Nursing Care: Altered Nutrition and Gastrointestinal Function

Prepare: The Nursing Care of Altered Nutrition and Gastrointestinal Function

Dietary Customs

• Idan, a 34-year-old client, has been admitted for a bowel obstruction. In the admission assessment, Idan identifies himself as a practicing Jewish man who follows Kosher dietary practices. Which statement, made by the nurse, is most appropriate?

Obesity

• Obesity impacts which body systems? Select all that apply.

Metabolic Syndrome

• Which health problems are associated with metabolic syndrome? Select all that apply.

Self-Check: Kosher Foods

• Idan is now post-operative day (POD) 3 from his bowel obstruction. He currently has a nasogastric (NG) tube for nutrition and medication intake. The healthcare provider has ordered enteral feeding be initiated, but Idan is concerned about the formula not following Kosher dietary practices. Which statement made by the nurse is most appropriate?

Self-Check: Behavioral or Lifestyle Modifications

• The nurse is attending a community event for obese adults who are about to begin behavior and lifestyle modifications to lose weight. Which action is most appropriate?

Self-Check: Carol's Case Study

BMI

• Past Medical History: Asthma, diabetes mellitus type 2, gastroesophageal reflux disease (GERD) , hypertension Calculate Carol’s body mass index (BMI). Which category does she fall in to?

Nursing Diagnosis

• Carol has come to the healthcare provider’s office for a physical. The healthcare provider asks Carol about her weight and begins to discuss the correlation between her health concerns and excessive fat. Carol states that the only reason she is her current weight is due to her genetics and has nothing to do with her food intake or lack of exercise. Which nursing diagnosis is most appropriate for Carol?

Pre-Operative Nursing Care

• A few months have passed, and Carol has made the decision to undergo a sleeve gastrectomy. She has arrived at the preoperative holding area to await her surgery. Carol must use the bathroom and has pressed her call button for help. The nurse and a student nurse have arrived and are preparing to help Carol. Which statement made by the student nurse requires immediate correction? “Is Carol allowed to stand before surgery?”

Reflect: The Nursing Care of Altered Nutrition and Gastrointestinal Function

Delegation

• The nurse is preparing for Carol’s arrival to the medical surgical unit from the post anesthesia care unit (PACU). Which tasks could the nurse delegate to an unlicensed assistive personnel (UAP)? Select all that apply.

Plan of Care

• Carol returns to the medical-surgical unit after her sleeve gastrectomy procedure. She currently has a nasogastric (NG) tube connected to low, intermittent suction. Which nursing actions are appropriate? Select all that apply.

Post-Operative Nursing Care

• The nurse goes into Carol’s room to assess her abdominal surgical incision. Carol is complaining of incisional pain, and the nurse notices slight erythema at the incision edges. Her current vital signs are as follows:
• The nurse recognizes that this is part of the normal healing process, but is concerned about which barrier to healing? Select all that apply.

Communication

• Carol is in her room on the medical surgical unit when the unlicensed assistive personnel (UAP) arrives to take her vital signs. The UAP reports the vital signs to the nurse and mentions that Carol appears upset and tearful in her bed. Her vital signs are as follows:
• The nurse approaches Carol in her room. Carol says, “I’m so sorry, I know I must be a bother to you. I know caring for me can be more complicated because of my size. I’m okay, though. Thank you for checking on me, I’m fine for right now.” Which action made by the nurse is most appropriate?

Teaching

• The nurse is preparing to provide Carol with discharge teaching. Which information will the nurse plan to include?

Long-Term Goal

• What would an appropriate long-term goal be for Carol? Select all that apply.

Dietary Preferences

• Idan is asking the nurse about potential changes in his dietary preferences so his bowel obstruction does not reoccur. The nurse recognizes that they have deficient knowledge regarding Kosher dietary preferences and is unsure of how to respond to Idan. Which is the most appropriate action?

Dietary Intake

• When discussing appropriate daily nutritional intake, which proportions are correct?

Malnutrition

Prepare: Malnutrition

Risk Factors

• What are conditions that increase a client's risk of developing malnutrition? Select all that apply.

Enteral Nutrition

• What is a characteristic of enteral nutrition?

Nursing Care Enteral Nutrition

• What is the importance of raising the client's head of bed prior to administering enteral nutrition?

Self-Check: Assessment

• You are completing a nutritional assessment on a newly admitted client. Which of the following questions are most important to ask? Select all that apply

Self-Check: Assessments

• Eric, a 67-year-old male client, has suffered a large ischemic stroke. He is currently dysphagic and lethargic, so a percutaneous gastrostomy (PEG) tube was ordered for nutritional support. His wife, Lydia, is asking questions regarding the rationale for the PEG tube. Which response by the nurse is best?

Self-Check: Post-Operative Tube Insertion

• Eric has returned from the operating room with a percutaneous gastrostomy (PEG) tube. He currently has 50mL/hour of IV lactated Ringer's solution running. Nothing is infusing in the PEG tube. Which action should the nurse implement? Select all that apply.

Self-Check: Gastrointestinal Obstruction

• Robin is admitted with a gastrointestinal obstruction. Which of the following options is best for Robin to receive nutritional support?

Self-Check: Assessments

• Robin has a peripherally inserted central catheter (PICC) placed for her parenteral nutrition. Which of the following assessments would be appropriate for the nurse to include in Robin's plan of care? Select all that apply.

Self-Check: Types of Nutritional Support

• Match the information to the appropriate type of nutritional support .

Reflect: Malnutrition

Delegation

• The nurse is attempting to delegate activities and interventions to other members on the team. Which of the following actions is inappropriately delegated to the correct person?

Nursing Care

• The nurse is preparing to care for Eric with the assistance of a student nurse. Which action by the student nurse will require the nurse to step in?

Nursing Care

• Eric and his wife Lydia are prepping for discharge. Match the interprofessional team member with their role in helping Eric and Lydia. Click on an item in the first column, then click on the matching item in the second column.

Complications

• The nurse is writing a priority nursing diagnosis for Robin. Create the nursing diagnosis below.

Complications

• The nurse notices that Robin's parenteral nutrition bag has run dry, and a new one has not been prepared and sent from pharmacy. Which complication is the nurse anticipating?

Nursing Care

• Since the nurse has recognized that Robin is now at an increased risk for hypoglycemia, which of the following orders is most important to implement?

Nursing Care

• Case management is discussing the potential of discharging Robin home with her parenteral nutrition and peripherially inserted central cathether (PICC) line in place. Which of the following assessments would be most beneficial in determining Robin's readiness to return home at this time? Select all that apply.

Home Care

• Which of the following is a priority concern for Robin while at home?

GERD

Prepare: GERD

Lower Esophageal Sphincter

• Where is the lower esophageal sphincter?

Manifestations

• What are common manifestations of gastroesophageal reflux disease? Select all that apply.

Drug Therapy

• Which of the following prescriptions is commonly administered for gastroesophageal reflux disease (GERD)?

Self-Check: Risk Factors

• What are some risk factors commonly associated with the development of GERD? Select all that apply.

Self-Check: Meet Rebecca

• Rebecca, a 58 year old female with a history of hypertension and arthritis, has arrived to the emergency department (ED) for symptoms of chest pain. She was finishing dinner with her husband, Ron, when the symptoms started. Rebecca took a calcium carbonate tablet while enroute to the ED, and took her hypertensive medications this morning as prescribed. Which of the following questions would best alert the nurse to the possible cause of Rebecca’s chest pain?

Self-Check: Risk Factors

• Jeff is a 64 year old retired contractor with gastroesophageal reflux disease (GERD). He has smoked 1.5 packs of cigarettes a day for 30 years (equaling a 45 pack year history), drinks “one or two glasses of whiskey at night”, and loves tomato soup. His BMI is 39. What lifestyle changes can Jeff make to decrease his symptoms of GERD? Select all that apply.

Self-Check: Post Procedure

• Rebecca has just returned from an endoscopy to evaluate for gastroesophageal reflux disease (GERD) and is asking for ice chips. Which of the following assessments is the nurse’s priority?

Self-Check: Lifestyle Changes

• Rebecca has been diagnosed with gastroesophageal reflux disease (GERD). She is concerned about the lifestyle changes that she will need to implement in order to maintain her symptoms. Which of the following recommendations would be most beneficial for Rebecca?

Reflect: GERD

Diet

• Jeff just had his meal tray delivered to his room. Which of the following food choices would the nurse see as an opportunity for client teaching?

Medication Schedule

• Rebecca has been discharged from the hospital with a new list of home medications. The healthcare provider prescribed 40mg of pantoprazole for her gastroesophageal reflux disease (GERD) symptoms. Select the proper slot in Rebecca’s datebook to schedule her dose of pantoprazole

Post Discharge Help

• Rebecca’s husband, Ron, mentions that Rebecca has been unable to sleep recently due to her heartburn and dyspepsia, and asks how he can help her get comfortable when they are home. Which of the following recommendations should the nurse provide?

Post Operative

• Jeff has returned to the nursing unit after a Nissen fundoplication. He has an indwelling urinary catheter, a nasogastric (NG) tube to low continuous suction, and two IVs. Jeff is alert and oriented with a 4/10 pain score on the 0-10 scale. The nurse notes bright red blood in the NG tube. What action should the nurse take first?

Drug Therapy

• Rebecca is asking the nurse why she was prescribed pantoprazole. In teaching her about this medication, the nurse explains that this drug:

Pantoprazole

• A few months after discharge, Rebecca returns to the hospital and has developed watery diarrhea and a fever after prolonged pantoprazole therapy. In which order will the nurse complete the following actions?

Home Medications

• Jeff is back at his healthcare provider’s office and his complaining of worsening constipation. In looking at Jeff’s home medication list, what does the nurse attribute to Jeff’s constipation? Select all that apply.

Screening

• The nurse is at a community event screening clients for their risks of developing gastroesophageal reflux disease (GERD). Which of the following clients is at risk of developing GERD? Select all that apply.

Inflammatory Bowel Disease

Prepare: Inflammatory Bowel Disease

Crohn’s Disease Location

• What portion of the intestinal tract can be affected with Crohn’s Disease?

Autoimmune Disease Characteristics

• What is a classic characteristic of autoimmune diseases?

Goals of Treatment

• What are the goals of treatment with inflammatory bowel disease (IBD)? Select all that apply.

Self-Check: Crohn’s Disease Complication

• Knowing the pathophysiology of inflammation for Crohn’s disease, the client with this disease is at risk for developing which of the following complications?

Self-Check: Ulcerative Colitis Complication

• The nurse knows that rectal bleeding is a common finding in ulcerative colitis. Which of the following questions is important for the nurse to ask James upon assessment?

Self-Check: Priority Concerns

• Based on your previous clients’ charts, which of the following statements are the priority concerns for Bonnie and James? Choose the correct answer from the drop down boxes.

Self-Check: Ulcerative Colitis

• Amy is a 28-year-old busy graduate student with ulcerative colitis (UC). Her father is James, one of your previous clients. Which of the following risk factors are associated with UC? Select all that apply.

Self-Check: Therapeutic Response

• James has made a follow-up appointment with his healthcare provider about his cancer diagnosis. They have decided to proceed with a total colectomy with creation of a temporary ileostomy due to his severe ulcerative colitis. James and his wife seem visibly anxious about the lifestyle changes and care that his new ileostomy will bring to their lives. What is the most therapeutic response by the nurse?

Reflect: Inflammatory Bowel Disease

Expected Prescriptions

• J.T, a 34-year-old male arrives to the emergency department with an exacerbation of ulcerative colitis. He is complaining of stabbing abdominal pain that is 9 out of 10 on the 0-10 pain scale, with worsening bloody diarrhea. Which of the following prescriptions do you anticipate that the healthcare provider will order? Select all that apply.

Ileostomy Diet

• James is worried about dealing with the odor associated with his temporary ileostomy. Which of the following food items would you instruct James to keep out of his diet as they are gas forming, odor producing, or can cause diarrhea? Select all that apply.

Routes of Administration

• Understanding the routes of administration for biologic/targeted therapy for inflammatory bowel disease (IBD), which of the following clients would be appropriate for subcutaneous injections? Select all that apply

Immediate Interventions

• Which of the following clients with ostomies require immediate intervention?

Medication Adherence

• Bonnie has come back to the clinic to discuss methods to assist her in being more compliant with her medications. Which of the following methods do you recommend? Select all that apply.

Ostomy Care

• Reorder the steps of ostomy care from start to finish. Drag and drop the items into the correct order.

Priority Nursing Diagnosis

• The nurse has entered the room of a client with a newly created ileostomy. They observe the client tearful sitting in bed. When the nurse approaches the client to change her ostomy dressing, the client becomes upset, stating, “Don’t touch that! It’s so awful to look at and it smells terribly. I’m never leaving my house again”. What is priority nursing diagnosis for this client?

Client Education

• J.T. was started on methotrexate and adalimumab for his ulcerative colitis, and is about to be discharged home. What client education would you provide J.T. about his new medication regimen? Select all that apply.