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Assessing Clients with Nutritional and Gastrointestinal Disorders Chapter 24 Nutrients • These are found in food and used by the body to promote growth, maintenance and repair • 6 Categories – carbohydrates – protein – fats -vitamins -minerals -water Carbohydrates • Sugar and starches • Grains (Whole wheat) Proteins • • • • Animal products Milk Soy Bean Fats - Lipids • Minimal amounts Vitamins • Fruits and vegetables • Green leafy vegetables Minerals • Minerals are found in all foods – vegetables, nuts, milk and some meats Anatomy and Physiology • Gastrointestinal Tract – – – – – mouth pharynx esophagus stomach intestine Stomach • Cardiac region, fundus, body, pylorus • Gastric glands- Parietal, chief, • Mucous, and Enteroendocrine. 4-6 hours stomach to empty. The nervous system controls Gastric secretion. Pyloric sphincter -Emptying Small Intestine • 3 Regions – duodenum – jejunum – ileum • Function – chemical digestion and absorption of food Accessory Digestive Organs • Liver and Gallbladder • Pancreas Liver and Gallbladder • Function – – – – secretes bile stores fat-soluble vitamins (A, E, D & K) metabolizes bilirubin stores and releases blood, iron and copper, glucose – synthesizes clotting factors (I, II, VII, IX, & X) Liver Disease Pancreas • Function – produce enzymes that aid in digestion of fats • Lipase - promotes fat breakdown and absorption • Amylase - completes starch digestion • Trypsin - assists in protein digestion Health Assessment Interview • What is your usual dietary intake? • Describe what you believe is a healthy diet • Have you had any episodes of indigestion, nausea, vomiting, diarrhea or constipation? The Physical Assessment • Preparation – anthropometric measurements • • • • • height and weight compare to ideal body weight (IBW) usual body weight triceps skin fold thickness (TSF) measure mid-arm circumference (MAC) Physical Assessment • Inspection – mouth • lips, tongue, buccal mucosa, • teeth, gums throat, breath – abdomen • skin integrity, venous pattern, pulsations Abdominal Drapping Inspection, what do you see? Physical Assessment • Auscultation – all 4 quadrants, begin in the rt lower quadrant • Percussion – using your hands to illicit a sound – normal tympany is heard over the abdomen – dullness over organs (liver and spleen) Abdomen Physical Assessment • Palpation – in all 4 quadrants – circular motion, first light, then deep • pain? • guarding? • masses? Abdominal Palpation GI Changes with aging • Changes in GI function associated with aging can have a significant effect on nutrition, health and well-being. • Periodontal disease-Disease of the supporting structures of the teeth; common cause of tooth loss in older adults. Result of poor dental hygiene lack of access to fluoridated water and genetics. • See textbook. NCLEX Questions • The nurse caring for a client with dry mouth knows that this can affect the client’s nutrition because • A. the client needs to drink more water during a meal NCLEX Questions • B. digestion begins in the mouth • C. foods are likely to taste stronger • D. the client will eat more candy to stimulate saliva. NCLEX questions • A client is ordered to be on a low sodium diet. The nurse is teaching this client about foods that are allowed in their diet. Which food item would the Nurse instruct the patient to consume. • A. Tomato soup • B Summer squash NCLEX Questions • C. Instant oatmeal • D. Boiled shrimp NCLEX questions • A client loses a significant portion of the small intestine • • • • as a result of a gunshot wound. The nurse caring for the client knows that this is likely to affect A. the absorption of most nutrients from food B. the ability to form a solid stool mass C. secretion of hydrochloric acid D. conjugation and elimination of bilirubin NCLEX Questions • The client’s temperature rises to 100.4 on the first postoperative day following abdominal surgery. The nurse interprets this to be: • A. indicative of a wound infection • B. a normal physiological response to the trauma of surgery • C. suggestive of a urinary tract infection • D. an indication of overhydration NCLEX • A client has had a liver biopsy. After the procedure, the nurse should position the patient on the right side. What is the primary reason for this position? • A. to immobilize the diaphragm • B. to facilitate full chest expansion • C. to minimize the danger of aspiration • D. to reduce the likelihood of bleeding NCLEX Questions • An adult has a nasogastric tube in place. Which nursing action will relieve discomfort in the nostril with the NG tube? • A. Remove any tape and loosely pin the NG tube to his gown • B. Lubricate the NG tube with viscous lidocaine • C. Loop the NG tube to avoid pressure on the nares • D. Replace the NG tube with a smaller diameter tube NCLEX Questions • A low-residue diet is ordered for a client. Which food would be contraindicated for this person? • A. Roast beef • B. Fresh peas • C. Mashed potatoes • D. Baked chicken
