GI Nursing for NCLEX: Liver Disease, IBD, Bowel Obstruction & GI Bleeding

Gastrointestinal Nursing for NCLEX Review

Gastrointestinal conditions are commonly tested on the NCLEX, requiring knowledge of assessment, management, and nursing interventions for a range of GI disorders from liver disease to bowel obstructions.

Liver Cirrhosis

Cirrhosis is irreversible scarring of the liver that impairs hepatic function. Causes include chronic alcohol use, hepatitis B and C, and nonalcoholic fatty liver disease. Complications include portal hypertension leading to esophageal varices, ascites, hepatic encephalopathy, and coagulopathy. For ascites, nursing interventions include sodium and fluid restriction, daily weights, measuring abdominal girth, administering diuretics (spironolactone), and assisting with paracentesis. For hepatic encephalopathy, administer lactulose (goal of 2-3 soft stools per day to eliminate ammonia) and rifaximin. Restrict protein only in acute encephalopathy. Monitor ammonia levels and neurological status.

Inflammatory Bowel Disease

Crohn disease can affect any part of the GI tract (mouth to anus) with skip lesions and transmural inflammation. Complications include fistulas, strictures, and malabsorption. Ulcerative colitis affects only the colon and rectum with continuous inflammation limited to the mucosa. Complications include toxic megacolon and increased colorectal cancer risk. Both present with diarrhea, abdominal pain, and weight loss. Treatment includes anti-inflammatory medications (5-ASA compounds), immunomodulators, biologics, and corticosteroids for flares. Monitor for medication side effects and nutritional deficiencies.

Bowel Obstruction

Small bowel obstruction presents with colicky abdominal pain, vomiting (may be bilious or feculent), abdominal distension, and hyperactive then absent bowel sounds. Large bowel obstruction presents with more gradual onset, constipation, and significant abdominal distension. Nursing management includes NPO status, nasogastric tube insertion for decompression, IV fluid replacement, monitoring for signs of strangulation (fever, tachycardia, severe pain), and preparation for possible surgery.

GI Bleeding

Upper GI bleeding (above the ligament of Treitz) presents with hematemesis and melena. Lower GI bleeding presents with hematochezia (bright red blood). Nursing priorities include hemodynamic assessment, two large-bore IVs, type and crossmatch, fluid resuscitation, and gastric lavage for upper GI bleeds. Practice with our clinical nursing mini-exams and review GI nursing cheat sheets.