Dysfunctional Gastrointestinal Motility Nursing Diagnosis & Care Plan

Dysfunctional gastrointestinal motility is a nursing diagnosis that refers to the impaired movement of food and fluids through the digestive tract. This condition can significantly impact a patient’s nutritional status, comfort, and well-being. As a nurse, understanding this diagnosis is crucial for providing effective care and improving patient outcomes.

Causes (Related to)

Dysfunctional gastrointestinal motility can result from various factors affecting the nervous system, muscles, or hormones involved in digestive processes. Common causes include:

• Neurological disorders (Parkinson’s disease, multiple sclerosis)
• Muscular disorders (scleroderma, amyloidosis)
• Endocrine disorders (diabetes mellitus, hypothyroidism)
• Medications (opioids, anticholinergics)
• Gastrointestinal surgeries
• Stress and anxiety
• Pregnancy
• Aging
• Electrolyte imbalances
• Infections (gastroenteritis)

Signs and Symptoms (As evidenced by)

Patients with dysfunctional gastrointestinal motility may present with various signs and symptoms, including:

Subjective: (Patient reports)

• Nausea
• Abdominal pain or discomfort
• Bloating
• Early satiety
• Loss of appetite
• Regurgitation
• Heartburn

Objective: (Nurse assesses)

• Vomiting
• Changes in bowel habits (constipation or diarrhea)
• Abdominal distension
• Decreased or absent bowel sounds
• Weight loss
• Dehydration
• Malnutrition
• Electrolyte imbalances
• Abnormal diagnostic test results (e.g., gastric emptying studies, manometry)

Expected Outcomes

The following are common nursing care planning goals and expected outcomes for dysfunctional gastrointestinal motility:

• The patient will report reduced abdominal discomfort and bloating.
• The patient will demonstrate normal bowel patterns (at least three bowel movements per week).
• The patient will maintain adequate hydration and nutrition status.
• The patient will show improved tolerance to oral intake.
• The patient will exhibit normal bowel sounds (5-35 per minute).
• The patient will demonstrate weight maintenance or gain as appropriate.
• The patient will report improved quality of life and ability to perform daily activities.

Nursing Assessment

A comprehensive nursing assessment is crucial for identifying and managing dysfunctional gastrointestinal motility. The following steps should be included:

1. Obtain a detailed health history.
   Focus on gastrointestinal symptoms, onset, duration, and any exacerbating or alleviating factors. Inquire about dietary habits, medication use, and past medical history.
2. Perform a physical examination.
   Assess the abdomen for distension, tenderness, and masses. Auscultate bowel sounds in all four quadrants.
3. Monitor vital signs.
   Pay attention to signs of dehydration or electrolyte imbalances, such as tachycardia or hypotension.
4. Assess nutritional status.
   Evaluate recent weight changes, appetite, and ability to tolerate various foods.
5. Review medication history.
   Identify any medications that may contribute to gastrointestinal motility issues.
6. Assess psychological status.
   Evaluate for signs of anxiety or depression, which can impact gastrointestinal function.
7. Review diagnostic test results.
   Analyze results from tests such as gastric emptying studies, manometry, or imaging studies.
8. Assess hydration status.
   Check for signs of dehydration, such as dry mucous membranes, decreased skin turgor, or concentrated urine.
9. Evaluate bowel patterns.
   Document frequency, consistency, and any associated symptoms of bowel movements.
10. Assess for complications.
    Look for signs of aspiration, malnutrition, or electrolyte imbalances.

Nursing Interventions

Effective nursing interventions are essential for managing dysfunctional gastrointestinal motility and promoting patient comfort and health. Consider the following interventions:

1. Implement dietary modifications.
   Encourage small, frequent meals and foods that are easily digestible. Avoid foods known to exacerbate symptoms.
2. Promote adequate hydration.
   Encourage fluid intake unless contraindicated. Monitor fluid balance and provide IV fluids if necessary.
3. Administer medications as ordered.
   This may include prokinetics, antiemetics, or pain management medications. Ensure proper timing and administration.
4. Assist with positioning.
   Encourage upright positioning during and after meals to promote digestion and reduce reflux.
5. Implement bowel management strategies.
   This may include scheduled toileting, abdominal massage, or using stool softeners as appropriate.
6. Provide education.
   Teach patients about their condition, dietary recommendations, and medication management.
7. Monitor for complications.
   Regularly assess for signs of aspiration, dehydration, or malnutrition.
8. Collaborate with the healthcare team.
   Work closely with dietitians, gastroenterologists, and other specialists to provide comprehensive care.
9. Implement stress reduction techniques.
   Teach relaxation methods such as deep breathing or guided imagery to reduce anxiety-related gastrointestinal symptoms.
10. Assist with mobility.
    Encourage regular physical activity as tolerated to promote gastrointestinal motility.
11. Provide oral care.
    Implement regular oral hygiene to prevent complications from frequent vomiting or reflux.
12. Monitor nutritional intake.
    Keep accurate records of oral intake and consider alternative feeding methods if necessary.

Nursing Care Plans

Nursing Care Plan 1: Diabetes Mellitus

Nursing Diagnosis Statement:
Dysfunctional Gastrointestinal Motility related to diabetes mellitus as evidenced by early satiety, bloating, and delayed gastric emptying.

Related factors/causes:
Autonomic neuropathy is secondary to long-standing diabetes mellitus.

Nursing Interventions and Rationales:

1. Assess gastric residual volumes before meals.
   Rationale: Helps determine the extent of delayed gastric emptying and guides feeding decisions.
2. Administer prescribed prokinetic medications 30 minutes before meals.
   Rationale: Improves gastric motility and enhances nutrient absorption.
3. Educate the patient on consuming small, frequent meals with low-fat content.
   Rationale: Smaller meals are easier to digest, and low-fat content can reduce symptoms of delayed gastric emptying.
4. Monitor blood glucose levels regularly.
   Rationale: Hyperglycemia can further impair gastric motility.

Desired Outcomes:

• The patient will report reduced bloating and early satiety within 1 week.
• The patient will demonstrate improved gastric emptying as evidenced by decreased gastric residual volumes within 2 weeks.
• The patient will maintain stable blood glucose levels within the target range.

Nursing Care Plan 2:

Nursing Diagnosis Statement:
Dysfunctional Gastrointestinal Motility related to opioid medication use as evidenced by constipation and abdominal discomfort.

Related factors/causes:
Opioid-induced bowel dysfunction.

Nursing Interventions and Rationales:

1. Implement a bowel regimen, including stool softeners and stimulant laxatives as prescribed.
   Rationale: Counteracts the constipating effects of opioids.
2. Encourage increased fluid intake to at least 2 liters per day unless contraindicated.
   Rationale: Adequate hydration helps prevent constipation.
3. Assist the patient in maintaining a daily log of bowel movements.
   Rationale: Helps track the effectiveness of interventions and identifies patterns.
4. Educate the patient on the importance of physical activity as tolerated.
   Rationale: Regular movement can stimulate bowel motility.

Desired Outcomes:

• The patient will have a bowel movement at least every 3 days without straining.
• The patient will report decreased abdominal discomfort within 3 days.
• The patient will demonstrate an understanding of bowel management strategies.

Nursing Care Plan 3: Abdominal Surgery

Nursing Diagnosis Statement:
Dysfunctional Gastrointestinal Motility related to recent abdominal surgery as evidenced by postoperative ileus and absent bowel sounds.

Related factors/causes:
Manipulation of intestines during surgery and effects of anesthesia.

Nursing Interventions and Rationales:

1. Auscultate bowel sounds every 4 hours.
   Rationale: Helps monitor the return of gastrointestinal function.
2. Encourage early ambulation as tolerated.
   Rationale: Movement can stimulate the return of peristalsis.
3. Administer prescribed prokinetic medications.
   Rationale: Helps stimulate gastrointestinal motility.
4. Monitor for signs of abdominal distension or vomiting.
   Rationale: Early detection of complications allows for prompt intervention.

Desired Outcomes:

• The patient will demonstrate the return of bowel sounds within 24-48 hours post-surgery.
• The patient will pass flatus within 3 days post-surgery.
• The patient will have a bowel movement within 5 days post-surgery.

Nursing Care Plan 4: Scleroderma

Nursing Diagnosis Statement:
Dysfunctional Gastrointestinal Motility related to scleroderma as evidenced by dysphagia, reflux, and slow transit constipation.

Related factors/causes:
Fibrosis of smooth muscle in the gastrointestinal tract due to scleroderma.

Nursing Interventions and Rationales:

1. Assist the patient in maintaining an upright position for 30 minutes after meals.
   Rationale: Reduces the risk of aspiration and reflux.
2. Teach the patient swallowing techniques such as the chin tuck.
   Rationale: Improves swallowing safety and reduces the risk of aspiration.
3. Administer prescribed proton pump inhibitors.
   Rationale: Reduces gastric acid production and helps manage reflux symptoms.
4. Implement a high-fiber diet with adequate fluid intake.
   Rationale: Helps manage constipation associated with slow transit time.

Desired Outcomes:

• The patient will report a decreased frequency of reflux episodes within 1 week.
• The patient will demonstrate proper swallowing techniques during meals.
• The patient will have a bowel movement at least every 3 days without straining.

Nursing Care Plan 5: Parkinson’s Disease

Nursing Diagnosis Statement:
Dysfunctional Gastrointestinal Motility related to Parkinson’s disease as evidenced by dysphagia, delayed gastric emptying, and constipation.

Related factors/causes:
Neurological impairment affecting the enteric nervous system.

Nursing Interventions and Rationales:

1. Assess swallowing function before each meal.
   Rationale: Helps identify aspiration risk and guides feeding decisions.
2. Administer levodopa medications 30-60 minutes before or after meals.
   Rationale: Improves medication absorption and efficacy.
3. Implement a scheduled toileting program.
   Rationale: Helps manage constipation and establishes a regular bowel routine.
4. Provide foods with pureed or soft consistency as recommended by a speech therapist.
   Rationale: Reduces the risk of aspiration and improves swallowing safety.

Desired Outcomes:

• The patient will demonstrate improved swallowing function within 2 weeks.
• The patient will report reduced constipation and at least three bowel movements per week.
• The patient will maintain adequate nutrition and hydration status.

References

1. Camilleri, M., & Bharucha, A. E. (2010). Gastrointestinal dysfunction in neurologic disease. Seminars in Neurology, 30(1), 70-83.
2. Carrington, E. V., et al. (2019). Advances in the evaluation of anorectal function. Nature Reviews Gastroenterology & Hepatology, 16(5), 309-323.
3. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales (15th ed.). F.A. Davis Company.
4. Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, and outcomes (9th ed.). Elsevier.
5. Herdman, T. H., & Kamitsuru, S. (Eds.). (2018). NANDA International nursing diagnoses: Definitions and classification 2018-2020 (11th ed.). Thieme.
6. Kumar, A., et al. (2020). Gastrointestinal dysmotility in critically ill patients: Pathophysiology, assessment, and therapeutic options. JGH Open, 4(3), 421-430.
7. Malagelada, C., et al. (2015). New technologies to evaluate esophageal function. Journal of Neurogastroenterology and Motility, 21(3), 316-325.
8. Rao, S. S. C., & Rattanakovit, K. (2021). Diagnosis and management of chronic constipation in adults. Nature Reviews Gastroenterology & Hepatology, 18(2), 95-108.
9. Sanders, K. M., Ward, S. M., & Koh, S. D. (2014). Interstitial cells: Regulators of smooth muscle function. Physiological Reviews, 94(3), 859-907.
10. Tack, J., & Pandolfino, J. E. (2018). Pathophysiology of gastroesophageal reflux disease. Gastroenterology, 154(2), 277-288.