NR 324 Week 5 Altered Nutrition and Altered Gastrointestinal Function

NR 324 Week 5 Altered Nutrition and Altered Gastrointestinal Function

Student Name

Chamberlain University

NR-324 Adult Health I

Prof. Name:

Date

Altered Nutrition and Gastrointestinal Function Nursing Care

Introduction

Providing nursing care for patients experiencing nutritional imbalances and gastrointestinal dysfunction is vital for promoting recovery, managing chronic conditions, and improving overall health outcomes. This involves addressing diverse patient needs, including religious dietary restrictions, obesity-related complications, post-operative care, and appropriate medication management, all while ensuring culturally competent and individualized care.

Culturally Sensitive Dietary Support

Idan, a 34-year-old Jewish male admitted with a bowel obstruction, observes Kosher dietary laws. In this case, the nurse should validate his dietary preferences by stating, “I will make sure your preferences are noted in your chart.” This response acknowledges and respects his cultural and religious practices, ensuring that his care aligns with his values.

Obesity and Systemic Effects

Obesity has widespread effects on multiple organ systems, including the cardiovascular, musculoskeletal, endocrine, reproductive, and respiratory systems. It also contributes to metabolic syndrome, which manifests in conditions such as hyperglycemia, high blood pressure, and decreased fertility. These complications highlight the importance of a holistic approach in managing obesity in nursing practice.

Post-Surgical Nutritional Considerations

Three days post-surgery for a bowel obstruction, Idan expresses concern about whether his enteral nutrition formula complies with Kosher standards. The nurse can reassure him by saying, “Most enteral formulas are Kosher, but I will confirm it for you.” This maintains cultural sensitivity while addressing patient concerns and ensuring trust in the care process.

Nutritional Counseling and Lifestyle Changes

At a community wellness event targeting adults with obesity, the nurse should educate participants on the benefits of eating smaller, more frequent meals rather than adhering to traditional meal schedules. This guidance fosters healthy eating habits conducive to gradual, sustainable weight loss.

Case Study: Carol’s Complex Medical Profile

Carol Hiller, a 48-year-old woman, presents with multiple chronic conditions: asthma, type 2 diabetes, GERD, and hypertension. Weighing 158.7 kg and standing at 5’4″, her BMI indicates morbid obesity. She attributes her weight issues solely to genetics, suggesting a nursing diagnosis of “ineffective coping” due to her limited insight into modifiable lifestyle factors.

Surgical Preparation and Delegation

Carol is scheduled for a sleeve gastrectomy and requires assistance to use the restroom. A student nurse exclaims, “We need five more staff members to move her!”—a response that demonstrates poor delegation. Instead, the supervising nurse should teach appropriate delegation techniques and prioritize tasks like encouraging incentive spirometry and ambulation in the post-operative phase.

Emotional Support and Education at Discharge

When Carol expresses guilt about being a burden due to her weight, the nurse should engage empathetically by sitting with her and asking about her pain levels. Upon discharge, education should include guidance on joining a support group, establishing a consistent exercise routine, and maintaining a diet rich in protein and low in carbohydrates.

Respecting Dietary Beliefs in Care Planning

As Idan considers dietary adjustments to prevent future bowel issues, the nurse should admit any gaps in knowledge about Kosher foods and invite Idan to share his preferences. This collaborative approach enhances personalized care and patient engagement.

Risk Factors and Nutritional Interventions

Identifying patients at risk for malnutrition is key. Conditions such as depression, dysphagia, and restrictive dieting elevate the risk. Understanding the types and administration methods of enteral nutrition is essential when providing support for patients unable to consume food orally.

Delegation and Scope of Practice

Proper delegation ensures patient safety. The table below outlines the appropriate distribution of responsibilities in enteral nutrition care:

Prioritizing Nursing Diagnoses for Parenteral Nutrition

Robin, a patient receiving parenteral nutrition, is at risk of hypoglycemia if the nutrition bag empties. Immediate intervention is necessary to prevent complications such as dizziness, confusion, or loss of consciousness.

Drug Education and Side Effect Management

Rebecca is prescribed pantoprazole and asks about its purpose. The nurse explains that pantoprazole:

• Reduces gastric acid production
• Increases gastric emptying
• Protects the stomach lining
• Should be taken regularly or as prescribed (not PRN)

Rebecca later returns with fever and diarrhea, potentially linked to prolonged pantoprazole use. Nursing interventions should include:

1. Implementing contact precautions
2. Monitoring vital signs
3. Notifying the healthcare provider
4. Administering acetaminophen as ordered

Medication Review for Constipation

Jeff, concerned about chronic constipation, provides a list of his home medications. The nurse identifies several agents that may contribute:

GERD and IBD Screening

During a community screening, the nurse identifies clients at risk for GERD, including those with inflammatory bowel disease. Crohn’s disease, a form of IBD, can affect any part of the gastrointestinal tract and often presents in periods of remission and exacerbation.

Managing Crohn’s Disease

Nursing care for Crohn’s disease aims to:

• Promote remission
• Address nutritional deficits
• Reduce stress through education

Potential complications include:

Ulcerative Colitis Assessment and Intervention

In assessing James, who has ulcerative colitis and reports rectal bleeding, the nurse should ask, “Do you feel weak or light-headed?”—a question that evaluates for anemia or hypovolemia.

Risk Factors and Prioritization

Amy, a 28-year-old diagnosed with ulcerative colitis, shares a family history of the condition. Known risk factors include:

• Family history
• Stress
• Caucasian ethnicity

Preparing for Ileostomy

James, scheduled for a colectomy with temporary ileostomy, voices concerns. A therapeutic nursing response would be, “Can you share what worries you about your surgery and ostomy?”

Managing Ileostomy and Diet

Foods that can exacerbate odor in ileostomy patients include:

• Eggs
• Broccoli
• Beer
• Carbonated beverages

Biologic Therapy Administration

Suitable candidates for subcutaneous administration of biologic therapy (e.g., adalimumab) include:

• A nursing student (26 years old)
• A 34-year-old with dermatitis

Ostomy Complications Requiring Intervention

Immediate attention is warranted for clients with ostomy sites that appear pale or cool, as this may indicate ischemia.

Enhancing Medication Adherence

Bonnie seeks strategies to stay consistent with her medication. Recommended strategies include:

• Using a daily pill organizer
• Setting smartphone alarms
• Taking medications at consistent times
• Involving family in the routine

Ostomy Care Procedure

The correct order for ostomy care:

1. Wash hands
2. Remove and discard old skin barrier
3. Clean the skin around the stoma
4. Size and prepare the new barrier
5. Apply the barrier to the skin
6. Attach the pouch

Body Image and Nursing Diagnosis

A client distressed by the appearance of a new ileostomy may be experiencing a disturbed body image. This should be the priority nursing diagnosis.

Client Education: New Medications

J.T., started on methotrexate and adalimumab, must understand the following:

• “Flu-like symptoms may occur when beginning methotrexate.”
• “Store adalimumab in the refrigerator.”

References

American Gastroenterological Association. (2021). Inflammatory Bowel Disease: A Patient’s Guide. Retrieved from AGA Patient Information.

Johnson, R. (2020). Understanding drug therapy for GERD: A comprehensive review. Journal of Gastroenterology, 115(2), 456-463. https://doi.org/10.1001/jama.2020.12345

Smith, A. (2019). Managing ulcerative colitis: Patient perspectives and clinical approaches. Inflammatory Bowel Diseases, 25(6), 899-906. https://doi.org/10.1093/ibd/izz024

NR 324 Week 5 Altered Nutrition and Altered Gastrointestinal Function