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Chapter 38_ Assessment of Digestive and Gastrointestinal Function

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221 views

Chapter 38_ Assessment of Digestive and Gastrointestinal Function

Uploaded by

Justine Ingrid O. Fernandez
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Chapter 38

Assessment of Digestive and


Gastrointestinal Function
Organs of the Digestive System

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Anatomy and Blood Supply of the Large
Intestine

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Functions of the Digestive Tract

❖Breakdown of food for digestion


❖Absorption of small nutrient molecules
❖Elimination of undigested unabsorbed foodstuffs and
other waste products

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Terms

❖Digestion: food is broken down into small particles


❖Absorption: major function of the small intestine.
❖Vitamins and minerals absorbed are essentially
unchanged.
❖Absorption begins in the jejunum
❖Elimination: waste products are eliminated from
the body

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Major Enzymes and Secretions

❖Chewing and swallowing: saliva, salivary amylase


❖Gastric function: hydrochloric acid, pepsin, intrinsic
factor
❖Small intestine: amylase, lipase, trypsin, bile
❖Chyme, emulsification, peristalsis
❖Tables 38-1 and 38-2

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Question #1

Is the following statement true or false?

Lipase is an enzyme that aids in the digestion of


protein.

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Answer to Question #1

False

Rationale: Lipase is an enzyme that aids in the


digestion of fats. Trypsin is an enzyme that aids in the
digestion of protein.

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Question #2

What is ingestion?
A. Occurs when food is taken into the GI tract via
the mouth and esophagus
B. Occurs when enzymes mix with ingested food
and when proteins, fats, and sugars are broken
down into their component molecules
C. Occurs when small molecules, vitamins, and
minerals pass through the walls of the small
and large intestine and into the bloodstream
D. Occurs after digestion and absorption when
waste products are eliminated from the body

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Answer to Question #2

A. Occurs when food is taken into the GI tract via the


mouth and esophagus

Rationale: Ingestion occurs when food is taken into


the GI tract via the mouth and esophagus. Digestion
occurs when enzymes mix with ingested food and
when proteins, fats, and sugars are broken down into
their component molecules. Absorption occurs when
small molecules, vitamins, and minerals pass through
the walls of the small and large intestine and into the
bloodstream. Elimination occurs after digestion and
absorption when waste products are eliminated from
the body.
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Assessment of the GI System #1

❖Health history:
o Information about abdominal pain, dyspepsia,
gas, nausea and vomiting, diarrhea,
constipation, fecal incontinence, jaundice, and
previous GI disease is obtained
❖Pain:
o Character, duration, pattern, frequency,
location, distribution of referred abdominal pain,
and time of the pain vary greatly depending on
the underlying cause (OLD CART or PQRST)

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Common Sites of Referred Abdominal Pain

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Assessment of the GI System #2

❖Dyspepsia
o Most common symptom of patients with GI
dysfunction
❖Intestinal gas
o Bloating, distention, or feeling “full of gas” with
excessive flatulence as a symptom of food
intolerance or gallbladder disease
❖Nausea and vomiting
o Nausea is a vague, uncomfortable sensation of
sickness or “queasiness” that may or may not
be followed by vomiting

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Assessment of the GI System #3

❖Change in bowel habits and stool characteristics


o May signal colonic dysfunction or disease
o Constipation, diarrhea
❖Past health, family and social history
o Oral care and dental visits
o Lesions in mouth
o Discomfort with certain foods
o Use of alcohol and tobacco
o Dentures

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Physical Assessment of the GI System

❖ Oral cavity
o Lips
o Gums
o Tongue
❖ Abdominal assessment; four quadrant method
o Inspection
o Auscultation
o Percussion
o Palpation
❖ Rectal inspection

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Division of the Abdomen into Four
Quadrants or Nine Regions

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Question #3

Which is the correct order to complete an abdominal


assessment?
A. Inspection, auscultation, percussion, and palpation
B. Auscultation, inspection, palpation, and percussion
C. Percussion, palpation, inspection, and auscultation
D. Palpation, percussion, auscultation, and inspection

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Answer to Question #3

A. Inspection, auscultation, percussion, and palpation

Rationale: The correct order for an abdominal


assessment is inspection, auscultation, percussion,
and palpation. Auscultation must be completed before
manipulation of the abdomen because it has an
impact on motility and can lead to an inaccurate
interpretation of bowel sounds.

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Diagnostic Tests of the GI System #1

❖Serum laboratory studies


❖Stool tests (fecalysis)
❖Breath tests
❖Abdominal ultrasonography
❖Genetic testing
❖Imaging studies: CT, PET, MRI, scintigraphy, virtual
colonoscopy
❖Upper GI tract study
❖Lower GI tract study

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Diagnostic Tests of the GI System #2

❖GI motility studies


❖Endoscopic Procedures
o EGD (esophagogastroduodenoscopy)
o Colonoscopy
o Anoscopy, proctoscopy, and sigmoidoscopy
o Small‐bowel enteroscopy
o Endoscopy through an ostomy
❖Manometry and electrophysiologic studies

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Patient Undergoing Gastroscopy

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Colonoscopy and Flexible Fiber-Optic
Sigmoidoscopy

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Question #4

Is the following statement true or false?

When a colonoscopy is performed, the flexible scope


is passed through the rectum and sigmoid colon into
the descending, transverse, and ascending colon.

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Answer to Question #4

True

Rationale: When a colonoscopy is performed, the


flexible scope is passed through the rectum and
sigmoid colon into the descending, transverse, and
ascending colon. When a flexible fiberoptic
sigmoidoscopy is performed, the flexible scope is
advanced past the proximal sigmoid and then into the
descending colon.

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Nursing Interventions for GI Diagnostic
Tests

❖Inform the primary provider of known medical


conditions or abnormal laboratory values that may
affect the procedure
❖Assess for adequate hydration before, during, and
immediately after the procedure, and provide
education about maintenance of hydration
❖Provide health information and procedural education
to patients and significant others
❖Provide instructions about postprocedure care and
activity restrictions
❖Help the patient cope with discomfort and alleviate
anxiety
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