Learning Outcomes
By the end of this section, you should be able to:
- 17.2.1 Prioritize nutritional habits that optimize gastrointestinal wellness.
- 17.2.2 Generate solutions to optimize gastrointestinal wellness using nutritional habits.
Plan Nutritional Goals Based on Testing Results
Nutritional plans (meal plans) should be made with the client based on their specific signs and symptoms. This plan may also include nutrient intake adjustments based on absorption requirements. Nutritional plans should include any nutritional intake restrictions or additions for overall gastrointestinal health based on the client’s specific needs. In addition to the nutrients needed to avoid the deficiencies outlined in Table 17.4, the plan should include foods known to be beneficial for the overall wellness of the gut’s normal microbial growth and should be based on the client’s food preferences and dietary restrictions.
A common vitamin deficiency that displays with abnormal assessment findings is vitamin B. Vitamin B deficiencies that can be found, in order of most importance to the body for normal function, include:
- B12 (cobalamin)
- B1 (thiamine)
- B2 (riboflavin)
- B6 (pyridoxine)
- B3 (niacin)
- B9 (folate)
- B7 (biotin)
Several macro- and micronutrients can appear as abnormal assessment findings when deficient or toxic. They are listed as follows in order of importance for normal gastrointestinal function:
- Iron
- Zinc (deficiency and toxicity)
- Vitamin D
- Protein (deficiency and toxicity)
- Vitamin C
- Vitamin A (retinol)
- Vitamin E
- Magnesium
- Potassium (deficiency and toxicity)
- Sodium (deficiency and toxicity)
- Fiber, calcium, fluids (water)
- Phosphorus
- Folate
- Vitamin K
- Fluoride
- Calories (underconsumption and overconsumption)
- Saturated fats (specifically for overconsumption only)
The client may require enzyme replacement for digestion in the absence of a functioning liver, gallbladder, or pancreas.
When the nurse is evaluating the client’s diet to ensure healthy gut microbiota, dietary additions that might be considered include fiber, additional water, yogurt with active bacterial cultures, whole grains, fruits and vegetables, foods high in antioxidants, and probiotic and prebiotic foods (Afzaal et al., 2022; Gunnars, 2023; Lee et al., 2022; Weersma et al., 2020). Substances that should be restricted include saturated fats and trans fats, sodium, and alcohol (Afzaal et al., 2022).
Clinical Tip
Changes to a Client's Nutritional Intake
Before the dietitian or nurse makes any recommendations to add or restrict anything from the client’s nutritional intake, laboratory tests should be done to confirm what the physical assessment indicates. Once that testing is completed, the nutritional plan can be established.
Nurses must also understand the synergistic relationships between certain nutrients so they can plan interventions to optimize nutritional progress. For example, if a client is iron deficient, an acidic environment will increase iron absorption, which can be achieved by adding vitamin C to the diet (Academy of Nutrition and Dietetics, 2020a). An inability to absorb iron could be directly related to a problem in the gastrointestinal system because most of the body’s iron absorption occurs in the duodenum and proximal jejunum, so adding vitamin C to the client’s diet would be crucial to correct their deficiency (Ems et al., 2023). There are also inhibitory effects to be aware of; calcium, phytates, and polyphenols, for example, can reduce iron availability.
The inability to absorb nutrients is concerning when the client has gastrointestinal disease. Their nutritional plan will include supplementation and higher nutritional intake levels than for a healthy client. A client with a gastrointestinal disorder may eventually require injectable forms of vitamins to stay healthy if they cannot absorb them adequately through oral ingestion. To best prepare a nutritional plan with the client, the nurse must consider the client’s food preferences and cultural practices.
Identify Challenges to Nutritional Goals
A client may face several challenges when trying to achieve their nutritional goals for gastrointestinal health. The first is malabsorption. Even when the client adheres to the nutritional plan of care, their body may be unable to absorb the nutrients provided in their oral intake. Many gastrointestinal diseases can cause these issues (refer to Special Nutritional Considerations for Gastrointestinal Health for greater detail on gastrointestinal diseases). To address such deficiencies, the dietitian, nurse, and health care provider must work closely with the client to monitor laboratory results and add supplementation in oral, enteral (feeding tube), and parenteral forms as needed to reach nutritional goals.
Another challenge that may be encountered is the presence of food allergies or comorbidities. Many foods contain allergens, such as eggs, milk, red meat, nuts, wheat/barley/rye (gluten), shellfish, and citrus fruits. Comorbidities present a concern because if the client already has multiple nutritional restrictions due to other illnesses, such as diabetes, hypertension, or chronic kidney disease, fewer food options may be available to them. In addition, the client may be less motivated or able to follow a nutritional plan the more restrictive it becomes.
The final challenge to consider is the side effects of the gastrointestinal disease processes a client may be experiencing. When a client has a gastrointestinal disease, they may be dealing with nausea, vomiting, anorexia, and/or diarrhea. These issues may cause the client to be unable to consume food or to absorb enough nutrients from what they do consume. For a client with these issues to be successful with their nutritional goals, the health care provider, dietician, and nurse will need to address these issues, and the nutritional plan will need to include foods that do not aggravate the client’s conditions.