Module-1-Response-to-Altered-Ingestion

MODULE 1: RESPONSES TO ALTERED NUTRITION AND GASTROINTESTINAL TRACT

  • Prepared by: Geraldine Malayo, CNN, RN

  • University of San Agustin College of Nursing, Nutrition and Dietetics Nursing Program

CONTENTS

  • A. ASSESSMENT

  • B. ANALYSIS/NURSING DIAGNOSIS

  • C. PLANNING

  • D. IMPLEMENTATION OF CARE

  • E. CLIENT EDUCATION

  • F. EVALUATION OF THE OUTCOME OF CARE

  • G. REPORTING AND DOCUMENTATION OF CARE

DISTURBANCES IN GI FUNCTION

  • A. DISTURBANCES IN INGESTION

    • Achalasia

    • Hiatal Hernia

    • Gastroesophageal Reflux

  • B. DISTURBANCES IN DIGESTION

    • Gastritis

    • Peptic Ulcer Disease

  • C. DISTURBANCES IN ABSORPTION AND ELIMINATION

    • Celiac Disease

    • Intestinal Obstruction

    • Crohn's Disease

    • Ulcerative Colitis

MAIN FUNCTIONS OF THE GI SYSTEM

  1. INGESTION

  2. DIGESTION

  3. ABSORPTION

  4. EXCRETION

REVIEW OF ANATOMY & PHYSIOLOGY

  • Pharynx: Connects mouth and esophagus, aids in swallowing.

  • Epiglottis: Prevents food from entering the airway during swallowing.

  • Salivary Amylase: Enzyme that breaks down carbohydrates in saliva.

  • Esophagus: Transports food from mouth to stomach.

  • Smooth Muscle: Involved in movement of food through GI tract.

GI ANATOMY

  • Mucosa: Epithelial layer that absorbs and secretes mucus and enzymes.

    • Lamina Propria: Contains blood and lymph vessels.

    • Muscularis Mucosa: Smooth muscle layer that helps food move.

  • Stomach Structure:

    • Cardia, Fundus, Body, Pyloric Antrum.

    • Gastric pits and glands produce hydrochloric acid and pepsin for digestion.

  • Small Intestine:

    • Divided into duodenum, jejunum, and ileum, approximately 10.5m long.

    • Villi and Microvilli: Increase surface area for absorption of nutrients.

ACCESSORY ORGANS AND DIGESTIVE ENZYMES

  • Gallbladder: Stores and concentrates bile for fat emulsification.

  • Liver: Produces bile and processes nutrients.

  • Pancreas: Releases digestive enzymes (lipase, amylase, proteases) to aid in digestion.

  • Bicarbonate: Neutralizes stomach acid in the small intestine, optimizing enzyme activity.

LARGE INTESTINE FUNCTION

  • Colon Parts: Transverse, ascending, descending, cecum, sigmoid colon.

    • Absorbs excess water, forming fecal matter.

    • Home to trillions of gut bacteria, contributing to digestion and vitamin production (B & K).

  • Defecation Reflex: Involves the rectum's contraction and relaxation of the anal sphincter.

ACHALASIA

  • Definition: Rare disorder affecting the nervous control of food movement in the esophagus.

  • Esophageal Spasm:

  • Jackhammer esophagus: Hyper contractile esophagus

  • Diffuse Esophageal Spasm: Spasm are normal in amplitude

  • Type 3 Achalasia: Characterized by les obstruction

  • Symptoms:

    • Dysphagia (difficulty swallowing) Hallmark Signs

    • Regurgitation

    • Chest discomfort

    • Weight loss

    • Pyrosis (heartburn)

ACHALASIA CAUSE AND PATHOPHYSIOLOGY

  • Cause unknown; may involve decreased peristalsis and failure of the lower esophageal sphincter to relax, preventing food passage.

DIAGNOSTIC EXAMS FOR ACHALASIA

  • Endoscopy

  • Esophageal Manometry: Gold standard diagnostic method.

  • Esophagram: Imaging to assess swallowing.

ACHALASIA TREATMENT

  • Non-repairable; management strategies include:

    • Eating slowly, drinking fluids, and chewing thoroughly.

    • Remaining upright during and after meals.

  • Pharmacologic Options: Isosorbide dinitrate, calcium channel blockers.

  • Procedures: Botox injection-easier to swallow after 6-12 months pneumatic balloon dilation.

  • Surgical Treatments: Laparoscopic Heller myotomy.

HIATAL HERNIA

  • Definition: Part of the stomach pushes through the diaphragm into the chest cavity.

  • Pathophysiology: Enlarged esophageal hiatus allows stomach to protrude.

  • Types:

    1. Sliding Hiatal Hernia: Stomach slides up and down due to pressure changes.

    2. Paraesophageal Hiatal Hernia: Portion of stomach remains in chest permanently.

HIATAL HERNIA CAUSES AND SYMPTOMS

  • Causes: Heavy lifting, hard coughing, pregnancy, obesity, hard sneezing, vomiting, constipation

  • Symptoms: Heartburn, regurgitation, dysphagia, sensation of fullness.

DIAGNOSIS AND TREATMENT OF HIATAL HERNIA

  • Diagnosis: Chest X-ray, Barium swallow, Upper endoscopy.

  • Treatment: PPIs, antacids, surgical procedures like Nissen fundoplication.

GASTROESOPHAGEAL REFLUX DISEASE (GERD)

  • Causes: Incompetent lower esophageal sphincter, aging, diet C.A.S.H COFFE, ALCOHOL, SPICY FOOD AND HOT FOOD

  • Positioning: Maintain upright position, semi-Fowler's when sleeping or 2 pillows

  • Symptoms: Nausea, vomiting, feelings of fullness.

GASTROESOPHAGEAL REFLUX DISEASE (GERD) TREATMENT

  • Medications: Antacids, H2 receptor blockers, proton pump inhibitors, fundoplication

  • Diagnosis: Barium swallow, endoscopy, pH monitoring and esophageal manometry.

  • Surgical options available for severe cases.

  • Best time to take medication

Antacid-1-3 After Meal

H2 Receptors- With Meals

Proton-Pump Inhibitors- 1 hour before meals

Carafate- Before Meal

Cytotec- After Meal