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Lesson 25

Lesson 25. Common Diseases & Disorders: Gastrointestinal & Endocrine Systems. Objectives. Student will be able to explain the common diseases of the Gastrointestinal (GI) System which affect the elderly.

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Lesson 25

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  1. Lesson 25 Common Diseases & Disorders: Gastrointestinal & Endocrine Systems

  2. Objectives • Student will be able to explain the common diseases of the Gastrointestinal (GI) System which affect the elderly. • Student will be able to explain the common diseases of the Endocrine System which affect the elderly.

  3. GI System

  4. Gastrointestinal System Anatomy/physiology • Mouth/teeth- takes in, masticates (chew) food or fluid • Pharynx (throat)- tube taking food to esophagus • Esophagus- tube that transports masticated food from mouth to stomach • Stomach- sac that mixes food and fluid with digestive juices • Small intestine- tube that absorbs nutrients from food • Large intestine- tube that absorbs water from waste • Rectum- sac at end of large intestine which stores waste • Anus- opening at end of rectum through which waste is expelled • Liver- produces bile necessary for fat metabolism • Gallbladder- stores bile until needed • Pancreas- produces insulin for metabolism of sugars

  5. Normal Changes with aging • Decreased saliva production affects chewing/swallowing. • Dulled sense of taste and smell may result in poor appetite. • Absorption of vitamins/minerals decreases. • Digestion takes longer, is less efficient causing indigestion and gas. • Paristalsis slows (body waste moves more slowly through intestines); constipation is more frequent. • Tooth/gum problems or poor fitting dentures make it harder to chew • Metabolism slows, causing decreased need for calories

  6. Transparency 17-1: Factors Affecting Bowel Elimination • Normal changes of aging - Peristalsis slows. - Digestion takes longer and is less efficient. - Possible tooth loss and less saliva affect digestion. - Medication use and dulled sense of taste may result in poor appetite. • Psychological factors - Stress, anger, and fear increase peristalsis. - Depression decreases peristalsis. - A lack of privacy can greatly affect elimination. • Food and fluids - Fiber improves elimination. - Animal fats and low-fiber foods can cause constipation. - Some foods cause gas, which can help with elimination. - Proper fluid intake helps elimination.

  7. Transparency 17-1: Factors Affecting Bowel Elimination (cont’d) • Physical activity - Regular activity helps elimination. - Immobility weakens muscles and may slow elimination. • Personal habits - Time of day varies, but it usually occurs after meals. - Supine position causes most trouble for bowel elimination. - Best position for elimination is squatting and leaning forward. • Medications - Laxatives help elimination. - Pain relievers can slow elimination. - Antibiotics may cause diarrhea.

  8. Common diseases of GI system GastroesophagealReflux Disease (GERD)- stomach contents leak backwards from the stomach into esophagus • Heartburn or burning in the chest is most common symptom. • Feeling of something stuck behind the breastbone • Bending, stooping, lying flat or eating can worsen symptoms • Often worse at night • Nausea after eating • Regurgitation • Coughing or wheezing • Difficulty swallowing • Hiccups • Hoarseness or change of voice • Sore throat

  9. GERD Treatment & interventions • Medication- antacids (non CNA intervention) • Serving the evening meal three to four hours before bedtime • Avoid lying down until two to three hours after eating • Using extra pillows to keep the body more upright during sleep • Serving the largest meal of the day at lunchtime • Eating smaller meals throughout the day • Reducing fast foods, fatty foods, and spicy foods • Stopping smoking • Not drinking alcohol • Wearing loose clothing.

  10. Common diseases of GI system Peptic Ulcers-painful sores or ulcers in the lining of the stomach or first part of small intestine (duodenum) • Caused by excessive acid production • Symptoms: pain after eating, belching, vomiting, bloating, heartburn, n/v, dark or black stools, weight loss, gnawing or burning or severe pain in the mid to upper abdomen • Treatment: medications, avoiding smoking, alcoholic drinks, and caffeine, and change of diet.

  11. Common diseases of GI system Ulcerative Colitis and Colitis- serious chronic inflammatory disease of the large intestine and rectum causing recurrent episodes of pain, fever, chills, and profuse diarrhea • Symptoms include cramping, diarrhea, pain occurring on one side of the lower abdomen, rectal bleeding, and loss of appetite. • Treatment includes medications and surgical treatment (a colostomy). • Colitis, or irritable bowel syndrome, is milder and is controlled by diet and/or medication.

  12. Common diseases of GI system Hemorrhoids- enlarged, bulging blood vessels in an around the anus or lower rectum External (outside) hemorrhoids- near the anus, covered by very sensitive skin Internal (inside) hemorrhoids- within the anus beneath the lining • Results from straining during bowel movements, chronic constipation, obesity, pregnancy, and sitting for long periods of time on the toilet • Symptoms include rectal itching, burning, pain, and bleeding. • Treatment may include medications, compresses, sitz baths, and possibly surgery. • NAs should be careful to avoid causing pain while cleaning anal area.

  13. Common diseases of GI system Constipation-person has 3 or less bowel movements per week or has hard, dry, small stools painful to pass • Occurs when feces moves too slowly through the intestine • Can result from decreased fluid, poor diet, inactivity, medications, aging, certain diseases, or ignoring urge to eliminate • Symptoms are abdominal swelling, gas, irritability, and record of no recent bowel movement • Treatment involves increasing fiber in diet and increasing activity, as well as medication (enemas and suppositories may be ordered to help). COCA of bowel movements are important.

  14. Common diseases of GI system Diarrhea- having 3 or more loose or liquid stools per day. • Results from bacterial and viral infections, microorganisms in food and water, irritating foods, and medications • Treatment involves medication, increase in certain fluids, and change of diet.

  15. Common diseases of GI system Fecal incontinence- loss of bowel control • Causes are constipation, muscle and nerve damage, loss of storage capacity in the rectum, and diarrhea. • Treatment includes a change in diet, medication, bowel training, or surgery. Fecal impaction- stool caught or stuck in rectum • Results from unrelieved constipation • Symptoms include no stool for several days, oozing of liquid stool, cramping, abdominal swelling, and rectal pain • Treatment is doctor or nurse breaking the mass into fragments • Prevention involves high-fiber diet, increased fluids and activity, and, possibly, medication.

  16. Review Terms Ostomy- a surgically-created opening from an area inside the body to the outside. Ureterostomy- a surgically-created opening from an ureter to the abdomen for urine to be eliminated. (Urinary System) Colostomy- surgically-created opening through the abdomen into the large intestine to allow feces to be expelled. Ileostomy- a surgically-created opening into the end of the small intestine to allow stool to be expelled.

  17. Colostomy & ileostomy • (Reversible or Irreversible) CNA Considerations: • Make sure resident receives careful skin care. • Empty and clean or replace the ostomy bag whenever stool is eliminated. • Always wear gloves and wash hands carefully. Follow Standard Precautions. • Teach proper hand washing techniques to residents with ostomies. • Skin barriers protect skin around stoma from irritation.

  18. OstomyPics Stoma, gone bad Stoma/Ostomy supplies Ostomy Reversal

  19. Sxs to report • Difficulty swallowing or chewing • Fecal incontinence • Weight gain or loss • Loss of appetite • Abdominal pain or cramping • Diarrhea • Nausea and vomiting (especially coffee grounds type)

  20. SxS to Report continued • Constipation • Flatulence • Hiccups, belching • Bloody, black, or hard stools • Heartburn • Poor nutritional intake This is why COCA is so important

  21. Endocrine system anatomy & physiology Composed of glands that produce hormones and secretions to regulate body functions • Adrenal Glands- located on the top of each kidney secreting: epinephrine/norepinephrine- hormones released during stress/emergencies “fight or flight” response corticosteroids- regulate carbohydrate metabolism, control stress response and inflammation, and regulate salt and water balance • Pituitary Glands- located at the base of the brain controlling other glands to secrete various hormones and secretes a growth hormone used throughout life to maintain bone & muscle health

  22. Endocrine system Anatomy & physiology • Thyroid Gland- located in the neck in front of the larynx and secretes a hormone that regulates metabolism • Parathyroid Gland- located on each side of the thyroid and secretes a hormone to regulate the body’s phosphorous and calcium • Pancreas- located behind the stomach and in front of the spine and secretes the hormone insulin necessary for sugar metabolism • Ovaries & Testes- female and male reproductive glands secreting hormones necessary for reproduction and the appearance of sex characteristics

  23. Endocrine system

  24. Endocrine system disorders Diabetes Mellitus- caused by lack of the pancreatic hormone, insulin, resulting in the inability to metabolize starches (carbohydrates) and sugars (glucose). Type I (insulin not produced) vs Type II (insulin produced, but not used effectively • Sugar can accumulate in the blood and urine causing high blood glucose levels= hyperglycemia SXS of Hyperglycemia: distinct fruity breath, SOB, n/v, frequent urination, thirst, hot/flushed skin, confusion, coma • Hypoglycemia = low blood glucose levels can also occur often as a result of attempting to control the hyperglycemia with “synthetic” insulin SXS of Hypoglycemia: cold, clammy, pale skin, vision changes, shaking, hunger, tingling or numbness of skin, increased confusion

  25. Endocrine system disorders Hyperthyroidism-condition in which the thyroid gland makes too much thyroid hormone which regulates metabolism. SXS include: -Difficulty concentrating -Fatigue -Frequent BM’s -Hand tremors -Heat intolerance -Increased appetite -Increased sweating -Nervousness -Restlessness -Sleep problems -Weight loss -Enlarged thyroid gland (goiter) or thyroid nodules

  26. Endocrine system disorders Hypothyroidism-condition in which the thyroid gland does not make enough thyroid hormone to regulate metabolism. SXS Include: -Hard Stools or constipation -Fatigue or lethargy -Joint or muscle pain -Pale, dry skin -Depression -Thin, brittle hair and nails -Weakness -Weight gain -Increased sensitivity to cold -Heavier or irregular menstrual periods

  27. VS.

  28. Endocrine system:normal changes with aging • Decreased estrogen in women leads to menopause, calcium bone loss, appearance of male sex characteristics such as facial hair, drooping breasts, etc. • Decreased progesterone in men causing slower sexual response and the appearance of female sex characteristics such as breast enlargement, loss of facial/body hair, etc. • Less production of insulin= increased risk for diabetes • Less able to handle stress and increases potential edema • Thyroid hormone decreases causing decreased metabolism (need for less calories)

  29. Endocrine systemRole of the CNA • Diabetic residents- monitor meal consumptions closely and letting nurse know if consumption is less than 50% at meals or snacks • Notifying nurse if residents shows signs of hyperglycemia or hypoglycemia • Notifying nurse if residents are non-compliant with ordered diets

  30. Review Questions • List signs and symptoms of hypoglycemia. • List signs and symptoms of hyperglycemia. • True or False? Coffee ground emesis is indicative of internal bleeding. • What should a CNA do if the residents has not had a BM for 3 days? • True or False? Decreased hormone production in the elderly causes a decreased ability to handle stress.

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