AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Gastrointestinal System
Instructor
Serial/Semester
Location
Start/Finish Time
Date
LESSON OBJECTIVE
Performance: To gain an understanding of the gastrointestinal system.
Conditions:
The student will be presented a powerpoint presentation by the instructor and will have
all necessary references made available to him/her.
Standard:
1.
Given the five elements of the nursing care process and a scenario of a patient in
the clinical setting with a gastrointestinal disorder by correctly responding to
written, oral, and experiential assessment measures .
TEACHING POINTS
1. Define key terms related to the
gastrointestinal system.
2. Identify common diagnostic tests used to
determine gastrointestinal disorders and
determine nursing interventions and patient
teaching for the patient undergoing diagnostic
testing for disorders of the gastrointestinal
system.
3.
4.
5.
6.
7.
8
9.
10.
INSTRUCTIONAL STRATEGY
Interactive Lecture
Method:
Instructor
Media:
Classroom
Environment:
OTHER LESSON SPECIFICATIONS
Knowledge Lesson
Type of Lesson:
1/50
Ratio:
Resources:
.
End of Lesson Test: None
Instructional Time: 129
Reference(s):
ISBN 0-323-01728-2
Adult Health Nursing, 4th Edition
01 Jan 2003
Minutes
LESSON PLAN APPROVAL
Signature of Standards Officer
Date
AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Gastrointestinal System
INTRODUCTION
Allocated Time:
Review:
5 Minutes
You have had previous anatomy and physiology lectures in your combat medic
training, this lecture will build upon prior instruction.
Objective:
To discuss/describe topics related to the nursing process.
Importance:
Nurses work in various health care settings so it is important to gain an
understanding of this subject as it will apply to your clinical practice.
Fit:
The digestive tract, or alimentary canal, is a musculomembranous tube existing
from the mouth to the anus and is approximately 30 feet long. It consists of
the mouth, pharynx, esophagus, small intestine, large intestines, and anus.
Approach:
You will be presented the subject in lecture format and will be tested using a
written exam at a later date.
Control Statement:
If you have any questions during the lesson please feel free to ask.
BODY
1. Teaching Point: Define key terms related to the gastrointestinal system.
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson
Skill Lesson
Learning Support:
a. Alasia-Abnormal condition characterized by the inability of a muscle, particularly the cardiac sphincter
of the stomach, to relax.
b. Achlorhydria- Abnormal condition characterized by the absence of hydrochloric acid in the gastric
secretions.
c. Anastomosis-Surgical joining of two ducts or blood vessels to allow flow from one to the other.
d. Cachexia-General ill health and malnutrition marked by weakness and emaciation, usually associated
with a serious disease such as cancer.
e. Carcinoembryonic antigen (CEA)-Oncofetal glycoprotein antigen found in colonic adenocarcinoma
and other cancers; also found in nonmalignant conditions.
f. Dehiscence-Partial or complete separation of the wound edges.
g. Dysphagia-Difficulty in swallowing.
h. Evisceration-State in which the patient’s viscera protrude through a disrupted wound.
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Gastrointestinal System
i. Exacerbation-An increase in the seriousness of a disease or disorder; marked by greater intensity
in the signs or symptoms of the patient being treated.
j. Hematemesis-Vomiting blood.
k. Intussusception-Infolding of one segment of the intestine into the lumen of another segment; occurs in
children.
l. Leukoplakia-A white patch in the mouth or on the tongue.
m. Lumen-Space within an artery, vein, intestine, or tube.
n. Melena-Abnormal, black tarry stool containing digested blood.
o. Occult blood-Blood that is hidden or obscured from view.
p. Pathognomonic-Sign or symptom specific to a disease condition.
q. Remission-A decrease in the severity of a disease or any of its symptoms.
r. Steatorrhea-Excessive fat in the feces.
s. Stoma-Combining form meaning a mouth or opening.
t. Tenesmus-Ineffective and painful straining with defecation.
u. Volvulus-Twisting of the bowel on itself, causing intestinal obstruction.
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
What makes up the digestive tract?
Mouth, pharynx, esophagus, small intestine, large intestine, and anus.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
2. Teaching Point: Identify common diagnostic tests used to determine gastrointestinal disorders and
determine nursing interventions and patient teaching for the patient undergoing diagnostic
testing for disorders of the gastrointestinal system.
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson
Skill Lesson
Learning Support:
a. Diagnostic Test. Upper Gastrointestinal Study (upper GI Series, UGI).
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Gastrointestinal System
(1) The upper GI study consists of a series of X-rays of the lower esophagus, stomach, and duodenum.
Barium is used as contrast medium. An UGI series is used to detect any abnormal conditions of the upper
GI tract, any tumors, or other ulcerative lesions.
(2) Nursing Interventions and Patient Teaching.
(a) Instruct patient to remain NPO (nothing by mouth) after midnight.
(b) Explain the importance of rectally expelling all barium after the examination.
(c) Inform the patient that the stool will be light in color.
(d) Instruct the patient to increase fluid intake.
(e) Milk of magnesia is usually given after the examination to assist in prevention of constipation
unless contraindicated.
b. Diagnostic Test. Tube Gastric Analysis.
(1) Stomach contents are aspirated to determine the amount of acid produced by the parietal cells in the
stomach. Done to determine the completeness of a vagotomy, confirm hypersecretion or achlorhydria,
estimate acid secretory capacity, or assay for intrinsic factor.
(2) Nursing Interventions and Patient Teaching.
(a) Instruct patient to remain NPO after midnight and that any anticholinergic medications will be
held for 24 hours before the test so the gastric acid secretion will not be altered.
(b) Because nicotine stimulates the flow of gastric secretions, instruct patient not to smoke before the
test.
(c) Explain that a nasogastric tube will be inserted into the stomach to aspirate gastric content.
(d) Send specimens immediately to the laboratory.
c. Diagnostic Test. Esophagogastroduodensoscopy (EGD, UGI Endoscopy, Gastroscopy).
(1) Direct visualization is by an endoscopes. Used to examine the esophagus, stomach, and duodenum
for tumors, varices, mucosal inflammations, hiatal hernias, polyps, ulcers, presence of helicobacter pylori,
strictures, and obstructions.
(a) Can remove polyps, coagulate sources of active GI bleeding, and perform sclerotherapy or
esophageal varices through endoscopy.
(b) Enteroscopy (longer fiberoptic scope) can also be used to evaluate the esophagus, stomach
duodenum, and upper small intestine.
(2) Nursing Interventions and Patient Teaching.
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Gastrointestinal System
(a) Explain the procedure to the patient and tell them that they will be NPO after midnight.
(b) Obtain the signature of the patient on a consent form and complete a preoperative checklist.
(c) Inform the patient that he/she will receive a preoperative intravenous sedative such as midazolalm
(Versed).
(d) Explain to the patient that he/she will not be able to eat or drink until the gag reflex returns.
(e) Assess the patient for signs and symptoms of perforation, including abdominal pain and
tenderness, guarding, oral bleeding, melena, and hpypovolemic shock.
d. Diagnostic Test. Barium Swallow/Gastrografin Studies.
(1) Provides a more thorough study than most UGI examinations. Detects anatomical abnormalities
such as:
(a) Hiatal hernia.
(b) Left atrial dilation.
(c) Aortic aneurysm.
(d) Paraesophageal tumors (such as bronchial or mediastinal tumors).
NOTE:Gastrografin is now used in place of barium for patients with GI bleed and where surgery is being
considered. Gastrografin is water soluble and rapidly absorbed. If Gastrografin escapes from the GI
tract, it is easily absorbed by surrounding tissue, but complications can occur if barium leaks from the GI
tract.
(2) Nursing Interventions and Patient Teaching. Same as Upper GI series.
e. Diagnostic Test. Esophageal Function Studies (Berstein Test).
(1) The Berstein Test (acid-perfusion test) is used to produce the symptoms of gastroesophageal
reflux.
(a) Used to differentiate esophageal pain from angina pectoris.
(b) The test is positive for esophageal reflux if the patient suffers pain with the installation of
hydrochloric acid into the esophagus.
(2) Nursing Interventions and Patient Teaching
(a) Explain that they will be NPO 8 hours prior to procedure and medications that may interfere with
the production of acid , such as antacids and analgesics will be held.
(b) Patient needs to participate in the procedure so avoid sedating.
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Gastrointestinal System
(c) Explain to patient that they will be asked to swallow and describe any discomfort during the
instillation of hydrochloric acid.
f. Diagnostic Test. Examination of Stool for Occult Blood
(1) A benign or malignant GI tumor should be expected if occult blood (blood that is obscure or hidden
from view) is detected in the stool. Usually the bleeding is so slight that gross blood is not seen in the
stool when a tumor ulcerates and bleeding occurs.
(2) Nursing Interventions and Patient Teaching --Instruct patient to collect the stool specimen,
ensuring it is free from urine and toilet paper, because it could possibly contaminate the specimen or alter
the test results.
g. Diagnostic Test. Sigmoidoscopy (Lower GI Endoscopy)
(1) Sigmoidoscopy allows visualization of the lower GI tract and, if indicated, access to obtain biopsy
specimens of tumors, polyps, or ulcerations of the anus, rectum and sigmoid colon.
(a) Direct visualization through sigmoidoscopy is beneficial because the lower GI tract is difficult to
visualize radiographically
(b) Diagnoses of many lower bowel disorders can be obtained through microscopic review of tissue
specimens by use of this procedure.
NOTE: There are 3 basic tests for colon cancer: a stool test (to check for blood); sigmoidoscopy
(inspection of the lower colon; and colonoscopy (inspection of the entire colon). All 3 are effective in
catching cancers in the early stages, when treatment is most beneficial.
(2) Nursing Interventions and Patient Teaching
(a) Inform the patient of the procedure and obtain the patient’s signature on the consent form for the
procedure.
(b) Administer enemas per order the evening prior and/or the morning before the examination.
(c ) Following the procedure, monitor for evidence of bowel perforation (abdominal pain, tenderness,
distention, and bleeding).
h. Diagnostic Test. Barium Enema Study (Lower GI Series).
(1) The barium enema (BE) study can detect the presence and location of polyps, tumors, diverticula
and positional abnormalities (such as malrotation).
(a) Barium sulfate is more effective for visualizing mucosal detail.
(b) The BE study may be used therapeutically to reduce nonstragulated ileocolic intussusception
(infolding of one segment of the intestine into the lumen of another segment) in children.
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Gastrointestinal System
NOTE:The barium enema is a valuable diagnostic tool that helps detect abnormalities in the large
intestine (colon). The barium enema, along with colonoscopy, remain standards in the diagnosis of colon
cancer, ulcerative colitis, and other diseases of the colon.
(1) Nursing Interventions and Patient Teaching
(a) The evening before or the morning of the BE, administer cathartics such as magnesium citrate or
some other cathartics in accordance with the hospital’s policy/doctor’s order.
(b) The physician may order milk of magnesia after the BE to assist in expelling the barium.
(c) Assess the patient after the BE, ensuring all barium (stool light in color) had been expelled. If the
patient fails to expell all barium, it could cause hardened impaction.
i. Diagnostic Test. Colonoscopy
(1) The fiberoptic colonoscope examines the entire colon-from anus to cecum allowing the
visualization of benign and malignant neoplasms, mucosal inflammation for ulceration, and sites of active
hemorrhage. Biopsy specimens can be obtained, small tumors removed and actively bleeding vessels
coagulated through the scope. For patients at high risk for colon cancer, colonoscopy allows early
detection of any primary or secondary tumors.
(2) Nursing Interventions and Patient Teaching
(a) Explain to the patient that he/she needs to sign a consent form for the procedure.
(b) Instruct patient to restrict his/her diet to liquids for 1 to 3 days prior to the procedure and remain
NPO for 8 hours before the procedure.
(c) The physician may order an enema and Golytely, both used as cathartics to decrease the residue
in the bowel.
(d) Explain that 1 gallon of Golytely must be taken over a 2 our period.
(e) Warm blankets are provided during the procedure because many patients experience hypothermia
(f) A sedative such as Versed is often given before the procedure.
(g) After the procedure, assess for evidence of bowel perforation, hypovolemic shock and examine
the stool for gross blood.
j. Diagnostic Test. Stool Culture
(1) The physician may order a stool for culture to test for the presence of bacteria, ova, and parasites.
Many bacteria (such as Escherichia coli) are indigenous in the bowel. Bacterial cultures are usually done
to detect enteropathogens (such as Staphylococcus aureus, Salmonella, Shigella, E. coli, or Clostridium
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Gastrointestinal System
difficile). The stool is examined for ova and parasites (O&P) when a patient is suspected of having a
parasitic infection.
(2) Nursing Interventions and Patient Teaching
(a) Instruct the patient that if an enema is required to collect a stool specimen, the onlysolution that
can be used is normal saline or tap water. Any other solution such as soap could affect the viability of the
organisms collected.
(b) Instruct the patient not to mix urine with feces and the stool specimen is collected prior to barium
examinations.
(c) Once the specimen has been obtained, it should be taken to the lab within 30 minutes of
collection in a specified container.
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
Why is it important for a patient to expel barium?
The patient is at risk for constipation/impaction.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
END OF LESSON TEST
Allocated Time:
Instructions:
Test Questions or
Performance
Expected:
Test Key:
0 Minutes
CONCLUSION
Allocated Time:
Summary:
5 Minutes
Review and re-emphasize the difficult Teaching Points below.
1.
2.
3.
4.
5.
6.
7.
8
7
Define key terms related to the gastrointestinal system.
Identify common diagnostic tests used to determine gastrointestinal
disorders and determine nursing interventions and patient teaching for
the patient undergoing diagnostic testing for disorders of the
gastrointestinal system.
AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Gastrointestinal System
9.
10.
Closing Statement:
You will be presented the subject in lecture format and will be tested using a
written exam at a later date.
Re-motivating
Statement:
The digestive tract, or alimentary canal, is a musculomembranous tube existing
from the mouth to the anus and is approximately 30 feet long. It consists of the
mouth, pharynx, esophagus, small intestine, large intestines, and anus.
8