1. Chapter 20 Digestion and Bowel Elimination

2. 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

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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.

11. 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

12. 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

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

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

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

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

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

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

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

20. 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.

21. 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.

22. 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

23. 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

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

25. 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

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

27. 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

28. 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.

29. 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

30. 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

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

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

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

34. 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.

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

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