Chapter 20 Digestion and Bowel Elimination

Introduction Functions of the gastrointestinal (GI) tract GI problems are the source of complaints and discomfort for older adults Many factors impact GI health in older adults Self-treatment can delay the diagnosis and treatment of specific pathologies

Effects of Aging on GI Health Atrophy of the tongue affects taste buds and decreases taste sensation. Saliva production decreases Swallowing may be difficult. Presbyesophagus results in weaker esophageal contractions and weakness of the sphincter.

Effects of Aging on GI Health (cont.) Esophageal and stomach motility decreases Risk for aspiration and indigestion Decreased elasticity of the stomach Reduces the amount of food accommodation at one time Stomach has higher pH as a result of decline in hydrochloric acid and pepsin

Effects of Aging on GI Health (cont.) Decline in hydrochloric acid Increase in the incidence of gastric irritation Interferes with absorption of calcium, iron, folic acid, and vitamin B12 Decline in pepsin Interferes with absorption of protein Fewer cells on absorbing surface of intestinal wall impact the absorption of dextrose, xylose, and vitamins B and D

Effects of Aging on GI Health (cont.) Slower peristalsis, inactivity, reduced food/fluid intake, drugs, and low-fiber diet Increase in the risk of constipation Sensory perception decreases May lead to constipation or incomplete emptying of the bowel Bile salt synthesis decreases Increase in the risk of gallstone development Pancreas changes Affects digestion of fats

GI Health Promotion Good dental hygiene and regular dental visits can prevent disorders that threaten nutritional intake Proper nutrition enhances general health and minimizes the risk of indigestion and constipation Knowledge of the impact of medications on GI health is important Utilization of natural means (fiber, fluids, and timing) to promote bowel elimination

Dry Mouth (Xerostomia) Results from: Decreased saliva, some medications, Sjögren’s syndrome, mouth breathing, and altered cognition Consequences of decreased saliva production in the older adult population Interventions Saliva substitutes, sipping water, sugarless candy and gum

Question Which intervention will promote saliva production for the older adult living with xerostomia? Prescription diuretics once a day Daily oral hygiene Lemon–glycerin swabs every 4 hours Sucking on hard sugarless candy

Answer D. Sucking on hard sugarless candy Rationale: Persons with dry mouth benefit from frequent oral hygiene, saliva substitutes, sipping water to relieve dryness, and stimulating saliva production with hard sugarless candy.

Dental Problems Importance of dental care throughout the lifetime Poor dentition can restrict food intake and lead to: Constipation Malnourishment Impact on appearance and socialization Impact of potential financial limitations Encouragement of regular dental care Specific dental problems and their potential causes

Dysphagia Incidence of swallowing difficulties increases with age Causes Gastroesophageal reflux disease (GERD), stroke, and structural disorders Nursing assessment Goals of care and interventions: Prevention of aspiration Promotion of adequate nutritional status

Question Which medical problem may result in dysphagia? Hypertension GERD Osteoporosis Diverticulosis

Answer B. GERD Rationale: GERD is a common cause of dysphagia, as well as stroke or structural disorders of the GI system.

Hiatal Hernia Incidence Causes Types Sliding (axial) Rolling (paraesophageal) Signs and symptoms Treatment/management

Esophageal Cancer Incidence Types Causes Signs and symptoms Diagnosis Treatment/management

Peptic Ulcer Disease Predisposing factors Causes Signs and symptoms Complications Diagnosis Treatment/management

Cancer of the Stomach Incidence/prevalence Signs and symptoms Diagnosis Treatment/management Prevention

Diverticular Disease Diverticulum, diverticulosis, and diverticulitis Incidence Causes Signs and symptoms of each condition Treatment/management

Question Is the following statement true or false? Overeating, straining during a bowel movement, alcohol, and irritating foods may contribute to diverticulitis in the patient with diverticulosis.

Answer True Rationale: Bowel contents can accumulate in the diverticula and decompose, causing inflammation and infection which is considered diverticulitis. Overeating, straining during a bowel movement, alcohol, and irritating foods may contribute to diverticulitis in the patient with diverticulosis.

Colorectal Cancer Second most common malignancy in the United States Signs and symptoms Diagnosis and diagnostic tests Treatment/management Impact of a colostomy on an older adult

Chronic Constipation Contributing or causative factors Interventions to promote bowel elimination Need for education Safe use of laxatives Use of an elimination chart May require medical evaluation

Flatulence Causes Discomfort may occur if there is an inability to expel flatus Treatment/management Interventions

Intestinal Obstruction Causes Types Partial or complete Large intestine: cancer Small intestine: adhesions and hernias Signs and symptoms Vary depending on the site and cause

Intestinal Obstruction (cont.) Nursing assessment Careful attention to bowel sounds Treatment/management Timely intervention is extremely important Medical management Surgical management

Question Nursing evaluation and assessment of an older adult with a new-onset bowel obstruction will demonstrate what type of bowel sounds? Hypoactive bowel sounds High-pitched bowel sounds Absence of bowel sounds Presence of limited bowel sounds

Answer B. High-pitched bowel sounds Rationale: Bowel obstruction can cause high-pitched peristaltic rushes heard with auscultation. If the bowel obstruction has persisted for a long time, or the bowel has been significantly damaged, bowel sounds decrease and eventually are absent.

Fecal Impaction Prevention of constipation aids in avoiding fecal impaction A bowel elimination record is essential Signs and symptoms Diagnosis Nursing interventions Important to follow agency policy

Bowel Incontinence Involuntary defecation Inability to voluntarily control the passage of stool Most often associated with fecal impaction First step: assess for impaction Other causes Diagnosis Treatment/management

Acute Appendicitis Infrequent in older adults Atypical presentation Potential for a delay in diagnosis Potential for greater complications and mortality Treatment/management

Cancer of the Pancreas Difficult to detect Diagnosed at an advanced stage Signs and symptoms Diagnosis Treatment/management Generally poor prognosis

Question Is the following statement true or false? Signs and symptoms of pancreatic cancer include anorexia, weakness, weight loss, dyspepsia, belching, nausea, and vomiting.

Answer True Rationale: Anorexia, weakness, weight loss, and wasting are generalized symptoms of pancreatic cancer easily attributed to other causes. Dyspepsia, belching, nausea, vomiting, diarrhea, constipation, and obstructive jaundice may also occur.

Biliary Tract Disease Cholelithiasis (gallstones) Incidence increases with age Signs and symptoms Treatment/management Cancer of the gallbladder Poor prognosis

Summary GI symptoms need to be taken seriously Diagnosis of specific conditions/diseases can be difficult Careful assessment is extremely important