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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