Chapter 34

A home care nurse is caring for a client with complaints of epigastric discomfort who is scheduled for a barium swallow. Which statement by the client indicates an understanding of the test?

"I'll avoid eating or drinking anything 6 to 8 hours before the test."

A nursing instructor tells the class that review of oral hygiene is an important component during assessment of the gastrointestinal system. One of the students questions this statement. Which of the following explanations from the nurse educator is most appropriate?

"Injury to oral mucosa or tooth decay can lead to difficulty in chewing food."

The nurse is assessing a client following laparoscopy. The client states that his stomach looks bloated and asks if this is normal. How will the nurse respond?

"Yes, your abdomen may appear larger as a result of the injection of carbon dioxide for visualization."

Turns stool white

Barium

Expulsion of fas from the stomach through the mouth

Belching

A client presents to the emergency department, reporting that he has been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts this client at risk for which imbalances?

Metabolic alkalosis and hypokalemia

The nurse obtaining a health history related to dysfunction of the GI system. Discuss symptoms that the nurse should focus on when obtaining patient data.

Abdominal pain, dyspepsia, gas, N/V, diarrhea, constipation, fecal incontinence, jaundice, and previous GI disease

No sounds in 3 to 5 minutes

Absent

A 24-year-old athlete is admitted to the trauma unit following a motor-vehicle collision. The client is comatose and has developed ascites as a result of the accident. You are explaining the client's condition to his parents. In your education, what do you indicate is the primary function of the small intestine?

Absorb nutrients

Phase of the digestive process that occurs when small molecules, vitamins, and minerals pass through the walls of the small and large intestine into the bloodstream

Absorption

___________ is the process through which nutrients enter the bloodstream through the intestinal wall.

Absorption

Neuroregulator Stimulated by sight, smell, chewing food, stomach distention Targets gastric glands, other secretory glands, gastric and intestinal muscle. Increases gastric acid. Motility is generally increased; decreased sphincter tone

Acetylcholine

Absence of peristalsis of the lower esophagus resulting in difficulty swallowing, regurgitation, and sometimes pain.

Achalasia

An enzyme that aids in the digestion of starch

Amylase

Last section of the GI tract; outlet for waste products from the system

Anus

Inspection Auscultate Percussion Palpate

Assessment of Abdomen

A nurse assesses the abdomen of a newly admitted client. Which finding would necessitate further investigation?

Asymmetrical upper quadrants

Used to determine the character, location, and frequency of bowel sounds & vascular sounds.

Auscultation of the Abdomen

Turns stool black

Bismuth, iron, licorice, and charcoal

Initial diagnostic test begin with serum lab studies including: CBC Complete metabolic panel Prothrombin time/partial thromboplastin time Tyrglycerides Liver function tests Amylase Lipase

Blood studies

Heard as a loud prolonged gurgle

Borborymi or "stomach growling"

Mrs. Jones arrives at the GI clinic, and assesses whether the patient is properly prepared for the colonscopy. What questions should the nurse ask?

Bowel habits, last time they ate or drank

May be performed with or without oral or IV contrast Allergies to contrast agents, iodine, or shellfish IV sodium bicarbonate 1 hour before and 6 hours after and oral acetylcysteine (Mucomyst) for renal protective measures

CT

Immediately after a colonscopy, what possible complications should the nurse assess?

Cardiac dysrhythmias and respiratory depression S/S of bowel perforation (rectal bleeding, abdominal pain or distention, fever, focal peritoneal signs)

Turns stool Red

Carrots and beets

Hormonal Regulator Stimulated by fat in duodenum Targets gallbladder to release bile into the duodenum, the pancreas to increase production of enzyme-rich pancreatic secretions, stomach to inhibit gastric secretion somewhat

Cholecystokinin

Mixture of food with saliva, salivary enzymes, and gastric secretions that is produced as the food passes through the mouth, esophagus, and stomach

Chyme

Partially digested food mixed with gastric secretions is called_______.

Chyme

A nurse is giving a preprocedural teaching to a patient undergoing a colonscopy. Explain pertinent information necessary for this patient. Is the bowel preparation different for a patient with a colostomy?

Cleansing of the colon (Go-LYTELY) Clear liquid died noon the day before test Same prep for patient with a colostomy

Turns stool Dark red or brown

Cocoa

Provides cross-sectional images of abdominal organs and structures Multiple x-ray images are taken from numerous angles, digitized in a computer, reconstructed, and then viewed on a computer monitor.

Computed Tomography (CT)

Phase of the digestive process that occurs when digestive enzymes and secretions mix with ingested food and when proteins, fats, and sugars are broken down into their component smaller molecules.

Digestion

Heard over organs & solid masses

Dullness

Turns stool dark brown

Meat protein

If blood is shed in sufficient quantities into the upper GI tract, it produces a tarry-black stool.

Melena

Indigestion; upper abdominal discomfort associated with eating

Dyspepsia

The most common symptom of patients with GI dysfunction.

Dyspepsia

Phase of the digestive process that occurs after digestion and absorption, when waste products are evacuated from the body.

Elimination

A nurse is preparing a client with Crohn's disease for a barium enema. What should the nurse do the day before the test?

Encourage plenty of fluids

Direct visualization of the GI tract via a flexible fiber-optic, lighted scope. The endoscope is capable of obtaining biopsy specimens and clipping benign polyps.

Endoscopy

Collapsible tube connecting the mouth to the stomach, through which food passes as it is ingested

Esophagus

Pepsin, an enzyme that mediates protein digestion, is secreted by the salivary glands.

FALSE

When bleeding is occurring in the lower GI tract, stool will be tarry-black in color.

FALSE

Digestive enzymes contribute to the breakdown of foods for the body's use. Stomach contractions mix the food and gastric secretions and, eventually, the chyme moves to the small intestine. Which nutrient actually delays feeling hungry?

Fats

Intubation of a part of the GI system with a flexible, lighted tube to assist in diagnosis and treatment of diseases of the area

Fibroscopy (Gastrointestinal)

Expulsion of gas from the rectum

Flatulence

Begins with a complete history. Information about abdominal pain, dyspepsia, gas, nausea and vomiting, diarrhea, constipation, fecal incontinence, jaundice, and previous GI disease is obtained.

Focused GI assessment

High-pitched and can be heard over the liver and spleen during respiration

Friction Rubs

Hormonal Regulator Stimulated by stomach distention with food Targets gastric glands Increases secretion of gastric juice, which is rich in HCl Increased motility of the stomach, decreased time required for gastric emptying. Relaxes ileocecal sphincter Constricts gastroesophageal sphincter

Gastrin

Local regulator Unclear what stimulates it; substances in food Targets gastric glands Increases gastric production

Histamine

Gastrin Cholecystokinin Secretin

Hormonal Regulators

Acid secreted by the glands in the stomach; mixes with chyme to break it down into absorbable molecules and to aid in the destruction of bacteria

Hydrochloric acid

5 to 6 sounds heard in less than 30 seconds

Hyperactive

When 5 to 6 bowel sounds are heard within a period of less than 30 seconds, the patient's bowel sounds are considered ___________.

Hyperactive

One or two sounds in 2 minutes

Hypoactive

CEA (Carcinoembroyonic antigen) Cancer Antigen (CA) 19-9 Alpha-fetoprotein

Indicate sensitivity and specificity for colorectal and hepatocellular carcinomas, respectively.

Phase of the digestive process that occurs when food is taken into the GI tract via the mouth and esophagus

Ingestion

A gastic secretion that combines with vitamin B12 so that the vitamin can be absorbed

Intrinsic factor

The portion of the GI tract into which waste material from the small intestine passes as absorption continues and elimination begins; consists of several parts-- ascending segment, transverse segment, descending segment, sigmoid colon, and rectum

Large Intestine

An intestinal _______ solution is used to cleanse the bowel prior to a colonscopy.

Lavage

An enzyme that aids in the digestion of fats

Lipase

Examination of the colon i which barium is used as a contrast material NPO for 8 hours before test, clear liquids night before Colon must be free of stool, given laxatives and enemas the night before (fleets phospha soda or GoLytely) Barium is administered rectally, may have cramping and urge to defecate during procedure After test, increased fluid and laxative to expel the barium

Lower GI series or Barium Enema

NPO 6 to 8 hours before Remove all jewelry and metals May take 60-90 minutes

MRI

Used in gastroenterology to supplement ultrasongraphy and CT. This noninvasive technique uses magnetic fields and radio waves to produce images of the area being studied. Useful in evaluating abdominal soft tissues as well as blood vessels, abscesses, fistulas, neoplasms, and other sources of bleeding

MRI (Magnetic Resonance Imaging)

Saliva, salivary amylase

Major enzymes and secretions in the mouth

Amylase, lipase, trypsin, bile

Major enzymes and secretions in the small intestine

Hydrochloric acid, pepsin, intrinsic factor

Major enzymes and secretions in the stomach

What part of the GI tract begins the digestion of food?

Mouth

What information should the nurse include about the possible side effects of Go-LYTELY?

Nausea, bloating, cramps or abdominal fullness, fluid and electrolyte imbalance, and hypothermia

Acetylcholine & Norepinephrine

Neuroregulators

Neuroregulator Stimulated by stress, other various stimuli Targets secretory glands, gastric and intestinal muscle Generally inhibits secretions Motility is generally decreased; increased sphincter tone

Norepinephrine

Sounds heard every 5 to 20 seconds

Normal

Prouce images of the body by detecting the radiation emitted from radioactive substances. Radioactive substances are injected IV and usually tagged with a radioactive atom, such are carbon-11, fluorine-18, oxygen-15, or nitrogen-13.

PET (Positron Emission Tomography)

Purpose is to determine areas of tenderness, resistance, and swelling

Palpation of the abdomen

A gastric enzyme that is important in protein digestion

Pepsin

Purpose is to determine presence of fluid, distention, and/or masses

Percussion of the abdomen

A group of students are studying for an examination on the gastrointestinal (GI) system and are reviewing the structures of the esophagus and stomach. The students demonstrate understanding of the material when they identify which of the following as the opening between the stomach and duodenum?

Pyloric sphincter

Used to assess gastric emptying and colonic transit time

Radionuclide testing

Hormonal Regulator Stimulated by a pH of chyme in duodenum below 4-5 Targets the stomach to inhibit gastric secretion somewhat and the pancreas to increase production of bicarbonate-rich pancreatic juice Inhibits stomach contractions

Secretin

Turns stool yellow

Senna

Longest portion of the GI tract, consisting of three parts - duodenum, jejunum, and ileum - through which food mixed with all secretions and enzymes passes as it continues to be digested and begins to be absorbed into the bloodstream

Small Intestine

A nurse is teaching a client with malabsorption syndrome about the disorder and its treatment. The client asks which part of the GI tract absorbs food. The nurse tells the client that products of digestion are absorbed mainly in the:

Small intestine

Turns stool green

Spinach

Distensible pouch into which the food bolus passes to be digested by gastric enzymes

Stomach

Basic examination includes inspecting the specimen for consistency, color, and occult (not visible) blood. Additional studies include: Fecal urobilinogen Fecal fat Nitrogen Clostridium difficule Fecal leukocytes Calculation of stool osmolar gap Parasites Pathogens Food residues

Stool tests

Patient's often complain of bloating, distention, or feeling "full of gas" with excessive flatulence

Symtom of food intolerance or gallbladder disease

A patient schedules for a Hemoccult II study should be instructed to avoid red meat for 72 hours prior to the test.

TRUE

Helicobacter pylori in the mucosal lining of the stomach can be detected by a urea breath test.

TRUE

Pancreatic secretions are alkaline in pH in order to neutralize acidic stomach contents entering the duodenum.

TRUE

Developed to evaluate carbohydrate absorption, and to aid in the diagnosis of bacterial overgrowth in the intestine an short bowel syndrome.

The Hydrogen Breath Test

Upon review of a client's chart, the nurse notes the client has been receiving antiemetics every 6 to 8 hours. What in this client's history may necessitate such frequency?

Treatment for cancer

Enzyme that aids in the digestion of protein

Trypsin

Sound that results from the presence of air in the stomach and small intestines

Tympany

Noninvasive diagnostic technique in which high-frequency sound waves are passed into internal body structures and the ultrasonic echoes are recorded on an oscilloscope as they strike tissues of different densities.

Ultrasonography (Ultrasound)

Particularly useful in the detection of: Enlarged gallbladder or pancreas, gallstones Enlarged ovary, an ectopic pregnancy, or apendicitis Most recently has proven useful in diagnosing acute colonic diverticulitis

Ultrasonography (Ultrasound)

NPO for 8 hours before test After test risk of constipation from barium - given extra fluid, stool softeners, and / or laxatives Barium stool is clay colored

Upper GI series

X-ray where barium is used as a contrast material. Used to diagnosis structural abnormalities and problems of esophagus & stomach Pt swallows barium and x-rays are obtained to show; structures, function, position and abnormalities of organs from month the jejunum

Upper GI series or Barium swallow

Blood entering the lower portion of the GI tract of passing rapidly through it will appear....

bright or dark red

Defecation is a ______ reflex that can be inhibited voluntarily.

spinal

An examiner is performing the physical assessment of the rectum, perianal region, and anus. While this examination can be uncomfortable for many clients, health care providers must approach it in a prepared, confident manner. Which of the following considerations will help this examination flow smoothly and efficiently for both provider and client? Select all that apply.

• Position the client on the right side with the knees up to the chest. • Ask the client to bear down for visual inspection.