of peristaltic movement.

Saline agent

Magnesium hydroxide

Non-absorbable magnesium ions influence the consistency of stool by inducing osmotic movement of water into the intestines, thereby stimulating peristalsis. The action is initiated within a two-hour timeframe.

Lubricant

Mineral oil

By providing lubrication to the intestinal mucosa, nonabsorbable hydrocarbons aid in the softening of feces, promoting smoother stool movement. Typically, the onset of action happens in about 6 to 8 hours.

Stimulant

Bisacodyl

Sensory nerve endings become stimulated, irritating the colonic epithelium, which ultimately enhances mucosal secretion levels. Action generally begins within a period of 6 to 8 hours.

Fecal softener

Dioctyl sodium sulfosuccinate

The agent functions by hydrating the stool through its surfactant action on the colonic epithelium, thereby enhancing the wetting efficiency of intestinal water. This procedure enables the integration of both water-based and lipid-based substances. It does not cause any laxative effects.

Osmotic agent

Polyethylene glycol and electrolytes (Colyte)

Assists in rapidly cleaning the colon while stimulating the onset of diarrhea.

(Honan, 2024, pp. 777–780)

Education:

Educating patients should include creating a bowel routine, offering dietary recommendations, and reducing their anxiety.

Create Bowel Schedule

Periodically scheduled BMs.

After obtaining the patient's medical history, the nurse sets clear educational goals.

The main goals for the patient involve either restoring or maintaining a consistent pattern of elimination by responding promptly to the body's natural urge to defecate.

Additionally, it is essential to ensure an adequate intake of fluids and foods high in fiber.

The patient should also engage in learning strategies aimed at preventing constipation, alleviating anxiety associated with bowel elimination patterns, and mitigating the risk of potential complications.

(Honan, 2024, pp. 777–780)

Complications:

The complications associated with constipation encompass a range of clinical conditions, including hypertension, fecal impaction, hemorrhoids—characterized by the dilation of anal veins—anal fissures, which refer to pathological folds in the tissue, and megacolon, defined as an abnormal enlargement of the colon.

Elevated arterial pressure may occur during the act of defecation.

Straining during defecation, which can induce the Valsalva maneuver—characterized by forcible exhalation with the glottis closed—significantly affects reductions in arterial blood pressure.

The flow of venous blood within the thoracic cavity is briefly impeded during intense physical exertion, caused by elevated intrathoracic pressure.

This pressure often results in the occlusion of the major veins located within the thoracic cavity.

The atria and ventricles receive less blood, causing the left ventricle to eject a smaller volume of blood.

Cardiac output is diminished, accompanied by a temporary reduction in arterial pressure.

Fecal impaction refers to a situation where a hardened mass of dry feces becomes impossible to eliminate from the body.

A digital examination may reveal the mass, which could press against the colonic mucosa and potentially cause ulceration.

The term megacolon describes a condition marked by the swelling and expansion of the colon, frequently resulting from an obstruction caused by a mass of feces.

The symptoms experienced by patients include constipation, incontinence of liquid stools, and a distended abdomen. There is a possibility that megacolon may cause a perforation in the bowel.

(Honan, 2024, pp. 777–780)