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Study Guide Nursing Assessment 126 The Digestive System (126.4) This Study Guide contains: Brief Description, Objectives, Discussion Questions, Pre-view and Post-view Tests, Answer Keys and Glossary for this program. Institutions that have purchased the program from Educational Media Distributors have permission to duplicate any of the contents of this Study Guide for teaching purposes. The Digestive System Program Description The focus of this program is assessment related to the process of digestion and the function of the various structures forming the alimentary tract. It includes animated graphics of the digestive process and the function of both the anatomical structures and the digestive juices and enzymes. The focus of the subjective assessment addresses concerns related to both digestion and elimination, including the effects of aging on alimentary functions and symptoms of intolerance to specific foods such as gluten or lactose. The objective assessment includes demonstrations of observation, palpation and auscultation related to the digestive system. Digestive disorders discussed include GERD, hernia, appendicitis, and Crohn’s Disease. Learning Objectives After viewing the program, the learner will be able to do the following: 1. Describe the structures and function of the digestive organs. 2. Differentiate between digestion and absorption. 3. Discuss factors which are causing increases in gastrointestinal complaints. 4. Demonstrate abdominal auscultation. 5. Demonstrate abdominal palpation. 6. Outline the proper action if a pulsating abdominal mass is found. 7. List at least five gastrointestinal disorders. 8. Name the four tests currently used to detect colorectal polyps and cancer. Page 2 Educational Media Distributors 2013 The Digestive System Pre-Viewing Questions True or False 1. Pepsin and rennin are digestive enzymes. 2. Chyme is another name for stomach acid. 3. Most absorption of nutrition from food occurs in the small intestine. 4. Tarry stools indicate slow bleeding in the upper digestive tract. 5. It is adequate to ask a patient to state their current weight. 6. Ascites is an indicator of liver disease. 7. Scaphoid is another word for convex shape. 8. Stretch marks are called striae. 9. Bowel sounds are usually audible over the left lower quadrant at the ileocecal valve. 10. Rebound tenderness is commonly associated with appendicitis. 11. Irritable bowel syndrome is another name for Crohn’s disease. 12. The use of proton pump inhibitors can directly affect the absorption of other medications. Page 3 Educational Media Distributors 2013 The Digestive System Pre-Viewing Questions Answer Sheet Page 4 1. T F 2. T F 3. T F 4. T F 5. T F 6. T F 7. T F 8. T F 9. T F 10. T F 11. T F 12. T F Educational Media Distributors 2013 The Digestive System Pre-Viewing Questions Answer Key Page 5 1. F F 2. T F 3. T F 4. T F 5. T F 6. F F 7. T F 8. T F 9. T F 10. F F 11. T F 12. T F Educational Media Distributors 2013 The Digestive System Discussion Questions 1. How does digestion differ from absorption? 2. What things would indicate to you that your patient has an eating disorder and how would you approach the subject? 3. What action would you take if you encountered a pulsating mass during your assessment? Page 6 Educational Media Distributors 2013 The Digestive System Post-Viewing Questions For questions 1-5, choose the appropriate match from the column on the right. 1. 2. 3. 4. 5. Pepsin Chyme Rugae Villi Colon a. b. c. d. e. folds of the stomach lining large intestine digestive enzyme liquefied food finger-like projections 6. Older patients are more likely to complain of gastrointestinal disorders because: a. b. c. d. e. they are obsessed by worries over their digestion and elimination older people complain more in general the gastrointestinal system slows as part of aging blockages are very common in this age group None of the above For questions 7-11, choose the appropriate match from the column on the right. 7. 8. 9. 10. 11. Scaphoid Ascites Aortic aneurysm Striae Peristalsis a. b. c. d. e. pulsating mass stretch marks concave intestinal contractions fluid in abdomen 12. All of the following are true regarding abdominal auscultation except: a. b. c. d. e. use the bell of the stethoscope perform prior to palpation begin over the ileocecal valve listen until bowel sounds are heard or at least 5 minutes bruits may be heard 13. The abdomen is best palpated using a _______. a. b. c. d. e. Page 7 counter clockwise rotary pattern clockwise rotary pattern pattern of right to left straight rows pattern of top to bottom straight rows Any pattern as long as no areas of missed Educational Media Distributors 2013 The Digestive System Post-Viewing Questions continued 14. Document abdominal masses by: a. b. c. d. e. the quadrant in which they are located their consistency presence of tenderness All of the above None of the above For questions 15-19, choose the appropriate match from the column on the right. 15. 16. 17. 18. 19. Page 8 Appendicitis Hernia Crohn’s disease GERD Proton pump a. b. c. d. e. intestinal protrusion reflux disorder rebound tenderness inflammatory disorder stomach acid Educational Media Distributors 2013 The Digestive System Post-Viewing Questions Answer Sheet Page 9 1. a b c d e 2. a b c d e 3. a b c d e 4. a b c d e 5. a b c d e 6. a b c d e 7. a b c d e 8. a b c d e 9. a b c d e 10. a b c d e 11. a b c d e 12. a b c d e 13. a b c d e 14. a b c d e 15. a b c d e Educational Media Distributors 2013 The Digestive System Post-Viewing Questions Answer Key Page 10 1. a b c d e 2. a b c e e 3. a b c d e 4. a b c d e 5. a e c d e 6. a b e d e 7. a b e d e 8. a b c d e 9. e b c d e 10. a b c d e 11. a b c e e 12. a b c d e 13. a e c d e 14. a b c e e 15. a b c d e 16. e b c d e 17. a b c e e 18. a e c d e 19. a b c d e Educational Media Distributors 2013 The Digestive System Glossary of Terms Abdominal quadrants: Four areas of the abdomen defined by dividing the abdomen midline both horizontally and vertically, resulting in right and left upper and right and left lower quadrants. Anorexia: Loss of appetite. Appendix: An outgrowth within the body. The vermiform appendix is attached to the cecum of the intestine. Anus: The muscular opening at the lower end of the rectum. Ascites: Fluid accumulated in the abdominal cavity often associated the severe liver disease. Autoimmune: Inappropriate immune response that results in the body attacking itself. Bowel sounds: Sounds produced by bowel function. These are audible with a stethoscope and may also be audible without one. Bulimia: Eating disorder characterized by compulsive overeating followed by purging, either through induced vomiting or excessive use of laxatives, or both. Chyme: Liquefied food in the stomach. Chyme is formed in the early stages of digestion. Crohn’s disease: Regional severe inflammatory bowel disease. Exact cause is unknown, although it does run in families and may also be an autoimmune disorder. Currently no known cure, but symptom relief may be achieved with varying degrees of success. Digestion: The breakdown of ingested food; usable components are absorbed and the balance eliminated via the intestine. Digestive enzymes: Substances in the body capable of catalyzing the breakdown of food molecules into smaller molecules as part of the digestive process. Diverticuli: Abnormal blind pouches arising from the interior intestinal wall. They may become irritated, inflamed, or cancerous. Esophagus: The muscular tube connecting the throat to the stomach. Feces: Bodily waste excreted from the intestines via the anus. Gallbladder: Membranous muscular sac for storing bile secreted by the liver and used in digestion of fats. Page 11 Educational Media Distributors 2013 The Digestive System Glossary of Terms continued Gastrointestinal: Internal digestive pathway consisting of the esophagus, stomach, and small and large intestines. GERD: Gastric esophageal reflux disorder; the upward movement of stomach acids and contents into the esophagus. It is commonly called heart burn. Hemorrhoids: Varicose veins occurring at the anus and in the rectum. Hernia: The protrusion of an organ or part, such as the intestine through a weak place on the abdominal wall, or another organ through either connective tissue or a wall of the cavity in which it is normally enclosed. Ileocecal valve: The valve located at the opening of the ileum into the large intestine. Irritable bowel syndrome (IBS): A chronic disorder of the colon often characterized by diarrhea or constipation or diarrhea alternating with constipation, abdominal pain, bloating, and the presences of mucus in the stool. It is sometimes called irritable or spastic colon. Large intestine: Lower portion of the intestine consisting of the cecum, colon and rectum. It is primarily responsible for water reabsorption. Peristalsis: Repeated involuntary waves of muscular movement that serve to move ingested matter through the intestines during digestion. Proton pump inhibitor: A group of medications that reduce the secretion of stomach acids. Rebound tenderness: Pain felt on removal of pressure, as opposed to pain felt as pressure is applied. It is a common symptom of appendicitis. Rectum: The portion of the large intestine between the cecum and anus; the final segment of the intestine. Rectus muscles: The parallel bands of muscle over the central abdomen, commonly referred to as “the six pack.” Proper name: rectus abdominis. Ruga: Gastric or intestinal fold or wrinkle; the stomach is lined with rugae. Small intestine: That portion of the intestine lying between the stomach and the colon. It includes the duodenum, jejunum, and ileum and is primarily responsible for absorbing nutrients. Page 12 Educational Media Distributors 2013 The Digestive System Glossary of Terms continued Striae: Stripes in the skin coloration caused by stretching. Common during pregnancy and also seen in obesity. Ulcer: Injury to the tissues involving the loss of surface tissue and potential loss of underlying tissues. Pressure injuries are a common cause of surface ulcers. Umbilicus: The scar on the abdomen marking the attachment point of the umbilical cord on the fetus. Villi: Tiny finger or worm-like projections of tissue on the lining of the intestine that serve to increase the surface area of the intestinal lining thereby increasing the absorption of nutrients. Xiphoid process: Lower tip of the sternum. Page 13 Educational Media Distributors 2013