Assessing Clients with Assessing Clients with Nutritional and Gastrointestinal Nutritional and Gastrointestinal DisordersDisorders

Chapter 24

NutrientsNutrients

• These are found in food and used by the body to promote growth, maintenance and repair

• 6 Categories– carbohydrates -vitamins– protein -minerals– fats -water

CarbohydratesCarbohydrates

• Sugar and starches

• Grains (Whole wheat)

ProteinsProteins

• Animal products

• Milk

• Soy

• Bean

Fats - LipidsFats - Lipids

• Minimal amounts

VitaminsVitamins

• Fruits and vegetables

• Green leafy vegetables

MineralsMinerals

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

Anatomy and PhysiologyAnatomy and Physiology

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

StomachStomach

• 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 IntestineSmall Intestine

• 3 Regions– duodenum– jejunum– ileum

• Function– chemical digestion and absorption of food

Accessory Digestive OrgansAccessory Digestive Organs

• Liver and Gallbladder

• Pancreas

Liver and GallbladderLiver 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 DiseaseLiver Disease

PancreasPancreas

• 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 InterviewHealth 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 AssessmentThe 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 AssessmentPhysical Assessment

• Inspection– mouth

• lips, tongue, buccal mucosa,

• teeth, gums throat, breath

– abdomen• skin integrity, venous pattern, pulsations

Abdominal DrappingAbdominal Drapping

Inspection, what do you see?Inspection, what do you see?

Physical AssessmentPhysical 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)

AbdomenAbdomen

Physical AssessmentPhysical Assessment

• Palpation– in all 4 quadrants– circular motion, first light, then deep

• pain?

• guarding?

• masses?

Abdominal PalpationAbdominal Palpation

GI Changes with agingGI 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 QuestionsNCLEX 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 QuestionsNCLEX 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 questionsNCLEX 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 QuestionsNCLEX Questions

• C. Instant oatmeal

• D. Boiled shrimp

NCLEX questionsNCLEX 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 QuestionsNCLEX 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

NCLEXNCLEX

• 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 QuestionsNCLEX 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 QuestionsNCLEX 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