What is the main fnx of the GI tract? 

What are the major processes?

The main function of the GI tract is to supply nutrients to the body cells

Ingestion – the process of eating
Digestion – the breakdown of food into small molecules
Absorption – transfer of food particles into circulation
Elimination – excreting  the waste products of digestion

What are the two types of mvmt min the GI tract?

Peristalsis – a series of alternating contractions and relaxations of smooth muscle that lines the walls of the digestive organs and that forces food to move forward
Segmentation – churning (chyme) occurs in the small intestine, this is similar to peristalsis, except that the rhythmic timing of the muscle constrictions forces the food backward and forward rather than forward only

The secretions of the GI tract consist of hormones and enzymes for digestion, mucus to provide protection and lubrication, and water and electrolytes

Atrophic gastritis – is a form of chronic gastritis; this condition involves chronic inflammation and atrophy (tissue destruction) affecting the stomach's mucosal lining.

Chronic gastritis – is inflammation of the lining of the stomach that persists for a long time; may be caused by prolonged irritation from the use of nonsteroidal anti-inflammatory drugs (NSAIDs), infection with the bacteria Helicobacter pylori (H. pylori), or degeneration of the lining of the stomach from age
Acute gastritis – is a sudden inflammation of the stomach lining; lasting from a few hours to a few days; with complete healing of the mucosa after the episode

What is gastritis?

Gastritis commonly refers to inflammation of the lining of the stomach, it is the result of a breakdown in the normal gastric mucosal barrier

Eat smart – eat small frequent meals, avoid any foods that are irritating, especially those that are spicy, acidic, fried or fatty
Limit or avoid alcohol
Don’t smoke
Avoid NSAIDS (aspirins, ibuprofin) if irritation or inflammation occurs

Antacids -  Over-the-counter antacids (Maalox, Mylanta, others) in liquid or tablet form are a common treatment for mild gastritis. Antacids neutralize stomach acid and can provide fast pain relief
H₂ Acid blockers - When antacids don't provide enough relief, other medications, such as cimetidine (Tagamet) and ranitidine (Zantac); (reduces the amount of stomach acid)
Proton pump inhibitors -  reduce acid by blocking the action of tiny pumps within the acid-secreting cells of the stomach. This class of medications includes omeprazole (Prilosec), lansoprazole (Prevacid)
Nursing implications – important for nurse to teach about the therapeutic effects and how to monitor for side effects

are stronger than the nonprescription forms.
H2 blockers have been in use since the late 1960s. H2 blockers are well-studied and are considered very safe.
Minimal side effects occur with use of H2 blockers. Side effects may include:
HA, Dizziness; Diarrhea; Constipation; Nausea; Vomiting.
For aluminum-containing antacids (including magaldrate) Bone pain; Constipation (severe and continuing); Feeling of discomfort continuing); Loss of appetite; Mood or mental changes; Muscle weakness; Swelling of wrists or ankles; Weight loss (unusual)

The most common side effects of proton pump inhibitors are: headache, diarrhea, constipation, abdominal pain, nausea, and  rash.

What is peptic ulcer disease?

Where does it occure?

This is an erosion of the GI mucosa caused by HCl acid and pepsin

Occurs in either stomach or duodenum

What are signs of peptic ulcer disease?

Teaching and meds?

The client may not have pain or have pain that is burning or cramplike ; the pain may occur 2 to 4 hours after meals
The client should not eat foods that that irritate the gastric mucosa that include hot, spicy foods and pepper, alcohol, carbonated beverages, tea, coffee, and broth (meat extract) 
Pain may be relieved by antacids, H₂ acid blocker, antibiotics (to eradicate H. pylori) or  proton pump inhibitors

Gastric - is a break in the normal tissue that lines the stomach, lesion may have smooth margins that are round, oval or cone shaped, gastric secretion can be normal to decreased and this occurs more in women aged 50-60 years
Duodenal -  lesion is penetrating in the first 1-2 cm of duodenum, gastric secretion is increased and this occurs more in men, but ↑ in women especially postmenopausal, peak inccendental in age 35-45 years
Stress – acute ulcers that develop following a major insult like trauma or surgery, this can occur in the stomach or the intestine; it causes pain and burning

Hemorrhage - most common complication of PUD; occurs because of erosion of the ulcer through a major blood vessel
Perforation - is the most lethal complication of PUD; seen in large penetrating ulcers that do not heal; with spillage of gastric or duodenal contents into the peritoneal cavity
Gastric outlet obstruction – ulcers located in the antrum and pyloric areas of stomach and in the duodenum can develop into outlet obstructions, the obstruction is due to edema, inflammation, scar tissue, and pylorospasm, these all contribute to narrowing of the pylorus

After a nasogastric  or orogastric tube is placed, room temperature water or saline is used (follow your hospital policy and procedures)

Cleans out excess blood

What GI tubes may be used?

What are the purposes of the following GI tubes and when they might be used?

Levine - is a single-lumen nasogastric tube; it useful in instilling material into the stomach or suctioning material out of the stomach
Salem sump tube - a double-lumen nasogastric  used for suction and irrigation of the stomach. One lumen is attached to suction for the drainage of gastric contents and the second lumen is an air vent
Sengstaken-Blakemore - a multilumen tube used for tamponade (inflated balloon is stomach to put pressure against walls)of bleeding esophageal varices (varicous veins of esoph); 3 parts to this tube are a gastric balloon, an esophageal balloon, and a gastric suction port

Dumping syndrome is the result of surgical removal of a large portion of the stomach and the pyloric sphincter, when stomach contents move too rapidly through the small intestine; related to ingestion of high-sugar, high-fat foods or liquids that can occur after certain bariatric surgeries.
Symptoms of dumping syndrome include nausea, weakness, sweating, faintness, and, occasionally, diarrhea after eating, as well as the inability to eat sweets without becoming so weak and sweaty that the patient may have to lie down

In order to evaluate how effective the instruction has been the nurse needs to have the client demonstrate the skills that were taught or have follow-up care to assess if the client is following through with the plan of care; for example if the client was instructed to avoid irritating substances, like smoking and alcohol, this could be assessed at a future visit

Follow eating plan developed by speech therapy
Sit the client up at 90 degrees 20 minutes before and during eating and leave them in a sitting position at least 30 minutes after eating or drinking.

Demonstration and follow up care to ask question about their copping

i.e. avoiding smoking and alcohol

Provide appropriate diets:
mechanical soft- all foods are soft and easy to chew/ swallow
chopped- all foods are chopped into small easy to swallow pieces
ground- all meats are ground up, other foods are chopped or soft
pureed- foods are baby food consistency
Give the client small bites of food and time to swallow each bite
Thick- It or similar products may be used to thicken liquids so that they may be swallowed.
Provide mouth care before and after meals

Abdominal ultrasound

Endoscopy

Radiologic studies (x-ray)
For all procedures, teach the client how to prepare for the examination, provide an explanation of the procedure and teach the post procedure care

Lower GI or Barium enema – enema with contrast medium, client needs laxatives and enemas until colon is clear of stool the evening before procedure and clear liquid diet the evening before procedure

before procedure, avoid smoking after midnight before procedure; stool may be white for up to 72 hours after procedure; may need fluid and laxative to prevent impaction after procedure


Fluoroscopy: An x-ray procedure that makes it possible to see internal organs in motion.
Fluoroscopy uses x-ray to produce real-time video images. After the x-rays pass through the patient, instead of using film, they are captured by a device called an image intensifier and converted into light. The light is then captured by a TV camera and displayed on a video monitor.

Review on your own, Computed tomography (CT), Magnetic resonance imaging (MRI), Virtual colonoscopy, Liver biopsy, gastric analysis, and fecal analysis

Endoscopy-
Colonoscopy  - direct visualization of entire colon using a flexible fiberoptic scope; client may be on clear liquids for 1-2 days before procedure; enema or 1 gallon of polyethylene glycol (GoLYTELY) the night before procedure, and sedation will be used during the procedure
Stool culture – test for bacteria, including Clostridium  difficile; nurse needs to collect stool specimen

Clostridium difficile: A bacterium that is one of the most common causes of infection of the large bowel (colon). In technical terms, Clostridium difficile (C. difficile) is an obligate anaerobic or microaerophilic, gram-positive, spore-forming, rod-shaped bacillus.
C. difficile is now recognized as the chief cause of nosocomial (hospital-acquired) diarrhea in the US and Europe. Patients taking antibiotics are at risk of becoming infected with C. difficile. Antibiotics disrupt the normal bacteria of the bowel, allowing C. difficile bacteria to become established in the colon.

Serum amylase – measures secretion of amylase by pancreas; increased (↑) values indicate possible acute pancreatitis; normal result 0-130/30-122 (Lewis)U/L; explain procedure to client and obtain blood sample

Serum lipase – measures secretion of lipase from pancreas; ↑ values indicate possible acute pancreatitis; normal result 31-186(lewis) U/L; explain procedure to client

Serum cholesterol – synthesis and excretion by liver; ↑ values indicate possible biliary obstruction; decreased (↓) values indicate possible liver disease and malnutrition; normal result 140-200mg/dl

Serum protein – measurement of protein created by the liver; measurement of albumin, normal finding 3.5-5 g/dl; low value indicates inadequate protein intake, malnutrition, or hepatic disease

Assess

bowel sounds before feeding
tube placement before each feeding/drug admin

Whenever possible, use liquid medication instead of crushed tablets, crush tablets as finely as possible(fine powder) and dissolve in warm water (check to see if tablets are safe to crush; do not crush slow-acting or slow-release(SR) drugs)

Avoid adding medications to enteral feeding formula
Follow general principles for feedings – elevating HOB, for silicone NG tubes flush the tubing after checking for residual volumes
Assess

complications

aspiration

diarrhea

distention

constipation

fecal impaction

hyperglycemia

when is a Nasogastric  tube used

Describe NG and gastrostomy feeding tubes

Nasogastric tube is used for short-term feeding problems, these tubes are made of silicone or polyurethane material (soft and flexible) to increase the comfort level of the patient

Gastrostomy tube is used for long-term feeding problems, these tubes can be placed surgically, via x-ray or endoscopically

The second way, called percutaneous endoscopic gastrostomy (PEG) tube placement is usually done with sedation given in the vein and a local anesthetic applied to the back of the mouth. The procedure is done with the guidance of an endoscope placed through the patient’s mouth into their stomach.

Anorexia
Orofacial fractures
Head and neck cancer
Neurologic or psychiatric conditions that prevent oral intake
Massive burns
Clients receiving radiation or chemotherapy

Continuous pump infusion
Intermittent by gravity
Intermittent bolus by syringe
Cyclic feedings by pump

Continuous infusion is used the most often for critically ill patients

Parenteral nutrition (PN)
Is the administration of nutrition directly into the bloodstream when the GI tract cannot be used, it can be given through central or peripheral veins

PN via a central site is given through a catheter whose tip lies in the superior vena cava; utilizing hypertonic solutions (20-50% glucose, high protein, and calorie requirements) for long-term support

PN is administered via a peripheral vein using a peripherally inserted central catheter (PICC) using a large peripheral vein, using hypertonic solutions (20% glucose; less than central PN) for a short time

Parenteral nutrition is indicated for clients who are temporarily or permanently unable to meet nutritional requirements through enteral routes
Short bowel syndrome
Severe malabsorption
Severe anorexia nervosa
Chronic severe diarrhea and vomiting
Complicated surgery or trauma
Gastrointestinal (GI) tract anomalies
GI obstruction
Chronic severe diarrhea and vomiting

Nutritional screening to identify clients at risk for malnutrition or who are malnourished
Some clients at risk are those who have:
Anorexia nervosa/bulimia (binge on food and then vomit/purge)
Malabsorption problems (Crohn’s disease, ulcerative colitis, short bowel syndrome)
Multiple trauma (head injury, multiple fractures)
Pressure ulcers
Cachexia (cancer, muscle wasting)
Diabetes
End-stage renal or liver disease                     

Nursing Diagnoses
Self-care deficit (feeding) related to (RT) decreased strength and endurance, fatigue
Constipation or diarrhea RT poor eating patterns or effects of medications
Risk for infection RT malnutrition
Risk for Impaired skin integrity RT alterations in nutritional state
Planning
The client will:
Achieve weight gain
Maintain passage of soft, formed stool every 1 to 3 days without straining
Remain free from symptoms of infection
Maintain intact skin

What is an endoscopy?

Pre and post precures?

a procedure that provides direct visualization of the esophagus, stomach and duodenum using a lighted fiberoptic instrument;

Pre-procedure

client NPO for 8 hours, need a signed consent, administer pre-op medication if ordered; client will be sedated during procedure

Monitor for S/S of

over sedation (difficulty arrousing, poor resps, hypoxemia, tacycard or decrease BP

Hemorrhage (vitas, Hgb, Hct, pain, fever, bleedin)

Aspiration (dyspnea, tachypnea, adv sounds, tachycardia, fever)

Perforation (WBC, fever, pain, bleeding)

Abdominal ultrasound - uses reflected sound waves to produce a picture of the organs and other structures in the upper abdomen; client should be NPO for 8-12 hours before the test

Serum amylase – measures secretion of amylase by pancreas; increased (↑) values indicate possible acute pancreatitis; normal result 0-130/30-122 (Lewis)U/L; explain procedure to client and obtain blood sample

Serum lipase – measures secretion of lipase from pancreas; ↑ values indicate possible acute pancreatitis; normal result 31-186(lewis) U/L; explain procedure to client

Serum cholesterol – synthesis and excretion by liver; ↑ values indicate possible biliary obstruction; decreased (↓) values indicate possible liver disease and malnutrition; normal result 140-200mg/dl

Serum protein – measurement of protein created by the liver; measurement of albumin, normal finding 3.5-5 g/dl; low value indicates inadequate protein intake, malnutrition, or hepatic disease

What are the signs and symptoms a client might demonstrate that would indicate the client has pneumonia?

Tachypnea, use of accessory muscles;

BP <90

Temp <95, 104

Pulse >125

altered mental status

pleural effusion

PaO2<60

Hct <30%

Na <130

duskiness or cyanosis

Palpation ↑Fremitis over affected area

Percussion Dull over affected area

Early: bronchial sounds

Later: crackles; rhonchi; egophony; whispered pectoriloquy

Impaired gas exchange

Acute pain

Ineffectie airway clearance

Activity intolerance

Risk for imbalanced nutrition:  less than body requirements

Risk for deficient fluid volume

Deficient knowledge