Download Chapter 7 Body Systems

Medical-Surgical Nursing:
Concepts & Practice
3rd edition
Chapter 27
The Gastrointestinal System
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Chapter 27 Objectives
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Discuss the various functions of the GI
system
List major causative factors in the
development of disorders of the GI system
Summarize measures to prevent these
disorders
Determine nursing responsibilities in pre and
post test care of patients undergoing
diagnostic tests for disorders of the GI system
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Clinical Practice Objectives
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Perform an assessment of gastrointestinal
status.
Provide pretest and post-test care of patients
undergoing tests of the liver, gallbladder, and
pancreas.
Provide care for a patient who is experiencing
vomiting.
Teach patient strategies to alleviate
constipation.
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Gastrointestinal System
Structures and functions of different organs
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Gastrointestinal tract – mouth, pharynx,
esophagus, stomach, small intestine, large
intestine, rectum and anus
Gastroesophageal spincter – controls the opening
from the esophagus into the stomach- prevents
reflux
Stomach – upper left portion of the abdominal
cavity
Small intestine – duodenum, jejunum and ileum
Large intestine – decum, colon, rectum, anal canal
Appendix – attached to cecum – has no know
function in the digestive process
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Organs of the Digestive System
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Effects of Aging on the GI System page
626
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Esophageal sphincter becomes less efficient
– risk for aspiration increases
Taste buds atrophy
After 70 years, parietal cells in the stomach
decrease their secretion of HCL; enzyme and
intrinsic factor secretion also decrease.
Small intestine mucosa absorbs less, large
intestine dimished motility
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Structures and functions of accessory
organs pge 626
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Liver – manufactures and secretes bile,
synthesizes albumin, fibrogen, globulins and
clotting factors. All nutrients and oral
medications pass through the liver.
Responsible for how drugs are metabolized.
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Structures and functions of accessory
organs page 626
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Gallbladder – stores bile produced in the liver
and delivers it as needed to the small
intestine; the gallbladder can store up to 50
ml of bile.
Pancreas – produce hormones insulin and
glucagon into the blood; insulin is essential to
the metabolism of carbohydrates
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Accessory Organs of the Digestive
System
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Effects of Aging on the Acessory
Organs
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Gallstone incidence is higher in older adults,
tendency towards dehydration.
Pancreas secretion of lipase decreases –
altering fat digesion.
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The Stomach
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Absorptive and Storage Functions of
the Large Intestine
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Causes of Gastrointestinal Disorders
pg 627
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Infection, inflammation, physical and
chemical trauma, and structural defects
Surgery complications-scar tissue
Psychological and emotional stresses
Genetic predisposition, familial tendency, and
ethnic correlation
Immune disorders
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Causes of Accessory Organ Disorders
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Gallbladder - Risk factors associated with
gallbladder disease- rapid weight loss, age,
DM, Crohn disease, family history
Prevention of gallbladder disorders – normal
body weight, avoid rapid weight loss diets,
alcohol in moderation, remain active
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Risk Factors Associated with Liver
Disorders page 628
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Liver disorders – filters out many toxic
substances- constantly exposed to infectious
organisms in bloodstream. Hepatitis virus
attacks the liver
Liver Cancer – Hep B and Hep C. May be
primary or secondary to metastasis
Cirrhosis of the liver – drugs, chemicals,
alcohol, parasites. See table 27-1 page 629
Prevention – immunizations against Hep A
and B (no vaccine for Hep C) avoid above
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Risk Factors Associated with
Pancreatic Disorders page 629
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Pancreatitis – inflammation
Causes – alcoholism, peptic ulcer,
hyperlipidemia and trauma, age
Pancreatic cancer- smoking, DM, obesity,
chronic pancreatitis
Prevention – moderation alcohol, removing of
gallbladder that has gallstones to prevent
obstruction causing pancreatitis.
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Audience Response Question 1
The nurse discussing disease prevention measures
to a group of older adults during a senior seminar
should include which instruction(s)? (Select all that
apply.)
1.
2.
3.
4.
5.
Consume sufficient fiber.
Eat a normal, well-balanced diet.
Exercise regularly.
Drink at least three glasses of fluids.
Take laxatives regularly.
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Diagnostic Tests and Procedures –
Table 27-1
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Radiography
Computed tomography (CT) scans
Nuclear medicine scans
Magnetic resonance imaging
Ultrasound studies
Endoscopy
Biopsy
Laboratory tests
Tests of gastric secretions
Stool and urine studies
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Nursing Implications of
Diagnostic Tests
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Check the patient’s allergies.
A pregnancy test might be ordered.
Patient teaching
Diet, including NPO (nothing by mouth) status
and dehydration
Psychological care
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Assessment (Data Collection) see
page 636
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Family history
Diet and dietary intolerances
Presence of pain
Problems with blood clotting
Verify immunization status
Comprehensive history of illnesses and
exposure to toxic agents
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Auscultate Bowel Sounds in All Four
Quadrants
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Ascultating Bowel Sounds
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The normal frequency for bowel sounds is
about…….???
5 to 30 in one minute
Loud, frequent sounds occur when there is
excessive motility in the bowel
For bowel sounds to be considered absent –
no sounds after listing in each quadrant for 5
minutes.
Hypo – no sounds after listening in each quad
for 30 seconds.
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Anorexia – absence of appetite
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Any time a patient has continual problems
with eating – dental history and oral cavity
exam should be performed. Also check for
difficulty swallowing. Depression.
Taste and smell senses diminish with age
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Anorexia – absence of appetite
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Mouth care
Monitor laboratory results.
Document percentage of each meal eaten.
Psychosocial or cultural factors
Include a variety of colors, textures, and
tastes.
Nursing assignments to unlicensed assistive
personnel – assist with meals to encourage
eating.
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Nausea and Vomiting
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Interferes with with eating and hinders
nutrition
Smells that exacerbate nausea – strong
scents
Ginger for nausea – may decrease the action
of histamine receptor antagonists
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Accumulation of Flatus
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Surgery, mechanical obstruction, accidental
injury – peristalsis is decreased or flow of
chime is inhibited by obstruction.
Ambulation…Exercise to reduce gas and
bloating
Medications - simethicone
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Constipation
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Identify the cause of constipation – diet low in
fiber, dehydration, opiod medications, some
neurologic disorders.
Rectal suppository or enema
Stool softener
Raw fruits and vegetables
Acceptable exercise program
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Older Care Points
Constipation
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Decreased GI motility, lack of exercise,
limited fluid intake, constipating medications.
Reliance on laxatives common among older
adults
Need more dietary fiber and increased fluids
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Diarrhea
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Antidiarrheal agents
Mild – no treatment
Moderate – more than 24/48 hours – Lomotil
Kaopectate, clear liquids
Severe diarrhea- NPO until it subsides,
prolonged may require TPN
Probiotics for infectious diarrhea
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Nursing Management of Diarrhea
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Monitor intake and output.
Administer ordered medications.
Replace lost fluids. Monitor the patient for
electrolyte imbalances and watch for signs of
dehydration.
Avoid coffee and tea.
Thorough hand hygiene
Standard Precautions
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Bowel Incontinence
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Severe illness, trauma, neurologic damage,
or prolonged bed rest
Keep the patient clean and dry.
Tracking the time of incontinent movements
and offering toileting after each meal may
help eliminate the problem.
If incontinence is persistent, the cause should
be identified and then a bowel training
program instituted.
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C diff
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Antibiotics kill harmful bacteria, but also kill
normal intestinal flora. Clostridium difficile
(C.diff) may develop. Isolation precautions
implemented.
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Bowel Training
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The patient should be in a private
environment 20 to 40 minutes after a meal
and assume a normal sitting position for
defecation if possible or a side-lying position
if bedridden.
The nurse or patient performs digital
stimulation by gently inserting and rotating a
gloved, well-lubricated finger into the rectal
sphincter. This action should be done on a
regular basis to mimic the patient’s normal
bowel pattern.
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Bowel Training (Cont.)
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A warm drink or prune juice may also help to
stimulate the bowels. Consistency and
patience are vital to the success of retraining
the bowel.
In accordance with National Patient Safety
Goals, encourage patients to call for help
during bowel training. Reassure patients that
calling for help ensures safety and provides
an opportunity to observe the progress of the
training program.
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Audience Response Question 2
An older female patient of Puerto Rican descent
was admitted for persistent anorexia and
dehydration. With no apparent organic
underlying cause for loss of appetite, which
action(s) would be culturally appropriate?
(Select all that apply.)
1.
2.
3.
4.
5.
Determine food preferences.
Encourage family visits.
Provide warm beverages with meals.
Consider parenteral nutrition.
Consult a dietitian and speech therapist.
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