Dysfunctional Gastrointestinal Motility

Dysfunctional Gastrointestinal Motility 5 Nursing Care Plans

Dysfunctional Gastrointestinal Motility NCLEX Review Care Plans

5 Nursing Care Plans on Dysfunctional Gastrointestinal Motility

The gastrointestinal tract is the system responsible for converting food taken in through the mouth into the energy and nutrients that the human body needs. This process is called digestion and metabolism.

Upon entry of food by mouth, it is transported to the stomach and eventually the small and large intestines by wave-like contractions of the gastrointestinal muscles known as peristalsis.

Nursing Stat Facts

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Nursing Stat Facts

Peristalsis is responsible for motility – the movement of food through the gastrointestinal tract, from its entry via the mouth to its exit via the anus.

Like all body systems and organs, the gastrointestinal tract can also be affected by internal and external factors. Problems related to motility and digestion are common. F

actors that may affect the functionality of the gastrointestinal tract include age, anxiety levels, intolerances, nutrition and ingestion, mobility or immobility, malnutrition, medications, and recent or coming surgical procedures.

Dysfunctional gastrointestinal motility can be defined as the impairment of the digestive tract that results in ineffective gastric activity. Peristalsis may be increased, decreased, or may even be absent.

This leads to various occurrences that cause discomfort and pain to the patient. Likewise, depending on the cause and type of the dysfunction, the treatment applied and the complications that may occur also vary. 

Patients experiencing a decrease in or lack of gastrointestinal motility commonly present with abdominal pain, bloating, nausea, vomiting, and constipation. These result from absent, weak, or disorganized contractions that are caused by intestinal nerve or muscle problems.

Gastroesophageal reflux disease is a good example of a condition wherein motility is ineffective. This occurs when there is regurgitation or back-flow of gastric or duodenal contents into the esophagus. The most common signs and symptoms noted are heartburn, and indigestion.

Patients with this condition are instructed to maintain a low-fat diet and avoid caffeine, alcohol, nicotine, and dairy products. Medications such as antacids or histamine receptor blockers may be prescribed. If the condition does not improve, a surgical intervention called fundoplication may be done.

The complete lack of or ineffective peristalsis in the esophagus with the inability of the esophageal sphincter to relax in response to swallowing is termed achalasia. In this disorder, the esophagus gradually widens as food regularly accumulates in the esophagus.

Food is commonly regurgitated as it does not pass to the stomach, leading to chest pain, heartburn, nausea, and vomiting. Due to the regurgitation of food, a common complication is aspiration pneumonia. Patients with achalasia are advised to eat slowly and to drink fluids with meals. Medical management includes calcium channel blockers and nitrates as they assist in decreasing esophageal pressure and improving swallowing. Pneumatic dilation may be done. Surgically, esophagomyotomy is done to relieve the lower esophageal stricture. 

Ileus is the term for the absence of peristaltic activity in the lower gastrointestinal tract. Common causes of this disorder are recent abdominal surgeries and/or drugs that interfere with intestinal motility. Bloating, vomiting, abdominal cramping, watery stool, and constipation occur as food and fluid are prevented from passing through the intestines. Management of this disorder includes temporary cessation of diet and intravenous nutrient supplementation. Ileus is self-limiting and is usually resolved within 1 to 3 days.

Constipation is a condition wherein there is an abnormal decrease in frequency or irregularity of defecation. Stools may be hardened, painful to release, and may even remain in the rectum for prolonged periods of time. There are various etiologies of constipation, including but not limited to certain medications, rectal or anal disorders, obstruction, neuromuscular conditions, irritable bowel syndrome, immobility, and others.

Complications of constipation include impaction, hemorrhoids, and megacolon. Treatment of this condition depends on its cause. Symptomatically, treatment includes dietary modification, an increase in fluid intake, and the use of laxatives. 

Meanwhile, diarrhea is when there is an increased frequency of bowel movement, altered consistency of stool, and increased amount of stool. Diarrhea is often accompanied by urgency, anal discomfort, and incontinence.

Cramping may also be present. Common causes of diarrhea are irritable bowel syndrome, inflammatory bowel disease, and lactose intolerance. Other causes include medications, food poisoning, infection, and metabolic disorders. Unresolved diarrhea may result in fluid and electrolyte imbalances that may cause cardiac complications. Likewise, the continuous release of fluids may cause dehydration.

Nursing Care Plans on Dysfunctional Gastrointestinal Motility

Nursing Care Plan 1

Gastroesophageal Reflux Disease

Nursing Diagnosis: Dysfunctional Gastrointestinal Motility related to gastroesophageal reflux disease as evidenced by nausea and vomiting, abdominal cramping, and regurgitation.

Desired Outcome: The patient will practice appropriate behaviors to assist with resolution of condition.

InterventionRationale
Assess the extent of nausea, vomiting, and limited food and fluid intake.To provide baseline data and determine is fluid and nutrient supplementation is required.
Monitor for signs and symptoms of infection, such as fever and elevated heart rate.To note for possible aspiration pneumonia.
Note occurrence of nausea and vomiting, and its relationship to food intake. Educate the patient to avoid triggers.Certain food products exacerbate signs and symptoms of GERD.
Diet modification: small frequent feedings, bland meals, avoidance of caffeine, spicy, citrus, dairy products, and carbonated products.To minimize the occurrence of signs and symptoms of GERD and avoid exacerbation of the condition.
Administer fluids and electrolytes as ordered.To replace fluid and electrolyte loss.
Advise patient to eat slowly and chew food well.To prevent reflux.
Positioning: maintain an upright position at least 2 hours after meals.To help control reflux and cause less irritation to the esophagus.
Recommend patient to maintain a normal weight, or to lose weight if needed.Increased weight increases intraabdominal pressure and may lead to complications.
Administer medications as ordered.Antacids

Prokinetic agents
  To neutralize stomach acids and relieve pain.To help hasten gastric emptying time and reduce the occurrence of nausea and vomiting.
Prepare patient for possible diagnostic tests.To help diagnose the patient’s condition.

Nursing Care Plan 2

Gastroenteritis

Nursing Diagnosis: Dysfunctional Gastrointestinal Motility related to gastroenteritis as evidenced by frequency of stools, abdominal pain, and urgency.

Desired Outcome: The patient will pass formed stool no more than thrice per day.

InterventionRationale
Assess the patient for intake of contaminated food or water or undercooked or raw meals.Eating or drinking contaminated food or water predisposes the patient to intestinal infection.
Note pattern of defecation.The pattern will assist the healthcare team in providing speedy, appropriate treatment and management.
Submit stool sample as ordered.To determine causative organisms and provide appropriate medications.
Encourage to increase oral fluid intake if not contraindicated.To prevent the occurrence of dehydration.
Restrict intake of caffeine, milk, and dairy products.To prevent the worsening of diarrhea and abdominal pain.
Administer medications as ordered: antidiarrheals.To stop ongoing diarrhea.
To replace fluid and electrolyte loss.

Nursing Care Plan 3

Inflammatory Bowel Disease

Nursing Diagnosis: Dysfunctional Gastrointestinal Motility related to inflammatory bowel disease as evidenced by frequency of stools, and abdominal pain.

Desired Outcome: The patient will pass formed stool no more than thrice per day.

InterventionRationale
Assess complaints of pain, pain response, pain characteristics.The type of pain presented may assist in narrowing down the type of IBD the patient has.
Note pattern of defecation.The pattern will assist the healthcare team in providing speedy, appropriate treatment and management.
Submit stool sample as ordered.To determine causative organisms and provide appropriate medications.
Encourage to increase oral fluid intake if not contraindicated.To prevent the occurrence of dehydration.
Dietary modifications: nothing by mouth, liquids as tolerated.Bowel rest may reduce pain and cramping.
Administer medications as ordered: antidiarrheals, pain medicationsTo stop ongoing diarrhea and minimize pain experience.
Administer fluids and electrolytes as ordered.To replace fluid and electrolyte loss.

Nursing Care Plan 4

Constipation

Nursing Diagnosis: Dysfunctional Gastrointestinal Motility related to limited fluid intake and sedentary lifestyle as evidenced by infrequent passage of stool, straining upon defecation, passage of dry, hard stool.

Desired Outcome: The patient will maintain passage of soft, formed stool at a regular frequency.

InterventionRationale
Assess dietary habits, intake, and activity level.Irregular mealtimes may cause constipation. Sedentary lifestyle and lack of activity contribute to constipation.
Identify current medications being taken by the patient.Certain drugs can slow down peristalsis and contribute to constipation, i.e. opioids, antacids, antidepressants, anesthetics, etc.
Encourage to increase oral fluid intake if not contraindicated.Fluids are needed to maintain the soft consistency of fecal mass.
Encourage to increase physical activity and exercise as tolerated.Peristalsis is increased by movement.
Administer fluids as ordered.Fluids are needed to maintain the soft consistency of fecal mass.
Administer stool softeners as ordered.Laxatives soften stool and allow for easier defecation.

Nursing Care Plan 5

Post-appendectomy

Nursing Diagnosis: Dysfunctional Gastrointestinal Motility related to recent surgical procedure as evidenced by difficulty passing stool, hypoactive bowel sounds.

Desired Outcome: The patient will pass stool within 48 hours post-appendectomy.

InterventionRationale
Auscultate abdomen.Decreased bowel sounds may indicate ileus.
Maintain GI rest as indicated.To reduce bloating and risk of nausea, vomiting.
Administer fluids as ordered.To replace losses and improve gastrointestinal function.
Encourage rest post-meals.To maximize blood flow to GIT.
Encourage ambulation as tolerated.To stimulate peristalsis.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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