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Metabolism

organized process
through which nutrients
such as carbohydrates,
fats and proteins are
broken down,
transformed or otherwise
converted into cellular
energy
Nutrition

Process wherein food


can be assimilated into
the body
Nutrition

Ingestion
Digestion

Absorption
Energy

- measured in
kilocalories; obtained
from foods

* More than 90% of


body energy is stored in
the adipose tissue.
Adipose Tissue
- storage site for body
fuels
- provides insulation for
the body
- fills body crevices
- protects body organs

* Liver cells are able to store


small amount of lipids
Phases of Metabolism:

1. Anabolism (Constructive
phase)

- metabolic storage
and synthesis of cell
constituents
- requires energy
Phases of Metabolism:

2. Catabolism (Destructive
phase)

breakdown of
complex molecules
into substances that
can be used for energy
adenosine
triphosphate
(ATP)
GLUCOSE
METABOLISM
Liver
- regulates entry of
glucose into the
blood.
- buffer system to
regulate blood sugar
levels.
Excess
Glucose

Fatty Acids
(stored in fat Stored in liver
cells as and skeletal
triglycerides) muscles as
glycogen
GLYCOGENOLYSIS
- breakdown of glycogen

- controlled by epinephrine
and glucagon

- help maintain blood sugar


levels during periods of
fasting and strenuous
exercise.
GLYCOGENESIS

- conversion of glucose
into glycogen

- stimulated by insulin
GLUCONEOGENESIS
- building of glucose
from new sources

- conversion of amino
acids, lactate and
glycerol into glucose.
FAT METABOLISM

Triglycerides
Lipase
Fatty acids

Ketones
FAT METABOLISM

Ketones

- important source of
energy

- the brain adapts to use


of ketones during
prolonged periods of
starvation.
CARBOHYDRATES FATS
METABOLISM METABOLISM
PROTEIN METABOLISM

Amino Acids
- building blocks of
proteins

- converted to fatty
acids, ketones or glucose
and stored or used as
metabolic fuel
Mechanisms of Heat
Production or Energy

Expenditure:

1. Basal Metabolic Rate or


Resting Energy Equivalent

2. Diet Induced
Thermogenesis
Mechanisms of Heat
Production or Energy

Expenditure:

3. Exercise Induced
Thermogenesis

4. Thermogenesis in Response
to Changes in
Environmental Conditions
Alteration in Metabolism

- entails inefficient
energy source
mobilization that can
compromise well-being
CAUSES:

Adverse patterns in food


intake
- insufficient
quantities of nutrients
made available to
the body
CAUSES:

Structural defects
- interfere with
absorption/utilization
of metabolic substrates
or those that may
increase the need for
such.
CAUSES:

Overwhelming response
of bodily processes to
hormonal regulation
EFFECTS:

exhaustion of bodys
reserve

tissue depletion

biochemical lesion

clinical lesions
GOALS:

maintain cellular
nutrition in light of
metabolic demands

prevent cellular
degeneration

reverse functional
deterioration
Functions of the Stomach:

Mixes saliva, food, and


gastric juice to form
chyme

Reservoir for holding


food before release into
small intestine
Functions of the Stomach:

Secretes gastric juice,


which contains HCl,
pepsin, intrinsic factor,
and gastric lipase

HCl kills bacteria and


denatures proteins.
Functions of the Stomach:

Pepsin begins the


digestion of proteins

Intrinsic factor aids


absorption of Vitamin
B12
Functions of the Stomach:

Gastric lipase aids


digestion of
triglycerides.

Secretes gastrin into


the blood
Functions of the Liver:

Produces bile, needed


for emulsification and
absorption of lipids in
the small intestine
Functions of the Liver:

Functions in
carbohydrate, lipid, and
protein metabolism;
processing and
detoxification of drugs,
chemicals, alcohols, and
hormones
Functions of the Liver:

Excretion of bilirubin

Synthesis of bile salts

Activation of Vitamin D
Functions of the Liver:

Storage of vitamins and


minerals (i. e., copper,
Iron, Magnesium,
Vitamins B2, B12, and
B6, Folic acid, and
Vitamins A, D, E, & K)
Functions of the Liver:

phagocytosis (Kupffer
cells engulf harmful
bacteria and anemic red
blood cells)
Functions of the Pancreas:

Exocrine part
- about 80% of the
organ
- consists of acinar cells
which secrete enzymes
(trypsin, chymotrypsin,
amylase, and lipase)
Functions of the Pancreas:

Endocrine part
- made up of Islets of
Langerhans, with
alpha cells producing
glucagons and beta
cells producing
insulin
Functions of the Pancreas:

Pancreatic juice
- contains enzymes that
digest starch
(pancreatic amylase),
triglycerides (pancreatic
lipase), and nucleic
acids (ribonuclease and
deoxyribonuclease)
Functions of the Pancreas:

Pancreatic juice
- buffers acidic gastric
juice in chyme

- stops action of pepsin


from the stomach
Functions of the Small
Intestine:
segmentationsmix
chyme with digestive
juices

migrating motility
complexes propel
chyme toward the
ileocecal sphincter
Functions of the Small
Intestine:

digestive secretions
from small intestine,
pancreas, and liver
complete digestion of
carbohydrates, proteins,
lipids, and nucleic acids
Functions of the Small
Intestine:
circular folds, villi, and
microvilli increase surface
area for absorption

site where about 90% of


nutrients and water are
absorbed
The Large Intestine:

Mechanical
movements include
haustral churning,
peristalsis, and mass
peristalsis
The Large Intestine:

movement;
absorption;
elimination
Functions of the Large
Intestine:

Bacteria produce some B


vitamins and Vitamin K

Last stage of chemical


digestion occurs in the large
intestine through bacterial
action
Functions of the Large
Intestine:
Substances are broken
down and some vitamins
are synthesized.

absorbs water (1 to 2
liters), ions, (Na+ and
Cl-), and vitamins
Functions of the Large
Intestine:
Note:
Feces consist of
water, inorganic salts,
epithelial cells,
bacteria and
undigested foods.
GI CHANGES ASSOCIATED WITH AGING

Physiologic Disorders Nursing Rationale


Change Related to Inter-
Change ventions
STOMACH: Decreased Encourage Bland
Atrophy of HCl acid bland foods
gastric levels lead foods help
mucosa - to high in prevent
character decreased vitamins gastritis.
ized by absorption and iron.
decrease of iron and
in ratio of Vitamin B12
Physiologic Disorders Nursing Rationale
Change Related to Inter-
Change vention
s
gastrin- and to
secreting cells proliferation
to soma- of bacteria.
tostatin- Atrophic -Assess Assess-
secreting cells. gastritis for epi- ment
This change occurs as gastric helps
leads to con- pain. detect
decreased HCl sequence of gastritis.
levels (hypo- bacterial
chlorhydria). overgrowth.
Physiologic Disorders Nursing Rationale
Change Related to Inter-
Change ventions
LARGE Decreased - High-fiber To
INTESTINE sensation to diet and increase
defecate 1500 ml of sensation
Peristalsis can result fluid intake of
decreases, in post- daily (if not needing
and nerve ponement contra- to
impulses of bowel indicated) defecate.
are dulled. movements, - Encourage
which leads as much
to cons- activity as
tipation and tolerated.
impaction.
Physiologic Disorders Nursing Ratio-
Change Related to Inter- nale
Change ventions
Pancreas: Decreased Small, Helps
Dis-tention lipase level frequent preven
and dilation results in feedings t stea-
of pan- decreased torrhea
creatic fat
ducts absorption
change. and
digestion.
Physiologic Disorders Nursing Rationale
Change Related to Inter-
Change ventions
Calci- Steatorrhea, - Assess - Diarrhea
fication of or excess fat for may be
pancreatic in the feces, diarrhea. stea-
vessels occurs torrhea.
occurs because of
with decreased
decrease fat
in lipase digestion.
production
.
Physiologic Disorders Nursing Ratio-
Change Related to Inter- nale
Change ventions
Liver: Decreased Assess all Assess-
- Decrease enzyme clients for ment
in number activity adverse detects
and size of depresses effects of drug
hepatic cells drug all drugs, toxi-
leads to metabolism even those city.
decreased which leads admi-
liver weight to nistered in
and mass. accumulation normal
of drugs doses.
Physiologic Disorders Nursing Ratio-
Change Related to Inter- nale
Change ventions
Liver:
-Increase in
fibrous tissue
leads to decreased
protein synthesis
and changes in
liver enzymes.

-Enzyme activity
and cholesterol
synthesis are
diminished.
ASSESSMENT OF CLIENTS WITH
GI DISORDERS
I. HISTORY
Demographic Data
- age, gender,
culture, and
occupation

Family History and


Genetic Risk
ASSESSMENT OF CLIENTS WITH
GI DISORDERS
I. HISTORY
Personal History

- Previous GI disorder or
abdominal surgeries

- Prescription medications
being taken
ASSESSMENT OF CLIENTS WITH
GI DISORDERS
I. HISTORY
Personal History

- OTC medications taken

- Travel History
ASSESSMENT OF CLIENTS WITH
GI DISORDERS
Diet History

- gather information about


how well the clients
nutritional needs are being
met.
ASSESSMENT OF CLIENTS WITH
GI DISORDERS
Diet History

- Special diet; any known food


allergies; alcohol and caffeine
consumption.
ASSESSMENT OF CLIENTS WITH
GI DISORDERS

Diet History

- usual foods that are eaten


daily and times that meals are
taken.
ASSESSMENT OF CLIENTS WITH
GI DISORDERS
Diet History

- History of anorexia

- Changes in taste

- Dysphagia
ASSESSMENT OF CLIENTS WITH
GI DISORDERS
Diet History

- Abdominal pain/discomfort
that accompanies eating

- Nausea, vomiting, or dyspepsia

- Unintentional weight loss


ASSESSMENT OF CLIENTS WITH
GI DISORDERS
Chief Complaint

- Onset

- Duration

- Quality

- Severity
ASSESSMENT OF CLIENTS WITH
GI DISORDERS
Chief Complaint

- Location

- Precipitating, relieving factors

-Associated symptoms (bloating,


nausea and vomiting,
flatulence, etc.)
ASSESSMENT OF CLIENTS WITH
GI DISORDERS
Socioeconomic Status

Current Health Problems

- Change in bowel habits

- Pattern of bowel
movements
ASSESSMENT OF CLIENTS WITH
GI DISORDERS
Current Health Problems

- Color and consistency of


feces

- Occurrence of diarrhea or
constipation
ASSESSMENT OF CLIENTS WITH
GI DISORDERS

Current Health Problems

- Effective action taken to


relieve diarrhea or
constipation
ASSESSMENT OF CLIENTS WITH
GI DISORDERS

Current Health Problems

- Presence of frank blood or


tarry stools

- Presence of abdominal
distention or gas
ASSESSMENT OF CLIENTS WITH
GI DISORDERS
Current Health Problems

- Unintentional weight gain or


loss

- Changes in appetite or oral


intake
ASSESSMENT OF CLIENTS WITH
GI DISORDERS
Current Health Problems

- Smoking history (use of


cigars, pipe, tobacco, or
chewing tobacco)

- Pain (PQRST)
ASSESSMENT OF CLIENTS WITH
GI DISORDERS
Current Health Problems

- assess for skin discoloration


or rashes, itching, jaundice,
increased susceptibility to
bruising, increased
tendency to bleed
ASSESSMENT OF CLIENTS WITH
GI DISORDERS

Past Medical History

Psychosocial History and


Lifestyle
GI ASSESSMENT USING GORDONS
FUNCTIONAL HEALTH PATTERNS
NUTRITIONAL ELIMINATION
METABOLIC PATTERN
PATTERN

What is your What is your usual


typical daily food bowel elimination
intake? Describe a pattern? Frequency?
days snacks, meals, Character?
and vitamins. Discomfort?
Laxatives?
GI ASSESSMENT USING GORDONS
FUNCTIONAL HEALTH PATTERNS
NUTRITIONAL ELIMINATION
METABOLIC PATTERN
PATTERN

How much salt do Do you have any


you typically add to pain or bleeding
your food? Do you associated with
use salt substitutes? bowel movements?
NUTRITIONAL ELIMINATION
METABOLIC PATTERN
PATTERN

How is your Have you


appetite? Any experienced any
recent change? changes in your
usual bowel
pattern?
NUTRITIONAL ELIMINATION
METABOLIC PATTERN
PATTERN

Do you have any When was your


difficulty chewing last rectal
or swallowing? examination?
NUTRITIONAL ELIMINATION
METABOLIC PATTERN
PATTERN

How is your Have you


appetite? Any experienced any
recent change? changes in your
usual bowel
pattern?
NUTRITIONAL ELIMINATION
METABOLIC PATTERN
PATTERN

Do you have any When was your


difficulty chewing last rectal
or swallowing? examination?
NUTRITIONAL ELIMINATION
METABOLIC PATTERN
PATTERN

Do you wear Have you ever


dentures? How well had an endoscopy
do they fit? or a colonoscopy?
NUTRITIONAL ELIMINATION
METABOLIC PATTERN
PATTERN
Do you ever What is your usual
experience urinary elimination
indigestion or pattern? Frequency?
heartburn? How Amount? Color?
often? What seems Odor? Control?
to cause it? What
helps it?
NUTRITIONAL ELIMINATION
METABOLIC PATTERN
PATTERN

Do you have pain,


diarrhea, gas, or any
other problems? Do
any specific foods
cause this for you?
NUTRITIONAL ELIMINATION
METABOLIC PATTERN
PATTERN

What is your Have you noticed


typical daily fluid a change in the
intake? What type amount of urine?
of fluids (water,
juices, soft drinks,
coffee, tea)? How
much?
NUTRITIONAL ELIMINATION
METABOLIC PATTERN
PATTERN

Have you had any


recent change in
your weight?
Weight gain or loss?
How much?
NUTRITIONAL ELIMINATION
METABOLIC PATTERN
PATTERN

Have you noticed


a change in the
tightness of your
rings or shoes?
Tighter? Looser?
NUTRITIONAL ELIMINATION
METABOLIC PATTERN
PATTERN

Have you noticed


any difference in the
size of your
abdomen?