PAGE 4 PAGE 3 Chapter 21 Assessing Clients with Nutritional and Gastrointestinal Disorders *Review of anatomy and physiology of GI tract. pp 610-612 *Attention to accessory digestive organs?the liver, gallbladder and pancreas pp. 612-613 *Diagnostic Testing ? pp. 616-617 Chapter 22 Nursing Care of Clients with Nutritional Disorders *Morbid obesity/obesity Definitions: Overweight ? less than 20% over ideal body weight Obese ? more then 20% over ideal body weight Morbid Obesity ? more than 100% over ideal body weight *Respiratory distress Causes Heredity ? 1 obese parent = 40% chance, 2 obese parents = 80% chance Environment ? fast food ? increased calories, increased processing Restaurants ? 2-3x larger portions than needed Vending machines Food advertisement Socioeconomic ?Clean your plate? society Rewarding with food Sedentary lifestyle Psychological Decreased self-esteem Anxiety Depression Guilt Boredom Dx tests ? to determine cause of obesity BMI: Men ? 10-20% fat Women ? 20-30% fat Obese - >30% fat Anthropometry ?skin fold measurements Thyroid profile Serum glucose Serum cholesterol Lipid profile Electrocardiogram (ECG) Treatment ? Exercise Dietary management/nutrition Behavior modification Medications (Weight loss meds have short-term benefits with vast side effects) Surgery ? Liposuction Liectomy Bariatric - (people who undergo gastric bypass regain the weight within 2 years on average) *MAJOR lifestyle changes are the only permanent solution Nursing Dx ? Imbalanced Nutrition: More Than Body Requirements Activity Intolerance Ineffective Therapeutic Regimen Management Chronic Low Self?Esteem *Malnutrition ? ARDS, advanced aging, alcoholism, GI disorders Definition ? inadequate nutrient intake to meet body needs Dx tests ?Serum albumin/prealbumin ? decreased protein Total Lymphocyte count Serum Electrolytes ? decreased potassium Treatment - Medications ? supplemental vitamins and minerals Fluid and dietary management - calorie count determined by registered dietician; small, frequent feedings Enteral nutrition Definition ? tube feeding Route of administration Parenteral nutrition (total parenteral nutrition, TPN, hyperalimentation) Definition ?makeup of TPN solutions ? made in pharmacy specifically for patient (usually 50% glucose, Protein ? AA, Fat ? lipids, Carbs ? glucose, Electrolytes ? NA, K, Chloride, Calcium, Phosphate, Magnesium, Metals/Trace ? Zinc, Copper, Manganese, Chromium, Selenium, Vitamins ? A, C, D, E, K, B1, B2, Niacin, Panto. Acid, B6, Biotin, Choline, Folic Acid) Route of administration Dx tests for monitoring ? Serum glucose (plus finger sticks) Q6H Serum electrolytes Daily weight *If patient is receiving TPN, ½ degree increase in temperature could signify infection Nursing Dx ? Imbalanced Nutrition: Less Than body Requirements Risk for infection Risk for Deficit Fluid Volume Risk for Impaired Skin Integrity *Anorexia nervosa ? weight <85% of expected Defining characteristics ? p.651 *Bulimia nervosa ? recurring episodes of binge-purge Defining characteristics ? p.651 *Binge-eating disorder Defining characteristics ? p.651 Chapter 23 Nursing Care of Clients with Upper Gastrointestinal Disorders *Stomatitis ? infection, trauma, chemotherapy Defining characteristics ? inflammation of oral mucosa (specific manifestations on p. 657) Treatment ? usually comfort measures, oral antibiotic Types of common stomatitis conditions, manifestations and treatment p. 657 table Medications ? p.658 Nursing Dx ? Impaired Oral Mucous Membrane Impaired Oral Mucous membrane Imbalanced Nutrition: Less Than Body Requirements *Gastroesophageal reflux disease (GERD) Causes Transient lower esophageal sphincter relaxation Incompetent lower esophageal sphincter Increased intragastric pressure Dx tests ?Barium swallow Upper endoscopy 24-hour ambulatory pH monitoring Esophageal manometry EGD *Can be Dx by assessment and history ? Reflux, CP, Belching, Heart Pain, Dysphagia, Pain after eating Risk Factors ? caffeine, peppermint, spicy foods, chocolate, fatty foods, smoking Treatment ? diet modification ? small, frequent meals; eat at least 3 hours before bed; upright 2 hours after eating Medication ? pp. 665-666 very important! Surgical intervention ? Nissen fundoplication Nursing Dx ?Pain Imbalanced Nutrition: Less Than Body Requirement *Hiatal hernia ? p.667-668 Defining characteristics ? reflux, heartburn, feeling of fullness, substernal CP, dyspagia, occult bleeding, beliching, indigestion Tx similar to GERD *Achalasia ? p.668 Definining characteristics ? impaired peristalsis of the smooth muscle of the esophagus and impaired relaxation of the lower esophageal sphincter ? gradually increasing dysphagia ? fullness in the chest, CP, nighttime cough ? some develop diffuse esopgageal spasm- severe CP occurring at rest Tx ? Botulinum toxin injections Balloon dilation Laparoscopic myotomy *Stomach and duodenum Review of normal physiology ? p.671 *Gastritis Differentiate between acute and chronic gastritis - see chart p. 677 Dx tests ? Gastric analysis Hemoglobin, hematocrit, and red blood cell indices Serum vitamin B12 levels Upper endoscopy Medications ? Proton-pump inhibitors (PPI) Histamine 2 receptor blockers Sucralfate Type B chronic gastritis may be treated with combination of two Chapter 24 Nursing Care of Clients with Gallbladder, Liver, and Pancreatic Disorders *Gallbladder Disorders Cholelithiasis ? formation of stones within the gallbladder Cholecystitis ? inflammation of the gallbladder Acute ? usually obstruction from a gallstone Chronic ? repeated bouts of the acute form or persistent irritation from stones Dx tests ? Serum bilirubin Complete blood count (CBC) Serum amylase and lipase Abdominal x-ray Ultrasonography of the gallbladder Gallbladder scans Medications?Drugs to dissolve gallstones, Ursodiol, Chenodiol Tx ? Surgery, laparoscopic cholecystectomy, cholecystectomy with bile duct exploration Dietary management ? limited dietary fat intake Extracorporeal shock wave lithotripsy (ESWL) Nursing Dx ? Pain Imbalanced Nutrition: Less Than Body Requirements Risk for Infection *Liver disorders Hepatitis ? inflammation of the liver Viral Hepatitis ? see chart p. 705 pay attention to mode of transmission Manifestations of acute hepatitis ? see chart p. 706 Chronic Hepatitis ? chronic inflammation of the liver, damage leads to cirrhosis, liver cancer, and liver transplantation; caused by HBV, HCV, and HDV Dx texts ? liver function tests see p. 707 Medications ? prevention with vaccines for Hep A and Hep B p. 708 Postexposure prophylaxis Nursing Dx ? Risk for Infection (Transmission) Fatigue Imbalanced Nutrition: Less Than Body Requirements Disturbed Body Image *Review causative factors in Hepatitis ? Viral most common Know transfer routes of each type (Review page 581) ? Type A ? fecal/oral; Type B ? Blood; Type C Acute - ; Type C Chronic - *Pancreatitis Acute/Chronic p. 727 Dx tests Ultrasonography CT Scan ERCP Tx ? nutrition, surgery, gastrointestinal tract rest, NPO for a period of time, followed by reintroduction of clear liquids, then full liquids and finally solid foods Nursing Dx Pain Imbalanced Nutrition: less Than Body Requirements Risk for Deficient Fluid Volume Antibiotics and a PPI *Peptic ulcer disease (PUD) ? 10% of population; anywhere in GI tract (most often in the lesser curvature of antum stomach); mainly due to H. pylori; equal between sexes; mostly in elderly; brought on by stress, trauma, CNS surgery, burns, respiratory failure, renal failure Differentiate between duodenal ulcers and gastric ulcers Risk factors ? Chronic H. pylori infection Use of aspirin and NSAIDS Genetic factor Cigarette smoking Complications-Hemorrhage Gastric outlet obstruction Perforation Dx tests ? Upper GI series Gastroscopy Biopsy specimens Serologic testing to detect H. pylori Medications ? antibiotics to eradicate H. pylori Medication administration p. 684 Tx ? Dietary management Surgery Nursing Dx ? Pain Sleep Pattern Disturbance Imbalanced Nutrition: Less Than Body Requirements Deficient Fluid Volume *Care of Clients with a Gastrostomy or Jejunostomy Tube See box p. 692
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