Transcript Nursing Assessment of the Gastrointestinal System

Nursing Assessment of the
Gastrointestinal System
Sasha Alexis Rarang, RN, MSN
The digestive system
Structures and Function of the
GastroIntestinal System
Main Function of the GI System?????
Supply Nutrients to body cells
Process of Digestion and Elimination
A.
Ingestion ( Taking In Food)
B.
Digestion ( Breakdown of Food)
C.
Absorption ( transfer of food products into
the circulation)
D.
Elimination
Concepts of Structures and Functions
The GI System consists of the GI tract and its associated organs and glands
A.
GI tract
1. mouth
2. esophagus
3. stomach
4. small intestines
5. large intestines
6. rectum
7. anus
B. Associated organs
1. liver
2. gall bladder
3. pancreas
Mouth

Mouth


Oral or buccal cavity
Chewing
>> break food products into smaller
portions.
>> allows digestion and prevent trauma
to the mucous lining of the
esophagus.
>> person exert 25 to 275 lbs during the
chewing process.
>> Dentures vs. Natural teeth
>> poorly chewed foods are not readily digested.
Saliva



Secreted by the sublingual and
submandibular glands.
Lubricate and softens the food mass
Amylase – breaks down starches to
maltose.
Swallowing
Involves 3 phases
>>oral phase
>>involuntary pharyngeal phase
>>esophageal phase
> The time it takes for the bolus to reach the
stomach depends on the consistency of the
bolus and individual’s position.

Esophagus

Esophagus





A hollow muscular tube
Lies posterior to the trachea and larynx
Serves as a passage for food from mouth to
stomach.
>> upper esophageal sphincter
>> lower esophageal sphincter
Antireflux barrier
Act as a vent for increased intragastric pressure.
stomach
Stomach
Structures
a.1. fundus
a.2. body/central area
a.3. antrum/pyloric region
a.4. cardiac sphincter
a.5. Pyloric sphincter
B. Microscopic Glands ( epithelial lining of the stomach)
b.1. Cardiac glands – mucus
b.2. Peptic (Chief Cells) – mucus and pepsinogen
b.3. Parietal (Oxyntic) – HCl acid and water
protein digestion
intrinsic factor – B12 absorption
b.4. Neck cells – mucus
b.5. Pyloric glands – gastrin and mucus
stimulates HCl acid production
A.
Stomach
C. Functions
c.1. storage, mixing and liquefaction of the
bolus of food into chyme, control of
passage of food into the duodenum.
c.2. first stage of protein breakdown
c.3. mechanical breakdown of food
c.4. absorption of water, alcohol, glucose,
and some drugs.
c.5. protection
Stomach
D. Innervation
d.1. parasympatehetic – vagus nerve
d.1.1. increased gastric secretion
of acid, gastrin and pepsin.
d.1.2. increased gastric acid motor
activity.
d.2. sympathetic – inhibit gastric
secretion and motility.
Stomach
E. Secretions – 1.5L to 3.0.L of gastric juice per day.
e.1. HCl acid, pepsin, and mucus.
e.2. mucin, intrinsic factor, lipase, and
pepsinogen.
e.3. Gastric acid secretion is directly stimulated by
the distention of the stomach and presence of
protein.
e.4. vagal stimulation, acetylcholine, histamine, and
the hormone gastrin.
e.5. gastrin is released when the stomach becomes
distended with food.
Stomach
Stomach
Small intestines
Small Intestine
Structure (22 feet long/1 inch in diameter)
a.1. duodenum
a.2. jejunum
a.3. ileum
B. Function
b.1. completes the digestion of foods
b.2. absorbs the products of digestion
b.3. secretes hormones – control
secretions of bile, pancreatic juice, and
intestinal secretions.
A.
Small Intestine
C. Innervation
c.1. sympathetic – inhibits motility
c.2. parasympathetic – increases intestinal
tone and motility.
D. Secretions
d.1. Brunner’s glands(duodenal) – mucus
d.1.1. glucagon, presence of chyme, and vagal
stimulation.
d.1.2. sympathetic stimulation inhibits secretions of the
glands.
d.2. Goblet cells – mucus
d.3. crypts of Lieberkuhn – secretes an alkaline fluid
d.4. epithelial cells – digestive enzymes
d.4.1. enterokinase – activates trypsin
d.4.2. maltase,lactase, and sucrase – disaccharides
Small Intestine
E. Absorption
e.1. Complex foods are converted into its simplest
forms.
e.1.1. CHO – monosaccharides
e.1.2. CHON – amino acids
e.1.3. Fats – fatty acids,
monoglycerides,
diglycerides and triglycerides.
e.2. Water absorption – 8L/day
e.3. water-soluble vitamins, electrolytes,
minerals.
e.4. B12 absorption takes place in the
ileum
Large intestines
Large Intestines
Structures ( 5-6 feet long)
a.1. Cecum
a.2. Colon
a.2.1. Ascending
a.2.2. Transverse
a.2.3. descending
a.2.4. Sigmoid colon
a.3. Rectum and Anus ( final segments of the large intestine)
B. Function
b.1. absorb the remaining water, urea,and electrolytes.
b.2. secretes mucus
b.3. form and store the feces until defecation
A.
Large Intestine
C. Innervation
c.1. parasympathetic – vagus nerve
increases peristalsis, decrease
tone of the sphincter.
c.2. sympathetic – reduce peristaltic
activity and increase tone of
sphincters.
D. Secretion
d.1. water, mucus, potassium, and bicarbonate –
alkaline solution.
d.2. Mucus – lubricates, allows passage of the
fecal matters, protects the mucosa from
injury.
Rectum
Anus
Associated Organs of the GI
System
Liver
Activities of the tract
A.
Secretion of electrolytes, hormones, and
enzymes
B.
Movement of the Ingested products
C.
Digestion of food and fluids
D.
Absorption of end products into the
bloodstream.
A. Secretion of electrolytes, hormones,
and enzymes
Hormones – gastrin
Electrolytes – H2, Cl, Na, K,
Enzymes – pancreatic lipase, enterokinase,
ptyalin
Movement of the Ingested products
Digestion of food and fluids
Absorption of end products into the
bloodstream
Secretions
Mucous secretions
a. produced throughout the entire length of the
tract.
b. protects and lubricate the walls of the GI tract.
2. Digestive secretions.
a. produced in the mouth, stomach,
duodenunum, and jejunum.
b. break down ingested food so that it can be
absorbed.
1.
Secretion:
Motility
2 types of movement in the GIT
A. Mixing
B.
Propulsion / Peristalsis
****Soft muscle tissues of the GIT****
Digestion and Absorption
Food is broken down into small and simple
compounds enough to be absorbed into the
bloodstream by diffusion or active
transport.
Digestion and secretion
Effects of Aging on the
Gastrointestinal Tract
A.
B.
C.
D.
E.
Teeth may loosen up from the supporting gums and bones.
Decreased output of the salivary glands leads to dryness of mucous
membranes and increased susceptibility to breakdown, difficulty
swallowing and decrease stimulation of the taste buds.
Decreased secretion of digestive enzymes and bile – decrease ability
to digest and absorb food.
>> impaired absorption of fat and fat soluble vitamins
Atrophy of gastric mucosa leads to decrease HCl acid production.
>>decrease iron and B12 absorption – anemia
>>proliferation of bacteria – diarrhea and infection
Decrease peristalsis in the large intestine, decrease muscular tone of
the intestinal wall and decrease abdominal muscle strength –
decrease sensation to defecate and increase incidence of
constipation.
Teeth may loosen up from the supporting
gums

Decreased output of the salivary gland



Dryness of the mucous
membrane
Difficulty swallowing
Decrease stimulation of the
taste buds
Effects of aging on the gastrointestinal tract
Decreased secretion of digestive enzymes and
bile – decrease ability to digest and absorb
food.
Ex.
Impaired absorption of fat and fat soluble
vitamins
Effects of aging on the GI tract
> Atrophy of gastric mucosa leads to decrease
HCl acid production
Assessment of the GI System
Assessment of the GI System
A.
Past Health History
a.1. history or existence of ;
> abdominal pain
> nausea and
> diarrhea
> abdominal distention
> anemia
> dyspepsia
> hematemesis
> allergies
> excessive gas
> melena
> rectal bleeding
vomiting
> constipation
> jaundice
> heartburn
> changes in
appetite
> food intolerance
> indigestions
> bloating
> hemorrhoids
Assessment….
B. Medications:
b.1. past and current use of medications
b.1.1. OTC drugs
b.1.2. prescription drugs
b.1.3. herbal products and nutritional
supplements.
b.2. hepatotoxic, diarrhea, GI bleeding
C. Surgeries and other treatments
c.1. information about hospitalizations for
any problems related to GI
system
Functional Health Assessment
Assessment…Objective Data
A.
Inspection
a.1. Lips – symmetry, color and size
observe for abnormalities – pallor or
cyanosis, cracking, ulcers, or fissures.
a.2. Tongue – color, fissures, deviation
and lesions
a.3. Buccal Mucosa – color and lesions and
distinctive breath odors
a.4. teeth and gums – caries, loose teeth,
abnormal shape and position of the
teeth,
presence of swelling , bleeding,
discoloration.
Assessment….
a.5. Abdomen
a.5.1. Skin changes ( color, texture, scars,
striae, dilated veins, rashes, and
lesions.)
a.5.2. umbilicus – location and contour
a.5.3. symmetry
a.5.4. contour – flat, rounded, distended.
a.5.5. observable masses – hernias and other
masses.
a.5.6. movement – observable peristalsis and
pulsation.
Assessment: Inspection (Skin changes)
Assessment
Quadrants of the Abdomen
AbdominalDraping
distention;
dilated
veins
the Abdomen
Obese abdomen
Hepatomegaly
ascites
Umbilical Hernia
Pregnancy
Assessment….
B. Auscultation (done before percussion and palpation)
b.1. listening for increased or decreased bowel
sounds.
b.2. diaphragm of the stethoscope – bowel sounds
are
high pitched, occur 5-35x per
minute.
b.3. warm up stethoscope in the hands to prevent abdominal muscle
contraction.
b.4. listen for BS for 2-5 minutes. Absent BS
means no sounds for 5
minutes on each
quadrant.
C. Percussion
c.1. purpose??? Determine the presence of fluid, distention, and masses.
Presence of air –
tymphany,
fluid or masses – dull sounds
Auscultation: Listen for…….
Increased or decreased bowel
sounds
Normoactive, hypoactive,hyperactive,
or absent
Listen with the diaphragm side of
the stethoscope
BS are high pitched sounds,
3-5x a minute
Warm up the stethoscope in the
hands to avoid undue
abdominalmuscle contraction
Listen for BS for 2-5 minutes on
each quadrant
Absent BS means no sounds for 5
minutes.
Assessment: Percussion
Purpose?????
Determine the presence of fluid,
distention, and masses
Tymphany is normally present in
most areas of the abdomen
Dullness!!!!! Ac lue to an underlying
mass
Assessment: Palpation
Light palpation – 1cm deep
Look for area of tenderness
Look for patient’s facial expression and guarding
Deep palpation
Delineate body abdominal organs
Use two-hand method
Diagnostic Studies
Upper GI Series or Barrium Swallow
> X-ray study with fluoroscopy with contrast medium
> used to diagnose structural abnormalities of the
esophagus, stomach, and duodenal bulb
>NPO for 8-12 hours
> pt. will drink contrast medium
> give pt. laxatives and fluid to prevent contrast medium
impaction.
> the stool may be white up to 72 hours after the test
B. Small Bowel Series – same as upper GI series
A.
Diagnostic tests
C. Lower GI or Barium Enema
> Fluoroscopic examination of the colon using contrast medium
w/c is administered rectally.
> administer laxatives and enemas the night
before the
procedure.*****CLEAR****
> clear liquid diet the night before.
> NPO for 8 hours before the procedure.
> cramping and urge to defecate may occur.
> explain that pt will be assuming various position in tilt table.
> give laxatives, fluids to assist in expelling barium.
Diagnostic tests
C. Ultrasound
> noninvasive procedure uses high frequency soundwaves to visualize
the solid organs.
> NPO 8-12 hours
D. CT-Scan –
> non invasive radiologic examination that combines x-ray machine
and computer.
E. MRI
> non invasive procedure using radiofrequency waves and magnetic
field
> NPO for 6 hours
> C/I in pt with metal implants or who is pregnant
Diagnostic tests
End of Topic