NR 324 Week 5 Altered Nutrition and Altered Gastrointestinal Function

Student Name

Chamberlain University

NR-324 Adult Health I

Prof. Name

Date

Week 5: Altered Nutrition and Altered Gastrointestinal Function

Nursing Care: Altered Nutrition and Gastrointestinal Function

Dietary Customs

Idan, a 34-year-old client admitted with a bowel obstruction, identifies as a practicing Jewish individual who follows Kosher dietary practices. The most appropriate response from the nurse would be:

“Enteral formulas are usually Kosher prepared, I will check to make sure.”

This response is respectful of the patient’s beliefs and shows the nurse’s willingness to accommodate cultural dietary requirements.

Obesity and Body System Impacts

Obesity significantly affects multiple body systems. These include:

• Cardiovascular
• Musculoskeletal
• Respiratory
• Reproductive
• Endocrine

Metabolic Syndrome

Health problems associated with metabolic syndrome include:

• High blood glucose
• Hypertension
• Osteoarthritis

Kosher Foods and Enteral Nutrition

Idan, now on post-operative day 3, has concerns regarding the enteral formula not complying with Kosher practices. The most appropriate response is:

“Enteral formulas are usually Kosher prepared, I will check to make sure.”

This shows cultural competence and a patient-centered approach.

Behavioral or Lifestyle Modifications

Weight Loss Support in Community Settings

During a community event, the most appropriate action by the nurse is:

“Ask the clients what types of situations or emotions make them want to eat/increases their appetite.”

This encourages self-awareness and tailored interventions.

Case Study: Carol Hiller

BMI Calculation

Carol Hiller, age 48, weighs 158.7 kg and is 5’4″ tall. Her BMI is calculated as:

BMI = weight (kg) / height (m^2)

Height in meters = 1.63 m
BMI = 158.7 / (1.63^2) = ~59.7

Carol falls into the Extreme Obesity category.

Nursing Diagnosis

Given Carol’s belief that her weight is solely genetic, an appropriate nursing diagnosis is:

Ineffective coping

This reflects her resistance to accepting behavioral responsibility in managing her health.

Pre-Operative Nursing Care

Inappropriate Student Nurse Behavior

The statement that requires immediate correction:

“We can’t help move her alone! I’m getting 5 more staff members for this.”

This may increase Carol’s discomfort and anxiety. Proper assistance should be calmly coordinated.

Reflect: Delegation and Plan of Care

Tasks to Delegate to UAP

• Obtain compression socks
• Stock the room with a bariatric gown and cuff
• Place NPO sign at head of bed

Not Delegated: Creating a passive range of motion schedule (RN responsibility).

Appropriate Nursing Actions Post-Surgery

• Encourage coughing and deep breathing
• Encourage early ambulation
• Administer prescribed pain medications

Inappropriate: Offering fruit juice every 2 hours (contraindicated post-op).

Post-Operative Nursing Care

Healing Concerns

Although Carol’s vitals indicate a stable post-op course, barriers to healing include:

• Type 2 diabetes mellitus
• Excess abdominal skin and weight

Communication

Appropriate Nurse Response

“Sit with Carol and ask about the pain she is experiencing.”

This approach is empathetic and helps address both emotional and physical needs.

Teaching and Long-Term Goals

Discharge Teaching

• Drink fluids between meals
• Avoid high-fat diets
• Join a support group (start early, not after 1 year)
• Continue exercise programs

Appropriate Long-Term Goals:

• Join a support group
• Maintain exercise routine
• Be free from signs of malnutrition
• Attain target weight within 8 months

Cultural Sensitivity in Dietary Preferences

When unsure about Kosher practices, the nurse should:

“Excuse themselves to read a credible resource on Kosher preparation.”

This supports informed, respectful care.

Table: Daily Nutritional Intake Proportions

Nutrient Category	Recommended Daily Intake (%)
Carbohydrates	45-65%
Proteins	10-35%
Fats	20-35%

Malnutrition Risk Factors

Conditions increasing malnutrition risk:

• Depression
• Dysphagia
• Infections
• Dialysis
• Extreme dieting

Enteral Nutrition Characteristics

• Administered via tube, stoma, or catheter
• Appropriate when GI tract is intact

Importance of Head-of-Bed Elevation:

Reduces risk of aspiration

Nutritional Assessment Questions

• Have you recently gained or lost weight?
• Do you use meal services (e.g., Meals on Wheels)?
• Do you take medications?
• Do your dentures fit properly?

PEG Tube Rationale and Post-Op Care

Rationale for PEG Tube:

“It is not safe for Eric to have oral intake due to lethargy and dysphagia.”

Post-Operative Nursing Actions:

• Monitor PEG site
• Auscultate for bowel sounds
• Do not connect IV fluids to PEG

Nutritional Support for Obstruction

Best Option: Parenteral nutrition (PN)

PICC Line Care Includes:

• Respiratory assessments
• Monitor glucose
• Site inspection
• Daily weights
• I&O documentation

Delegation in Malnutrition Care

Incorrect Delegation:

Eve, UAP, educating the client about PEG care

Nursing Care and Student Supervision

Requires Intervention:

Lowering head of bed below 30° during med administration

Complication Management

Hypoglycemia Prevention:

Start D10 solution immediately when TPN ends unexpectedly

Home Readiness Assessment:

• Identify signs for physician contact
• Demonstrate parenteral nutrition process

Priority Home Concern: Infection

GERD: Gastroesophageal Reflux Disease

Common Symptoms:

• Dyspepsia
• Vomiting
• Pyrosis

NR 324 Week 5 Altered Nutrition and Altered Gastrointestinal Function

Common Medications: Famotidine

Risk Factors:

• Obesity
• Hiatal hernia
• Smoking
• Diabetes

Lifestyle Changes:

• Small frequent meals
• Avoid reflux-causing foods
• Smoking cessation

Assessment Priority Post-Endoscopy: Return of gag reflex

Client Education and Medication Management

GERD Teaching Includes:

• Medication schedules (e.g., pantoprazole before breakfast)
• Elevating head post meals
• Avoid late-night snacking

Post-Fundoplication Alert:

Bright red blood in NG tube = notify surgeon immediately

Pantoprazole Teaching:

Reduces acid production

Adverse Effects:

• Watery diarrhea
• Fever (suggests possible C. diff infection)

Constipation and Medication Causes

Medications Contributing to Constipation:

• Calcium carbonate
• Oxycodone

Inflammatory Bowel Disease (IBD)

Crohn’s Affected Areas: Anywhere along GI tract

Autoimmune Traits: Periods of exacerbation and remission

Goals of Treatment:

• Achieve remission
• Improve nutrition
• Cost-effective disease management

Complications of Crohn’s: Peritonitis

UC Symptoms: Rectal bleeding

Risk Factors for UC:

• Stress
• Family history
• Caucasian ethnicity

Therapeutic Response:

“Tell me what your concerns are…”

Expected Orders for Severe UC (e.g., J.T.)

• NPO
• Colectomy consent
• NG tube
• Cardiac monitoring

Foods to Avoid with Ileostomy:

• Broccoli
• Carbonated beverages
• Eggs
• Beer

Routes for Biologic Therapy

SubQ Candidates:

• 26-year-old male in school
• 34-year-old with dermatitis

Ostomy Concerns

Immediate Concern: Dusk/pale stoma

Priority Nursing Diagnosis: Disturbed body image

Medication Education (Methotrexate + Adalimumab)

• Store adalimumab in refrigerator
• Flu-like symptoms may occur with methotrexate
• Take medications routinely

References

American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). ANA Publications.

Lehne, R. A., Rosenthal, L. D., & Garrison, S. R. (2021). Pharmacology for nursing care (10th ed.). Elsevier.

NR 324 Week 5 Altered Nutrition and Altered Gastrointestinal Function

Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2021). Fundamentals of nursing (10th ed.). Elsevier.

U.S. Department of Health and Human Services. (2022). Dietary Guidelines for Americans 2020–2025. https://www.dietaryguidelines.gov/