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A.To propel ingested materials (food, Fluid) through the

GI tract and enhance the mixing of enzyme and food
particles involved in the digestive process.

B. Secretion of digestive enzymes to break down food

particles for digestion and assimilation.

C. To absorb water, electrolytes, and products of

digestion.
a   
 

a   

Ingestion, Digestion, Absorption and Elimination Process

A.Ingestion ± intake of food

1. Swallowing (deglutition) completes the process of

ingestion.
2. Intake of food is influenced by appetite center located in
hypothalamus.
3. Appetite stimulated by an empty stomach, decrease in
body temperature, hypoglycemia, habit and the sight,
smell and taste of food.
4. Appetite inhibited by stomach distention illness with fever,
hyperglycemia, nausea and some drugs (e.g.
Amphetamines).
B. Digestion ± physical and chemical breakdown of food.

1. Involves chemical, mechanical, and hormonal activity.

2. Ptyalin, an enzyme, acts on food in the mouth and begins
starch digestion.
3. Food moves through the esophagus by peristalsis to the
stomach.
4. Digestion of proteins occurs in the stomach.
5. Stomach acts as a reservoir for food:
6. Length of time food remains in stomach depends on type
of food, gastric motility, and psychological factors; average
time 3 to 4 hrs.
Š. Carbohydrates leave stomach the fastest; proteins and fats
leave the slowest:
8. pH is acidic in stomach, which promotes the enzyme in
gastric juice; pepsin, to break down proteins into proteases
and peptones.
9. Lipase acts to split fats.
10.Chyme (food mixed with gastric secretion) moves through
the pylorus to the small intestine.
11.Hormones are released into the bloodstream. Secretion
stimulates pancreas to secrete an alkaline fluid.
12.Bile is released from gallbladder and fats are emulsified.
C. Absorption ± transfer of food products into circulation.
1. Occurs in small intestine which has numerous villi to
increase absorptive surface area.
2. Simple sugars (from carbohydrates), fatty acids (from
fats), and amino acids (from proteins), water,
electrolytes, and vitamins are absorbed.

D. Elimination ± excretion of waste products.

1. Large intestine absorbs water and electrolytes, and
forms feces.
2. Serves as a reservoir for fecal mass until defecation
occurs.
à






A. Evaluate client's history.

1. Changes in bowel habits.
2. Changes in dietary habits.
3. Weight loss gain.
4. Pain.
5. Nausea and vomiting.
6. a. Associated with pain.
Š. b. Precipitating factors.
8. Presence or problems with flatulence.
a   
B. Assess vital signs in client's overall status.

C. Assess for presence and characteristics of pain.

D. Assess client's mouth.

1. Presence of adequate saliva.

2. Overall condition of teeth.
3. Overall condition of tongue
4. Presence of the gag reflex.
E. Evaluate the abdomen (client should be lying flat).

1. Divide the abdomen into four quadrants and describe

findings according to the quadrants.
2. Evaluate the general contour of the abdomen.
3. Evaluate the presence of surgical or trauma scars or
ostomies.
4. Assess for presence of and characteristics of bowel
sounds.
 Nursing Alert: Assessment: To determine
characteristics of bowel sounds: note characteristics of
bowel sounds.

a. Normally soft, gurgles should be heard every 5-15

sounds/minute
Elderly Care Focus

Changes in GI System Related to Aging

a. Decreased hydrochloric acid and decreased absorption

of vitamins; encourage frequent small feedings that are
high in vitamins.
b. Decreased peristalsis and decreased sensation to
defecate; encourage diet high in fiber and minimum of
1,500 cc of fluid daily, encourage physical activity.
c. Decreased lipase from pancreas to aid in fat digestion;
encourage smaller meals since diarrhea maybe caused
by increased fat intake.
Decreased liver activity with decreased production of
enzymes for drug metabolism, tendency toward
accumulation of medications instruct clients not to double
up on their medications, especially cardiac medications.

b. Loud, high pitch sounds may be heard when a client is

hungry or has gastroenteritis.

c. Borborygmi ± loud, gurgling sounds; may precede

diarrhea.

d. Hypoactive bowel sounds are at rate of one every

minute or longer.
5. Palpate the abdomen; begin with non-tender areas first.

a. Is it soft to palpation?
b. Presence of distention.
c. Presence of masses.

F. Asses rectal area.

G. Evaluate elimination patterns and effects of Aging on

GI tract.

H. Evaluate dietary pattern and fluid intake.

I. Assess stool specimen

1. Color
2. Consistency
3. Odor
4. Presence of blood or mucous
 

 
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1. Age Š. Position during defecation

2. Diet 8. Pain
3. Fluid intake 9. Pregnancy
4. Physical activity 10. Surgery and anesthesia
5. Psychological Factors 11. Medications
6. Personal Habits
  




 White or clay Absence of bile
Infant: yellow Black or tarry (melena) Iron ingestion or GI bleeding
Adult: brown Red upper lower, hemorrhoids
 Pale with fat Malabsorption of fat
Pungent; affected by food type Noxious change Blood in feces or infection
 Liquid Diarrhea, reduced absorption
Soft, formed Hard Constipation
  Infant more than 6 times daily Hypomotility or hypermotility
Varies: Infant 4 to 6 times or less than once every 1-2 Obstruction, rapid peristalsis
daily (breast fed) 0r 1 to 3 days; adult more than 3 times Internal bleeding, infection,
times daily (bottle fed) than once a week. swallowed, objects, irritation,
Adult average: 2- 3 times a Narrow, pencil inflammation
week Blood, pus, foreign bodies,
  mucus, worms
150 grams per day (adult)
 
Resembles diameter of rectum
 
Undigested food, dead
bacteria, fat, bile pigment,
cells lining intestinal mucosa,
water
!"#


A.Blood chemistry and electrolyte analysis

B. Hematologic studies: Hgb and Hct, PT, WBC

C. Serologic studies: carcinoembryonic antigen (CEA),

hepatitis associated antigens.

D. Urine studies: Amylase, bilirubin

E. Fecal studies: for blood, fat, infectious organisms

F. Upper GI Series (Barium Swallow) ± Fluroscopic
examination of upper GI tract to determine
structural problems and gastric emptying: client must
swallow barium sulfate or other contrast medium;
sequential films taken as it moves through the system.

G. Lower G I Series (Barium Enema) ± Barium is

instilled into the colon by enema; client retains
the contrast medium while x-rays are taken to identify
structural abnormalities of the large intestines or colon.
H. Endoscopy ± Direct visualization of the esophagus,
stomach and duodenum by insertion of a
lighted fiberscope; used to observe structures,
ulcerations, inflammation, tumors and may include a
biopsy.
I. Colonoscopy ± endoscopic visualization of the large
intestines; may include biopsy and
removal of foreign substances.

J. Sigmoidoscopy ± endoscopic visualization of the sigmoid

colon.
used to identify inflammation, lesions or remove foreign
bodes.
 3. Gastric Analysis - insertion of nasogastric tube to
examine fasting gastric contents for acidity
and volume.

L. Oral Cholecystogram ± injection of a radio paque

dye and x-ray examination to visualize the
gall bladder ability.
used to determine the gall bladder's ability to
concentrate and store dye and t assess patency of the
biliary duct system.

M. Liver Biopsy ± invasive procedure where a

specially designed needle is inserted into a liver
to remove a small piece of tissue for study
 `!

1. Understanding normal elimination.

2. Attaining regular defecation habits.
3. Understanding and maintaining proper fluid and food intake.
4. Achieving regular exercise program.
5. Achieving comfort.
6. Maintaining skin integrity.
Š. Maintaining self concept.
 $




 It is the process whereby the body uses food to

achieve and maintain health. It is concerned with the process
by which food is utilized to maintain biological structure
through growth and repair of tissues.
a. All body cells require adequate nutrition.
b. The nutrients essential to health are CHO, CHON,
Fats, vitamins and minerals.
c. Food requirements vary among individuals.
d. Psychosocial and cultural factors influence the
selection of food and patterns of behavior associated
with eating.
e. Hunger, thirst and satiety are nature¶s first defenses
against malnutrition.
%
& 
` `  

!± body weight of at least 20% in excess of normal

body weight for his height, age, sex and build.

 

|= weight in pounds X Š05 BMI< 20 = underweight

Height in inches BMI 20 -24 = normal
÷ Ht in inches BMI 25-29 = overweight
BMI > 30 = obese

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'(
#  ± in which the quantity and content are
designed to meet the needs of most clients in some
agencies, the regular diet is referred to as the normal,
house or standard diet.
2.  
   ± is on which the amount
of food, the kind of food or the frequency of eating in
prescribed.

- Special diets are used to treat a disease process. For

example, low salt diet for high blood pressure; to prepare
for a special examination or surgery and promote health.
For example, a low-calorie diet for an overweight client
and diabetic client.
3. # ± designed for post-operative and other
clients who are not ready for the regular diet.

4.  ± is easily chewed and digested. It is often

ordered for clients who have difficulty chewing and
swallowing.
-it is low residue (low fiber) diet containing very few
uncooked foods.

5. `  ± is a modification of soft diet, liquid may

be added to the food which is then blended to a semisolid
consistency.
6.   ± contains only liquid or foods that turn
to liquid at body temperature such as ice cream. Full
disturbance or are otherwise unable to tolerate solid or
semisolid foods.

Š.   ± is often limited to water, tea, coffee,

clear broths, ginger ale or other carbonated beverages,
apple juice and plain gelatin. It does not permit milk. This
diet provides the client with fluid and carbohydrate (in the
form of sugar) but does not supply adequate protein, fat,
vitamins, mineral or calories.