SAMAR STATE UNIVERSITY

College of Nursing and Health Sciences

Bachelor of Science in Nursing

NCM 116

UNIT 1:

NUTRITIONAL-METABOLIC PATERNS RESPONSES ON ALTERED NUTRITION:

Disturbances in Digestion such Nausea and Vomiting,

Gastrointestinal Bleeding, Gastritis and Peptic Ulcer

GIRAY, NORIEL N.

BSN 3-B

MARY ANN D. APACIBLE, RN EdD (CAR)

Clinical Instructor
ACTIVITY 2-B: Interpret 2 Social Media Story concerning on Disturbances in Digestion
 
1. Account or summarize their story.

 A summary of a four minutes video clip from the “Johns Hopkins Medicine” YouTube channel
based from the story of Stephanie White:

This is a story of Stephanie White, who was diagnosed with stage 3C adenocarcinoma
of the stomach and found oncologist Mark Duncan, M.D., and the Johns Hopkins Kimmel
Cancer Center. She recounts her treatment for stomach cancer, her recovery, and meeting her
fiancé.

 A summary of a nine minutes video clip from the “TODAY Original” YouTube channel—Living

With Crohn’s Disease: 1 Woman Shares Her Struggle:

Nicole Pozzi, a young Crohn's disease patient, talks about being diagnosed with the
condition, having surgery to remove a piece of her small intestine, and living with an invisible
illness every day.

2. What possible nursing diagnosis (at least 3) and intervention (at least 5) can you suggest by
applying your critical response to the story? 

 Stephanie’s Story

Nursing Diagnoses:

1. Acute pain related to the growth of cancer cells

2. Anxiety related to plan surgery

3. Imbalanced Nutrition Less Than Body Requirements related to nausea, vomiting

and no appetite

Nursing Interventions:
 1. Monitor nutritional intake and weigh patient regularly.
2. Monitor CBC and serum vitamin B12 levels to detect anemia, and monitor albumin
and prealbumin levels to determine if protein supplementation is needed.
3. Provide comfort measures and administer analgesics as ordered.
4. Frequently turn the patient and encourage deep breathing to prevent pulmonary
complications, to protect skin, and to promote comfort.
5. Maintain nasogastric suction to remove fluids and gas in the stomach and prevent
painful distention.
6. Provide oral care to prevent dryness and ulceration.
7. Keep the patient nothing by mouth as directed to promote gastric wound healing.
Administer parenteral nutrition, if ordered.
8. When nasogastric drainage has decreased and bowel sounds have returned, begin
oral fluids and progress slowly.
9. Avoid giving the patient high-carbohydrate foods and fluids with meals, which may
trigger dumping syndrome because of excessively rapid emptying of gastric contents.
10.Administer protein and vitamin supplements to foster wound repair and tissue
building.
11.Eat small, frequent meals rather than three large meals.
12.Reduce fluids with meals, but take them between meals.
13.Stress the importance of long term vitamin B12 injections after gastrectomy to
prevent surgically induced pernicious anemia.
14.Encourage follow-up visits with the health care provider and routine blood studies
and other testing to detect complications or recurrence.

 Nicole’s Story

Nursing Diagnoses:

1. Imbalanced Nutrition: Less than Body Requirements related to altered absorption of

nutrients secondary to Crohn’s disease, as evidenced by diarrhea, abdominal pain and cramping,
weight loss, nausea and vomiting, and loss of appetite
 2. Acute Pain related to abdominal muscle spasms secondary to Crohn’s disease as
evidenced by pain score of 10 out of 10, verbalization of abdominal pain and cramping, guarding sign
on the abdomen

3. Ineffective Coping related to unpredictable nature of disease process as evidenced

by preoccupation with physical self, chronic worry, emotional tension, poor self-esteem

Nursing Interventions:

1. Encourage patient to report pain.

Rationale: May try to tolerate pain rather than request analgesics.

2. Assess reports of abdominal cramping or pain, noting location, duration, intensity

(0–10 scale). Investigate and report changes in pain characteristics.

Rationale: Colicky intermittent pain occurs with Crohn’s disease

3. Note nonverbal cues (restlessness, reluctance to move, abdominal guarding,

withdrawal, and depression). Investigate discrepancies between verbal and nonverbal cues.

Rationale: Body language or nonverbal cues may be both physiological and

psychological and may be used in conjunction with verbal cues to determine extent and severity of the
problem.

4. Review factors that aggravate or alleviate pain.

Rationale: May pinpoint precipitating or aggravating factors (such as stressful

events, food intolerance) or identify developing complications.

5. Encourage patient to assume position of comfort (knees flexed).

Rationale: Reduces abdominal tension and promotes sense of control.

6. Provide comfort measures (back rub, reposition) and diversional activities.

Rationale: Promotes relaxation, refocuses attention, and may enhance coping

abilities.

7. Cleanse rectal area with mild soap and water or wipes after each stool and provide
skin care (A&D ointment, Sween ointment, karaya gel, Desitin, petroleum jelly).
 Rationale: Protects skin from bowel acids, preventing excoriation.

8. Provide sitz bath as appropriate.

Rationale: Enhances cleanliness and comfort in the presence of perianal

irritation or fissures.

9. Observe for ischiorectal and perianal fistulas.

Rationale: Fistulas may develop from erosion and weakening of intestinal

bowel wall.

10. Observe and record abdominal distension, increased temperature, decreased BP.

Rationale: May indicate developing intestinal obstruction from inflammation,

edema, and scarring.

11. Implement prescribed dietary modifications (commence with liquids and increase to

solid foods as tolerated).

Rationale: Complete bowel rest can reduce pain, cramping.