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Textbook For Nursing Assistants

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1 Textbook For Nursing Assistants
Chapter 31 - The Digestive System Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

2 Structure of the Digestive System
Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

3 Structure of the Digestive System
The digestive system is a long tube, or tract, consisting of the: Mouth Pharynx Esophagus Stomach Small intestine Large intestine Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

4 Structure of the Digestive System
Accessory organs assist in the process of breaking down food: Teeth Tongue Salivary glands Liver Gallbladder Pancreas Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

5 Structure of the Digestive System
Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

6 The Digestive Tract The walls of the “tube” that forms the digestive tract are made up of four layers of tissue: The mucosa The submucosa The muscle layer, and The serosa Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

7 The Digestive Tract: The Mucosa
The mucosa, a mucous membrane, lines the digestive tract The mucosa helps to Trap disease-causing microbes Protect the delicate tissues of the digestive tract from stomach acid, a very harsh fluid produced by the stomach to help digest food Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

8 The Digestive Tract: The Submucosa
The submucosa contains blood vessels and nerves Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

9 The Digestive Tract: The Muscle Layer
The muscle layer contains smooth muscle Peristalsis action of the muscle layer (contraction of the smooth muscle in the walls of the digestive tract) moves food through the system Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

10 The Digestive Tract: The Serosa
The serosa is a tough outer layer of connective tissue Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

11 The Mouth, Pharynx, and Esophagus
Food begins its journey through the digestive tract at the mouth, or oral cavity The mouth is lined with a mucous membrane and houses the teeth and tongue, accessory organs that assist with chewing and swallowing food Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

12 The Mouth, Pharynx, and Esophagus
The Pharynx From the mouth, food moves into the pharynx (throat) Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

13 The Mouth, Pharynx, and Esophagus
The Esophagus The esophagus is a long narrow tube that serves mainly as a passageway for food to get from the pharynx to the stomach After entering the abdominal cavity, the esophagus connects with the upper part of the stomach The mucus secreted by the esophageal mucosa, as well as the action of the muscle layer, helps to move food downward and into the stomach Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

14 The Stomach The stomach is a hollow, muscular holding pouch for food
The stomach has three main regions: The fundus The body The pylorus Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

15 The Stomach: The Fundus
The fundus is the upper region Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

16 The Stomach: The Body The body is the main region
The esophagus enters the stomach here The esophageal (cardiac) sphincter, a circle of muscular tissue, surrounds the place where the esophagus enters the stomach and keeps food from going back up the esophagus after it has entered the stomach Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

17 The Stomach: The Pylorus
The pylorus is the bottom region Food leaves the stomach through the pyloric sphincter, a circle of muscular tissue that surrounds the place where the stomach empties into the small intestine The pyloric sphincter helps to prevent food from returning to the stomach once it enters the small intestine Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

18 The Stomach: Rugae Folds of the mucosa, called rugae, flatten out as food enters the stomach, almost doubling the stomach’s holding capacity Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

19 The Small Intestine The small intestine, which is about 20 feet long, is so named because its diameter is much smaller than that of the large intestine The small intestine has three regions, called the duodenum, the jejunum, and the ileum Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

20 The Large Intestine The large intestine (also called the colon) is 4 1/2 feet long and is much larger in diameter than the small intestine The large intestine has several distinct regions: The cecum The ascending colon The transverse colon The descending colon The sigmoid colon The rectum The appendix Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

21 The Large Intestine: The Cecum
The cecum is like a waiting room for food that is leaving the small intestine through the ileocecal valve and entering the large intestine Food moves through the large intestine much more slowly than it moves through the small intestine Therefore, incoming deliveries from the small intestine need a place to wait until the next segment of the large intestine, the ascending colon, is able to accept more food for processing Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

22 The ascending colon travels upward from the cecum
The Large Intestine: The Ascending Colon The ascending colon travels upward from the cecum Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

23 The transverse colon travels across
The Large Intestine: The Transverse Colon The transverse colon travels across Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

24 The descending colon travels down
The Large Intestine: The Descending Colon The descending colon travels down Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

25 The Large Intestine: The Sigmoid Colon
The sigmoid colon is an S-shaped curve at the end of the descending colon Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

26 The Large Intestine: The Rectum
The rectum is the last segment of the colon The place where the rectum opens to the outside of the body is the anus Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

27 The Large Intestine: The Appendix
The appendix, a tiny, closed pouch that dangles from the cecum, has no known function The appendix has a way of making its presence known Inflammation or infection of the appendix causes appendicitis, a painful condition that is life-threatening if not treated Treatment is surgical removal of the appendix Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

28 The Accessory Organs Several organs that play a role in digestion but are not actually part of the digestive tract are called accessory organs Salivary glands Liver Gallbladder Pancreas Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

29 The Accessory Organs: Salivary Glands
The salivary glands are located near the mouth They produce and secrete saliva, a substance that helps with chewing and swallowing by moistening the food Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

30 The Accessory Organs: The Liver
The liver is a large organ located just underneath the diaphragm The liver produces and secretes bile into the duodenum Bile is a substance that helps with the digestion of fats The liver also has several other important functions that are not related to digestion. For example The liver produces clotting factors (chemicals that help our blood to clot) The liver helps to clear our blood of toxins, such as alcohol and drugs Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

31 The Accessory Organs: The Gallbladder
The gallbladder, a small pouch that is attached to the liver, stores bile produced by the liver that is not secreted directly into the duodenum Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

32 The Accessory Organs: The Pancreas
The pancreas is located behind the stomach, in the curve of the duodenum The pancreas produces substances that aid in digestion and secretes them into the duodenum The pancreas also produces insulin and glucagon, hormones that are secreted directly into the bloodstream Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

33 Function of the Digestive System
Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

34 Function of the Digestive System
The digestive system breaks down the food we eat into nutrients, which are then absorbed into the bloodstream for use by the body’s cells In addition, the digestive system removes unusable digested food from the body, in the form of feces So…the digestive system performs the following functions: Digestion Absorption Excretion Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

35 Function of the Digestive System: Digestion
Digestion: the breaking down of food into simple elements (nutrients) Mechanical digestion: breaking down by physical means, such as chewing Chemical digestion: breaking down by chemical means, such as enzymes Digestion begins in the mouth and continues in the stomach and small intestine Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

36 Function of the Digestive System: Digestion
After passing through the esophagus, the food we eat stays in the stomach for 3 to 4 hours, where digestion continues to take place Special glands in the stomach lining produce hydrochloric acid (sometimes called “stomach acid”) and enzymes The stomach acid and enzymes act on the pieces of food to break them down even further The peristaltic action of the stomach helps to mix the food with the acid and enzymes, creating a liquid substance called chyme Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

37 Function of the Digestive System: Digestion
The chyme passes into the duodenum, the first segment of the small intestine Once in the duodenum, the chyme mixes with bile (secreted by the liver) and digestive enzymes secreted by the pancreas These substances cause further breakdown of the food From the duodenum, the chyme passes into the jejunum Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

38 Function of the Digestive System: Absorption
Once the chyme reaches the jejunum, absorption of nutrients begins At this point, the food is fairly well-digested Now, it is time to start moving the nutrients from the digestive tract into the bloodstream To reach the bloodstream, the nutrients pass through the mucosa and into the blood vessels in the next layer, the submucosa Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

39 Function of the Digestive System: Absorption
The mucosa of the small intestine has millions of tiny finger-like structures called villi The villi increase the small intestine’s ability to absorb nutrients by increasing the surface area of the mucosa Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

40 Function of the Digestive System: Absorption
Although most of the absorption of nutrients takes place in the small intestine, the large intestine also plays a role in absorption Bacteria that live in the large intestine act on the chyme to produce vitamin K and some B vitamins, which are absorbed by the body Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

41 Function of the Digestive System: Absorption
The action of these bacteria on the chyme can also produce gas as a by-product, especially when high-fiber foods such as beans, onions, and broccoli are part of the diet As the chyme passes slowly through the large intestine, water is absorbed into the bloodstream By the time the chyme reaches the end of the long intestine, all nutrients and most of the water have been removed, and the chyme has taken on the soft, moist, semi-solid consistency of normal feces Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

42 Function of the Digestive System: Excretion
The feces (waste products of digestion) collect in the rectum, the last segment of the large intestine The walls of the rectum gradually expand as the feces build up At a certain point, the brain senses that the rectum is “full” and the urge to defecate (have a bowel movement) occurs Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

43 Effects of Aging on the Digestive System
Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

44 Effects of Aging on the Digestive System
Like all of the body’s organ systems, the digestive system is affected by the process of aging: Less efficient chewing and swallowing Less efficient digestion Increased risk for constipation Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

45 Effects of Aging on the Digestive System
Less efficient chewing and swallowing In older people, the production of saliva decreases, which may make chewing and swallowing more difficult Missing or painful teeth or poorly fitting dentures may cause the older person to choke as a result of trying to swallow food that has not been chewed properly Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

46 Effects of Aging on the Digestive System
Remember that when you are helping an older person to eat you must Create a relaxed, social environment for eating and help the person to cut food up into small, easy-to-chew pieces Report complaints of poorly fitting dentures, sores in the mouth or on the tongue, or a toothache to the nurse immediately Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

47 Effects of Aging on the Digestive System
Less efficient digestion In an older person, the production of saliva, stomach acid, and digestive enzymes slows, making chemical digestion less efficient Digestion is less efficient because not only are fewer chemicals available for chemical digestion, but the pieces of food that the chemicals must work on may be larger, due to inefficient chewing Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

48 Effects of Aging on the Digestive System
Increased risk for constipation In an older person, the movement of food through the digestive tract may be slower The chyme spends more time in the large intestine, which allows more water to be reabsorbed into the bloodstream As a result, by the time the chyme reaches the end of the large intestine, almost all of the water has been removed and the resulting feces are hard, dry, and difficult to pass Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

49 Disorders of the Digestive System
Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

50 Disorders of the Digestive System
Many of the people you will care for will have a digestive disorder of some sort, or will be recovering from one Because the digestive system contains so many different organs, there are many different disorders that can occur Four of the most common digestive disorders that you are likely to see in the health care setting are Ulcers Hernias Gallbladder disorders Cancer Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

51 Disorders of the Digestive System: Ulcers
Sores caused by wearing away of the protective mucosa that lines the digestive tract Can occur anywhere along the digestive tract The most common sites are the stomach (gastric ulcer) and the duodenum (duodenal ulcer) In severe cases, the ulcer may affect all of the layers of the stomach or duodenum wall, not just the mucosa, causing a penetrating ulcer. This is a life-threatening condition. Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

52 Causes of Ulcers Disorders of the Digestive System: Ulcers
Ulcers occur when the stomach produces too much hydrochloric acid Factors such as smoking, frequent use of over-the-counter pain drugs, and infection with a bacterium called Helicobacter pylori can increase a person’s chances of developing ulcers Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

53 Disorders of the Digestive System: Ulcers
Symptoms A person with an ulcer may feel uncomfortably full or nauseous after eating Stomach pain is common, especially within 3 hours of eating (or when the person does not eat) Most ulcers are chronic and the person will have periods of feeling well, interrupted by flare-ups of symptoms Treatment Most ulcers can be treated with medication People with severe ulcers may need surgery Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

54 Disorders of the Digestive System: Hernia
Hernias The abdominal cavity (the space in the body where most of the digestive organs are found) is bounded by muscular walls A hernia occurs when an internal organ bulges through a weakness in the muscular wall of the abdominal cavity Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

55 Disorders of the Digestive System: Hernia
Sometimes the weakness occurs at the site of an old surgical incision Other times, the muscle is just weak in spots If there is a weak spot in the muscular wall, and the person does something that requires a lot of physical effort (such as lifting a heavy object), a hernia may occur Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

56 Disorders of the Digestive System: Hernia
Inguinal hernias and femoral hernias Inguinal hernias and femoral hernias occur when a loop of intestine bulges through the abdominal wall in the groin area Inguinal hernias are more common in men, and femoral hernias are more common in women These types of hernias are repaired surgically Umbilical hernias Umbilical hernias occur around the naval (belly button) If the umbilical hernia is very small, no treatment may be needed However, surgery may be required to repair a larger umbilical hernia Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

57 Disorders of the Digestive System: Hernia
Hiatal hernias Part of the stomach passes through the hiatus, the opening in the diaphragm that allows the esophagus to pass into the abdominal cavity People with hiatal hernias often have heartburn because the stomach acid moves back up into the esophagus Eating small, frequent meals and sitting up for at least 2 hours after every meal helps to relieve the heartburn Medication can also provide relief of symptoms People with severe symptoms may need surgery to repair the hernia Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

58 Strangulated hernia Disorders of the Digestive System: Hernia
Complications occur if the muscle tightens around the trapped tissue, cutting off its blood supply This situation is a surgical emergency Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

59 This can lead to inflammation and infection of the gallbladder
Disorders of the Digestive System: Gallbladder Disorders Gallstones can form and block the flow of bile from the gallbladder into the duodenum This can lead to inflammation and infection of the gallbladder Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

60 Disorders of the Digestive System: Gallbladder disorders
Symptoms Episodes of severe pain that may stay in the upper abdominal region, or radiate to the back and shoulder on the person’s right side Indigestion, especially after eating foods that are high in fat Pale and “clay-colored” feces (due to low bile content) Treatment Medication or laser treatment to dissolve the gallstones In some cases, surgical removal of the gallbladder is needed Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

61 Cancer Disorders of the Digestive System: Cancer
Any of the organs in the digestive system can be affected by cancer The person’s signs and symptoms will vary, depending on the location of the tumor Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

62 Disorders of the Digestive System: Cancer
Symptoms may include: Loss of appetite Indigestion Pain Vomiting Constipation Changes in bowel movements Blood in the stool Treatment Surgery, radiation, chemotherapy, or a combination of these Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

63 Diagnosis of Digestive Disorders
Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

64 Diagnosis of Digestive Disorders
Digestive complaints such as heartburn, indigestion, nausea, vomiting, stomachache, gas, diarrhea, and constipation are common Often, these symptoms are not a sign of anything more serious than eating too much! However, sometimes they may signal a serious disorder Always report a new symptom, or a change in the person’s symptoms, to the nurse immediately Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

65 Diagnosis of Digestive Disorders
Sometimes, the doctor will order one or more tests to evaluate a person’s symptoms Some of these tests are simple, such as laboratory analysis of a stool sample Others are more involved, such as: Endoscopy Imaging studies x-rays computed tomography (CT) scans magnetic resonance imaging (MRI) scans Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

66 Diagnosis of Digestive Disorders
Endoscopy Endoscopy involves using a special instrument to look inside the digestive tract and obtain tissue or fluids for analysis Endoscopy allows the doctor to look inside the digestive tract for tumors or other abnormal growths The type of endoscope used depends on whether the instrument will be passed through the person’s mouth (to view the upper digestive tract) or anus (to view the lower digestive tract) Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

67 Diagnosis of Digestive Disorders
Imaging studies, such as x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans allow the doctor to view the organs of the digestive system without actually entering the body Sometimes, the person is asked to swallow barium or have a barium enema prior to the procedure Barium is a radioactive substance that coats the mucosa of the digestive tract, and makes the organs appear sharper and brighter Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

68 Diagnosis of Digestive Disorders
The person may have a special diet in the days leading up to the procedure, or be placed on NPO status Sometimes, an enema is ordered to clean out the large intestine prior to the procedure The nurse will let you know of any special care needs for a person who is having one of these procedures Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

69 Caring for a Person with an Ostomy
Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

70 An Ostomy Done when a segment of the intestine needs to be removed, due to disease or injury Provides the person with an alternate way of eliminating feces from the body following the surgery An artificial opening, called a stoma, is made in the abdominal wall and the remaining portion of the intestine is connected to it Feces pass through the stoma and into a pouch (called an ostomy appliance) that is worn over the stoma Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

71 An Ostomy: Ileostomy An ileostomy is created if the entire large intestine must be removed The end of the small intestine (that is, the ileum) is attached to the abdominal wall Because the chyme does not have the chance to travel through the large intestine (where water is reabsorbed), the person’s feces are very liquid and may flow fairly continuously For this reason, a person with an ileostomy is quite prone to dehydration Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

72 An Ostomy: Colostomy A colostomy is created if part of the large intestine is still present After the diseased part of the large intestine is removed, the healthy end is attached to the abdominal wall Among people with colostomies, the feces vary in consistency Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

73 Reasons for a Person to have an Ostomy
Cancer Bowel trauma and diseases such as diverticulitis (an inflammatory disease of the bowel) Sometimes, a temporary ostomy is done to allow a portion of the bowel to “rest.” Later, the ends of the bowel are sewn back together and normal bowel elimination resumes. Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

74 Feelings of a Person with an Ostomy
For many people, having an ostomy is very difficult, emotionally First, the person must cope with having an illness or injury serious enough to require major surgery Secondly, many people consider elimination, especially bowel elimination, a very private activity Having to wear a bag to collect feces on the outside of the body is very embarrassing for many people Especially in the beginning, it may be very hard for a person to accept the ostomy Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

75 Caring for a Person with an Ostomy
Take the time to listen carefully if the person wants to talk about his fears or uncertainties Be careful not to brush off the person’s concerns with a comment such as “Oh, everything will be OK now; don’t worry.” Instead, put yourself in the person’s shoes and think about how you would feel if you were in the same situation Report the person’s comments and questions to the nurse Once the nurse knows that the person is having trouble adjusting to the ostomy, there are many things he or she can do to help the person adjust Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

76 Caring for a Person with an Ostomy
In some states and facilities, helping patients or residents to care for an ostomy is within the scope of the nursing assistant Ostomies can be located in many different places on the abdomen and abdomens vary from person to person Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

77 Caring for a Person with an Ostomy
Ostomy appliances Some ostomy appliances consist of a bag with an adhesive opening that adheres to the skin around the stoma Other ostomy appliances have two pieces— a ring of flexible rubber that is applied to the skin around the stoma, and a bag that is snapped on to the ring Some appliances are used only once and then discarded, while others are emptied, cleaned, and used again Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

78 Caring for a Person with an Ostomy
Principles of ostomy care Are the same for every patient or resident with an ostomy Because the skin around the ostomy comes into contact with feces, it must be kept clean to prevent irritation The ostomy appliance can be changed with the person sitting or standing in the bathroom, or while the person is in bed If the ostomy appliance is being changed while the person is in bed, the person should either sit upright or lie flat Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

79 End of Presentation Copyright © 2005.  Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.


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