THE DIGESTIVE SYSTEM

1. THE DIGESTIVE SYSTEM

2. Terms Nutrients – basic components of food (45 known components) Mastication – chewing Peristalsis – squeezing action that helps propel food through the gastrointestinal (GI) Tract Chyme – food that has been churned to liquid by the stomach acids ‘Nutrition’ – sum of the processes by which a person takes in and uses food substance Kilocalorie (also coined ‘Calorie’) – amount of heat needed to raise 1 kilogram of water 1 degree Celsius *it is 1000 times larger than a Calorie 1gm CHO = 4 kilocalories of energy 1gm Fat = 9 kilocalories of energy 1gm Protein = 4 kilocalories of energy Water, vitamins and minerals Do Not yield energy (1gm Alcohol generates 7 kilocalories of energy but has no nutritional value

3. Digestion – process of breaking down food and nutrients into simple substances so that they can be absorbed 2 types: Mechanical – converting food to liquid form Chemical – liquid is mixed with acids and enzymes to form simple substances, which can be absorbed by the cells

4. FYI What would dinner look like without a uvula? The small cone-shaped thing that hangs down from the top of your throat keeps food from coming out your nose when you eat.

5. Tongue – 9,000 taste buds Taste and smell of foods trigger the salivary glands to produce saliva, (containing the enzyme, salivary amylase) which begins the process of digestion by converting food into a ball called a bolus.

6. The tongue propels the bolus to the back of the throat passed the pharynx (back wall), and passed the larynx (voice box). The epiglottis flops down over the trachea (to prevent food from getting into the lungs). The bolus continues down the esophagus, propelled by muscular action to the stomach.

7. Food enters the stomach through the Cardiac Sphincter The stomach churns the bolus into liquid (called chyme) with the help of hydrochloric acid and an enzyme called pepsin. Stomach acid also kills bacteria that may contaminate foods.

8. Small Intestines – length approx. 30 feet • 95% of food absorption takes place in the • small intestine • takes food 5 – 14 hours to travel through • the GI tract • 3 parts: Duodenum (12 inches) • Jejunum (4 feet long) • Ileum (stretches to 20 feet long) The chyme is further broken down by the small intestines with the help of 3 pancreatic enzymes and bile from the gall bladder. Once food is in small enough particles, it is absorbed through the villi in the small intestines and into the blood stream where it then goes to feed body cells.

9. Liver Functions: Makes bile, which aids in FAT digestion Controls blood clotting Detoxifies the body when drugs or harmful substances are ingested Stores sugar in the form of Glycogen Stores Fat-soluble Vitamins A,D,E,K

10. Gall bladder Function: Stores Bile. Bile is ejected into the small intestines when fatty foods are ingested

11. The Pancreas secretes 3 enzymes to finish the breakdown of Chyme into an absorbable form by the blood stream. Enzymes: Amylase (for starch breakdown) Lipase (for fat breakdown) Protease (for protein breakdown)

12. The large intestine is 3 ½ feet long • It is made up of 5 parts: • Ascending colon • Transverse colon • Descending colon • Sigmoid colon • Rectum • Anus • Functions of the Large Intestine: • Water absorption • Processes B vitamins and • Vitamin K (necessary for • clotting) • Forms wastes called feces

13. It was once thought that in ancient times, the Appendix was used to digest tough foods like tree bark. Scientists believe that eventually the appendix will disappear from the body.

14. Nutrition – the processes involved in the ingestion, digestion, absorption, and use of foods and fluids by the body Good Nutrition is needed for: Growth Healing Maintaining body functions

16. Fluid Balance: 2000 – 2500cc per day Water Retention = EDEMA Water Loss = DEHYDRATION

17. Intake = Water Juice Milk Coffee/Tea Ice-cream Jell-O custard IV fluids Blood products Tube feedings Soup Output = Urine Vomit Liquid diarrhea Sweat Nasogastric drainage Any fluids drained from the body Loss of blood INTAKE AND OUTPUT (I & O)

18. Fluids are measured in cc’s or ml’s 1 teaspoon= 5cc/5ml 1 ounce = 30cc/30ml

19. Weight is measured in kilograms (kg) 1kg = 2.2# 100# = 100/2.2 = ?

20. FACTS: • US life expectancy exceeds 70 years • 1:3 in the US are overweight • 1/3 of the people in the US eat an Inadequate Diet • Fat, Cholesterol, Sodium and Sugar intakes exceed the recommended amount

21. Factors Affecting Nutrition • Culture • Ethnicity • Religion • Regional Influences • Family • Friends • Media • Emotions • Aging • Illness

22. Major Causes of Death in the US: Heart Disease, Cancer, Strokes Factors Contributing to Disease: Unhealthy lifestyle choices Poor nutrition choices Inability to cope with stress Inactivity Poor environmental quality – pollutants in the air and water Inadequate health care Heredity

23. Aging and Diet • Taste an smell decline • Decreased saliva • Increased dental disease • Decreased hydrochloric acid produced • Decreased muscle tone in the intestines

24. Body/Nutritional results in Aging • Dry, coarse hair and skin • Changes in mental status • Osteoporosis and more prone to fractures • Iron deficiency anemia • Thiamin deficiency from poor food absorption (leading to heart damage, weakness, confusion)

25. Meeting Food and Fluid Needs • Assist with oral hygiene, make sure dentures are in place • Make sure eye glasses are clean and on • Make sure hearing aid is in and turned on • Make sure resident is clean and dry • Make sure the right tray, right diet is given to the resident • Position the person properly for eating - as high as possible • Assist residents who are weak by setting up their tray and/or assisting with feeding • Serve meals promptly – warm food if necessary • Prevent distractions during meals – quiet and calm mannerisms • Give the person time to chew and swallow

26. Assist the visually impaired by describing location of foods using the hands of a clock • Sit facing the person • Offer fluids frequently • When feeding, the spoon should be only 1/3rd full. Watch resident for ‘pocketing’. • Feed persons with paralysis on their strong side for proper swallowing • Engage in pleasant conversation during the meal • Watch for signs of Aspiration/choking: sudden cough, red face, difficulty breathing • Upon completion of the meal, record the amount of intake by % ingested.

27. Gastrostomy Tube

28. Enteral Nutrition • The person with a feeding tube (nasogastric or gastrostomy tube) is usually NPO (i.e. nothing by mouth) • Lubricate lips frequently and provide frequent mouth care • Tell the nurse if the pump alarm is going off. Do not turn off the pump. Tubes must be flushed to keep them from blocking up. • Keep the resident’s head elevated at least 30 degrees during feeing infusions, and for at least 1 hour after the infusion has completed to prevent aspiration. Avoid turning the patient on his left side. • The dressing on the abdomen is changed daily. All crusting around the opening should be removed with soap and water • Do not kink the tubing. Make sure it is not lying underneath the resident. • Watch for signs and symptoms of complications: SOB, nausea/vomiting, distension (swollen, enlarged abdomen), coughing and/or congestion, redness, drainage, odor or pain from the gastrostomy site, elevated temperature

29. Special Diets • Diabetic Patients: Serve meals and snacks on time Report if resident refuses to eat or eats very little • Sodium restricted diets: Measure I & O Give only amount fluid ordered Do not add salt to foods unless it is a salt substitute Report signs of edema • Edentulous Diet: pureed diets • Dysphagia Diet: Residents will have ‘thickened only’ liquids on their tray. Mix powder in their drinks to thicken the consistency. Use a spoon to give liquids, and feed the resident on the un-paralyzed side

30. Urinary Care

31. Care of Foley Catheters • Keep the drainage system below waist level • Hang the drainage system to the bed frame not the bed rails • Tubing should not lie under the resident. Do not pull or tug the tubing. • Bags are emptied before dressing the resident and at the end of the shift. Thread the bag through the bottom of the clothing. Hang the bag from the crossbars of the wheelchair. • Record Output if the resident is on I & O • Wear gloves. Place a paper towel on the floor. Put the graduate on the paper towel. Clean off the end of the tube with alcohol prior to draining it into the graduate. Emply the urine without touching the sides of the graduate. Wipe the drainage end again with alcohol after clamping the tube. Reinsert it into the jacket.

32. Recording Stool or Urinary Output • Amount • Consistency • Color • Frequency • Odor