Digestive System
Key Points
- Digestion progresses through ingestion, mechanical/chemical breakdown, absorption, and elimination.
- Peristalsis and sphincter coordination move bolus through the GI tract for nutrient uptake and waste removal.
- Aging increases risk for choking, constipation, malnutrition, and bowel obstruction.
Pathophysiology
The digestive system transforms food into absorbable nutrients and eliminates waste through coordinated motility and enzymatic processing. Food moves from mouth to esophagus, stomach, small intestine, and large intestine, where water reabsorption and stool formation occur before elimination.
Age-related decline in dentition, saliva, and motility can impair safe swallowing and bowel function. Slower transit increases stool drying and obstruction risk, while reduced absorption can contribute to malnutrition despite adequate intake volume.
Classification
- Oral/pharyngeal phase: Chewing, salivary enzyme action, and swallowing initiation.
- Transit/digestion phase: Esophageal peristalsis, gastric mixing, and small-intestinal digestion/absorption.
- Elimination phase: Large-intestinal water reabsorption and stool evacuation.
- Complication pathways: Aspiration, constipation, obstruction, and ostomy-related care needs.
Nursing Assessment
NCLEX Focus
Priority assessment distinguishes routine elimination discomfort from red flags requiring immediate nurse notification.
- Observe swallowing safety and signs of aspiration risk during meals or fluid intake.
- Monitor bowel pattern changes, stool characteristics, abdominal discomfort, and bloating trends.
- Assess hydration and fiber intake factors affecting motility and stool consistency.
- Report rectal bleeding, severe abdominal pain, persistent vomiting, or no flatus/bowel movement with distention.
Nursing Interventions
- Encourage adequate fluids, fiber-rich foods, and activity as tolerated to support motility.
- Assist safe feeding and positioning to reduce choking and aspiration risk.
- Support individualized trigger-food avoidance plans for chronic GI conditions.
- Provide ostomy-supportive care and report stoma/effluent changes promptly.
Obstruction and Aspiration Risk
Progressive constipation with distention or signs of aspiration can rapidly become life-threatening and must be escalated early.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| stool-softeners | Constipation-management context | Support bowel regularity while monitoring for overuse or ineffective response. |
| acid-suppression-therapy | GERD symptom-management context | Reinforce lifestyle measures alongside medication adherence. |
Clinical Judgment Application
Clinical Scenario
An older client with dry mouth and reduced mobility develops hard stools, abdominal bloating, and decreased appetite.
Recognize Cues: Multiple risk factors for slowed GI transit and stool retention. Analyze Cues: Dehydration and reduced motility are likely contributing to constipation progression. Prioritize Hypotheses: Immediate priority is preventing obstruction and further decline in intake. Generate Solutions: Increase fluid/fiber support, encourage movement, and report concerning trends. Take Action: Implement bowel-support interventions and reassess output/pain response. Evaluate Outcomes: Bowel function improves and warning signs do not progress.
Related Concepts
- constipation - Common downstream complication of reduced motility and hydration.
- dysphagia - Swallowing impairment increases aspiration and nutritional risk.
- nutrition-support - Intake quality and adequacy directly affect GI and recovery outcomes.
- bowel-obstruction - Severe transit failure requiring urgent escalation.
- colostomy-care - Specialized elimination support after GI surgery.
Self-Check
- Which findings suggest constipation has progressed toward obstruction risk?
- Why do reduced saliva and dentition changes increase aspiration potential?
- Which daily interventions most effectively protect GI function in older adults?