Nursing Care of Clients with Alterations

in Nutrition and Metabolism

Loyda Amor N. Cajucom, RN, MAN

Faculty, UPCN
Objectives

• Be able to determine the

nursing care needs of clients
with alterations in nutrition and
metabolism
• Apply concepts of nutrition and
metabolism in hypothetical
situations
Application of the Nursing Process to the
Clients with Nutrition and Metabolic Alterations
• Assessment:
1. Health History
a. dietary pattern
b. weight: compared to IBW, changes
in weight
c. changes in energy level
d. Stool: changes in frequency,
consistency, color, character
e. Urine: color, frequency
Application of the Nursing Process to the
Clients with Nutrition and Metabolic Alterations:
Assessment

f. Indigestion,
heartburn/regurgitation
g. Difficulty in swallowing
(dysphagia)
h. Difficulty tolerating certain foods
i. Vomiting or nausea
Application of the Nursing Process to the
Clients with Nutrition and Metabolic Alterations:
Assessment
j. Abdominal distention, flatus,
belching, fullness
k. history of abdominal surgery or
trauma
l. bleeding
m. alcoholic intake
n. family history
2. Physical Examination:
a. Inspection:
> skin color, bruises, hematomas
> oral assessment
> abdomen: visible peristalsis,
pulsations or masses, contour: rounded,
protuberant, concave, asymmetry; striae,
spider angiomas, engorged veins
> anorectal area: rash, hemorrhoids
b. Auscultation: listen to all four
quadrants of the abdomen
> bowel sounds: location, frequency,
characteristics; take note of:
hyperperistalsis, paralytic ileus,
borborygmi
c. Percussion:
> stomach-tympany
> liver- dull
> large intestine: check for gaseous
distention- increased tympany
 Sites to Auscultate for Bruits

Aorta
Right Renal Artery Left Renal
Artery
Right Iliac Artery Left Iliac Artery
Right Femoral Artery Left Femoral
Artery
Six Fs of Abdominal Distention

• Fat
• Flatus
• Fluid
• Fetus
• Feces
• Fatal growth
 Systematic Route for Abdominal Percussion

• General Tympany –
Percuss lightly in all four
quadrants. Tympany should
predominate because air in
the intestines rises to the
surface when the person is
suppine
• Abnormal Findings:
Dullness occurs over a
distended bladder, adipose
tissue, fluid or a mass
 Percussion of the Abdomen
• Do not percuss or
palpate in clients with
suspected abdominal
aneurysm or those
who have received
abdominal organ
transplants
• Perform these
techniques cautiously
in clients with
suspected
appendicitis
 Spleen Percussion Route
• Spleenic Dullness
Locate it by a dull
note from the 9th –
11th intercostal space
just behind the left
midaxillary line
• The area of spleenic
dullness is normally
not wider than 7 cm
in the adult and
should not encroach
on the normal
tympany over the
gastric air bubble
d. Palpation:
> note areas of pain, tenderness; organ
size and position
> masses
> skin: skin turgor, moisture
> in some cases, DRE may be done
Moderate Palpation
Deep Palpation
Description of Masses
If you identify a mass, first distinguish it from a
normally palpable structure or enlarged organ.
Then note its:
• Location
• Size
• Shape
• Consistency (soft, firm, hard)
• Surface (smooth, nodular)
• Mobility ( movement with respirations)
• Pulsatility
• Tenderness
Abdominal Structures Frequently Mistaken
as Masses
Palpation of the Liver
Differentiation of Enlarged Spleen with
Enlarged Left Kidney
Assessment of Ascites
Testing for Fluid Wave
Palpation to Elicit Rebound Tenderness
3. Diagnostic Examinations:
General Nursing Interventions for patients
undergoing diagnostic tests:
1. provide general information about the
test and the activities involved
2. instructions about pre and post
procedure care including activity
restrictions
3. alleviate anxiety
4. help patient cope with discomfort
5. encourage family members to offer
emotional support
6. Assess adequate hydration, before,
during and after tests
 Hematologic Studies
• Complete Blood Count
• Serum Electrolytes
• Liver Function Tests/Hepatobiliary function
test: AST(SGOT), ALT(SGPT), alkaline
phosphatase, ammonia, albumin, globulin,
total protein, total bilirubin, direct and
indirect bilirubin, cholesterol, triglyceride,
prothrombin time
• GI function: gastrin (40-150 pg/ml)
• Pancreatic function: serum glucose (FBS,
RBS, postprandial); lipase (20-180 IU/L);
amylase (56-190 IU/L)
Urine and Stool Exams

• Urine Tests: glucose, acetone;

urobilinogen
• Stool Tests: ova and parasites (stool
must be warm); occult blood (guaic);
fecal fat (after a 24-72 hour collection);
stool culture
 Special tests
• Breath Test
• Flat plate of Abdomen
• Upper GI series (Barium Swallow)
• Lower GI Series (Barium Enema)
• Cholecystography
• IV Cholangiography
• Percutaneous transhepatic
Cholangiography
• HBT Ultrasound
• Endoscopy
• Shilling Test
 Biopsies
• Percutaneuos liver biopsy
– Blind needle biopsy of liver tissue to
establish a microscopic picture of the liver
– Nursing care pre-test: check prothrombin
time (if less than 40%, it should not be
done); check platelet count (defer if less
than 100,000); instruct client to exhale ad
hold breath for 1-2 seconds while biopsy is
being done and not to move during
procedure; client may be placed on supine
position with right arm under the head
during procedure
– Nursing care post test: have client
lie on right side with pillow or
sandbag over the insertion point
under costal margin for 1-2 hours
– Closely monitor vital signs as
ordered for 24 hours
– Assess for pain or respiratory
distress
Common Nursing Diagnoses

• Imbalanced Nutrition: less/more than body

requirements
• Acute Pain
• Fluid volume deficit/excess
• Ineffective Tissue Perfusion
• Risk for Bleeding
• Risk for Infection
• Deficient Knowledge
General Nursing Planning, Implementation and
Evaluation
• Goal 1: Client will eat diet that conforms to
prescribed restrictions yet contains all needed
nutrients ( Identify Specific NOC and NIC)
• Evaluation: Client selects appropriate diet from
sample menus; verbalize rationale of diet
restriction; identifies life style factors that may
interfere with compliance and express
willingness to change such factors to comply
with dietary regimen
• Goal 2: Client will express comfort
and have reduced if not completely
without pain ( Identify Specific NOC
and NIC)
• Evaluation: Client’s pain rating is
reduced/lowered or non-existent;
demonstrates use of non
pharmacologic measures to reduce
pain; verbalizes measures to
prevent recurrence of pain
 Goal 3: Clients fluid will be balanced
and electrolyte levels will return to
normal ( Identify Specific NOC and
NIC)

• Evaluation: Clients I and O are

balanced and electrolyte levels are
within normal limits
• Goal 4: Client will have adequate
tissue perfusion throughout organ
systems
• Evaluation: Client shows pinkish
skin and mucosa, normal urine
output, adequate blood pressure,
remains conscious, coherent and
with (-) chest pain