Mod 4 GI + Nutrition

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Radhika316
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283072
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Mod 4 GI + Nutrition
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2014-09-14 21:52:35
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Nursing Mod4 GI Nutrition NS1
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Mod 4 GI + Nutrition
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  1. Function:
     supply nutrients to body cells.  Ingestion, digestion, absoption, and elimination.
  2. Intraperitoneal Organs
    Liver, Gallbladder, Bile ducts, Stomach, Spleen, Small Intestine, Large Intestine,

    -Lower esophageal sphincter remains contracted to prevent gastric reflux. Open for swallowing, belching, vomitting.
  3. =>Retroperitoneal Organs:
    KidneysUretersBladderPancreas
  4. Alimentary Tract:
    Oral cavity – start digestion

    Epiglottis: closes larynx resp. tube when we’re eating.

    Esophagus - peristaltic waves; Lower esophageal sphincter: abnormal relaxation will have heartburn, belching.

    Stomach - food storage, mixing & release

    Small intestine - food digestion & absorption

    Large intestine - proximal half absorption & distal half storage of feces

    Rectum - stores & expels feces
  5. => Major Enzymes/Secretions:
    Mouth: saliva, salivary amylase

    Stomach: hydrochloric acid, pepsin, intrinsic factor (vit B12)

    Small intestine: amylase, lipase, trypsin, bile
  6. Assessment: History
    • Abdominal pain
    • Dyspepsia: acid reflux
    • Gas
    • n/v: nausea/vomitting
    • constipation, diarrhea,
    • change in bowel patterns
    • fecal continence
    • characteristics of stool
    • Jaundice
    • history of GI surgery or problems
    • appetite and eating patterns
    • Teeth
    • nutritional assessment, including weight patterns
    • Include things related to ingestion, digestion, elimination. These are the physical parts.

    • -Psychosocial, spiritual, and cultural factors
    • -Assess knowledge; need for patient education
  7. =>Psychosocial History
    • Dietary intake
    • Alcohol intake, smoking, street drugs
    • Weight gain or loss
    • Recent stressful events
    • Exposure to infectious disease, travel
    • Trauma
    • Medications ( NSAIDS)
    • ASA
    • steroids-alter apetites
    • Environment: to prepare foods
  8. =>Past Medical History
    • Diagnostic evaluation or hospitalization for GI disorder
    • Abdominal surgery or injury
    • Any colostomy; location, type, reason
    • Major illness
    • Blood transfusions
    • Hepatitis vaccination
  9. =>Auscultation: Bowel Sounds
    Listen to all 4 quadrants

    Normoactive of Active: 5 to 30/min. “gurgling”

    Normal Hyperactive : borborygmi “growling”Hyperactive: numerous, fast, higher-pitched sounds. gastroenteritis (stomach flu), diarrhea

    Hypoactive: less frequent sounds. surgical manipulation of bowel, constipation

    Absent: Listen for 5 minutes per quadrant before can say “it’s absent”
  10. =>Percussion
    Tympany: stomach, intestines

    Dullness : liver, spleen, lower colon filled with feces, bladder filled with urine

    Increased tympany: gaseous bowel distensionShifting dullness: ascites
  11. =>Palpation*Normally Palpable:
    • -Edge of Liver in thin adults
    • -Lower border of right kidney in thin adults
    • -Inguinal Lymph Nodes

    Possibly Palpable Full Bladder:Full Lower Colon

    Not Palpable: Gallbladder, left kidney &Spleen
  12. =>Altered GI Functioning in the Elderly
    Decreased motility of the large intestine: Decreased motility = constipation

    Impaired absorption of the B’s vitamins, esp. B12

    Less secretion of digestive enzymes

    Decreased secretion of protective mucus in the intestine

    Decreased tolerance of foods

    Decreased liver size, hepatic blood flow & hepatic metabolism

    Increased risk of gallstone formationAltered dentition, ability to swallow
  13. -Abdominal ultrasound:
    Ultrasounds are used to show the size and configuration of organ. Noninvasive procedure uses high frequency sound waves which are passed into body structure and recorded as they are reflected/rebounded.
  14. Computed Tomography (CT):
    Noninvasive radiologic examination allows for exposures at diff depths, detects biliary tract, liver and pancreatic disorders. Use of oral and IV contrast medium accentuates density differences. Determine sensitiviy to iodine or shellfish if contrast material is used.
  15. MRI (Magnetic Resonance Imaging):
    Noninvasive procedure using radiofrequency waves and a magnetic field. Used to detect hepatobiliary disease, hepatic lesions, sources of GI bleeding and and to stae colorectal cancer. IV contrast medium may be used. Contraindicated inpatient w/ metal implants or pregnant.
  16. Diagnostic studies: Nursing Responsibilities
    • Know whether patient needs to be NPO
    • Check for allergy to seafood, iodine used in dye
    • Bowel prep required? Good results?
    • Informed consent?
    • After test, NPO until gag reflex returns
    • Nursing responsibilities, teaching
  17. Colonoscopy:
    Directly visiualizes entire colon up to ileocecal valve with fleible fiberoptic scope. patient's position is changed frequently during procedure to assist with advancing scope to the cecum. Used to diagnose or detect inflammatory bowel disease, polyps, tumors and diverticulosis and dilate structures. Procedure allows for biopsy and removal of polyps without laparotomy.
  18. Nasogastric Tube: GI Intervention
    Know purpose: used for several purposes including feeding for nutrition when the client is comatose, semiconscious, or unable to consume sufficient nutriition orally. NG suction tubes are used for decompression of gastric content after GI surgery and to obtain GI specimens for diagnosis of peptic ulcer. Tubes used for irrigation to clean and flush stomach after oral ingestion of poisonous substances. NG tubes used to document the presence blood in the stomach, monitor the recurrence of bleeding in the stomach.

    => assess: the clinets consciousness, nostril surgery, use a penlight to assess nostrils for a deviated septum. Ask client to breath through each nostril and assess for latex surgery.

    • =>nursing responsibilities: planning and client education: explain procedure, "hand signal", potential complications, encourage physical activity to enhance GI mobility. Documentation
    • NG tube insertion, placement 
  19. =>Bowel Elimination Problems
    • Constipation
    • Diarrhea
    • Flatulence
    • Bowel Incontinence-Attempt open-ended questions first.
    • Based on client’s comfort of talking about stools.
    • Gas = flatus is Goood c:
  20. =>Cultural Care: Nurse should:
    Include cultural/ethnic considerations :Dietary choices (traditional foods)& Weight maintenance

    Avoid cultural stereotyping

    Teach dietary restrictions/changes with entire family
  21. =>Malnutrition
    Deficit, excess, or imbalance in essential components of balanced diet 

    -Undernutrition:Poor nourishment due to inadequate diet or disease

    -Overnutrition: Ingestion of more food than required

    Sick persons have increased nutritional needs
    Not an uncommon consequence of Illness, Surgery, Injury, HospitalizationFever increases basal metabolic rate—leading to protein depletion

    • Laboratory studies indicate or confirm the severity of malnutrition, the duration, and the type (protein-calorie vs. vitamin, etc).
  22. =>Tube Feeding
     Also known as enteral nutritionAdministration of nutritionally balanced liquefied food or formula through tube inserted into:Stomach,Duodenum, Jejunum

    • Provide nutrients to GI tract alone or supplemental to oral or parenteral nutrition
    • Easily administered
    • Safer than parenteral More physiologically efficient than parenteral
    • Less expensive than parenteral
    • Tube Feeding


    • -->Gerontologic Considerations
    • More vulnerable to complications
    • Fluid and electrolyte imbalances
    • Glucose intolerance
    • Decreased ability to handle large volumes
    • Increased risk of aspiration
  23. => Enteral tube
    feedings maintain the structural and functional integrity of the GI tract, enhance the utilization of nutrients, and provide a safe and economic metod of feeding.

    Enteral feedings contraindicated in clients with: intestianl obstruction, severe diarrhea, intractable vomiting due to payalytic ileus.

    -Use caution with patients who have: severe pancreatis, GI ischemia

    -PEG: Percutaneous Endoscopic Gastrostomy: placesment is performed by the health care privider at te bedside or in the endoscopy room; insertion of PEG does not requeire general anesthesia surgery. This metohod is more common than conventional enterostomies and it is less risky b/c surgery isn't required.

    -Intermittent feeding: 4-6 x day-aspirate gastric contents every 4 hrs.
  24. Bilirubin:
     a pigment derived to the breakdown of hemoglobin, constantly produce, insoluble in water, conjugated in liver with curonic acid.
  25. Borborygmi:
     stomach growling, loud gurgles that indicate hyperperistalsis, hyperactive bowel after eating.
  26. Chelosis:
    gastrointestinal abnormality: softerning, fissuring and cracking of lips at angles of mouth. Due to riboflavin deficiency.
  27. Deglutition:
    swallowing; the mechanical components of ingestion. By Mouth, Pharynx and esophagus
  28. Endoscopy:
    refers to the diriect visualization of a body structure through a lighted fiberoptic instrument. Esophagus, stomach, duodenum and the colon can be examines and bilde ducts visualized.
  29. Hematemesis:
    vomiting of blood. Esophageal varices, bleeding peptic ulcer
  30. Hepatocytes:
    rows of hepatic cells in the lobules of the liver which are arranged around a central vein.
  31. Kupffer cells:
    Part of the liver in mononuclear phagocyte system:break down of old RBC’s, WBCs, bacteria, and other particles. Breakdown of fhemoglobin from old RBCs to bilirubin and biliverdin.
  32. Melena:
     Abnormal, black, tarry stool containing digested blood. Signifies cancer, bleeding in upper GI tract from ulcer, varices
  33. Pyorrhea:
    recessed gingivae, purulent pockets, signififies periodontitis
  34. Pyrosis:
    Heartburn, burning in epigastric or substernal area
  35. Steatorrhea:
    Fatty, frothy, foul smelling stool. Signifies: Chronic pancreatitis, biliary obstruction, malabortion problems.
  36. Tenesmus:
    Painful and ineffective straing at stool. Sense of incomplete evacuation. Signifies: Inflammatory bowel disease, irritable bowel syndrome, diahrrhea secondary to GI infection (ex: food poisioning)
  37. Anorexia Nervosa (Ch. 40):
    characterized by a self-imposed weight loss, endocrine dysfunction and a distorted psychopathological attitude toward weight and eating. More frequent in women, manifests as abnormal weight loss, deliberate self-starvation, intense fear of gaining weight,hair loss, sensitivity to cold, irregular menstruation, constipation.
  38. Bulimia nervosa:
    A disorder characterized by frequent binge eating and self-induced vomiting associated with loss of control related to eating and a persistent concern with body image. Tend to abuse laxatives, diuretics, exercise and diet drugs. May have signs of frequent vomiting: macerated knuckles, swollen salivary glands, broken BVs in eyes and dental problems. Test for: hypokalemia, metabolic alkalosis, and elevated serum amylase.
  39. Enteral nutrition:
    aka tube feeding, is defined as nutrition provided through the GI tract via a tube, catheter, or stoma that delivers nutrients distal to the oral cavity. EN may be ordered for the patient who has a functioning GI tract but unable to get enough oral nourismhment. Ex:orofacial fractures, anorexia, head/neck cancer,critical illness.
  40. Malabsorption syndrome:
    the impaired absorption of nutrients from the GI tract. Ecreases in digestive enzymes or in bowel surface area ca n quickly lead to a deficiency state.
  41. Malnutrition:
     is a deficit, excess or imbalance of essential nutrients. It may occur with or without inflammation. Affects body composition and fuctional status. Includes Under and overnutrition.
  42. Parenteral nutrition:
    refers to the administration of nutrients by a route other than the GI tract (ex: bloodstream). It is used when the GI tract cannoted be used for igestion, digestion and absorption of essential nurtients.
  43. Tube feeding:
    see Enteral Nutrition. Orogastic, Nasogastric, Nasointestinal, gastrostomy, jejunostomy tubes. Problems related to Tube feeding (Table 40-11; pg. 898)
  44. Identify clients who are at risk for nutritional deficits.
    a. The Elderly.

    b. Conditions that increase risk for malnutrition: Dementia, Depression, Chronic alcoholism, Excessive dieting to lose weight, swallowing disorders (head/neck cancer), decreased motility that limits access to food, nutrient losses from malabsorption, dialysis, fistulas or wounds. Drugs with antinutrient or catabolic properties such as corticosteroids ad oral antibiotics. Extreme need for nutrients b/c of hypermetabolism or stresses such as infection burns trauma or fever. No oral intake and/or receiving standard IV solutions (adults-10 days and elderly: 5 days) (Table 40-6; pg. 890)
  45. 3. Describe the procedure for initiating and maintaining tube feedings. (pg. 897)
    a. Initiating: Tube feeding is provided through the GI tract via tube, catheter or stoma.

    • i. Gastronemy tubes are placed surgically, radiological or endoscopically.
    • PEG tube: patient must have an intact unobstructed GI tract and esophageal lumen must be wide enough to pass endoscope for PEG tube placement. IV antibiotics are given before the procedure. Feeding must start within 2 hours. Figure 40-7: Gastronomy Tube placement via percutaneous endoscopy. With use of endoscopy, a gastrostomy tube is inserted through esophagus into the stomach and then pulled through a stab wound of abdominal wound.

    ii. Jejunostomy (j-tube): placed endoscopically or Laparoscopic surgery.

    iii. Nasally/orally tubes (orogastric and NG) are most commonly used for short term feeding, less than four weeks.

    b. Maintaining: Aspiration and dislodged tubes are two important safety concern. Elevated head of bed to 30 degrees minimum.
  46. Describe the methods to avoid complications of tube feedings. (table 40-11- Pg 899)
    • Vomitting/aspiration:
    • placepment of tube
    • Delayed gastric emptying, increased residual volume
    • potential for aspiration
    •  
    • Dehydration: excessive diarrhea/vomitting, poor fluid intake, high protein formula, hyperolsmotic diuresis

    Diarrhea: Feeding too fast, Medications, low-fiber formula tube moving distally, contamination of formula.

    Constipation: formula compnents, poor fluid intake, drugs impaction
  47. Identify the basic organs and function of the gastrointestinal system, including the alimentary canal and accessory organs. (Ch. 39)
    a. Mouth, pharynx, esophagus, stomach, small intestine , large intestine

    b. Liver, Gallbladder, Pancreas
  48. Discuss important health history components that provide information about GI system status.
    a. Health perception: recent foreign travel, alcohol intake, diet history, sugar and salt subsititiutes

    b. Elimination: type of fluid and fiber intake, food allergies, external drainage systems. Immobility.

    c. Sleep/rest: GI symptoms that interfere with sleep quality: nausea, vomiting, diarrhea

    d. Cognitive: any change in taste/smell, heat or cold sensitivity while eating,appetite suppression pain meds?

    e. Self perception: psyche

    f. Role relationship: impact on relationships

    g. Sexual/reproductive, coping stress

    h. Values & beliefs
  49. a. Abdomen is divided into four different quadrant:
    1. RLQ: Lower pole of right kidney, cecum and appendix, portion of ascending colon, bladder (if distended), Right ovary and salpinx, uterus (if enlarged), Right spermatic cord. Right ureter.

    2. RUQ: Liver, gallbladder, pylorus, duodenum, head of pancreas, right adrenal gland, portion of right kidney, Hepatic flexur of colorn, portion of ascending and transverse colon.

    3. LUQ: Left lobe of liver, spleen, stomach, body of pancreas, left adrenal gland, portion of left kidney, splenic flexure of colorn, portion of transverse and descending colon.

    4. LLQ: Lower pole of left kidney, sigmoid flexure, portion of descending colon, bladder (distended), left ovary, uterus (enlarged), left spermatic cord, left urether
  50. Cite measures that may help to stimulate appetite in the hospitalized client.
     Preparation of foods preferered by patient enhances the daily intake; encourage the family to bring the patients favorite food from home while patient is hospitalized; appetite stimulants; if this doesn’t work, then enteral feedings
  51. Adult patient Physical Assessment
    i. good lighting, supine positon, flexed knees, raise head of bed slightly, empty bladder, warm hands, breath through mouth

    ii. Inspection: assess abdomen for skin changes (color, texture, scars, striae, dilated veins, rashes, lesions) umbilicus (concave,convex, distended?), symmetry, contour of belly, movement (pulsastions, peristalsis).

    • iii. Auscultation: Use diagraphm of stethoscope. Listen for bowel sounds: Hypoactive.
    • Borborygmi: stomach growling from peristalsis. Describe pitches. Look for bruit: swishing or buzzing sound indicating turbulent blood flow.

    • iv. Percussion: estimate the size of the liver and determine the presence of fluid distention and masses.
    • Tympany: hollow/air vs dullness: short, high pitched sound with little resonance. Tympany is predominant in the abdomen.Percuss liver: look for dullness area in Right mid-clavicular region. Light palpation: detects tenderness or cutaneous hypersensitivity, muscular resistance, masses and swelling. Deep palpation: delineate abdominal organs and mass; uses the palmar surfaces of fingers to press more deeply. Look for rebound tendernessv. Palpate: liver: place left hand behind the patient to support eleventh rib. Press the left hand forward and blace the right hand on the patients right abdomen lateral to rectus muscle. Spleen: move to left side of patient, place right hand under patient and place left hand below the left costal margin and press it in toward the spleen; ask patient to breathe deeply.

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