Tabloski ch20 lecture

Gerontological NursingGerontological Nursing

CHAPTER

THIRD EDITION

Copyright © 2014, © 2010, © 2006 by Pearson Education, Inc.All Rights Reserved

The Gastrointestinal System

20

Gerontological Nursing, Third EditionPatricia A. Tabloski

Learning Objectives

1. Describe age-related changes that affect gastrointestinal function.

2. Recognize the impact of age-related changes of gastrointestinal function.


Learning Objectives

3. Identify risk factors to health for the older person with gastrointestinal problems.

4. Interpret unique presentations of gastrointestinal problems in the older person.


Learning Objectives

5. Define appropriate nursing interventions directed toward helping the older adult with gastrointestinal problems develop self-care abilities.

6. Formulate and implement appropriate nursing interventions to care for the older person with gastrointestinal problems.


Introduction

• The gastrointestinal (GI) tract is responsible for four major functions relating to food ingestion:–Digestion–Absorption–Secretion–Motility


Introduction

• The GI tract begins at the mouth and ends at the rectum and includes the accessory organs of digestion, the liver, gallbladder, and pancreas.


Figure 20-1 Normal configuration of the GI tract.


Normal Changes of Aging

• Biological changes in GI function include:–Changes in the mouth–Decreased esophageal motility–Diminished gastric motility with

increased stomach-emptying time–Diminished capacity of the gastric

mucosa to resist damage



• Biological changes in GI function include:–Achlorhydria or insufficient hydrochloric

acid in the stomach–Decreased production of intrinsic factor

leading to increased risk of developing pernicious anemia

–Decreased intestinal absorption, motility, and blood flow



• Biological changes in GI function include:–Decreased pancreas size with duct

hyperplasia and lobular fibrosis– Increased incidence of cholelithiasis

(gallstones) and decreased production of bile acid synthesis

–Decreased liver size and blood flow



• Biological changes in GI function include:–Decreased thirst and hunger drive due

to cognitive changes or psychological conditions

– Increased medication use–Possible adverse drug reactions


Common GI Disorders

• Aging alone has very little impact on GI function. However, aging is associated with an increased prevalence of many GI disorders, and these should be evaluated carefully and not be attributed to normal aging.


Common GI Disorders

• GI disorders include:–Esophageal disorders–Gastroesophageal reflux disease–Gastric disorders; gastritis, ulcers, hiatal

hernias, and stomach tumors–Gastric volvulus


Lower Gastrointestinal Tract

• The lower GI tract is composed of the colon and the rectum. The function of the lower GI tract is affected by metabolic or endocrine disorders, lifestyle and environmental factors, neurologic disorders or injury, and many medications.



• Aging is associated with diminished anal sphincter tone and strength.

• The structural weakening of colonic muscle may contribute to the development of diverticula, or saclike mucosal projections through the muscle wall.



• Older persons with the presence of diverticula are diagnosed with diverticulosis.

• Several factors can alter colonic function and lead to alterations in lower bowel function.

• These factors may make the older person more susceptible to fecal incontinence, constipation, or diarrhea.


Common Lower Gastrointestinal Disorders

• Diverticular Disease or Diverticulosis• Irritable Bowel Disease• Inflammatory Bowel Disease• Benign and Malignant Tumors• Antibiotic-associated Colitis and

Diarrhea• Constipation


Common Lower Gastrointestinal Disorders

• Diarrhea• Fecal Incontinence• Hemorrhoids and Rectal Bleeding• Liver and Biliary Disorders• Gallstones• Pancreatitis


Endoscopic Gastrointestinal Procedures

• Upper or lower gastrointestinal endoscopic procedures can be done to view body cavities with fiber optic tubing.

• Esophagogastroduodenoscopy visualizes the upper gastrointestinal tract.


Endoscopic Gastrointestinal Procedures

• A sigmoidoscopy permits inspection of the rectum and distal sigmoid colon, and most of the descending colon.

• Colonoscopy allows visual examination of the entire colon. Colonoscopy is indicated for routine testing or when anemia is present, positive fecal occult blood testing is noted, or polyps are suspected.


Nursing Diagnoses

• Nursing diagnoses for problems associated with the gastrointestinal tract include the following:– Imbalanced Nutrition

Less Than Body Requirements

–Risk for Infection –Constipation and Perceived Constipation–Diarrhea–Bowel Incontinence


Nursing Diagnoses

• Nursing diagnoses for problems associated with the gastrointestinal tract include the following:–Risk for Constipation– Ineffective Tissue Perfusion

Gastrointestinal Tract

–Risk for Aspiration– Impaired Oral Mucous Membrane–Social Isolation


Nursing Diagnoses

• Nursing diagnoses for problems associated with the gastrointestinal tract include the following:–Noncompliance– Ineffective Health Maintenance–Toileting Self-care Deficit–Acute or Chronic Pain Disturbance–Nausea


Nursing Diagnoses

• The nurse should educate older persons and their families regarding the causes, prevention, and treatment of gastrointestinal diseases.


Complementary and Alternative Therapies

• Milk thistle (a member of the daisy family) is used for its hepatoprotective characteristics and to treat cirrhosis, chronic hepatitis, fatty infiltration caused by alcohol and other toxins, and gallbladder disorders.


Complementary and Alternative Therapies

• Acidophilus capsules contain active cultures that can be used to treat a variety of gastrointestinal problems including irritable bowel syndrome, diarrhea, flatulence, bad breath, and adjunct to antibiotic therapy to prevent antibiotic-associated diarrhea caused by overgrowth of C. difficile.



• Regardless of treatment, the gerontological nurse should provide holistic care including careful attention to pain and symptom control, nutritional issues, skin care, emotional support for the older person and family, and issues relating to death and dying.

Tabloski ch20 lecture

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