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Chapter 17: Applying Clinical Judgment to Promote Nutrition for Gastrointestinal Wellness

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Chapter 17: Applying Clinical Judgment to Promote Nutrition for Gastrointestinal Wellness

16 problems · 0 figures

Case Study 17.1.1 §17.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study will evolve throughout the chapter.

Mrs. Azan tells the nurse that she has been having muscle weakness and cramping, abdominal pain, mouth and tongue swelling, and sores in her mouth. When the nurse assesses Mrs. Azan, the nurse finds that she has angular cheilitis, multiple canker sores in her buccal areas, a red and swollen tongue, and general pallor.

Based on both the objective and subjective assessment findings, what would the nurse rule out as a potential deficiency being experienced by this client?
  1. a.
    Potassium
  2. b.
    Magnesium
  3. c.
    Vitamin B12
  4. d.
    Vitamin A

Answer

A. Potassium
Vitamin A deficiency is not associated with any of the client’s symptoms and could be ruled out based on the assessment data. Based on the findings, the health care provider orders laboratory tests to determine the client’s potassium, magnesium, and vitamin B12 levels.

Case Study 17.1.2 §17.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study will evolve throughout the chapter.

Mrs. Azan tells the nurse that she has been having muscle weakness and cramping, abdominal pain, mouth and tongue swelling, and sores in her mouth. When the nurse assesses Mrs. Azan, the nurse finds that she has angular cheilitis, multiple canker sores in her buccal areas, a red and swollen tongue, and general pallor.

Based on Mrs. Azan’s presentation, which additional laboratory test should the nurse expect the health care provider to order?
  1. a.
    Iron
  2. b.
    Vitamin D
  3. c.
    Calcium
  4. d.
    Vitamin E

Answer

A. Iron
The health care provider would be expected to check the client’s iron level. Iron deficiency can cause tongue redness and inflammation and pallor. The provider decides to order a complete metabolic panel and vitamin B12, iron, and magnesium levels.

Case Study 17.4.3 §17.4 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.

Mrs. Azan returns to the clinic several months later after meeting with the registered dietician to make dietary modifications. She has been taking her prescribed supplements. Although her previous signs and symptoms have resolved, she is now presenting with unplanned weight loss; pallor; dry, brittle nails; hair loss; edema in the legs; and muscle weakness.

What does the nurse recognize as a potential deficiency with these new presenting symptoms?
  1. a.
    Vitamin C
  2. b.
    Magnesium
  3. c.
    Iron
  4. d.
    Protein

Answer

D. Protein
Protein deficiency can cause weight loss, poor appetite, pallor, hair loss, and dry, brittle nails.

Case Study 17.4.4 §17.4 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.

Mrs. Azan returns to the clinic several months later after meeting with the registered dietician to make dietary modifications. She has been taking her prescribed supplements. Although her previous signs and symptoms have resolved, she is now presenting with unplanned weight loss; pallor; dry, brittle nails; hair loss; edema in the legs; and muscle weakness.

Mrs. Azan states that she has decided to follow a vegetarian diet. Which of the following food choices can the nurse recommend for this diet because it is a high-protein source?
  1. a.
    Carrots
  2. b.
    Quinoa
  3. c.
    Corn
  4. d.
    Whole grain bread

Answer

B. Quinoa
Quinoa is a seed grouped with whole grain that is high in protein and is a good protein option in a vegetarian diet.

Case Study 17.4.5 §17.4 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Parts A and B.

Mrs. Azan has returned for her follow-up appointment. It has been 3 months since her last visit. Blood levels were redrawn a week ago, and the results show that vitamin B12, magnesium, and potassium have stabilized to a low normal range, but iron is still very low. The laboratory tests ordered also show that Mrs. Azan’s calcium and vitamin D levels are low now despite being normal previously. The 72-hour recall the client reports is consistent with the nutritional goals and education given, and she says she has been following the plan closely. Her food choices are diverse enough to ensure that the calcium and vitamin D levels should not have decreased.

Given the results, what should the nurse conclude about the effectiveness of the nutritional plan?
  1. a.
    It is effective, but the client is nonadherent.
  2. b.
    It is effective, but the client is not documenting her food intake correctly.
  3. c.
    It is ineffective because the client cannot comprehend the instructions well enough.
  4. d.
    It is ineffective because the client’s Crohn’s disease is preventing absorption.

Answer

D. It is ineffective because the client’s Crohn’s disease is preventing absorption.
With Crohn’s disease, and when a client has many bowel movements daily, absorption becomes a problem. In particular, iron, calcium, and vitamin D are not absorbed properly in this disease process.

Case Study 17.4.6 §17.4 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Parts A and B.

Mrs. Azan has returned for her follow-up appointment. It has been 3 months since her last visit. Blood levels were redrawn a week ago, and the results show that vitamin B12, magnesium, and potassium have stabilized to a low normal range, but iron is still very low. The laboratory tests ordered also show that Mrs. Azan’s calcium and vitamin D levels are low now despite being normal previously. The 72-hour recall the client reports is consistent with the nutritional goals and education given, and she says she has been following the plan closely. Her food choices are diverse enough to ensure that the calcium and vitamin D levels should not have decreased.

Based on the findings, how should the nurse expect the nutritional plan to be modified?
  1. a.
    There will be no changes because the client has a chronic condition that cannot be cured.
  2. b.
    The amount of food to be consumed will be increased.
  3. c.
    Supplementation, either enteral (feeding tube) or parenteral, will be initiated.
  4. d.
    There will be no changes; instead, the client will be reeducated about the current plan to improve its effectiveness.

Answer

C. Supplementation, either enteral (feeding tube) or parenteral, will be initiated.
The nurse should expect supplementation to be ordered. Enteral supplementation will likely be used, but if that is not sufficient, parenteral supplementation may be considered.

17-1 §17.RQ source ↗

The nurse is assessing a client who has poor dentition. Which function of the gastrointestinal system will be affected most by this?
  1. a.
    Ingestion
  2. b.
    Digestion
  3. c.
    Absorption
  4. d.
    Metabolism

Answer

B. Digestion
Digestion includes mastication, which requires the teeth to be in working condition.

17-2 §17.RQ source ↗

The nurse is assessing a client for gastrointestinal wellness. Which action should the nurse complete to assess the gastrointestinal system?
  1. a.
    Auscultate the lungs.
  2. b.
    Inspect the nares.
  3. c.
    Palpate the abdomen.
  4. d.
    Percuss the thorax.

Answer

C. Palpate the abdomen.
Palpating the abdomen can reveal any pain, guarding, or tenderness present in the gastrointestinal organs.

17-3 §17.RQ source ↗

The nurse is assessing a client for gastrointestinal wellness. Which finding could indicate a vitamin deficiency?
  1. a.
    Cyanotic lips
  2. b.
    Angular cheilitis
  3. c.
    Abdominal tenderness
  4. d.
    Diaphoretic skin

Answer

B. Angular cheilitis
Angular cheilitis, or fissures and crusts in the corners of the lips, can indicate vitamin B1 (thiamine), vitamin B12, or iron deficiency.

17-4 §17.RQ source ↗

The nurse prioritizes the nutritional content of clients’ meal options when planning their care. Which protein option is best for clients of the Buddhist faith who are vegetarians?
  1. a.
    Broccoli
  2. b.
    Fish
  3. c.
    Tofu
  4. d.
    Whole wheat bread

Answer

C. Tofu
Tofu is a plant-based protein that can be an option in a vegetarian diet.

17-5 §17.RQ source ↗

The nurse is caring for a client with a protein and iron deficiency who is allergic to beef. Which is the best alternative for the nurse to suggest?
  1. a.
    Edamame
  2. b.
    Milk
  3. c.
    Cheese
  4. d.
    Okra

Answer

A. Edamame
Edamame is a plant-based source of both protein and iron.

17-6 §17.RQ source ↗

The nurse is providing dietary instruction to a client who needs to eat foods that support the gut’s normal microbial growth. Which of the following statements indicates that the client understands the education?
  1. a.
    “I will drink at least a liter of water every day.”
  2. b.
    “I will eat yogurt every morning with my breakfast.”
  3. c.
    “I will make sure I eat protein at every meal.”
  4. d.
    “I will drink an extra glass of milk every day.”

Answer

B. “I will eat yogurt every morning with my breakfast.”
Eating yogurt and other probiotic foods supports the gut’s normal microbial growth.

17-7 §17.RQ source ↗

The nurse is working with a client with an iron deficiency. Which of the following foods would increase iron absorption?
  1. a.
    Whole milk
  2. b.
    Whole grain toast
  3. c.
    Scrambled eggs
  4. d.
    Fresh orange

Answer

D. Fresh orange
Oranges have vitamin C and help create an acidic environment that increases iron absorption.

17-8 §17.RQ source ↗

The nurse is preparing a client’s nutritional plan for increasing their iron intake. Which vitamin should the nurse include?
  1. a.
    Vitamin A
  2. b.
    Vitamin C
  3. c.
    Vitamin E
  4. d.
    Vitamin D

Answer

B. Vitamin C
Vitamin C assists with iron absorption and should be included in the nutritional plan.

17-9 §17.RQ source ↗

The nurse is reviewing a client’s laboratory results and notices there has been little progress in raising the client’s vitamin K level. Which assessment finding can the nurse directly relate to this continued deficiency?
  1. a.
    Pharyngitis
  2. b.
    Ecchymosis
  3. c.
    Skin dryness
  4. d.
    Weight loss

Answer

B. Ecchymosis
Ecchymosis, or bruising, is consistent with vitamin K deficiency because vitamin K is needed for adequate blood clotting.

17-10 §17.RQ source ↗

The nurse is caring for a vegan client who is having difficulty eating enough protein. Which food item is appropriate for the nurse to recommend to this client?
  1. a.
    Quinoa
  2. b.
    Fish
  3. c.
    Eggs
  4. d.
    Carrots

Answer

A. Quinoa
For vegan clients, protein options such as quinoa, tofu, and edamame are appropriate suggestions.

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Problems and answers are adapted from Nutrition for Nurses by Emerald Charity Bilbrew, Jody Vogelzang and Kelli Whittington, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/nutrition/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.