Download GASTROINTESTINAL SYSTEM

GASTROINTESTINAL
SYSTEM
-BASIC CONCEPTS OF
NUTRITION
-NUTRITIONAL NEEDS
-INTESTINAL ELIMINATION
OBJECTIVES
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Syllabus page 39-41
PRETEST
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1. Name 1 fat-soluble vitamin
2. Name 1 water-soluble vitamin
3. How often should a nasogastric tube
be changed on a client?
4. Identify 1 type of enema
5. Define effluence
ANSWERS
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1. K, A, D, E
2. C, vitamin B-complex: folic acid,
niacin, thiamine, riboflavin, pyridoxine,
cobalamin
3. PRN and per agency policy
4. Hypertonic, hypotonic, isotonic,
soap, oil
5. Product or drainage from an ostomy
WHAT IS NUTRITION?

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Nutrition is the sum of all the
interactions between an organism and
the food it consumes
It is what a person eats & how the body
uses it
WHAT ARE NUTRIENTS?

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Nutrients are the organic & inorganic
substances found in foods & required
for body functioning
Essential nutrients in food are needed
for growth & maintenance of all body
tissues & the normal functioning of all
body processes
WHAT ARE THE ESSENTIAL
NUTRIENTS? (6)
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1.
2.
3.
4.
5.
6.
Water
Carbohydrates (CHO)
Proteins
Fats
Vitamins
Minerals
WHAT ARE THE FUNCTIONS
OF NUTRIENTS? (3)
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1. Providing energy for body process &
movement
2. Providing structural material for body
tissues
3. Regulating body processes
WHAT DOES NUTRITIVE
VALUE MEAN?

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It is the nutrient content of a specified
amount of food
No one food provides all essential
nutrients
WHAT DOES CALORIC
VALUE MEAN?

It is the amount of energy that nutrients
or foods supply to the body
WHAT IS A CALORIE?

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A calorie is the amount of heat required
to raise the temperature of 1 gram of
water 1 degree C
1 gm of CHO =4 kcal (after
metabolization)
1 gm of protein = 4 kcal (after
metabolization)
1 gm of fat= 9 kcal after
(metabolization)
WHAT DOES NUTRIENT
DENSITY MEAN?
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It refers to foods that deliver the most
nutrient for the lowest kilocalorie
Nutrient-dense food provides a high
quantity of 1 or more essential nutrients
with a small quantity of kilocalories
eg: 1 baked potato + butter= 260 KCAL
3oz sirloin = 240 KCAL
WHAT IS METABOLISM?


Metabolism refers to all biochemical &
physiologic processes by which the
body grows and maintains itself
It is normally expressed in terms of the
rate of heat liberated during these
chemical reactions
WHAT IS BASAL METABOLIC
RATE? (BMR)

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It is the rate at which the body
metabolizes food to maintain the energy
requirements of a person who is awake
and at rest
the energy in food maintains the basal
metabolic rate of the body & provides
energy for activities
WHAT FACTORS AFFECT
CALORIC NEEDS? (8)
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1.
2.
3.
4.
5.
6.
7.
8.
Age
Growth
Gender
Climate
Sleep
Activity
Fever
Illness
WHAT IS THE BODY’S MOST
BASIC NUTRIENT?

WATER
WHAT ARE
MACRONUTRIENTS?

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These are energy-providing nutrients
(3)= carbohydrates (CHO), fats, and
proteins
Hunger impels people to eat enough of
these to meet their energy needs
WHAT ARE
MICRONUTRIENTS?

These are vitamins and minerals which
are needed by the body
WHAT ARE
CARBOHYDRATES
COMPOSED OF?
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3 elements: Carbon (C), hydrogen (H),
and oxygen (O); abbreviated CHO
There are 2 basic kinds: Simple CHO
(sugars) and complex CHO (starches
and fiber)
WHAT IS A SUGAR?
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A sugar is the simplest of all CHO
It is water soluble
it is produced naturally by both plants &
animals
There are monosaccharides (single
molecules) and Disaccharides ( double
molecules)
WHAT ARE THE 3
MONOSACCHARIDES?
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1. Glucose; this one is the most
abundant
2. Fructose
3. Galactose
Examples of foods containing sugars
are sugar cane, fruits, lactose and
processed sugars such as cookies,
candy, ice cream
WHAT IS A STARCH?
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A starch is an insoluble, nonsweet
form of CHO
They are polysaccharides = composed
of branched chains of dozens or
hundreds of glucose molecules
Nearly all starches exist naturally in
plants, such as grains, legumes &
potatoes
They are processed as cereals, etc.
WHAT IS FIBER?
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It is a complex CHO derived from plants
Cannot be digested by humans;
supplies roughage
Bulk satisfies appetite & helps the
digestive tract to function effectively to
eliminate wastes
WHAT ARE OTHER
FUNCTIONS OF CHO?
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1. Supply vital nutrients: protein,
vitamins, minerals, & dietary fiber that
are not found in processed foods
2. Refined CHO foods are relatively
low in nutrients in relation to the large
number of calories they contain=
“empty calories”
WHAT IS A PROTEIN?
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It is an organic substance composed of
amino acids
Contain carbon, hydrogen , oxygen &
nitrogen
Every cell in the body contains some
protein
3/4 of body solids are proteins
WHAT ARE THE TYPES OF
AMINO ACIDS?
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1. Essential amino acids- cannot be
manufactured by body & must be
supplied through protein ingested in
diet; 9 essential amino acids necessary
for tissue growth & maintenance
2. Nonessential amino acids= body
can manufacture by taking apart amino
acids derived from diet & reconstructing
new ones
WHAT ARE THE TYPES OF
PROTEIN? (4)
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1. Complete proteins= contain all
essential amino acids + many
nonessential ones; eg.: most animal
proteins like meats, poultry, fish, dairy
products & eggs
2. Partially complete proteins=contain
less than the required amt. of 1 or more
essential amino acids; cannot alone
support growth e.g. milk protein casein
(CON’t)
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3. Incomplete proteins= lack 1 or
more essential amino acids; are usually
derived from vegetables; if an
appropriate mixture of plant proteins is
provided in diet, a balanced ration of
essential amino acids can be achieved
4. Complementary proteins=
combinations of 2 or more vegetables
WHAT IS THE FUNCTION OF
PROTEIN?

Protein is essential in building,
maintaining & repairing body tissue
WHAT DOES PROTEIN
METABOLISM CONSIST OF?
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1. Anabolism= building tissue
2. Catabolism= breaking down tissue
3. Balance
WHAT IS NITROGEN
BALANCE?
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Measure of the degree of protein
anabolism & catabolism
it is the net result of intake and loss of
nitrogen
Nitrogen intake should equal nitrogen
output= Nitrogen balance; this is the
normal state of healthy people
WHEN DOES POSITIVE
NITROGEN EXIST?
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1. During periods of growth= childhood
& adolescence, pregnancy, phases of
physical exercise
2. During periods of tissue
replacement= convalescence from
protein-depleting illness and after
fasting or inadequate intake of protein &
calories when body tissues are
regenerated
WHEN DOES -NITROGEN
BALANCE EXIST?
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1. Pt. does not consume adequate
essential amino acids &/or calories
2. Pt. is inmobilized
3. Pt. is exposed to unusual stress as a
result of trauma
WHAT IS A LIPID?
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Lipids are organic substances that are
greasy and insoluble in H2O but soluble
in ETOH or ether
Fats are lipids that are solid at room
temp.
Oils are lipids that are liquid at room
temp
WHAT IS AN UNSATURATED
FATTY ACID?
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It is a fatty acid that could accommodate
more H atoms than it currently does;
e.g.: vegetable oil
These products are usually liquid at
room temp.
WHAT ARE FUNCTIONS OF
FATS?
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1. Energy metabolism
2. Skin/hair (shine);provides structure
3. Provides insulation ( insulates body
from extreme temp)
4. Provides protection of vital organs
5. Transportation of fat soluble vitamins
(KADE)
6. Adds flavor to food
WHAT IS CHOLESTEROL?
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It is a lipid that is both produced by the
body and found in foods of animal origin
Most of the body’s cholesterol is
synthesized in the liver
Some is absorbed from the diet eg:
milk, egg yolk, & organ meats
WHAT ARE FUNCTIONS OF
CHOLESTEROL?
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Important component of cell membrane
Abundant in brain & nerve cells
Used to synthesize bile acids
Is a precursor of steroid hormones &
vitamin D
High levels = ^ risk of ASHD; < by
eating less total fat (saturated fat ) & ^
fiber intake to increase fecal excretion
of cholesterol
WHAT ARE FOOD SOURCES
OF CHOLESTEROL?
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Egg Yolks
Shell fish
organ meats
Dairy fats
WHAT ARE THE
MICRONUTRIENTS?
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1. Vitamins
2. Minerals
WHAT IS A VITAMIN?
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It is an organic compound that cannot b
manufactured by the body & is need in
small quantities to catalyze metabolic
processes
When vitamins are lacking in the diet,
metabolic deficits result
WHAT ARE THE TYPES OF
VITAMINS?
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1. Water soluble= C and B-complex
(B1, B2, B3, B6, B9, B 12 Pantothenic
acid & biotin)
2. Fat soluble vitamins= K, A, D, & E
FAT SOLUBLE VITAMINS
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Dissolve in fatty tissue
Not destroyed by ordinary cooking
methods
Absorbed with fats from intestines
Soluble in fat
WATER SOLUBLE VITAMINS
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Dissolve in H2O
Easily absorbed in small intestine then
passed into blood stream
Not stored in body
Must be taken daily
WHAT IS A SATURATED
FATTY ACID?
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It is a fatty acid in which all C atoms are
filled to capacity with H; e.g.: butter
These products are usually solid at
room temp.
WHAT IS A MINERAL?
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It is found in organic compounds as free
ions
there are 2 categories of minerals=
macrominerals = those required daily
in amts. over 100mg
microminerals = those required daily
in amounts less than 100 mg
WHAT ARE THE MINERALS?
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Macro minerals: Calcium, Potassium,
Chloride, Phosphorus
Micro minerals; Iron, and Zinc
WHAT ARE RECOMMENDED
DIETARY ALLOWANCES?
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RDA = standards list published by
Committee on Dietary Allowances of the
Food and Nutrition Board of the
National Academy of Sciences
RDAs= levels of intake in gms and mgs
of essential nutrients that adequately
meet the known nutritional needs of
most healthy people; most appropriate
for pros.
(con’t)
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RDAs nutrient levels are high enough to
meet the needs of 97.5% of people in
the group & to allow some loss of
nutrient as it makes its way through the
body
the effect of illness or injury & the
variability among individuals within any
given subgroup are not taken into
account in the RDAs
WHAT ARE DIETARY
GUIDELINES?
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These guides were developed to help
healthy people meet the daily
requirements of essential nutrients & to
facilitate meal planning e.g.:
The Food Guide Pyramid
Dietary Guidelines for Americans
BASIC FOUR FOOD GUIDE
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Based on 4 basic food groups:
1. Milk & milk products
2. Meats & alternatives
3. Breads & cereals
4. Fruits & vegetables
Introduced by USDA in 1956
WHAT DOES THE FOOD
PYRAMID CONSIST OF?
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Combines Dietary Guidelines + old
Basic Four Food Guide
Divides food into 6 groups
Designed to help reduce intake of fat &
concentrated sugars
Doesn’t address fluid intake or combo foods
Doesn’t guarantee consumption of necessary
levels of all essential nutrients
WHAT FACTORS AFFECT
CHOICE OF FOOD?
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1.
2.
3.
4.
5.
6.
7.
Ethnicity & culture
Age
Religion
Economic status
Peer Groups
Personal Preference & uniqueness
Life-Style
(Con’t)
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8. Beliefs About Health
9. ETOH Abuse
10. Advertising
11. Psychologic Factors
12. Health Status
13. Therapy
14. Medications
MEETING NUTRITIONAL
NEEDS
HOW IS A NUTRITIONAL
ASSESS. DONE?
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A. Anthropometric measurements
B. Biochemical data
C. Examine Pt. for clinical signs of
nutritional status
D. Obtain Diet History
WHAT ARE
ANTHROPOMETRIC
MEASUREMENTS?

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1. Direct Measurements=Height,
Weight, Skin fold measurements, Midupper arm circumference
2. Calculated measures= mid-upper
arm muscle circumference, body mass
index
WHAT BIOCHEMICAL DATA
(6) CAN BE USED?
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1.
2.
3.
4.
5.
6.
H&H
Serum Albumin
Transferrin
Total Lymphocyte count
Nitrogen Balance
Creatinine Excretion
WHAT ARE CLINICAL S/S OF
NUTRITIONAL STATUS?
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1.
2.
3.
4.
5.
6.
7.
Hair
Skin
Eyes
Tongue
Mucous membranes
CV
GI 8. Nervous 9. Vitality 10. Weight
HOW IS A DIET HX DONE?
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1. Includes Hx. About Pt.s usual eating
patterns & habits, food preferences &
restrictions, daily fluid intake, use of
vitamin or mineral supplements, dietary
problems, physical activity, Health Hx.,
concerns re. buying & preparing food
2. Do a 24-hr diet Hx
3. Ask re. Pt.s meds (especially pc or
ac)
WHAT ARE SPECIAL OR
THERAPEUTIC DIETS?
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A diet in which the amount of food or the
frequency of eating is prescribed
Can be used to Tx. a disease process
or to prepare for special exam or
surgery
Can be used to promote health
Can be temporary or lifetime
WHAT ARE THE TYPES OF
SPECIAL HOSPITAL DIETS?
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1. Regular diet= no special needs
2. Light diet= postop Pt.; foods plainly
cooked; lge amts of bran & fat omitted
3. Soft diet= easily chewed & digested;
low-residue
4. Pureed diet= liquid is added to food
for semi solid consistency
(Con’t)
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5. Full liquid diet= foods + liquids that
turn to liquid at body temp.; is only short
term; it is for Pt.s with GI disturbances;
is monotonous
6. Clear Liquid = H2O = tea, coffee,
clear broths, ginger ale or carbonated
beverages, strained & clear fruit juices,
plain jello, sugar & hard candy; relieves
thirst
(Con’t)
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7. Restricted Diets in Calories or
Minerals e.g. =
a. 1800 Calorie ADA diet
b. 2000 mg Na Diet
WHAT FACTORS DEPRESS
APPETITE OF HOSPITALIZED
PATIENTS?
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1. Physical illness
2. Unfamiliar or unpalatable food
3. Environmental factors
4. Psychologic factors
5. Physical discomfort or pain
What principles Improve the
appetite?
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1. Relieve illness s/s= < pain,fever
2. Provide familiar food Pt. likes
3. Select small portions
4. Avoid unpleasant or uncomfortable
Tx around meal time
5. Provide tidy, clean environment
6. Encourage oral hygiene
7. Reduce psychological stress
WHAT ARE NSG.
RESPONSIBILITIES WHEN
PROVIDING MEALS?
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1. Check Pt.s kardex or chart for
appropriate diet
2. Notify dietary staff of chgs in diet
3. Offer Pt. bathroom facility & hygiene
4. Assist with sitting if permitted
5. Clear overbed table or arrange table
close to bedside
(CON’t)
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6. Assist Pt. prn with food preparation
7. For blind Pt. Identify placement of
food using clock image
8. Replace food covers & do I & O &
record % food taken after meal
9. If Pt. not eating notify nurse in
charge or dietician
WHAT ARE 2 GROUPS OF
PTS. WITH SPECIAL NEEDS?


1. Elderly= weakened and quickly
fatigued when ill
2. Handicapped= blind Pts and those
who cannot use their hands or those
who must remain in a back lying
position
WHAT CAN BE DONE FOR
THESE SPECIAL
POPULATIONS?

1. Be sensitive to Pt.’s feelings of
embarrassment, resentment & loss of
autonomy= Help Pt. feed himself; Try to
appear unhurried ; Ask what order Pt.
would like to eat food; use adaptive
devices, allow ample time for chewing &
swallowing; offer fluids, make pleasant
conversation
WHAT PTS. ARE AT RISK FOR
NUTRITIONAL PROBLEMS?

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1. Any Pt. with a condition that
interferes with the ability to ingest,
digest, absorb & metabolize nutrients
2. Pt.s with ^ demand for nutrients=
pregnant women, hyperthyroidism,
cancer
WHAT NSG. MEASURES ARE
USED FOR FEEDING
INFANTS?
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1. Do not prop the bottle of formula
2. Start feeding solids at 6 months or
as per Pediatricians orders
3. Encourage breast feeding when
possible
4. Be cognizant of lactose insensitivity
5. Fluid needs of infants are
proportionately greater than adults
WHAT ARE INFANT
VARIATIONS IN NUTRITION?
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Demand feeding
Regurgitation
Iron Deficiency anemia
Bottle mouth Syndrome
WHAT NSG. MEASURES
APPLY TO FEEDING
TODDLERS?
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1. Use finger foods
2. Be aware of food “Jags”
3. Offer fluids often
4. Allow parents to bring in food from
home when possible
WHAT ARE SPECIAL
COMMUNITY NUTRITIONAL
SVS?
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1. Commodity Supplemental Food
Program
2. Emergency Food Assistance
program
3. Food Stamp Program
4. Supplemental Food Program for
Women, Infants & Children (WIC)=
provides food stamps & vouchers for
pregnant &lactating women & children
WHAT ARE ALTERNATIVE
FEEDING METHODS? (2)

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1. Parenteral methods of nutrition=
Intravenous= TPN
2. Enteral= Gastrointestinal other than
Oral; Using : Nasogastric, Gastrostomy,
Jejunostomy tubes; chg. Tube prn or
per agency protocol
WHAT ARE THE PURPOSES
OF A NASOGASTRIC TUBE?

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1. Prevent nausea, vomiting & gastric
surgery post-op ( connected to suction)
2. To remove stomach contents for lab
analysis
3. To lavage (wash) stomach in cases
of poisoning or overdose of meds.
4. For feeding clients who are unable or
unwilling to take nutrients orally
HOW IS NG FEEDING DONE?

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1. Specially prepared nutrients are
instilled into the GI tract through a tube
inserted through one of nostrils, down
nasopharynx & into alimentary tract
2. Large-bore tubes are placed into
stomach
3. Small-bore tubes are placed either
into stomach or upper small intestine:
duodenum or jejunum
HOW IS PLACEMENT
VERIFIED WITH LARGE
BORE TUBES?
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1. Aspirate GI secretions
2. Measure the pH of aspirated fluid
3. Inject 5 to 20 ml of air through
feeding tube while auscultating
epigastrum or Lft upper abd. Quad &
listening for whooshing sound
4. Ask pt to hum or speak
5. Obs. Pt. for coughing & choking
WHAT IS THE TUBE FED PT.
ASSESSED FOR?
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1. Allergies to any food in the feeding
2. Bowel sounds prior to each feeding
or q 4-8 hrs with continuous feedings
3. Abdominal distention q day
4. Correct placement of tube before
feedings
5. Dumping symdrome
(Con’t)
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6. Diarrhea, constipation or flatulence
7. Urine for sugar & acetone
8. Hematocrit & urine specific gravity
9. Serum BUN & Na levels
10. Presence of regurgitation & feelings
of fullness after feedings
WHAT IS A GASTROSTOMY
FEEDING?


Instillation of liquid nourishment through
a tube that enters a surgical opening
through the abd. wall into the stomach;
usually a temporary measure
Percutaneous endoscopic gastrostomy
(PEG) is long-term
WHAT ARE THE TYPES OF
ENTERAL FEEDINGS?

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1. Bolus or intermittent
2. Continuous; use enteral feeding
pump
ALWAYS PREVENT ASPIRATION
WHAT ARE PEDI
CONSIDERATIONS FOR
ENTERAL FEEDING?



1. Use pacifier while feeding to
maintain suck reflex
2. Prevent aspiration
3. Prevent tube dislodgment through
secure anchoring & frequent oral care
INTESTINAL ELIMINATION
WHAT ARE THE
CHARACTERISTICS OF
FECES?

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1.
2.
3.
4.
5.
6.
Color
Consistency
Shape
Amount
Odor
Constituents
WHAT ARE COMMON FECAL
ELIMINATION PROBLEMS?


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
1.
2.
3.
4.
5.
Constipation
Fecal impaction
Diarrhea
Fecal incontinence
Flatulence
CAUSES & FACTORS=
CONSTIPATION

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1.
2.
3.
4.
5.
6.
7.
Irregular defecation habits
Overuse of laxatives
Increased psychologic stress
Inappropriate diet
Insufficient fluid
Medications
Insufficient exercise
(con’t)

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8. Age
9. Disease Process
DEFINING
CHARACTERISTICS OF
CONSTIPATION

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1.
2.
3.
4.
5.
6.
7.
Decreased frequency of defecation
Hard, dry, formed stools
Straining at stool; painful defecation
Palpable mass
Reports of fullness or pressure
Abd. Cramping or pain or distention
Use of laxatives, decreased appetite
NSG. INTERVEN. &
RATIONALE FOR
CONSTIPATION MGMT
WHAT IS FECAL IMPACTION?

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Mass or collection of hardened, puttylike
feces in folds of rectum
Results from prolonged retention &
accumulation of fecal material
Passage of liquid fecal seepage
(diarrhea) & no normal stool are
defining characteristics
Digital removal of impaction/ or enemas
are sometimes needed
WHAT ARE THE MAJOR
CAUSES OF DIARRHEA?
BOWEL INCONTINENCE
FLATULENCE


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
Presence of excessive flatus in
intestines
Primary Causes:
1. Action of bacteria on chyme in large
intestine
2. Swallowed air
3. Gas diffusing into intestine from
bloodstream
COMMON CAUSES OF
FLATULENCE

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1. Constipation
2. Codeine, barbituates (anesthetics)
3. States of anxiety during which large
amts. of air are swallowed
4. Dietary changes
5. Decreased activity
DECREASING FLATULENCE

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1. Decrease gas-producing foods
2. Encourage exercise
3. Reposition clients
4. Insert rectal tube & leave in rectum
for no longer than 30 mins
5. Admin. Return flow enema
DIAGNOSTIC STUDIES OF GI



1. Direct visualization
techniques=endoscopic studies
2. Indirect
visualization=roentgenography through
use of barium
3. Lab tests for abnormal
consituents=stool samples for lab;
bedside testing for occult blood= Guiac
WHAT ARE THE TYPES OF
LAXATIVES?



Laxative= mild drug that induces
defecationwith frequent, soft or liquid
BM + abd cramps
Cathartic=strong drug that induces
defecation with purgative effect
Contraindicated in Pt. with n/v, cramps,
colic, undiagnosed abd. Pain
WHAT ARE ANTIDIARRHEAL
MEDS?


Decrease defecation frequency
“Guideines for Using Antidiarrheal
Medications”
WHAT ARE ENEMAS?



A sln. Introduced into the rectum &
sigmoid colon
4 groups= cleansing, carminative,
retention, return flow
Cleansing Enema Types of Solutions
(4)= hypertonic, hypotonic, isotonic,
soap, oil
WHAT ARE COMMONLY
USED ENEMA SLN. ACTIONS
& ADVERSE EFFECTS?
WHAT IS A BOWEL
DIVERSION OSTOMY?






Opening into the abdominal wall for
elimination of feces or urine
1. Ileostomy
2. Colostomy
3. Gastrostomy
4. Jejunostomy
5. Ileal conduit
HOW ARE BOWEL
DIVERSION OSTOMIES
CLASSIFIED?



1. Permanence
2. Anatomic location
3. Construction of stoma
HOW ARE STOMAS
ASSESSED?






1. Color
2. Size and shape
3. Bleeding
4. Status of peristomal skin
5. Amt & type of feces from stoma=
effluence
6. complaints
NSG. INTERVENTIONS FOR
APPLIANCE CHANGE
TOILET TRAINING OF
CHILDREN





Daytime control is normally attained by
age 2 1/2 yrs.
1. Provide clothing child can remove
independently
2. Give child personal, comfortable seat
3. Allow sufficient time
4. Offer positive reinforcement
(Con’t)


5. Avoid punishment or disapproval
6. Initiate toilet training during
nonstressful periods of child’s life
WHAT FACTORS AFFECT
DEFECATION?







1.
2.
3.
4.
5.
6.
7.
Age & development
Diet
Fluid
Activity
Psychologic factors
Life-style
Medications
(Con’t)





8. Diagnostic Procedures
9. Anesthesia & Surgery
10. Pathologic Conditions
11. Irritants
12. Pain