Digestive System

Structure

Abdominal Quadrants

Abdominal Regions

Mouth

• where the digestive process begins

• consists of the tongue, salivary glands, teeth, and pharynx

Esophagus

• A tube 10 to 12 inches long that carries food from the mouth to the stomach

Stomach

• a hollow, muscular, J-shaped organ• holds food from 3 to 4 hours• has three parts: the fundus, body, and

pylorus• produces gastric juices that help break

down food

Intestines

• the small intestine: where most of the food the body needs are absorbed into the bloodstream

• the large intestine: where most water is absorbed, wastes are changed into solid form

Appendix

• function is not known

• attached to the cecum

Liver

• The largest gland in the body

• helps control the amount of protein and sugar in the body by changing and storing excess amounts

Gallbladder

• a small hollow sac that is attached to the underside of the liver

• it releases bile from the liver into the small intestine to help digest a fatty meal

Pancreas

• located behind the stomach

• aids in the digestion of food

• produces insulin

Common Conditions of the Digestive System

Malignancies• very common

• symptoms depend on location– indigestion–vomiting–constipation–obstruction–bloody stool

Ulcerations

• a sore or tissue breakdown

• common places: colon, stomach, duodenum

Hernias

• the intestine pushes through a weakened area of the abdominal wall

Gallbladder Conditions

• cholecystitis: inflammation of the gallbladder

• cholelithiasis: formation of stones in the gallbladder

Common Problems Related to the Lower Bowel

• diarrhea: multiple watery stools

• constipation: when stool passes through the colon too slowly – most severe form: fecal impaction

• bowel incontinence: involuntary passage of fecal material from the anus

Procedures Related to the Digestive System

Nasogastric Tube

NG Tube cont.

• may be placed for stomach decompression (ex. – during CPR)

• to give stomach rest

• to relieve nausea

Normal CT of Abd

CT Scans

• CTs may be done of abd/pelvis, with or without contrast (IV or PO)

• used to diagnose abnormalities/conditions of digestive system

Esophagogastroduodenoscopy (EGD)

• May be used to diagnose problems of the esophagus, stomach or duodenum

• May be done in GI Lab at a Hospital as an outpatient

Nutrition

• Food & fluids contain Nutrients-a substance the is taken in , digested, absorbed, and used by the body

• Grouped into fats, proteins, carbohydrates, vitamins, minerals, and water (FPCVMW)

• Which nutrients give the body fuel for energy?

• FPC• Energy measured in

calories• Food guide pyramid

helps to guide healthy food choices-has 4 levels

Nutrients

• Essential nutrients come from many different foods

• Refer to basic information sheet about nutrition

• Sometimes special diets needed to manage nutrition in patients

Fluid Balance

• Water needed to live• Death can occur if there

is too little or too much• Water is taken in

through food and fluids• Water lost through

elimination of urine and feces also through vomiting, perspiration and exhaling

• To be healthy fluid balance is needed

• Fluid taken in (intake) and lost (output) needs to be equal

• Swelling (edema) occurs when more is taken in than put out

• Dehydration occurs when more fluid is put out than taken in

Fluid Balance

• Adults need to take in 1500 ml per day

• For normal fluid balance about 2000-2500 ml is needed per day

• Normal person can take fluid orally

• Sometimes patients require special orders for fluids

• Fluids may need to be encouraged to increase intake

• Fluids may be restricted to a certain amount per day

Enteral Nutrition-Tubes• Nutrition given by gavage

(tube feeding)• Different types of tubes• Nasogastric (NG) -

inserted through the nose• Gastrostomy- inserted

into the stomach through a surgically created opening

• Jejunostomy – inserted in to small intestines through surgically created openint

• Percutaneous endoscopic gastroostomy (PEG) Tube- inserted into the stomach with an endoscope and through a puncture wound made through the skin into the stomach

Enteral Nutrition-Formula

• Formula ordered by doctor

• Most contain all of the nutrients

• Sometime may be made by the dietary department

• Feedings may be continuous or scheduled at intervals

• If they are continuous a pump is used to give the feeding

• Scheduled feedings may be given with a syringe or tube feeding bag that allows feeding to drip

Enteral Feeding- Observations

• Major risk is aspiration –which is breathing in of fluid or an object into the lungs

• Aspiration can cause pneumonia and death

• It is important to take measures to prevent aspiration

• Nurse must regularly make sure tube is in the right place because tubes can move from coughing and sneezing or vomiting

Tube Feeding-Preventing Aspiration

• X-ray may be taken after tube is inserted to verify placement

• Nurse may check tube placement by aspirating gastric secretions

• Prevent regurgetation by positioning patient in semi-Fowler’s Position –ask nurse of check care plan to find our how long

• If there is a delay in stomach emptying can regurgitate feeding

• Avoid left side lying position

• Less of a problem with J-Tube

Observations for Patients receiving Tube Feedings

• Observe and report immediately to nurse:

• Nausea, vomiting• Diarrhea• Discomfort during tube

feeding• Enlarged or swollen

stomach• Elevated temperature

• Redness, swelling, drainage

• odor or pain at the insertion site

• Difficulty breathing• Elevated pulse rate• Coughiing • Complaints of bloating

or flatulence

Intravenous Therapy

• This is giving fluids by way of a needle or catheter that has been inserted into a patient’s vein usually by an RN

• May be given in various settings such as hospital, outpatient, doctor’s office, home care setting, long-term care setting

• Requires a doctor’s order

• Given to replace fluids, replace vitamins and minerals lost from illness or injury

• Blood and blood products are given through IV

Intravenous Therapy Sites

• Peripheral Sites- away from the center of the body

• Sites may be in the hand, wrist, and antecubital space ( bend of elbow)

• If site is an IV catheter or needle facility may allow PCT to discontinue

• PCT must know how and have been delegated this responsibility by the RN before attempting to D/C an IV.

• Central Venous

TPN

• Provides total parenteral nutrition (TPN) also called Hyperalimentation to patients.

• May be given through aperipheral

• TPN contains all of the essential nutrients needed to sustain life, Fat may be added in the form of lipids

Specimen Collection Principles• Adhere to medical asepsis

principles• Follow Standard

Precautions• Use a clean or sterile

container for each specimen

• Use the right container for the specimen

Label the specimen correctly• Avoid touching the inside

of the container and lid• Urine must be free of

feces• No tissue in urine and

stool specimen• Place specimen in plastic

bag• Specimen should be taken

to lab promptly