PowerPoint Presentation

Gastrointestinal SystemCNA2-Core & AcuteOSBN Curriculum

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MouthEsophagusStomachSmall IntestineDuodenumJejunumIleumLarge IntestineColonDigestive System

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Takes in food, digests to extract energy and nutrients, then expels waste Mouth contains teeth, salivary glands- mastication (chewing) and begins digestion Esophagus- throat, works by swallow reflex Epiglottis protects respiratory passage Stomach- muscular pouch- acid and churning breaks down food Small Intestine- 3 parts: Duodenum, jejunum, ileum

Large Intestine (referred to as the Colon): 3 portions: ascending, transverse, descending About 5 feet long Dries out and stores GI contents for elimination Sigmoid Colon- S-shaped and Rectum Stores feces prior to defecation Rectum and anus expel feces2Digestion

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3 PartsDuodenumJejunumIleum>20 Ft. PeristalsisAccessory OrgansLiverGallbladderPancreasSmall Intestine

Small Intestine- 3 parts: Duodenum, jejunum, ileum More than 20 feet long Peristalsis- moves food contents Nutrient absorption Accessory organs of small intestine: Liver- makes bile, fat emulsifier Gallbladder- stores bile Pancreas- enzymes for digestion

43 PortionsAscendingTransverseDescending5 FtDries and StoresSigmoid Colon/RectumStores FecesExpel Feces

Large Intestine/Colon

Large Intestine (referred to as the Colon): 3 portions: ascending, transverse, descending About 5 feet long Dries out and stores GI contents for elimination Sigmoid Colon- S-shaped and Rectum Stores feces prior to defecation Rectum and anus expel feces

5Inability/Difficulty SwallowingFood/Fluids not Down EsophagusCausesEsophageal StrictureMuscles not WorkingNerve or Brain Problem

Dysphagia

Inability to swallow or difficulty swallowing Food or fluids do not easily pass down the esophagus Esophagus walls may thicken causing a narrowing (stricture) of the passageway Causes: Ulcer, stricture or cancer of esophagus Muscles in mouth, throat or esophagus not working Nerve or brain problem (e.g. CVA, head injury)6Frequent Coughing/ChokingChange in Voice/GurglingWatery Eyes/Runny NoseHeartburnPt. c/o Fullness in ThroatIncomplete SwallowRefuse Certain Textures

Observation & Reporting

Frequent coughing/choking Change in voice, sounding wet or gurgling Watering of eyes, runny nose Change in breath sounds- (per nurse) Heartburn; regurgitation of food or stomach acid Patient complains of a feeling of fullness in throat/food sticking in throat Incomplete swallow noted at larynx (Adams Apple) Patient complains of consistency of food or refusal to eat certain textures New onset dysphagia should be reported to nurse immediately7Report New Dysphagia to NurseReport Abnormals to NurseSpeech Therapist to EvaluatePt. PositionHOB 45-90 DegreesSlight Tilt Forward w/SwallowFeeding TechniquesCheck for Food PocketingNo Feeding during CoughingDecrease DistractionsFood ConsistenciesThickened Liquids

CNA 2 Actions

FEEDING TIPS-Position: HOB upright (sitting) at 45-90 degrees Tilt pts head slightly forward with swallow May also be instructed by Speech Therapy to tuck chin and tilt head to the side with swallow; check care plan devised by speech therapy Feeding Techniques: Observe to see if larynx goes up and down completely with bites/sips Give directions like Open your mouth, swallow. Always check for pocketing of food; food leaking out side of mouth Do not feed patient while patient is coughing Place food on strong side of mouth (as in CVA/stroke patients) Do not have a social conversation, TV on during meals- this may distract patient Be sure patient is able to see fork/spoon coming to their mouth and use slow movementsFood consistencies: Thin liquids are difficult to swallow Mixed textures are difficult to swallow Thickened liquids allow better control of swallow and will decrease risk of choking High-risk patients should have diets ordered accordingly Report: Any abnormal signs or symptoms to nurse Concern about needing change in patients diet to nurse8GERDStomach Acid into EsophagusCauses:DiscomfortInflammationDamage to Esophageal LiningGastroesophageal Reflux

Acid from stomach flows back into esophagus Causes discomfort, sometimes inflammation, and damage to esophageal lining9FrequentHeartburnBurpingSour-Tasting FluidSx.s Worse after EatingDifficulty/Painful SwallowingObservation & Reporting

Frequent heartburn or burping Sour-tasting fluid backing up into mouth Symptoms may get worse after eating, bending over or lying down Difficulty or pain when swallowing10Report Abnormals to NurseIncreased HeartburnRegurgitationDifficulty SwallowingPain in ChestComfort MeasuresCNA2 Actions

Report any abnormal signs or symptoms to nurse Report increased heartburn, regurgitation, or difficulty swallowing Pain in chest Comfort measures11Inflammation of Stomach LiningPainfulCausesAspirinAnti-Inflammatory MedsStressTobacco/Alcohol UseHelicobacter Pylori BacteriaH-Pylori

Gastritis

Inflammation of stomach lining Painful- acids may damage stomach lining Causes: Aspirin and anti-inflammatory meds Stress Tobacco or alcohol use Helicobacter pylori bacteria12Burning Feeling in Upper Abd.Pain after EatingGas/Bloated feeling in StomachFrequent BelchingN/VBloody EmesisBlack Tarry StoolsObservation & Reporting

Complains of a burning feeling in upper abdomen Pain that occurs after eating certain foods (usually spicy, fried, etc.) Gas or bloated feeling in stomach Frequent belching Nausea with or without vomiting, black tarry stools13Report Abnormals to NurseEase StressBland DietCNA 2 Actions

Report any abnormal signs or symptoms to nurse Help ease patients stress14Inflammation of Stomach/Intestinal TractAKA: Intestinal or Stomach FluCausesVomitingDiarrheaS/S of DehydrationCausesVirusesBacteria in Food and Water

Gastroenteritis

Inflammation of the stomach and intestinal tract Also referred to as intestinal or stomach flu Causes vomiting and/or diarrhea, with signs and symptoms of dehydration Most common causes are viruses and bacteria in food (food poisoning) and water15Abd. Pain/CrampingIndigestionN/VDiarrhea Rumbling in Stomach

Observation & Reporting

Abdominal pain/cramping Indigestion, nausea and/or vomiting Fever/chills, fatigue Rumbling in stomach Diarrhea16Report Abnormals to NurseAccurate I&OComfort MeasuresCold TherapyHeat TherapyAs Ordered by NurseCNA 2 Actions

Report abnormal signs or symptoms to nurse Intake and output Comfort measures; cold or heat therapy as ordered by nurse for fever/chills17Open Sores in the Lining of the StomachCommon CausesAnti-Inflammatory DrugsAlcohol/Tobacco UseInfection w/H-PyloriNo Bigger than Pencil EraserVery PainfulGastric Ulcers

Gastric Ulcers (Peptic Ulcers) Open sores that develop on inside lining of stomach Common causes are some anti-inflammatory drugs, use of alcohol or tobacco; and infection with Helicobacter pylori Most ulcers are no bigger than a pencil eraser, but they can cause great discomfort and painResponsive18Gnawing/Burning Abd. PainChest PainPain often btwn MealsN/VLoss of AppetiteBlack/Tarry StoolsObservation & Reporting

Gnawing/burning pain in abdomen Chest pain Pain often occurs between meals and sometimes awakens people from sleep Nausea/vomiting of blood; loss of appetite Black, tarry or bloody stools (ulcer is bleeding)19Report Abnormals to NursePain LevelVSAccurate I&OEnforce Ordered DietCNA 2 Actions

Report any abnormal signs or symptoms to nurse Pain level Vital signs Intake and output Ensure pt. stays on ordered diet20Inflammation: Lining of the ColonUlcerative ColitisUlcersBleedProducePusMucusColitis

Inflammation of the lining of the colon (ulcerative colitis) Ulcers of the colon bleed and produce pus and mucus21DiarrheaSevere Straining w/BMsBlood/Pus StoolsAbd./Rectal PainSpasmsFeverFatigueObservation & Reporting

Diarrhea or severe straining with bowel movements Blood/pus in stools, rectal bleeding Abdominal and/or rectal pain Spasms Fever Fatigue22Report Abnormals to NurseGood Peri-CareStress ReductionEmotional SupportCNA 2 Actions

Report any abnormal s/s to nurse Provide good peri-care Reduce stress if possible23Chronic Inflammation/IrritationAnywhere from Mouth to AnusNo Know CureSurgery May HelpPeriods of RemissionCrohns Disease

Inflammatory bowel disease (IBD) Chronic inflammation and irritation of the intestinal tract anywhere from mouth to anus No known medical cure Surgery may help control May have long periods of remission24Abd. Pain & Bloating after MealsSores in Anal AreaHigh Fever & ChillsLoss of AppetiteWt. LossBloody DiarrheaN/VFatigueObservation & Reporting

Abdominal pain and bloating after meals Sores in anal area High fever and chills Loss of appetite, possible weight loss Bloody diarrhea Nausea/vomiting Fatigue25Report to NurseBloody StoolPain LevelDecreased AppetiteWt. LossAccurate I&OEncourage PO FluidsGood Peri-CareEmotional SupportCNA 2 Actions

Report blood in stool to nurse Report pain level Report decreased appetite and weight loss Intake and Output- encourage fluids to avoid dehydration Provide good peri-care26Pouches (Diverticula) in Digestive TractLarge IntestineParticles Collect in PouchesMildRestDietary ChangesAntibioticsSeriousSurgeryDiverticulosis

Formation of diverticula (pouches) anywhere in the digestive tract Most common in large intestine When feces collect in pouches they become infected and inflamed- (Diverticulitis) Mild cases can be treated with rest, dietary changes and antibiotics Serious cases require surgery to remove diseased bowel27Abd. Pain/CrampingFeverChillsN/VBloatingRectal BleedingConstipationDiarrheaObservation & Reporting

Abdominal pain/cramping ( especially in lower left side) Fever/chills Nausea and/or vomiting Bloating; rectal bleeding Constipation or diarrhea28Report Abnormals to NurseGood Peri-CareHigh Fiber DietEncourage PO FluidsCNA 2 Actions

Report abnormal signs or symptoms to nurse Provide good peri-care29Enlarged/Swollen/Painful/BleedingVeins around AnusInternalExternalHemorrhoids

Enlarged, swollen, painful or bleeding veins around anus May be internal or external30Bright Red Blood Covering StoolMay Protrude through AnusIrritated/Painful/Itchy

Observation & Reporting

Bright red blood covering the stool, on toilet paper or in toilet Hemorrhoid may protrude through anus, becoming irritated/painful/itchy Drainage of mucus may also cause itching31Report Abnormals to NurseGentle Peri-CareAssist w/Comfort Measuresas Directed by NurseCNA 2 Actions

Report any abnormal signs or symptoms to nurse Gentle peri-care Assistance with comfort measures as directed by nurse (ie. Sitting on a donut orusing Tucks pads)32Slow Moving FecesMore Water AbsorbedResults in Hard, Dry StoolStool LargeMarble SizedPt. Often Strains at BMCommon CausesInactivityLow Fiber DietDecreased Fluid IntakeOpiate Pain MedsConstipation

Occurs when feces move too slowly through the bowel, causing more water to be absorbed and dry, hard stool Decrease in normal frequency of defecation with difficult passage of stool- often dry and hard; can be temporary or chronic Stool can be large or marble-sized Large stools can cause pain as they pass through anus Patient usually strains to have a BM May be controlled by diet and medication Common causes: Low fiber diet; decreased fluid intake Inactivity Ignoring urge to have a bowel movement Opiate pain medications (e.g. Morphine/Vicodin) ; stool softeners/ fiber may be prescribed33Report No BM X3days to NurseEncourage Fluids and DietEncourage ActivitySuppositoriesEnemasReport to NurseCNA 2 Actions

Report if no BM in three days Assist patient with toileting as needed Encourage fluid intake and appropriate diet Encourage activity within care plan Suppositories and/or enema to cause BM34Accessory Organs

GallstonesBlock the Flow of BileCholecystitisExtreme PainComes in WavesCholecystectomyJP or T-tubeGreenishbrown

Cholelithiasis

Formation on stones (calculi) within the gallbladder blocking the flow of bile from gallbladder to small intestine Stones can range in size from like grain of sand to 1 inch diameter Causes inflammation of the gallbladder- cholecystitis Extreme pain (often described as pain in waves) Surgery may be required to remove gall stones or Cholecystectomy- removal of gall bladder If surgery performed, patient may have a drain in place (JP or T-tube), draining greenishbrown (bile) liquid36PainEpigastricRUQBackR Shoulder PainHeartburnN/VJaundiceSlight FeverObservation & Reporting

Epigastric, right upper quadrant, back and/or right upper shoulder pain Heartburn, nausea/vomiting Jaundice (yellowing of skin and/or the whites of the eyes) Slight fever37Report Abnormals to NurseAccurate I&OObserve DrainsPain Level

CNA 2 Actions

Intake and output Pain level Report abnormal signs and symptoms to nurse38Irreversible Liver DamageUnable to DetoxifyPurifyManufactureResult ofChronic AlcoholismViral Hepatitis CEnvironmental ExposureMedsSxs Often Not Seen EarlyCirrhosis

Hepatitis (inflammation of the liver, usually caused by infection) covered under ImmuneChronic Liver Disease (Cirrhosis) Irreversible damaged or scarred liver Liver cannot detoxify, purify the blood or manufacture vital nutrients No cure, but treatment available Usually result of chronic alcoholism, viral hepatitis C, or environmental exposure (eg. Pesticides) Certain medications Symptoms often not apparent in early stages39Fatigue/Weakness/ExhaustionConfusionAgitationHallucinationsJaundice SkinAscitesBloody StoolsItchy SkinEasily Brusied

Observation & Reporting

Fatigue, weakness, exhaustion Confusion/agitation/hallucinations Vomiting with/without blood Weight loss or gain Yellowish skin or eyes (jaundice) Swollen abdomen- (from fluid collection-ascites); and legs Blood in stool Easy bruising of skin, itching of skin40Report Abnormals to NurseSafety PrecautionsObserve for Alcohol WithdrawalAccurate I&OCNA 2 Actions

Report any abnormal s/s to nurse Use appropriate safety measures for alcohol withdrawal41Releases Insulin/Glucagon/EnzymesInflammation/InfectionOften Associated w/ Alcohol AbuseAlso Other CausesAcute or Chronic

Pancreatitis

Pancreatitis is inflammation or infection of the pancreas The pancreas is the gland located behind the stomach that releases the hormones insulin and glucagon and substances that help with digestion. Often associated with alcohol abuse, and other causes as well (such as gallbladder disease). Can be Acute or Chronic:42Severe Abd. PainAnxietyFeverJaundiceN/VSweatingIndigestionClay-Colored StoolsHiccupsSkin Rash/LesionSwollen Abd.Acute Pancreatitis

Severe abdominal pain Anxiety Fever Mild yellowing of the skin and the whites of the eyes (jaundice) Nausea and vomiting Sweating Indigestion Clay-colored stools Gaseous abdominal fullness Hiccups Skin rash or lesion Swollen abdomen43Pain MedsIV FluidsNPOPossible NGTDrainage of Pancreatic FluidRemoval GallstonesLow-Fat Diet when EatingInsulin Pancreatic EnzymeOccasionally ORAcute Pancreatitis Tx

Pain medicines Fluids given through a vein (IV) Withholding food or fluid by mouth to limit the activity of the pancreas Possible nasogastric suction (NG tube) Drainage of fluid collections in or around the pancreas Removal gallstones Analgesics or surgical nerve block to relieve pain Eating a low-fat diet Getting enough vitamins and calcium in the diet Taking insulin to control blood sugar (glucose) levels Taking pancreatic enzyme Relieve blockages of the pancreatic duct Occasionally surgery is indicated

44Abd. PainDigestive ProblemsFatty StoolsN/VClay-Colored StoolsUnintentional Wt. LossChronic Pancreatitis

Abdominal pain Digestive problems Fatty stools Nausea and vomiting Pale or clay-colored stools Unintentional weight loss45Analgesics/Surgical Nerve BlockLow-Fat DietVitamins & CalciumPancreatic EnzymesRelieve Blockages of Pancreatic DuctOccasionally ORChronic Pancreatitis Tx

Analgesics or surgical nerve block to relieve pain Eating a low-fat diet Getting enough vitamins and calcium in the diet Taking insulin to control blood sugar (glucose) levels Taking pancreatic enzyme supplements Relieve blockages of the pancreatic duct Occasionally surgery is indicated46FeverHypotensionTachycardiaTachypneaAbd. PainN/VFirm, Hard Abd.Observation & Reporting

Fever Hypotension and/or rapid heart rate (tachycardia) Rapid respirations (tachypnea) Abdominal pain (may be worse after eating/ drinking, or when lying down) Nausea/ vomiting Firm, hard abdomen47Report Abnormals to NurseObserve for Alcohol WithdrawalReduce StressAccurate I&OReport Pain LevelNGT CareAccurate Recording of Drainage

CNA 2 Actions

Report any abnormal s/s to nurse Use appropriate safety measures for alcohol withdrawal Reduce stress if possible Intake and output Pain level If NG tube present, take care to prevent tube being dislodged/kinked Reconnect NG tube after patient back to bed Accurate recording of NG drainage48Intestinal ObstructionBlockage of the Bowel80% Sm. IntestineMedical EmergencyMechanical ObstructionPhysical BlockageBowel Diversion Paralytic IleusCommon Post-Abd ORAbsent Peristalsis>24Hrs + NGTBowel Obstruction

Intestinal obstruction: involves a partial or complete blockage of the bowel that prevents intestinal contents to pass through. Can occur at any level in digestive tract- 80% in small intestine; 20% in colon. Is a medical emergency. Mechanical obstruction: occurs when movement through intestines is physically blocked (hernia, adhesions, scar tissue from surgery, tumors). Surgery may be required to remove obstruction. Bowel diversion is often necessary (either temporarily or permanently). Paralytic Ileus (non-mechanical obstruction) May develop in small intestine after abdominal surgery Decreased or absent peristalsis (movement of bowel) Longer than 48 hours, NG tube may be inserted by nurse to decrease abdominal distention49Abd. PainN/VAbd. DistentionWatery StoolAbnormal VSObservation & Reporting

Abdominal pain, nausea/vomiting, abdominal distention Liquid, watery stool (may be expelled past a fecal impaction or higher blockage) Monitor Intake and Output Level of pain on pain scale Abnormal vital signs50Report Abnormals to NurseMonitor I&OLevel of PainNGTSafetyReconnectAccurate Recording

CNA 2 Actions

Report any abnormal signs and symptoms to nurse If NG tube present, take care to prevent tube being dislodged/kinked Reconnect NG tube after patient back to bed Accurate recording of NG drainage51Surgical Alteration of the GI TractCreating an External StomaTemporary or PermanentDisposable Drainage PouchStomas1 month Non-Acute by Nursing Staff

Bowel Diversion

Surgical alteration of GI tract to create external stoma (opening) on outside of the abdomen for elimination of feces, remove infarcted tissue, and/or anastamose healthy tissue May be temporary or permanent Disposable drainage pouch is attached over stoma to collect feces Stomas < 1 month old are treated by wound care- considered acute; greater than 1 monthconsidered non-acute and can be cared for by nursing staff52IleostomyLast SectionLiquid StoolStrong OdorColostomyFormed StoolTypes

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Video Link: types of ostomies

Ileostomy- opening into ileum, last section of small intestine- liquid stool (strong odor) Ifpermanent, whole colon is removed Colostomy- opening into colon- more formed stool

53Pouch LeakageSkin IrritationStoolBloodChange in CharacterAmt. of DrainagePills/Meds?Pt. ComplaintsStomaEdema/ChangeObservation & Reporting

Pouch leakage; skin irritation, breakdown or rash Blood in stool, or remarkable change in character and/or amount of drainage Pills/medication noted in drainage Patient complaints of discomfort, burning, or itching around stoma Color change or edema of stoma54StandardInitialDaily CareReport vs Document

Post-Op Care

This is also geared toward the nurse but can be used w/other link on the technical skills slide.This video link also includes initial and changing the bag55Report Abnormals to NurseEmpty Pouch < 1/3rd FullFull of GasEnteral FeedingHOB 45-90 DegreesObserveAbd. DistentionSOBCNA 2 Actions

Report abnormal signs and symptoms to nurse Empty pouch before it is 1/3 full of stool or full of gas If patient receiving enteral tube feedings, keep head of bed elevated at 45-90 degrees, observe for abdominal distention and shortness of breath56Changing an Ostomy Baghttp://www.medcomrn.com/dev/flash/flvplayer/movie.php?movie=http://ss1.medcomrn.com/flv/m216r_sec04_300k.flv&title=&detectflash=false&detectflash=false

Technical SkillChanging an Ostomy Bag, also explains some A&P. Also this video is directed toward CNAs Go to skills lab and preform skill 57Nasogastric Feeding Tubes: http://www.medcomrn.com/dev/flash/flvplayer/movie.php?movie=http://ss1.medcomrn.com/flv/m245ar_sec05_300k.flv&title=&detectflash=false&detectflash=falseFeeding Tube Components: http://www.medcomrn.com/dev/flash/flvplayer/movie.php?movie=http://ss1.medcomrn.com/flv/m245ar_sec02_300k.flv&title=&detectflash=false&detectflash=false

Tube FeedingGastroccult vs hemmoculthttps://www.youtube.com/watch?v=BdUaXubDZIsHemmoculthttps://www.youtube.com/watch?v=Pc3MtqUwFwE

Testing for Blood