Introduction to Medical-Surgical Nursing, 6th ed.
39
Lesson Plans for
Upper Digestive Tract Disorders
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 39.1:
2. List the data to be included in the nursing assessment of the patient with an upper digestive disorder
4. Assist in developing nursing care plans for patients receiving treatment for upper digestive disorders.
Lesson 39.2:
4. Assist in developing nursing care plans for patients receiving treatment for upper digestive disorders.
(Cont.)
CHAPTER TEACHING FOCUS
• In this chapter, the student is introduced to topics related to upper digestive tract disorders, including
disorders that affect ingestion, digestion and absorption, and absorption.
• Nursing assessment of the digestive tract, diagnostic tests and procedures, and common therapeutic
measures are discussed.
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for
each concept have been tailored specifically to correspond to the Linton textbook.
THEME: Homeostasis and Regulation
• Concept: Nutrition
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CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) Which of the following is the primary function of the digestive tract?
a) Absorption of nutrients
b) Regulation of hormones
c) Production of blood cells
d) Maintenance of water balance
2) The jejunum is part of the __________.
a) stomach
b) large intestine
c) small intestine
d) colon
3) An age-related change of the digestive system is __________.
a) increased secretions
b) decreased secretions
c) thickening of the stomach lining
d) an increase in digestive juices
4) For continuous tube feeding, how many hours-worth of formula should be hung for infusion?
a) 12
b) 8
c) 6
d) 2
5) Inflammation of the oral mucosa is termed __________.
a) stomatitis
b) gingivitis
c) periodontitis
d) trench mouth
6) Inflammation of the gums is termed __________.
a) stomatitis
b) gingivitis
c) periodontitis
d) trench mouth
7) The most life-threatening disorder affecting the mouth is __________.
a) herpes simplex
b) stomatitis
c) oral cancer
d) trench mouth
8) Protrusion of the lower esophagus and stomach upward through the diaphragm and into the chest is
termed __________.
a) gastroesophageal reflux disease (GERD)
b) hiatal hernia
c) gastritis
d) peptic ulcer
9) Gastric ulcers usually cause __________.
a) pain in the epigastric area before meals
b) pain the epigastric area 1 to 2 hours after meals
c) weight gain in the gastric region
d) burning and cramping 2 to 4 hours after meals
10) Which of the following diets is a risk factor for stomach cancer?
a) High-fiber
b) Calcium-rich
c) Fruit- and vegetable-rich
d) Salted meat–rich
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Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What are the functions of the digestive tract?
Question: What are the main and accessory parts of the digestive tract?
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LESSON 39.1
Instructor Preparation
Textbook Objectives Covered
1. Identify the nursing responsibilities in the care of patients undergoing diagnostic tests and
procedures for disorders of the upper digestive tract.
3. Describe the pathophysiology, signs and symptoms, complications, and medical treatment of
selected upper digestive disorders.
4. Assist in developing nursing care plans for patients receiving treatment for upper digestive
disorders.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying digestive tract disorders, including:
• Anatomy and physiology of the digestive tract
• Nursing assessment of the digestive tract
Materials and Supplies
Key Terms
• eructation (p. 808)
• peritonitis (p. 813)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 39.1
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 785-786, 787-794)
REVIEW
• Figure 39-1: The digestive tract and associated structures (p. 786)
• Figure 39-2: Examples of tubes used in the digestive tract (p. 792)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1, 3 (p. 819)
ANSWER – Study Guide
• Part ID: 1-8 (p. 249)
2
READ – Textbook (pp. 786-787)
REVIEW
• Box 39-1: Assessment of the Patient with a disorder of the Upper Digestive Tract (p. 787)
ANSWER – Text
• Review Questions for the NCLEX Examination: 2 (p. 819)
3
READ – Textbook (pp. 798-807)
REVIEW
• Figure 39-6: Acute gingivitis (p. 801)
• Figure 39- 7: Surgical procedures for oral cancer (p.802)
ANSWER – Study Guide
Part IA: 1-8 (p. 247)
Part IB: 1-8 (p. 248)
Part IC: 1-10 (p. 248)
4
READ – Textbook (pp. 798-807)
ANSWER – Study Guide
• Part IIIG: 2 (p. 252)
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LESSON 39.1
Lecture Outline 20 minutes
Slide 1
Chapter 39
Disorders of the Upper Digestive Tract
1
Slide 2
Anatomy and Physiology of the Digestive Tract
• Mouth
• Where teeth, tongue, and salivary glands begin food digestion
• Pharynx
• Muscular structure shared by the digestive and respiratory tracts
TALKING POINTS:
• The digestive tract is also called the gastrointestinal tract (or GI tract) and the alimentary
tract.
Slide 3
Age-Related Changes
• Teeth are mechanically worn down with age
• The jaw may be affected by osteoarthritis
2
Health History
• Chief complaint and history of present illness
Health History (cont.)
• Medical history
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LESSON 39.1
Health History (cont.)
• Functional assessment
• Information about general dietary habits should include the daily pattern of food intake
Slide 7
Physical Examination
• Head and neck
• Inspect the mouth
TALKING POINTS:
• Describe caries, moisture, color, and lesions.
• Note any unpleasant or unusual odors of the mouth.
1
Slide 8
Diagnostic Tests and Procedures
• Endoscopic examinations
• Upper GI
Slide 9
Diagnostic Tests and Procedures (cont.)
• Laboratory studies
• Gastric analysis
Slide 10
Gastrointestinal Intubation
• Tube feedings
• Delivered by gravity flow or by infusion pump
• Critical to confirm tube is in the duodenum before administering feedings
• Radiographic confirmation is the most reliable method
TALKING POINTS:
• Tubes that are passed through the nose are called nasogastric, nasoduodenal, or
nasoenteric tubes, depending on whether the end is located in the stomach or the small
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LESSON 39.1
Slide 11
• How should the nurse administer a syringe feeding?
Gastrointestinal Intubation (cont.)
• Tube feedings (cont.)
• Obtain correct formula
• Tube feedings may be diluted when first started
• Stop feeding if patient has nausea or pain
TALKING POINTS:
• Why is it essential to provide additional water after each bolus feeding?
Slide 12
Gastrointestinal Decompression
• For the relief or prevention of distention
• Levin and gastric sump tubes
• Use prescribed suction apparatus
TALKING POINTS:
• What steps should the nurse take if the tube is not draining?
• What can result from frequent irrigations of the tube?
Gastrointestinal Decompression (cont.)
• Monitor the suction output
• Assess for return of peristalsis
TALKING POINTS:
• Which assessment findings indicate peristalsis is returning?
• Which measures will increase the patient’s comfort?
Total Parenteral Nutrition
• Bypasses digestive tract by delivering nutrients directly to the bloodstream
• Catheter inserted into large vein feeds into the superior vena cava to allow dilution of
Slide 15
Total Parenteral Nutrition (cont.)
• Sterile technique for site care to prevent infection
• Monitor for signs of infection
• Monitor flow rate to prevent circulatory overload, changes in blood glucose or excessive
diuresis
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LESSON 39.1
3
Slide 16
Anorexia
• Causes
• Nausea, decreased sense of taste or smell, mouth disorders, and medications
• Emotional problems such as anxiety, depression, or disturbing thoughts
TALKING POINTS:
• Unpleasant odors or sights can quickly dampen a patient’s enthusiasm for a meal.
• What factors may cause a decreased appetite in the older adult?
Slide 17
Anorexia (cont.)
• Medical diagnosis
• Provider assesses for malnutrition
• Weight may be monitored over several weeks
Slide 18
Anorexia (cont.)
• Medical treatment
• Correctable causes of anorexia are treated, but sometimes no physical cause is found
• Nutritional supplements
4
Slide 19
Anorexia (cont.)
• Assessment
• Record chronic and recent illnesses, hospitalizations, medications, and allergies
• Female patient’s obstetric history
TALKING POINTS:
• What signs of malnutrition should be noted during the physical assessment?
• It is very important to have the patient remove the dentures before the gums are assessed.
Slide 20
Anorexia (cont.)
• Interventions
• Assist with oral hygiene before and after meals
• Teach proper oral hygiene; refer for dental care
• Relieve nausea before presenting a meal tray
TALKING POINTS:
• Poorly fitting dentures need to be relined for a tighter fit or replaced.
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LESSON 39.1
3
Slide 21
Feeding Problems
• Patients with paralysis, arthritis, neuromuscular disorders, confusion, weakness, or visual
impairment are likely to need assistance
4
Slide 22
Feeding Problems (cont.)
• Assessment
• Assess each patient’s ability to feed self
• Determine nature of patient’s difficulty and identify remaining abilities
• Assess visual acuity, range of motion and muscle strength in both arms, and range of
motion and grip strength in both hands; ability to follow instructions
Feeding Problems (cont.)
• Interventions
• Proper positioning and arrangement of the meal tray
TALKING POINTS:
• What points should be remembered when feeding a patient?
3
Slide 24
Stomatitis
• A general term for inflammation of the oral mucosa
• Medical treatment is directed toward determining the cause and eliminating it; a soft, bland
diet may be ordered
TALKING POINTS:
• What factors may cause stomatitis?
Vincent Infection
• Bacterial infection that causes a metallic taste and bleeding ulcers in the mouth, foul
TALKING POINTS:
• Why has Vincent infection been called trench mouth?
Herpes Simplex
• Caused by the herpes simplex virus type 1
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LESSON 39.1
Slide 27
Aphthous Stomatitis (“Canker Sore”)
• May be caused by a virus
• Characterized by ulcers of the lips and mouth that recur at intervals
• Topical or systemic steroids may be used
Candida albicans
• Yeastlike fungus causes the oral condition known as thrush or candidiasis
4
Nursing Care
• Assessment
• Pain location, onset, and precipitating factors
Nursing Care (cont.)
• Interventions
• Gentle oral hygiene, prescribed mouthwashes
TALKING POINTS:
• Instead of just swallowing the medication, the patient may need to swish liquid medication
3
Oral Cancer
• Squamous cell carcinoma and basal cell carcinoma
• Risk factors
TALKING POINTS:
Oral Cancer (cont.)
• Signs and symptoms
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LESSON 39.1
Oral Cancer (cont.)
• Medical diagnosis and treatment
TALKING POINTS:
4
Oral Cancer (cont.)
• Assessment
• History of prolonged sun exposure, tobacco use, or alcohol consumption
Slide 35
Oral Cancer (cont.)
• Interventions
• Ineffective breathing pattern
• Acute pain
3
Parotitis
TALKING POINTS:
• Parotitis may develop in patients who are unable to take oral liquids for a long time,
Achalasia
• Progressively worsening dysphagia
TALKING POINTS:
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LESSON 39.1
Esophageal Cancer
• Pathophysiology
• No known cause, but predisposing factors are cigarette smoking, excessive alcohol
TALKING POINTS:
Slide 39
Esophageal Cancer (cont.)
• Medical diagnosis
• Barium swallow, computed tomography, esophagoscopy, and endoscopic
ultrasonography
TALKING POINTS:
• General physical appearance and height and weight are important aspects of the physical
examination.
4
Esophageal Cancer (cont.)
• Assessment
Slide 41
Esophageal Cancer (cont.)
• Interventions
• Acute pain
• Imbalanced nutrition: Less than body requirements
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LESSON 39.1
3
Slide 42
Nausea and Vomiting
• Nausea: sometimes referred to as queasiness
• Vomiting: forceful expulsion of stomach contents through the mouth
• Complications
• Significant losses of fluids and electrolytes
• Aspiration
• Medical treatment
TALKING POINTS:
• What factors may cause nausea and vomiting?
4
Slide 43
Nausea and Vomiting (cont.)
• Assessment
• Onset, frequency, and duration of present illness
• Conditions under which nausea and vomiting occur
Nausea and Vomiting (cont.)
• Interventions
• Imbalanced nutrition
Slide 45
Question 1
• Which of the following is not considered a main part of the digestive tract?
A. Esophagus
B. Small intestine
C. Liver
D. Anus
TALKING POINTS: