1. GASTROINTESTINAL
SYSTEM: INCORPORATING
THE 3 P’S
Jessica Lofgren, BSN, RN
NURS 5473: Facilitating Learning for Healthcare Professionals
Thomas Pienkos, MSN-Ed, APRN-CNP, PMHNP-BC, CCRN-CMC-CSC, CEN, CNS
April 14, 2024
2. Objectives
- Remember: Structure and Function of the Gastrointestinal (GI)
System
- Understanding: Identify Common Gastrointestinal Disorders
- Applying: Physical Assessment of GI System
- Evaluate: Pharmacological Knowledge & Common Medications
- Application: Case Study
Objectives using Bloom’s Taxonomy, Marzano (2001)
3. Introduction to the GI System:
MAJOR FUNCTION
- Ingestion
- Digestion
- Absorption
- Defecation
MAIN COMPONENTS
- Alimentary canal
- Accessory organs
- Peritoneum
7. Pharmacology
Antacids and Acid Blockers: Use in GERD and peptic ulcers.
Antibiotics: Role in treating infections like Helicobacter pylori.
Antidiarrheals and Laxatives: Managing symptoms of IBS,
Crohn's Disease.
Biologic Therapies: Use in autoimmune GI disorders like
Crohn's Disease and Ulcerative Colitis.
8. Case Study
- Name: Dawn Tootin
- Age: 42
- Sex: Female
- Medical History:
- Non-smoker, No prior history of major illnesses
- No known drug allergies
- Presenting Complaint: Patient reports frequent
heartburn, especially after eating, and
occasional regurgitation of food and spicy food.
9. Physical Assessment
- General Appearance: The patient appears well-nourished and not in
acute distress.
- Vital Signs: Within normal limits.
- Abdominal Examination:
- Inspection: No abdominal distension or visible masses.
- Palpation: No tenderness or organomegaly noted.
- Percussion: Tympanic sounds are present, and there are no signs of
fluid accumulation.
- Auscultation: Normal bowel sounds, no bruits over renal or aortic areas.
10. What do you think is going on with
Dawn?
A. Irritable bowel syndrome (IBS)
B. Allergic to spicy food
C.Gastroesophageal reflux disease (GERD)
D. Peptic Ulcer Disease
12. Lifestyle Changes could
we recommend?
Education: What
education could we
provide our patient?
What types of
food should she
avoid?
13. - Medication Prescribed:
- Omeprazole 20 mg daily: A proton pump inhibitor (PPI) that
reduces stomach acid production, thereby minimizing
esophageal irritation.
- Lifestyle Advice:
- Avoid trigger foods (e.g., spicy foods, caffeine, and
chocolate).
- Eat smaller, more frequent meals.
- Avoid lying down immediately after eating and elevate the
head of the bed.
14. References
Ernstmeyer, K., &Christman, E. (2023). Chapter 7Gastrointestinal system. NursingPharmacology -
NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK594994/
Harris, R. (2002). Physical Assessment of Patients: TheByron Physical Assessment Framework.
John Wileyand Sons, Inc.
Marzano, R. J. (2001). Designinganew taxonomyof educational objectives. Corwin Press.
National Instituteof Diabetes and Digestiveand KidneyDiseases. (n.d.). Acid Refluxin Adults.
Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/acid-
reflux-ger-gerd-adults
The gastrointestinal (GI) system, or the digestive system, supports the body's functions through digestion and eliminating waste products via defecation. The human digestive system has three main components: the alimentary canal, accessory organs, and the peritoneum. The alimentary canal includes the oral cavity, pharynx, esophagus, stomach, small intestine, large intestine, rectum, and anal canal. The accessory organs comprise the salivary glands, liver, pancreas, and gallbladder. The peritoneum is a serous membrane that holds the digestive organs in place in the body’s abdominal cavity. Ernstmeyer and Christman (2023)
Mouth: The mouth carries out mechanical and chemical digestion by breaking down food into smaller pieces through mastication and saliva secretion. The oral cavity consists of the buccal mucosa, lips, tongue, hard palate, soft palate, teeth, and salivary glands. Food then moves from the oral cavity through the pharynx and esophagus.
Esophagus: This organ transports food from the mouth to the stomach and is regulated by two sphincters, the upper and lower.
Stomach: Secretes acid and enzymes; churns food to enhance digestion.
Small Intestine: Major site for digestion and absorption of nutrients.
Large Intestine: Absorbs water and forms feces.
Liver and Pancreas: Produce bile and pancreatic juices, respectively, critical for fat digestion and nutrient absorption.
Ernstmeyer and Christman (2023)
Gastroesophageal reflux disease (GERD) is when stomach acid flows back into the esophagus, causing irritation. This backwash is known as acid reflux.
Peptic Ulcer Disease is the development of open sores on the inside lining of your stomach and the upper part of your small intestine. The most common indicator of a peptic ulcer is abdominal pain.
Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by symptoms such as abdominal pain, bloating, and changes in bowel movements.
Crohn's disease is an inflammatory bowel disease that causes abdominal pain, severe diarrhea, fatigue, weight loss, and malnutrition.
Ulcerative Colitis (UC) is a chronic condition that causes inflammation and ulcers in the colon and rectum. Symptoms include abdominal pain, bloody diarrhea, weight loss, fever, and anemia. Symptoms may range from mild to severe. Complications may include abnormal colon dilation, eye, joint, or liver inflammation, and colon cancer.
Ernstmeyer and Christman (2023)
Physical examination involves various methods to evaluate a patient's health. Inspection: Observe the abdomen for bulges, asymmetry, and skin changes (e.g., excessive hair, yellowing of skin, scars, rash). Auscultation: Listen for bowel and vascular sounds (bruit). Percussion: Tap the abdomen to identify air, fluid, or masses. Palpation: Use hands to examine the abdomen for tenderness, masses, and organomegaly (abnormal or enlarged organs).
Harris (2002)
Medical treatment for gastrointestinal disorders involves the use of different classes of medication. These include antacids and proton pump inhibitors, which reduce stomach acid production and help treat conditions like GERD. Antibiotics are used to treat bacterial infections within the GI tract. Antidiarrheal and laxatives are used to manage symptoms of diarrhea and constipation, respectively. Antacids and acid blockers are used in treating GERD and peptic ulcers. Antibiotics play a significant role in treating infections like Helicobacter pylori. Antidiarrheals and laxatives help manage symptoms of IBS and Crohn's Disease. Biologic therapies treat autoimmune GI disorders like Crohn's Disease and Ulcerative Colitis. Each class of medication has specific indications and mechanisms of action, and their use must be tailored to individual patient needs based on a comprehensive assessment.
Ernstmeyer and Christman (2023)
Gastroesophageal reflux disease (GERD) occurs when the stomach acid frequently flows back into the esophagus, which is the tube connecting the mouth and stomach. This acid reflux can irritate the lining of the esophagus leading to several factors that contribute to GERD, including lower esophageal sphincter dysfunction, which happens when the sphincter closure at the lower end of the esophagus becomes ineffective, allowing the stomach contents to flow back up. Hiatal hernia, which is the protrusion of the stomach into the chest through the diaphragm, contributes to LES dysfunction and is commonly seen in patients with persistent reflux. Gastric motility disorders, such as delayed gastric emptying, can also exacerbate symptoms. (National Institute of Diabetes and Digestive and Kidney Diseases, n.d.)
Take a few minutes. Write down your answers to the questions on the screen.
