Assessing%20Clients%20with%20Nutritional%20and%20Gastrointestinal%20Disorders

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Assessing Clients with Nutritional and
Gastrointestinal Disorders

• Chapter 24

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Nutrients

• These are found in food and used by the body to
  promote growth, maintenance and repair
• 6 Categories
• carbohydrates -vitamins
• protein -minerals
• fats -water

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Carbohydrates

• Sugar and starches
• Grains (Whole wheat)

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Proteins

• Animal products
• Milk
• Soy
• Bean

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Fats - Lipids

• Minimal amounts

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Vitamins

• Fruits and vegetables
• Green leafy vegetables

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Minerals

• Minerals are found in all foods
• vegetables, nuts, milk and some meats

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Anatomy and Physiology

• Gastrointestinal Tract
• mouth
• pharynx
• esophagus
• stomach
• intestine

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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

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Small Intestine

• 3 Regions
• duodenum
• jejunum
• ileum
• Function
• chemical digestion and absorption of food

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Accessory Digestive Organs

• Liver and Gallbladder
• Pancreas

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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)

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Liver Disease
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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

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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?

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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)

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Physical Assessment

• Inspection
• mouth
• lips, tongue, buccal mucosa,
• teeth, gums throat, breath
• abdomen
• skin integrity, venous pattern, pulsations

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Abdominal Drapping
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Inspection, what do you see?
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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)

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Abdomen
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Physical Assessment

• Palpation
• in all 4 quadrants
• circular motion, first light, then deep
• pain?
• guarding?
• masses?

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Abdominal Palpation
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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.

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NCLEX Questions

• The nurse caring for a client with dry mouth
  knows that this can affect the clients nutrition
  because
• A. the client needs to drink more water during a
  meal

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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.

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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

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NCLEX Questions

• C. Instant oatmeal
• D. Boiled shrimp

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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

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NCLEX Questions

• The clients 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

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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

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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

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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