ADULT MEDICAL SURGICAL study notes
Dealing with CONSTIPATION (difficult or infrequent passage of stools, which may be hard or
dry.)
Causes: irregular bowel habits, psychogenic factors, inactivity, chronic laxative use or
abuse, obstruction, medications, and inadequate consumption of fiber and fluid.
ENCOURAGING EXERCISE AND A DIET HIGH IN FIBER
AND PROMOTING ADEQUATE FLUID INTAKE MAY HELP
ALLEVIATE SYMPTOMS.
Dealing with DYSPHAGIA (an alteration in the client’s ability to swallow.)
Causes: obstruction, inflammation, edema, certain neurological disorders.
MODIFYING THE TEXTURE OF FOODS AND THE CONSISTENCY OF LIQUIDS
MAY ENABLE THE CLIENT TO ACHIEVE PROPER NUTRITION.
CLIENTS WITH DYSPHAGIA ARE AT AN INCREASED RISK OF ASPIRATION.
PLACE THE CLIENT IN AN UPRIGHT OR HIGH-FOWLER’S POSITION TO
FACILITATE SWALLOWING.
PROVIDE ORAL CARE PRIOR TO EATING TO ENAHNCE THE CLIENT’S SENSE
OF TASTE.
ALLOW ADEQUATE TIME FOR EATING, UTILIZE ADAPTIVE EATING DEVICES,
AND ENCOURAGE SMALL BITES AND THOROUGH CHEWING.
AVOID THIN LIQUIDS AND STICKY FOODS.
DUMPING SYNDROME: occurs as a complication of gastric surgeries that
inhibit the ability of the pyloric sphincter to control the movement of food into the small
intestine.
The “DUMPING” results in nausea, distention, cramping pains, and diarrhea within 15
minutes after eating.
SE: Weakness, dizziness, a rapid heartbeat, and Hypoglycemia may occur.
-SMALL FREQUENT MEALS ARE INDICATED.
-CONSUMPTION OF PROTEIN AND FAT AT EACH MEAL IS INDICATED.
-AVOID CONCENTRATED SUGARS.
-RESTRICT LACTOSE INTAKE.
-CONSUME LIQUIDS 1 HR BEFORE OR AFTER EATING INSTEAD OF WITH
MEALS (A DRY DIET)
,GASTROESOPHAGEAL REFLUX DISEASE (GERD): leads to
indigestion and heartburn from the backflow of acidic gastric juices onto the mucosa of the lower
esophagus.
ENCOURAGE WEIGHTLOSS FOR OVERWEIGHT CLIENTS
AVOID LARGE MEALS AND BEDTIME SNACKS
AVOID TRIGGER FOODS SUCH AS CITRUS FRUITS AND JUICES, SPICY FOODS, AND
CARBONATED BEVERAGES.
AVOID ITEMS THAT REDUCE LOWER ESOPHAGEAL SPHINCTER (LES)
PRESSURE SUCH AS ALCOHOL, CAFFEINE, CHOCOLATE, FATTY FOODS,
PEPPERMINT AND SPEARMINT FLAVORS, AND CIGARETTE SMOKING.
PEPTIC ULCER DISEASE (PUD): characterized by an erosion of the mucosal
layer of the stomach or duodenum.
Causes: bacterial infection with Helicobacter pylori, or the use of non-steroidal anti-
inflammatory drugs (NSAIDS), such as aspirin and ibuprofen.
AVOID EATING FREQUENT MEALS AND SNACKS AS THEY PROMOTE
INCREASED GASTRIC ACID SECRETION.
AVOID ALCOHOL, CIGARETTE SMOKING, ASPIRIN AND OTHER NSAIDS, COFFEE,
BLACK PEPPER, SPICY FOODS, AND CAFFEIENE.
Lactose Intolerance: results from an inadequate supply of lactase, the enzyme that digests
lactose.
SYMPTOMS: distention, flatus, cramps, and diarrhea.
CLIENTS SHOULD BE ENCOURAGED TO AVOID OR LIMIT THEIR INTAKE OF FOODS
HIGH IN LACTOSE SUCH AS: MILK, SOUR CREAM, CHEESE, CREAM SOUPS. COFFEE
CREAMER, CHOCOLATE, ICE CREAM, AND PUDDINGS.
A high-fiber diet may prevent DIVERTICULOSIS AND DIVERTICULITIS
by producing stools that are easily passed and thus decreasing pressure within the colon.
During Acute Diverticulitis, a low-fiber diet is prescribed in order to reduce bowel
stimulation.
-AVOID FOODS WITH SEEDS OR HUSKS.
-CLIENTS REQUIRE INSTRUCTION REGARDING THEIR DIET ADJUSTMENT
BASED ON THE NEED FOR AN ACUTE INTERVENTION OR PREVENTATIVE
APPROACH.
,CHOLECYSTITIS: is characterized by inflammation of the GALLBLADDER. The
gallbladder stores and releases BILE that AIDS in DIGESTION of FATS.
FAT INTAKE SHOULD BE LIMITED TO REDUCE STIMULATION OF THE GALLBLADDER.
OTHER FOODS THAT MAY CAUSE PROBLEMS INCLUDE: COFFEE, BROCCOLI,
CAULIFLOWER, BRUSSEL SPROUTS, CABBAGE, ONIONS, LEGUMES, AND HIGHLY
SEASONED FOODS.
OTHER WISE, THE DIET IS INDIVIDUALIZED TO THE CLIENT’S NEEDS AND
TOLERANCE.
ACUTE RENAL FAILURE: is an abrupt, rapid decline in renal function. It is usually
caused by trauma, sepsis, poor perfusion, or medications. ARF can cause hyponatremia,
hyperkalemia, hypocalcemia, and hyperphosphatemia.
Diet therapy for ARF is dependent upon the phase of ARF and its
underlying cause.
PRE-END STAGE RENAL DISEASE (pre-ESRD): is a pre-dialysis
condition characterized by an increase in SERUM CREATININE.
GOALS OF NUTRITIONAL THERAPY:
HELP PRESERVE REMAINING RENAL FUNCTION BY LIMITING THE INTAKE
OF PROTEIN AND PHOSPHORUS.
CONTROL BLOOD GLUCOSE LEVELS AND HYPERTENSION, WHICH ARE BOTH
RISK FACOTRS. PROTEIN RESTRICTION IS KEY FOR CLIENTS WITH PRE-ESRD.
SLOWS THE PROGRESSION OF RENAL DISEASE.
TOO LITTLE PROTEIN RESULTS IN BREAKDOWN OF BODY PROTEIN, SO PROTEIN
INTAKE MUST BE CAREFULLY DETERMINED.
RESTRICTING PHOSPHORUS INTAKE SLOWS THE PROGRESSION OF RENAL
DISEASE.
HIGH LEVELS OF PHOSPHORUS CONTRIBUTE TO CALCIUM AND PHSOPHORUS
DEPOSITS IN THE KIDNEY.
LIMIT MEAT INTAKE.
LIMIT DAIRY PRODUCTS TO 1.2 CUP PER DAY.
LIMIT HIGH PHSOPHORUS FOODS: PEANUT BUTTER, DRIED PEAS AND BEANS,
BRAN, COLA, CHOCOLATE, BEER, SOME WHOLE GRAINS.
RESTRICT SODIUM INTAKE TO MAINTAIN BLOOD PRESSURE.
CAUTION CLIENTS TO USE VITAMIN AND MINERAL SUPPLEMENTS ONLY
WHEN RECOMMENDED BY THE PROVIDER.
, END STAGE RENAL DISEASE: OR chronic renal failure, occurs when the
glomerular filtration rate (GFR) is less than 25 mL/min, the serum creatinine level steadily rises,
or dialysis or transplantation is required.
THE GOAL OF NUTRITIONAL THERPAY IS TO MAINTAIN APPROPRIATE FLUID STATUS,
BLOOD PRESSURE, AND BLOOD CHEMISTRIES.
A HIGH PROTEIN-DIET, LOW-PHOSPHORUS, LOW POTASSIUM, LOW SODIUM,
FLUID RESTRICTED DIET IS RECOMMENDED.
CALCIUM AND VITAMIN D ARE NUTRIENTS OF CONCERN.
PROTEIN NEEDS INCREASE ONCE DIALYSIS IS BEGUN BECAUSE PROTEIN AND
AMINO ACIDS ARE LOST IN THE DIASYLATE.
FIFTY PERCENT OF PROTEIN INTAKE SHOULD COME FROM BIOLOGIC SOURCES (EGGS,
MILK, MEAT, FISH, POULTRY, SOY)
ADEQUATE CALORIES SHOULD BE CONSUMED TO MAINTAIN BODY PROTEIN
STORES. PHOSPHORUS MUST BE RESTRICTED.
THE HIGH PROTEIN REQUIREMENT LEADS TO AN INCREASE IN PHOSPHORUS
INTAKE. PHOSPHATE BINDERS MUST BE TAKEN WITH ALL MEALS AND
SNACKS.
VITAMIN D DEFICIENCY OCCURS BECAUSE THE KIDNEYS ARE UNABLE TO CONVERT ITS
ACTIVE FORM.
CALCIUM SUPPLEMENTS WILL LIKELY BE REQUIRED BECAUSE FOODS HIGH IN
PHOSPHORUS ARE ALSO HIGH IN CALCIUM.
POTASSIIUM INTAKE IS DEPENDENT ON THE CLIENT’S LAB VALUES, WHICH
SHOULD BE CLOSESLY MONITORED.
SODIUM AND FLUID ALLOWANCES ARE DETERMINED BY BLOOD PRESSURE, WEIGHT,
SERUM ELECTROLYTE LEVELS, AND URINE OUTPUT.
ACHIEVING A WELL-BALANCED DIET BASED ON THE ABOVE GUIDELINES IS A DIFFICULT
TASK.
NEPHROTIC SYNDROME: results in serum proteins leaking into the urine.
THE GOALS OF NUTRITIONAL THERAPY ARE TO MINIMIZE EDEMA, REPLACE LOST
NUTRIENTS, AND MINIMIZE PERMANENT RENAL DAMAGE.
DIETARY RECOMMENDATIONS INDICATE SUFFICIENT PROTEIN AND LOW
SODIUM INTAKE.
NEPHROLITHIASIS (KIDNEY STONES)
INCREASING FLUID CONSUMPTION IS THE PRIMARY INTERVENTION FOR THE
TREATMENT AND PREVENTION OF THE FORMATION OF RENAL CALCULI. EXCESSIVE
INTAKE OF PROTEIN, SODIUM, CALCIUM, AND OXALATES (RHUBARB, SPINACH,
BEETS) MAY INCREASE THE RISK OF STONE FORMATION.
GLAUCOMA: is a disturbance of the functional or structural integrity of the optic nerve.
Decreased fluid drainage or increased fluid secretion increases intraocular pressure (IOP) and can
cause atrophic changes of the optic nerve and visual defects.
Dealing with CONSTIPATION (difficult or infrequent passage of stools, which may be hard or
dry.)
Causes: irregular bowel habits, psychogenic factors, inactivity, chronic laxative use or
abuse, obstruction, medications, and inadequate consumption of fiber and fluid.
ENCOURAGING EXERCISE AND A DIET HIGH IN FIBER
AND PROMOTING ADEQUATE FLUID INTAKE MAY HELP
ALLEVIATE SYMPTOMS.
Dealing with DYSPHAGIA (an alteration in the client’s ability to swallow.)
Causes: obstruction, inflammation, edema, certain neurological disorders.
MODIFYING THE TEXTURE OF FOODS AND THE CONSISTENCY OF LIQUIDS
MAY ENABLE THE CLIENT TO ACHIEVE PROPER NUTRITION.
CLIENTS WITH DYSPHAGIA ARE AT AN INCREASED RISK OF ASPIRATION.
PLACE THE CLIENT IN AN UPRIGHT OR HIGH-FOWLER’S POSITION TO
FACILITATE SWALLOWING.
PROVIDE ORAL CARE PRIOR TO EATING TO ENAHNCE THE CLIENT’S SENSE
OF TASTE.
ALLOW ADEQUATE TIME FOR EATING, UTILIZE ADAPTIVE EATING DEVICES,
AND ENCOURAGE SMALL BITES AND THOROUGH CHEWING.
AVOID THIN LIQUIDS AND STICKY FOODS.
DUMPING SYNDROME: occurs as a complication of gastric surgeries that
inhibit the ability of the pyloric sphincter to control the movement of food into the small
intestine.
The “DUMPING” results in nausea, distention, cramping pains, and diarrhea within 15
minutes after eating.
SE: Weakness, dizziness, a rapid heartbeat, and Hypoglycemia may occur.
-SMALL FREQUENT MEALS ARE INDICATED.
-CONSUMPTION OF PROTEIN AND FAT AT EACH MEAL IS INDICATED.
-AVOID CONCENTRATED SUGARS.
-RESTRICT LACTOSE INTAKE.
-CONSUME LIQUIDS 1 HR BEFORE OR AFTER EATING INSTEAD OF WITH
MEALS (A DRY DIET)
,GASTROESOPHAGEAL REFLUX DISEASE (GERD): leads to
indigestion and heartburn from the backflow of acidic gastric juices onto the mucosa of the lower
esophagus.
ENCOURAGE WEIGHTLOSS FOR OVERWEIGHT CLIENTS
AVOID LARGE MEALS AND BEDTIME SNACKS
AVOID TRIGGER FOODS SUCH AS CITRUS FRUITS AND JUICES, SPICY FOODS, AND
CARBONATED BEVERAGES.
AVOID ITEMS THAT REDUCE LOWER ESOPHAGEAL SPHINCTER (LES)
PRESSURE SUCH AS ALCOHOL, CAFFEINE, CHOCOLATE, FATTY FOODS,
PEPPERMINT AND SPEARMINT FLAVORS, AND CIGARETTE SMOKING.
PEPTIC ULCER DISEASE (PUD): characterized by an erosion of the mucosal
layer of the stomach or duodenum.
Causes: bacterial infection with Helicobacter pylori, or the use of non-steroidal anti-
inflammatory drugs (NSAIDS), such as aspirin and ibuprofen.
AVOID EATING FREQUENT MEALS AND SNACKS AS THEY PROMOTE
INCREASED GASTRIC ACID SECRETION.
AVOID ALCOHOL, CIGARETTE SMOKING, ASPIRIN AND OTHER NSAIDS, COFFEE,
BLACK PEPPER, SPICY FOODS, AND CAFFEIENE.
Lactose Intolerance: results from an inadequate supply of lactase, the enzyme that digests
lactose.
SYMPTOMS: distention, flatus, cramps, and diarrhea.
CLIENTS SHOULD BE ENCOURAGED TO AVOID OR LIMIT THEIR INTAKE OF FOODS
HIGH IN LACTOSE SUCH AS: MILK, SOUR CREAM, CHEESE, CREAM SOUPS. COFFEE
CREAMER, CHOCOLATE, ICE CREAM, AND PUDDINGS.
A high-fiber diet may prevent DIVERTICULOSIS AND DIVERTICULITIS
by producing stools that are easily passed and thus decreasing pressure within the colon.
During Acute Diverticulitis, a low-fiber diet is prescribed in order to reduce bowel
stimulation.
-AVOID FOODS WITH SEEDS OR HUSKS.
-CLIENTS REQUIRE INSTRUCTION REGARDING THEIR DIET ADJUSTMENT
BASED ON THE NEED FOR AN ACUTE INTERVENTION OR PREVENTATIVE
APPROACH.
,CHOLECYSTITIS: is characterized by inflammation of the GALLBLADDER. The
gallbladder stores and releases BILE that AIDS in DIGESTION of FATS.
FAT INTAKE SHOULD BE LIMITED TO REDUCE STIMULATION OF THE GALLBLADDER.
OTHER FOODS THAT MAY CAUSE PROBLEMS INCLUDE: COFFEE, BROCCOLI,
CAULIFLOWER, BRUSSEL SPROUTS, CABBAGE, ONIONS, LEGUMES, AND HIGHLY
SEASONED FOODS.
OTHER WISE, THE DIET IS INDIVIDUALIZED TO THE CLIENT’S NEEDS AND
TOLERANCE.
ACUTE RENAL FAILURE: is an abrupt, rapid decline in renal function. It is usually
caused by trauma, sepsis, poor perfusion, or medications. ARF can cause hyponatremia,
hyperkalemia, hypocalcemia, and hyperphosphatemia.
Diet therapy for ARF is dependent upon the phase of ARF and its
underlying cause.
PRE-END STAGE RENAL DISEASE (pre-ESRD): is a pre-dialysis
condition characterized by an increase in SERUM CREATININE.
GOALS OF NUTRITIONAL THERAPY:
HELP PRESERVE REMAINING RENAL FUNCTION BY LIMITING THE INTAKE
OF PROTEIN AND PHOSPHORUS.
CONTROL BLOOD GLUCOSE LEVELS AND HYPERTENSION, WHICH ARE BOTH
RISK FACOTRS. PROTEIN RESTRICTION IS KEY FOR CLIENTS WITH PRE-ESRD.
SLOWS THE PROGRESSION OF RENAL DISEASE.
TOO LITTLE PROTEIN RESULTS IN BREAKDOWN OF BODY PROTEIN, SO PROTEIN
INTAKE MUST BE CAREFULLY DETERMINED.
RESTRICTING PHOSPHORUS INTAKE SLOWS THE PROGRESSION OF RENAL
DISEASE.
HIGH LEVELS OF PHOSPHORUS CONTRIBUTE TO CALCIUM AND PHSOPHORUS
DEPOSITS IN THE KIDNEY.
LIMIT MEAT INTAKE.
LIMIT DAIRY PRODUCTS TO 1.2 CUP PER DAY.
LIMIT HIGH PHSOPHORUS FOODS: PEANUT BUTTER, DRIED PEAS AND BEANS,
BRAN, COLA, CHOCOLATE, BEER, SOME WHOLE GRAINS.
RESTRICT SODIUM INTAKE TO MAINTAIN BLOOD PRESSURE.
CAUTION CLIENTS TO USE VITAMIN AND MINERAL SUPPLEMENTS ONLY
WHEN RECOMMENDED BY THE PROVIDER.
, END STAGE RENAL DISEASE: OR chronic renal failure, occurs when the
glomerular filtration rate (GFR) is less than 25 mL/min, the serum creatinine level steadily rises,
or dialysis or transplantation is required.
THE GOAL OF NUTRITIONAL THERPAY IS TO MAINTAIN APPROPRIATE FLUID STATUS,
BLOOD PRESSURE, AND BLOOD CHEMISTRIES.
A HIGH PROTEIN-DIET, LOW-PHOSPHORUS, LOW POTASSIUM, LOW SODIUM,
FLUID RESTRICTED DIET IS RECOMMENDED.
CALCIUM AND VITAMIN D ARE NUTRIENTS OF CONCERN.
PROTEIN NEEDS INCREASE ONCE DIALYSIS IS BEGUN BECAUSE PROTEIN AND
AMINO ACIDS ARE LOST IN THE DIASYLATE.
FIFTY PERCENT OF PROTEIN INTAKE SHOULD COME FROM BIOLOGIC SOURCES (EGGS,
MILK, MEAT, FISH, POULTRY, SOY)
ADEQUATE CALORIES SHOULD BE CONSUMED TO MAINTAIN BODY PROTEIN
STORES. PHOSPHORUS MUST BE RESTRICTED.
THE HIGH PROTEIN REQUIREMENT LEADS TO AN INCREASE IN PHOSPHORUS
INTAKE. PHOSPHATE BINDERS MUST BE TAKEN WITH ALL MEALS AND
SNACKS.
VITAMIN D DEFICIENCY OCCURS BECAUSE THE KIDNEYS ARE UNABLE TO CONVERT ITS
ACTIVE FORM.
CALCIUM SUPPLEMENTS WILL LIKELY BE REQUIRED BECAUSE FOODS HIGH IN
PHOSPHORUS ARE ALSO HIGH IN CALCIUM.
POTASSIIUM INTAKE IS DEPENDENT ON THE CLIENT’S LAB VALUES, WHICH
SHOULD BE CLOSESLY MONITORED.
SODIUM AND FLUID ALLOWANCES ARE DETERMINED BY BLOOD PRESSURE, WEIGHT,
SERUM ELECTROLYTE LEVELS, AND URINE OUTPUT.
ACHIEVING A WELL-BALANCED DIET BASED ON THE ABOVE GUIDELINES IS A DIFFICULT
TASK.
NEPHROTIC SYNDROME: results in serum proteins leaking into the urine.
THE GOALS OF NUTRITIONAL THERAPY ARE TO MINIMIZE EDEMA, REPLACE LOST
NUTRIENTS, AND MINIMIZE PERMANENT RENAL DAMAGE.
DIETARY RECOMMENDATIONS INDICATE SUFFICIENT PROTEIN AND LOW
SODIUM INTAKE.
NEPHROLITHIASIS (KIDNEY STONES)
INCREASING FLUID CONSUMPTION IS THE PRIMARY INTERVENTION FOR THE
TREATMENT AND PREVENTION OF THE FORMATION OF RENAL CALCULI. EXCESSIVE
INTAKE OF PROTEIN, SODIUM, CALCIUM, AND OXALATES (RHUBARB, SPINACH,
BEETS) MAY INCREASE THE RISK OF STONE FORMATION.
GLAUCOMA: is a disturbance of the functional or structural integrity of the optic nerve.
Decreased fluid drainage or increased fluid secretion increases intraocular pressure (IOP) and can
cause atrophic changes of the optic nerve and visual defects.
