Chapter 26 Gastrointestinal Conditions

1. Chapter 26Gastrointestinal Conditions

2. Gastrointestinal Problems • Indigestion • Belching • Diarrhea • Constipation • Nausea • Vomiting • Anorexia • Weight gain or loss • Flatulence

3. Factors Influencing Gastrointestinal Tract Health • Poor nutrition • Medications • Emotions • Inactivity • A variety of other factors

4. Causes of Anorexia • Medication side effects • Inactivity • Physical illness • Age-related changes • Anxiety and depression

5. Management of Anorexia • Depending on the cause, treatment could consist: • A high-calorie diet • Referral to social programs • Tube feeding • Hyperalimentation • Psychiatric therapy • Medications

6. Xerostomia (Dry Mouth) • Causes: • Drugs • Sjogren’s syndrome • Mouth breathing • Altered cognition • Interventions: • Sipping water • Hard candies • Saliva substitutes

7. Factors That Could Lead to Poor Dental Status in Elders • Limited funds • Lack of knowledge • Diseases • Fear of Dentists

8. Causes of Dysphagia • Gastroesophageal reflux disease (GERD) • Stroke • Structural disorders

9. Types of Dysphagia • Oropharyngeal • Difficulty transferring food from the mouth into the the pharynx and esophagus. • Esophageal • Difficulty transferring food down the esophagus.

10. Interview Questions for Patients with Dysphagia • When did the problem begin? • What other symptoms accompany the dysphagia? • What types of foods are most problematic? • Is the problem intermittent or present with every meal?

11. Types of Hiatal Hernias • Sliding (axial) • A part of the stomach and the junction of the stomach and esophagus slide through the diaphragm. • Rolling (paraesophageal) • The fundus and greater curvatures of the stomach roll up through the diaphragm.

12. Symptoms of Hiatal Hernias • Heartburn • Dysphagia • Belching • Vomiting • Regurgitation

13. Symptoms of Esophageal Cancer • Dysphagia • Weight loss • Excessive salivation • Thirst • Hiccups • Anemia • Chronic bleeding

14. Factors Contributing to Peptic Ulcers • Stress • Diet • Genetic predisposition • Longevity • More precise diagnostic evaluation • Increasing prevalence of chronic obstructive pulmonary disease

15. Symptoms of Peptic Ulcers • Pain • Bleeding • Obstruction • Perforation

16. Complications of Peptic Ulcers • Constipation or diarrhea caused by antacid therapy • Pyloric obstruction resulting in dehydration, peritonitis, hemorrhage, and shock

17. Factors Causing Stomach Cancer to Be Common Problem in Late Life • Chronic constipation • Obesity • Age-related atrophy of intestinal walls • Low-fiber diet

18. Factors Contributing to Diverticular Disease • Chronic constipation • Obesity • Hiatal hernia • Atrophy of the intestinal wall muscles with aging

19. Medical Management of Diverticular Disease • Increase in dietary fiber intake • Weight reduction • Avoidance of constipation

20. Factors Contributing to Diverticulitis • Overeating • Straining during a bowel movement • Alcohol • Irritating foods

21. Nursing Interventions for Diverticulitis • Acute Phase • Reduce infection. • Provide nutrition. • Relieve discomfort. • Promote rest. • Following Acute Phase • Consume a low-residue diet.

22. Symptoms of Cancer of the Colon • Bloody stools • Change in bowel function • Anorexia • Nausea • Epigastric pain • Jaundice

23. Screening Measures for Colon Cancer • Digital rectal examination • Fecal occult blood testing • Barium enema • Sigmoidoscopy with biopsy

24. Factors Contributing to Chronic Constipation • An inactive lifestyle • Low fiber and fluid intake • Depression • Laxative abuse • Certain medications • Dulled sensations for bowel elimination • Failure to allow sufficient time for complete emptying of the bowel

25. Measures to Promote Bowel Elimination • Scheduling a regular time for it. • Incorporating high-fiber foods into the diet. • Rocking the trunk from side to side and back and forth while sitting on the toilet.

26. Causes of Bowel Obstruction • Cancer of the colon • Diverticulitis • Ulcerative colitis • Hypokalemia • Vascular problems • Paralytic ileus

27. Symptoms of Bowel Obstruction • Small Bowel Obstruction • Upper and midabdominal pain in rhythmic recurring waves; vomiting may occur. • Obstructions Occuring Past the Ileum • Abdominal distension so severe that the raised diaphragm can inhibit respirations. • Vomiting is more severe.

28. Symptoms of Bowel Obstruction (cont.) • Obstruction of the Colon • Lower abdominal pain, altered bowel habits, distension, and a sensation of the need to defecate. Vomiting usually does not occur until late.

29. Possible Causes of Incontinence • Decreased contractile strength • Impaired automaticity of the puborectal and external anal sphincter • Reduced reservoir capacity

30. Symptoms of Pancreatic Cancer • Anorexia • Weakness • Weight loss and wasting • Dyspepsia • Belching • Nausea • Vomiting

31. Symptoms of Pancreatic Cancer (cont.) • Diarrhea • Constipation • Obstructive jaundice • Fever may or may not be present. • Epigastric pain radiating to the back may be experienced.

32. Treatment Measures for Biliary Tract Disease • Nonsurgical Therapies • Rotary lithotrite treatment • Extracorporeal shock wave lithotripsy • Standard Surgical Procedures

33. Source • Eliopoulos, C. (2005).  Gerontological Nursing, (6th ed.).  Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).