The Gastrointestinal System

101 15 The Gastrointestinal System 1. Define important words in this chapter 2. Explain key terms related to the body 3. Explain the structure and function of the gastrointestinal system 4. Discuss changes in the gastrointestinal system due to aging 5. List normal qualities of stool and identify signs and symptoms to report about stool 6. List factors affecting bowel elimination and describe how to promote normal bowel elimination 7. Discuss common disorders of the gastrointestinal system 8. Discuss how enemas are given 9. Demonstrate how to collect a stool specimen 10. Explain occult blood testing 11. Define the term ostomy and identify the difference between colostomy and ileostomy 12. Explain guidelines for assisting with bowel retraining Supplemental Tools transparency 15-1 the gastrointestinal system transparency 15-2 factors affecting bowel elimination handout 15-1 suppositories handout 15-2: ileostomy care chapter 15: exam Assignments textbook reading, pp. 270-294 workbook exercises, pp. 89-93 Overview of Teaching Strategies This chapter introduces the students to the terms related to the body and the ten body systems. The concept of homeostasis is also introduced. The structure and function of the gastrointestinal system is briefly explained, and normal changes of the gastrointestinal system due to aging are described. The normal changes of aging for each body system should be emphasized so that students are better able to recognize abnormal changes. This chapter describes the process of bowel elimination and describes normal qualities of stool. Emphasis should be placed on the importance of regular bowel movements for maintaining health in elderly people. Students will learn signs and symptoms about stool that should be reported to the nurse. Factors affecting bowel elimination are described. Stress that the NA has an important role in promotion of bowel elimination for his or her residents. Common disorders of the gastrointestinal system are described in this chapter. It may be a good idea to have students make flash cards for these disorders and those described in the other body systems chapters. An important component of this chapter is the emphasis on providing plenty of privacy for all elimination and support for residents who have ostomies or are incontinent. Ask students to think about what it would feel like if they could not control their bowels and had to rely on others for assistance with elimination. 1. Define important words in this chapter textbook pp. 270-271 workbook p. 89

102 Pronounce and define each of the key terms listed in the Learning Objective on pages 270-271. 2. Explain key terms related to the body textbook p. 272 workbook p. 89 Biology Anatomy Physiology Cells Tissues Organs Body systems Homeostasis Pathophysiology Review the ten systems that make up the human body: Gastrointestinal or digestive Urinary Reproductive Integumentary or skin Circulatory or cardiovascular Respiratory Musculoskeletal Nervous Endocrine Immune and lymphatic 3. Explain the structure and function of the gastrointestinal system textbook pp. 272-274 workbook pp. 89-90 Gastrointestinal tract Peristalsis Chyme Duodenum Absorption Feces Electrolytes Colon Defecation Ingestion Digestion Elimination Display Transparency 15-1 the gastrointestinal system Discuss the following points: Digestion prepares food for absorption into cells. Elimination is expelling solid wastes. Review the functions of the gastrointestinal system: Ingestion of food and fluids Digestion of food Absorption of nutrients Elimination of waste products from food/fluids 4. Discuss changes in the gastrointestinal system due to aging textbook p. 274 workbook p. 90 Review normal changes of aging: Ability to taste decreases. Process of digestion takes longer and is less efficient. Body waste moves more slowly through the intestines, causing more frequent constipation. Difficulty chewing and swallowing may occur. Absorption of vitamins and minerals decreases. Production of saliva and digestive fluids decreases.

103 5. List normal qualities of stool and identify signs and symptoms to report about stool textbook p. 274 workbook p. 90 Bowel elimination Discuss normal bowel elimination: Stool is normally brown, soft, moist, and formed. No pain with passing stool There should not be blood, pus, mucus, or worms in the stool Review signs and symptoms to report about stool: Bloody or abnormally-colored stool Hard, dry stools Diarrhea Constipation Pain with bowel movements Blood, pus, mucus, or discharge in stool Fecal incontinence 6. List factors affecting bowel elimination and describe how to promote normal bowel elimination textbook pp. 274-280 workbook pp. 90-91 Fracture pan Portable commode Display Transparency 15-2 factors affecting bowel elimination Discuss the factors listed on the transparency: Growth and development Psychological factors Diet Fluid intake Physical activity and exercise Personal habits Medications Demonstrate each of the following procedures, including all of the numbered steps in your demonstration: Assisting a resident with use of a bedpan Assisting a male resident with a urinal Helping a resident use a portable commode Have the students return each demonstration. Procedure checklists are located at the back of the 7. Discuss common disorders of the gastrointestinal system textbook pp. 280-283 workbook pp. 91-92 Heartburn Review the following points about heartburn: Cause: weakening of the sphincter muscle which joins the esophagus and the stomach Symptoms: burning feeling in the esophagus, chest pain, bitter taste in the mouth, feeling of food coming back up into the throat or the mouth Pain usually occurs directly after a meal and may worsen when person is lying down. Treatment: medication, change in diet or sleep position Gastroesophageal reflux disease (GERD) Review the following points about GERD: Cause: liquid contents of the stomach back up into the esophagus; can inflame and damage lining of the esophagus and cause bleeding, ulcers, or difficulty swallowing Symptoms: frequent heartburn, chest pain, hoarseness in the morning, difficulty swallowing,

104 tightness in the throat, coughing, foul-smelling breath Possible causes: hiatal hernia, weak lower esophageal sphincter, slow digestion, diets high in acidic and spicy foods, obesity, smoking, alcohol use Treatment: stopping smoking and drinking alcohol; losing weight; wearing loose-fitting clothing; serving frequent, small meals throughout the day; serving last meal of the day three to four hours before bedtime; sitting up for at least two to three hours after eating; elevation of the head of the bed; and using extra pillows Review the following points about ulcers: Raw sores in the stomach or small intestine Cause: excessive acid Symptoms: dull or burning pain after eating, belching, vomiting Treatment: antacids and medications, change in diet Avoid alcohol, caffeine, and cigarette use Ulcerative colitis Review the following points about ulcerative colitis: Symptoms: diarrhea, abdominal pain, cramping, rectal bleeding, poor appetite, fever, weight loss Can cause intestinal bleeding and death, if not treated Medication can help symptoms but do not cure it. Treatment may include an ostomy. Crohn s disease Review the following points about Crohn s disease: Causes the wall of the intestines to become inflamed Symptoms: diarrhea, abdominal pain, fever, weight loss, joint pain Medication can help symptoms but do not cure it Treatment may include an ostomy Diverticulosis Diverticulitis Review the following points about diverticulosis and diverticulitis: Diverticulosis causes sac-like pouches to develop in weakened areas of the intestinal wall. Some people with diverticulosis will develop diverticulitis, or inflammation inside the pouchings. Cause: low-fiber diet Treatment: rest, medications, special diets, surgery Define the following terms: Flatulence Malabsorption Irritable bowel syndrome (IBS) Review the following points about flatulence: Presence of excessive air in the digestive tract Causes: high fiber foods, intolerance of foods, swallowing air when eating, antibiotics, malabsorption, IBS May be relieved by positioning, rectal tube Define the following terms: Constipation Enema Suppository Optional Distribute Handout 15-1 suppositories If regulations require you to teach this procedure, distribute the handout and discuss how to safely administer a suppository. Review the following points about constipation: Inability to eliminate stool, or the infrequent, difficult and often painful elimination of a hard, dry stool Causes: changes of aging, poor diet, lack of exercise, decrease in fluid intake, medication, disease, or ignoring urge to eliminate Signs include abdominal swelling, gas, irritability Treatment: increasing fiber, physical activity, and medication

105 Diarrhea Review the following points about diarrhea: It is the frequent elimination of liquid or semiliquid feces. Causes: infections, microorganisms, irritating foods, medication Treatment: medication, change of diet Fecal incontinence Review the following points about fecal incontinence: It is an inability to control the bowels. Causes: muscle and nerve damage, disorders of the spinal cord or anus, fecal impaction, constipation, tumors Treatment: changes in diet, medication, bowel training, surgery Fecal impaction Review the following points about fecal impaction: Buildup of dry, hardened feces in the rectum Signs include: no stool for several days, cramping, abdominal and rectal pain, abdominal swelling, nausea, and vomiting. Nurse or doctor will break mass into fragments. Can be fatal if complete bowel obstruction occurs Hemorrhoids Review the following points about hemorrhoids: Enlarged veins in the rectum Causes: constipation, obesity, pregnancy, diarrhea, overuse of enemas and laxatives, straining during bowel movements Symptoms: rectal itching, burning, pain, and bleeding Treatment: changes in diet, surgery 8. Discuss how enemas are given textbook pp. 283-287 workbook p. 92 Review different types of enemas: Tap water enema Soapsuds enema Saline enema Commercial enema Tell students that residents must be in Sims position to receive an enema. Emphasize that an enema should be stopped immediately if the resident complains of pain or if the NA feels resistance. This must be reported to the nurse. If your facility allows, demonstrate each of the following procedures, including all of the numbered steps in your demonstration: Giving a cleansing enema Giving a commercial enema Have the students return the demonstration. Procedure checklists are located at the end of the Emphasize that these procedures should only be performed if allowed by the facility and if the NA is trained to perform the procedure. 9. Demonstrate how to collect a stool specimen textbook pp. 288-289 workbook p. 92 Specimen Discuss these points about stool specimens: Stool is tested for blood, pathogens, and other things. Stool must be warm if being tested for ova and parasites. Urine or tissue in a stool sample can ruin the sample. Demonstrate the procedure: Collecting a stool specimen. Include all of the numbered steps in your demonstration.

106 Have the students return the demonstration. Procedure checklists are located at the end of the 10. Explain occult blood testing textbook pp. 289-290 workbook p. 92 Occult Discuss the fact that blood in the stool may be a sign of a serious problem, such as cancer. The Hemoccult test is one test that checks for occult blood. If in a facility and staff performs this test, demonstrate the procedure: Testing a stool specimen for occult blood. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the 11. Define the term ostomy and identify the difference between colostomy and ileostomy textbook pp. 290-292 workbook p. 93 Ostomy Stoma Colostomy Ileostomy Ureterostomy Urostomy Point out the body locations of the types of openings and why the care of the skin and the stoma are very important. Discuss and show different types of commercially sold ostomy appliances and equipment. Point out which types are most appropriate for certain ostomies. Emphasize that some residents are embarrassed about having an ostomy and promoting privacy is very important. Review the guidelines for ostomy care: Follow Standard and/or Transmission-Based Precautions. Provide good skin care and hygiene. Remove ostomy appliances carefully. Before removing appliance, allow a little air out of the bag. Observe contents of bag. Empty, clean, and replace the ostomy bag whenever stool is eliminated. Assist residents to wash hands. Observe for skin irritation, rashes, swelling or bleeding around stoma. Use skin barriers as ordered. Make sure bottom of appliance/bag is securely clamped before applying to stoma. Make sure bag is attached securely before completing care and before residents go out or receive visitors. Be supportive, empathetic, and caring. Demonstrate the procedure: Caring for an ostomy. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Optional Distribute Handout 15-2 ileostomy care Distribute this handout if you want to include more information on ileostomy care. Go over all of the numbered steps.

107 12. Explain guidelines for assisting with bowel retraining textbook pp. 292-293 workbook p. 93 Discuss how NAs may assist in bowel retraining, including: Explain the schedule to the resident. Follow the schedule. Follow Standard Precautions. Wear gloves. Observe resident s elimination habits. Keep a record of elimination. Offer bedpan or trip to the bathroom at specific times each day. Answer call lights promptly. Provide privacy. Do not rush resident. Help with perineal care. Encourage fluids and proper diet. Dispose of wastes properly. Praise attempts and successes in controlling bowels. Never show frustration or anger. Discuss with students how to keep a positive attitude when assisting residents who are going through bowel retraining and have accidents. Ask students how they would feel if they were unable to control elimination. Create empathy for residents. Chapter Review Exam distribute chapter 15: exam (appendix c, pp. 321-322) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Answers to Chapter Review in Textbook 1. Anatomy is the study of body structure. Physiology is the study of how body parts function. Cells are the basic structural unit of all organisms. Tissues are groups of cells that perform similar tasks. Organs are structural units in the human body that perform specific functions. Body systems are groups of organs that perform specific functions in the human body. Homeostasis is the condition in which all of the body s systems are balanced and are working at their best. 2. Peristalsis is muscular contractions that push food from the stomach toward the esophagus. 3. Feces is solid body waste excreted through the anus from the large intestine. 4. Ingestion of food, digestion of food, absorption of nutrients, and elimination of waste products from food/fluids 5. Answers include: Ability to taste decreases. Process of digestion takes longer and is less efficient. Body waste moves more slowly through the intestines, causing more frequent constipation. Difficulty chewing and swallowing may occur. Absorption of vitamins and minerals decreases. Production of saliva and digestive fluids decreases. 6. Brown in color; soft; moist; and formed 7. Answers include: abnormally colored stool; hard, dry stool; liquid stool; constipation; pain when having a bowel movement; blood, pus, mucus or discharge in stool; or fecal incontinence 8. Answers include: Growth and development: Encourage fluids and nutritious meals. Encourage regular activity and exercise. Provide good oral care. Make sure dentures are clean and fit properly. Psychological factors: Provide privacy and allow plenty of time for elimination. Leave the call light in reach. Respond to call lights and toileting requests immediately. Listen to residents if they want to talk. Diet: Encourage nutritious meals. Increase fiber intake. Decrease fatty and sugary foods. Use dietary supplements as ordered. Fluid intake: Encourage fluid intake. Remind residents to drink often. Make sure pitcher and water are in reach and light enough to lift. Assist with fluid intake as needed.

108 Physical activity and exercise: Increase daily exercise. Encourage regular walks and other activities that are allowed. Personal habits: Help residents to the bathroom at the best time for them. Use the bathroom resident prefers or get portable commode. Raise the head of the bed for residents using bedpan. Medications: Laxatives may be ordered. Report diarrhea or constipation to nurse promptly. 9. A fracture pan is used for small or thin people or those who cannot lift their buttocks onto a standard bedpan. 10. Position a standard bedpan so that the wider end is aligned with a resident s buttocks. Position a fracture pan with the handle toward the foot of the bed. 11. Portable commodes are used for people who can get out of bed but find it difficult to walk to the bathroom. 12. A resident with GERD should sit up for at least two to three hours after eating. 13. Medication and surgery 14. Answers include: high fiber foods, eating foods that a person cannot tolerate, swallowing air, antibiotics, malabsorption, or irritable bowel syndrome (IBS) 15. Answers include: increasing fiber in the diet and physical activity, and medications such as laxatives, enemas, or suppositories 16. Answers include: muscle and nerve damage, disorders of the spinal cord or anus, injuries to the anal muscles, fecal impactions, constipation, or tumors 17. Answers include: no stool for several days; cramping; abdominal or rectal pain; abdominal swelling; nausea; vomiting; seeping or oozing of liquid stool; increase in urination; inability to urinate; fever; or confusion or disorientation 1000 ml water with 5 ml of mild castile soap added. A saline enema has 500-1000 ml water with two teaspoons of salt added. A commercial enema has 120 ml solution and may have oil or other additives. 20. Sims position 21. Stop immediately 22. Not more than 12 inches 23. Tests must be done while the stool is still warm. 24. Urine or toilet paper 25. Hat 26. With a microscope or special chemical test 27. An ostomy is the surgical creation of an opening from an area inside the body to the outside. 28. Due to bowel disease such as diverticulitis or Crohn s disease, colon cancer, or trauma 29. A colostomy is a surgically-created opening into the large intestine to allow feces to be expelled. With a colostomy, stool may be semi-solid. An ileostomy is a surgically-created opening into the end of the small intestine, the ileum, to allow feces to be expelled. Stool will be liquid and may be irritating to the skin. 30. Answers include: Follow the plan consistently. Follow Standard Precautions. Observe residents elimination habits. Keep a record of elimination, including episodes of incontinence. Offer bedpan or trip to the bathroom at specific times each day. Answer call lights promptly. Provide privacy. Do not rush the resident. Help with perineal care as needed. Encourage fluids. Encourage proper diet. Dispose of wastes properly. Praise attempts and successes in controlling the bowels. Never show frustration or anger toward residents who are incontinent. 18. Answers include: excessive cleaning and wiping of the area, scented soaps 19. A tap water enema has 500-100 ml water with nothing added. A soapsuds enema has 500-