Transcript Nutrition in Patients with Gastrointestinal Disorder

Nutrition in Patients with
Gastrointestinal Disorder
• The major organs of digestion are those
within the gastrointestinal tract (GIT),
which begins with the mouth and ends
with the anus.
• The accessory organs or digestion include
the liver, gallbladder and pancreas.
• The digestive system is responsible for
digestion (mechanical and chemical) of
food, absorption of nutrients and
elimination of waste materials.
• Digestive system
– Organs and their functions
• Mouth: beginning of digestion
• Teeth: bite, crush, and grind food
• Salivary glands: secrete saliva
• Esophagus: moves food from mouth to
stomach
• Stomach: churn and mix contents with
gastric juices
• Small intestine: most digestion occurs here
• Large intestine: forms and expels feces
• Rectum: expels feces
• Accessory organs of digestion
– Organs and their functions
• Liver: produces bile; stores it in the
gallbladder
• Pancreas: produces pancreatic juice
• Regulation of food intake
– Hypothalamus
• One center stimulates eating and
another signals to stop eating
Laboratory and Diagnostic Examinations
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Upper GI series
Gastric analysis
Esophagogastroduodenoscopy (EGD)
Barium swallow
Bernstein test
Stool for occult blood
Sigmoidoscopy
Barium enema
Colonoscopy
Stool culture and sensitivity; stool for ova
and parasites
• Flat plate of the abdomen
• Digestive disorders can be due to
structural malfunction, infection,
inflammation or disease.
• The physician who specializes in treating
GI disorders is called gastroenterologist.
• The enterostomal therapist (ET) is a nurse
who assists people with learning to care
for surgically adapted openings , called
ostomies, into the stomach (gastrostomy),
intestine (ileostomy) or colon (colostomy)
DIAGNOSTIC TESTS:
PLAIN ABDOMEN: Done at random, no dietary
preparation required
BARIUM STUDIES (UPPER AND LOWER
GI SERIES)
• The patient must understand the appropriate
dietary and bowel preparations and should know
what the procedure entails.
• A substance called GOLYTELY is used. It
contains electrolytes that cause complete bowel
evacuation. The patient is instructed to eat a
light supper (some physicians require clear
liquids) in the evening and then to be on NPO,
except for the bowel prep after supper.
DIAGNOSTIC TESTS:
CHOLECYSTOGRAM
• Patient is instructed to eat a fat-free
supper the night before the X-RAY study.
Takes a radio opaque dye PO.
• Eat nothing for the next 12 hours after
taking the dye which allows time for the
dye to concentrate in the gallbladder.
• The patient may have water until bedtime
then NPO thereafter.
OTHER DIAGNOSTIC PROCEDURES:
• Gastroscopy, ERCP, colonoscopy
COMMON MEDICAL AND SURGICAL
TREATMENTS
GASTROINTESTINAL INTUBATION
• Insertion of a tube through the nostrils,
mouth or abdominal wall. (NGT,
Gastrostomy, jejunostomy.
• Used for enteral nutrition either short or
long duration
ENTERAL NUTRITION:
• Enteral nutrition also known as tube
feedings assists the patient to obtain
nutritional intake when he or she is unable
to obtain adequate calories, appropriate
nutrients, solid foods or liquids by mouth.
Patient must have a normally functioning
GI tract.
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PARENTERAL NUTRITION
Parenteral nutrition involves direct IV
administration of fluids and nutrients into
the circulatory system.
This is sometimes referred to as TPN –
Total Parenteral Nutrition when the nutrient
is exclusively given via IV.
Parenteral nutrition may be given as TPN
or as supplemental.
This nutrition provides large quantities of
fluids, and nutrients which include
proteins, fats, water, electrolytes, vitamins
and minerals.
GASTRIC SURGERIES
TOTAL OR SUBTOTAL GASTRECTOMY:
• Surgical procedure to remove part of or
the entire stomach
• Postoperative complications include the
development of anemia, such as
pernicious anemia or iron deficiency
anemia.
• Electrolyte disturbance may also result
from NG suction, malabsorption, diarrhea
and vitamin deficiencies.
DUMPING SYNDROME, occurs after
gastrectomy and usually develops after
overeating or eating foods that are not
recommended.
There is rapid gastric emptying.
Symptoms include borborygmi, palpitation,
diaphoresis, faintness, excessive
weakness, and diarrhea and/or vomiting.
Foods most likely to cause dumping are
those foods high in carbohydrates and salt.
Food containing MSG, monosodium
glutamate is particularly irritating.
DUMPING SYNDROME,
Diet
- Eat 6 small meals/day
- High protein and fat, low in carbohydrates
- Eat slowly and avoid fluids during meals
- Vitamin B12 for pernicious anemia
- Recline for about an hour after meals
Gastroesophageal reflux disease (GERD)
– Etiology/pathophysiology
• Backward flow of stomach acid into the
esophagus
– Clinical manifestations/assessment
• Heartburn (pyrosis) 20 min – 2 hrs after
eating
• Regurgitation
• Dysphagia or odynophagia
• Eructation
Gastroesophageal reflux disease
– Diagnostic tests
• Esophageal motility and Bernstein tests
• Barium swallow
• Endoscopy
– Medical management/nursing
interventions
• Antacids or acid-blocking medications
• Lifestyle: eliminate smoking, avoid
constrictive clothing, HOB up at least 6-8
inches for sleep
GERD
Diet:
- Eat 4-6 small meals/day
- Follow a low fat, adequate protein diet
- Reduce intake of chocolate, tea and all food
and beverage that contain caffeine
- Limit or eliminate alcohol intake
- Eat slowly and chew food thoroughly
- Avoid taking evening snack
- Do not eat for 2-3 hours before bedtime
- Remain upright for 1-2 hours after eating
- Avoid any food that produce heartburn
- REDUCE OVERALL BODY WEIGHT
Disorders of the Stomach
• Acute gastritis
– Etiology/pathophysiology
• Inflammation of the lining of the stomach
• May be associated with alcoholism,
smoking, and stressful physical problems
– Clinical manifestations/assessment
• Fever; headache
• Epigastric pain; nausea and vomiting
• Coating of the tongue
• Loss of appetite
Disorders of the Stomach
• Acute gastritis (continued)
– Diagnostic tests
• Stool for occult blood; WBC; electrolytes
– Medical management/nursing
interventions
• Antiemetics
• Antacids
• Antibiotics
• IV fluids
• NG tube and administration of blood, if
bleeding
• NPO until signs and symptoms subside
Disorders of the Stomach
• Gastric ulcers and duodenal ulcers
– Ulcerations of the mucous membrane or
deeper structures of the GI tract
– Most commonly occur in the stomach and
duodenum
– Result of acid and pepsin imbalances
– H. pylori
• Bacterium found in 70% of patients with
gastric ulcers and 95% of patients with
duodenal ulcers
Disorders of the Stomach
• Gastric ulcers (continued)
– Etiology/pathophysiology
• Gastric mucosa are damaged, acid is
secreted, mucosa errosion occurs, and an
ulcer develops
• Duodenal ulcers (continued)
– Etiology/pathophysiology
• Excessive production or release of gastrin,
increased sensitivity to gastrin, or
decreased ability to buffer the acid
secretions
Disorders of the Stomach
• Gastric and duodenal ulcers (continued)
– Clinical manifestations/assessment
• Pain: Dull, burning, boring, or gnawing,
epigastric
• Dyspepsia
• Hematemesis
• Melena
– Diagnostic tests
• Esophagogastroduodenoscopy (EGD)
• Breath test for H. pylori
Fiberoptic
endoscopy of
the stomach.
Disorders of the Stomach
• Gastric and duodenal ulcers (continued)
– Medical management/nursing
interventions
• Antacids
• Histamine H2 receptor blockers
• Proton pump inhibitor
• Mucosal healing agents
• Antibiotics
Diet and other interventions:
1. Quit smoking
2. Small frequent meals
3. Avoid high fiber foods
4. Avoid foods rich in sugar, salt and milk
5. Eat slowly and chew food well
6. Avoid caffeine, alcohol, aspirin or any
NSAID
7. High in fat and carbohydrates; low in
protein and milk products.
8. Bland diet (?)
Cancer of the stomach
– Etiology/pathophysiology
• Most commonly adenocarcinoma
• Primary location is the pyloric area
• Risk factors:
–History of polyps
–Pernicious anemia
–Hypochlorhydria
–Gastrectomy; chronic gastritis; gastric ulcer
–Diet high in salt, preservatives (nitrites,
nitrates), and carbohydrates
–Diet low in fresh fruits and vegetables
Disorders of the Intestines
• Irritable bowel syndrome (IBS)
– Etiology/pathophysiology
• Episodes of alteration in bowel function
• Spastic and uncoordinated muscle
contractions of the colon
– Clinical manifestations/assessment
• Abdominal pain
• Frequent bowel movements
• Sense of incomplete evacuation
• Flatulence, constipation, and/or diarrhea
• Irritable bowel syndrome (continued)
– Diagnostic tests
• History and physical examination
– Medical management/nursing
interventions
• Diet and bulking agents
• Medications
–Anticholinergics
–Milk of Magnesia, fiber, or mineral oil
–Opioids
–Antianxiety drugs
• Irritable bowel syndrome (continued)
– Medical management/nursing
interventions
Diet and bulking agents:
• Adequate fiber is more reliably provided
with bulking agents such as Metamucil®.
• The bulking agents seem to be most
effective in the treatment of constipationpredominant IBS, although they may
alleviate mild diarrhea.
• If a patient has exacerbation of symptoms
after certain foods, those foods should be
avoided
Disorders of the Intestines
• Ulcerative colitis
– Etiology/pathophysiology
• Ulceration of the mucosa and submucosa
of the colon
• Tiny abscesses form which produce
purulent drainage, slough the mucosa, and
ulcerations occur
– Clinical manifestations/assessment
• Diarrhea—pus and blood; 15-20 stools per
day
• Abdominal cramping
• Involuntary leakage of stool
• Ulcerative colitis (continued)
– Diagnostic tests
• Barium studies, colonoscopy, stool for
occult blood
– Medical management/nursing
interventions
• Medications
–Azulfidine, Dipentum, Rowasa,
corticosteroids, Imodium
• Stress control
• Assist patient to find coping mechanisms
• Ulcerative colitis (continued)
– Medical management/nursing
interventions
Diet:
- Therapy should exclude milk and products
- Avoid highly spiced foods
- A high protein, high calorie diet is
recommended for people who are
nutritionally deficient.
- Total parenteral nutrition may be used in
severe cases
Disorders of the Intestines
• Crohn’s disease
– Etiology/pathophysiology
• Inflammation, fibrosis, scarring, and
thickening of the bowel wall
– Clinical manifestations/assessment
• Weakness; loss of appetite
• Diarrhea: 3-4 daily; contain mucus and pus
• Right lower abdominal pain
• Steatorrhea
• Anal fissures and/or fistulas
Disorders of the Intestines
• Crohn’s disease (continued)
– Medical management/nursing interventions
• Medications
–Corticosteroids
–Azulfidine
–Antibiotics
–Antidiarrheals; antispasmodics
–Enteric-coated fish oil capsules
–B12 replacement
• Surgery
–Segmental resection of diseased bowel
Crohn’s disease (continued)
Medical management/nursing interventions
Diet:
– High-protein (100 g/day) for patients with
hypoproteinemia
– Elemental diet such as Criticare, Travasorb-HN,
and Precision High Nitrogen
– TPN in severe cases
– Avoid: Lactose-containing foods, brassica
vegetables (cabbage,cauliflower, broccoli,
asparagus and brussels sprouts), caffeine, beer,
monosodium glutamate, highly seasoned foods,
carbonated beverages, fatty foods
Hiatal hernia.
A, Sliding hernia.
B, Rolling hernia.
Disorders of the Intestines
• Hiatal hernia (continued)
– Medical management/nursing interventions
• Head of bed should be slightly elevated
when lying down
• Surgery
–Posterior gastropexy
–Transabdominal fundoplication (Nissen)
Disorders of the Intestines
• Intestinal obstruction
– Etiology/pathophysiology
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Intestinal contents cannot pass through the GI tract
Partial or complete
Mechanical
Non-mechanical
– Clinical manifestations/assessment
• Vomiting; dehydration
• Abdominal tenderness and distention
• Constipation
Figure 5-17
Intestinal obstructions. A, Adhesions. B, Volvulus.
Disorders of the Intestines
• Intestinal obstruction (continued)
– Diagnostic tests
• Radiographic examinations
• BUN, sodium, potassium, hemoglobin, and
hematocrit
– Medical management/nursing interventions
• Evacuation of intestine
–NG tube to decompress the bowel
–Nasointestinal tube with mercury weight
• Surgery
–Required for mechanical obstructions
Disorders of the Intestines
• Cancer of the colon
– Etiology/pathophysiology
• Malignant neoplasm that invades the
epithelium and surrounding tissue of the
colon and rectum
• Second most prevalent internal cancer in
the U.S.
– Clinical manifestations/assessment
• Change in bowel habits; rectal bleeding
• Abdominal pain, distention and/or ascites
• Nausea
• Cachexia
Nursing Process
• Nursing diagnoses
 Activity intolerance
 Anxiety
 Body image,
disturbed
 Constipation
 Coping, ineffective
 Diarrhea
 Fear
 Fluid volume,
deficient, risk for
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Home management, impaired
Management of therapeutic
regimen, ineffective
Nutrition, imbalanced: less
than body requirements
Pain, chronic/acute
Skin integrity, risk for impaired
Sleep pattern, disturbed
Social isolation
Tissue perfusion, ineffective
• OK.. DONE, LET’S GO HOME!!
Nursing Diagnoses