Anatomy and Physiology of Digestive

8/3/2019 Anatomy and Physiology of Digestive

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I. INTRODUCTION

II. Chief Complaint

Abdominal pain and vomiting

III. PATIENTS PROFILE

NAME: Romney Farmantier Panaligan AumentadoAddress: 2174 Malungay St. Ph. 4 Brgy. CAA, Las Pinas City 1740Age: 2 years oldSex: MaleMArital Status: SingleOccupation: NoneReligion: CatholicHealth Care Financing: Private ResourcesUsual Source of Medical Care: Health Center, District hospital.

IV.Nursing History

1. History of present illness.

Patient was apparently well until night PTA when after eating rice andsotanghon soup suddenly had 4 episodes of vomiting of previouslyingested food to blood streaked content. this was associated with 1

episode of loose stool, watery, non-blood streaked, nonfoul smell. thisprompted consult at ER to subsequently.

2. Past Medical History.

a. Injuries or accidentsN/A

b. Hospitalizations and operations

~ This is the first time that the patient has been hospitalized.c. Immunization

BCG: / / at birth / / school entrance

DPT: / / 1 st dose / / 2 nd dose / / 3 rd dose

OPV: / / 1 st dose / / 2 nd dose / / 3 rd dose

AMV: / /

Hepatitis B vaccine:/ / 1 st dose / / 2 nd / / 3 rd

d. Allergies:


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/ / food, specify:___N/A__________________

/ / drugs, specify:___ N/A ________________

/ / chemicals, specify: __ N/A ______________

/ / environmental allergies, specify: __ N/A____

3. Family History of Illness

According to the patient's mother, there were no occurence of hereditary diseases such as diabetes, hypertension, cancer.

6. GORDONS FUNCTIONAL HEALTH PATTERNS

6.1 HEALTH-PERCEPTION AND HEALTH MANAGEMENTPATTERN

6.1.1 Perception of ownhealth and well-being?

Wasnt able to answer due tounderlying condition

6.1.2 How does he keep self healthy? According to mother, theywere giving nutritious andhealthy food and patient istaking vitamins such asCEELIN and NUTRILIN.

6.1.3 Understand and awareof diagnosis angprognosis?

The diagnosis and wereexplained well to thepatients parents.

6.1.4 Complies withtreatment regimen? If not, reasons for notcomplying?

They follow and comply withthe treatment regimen.

6.1.5 Plans for fasterrecovery?

The mother said that theywere following doctorsorders for the patientsfaster recovery.


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6.2 NUTRITIONAL-METABOLIC PATTERN

6.2.1 Appetite in general?

Usual eating pattern?Likes? Dislikes?Dietary Restrictions?

Chocolates and fatty foods

were retricted to patient. Hehas good appetite and takingvitamis like nutrilin andceelin.

6.2.2 Effects of illness andhospitalization toappetite andnutritional intake?

According to mother, thepatient has better appetite inhome compare when he wasadmitted to the hospital.

6.2.3 24-hour diet recall DINNER slice of watermelon cup of rice1 piece of chicken1 bottle of milk1 glass of water

BREAKFAST1 bottle of milk2 glass of water bottle of Gatorade

Lunch2 glass of water bottle of Gatorade1 bottle of milk cup rice cup vegetables1 slice of fish

6.2.4 Weight loss or gain? The patient gained loss.

6.2.5 Uses vitamins orsupplements,slimming aids?

The patient takes Ceelin andNutrilin.

6.3 ELIMINATION PATTERN


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6.3.1 Urination (frequency,urine characteristics,discomforts felt)

According to patient's mother,patient urinates less than 10times a day with clear, ambercolored urine and with nodisccomfort.

6.3.2 Defecation(frequency, stoolcharacteristics,discomforts felt)

Patient also defecates once aday. His stool is from wateryto yellow semiformed shapewith no discomfort felt.

6.3.3 Effects of illness andhospitalization tourination anddefecation patterns?

None.

6.3.4 Last urination andbowel movement?

Last urination and bowelmovement were afterlunch,November 23, 2010.

6.3.5 Use of laxatives ordiuretics?

None

6.4 ACTIVITY- EXERCISE PATTERN

6.4.1 Ability to performactivities if dailyliving (ADLs)?

The patient was not able toperform ADLs uponconfinement.

6.4.2 Type of exercise?Frequency?

He is playing with toys astolerated.

6.4.3 Tires easily?He does not tires easily.

6.4.4 Occasions of dizziness, shortnessof breath? Trigers?

There were no occasions of dizziness and shortness of breath.

6.4.5 Perceived benefit of exercise

According to the mother, thechild is exercising throughplaying, patient keeps hisbone and muscle healthy.


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6.4.6 Use of energy-givingsupplements

None

6.4.7 General mobilitysince hospitalized?

Limited movements

6.4.8 Effects of illness andhospitalization togeneral mobility andself-care?

Patient experiencedweakness and limitedmovement upon admission.

6.5 SLEEP-REST PATTERN

6.5.1 Usual hours of sleep?Intermittent orcontinuous?

According to patient'smother, pt is taking nap onafternoon for 2 hours and 10hours of continuous sleep atnight

6.5.2 Sleeping problems?Describe

Patient has no sleepingproblems.

6.5.3 Use of coffee, tea,

cafeinated beveragesand alcohol? Amountper day?

None

6.5.4 Difficulty fallingasleep?

None

6.5.5 Wakes up during thenight? How often?

No.

6.5.6 Feels rested aftersleep?

No

6.5.7 Snoring?Sleepwalking? Sleepapnea?

6.5.8 Use of sleeping aidsor medications?

None

None

6.5.9 Effects of illness andhospitalization to

sleeping pattern?

None


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6.6 COGNITIVE-PERCEPTUAL PATTERN

6.6.1 Sensory deficits? No sensory deficits.

6.6.2 Memory lapses? No memory lapses.

6.6.3 Pain perception(tolerance, threshold)

Wasnt able to assess due tounderlying condition

6.6.4 Ability to understandinstructions?

The patient does not totallyunderstand all instructions.

6.6.5 Learning patterns?6.6.6 Use of pain

medication?

None.

6.6.7 Effects of illness andhospitalization tomemory andperception?

None

6.7 SELF-PERCEPTION AND SELF-CONCEPT PATTERN

6.7.1 Description of personalcharacteristics.

Wasnt able to assess due toimmaturity.

6.7.2 How does she see self as a person?


6.7.3 Feeling aboutappearance?


6.7.4 Effects of illness andhospitalization to self-concept?



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6.8 ROLE-RELATIONSHIP PATTERN

6.8.1 Roles and responsibilitiesin the family?

The patient is a child.

6.8.2 Relationship withspouse/partner/significantothers?

There is no change inrelationship of the childto his parents, accordingto mother.

6.8.3 Availability of supportpersons?

His family always visither in the hospital.

6.8.4 Significant persons? There are alwaysavailable.

6.8.5 Effects of illness andhospitalization to roleperformance andrelationships withsignificant persons?

There is no effect of illness and hospitalizationto relationship of thepatient to his family,according to the mother.

6.9 COPING AND STRESS TOLERANCE PATTERN

6.9.1 Usual stressors? Wasnt able to assess due toimmaturity.

6.9.2 Coping strategies?Effective?


6.9.3 Feelings aboutilness? Coping?


6.9.4 Stresses with illnessand hospitalization?Coping?



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6.10 VALUE-BELIEF PATTERN

6.10.1 Important religiouspractices?

Wasnt able to assess due toimmaturity

6.10.2 Perceived help of faith?


6.10.3 Ways that couldsupport spirit?


6.10.4 Effects of illnessand hospitalization tofaith and belief?


V. PHYSICAL EXAMINATION

III. Physical Assessment

SYSTEM WHAT TO ASSESS ACTUAL FINDINGS

A. Vital Signs

Temperature,pulse, respiration, BP Temp:PR:

RR:

BP: 110/80 mmHg

B. Integumentary

1. skin Color, odor,temperature,

moisture, texture,thickness, mobility,turgor, vascularity,swelling, rashes

uniform skin color warm to touch

axillae ismoistened Has good skinturgor Has no lesions,swelling and edemaon skin


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2. hair

3. nails

Distribution,thickness, texturelubrication, scalp

characteristics

Nail bed color,consistency,thickness, shapetexture, anglebetween nail and nailbed, capillary refill

Evenly distributed

black hair Thin, oily hair No infection andinfestations in thescalp No dandruff Variable/unevendistribution of bodyhair

Smooth texture Pink nail beds Convex curvaturewith nail plate havingan angle of about160 Intactepidermis/tissuessurrounding nails Capillary refill lessthan 2 seconds

C. Head and Neck

1. head Size, shape,contour

Rounded,normocephalic,andsymmetrical frontal,parietal and occipitalprominences Smooth No nodules ormasses Symmetricalfacial movements

20/200 on botheyes

-as verbalized by thepatient

Diminished


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2. eyes

Visual acuity,extra ocular movt,visual fields, position

and alignment

Eyebrows:symmetry,movement,

extension, quantityof hair

Eyelashes:distribution,

Eyelids: positionand movt, color

Conjunctiva: color

Pupils: equality,shape, reaction tolight,accommodation

peripheral vision Both eyes

coordinated inmovement

Hair evenlydistributed, skinintact

Symmetricallyaligned, equalmovement

Equally distributed,curled slightlyoutward

Lids closesymmetrically

17 blinks per minute No discharge and

discoloration

Transparent;capillaries present;smooth and pinkconjunctiva; whitesclera

Pupils round, equal insize

Black in color Arcus senilis present Patient blinks when

cornea is touched Illuminated pupil

constricts Nonilluminated pupil

constricts when theother pupil isilluminated

Reactive toaccommodation

Same color as facialskin; symmetrical;smooth in texture

Pinna recoils after it


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3. ears

4. nose

Auricle: position,size, shape, texture

External auditorycanal: discharge of cerumens color,

consistency

External nose:shape, symmetry,texture, skin color

Nares: shapesymmetry, discharge

Mucosa: color,discharge

is folded

Dry yellowishcerumen

Uniform in color,symmetric andstraight, smooth intexture

Has discharge No tenderness; both

nares are patent forair; symmetric inshape

Pink in color; No lesions

Not palpable andtender

Uniform dark red color;soft, smooth and drytexture; symmetricin contour and ableto purse lips

No teeth and usingdentures

Central position;uniform pink in color;moist and raisedpapillae/taste buds;thin whitish coating;moves freely and no

tenderness


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5. mouth

Sinus: texture

Lips: color,texture, hydration,contour

Teeth: position,color, hygiene Tongue: color,

position, texture,coating, mobility

Gums: color,texture

Pharynx: color,hydration

Salivary Glands

Palate

Thyroid Gland

Uniform dark red incolor;moist and firm in

texture

Pink and smoothposterior wall; moistin texture

Same color as of buccal mucosa andfloor of the mouth

Dark red, smooth

Glands ascendsduring swallowingbut it is not visible

Not palpable


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6. Neck

Lymph Nodes

D. Thorax and Lungs Posterior Thorax

Shape, symmetry Chest excursion

or movement

Anterior Thorax

RR Rhythm

Chest symmetric Full and symmetric

excursion Skin intact, uniform

temperature

Effortlessrespirations

E. Breast and Axillae

Size, symmetry,skin color, contour,shape

Moles and othermarkings Areola: size,

Breasts even withthe chest wall Skin uniform incolor skin smooth andintact moistened axilla

Some moles,without birthmark

Oval and bilateral


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shape, surfacecharacteristics

Nipples: size,shape, color,direction, surfacecharacteristics anddischarge

areola, brown-colored

Rounded, equal in

size

F. Abdomen Skin

Contour,symmetry

Umbilicus:position, shape, color

Normalrespiratorymovement

Post-operativesurgical incision withdressing at rightupper quadrant

Uniform color; notenderness; flatrounded (convex);

Midline and circularin shape; darker incolor compared tothe abdomen

Symmetric contourmovements causedby respirations

G. Neurologic Level of consciousness:language, responseto stimulation,intellectual function,abstract thinking,ability to performsimple arithmeticcalculations, make

judgment

Client is awakeand oriented toperson, time andplace.


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ANATOMY AND PHYSIOLOGY

DIGESTIVE SYSTEM

Digestion is the process by which food broken down so that it can be used bythe body. The digestive system begins in the mouth. The digestive tract is a longtube running from the mouth to the anus. In a living body it is contracted to twelve tofourteen feet (12-14 ft).

Digestion begins in the oral cavity. Food enters the mouth and then

mastication takes place. Mastication begins the process of mechanical digestion, inwhich large food particles are broken down into smaller ones. The teeth crush or tear the food into small pieces. T he tongue , large muscular organ, moves food in themouth and, in cooperation with the lips and cheeks, holds the food in place duringmastication. It also plays a major role in the process of swallowing. The tongue is amajor sensory organ for taste, as well as being one of the major organs of speech.During chewing, much greater quantities of saliva are secreted by three pairs of extrinsic salivary glands , namely the parotid glands (located under the skin anterior to each earlobe), the submandibular glands (located under the base of the tongue),and the sublingual glands (located in the floor of the mouth). Saliva is a watery fluidcontaining several components including lysozyme, an enzyme that kills bacteria,and salivary amylase, an enzyme that begins the digestion of starch. Once the foodis chewed and softened in the mouth, the tongue rolls it into a ball or bolus and thenpushes the bolus to the throat to be swallowed.

As the food passes to the pharynx or throat, the epiglottis is tippedposteriorly so that the opening in the larynx is covered, preventing food from entering

the larynx. The food then passes into esophagus. Esophagus is a muscular tubeconnecting the mouth with the stomach. Like a stretchy pipe that's about 10 inches(25 centimeters) long. The esophagus moves the food to the stomach by a serious of muscular contractions called peristalsis. Peristalsis is the wavelike contraction of muscles that move food through the digestive system. This takes about 2 or 3seconds. The lower end of the esophagus, which passes through a hole in thediaphragm to meet the stomach within the abdominal cavity, has a lower esophageal(or cardiac) sphincter which briefly relaxes to allow the bolus of food to enter the

stomach.
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As the food enters the stomach, muscle contractions begin to twist, turn, andchurn the food. The twisting, turning, and churning of food in the stomach are part of mechanical digestion . The stomach is a muscular sac that is located in the upper left portion of the abdominal cavity. The inner lining of the stomach wall containsmillions of tiny gastric glands that secrete gastric juice, which dissolves the food toform a thick liquid called chyme . Gastric juice contains several substances includinghydrochloric acid, intrinsic factor (which is essential for the intestinal absorption of vitamin B 12) and pepsinogen (an inactive protein -digesting enzyme). Thehydrochloric acid has several functions including destroying ingested bacteria, andconverting pepsinogen into its active form, pepsin, in order to initiate the digestion of protein.

At the lower end of the stomach is the pyloric sphincter, a valve through whichchyme must flow to enter the small intestine. Over a period of three to six hours,peristalsis moves chyme through the duodenum into the next portion of the smallintestine, the jejunum, and finally into the ileum, the last section of the smallintestine. The small intestine is a long, coiled organ about one inch in diameter. Thesmall intestine is 6 meters in length. It consists of three segments named theduodenum, jejunum and ileum.

During this time, the liver releases bile into the small intestine. The bile

enters the small intestine through the bile duct. The liver filters out harmfulsubstances or wastes, turning some of the waste into more bile. Bile prepares thefats for digestion; it helps to absorb fats into the bloodstream. And the gallbladder serves as a warehouse for bile, storing it until the body needs it. Pancreatic juice ,secreted by the pancreas , contains enzymes that break down sugars and starchesinto simple sugars, fats into fatty acids and glycerol, and proteins into amino acids.The pancreatic juice enters through pancreatic duct. The walls of the small intestinerelease enzymes that complete the digestion of all three basic nutrients. In the wallsof the small intestine are millions of small projections called villi . These villi increasethe small intestine capacity for absorption. Digested food is absorbed into theseblood vessels and carried to all body cells. Food may spend as long as 4 hours inthe small intestine and will become a very thin, watery mixture.\

A watery residue of indigestible food and digestive juices remainsunabsorbed. This residue leaves the ileum of the small intestine and moves byperistalsis into the large intestine , where it spends 12 to 24 hours. The largeintestine forms an inverted U over the coils of the small intestine. It starts on thelower right-hand side of the body and ends on the lower left-hand side. The largeintestine is 1.5 to 1.8 m (5 to 6 ft) long and about 6 cm (2.5 in) in diameter.The large intestine serves several important functions. It absorbs waterabout 6liters (1.6 gallons) dailyas well as dissolved salts from the residue passed onby the small intestine. In addition, bacteria in the large intestine promote thebreakdown of undigested materials and make several vitamins, notably vitamin K,which the body needs for blood clotting. The large intestine moves its remaining


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contents toward the rectum, which makes up the final 15 to 20 cm (6 to 8 in) of thealimentary canal. The rectum stores the feceswaste material that consists largelyof undigested food, digestive juices, bacteria, and mucusuntil elimination. Then,muscle contractions in the walls of the rectum push the feces toward the anus .When sphincters between the rectum and anus relax, the feces pass out of the body.

BIBLIOGRAPGY: Saladin, Kenneth S. Anatomy & Physiology: The Unity of Formand Function, 2nd ed. New York: McGraw-Hill, 2005

: Rod R. Seeley, et al, Essentials of Anatomy and Physiology, 6 th ed.New York: McGraw-Hill, 2007.

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Anatomy and Physiology of Digestive