Functions of the Gastrointestinal System

• To prepare food for absorption into the body and utilization by the cells
• To excrete any food material of no use to the body

 

Gastrointestinal System composed of:

• Gastrointestinal tract
• Accessory organs and structures

 

Gastrointestinal Tract

• Approx 4.5 meters in length
• Almost doubled when no muscle tone
• A fibromuscular tube

 

Gastrointestinal tract is made up of:

• Mouth
• Pharynx
• Esophagus
• Stomach
• Small intestine
• Large Intestine

 

Accessory organs & structures are:

• Salivary glands
• Teeth
• Tongue
• Liver
• Gall bladder
• Pancreas

 

Digestive Processes – 5 stages:

1.    Ingestion

2.    Movement of food

§  Peristalsis

3.    Digestion

§  Mechanical

§  Chemical

4.    Absorption

5.    Defecation

 

Mucosal layers (3)

• protection
• secretion
• absorption

 

Mouth

• Provides an entrance to the gastrointestinal system
• Initiates digestion by the mechanical breakdown of food material
• Normal swallowing mechanisms move the food bolus to the esophagus
• Mediated by Cranial nerves IX, X, and XII

 

Functions of the Mouth

• Chewing, grinding and mixing of food
• Formation of a bolus
• Initiation of digestive processes
• Swallowing
• Taste
• These functions assisted by teeth, tongue, salivary glands and sensory nerve endings

 

Pharynx

• Food passes through the oropharynx and laryngopharynx to reach the esophagus
• Once a bolus of food reaches the pharynx swallowing is no longer voluntary

 

Swallowing

• swallowing initiates peristalsis

 

Peristalsis

• An involuntary activity of the longitudinal and circular layers of smooth muscle within the wall of the tract
• Rhythmic, pulsatile contractions of these muscle layers move the contents of the tract forward

 

Esophagus

• Hollow tube connecting mouth to stomach
• Runs through mediastinum
• Attaches to the stomach just below the diaphragm
• Mucus membrane lining secreting protective mucoid substance

 

Functions of the esophagus

• Transport of food
• Movement of food by peristalsis
• Mechanical dispersion of food as the first part of digestion

 

Cardiac Sphincter

• A one-way valve preventing reflux of stomach contents into the esophagus
• Relaxes as peristaltic wave approaches so that food can enter the stomach
• Also known as the lower esophageal sphincter

 

Stomach

• A dilation of the intestinal tract between the esophagus and the beginning of small intestine
• Separated form the small intestine by the pyloric sphincter
• Has three regions:
  1. fundus
  2. body
  3. pylorus

 

Stomach

• Food bolus enters the stomach moving slowly towards the pylorus (2 – 6 hours)
• Fluid mass in stomach called chyme
• Chyme pumped through pyloric sphincter into the small intestine
• Rate of movement of stomach contents depends on:
  1. food type and consistency
  2. rate of pancreatic and biliary secretions
• Functions of the Stomach
  1. Temporary storage
  2. Mixing
  3. Exocrine secretions
     • hydrochloric acid
     • intrinsic factor
     • pepsinogen
     • mucus
  4. Outflow regulation of processed food particles to the small intestine
  5. Extraction of iron from food
  6. Limited absorption

 

Control of Gastric Activity

• Gastric secretion is regulated by nervous and hormonal activity
• Gastric emptying is stimulated in response to stretch, stomach gastrin, and certain food types
• Gastric emptying is inhibited by reflex and hormonal activity

 

Small Intestine

• 2.5cms wide and 6m long
• Fills most of the abdomen
• Begins at the pyloric sphincter and ends with its connection to the large intestine at the ileocecal valve
• 3 parts:
  1. Duodenum
     • First 25cms of small intestine
     • Receives chyme from the stomach through the pyloric sphincter
     • Fluids from the pancreas and gall bladder via the common bile duct
     • Manufactures intestinal juice
     • Susceptible to inflammatory processes  
• Function:
  • Neutralizes the acidic chyme from the stomach
  • Mixes chyme with pancreatic, biliary and intestinal secretions

1. Jejunum
   • Jejunum – the largest section of small intestine
   • 8 feet
   • Absorption of Magnesium, Calcium, Iron
2. Ileum
   • last 40cms of small intestine
   • Chyme moves slowly towards the ileocecal valve (3 – 10 hours)

 

• Functions of Small Intestine
  1. Forward propulsion of contents
  2. Major site of digestion
  3. 90% absorption
  4. Protection against infection
  5. Hormone secretion
  6. Intestinal juice secretion

 

Large intestine

• 2.5cms wide 1.5m long
• Stretches from ileocaecal valve to rectum
• Often described in 7 parts
  • cecum
  • ascending colon
  • transverse colon
  • descending colon
  • sigmoid colon
  • rectum
  • anal canal
• Exit tract controlled by anal sphincters
• Functions of the Large Intestine
  • Reabsorption water and electrolytes
  • Microbial activity
  • Mass movement
  • Defecation – reflex action, abdo/diaphragmatic contraction
  • Feces
    • Water
    • Inorganic salts
    • Eplithelial cells
    • Bacteria – E- Coli is the main bacteria present
    • Undigested food

 

Normal enteroclysis- nasojejunal tube inserted to DJ flexure. Contrast outlines the duodenum and the first bit of jejunum. Note the irregular gas bubble in the stomach.

 

 

 

 

 

 

Upper GI Bleed VS Lower GI Bleed

 

ü 

 

 

Melena is described as black tarry in color from an upper GI source, “tarry” feces that are associated with gastrointestinal hemorrhage. The black color is caused by oxidation of the iron in hemoglobin during its passage through the ileum and colon.

ü  Hematochezia – passing a large loose, bright red or maroon colored stool, considered frank bleeding usually from the rectum, considered a lower GI Bleed.

ü  Coffee ground stool is classic of an upper GI bleed as it is old blood that had been decomposed by the stomach acid.

ü  Ischemic bowel disease-  - a blood clot  or other blockage has cut off blood flow to the colon as a result of reduced blood flow Ischemia seen in the elderly, a twisting of the intestine that is not relived, those with hx of atrial fib throw clots.

ü  Mallory –Weiss tear- Repeated or profuse vomiting may cause erosions to the esophagus or small tears in the esophageal mucosa

ü  Diverticula -are found throughout the colon, and sustained dark red lower GI bleeding from the large intestine is characteristic of  a bleeding diverticula

ü  Exanguination ( bleeding out) the fatal process of total hypovolemia ( Blood loss) commonly known as bleeding to death can be from the following caused:

1.      Mallory-Weiss tear

2.      Esophageal varices ( may be torn- ie: Mallory Weiss seen in protracted vomiting, and  by an alcoholic vomiting with end-stage liver disease,

3.      or distended varices due to backed up hepatic/portal circulation with loss of clotting factors in end stage Liver disease – cirrhosis

4.      Slitting the throat in suicide (cutting any of the arteries carotid, radial, brachia, ulnar, and femoral.

Treatment of an Upper GI Bleed

1.       Fluid resuscitation by restoring blood volume with Normal Saline.

2.      Maintain open airway – us of oxygen, and mechanical ventilation if needed.

3.      Coffee ground, melena indicative  of upper GI. Bleeding

4.      If unable to stabilize, usually if flushing NGT does not clear, patient will go stat to GI lab for endoscopy.

 

 

Treatment of Lower GI Bleed

1.       Establish underlying cause, and location of bleed,

2.      Hematochezia

3.      If unstable based on labs and patient VS – IV Fluids and will go to GI Lab for colonoscopy STAT

 

  

 

 

 

 

 

 

 

 

 

Recent nurse graduates frequently struggle with the freedom from the ball and chains of nursing school routine.  Many are not sure really what to do with the free time now afforded them.  With this comes the quandary, what am I supposed to be doing now?  Sure they were told that it was important to prepare for NCLEX examination required for licensure, but how is the big question. 

The graduates will express the vivid memory of past nursing instructor remarks, about the final test, the big daddy of all, the NCLEX.  They no longer have the comfort of the talking head that kept them goal focused.  Hooray, Hooray class is over, this  reality fades after a few weeks without the rigid routine.  The overwhelming task of preparing for NCLEX is visualized as the clear new reality.   Where do I start, and how can I do this? I am so burned out, I’m tired of studying  Some relate the difficulty of returning to textbooks that consumed what little time was free after clinical, lecture and part time jobs. When am I ready?, is a consistent question noted in Face Book comments by  graduate students.  Most graduates motivate each other as they set dates to test.  

Some students have review products rolled into their school loan package such as ATI or Meds Publishing. These products are excellent if used. Many students will say the only thing they did was review the meds pub review book, yet some will say they ditched the review book and relied on the NCLEX type questions on the Meds pub website.  Others will purchase an ATI Virtual tutor to guide them post graduation. The ATI Virtual tutor’s  price is very close its competitors  products which offer  three day NCLEX review courses, as well as web-based take as many as you need NCLEX style questions.  

Many students will opt for a quick trip to refresh themselves before assuming the task preparing for state board exams.  Often to return from the trip rested, yet restless and not able to settle into the big challenge of revisiting all the textbooks that exiled them from previous social networks.   The majority that are successful will admit, one good review reference if really used works. No one needs an arsenal of NCLEX review books, just consistent review of one source will provide assistance to those that are willing to surrender to the process of review.

Taking predictor exams prior to graduation is helpful in guiding graduates in  selected areas where review is indicated. It may also prevent a graduate from leaping to the board too quickly.  The predictors are actually quite eye openers for some, and if the student uses the predictor results as a road map, it will direct the graduate nurse down the path to a successful board result.  Regardless of which method the graduate chooses the bottom line is, success comes to those that step up, review and test within a few months of graduation. 

As we say good-by, it is necessary to share a few parting thoughts from one seasoned nurse to the graduate nurse. Never stop asking questions. Always ask if unsure. There is no dumb question. Patient safety is your top priority. The first year will certainly fly as swiftly as nursing school. Inexperience offers the opportunity for growth. Internal fear may prevent you from trying new skills. Do not succumb to the fear. Step up to the new challenges presented to you. Challenge yourself. Upon the completion of each shift, review what went well and what didn’t. Use the nursing process on yourself and solve whatever the issue was that made you feel unsuccessful or inadequate.

Observe other nurses as they perform procedures, especially those procedures that you may feel uncomfortable doing alone. It is expected that as a new graduate, there will be requests from you for stand by assist of a colleague. The uneasiness and discomfort inside the new nurse disappears with the passage of time and after leaving many shifts feeling frustrated. Experience is always the solution. Your learning curve has just begun. As a nurse to remain competent means that knowledge is a life time commitment.

It is important to use the suggestions of the experienced nurse to assist you in your growth. Never take any comments by frustrated nurses, personally. Perhaps this nurse just held the hand of a dying patient and maybe because she took that time with the dying patient, it left her unable to complete the necessary charting that will keep her overtime today . Perhaps she is filled with sadness and has not processed the loss of the patient. Always offer to help. Helping others with their assignments gives support and builds relationships. Work hard and do not complain about assignments given to you.

It is unfortunate that there is some truth to the saying that nurses eat their young. Often preceptors are training new nurses yet they still have their own full assignment. Do not try to cover up mistakes or feel embarrassed when you are not sure, always admit what you do not know. If the nurse is being critical, ask yourself, is this constructive criticism? If so accept the recommendations and work on becoming a better nurse. If the comment is not constructive gently remind the nurse or ask her if she can remember what it was like when she was a new nurse. Often times if you smile and remain calm it will be difficult for that nurse to be mean to you.

You are the future of Nursing. You can make a difference. You are entering the nursing world in a time of great financial insecurity. The next few years we will see our patient’s in times of trial and great hardship. Your patient’s will come to you much sicker due to the loss of income from lost jobs and loss of medical insurance. It will be vital to listen to what your patient’s tell you. You will never ever regret taking time to listen.

Nurses have the highest ranking with regard to integrity and honesty. Nurses are given the opportunity to become intimate when our patients pour out their heart, soul, sharing their darkest secrets and fears. Nurses are respected because of the trust that is afforded our profession. Nurses are privileged to witness the resilience of those fighting for life, as well as the gift of sharing one’s final moments.  What a privilege to provide comfort at the end of life, or share the joy of new life witnessing the delivery of a newborn. Being a nurse is one of the few careers where you are able to make a difference daily in someone’s life.

As I say good-by as that seasoned nurse, I want to leave you with heart felt warmth and gratitude ,of what each and every graduate contributed to the success of your class. Your efforts and contributions to LVNSTUDY.com will be a legacy that will be shared with nurse’s world -wide in an effort to keep nurses competent. Each and everyone inspired the faculty daily and we look forward to hearing back via this website as your share your new experiences as nurses.

What kind of leader are you?

Autocratic Leader
Democratic Leader
Laissez-Faire Leader
Multicratic or Participative Leader

As an LVN you may be in many situations where you will need to be a leader. Post in the comments below what you have learned about your leadership style.

Schizophrenia
and Psychosis

By Michael Bengston, M.D.
30 Mar 2001

Throughout recorded history, the disease we now know as schizophrenia has been a source of bewilderment. Those suffering from the illness once were thought to be possessed by demons and were feared, tormented, exiled or locked up forever. In spite of advances in the understanding of its causes, course and treatment, schizophrenia continues to confound both health professionals and the public. It is easier for the average person to cope with the idea of cancer than it is to understand the odd behavior, hallucinations or strange ideas of the person with schizophrenia.

As with many mental disorders, the causes are poorly understood. Friends and family commonly are shocked, afraid or angry when they learn of the diagnosis. Expectations become more realistic as schizophrenia is better understood as a brain disease that requires ongoing treatment.

Schizophrenia is characterized by a broad range of unusual behaviors that cause profound disruption in the lives of the patients suffering from the condition and in the lives of the people around them. Schizophrenia strikes without regard to gender, race, social class or culture.

One of the most important kinds of impairment caused by schizophrenia involves the person’s thought processes. The individual can lose much of the ability to rationally evaluate his surroundings and interactions with others. There can be hallucinations and delusions, which reflect distortions in the perception and interpretation of reality. The resulting behaviors may seem bizarre to the casual observer, even though they may be consistent with the schizophrenic’s abnormal perceptions and beliefs.

Nearly one-third of those diagnosed with schizophrenia will attempt suicide. About 10 percent of those with the diagnosis will commit suicide within 20 years of the beginning of the disorder. Patients with schizophrenia are not likely to share their suicidal intentions with others, making life-saving interventions more difficult. The risk of depression needs special mention due to the high rate of suicide in these patients. The most significant risk of suicide in schizophrenia is among males under 30 who have some symptoms of depression and a relatively recent hospital discharge. Other risks include imagined voices directing the patient toward self-harm (auditory command hallucinations) and intense false beliefs (delusions).

The relationship of schizophrenia to substance abuse is significant. Due to impairments in insight and judgment, people with schizophrenia may be less able to judge and control the temptations and resulting difficulties associated with drug or alcohol abuse.

In addition, it is not uncommon for people suffering from this disorder to try to “self-medicate” their otherwise debilitating symptoms with mind-altering drugs. The abuse of such substances, most commonly nicotine, alcohol, cocaine and marijuana, impedes treatment and recovery.

Schizophrenia

SYMPTOMS

Schizophrenia is characterized by at least 2 of the following symptoms, for at least one month:

· Delusions

· Hallucinations

· Disorganized speech (e.g., frequent derailment or incoherence)

· Grossly disorganized or catatonic behavior

· Negative symptoms (e.g., a “flattening” of one’s emotions, alogia, avolition; see below)

(Only one symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other.)

For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).

Schizoaffective Disorder and Mood Disorder with Psychotic Features have been considered as alternative explanations for the symptoms and have been ruled out. The disturbance must also not be due to the direct physiological effects of use or abuse of a substance (e.g., alcohol, drugs, medications) or a general medical condition.

If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).

Different Types of Schizophrenia:

Paranoid schizophrenia a person feels extremely suspicious, persecuted, grandiose, or experiences a combination of these emotions.

Disorganized schizophrenia a person is often incoherent but may not have delusions.

Catatonic schizophrenia a person is withdrawn, mute, negative and often assumes very unusual postures.

Residual schizophrenia a person is no longer delusion or hallucinating, but has no motivation or interest in life.

These symptoms can be most devastating.

Schizophrenia usually first appears in a person during their late teens or throughout their twenties. It affects more men than women, and is considered a life-long condition which rarely is “cured,” but rather treated. The primary treatment for schizophrenia and similar thought disorders is medication. Unfortunately, compliance with a medication regimen is often one of the largest problems associated with the ongoing treatment of schizophrenia. Because people who live with this disorder often go off of their medication during periods throughout their lives, the repercussions of this loss of treatment are acutely felt not only by the individual, but by their family and friends as well.

Successful treatment of schizophrenia, therefore, depends upon a life-long regimen of both drug and psychosocial, support therapies. While the medication helps control the psychosis associated with schizophrenia (e.g., the delusions and hallucinations), it cannot help the person find a job, learn to be effective in social relationships, increase the individual’s coping skills, and help them learn to communicate and work well with others. Poverty, homelessness, and unemployment are often associated with this disorder, but they don’t have to be. If the individual finds appropriate treatment and sticks with it, a person with schizophrenia can lead a happy and successful life. But the initial recovery from the first symptoms of schizophrenia can be an extremely lonely experience. Individuals coping with the onset of schizophrenia for the first time in their lives require all the support that their families, friends, and communities can provide.

With such support, determination, and understanding, someone who has schizophrenia can learn to cope and live with it for their entire life. But stability with this disorder means complying with the treatment plan set up between the person and their therapist or doctor, and maintaining the balance provided for by the medication and therapy. A sudden stopping of treatment will most often lead to a relapse of the symptoms associated with schizophrenia and then a gradual recovery as treatment is reinstated.

Psychotherapy

Psychotherapy is not the treatment of choice for someone with schizophrenia. Used as an adjunct to a good medication plan, however, psychotherapy can help maintain the individual on their medication, learn needed social skills, and support the person’s weekly goals and activities in their community. This may include advice, reassurance, education, modeling, limit setting, and reality testing with the therapist. Encouragement in setting small goals and reaching them can often be helpful.

People with schizophrenia often have a difficult time performing ordinary life skills such as cooking and personal grooming as well as communicating with others in the family and at work. Therapy or rehabilitation therapy can help a person regain the confidence to take care of themselves and live a fuller life.

Group therapy, combined with drugs, produces somewhat better results than drug treatment alone, particularly with schizophrenic outpatients. Positive results are more likely to be obtained when group therapy focuses on real-life plans, problems, and relationships; on social and work roles and interaction; on cooperation with drug therapy and discussion of its side effects; or on some practical recreational or work activity. This supportive group therapy can be especially helpful in decreasing social isolation and increasing reality testing (Long, 1996).

Family therapy can significantly decrease relapse rates for the schizophrenic family member. In high-stress families, schizophrenic patients given standard aftercare relapse 50-60% of the time in the first year out of hospital. Supportive family therapy can reduce this relapse rate to below 10 percent. This therapy encourages the family to convene a family meeting whenever an issue arises, in order to discuss and specify the exact nature of the problem, to list and consider alternative solutions, and to select and implement the consensual best solution. (Long, 1996).

Medications

Schizophrenia appears to be a combination of a thought disorder, mood disorder, and anxiety disorder. The medical management of schizophrenia often requires a combination of antipsychotic, antidepressant, and antianxiety medication. One of the biggest challenges of treatment is that many people don’t keep taking the medications prescribed for the disorder. After the first year of treatment, most people will discontinue their use of medications, especially ones where the side effects are difficult to tolerate.

As a recent National Institute of Mental Health Study indicated, regardless of the drug, three-quarters of all patients stop taking their medications. They stopped the schizophrenia medications either because they did not make them better or they had intolerable side effects. The discontinuation rates remained high when they were switched to a new drug, but patients stayed on clozapine about 11 months, compared with only three months for Seroquel, Risperdal or Zyprexa, which are far more heavily marketed — and dominate sales. Because of findings such as this, it’s generally recommended that someone with schizophrenia begin their treatment with a drug such as clozapine (clozapine is often significantly cheaper than other antipsychotic medications). Clozapine (also known as clozaril) has been shown to be more effective than many newer antipsychotics as well.

Antipsychotic medications help to normalize the biochemical imbalances that cause schizophrenia. They are also important in reducing the likelihood of relapse. There are two major types of antipsychotics, traditional and new antipsychotics.

Traditional antipsychotics effectively control the hallucinations, delusions, and confusion of schizophrenia. This type of antipsychotic drug, such as haloperidol, chlorpromazine, and fluphenazine, has been available since the mid-1950s. These drugs primarily block dopamine receptors and are effective in treating the “positive” symptoms of schizophrenia.

Side effects for antipsychotics may cause a patient to stop taking them. However, it is important to talk with your doctor before making any changes in medication since many side effects can be controlled. Be sure to weigh the risks against the potential benefits that antipsychotic drugs can provide.

Mild side effects: dry mouth, blurred vision, constipation, drowsiness and dizziness. These side affects usually disappear a few weeks after the person starts treatment.

More serious side effects: trouble with muscle control, muscle spasms or cramps in the head and neck, fidgeting or pacing, tremors and shuffling of the feet (much like those affecting people with Parkinson’s disease).

Side effects due to prolonged use of traditional antipsychotic medications: facial ticks, thrusting and rolling of the tongue, lip licking, panting and grimacing.

There are many newer antipsychotic medications available since the 1990’s, including Seroquel, Risperdal, Zyprexa and Clozaril. Some of these medications may work on both the serotonin and dopamine receptors, thereby treating both the “positive” and “negative” symptoms of schizophrenia. Other newer antipsychotics are referred to as atypical antipsychotics, because of how they affect the dopamine receptors in the brain. These newer medications may be more effective in treating a broader range of symptoms of schizophrenia, and some have fewer side effects than traditional antipsychotics. Learn more about the atypical antipsychotics used to help treat schizophrenia.

Coping Guidelines For The Family

1. Establish a daily routine for the patient to follow.

2. Help the patient stay on the medication.

3. Keep the lines of communication open about problems or fears the patient may have.

4. Understand that caring for the patient can be emotionally and physically exhausting. Take time for yourself.

5. Keep your communications simple and brief when speaking with the patient.

6. Be patient and calm.

7. Ask for help if you need it; join a support group.

Self-Help

Self-help methods for the treatment of this disorder are often overlooked by the medical profession because very few professionals are involved in them. Adjunctive community support groups in concurrence with psychotherapy is usually beneficial to most people who suffer from schizophrenia. Caution should be utilized, however, if the person’s symptoms aren’t under control of a medication. People with this disorder often have a difficult time in social situations, therefore a support group should not be considered as an initial treatment option. As the person progresses in treatment, a support group may be a useful option to help the person make the transition back into daily social life.

Another use of self-help is for the family members of someone who lives with schizophrenia. The stress and hardships causes of having a loved one with this disorder are often overwhelming and difficult to cope with for a family. Family members should use a support group within their community to share common experiences and learn about ways to best deal with their frustrations, feelings of helplessness, and anger.

References: Psych Central, National Mental Health Association,
National Institute for Mental Health, National Alliance for the Mentally Ill,
Internet Mental Health

Last reviewed:
On 12 Oct 2006
By John M. Grohol, Psy.D.

Article from PsychCental   Http://psychcentral.com/

A panic attack is a discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:

• Palpitations, pounding heart, or accelerated heart rate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath or smothering
• Feeling of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, lightheaded, or faint
• Derealization (feelings of unreality) or depersonalization (being detached from oneself)
• Fear of losing control or going crazy
• Fear of dying
• Paresthesias (numbness or tingling sensations)
• Chills or hot flushes
• References:
  American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.

National Institutes of Health, National Institute of Mental Health, NIH Publication No. 95-3879 (1995)

Cluster A personality disorders in \”The Wizard of Oz\”