Digestive and GI Function - Assessment

Topic Outline

• Gastro includes chapters on assessment, oral/esophageal disorders, gastric/duodenal disorders, intestinal/rectal disorders, obesity, hepatic disorders, and biliary disorders.
• Endo includes assessment/management of endocrine disorders and disorders of the pituitary and thyroid glands.

Assessment of Digestive and GI Function (Chapter 38)

• The digestive tract breaks down food for digestion.
• It facilitates absorption of small nutrient molecules into the bloodstream.
• Undigested materials are eliminated.
• Digestion starts with chewing, breaking food into small particles mixed with digestive enzymes.
• Nutrient absorption occurs primarily in the small intestine, vitamins and minerals are mostly unchanged.
• Absorption starts in the jejunum via active transport and diffusion into circulation.
• Waste elimination happens post-digestion and absorption.

Major Enzymes and Secretions

• Saliva and salivary amylase facilitate chewing and carbohydrate breakdown.
• Gastric function involves hydrochloric acid for food breakdown and bacteria destruction.
• Pepsin is used for protein ingestion, and intrinsic factor is also made.
• The small intestine uses amylase, lipase, and trypsin from the pancreas, along with bile.
• Chyme emulsifies and peristalsis occurs.

Health History

• Information on abdominal pain, dyspepsia, gas, nausea, vomiting, diarrhea, constipation, fecal incontinence, jaundice, and prior GI issues are important.
• The pain’s characteristics, duration, pattern, frequency, location, and timing are key.
• OLD CART (Onset, Location, Duration, Characteristic, Alleviating & Aggravating Factors, Radiation or Relieving Factors, Timing, Severity) and PQRST (Palliative factors/Provocative factors, Quality, Radiation/Region, Severity, Timing/Treatment) assessments can be used.

GI System Assessment

• Dyspepsia is epigastric pain commonly seen in GI dysfunction.
• Intestinal gas presents as bloating, distention, or fullness, relating to food intolerance or gallbladder issues.
• Nausea is general sickness that may lead to vomiting.
• Changes in bowel habits and stool may indicate colonic issues like constipation or diarrhea.
• Past health, family, social history, oral care, dental visits, mouth lesions, food discomfort, use of alcohol and tobacco, and dentures are all relevant.

Physical Assessment

Oral Cavity

• Assess lips, gums (Phenytoin/Dilantin can cause gingivitis), and tongue.

Abdomen

• Use the four-quadrant method (inspection, auscultation, percussion, palpation).

Rectal

• Perform rectal inspection.

Additional steps

• Consider genetic testing and imaging (CT, PET, MRI, scintigraphy, virtual colonoscopy, upper/lower GI studies, motility studies)

Endoscopic Procedures

• EGD (esophagogastroduodenoscopy), colonoscopy, anoscopy, proctoscopy, sigmoidoscopy, small-bowel enteroscopy, and endoscopy through an ostomy are options.

Nursing Interventions

• Inform the provider of any relevant medical conditions or lab results.
• Hydration status should be addressed before, during, and after procedures with related education.
• Offer health information and procedural education, instructions on post-procedure care and activity, and comfort/anxiety relief.
• In older adults, be aware of decreased saliva, appetite, taste, smell, dental issues, delayed esophageal emptying, decreased HCl acid/intrinsic factor, smaller liver, gallbladder disease, and food intake risks.

Management of Oral and Esophageal Disorders (Chapter 39)

• Digestion begins in the mouth and can be influenced changes in the oral cavity, affecting the type and amount of food ingested and how well food mixes with saliva.
• Diseases of the mouth interfere with communication, affect food/fluid intake, and can impact general health.
• Periodontal disease is the top cause of tooth loss for adults..
• Gingivitis inflammes the gums and periodontitis affects soft tissue/bone supporting the teeth.

Interventions

• Focus on proper oral hygiene with management including, rinse, and proper alignment.
• Those at risk are older adults, smokers, low income, people with CV or DM, and those with rheumatoid issues.
• Dental plaque causes tooth decay and caries.
• Perapical issues and infections should be treated with warm compress, extraction and antibiotics
• Needle aspiration is a nursing interventions to relieve pressure and pain

Disorders of the Jaw

• Temporomandibular disorders can involve myofascial pain, internal joint derangement, or degenerative joint disease.
• Fractures and mandibular abnormalities can occur in the jaw.

Salivary Glands

• Disease may indicate required removal or massage and warm compress
• Stones may need removal
• Neoplasms indicate Lithotripsy

Oral Cancer

• Risk factors include but are not limited to: all tobacco types, alcohol, HPV , head/neck cancer.
• Those affected are men more often.
• It can happen anywhere but most often affects the lips, tongue, and floor of the mouth.
• Red or white patches that bleed easily are early signs, while tenderness, trouble chewing/swallowing/speaking, bloody sputum, and enlarged lymph nodes are later signs
• Assessment includes patient history, oral inspection, and also palpating structures of the neck
• Management includes surgical resection, radiation and chemotherapy
• Offer wound and skin care

Oral Disorders

• Preventative care with regular dental visits, brushing/flossing, hydration and oral care are all interventions for treatment
• Ensure adequate food and fluid intake via referrals and diet consults, encouraging verbalization, and referrals to support or spiritual advisors
• Alleviate pain by avoiding spicy, or hard foods and viscous lidocaine and assess for signs and symptoms of infection

Esophagus Motility Disorders

• Achalasia creates issues of the lower esophogaus peristalsis

Oral Cancer

• Early stage involves few or no symptoms
• Manifested in a painlesss mass that may not heal that may be an ulcer

Management

• Focus should be preventive with regular dental and cancer checks
• Focus on oral hygiene and gentle cleaning with proper diet
• Patient education about the disease is key and verbalizing
• Diet consult to ensure easy proper diet