Nursing A ConceptBased Approach to Learning VOLUME ONE
Nursing: A Concept-Based Approach to Learning VOLUME ONE EDITION VOLUME ONE|| SECOND EDITION MODULE 4 Digestion Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
The Concept of Digestion • Digestions: conversion of food into absorbable substances in GI tract • Mechanical, chemical breakdown of food § Aided by glands inside, outside stomach Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Normal Digestion • Physiology review § Digestive system • Mouth, pharynx, esophagus, stomach • Small, large intestines • Accessory organs: liver, gallbladder, pancreas § Works with digestive enzymes Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Genetic and Lifespan Considerations • Infants and children § Deficiency of amylase, lipase, trypsin enzymes; immature liver § By age 2, digestive processes complete § About age 3, control of elimination • Older adults § Taste less acute, tooth enamel brittle § Decreased saliva, esophageal motility § Appearance of abdomen changes Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Alterations to Digestion • Motility Moves food, fluid from mouth to anus ANS regulates rate, strength of motility Disorders when rate too slow or too fast Food intake, bacteria affect number, consistency of stools § Motility affected by inflammation, tumors, obstructions, stress, postponement of defecation § § Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Alterations to Digestion, continued • Absorption § Moves nutrients, fluid from outside the GI tract to inside body § Occurs through active transport and diffusions § Medical or surgical conditions can hinder absorption Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Alterations and Manifestations • • Nausea, vomiting Anorexia (loss of appetite) Gastroesophageal reflux disease (GERD) Hepatitis Malabsorption Maldigestion Pancreatitis Pyloric stenosis Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Concepts Related to Digestion • Nutrition • Development • Fluids and Electrolytes Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Prevalence • Nausea, vomiting, diarrhea § Common in all age groups § Food, stress, medications, smells, and tastes are common causes § Stress reduction strategies can relieve Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Genetic Considerations and Nonmodifiable Risk Factors • Early identification of risk factors leads to early intervention and disease prevention. • Genetics may play role in GERD, pyloric stenosis, celiac disease, pancreatitis Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Prevention • Preventing alterations in digestion involves lifestyle choices and management. • Modifiable risk factors § Lifestyle choices • Screenings § Blood tests § Early diagnosis, treatment § Prevention of complications Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nursing Assessment • Assessment interview § Health history § Changes in appetite, weight, bowel habits, flatulence and pain § Current therapies in use. § Assess for findings of malnutrition Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nursing Assessment, continued • Physical assessment § § Inspection Auscultation Percussion Palpation Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Lifespan and Cultural Considerations • Begin inspection for infant or child by noting shape, contour of the abdomen and observing the condition of the umbilicus. • Child's abdomen is normally symmetric and rounded when lying down. • Assessment of children includes weight, head circumference and BMI Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Lifespan and Cultural Considerations, continued • Nurse uses the diaphragm of the stethoscope to auscultate the digestive system. • Nurse uses percussion to identify the borders of the liver, spleen, bladder, and any masses. • Palpation of the abdomen should occur last, when child is calm and cooperative Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Diagnostic Tests • • • Upper GI series (barium swallow) Endoscopy Abdominal x-ray CT scan Amylase Lipase Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Interventions and Therapies • Monitoring, early intervention • Assessment of pain • Most cases of nausea, vomiting selflimiting Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Independent • Identify individuals that have digestive concerns • Promote fluid, electrolyte balance • Provide client education • Refer for further evaluation, treatment • Severe vomiting may require acute care Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Collaborative • Pharmacologic therapy § § § Antacids H 2 -receptor antagonists Proton pump inhibitors Antiemetics Metoclopramide hydrochloride Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Collaborative, continued • Nutrition therapy § Enteral nutrition (tube feeding) • If client cannot get adequate nutrition orally • Complications: aspiration, diarrhea Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Collaborative, continued • Nutrition therapy § Parenteral nutrition (IV administration of amino acids) • May be concurrent with enteral nutrition • Used after major surgery or trauma or with seriously undernourished client • Complications: glucose intolerance, hyperlipedemia, fluid overload, electrolyte imbalance § Diet low in fat, cholesterol Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
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