Gastrointestinal System

Applications and Nursing Care

ISTANBUL GELISIM UNIVERSITY

BASIC PRINCIPLES AND PRACTICES OF

NURSING II

Assist. Prof. Dr. Funda Karaman

GI tract anatomy

• 30 ft. long from mouth to anus.

• Consists of mouth, esophagus, stomach,

small intestine, large intestine, rectum, anus.

• Associated organs: liver, pancreas,

gallbladder.

Function of GI tract

• Each part of system performs different

activities.

• Ingestion and propulsion of food: mouth,

pharynx, esophagus.

• Digestion and absorption: mouth, stomach,

small intestine.

• Elimination: large intestine

Factors affecting GI tract:

• Emotional factors: stress, anxiety..

• Physical factors: diet, alcohol, caffeine,

cigarette smoking, fatigue, organic diseases.

• Emotional and physical factors may be

manifested by anorexia, epigastric and

abdominal pain, diarrhea, constipation.

Digestive System Organization

• Gastrointestinal (Gl) tract

– Tube within a tube

– Direct link/path between organs

– Structures• Mouth

• Pharynx

• Esophagus

• Stomach

• Small intestine

• Large Intestine

• Rectum

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Mouth• Teeth mechanically

break down food into

small pieces. Tongue

mixes food with saliva

(contains amylase,

which helps break down

starch).

• Epiglottis is a flap-like

structure at the back of

the throat that closes

over the trachea

preventing food from

entering it. It is located

in the Pharynx.

Esophagus• Approximately 20 cm long.

• Functions include:

1. Secrete mucus

2. Moves food from the throat to

the stomach using muscle

movement called peristalsis

• If acid from the stomach gets in

here that’s heartburn.

Mouth, Pharynx and Esophagus

Video

Stomach

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• J-shaped muscular bag that stores the food you eat, breaks it down into tiny pieces.

• Mixes food with Digestive Juices that contain enzymes to break down Proteins and Lipids.

• Acid (HCl) in the stomach Kills Bacteria.

• Food found in the stomach is called Chyme.

Stomach

• Body, FUNDUS

• CORPUS

• ANTRUM

• PYLORUS

Fundus

Body

Small Intestine

• small bowel

• enter/o - small intestine

• villi

• Parts

– duodenum

– jejunum

– ileum

• ileocecal valve

Small intestine• Functions are digestion and

absorption.

• Digestion completed in small

intestine, where

carbohydrates and fats are

broken-down.

• ~23 ft. long, extends from

pylorus to ileocecal valve.

• Composed of duodenum,

jejunum, ileum.

Large intestine

• About 1.5 meters long

• Function is absorption of water and

electrolytes, elimination (forms

feces and serves as reservoir)

• 4 parts: cecum (and appendix),

colon (ascending colon on the right

side, transverse, descending colon

on the left side, sigmoid), rectum,

anus.

defecation

• Reflex action involving voluntary and

involuntary control.

Accessory Organs The Glands

• Not part of the path

of food, but play a

critical role.

• Include: Liver, gall

bladder, and

pancreas

Liver

• Directly affects digestion by producing

bile

– Bile helps digest fat

• filters out toxins and waste including

drugs and alcohol and poisons.

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Gall Bladder

• Stores bile from the

liver, releases it into the

small intestine.

• Fatty diets can cause

gallstones

Pancreas

• Produces digestive

enzymes to digest fats,

carbohydrates and

proteins

• Regulates blood sugar

by producing insulin

Web Page Reinforcement Video

GIS DIAGNOSIS METHODS

• LAB. TESTS

• Blood tests, urine and gaita analyzes

• RADIOLOGICAL INSPECTIONS

• * Direct Abdomen Graph

• * Ultrasonography

• *Tomography

• * Endoscopic examinations

Nutrition

• Problems present in all age groups, cultures

and socioeconomic classes in all parts of

world.

• caregivers can act as educator and resource

person can have influence on information

and practices of patients and their families.

Factors affecting nutrition and

diet

• Attitudes

• Cultural and/or religious preferences

• Economic factors

• State of health

• Psychological issues

NUTRITION PROBLEMS

Malnutrition

• May be excess, deficit or imbalance in

essential components of a balanced diet.

• Most common in developing countries with

inadequate food sources, poor economic

conditions or lack of education regarding

nutrition.

Obesity

• Problems associated when more than 20% over

ideal body weight.

• Associated problems-cardiovascular and

respiratory problems, vascular (hypertension),

diabetes, gallstone formation, sleep apnea,

emotional issues, degenerative joint disease, fatty

liver infiltrates.

Obesity

• Influences: culture, economics, habits, socialization, exercise pattern, work shift

• Diets: calorie in/calorie out.

• Changes: less exercise, larger portions, more carbohydrates.

• Health consequences: diabetes, cardiovascular problems, respiratory, musculoskeletal, Gerd, liver problems.

Anorexia/bulimia

• Specific psychiatric diagnosis-characterized

by refusal to maintain body weight to

greater than 85% of expected for age and

height.

• Key feature-concern about body image

• Most common in girls and women and

higher economic status.

Complications

• Amenorrhea, bradycardia, hypotension, hair

loss, constipation, edema with altered fluid

balance, cardiac complications, malignant

arrhythmias, emotional problems.

Anorexia

• Often common in adolescent girls

• Restrictive eating habits, secretive

• Usually long-standing behavior, familial

tendencies

• Use of laxatives and enemas common

Bulimia

• The individual takes a lot of food at a high

rate, then vomits immediately afterwards to

empty the stomach.

Nutrition Education

The aims of nutrition education;

• Develop adequate and balanced eating

habits

• Preventing wrong practices and adverse

effects of food on health

• To provide more efficient and more

economical use of food resources

NUTRITION TYPES

• Oral route

• Tubes

• - Nazogastric

• - Gastrostomy

• - Jejunostomi

• Parenteral route

• - Total Parenteral Nutrition (TPN)

Oral route

• Diet I- fluid diet

• Diet II- Soft diet

• Diet III- Normal diet

Special Diets

• In the treatment of diseases (HT is salt-free

or low-salt diet, diabetic diet)

• For special examination or operation

preparation (soft diet)

• The development and maintenance of health

(low calorie diet in fat individuals)

Stomach intubation

• If you can’t eat or swallow, you may

need to have a nasogastric tube

inserted.

• This process is known as nasogastric

(NG) intubation

Gastric AnalysisGavageLavage

Decompression

• Gastric Analysis

• Gavage

• Lavage

Gastric Analysis

• Help to diagnose GIS

• Examination of stomach contents

• The stomach contents are removed by

placing the catheter on the empty stomach

Gavage

• Gastric Gavage is a means of supplying

nutritional substance via a small plastic tube

direct to the stomach.

Lavage

Gastric lavage, also commonly called stomach

pumping or gastric irrigation, is the process of

cleaning out the contents of the stomach

Indication of Lavage

• Toxicity and overdose drug

• In stomach bleeds

• When taking poison or foreign matter, the

substance must be digested intensively

• It is applied within the first 4 hours of

intake of such substances

Decompression

A surgical procedure used to relieve pressure

on stomach.

Indications for GI Intubation

To decompress the stomach and remove gas and fluid

To lavage the stomach and remove ingested toxins

To diagnose disorders of GI motility and other disorders

To administer medications and feedings

To treat an obstruction

To compress a bleeding site

To aspirate gastric contents for analysis

Gather equipment:

14 0r 16 Fr NG tube

Lubricating jelly or 0.9% NaCl solution

Tongue blade

Flashlight

Emesis basin

Stethoscope

Disposable gloves

Kidney bathtub

Sticking plaster

50 ml. pine end injector

A glass of water and pipette

Treatment cloth, cottonwood, paper towel

Procedure

− Explain procedure to client

− Position the client in a sitting or high

fowlers position. If comatose-semi fowlers.

− Examine feeding tube for flaws.

− Determine the length of tube to be inserted.

− Measure distance from the tip of the nose to

the earlobe and to the xyphoid process of the

sternum.

− Prepare NG tube for insertion.

Measure distance

from the tip of the

nose to the earlobe

and to the xyphoid

process of the

sternum.

Approximately 55-65 cm

• In pediatric

applications,

measure distance

from the tip of

the nose to the

earlobe and to the

umbilicus.

Implementation

− Wash Hands

− Put on clean gloves

− Lubricate the tube

− Hand the client a glass of water

− Gently insert tube through nostril to back of throat

(posterior nasopharnyx). Aim back and down toward the ear.

− Have client flex head toward chest after tube has

passed through nasopharynx

Don't use liquid vaseline and glycerine,

because they do not melt in water

Because we can accidentally enter the respiratory tract and

fat droplets can cause pneumonia in the lungs.

Emphasize the need to mouth breathe and swallow during

the procedure.

Swallowing facilitates the passage of the tube through the

oropharnyx.

When the tip of the tube reaches the trakea stop and listen

for air exchange from the distal end of the tube. If air is heard

remove the tube.

Advance tube each time client swallows or drinks water

until desired length has been reached.

Do not force tube. If resistance is met or client starts to

cough, choke or become cyanotic stop advancing the tube and

pull back.

During each swallowing

movement, the catheter is

advanced 4-5 cm

• Swallowing provides epiglottis closure

at the entrance of the trachea.

• Thus the tube easily advances in the

esophagus.

Nasogastric Tube Position

5-10 ml of stomach

contents are aspirated

and given back to

the stomach.

When stomach contents are aspirated,

if stomach contents are, catheter is in the stomach

Testing Placement

• If unable to aspirate:

– Advance tube – may be in air space above aspirate level

– If intestinal placement suspected (pH 4-6) withdraw tube 5 to 10 cm

– Have client lie on his/her left side wait 10-15 mins and attempt aspiration again.

• Place a stethoscope over the patient’s

epigastrum, while instilling a 5-10 cc air

bolus using an irrigation syringe (the air

enters the stomach when a whooshing

sound is heard).

The catheter must be fixed on the

nose. When the catheter fixed,

pressure should be prevented in the

nostril.

GAVAGE

• Feeding via a small plastic tube

• Digestion and absorption should be

adequate

• In patients fed with gavage, nothing is given

orally.

with which methods?

• Nasogastric

• Oragastric

• Gastrostomy

• Jejunostomy

Administering Enteral Feeds

Indications:

• Clients who are unable to maintain adequate oral intake to

met metabolic demands

• Surgical cases

• Ventilated clients

• Neuromuscular impairment

• Clients requiring bowel rest.

• Generally these clients have been referred to the Dietician.

• Gavage foods should not be stored at room

temperature for more than 6 hours

• If you store more than 24 hours in the

refrigerator or more than 6 hours in the

room, the risk of bacterial contamination is

high.

There are two methods of feeding

• given by injector

• given by Nutritional

pump

Feeding with tube

(By injector)

• Gavage food

• 50 ml injector

• 20-50 ml injector

• 100-150 ml of water

• Stethoscope

Procedure

− Explain procedure to client

− The patient is given fowler position or if not

possible, the head is raised by 30 ° and the

right lateral position is given

• The residual quantity is checked

• (Rezidual amount: It means the amount

of content left in the previous meal)

• Stomach content is aspirated with

injector

• After the quantity is determined, the

content is returned (otherwise the fluid

will cause electrolyte loss)

• If the stomach contents are 50 ml or

more, it is an indication of the delay of

the discharge time

• Nutrition needs to be rearranged.

Before the meal, 15-30 ml of water

is given

Food is poured into the injector

• The injector is kept 30-45 cm above the stomach level

• The nutrient is injected continuously into the injector so that

the injector mustn't completely empty

• Air doesn't go into the stomach and the distension is

prevented.

• 30-60 ml of water is given after the food is

consumed

• (Food residues in the tube are washed away

and blockage of the tube is avoided)

• Nutrition process lasts 30 minutes on

average

• After feeding, the catheter is closed with the

clamp

• The food is either given

to the patient

continuously at the

same rate for 24 hours,

or

• is given intermittently at

certain time intervals

during the day and the

amount needed for 24

hours is completed.

This is

nutritional

pump

Nutritional pump

COMPLICATIONS

Intestinal crampsDiarrheaDehydrationNauseaVomiting

•Delivery of carbohydrate content and excess nutrients

•Delivery food quickly

•Bacterial contamination

Food intensity should be reduced

Slowly given

Dehydration indication observed

(mucosal dryness, thirst)

Fluids taken from the body and removed fluids should be followed

Glycosuria

Hyperglycaemia

Check blood sugar and urine sugar

Nursing Care

• Oral and nose care

• In take- out put should be followed

• Weight monitoring

• Blood sugar follow

Delivery of drugs through tube

• Liquid forms of drugs should be used

• Sufficient amount should be diluted with water (heavy drugs block the probe)

• The tablet should be crushed

• Before and after giving the medicines, water should be given by the probe

• If more than one drug is to be given, each drug should be given separately and 5-10 ml of water should be given between the drugs by way of the probe

• Drugs should not be given with gavage food (otherwise there may be drug-food interaction)

Gastrostomy

• Surgical procedure in which an opening is created into the stomach

• Preferred route for prolonged nutrition((greater than 3 to 4 weeks)

• Preferred in clients who are comatose – decreases the risk for

regurgitation and aspiration

Methods of Insertion

• Percutaneous endoscopic gastrostomy

(PEG) may be clamped between feedings

• Low-profile gastrostomy device (LPGD)

may be inserted 3-6 months after initial

gastronomy tube placement

Feeds can be given by gravity

Jejunostomy

• Jejunostomy is the surgical

creation of an opening (stoma)

through the skin at the front of

the abdomen and the wall of

the jejunum (part of the small

intestine). It can be performed

either endoscopically, or with

formal surgery

Total Parenteral Nutrition

(TPN)

• TPN; is the feeding of a

person intravenously,

bypassing the usual process

of eating and digestion.

• The person receives

nutritional formulae that

contain nutrients such as

glucose, salts, amino acids,

lipids and added vitamins

and dietary minerals.

Indications

• Severe diarrhea

• In patients like chemotherapy, severe

mucositis and esophagitis

• After surgical interventions where the bowel

is to be rested

• Patients with severe malnutrition

• Gastrointestinal system obstruction

• In persistent nausea and vomiting

Complications

• İnfections

• Metabolic complications

• Nursing Care;

• Check weight

• Check ın take-out put

• Check Blood sugar

• Check Electrolyte of other laboratory

findings

References

• Ay F. A. (2013). Basic Concepts And Skills

In Health Practices. Nobel Medical

Bookstore, Istanbul.

• Astı T. A., Karadag A. (2016). Nursing

Fundamentals Nursing Science and Art.

Academy Press And Publishing, Istanbul.