Download GASTROINTESTINAL NURSING Anatomy and Physiology of the

 GASTROINTESTINAL NURSING
 Anatomy and Physiology of the Digestive Tract
 Mouth
 Where teeth, tongue, and salivary glands begin food digestion
 Pharynx
 Muscular structure shared by the digestive and respiratory tracts
 It joins the mouth and nasal passages to the esophagus
 Esophagus
 Long muscular tube that passes through the diaphragm into the stomach
 Stomach
 Churns and mixes food with gastric secretions until a semiliquid mass called
chyme
 Anatomy and Physiology of the Digestive Tract
 Small intestine
 Chemical digestion and absorption of nutrients take place
 Approximately 20 feet long and consists of three sections: the duodenum, the
jejunum, and the ileum
 Liver and pancreatic secretions enter the digestive tract in the duodenum
 Anatomy and Physiology of the Digestive Tract
 Large intestine and anus
 The first section of the large intestine is the cecum
 Ascending colon goes up right side of the abdomen
 Transverse colon crosses abdomen just below waist
 Descending colon goes down left side of abdomen
 The last 6 to 8 inches of the large intestine is the rectum, which ends at the anus,
where wastes leave the body
 Age-Related Changes
 Teeth are mechanically worn down with age
 The jaw may be affected by osteoarthritis
 A significant loss of taste buds with age
 Xerostomia (dry mouth) is common
 Walls of esophagus and stomach thin with aging, and secretions lessen
 Production of hydrochloric acid and digestive enzymes decreases
 Gastric motor activity slows
 Movement of contents through the colon is slower
 Anal sphincter tone and strength decrease
 Nursing Assessment and
Health History
 ?? Common complaints of GI system
 Why is past medical history important??
 What family history might be relevant??
 What are some common questions you need to ask in your review of systems???
 Diagnostic Tests & Procedures

Gastrointestinal
 System
 Stool Specimens
 O&P
 OB
 Fecal Fat
 C&S
 RADIOGRAPHIC TESTS

Most common tests:
1) Barium swallow or UGI
2) Small Bowel series
3) Barium enema
Others: CTS,US abd. X-rays
 ENDOSCOPIC TESTS (for upper GI system)
 Esophagoscopy
 Gastroscopy
 Gastroduodenoscopy
 EGD
 ERCP
 ENDOSCOPIC TESTS ( for lower GI system)
 Colonoscopy
 Proctoscopy
 Sigmoidoscopy
 Laboratory Tests
 Gastric Analysis
 CBC
 PT (prothrombin time)
 INR
 PTT (partial thromboplastin time)
 Bilirubin
 Blood proteins
 Alkaline Phosphatase
 LDH
 GGT
 AST
 ALT
 Cholesterol & Triglycerides
 Amylase
 CEA
 Abnormal Assessment Findings
 Distention
 Firmness
 Tenderness
 Altered bowel sounds
 Therapeutic Measures & Related Nursing Interventions
 With GI Patients
 Gavage or Enteral Nutrition (Tube Feedings)
 Provide nutritional support through a tube
 Short or long term
 In conditions that prohibit oral nourishment
 Gastric Decompression
 Types of tubes ( pg. 780 )
 What is the purpose of gastric decompression?
 ??Nursing Interventions??
 Types of Tubes
 Nasogastric - (NG)
 Gastrostomy – (G-tube)
 Jejunal – (J-tube)
 Percutaneous – (PEG)
 Total Parenteral Nutrition – (TPN)
 Nutritionally complete
 Used when GI system not functioning
 Short or long term
 Critical Thinking Exercise
 A 71 y.o. woman who underwent a bowel resection for the removal of a tumor is
receiving TPN through a central venous catheter. The patient’s fingerstick blood glucose
is 250 mg/dl, and the patient’s temp is 102 F and the nurse notes puralent drainage at the
catheter insertion site.
 Pre-Op Nursing Interventions
 For GI surgery patients
 GI tract cleansing
 Assess vital signs
 Liquids for 24 hrs. or NPO
 IV
 Antibiotics
 NGT insertion
 Post-Op Nursing Interventions
 For GI surgery patients

Relieve pain

Detect complications

Prevent gastric distention

Replace lost fluids

Maintain urine elimination
 Digestive Disorders
 Medical Anorexia
 Loss of Appetite Caused by:
 Nausea, decreased sense of taste or smell, mouth disorders, and medications
 Emotional problems such as anxiety, depression, or disturbing thoughts
 Anorexia
 Medical diagnosis
 Physician assesses for malnutrition
 Weight may be monitored over several weeks
 Complete history and physical examination
 Serum hemoglobin, iron, total iron-binding capacity, transferrin, calcium, folate,
B12, zinc
 Thyroid function tests
 Anorexia
 Assessment
 Record chronic and recent illnesses, hospitalizations, medications, and allergies
 Female patient’s obstetric history
 Symptoms: pain, nausea, dyspnea, extreme fatigue
 The functional assessment reveals patterns of activity and rest, usual dietary
patterns, current stressors, and coping strategies—all can affect appetite
 Anorexia
 Interventions
 Assist with oral hygiene before and after meals
 Teach proper oral hygiene; refer for dental care
 Relieve nausea before presenting a meal tray
 Before serving meal tray, remove bedpans/emesis basins from sight, conceal
drains and drainage collection devices, deodorize room if necessary
 Socialization during mealtime
 Respect food likes and dislikes
 Position patient comfortably with easy access to food
 Obesity
 20% over ideal body wt.
 Morbid obesity= 2X normal body wt.
 Complications
 CV disease
 Diabetes
 Respiratory difficulties
 Musculoskeletal problems
 Emotional and social isolation
 Causes
 Caloric intake > expenditure
 Heredity
 Emotional stress/psychosocial factors
 Slowed metabolism
 Medical Management
 Weight reduction diet
 Exercise
 Medication
 Counseling
 Surgical Treatment
 RNYGBP
 VBG
 LBP
 Liposuction
 Dumping Syndrome
 Show what you know…
 List 3 Nursing Diagnosis & related Nursing Interventions for the:
 OBESE PATIENT
 Disorders of the Mouth
 Dental Caries
 Destructive process of tooth decay
 Causes:
 Bacteria
 Poor oral hygiene
 Prevention
 Frequent brushing and flossing
 Dentist visit 2X/yr
 Good nutrition
 Fluoride
 Treatment
 Removal of diseases portion of tooth and filling
 May need dentures
 If untreated, may lead to periodontal disease
 Stomatitis
 Inflammation of the oral mucosa
 Causes are???
 Treatment is ???
 What is Aphthous Stomatitis?
 Herpes Simplex
 HSV Type 1
 Vesicles around the mouth & lips
 Tx is comfort not curative
 Zovarax ointment (antiviral)
 Candidiasis
 Fungal infection (Thrush)
 Candida Albicans
 White patches in mouth
 Immunosuppression
 Abx therapy
 DISORDERS OF THE
 TEETH & GUMS
 Periodontal Disease
 Gingivitis(inflammation of gums and supporting tissues)
 Gums are red, swollen, painful and bleed easily
 Cause poor oral hygiene & nutrition
 SHOW WHAT YOU KNOW…
 Assessment…?
 Nursing Diagnosis….?
 Interventions….?
 Oral Cancer

2 types of malignant tumors

Squamous and Basal cell

Early s/s may be ignored

Tongue irritation, loose teeth, pain in ear or in tongue
 Risk Factors
 Tobacco use
 Alcohol use
 Poor nutrition
 Chronic irritation
 http://www.oralcancerfoundation.org/dental/slide_show.htm
 Treatment
Chemo
Radiation
Surgery
 Post Op Care
Radical Neck
 Impaired oral mucous membrane
 Ineffective breathing pattern
 Acute pain
 NGT, PEG, or TPN
 Disturbed Body Image
 Disorders of Esophagus
 Esophageal Cancer

Not common, poor prognosis

Middle or lower portion of esophagus

No known cause
 Predisposing Factors
 Cigarette smoking
 Excessive alcohol intake
 Poor oral hygiene
 Eating spicy foods
 Signs and Symptoms
 Progressive dysphagia
 Weight loss may be dramatic
 TX  Chemo or surgery
 Esophagectomy, Esophagogastrostomy, or Esophagogastrectomy

Nursing Care of the patient with Esophageal CA
 Assessment….?
 Nursing Diagnosis….?
 Interventions….?
 Nutrition
 Anxiety
 Risk for infection, injury
 Esophageal Diverticulum
 Esophageal out-pouching
 Zenker’s Diverticulum
 “Bad breath” due to accumulation of food in diverticulum
 Treatment
 Bland diet
 Antacids
 Anti-emetics
 Surgery
 Pre-Op Nursing Measures
 Semi-fowlers
 Small meals
 Loose clothing
 Disorders Affecting Digestion
 And Absorption
 Hiatal Hernia
 Protrusion of the lower esophagus and stomach upward through the diaphragm
 Two types: Sliding and Rolling
 Causes
 Weakness of muscles of diaphragm
 Exact cause is unknown
 Excessive intra-abdominal pressure
 Contributing Factors
 Obesity
 Pregnancy
 Abdominal tumors, ascites or repeated heavy lifting
 Signs and Symptoms
 Feeling of fullness
 Eructation
 Heartburn
 Dysphagia
 Regurgitation
 Medical Treatment
 Avoid increased intra-abdominal pressure
 HOB ^ 6-12 inchesprevents nighttime reflux
 Drug Therapy
 Diet

Surgical Treatment
 Nissen Fundoplication
 Angelchik Prosthesis
 Figure 38-14 &
38-15
 Nissen Fundoplication
 THINK !!
 Describe your Post-Op Nrsg Interventions for this patient?
 GERD
 Gastroesophageal Reflux Disease
 Backward flow of stomach contents into the espohagus
 Sometimes occurs with a sliding hiatal hernia
 WHAT IS “NERD” ???
 Signs & Symptoms
 Burning sensation that moves up and down, commonly after meals
 Intermittent dysphagia
 belching
 Diagnosis
 Based on symptoms
 Sx relief w/ PPI; return when DC’d
 Endoscopy
 Gastric analysis
 Med Treatment & Nrsg Care

Same as for hiatal hernia

Drug therapy may include: Zantac, Reglan, Prilosec & antacids

Fundoplication if required
 Patient Teaching
 Avoid ASA and NSAIDS
 Chew food well
 Avoid eating 2 hrs. before bedtime
 Gastritis
 Inflammation of the stomach mucosa/lining
 Several types; sam pathophysiology
 H-pylori prime culprit; NSAIDS, stress, ETOH
 Signs & Symptoms
 N/V
 Abdominal pain
 Anorexia
 Feeling of fullness
 Treatment
 Meds
 Replacement of fluids after N,V & diarrhea subsides
 Elimination of the cause
 Tx & nrsg. Interventions same as for Ulcer Disease
 THINK…..
 List 3 Nursing Diagnosis and related interventions when caring for the patient with
gastritis
 What teaching would you do with this patient???
 Peptic Ulcer
 Lesion on either the mucosa of stomach or duodenum
 80% are in duodenum
 May be acute or chronic
 Classified as gastric or duodenal
 See Table 38-4
 Causes
 Bacterium H. pylori
 ASA, NSAIDS
 Physical trauma (shock,burns)
 Foods or conditions that cause excessive gastric acid secretions
 Comparison of Peptic Ulcers
 GASTRIC
 Incidence
 Ulcer depth
 S/S
 Complications
 DUODENAL
 Incidence
 Ulcer depth
 S/S
 Complications
 Very Important Patient Teaching
 1) Limit milk products

2) No baking soda
 Complications of Peptic Ulcers

Hemorrhage

Perforation

Peritonitis

Obstruction
 Medical Treatment
 Drug therapy
 Diet therapy
 NGT  hemorrhage
 Saline Lavage
 Surgical treatment options Table 38-6 Fig. 38-16
 Complications after Gastrectomy
 Dumping syndrome pg. 813
 Sx occur within 20 min of eating
 Bloating, flatulence, cramps & diarrhea
 Diaphoresis, anxious, shaky
 Malabsorption--> Malnutrition
 THINK…
 What teaching would you provide to the patient experiencing Dumping Syndrome??
 Stomach Cancer
 “Silent neoplasm”
 Poor prognosis
 No early s/s
 Late s/s: vomiting, ascites, abd. Mass, enlarged liver
 Risk Factors
 H-pylori infection
 Pernicious anemia
 Chronic gastritis
 Family history
 Treatment
 Chemo
 Radiation
 Surgery
 Health Promotion Considerations
 What are some things we can do and or teach others to do which might reduce the risk of
developing several types of Cancer not just stomach Cancer???/
 AbSORPTION &
ELIMINATION
 Disorders Affecting
 Malabsorption
 Intestinal absorption of nutrients is reduced
 Two examples are:
1) Celiac sprue
2) Lactase deficiency
 Signs & Symptoms
 Steatorrhea
 Malnutrition & weight loss
 Abdominal pain, cramping
 Bloating
 diarrhea
 Treatment
 Sprue diet and drug therapy, avoid foods w/ gluten(wheat, barley, oats)
 Lactase  avoid milk products & take lactase enzyme ( Lactaid)
 Critical Thinking Question
A nurse enters the room of a 72-year-old patient who is receiving a continuous tube feeding
and finds the patient lying flat in bed. The nurse questions the nurse assistant and
discovers that the patient requested to be placed flat. What is significant about this
situation? Why? How should the nurse handle the situation?
 THAT’S IT…!!
 YOUR DONE
WITH GI UNIT 1
 ON TO UNIT 2…..