Transcript Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 28

Medical-Surgical Nursing: An
Integrated Approach, 2E
Chapter 28
NURSING CARE OF
THE CLIENT:
GASTRO-INTESTINAL
SYSTEM
The Digestive System

Also known as the gastrointestinal (GI)
tract or the alimentary system, it is
responsible for breaking down the
complex food into simple nutrients the
body can absorb and convert into energy.
This process is known as digestion.
Mouth/Esophagus
Digestion begins in the mouth where the
teeth mechanically break food down into
smaller pieces by chewing and mixing it
with saliva.
 The food is then swallowed and
transported down into the esophagus
through the rhythmic contraction of
muscles known as peristalsis.

Stomach

Further mechanical and chemical
breakdown of the food occurs in the
stomach, which secretes gastric juices
that contain hydrochloric acid and
pepsinogen, a nonactive form of the
enzyme pepsin.
Small Intestine
Approximately 20 to 25 feet long and is
responsible for absorbing nutrients from
the chyme (semi-liquid mass of partially
digested food).
 Small intestine divided into: duodenum
(first 10-12 inches); jejunum (the middle
8-10 feet) and the ileum (the distal 12
feet).

Large Intestine
Also known as the colon, the large
intestine is responsible for absorbing
water, electrolytes, and salts.
 The last 5 inches of the large intestine
comprise the rectum. The distal end of the
rectum forms the anal canal composed of
muscles that control defecation. The
opening to the anal canal is called the
anus.

Accessory Organs
The digestive system is also comprised of
organs that aid in digestion of food:
Pancreas.
 Liver.
 Gallbladder.

Functions of the Liver






Produce and secrete
bile, which emulsifies fat.
Convert glucose into
glycogen for storage.
Convert glycogen to
glucose when blood
sugar level drops.
Metabolize hormones.
Break down nitrogenous
wastes to urea.
Incorporate amino acids
into proteins.






Filter blood and destroy
bacteria.
Produce prothrombin and
fibrinogen, which are
necessary for blood
clotting.
Manufacture cholesterol.
Produce heparin.
Store vitamin B12 and fat
soluble vitamins A,D,E,
and K.
Detoxify poisonous
substances.
The Gallbladder
A pear-shaped sac attached to the
underside of the liver.
 Stores and concentrates the bile until it is
needed in the small intestine.

Changes in the Digestive
System with Aging
Decrease in peristalsis.
 Oral changes.
 Decrease in enzyme secretion.
 Decrease in saliva.

Assessment for Clients with GI
Complaints
History of present complaint regarding specific symptoms
Medication history including medications
Complete nutritional history
Psychosocial factors
Physical examination including inspection
Bowel elimination patterns
Evaluation and diagnostic data including laboratory tests
and radiologic and endoscopic examinations
Disorders of the GI Tract:
Stomatitis
A painful condition characterized by
inflammation and ulcerations in the
mouth.
 Can be caused by infections, damage to
the mucous membranes by irritants, or
chemotherapy.

Disorders of the GI Tract:
Esophageal Varices
An enlarged, tortuous vein in the
esophagus, often associated with
cirrhosis of the liver.
 Varices have no symptoms so clients may
not be aware of them until they start
bleeding.

Disorders of the GI Tract:
Gastroesophageal Reflux Disease

A disease in which the gastric secretions
flow upward into the esophagus,
damaging the tissue.
Disorders of the GI Tract:
Gastritis

An inflammation of the stomach mucosa
occurring when the stomach has been
exposed to irritating substances such as
medications, smoke, food allergens, or
toxic chemicals.
Disorders of the GI Tract:
Ulcers
Peptic ulcers are erosions that form in the
esophagus, stomach, or duodenum
resulting from acid/pepsin imbalance.
 Gastric ulcers refer to erosions in the
stomach and are correlated to exposure
to irritants including smoking, alcohol,
food allergens, toxic chemicals, etc.

Disorders of the GI Tract:
Appendicitis
An inflammation of the vermiform
appendix, a small, slender tube attached
to the cecum.
 If the appendix ruptures, fecal content
spills into the abdominal cavity causing
peritonitis, which can be fatal.

Disorders of the GI Tract:
Diverticulosis and Diverticulitis
The diverticula are saclike protrusions of
the intestinal wall.
 Diverticulosis is a condition of the colon in
which multiple diverticula are present.
 Diverticulitis refers to the inflammation of
one or more of the diverticula generally in
the sigmoid colon.

Colostomy

A surgically created opening from the
colon through the abdominal wall to
relieve either a disease or functional
problem in the large intestine.
Inflammatory Bowel Disease
The term used to describe Crohn’s
disease and ulcerative colitis (UC).
 Crohn’s disease is characterized by
lesions that affect the entire thickness of
the bowel and can occur anywhere
throughout the colon and small intestine.
 UC is characterized by mucosal lesions
occurring typically in the rectal area and
progressing through the colon.

Intestinal Obstruction
Sometimes called an ileus, it occurs when
the contents cannot pass through the
intestine.
 May be caused by tumor; fecal impaction;
hernia; volvulus (twisting of the bowel on
itself); tussusception (telescoping of
bowel where bowel slides inside itself) or
adhesions, scar tissue in the abdomen
from prior surgeries or disease process.

Hernias

Occurs when the wall of a muscle
weakens and the intestine protrudes
through the muscle wall.
Peritonitis
An inflammation of the peritoneum, the
membranous covering of the abdomen.
 Caused by irritating substances such as
feces, gastric acids, bacteria, or blood in
the abdominal cavity.

Hemorrhoids
Swollen vascular tissues in the rectal
area.
 May be internal or external and may be
caused by straining with constipation.
 Frequently occur with pregnancy.

Disorders of the Accessory Organs:
Cirrhosis
Refers to the chronic, degenerative
changes in the liver cells and thickening
of surrounding tissue that result from the
liver repairing itself after chronic
inflammation.
 Causes include chronic hepatitis,
repeated exposure to toxic substances,
cancer, and chronic alcohol abuse.

Disorders of the Accessory Organs:
Hepatitis

A chronic or acute inflammation of the
liver caused by a virus, bacteria, drugs,
alcohol abuse, or other toxic substances.
Pancreatitis

An acute or chronic inflammation of the
pancreas caused when pancreatic
enzymes digest the lining of the pancreas.
Cholecystitis and Cholelithiasis
Cholecystitis is an inflammation of the
gallbladder. In more than 90% of the
cases, gallstones are present.
 Cholelithiasis is the presence of
gallstones or calculi (concentration of
mineral salts) in the gallbladder.

Neoplasms of the
Gastrointestinal System
Oral cancer (cancer of the lips, tongue,
oral cavity, and pharynx).
 Colorectal cancer (almost all arise from
polyps, an abnormal growth of tissue that
protrudes into the colon).
 Liver cancer.
