Jane Bordner RN BSN Nursing Instructor HACC Central Pennsylvanias Community College N100 Spring 2015 Anatomy and Physiology Flexible hollow muscular tube 26 feet Lined with mucous membrane ID: 242563
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Slide1
Gastrointestinal System
Jane Bordner, RN BSN Nursing Instructor
HACC, Central Pennsylvania’s Community College
N100
Spring
2015Slide2Slide3
Anatomy and PhysiologySlide4
Flexible, hollow, muscular tube
26 feet
Lined with mucous membrane
GI TractSlide5Slide6
Principle responsibility of GI tractOccurs in mouth, stomach, and small intestines
Majority in small intestines
DigestionSlide7
Teeth break food into smaller pieces
Saliva dilutes and softens bolus of food
Amylase begins chemical break down
Tongue:
Made of skeletal muscle
Contains taste buds
Keeps food between teeth
Elevates to move food back into pharynx
Oral CavitySlide8
Passage of food from oral cavity to esophagusMuscular tube
Constrictor muscles that contract as part of swallowing
PharynxSlide9Slide10
Esophagus
Carries food from pharynx to stomach
No digestion
Food passes through upper esophageal sphincter
Peristalsis pushes food through cardiac sphincterSlide11
TasksStorage
Mixing
Emptying
Produces and secretes
Hydrochloric Acid (HCl)
Pepsin
Mucus
Intrinsic factor
StomachSlide12Slide13
Segmentation Peristalsis7 to 10 L of liquid moves through in one day
Chyme is reduced to a volume of 600 to 800 ml that is paste-like consistency
Small IntestineSlide14
3 Sections:Duodenum – 2 feet long
Continues to process chyme
Jejunum – 5 feet long
Absorption of CHO and protein
Ileum – 12 feet long
Absorption of H2O, fat, and bile salts
Most nutrients and electrolytes are absorbed
Small IntestineSlide15Slide16Slide17
Impaired functionDigestive process is altered
Conditions such as
Inflammation
Ulceration
Surgical resection
Obstruction
Small IntestineSlide18
Lower GI tract/Large ColonBowel elimination
Larger diameter
5 to 6 feet in length
3 sections
Cecum
Colon
Rectum
Large IntestineSlide19
Chyme enters through ileocecal valveCecum is 1
st
part
Colon sections
Ascending
Transverse
Descending
Sigmoid
Rectum and Anal Canal
Large IntestineSlide20
4 FunctionsAbsorption
H2O
Na & Cl
Protection
bacteria
Secretion
Bicarbonate and K
Elimination
Bulk waste
Large IntestineSlide21
Accessory Structures of Digestion
Pancreas
Liver
Gall bladderSlide22
Gland Posterior to stomach
Exocrine = secretes pancreatic juices
Amylase = CHO
Lipase = Fats
Trypsin = Protein and bicarbonate
Endocrine
PancreasSlide23
Pancreatic DuctSlide24
Largest organ in bodyRemarkable and complex
O2 rich blood received through hepatic arteries
Nutrient rich blood received through portal vein
2 lobes
LiverSlide25Slide26
Secretes bile
Produces
bilirubin
Removes nutrients from blood
Stores vitamins and iron
Converts glucose to
glycogen
Stores glycogen
Liver FunctionsSlide27Slide28
Converts excess fatty acids and ureaHelps metabolize proteins, fats, and CHO
Detoxifies drugs and poisons
Phagocytizes bacteria and old RBC’s
Liver FunctionsSlide29
Stores and concentrates bileHormone CCK
(cholecystokinin)
secreted by intestinal mucosa
stimulates gall bladder to contract and release bile
Gall BladderSlide30Slide31
Factors that Affect GI Function
Disease process
Chemical/physical trauma
Social/economic factors
Stress/emotional factors
Congenital defects
Aging processSlide32
AssessmentSlide33
History (SUBJECTIVE AND OBJECTIVE)Inspection (LOOK)
Auscultation (LISTEN)
Palpation (FEEL)
Percussion
Assessment of GI StatusSlide34
W - Where is it?
H - How does it feel?
A - Aggravating and alleviating factors?
T - Timing?
S - Severity?
U - Useful other data?
P - Patient perception of problem?
Also include medications, nutritional assessment, family history, cultural influences, height and weight
HistorySlide35
Inspection (LOOK)Slide36
Auscultation (LISTEN)Slide37
Palpation (FEEL)
RUQ
LUQ
RLQ
LLQSlide38
PercussionSlide39
Diagnostic StudiesSlide40
Obstruction SeriesUpper GI/Barium Swallow
Lower GI/Barium Enema
Radiological ExamsSlide41
Upper GI SeriesSlide42
Lower GI/Barium EnemaSlide43
Light, low fat, low residue diet for 2 days
Clear liquid dinner evening before
NPO after midnight
Stimulant laxative night before
Enemas until clear or Colyte/Golytely prep
**Bowel must be clean of stool for accurate results**
Patient PrepSlide44
EGDERCP
Sigmoidoscopy/Colonoscopy
Endoscopy – Flexible scopeSlide45
Eliminates need for exploratory surgery
Collection of biopsy material
Remove foreign objects
Preparation
NPO
6 to 12 hours before
Use of local anesthetic to control gag reflex
Post-procedure
NPO
until gag reflex returns
Watch for signs of perforation and/or bleeding post-op
EGD
(
Esophagogstrodudenscopy
)Slide46
ERCP (Endoscopic Retrograde Cholangiopancreatography)Slide47
Visualize colon and sigmoid areaEmpty bowel prior to test
Bowel Prep
2 day prep (outpatient)
Clear liquid diet for 1 - 2 days
Enema until clear or Go-lytley prep
IV sedation may be used during procedure
Patients find this test intrusive
Sigmoidoscopy/Colonoscopy Slide48Slide49
More sensitive than x-ray
Non-invasive, no pain
May prep with contrast (clear)
CT ScanSlide50
Extremely sensitiveVisualizes changes in structure and tissue
MRISlide51
Outlines borders of structures
liver, pancreas, gall bladder
UltrasoundSlide52
Amylase and lipase blood levels
Pancreatic function
Liver enzymes (AST, ALT, LDH)
Liver function
Bilirubin
Liver function
Breakdown of RBC’s
Ammonia
Liver function
Laboratory StudiesSlide53
Albumin
Liver function
Prothrombin time
Liver function
Gastric Analysis
pH
Stool Exams
Infection, parasites, organisms
Hemoccult (guaiac)
Consistency
Color
Odor
Laboratory StudiesSlide54
GI System Review
Anatomy and PhysiologySlide55
Where is the cardiac sphincter located?Where is the pyloric sphincter located?
Where is the ileocecal valve located?
List the 3 segments of the small intestine
_____________________
_____________________
_____________________
Where does most absorption of nutrients take place?Slide56
List 5 digestive juices and the organs that secrete them_________________ ___________________
_________________ ___________________
_________________ ___________________
_________________ ___________________
_________________ ___________________
Which nutrients enter the blood stream directly?
Which nutrients enter the lymph system first?
Describe peristalsisSlide57
List exocrine function of pancreasList function of gall bladder
List functions of liver
___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________Slide58
Therapeutic Uses of Salem Sump Tube
Remove gas and fluids from stomach (decompression)
Obtain gastric secretions for analysis
To relieve/reduce obstructions or bleeding
Promote healing after surgery – prevent strain on sutures
Remove toxic substances (lavage with poisonings)Slide59
Assessing Placement
Ask client to speak
Inspect pharynx
Instill 15 – 30 ml of air while listening over stomach
Aspirate gastric contents
Assess color
Assess pH
Gastric secretions: < 4Slide60
Assessing Drainage
IrrigationSlide61
Total Parenteral Nutrtion
Intravenous
hyperalimentation
Burns, trauma, malnutrition, cancerSlide62Slide63
Common Problems
Constipation
Impaction
Diarrhea
Flatulence
Incontinence
Hemorrhoids
Gastritis
Gastric Ulcer Disease
GERDSlide64
Constipation
Decreased BM
Hard, dry stool
Causes
Nursing InterventionsSlide65
Nursing DiagnosisGoalInterventionsWho is at risk???
ConstipationSlide66
Risk factors
History of constipation
Chronic confusion
Comatose
Weak and debilitated
S&S
No BM for several days
Distended abd.
Anorexia/Nausea/Vomiting
Oozing of diarrhea stool
Feel hard fecal mass with digital exam
Fecal ImpactionSlide67
Fecal ImpactionSlide68Slide69
Constipation TreatmentStimulants
Stimulates peristalsis
Pulls fluid into stool
Used for bowel prep
Used for acute constipation
Side Effects
Pain/cramps
Diarrhea
Dehydration
Examples
magnesium citrate
Milk of Magnesia (MOM)
Senokot
(
sennosides
)
Dulcolax
(
bisacodyl
)Slide70
Increase water in stool
Prevents straining
Colace (docusate sodium)
Side Effects
Stool SoftenersSlide71
Increase stool mass and water contentPrevent and treat simple constipation
Metamucil (psyllium)
FiberCon/Fiber-Lax (polycarbophil)
Always give with 8 ounces of fluid
Side Effects
Bulk-Forming LaxativesSlide72
Create slippery barrier between stool and intestinal wall
Softens impacted stool
Fleets Mineral Oil
LubricantsSlide73
Uses osmotic pressure to draw water into stool
Used for bowel cleansing or occasional constipation
Colyte
/Go-
Lytely
(polyethylene glycol/electrolyte)
Miralax
(polyethylene glycol)
Fleet Enema, Fleet
Phospho
-Soda (phosphate/
biphosphate
Side Effects
OsmoticsSlide74
Song
We know that it’s a problem
That we all too often see.
It may go on for several days
Sometimes it worries me
Yes, it’s a private matter
But I can clearly see
We just don’t do enough ‘bout constipation.
We listen to heir bowel sounds and we ask them how they feel
We make sure they have lots to drink with each and every meal.
I hate to have to say it, but I very firmly feel: We just don’t do enough ‘bout constipation!
I’d like to say a word on our behalf. Constipation is a pain in the ……
How do you help the soul with constipation?
How do you keep their bowel from standing still? How do you treat the soul with constipation? An enema? A suppository? A pill?
Many a thing you know you’d like to tell them
Many a thing they ought to understand
But how do you make them stay and listen to all you say?
How do you make them comply with the plan?
Oh how do you help the soul with constipation? We must prevent impaction if we can!
When they’re rushed and when they’re hurried
When they’re stressed and when they’re worried
And they don’t eat a healthy foods they way they should
Then they come in when they’re sick, And their bowels don’t move a lick
Then we give them
opioids
, O that’s not good!
“
cuz
it slows down their digestion, causing problems without question
But they need it for their pain and that’s a fact.
So we give them
Senekot
, some will take it, some will not, document it when they go and what you got!!
(REPEAT CHORUS)Slide75
http://www.sunnycorner.com/movies/featured/som/music/mariasom.phpSlide76
Diarrhea
Increased number of BM’s
Loose, unformed stools
Risk for fluid and
electrolyte imbalance
Risk for skin breakdownSlide77
Nursing DiagnosisGoalInterventions
DiarrheaSlide78
Anti-Diarrheal Medications
Systemic Anti-Diarrheal Agents
Decrease peristalsis
Lomotil
(
diphenoxylate
& atropine)
Imodium (
lopermide
)
Side effects
Constipation
Fatigue
Locally-Acting Agents
Absorbs water from stool
Kaopectate
(bismuth subsalicylate)Slide79
Incontinence
Inability to control passage of feces and/or gas
Causes
Impact
Body image, disturbed
Risk for skin breakdown
Nursing
Interventions
Bowel schedule
Meticulous skin careSlide80
Flatulence
S&S
Abd. pain
Abd. distention
SOA
Nursing Interventions
Increase mobility
Limit carbonation
Comfort measuresSlide81
Hemorrhoids
Nursing Interventions
Assess size, color and bleeding
Prevent constipation
Comfort measures
Slide82
Nausea – subjective feeling of urge to vomitVomiting – expelling stomach contents
May cause fluid and electrolyte imbalance
Treat cause
Nausea and VomitingSlide83
Protect airwayMonitor fluid and electrolyte balance
Provide replacement fluids (
po
and/or IV)
Prevent further N&V
Administer
Antiemetics
Nursing Interventions for N&VSlide84
DiagnosisGoalInterventions
Nursing Diagnosis for N&VSlide85
Inhibit dopamine receptors in brain
Compazine
(
prochlorperazine
)
Phenergan
(
promethazine
)
Side Effects
Dry eyes and mouth
Constipation
Confusion and sedation
Extrapyramidal
reactions
PhenothiazinesSlide86
Blocks effects of serotonin at receptor sites in vagal nerve and chemoreceptors in CNS
Anzetmet (dolasetron)
Zofran (ondansetron)
Side Effects
Headache
Constipation
Diarrhea
5-HT3 antagonistsSlide87
Inhibits vestibular stimulationUsed for motion sickness
Side effects
Drowsiness
Anorexia
Dramamine (
dimenhydrinate
)
Anivert
(
meclizine
)Slide88
Blocks dopamine Increases GI motilityPrevention of chemo induced N&V
Tx of gastric stasis and post-op N&V
Side effects
Drowsiness
Restlessness
Extrapyramidal reactions
Reglan (
metoclopramide
)Slide89
CNS depressant and histamine 1 receptor blockerUsed as adjunct to opioid analgesic
Side effects
Drowsiness
Dry mouth
Pain at injection site
Vistaril (
hydroxyzine
)Slide90
Inflammation of stomach liningAbd. Pain, nausea and anorexia
Interventions
Bland diet/soft food (no caffeine, spicy food)
No smoking
Antacids
Medication to decrease stomach acid
Antiemetics
GastritisSlide91
Loss of tissue (erosion) in mucosal wall of esophagus, stomach or duodenum
Referred to as
Gastric
Duodenal
Esophageal
Stress
Peptic Ulcer DiseaseSlide92
Ulcers may extend deeply into muscle layers or through muscle to peritoneum
Etiology
Poorly understood
H.pylor
i
bacteria
May be acute or chronic
Peptic Ulcer DiseaseSlide93Slide94
S&SSharp, burning, gnawing, mid-
epigastric
pain
Pain occurs 1-3 hours after meals or with meals
Heartburn and belching
Melena
or
Hematemesis
Peptic Ulcer DiseaseSlide95
DiagnosisUrea breath test
IgG
antibody for
H.pylori
infection
Upper GI
EGD
Gastric secretion analysis
Stools for occult blood (
Melena
)
Gastrocult
/
Hematemesis
Peptic Ulcer Disease Slide96
ManagementDiet
Rest
Stress reduction
No smoking or ETOH use
Medication
Peptic Ulcer Disease Slide97
Back flow of stomach contents into esophagus
Incompetent cardiac sphincter
S&S
Burning pain in esophagus
Diagnosis
Clinical S&S
EGD
GERDSlide98Slide99
Potential complicationsEsophagitis
Esophageal stricture
Esophageal ulceration
Barrett’s Esophagus
Esophageal Cancer
GERDSlide100
TreatmentElevate HOB
Avoid acid-stimulating foods
Antacids
Histamine blockers (H2 receptor antagonists)
GERDSlide101Slide102
Gastric MedicationsSlide103
1
st
line for
GERD
Buffers
HCL
acid
Maalox (magnesium & aluminum hydroxide)
Mylanta (magnesium & aluminum hydroxide)
Riopan
(
magaldrate
)
Side Effects
AntacidsSlide104
Inhibits action of histamine at H2-receptor sites in gastric parietal cells
2
nd
choice for GERD
Tx of peptic ulcer disease
Zantac (ranitidine)
Pepcid (famotidine)
Tagamet (cimetidine)
Axid (nizatidine)
Side effects
Confusion
Decrease in WBC and RBC
Low-dose Histamine H-2 AntagonistSlide105
Inhibit gastric secretions by blocking the effect of histamine or acetylcholine on receptors found in parietal cellsTagamet
Zantac
Pepcid
H2 inhibitors (Blockers)Slide106
3
rd
choice for GERD
Tx
of duodenal ulcers
Prevention of GI bleeding in critically ill ICU pt.
Binds to an enzyme on gastric parietal cells in presence of acidic gastric pH, preventing final transport of H ions into gastric lumen
Prilosec
(
omeprazole
)
Prevacid
(
lansoprazole
)
Nexium
(
esomeprazole
)
AcipHex
(
rabeprazole
)
Side effects
Diarrhea
Abdominal pain
Rash
(allergic reaction)
Proton-Pump InhibitorsSlide107
Bind to an enzyme in the presence of acidic gastric pH, preventing final transport of hydrogen ions into the gastric lumenPrilosec
Prevacid
Proton Pump InhibitorsSlide108
Used for severe GERD
(Big guns)
Tx
of pathological gastric
hypersecretory
disorders
Adjunct
tx
of duodenal ulcers (Unlabeled)
Same as proton-pump inhibitors
Protonix
(
pantoprazole
)
Gastric Acid Pump InhibitorSlide109
Tx/prevention of duodenal ulcers
Tx of
GERD
(Unlabeled)
Forms a complex that adheres to ulcers; protecting and promoting healing
Carafate
(
sucralfate
)
Side Effects
Constipation
Dry mouth
Take on empty stomach
GI ProtectantSlide110
Increased prostaglandin decreases gastric acid and pepsin secretion and increases protective mucus production
Use for patient on NSAIDS and ASA
Cytotec
(
misoprostol
)
Side Effects
Diarrhea
Abdominal pain
Miscarriage
GI ProstaglandinSlide111
Tx H. pylori Usually combo of 1 – 2 antibiotics with proton pump inhibitor &/or H2 antagonist
Amoxil (amoxicillin)
Biaxin (clarithromycin)
Flagyl (metromidazole)
tetracycline
AntibioticsSlide112
Nursing DiagnosisGoalInterventions
Nursing Diagnosis for PUDSlide113
Miscellaneous TopicsSlide114
ObstructionHemorrhagePerforation
Neurological
Inflammation
Neoplasms
Pathology of GI TractSlide115
Intestinal Stoma = artificial opening in abdominal wall
Types
Colostomy
Ileostomy
Assessment
Stool
Stoma
Care
Soap and water
Intestinal StomasSlide116Slide117
Colostomies And IleostomiesPatient may lose up to 1000 ml/day of fluid through ileostomy
Patients should avoid high fiber foods because of increase in GI transit time
May be temporary or permanent
Intestinal StomasSlide118Slide119
Stoma picture
Ileostomy
Ascending colostomy
Transverse colostomy
Descending colostomy
Sigmoid colostomySlide120
Bottoms upSlide121
Nursing DiagnosisSlide122
Nursing Care