Exam 2 Review

39, 40, 41, 42, 43, 44
Exam 2 9/28

CH 29 textbook

1.

Describe the structures and functions of the organs of the
gastrointestinal tract, liver, gallbladder, biliary tract, and
pancreas.

Mouth - Lips and oral cavity with teeth and tongue
Tongue- assists in mastication by keeping food between teeth during
chewing and moving food to back of throat for swallowing
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Three pairs of salivary glands
o Parotid
o Submxillary
o Sublingual glands
Salivary glands produce saliva which consists of water, protein, mucin,
inorganic salts, and salivary amylase ( breaks down starches to
maltose)

Pharynx- musculomembranous tube – divided into nasopharynx, oropharynx, and
laryngeal pharynx
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Mucous membrane is continuous with nasal cavity, mouth, auditory tubes,
and larynx
Oropharynx secretes mucus which aids in swallowing
o Swallowing reflex
Epiglottis opens during swallowing
Tonsils and adenoids assist in preventing infection

Esophagus – hollow muscular tube – moves food from pharynx to stomach by
peristaltic contractions
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7 to 10 inches long
Two sphincters
o Upper esophageal sphincter
o Lower esophagus sphincter
 Prevents reflux of acidic gastric contents into esophagus

Stomach – store food, mix food with gastric secretions, and empty contents
into the small intestine at a good rate for digestion

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Only absorbs small amount of water, electrolytes, alcohol, and certain
drugs
Pyloric sphincter and LES guard the entrance and exit from the
stomach

Small Intestine- digestion and absorption (uptake to the bloodstream)
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Ileocecal valve separates the small intestine from the large intestine and
prevents reflux from large intestine
Villi – minute fingerlike projection in the mucous membrane – increase
surface area of SI
Microvilli – compose the brush border – increase surface area of SI
o Digestive enzymes live on brush border

Large Intestine – hollow muscular tube
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Cecum and appendix
Color
Rectum
Anus

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Absorbs water and electrolytes

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Forms feces and reservoir for fecal mass

Liver – weighs 3 lbs
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Functions in manufacture, storage, transformation, and excretion of a
number of substances involved in metabolism
o Carbohydrate metabolism
 Glycogenesis (glucose to glycogen)
 Glycogenolysis (glycogen to glucose)
 Gluconeogenesis (formation of glucose from amino acids
and fatty acids)
o Protein Metabolism
 Synthesis of nonessential amino acids, plasma proteins,
clotting factors, urea formation from ammonia
o Fat metabolism
o Detoxification
o Steroid metabolism
o Bile synthesis
 Production and synthesis
o Storage
 Glucose in form of glycogen
 Vitamins

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 Amino acids
o Mononuclear phagocyte system
 Kupffer cells
 Breakdown old RBCs, WBCs, bacteria, and other
particles
 Breakdown of hemoglobin from old RBCs to bilirubin
and biliverdin
Functional units are lobules
o Consists of rows of hepatic cells arranged around a central vein
o Capillaries located between the rows of hepatocytes
o Kupffer cells carry out phagocytic activity
o Interlobular bile ducts form from bile capillaries (canaliculi)
 Hepatic cells secrete bile into canaliculi

Biliary Tract- consists of gallbladder and duct system
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Gallbladder is pear shaped sac located below the liver
o Concentrates and stores bile (holds 45mL)
o Bile moved from here to duodenum via common bile duct

Pancreas- long, slender gland lying behind the stomach and in front of the first and
second lumbar vertebrae
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Contains lobes and lobules
Pancreatic duct extends along the gland and enters the duodenum through
the common bile duct
o Has both exocrine and endocrine functions
 Exocrine cells secrete pancreatic enzymes for digestion
 Endocrine function occurs in the islets of Langerhans, whose
beta cells secrete insulin and amylin; alpha cells secrete
glucagon; delta cells secrete somatostatin; F cells secrete
pancreatic polypeptide

2.

Differentiate the processes of ingestion, digestion, absorption,
and elimination.

Ingestion – taking in food
Digestion – breakdown of food
Absorption – transfer of food products into circulation
Elimination – process of excreting the waste products of digestion

3.
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Explain the processes of biliary metabolism, bile production, and
bile excretion.

Bile is produced by the hepatic cells and secreted into the biliary
canaliculi of the lobules.
It then drains into the interlobular bile ducts, which unite into the two
main left and right hepatic ducts
Hepatic ducts merge with the cystic duct from the gallbladder to form
the common bile duct
Most bile is stored and concentrated in the gallbladder
It is then released into the cystic duct and moves down the common
bile duct to enter the duodenum at the ampulla of Vater

Bile consists of water, cholesterol, Bile salts, electrolytes, and phospholipids,
and bilirubin

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Bilirubin – pigment derived from breakdown of hemoglobin – it is
excreted in bile

Liver makes bile (bile salts, bile pigments, and cholesterol). Liver excretes 1L
bile a day

4.

Relate the age-related changes of the gastrointestinal system to
the differences in assessment findings.

EXPECTED AGING CHANGES
DIFFERENCES IN ASSESSMENT FINDINGS
Mouth
Gingival retraction
Loss of teeth, presence of dentures, difficulty chewing
Decreased taste buds, decreased sense of smell
Diminished sense of taste (especially salty and sweet)
Decreased volume of saliva
Dry oral mucosa
Atrophy of gingival tissue

Poor-fitting dentures
Esophagus
Lower esophageal sphincter pressure decreased, motility decreased
Epigastric distress, dysphagia, potential for hiatal hernia and aspiration
Abdominal Wall
Thinner and less taut
More visible peristalsis, easier palpation of organs
Decreased number and sensitivity of sensory receptors
Less sensitivity to surface pain
Stomach
Atrophy of gastric mucosa, decreased blood flow
Food intolerances, signs of anemia as result of cobalamin
malabsorption, decreased gastric emptying
Small Intestines
Slightly decreased secretion of most digestive enzymes and motility
Complaints of indigestion, slowed intestinal transit, delayed absorption
of fat-soluble vitamins
Liver
Decreased size and lowered in position
Easier palpation due to lower border extending past costal margin
Decreased protein synthesis, ability to regenerate decreased
Decreased drug and hormone metabolism
Large Intestine, Anus, Rectum
Decreased anal sphincter tone and nerve supply to rectal area
Fecal incontinence
Decreased muscular tone, decreased motility

Flatulence, abdominal distention, relaxed perineal musculature
Increased transit time, sensation to defecation decreased
Constipation, fecal impaction
Pancreas
Pancreatic ducts distended, lipase production decreased, pancreatic
reserve impaired
Impaired fat absorption, decreased glucose tolerance

5.

Select significant subjective and objective assessment data
related to the gastrointestinal system that should be obtained
from a patient.

Subjective:
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Common complaints
Medications
Surgery or other treatments
Health perception – health management plan
Nutritional-metabolic pattern
Elimination
Activity-Exercise Pattern
Sleep-rest Pattern
Cognitive-Perceptual Pattern

Objective
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Physical inspection

7.
Identify the appropriate techniques used in the physical
assessment of the gastrointestinal system.
8.
Differentiate normal from abnormal findings of a physical
assessment of the gastrointestinal system.
Table 39-11

9.
Describe the purpose, significance of results, and nursing
responsibilities related to diagnostic studies of the gastrointestinal
system.

Table 39-12

CH 40

1.
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Relate the essential components of a nutritionally good diet to
their importance to health.
Daily caloric requirements
o Mifflin-St. Jeor equation
 Men: Energy expenditure = 5+10(wt in kg) + 6.25 (ht in
cm) – 5 (age)
 Women: Energy Expenditure = -161+ 10(wt in kg) +
6.25(ht in cm) – 5(age)
Carbohydrates 45 – 65% of daily calories
o 14 grams of dietary fiber per 1000 calories eaten per day
Fats 20% - 35% of total calories
o Less than 10% from saturated fatty acids
Protein – 10% to 35% of daily caloric needs
o 0.8 to 1g/ kg of body weight
Vitamins
Mineral Salts

2.
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Describe the common etiologic factors, clinical manifestations,
and management of malnutrition.

Protein-calorie malnutrition (PCM) – most common form of
undernutrition
o Primary – nutritional needs are not met
o Secondary – result of an alteration or defect in ingestion,
digestion, absorption, or metabolism
 May result from GI obstruction, surgical procedure, cancer,
malabsorption syndromes, drugs, or infectious diseases
 “disease-related malnutrition”
o Marasmus and Kwashiorkor are most severe forms of PCM
 Marasmus – generalized loss of body fat and muscle
 Emaciated, but may have normal serum protein
 Kwashiorkor – deficiency of protein
 Edema and low serum protein levels
Etiology factors that increase the risk
o Dementia
o Depression
o Chronic alcoholism
o Excessive dieting
o Swallowing disorders
o Decreased mobility that limits access to food or its preparation
o Nutrient losses from malabsorption, dialysis, fistulas, or wounds

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o Drugs with antinutrient or catabolic properties such as
corticosteroids and oral antibiotics
o Extreme need for nutrients become of hypermetabolism or
stresses
o No oral intake
Clinical manifestations
o Most obvious clinical sign are
 Dry and scaly skin, brittle nails, rashes, hair loss
 Mouth – crusting and ulceration, changes in tongue
 Muscles – decreased mass and weakness
 CNS – mental changes such as confusion, irritability
o Lab values
 Serum albumin, prealbumin, transferrin levels when low
are marker of PCM
 C-reactive protein – positive acute phase protein typically
elevated during inflammation
 Determines which low levels of visceral proteins are
attributed to an inflammatory process or if they are
indeed an indicator of undernutrition
 Serum potassium level is often elevated
 Rbc count and hemoglobin indicate the presence and
degree of anemia
 Total lymphocyte count decreases during malnutrition
states
 Liver enzyme levels may be elevated during malnutrition
Anthropometric measurements

Anthropometric Measurements
• Height and weight
• Body mass index (BMI)
• Rate of weight change
Physical Examination
• Physical appearance
• Muscle mass and strength
• Dental and oral health
Health History Health History

• Personal and family history
• Acute or chronic illnesses
• Current medications, herbs, supplements
Diet History
• Chewing and swallowing ability
• Changes in appetite, taste, or intake
• Food and nutrient intake
• Availability of food
Laboratory Data
• Glucose
• Electrolytes
• Albumin/protein
• Lipid profile
• Blood urea nitrogen (BUN)

BMI = weight (kg) / Height (m2)

3.
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Explain the indications, complications, and nursing management
related to the use of enteral nutrition.
Enteral nutrition = tube feeding
Indications – anorexia, orofacial fractures, head and neck cancer,
neurologic or psychiatric conditions prevent oral intake, extensive
burns, critical illness, and those who are receiving chemotherapy and
radiation therapy
Common delivery by pump, intermittent infusion by gravity,
intermittent bolus by syringe, and cyclic feedings by infusion pump
Nasogastric (NG) tube most commonly used to short-term feeding
problems
o Patient does not have to be conscious
o Disadvantages

Small diameter, tubes more easily clogged when feedings
are thick and are more difficult to use for checking residual
volumes
 Prone to obstruction
 Can be dislodged by vomiting or coughing
 Can be knotted or kinked in the GI tract
Gastrostomy and jejunostomy
o For use over extended period of time


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4.
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Explain the indications, complications, and nursing management
related to the use of parenteral nutrition.
Indications
o Chronic severe diarrhea and vomiting
o Complicated surgery or trauma
o Gastrointestinal obstructin
o Intractable diarrhea
o Severe anorexia nervosa
o Severe malabsorption
o Short bowel syndrome
o Gastrointestinal tract anomalies and fistulae
Complications
o Infectious
 Fungus
 Gram-+ bacteria
 Gram – bacteria
o Metabolic
 Hyperglycemia, hypoglycemia
 Altered renal function
 Essential fatty acid deficiency
 Electrolyte and vitamin excesses and deficiencies
 Trace mineral deficiencies
 Hyperlipidemia
o Mechanical
 Insertion
 Air embolus
 Pneumothorax, hemothorax, chylothorax,
hydrothorax, hemorrhage
 Dislodgement
 Thrombosis of vein
 Phlebitis

5.
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Compare the etiologic factors, clinical manifestations, and
nursing management of eating disorders.
Anorexia nervosa
o Iron-deficienty anemia and an elevated blood urea nitrogen level
Bullemia Nervosa
o Frequent binge eating and self-induced vomiting associated with
loss of control related to eating and a persistent concern with
body image

Chapter 41 Obesity
1.

Discuss the epidemiology and etiology of obesity.

Obesity – characterized by adipocyte hypertrophy and hyperplasia
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Adipocytes can increase their volume several thousand-fold to
accommodate large increases in lipid storage
In addition, preadipocytes are triggered to become adipocytes
Primarily occurs in the visceral (intraabdominal) and subcutaneous
tissues of the body

Epidemiology of Obesity
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Over 1/3 of the population is obese
o Most common ages are between 40 and 59 for both men and
women
o 66% of Americans over age 20 are either overweight or obese
o Obesity
 African Americans have 50% higher prevalence of obesity
 Hispanics have 21%

2.
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Compare the classification systems for determining a person's
body size.

Primary obesity – excess calorie intake for the body’s metabolic
demands
Secondary obesity – can result from various congential anomalies,
chromosomal anomalies, metabolic problems, or CNS lesions and
disorders

BMI (body mass index) – assessment of to what degree a patient is classified
as underweight, healthy(normal) weight, overweight, or obese
BMI (kg/m2) = Weight(pounds) x 703 / Height (inches)2
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Underweight – 18.5kg/m2
Normal weight – 18.5kg/m2 to 24.9kg/m2
Overweight – 25kg/m2 to 29.9kg/m2
Obese – Greater than 30kg/m2
Morbidly obese – greater than 40kg/m2

Waist circumference – another way to asses and classify weight
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People with visceral far are especially at risk for cardiovascular disease
and metabolic syndrome
Waist to hip ratio (WHR)
o Less than 0.8 is optimal
 Greater than 0.8 indicates risk

3.

Explain the health risks associated with obesity.

- Mortality rates are increased for obese people by 50% to 100% above those
persons with normal BMI
- Mortality rates are increased by 20 to 40% in people who are overweight
compared to those who have a normal BMI
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Cardiovascular problems
o Significant risk factor for predicting cardiovascular disease
 Android obesity is best predictor
 Linked with increased low-density lipoproteins (LDLs),
high triglycerides, and decreased high-density
lipoproteins (HDLs)
o Associated with hypertension
 Occurs because of increased circulating blood volume,
abnormal vasoconstriction, decreased vascular relaxation,
and increased cardiac output
Respiratory problems
o Sleep apnea
o Obesity hypoventilation syndrome
o Reduced chest wall compliance
o Increased work of breathing
o Decreased total lung capacity and functional residual capacity
Diabetes Mellitus

o Hyperinsulinemia and insulin resistance are common features in
obesity
o Major risk factor for type 2 diabetes
- Musculoskeletal problems
o Increased incidence of osteoarthiritis due to stress on weightbearing joints
o Hyperuricemia and gout
- Cancer
o Causes 100,000 cases of cancer
o Breast, endometrium,(may be estrogen levels) kidney,
colon/rectum (hyperinsulinemia), pancreas, esophagus (GIRD),
and gallbladder cancers are linked to obesity
- psychosocial
4.
Discuss nutritional therapy and exercise plans for the obese
patient.

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Low calorie (800 to 1200 cal) diet
Very low calorie (less than 800 cal)
Exercise
Behavior modification
o Obesity is a learned disorder caused by overeating
o Often the critical difference between an obese person and a
person of normal weight is the cures that regulate eating
behavior
Support group
Drug therapy
o 30kg/m2 and above

5.
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Describe the different bariatric surgical procedures used to treat
obesity.

Bariatric surgery – currently the only treatment that has been found to
have a successful and lasting impact for sustained weight loss for
severely obese individuals
o Reserved for people with BMI over 40 or 35 with one or more
severe obesity-related medical complications
o Restrictive surgeries
 Vertical banded gastroplasty (VBG) – limits stomach
capacity
6.
Describe the nursing management related to conservative and
surgical therapies for obesity.

7.
Describe the etiology, clinical manifestations, and nursing and
collaborative management of metabolic syndrome.