1. 4 Nursing: A Concept-Based Approach to Learning Digestion MODULE
VOLUME ONE | SECOND EDITION 4
MODULE
Digestion

2. 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

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

4. 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

5. 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

6. 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

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

8. Concepts Related to Digestion
Nutrition
Development
Fluids and Electrolytes

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

10. 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

11. Prevention
Preventing alterations in digestion involves lifestyle choices and management.
Modifiable risk factors
Lifestyle choices
Screenings
Blood tests
Early diagnosis, treatment
Prevention of complications

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

13. Nursing Assessment, continued
Physical assessment
Inspection
Auscultation
Percussion
Palpation

14. 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

15. 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

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

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

18. 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

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

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

21. 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