Ch 23 HUN

IBD consists of which 2 diseases?

Chron's disease and ulcerative colitis. (p. 523)

As you read about hepatitis what did you learn that you did not already know and that you feel you should remember for professional purposes?

-symptoms include gastrointestinal complaints which can lead to poor nutrition health and diminished oral intake -glycogen storage, production of bile, storage of vitamins and minerals (liver functions) are negatively affected -increased nutritional needs -avoid alcohol

What factors increase the risk of gallstones?

- OBESITY - RAPID WEIGHT LOSS - PROLONGED FASTING - DIETS HIGH IN ADDED SUGARS AND LOW IN FIBER

___________ (1 WORD) Dz is an autoimmune condition that results in atrophy of intestinal villi when gluten is consumed.

Celiac (p. 528)

Examine Table 23-2 on page 530; list 6 things you see that you would not have associated with gluten:

Gravy, pudding, processed meats, seasoning and seasoned coatings, lipgloss, and salad dressing.

In summary, which 3 GI accessory organs have been addressed on this assignment?

Liver, pancreas, gallbladder

You learned about pernicious anemia in a previous chapter; this condition is caused by a deficiency of vitamin ____. When this vitamin cannot be absorbed from food due to reduced acidity in the stomach caused by frequent use of antacid medications, then pernicious anemia can be the consequence.

B 12 (p. 522)

Cirrhosis can lead to third-spacing of fluids in the abdominal cavity known as _____________ (1 WORD).

ascites (p. 535-536)

With celiac dz, what 3 grains must be entirely eliminated from the diet?

Wheat, rye, and barley.

Liver dz necessitates a high ______________ (1 WORD) diet as part of dz management.

carbohydrate (p. 536)

Read about CONSTIPATION on page 532; LIST the contributing factors:

)Reduced physical activity, medications, and medical conditions. May also be systemic, functional, and neurological disorders. (IF YOU DID NOT LIST ALL OF THESE BE SURE TO ADD WHAT'S MISSING TO YOUR HARD COPY NOW. - SLOWED TRANSIT TIME WITH AGING - LOW LEVELS OF PHYSICAL ACTIVITY -MEDICAL CONDITIONS IN OLDER ADULTS -MEDICATIONS -CA+ SUPPLEMENTS)

Define ENCEPHALOPATHY (Google it):

A broad term for any brain disease that alters brain function or structure.

In the case of diarrhea, intakes of excessive sweetened beverages and juices should be assessed WHY?

BECAUSE THE HIGH SUGAR CONTENT OF THE BEVERAGES CAN HAVE AN OSMOTIC EFFECT, THUS CAUSING THE DIARRHEA. (p. 534)

An endocrine function of the pancreas is the production of _______________ (1 WORD).

insulin (p. 538)

Read about the liver functions on page 535; this is your chance to truly appreciate the immensity of its role in physiology; LIST its functions here:

- STORAGE OF GLUCOSE AS GLYCOGEN -PRODUCES FATTY ACIDS & CHOLESTEROL -ACTIVATES/STORES MOST VITAMINS & IRON - PRODUCES BILE FOR FAT DIGESTION -PRODUCES PROTEINS THAT SERVE MANY ROLES

Read the details about Crohn's Dz; bullet the key points you feel you need to remember in order to support your permanent understanding of the dz for when you encounter it:

-in the small intestine (usually ilium) -causes inflammation in mucosa of the bowel wall -a significant effect on nutrition because the small intestine is a major site of nutrient absorption -symptoms: bleeding, pain, poor appetite, abdominal cramping, and diarrhea

For what reasons might a person have SBS?

Surgical resections of the small and large intestine, trauma, disease, and congenital defects. (p. 525)

What are intestinal VILLI?

Tiny, finger-like projections in the walls of our intestine that increase surface area and aid in the absorption of nutrients.

Which dz warrants greater concern in terms of malnutrition? Crohn's (CD) or Ulcerative Colitis (UC)?

chron's disease

The goal of nutritional therapy in constipation is intake of a high-fiber and adequate-fluid diet to promote normal _____________________________ (2 WORDS).

intestinal transit (p. 532)

When the pancreas is inflamed it is called ______________________ (1 WORD).

pancreatitis (p. 538)

Nutritional health is affected by IBD because of what 3 factors?

-diminished intake as a result of symptoms -nutrient losses because of malabsorption and fistulas -the increased nutritional requirements associated with inflammation and the need to promote mucosal healing and fistula closure (p. 524)

A client suspected of having celiac sprue (celiac dz) is scheduled for a bowel biopsy. What should the nurse instruct this client to prepare for this procedure?

. Follow a normal diet to avoid false negative results explanation: Clients preparing for a bowel biopsy to establish a diagnosis of celiac sprue should be instructed to continue their normal diet to avoid false-negative results that could occur if gluten is removed from their diet. Products containing oats should be closely examined since some cross-contamination can occur during the processing of grains. Eating additional foods containing gluten should be avoided to prevent an exacerbation of gastrointestinal symptoms if celiac sprue if suspected. Excessive intake of foods containing wheat or wheat by-products should be avoided until after biopsy results are available.

An obese client with nonalcoholic fatty liver disease asks for suggestions to lose weight. What should the nurse recommend to this client?

A modified diet for slow weight loss explanation: In an overweight or obese client with fatty liver disease, slow weight loss should be recommended. Rapid weight loss through excessive dieting or bypass surgery should be avoided since it contributes to fatty liver disease. A high-fiber diet is recommended for weight loss and bowel health.

In long-term SBS, cholelithiasis and nephrolithiasis are additional complications (p. 527). DEFINE both terms:

Cholelithiasis - the formation of gallstones (hardened deposits of digestive fluid) Nephrolithiasis - kidney stones (hard deposits of minerals and acid salts that stick together in concentrated urine; form in kidneys)

Cystic Fibrosis goes hand-in-hand with pancreatic insufficiency; why is nutrition status an issue?

Because of poor digestion and absorption of nutrients and the high metabolic needs associated with infection and labored breathing.

Differentiate between diverticulosis and diverticulitis:

Diverticulosis - the presence of one or more small pouches (diverticula) that occur in the colon because of weakened muscle (managed with nutrition intervention) Diverticulitis - when the diverticula become inflamed and infected (medically managed, potentially with antibiotics or surgery)

How does HEMOCHROMATOSIS develop?

Either an inherited genetic defect or a result of chronic blood transfusions of inherited or acquired anemias.

Differentiate between PREbiotics and PRObiotics:

Prebiotics are dietary substances that stimulate the growth or activity of microbiota in the intestine that in turn benefit the host (promote the growth of helpful probiotic bacteria) Probiotics are nonpathogenic bacteria in the intestine that confer health benefits to the host (potential beneficial effect on intestinal health by modifying the intestinal flora) (PRE = DIETARY SUBSTANCES THAT STIMULATE GROWTH OR ACTIVITY OF MICROBIOTA IN THE INTESTINES PRO = NON=PATHOGENIC BACTERIA IN THE INTESTINES...)

What is Short Bowel Syndrome (SBS)?

The loss of intestinal length and the resulting malabsorptive symptoms and poor nutrition status that follow. (p. 525)

It is also recommended that those with GERD avoid ________________ (1 WORD) because is decreases LES pressure and prolongs gastric acid exposure time by increasing gastric acid production.

alcohol (p. 520)

A client is experiencing frequent nausea and vomiting. Which dietary suggestion should the nurse make to this client? a. Move around as much as possible after eating to speed digestion. b. Eat foods high in fat and protein to provide ample calories for energy c. Consider total parenteral nutrition (TPN) because of the amount of nausea and vomiting d. Limit intake to high-carbohydrate liquids and foods in small amounts throughout the day

d. Limit intake to high-carbohydrate liquids and foods in small amounts throughout the day explanation: If a client is experiencing intermittent nausea and vomiting, a high-carbohydrate diet consisting of foods or liquids in small portions throughout the day will promote adequate nutrition and hydration. TPN is reserved for clients who are unable to tolerate any intake for several days. Clients should be advised to avoid or limit physical activity just before and after eating. High-fat foods should be avoided since they take longer to empty from the stomach and may promote nausea.

A client with diabetes is being treated for weight loss, nausea, vomiting, and loss of appetite caused by gastroparesis. What should be included when providing this client with a pureed diet? a. High fiber to stimulate peristalsis b. High fat to provide calories for energy c. No spices to avoid gastrointestinal upset d. Liquid nutritional supplements three times a day

d. Liquid nutritional supplements three times a day explanation: Gastroparesis is a motility disorder of the stomach that causes low gastric emptying and results in nausea, vomiting, and loss of appetite which can lead to malnutrition. Liquid nutritional supplements may be used to ensure adequate caloric and nutritional intake. High-fiber foods are avoided to prevent obstructions. High-fat foods are avoided due to slower gastric emptying. The addition of spices has no effect on this condition.

The goal of nutrition tx for GERD and ulcer dz is reduction in the symptoms through elimination of ________________________________ (2 WORDS).

dietary contributors (p. 520)

Nutritional health is affected with ______________________ (2 WORDS) because of the malabsorption that occurs with the rapid transit of poorly digested food through the GI tract.

dumping syndrome (p. 522)

COLON resection can lead to problems with absorption of:

electrolytes (minerals), fluids (p. 525)

Should it be determined that oral intake is unsafe, _________________________________ (3 WORDS) can be prescribed.

enteral nutrition support (p. 519)

The production of digestive _______________ (1 WORD - plural) is an exocrine function of the pancreas.

enzymes (p. 538)

Nutrition interventions for GERD are focused on reducing intake of foods known to diminish lower _____________________________________ (2 WORDS) pressure.

esophageal sphincter (p. 520)

With regard to CD & UC there are numerous dietary limitations to consider. TRUE / FALSE

false PAGE 525: "...NO SPECIFIC RECOMMENDATIONS EXIST..."

IBS is a common disease and iS often easily identified by the presence of abdominal bloating and either constipation or diarrhea. TRUE / FALSE

false (IT IS NOT A DISEASE; IT'S A FUNCTIONAL DISORDER (A SYNDROME))

Extensive scientific evidence exists to support the role of a gluten-free diet in the health of all people. TRUE / FALSE

false (p. 530)

It's important to emphasize to patients with diverticular dz that they avoid nuts, seeds, and popcorn hulls. TRUE / FALSE

false (p. 532)

The dietary management of diverticular dz is a high ________ (1 WORD) diet.

fiber (p. 532)

In the case of eosinophilic esophagitis ___________ (1 WORD) has been identified as a trigger in some patients, hence allergy testing becomes a necessity.

food (p. 521)

_________________________ (2 WORDS) between the gum line and cheek can be discovered after a meal or during mouth care and can be indicative of dysphagia.

food pocketing (p. 519)

COMPLETE THIS SENTENCE FROM BOOK: "Dysphagia can occur because of impairments in one or more swallowing phases..."

from neuromuscular conditions, such as stroke, head injury, dementia, Parkinson's disease, and multiple sclerosis; medications, such as anticholinergic and antidepressants; poor or absent dentition; and lack of saliva from medications, disease, or following radiation therapy to the mouth area. (p. 516-517)

The liver produces bile and it is stored in the ____________________ (1 WORD).

gallbladder (p. 539)

Many disorders of the GI tract lead to _____________________ & ______________________. The words can be in any order, but please type them as above, using "&" symbol.

maldigestion & malabsorption (p. 516)

The above condition, logically (based on #51 & #52) has "...nutritional consequences because of..." (COMPLETE THE SENTENCE FROM BOOK).

maldigestion and poor absorption.

The book explains that NAFLD is often referred to as the "hepatic manifestation of ____________________ (2 WORDS)."

metabolic syndrome (p. 535)

Avoidance of simple sugars is important in managing the aforementioned condition because of the _______________ (1 WORD effect they exert, which stimulates the problem.

osmotic (p. 522)

A _____________________________________________ (3 WORDS) is generally the HCP responsible for the formal swallowing evaluation and treatment recommendations.

speech language pathologist (p. 517)

HEPATITIS is actually short for __________________ (1 WORD).

steatohepatitis (p. 535)

As a nurse in a hospital, you observe a patient's feces in the toilet bowl; you can see that it appears very white, which is indicative of intestinal fat malabsorption. You will chart on the patient, stating that you witnessed _______________________ (1 WORD).

steatorrhea (p. 525)

Sit back without looking at anything, and record here the travel through the GI tract as I did in the lecture verbally. Can you do it? Think about each part and what all happens; don't forget the accessory organs.

the food begins in the oral cavity (mouth) where it is broken up by mastication (physical) and salivary enzymes (chemical) it is pushed into the pharynx where it passes the larynx which uses the epiglottis to block the trachea and goes into the esophagus peristalsis moves food through to esophagus and into the stomach stomach contractions (physical) and digestive enzymes (chemical) break the food up into chyme the chyme then enters the small intestine which is made up of the duodenum, jejunum, and ilium the liver makes bile which is stored in the gallbladder and the pancreas makes digestive enzymes bile and these digestive enzymes from these accessory organs gets secreted into the small intestine where chyme is broken down further the small intestine is also a major site of nutrient absorption (macronutrients and vitamins) the food leaves the small intestine and travels into the large intestine (colon) here minerals and water are absorbed and feces is formed mass movement pushes feces towards the rectum for elimination through the anus

It is a general consensus that most people with lactose intolerance are capable of tolerating some lactose in the diet and that tolerance can be improved over time with lactose consumption.

true (p. 523)

Fatty Liver Dz (NAFLD) is common in this country due to an association with obesity and diabetes. TRUE / FALSE

true (p. 535)