Download GI 101 Assessment

NURS 101
Anatomy and Physiology Review
GI Tract
 Extends from mouth to anus
 Function is to supply nutrients to body cells
 Ingestion-digestion-absorption
 Elimination excretes waste productions of digestion
GI organs
 Mouth
 Liver
 Esophagus
 Pancreas
 Stomach
 gallbladder
 Small intestine
 Large intestine
 Rectum
 Anus
GI Tract
 Receives approx. 25-30% of cardiac output
 Enteric nervous system (gut brain) coordinates motor
and secretory activities
Factors that affect function
 Stress, anxiety
 Dietary intake
 Alcohol or caffeine, cigarettes
 Poor sleep, fatigue
 Medications
 Disease
Digestion/Absorption
 Begins in mouth: chemical and mechanical
 Stomach holds food and empties into small intestine
at rate at which digestion can occur.
 Low pH (acidic) gastric fluids aids in protection
against ingested organisms
 Most absorption occurs in small intestine (transfer of
end products of digestion across intestinal wall to
circulation)
Small Intestine
 Functional unit is villi, microvilli
 Digestive enzymes break down nutrients to be
absorbed.
Digestive Secretions
 Salivary glands: amylase
 Stomach: Pepsinogen, HCl acid, Lipase, Intrinsic
factor
 Small Intestine: Enterokinase, Amylase, Peptidases,
Aminopeptidase, Maltase, Sucrase, Lactase, Lipase
 Pancreas: Trypsinogen, Chymotrypsin, Amylase,
Lipase
 Liver and Gall Bladder: Bile
Elimination
 Large intestine: Cecum/appendix, colon (ascending,
transverse, descending, sigmoid), rectum, anus
 Most important function: absorption of water and
electrolytes
 Feces is 75% water, bacteria, unabsorbed minerals,
undigested food, bile pigments, shedded eptithelial
cells.
Large Intestine
defecation
 Feces stimulates sensory nerves
 Nerve fibers produce contraction of rectum and
relaxation of sphincter
 Controlled voluntarily by relaxing the internal and
external sphnicter
 “acceptable environment” is necessary
 Facilitated by Valsalva maneuver
Liver
 Carbohydrate metabolism
 Protein metabolism
 Fat metabolism
 Steroid metabolism
 Detoxification
 Bile synthesis
 Storage
 Breakdown old blood cells
Age Related Changes to GI
 Tooth/gum breakdown and disease
 Salivary secretions diminish
 Delayed esophogeal clearance
 Increased GERD
 Delayed motility
 Increase incidence of gallstones
 Decreased sphincter tone
 Increased incidence of constipation
Assessment
 Health History
 Abdominal pain
 Dyspepsia
 Gas
 Diarrhea or constipation
 Fecal incontinence
 Jaundice
 Previous GI disease
“gas”
 Belching or flatulence (“flatus”)
 Food intolerance or gall bladder dz may increase gas
 Excess gas may lead to bloating and discomfort
history
 Personal and social history
 Oral care
 Medications
 Nutrition and eating habits
 Family history
 CA
Physical Assessment
OBJECTIVE DATA
Inspect
Auscultate
Percuss
Palpate
MOUTH
Symmetry, color, size
Pallor, cyanosis, cracking, ulcers, fissures,
lesions
Loose teeth, swollen gums, note breath
Palpate any suspicious areas. Note presence
of dentures and ask pt to remove for thorough
exam.
Use a tongue blade.
abdomen
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Inspect for skin changes, dilated veins, contour, symmetry
Contour: flat, round, concave, distended
Movement: pulses or peristalsis
Auscultate next!!! Why???
Use diaphragm of stethoscope for high pitched bowel
tones; should hear clicks or gurgles
 Starting in lower right quadrant (why?) listen in all 4
quadrants
 Percuss to determine presence of fluid, distention, masses.
Tympany is predominant sound.
 Palpate to detect tenderness, masses, muscular resistance.
RECTUM AND ANUS
Inspect perianal and anal areas for color,
texture, lumps, scars, hemorrhoids,
discharge, prolapse.
Gloved finger to palpate inside rectum
(point toward umbilicus) and to obtain
fecal occult blood specimen.
STOOL APPEARANCE
LABS ASSOCIATED WITH GI ASSESSMENT
LFT’S
AMYLASE
LIPASE
FECAL OCCULT BLOOD TEST
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Detects “hidden blood”
Small smear of feces on testing card, apply reagent
Positive test is _______
Single test has limited value in detecting colorectal CA
Sometimes called “Guaiac”
Certain foods may cause false -positive reading.
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______________
______________
______________
______________
 Vit C may cause false neg
UPPER GI SERIES
 AKA _________ ___________
 Diagnoses structural abnormalities of esophagus, stomach,
and duodenum
 Nurses explain procedure to pt, position during fluoroscopy
 NPO for 8-12 hours, including smoking
 Oral contrast
 Fluids,laxatives to prevent post study impaction.
 Expect white stool
LOWER GI SERIES
 Aka barium enema
 Nurses: administer laxatives and enemas until colon is clear
before study. NPO 8 hours prior. Explain procedure and
position patient. Explain that urge to defecate may occur
during procedure. After procedure, give laxatives and enemas
to help expel contrast
ABDOMINAL ULTRASOUND
 Used to show size and configuration of organs. Non invasive.
Conductive gel is applied to skin and transducer is placed on
area.
 NPO ____ hours before.
 For gall bladder studies, ___________meal the night before.
 Air, gas, or presence of food in GI tract can result in reduced
quality of images