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Gastrointestinal System Gastrointestinal System

Gastrointestinal System - PowerPoint Presentation

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Gastrointestinal System - PPT Presentation

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

gastric amp constipation nursing amp gastric nursing constipation side stomach food bowel intestine ulcer disease peptic liver pain effects

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Slide1

Gastrointestinal System

Jane Bordner, RN BSN Nursing Instructor

HACC, Central Pennsylvania’s Community College

N100

Spring

2015Slide2
Slide3

Anatomy and PhysiologySlide4

Flexible, hollow, muscular tube

26 feet

Lined with mucous membrane

GI TractSlide5
Slide6

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

PharynxSlide9
Slide10

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

StomachSlide12
Slide13

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 IntestineSlide15
Slide16
Slide17

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

LiverSlide25
Slide26

Secretes bile

Produces

bilirubin

Removes nutrients from blood

Stores vitamins and iron

Converts glucose to

glycogen

Stores glycogen

Liver FunctionsSlide27
Slide28

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 BladderSlide30
Slide31

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 Slide48
Slide49

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, cancerSlide62
Slide63

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 ImpactionSlide68
Slide69

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 DiseaseSlide93
Slide94

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

GERDSlide98
Slide99

Potential complicationsEsophagitis

Esophageal stricture

Esophageal ulceration

Barrett’s Esophagus

Esophageal Cancer

GERDSlide100

TreatmentElevate HOB

Avoid acid-stimulating foods

Antacids

Histamine blockers (H2 receptor antagonists)

GERDSlide101
Slide102

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 StomasSlide116
Slide117

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 StomasSlide118
Slide119

Stoma picture

Ileostomy

Ascending colostomy

Transverse colostomy

Descending colostomy

Sigmoid colostomySlide120

Bottoms upSlide121

Nursing DiagnosisSlide122

Nursing Care