Chapter 9: GI and Renal Nursing — From Bowel to Kidney Care

Gastrointestinal and renal disorders are interconnected through fluid balance, electrolyte regulation, and waste elimination. Nurses must recognize life-threatening complications — GI hemorrhage, hepatic encephalopathy, hyperkalemia — and intervene rapidly.

Gastrointestinal Nursing

GI Bleeding

Upper GI bleeding (esophagus to ligament of Treitz): presents as hematemesis (bright red or coffee-ground emesis) and melena (black, tarry stools). Causes: peptic ulcers, esophageal varices, Mallory-Weiss tear.

Lower GI bleeding (below ligament of Treitz): hematochezia (bright red blood per rectum). Causes: diverticulosis, colorectal cancer, hemorrhoids, IBD.

Nursing priorities: IV access (large-bore × 2), fluid resuscitation, type and crossmatch, monitor vital signs q15–30 min, NGT insertion and lavage as ordered, prepare for endoscopy/colonoscopy.

Bowel Obstruction

Signs: abdominal pain, distension, N/V, obstipation (no stool or gas). Bowel sounds: high-pitched “tinkling” sounds early; absent sounds late (ileus).

Nursing: NPO, NGT to suction (decompress), IV fluids, monitor for ischemia/perforation (fever, peritoneal signs, sudden severe pain).

Liver Cirrhosis and Complications

Complication	Mechanism	Nursing Management
Ascites	Portal hypertension, low albumin	Sodium restriction, daily weight, paracentesis
Hepatic Encephalopathy	Ammonia accumulation	Lactulose (target 2–3 soft stools/day), low-protein diet (avoid excessive restriction), safety precautions
Esophageal Varices	Portal hypertension dilates veins	Bleeding precautions; octreotide, vasopressin; banding/sclerotherapy
Coagulopathy	Liver cannot produce clotting factors	Monitor PT/INR; avoid invasive procedures; fall precautions

Renal Nursing

Chronic Kidney Disease (CKD)

CKD stages based on GFR:

Stage	GFR (mL/min/1.73m²)	Description
1	≥90	Normal/high; kidney damage markers
2	60–89	Mildly decreased
3a/3b	30–59	Moderately decreased
4	15–29	Severely decreased
5	< 15	Kidney failure (ESRD)

Key electrolyte concerns: hyperkalemia (life-threatening arrhythmias; avoid potassium-rich foods, K-sparing diuretics, NSAIDs), hyperphosphatemia (use phosphate binders with meals), metabolic acidosis (bicarbonate supplementation).

Dialysis: Hemodialysis vs. Peritoneal Dialysis

Feature	Hemodialysis (HD)	Peritoneal Dialysis (PD)
Frequency	3× per week, 3–4 hours	Daily (CAPD) or nightly (APD)
Access	AV fistula, graft, or central catheter	Peritoneal catheter (Tenckhoff)
Fluid removal	Ultrafiltration	Osmotic gradient via dialysate
Key nursing concern	Hypotension during/after, clotting of access	Peritonitis (cloudy effluent, abdominal pain, fever)
Patient advantage	Supervised; efficient	Home-based; more independence

AV fistula care: Never take BP or draw blood from the fistula arm; assess for bruit and thrill (absence = occlusion).

Fluid and Electrolyte Balance

Electrolyte	Normal	Hypo- signs	Hyper- signs
Sodium (Na⁺)	135–145 mEq/L	Confusion, seizures, hyponatremia	Thirst, confusion, seizures
Potassium (K⁺)	3.5–5.0 mEq/L	Muscle weakness, U wave on ECG	Peaked T waves, fatal arrhythmia
Calcium (Ca²⁺)	8.5–10.5 mg/dL	Trousseau’s/Chvostek’s sign, tetany	Bone pain, “stones, bones, moans, groans”

Key Checklist

• Differentiate upper vs. lower GI bleeding by clinical presentation and list the priority nursing interventions
• Explain the mechanism of hepatic encephalopathy and describe the nursing management including lactulose therapy
• Compare hemodialysis and peritoneal dialysis for a patient with ESRD, including access care and key complications