Highlighted in blue = things i think are important // mrs. wright emphasized
= disorders Highlighted in yellow = practice questions Highlighted in green = on exam 1
<Do you know the signs and symptoms, how to recognize the disease and nursing management?=
<Nursing education will be my big ...
Adult Health 2 Exam 1
Highlighted in blue = things i think are important // mrs. wright emphasized
Highlighted in pink = disorders
Highlighted in yellow = practice questions
Highlighted in green = on exam 1
<Do you know the signs and symptoms, how to recognize the disease and nursing management?=
<Nursing education will be my big thing for tests=
Chapter 38: Assessment of the Digestive and Gastrointestinal Function
1. Anatomy
a.
2. GI System A&P
a. 23-26ft in length extending from the mouth to the anus
b. Includes the mouth, esophagus, stomach, small & large intestines, rectum
and anus
c. Gastric artery – supplies O2 & nutrients supplied to the stomach
d. Mesenteric arteries – supplies O2 & nutrients to the intestines
e. Blood flow to GI tract = 20% of total cardiac output & increases significantly
after eating
f. Stomach → stores food during eating, secretes digestive fluids, and propels the
partially digested food, or chyme, into the small intestine
g. Small Intestine → 230 feet of surface area for secretion and absorption, the
process by which nutrients enter the bloodstream through the intestinal walls
i. Duodenum
ii. Jejunum
iii. Ileum
h. Large Intestine
i. Ascending
ii. Transverse
iii. Descending
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i. GI tract innervated by the SNS and PSNS
3. Main Functions of the GI Tract
a. Digestion - Break down food particles into molecular form
b. Absorption – of small nutrient molecules produced by digestion
c. Elimination – of undigested, unabsorbed food & waste products
4. Gastric Function
a. Chewing (beginning of the process)
b. Eating or even sight, smell, or thought of food – can cause reflex salivation
c. Swallowing – begins as a voluntary act but ends as a reflex action as the epiglottis
moves to cover the tracheal opening to prevent aspiration of food into the lungs
d. Stomach glands secrete HCl acid - to break down food into more absorbable
components and to aid in the destruction of most ingested bacteria (* pepsin &
intrinsic factor also secreted by gastric mucosa)
i. Pepsin: digests and breaks down contents in the stomach pancreas and
intestine
ii. Intrinsic factor: necessary for the absorption of vitamin B12 (responsible
for RBCs)
e. Food remains in stomach for 30 min – several hours depending on size of
particles, volume, & chemical composition
f. Chyme – partially digested food mixed with gastric secretions
5. Small Intestine Function
a. Duodenal secretions contain digestive enzymes (amylase, lipase, bile) and are
derived from the pancreas, liver, and gallbladder4and the glands in the wall
of the intestine itself.
b. Contractions – segmentation contractions & intestinal peristalsis – both stimulated
by presence of chyme
c. Absorption is the small intestines MAJOR function
d. Vitamins and minerals are absorbed essentially unchanged
6. Colonic (Large intestine) Function
a. Residual waste materials enter the colon from the small intestine via the ileocecal
valve
b. Bacteria in the large intestine help to complete the breakdown of waste material
c. Slow transport through the colon allows for water and electrolyte reabsorption
(MAJOR function of the colon)
i. Synthesizes vitamin K which is assisted in blood coagulation
d. Waste product of digestion
i. Stool (feces) which contains undigested food, inorganic materials, water,
& bacteria
ii. Chyme becomes solid
7. Gerontologic Considerations
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a.Issues with dentition
b.Decreased motility most significant change
c.Weakened gag reflex
d.Atrophy (taste buds, gastric mucosal surfaces, small intestine muscles, etc.)
e.Increased complaints of dysphagia, anorexia, dyspepsia, & constipation
f.What are some potential nursing diagnoses for these patients?
i. Impaired nutrition (imbalanced nutrition: less than requirements)
ii. Constipation
iii. Fear
iv. Anxiety
v. Deficient volume
8. Conducting Health History
a. Hx of any symptoms or previous disease
b. Common Symptoms
i. Pain
ii. Dyspepsia (indigestion) = the most common symptom of GI
dysfunction
iii. Intestinal gas
iv. Nausea and vomiting
v. Change in bowel habits (first change in pt with colorectal cancer)
vi. Change in stool characteristics
c. Past and current medication use
d. Past and current use of tobacco or ETOH
e. Previous diagnostic studies, treatments, or surgeries
f. Labs
i. Liver enzymes (AST, ALT)
ii. Comprehensive metabolic panel
iii. CBC
g.
9. Physical Assessment
a. Lips
b. Gums
c. Tongue
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d. Abdomen
i. Questions to consider:
1. In what order should an abdominal assessment be performed?
2. What order do you move your stethoscope? When do you use
the bell? What is normal, hypo, or hyperactive?
e.
10. Diagnostic Evaluation
a. Serum lab studies
i. AST and ALT
ii. Coagulation studies
iii. CMP
b. Stool tests
i. Fecal occult blood
1. Parasites? That might suggest c. diff.
2. At least 3 repeats of a positive guaiac FOBT confirms GI bleeding
c. Hydrogen breath test
i. Tests to see if your carbs are being absorbed
ii. Ingest a capsule of carbon labeled urea
iii. H. pylori metabolizes urea really quickly, so if that’s positive that means
you have h. pylori which causes peptic ulcer disease
d. Abdominal ultrasound
e. Imaging studies
i. CT-scan
ii. Cross sectional images constructed from multiple images
iii. Useful for diagnosing many Abd. disorders
iv. Can use oral or IV contrast
1. Check for allergies (iodine or shellfish)
2. Risk for AKI after contrast
f. Upper GI/esophagogastroduodenoscopy (EGD)
i. NPO at least 8 hours prior
ii. Conscious sedation
iii. Left side lying with HOB elevated
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