Apprenticeship Learning Log

 

Date of Learning: 22/10/25

Time: 9:30 – 16:30

Title of learning activity: Anatomy and physiology of the gastrointestinal system. GI system. Complex endocrine conditions: Living with DM. Drug Calculation and Safe Medicate.

 

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

Reflection on Learning Activity (include model of reflection e.g. Driscoll or Gibbs):

 

On today’s session we discussed Gastrointestinal Track (GIT) covering all mentioned below learning logs.

 

Structure of the Gastrointestinal Tract (GIT) is a continuous tube that extends from the mouth to the anus. It is responsible for the digestion and absorption of nutrients, and the elimination of waste.

It consists of four main layers that are generally consistent throughout, though modified in different regions to suit specific functions.

1. Mucosa

• Innermost layer lining the lumen (inside space).
• Composed of:
  • Epithelium: varies (stratified squamous in mouth/esophagus; columnar in stomach/intestine).
  • Lamina propria: connective tissue with blood and lymph vessels.
  • Muscularis mucosae: thin smooth muscle that helps movement of the mucosa.
• Function: secretion of mucus, enzymes, and hormones; absorption; protection from pathogens.

2. Submucosa

• Dense connective tissue layer beneath the mucosa.
• Contains blood vessels, lymphatics, and nerves (submucosal or Meissner’s plexus).
• Function: supports the mucosa and connects it to the muscular layer; helps coordinate secretions.

3. Muscularis Externa

• Two (sometimes three) layers of smooth muscle:
  • Inner circular layer – constricts the lumen.
  • Outer longitudinal layer – shortens the tract.
• Between these layers lies the myenteric (Auerbach’s) plexus, which controls motility and peristalsis.
• Function: mixes and propels food along the tract.

4. Serosa (or Adventitia)

• Outermost layer:
  • Serosa: a thin membrane (visceral peritoneum) covering organs in the abdominal cavity.
  • Adventitia: fibrous connective tissue (in areas outside the abdomen, e.g., esophagus.
• Function: protection and structural support.

Regions of the GIT (Gastrointestinal Track)

1. Mouth and Pharynx – ingestion, chewing, swallowing.
2. Esophagus – transports food to stomach.
3. Stomach – mechanical and chemical digestion (proteins).
4. Small Intestine – digestion and nutrient absorption.
5. Large Intestine – water and electrolyte absorption; feces formation.
6. Rectum and Anus – storage and elimination.

Functions of the Gastrointestinal Tract (GIT) – performs several essential functions to ensure the body receives nutrients, water, and energy from food while eliminating waste products.

The main functions include:

1. Ingestion- the process of taking food and liquids into the mouth, involves chewing (mastication) and mixing food with saliva to form a bolus that can be swallowed.
2. Propulsion – movement of food through the digestive tract. Includes Swallowing (deglutition) – voluntary and involuntary stages. Peristalsis – rhythmic, wave-like contractions of smooth muscle that push food along the tract from the esophagus to the anus.
3. Mechanical Digestion- physical breakdown of food into smaller particles to increase surface area for enzymes. Occurs in mouth (chewing) stomach (churning and mixing with gastric juice to form chyme. Small intestine (segmentation, mixing movements).
4. Chemical Digestion – Breakdown of large food molecules into smaller, absorbable units by enzymes.

Examples:

• • Carbohydrates → simple sugars (glucose) by amylase.
  • Proteins → amino acids by pepsin and proteases.
  • Fats → fatty acids and glycerol by lipase and bile salts.

5. Secretion, the GIT and its accessory organs secrete fluids necessary for digestion:

• • Saliva (salivary glands) – lubricates and begins carbohydrate digestion.
  • Gastric juice (stomach) – contains acid and enzymes.
  • Bile (liver and gallbladder) – emulsifies fats.
  • Pancreatic juice – provides digestive enzymes and bicarbonate.
  • Intestinal secretions – enzymes and mucus for lubrication.

6. Absorption, the process of moving nutrients, water, and electrolytes from the digestive tract into the bloodstream or lymph. Occurs mainly in the small intestine (through villi and microvilli). Large intestine absorbs water and some vitamins.
7. Defecation

• Elimination of indigestible substances and waste as feces through the anus.
• Controlled by voluntary and involuntary muscle actions.

8. Protection and Immune Function

• The GIT serves as a barrier against pathogens.
• Contains lymphoid tissue (GALT) that produces immune cells to defend against microbes entering with food.

Summary Table

Function	Description	Main Site(s)
Ingestion	Taking in food	Mouth
Propulsion	Moving food along tract	Esophagus → Intestine
Mechanical Digestion	Physical breakdown	Mouth, Stomach, Intestine
Chemical Digestion	Enzymatic breakdown	Mouth, Stomach, Small Intestine
Secretion	Release of fluids and enzymes	Glands & Accessory Organs
Absorption	Transfer of nutrients	Small & Large Intestines
Defecation	Waste elimination	Rectum & Anus
Protection	Immune defense	Throughout GIT

 

 

Diabetes Mellitus (DM) is a chronic metabolic disorder characterised by high blood glucose levels (hyperglycaemia) resulting from defects in insulin secretion, insulin action, or both.

Pathophysiology

Type	Mechanism
Type 1 Diabetes Mellitus	Autoimmune destruction of pancreatic β-cells → absolute insulin deficiency. Body cannot produce insulin → glucose cannot enter cells → hyperglycemia.
Type 2 Diabetes Mellitus	Combination of insulin resistance (cells don’t respond properly to insulin) and relative insulin deficiency. Often linked to obesity, sedentary lifestyle, and genetics.
Gestational Diabetes	Occurs during pregnancy due to hormonal changes causing insulin resistance; usually resolves after birth but increases risk of later Type 2 DM.

Result:
Glucose remains in the bloodstream → energy-starved cells → increased fat/protein breakdown → ketone formation → possible ketoacidosis (especially in Type 1)

Signs and Symptoms (S/S)

Classic Symptoms (3 P’s)	Other Symptoms
Polyuria – frequent urination	Fatigue and weakness
Polydipsia – excessive thirst	Blurred vision
Polyphagia – increased hunger	Slow wound healing
Weight loss (Type 1)	Recurrent infections (e.g., thrush, skin)
	Dry mouth and itchy skin.    Numbness or tingling in hands/feet Dry mouth and itchy skin.

Management:

1. Lifestyle Modifications

• Diet: balanced, controlled carbohydrate intake; high fiber; limited saturated fats and sugars.
• Exercise: regular physical activity increases insulin sensitivity.
• Weight control: especially important in Type 2 DM.

2. Medications

• Type 1 DM: requires lifelong insulin therapy (injections or insulin pump).
• Type 2 DM:
  • Oral hypoglycemics (e.g., Metformin – increases insulin sensitivity).
  • GLP-1 agonists or SGLT2 inhibitors for advanced control.
  • May progress to insulin use.

3. Monitoring

• Blood glucose monitoring: finger-stick tests or continuous glucose monitors (CGM).
• HbA1c testing measures long-term glucose control (target <7%).
• Regular medical review: for complications and medication adjustment.

4. Education and Support

• Teaching on insulin administration, diet planning, foot care, and recognizing signs of hypo- or hyperglycemia.
• Psychological support to cope with lifestyle changes.

 Complications:

Short-Term (Acute)

Condition	Description
Hypoglycemia	Low blood sugar from excess insulin or missed meals — symptoms: sweating, shaking, confusion.
Diabetic Ketoacidosis (DKA)	Mostly in Type 1; body breaks down fat → ketone build-up → metabolic acidosis.
Hyperosmolar Hyperglycemic State (HHS)	Seen in Type 2; severe hyperglycemia without ketosis, leading to dehydration and confusion.

Long-Term (Chronic)

System	Complication
Vascular (Macrovascular)	Coronary artery disease, stroke, peripheral vascular disease.
Microvascular	Retinopathy (eye damage), nephropathy (kidney damage), neuropathy (nerve damage).
Others	Poor wound healing, diabetic foot ulcers, increased infection risk.

Summary Table

Aspect	Key Points
Definition	Chronic disorder of carbohydrate metabolism with hyperglycemia.
Pathophysiology	Insulin deficiency/resistance → glucose cannot enter cells.
S/S	Polyuria, polydipsia, polyphagia, fatigue, infections.
Management	Diet, exercise, medication (insulin/oral), monitoring, education.
Complications	DKA, HHS, retinopathy, nephropathy, neuropathy, CVD.

 

 

During our afternoon session we were introduced to the Safe Medicate application and we were practicing drug calculation.

KSBs addressed:

 

K13: Understand the contribution of social influences, health literacy, individual circumstances, behaviours and lifestyle choices to mental, physical and behavioural health outcomes

K14: Understand the importance of health screening

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs