MODULE 10 - GIT AND NUTRITIONAL CONDITIONS Flashcards
(26 cards)
What is the pathophysiology of weight gain?
Conscious thought about food by the cerebral cortex stimulates the hypothalamus. The hypothalamus regulates food intake. The digestive tract also sends signals to the hypothalamus. The hormone ghrelin is released by the stomach in the hours after a meal to increase appetite. When food is present in the stomach, stretch receptors send signals back to the hypothalamus, and gastrointestinal (GI) hormones are released to inhibit further food intake. The hormone leptin, which is released by adipose cells, inhibits appetite at the hypothalamus.
How is the diagnosis of overweight and obesity determined?
BMI and waist circumference
BMI categories for adults are as follows:
- 18.5 kg/m2 is underweight
- 18.5 to 24.9 kg/m2 is healthy weight
- 25.0 to 29.9 kg/m2 is overweight
- > 30.0 kg/m2 is obese.
What are the risk factors of obesity?
BEHAVIOURAL: Decreased physical activity, intake of high caloric foods without equal attention given to output of energy
NON-MODIFIABLE: gender, family history
BIO-MEDICAL: depression, genetic disorders, certain medications, eating disorders
PHYSICAL ENVIRONMENTAL DETERMINANTS: employment, low socioeconomic
SOCIAL: lack of support, peer pressure, marketing of foods
What are the impacts that obesity and overweight have on a persons health?
Increases the likelihood of developing many chronic conditions, including some cancers, CVD, asthma, back pain, CKD, dementia, diabetes, gallbladder disease, gout and osteoarthritis
What are the 5A’s of weight management?
ASK AND ASSESS: behaviours and BMI, waist circumference
ADVISE: benefits of healthy lifestyle and weight management
ASSIST: individual weight management programs, review and monitor
ARRANGE: referrals, support for long term weight management programs
What are the factors complicating obesity management?
- dyslipidaemia or hyperlipidaemia
- depression or anxiety disorders
- stroke or cardiovascular issues
What are some examples of self management for obesity?
- lifestyle education
- dietary factors
- physical exercise
- pharmacological agents
- surgical treatment
- psychotherapy (cognitive behaviour therapy)
What is the function of the GIT?
To supply nutrients to body cells
What are the structures of the GIT?
- mouth
- oesophagus
- stomach
- small & large intestine
- associated organs
- liver
- pancreas
- gallbladder
What are the processes of the GIT?
INGESTION
DIGESTION
ABSORPTION
ELIMINATION
What are the major problems associated with the GIT system?
- diarrhoea/constipation
- abdominal pain
- nausea/vomiting
- trauma/haemorrhage/bleeding
- inflammation
- obstruction
- cancer
- GORD
- food intolerances
- jaundice
- hepatitis
- obesity
- malabsorption
What is gastro oesophageal reflux disease?
When gastric or duodenal contents flow back into the oesophagus without belching or vomiting. All adults & children normally have a small amount reflux particularly after meals. It is only pathological when excessive or symptomatic.
Is a common condition in the very young & the elderly
What is the nursing management/care priorities for GORD?
Behaviour modification incorporating
- Diet
- Avoid foods/liquids such as Alcohol, tomatoes, caffeine in tea, coffee, cola &chocolate
- Weight loss
Avoid tight fitting garments
- Elevation of the head of the bed~30degrees
- Not just sit up with pillows (bend in middle raising intra-abdominal pressure)
- This is particularly important in paediatrics, in surgery & geriatrics
Cease smoking
Avoid food or drink ~ 2 hrs. before bed.
What is the nursing management for infants in regards to reflux?
¼ to ½ all infants under 6 months manifest some symptoms of reflux . It has a benign course & usually improves by 8-9 months
If severe: nursing management
- Limit volume of formula to small and often
- Thickened feeds (with Gaviscon or rice cereal)
- Place infant 30 degrees prone after feeds
- Avoid active play for 1 hr after feed
What are the nursing interventions supporting GIT disturbances?
- promote optimal diet and fluid intake
- promote elimination
- promote personal hygiene
- fluid balance chart
- stool chart
- monitor vital signs/bowel sounds/pain/abdominal distension/skin/mucous membrane
- weight/girth measurement
- monitor Se biochemistry/haematology and any special faecal or GIT related tests
What are some examples of patient education, including self management strategies
- identify factors that contribute /impact GIT dysfunction
- regular bowel motions
- adequate exercise
- OTC medications
- food and fluid handling and cleanliness
- coping strategies (toileting patterns)
- care of stoma’s
- avoidance of irritating foods
- how and why taking medications/ side effects, adverse reactions
- promote optimal muscle tone
What is chronic inflammatory bowel disease?
2 conditions under the umbrella of IBD
- Ulcerative colitis
- Crohn’s disease
Peak incidence appears between the ages of 15-35 & a second peak at 60-80years.
- Recurrent
- Stress responses are often associated with exacerbations (however do not cause IBD)
- Distinct differences between the 2 disease processes
- Both have multi-system effects
What are the differences between ulcerative colitis and Crohn’s disease (including complications)?
Ulcerative colitis:
- 15-35 years secondary peak 50-70 years
- Chronic / intermittent
- Cramping LL) Quad
- Nutritionally – anaemia, hypoalbuminaemia, weight loss
- Fever rare, may have associated arthritic / skin / other organ involvement e.g. uveitis
- Mucosa / submucosa
- Typically rectum, sigmoid colon, sometimes entire large bowel
- Mucosa granular, dull, friable, hyperaemic
Complications: toxic megacolon, perforation, massive haemorrhage, colorectal cancer
Crohn’s Disease
- 10-30 years
- Slowly progressive
- Cramping or steady RL) Quad or periumbilical
- Significant nutritional deficit – anaemia, weight loss, multiple vit & mineral deficits
- Fever malaise, fatigue
- Entire bowel wall (transmural), any portion involved
- Mucosa – cobblestone appearance
Complications: Fistulas, abscess formation, malabsorption, strictures
Colon cancer
What is ulcerative colitis?
- Chronic affecting mucosa / submucosa
- Onset insidious, lasting 1-3 months
- Distal colon affected (although some develop fulminant colitis i.e. affecting the entire colon)
What are the manifestations of ulcerative colitis?
- diarrhoea: containing blood and mucous
mild - less than 5 stools per day
sever - more than 6-10 bloody stools per day - rectal inflammation: causes faecal urgency, cramping pain relieved by defecation some develop thrombosis-emboli (blood vessel obstruction) from clots carried from the site of formation
What is Crohn’s disease?
- Typically begins as a small shallow ulcer with a white base & elevated margin
- Lesions may regress or progress to all layers of the bowel
Progression of the disease causes fibrotic changes cause thickening & loss of flexibility ‘rubber hose like’
- Inflammation, oedema & fibrosis can lead to local obstruction of the bowel, abscess formation& fistulas between loops of bowel & other organs
- Enteroenteric fistulas – between loops of bowel
- Enterovesical fistulas – between bowel & bladder
- Enterocutaneous fistulas – between bowel & skin
What are the manifestations of Crohn’s disease?
- malabsorption
- diarrhoea
- pain
- palpable
- systemic
- ano-rectal lesions
What are the medications used for IBD?
- aminosalicylates (sulphasalazine)
- antimicrobials (rarely in U.C) (ciprofloxacin, metronidazole)
- corticosteroids (prednisone)
- immunosuppressants (given to patients who do not respond to the above)
- biological therapy (preparations to induce healthy bowel flora)
What are the self care management and education strategies for chronic IBD
key is to control flare ups (no cure) i.e inflammation
- continued use of medications, ensure patient doesn’t abruptly stop taking medications
- teach patient how to monitor for signs of infection
- regular BGL monitoring if on corticosteroids
- avoid triggers of flare ups
- recognise signs and symptoms of malnutrition
