Upper GI Tract Clinical Case Scenarios
Krause Text page 607 & 608
Please read both clinical case scenarios and complete the corresponding nutrition care questions. In addition to completing the questions below, please create another PES statement.
Clinical Scenario 1
Jim, a 45-year-old man, is an executive who travels extensively in his work. He recently visited his doctor complaining about upper gastrointestinal (GI) distress. He reports frequent bouts of heartburn in the middle of the night, and he has lost 15 lb during the last year without intentionally dieting. Jim also occasionally experiences heartburn soon after consumption of specific meals and foods. Jim’s doctor diagnosed esophageal reflux, and x-ray studies revealed a hiatal hernia.
Jim has received a good deal of advice regarding specific foods and diets from a variety of sources, but he is confused about what he should eat. Jim is coming to you to discuss nutrition therapies.
Nutrition Diagnostic Statements
1) Involuntary weight loss related to heartburn and GI pain after some meals and foods as evidenced by 15-lb weight loss in the absence of dieting.
2) Food-and nutrition-related knowledge deficit relate to appropriate foods for reflux as evidenced by confusion related to multiple sources of information.
Nutrition Care Questions
1) What is heartburn? Does hiatal hernia have anything to do with it?
2) Why might Jim experience heartburn in the middle of the night?
3) Why might Jim experience burning after consumption of certain foods or meals?
4) Why do you suppose Jim lost weight?
5) Do you recommend that he regain the weight?
6) What recommendations would you give for reducing Jim’s symptoms?
7) Write a progress note using ADIME language.
Mr. Smith had his stomach removed 3 months ago as a result of gastric cancer. He is having difficulty with bloating, nausea, and light-headedness soon after meals. Late, after the meal, he often experiences lower abdominal cramping and diarrhea.
Nutrition Diagnostic Statement
Altered gastrointestinal function related to dumping symptoms following meals as evidenced by history of gastric carcinoma requiring resection of stomach.
Nutrition Care Questions
1) What do you think could be responsible for the different symptoms Mr. Smith is experiencing?
2) What additional information should you gather about Mr. Smith in your nutritional assessment?
3) Should you recommend laboratory work to check any vitamin or mineral levels?
4) Are there measures you can recommend to prevent his postprandial symptoms?