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GI Assessment and Nutrients
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| Abdominal PHYSICAL EXAMINATION | Inspect the abdomen, noting shape and contour, any visible vessels, striae, or other skin or color changes. Observe for visible peristalsis. Auscultate for bowel sounds, listening in all four quadrants (Figure 24-8 a). Bowel sounds (clicks or gurgles) normally are heard every 5 to 15 seconds. Percuss the abdomen in all four quadrants as indicated. Tympany normally is heard over the stomach and much of the bowel. A fecal mass, tumor, or full bladder may cause a dull percussion tone. The percussion tone also is dull over the liver. Lightly palpate all abdominal quadrants, noting muscle tone or guarding and any areas of tenderness. If the client has complained of abdominal pain, palpate the affected quadrant or area last. |
| Nutrition | s the process of ingesting, absorbing, using, and eliminating food in the body. The digestive organs involved in these processes are the gastrointestinal (GI) tract and the accessory digestive organs. |
| GI tract | mouth, pharynx, esophagus, stomach, small intestine, and large intestine |
| Accessory digestive organs | liver, gallbladder, and pancreas. |
| Primarily an organ of elimination | large intestine |
| COMMON CHANGES ASSOCIATED WITH AGING | Periodontal disease, disease of the supporting structures of the teeth, is a common cause of tooth loss in older adults. It results from poor dental hygiene and environmental factors such as lack of access to fluoridated water supplies.Loosening and loss of teeth affect the older adult’s ability to chew food effectively. The tongue atrophies with aging and the number of taste buds decrease. The resulting alterations in taste can lead to excessive use of salt to make food more flavorful and appealing. Saliva production decreases with aging. The mouth is dry, increasing the risk for irritation of the oral mucosa. The lack of saliva also interferes with the initial digestion of starches, which occurs in the mouth, and with swallowing. The swallowing mechanism itself also is impacted by age, increasing the time required to initiate and complete a swallow. Esophageal peristalsis slows, and food may remain in the esophagus, causing discomfort. The lower esophageal (cardiac) sphincter tends to relax, increasing gastric reflux and the risk for aspiration.n the stomach and proximal small intestine, digestive juice secretion may be decreased. As a result, the older adult may experience more food intolerances and a feeling of sati- ety (fullness) after just a few bites of food. In the small intes- tine, fats are more slowly absorbed, and other nutrients such as glucose, some B vitamins, vitamin D, and minerals such as calcium and iron are less effectively absorbed. Intestinal peristalsis slows, and less mucous secretion occurs in the large bowel. The rectal wall is less elastic, affecting the abil- ity to expel feces. These changes, along with changes in food intake patterns and lower activity levels common in aging, increase the risk for constipation. |
| NUTRITIONAL ASSESSMENT | Mini Nutritional Assessment (MNA) tool, can be used to determine whether an older adult is malnourished or at risk for malnutrition. The MNA uses questions related to food intake, history of weight loss, mobility, and psychologic stress, as well as objective data such as BMI and the presence or absence of acute disease, dementia, and other psychologic conditions |
| Carbohydrates | Composed of simple or complex sugars a Recommended intake: 125–175 g/day Simple sugars:milk,sugar cane, sugar beets,honey,fruits Converted to glucose,used by cells to make ATP Excess: obesity,dental caries, elevated serum triglycerides Complex starches:grains, legumes,root vegetables Excess glucose converted to glycogen or fat for storage Deficit:tissue wasting (protein breakdown),metabolic acidosis (fat breakdown) |
| Proteins | Composed of amino acids a Recommended intake: 0.8 g/kg body weight Complete proteins (contain all the essential amino acids): eggs,milk,milk products, and meat,fish,and poultry Plant (or complementary) pro- teins: legumes,nuts,grains, cereals,and vegetables Vital for body structure and function Nitrogen balance maintained by intake equal to that needed for protein synthesis, preventing breakdown of body proteins Excess: obesity Deficit:weight loss,tissue wasting,thin,sparse hair, edema,anemia |
| Fats (Lipids) | Composed of triglycerides, phospholipids,sterols a Recommended intake: 30% or less of total daily caloric intake; saturated fat,10% or less of total daily caloric intake Saturated fats: animal fats, cocoa butter,palm and coconut oils; hydrogenated (solid) vegetable fats (stick margarine,vegetable shortening) Unsaturated fats:liquid vegetable oils,soft margarines Triglycerides: fuel supply,insula- tion; essential fatty acids help form cell membranes and hormones; carry fat-soluble vitamins A,D,E,and K Phospholipids:cell membranes Sterols:bile,sex hormones,adre- nal hormones,vitamin D,and cholesterol Excess: obesity,increased risk of heart disease Deficit:weight loss; skin lesions. |
| Vitamins | Organic,essential nutrients; includes fat-soluble A,D,E,K; water-soluble B complex (including niacin,biotin,folic acid) and C. a Recommended intake: Varies by specific vitamin Found in a variety of foods, including fruits,vegetables, grains,and animal products Specific functions that promote growth,reproduction,maintenance of health Selected effects of deficits: Nails: iron—soft,spoon-shaped Hair:zinc—dry,dull,sparse Skin:vitamins A,B—flaky,dry; niacin—cracks; vitamin K— easy bruising; vitamin C— delayed healing Eyes:vitamin A—poor night vision; iron—pale conjunctiva. Nervous system: thiamine— deep tendon reflexes, peripheral neuropathies, confusion,apathy Musculoskeletal:thiamine—calf pain; vitamin C—joint pain GI:vitamin B complex—cheilosis, stomatitis,glossitis |
| Minerals | Inorganic elements; includes sodium,potas- sium,calcium,magnesium, chloride,phosphorus a Recommended intake: Varies by mineral Found in a variety of foods, including fruits,vegetables, grains,and animal products Specific regulatory functions. |
| Water | Recommended intake: 1,500 to 2,000 mL/day as fluid Water Other liquids such as fruit juices,milk,coffee,tea,soft drinks Foods such as gelatin Body structure and form Deficit:thirst,weakness,weight loss, BP,orthostatic hypotension, heart rate, poor skin turgor Excess: BP, heart and respi- ratory rates,shortness of breath,weight gain,edemaTransport and exchange medium Medium for metabolic reactions within cells Insulation and temperature regulation Lubricant |
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Nursing Instructor |
Milwaukee Area Technical College |
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