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Digestive System

Digestive System. Chapter 56. Structures of Digestive System. Oral Cavity Esophagus Stomach Small intestine Large intestine Pancreas Gallbladder Liver. Teeth, Gums and Mouth. Is the client capable of chewing Do they have teeth? What condition are the teeth in?

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Digestive System

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  1. Digestive System Chapter 56

  2. Structures of Digestive System • Oral Cavity • Esophagus • Stomach • Small intestine • Large intestine • Pancreas • Gallbladder • Liver

  3. Teeth, Gums and Mouth • Is the client capable of chewing • Do they have teeth? • What condition are the teeth in? • Are there sores in the mouth that make it painful to chew?

  4. Oral Cavity • Chewing mechanically breaks food into smaller particles, which can be swallowed more easily and provide a larger surface area for enzyme action. • Saliva lubricates the food for easier swallowing and initiates the digestion of starches.

  5. Esophagus • Can the client swallow? • Do they have a history of GERD, Hiatal hernia or esophageal stricture?

  6. Esophagus • Main function is to move food from the pharynx to the stomach. • Secretes some mucous and has some peristaltic movement. • Two sphincters: • Upper sphincter prevents air from entering the esophagus during inspiration • Lower esophageal sphincter prevents reflux of acidic gastric contents into the esophagus

  7. Secretions of Digestive System • Mucus • Saliva • Gastric juices • Mucous • Digestive enzymes • Hydrochloric acid • Electrolytes

  8. Stomach • Serves as a reservoir • Churns and mixes the food with digestive juices: • Secretes mucous • Hydrochloric acid • Enzymes • Starts protein breakdown and secretes intrinsic factor for absorption of vitamin B12 from the ileum • Little absorption of any nutrients • Highly lipid-soluble substances - some drugs and alcohol – are absorbed • Gastric emptying time about 4 hours

  9. Gastric Juices • Major digestive enzyme of gastric juice is pepsin, a proteolytic enzyme that functions best at a pH of 2 of 3. • Hydrochloric acid provides the acid medium to promote pepsin activity • Major function of gastric juice is to begin digestion of proteins.

  10. Hydrochloric Acid • pH of 2 to 3 • Provides acid medium to promote pepsin activity.

  11. Mucous • Mucous is secreted in the stomach to protect the stomach wall from the proteolytic action of pepsin. • When mucous is not secreted, gastric ulceration occurs.

  12. Pancreatic Juices • Pancreatic juices are alkaline (pH of 8 or above) • Contains amylase for carbohydrate digestion, lipase for fat digestion, and trypsin and chymotrypsin for protein digestion. • Contains sodium bicarbonate a base that neutralizes the acid from the stomach.

  13. Small Intestine • Consists of duodenum, jejunum, ileum • Pancreatic and bile ducts empty into the duodenum • Secretes digestive enzymes, hormones and mucous • Digestion and absorption occurs – including most orally administered drugs

  14. Large Intestine • Consists of cecum, colon, rectum, and anus • Mainly due to elimination

  15. Nutritional Support Products, Vitamins, and Mineral-Electrolytes Chapter 57

  16. Nutrients • Water, carbohydrates, proteins, fats, vitamins and minerals are required to promote and maintain health and prevent illness. • Vitamins are required for normal body metabolism, growth, and development.

  17. Nutritional Deficiency • Clients are unable to ingest, digest, absorb or not utilize sufficient nutrients to improve or maintain health.

  18. Nutritional Products • Liquid enteral products • Intravenous fluids • Pancreatic enzymes • Vitamins • Minerals - electrolytes

  19. Liquid Enteral Products

  20. Liquid Formulas • OTC preparation for oral or tube feedings • Nutritionally complete except for water • Special formulas for clients with renal or hepatic failure • High protein for increased calories

  21. Nursing Responsibilities • Read can to make sure the supplement ordered is correct • Calories per ounce and additives may differ • Make sure client drinks water • Especially important on clients dependant on care takers for fluid intake – gastrostomy tube feeds • With GT tube additional water will need to be given

  22. Intravenous Solutions • Used when oral fluids or tube feedings are contraindicated • Used short term to provide fluids and electrolytes • Dextrose and sodium chloride major solution used • Most common: Dextrose 5% in 0.2 or 0.45 normal saline – additives may include potassium chloride or KCL at dosages of 2 meq / 100 mL of IV solution (KCL is considered a medication and needs to be charted on MAR)

  23. Total Parenteral Nutrition • Long-term use from weeks to months to provide all nutrients required for normal body functions – growth and tissue repair • Usually administered through central line • Fluids often have high concentration of dextrose 5 or 10% along with extra minerals • Proteins and lipids are given IV through special filters • Must go in at prescribed rate – no catching up on fluids.

  24. Pancreatic Enzymes • Amylase, protease and lipase needed for absorption of carbohydrates, protein and fat • In pancreatic dysfunction commercially prepared enzymes are given with each meal or snack

  25. Vitamin Supplements • Most often self supplied • Billion dollar OTC industry • Preparations should not included more than recommended amounts of vitamin D, folic acid and vitamin A • Most are synthetic preparations • Most contain minerals – large doses of all minerals are toxic

  26. Minerals - Electrolytes • 22 minerals • Calcium and phosphorus have major role in bone metabolism • Electrolytes - Body must contain equal number of negative and positive charges • Adequate amounts contained in protein foods so extra intake is not needed if diet is adequate • Most common dietary deficiency: calcium and iron

  27. Calcium - Iron Calcium supplements - most adolescent and adult females would benefit from calcium supplements (1000 to 1300 mg daily) Iron supplements – often used during periods of increase need – pregnancy Iron should not be taken otherwise due to high risk for accumulation and toxicity

  28. Drugs to Aid Weight Management Chapter 58

  29. Overweight / Obese Adults • 60% of adults are overweight or obese • Etiology • Physiologic factors • Genetic factors • Environmental factors • Psychosocial factors - depression

  30. BMI • BMI = weight (pounds) divided by height (inches) x 704.5 • Desired BMI is 18.5 to 24.9 • Extremes may represent underweight or overweight / obese

  31. Diseased Related to Obesity • Cancer • Cardiovascular disease • Diabetes type II • Dyslipdemias • Gallstones

  32. Drug Therapy • BMI greater than 30 • Part of a weight management program – exercise – decrease in calorie intake • Once drugs stopped weight gain tends to re-occur

  33. Drugs Used in Weight Loss • Appetite suppressants - • Phentermine – short term use only – use with caution in clients with hypertension • Sibutramine – most commonly prescribed drug – inhibits reuptake of serotonin and norepinephrine in brain • Fat blockers • Orlistat – decreases absorption of dietary fat from the intestines – recommended for persons clinically obese

  34. Drugs Used for Peptic Ulcer and Acid Reflux Disorders Chapter 59

  35. Peptic Ulcer Disease • Ulcer formation in the esophagus, stomach or duodenum • Mucous exposed to gastric acid and pepsin • Imbalance between cell-destructive and cell-protective effects • Gastric acid and pepsin • H. pylori – infectious process

  36. Peptic Ulcer Disease

  37. Gastric Ulcers • Associated with stress • NSAID ingestion • H. pylori • More likely to occur in older adults

  38. Duodenal Ulcer • Associated with H. pylori and NSAIDs • Higher incidence in smokers

  39. GERD • Most common disorder of esophagus • Characterized by regurgitation of gastric contents into esophagus and exposure of esophageal mucous to gastric acid and pepsin. • Main symptom is heart burn - occurs after eating • Cause is thought to be incompetent lower esophageal sphincter

  40. GERD

  41. Treatment of acid-peptic disorders • Promote healing of lesions and prevent recurrence of lesions by decreasing cell-destructive effects or increasing cell- protective effects

  42. Antacids • Alkaline substances work primarily in the stomach • Work to raise the pH to 3.5 and inhibits conversion of pepsingogen to pepsin • Common antacid products: • Maalox • Mylanta • Gelusil • Amphojel

  43. Helicobacter pylori Agents • Multiple drug therapy to treat the H. pylori organism and heal related ulcers • Antimicrobial • Amoxacillin • Clarithromycin • Metronidazol • Tetrocycline) • Histamine2 Receptor Antagonists

  44. Histamine2 Receptor Antagonists • Histamine causes strong stimulation of gastric acid • Histamine 2 receptor blocks this action • Cimetidine or Tagamet – most widely used • Famotidine or Pepcid • Nizatidine or Axid • Ranitidine or Zantac – more potent than Tagamet

  45. Proton Pump Inhibitors • Strong inhibitors of gastric acid secretion • Nexium • Prevacid • Prilosec • Aciphex • Cytotec • Carafate

  46. Use in Special Populations • Pediatrics – will be given to prevent GI bleeding • Asthmatics on IV or po corticosteroids • Head trauma on IV dexamethasone for cerebral swelling • Older Adults – calcium carbonate antacids like “Tums” due to decreased side effects • Renal impairment – magnesium containing preparations (Mylanta, Maalox) contraindicated – need good kidney function to eliminate magnesium • Critical care units may use to prevent GI bleeding

  47. Laxatives and Cathartics Chapter 60

  48. Laxatives and Cathartics • Used to promote bowel elimination • Laxatives implies mild effects and elimination of soft, formed stool • Cathartics implies strong effects and elimination

  49. Indications for Use • Relieve constipation in pregnant women and elderly clients • To prevent straining of clients with coronary artery disease • To empty the bowel in preparation for a surgery or diagnostic procedure • To accelerate elimination of toxic substance • To reduce serum cholesterol

  50. Bulk Forming Laxatives • Substances that are largely unabsorbed from the intestine • When water is added the substances swell and become gel like • Added bulk and size of the fecal mass stimulates peristalsis and defecation

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