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▄ Malnutrition – a condition resulting from excessive or inadequate nutrient availability over an extended
period.
*starvation – inadequate delivery of nutrients to the body.
Types:
1. Primary malnutrition – adequate nutrition is not delivered to the upper GIT over an extended period
2. Secondary malnutrition – occurs when GIT fails to absorb, metabolize or use nutrients
3. Mixed type malnutrition – inadequate calorie/protein intake with increased nutritional requirements
* Micronutrient malnutrition – occurs when vitamins, minerals, trace elements are not absorbed, delivered
or used by GIT
- vitamins, minerals, trace elements deficits occur in combination. It is difficult to identify deficit of single
micronutrient
*Obesity – may result from nutrient delivery that exceeds the client’s nutritional requirement
I. History taking
▄ Biographical and Demographic Data
- analyze client’s demographic data within the context of nutritional status and upper GI function- -
women are at risk for problems r/t calcium deficiency
- culture, religion and ethnic origin may also affect the type, amount and frequency of dietary
consumption
▄ Chief complaints (n/v, indigestion, abdo pain, diarrhea, changes in weight or appetite)
-clinical manifestations that are related to nutritional status and upper GI function
-do symptom analysis
▄ Symptom analysis
▄ ROS
- condition of the mouth- dental caries, number and condition of teeth
- oral lesions, halitosis, increased or decreased salivation
- brushing of teeth, visit to the dentist
- trouble chewing or swallowing
- dysphagia, odynophagia
- change in bowel habits or stool characteristics
- changes in appetite
- problems of hepatic or biliary systems (jaundice, pruritus, ascites, dark-colored urine, acholic stools,
bleeding problems
2. Body Mass Index- acceptable method of standardizing height for weight measurement
BMI= weight in kg/ height in meters2
= weight in lbs/ height in inches2 x 703
▄ Mouth
Inspection
- lips = symmetry, color, hydration, lesions, nodules
- teeth = number and position; dental caries, missing or broken teeth,
= erythroplakia (red lesions); leukoplakia (white lesions)
- pharynx = tonsillitis
- tongue = symmetry, color, moisture
= Palpation
- lips, gingivae, buccal mucosa = loose teeth, masses, swelling, areas of tenderness
- tongue = lesions, masses, color changes
- dysphagia –
- tonsils –
▄ Abdomen-
Inspection
- skin, abdominal contour = smooth, intact, with varying amounts of hair, flat, concave or rounded-
= areas of distention or irregular contour
= rashes, discoloration, scars, petechiae, striae
- umbilicus = concave, located at the midline, no drainage and same color of the abdo skin
- peristaltic movement or abdominal pulsation
Auscultation-
- RLQ, RUQ, LUQ, LLQ- clockwise fashion
- Normal bowel sounds: every 5 to 15 sec; occur irregularly at a rate of 5 to 35 per minute
- borborygmi = loud, high-pitch bowel sounds
= hyperactive GIT
- hypoactive bowel sounds = bowel sound of 1 or fewer every minute
- use the bell of the steth to auscultate for vascular sounds = bruit, venous hum, friction rub
• bruit- vascular turbulence - aneurysm or partial obstruction of the vessel
• venous hum- heard in the periumbilical area indicates engorged liver circulation
• friction rub- two pieces rubbing together; suggest hepatic tumor when heard loudest over the
lower right rib cage or splenic inflammation when hear loudest over the lower rib cage in the
anterior axillary line
Percussion
- size and location of abdominal organs and to determine fluid, air or masses
- high-pitch, loud, musical sounds over gas-filled organs- tympanic
- dull sounds over fluid or solid organs- thud like
- determine size and position of liver and spleen
DIAGNOSTIC PROCEDURES
• Inform pt. that some discomfort, coughing or gagging may be experienced during tube passage
• Hang labeled containers of NSS and 0.1 N HCL Solution on an IV pole then connect NGT to IV
tubing.
• Open the line from NSS @ 60-120gtts/min for 5-10 mins. then note pt.’s response.
• Close the line from NSS then open the line from HCL solution, same rate with NSS but to run for 30
mins., then note pt.’s response
• Stop the solution and withdraw NGT if the pt. experiences no discomfort after perfusion of HCL for
30 mins.
Post-Test
• Administer antacid as ordered
Nursing Alert!!!
• Observe the pt. closely for arrhythmias
• Withdraw the tube immediately if the pt. develops cyanosis or paroxysmal coughing
Normal Finding:
• Absence of pain
Abnormal Finding:
• Acidic solution causes pain or burning sensation (esophagitis)
B. BARIUM SWALLOW
AKA: Upper GI Series
Description: Is a fluoroscopic and x-ray examination of the esophagus, stomach and small intestine
Purpose:
• To detect ulcer, polyps, tumor, hernia, varices, strictures and foreign bodies
Nursing Responsibilities
Pre-Test
• Explain the procedure and purpose to the client
• Record V/S
• The client should be NPO and refrain from smoking for 8-12 hrs
• Inform the pt. That the test does not cause significant discomfort
Post-Test
• Check with the radiology department that the Upper GI Series and/or small bowel series are
completed before giving meal
• Inform the client that the stools should be light in color for the next several days
• Instruct the client to notify HCP if he/she does not have bowel movement in 2-3 days
Normal Findings:
The bolus evenly fills and distends the lumen and the mucosa appears smooth and regular, normal
peristalsis
Abnormal Findings:
ulcer, polyps, tumor, hernia, varices, strictures and foreign bodies
C. BARIUM ENEMA
AKA: Lower GI Series
Description: Radiographic examination of the large intestine after rectal instillation of barium sulfate
2 Types
a. Single Contrast (only barium sulphate)- provides a profile view of the large intestine
b. Double Contrast (Barium sulphate and air)- provides profile nad frontal view. It is better
for detecting small intraluminal tumors (esp. Polyps)
Purpose:
• To aid diagnosis of colorectal cancer and inflammatory diseases
NURSING RESPONSIBILITIES
Pre-Test
• Explain the procedure and purpose of the test
• Instruct the pt. to restrict dairy products and to follow a liquid diet for 24 hrs
• Inform patient that he/she will assume several position during instillation of barium.
Post-Test
• The client should expel the barium in the bathroom or bedpan immediately after the test
• Encourage rest
• Administer laxative such as milk of magnesia or magnesium citrate or give cleansing enema as
ordered
• Inform pt. That the stool will be light colored for 24-72 hrs
Nursing Alert!!!
• Barium enema is contraindicated in pt. With tachycardia, severe ulcerative colitis, active GI
bleeding, suspected perforation
Normal Findings:
Single Contrast: The intestine is uniformly filled with barium and mucosa has a regular and feathery
appearance
Double Contrast: The intestine is uniformly distended with air, with a thin layer of barium providing
excellent detail of the mucosal pattern
Abnormal Findings:
• Carcinoma, IBD, diverticula, fistulas, polyps, intussusception
Purpose:
• To detect GI bleeding
NURSING RESPONSIBILITIES
• Explain the procedure and purpose to the client
• Instruct the client to maintain high-fiber diet and to refrain from eating red meat, poultry, fish,
green leafy vegetables for 48-72 hrs
• Instruct the client to withhold ascorbic acid, iron preparations, salicylates, and steroids for 48 hrs
• Instruct client to report epigastric pain and abnormal-colored stool
Normal Finding:
• Negative (Green Rxn)- less than 2.5 ml of blood in the stool
Abnormal Finding:
• Positive (Blue Rxn)- more than 2.5 ml of blood in the stool
Purpose:
• To diagnose hepatic parenchymal disease, malignant tumors and granulomatous infections
NURSING RESPONSIBILITIES
Pre-Test
• Explain the procedure and purpose of the test
• Instruct the pt. to restrict food and fluids for 4-8 hrs
• Make sure PT, PTT, and platelet count are performed and recorded
• Record V/S
• Instruct pt. to hold his breath while needle biopsy is inserted in the liver
Post-Test
• Position pt. On his right side for 2 hours, with small pillow or sandbag under the costal margin
• Check pt. V/S q 15 mins. For the 1 hr., then q 30 mins. for 4 hrs, and q 4 hrs for 24 hrs
Nursing Alert!!!
• Watch for bleeding, signs of shock, bile peritonitis and pneumothorax
-S/SX of bile peritonitis: tenderness and rigidity around the biopsy site
-S/SX of pneumothorax: risisng RR, depressed breath sounds, dyspnea, persistent
shoulder pain, and pleuritic chest pain
Normal Findings:
• Normal liver cells
Abnormal Findings:
• Presence of malignancies and hepatic diseases
F. CT Scan
AKA: CAT Scan, CTT Scan, CATT Scan
- Computed Axial Tomography (CAT), Computed Transaxial Tomography (CTT),
Computed-assisted Transaxial Tomography
Description: It produces a narrow x-ray beam that examines body sections from many different angles.
Purpose:
To produce tissue analysis and images not readily seen on standard radiographs
Pre-Test:
• Explain the procedure and purpose of the test
Post-Test:
• Observe for delayed allergic reaction to the contrast dye
• Instruct pt. To increase fluid intake to enhace the excretion of contrast dye
• Instruct the client to resume his/her usual activity and diet as indicated
Nursing Alert!!!
• Watch for dyspnea, palpitations, tachycardia, itching and urtucaria
G. ULTRASONOGRAPHY
AKA: Ultrasound, Sonogram
Description: A procedure used to visualize body tissue structure or wave-form analysis of Doppler studies
Purpose:
• To detect tissue abnormalities
NURSING RESPONSIBILITIES
Pre-Test:
• Explain the procedure and the purpose of the test
Post-Test:
• Instruct the client to resume his/her usual activity and diet as indicated
H. X-RAY
AKA: Radiography, Roentgenography
Description: A procedure that emits x-radiation that is used to identify structure, size, and shape of bone
and body tissues
Purpose:
• For Screening purposes
NURSING RESPONSIBILITIES
• Explain the procedure and the purpose of the test
• Instruct pt. to lie in supine position with his arms away from the body