DSM: Malabsorption Disorders
The nurse reviews the results of a patient's lactose tolerance test. Which result should the nurse expect if the patient is lactose intolerant?
Blood glucose elevation does not occur. If lactose is digested & absorbed normally, the blood glucose rises more than 20 mg/dL. The expected blood glucose elevation does not occur in PTs with lactose intolerance.
The nurse is conducting an assessment of a patient with a suspected malabsorption disorder. Which info should the nurse obtain during the health history?
Eating and elimination patterns. During the health hx, the nurse will asks questions to elicit patient responses directly related to the dx of malabsorption, which would more specifically include questions on dietary and elimination habits.
The HCP prescribes a full panel of lab testing for a PT recently diagnosed with short bowel syndrome. The PT asks, "Why do I need all these tests?" Which reason should the nurse provide?
Evaluate nutritional deficiencies. Lab & diagnostic studies are used to evaluate nutrient deficiencies in patients with short bowel syndrome.
The nurse suspects that a patient should be prescribed a lactase-free diet. Which info caused the nurse to make this clinical determination for this patient?
Hx of radiation treatments to the abd. Risk factors for lactose intolerance include: Previous radiation therapy for abd cancer. Hx of celiac disease, Crohn disease, Premature birth, Increasing age
A patient seeks medical attention because of abdominal cramping and pain that occurs every morning after eating cereal for breakfast. Which health problem should the nurse consider this patient is experiencing?
Lactase intolerance. Manifestations of lactose intolerance include lower abd cramping, pain, & diarrhea following milk ingestion. Frequent stools, not constipation, would be a symptom of lactose intolerance, which does not generally present with the symptom of dehydration caused by diarrhea, as the condition is limited to the times lactose-containing foods are ingested.
A PT with celiac disease wants to discuss the issues associated with severe diarrhea. Which intervention should the nurse recommend to monitor and support bowel function?
Monitoring intake & output. PT should be instructed on ways to assess for fluid balance such as daily weights, monitoring I&O, & assessing skin & mucous membranes for signs of dehydration. Actions to improve bowel function in PTs c malabsorption disorders include: Monitoring weight daily. Assessing skin & mucous membranes for signs of dehydration. Monitoring perianal area for breakdown
The nurse instructs a young adult patient regarding dietary changes for celiac disease. Which meal selection indicates that the teaching has been effective?
Salad of mixed greens with roasted chicken, reduced-fat cheddar cheese, and low fat-dressing; an apple; & lemonade. Nutritional intake for PTs c celiac disease should include foods that are gluten-free to prevent repeated immune-mediated responses. It should be high in protein to heal damaged small bowel & to provide for growth, fat-restricted to reduce steatorrhea, & lactose-reduced because of loss of absorption surface of the small intestine.
A PT is recovering from small bowel resection surgery as tx for Crohn disease. For which reason should the nurse realize the PT may experience nutritional deficiencies and chronic diarrhea after this surgery?
Short bowel syndrome. small bowel may be resected because of tumors, infarction of bowel mucosa, incarcerated hernias, Crohn disease, trauma & enteropathy resulting from radiation therapy. Resection of significant portions of the small intestine may result in a condition known as short bowel syndrome. Because of the resultant surgical reduction in the surface area of the small intestine for absorption, nutrient deficiency & chronic diarrhea may occur. Others: sig impairment of digestion & absorption, nutrient deficiencies, WT loss, diarrhea, increased risk for kidney stones & gallstones
The nurse is working with a PT who is newly diagnosed with celiac disease and is sharing info related to desired outcomes. Which result shows improvement of the PT's condition?
The patient maintained adequate nutritional status. Nurse should evaluate outcomes by assessing the PTs nutritional status. The nurse would expect a positive outcome to include a decrease & not an increase in abd distention. Skin turgor that is decreased would be a negative outcome
The nurse is caring for a patient suspected of having celiac disease. Which test should the nurse expect to be prescribed for this patient?
Tissue biopsy of the small intestine. Celiac disease is diagnosed by a tissue biopsy to identify intestinal cells that resemble those damaged by the T-cell-mediated immune response. Diagnostic tests for celiac disease include: Enteroscopy for direct exam of intestinal mucosa & collection of a tissue specimen for biopsy. Upper GI series c small-bowel follow-through to evaluate structures of the upper GI tract. Measuring fecal fat to document presence of steatorrhea.
During a home visit, the nurse evaluates the effectiveness of diet teaching provided to a patient with celiac disease. Which patient statement should the nurse expect that indicates adherence to the prescribed diet?
"I cannot use regular bread to make my sandwiches anymore." Strategies for a PT with malabsorption disorders include: Dietary support, Education on reading nutritional labels, Keeping food diaries Monitoring weight
The nurse is instructing a parent on the care of a child diagnosed with celiac disease. Which response by the parent indicates teaching has been effective?
"I should alert my child's school that my child requires a gluten-free diet." Manifestations of celiac disease in children: Irritability & behavioral issues, Bloating, Gas, Diarrhea, Vomiting, Skin rashes, Decreased appetite, Poor weight gain, Failure to thrive, Delayed growth or puberty, Weak bones prone to fracture
The nurse prepares info to help a middle-aged adult PT understand a new onset of lactose intolerance. Which statement should the nurse provide to explain the connection of age to this health problem?
"There may be a reduction of lactase production as you age." Risk factors for lactose intolerance include previous radiation therapy for abd cancer, history of celiac disease or Crohn disease, premature birth, and increasing age. As we age, we may experience a normal decline in amount of lactase found in the small intestine. For some older adults, this leads to acquired lactase deficiency, which manifests as an increasing intolerance to lactose over time.
Aa patient is experiencing a local manifestation of celiac disease. Which diagnostic test should the nurse anticipate being prescribed for this patient.
Fecal fat level. A fecal fat level measurement will most likely be prescribed because it is a diagnostic test for steatorrhea, which is a local manifestation of celiac disease
Connections between socioeconomic factors & celiac disease are not well understood, but research suggests a higher prevalence of celiac disease among children of higher socioeconomic status. This could be due to:
*increased care-seeking behaviors among parents of higher socioeconomic status *improved access to care, resulting in more frequent dx of the disease. *PTs of lower socioeconomic status diagnosed with celiac disease: tend to experience worse health related to the condition, exhibit more symptoms of disease. May be due to: a lack of education about lifestyle modifications more limited access to gluten-free foods.
The nurse suspects that a PT has celiac disease. Which info should the nurse identify to support this clinical determination?
Abdominal bloating. Assessment findings that support the current dx include abd bloating, muscle wasting, & anemia. Black tarry stools are not associated c celiac disease.
A PT with celiac disease has been experiencing frequent bouts of diarrhea. Which action should the nurse instruct this PT to improve bowel function & prevent further small intestine damage
Avoid all foods/products that contain gluten. Teaching the patient to eliminate all gluten in the diet is paramount in the control of this disease. Foods to avoid when diagnosed with celiac disease include: Wheat, Rye, Barley, Oats
The nurse considers dietary changes needed to help a patient with celiac disease. Which change should the nurse emphasize with the patient?
Avoid gluten. Consumption of gluten-free foods is the primary treatment for celiac disease. Increasing fat intake is contraindicated.
The nurse evaluates teaching provided to a patient with a malabsorption problem. Which patient statement should indicate to the nurse that the patient understands teaching?
"I should adhere to my prescribed diet to avoid the onset of bloating and discomfort." An outcome to determine if teaching is effective would be the PT being aware of the connection between the prescribed diet & symptoms.
The nurse prepares teaching material for a patient with celiac disease.Which nutrients should the nurse explain as being difficult to absorb because of this health problem?
Fats.
The nurse prepares teaching material for a patient with celiac disease. Which nutrients should the nurse explain as being difficult to absorb because of this health problem?
Fats. Celiac disease AKA celiac sprue or nontropical sprue, is a chronic immune-mediated disorder of the small intestine in which absorption of nutrients, particularly fats, is impaired. absorption of sugar, protein, or water are not as impaired as absorption of fats.
HSCP prescribes medication to reduce the inflammatory process in a patient with celiac disease. For which med should the nurse prepare teaching for this patient?
Corticosteroid.
The nurse reviews a patient's health history prior to completing an assessment. Which factor should the nurse identify as increasing this patient's risk for lactase deficiency?
Crohn disease. Lactase deficiency can occur secondary to celiac & Crohn disease, not pancreatitis or ulcerative colitis. Ethnicity also plays role in lactose intolerance; is more common in Native Americans, Asians, Hispanics, & Blacks. Risk factors lactose intolerance include:Previous radiation therapy for abd cancer, hx of celiac disease or Crohn disease, Premature birth, Increasing age
The nurse reviews a patient's health history prior to completing an assessment. Which factor should the nurse identify as increasing this patient's risk for lactase deficiency?
Crohn disease. Lactase deficiency can occur secondary to celiac and Crohn disease. Risk factors for lactose intolerance include: Previous radiation therapy for abdominal cancer. History of celiac disease or Crohn disease. Premature birth. Increasing age
A PT with bloating and severe diarrhea every morning is being tested for lactose intolerance. Which gas should the nurse expect to be identified when the patient has the lactose breath test?
Expired hydrogen gas. The lactose breath test is a noninvasive test that may be used to diagnose lactose intolerance. Expired hydrogen gas (H2) is measured following oral administration of 50 g of lactose.
The nurse prepares teaching material for a patient with celiac disease. Which nutrients should the nurse explain as being difficult to absorb because of this health problem?
Fats.
The nurse is reviewing the discharge instructions with a PT recently diagnosed with celiac disease. Which item should be included in this teaching session?
Recognizing gluten containing ingredients on food labels. PT & family teaching includes explaining how to identify gluten-containing commercial products by reading labels and lists of ingredients and encouraging the purchase and use of a gluten-free cookbook.
A pregnant PT with a hx of celiac disease is experiencing symptoms of lactose intolerance. For which reason should the nurse consider celiac disease when teaching this patient on ways to control the symptoms of lactose intolerance?
The PT will need to be instructed on maintaining a gluten free diet as well as limiting lactose-containing foods. Maternity patients with celiac disease who develop lactose intolerance need to be instructed to continue maintenance of their gluten-free diets while also limiting the ingestion of lactose-containing foods.
A 12 YO PT is diagnosed with short bowel syndrome. Which manifestation should the nurse note and plan for in the patient's plan of care?
Weakness. Short bowel syndrome is considered one of the malabsorption syndromes. Weight loss, weakness, general malaise, muscle cramps, bone pain, abnormal bleeding, and anemia are common systemic manifestations of malabsorption.
A patient with osteopenic bone disease has an iron deficiency. Which disorder should the nurse suspect this patient is experiencing?
Celiac disease. High-risk populations have been identified in familial forms of celiacdisease, including individuals with iron-deficiency anemia and those with osteopenic bone disease. Complications caused by celiac disease include: GI malignancies, Intestinal lymphoma, Intestinal ulceration, Development of refractory disease, Disease that no longer responds to a gluten-free diet, Vit & mineral deficiencies
