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Nutrition for Nurses

17.4 Evaluate Nutritional Strategies to Impact Gastrointestinal Wellness

Nutrition for Nurses17.4 Evaluate Nutritional Strategies to Impact Gastrointestinal Wellness

Learning Outcomes

By the end of this section, you should be able to:

  • 17.4.1 Evaluate a nutritional plan for its effect on gastrointestinal wellness.
  • 17.4.2 Modify a nutritional plan to promote gastrointestinal wellness.

Evaluation of the Client’s Adherence to the Meal Plan

After a nutritional plan has been in place for at least 3 months, its effectiveness should be evaluated. The client’s ability to follow the plan must first be established before the plan is modified. If a client is not able to follow the plan as prescribed, then changes need to be made based on the client’s unique reasons for nonadherence.

Unfolding Case Study

Part B

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.

3.
What does the nurse recognize as a potential deficiency with these new presenting symptoms?
  1. Vitamin C
  2. Magnesium
  3. Iron
  4. Protein
4.
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. Carrots
  2. Quinoa
  3. Corn
  4. Whole grain bread

Evaluation of the Effectiveness of a Nutritional Plan

After it is established that the client is adhering to their nutritional plan, evaluating the effectiveness of the plan requires checking laboratory results and watching trends as well as performing physical reassessments. If the plan is not effective, adjustments should be made based on the cause of ineffectiveness.

Unfolding Case Study

Part C

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.

5.
Given the results, what should the nurse conclude about the effectiveness of the nutritional plan?
  1. It is effective, but the client is nonadherent.
  2. It is effective, but the client is not documenting her food intake correctly.
  3. It is ineffective because the client cannot comprehend the instructions well enough.
  4. It is ineffective because the client’s Crohn’s disease is preventing absorption.
6.
Based on the findings, how should the nurse expect the nutritional plan to be modified?
  1. There will be no changes because the client has a chronic condition that cannot be cured.
  2. The amount of food to be consumed will be increased.
  3. Supplementation, either enteral (feeding tube) or parenteral, will be initiated.
  4. There will be no changes; instead, the client will be reeducated about the current plan to improve its effectiveness.
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