Nursing Care of Clients with Digestive Disorders - FINAL PDF

NCM 3116 (Care of Clients with Problems in Nutrition and Gastro-intestinal metabolism and Endocrine Function, Perception and Coordination-Acute and Chronic – LECTURE) ○ On the gastri...

NCM 3116 (Care of Clients with Problems in Nutrition and Gastro-intestinal metabolism and Endocrine Function, Perception and Coordination-Acute and Chronic – LECTURE) ○ On the gastric lining: NURSING CARE OF CLIENTS WITH DIGESTIVE - Gastric Pits PROBLEMS - Gastric Glands - Intestinal Cells - Parietal cells - produces and secretes gastric juice HCL acid (pH1) and Intrinsic Factors (Vit. B12 binding protein) - Mucous Neck Cells - production of sticky mucus and clings to mucosa as protection from HCL and digestive enzymes. - Chief cells - production of protein digesting enzymes (Pepsin) SMALL INSTETINE o Chemical digestion o Absorption of nutrients, vitamins, electrolytes o Parts: ○ Duodenum ○ Pancreatic Duct - Pancreas - secretes pancreatic enzymes - Trypsin - breakdown protein - Amylase - starch - Lipase - fats - Alkaline in pH because of high concentration of bicarbonate, alkaline pH help neutralize acid ○ Ampulla of Vater ○ Common Bile Duct - Gallbladder - stores and secretes bile ▪ Emulsify fats ▪ Absorbs fats and fat soluble Vits (ADEK) I. GASTROINTESTINAL TRACT - Liver - Produces Bile MOUTH ▪ Yellow to green fluid Ingestion and mastication containing bile salts, bile pigments (Bilirubin), PHARYNX cholesterol Passageway for air, food, fluids ○ Jejunum EPIGLOTTIS ○ Ileum Flap the open and closes to prevent food or fluids enter the - Ileocecal valve trachea ESOPHAGUS 2 Types of Contractions Secretes mucus, passageway and facilitates movement of Peristalsis food Propels contents toward the colon. STOMACH Temporary storage Segmentation Break down food by churning & churning to turn it into Produces mixing waves that move contents back and forth CHYME consistency (heavy cream) in churning motion. Parts: ○ Lower Esophageal or Cardioesophageal sphincter ○ Fundus ○ Body ○ Pylorus ○ Pyloric Sphincter 1  LARGE INSTETINE To help elicit information about the current symptoms: Use COLDSPA mnemonic as your Water and Na Ion absorption temporary storage of fecal guide. matter; Elimination. o CHARACTER – Describe the sign or symptom e.g. Parts: ▪ Abdominal pain o Ileocecal Valve ▪ Dyspnea o Cecum ▪ Intestinal gas o Appendix ❖ BELCHING – o Colon expulsion of gas - Ascending from stomach to - Transverse mouth. - Descending ❖ FLATULENCE – o Sigmoid expulsion of gas o Rectum from the rectum. o Anal canal, internal and external sphincter ▪ Nausea & Vomiting ▪ Change in bowel habits stool COMPONENTS OF LARGE INTESTINE: characteristics. Bacteria, assist in completing the breakdown of the waste o ONSET – when it is started? materials (undigested / unabsorbed proteins and bile salts) o LOCATION – Where? Radiating? 2 types of colonic secretions: o DURATION – How long it last? 1. Bicarbonate solution – to neutralize. Recurring? 2. Mucus – protects the colonic mucosa. o SEVERITY – mild, mod, severe? Pain scale. Peristalsis: Slow and weak – move the colonic components. TYPES OF ABDOMINAL PAIN Intermittent and strong propel contents for considerable 1.) Visceral Pain distance. Caused by distension hollow organs or stretching of solid organs WASTE PRODUCT OF Description: Crampy, Achy, Dull, Burning, DIGESTION Colicky, Poorly Localized. FECES consist of: Onset: Gradual o Undigested food 2.) Parietal Pain o Inorganic materials Caused by inflammation or irritation of parietal o Water peritoneum e.g. appendicitis, peritonitis o Bacteria Description: Sharp, stabbing pain, Steady and Brown color – results from the breakdown of bile by the severe, Tenderness, Guarding, Rigidity, intestinal bacteria. Rebound, Well Localized. Fecal odor is chemically formed by the intestinal bacteria. Onset: Sudden ACCESSORY DIGESTIVE ORGANS REFFERED ABDOMINAL PAIN Teeth Pain occurs, travels or refers from the primary site and becomes Salivary glands highly localized at DISTANT SITES Secretes 1.5L of saliva a day to lubricate and facilitate swallowing. Contains mucus, water, enzyme, ptyalin or salivary amylase to break down starches. o Parotid o Submandibular o Sublingual Pancreas Liver / Gallbladder Metabolism of CHON, CHO, and FATS Secretes bile Detoxifies various substances (drug and hormones) Vitamin metabolism – stores vit. A, B, K, and B12 HEALTH HISTORY Collection of subjective data Nursing health history 2. Past Health History 1. Present health concern Any gastrointestinal disorder or conditions in the past? 2. Past health history 3. Family history Had any infections? 4. Lifestyle and health pattern Had any abdominal surgery or trauma? Taking any prescribed or OTC medications? 1. Present health history 2 3. Family History REGIONS AND QUADRANTS OF ABDOMEN Any history of GIT diseases or disorders in the family? 4. Lifestyle and Health Practices Alcohol consumption and cigarette smoking Coffee and food preferences and consumption Activities, exercises, stress level KEY POINTS FOR ASSESSMENT: Explain each aspect of the examination to ease anxiety level and obtain cooperation. Provide privacy. Position on supine with knee flexed Sequence pf the abdominal assessment; not to alter patterns of bowel sounds. o Inspection o Auscultation o Percussion (use diaphragm of the ORGANS PER QUADRANT stethoscope) o Palpation Void first (distended bladder interfere accurate examination) Observe for verbal and non – verbal cues. INSPECTION OBSERVE COLORATION OF SKIN ○ A: Redness, Pale, Yellowish, Bruises, Hematoma - Inspect for stretch marks/scars (ask the source of scar, measure the length, document the location and appearance of scar ○ A: Nonhealing, redness, inflamed, keloids - Assess for lesions and rashes ○ A: Changes in mole size, color, border symmetry, CONDITIONS PER REGIONS wounds - Inspect the umbilicus ○ A: Purple or bluish discoloration around umbilicus (Cullen’s Signs) - Indicate intra-abdominal bleeding, deviated, everted INSPECT ABDOMINAL CONTOUR ○ A: Distended or generalized protuberant from obesity, air or fluid accumulation, scaphoid (sunken) seen with severe weight loss - Assess abdominal symmetry ○ A: from organ enlargement, large masses, bulging of abdominal wall from hernia, bowel obstruction - Inspect abdominal movement when breathing ○ A: Diminished abdominal respiration - Observe aortic pulsation ○ A: Exaggerated pulsation with abdominal aortic aneurysm - Observe for peristaltic waves 3  NATURE OF VOMITUS Mechanical bowel obstruction, ileus Drugs (laxative abuse, anticholinergic agents, opiates) Loss of innervation (Hirschsprung's disease) Neuromuscular (paralysis, spinal cord injury or sacral lesion, multiple sclerosis) Anorectal disorders (hemorrhoids, fecal impaction, cancer, abscess, fissures) DISORDER OF THE MOUTH STOMATITIS inflammation of the oral cavity TYPES OF STOMATITIS 1. Primary APHTHOUS STOMATITIS or canker sores MOST COMMON TYPE BENIGN AND NON-CONTAGIOUS 2. Secondary DIARRHEA candidiasis or oral thrush CAUSES may be due to overgrowth of normal flora. Infectious agents (Escherichia coli, Salmonella, Shigella,Campylobacter, Glardia, Amoeba, Clostridium difficile, Cyclospora, Cryptosporidium, Rotavirus) Food poisoning Drugs (antibiotics, magnesium) Fecal impaction Bowel disease (irritable bowel syndrome, ulcerative colitis) Malabsorption syndromes (lactose Intolerance, Celiac sprue, fat malabsorption) Short bowel syndrome CHARACTERISTICS OF STOOL 1. Appearance Tarry black (melena) - Upper GI bleed Bright red blood-Lower GI bleed Blood streaking on surface of stool or on toilet paper- Lower rectal or anal bleeding 2. Other characteristics with specific problem Bulky, greasy, foamy, foul smelling, gray with silvery sheen-steatorrhea (fatty stool) Light gray "clay colored" (due to absence of bile pigment, acholic)-biliary obstruction Mucus or pus visible-chronic ulcerative colitis Small, dry, rocky-hard masses-constipation obstruction Marble-sized stool/ pellets-spastic colon syndrome DYSPHAGIA (DIFFICULTY IN SWALLOWING) ETIOLOGY onset ( acute or gradual), intermittent, continuous Infection e.g. herpes zoster or cytomegalovirus, syphilis and etc CONSTIPATION Allergy to coffee, potatoes, cheese, nuts, citrus fruits frequency, consistency, color, blood/mucus,size. Change in Vitamin deficiency eg. Vitamin B folate, zinc and iron bowel habits, diet. Systemic disease e g. HIV chronic renal failure, inflammatory bowel disease CAUSES OF CONSTIPATION Irritants eg. tobacco and alcohol Chemotherapy and Radiation Inadequate fluid intake Psychological factors Trauma Electrolyte imbalances Hormonal abnormalities 4