Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 28

1. Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 28 NURSING CARE OF THE CLIENT: GASTRO-INTESTINAL SYSTEM

2. The Digestive System • Also known as the gastrointestinal (GI) tract or the alimentary system, it is responsible for breaking down the complex food into simple nutrients the body can absorb and convert into energy. This process is known as digestion.

3. Mouth/Esophagus • Digestion begins in the mouth where the teeth mechanically break food down into smaller pieces by chewing and mixing it with saliva. • The food is then swallowed and transported down into the esophagus through the rhythmic contraction of muscles known as peristalsis.

4. Stomach • Further mechanical and chemical breakdown of the food occurs in the stomach, which secretes gastric juices that contain hydrochloric acid and pepsinogen, a nonactive form of the enzyme pepsin.

5. Small Intestine • Approximately 20 to 25 feet long and is responsible for absorbing nutrients from the chyme (semi-liquid mass of partially digested food). • Small intestine divided into: duodenum (first 10-12 inches); jejunum (the middle 8-10 feet) and the ileum (the distal 12 feet).

6. Large Intestine • Also known as the colon, the large intestine is responsible for absorbing water, electrolytes, and salts. • The last 5 inches of the large intestine comprise the rectum. The distal end of the rectum forms the anal canal composed of muscles that control defecation. The opening to the anal canal is called the anus.

7. Accessory Organs The digestive system is also comprised of organs that aid in digestion of food: • Pancreas. • Liver. • Gallbladder.

8. Produce and secrete bile, which emulsifies fat. Convert glucose into glycogen for storage. Convert glycogen to glucose when blood sugar level drops. Metabolize hormones. Break down nitrogenous wastes to urea. Incorporate amino acids into proteins. Filter blood and destroy bacteria. Produce prothrombin and fibrinogen, which are necessary for blood clotting. Manufacture cholesterol. Produce heparin. Store vitamin B12 and fat soluble vitamins A,D,E, and K. Detoxify poisonous substances. Functions of the Liver

9. The Gallbladder • A pear-shaped sac attached to the underside of the liver. • Stores and concentrates the bile until it is needed in the small intestine.

10. Changes in the Digestive System with Aging • Decrease in peristalsis. • Oral changes. • Decrease in enzyme secretion. • Decrease in saliva.

11. Assessment for Clients with GIComplaints

12. Disorders of the GI Tract:Stomatitis • A painful condition characterized by inflammation and ulcerations in the mouth. • Can be caused by infections, damage to the mucous membranes by irritants, or chemotherapy.

13. Disorders of the GI Tract:Esophageal Varices • An enlarged, tortuous vein in the esophagus, often associated with cirrhosis of the liver. • Varices have no symptoms so clients may not be aware of them until they start bleeding.

14. Disorders of the GI Tract:Gastroesophageal Reflux Disease • A disease in which the gastric secretions flow upward into the esophagus, damaging the tissue.

15. Disorders of the GI Tract:Gastritis • An inflammation of the stomach mucosa occurring when the stomach has been exposed to irritating substances such as medications, smoke, food allergens, or toxic chemicals.

16. Disorders of the GI Tract:Ulcers • Peptic ulcers are erosions that form in the esophagus, stomach, or duodenum resulting from acid/pepsin imbalance. • Gastric ulcers refer to erosions in the stomach and are correlated to exposure to irritants including smoking, alcohol, food allergens, toxic chemicals, etc.

17. Disorders of the GI Tract:Appendicitis • An inflammation of the vermiform appendix, a small, slender tube attached to the cecum. • If the appendix ruptures, fecal content spills into the abdominal cavity causing peritonitis, which can be fatal.

18. Disorders of the GI Tract:Diverticulosis and Diverticulitis • The diverticula are saclike protrusions of the intestinal wall. • Diverticulosis is a condition of the colon in which multiple diverticula are present. • Diverticulitis refers to the inflammation of one or more of the diverticula generally in the sigmoid colon.

19. Colostomy • A surgically created opening from the colon through the abdominal wall to relieve either a disease or functional problem in the large intestine.

20. Inflammatory Bowel Disease • The term used to describe Crohn’s disease and ulcerative colitis (UC). • Crohn’s disease is characterized by lesions that affect the entire thickness of the bowel and can occur anywhere throughout the colon and small intestine. • UC is characterized by mucosal lesions occurring typically in the rectal area and progressing through the colon.

21. Intestinal Obstruction • Sometimes called an ileus, it occurs when the contents cannot pass through the intestine. • May be caused by tumor; fecal impaction; hernia; volvulus (twisting of the bowel on itself); tussusception (telescoping of bowel where bowel slides inside itself) or adhesions, scar tissue in the abdomen from prior surgeries or disease process.

22. Hernias • Occurs when the wall of a muscle weakens and the intestine protrudes through the muscle wall.

23. Peritonitis • An inflammation of the peritoneum, the membranous covering of the abdomen. • Caused by irritating substances such as feces, gastric acids, bacteria, or blood in the abdominal cavity.

24. Hemorrhoids • Swollen vascular tissues in the rectal area. • May be internal or external and may be caused by straining with constipation. • Frequently occur with pregnancy.

25. Disorders of the Accessory Organs:Cirrhosis • Refers to the chronic, degenerative changes in the liver cells and thickening of surrounding tissue that result from the liver repairing itself after chronic inflammation. • Causes include chronic hepatitis, repeated exposure to toxic substances, cancer, and chronic alcohol abuse.

26. Disorders of the Accessory Organs:Hepatitis • A chronic or acute inflammation of the liver caused by a virus, bacteria, drugs, alcohol abuse, or other toxic substances.

27. Pancreatitis • An acute or chronic inflammation of the pancreas caused when pancreatic enzymes digest the lining of the pancreas.

28. Cholecystitis and Cholelithiasis • Cholecystitis is an inflammation of the gallbladder. In more than 90% of the cases, gallstones are present. • Cholelithiasis is the presence of gallstones or calculi (concentration of mineral salts) in the gallbladder.

29. Neoplasms of the Gastrointestinal System • Oral cancer (cancer of the lips, tongue, oral cavity, and pharynx). • Colorectal cancer (almost all arise from polyps, an abnormal growth of tissue that protrudes into the colon). • Liver cancer.