1. NURS 2750 Nutrition for GI Disorders Colleen Snell, MS, RN

2. Upper GI Disorders Disorders of mouth, esophagus, and stomach: ▫Nausea and vomiting ▫Anorexia ▫Dysphagia ▫Gastroesophageal Reflux Disease (GERD) ▫Peptic Ulcer Disease (PUD) ▫Dumping Syndrome

3. Anorexia A symptom = lack of appetite; common with numerous medical diagnoses and medications Nursing actions: ▫Assess environment, anxiety, depression, effects of meds, changes in bowel status ▫Modify environment: remove items that may contribute; serve food attractively; small, frequent, early in day ▫Liquid supplements between meals ▫Mouth care

4. Nausea and Vomiting Etiology: Assess for cause: infection, increased ICP, adverse effects of meds, decreased gastric acid secretion, decreased GI motility, liver, pancreatic, or gall bladder d/o Short term: correct fluid and electrolyte balance Nutrition interventions: ▫Good oral hygiene ▫Limit liquids with meals; encourage between ▫Serve food at room temp or chilled ▫Avoid high-fat or spicy foods ▫Encourage readily digested low-fat carbs

5. Dysphagia Impaired swallowing in oral, pharyngeal, or esophageal phase: ▫https://www.nlm.nih.gov/medlineplus/ency/anatomyvideos/000126.htmhttps://www.nlm.nih.gov/medlineplus/ency/anatomyvideos/000126.htm ▫https://vimeo.com/60944584https://vimeo.com/60944584 Causes of dysphagia: Aging, neurologic impairments, inflammation, obstruction https://www.youtube.com/watch?v=MrbEUDO6S5U

6. Considerations with Dysphagia Priority = safety; aspiration risk ▫Position upright or high Fowler’s ▫Speech therapy referral ▫Mouth care ▫Adaptive eating devices; don’t rush, small bites and thorough chewing ▫Modification of food texture and consistency:  Based on patient specific swallowing limitations  Avoid thin liquids and sticky foods  National Dysphagia Diet:  3 levels of solid textures: pureed, mechanically altered, advanced  4 liquid consistencies: thin, nectarlike, honeylike, spoon- thick

7. Gastroesophageal Reflux Disease (GERD) Abnormal reflux of gastric secretions up esophagus = indigestion and heartburn Infancy; preemies at risk; obesity, pregnancy, smoking, genetic factors Encourage weight loss; exercise, no smoking Avoid increased abdominal pressure; positioning; elevate HOB Avoid spicy foods and other trigger foods Medications/surgery may be next step https://www.nlm.nih.gov/medlineplus/gerd.html#cat63 https://www.nlm.nih.gov/medlineplus/videos/news/Proton_Pump_102815.html http://www.mayoclinic.org/fundoplication/vid-20084708 http://www.uofmmedicalcenter.org/Specialties/ThoracicSurgery/ComplexEsophagealConditions/LINX/index.htm

8. Gastroesophageal Reflux

9. Peptic Ulcer Disease (PUD) Erosion of mucosal layer; most often in duodenum; also stomach, jejunum; lower end of esophagus Helicobacter pylori or chronic use of NSAIDs Manifestations: pain in back or epigastric; eating may relieve; may be asymptomatic Bleeding most severe complication No evidence diet causes or helps treat; but may help control symptoms: avoid caffeine/coffee, NSAIDs, smoking, black pepper, spicy foods

10. Dumping Syndrome Complication after gastric bypass Group of symptoms d/t rapid emptying of stomach contents into intestine: ▫Early: fullness, faintness, tachy, hyoptension ▫Late: Rapid rise in BG causes increase in insulin secretion and resulting HYPOglycemia: sweating, shakiness, confusion To minimize: ▫Small, frequent meals ▫Avoid liquids with meals ▫Avoid simple sugars and restrict lactose intake ▫Eat protein at each meal ▫Lie down for 20-30 minutes after meals ▫Assess for vitamin and mineral deficits: Iron and Vitamin B12

11. Dumping Syndrome https://www.nlm.nih.gov/medlineplus/ency/imagepages/1983 0.htm

12. Lower GI Disorders: Disorders of the small and large intestine, rectum, anus and accessory organs: liver, pancreas and gallbladder: ▫Constipation and Diarrhea ▫Lactose Intolerance ▫Inflammatory Bowel Disease (IBD) ▫Celiac Disease ▫Diverticular Disease ▫Ileostomies and colostomies ▫Liver Disease ▫Pancreatitis ▫Gall Bladder Disease

13. The Iron Chef…or would that be Chopped?…meets NURS 2750 Get into clinical groups Obtain Lower GI Disorder Assign the following to group members: ▫6 Shoppers (will shop one at a time) ▫1 Recorder (in group and on board) ▫1 Reporter (will report to class) ▫1 Master Chef and 1 Assistant Chef(apprentice) take items and plan a meal with rationale for client on why this food item is incorporated