Gastrointestinal Disorders: Assessment, Ostomy Care, and Wound Management

Gastrointestinal Disorders: Assessment, Ostomy Care, and Wound Management

Gastrointestinal (GI) disorders are among the most common reasons patients seek hospital care. As an LPN, you will assess the abdomen, care for patients with ostomies, and manage wounds — often in the same shift. Mastering these skills protects patient safety and supports recovery.

Abdominal Assessment: The Correct Sequence

Abdominal assessment always follows a specific order: inspection, auscultation, percussion, palpation. This sequence differs from other body systems because palpation and percussion can alter bowel sounds. Changing the order produces inaccurate findings.

Inspection — Observe the abdomen for shape, symmetry, distension, visible peristalsis, skin color, scars, and stomas. Ask the patient to take a breath; a distended abdomen may indicate gas, fluid (ascites), or an obstructive process.

Auscultation — Use the diaphragm of the stethoscope. Listen in all four quadrants for at least 1 minute per quadrant before concluding sounds are absent. Normal bowel sounds are gurgling, irregular, and occur roughly 5–30 times per minute. Absent bowel sounds suggest ileus or obstruction and must be reported. Hyperactive, high-pitched sounds (borborygmi) can indicate early obstruction or gastroenteritis.

Percussion — Lightly percuss all four quadrants. Tympany (a hollow, drum-like tone) is normal over gas-filled bowel. Dullness indicates solid organ, fluid, or stool. Shifting dullness when the patient rolls suggests ascites.

Palpation — Begin with light palpation, then deep. Note tenderness, guarding, or masses. Rigidity (board-like abdomen) and rebound tenderness (pain that worsens when pressure is suddenly released) are signs of peritoneal irritation — a medical emergency. Never apply deep palpation over an area of known aneurysm or a tender mass without provider guidance.

Document all findings using clear, objective language and report abnormalities immediately.

Ostomy Care

An ostomy is a surgically created opening (stoma) that diverts fecal or urinary output. A colostomy brings a portion of the colon to the abdominal wall. A healthy stoma is moist, beefy-red or pink, and slightly raised. A pale, dark, or dusky stoma signals impaired circulation — report immediately.

Pouch Change Procedure

1. Perform hand hygiene and apply clean gloves.

2. Empty the pouch before removal to reduce spillage.

3. Gently remove the old pouching system, pushing skin away from the barrier (not pulling the barrier away from skin).

4. Cleanse peristomal skin with warm water; pat dry. Avoid soap with oils or lotions, which impair adhesion. Inspect skin for redness, breakdown, or fungal rash.

5. Measure the stoma with a stoma guide. The skin barrier opening should be cut to fit within approximately 1/8 inch (3 mm) of the stoma edge — too large exposes skin to effluent; too small can constrict the stoma.

6. Apply the new skin barrier and pouching system, pressing firmly from the stoma outward to eliminate air pockets.

7. Document stoma color, size, output color, consistency, and amount, and peristomal skin condition.

Patient teaching is a core LPN role. Instruct patients that output from a sigmoid colostomy is usually formed, while output from an ascending colostomy is liquid. Empty the pouch when it is one-third to one-half full to prevent leakage and weight strain on the seal.

Wound Assessment Using the TIME Framework

The TIME framework guides systematic wound assessment:

• T – Tissue: Identify wound bed tissue. Healthy granulation tissue is moist and red. Slough (yellow, soft) and eschar (black, hard) indicate non-viable tissue that delays healing.
• I – Infection/Inflammation: Look for erythema, warmth, edema, purulent drainage, odor, and increased pain. These suggest infection; a culture may be ordered.
• M – Moisture: Wounds need adequate but not excessive moisture. Maceration of surrounding skin appears white and waterlogged; a drier dressing may be needed. Dry wound beds need moisture-retentive dressings.
• E – Edge: Wound edges should be migrating inward. Rolled, callused, or undermined edges indicate healing problems.

Sterile vs. Clean Technique

Sterile technique (surgical asepsis) is required for acute wounds, post-operative incisions, and wounds at high infection risk. Sterile gloves, a sterile field, and sterile supplies are used. Never reach over a sterile field or allow unsterile items to touch it — this breaks the sterile field.

Clean technique uses non-sterile gloves and clean (but not sterile) supplies. It is appropriate for chronic wounds such as pressure injuries or venous ulcers in community settings, per agency policy and provider orders.

Basic Sterile Dressing Change Steps

1. Perform hand hygiene; don clean gloves to remove old dressing.

2. Discard old dressing and soiled gloves; perform hand hygiene again.

3. Open sterile supplies using sterile technique; don sterile gloves.

4. Cleanse wound as ordered (commonly normal saline) using a single stroke per gauze, moving from clean to dirty.

5. Assess wound using TIME framework and measure length × width × depth.

6. Apply sterile dressing; secure without restricting circulation.

7. Remove gloves, perform hand hygiene, and document findings.

Safety Priorities

• Always perform hand hygiene before and after any patient contact and between tasks.
• Report a dusky or black stoma immediately — it may indicate ischemia.
• Never ignore rebound tenderness or rigidity — these require urgent provider notification.
• Maintain the sterile field at all times during sterile dressing changes; if a break occurs, start over.
• Check the patient's identity and the wound/ostomy location before beginning any procedure.