4 Nursing: A Concept-Based Approach to Learning Digestion MODULE VOLUME ONE | SECOND EDITION 4 MODULE Digestion

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

Normal Digestion Physiology review Digestive system Mouth, pharynx, esophagus, stomach Small, large intestines Accessory organs: liver, gallbladder, pancreas Works with digestive enzymes

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

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

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

Alterations and Manifestations Nausea, vomiting Anorexia (loss of appetite) Gastroesophageal reflux disease (GERD) Hepatitis Malabsorption Maldigestion Pancreatitis Pyloric stenosis

Concepts Related to Digestion Nutrition Development Fluids and Electrolytes

Prevalence Nausea, vomiting, diarrhea Common in all age groups Food, stress, medications, smells, and tastes are common causes Stress reduction strategies can relieve

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

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 Assessment Assessment interview Health history Changes in appetite, weight, bowel habits, flatulence and pain Current therapies in use. Assess for findings of malnutrition

Nursing Assessment, continued Physical assessment Inspection Auscultation Percussion Palpation

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, height, head circumference and BMI

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

Diagnostic Tests Upper GI series (barium swallow) Endoscopy Abdominal x-ray CT scan Amylase Lipase

Interventions and Therapies Monitoring, early intervention Assessment of pain Most cases of nausea, vomiting self-limiting

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

Collaborative Pharmacologic therapy Antacids H2-receptor antagonists Proton pump inhibitors Antiemetics Metoclopramide hydrochloride

Collaborative, continued Nutrition therapy Enteral nutrition (tube feeding) If client cannot get adequate nutrition orally Complications: aspiration, diarrhea

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