Nursing Assessment of the Gastrointestinal System
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Nursing Assessment of the Gastrointestinal System
Sasha Alexis Rarang, RN, MSN
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The digestive system
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Structures and Function of the GastroIntestinal System
Main Function of the GI System?????
Supply Nutrients to body cells
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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
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Concepts of Structures and FunctionsThe GI System consists of the GI tract and its associated organs and glandsA. GI tract
1. mouth2. esophagus3. stomach4. small intestines5. large intestines6. rectum7. anus
B. Associated organs1. liver2. gall bladder3. pancreas
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Mouth
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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.
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Saliva Secreted by the sublingual and
submandibular glands. Lubricate and softens the food mass Amylase – breaks down starches to
maltose.
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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.
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Esophagus
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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.
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stomach
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StomachA. Structures
a.1. fundusa.2. body/central areaa.3. antrum/pyloric regiona.4. cardiac sphinctera.5. Pyloric sphincter
B. Microscopic Glands ( epithelial lining of the stomach)b.1. Cardiac glands – mucusb.2. Peptic (Chief Cells) – mucus and pepsinogenb.3. Parietal (Oxyntic) – HCl acid and water
protein digestionintrinsic factor – B12 absorption
b.4. Neck cells – mucusb.5. Pyloric glands – gastrin and mucus
stimulates HCl acid production
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StomachC. 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 breakdownc.3. mechanical breakdown of foodc.4. absorption of water, alcohol, glucose,and some drugs.c.5. protection
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StomachD. Innervation
d.1. parasympatehetic – vagus nerved.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.
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StomachE. 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.
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Stomach
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Stomach
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Small intestines
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Small IntestineA. Structure (22 feet long/1 inch in diameter)
a.1. duodenuma.2. jejunuma.3. ileum
B. Functionb.1. completes the digestion of foodsb.2. absorbs the products of digestionb.3. secretes hormones – control
secretions of bile, pancreatic juice, andintestinal secretions.
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Small IntestineC. Innervation
c.1. sympathetic – inhibits motilityc.2. parasympathetic – increases intestinal tone and motility.
D. Secretionsd.1. Brunner’s glands(duodenal) – mucusd.1.1. glucagon, presence of chyme, and vagal stimulation.d.1.2. sympathetic stimulation inhibits secretions of the glands.d.2. Goblet cells – mucusd.3. crypts of Lieberkuhn – secretes an alkaline fluidd.4. epithelial cells – digestive enzymesd.4.1. enterokinase – activates trypsind.4.2. maltase,lactase, and sucrase – disaccharides into simple sugars.
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Small IntestineE. Absorption
e.1. Complex foods are converted into its simplest forms.e.1.1. CHO – monosaccharidese.1.2. CHON – amino acidse.1.3. Fats – fatty acids, monoglycerides, diglycerides and triglycerides.e.2. Water absorption – 8L/daye.3. water-soluble vitamins, electrolytes, minerals.e.4. B12 absorption takes place in the ileum
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Large intestines
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Large IntestinesA. Structures ( 5-6 feet long)
a.1. Cecuma.2. Colon
a.2.1. Ascendinga.2.2. Transversea.2.3. descendinga.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 mucusb.3. form and store the feces until defecation
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Large IntestineC. Innervation
c.1. parasympathetic – vagus nerveincreases peristalsis, decreasetone of the sphincter.c.2. sympathetic – reduce peristalticactivity and increase tone ofsphincters.
D. Secretiond.1. water, mucus, potassium, and bicarbonate –alkaline solution.d.2. Mucus – lubricates, allows passage of the fecal matters, protects the mucosa from injury.
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Rectum
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Anus
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Associated Organs of the GI System
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Liver
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Activities of the tractA. 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.
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A. Secretion of electrolytes, hormones, and enzymes
Hormones – gastrin
Electrolytes – H2, Cl, Na, K,
Enzymes – pancreatic lipase, enterokinase, ptyalin
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Movement of the Ingested products
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Digestion of food and fluids
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Absorption of end products into the bloodstream
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Secretions1. 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.
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Secretion:
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Motility2 types of movement in the GITA. Mixing
B. Propulsion / Peristalsis
****Soft muscle tissues of the GIT****
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Digestion and AbsorptionFood is broken down into small and simple
compounds enough to be absorbed into the bloodstream by diffusion or active
transport.
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Digestion and secretion
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Effects of Aging on the Gastrointestinal TractA. Teeth may loosen up from the supporting gums and bones.B. 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.
C. Decreased secretion of digestive enzymes and bile – decrease ability to digest and absorb food.>> impaired absorption of fat and fat soluble vitamins
D. Atrophy of gastric mucosa leads to decrease HCl acid production.>>decrease iron and B12 absorption – anemia>>proliferation of bacteria – diarrhea and infection
E. 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.
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Teeth may loosen up from the supporting gums
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Decreased output of the salivary gland Dryness of the mucous
membrane Difficulty swallowing Decrease stimulation of the
taste buds
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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
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Effects of aging on the GI tract> Atrophy of gastric mucosa leads to decrease
HCl acid production
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Assessment of the GI System
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Assessment of the GI SystemA. Past Health History
a.1. history or existence of ;> abdominal pain > nausea and vomiting> diarrhea > constipation> abdominal distention > jaundice> anemia > heartburn> dyspepsia > changes in appetite> hematemesis > food intolerance> allergies > indigestions> excessive gas > bloating> melena > hemorrhoids> rectal bleeding
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Assessment….B. Medications:
b.1. past and current use of medicationsb.1.1. OTC drugsb.1.2. prescription drugsb.1.3. herbal products and nutritional supplements.b.2. hepatotoxic, diarrhea, GI bleeding
C. Surgeries and other treatmentsc.1. information about hospitalizations for any problems related to GI system
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Functional Health Assessment
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Assessment…Objective DataA. Inspection
a.1. Lips – symmetry, color and sizeobserve for abnormalities – pallor or cyanosis, cracking, ulcers, or fissures.a.2. Tongue – color, fissures, deviation and lesionsa.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.
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Assessment….a.5. Abdomena.5.1. Skin changes ( color, texture, scars, striae, dilated veins, rashes, and lesions.)a.5.2. umbilicus – location and contoura.5.3. symmetrya.5.4. contour – flat, rounded, distended.a.5.5. observable masses – hernias and other masses.a.5.6. movement – observable peristalsis and pulsation.
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Assessment: Inspection (Skin changes)
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AssessmentQuadrants of the Abdomen
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Abdominal distention; dilated veinsDraping the Abdomen
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Obese abdomen
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Hepatomegaly
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ascites
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Umbilical Hernia
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Pregnancy
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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. Percussionc.1. purpose??? Determine the presence of fluid, distention, and masses. Presence of air – tymphany,
fluid or masses – dull sounds
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Auscultation: Listen for…….
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Increased or decreased bowel sounds
Normoactive, hypoactive,hyperactive, or absent
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Listen with the diaphragm side of the stethoscope
BS are high pitched sounds,3-5x a minute
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Warm up the stethoscope in the hands to avoid undue abdominalmuscle contraction
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Listen for BS for 2-5 minutes on each quadrant
Absent BS means no sounds for 5 minutes.
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Assessment: Percussion
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Purpose?????
Determine the presence of fluid, distention, and masses
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Tymphany is normally present in most areas of the abdomen
Dullness!!!!! Ac lue to an underlying mass
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Assessment: Palpation
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Light palpation – 1cm deep
Look for area of tendernessLook for patient’s facial expression and guarding
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Deep palpation
Delineate body abdominal organs
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Use two-hand method
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Diagnostic StudiesA. 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
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Diagnostic testsC. 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.
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Diagnostic testsC. 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
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Diagnostic tests
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End of Topic