Page 505 - Nutrition Essentials for Nursing Practice

C H A P T E R 1 8 Nutrition for Patients with Disorders of the Lower GI Tract and Accessory Organs 493

KEY CONCEPTS

■ The first half of the small intestine is the site where most nutrients are absorbed.
Conditions that affect the small intestine can impair the absorption of one or many
nutrients.

■ The large intestine absorbs water and electrolytes. Disorders of the colon can cause
major problems with fluid and electrolyte balance.

■ Most cases of constipation can be alleviated or prevented by increasing fiber and fluid
intake. Most Americans consume approximately half the amount of fiber recommended
daily.

■ To achieve a high-fiber diet, high-fiber foods are eaten in place of those low in fiber,
such as whole wheat bread for white bread, high-fiber cereal for refined cereal, and
whole fruits for fruit juices. High-fiber foods to add to a usual diet include dried peas
and beans, more vegetables, nuts, and seeds.

■ Other than encouraging fluids and foods high in potassium, nutrition therapy usually
is not necessary for acute diarrhea of short-term duration. Because many clear liquids
are hyperosmolar and may contribute to osmotic diarrhea, they should be avoided
until diarrhea subsides. Foods that help thicken stools, such as bananas and oatmeal,
are encouraged. Patients should avoid items that stimulate peristalsis, such as caffeine;
alcohol; and high-fiber, gassy foods.

■ A low-fiber diet is appropriate only for short-term use. Its effect is to decrease stimulation
to the bowel and slow intestinal transit time.

■ Primary lactose intolerance is common in much of the world’s adult population;
tolerance varies considerably among individuals. Some people tolerate milk with food;
others tolerate only lactose-reduced milk. Lactose intolerance that occurs secondary to
intestinal disorders is usually more symptomatic than primary lactose intolerance and
requires a more restrictive intake.

■ During exacerbation of inflammatory bowel diseases, patients need increased amounts
of calories and protein and may not tolerate fiber and lactose. Patients are often
reluctant to eat, fearing that food will cause pain and diarrhea. Some patients require
EN or PN for bowel rest. During remission, the diet is liberalized as tolerated.

■ A gluten-free diet prevents intestinal villi changes, steatorrhea, and other symptoms
in patients with celiac disease. All forms and sources of wheat, rye, and barley must
be permanently eliminated from the diet, even in patients who are asymptomatic.
A gluten-free diet requires major lifestyle changes and is difficult to follow.

■ Short bowel syndrome occurs in patients who have had more than 50% to 70% of the
small intestine removed. Maldigestion and malabsorption may lead to malnutrition.
PN is usually used until adaptation begins, although some patients need PN
permanently. Patients need to eat as soon as possible to stimulate the bowel and
promote adaptation. Tolerance to fat, lactose, and sugar is impaired.

■ Irritable bowel syndrome (IBS) is a common but not serious disorder. A high-fiber and/
or low-lactose diet may help relieve symptoms in some people. Research on the benefits
of probiotics and prebiotics is encouraging but not conclusive. A low-FODMAP diet
may offer the most significant and sustained improvement in IBS symptoms.

■ During acute diverticulitis, patients may be given a low-fiber diet to reduce bowel
stimulation. A recent study showed that a high-fiber diet, traditionally used to prevent
diverticular disease, may actually increase, not decrease, the risk of diverticulosis.

■ Fluid and electrolytes are of primary concern for patients with ileostomies and
colostomies. Low-fiber foods may help to reduce stoma discharge and irritation.
Additional calories and protein are needed to promote healing.