Chapter 26 Gastrointestinal Conditions

Gastrointestinal Problems Indigestion Belching Diarrhea Constipation Nausea Vomiting Anorexia Weight gain or loss Flatulence

Factors Influencing Gastrointestinal Tract Health Poor nutrition Medications Emotions Inactivity A variety of other factors

Causes of Anorexia Medication side effects Inactivity Physical illness Age-related changes Anxiety and depression

Management of Anorexia Depending on the cause, treatment could consist: –A high-calorie diet –Referral to social programs –Tube feeding –Hyperalimentation –Psychiatric therapy –Medications

Xerostomia (Dry Mouth) Causes: –Drugs –Sjogren’s syndrome –Mouth breathing –Altered cognition Interventions: –Sipping water –Hard candies –Saliva substitutes

Factors That Could Lead to Poor Dental Status in Elders Limited funds Lack of knowledge Diseases Fear of Dentists

Causes of Dysphagia Gastroesophageal reflux disease (GERD) Stroke Structural disorders

Types of Dysphagia Oropharyngeal –Difficulty transferring food from the mouth into the the pharynx and esophagus. Esophageal –Difficulty transferring food down the esophagus.

Interview Questions for Patients with Dysphagia When did the problem begin? What other symptoms accompany the dysphagia? What types of foods are most problematic? Is the problem intermittent or present with every meal?

Types of Hiatal Hernias Sliding (axial) –A part of the stomach and the junction of the stomach and esophagus slide through the diaphragm. Rolling (paraesophageal) –The fundus and greater curvatures of the stomach roll up through the diaphragm.

Symptoms of Hiatal Hernias Heartburn Dysphagia Belching Vomiting Regurgitation

Symptoms of Esophageal Cancer Dysphagia Weight loss Excessive salivation Thirst Hiccups Anemia Chronic bleeding

Factors Contributing to Peptic Ulcers Stress Diet Genetic predisposition Longevity More precise diagnostic evaluation Increasing prevalence of chronic obstructive pulmonary disease

Symptoms of Peptic Ulcers Pain Bleeding Obstruction Perforation

Complications of Peptic Ulcers Constipation or diarrhea caused by antacid therapy Pyloric obstruction resulting in dehydration, peritonitis, hemorrhage, and shock

Factors Causing Stomach Cancer to Be Common Problem in Late Life Chronic constipation Obesity Age-related atrophy of intestinal walls Low-fiber diet

Factors Contributing to Diverticular Disease Chronic constipation Obesity Hiatal hernia Atrophy of the intestinal wall muscles with aging

Medical Management of Diverticular Disease Increase in dietary fiber intake Weight reduction Avoidance of constipation

Factors Contributing to Diverticulitis Overeating Straining during a bowel movement Alcohol Irritating foods

Nursing Interventions for Diverticulitis Acute Phase –Reduce infection. –Provide nutrition. –Relieve discomfort. –Promote rest. Following Acute Phase –Consume a low-residue diet.

Symptoms of Cancer of the Colon Bloody stools Change in bowel function Anorexia Nausea Epigastric pain Jaundice

Screening Measures for Colon Cancer Digital rectal examination Fecal occult blood testing Barium enema Sigmoidoscopy with biopsy

Factors Contributing to Chronic Constipation An inactive lifestyle Low fiber and fluid intake Depression Laxative abuse Certain medications Dulled sensations for bowel elimination Failure to allow sufficient time for complete emptying of the bowel

Measures to Promote Bowel Elimination Scheduling a regular time for it. Incorporating high-fiber foods into the diet. Rocking the trunk from side to side and back and forth while sitting on the toilet.

Causes of Bowel Obstruction Cancer of the colon Diverticulitis Ulcerative colitis Hypokalemia Vascular problems Paralytic ileus

Symptoms of Bowel Obstruction Small Bowel Obstruction –Upper and midabdominal pain in rhythmic recurring waves; vomiting may occur. Obstructions Occuring Past the Ileum –Abdominal distension so severe that the raised diaphragm can inhibit respirations. –Vomiting is more severe.

Symptoms of Bowel Obstruction (cont.) Obstruction of the Colon –Lower abdominal pain, altered bowel habits, distension, and a sensation of the need to defecate. Vomiting usually does not occur until late.

Possible Causes of Incontinence Decreased contractile strength Impaired automaticity of the puborectal and external anal sphincter Reduced reservoir capacity

Symptoms of Pancreatic Cancer Anorexia Weakness Weight loss and wasting Dyspepsia Belching Nausea Vomiting

Symptoms of Pancreatic Cancer (cont.) Diarrhea Constipation Obstructive jaundice Fever may or may not be present. Epigastric pain radiating to the back may be experienced.

Treatment Measures for Biliary Tract Disease Nonsurgical Therapies –Rotary lithotrite treatment –Extracorporeal shock wave lithotripsy Standard Surgical Procedures

Source Eliopoulos, C. (2005). Gerontological Nursing, (6 th ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN ).