ACUTE PHASE NURSING: GASTROINTESTINAL AND GENITOURINARY PROBLEMS

GASTROINTESTINAL SYSTEM

  1. Problems include paralytic ileus, distended abdomen, stress ulcers, gastric hemorrhage, and constipation

  2. Causes include spinal shock/loss of peristalsis and loss of pain sensation

  3. Nursing Diagnoses include ineffective breathing pattern and risk for altered respiratory function due to distended abdomen; risk for injury, bowel incontinence, constipation, paralytic ileus, and GI bleeding

  4. Assessments include abdominal auscultation for bowel sounds, monitoring stools for occult blood and gastric pH, CBC, and decreased hemoglobin due to hemorrhage

  5. Nursing Interventions include inserting a nasogastric tube to intermittent suctioning for GI decompression; maintaining NPO status until bowel sounds return and nasogastric tube is removed; initiating a bowel program as soon as possible; administering antacids to maintain a pH >5.0, drugs to decrease gastric secretions, and stool softeners/laxatives to facilitate a bowel program

GENITOURINARY SYSTEM

  1. Problems include atonic bladder and UTI

  2. Causes include loss of bladder reflexes and control and bladder distention

  3. Nursing Diagnoses include reflex incontinence, altered pattern of urinary elimination, urinary retention, and risk of infection

  4. Assessments include bladder palpation for distention, intake & output record review, urine cultures and urinalysis for UTIs, and blood urea nitrogen and creatinine for kidney function

  5. Nursing Interventions include immediate insertion of indwelling catheter, aseptic technique to manage indwelling catheter, progression to intermittent catheterization every 8 -10 hours when the patient is stable, aggressive treatment of UTI, and intake & output record maintenance

The PoinTIS Spinal Cord Nursing site of the SCI Manual for Providers is based on information in Hickey JV. The Clinical Practice of Neurological and Neurosurgical Nursing, 4th ed., Philadelphia: Lippincott, 1997; Chin PA, et al. Rehabilitation Nursing Practice, N.Y.: McGraw-Hill, 1998; and Wirtz KM, Managing chronic spinal cord injury: issues in critical care, Critical Care Nurse 1996 16(4):24-35 Aug., except for information where other papers are cited.