Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
The Gastrointestinal
System
23/12/2010
LEARNING OUTCOME 1
Describe age-related changes that affect gastrointestinal
function.
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23/12/2010
Begin before age 50
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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Aging has limited impact on system
Aging associated with increased prevalence of
many GI disorders
Evaluate disorders closely
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Number-one esophageal disorder in older people
Impacts oral intake
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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
10
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Signs and symptoms
Reports of difficulty swallowing
Difficulty controlling food or saliva in mouth
Facial droop
Dementia, frailty, confusion
Inability to sit upright
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Signs and symptoms
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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Risk factors
Incorrect positioning
Inappropriate intake
Rapid feeding
Older persons labeled as difficult
Comorbidities
Neurological disorders
Muscular disorders
Anatomical abnormalities
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Nursing assessment
Observation of individual during eating and drinking
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Nursing assessment
Question patient concerning
Choking
Dry mouth
Excess saliva
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Nursing interventions
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
16
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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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Risk factors
Aging
Thyroid disease
Scleroderma or connective tissue disorders
Diabetes
18
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Signs and symptoms
Heartburn
Indigestion
Belching:(also known as burping, ructus, or eructation) involves
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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Triggers
Eating large meals
Certain medications
High-fat foods
High caffeine intake
Alcohol and tobacco use
Reclining after eating
Obesity
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Consequences for GERD
Nursing assessment of GERD
Diagnostic testing
Barium swallow
Endoscopy
Esophageal contents pH
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Goals of treatment
Symptom control
Heal mucosal injury
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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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Lifestyle modifications
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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Medications
Antacids
Aluminum-containing antacids
Histamine 2 receptor agonists
Proton pump inhibitors
Combination drugs
Surgery
25
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Gastritis
Inflammation of the gastric mucosa
Classification
Severity
Site involvement
Diagnosis
Endoscopy
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Gastritis
Treatment
Reducing contributing factors
Acid neutralization and suppression
Antibiotic therapy
Transfusions as needed
27
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Peptic and duodenal ulcer disease
An excoriated area of the gastric mucosa
Signs and symptoms
Bleeding
Positive fecal occult blood test
Pain
Diagnosis
H. pylori breath test
Endoscopy
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Peptic and duodenal ulcer disease
Treatment
Discontinue use of NSAIDs, alcohol, tobacco, and caffeine
Small, frequent meals
Medications
29
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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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Gastric volvulus
Turning, twisting, or telescoping of the stomach onto
or into itself
Symptoms
Acute pain
Shock and hypotension
Abdominal distention
Inability to vomit
Dyspnea
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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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Diverticular disease
Risk factors
Physical inactivity
Constipation
Obesity
Smoking
NSAID therapy
Management
Increase fiber intake
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Diverticulitis
Normal bowel flora and fecal material becomes
trapped in pouches resulting in inflammation,
infection, and obstruction
Signs and symptoms
Fever
Leukocytosis
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Assessment of diverticular disease
Physical examination
Questions regarding bowel history
Diagnosis
Abdominal CT scan
Ultrasound
35
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Goals of treatment
Eliminate bacterial infection
Liquid diet advancing to low fiber to allow colon to
rest
36
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Ulcerative colitis
Chronic inflammatory process
Impacts superficial layers of colon walls
Wide spread ulceration of colon walls
Signs and symptoms
Bloody diarrhea
Lower left quadrant abdominal pain
Weight loss
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Ulcerative colitis
Diagnosis
Sigmoidoscopy
Colonoscopy
Stool specimens
Treatment
Oral corticosteroids
5-ASA drugs
Surgery
38
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Crohns disease
Chronic inflammatory disorder of the terminal ileum or
colon
Characterized by inflammation, linear ulcerations, and
granulomas
Signs and symptoms
Diarrhea
Fever
Abdominal pain
Weight loss
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Crohns disease
Diagnosis
Abdominal CT scan
Complete blood cell count
Treatment
Oral corticosteroids
Surgery
40
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Benign tumors or polyps seen in 75% of persons
over age 50
Predisposing factors
Age
Diet
Family history
Prior diagnosis polyps
41
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Malignant tumor
2nd most common malignancy in the United States
Increase incidence with age
Predisposing factors
Family history
Inflammatory bowel disease
42
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Malignant tumor
Signs and symptoms
Change in bowel habits
Abdominal pain
Abdominal mass
Anemia
Rectal bleeding
Weight loss
43
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Malignant tumor
Diagnostic testing
Colonoscopy
Carcinoembryonic antigen levels
Sigmoidoscopy
Treatment
Surgical resection
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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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Signs and symptoms
Watery, nonbloody diarrhea
Low abdominal pain
Fever
Potential complications
Dehydration
Hypotension
Colonic perforation
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Diagnosis
Stool perforation
Treatment
Metronidazole
Vancomycin
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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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Predisposing factors
Aging
Certain medications
Metabolic and endocrine disorders
Muscular dystrophy
Neurologic disorders
Recent abdominal surgery
Obstructive disorders
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Complications
Abdominal discomfort
Loss of appetite
Nausea and vomiting
Excessive straining
Hemorrhoids, anal fissures, and rectal prolapse
Intestinal obstruction
Colonic ulceration
Overflow incontinence with stool leakage
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Assessment
Evaluate complaint
Management
Education
Hydration
Increased mobility
Fiber supplementation
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Assessment
Management
Medication
Bulk laxative
Stool softeners
Osmotic laxatives
Senna
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Defined as abnormally loose stool accompanied
by change in frequency or volume
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Causes
Virus
Food poisoning
Food contamination
Medications
Lactose intolerance
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Symptoms
Urgency
Cramping
Bloating
Incontinence
Pain on defecation
Presence of blood in stool
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Assessment
Interview
Physical examination
Management
Antidiarrheal agents
Soluble fiber
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Seen in 50% of institutionalized elderly
Cause
Mobility problems
Severe depression
Cognitive impairment
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Hemorrhoids and colorectal cancer most common
causes of rectal bleeding
Hemorrhoids are varicose of anorectal junction
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Signs and symptoms
Older adults often present with vague, ambiguous
symptoms
Fatigue
Weight loss
Anorexia
Malaise
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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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Hepatic cysts
Common in older adults
Typically benign
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Metastatic carcinoma
Most common liver cancer
Highest rates in those aged 5070
Associated with alcohol and tobacco use
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Metastatic carcinoma
Signs and symptoms
Jaundice
Variceal bleeding
Ascites
Weight loss
Enlarged liver
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Metastatic carcinoma
Diagnostic tests
Liver function tests
Abdominal ultrasound
CT scan
Liver biopsy
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Gallstones
Increased incidence with age
1:3 people over age 70 have gallstones
Symptoms
Right upper quadrant pain
Gas
Distention
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Gallstones
Diagnostic testing
Abdominal CT scan
Ultrasound
Treatment
Laparoscopic cholecystectomy
Pharmacological dissolution
Dietary modifications
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Pancreatitis
Acute pancreatitis
Symptoms
Epigastric pain
Amylase
Lipase
Bilirubin
Alkaline phosphatase
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Pancreatitis
Acute pancreatitis
Treatment
Nasogastric suction
Pain management
Hyperalimentation
Fluid replacement
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Pancreatitis
Chronic pancreatitis
Symptoms
Weight loss
Diarrhea
Diabetes
Persistent pain
Treatment
Behavior modification
Surgery
69
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Anticholinergics
Antidepressants
Neuroleptics
Antihistamines
Antiparkinsonian agents
71
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Antihypertensives
Calcium channel blockers
ACE inhibitors
Diuretics
Opiates
Laxatives
72
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Nonsteroidal anti-inflammatory drugs (NSAIDs)
Potassium chloride
Tetracycline
Quinidine
Alendronate
Ferrous sulfate
Theophylline
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Inappropriate positioning for mealtimes
Inappropriate feeding of foods and liquids
Thin food and liquids difficult to swallow
Thickened liquids slow the swallow process
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Primary
Length and frequency of esophageal acid exposure
Others
Thyroid disease
Diabetes
Scleroderma
Connective tissue disorders
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Higher doses of NSAIDs
History of peptic ulcer disease
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Inadequate dietary fiber intake
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Age
Diet
Family history
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Recent surgery
Nasogastric or gastric intubation
Antibiotics
79
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Nonsteroidal anti-inflammatory drugs (NSAIDs)
Magnesium-containing antacids
Antiarrhythmics
Beta-blockers
Quindine
Colchicines
Digoxin
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Dehydration
Side effects of medications
Anticholinergic side effects
Antidepressants
Neuroleptics
Antihistamines
Antiparkinsonian agents
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Side effects of medications
Selected antihypertensive agents
Calcium channel blockers
ACE inhibitors
Diuretics
82
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Side effects of medications
Iron supplements
Calcium supplements
Aluminum-containing antacids
Benzodiazepines
Antiarrhythmics
Opiates
83
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Insufficient fiber intake
Cognitive impairment and immobility
Physical illness
Metabolic/endocrine disorders
Muscular dystrophy
Neurological disorders
Recent abdominal surgery
Obstructive disorders
84
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Dementia
Depression
Chronic pain
Lack of mobility
Lack of sensation
85
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Gallstones
Hyperlipidemia
Hypercalcemia
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Medications
Estrogen
Furosemide
ACE inhibitors
Mesalamine
Alcohol abuse
Cancer
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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 age-
related change
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Diabetes
Neurological illness
Vascular disorders
90
91
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Presentation and reporting of symptoms of GI
problems in the older adult
Impact of select medications on the GI system
92
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Lose weight as appropriate
Avoid tight clothing
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Impaired swallowing
Impaired skin integrity
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Discontinue use of all NSAIDs
Discontinue use of alcohol, tobacco, and caffeine
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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
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Annual fecal occult blood testing
Colonoscopy and sigmoidoscopy screenings
Initially begin with sigmoidoscopy
Colonoscopy screening should begin at age 50
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Patient education
Dietary intake of fluid and fiber
Exercise
Awareness in bowel habits
Understanding of potential impact of selected
medications
98
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Minimize distractions during eating
Provide a pleasant mealtime environment
100
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Monitor respirations
Provide oral hygiene before and after mealtimes
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Never force-feed
Monitor weight, function status, and patient
satisfaction during meals
Evaluate swallowing capacity every 6 months
and prn
Avoid nasogastric tubes
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Impaired Swallowing
Feeding Self-Care Deficit
103
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Neuromuscular impairment
Decreased strength or excursion of muscles
involved in mastication
Perceptual impairment
104
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Mechanical obstruction (edema, tracheostomy
tube, tumor)
Fatigue
Limited awareness
105
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Frequently assess pulse and blood pressure
Establish schedule to offer fluids every 15 to 30
minutes
Measure intake and output
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Regular toileting program
Administration of high-fiber diet
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Esophagogastroduodenoscopy
Restrict intake prior to procedure
Strong laxative
Antibiotics for patients at high risk for infection
Oxygen during tube insertion
Sigmoidoscopy
Sedation not required
Phosphate enemas
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Colonoscopy
1 to 2 days of liquid diet
Cathartic evening prior
Monitor patients with cardiovascular or renal
instability
109
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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
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Risk for Constipation
Ineffective Tissue perfusion: Gastrointestinal
Tract
Risk for Aspiration
111
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Ineffective Breath Maintenance
Toileting Self-Care Deficit
Nausea
112