Tabloski ch20 lecture

Gerontological Nursing
THIRD EDITION
CHAPTER
20
The
Gastrointestinal
System
Copyright © 2014, © 2010, © 2006 by Pearson Education, Inc.
All Rights Reserved

Learning Objectives
1. Describe age-related changes that
affect gastrointestinal function.
2. Recognize the impact of age-related
changes of gastrointestinal function.
Gerontological Nursing, Third Edition
Patricia A. Tabloski

Learning Objectives
3. Identify risk factors to health for the
older person with gastrointestinal
problems.
4. Interpret unique presentations of
gastrointestinal problems in the older
person.

Learning Objectives
5. Define appropriate nursing
interventions directed toward helping
the older adult with gastrointestinal
problems develop self-care abilities.
6. Formulate and implement appropriate
nursing interventions to care for the
older person with gastrointestinal
problems.

Introduction
• The gastrointestinal (GI) tract is
responsible for four major functions
relating to food ingestion:
– Digestion
– Absorption
– Secretion
–Motility

Introduction
• The GI tract begins at the mouth and
ends at the rectum and includes the
accessory organs of digestion, the liver,
gallbladder, and pancreas.

Figure 20-1 Normal configuration of the GI tract.

Normal Changes of Aging
• Biological changes in GI function
include:
– Changes in the mouth
– Decreased esophageal motility
– Diminished gastric motility with
increased stomach-emptying time
– Diminished capacity of the gastric
mucosa to resist damage

include:
– Achlorhydria or insufficient hydrochloric
acid in the stomach
– Decreased production of intrinsic factor
leading to increased risk of developing
pernicious anemia
– Decreased intestinal absorption,
motility, and blood flow

include:
– Decreased pancreas size with duct
hyperplasia and lobular fibrosis
– Increased incidence of cholelithiasis
(gallstones) and decreased production
of bile acid synthesis
– Decreased liver size and blood flow

include:
– Decreased thirst and hunger drive due
to cognitive changes or psychological
conditions
– Increased medication use
– Possible adverse drug reactions

Common GI Disorders
• Aging alone has very little impact on GI
function. However, aging is associated
with an increased prevalence of many
GI disorders, and these should be
evaluated carefully and not be
attributed to normal aging.

Common GI Disorders
• GI disorders include:
– Esophageal disorders
– Gastroesophageal reflux disease
– Gastric disorders; gastritis, ulcers, hiatal
hernias, and stomach tumors
– Gastric volvulus

Lower Gastrointestinal Tract
• The lower GI tract is composed of the
colon and the rectum. The function of
the lower GI tract is affected by
metabolic or endocrine disorders,
lifestyle and environmental factors,
neurologic disorders or injury, and
many medications.

• Aging is associated with diminished
anal sphincter tone and strength.
• The structural weakening of colonic
muscle may contribute to the
development of diverticula, or saclike
mucosal projections through the muscle
wall.

• Older persons with the presence of
diverticula are diagnosed with
diverticulosis.
• Several factors can alter colonic
function and lead to alterations in lower
bowel function.
• These factors may make the older
person more susceptible to fecal
incontinence, constipation, or diarrhea.

Common Lower Gastrointestinal
Disorders
• Diverticular Disease or Diverticulosis
• Irritable Bowel Disease
• Inflammatory Bowel Disease
• Benign and Malignant Tumors
• Antibiotic-associated Colitis and
Diarrhea
• Constipation

Common Lower Gastrointestinal
Disorders
• Diarrhea
• Fecal Incontinence
• Hemorrhoids and Rectal Bleeding
• Liver and Biliary Disorders
• Gallstones
• Pancreatitis

Endoscopic Gastrointestinal
Procedures
• Upper or lower gastrointestinal
endoscopic procedures can be done to
view body cavities with fiber optic
tubing.
• Esophagogastroduodenoscopy
visualizes the upper gastrointestinal
tract.

Endoscopic Gastrointestinal
Procedures
• A sigmoidoscopy permits inspection of
the rectum and distal sigmoid colon,
and most of the descending colon.
• Colonoscopy allows visual examination
of the entire colon. Colonoscopy is
indicated for routine testing or when
anemia is present, positive fecal occult
blood testing is noted, or polyps are
suspected.

Nursing Diagnoses
• Nursing diagnoses for problems
associated with the gastrointestinal
tract include the following:
– Imbalanced Nutrition
 Less Than Body Requirements
– Risk for Infection
– Constipation and Perceived Constipation
– Diarrhea
– Bowel Incontinence

Nursing Diagnoses
– Risk for Constipation
– Ineffective Tissue Perfusion
 Gastrointestinal Tract
– Risk for Aspiration
– Impaired Oral Mucous Membrane
– Social Isolation

Nursing Diagnoses
– Noncompliance
– Ineffective Health Maintenance
– Toileting Self-care Deficit
– Acute or Chronic Pain Disturbance
– Nausea

Nursing Diagnoses
• The nurse should educate older persons
and their families regarding the causes,
prevention, and treatment of
gastrointestinal diseases.

Complementary and Alternative
Therapies
• Milk thistle (a member of the daisy
family) is used for its hepatoprotective
characteristics and to treat cirrhosis,
chronic hepatitis, fatty infiltration
caused by alcohol and other toxins, and
gallbladder disorders.

Complementary and Alternative
Therapies
• Acidophilus capsules contain active
cultures that can be used to treat a
variety of gastrointestinal problems
including irritable bowel syndrome,
diarrhea, flatulence, bad breath, and
adjunct to antibiotic therapy to prevent
antibiotic-associated diarrhea caused
by overgrowth of C. difficile.

• Regardless of treatment, the
gerontological nurse should provide
holistic care including careful attention
to pain and symptom control,
nutritional issues, skin care, emotional
support for the older person and family,
and issues relating to death and dying.

Tabloski ch20 lecture

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