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GASTROINTESTINAL NURSING

GASTROINTESTINAL NURSING. Digestive Tract Disorders 2013. Anatomy and Physiology of the Digestive Tract. Mouth Where teeth, tongue, and salivary glands begin food digestion Pharynx Muscular structure shared by the digestive and respiratory tracts

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GASTROINTESTINAL NURSING

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  1. GASTROINTESTINAL NURSING Digestive Tract Disorders 2013

  2. Anatomy and Physiology of the Digestive Tract Mouth Where teeth, tongue, and salivary glands begin food digestion Pharynx Muscular structure shared by the digestive and respiratory tracts It joins the mouth and nasal passages to the esophagus Esophagus Long muscular tube that passes through the diaphragm into the stomach Stomach Churns and mixes food with gastric secretions until a semiliquid mass called chyme

  3. Anatomy and Physiology of the Digestive Tract Small intestine Chemical digestion and absorption of nutrients take place Approximately 20 feet long and consists of three sections: the duodenum, the jejunum, and the ileum Liver and pancreatic secretions enter the digestive tract in the duodenum

  4. Anatomy and Physiology of the Digestive Tract Large intestine and anus The first section of the large intestine is the cecum Ascending colongoes up right side of the abdomen Transverse colon crosses abdomen just below waist Descending colon goes down left side of abdomen The last 6 to 8 inches of the large intestine is the rectum, which ends at the anus, where wastes leave the body

  5. Age-Related Changes Teeth are mechanically worn down with age The jaw may be affected by osteoarthritis A significant loss of taste buds with age Xerostomia (dry mouth) is common Walls of esophagus and stomach thin with aging, and secretions lessen Production of hydrochloric acid and digestive enzymes decreases Gastric motor activity slows Movement of contents through the colon is slower Anal sphincter tone and strength decrease

  6. Nursing Assessment and Health History ?? Common complaints of GI system Why is past medical history important?? What family history might be relevant?? What are some common questions you need to ask in your review of systems???

  7. Diagnostic Tests & Procedures Gastrointestinal System

  8. Stool Specimens • O&P • OB • Fecal Fat • C & S

  9. RADIOGRAPHIC TESTS • Most common tests: 1) Barium swallow or UGI 2) Small Bowel series 3) Barium enema Others: CTS,US abd. X-rays

  10. ENDOSCOPIC TESTS (for upper GI system) • Esophagoscopy • Gastroscopy • Gastroduodenoscopy • EGD • ERCP

  11. ENDOSCOPIC TESTS ( for lower GI system) • Colonoscopy • Proctoscopy • Sigmoidoscopy

  12. Laboratory Tests • Gastric Analysis • CBC • PT (prothrombin time) • INR • PTT (partial thromboplastin time)

  13. Bilirubin • Blood proteins • Alkaline Phosphatase • LDH • GGT

  14. AST • ALT • Cholesterol & Triglycerides • Amylase • CEA

  15. Abnormal Assessment Findings • Distention • Firmness • Tenderness • Altered bowel sounds

  16. Therapeutic Measures & Related Nursing Interventions With GI Patients

  17. Gavage or Enteral Nutrition (Tube Feedings) • Provide nutritional support through a tube • Short or long term • In conditions that prohibit oral nourishment

  18. Gastric Decompression • Types of tubes ( pg. 780 ) • What is the purpose of gastric decompression? • ??Nursing Interventions??

  19. Types of Tubes • Nasogastric - (NG) • Gastrostomy – (G-tube) • Jejunal – (J-tube) • Percutaneous – (PEG)

  20. Figure 38-6

  21. Total Parenteral Nutrition – (TPN) • Nutritionally complete • Used when GI system not functioning • Short or long term

  22. Figure 38-9

  23. Critical Thinking Exercise A 71 y.o. woman who underwent a bowel resection for the removal of a tumor is receiving TPN through a central venous catheter. The patient’s fingerstick blood glucose is 250 mg/dl, and the patient’s temp is 102 F and the nurse notes puralent drainage at the catheter insertion site.

  24. Pre-Op Nursing Interventions For GI surgery patients

  25. GI tract cleansing • Assess vital signs • Liquids for 24 hrs. or NPO • IV • Antibiotics • NGT insertion

  26. Post-Op Nursing Interventions For GI surgery patients

  27. Relieve pain • Detect complications • Prevent gastric distention • Replace lost fluids • Maintain urine elimination

  28. Digestive Disorders

  29. Medical Anorexia Loss of Appetite Caused by: Nausea, decreased sense of taste or smell, mouth disorders, and medications Emotional problems such as anxiety, depression, or disturbing thoughts

  30. Anorexia Medical diagnosis Physician assesses for malnutrition Weight may be monitored over several weeks Complete history and physical examination Serum hemoglobin, iron, total iron-binding capacity, transferrin, calcium, folate, B12, zinc Thyroid function tests

  31. Anorexia Assessment Record chronic and recent illnesses, hospitalizations, medications, and allergies Female patient’s obstetric history Symptoms: pain, nausea, dyspnea, extreme fatigue The functional assessment reveals patterns of activity and rest, usual dietary patterns, current stressors, and coping strategies—all can affect appetite

  32. Anorexia Interventions Assist with oral hygiene before and after meals Teach proper oral hygiene; refer for dental care Relieve nausea before presenting a meal tray Before serving meal tray, remove bedpans/emesis basins from sight, conceal drains and drainage collection devices, deodorize room if necessary Socialization during mealtime Respect food likes and dislikes Position patient comfortably with easy access to food

  33. Obesity • 20% over ideal body wt. • Morbid obesity= 2X normal body wt.

  34. Complications • CV disease • Diabetes • Respiratory difficulties • Musculoskeletal problems • Emotional and social isolation

  35. Causes • Caloric intake > expenditure • Heredity • Emotional stress/psychosocial factors • Slowed metabolism

  36. Medical Management • Weight reduction diet • Exercise • Medication • Counseling

  37. Surgical Treatment • RNYGBP • VBG • LBP • Liposuction • Dumping Syndrome

  38. Show what you know… List 3 Nursing Diagnosis & related Nursing Interventions for the: OBESE PATIENT

  39. Disorders of the Mouth

  40. Dental Caries • Destructive process of tooth decay • Causes: • Bacteria • Poor oral hygiene

  41. Prevention • Frequent brushing and flossing • Dentist visit 2X/yr • Good nutrition • Fluoride

  42. Treatment • Removal of diseases portion of tooth and filling • May need dentures • If untreated, may lead to periodontal disease

  43. Stomatitis • Inflammation of the oral mucosa • Causes are??? • Treatment is ??? • What is Aphthous Stomatitis?

  44. Herpes Simplex • HSV Type 1 • Vesicles around the mouth & lips • Tx is comfort not curative • Zovarax ointment (antiviral)

  45. Candidiasis • Fungal infection (Thrush) • Candida Albicans • White patches in mouth • Immunosuppression • Abx therapy

  46. DISORDERS OF THE TEETH & GUMS

  47. Periodontal Disease • Gingivitis(inflammation of gums and supporting tissues) • Gums are red, swollen, painful and bleed easily • Cause poor oral hygiene & nutrition

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