Transcript lecture 9: The Gastrointestinal System

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Lecture Note PowerPoint Presentation
The Gastrointestinal
System
23/12/2010
LEARNING OUTCOME 1
Describe age-related changes that affect gastrointestinal
function.
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Gerontological Nursing, Second Edition
Patricia A. Tabloski
GASTROINTESTINAL CHANGES
ASSOCIATED WITH AGING
Begin before age 50
23/12/2010

Changes in the mouth
 Decreased esophageal motility
 Reduced peristalsis
 Diminished ability of gastric mucosa to resist damage
 Decreased production of intrinsic factor
 Reduced intestinal absorption and blood flow


Intrinsic factor (IF) also known as gastric intrinsic factor (GIF) is a glycoprotein
produced by the parietal cells of the stomach. It is necessary for the absorption of vitamin
B12 later on in the terminal ileum
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FIGURE 20-1
NORMAL CONFIGURATION OF THE GI TRACT.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
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GASTROINTESTINAL CHANGES
ASSOCIATED WITH AGING
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Begin before age 50
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Decreased pancreas size
Increased incidence of cholelithiasis, decreased
production of bile synthesis
Decreased liver size and blood flow
Decreased thirst and hunger
Increased medication use
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Gerontological Nursing, Second Edition
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LEARNING OUTCOME 2
Describe the impact of age-related changes of
gastrointestinal function.
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AGING AND THE GASTROINTESTINAL
SYSTEM
23/12/2010
Aging has limited impact on system
 Aging associated with increased prevalence of
many GI disorders
 Evaluate disorders closely

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Gerontological Nursing, Second Edition
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FIGURE 20-2
NORMAL CHANGES
OF AGING RELATED TO THE GASTROINTESTINAL TRACT.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
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DYSPHAGIA
23/12/2010
Number-one esophageal disorder in older people
 Impacts oral intake
 Seen in 50% of institutionalized persons

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Gerontological Nursing, Second Edition
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DYSPHAGIA
Causes
Poor tongue control
 Poor preparation of food bolus for swallowing
 Poor dentition: pertains to the development of teeth
and their arrangement in the mouth
 Lack of saliva
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Gerontological Nursing, Second Edition
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DYSPHAGIA
Signs and symptoms
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Reports of difficulty swallowing
Difficulty controlling food or saliva in mouth
Facial droop
Dementia, frailty, confusion
Inability to sit upright
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Gerontological Nursing, Second Edition
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DYSPHAGIA
Signs and symptoms
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Choking or coughing while eating
Increased oral or nasal congestion after meals
Weak voice or slurred speech
Recurrent upper respiratory infections
Unexplained weight loss
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Gerontological Nursing, Second Edition
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DYSPHAGIA
Risk factors
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Incorrect positioning
Inappropriate intake
Rapid feeding
Older persons labeled as “difficult”
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Comorbidities
Neurological disorders
 Muscular disorders
 Anatomical abnormalities

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DYSPHAGIA
Nursing assessment

Observation of individual during eating and drinking
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Gerontological Nursing, Second Edition
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DYSPHAGIA
Nursing assessment

Question patient concerning
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Choking
 Dry mouth
 Excess saliva
 Inability to control food in mouth
 Spitting up after meals
 Need to frequently clear throat
 Difficulty sitting up during mealtimes
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Gerontological Nursing, Second Edition
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DYSPHAGIA
Nursing interventions
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Minimize distractions while eating
Use consistent feeding techniques
Proper positioning during mealtime
Monitor respirations during feeding
Provide oral hygiene before and after eating
Offer intake consistencies as recommended
Do not forcefully feed
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Gerontological Nursing, Second Edition
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GASTROESOPHAGEAL REFLUX DISEASE
23/12/2010
Caused by weakness of esophageal sphincter
 Increased incidence of hiatal hernia
 Risk factors

Aging
 Thyroid disease
 Scleroderma or connective tissue disorders
 Diabetes

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Gerontological Nursing, Second Edition
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GASTROESOPHAGEAL REFLUX DISEASE
Risk factors
Aging
 Thyroid disease
 Scleroderma or connective tissue disorders
 Diabetes
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Gerontological Nursing, Second Edition
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GASTROESOPHAGEAL REFLUX DISEASE
Signs and symptoms
Heartburn
 Indigestion
 Belching:(also known as burping, ructus, or eructation) involves
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23/12/2010
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the release of gas from the digestive tract (mainly esophagus and
stomach) through the mouth.
Hiccups
 Regurgitation of gastric contents
 Voice hoarseness

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Gerontological Nursing, Second Edition
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GASTROESOPHAGEAL REFLUX DISEASE
Triggers
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Eating large meals
Certain medications
High-fat foods
High caffeine intake
Alcohol and tobacco use
Reclining after eating
Obesity
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Gerontological Nursing, Second Edition
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GASTROESOPHAGEAL REFLUX DISEASE
23/12/2010
Consequences for GERD
 Nursing assessment of GERD
 Diagnostic testing

Barium swallow
 Endoscopy
 Esophageal contents pH

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GASTROESOPHAGEAL REFLUX DISEASE
Goals of treatment
Symptom control
 Heal mucosal injury
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Gerontological Nursing, Second Edition
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GASTROESOPHAGEAL REFLUX DISEASE
Lifestyle modifications
Elevate head of bed
 Reduce portion size
 Avoid trigger foods
 Drink 6 to 8 ounces of water with medications
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Gerontological Nursing, Second Edition
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GASTROESOPHAGEAL REFLUX DISEASE
Lifestyle modifications
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Report all medications to physician
Avoid tight-fitting clothes and girdles(belt-shaped
textile)
Remain upright after meals for 1 to 3 hours
Avoid right side-lying position
Stop smoking
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GASTROESOPHAGEAL REFLUX DISEASE
Medications
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Antacids
Aluminum-containing antacids
Histamine 2 receptor agonists
Proton pump inhibitors
Combination drugs
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Surgery
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Gerontological Nursing, Second Edition
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GASTRIC DISORDERS
Gastritis
Inflammation of the gastric mucosa
 Classification

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Severity
 Site involvement
 Inflammatory cell type


Diagnosis

Endoscopy
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Gerontological Nursing, Second Edition
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GASTRIC DISORDERS
Gastritis

Treatment
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Reducing contributing factors
 Acid neutralization and suppression
 Protection of gastric mucosa
 Antibiotic therapy
 Transfusions as needed
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Gerontological Nursing, Second Edition
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GASTRIC DISORDERS
Peptic and duodenal ulcer disease
An excoriated area of the gastric mucosa
 Signs and symptoms
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Bleeding
 Positive fecal occult blood test
 Pain
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Diagnosis
H. pylori breath test
 Endoscopy
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Gerontological Nursing, Second Edition
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GASTRIC DISORDERS
Peptic and duodenal ulcer disease

Treatment
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Discontinue use of NSAIDs, alcohol, tobacco, and caffeine
 Small, frequent meals
 Medications
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Gerontological Nursing, Second Edition
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GASTRIC DISORDERS
Zollinger-Ellison syndrome
Caused by a gastrin-producing tumor
 Characterized by gastric hypersecretion and peptic
ulceration
 Treatment may include tumor removal and surgical
resection
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Gerontological Nursing, Second Edition
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GASTRIC DISORDERS
Gastric volvulus
Turning, twisting, or telescoping of the stomach onto
or into itself
 Symptoms

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
Acute pain
 Shock and hypotension
 Abdominal distention
 Inability to vomit
 Dyspnea
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Gerontological Nursing, Second Edition
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LOWER GASTROINTESTINAL TRACT
DISORDERS
Diverticular disease
Saclike mucosal projections protrude through
muscular layer of GI tract
 Projections may trap feces resulting in inflammation,
infection, and rupture
 Seen most in sigmoid and descending colon
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LOWER GASTROINTESTINAL TRACT
DISORDERS
Diverticular disease

Risk factors
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
Physical inactivity
 Constipation
 Obesity
 Smoking
 NSAID therapy


Management

Increase fiber intake
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LOWER GASTROINTESTINAL TRACT
DISORDERS
Diverticulitis
Normal bowel flora and fecal material becomes
trapped in pouches resulting in inflammation,
infection, and obstruction
 Signs and symptoms

23/12/2010

Fever
 Leukocytosis
 Pain or abdominal tenderness

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Gerontological Nursing, Second Edition
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LOWER GASTROINTESTINAL TRACT
DISORDERS
Assessment of diverticular disease
Physical examination
 Questions regarding bowel history
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Diagnosis
Abdominal CT scan
 Ultrasound

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Gerontological Nursing, Second Edition
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LOWER GASTROINTESTINAL TRACT
DISORDERS
Goals of treatment
Eliminate bacterial infection
 Liquid diet advancing to low fiber to allow colon to
rest
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Gerontological Nursing, Second Edition
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INFLAMMATORY BOWEL DISEASE
Ulcerative colitis
Chronic inflammatory process
 Impacts superficial layers of colon walls
 Wide spread ulceration of colon walls
 Signs and symptoms

23/12/2010
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Bloody diarrhea
 Lower left quadrant abdominal pain
 Weight loss

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Gerontological Nursing, Second Edition
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INFLAMMATORY BOWEL DISEASE
Ulcerative colitis

Diagnosis
23/12/2010
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Sigmoidoscopy
 Colonoscopy
 Rectal mucosa biopsy
 Stool specimens
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Treatment
Oral corticosteroids
 5-ASA drugs
 Surgery
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Gerontological Nursing, Second Edition
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INFLAMMATORY BOWEL DISEASE
Crohn’s disease
Chronic inflammatory disorder of the terminal ileum or
colon
 Characterized by inflammation, linear ulcerations, and
granulomas
 Signs and symptoms

23/12/2010

Diarrhea
 Fever
 Abdominal pain
 Weight loss
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Gerontological Nursing, Second Edition
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INFLAMMATORY BOWEL DISEASE
Crohn’s disease

Diagnosis
23/12/2010
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Abdominal CT scan
 Complete blood cell count
 Barium enema colonoscopy
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
Treatment
Oral corticosteroids
 Surgery
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Gerontological Nursing, Second Edition
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BENIGN AND MALIGNANT TUMORS
23/12/2010
Benign tumors or polyps seen in 75% of persons
over age 50
 Predisposing factors

Age
 Diet
 Family history
 Prior diagnosis polyps

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BENIGN AND MALIGNANT TUMORS
Malignant tumor
2nd most common malignancy in the United States
 Increase incidence with age
 Predisposing factors
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23/12/2010

Family history
 Inflammatory bowel disease
 History of colorectal tumors
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Gerontological Nursing, Second Edition
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BENIGN AND MALIGNANT TUMORS
Malignant tumor

Signs and symptoms
23/12/2010
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Change in bowel habits
 Abdominal pain
 Abdominal mass
 Anemia
 Rectal bleeding
 Weight loss

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Gerontological Nursing, Second Edition
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BENIGN AND MALIGNANT TUMORS
Malignant tumor
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Diagnostic testing
23/12/2010

Colonoscopy
 Carcinoembryonic antigen levels
 Sigmoidoscopy
 Fecal occult blood testing


Treatment

Surgical resection
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ANTIBIOTIC THERAPY ASSOCIATED
DIARRHEA AND COLITIS
23/12/2010
Occurs during or shortly after administration of
antibiotics
 Caused by Clostridium difficile cytoxin, causing
bowel inflammation and epithelial necrosis
resulting in diarrhea and postmembranous colitis

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Gerontological Nursing, Second Edition
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ANTIBIOTIC THERAPY ASSOCIATED
DIARRHEA AND COLITIS
Signs and symptoms
Watery, nonbloody diarrhea
 Low abdominal pain
 Fever
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23/12/2010
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Potential complications
Dehydration
 Hypotension
 Colonic perforation
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ANTIBIOTIC THERAPY ASSOCIATED
DIARRHEA AND COLITIS
Diagnosis
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
Stool perforation
23/12/2010
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Treatment
Metronidazole
 Vancomycin

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CONSTIPATION
Definitions
Infrequent defecation
 Hardened or reduced caliber of stool
 Sensation of incomplete evacuation or need to strain
with stools
 Three bowel movements or less per week
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CONSTIPATION
Predisposing factors
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Aging
Certain medications
Metabolic and endocrine disorders
Muscular dystrophy
Neurologic disorders
Recent abdominal surgery
Obstructive disorders
23/12/2010
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CONSTIPATION
Complications
Abdominal discomfort
 Loss of appetite
 Nausea and vomiting
 Excessive straining
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23/12/2010
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Hemorrhoids, anal fissures, and rectal prolapse
Intestinal obstruction
 Colonic ulceration
 Overflow incontinence with stool leakage
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Gerontological Nursing, Second Edition
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CONSTIPATION
Assessment
Evaluate complaint
 Management
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23/12/2010
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Education
 Hydration
 Increased mobility
 Fiber supplementation
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Gerontological Nursing, Second Edition
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CONSTIPATION
Assessment

Management
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23/12/2010
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Medication
 Bulk laxative
 Stool softeners
 Osmotic laxatives
 Magnesium containing laxatives
 Senna
 Suppositories and enema
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Gerontological Nursing, Second Edition
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DIARRHEA
Defined as abnormally loose stool accompanied
by change in frequency or volume
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DIARRHEA
Causes
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Virus
Food poisoning
Food contamination
Medications
Lactose intolerance
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DIARRHEA
Symptoms
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Urgency
Cramping
Bloating
Incontinence
Pain on defecation
Presence of blood in stool
23/12/2010
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Gerontological Nursing, Second Edition
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DIARRHEA
Assessment
Interview
 Physical examination
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23/12/2010
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Management
Antidiarrheal agents
 Soluble fiber
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FECAL INCONTINENCE
23/12/2010
Seen in 50% of institutionalized elderly
 Cause

Mobility problems
 Severe depression
 Cognitive impairment

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HEMORRHOIDS AND RECTAL BLEEDING
23/12/2010
Hemorrhoids and colorectal cancer most common
causes of rectal bleeding
 Hemorrhoids are varicose of anorectal junction
 Treatment based upon size

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LIVER AND BILIARY DISORDERS
Signs and symptoms
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Older adults often present with vague, ambiguous
symptoms
Fatigue
Weight loss
Anorexia
Malaise
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LIVER AND BILIARY DISORDERS
23/12/2010
Risk of disease increases with aging
 Hepatitis A
 Hepatitis B
 Hepatitis B and C
 Hepatic cysts

Common in older adults
 Typically benign

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LIVER AND BILIARY DISORDERS
Hepatic cysts
Common in older adults
 Typically benign
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23/12/2010
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LIVER AND BILIARY DISORDERS
Metastatic carcinoma
Most common liver cancer
 Highest rates in those aged 50–70
 Associated with alcohol and tobacco use

23/12/2010
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LIVER AND BILIARY DISORDERS
Metastatic carcinoma

Signs and symptoms
23/12/2010

Jaundice
 Variceal bleeding
 Ascites
 Right upper quadrant pain
 Weight loss
 Enlarged liver

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LIVER AND BILIARY DISORDERS
Metastatic carcinoma

Diagnostic tests
23/12/2010

Liver function tests
 Abdominal ultrasound
 CT scan
 Liver biopsy


Treatment based upon tumor stage and patient’s
health status
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LIVER AND BILIARY DISORDERS
Gallstones
Increased incidence with age
 1:3 people over age 70 have gallstones
 Symptoms

23/12/2010

Right upper quadrant pain
 Gas
 Distention
 Nausea and vomiting

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LIVER AND BILIARY DISORDERS
Gallstones

Diagnostic testing
23/12/2010

Abdominal CT scan
 Ultrasound


Treatment
Laparoscopic cholecystectomy
 Pharmacological dissolution
 Extracorporeal shock wave lithotripsy
 Dietary modifications

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LIVER AND BILIARY DISORDERS
Pancreatitis

Acute pancreatitis

23/12/2010

Symptoms
 Epigastric pain
 Nausea and vomiting
 Elevated serum liver function studies




Amylase
Lipase
Bilirubin
Alkaline phosphatase
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Gerontological Nursing, Second Edition
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LIVER AND BILIARY DISORDERS
Pancreatitis

Acute pancreatitis

23/12/2010

Treatment
 Nasogastric suction
 Pain management
 Hyperalimentation
 Fluid replacement
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LIVER AND BILIARY DISORDERS
Pancreatitis

Chronic pancreatitis
23/12/2010

Symptoms
 Weight loss
 Diarrhea
 Diabetes
 Persistent pain
 Treatment
 Behavior modification
 Surgery

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23/12/2010
LEARNING OUTCOME 3
Identify risk factors to health for the older person with
gastrointestinal problems.
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MEDICATIONS WITH POTENTIAL TO
AFFECT THE GASTROINTESTINAL TRACT
Anticholinergics
Antidepressants
 Neuroleptics
 Antihistamines
 Antiparkinsonian agents

23/12/2010
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MEDICATIONS WITH POTENTIAL TO
AFFECT THE GASTROINTESTINAL TRACT
Antihypertensives
Calcium channel blockers
 ACE inhibitors
 Diuretics

23/12/2010

Iron and calcium supplements
 Aluminum-containing antacids
 Opiates
 Laxatives

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MEDICATIONS AS RISK FACTORS FOR
ESOPHAGEAL INJURY
23/12/2010
Nonsteroidal anti-inflammatory drugs (NSAIDs)
 Potassium chloride
 Tetracycline
 Quinidine
 Alendronate
 Ferrous sulfate
 Theophylline

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RISK FACTORS FOR DYSPHAGIA IN
INSTITUTIONALIZED OLDER PERSONS
23/12/2010
Inappropriate positioning for mealtimes
 Inappropriate feeding of foods and liquids

Thin food and liquids difficult to swallow
 Thickened liquids slow the swallow process

Too-rapid feeding of at-risk patients
 Residents labeled as “difficult” or “uncooperative”

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Gerontological Nursing, Second Edition
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GERD RISK FACTORS
Primary


Length and frequency of esophageal acid exposure
23/12/2010

Others
Thyroid disease
 Diabetes
 Scleroderma
 Connective tissue disorders

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Gerontological Nursing, Second Edition
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RISK FACTORS FOR LARGER ULCERS
23/12/2010
Higher doses of NSAIDs
 History of peptic ulcer disease
 Concurrent use of anticoagulants

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Gerontological Nursing, Second Edition
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LIFESTYLE FACTORS CONTRIBUTE TO RISK
OF DIVERTICULOSIS
Inadequate dietary fiber intake
23/12/2010
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Gerontological Nursing, Second Edition
Patricia A. Tabloski
PREDISPOSING FACTORS FOR BENIGN
TUMORS
23/12/2010
Age
 Diet
 Family history
 Prior diagnosis of polyps

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Gerontological Nursing, Second Edition
Patricia A. Tabloski
C. DIFFICILE-INDUCED DIARRHEA AND
COLITIS
23/12/2010
Recent surgery
 Nasogastric or gastric intubation
 Antibiotics
 Common in older persons receiving treatment in
hospitals or residing in nursing homes

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Gerontological Nursing, Second Edition
Patricia A. Tabloski
DRUGS COMMONLY ASSOCIATED WITH
DIARRHEA
23/12/2010
Nonsteroidal anti-inflammatory drugs (NSAIDs)
 Magnesium-containing antacids
 Antiarrhythmics
 Beta-blockers
 Quindine
 Colchicines
 Digoxin

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Gerontological Nursing, Second Edition
Patricia A. Tabloski
RISK FACTORS FOR CONSTIPATION

23/12/2010
Dehydration
 Side effects of medications

Anticholinergic side effects
Antidepressants
 Neuroleptics
 Antihistamines
 Antiparkinsonian agents

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Gerontological Nursing, Second Edition
Patricia A. Tabloski
RISK FACTORS FOR CONSTIPATION
Side effects of medications

Selected antihypertensive agents
23/12/2010

Calcium channel blockers
 ACE inhibitors
 Diuretics

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Gerontological Nursing, Second Edition
Patricia A. Tabloski
RISK FACTORS FOR CONSTIPATION
Side effects of medications






Iron supplements
Calcium supplements
Aluminum-containing antacids
Benzodiazepines
Antiarrhythmics
Opiates
23/12/2010

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Gerontological Nursing, Second Edition
Patricia A. Tabloski
RISK FACTORS FOR CONSTIPATION





23/12/2010
Insufficient fiber intake
 Cognitive impairment and immobility
 Physical illness

Metabolic/endocrine disorders
Muscular dystrophy
Neurological disorders
Recent abdominal surgery
Obstructive disorders
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Gerontological Nursing, Second Edition
Patricia A. Tabloski
RISK FACTORS FOR FECAL INCONTINENCE
23/12/2010
Dementia
 Depression
 Chronic pain
 Lack of mobility
 Lack of sensation

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Gerontological Nursing, Second Edition
Patricia A. Tabloski
FACTORS THAT INCREASE RISK FOR
PANCREATITIS
23/12/2010
Gallstones
 Hyperlipidemia
 Hypercalcemia

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Gerontological Nursing, Second Edition
Patricia A. Tabloski
FACTORS THAT INCREASE RISK FOR
PANCREATITIS
Medications
Estrogen
 Furosemide
 ACE inhibitors
 Mesalamine

23/12/2010

Alcohol abuse
 Cancer

87
Gerontological Nursing, Second Edition
Patricia A. Tabloski
23/12/2010
LEARNING OUTCOME 4
Describe unique presentations of gastrointestinal
problems in the older person.
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Gerontological Nursing, Second Edition
Patricia A. Tabloski
PRESENTATION OF GI DISORDERS IN THE
OLDER ADULT

23/12/2010
Present with different symptoms than the
younger adult
 Peptic ulcer disease

Impaired visceral pain perception

Longer to recognize and report pain
Symptoms for gastric disorders tend to be vague
 Symptoms may be attributed as a normal agerelated change

89
Gerontological Nursing, Second Edition
Patricia A. Tabloski
OTHER DISORDERS RESULTING IN GI
SYSTEM CHANGES
23/12/2010
Diabetes
 Neurological illness
 Vascular disorders

90
Gerontological Nursing, Second Edition
Patricia A. Tabloski
23/12/2010
LEARNING OUTCOME 5
Define appropriate nursing interventions directed
toward assisting the older adult with gastrointestinal
problems to develop self-care abilities.
91
Gerontological Nursing, Second Edition
Patricia A. Tabloski
PATIENT EDUCATION NEEDS
23/12/2010
Presentation and reporting of symptoms of GI
problems in the older adult
 Impact of select medications on the GI system
 Safe and appropriate use of prescribed
mediations
 Recommended health screenings for the GI
system

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Gerontological Nursing, Second Edition
Patricia A. Tabloski
LIFESTYLE MODIFICATION FOR GERD
23/12/2010
Lose weight as appropriate
 Avoid tight clothing
 Remain in upright position after eating
 Reduce alcohol, caffeine, and fat intake

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Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING DIAGNOSES FOR PATIENTS WITH
GERD
23/12/2010
Impaired swallowing
 Impaired skin integrity
 Impaired social interaction (if appropriate)
 Sleep pattern disturbance (if appropriate)
 Acute or chronic pain

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Gerontological Nursing, Second Edition
Patricia A. Tabloski
LIFESTYLE MODIFICATION FOR
PEPTIC/DUODENAL ULCER DISEASE
23/12/2010
Discontinue use of all NSAIDs
 Discontinue use of alcohol, tobacco, and caffeine
 Avoid offending foods

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Gerontological Nursing, Second Edition
Patricia A. Tabloski
LIFESTYLE MODIFICATIONS TO
PREVENT DIVERTICULITIS AND
MANAGE DIVERTICULAR DISEASE
23/12/2010
Increase dietary fiber
 Drink at least 8 full glasses of water per day
(unless contraindicated by other medical
condition)
 Do not ignore the urge to have a bowel movement
 Exercise regularly
 Avoid foods that precipitate painful attacks

96
Gerontological Nursing, Second Edition
Patricia A. Tabloski
EARLY DETECTION AND PREVENTION OF
COLON CANCER
23/12/2010
Annual fecal occult blood testing
 Colonoscopy and sigmoidoscopy screenings

Initially begin with sigmoidoscopy
 Colonoscopy screening should begin at age 50

97
Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING MANAGEMENT OF
CONSTIPATION
Patient education
Dietary intake of fluid and fiber
 Exercise
 Awareness in bowel habits
 Understanding of potential impact of selected
medications

23/12/2010

98
Gerontological Nursing, Second Edition
Patricia A. Tabloski
23/12/2010
LEARNING OUTCOME 6
Identify and implement appropriate nursing
interventions to care for the older person with
gastrointestinal problems.
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Gerontological Nursing, Second Edition
Patricia A. Tabloski
INTERVENTIONS TO PREVENT ASPIRATION
23/12/2010
Minimize distractions during eating
 Provide a pleasant mealtime environment
 Use consistent feeding techniques
 Document patient food preferences and
consumption patterns
 Position patient upright during and 1 hour
following mealtime
 Allow time for swallowing

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Gerontological Nursing, Second Edition
Patricia A. Tabloski
INTERVENTIONS TO PREVENT ASPIRATION
23/12/2010
Monitor respirations
 Provide oral hygiene before and after mealtimes
 Provide meals when patient is rested
 Provide food and fluid of appropriate
consistencies

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Gerontological Nursing, Second Edition
Patricia A. Tabloski
INTERVENTIONS TO PREVENT ASPIRATION
23/12/2010
Never force-feed
 Monitor weight, function status, and patient
satisfaction during meals
 Evaluate swallowing capacity every 6 months
and prn
 Avoid nasogastric tubes

102
Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING DIAGNOSES FOR PATIENTS WITH
DYSPHAGIA
23/12/2010
Impaired Swallowing
 Feeding Self-Care Deficit
 Risk for Fluid Volume Imbalance (Deficit)
 Ineffective Airway Clearance
 Risk for Aspiration
 Altered Dentition (if appropriate)

103
Gerontological Nursing, Second Edition
Patricia A. Tabloski
RELATED FACTORS IDENTIFIED BY
NANDA IN 2003
23/12/2010
Neuromuscular impairment
 Decreased strength or excursion of muscles
involved in mastication
 Perceptual impairment

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Gerontological Nursing, Second Edition
Patricia A. Tabloski
RELATED FACTORS IDENTIFIED BY
NANDA IN 2003
23/12/2010
Mechanical obstruction (edema, tracheostomy
tube, tumor)
 Fatigue
 Limited awareness
 Reddened, irritated oropharyngeal cavity

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Gerontological Nursing, Second Edition
Patricia A. Tabloski
AGGRESSIVE NURSING INTERVENTIONS TO
PREVENT DEHYDRATION
23/12/2010
Frequently assess pulse and blood pressure
 Establish schedule to offer fluids every 15 to 30
minutes
 Measure intake and output
 Assess skin turgor
 Notify primary care provider if dehydration is
imminent

106
Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING INTERVENTIONS FOR FECAL
INCONTINENCE
23/12/2010
Regular toileting program
 Administration of high-fiber diet
 Elimination of medications associated with
diarrhea
 Treatment of infections

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Gerontological Nursing, Second Edition
Patricia A. Tabloski
ENDOSCOPIC GASTROINTESTINAL
PROCEDURES
Esophagogastroduodenoscopy
Restrict intake prior to procedure
 Strong laxative
 Antibiotics for patients at high risk for infection
 Oxygen during tube insertion


23/12/2010

Sigmoidoscopy
Sedation not required
 Phosphate enemas

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Gerontological Nursing, Second Edition
Patricia A. Tabloski
ENDOSCOPIC GASTROINTESTINAL
PROCEDURES
Colonoscopy
1 to 2 days of liquid diet
 Cathartic evening prior
 Monitor patients with cardiovascular or renal
instability

23/12/2010

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Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING DIAGNOSES ASSOCIATED WITH
GASTROINTESTINAL TRACT PROBLEMS
23/12/2010
Imbalanced Nutrition: Less Than Body
Requirements for those with anorexia
 Risk for Infection, for those undergoing
endoscopic examination and needing antibiotic
prophylaxis
 Constipation and Perceived Constipation
 Diarrhea
 Bowel Incontinence

110
Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING DIAGNOSES ASSOCIATED WITH
GASTROINTESTINAL TRACT PROBLEMS
23/12/2010
Risk for Constipation
 Ineffective Tissue perfusion: Gastrointestinal
Tract
 Risk for Aspiration
 Impaired Oral Mucous Membrane
 Social Isolation (if appropriate)
 Noncompliance (if appropriate)

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Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING DIAGNOSES ASSOCIATED WITH
GASTROINTESTINAL TRACT PROBLEMS
23/12/2010
Ineffective Breath Maintenance
 Toileting Self-Care Deficit
 Acute or Chronic Pain Disturbance
 Nausea

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Gerontological Nursing, Second Edition
Patricia A. Tabloski