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
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–
–
–
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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
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•
•
•
•
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