NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Cebu Doctors’ University l Fated Nurses
Clinical Instructor: Ms. Ortiz, J.
Review of the Anatomy and Physiology of the
Digestive System
Esophagus
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Nutrients are required by all of the body’s cells
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Proteins
Lipids
Carbohydrates
Vitamins
Minerals
Cellulose fibers
and other vegetable matter
Functions of Digestive System:
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To process food substances
Absorb the products of digestion into the
blood
Excretion of unabsorbed materials
Provide an environment for
microorganisms to synthesize nutrients
(vitamin K - essential in blood clotting)
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Contains the lips, cheeks, palate, teeth,
salivary glands, muscles and maxillary
bone.
These organs are responsible for
mastication or chewing up food into
smaller particles to be swallowed.
Saliva amylase
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Reflex salivation can be triggered by
eating or even sight, smell or taste of food.
The parotid, submaxillary and sublingual
glands create about 1.5 Liters of saliva
everyday
Ptyalin (also known as salivary amylase)
is a starch digestive enzyme
The first breakdown of starch starts in the
mouth with the help/ presence of amylase
Saliva also contains water and glucose
which assists lubricating the meal as it is
being chewed making swallowing easier.
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Found anterior to the spine and posterior
to the trachea and heart in the
mediastinum.
It is a collapsible muscular tube about 10
inches long and it travels through the
diaphragm at an opening called
DIAPHRAGMATIC HIATUS
The esophagus carries food from the
pharynx to the stomach
Stomach
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Mouth
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Bamba
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Located within the peritoneal cavity (under
the left lobe of the liver) and the
diaphragm (upper left part of the
abdomen)
Mostly covers the pancreas
Hollow muscular organ that holds about
1500 ml of liquid
FUNCTION: serve as a food storage
during eating; secretes digestive fluids
and propels the partially digested food or
time into the small intestine.
The stomach is divided into 4 regions:
1. The cardia, which surrounds the
opening of the esophagus into the
stomach
2. The fundus of stomach, which is
the area above the level of the
cardial orifice.
3. The body of stomach, which is
the largest region of the stomach
4. The pyloric part, which is divided
into the pyloric antrum and
pyloric canal and is the distal end
of the stomach
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NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Cebu Doctors’ University l Fated Nurses
Clinical Instructor: Ms. Ortiz, J.
Small Intestine
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The stomach also has (mucous glands?)
that are located in the gastric mucosa and
prevent autodigestion by providing an
alkaline protecting covering.
2 sphincters:
> the cardiac sphincter (lower
esophagus sphincter) closes off the top
end of the stomach.
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prevents a reflux of gastric
contents into the
esophagus
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which is the gastrointestinal tract’s longest
part accounting for roughly three quarters
of the entire length.
It folds inwards and outwards providing
approximately (70 m or 230 ft) of surface
area
It is where secretion and absorption takes
place
3 Parts: Duodenum, Jejunum, Ileum
Duodenum - most proximal region
Jejunum - midsection
Ileum - distal portion
The Ileum comes to an end in the illusive
valve (also known as a sphincter)
regulates the flow of digested material
from the ileum into the sequel part of the
large intestine while preventing bacterial
reflux into the small intestine.
The vermiform appendix is an extension
that attaches to the cecum.
Physiologically, it serves little to no
purpose
The common bowel duct which empties
into the duodenum at the ampulla of vater
permits both bile and pancreatic fluids to
pass through
> the pyloric sphincter closes off
the bottom.
- which regulates the rate of
the stomach emptying into the small intestine
Large Intestine
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CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING
The length is around 5 ft or 1.5 m
It is made up of an ascending section and
the right side of the abdomen.
Transverse segment in the upper
abdomen that runs from right to left
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NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Cebu Doctors’ University l Fated Nurses
Clinical Instructor: Ms. Ortiz, J.
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Descending segment on the left side
Sigmoid colon, rectum and anus make
up the large intestine terminal section.
Anal outlet is controlled by a network of
striated muscle that forms both the
internal and external anal sphincters
FUNCTION: to absorb water and waste
elimination; responsible for the synthesis
of vitamin B complex and vitamin K with
the help of the intestinal bacteria.
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Pancreas
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Has both an exocrine and endocrine
function
Exocrine gland: secretes sodium
bicarbonate that neutralizes the acidity of
the stomach contents that enter the
duodenum
Pancreatic juices contains enzymes for
digesting carbohydrates, fats and proteins
Endocrine gland: secretes glucose to raise
blood glucose levels and secretes
somatostatin to exert hypoglycemic effect.
: located in the pancreas
(islets of langerhans) which secretes insulin important for carbohydrate metabolism
Refer to book (Table 44-1)
DIGESTIVE ACCESSORY ORGAN
Liver
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Largest gland in the body weighing about
3 to 4 lbs
It contains kupffer cells which remove
bacteria in the portal venous blood
Removes excess glucose and amino
acids from the portal blood
It synthesizes glucose, amino acids and
fats
It aids in the digestion of fats as it
produces bile, carbohydrates and proteins
Also stores and filters blood so it is highly
vascularized
About 200 to 400 ml of blood is being
stored by the liver
It also stores vitamin A, B and iron
Secretes bile about 500 to 1000 ml per
day which helps emulsify fats and broken
down into fatty acids so that the body can
use it.
CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING
Normal Digestion to Elimination Process
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NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Clinical Instructor: Ms. Ortiz, J.
1. INGESTION
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Begins with Ingestion in our mouth with
the help of the salivary glands.
In the mouth, it is where we chew food
and our food eaten has been broken down
into little particles that are injected and
combined with other enzymes which is
also the start of the digestion process.
With the help of saliva produced by the
salivary glands particularly the parotid,
submaxillary (submandibular) and
sublingual glands. With the help in the
breakdown of food.
Saliva also contains ptyalin (salivary
amylase) which breaks down
carbohydrates. Saliva also has water and
mucus which is helpful in lubricating the
meal as it is being chewed making
swallowing easier.
2. PROPULSION
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the ingested food that has been broken
down into pieces and there is already an
initial breakdown of carbohydrates. With
the salivary amylase it has been passed
down or propelled into our esophagus
through the act of swallowing.
swallowing begins initially as a voluntary
action controlled by the central nervous
system’s medulla oblongata swallowing
center.
epiglottis moves to cover the tracheal
opening as a bolus of food is swallowed.
This prevents food aspiration into the
lungs.
swallowing also forces the food bolus into
the upper esophagus, thereby comes to a
help as a reflex action
to move the bolus of food into the system,
the smooth muscle in the esophageal wall
contracts into a rhythmic sequence from
the upper esophagus to the stomach. This
rhythmic contraction pushes down food
towards the stomach. Subsequently the
lower esophageal sphincter then relaxes
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Cebu Doctors’ University l Fated Nurses
to allow the entry food, as it relaxes it also
Bamba
closesm2017
tightly to prevent reflux of the
stomach contents into the esophagus
3. DIGESTION
- this has two processes:
• Mechanical
➢ Mechanical breakdown of food happens
when the contents of the stomach are
being propelled toward the pylorus by the
peristaltic contraction. Now the large food
particles are being turned back into the
stomach since it cannot pass through the
pyloric sphincter.
➢ Inside our stomach the food is then
mechanically broken down into small
pieces or into smaller particles.
• Chemical
➢ This happens when the stomach releases
different gastric juices containing gastric
enzymes to produce or breakdown the
food particles into smaller portions so that
it will pass through the pyloric sphincter, it
is then known as chyme
➢ Chyme contains food particles that has
been broken down mechanically by our
stomach and it also contains gastric
enzymes
➢ Hormones, neural regulators, and local
regulators present in the gastric secretions
impact the stomach’s mobility or
influences the stomach’s motility and
modulate the rate of secretions
➢ The duodenum, also the first part of the
small intestines there is a continuation of a
chemical process. With the help of the
different accessory digestive organs which
are the: liver, gallbladder, pancreas.
They release different enzymes to help
breakdown the food into absorbable
particles that is utilized by our body
➢ Take note that our pancreas releases
amylase which breaks down
carbohydrates, lipase that digests fats,
trypsin and chymotrypsin which leaves
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NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Cebu Doctors’ University l Fated Nurses
Clinical Instructor: Ms. Ortiz, J.
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protein. The gallbladder releases or
emulsifies fats.
The pancreas also releases sodium
bicarbonate. Sodium bicarbonate is
alkalotic in nature, so it neutralizes the
chyme that has been passed from the
stomach to the duodenum is alkalotic in
nature, so it neutralizes the chyme that
has been passed from the stomach to the
duodenum so as to protect lining of the
duodenum.
These chemicals or enzymes are released
into their common pathway which is the
common bile duct, where everything
drains.
Common bile duct is connected to the
duodenum. As these progresses, this
branches out to the different organs
draining into the common bile duct. From
the common bile duct, this releases these
combined enzymes into the duodenum to
complete the chemical digestion process.
The bile is released by the gallbladder
passing through the cystic duct, releases
and draining into the common bile duct
The pancreas releases: sodium
bicarbonate, amylase, lipase and
trypsin through the pancreatic duct, flows
and meets at common bile duct. Then
release into the duodenum breaking
furthermore the chyme into its absorbable
contents
Bile is produced in the liver and stored in
the gallbladder, its function is to aid in
digestion and absorption of fats through
emulsification. The flow of the bile is being
controlled by Sphincter of Oddi which is
located at the junction of the common bile
duct
Pancreatic juice, bile, and small intestine
gland secretions total about 1 liter each
day including about 0.5 liter of bile and 3
liters of small intestine gland secretions
The Small Intestine contracts twice a
day in two methods: Segmentation and
Contraction
Segmentation contractions produce
mixing waves that move the contents of
the intestine back and forth. The contents
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of small intestine are pushed into the Bamba
colon by
the intestinal peristalsis
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➢ The process of digestion breaks down
food into absorbable particles when it is
consumed through lipids, proteins and
carbohydrates.
➢ When carbohydrates are ingested, this
will be broken down into glucose, fructose,
maltose, sucrose and galactose. When
proteins are ingested, this will be broken
down into amino acids and peptides. If
fats are ingested, this will be broken down
into monoglycerides and fatty acids.
➢ Now the chyme lingers in the small
intestine for about 6 hours, to allow
nutrients to broken down and absorbed.
Absorption also happens in the small intestine
through the villi
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Villi are little finger-like extension that run
the length of the gastrointestinal tract and
serve as a liner
helps the small intestine to both absorb
nutrition and to create digestive enzymes
Main role of the small intestine is absorption.
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Absorption of vitamins and minerals is
unaffected in the small intestine.
Active transport and diffusion over the
intestinal wall into the circulation begin in
the jejunum while nutrients are absorbed
in all throughout the intestine and
duodenum. Ilium is where vitamin b12
and bile salts are being absorbed. All
throughout the small intestine as well
absorption of magnesium phosphate and
potassium happens.
5. DEFECATION AND EXPULSION
Food is now being pushed through the ileocecal
valve - start of defecation and expulsion
happens
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Passes through the ileocecal valve
Leftover waste material moves into the
terminal ileum and slowly into the right
colon proximal part within four hours of
eating
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NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Cebu Doctors’ University l Fated Nurses
Clinical Instructor: Ms. Ortiz, J.
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Valves opens briefly and allows some of
the contents of the small intestine to enter
into the colon with each peristaltic wave of
the small intestine
The entry and the opening of the ileocecal
valve is dependent on the peristaltic
movement made by the small intestine
As a substantial component of the
contents of the large intestine, bacteria
play an important role in the complete
breakdown of waste materials such as
proteins and bile salts that have not been
digested or absorbed in the small intestine
electrolyte solution and mucous are the
two types of colonic secretions that are
added to the leftover material
Majority of the electrolyte solution in the
colon is bicarbonate
▪ neutralizes the bacterial
end products created in the
colon
Mucous protects the colonic mucosa from
the interluminal contents and helps the
fecal bulk cling to the feces
Colonic contents are moved along the
track by a slow feeble peristalsis
Colon's main rule is to allow for efficient
reabsorption of water and electrolytes
Because of the slow movement or the
slow peristalsis that is happening all
throughout the large intestine, the slow
movement allows reabsorption mainly of
water and other nutrients
o to make sure that the things that
we are passing outside our body is
really waste
The contents are propelled for long
distances with strong peristaltic waves
that occur on a regular basis
o usually happens when intestines
stimulating hormones are released
after another meal
o In roughly 12 hours, the waste
component from a meal reach and
distend the rectum
o As much as 1/4 of the waste
materials from a meal may still be
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in the rectum three days after the
Bamba
meal
has
been
ingested
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6. SECRETION
Undigested meals in organic elements water and
bacteria make up the feces
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fluid content of feces is roughly 75%
feces is mostly liquid in nature and only
25% of our feces is solid because a major
amount of the fecal mass is of non-dietary
origin produced from the secretions of the
gastrointestinal tract
dietary changes have little effect on
decomposition
bile is broken down by the bacteria that is
present in the large intestine resulting in
the brown color of the feces
stench or the smell of the feces is largely
due to chemicals produced by the
bacteria present in the large intestine
o methane hydrogen sulfide and
ammonia are among the gases
that are produced - either
absorbed into the portal circulation
and detoxified by the liver or
ejected from the rectum are
generally found in the GI tract and
it is expelled as a flatus
stool elimination begins with rectal
distension which triggers a reflex - it
relaxes the normally closed internal anal
sphincter and spasms of the rectal
muscles
autonomic nervous system is in charge
of the internal sphincter while the cerebral
cortex is in charge of the external
sphincter
external anal sphincter relaxes freely
during feces to allow the content of colon
to be evacuated
o normally, in a tonic contraction
condition by maintaining the
external anal sphincter closed
Defecation can be understood as a spinal reflex
that can be actively inhibited.
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NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Cebu Doctors’ University l Fated Nurses
Clinical Instructor: Ms. Ortiz, J.
Digestive Enzymes
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Hydrochloric acid (HCl) kills
microorganisms breaks down food into
small particles and provides a chemical
environment that facilitates gastric
enzyme activation
Pepsin is the chief coenzyme of gastric
juice which converts proteins into
proteoses and peptones
intrinsic factor comes from parietal cells
and is necessary for the absorption of
vitamin b12
Gastrin is responsible for controlling the
gastric acidity
Caution:
Metabolism is as a series of chemical reactions
that take place inside of our bodies to sustain life.
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the requirements of life in a human being
is maintaining a constant internal
temperature, reproducing, growing
body's ability to utilize four essential bio
molecules
Four essential biomolecules
1. Macromolecules
a. proteins,
b. fats,
c. carbohydrates or carbs
d. nucleic acids like DNA and RNA
All of these biomolecules perform different lifesustaining reactions inside of all of the cells in our
body to promote life.
Metabolism is the study of how we're able to
obtain these important biomolecules to sustain
life.
How do we obtain biomolecules?
Eat food to obtain all of these important
biomolecules.
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Since most food comes from living organisms like
plants and animals, these plants and animals
also contain an array of proteins, fats,
carbohydrates and nucleic acids but not
necessarily in the same flavor or configuration
that our bodies would prefer.
What do our bodies do?
In our bodies, we go ahead and eat the food. We
break down this food through a process called
digestion.
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Two Types of Metabolism
1. Anabolism
2. Catabolism
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Smallest subunit of proteins is called an
amino acid and our body breaks down all
the different types of proteins that we
digest into individual amino acids
The same pattern continues for the rest of the
biomolecules
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Fatty acids which are the smallest
subunits of fats
Carbohydrates are long chains of sugars
o one of the most common subunits
of carbohydrates that our body
loves is called glucose
Nucleic acids
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nucleotides
our body has a delicate balance going on
between the processes of breaking down
molecules such as in the process of
digestion and then taking these products
and building them back up
Metabolism is a balance between breaking things
down and building them back up in our body.
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Catabolism: (to remember, think of the
letter C. Cutting. Cutting molecules up
into
tiny
pieces.
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Anabolism: used to describe the
process of building molecules back up.
(To remember, think of the letter A.
Apex. Apex of a building. Building
molecules back up requires energy.
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NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Cebu Doctors’ University l Fated Nurses
Clinical Instructor: Ms. Ortiz, J.
Discussion:
The energy comes from eating food. The
energy currency of our bodies is a molecule
called ATP or adenosine triphosphate. This
high energy molecule, when it is broken down
into ADP so it loses a phosphate group. It
releases usable chemical energy that can fuel
energy-requiring processes of in our body
such as the building up process of anabolism.
In order for this process to continue non-stop
in our bodies, ADP must be regenerated into
ATP, and that is where food comes in.
Remember: We digest our food into all of
these subunits. Some of these subunits such
as glucose and fatty acids mainly but
occasionally amino acids can essentially be
used as fuels in our body. These fuels in our
body can essentially be broken down even
further to produce the energy that’s necessary
to convert ADP back into ATP. Thus, allowing
this cycle to continue.
Cellular Respiration involves breaking down
things even further. It is a catabolic process.
Catabolism fuels anabolism.
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Catabolism is coupled with this process
of building things back up. In essence,
one relies on the other. These
processes are really tightly regulated in
our bodies because you wouldn’t want
to be breaking down something while
you're building something back up. In
fact, catabolism and anabolism are
often regulated through the use of
hormones.
Hormones are a form of regulation and
they tell the body whether it should be
in a catabolic or anabolic state.
CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING
Factors influencing an individual’s
metabolic rate
(MR)
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Bamba
Activity/ Exercise
Elevated body temperature
Hormonal activity
Digestion
Age and growth
Gender
Climate
Drugs or taking in medications
FACTOR
Surface
Area
Sex
Thyroxine
production
Age
VARIATION
EFFECT ON
BMR
Large in relation to
body volume =
thin/small
individuals
Small = large
individuals
Male = higher
Female =
Increased =
Decreased =
Young, rapid
growth = they need
more energy, more
calories
Aging, elderly =
slower MBR
Strong
emotions
(anger/fear)
& infections
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NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Cebu Doctors’ University l Fated Nurses
Clinical Instructor: Ms. Ortiz, J.
World Food Programme (WFP)
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In-charge of food aid
Largest humanitarian organization
dedicated to hunger and food security
in the world
The largest provider of school meals
Based in Rome and has offices in 80
countries
Founded in 1961.
It serviced 115.5 million people in 80
plus countries as of 2020 and it is the
highest number since 2012
This program has been created to
address deficiencies of iron vitamin A
and Zinc which are ranked among the
world health organization’s top 10
leading causes of death through
disease in developing countries.
Micronutrient Deficiencies: mostly affects
children
Iron
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The most prevalent form of malnutrition
worldwide, affecting millions of people.
Iron deficiency also impedes cognitive
development, affecting 40-60% of
children aged 6-24 months in
developing countries.
Vitamin A
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Increases the risk of dying from
diarrhea, measles and malaria by 2024%
Affecting 140 million preschool children
in 118 countries and more than seven
million pregnant women, it is also a
leading cause of child blindness across
developing countries.
Iodine
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Affects 780 million people worldwide.
The clearest symptom is a swelling of
the thyroid gland.
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According to UN research, some Bamba
20
millionm2017
children are born mentally
impaired because their mothers did not
consume enough iodine.
Zinc
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Contributes to growth failure and
weakened immunity in young children.
It is linked to a higher risk of diarrhea
and pneumonia, resulting in nearly
800,000 death per year.
BODY BUILD (Type, Size, Composition)
Type - refers to the category if physique. It is
a description of any kind of human body shape
using general body descriptors.
Example: slim, fat, tall, petite, wide shoulder,
pear shape, etc)
Size – refers to the person’s height and weight
Composition – refers to the person’s body fat
percentage.
3 Extreme Body Types
1. Endomorph (Pykinic)
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A pear-shaped body
A rounded head
Wide hips and shoulders
Wider front to back rather than side to
side
A lot of fat on the body, upper arms, and
thighs
2. Mesomorph (Sthenic)
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A wedged-shaped body
A cubical head
Wide broad shoulders
Muscled arms and legs
Narrow hips
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NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Cebu Doctors’ University l Fated Nurses
Clinical Instructor: Ms. Ortiz, J.
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Narrow from front to back rather than
side to side
A minimum amount of fat
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3. Ectomorph (Asthenic)
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A high forehead
Receding chin
Narrow shoulders and hips
A narrow chest and abdomen
Thin arms and legs
Little muscle and fat
FAT AND MUSCLE DISTRIBUTION
Obesity
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Increases the risk of diabetes, heart
disease stroke, arthritis, and some
cancers
If an obese person loses even 5-10% of
his/her body weight, it can delay or
even prevent some of these diseases
Overweight
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Weighing too much
Weight may come from muscle bone fat
and or body water
Note: Both terms means that a person’s weight
is greater than what’s considered healthy for
his or her height.
Cachexia
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Extreme loss of weight and body
wasting associated with a serious
illness
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Fat is mainly accumulated in hip, middle
Bamba
abdomen
and
thigh
surroundings
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Aging = whole figure assumes a
stooping posture and the spine is never
erect due to the heavy hips and thighs
Vital organs affected mostly are
kidneys, uterus, intestines, bladder,
and bowels
Exercises or dieting will not help
appreciably in reducing weight
B. Android/ Apple-Shaped
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Most are males
Fat is mainly stored in abdomen
Vital organs affected will be mostly the
heart, live, kidneys & lungs (major risk
for heart damage & heart disease due
to high cholesterol)
C. Ovoid/ Barrel-Shaped
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Gait is more rolling rather than walking
Fat tissues in body hinder the
movement of all the internal organs &
consequently
affect
their
brisk
functioning
Any exercise is difficult due to the
enormous size of the body
Comparison of the Body Fat
Percentage between a Man and a
Woman
Starvation
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Can be reversed through refeeding
A. Gynoid/ Pear-Shaped
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Most are females
Narrow shoulders
Small breast
Slim waist
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<3 END OF VIDEO 1 <3
10
NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Cebu Doctors’ University l Fated Nurses
Clinical Instructor: Ms. Ortiz, J.
Video 2:
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Opening or split on the upper lip, the roof of
the mouth, or the palate or both are known
as cleft lip and cleft palate.
Cleft Lip and palate are birth abnormalities
that occur when the lip or mouth of a baby
does not develop normally during
pregnancy.
These congenital malformations are
collectively known as orofacial clefts.
The most frequent birth abnormalities are
cleft lip and cleft palate. They are most
typically found as single birth abnormalities
but they are also linked to a variety of
inherited genetic disorder and syndromes.
Cleft lips can develop on one or both sides
of the lip or in the center, which is extremely
unusual. The separation can include the
gum line or the palate.
A cleft palate is a split or opening in the
roof of the mouth. It can involve the hard
palate, which is the bony front portion of the
roof of the mouth and/or the soft palate,
which is the soft back portion of the roof of
the mouth and can be associated with a
cleft lip.
Cleft lip and cleft palate can occur on a one
or both sides of the mouth as mentioned
earlier. Because the lip and the palette
develop separately, it is possible to have a
cleft lip without a cleft palate. A cleft palate
without a cleft lip or, both a cleft lip and a
cleft palate together is the most frequently
occurring defect.
Cleft lip and/or cleft palate affects 1 in
1,000 babies every year and it is the 4th
most common birth defect in the US. Clefts
occur more often in children of Asian
descent. Twice as many boys as girls have
a cleft lip both with and without a cleft
palate. However, twice as many girls as
boys have cleft palate without a cleft lip.
Pathophysiology
Predisposingm2017
Factor:
•
Genetics
Precipitating Factors:
•
•
•
Smoking
Diabetes
Use of certain medications such as:
topiramate or valproic acid
Discussion:
•
•
•
•
•
•
•
CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING
Bamba
The lips develop between the 4th and 7th
week of pregnancy. Body tissue and
specific cells from either side of the head
grow toward the middle of the face during
pregnancy and combine together to form
the face. The lips and mouth for example,
are formed by the connecting of tissue
between the 6th and 9th week of pregnancy,
the palate or the roof of the mouth is
created. They are created separately.
Most cases of cleft lip and palate are
thought to be caused by a combination of
hereditary and environmental factors. A
definite reason isn’t found yet in many
newborns.
Cleft genes can be passed down from
either the mother or the father, either alone
or as part of a genetic condition that
includes a cleft lip or palate as one if its
symptoms.
In some situations, kids are born with a
gene that makes them more likely to
develop a cleft and then the cleft is caused
by an environmental trigger.
Women who smoke during pregnancy, are
more likely than non-smokers to have a
baby with an orofacial cleft.
When compared to a woman who did not
have diabetes before pregnancy, women
with diabetes had a higher risk of having a
child with a cleft lip and or cleft palate.
Women who took specific epilepsy
medicines during their first trimester or the
first three months of pregnancy which is the
formation of the lip and the palate occurs
such as topiramate or valproic acid had a
11
NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Cebu Doctors’ University l Fated Nurses
Clinical Instructor: Ms. Ortiz, J.
higher chance of having a baby with a cleft
lip with or without cleft palate than women
who did not take these medicines.
FUSION FAILURE OF THE MAXILLARY AND
PREMAXILLARY PROCESSES
CLEFT PALATE FAILURE OF FUSION OF
TWO PALATINE SHELVES
•
•
•
Dental problems. Tooth development Bamba
may bem2017
hampered if the cleft extends
through the upper gum.
Speech difficulties. A cleft palate can
impede the development of proper speech
since the palate is utilized to generate
sounds. It’s possible that the speech is too
nasal(?).
Challenges of coping with a medical
condition.
Due
to
disparities
in
appearance and the stress of rigorous
medical care, children with clefts may
experience
social,
emotional,
and
behavioral issues.
Physical Assessment Diagnostic
•
•
Discussion: Failure of the maxillary and
premaxillary processes to fuse during the 5 th to 8th
week of intrauterine life causes cleft lip while failure
in the fusion of two palatine shelves result in the
formation of the cleft palate. Cleft lip/palate can
either be complete or incomplete.
•
Complications
•
•
Difficulty feeding. Feeding is one of the
most pressing concerns after birth. While
most babies with a cleft lip can be
breastfeed, sucking might be challenging
for those with a cleft palate due to the
incomplete closure of the palate not
creating a seal while the baby is sucking
with a separation or opening in the palate,
food and liquids can pass from the mouth
back through the nose.
Ear infections and hearing loss. Cleft
palate babies are at an increased risk of
acquiring middle ear fluid resulting to
hearing loss.
CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING
•
•
Cleft lip is diagnosed based on the
newborn’s physical appearance while a
cleft palate is diagnosed at delivery.
During inspection, cleft palate is diagnosed
at birth with a thorough examination of the
newborn’s palate. This is to ensure that a
cleft palate is not missed. The examiner
must enter a gloved finger into the
newborn’s mouth and feel the palate to
ensure that it is intact.
During
observation,
the
outward
appearance of the infant can be used to
diagnose cleft lip and palate. Aside from
that, a submucosal cleft palate which
occurs only in the muscles of the soft palate
is less common and is hard to diagnose.
Signs and symptoms are difficulty with
feedings,
difficulty
swallowing
with
potential for liquids or foods to come out on
the nose. Nasal speaking voice and chronic
ear infection.
During pregnancy, a routine ultrasound will
reveal an orofacial cleft.
Surgical Management
The focus of management for patients with
orofacial clefts is through surgery.
•
Cheiloplasty.
o Is reconstructive
repairs a cleft lip
surgery
that
12
NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Cebu Doctors’ University l Fated Nurses
Clinical Instructor: Ms. Ortiz, J.
o
Performed when the patient is at 3
months old or weighs 12 pounds.
Discussion: A cleft lip may require one or two
surgeries depending on the extent like if it is
complete or incomplete and the width or if it is
narrow or wide of the cleft. The first surgery is to
close the lip usually occurs when the baby is
between 3 and 6 months old or the baby weighs 12
pounds. The second surgery, if necessary, is
usually done when the child is 6 months.
•
Bamba
m2017
Image (below) of patient with a bilateral cleft lip
and after bilateral cheiloplasty.
Palatoplasty.
o Is reconstructive surgery that
repairs a cleft palate
o Repair of a cleft palate is
performed at 12 months
Discussion: To address cleft palate, palatoplasty
is performed. Repair of a cleft palate is performed
at 12 months and creates a working palate and
reduces the chances that fluid will develop in the
middle ears. To prevent fluid buildup in the middle
ear, children with cleft palate usually needs special
tube placed in the eardrums to a fluid drainage and
their hearing needs to be checked once a year.
This is often done at the time of palate repair.
Figure 2 (image below) -A and B- Pre- and
postoperative aspect of cheiloplasty (surgical
repair of the lip); C and D – Pre- and postoperative
aspect of palatoplasty (surgical repair of the
palate)
Medical Management
Several techniques can improve the outcomes of
cleft lip and palate repairs when used appropriately
before surgery. They are non-invasive and
dramatically change the shape of the baby’s nose
and mouth.
•
•
•
Lip-Taping Regimen
o Can narrow the gap in the child’s
cleft lip
Nasal Elevator
o Used to help form the correct shape
of the baby’s nose
Nasal-Alveolar Molding (NAM)
o This device is used to help mold the
lip tissued into a more favorable
position and preparation for the lip
repair
Nursing Management
Another image (image below) shows a complete
unilateral cleft lip which also reveals the post-op
condition of the patient.
CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING
This can be applicable pre and post operatively to
patients with orofacial clefts.
•
•
Suction secretions gently
Place the infant on the side to prevent
pressure and tearing of the suture line
after CL surgery.
13
NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Cebu Doctors’ University l Fated Nurses
Clinical Instructor: Ms. Ortiz, J.
If the surgical site is on the patient’s
left side, we should position the
patient to his/her right side.
Feed the infant using a commercial cleft
lip nipple (Brecht or Haberman feeder)
o This is for both pre-op and post-op.
o
•
L-Larger Nipple Opening
m2017
I-Incidence ^ (increased)
in Males
P-Prevent Crust Formation; Prevent Aspiration
Evaluation
•
•
•
•
•
•
•
Method: Enlarge, Stimulate, Swallow,
Rest (ESSR)
o Follow the method enlarge,
stimulating the infant by brushing
off his or her side of the cheek
allowing the infant to swallow and
allowing rest period before doing
another feeding.
Instruct the mother how to pump or
manually express breast milk to
maintain a supply at this time.
o This is to maintain a good milk
supply at this time while the infant
cannot directly latch on the
mother’s breast.
Bubble the infant well after feeding
Offer small sips of fluid (clear water) or
place drops of NSS (Normal Saline
Solution) to prevent drying of the
mucous
membranes
and
crust
formation
Keep the suture line as clean as
possible after feeding.
o To prevent infection.
CLEFT LIP-POST OP CARE
C-Choking
L-Lie on Back
E-Evaluate Airway
F-Feed Slowly
T-Teaching
CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING
Bamba
Child’s respiratory rate is 20-30 breaths per
minute without retractions or obvious
distress.
Child ingests an adequate diet of 50
kcal/lbs. (110 kcal/kg) in 24 hours; weight
is maintained within 10& of birth weight.
Malnutrition
-is a condition that occurs when a person’s body
is not getting enough nutrients.
-The cellular imbalance between supply of
nutrients and energy and the body’s demand for
them to ensure growth, maintenance, and specific
functions (WHO).
Nutrition in the first 1,000 days of a child’s life
by UNICEF
1,000 days, that’s the number of deadlines for
reaching MDGs and the number of days in which
to save a child’s future. When children are denied
the right nutrition from pregnancy to the age of two
they suffer stunting, the damage to their
development is irreversible, there’s no cure
extended children are not only shorter than they
might have been, they’re more susceptible to
disease, at higher risk of obesity, diabetes, and
cardiovascular disease. Their brain cells don’t
grow as they should connections between brain
cells fail to develop so they’re more likely to fall
behind in school ☹ to earn less in the future and
thus not to contribute as fully as they could to their
nation’s prosperity. 165,000,000 children under
the age of five stunted worldwide, no child deserve
this, no society should allow it, we can prevent
stunting and at relatively little cost. All it takes are
micronutrients, handwashing, breast feeding, good
child feeding practices, and community nutrition
program. When every child can fully seize the
future, it is our future that benefits as well.
14
NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Cebu Doctors’ University l Fated Nurses
Clinical Instructor: Ms. Ortiz, J.
The first 1,000 days of life is a critical stage of a
child’s growth and development, this stage begins
from the time of conception up until the second
year of a child. It offers a golden opportunity for
parents to shape a healthier and more prosperous
future for their child. The first 1,000 days of life
consist of three separate stages:
1. Pregnancy. This includes the first 270
days of the baby inside the womb to
birth, during this stage a mother’s nutrition
and care is a matter of utmost importance.
Mothers should drink iron and folate to
prevent anemia and birth defects. It is
important for mothers to consume
adequately iodized salt during pregnancy.
Iodine deficiency may reduce IQ by as
much as 10-15 points and may also lead
to low birth weight or still birth. A
balanced diet including rice, meat/fish,
green leafy, vegetables, yellow fruits and
milk/egg products can help ensure
optimum health of the mother and her child.
2. Infancy. This includes from the time of
baby’s birth up to their first 180 days or
from zero to six months. The first hours
after birth the baby will be able to receive
colostrum from the mother’s breast milk,
colostrum is the baby’s first vaccination
and protection from life-threatening
diseases it can also increase the baby’s
IQ by five to seven points.
3. Toddler years. This includes the next 550
days after infancy or the baby’s first seven
months after his second year. The baby
can still continue to breastfeed during the
toddler years. During this time, the baby is
ready to take in semi-solid foods from six to
twenty-three months.
With proper care and nutrition;
❖ Children can overcome and prevent lifethreatening diseases.
❖ Complete 4.6 more grades of school.
❖ Have healthier families during adulthood.
CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING
In the Philippines…
•
•
•
Bamba
Metro m2017
Manila (CNN Philippines, May 02,
2017)- According to Save the children
foundation, 1 in 3 children below 5 years
old in the Philippines is malnourished.
Food and Nutrition Research Institute: 26
percent of children up to 2 years old suffer
from chronic malnutrition, the highest
number in 10 years.
Many children, including those in poor
communities, may have access to food, but
they’re not eating right, because parents
lack basic knowledge on proper nutrition.
National Nutrition Council (NNC) under the
Health Department is launching an action plan for
nutrition.
•
•
•
Seeks to get commitment from partners
and
stakeholders,
especially
local
government units, to support services.
Reminds parents that as a rule of thumb
children past the breastfeeding age should
always have four things on their plate:
carbohydrates, protein, vegetables, and
plenty of fruits.
According to DOH, it is also considered an
integral part of the Philippine Development
Plan 2017-2022 and the Duterte
administration’s
10-points
economic
agenda.
Causes of Malnutrition;
•
•
•
•
Inadequate food intake (main problem)
Poor standard of living
Inadequate understanding or knowledge
for optimal nutrition intake
Inadequate absorption
According to the Savethechildren.org.ph. 33.4% of
Filipino children under the age of five are stunted.
9.1% of Filipino newborns have low birth weight
due to intrauterine growth restriction. 7.1% of
Filipino children under the age of five have wasting
which means that they are too thin for their weight.
21.5% of Filipino children under the age of fiver are
underweight.
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NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Clinical Instructor: Ms. Ortiz, J.
Cebu Doctors’ University l Fated Nurses
the needs to function. Protein energy malnutrition
Bamba
doesn’t occur m2017
due to short-term illnesses, it is more
likely due to the malnutrition over a long period of
time.
•
•
•
•
Healthy- Normal weight and height
Wasted-Thinner than normal
Stunted- Shorter than normal
Wasted and Stunted- Thinner and shorter
than normal
World Health Organization estimates that by 2025
about 127 million children under five years old will
be stunted assuming that current trends continue.
With Covid-19 pandemic, there is a possibility that
more children will be stunted if there are no
mitigating measures that are put in place.
•
•
•
•
Republic Act (RA) 11148 or the
Kalusugan at Nutrisyon ng Mag-nanay Act
RA 10028 of the Expanded Breastfeeding
Promotion Act
RA 11210 or the Expanded Maternity
Leave Act
Executive Order 52 or the Philippine Milk
Code
Kwashiorkor vs. Marasmus
Discussion: Our body needs calories, protein and
overall general nutrients to function, without
adequate nutrition our muscles waste away, our
bones become brittle and our thinking becomes
foggy. Calories are units of energy that our body
needs to function, our body also needs a large
amount of protein for without an enough protein,
we might not be able to easily heal injuries or
wounds. One type of malnourishment is protein,
called protein energy malnutrition.
Protein energy malnutrition
-happens if the body has a severe calorie or
protein deficiency. This can occur if a person does
not consume the number of calories and protein
CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING
Kwashiorkor
-occurs in people who have a severe protein
deficiency. Children who develop kwashiorkor are
often older than children who have marasmus.
-Having a diet that is mainly carbohydrates can
lead to this condition because there is no protein
that has been included in child’s diet.
Marasmus
-a form of nutrition deficiency disorder usually
occurring in children. It can be life threatening if it
has not been diagnosed at an early stage.
-Marasmus occur more often in young children and
babies. Leads to dehydration and weight loss.
Starvation is a form of this disorder; this is also due
to the inadequate calorie intake.
Pathophysiology:
KWASHIORKOR
↓Protein (CHON) → Main S/S: protruding belly,
ankle edema → Kwashiorkor
Review: Protein (CHON) is required in our body
for cell repair and cell regeneration. This nutrient is
important during pregnancy and the child’s growth
and development. Without protein in our diet
resulting protein deficiency, this has an effect and
alteration on the growth and development of our
normal bodily function.
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NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Cebu Doctors’ University l Fated Nurses
Clinical Instructor: Ms. Ortiz, J.
-
CLINICAL MANIFESTATIONS
OF KWASHIORKOR
EDEMA
The presence of edema and Kwashiorkor is
correlated with very low albumin concentration.
- Edema results from a loss of fluid balance
between the hydrostatic and oncotic
pressure across the capillary blood vessel
walls due to the lack of protein which
affects the body’s ability to draw fluid from
the tissues into the bloodstream.
- Low albumin concentration negatively
influences the strength of oncotic pressure
- Failure leads to buildup in the abdomen
resulting in edema and belly distention.
- In simpler terms, edema is a RESULT of
hypoalbuminemia
o Albumin comes from the protein
that we ingest.
o Lack of protein in the diet will result
to low albumin present in our body.
Our albumin is located INTRAVASCULARLY (so
it is only present inside the blood vessel)
-
Albumin creates an oncotic pressure.
Kwashiorkor=lack of albumin
intravascularly
Oncotic pressure is low=fluid leak of the
blood vessel wall
Fluid shifting- the fluid has been
transferred or leaked extravascularly
causing edema.
HYPERKERATOSIS & DISPIGMENTATION
- There is a reduction of enzymes in the
skin causing hyperkeratosis and
dispigmentation
FATTY LIVER
- Caused by a reduction of beta lipoprotein
synthesis causing fatty changes inside the
liver
- Beta lipoprotein is essential in exporting
lipids
ANEMIA
- Reduced globin in our body resulting to
reduced hemoglobin and reduced RBC
causing anemia.
MARASMUS
Marasmus is mainly caused by inadequate food
intake of all food groups. Inadequate food intake
can be caused by the following:
•
•
Another contributing factor why edema is present
in some patients with kwashiorkor is the release
of the ANTI-DIURETIC HORMONE.
-
-
our body will perceive that the pressure
inside our blood vessel wall is low causing
HYPOVOLEMIA
As a compensatory mechanism, our body
releases ADH.
It restricts or it does not allow fluid to be
eliminated outside of our body.
o Causes edema, specifically the
peripheral edema.
CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING
Plasma renin is also being stimulated Bamba
causing
sodium retention
m2017
•
Poor diet
o A nutrient-rich balanced diet is
important for growth, especially in
children. If the child has a poor diet
that lacks essential nutrients, the
child may be at risk of developing
marasmus.
Food shortages
o Marasmus is more common in
developing countries that have
high poverty and lack of food,
these regions also have a frequent
famines and natural disasters
resulting in food shortages.
Children and adults living in these
areas are at higher risk of getting
marasmus.
Insufficient breast feeding
o Mother's milk is rich in nutrients
that help children grow, if mothers
are malnourished, they are unable
to feed their infants enough milk
for breast feeding. This can cause
or this can increase the chances of
17
NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Clinical Instructor: Ms. Ortiz, J.
•
•
protein energy malnutrition in
children.
Infections and diseases
o Infections and diseases caused by
viruses, bacteria, parasites and
other pathogens can cause a loss
in appetite, this can lead to a low
intake of essential nutrients in
infected children and adults.
Diseases such as HIV/AIDS and
malaria in rural areas can cause
marasmus, it can also be caused
by poor absorption of nutrients due
to celiac disease and pancreatic
problems
Anorexia
o Although marasmus in developed
countries is quite rare, any person
can get this condition if they are
subject to a severe lack of
nutrients, if someone isn't getting
enough food due to an eating
disorder, their body will be at risk
of malnutrition
Cebu Doctors’ University l Fated Nurses
Bamba
m2017
So this is a comparative chart between a patient
with marasmus and kwashiorkor.
Severe protein and calorie deficiency in children
can result in loss of fat and muscle mass, the
most common symptom of marasmus is being
underweight due to malnourishment. The
following symptoms can occur due to deficiency,
dehydration, electrolyte imbalance or infection if
marasmus remains untreated for a long time:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Weight loss
Stunted growth
Dry skin and eyes
Brittle hair
Diarrhea
Lower immunity
Stomach infection and lactose intolerance
Respiratory infections
Rickets due to calcium and vitamin D
deficiency
Anemia due to iron deficiency
Impaired brain function and intellectual
disability
Low blood pressure or hypotension
Low body temperature or hypothermia
Slow heart rate or bradycardia
CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING
18
NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Cebu Doctors’ University l Fated Nurses
Clinical Instructor: Ms. Ortiz, J.
Discussion:
Comparative chart for patients with
kwashiorkor and marasmus.
•
•
Appearance for kwashiorkor it usually
appears between 0 to 5 years old
o Deficient: Protient
o Has pitting edema
o Activity: apathetic & irritable
o Presence of hair changes
o Subcutaneous Fat: Reduced
o Face: moon-shaped face
o Mental changes: very common
o Anemia: severe
o Fatty liver: present
o Dermatosis: common
o Infection: most prone
Appearance for marasmus it usually
occurs below 1 year old
o Deficient: Calories
o No edema
o Activity: apathetic
o Wasting: markedly present
o Uncommon for hair changes
o Subcutaneous Fat: Absent
o Face: like an old man’s
o Mental changes: uncommon
o Anemia: present
o Fatty liver: absent
o Dermatosis: does not occur
o Infection: less prone
PHYSICAL ASSESSMENT
•
•
•
LABORATORY ASSESSMENT
•
•
•
•
•
•
SIGN AND SYMPTOMS:
•
•
•
•
•
•
Clinically: failure to gain weight followed
by weight loss and emaciation
Fat is lost last from the cheeks = “old
man’s face”
Abdomen = flat or distended
Muscle atrophy and hypotonia
Low BMR
Infant: constipated or have the “starvation
type” of diarrhea with mucus
CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING
Low albumin concentration
Low plasma glucose
Ketonuria
Low plasma amino acids
Decreased K+, Mg++
Low cholesterol
MANAGEMENT
•
Based on management of the associated
conditions (infections, dehydration,
anemia, diarrhea) and institution of
adequate diet
WHO 10 steps to management of severe acute
malnutrition
STABILIZATION
Reduction of edema and restoration of tissue and
body organ function through:
MARASMIC KWASHIORKOR
Child can develop pitting edema, protein
insufficient, severe malnutrition
m2017dietary history
An accurate
Evaluation of height, weight, head
circumference and past rates of growth
Measurement of mid-arm circumference
and skin fold thickness and other tests
DIAGNOSIS
•
•
Bamba
•
•
•
•
•
Treatment of infection and other medical
problems
Providing sufficient energy and nutrients
Correcting electrolyte imbalance using the
formula diet F-75 that contains 75 cal and
0.9 grams of protein per 100 mL
Children 60-66 aged months: SAM
(severe acute malnutrition) height/weight >
(-3) standard deviations of WHO
standards or mid upper arm circumference
of less than 115 millimeters and presence
of bilateral edema
SAM affects 20 million children under age
of 5 and 1-2 million preventable deaths
every year
Risk for death compare to moderate
malnutrition
19
NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Cebu Doctors’ University l Fated Nurses
Clinical Instructor: Ms. Ortiz, J.
•
•
Fatality rates remain high at about 20-60
%
Children with complicated severe
malnutrition those with poor appetite,
fever, pneumonia, dehydration, severe
edema, or infants aged in patients
facilities until complication are resolved
Bamba
m2017
REHABILATIONS
•
•
•
•
•
Providing extra energy and nutrients
Utilization of formula F-100 containing 100
kcal and 3 grams of protein per 100 mL
Mental stimulation through play sessions
Health education to the significant other
Children provided with extra energy and
nutrients for rapid weight gain and for
rapid weight gain and catch-up growth
TRACHEOESOPHAGEAL FISTULA
ASSESSMENT
- is an abnormal connection (fistula)
between the esophagus and the trachea,
TEF is a common congenital abnormality,
but when occurring late in life is usually
the sequela of surgical procedure such as
laryngectomy
UNCOMPLICATED SEVERE ACUTE
MALNUTRITION (can be managed in the
community)
•
Ready-to-use therapeutic food (RUTF)
o An energy-dense micronutrientfortified food with properties similar
to F-100
o Does not require cooking
o Has a low moisture content giving
long shelf life
o Does not require supervised
feeding this approach also
addresses lack of the access
coverage and timely treatment
associated with traditional inpatient model it has been widely
shown to achieve good levels of
nutritional recovery to reduce
mortality and to shorten the
duration of inpatient treatment for
children with SAM
o Integrating these two arms of
treatment allows referral of
complicated cases presented in
the community to treatment
centers for stabilization and
subsequent discharge of children
for rehabilitation once
complications are resolved
CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING
3 C’S
•
•
•
•
•
•
Coughing
Choking
Cyanosis
Atresia with distal Fistula – the
esophagus has been cut and another end
of esophagus sticks to the trachea
Atresia with double fistula- both ends of
the esophagus that has been cut off a
stick to trachea creating fistula
Atresia with proximal fistula – upper
portion of the esophagus that has been
cut off stick to trachea and the other end
connects to the stomach has been left
20
NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Cebu Doctors’ University l Fated Nurses
Clinical Instructor: Ms. Ortiz, J.
•
•
Atresia – the two esophagus has not
been completely connected and there is
not fistula or there is no end that stuck into
trachea
Fistula – there is no disconnection
between or there is no interruption
between esophagus however there is an
abnormal sticking on one side of the
esophagus to the trachea
Diagnostic examination:
•
•
•
Sonogram
Feeding tube passed stops at 10-12 cm
instead of 17 cm
Follow-up with Radiographics studies,
absence of air in stomach- EA w/o TEF
Management:
•
•
•
Gastrostomy feeding/ TPN – to support
nutritional requirement of the body
Closing of fistula and gastronomy insertion
(to minimize gastroesophageal disease
GERD)
Anastomosis – reconnection of ruptured
esophagus
MALIGNANT TEFs
•
•
•
•
•
•
m2017 and started promptly
Individualized,
Palliative care
o Relief of obstruction
o Diversion of contamination from
the respiratory tract
Procedures
o Endoprosthesis (covered selfexpandable metal stent SEMS)
o Esophageal exclusion or bypass,
resection, or direct closure
Procedure that holds upon a structure in
gastrointestinal tract to allow the passage
of food kind stool or other secretion
related to digestion
Surgeons insert stems by endoscopy
inserting optic camera either passing
through the mouth or the colon ton reach
an area of narrowing
SEMS inserted using fluoroscopy where
the surgeon uses an x-ray image to guide
the insertion or an adjunct to endoscopy
NURSING MANAGEMENT
Pre-op (prevention of aspiration and
regurgitation)
•
•
•
CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING
Bamba
NPO
Continuous suction
Supine with elevated head (decreases
pressure on thorax and minimize reflux
of gastric acid secretion intro trachea
and bronchi)
21
NCM 116: THEORY
MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION
Clinical Instructor: Ms. Ortiz, J.
Cebu Doctors’ University l Fated Nurses
POST-OP:(patent airway, prevent trauma)
•
•
•
•
•
•
•
Gentle sanctioning
Observation for airway obstruction
NPO until bowel sounds return
IV (dextrose solutions) & TPN to prevent
hypoglycemia
Glucose water if tolerated then formula pr
breast milk for babies
Pacifier to prepare for oral feeding
Barium swallow: to check for any leaks
before resuming 1 week after
Bamba
m2017
TEF Complication: Aspiration pneumonia
Objective of care:
•
•
Airway will remain patent
Hydration maintained
Family teaching
•
•
Observe for esophageal stricturedysphagia, increased drooling, coughing,
choking
Gastrostomy, care and feeding
CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING
22