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Exam 2 9/28
CH 29 textbook
1.
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
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
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
Pancreas- long, slender gland lying behind the stomach and in front of the first and
second lumbar vertebrae
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2.
3.
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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
Liver makes bile (bile salts, bile pigments, and cholesterol). Liver excretes 1L
bile a day
4.
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
5.
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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2.
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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
3.
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4.
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5.
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Chapter 41 Obesity
1.
Epidemiology of Obesity
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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
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.
- 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
5.
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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.