Nutrition for Nursing PDF

CHAPTER 13 UNIT 3 ALTERATIONS IN NUTRITION NUTRITIONAL GUIDELINES AND CHAPTER 13 Gastrointestinal NURSING INTERVENTIONS Disorders General gastrointestinal conside...

CHAPTER 13 UNIT 3 ALTERATIONS IN NUTRITION NUTRITIONAL GUIDELINES AND CHAPTER 13 Gastrointestinal NURSING INTERVENTIONS Disorders General gastrointestinal considerations Monitor gastrointestinal parameters. ◯ Weight and weight changes ◯ Laboratory values Nurses must gain an awareness of nutritional ◯ Elimination patterns needs for clients who have gastrointestinal ◯ I&O Lo ber diets a oid foods that are high in residue (GI) disorders. It is important to explore content (whole-grain breads and cereals, raw fruits dietary needs with the client and recommend and vegetables). iets lo in ber reduce the fre uency and olume of modifications in relationship to the disease ◯ fecal output and slow transit time of food through the process. Understanding the role of primary digestive tract. ◯ Lo ber diets are used short term for clients ho and secondary prevention is essential to have diarrhea or malabsorption syndromes. successful treatment. igh ber diets focus on foods containing more than g of ber per ser ing A diet high in ber helps Nutrition therapy for gastrointestinal disorders ◯ Increase stool bulk. ◯ Stimulate peristalsis. is generally aimed at minimizing or preventing ◯ Prevent constipation. manifestations. In some conditions (celiac ◯ Protect against colon cancer. disease), nutrition is the only treatment. For Nausea and vomiting some GI disorders, nutrition therapy is the Potential causes of nausea and vomiting include foundation of treatment. decreased gastric acid secretion; decreased gastrointestinal motility; allergy to food(s); bacterial or viral infection; increased intracranial pressure; liver, ASSESSMENT/DATA COLLECTION pancreatic, and gall bladder disorders; and adverse e ects of some medications Determine whether the client is experiencing any of The underlying cause of nausea and vomiting should be the following. investigated. Assessing the appearance of the emesis ◯ ifficulty che ing or s allo ing ill aid in diagnosis and treatment co ee ground ◯ Nausea, vomiting, or diarrhea emesis indicates the presence of blood; pale green ◯ loating, e cessi e atus, occult blood, steatorrhea, indicates bile). abdominal pain or cramping, abdominal distention, Once manifestations subside, begin with clear pale, sticky bowel movements liquids followed by full liquids, and advance the diet ◯ Changes in weight, eating patterns, or bowel habits as tolerated. Determine whether the client uses the following. Easy-to-digest, low-fat carbohydrate foods (crackers, ◯ Tobacco toast, oatmeal, pretzels, plain bread, bland fruit) are ◯ Alcohol usually well-tolerated. ◯ Ca eine ◯ Over-the-counter medications to treat GI NURSING ACTIONS conditions (many can have GI complications or be Promote good oral hygiene with tooth brushing, mouth contraindicated with GI conditions) swabs, mouthwash, and ice chips. ◯ Nutritional supplements Elevate the head of the bed. ◯ Herbal supplements for GI conditions or other Serve foods at room temperature or chilled. problems (some clients do not consider them to CLIENT EDUCATION be medications, so they do not mention them to Avoid hot and spicy foods. the provider) Avoid liquids with meals, as they promote a feeling of fullness. Avoid high-fat foods if they contribute to nausea because they are difficult to digest NUTRITION FOR NURSING CHAPTER 13 GASTROINTESTINAL DISORDERS 77  Anorexia Diarrhea Anore ia is de ned as a lac of appetite It is a common iarrhea can cause signi cant losses of potassium, nding for numerous physical conditions and is an sodium, and uid, as ell as nutritional complications ad erse e ect of certain medications It is not the same Common causes of diarrhea include emotional and as anorexia nervosa. physical stress, gastrointestinal disorders, malabsorption Anorexia can lead to decreased nutritional intake and disorders, infections, and certain medications. subse uent protein and calorie de cits Lo ber diets might be recommended on a short term basis to decrease bowel stimulation. NURSING ACTIONS Nutrition therapy varies with the severity and duration of Decrease stress at meal times. diarrhea A liberal uid inta e to replace losses is needed Collect data regarding ad erse e ects of medications Administer medications to stimulate appetite. Dysphagia Assess and modify environment for unpleasant odors. Remove items that cause a decrease in appetite Dysphagia is an alteration in the client’s ability to swallow. (soiled linens, garbage, emesis basins, bedpans, used Causes include obstruction, in ammation, and certain tissues, clutter). neurologic disorders. Assess and manage anxiety and depression. Modifying the texture of foods and the consistency of Provide small, frequent meals and avoid high-fat foods to liquids can enable the client to achieve proper nutrition. help maximize intake. Beverages should be held at least Dry mouth can contribute to dysphagia. Evaluate 30 min before and after meals to prevent the client from medications being taken to determine if this is a feeling full before adequate intake of calories from food. potential ad erse e ect Provide liquid supplements between meals to improve Clients who have dysphagia should be referred to a protein and calorie intake. speech therapist for evaluation. Ensure that meals appear appealing. Serve larger meals ietary modi cations are based on the speci c early in the day. swallowing limitations experienced by the client. Assess for changes in bowel status (increased gastric utritional supplements are bene cial if nutritional emptying, constipation, diarrhea). intake is deemed inadequate. Position to increase gastric motility. NURSING ACTIONS Provide mouth care before and after meals. Clients who have dysphagia are at an increased risk of aspiration. Place the client in an upright or high-Fowler’s Constipation position to facilitate swallowing. Clients ho ha e constipation ha e difficult or Provide oral care prior to eating to enhance the client’s infrequent passage of stools, which can be hard and dry. sense of taste. Causes include irregular bowel habits, psychogenic factors, Allow adequate time for eating, use adaptive inactivity, chronic laxative use, obstruction, medications, eating devices, and encourage small bites and GI disorders (irritable bowel syndrome [IBS]), pregnancy, thorough chewing. or secondary to genital/rectal trauma (sexual abuse or CLIENT EDUCATION childbirth , and inade uate consumption of ber and uid ills should be ta en ith at least o of uid can be ncourage e ercise and a diet high in ber g day for thickened) to prevent medication from remaining in females and 38 g/day for males), and promote adequate the esophagus. uid inta e to help alle iate constipation Avoid thin liquids and sticky foods. If caused by medication, a change in the medication might be necessary. Dumping syndrome NURSING ACTIONS Normally, the stomach controls the rate in which Determine onset and duration of past and present nutrients enter the small intestine. When a portion of elimination patterns, what is normal for the client, the stomach is surgically removed, the contents of the activity levels, occupation, dietary intake, and stress levels. stomach are rapidly emptied into the small intestine, Collect data about past medical and surgical history, causing dumping syndrome. medication use (OTC, herbal supplements, laxatives, Early manifestations typically occur 10 to 20 min enemas, and prescriptions), presence of rectal pressure after eating. Early manifestations include a sensation or fullness, and abdominal pain. of fullness, abdominal cramping, nausea, diarrhea, ncourage client to gradually increase daily inta e of ber and vasomotor manifestations (faintness, syncope, CLIENT EDUCATION diaphoresis, tachycardia, hypotension, ushing Increase uid inta e to o day unless contraindicated Late manifestations occur 1 to 3 hr after eating. Late An increase in ber inta e is the preferred treatment for manifestations include diaphoresis, weakness, tremors, constipation. Avoid chronic use of laxatives. anxiety, nausea, and hunger. Manifestations resolve after intestine is emptied. However, there is a rapid rise in blood glucose and increase in insulin levels immediately after the intestine empties. This leads to hypoglycemia. 78 CHAPTER 13 GASTROINTESTINAL DISORDERS CONTENT MASTERY SERIES  NURSING ACTIONS Manifestations include abdominal pain or discomfort Monitor clients receiving enteral tube feedings and report (can be relieved by eating), headache, lethargy, nausea, manifestations of dumping syndrome to the provider. anorexia, hiccuping (lasting a few hours to days), onitor the client for itamin and mineral de cits iron heartburn after eating, belching, sour taste in mouth, and vitamin B12). vomiting, bleeding, and hematemesis (vomiting of blood). Acute recovery typically occurs in 1 day, but can take 2 CLIENT EDUCATION to 3 days. The client should eat a bland diet when able to Consume small, frequent meals. tolerate food I uid replacement therapy is indicated if Consume protein and fat at each meal. the condition persists. Avoid food that contains concentrated sugars and When the condition occurs due to ingestion of strong restrict lactose intake. acids or alkalis, dilution and neutralization of the causal Plan to consume liquids 1 hr after meals or between agent is needed. Avoid lavage and emetics due to meals (no sooner than 30 min after eating). potential perforation and esophageal damage. Lie do n after meals to delay gastric emptying If re u is a problem, try a reclining position. CHRONIC MANAGEMENT: Modify diet, reduce and manage stress, avoid alcohol and NSAIDs. If condition is Gastroesophageal reflux disease persistent, the provider will prescribe an H2 receptor antagonist (famotidine). astroesophageal re u disease occurs as the result of the abnormal re u of gastric secretions up the NURSING ACTIONS: onitor for itamin de ciency, esophagus. This leads to indigestion and heartburn. especially of vitamin B12. Factors that contribute to GERD include hiatal hernia, CLIENT EDUCATION obesity, pregnancy, smoking, some medications, Avoid eating frequent meals and snacks, as they and genetics. promote increased gastric acid secretion. Long-term GERD can cause serious complications, Avoid alcohol, cigarette smoking, aspirin and other including adenocarcinoma of the esophagus and nonsteroidal anti in ammatory drugs AI s , co ee, Barrett’s esophagus. blac pepper, spicy foods, and ca eine Manifestations include heartburn, retrosternal burning, painful swallowing, dyspepsia, regurgitation, coughing, Peptic ulcer disease hoarseness, and epigastric pain. Pain can be mistaken for a myocardial infarction. Peptic ulcer disease (PUD) is characterized by an erosion of the mucosal layer of the stomach or duodenum. This CLIENT EDUCATION can be caused by a bacterial infection with H. pylori or Avoid situations that lead to increased abdominal the chronic use of NSAIDs (aspirin, ibuprofen). pressure, such as earing tight tting clothing Some clients who have PUD do not experience Avoid eating for 3 hr before lying down. manifestations. Others report dull, gnawing pain, le ate the body on pillo s instead of lying at and burning sensation in the back or low midepigastric area, avoid large meals and bedtime snacks. heartburn, constipation or diarrhea, sour taste in mouth, Attempt weight loss if overweight or obese. burping, nausea, vomiting, bloating, urea present in Avoid trigger foods (citrus fruits and juices, spicy foods, breath, and tarry stools. Eating can temporarily relieve carbonated beverages). pain. Anemia can occur due to blood loss. Avoid items that reduce lower esophageal sphincter For PUD caused by H. pylori, the provider prescribes pressure fatty foods, ca eine, chocolate, alcohol, triple therapy (a combination of antibiotics and acid cigarette smoke, all nicotine products, peppermint and reducing medications) to be taken for 10 to 14 days. spearmint a ors CLIENT EDUCATION: A oid co ee, alcohol, ca eine, Acute and chronic gastritis aspirin and other NSAIDs, cigarette smoking, black pepper, and spicy foods. astritis is characteri ed by in ammation of the gastric mucosa. The gastric mucosa is congested with blood and Lactose intolerance uid, becoming in amed There is a decrease in acid produced and an o erabundance of mucus uper cial Lactose intolerance results from an inadequate supply of ulcers occur, sometimes leading to hemorrhages. lactase in the intestine, the enzyme that digests lactose. Acute gastritis occurs with excessive use of NSAIDs, bile The enzyme that converts lactose into glucose, and re u , ingestion of a strong acid or al ali substance, as galactose is absent or insufficient anifestations a complication of radiation therapy, or as a complication include distention, cramps, atus, and osmotic diarrhea of trauma (burns; food poisoning; severe infection; liver, Small amounts (4 to 6 oz) of milk taken during meals kidney, or respiratory failure; major surgery). can be tolerated. Chronic gastritis occurs in the presence of ulcers Some dairy products (yogurt, aged cheeses) are low in (benign or malignant), Helicobacter pylori, autoimmune lactate and can be better tolerated. disorders (pernicious anemia), poor diet (excessive NURSING ACTIONS: Monitor for vitamin D and calcium ca eine, e cessi e alcohol inta e , medications de ciency alendronate, perindopril , and re u of pancreatic secretions and bile into stomach. NUTRITION FOR NURSING CHAPTER 13 GASTROINTESTINAL DISORDERS 79  NURSING ACTIONS Inflammatory bowel disease (IBD) Avoid or limit intake of foods high in lactose (milk, soft Crohn’s disease (regional enteritis) and ulcerative colitis cheese, ice cream, cream soups, sour cream, puddings, are chronic, in ammatory bo el diseases characteri ed co ee creamer by periods of exacerbation and remission. Ask the provider about the use of a lactase enzyme. Manifestations include nausea, vomiting, abdominal cramps, fever, fatigue, anorexia, weight loss, steatorrhea, Ileostomies and colostomies and low-grade fever. An ostomy is a surgically created opening on the surface Nutrition therapy is focused on providing nutrients in of the abdomen from either the end of the small intestine forms that the client can tolerate. (ileostomy) or from the colon (colostomy). A low-residue, high-protein, high-calorie diet with Fluid and electrolyte maintenance is the primary vitamin and mineral supplementation is prescribed concern for clients who have ileostomies during exacerbation to minimize bowel stimulation. and colostomies. Fluid and electrolyte imbalances are corrected with IV The colon absorbs large amounts of uid, sodium, uids or oral replacement uids and potassium. Enteral nutrition can be prescribed during exacerbations, Nutrition therapy begins with liquids only and is slowly especially if the client is reluctant to eat. Because advanced based upon client tolerance. parenteral nutrition is more costly with a relatively similar bene t, it is not used unless enteral nutrition is NURSING ACTIONS: Provide emotional support to clients ine ecti e or contraindicated due to the risk of altered body image. When the client is not experiencing an exacerbation, CLIENT EDUCATION the diet can be broadened based on the client s speci c Consume a diet that is high in uids at least to L disease process and triggers. to o per day and soluble ber Additional therapy Avoid foods that cause gas (beans, eggs, carbonated Complementary therapies including vitamin C and herbs beverages), stomal blockage (nuts, raw carrots, popcorn), a seed and foods that produce odor eggs, sh, garlic Yoga, hypnosis, and breathing exercises Increase intake of calories and protein to promote Sedatives healing of the stoma site. Antidiarrheal and antiperistaltic agents Aminosalicylate medications and corticosteroids to Diverticulosis and diverticulitis reduce in ammation Diverticula are pouches protruding through the muscle of Immunomodulators to alter the immune response and the intestinal wall, usually from increased intraluminal prevent relapse pressure. They occur anywhere in the colon, but usually urgery hen other treatments are not e ecti e in the sigmoid colon. Unless infection occurs, diverticula CLIENT EDUCATION: Avoid intake of substances that cause cause no problems. or exacerbate diarrhea, and avoid nicotine. Diverticulosis is a condition characterized by the presence of diverticula. Cholecystitis i erticulitis is in ammation that occurs hen fecal matter becomes trapped in the diverticula. Cholecystitis is characteri ed by in ammation of Manifestations of diverticulitis include abdominal pain, the gallbladder. nausea, vomiting, constipation or diarrhea, and fever, The gallbladder stores and releases bile that aids in the accompanied by chills and tachycardia. digestion of fats. The client receives antibiotics, anticholinergics, and Manifestations include pain, tenderness, and rigidity analgesics. Clients who have severe manifestations are in upper right abdomen. Pain can radiate to the right admitted to the hospital and dehydration is treated with shoulder or midsternal area. Nausea, vomiting, and IV therapy. Opioid analgesics are administered for pain. anore ia also can occur If the gallbladder becomes lled Complications (peritonitis, bowel obstruction, abscess) with pus or becomes gangrenous, perforation can result. can warrant surgical intervention. In clients who have large stones or inability to control the A high ber diet can pre ent di erticulosis and condition ith diet modi cations, surgery is re uired diverticulitis by producing stools that are easily passed, Pancreatitis and liver involvement can result from thus decreasing pressure within the colon. uncontrolled cholecystitis. During acute diverticulitis, a clear liquid diet is Fat intake should be limited to reduce stimulation of prescribed until in ammation decreases, then a the gallbladder. high ber, lo fat diet is indicated The diet is individualized to the client’s needs Clients require instruction regarding diet adjustment and tolerance. based on the need for an acute intervention or preventive approach. 80 CHAPTER 13 GASTROINTESTINAL DISORDERS CONTENT MASTERY SERIES  Pancreatitis Treatment for celiac disease is limited to avoiding gluten. However, eliminating gluten, which is found in wheat, rye ancreatitis is an in ammation of the pancreas, hich and barley, is difficult because it is found in many prepared can be acute or chronic. In 70% of the acute cases, alcohol foods. Clients must read food labels carefully in order to use and gallstones are major causes. Chronic pancreatitis adhere to a gluten-free diet. Some gluten-free products are can result from acute pancreatitis that does not resolve. unappealing to clients, and many are more expensive than The pancreas is responsible for secreting enzymes other products. Prognosis is good for clients who adhere to needed to digest fats, carbohydrates, and proteins. a gluten-free diet. Nutritional therapy for acute pancreatitis involves reducing pancreatic stimulation. The client is prescribed NURSING ACTIONS nothing by mouth (NPO), and a nasogastric tube is Monitor for complications including bleeding (bruising) inserted to suction gastric contents. due to inadequate vitamin K intake, manifestations of TPN can be used until oral intake is resumed. anemias (iron, folate, vitamin B12), and manifestations Nutritional therapy for chronic pancreatitis usually of osteoporosis. includes a low-fat, high-protein, and high-carbohydrate Collaborate with a dietitian to assist with food selection diet. It can include providing supplements of vitamin C and label reading. and B-complex vitamins. CLIENT EDUCATION Eat foods that are gluten-free (milk, cheese, rice, corn, Liver disease eggs, potatoes, fruits, egetables, fresh meats and sh, The liver is involved in the metabolism of most nutrients. dried beans). isorders a ecting the li er include cirrhosis, hepatitis, Read labels on processed products. Gravy mixes, sauces, and cancer. cold cuts, soups, and many other products have gluten Malnutrition is common with liver disease. as an ingredient. Protein needs are increased to promote a positive Read labels and research nonfood products (lipstick, nitrogen balance and prevent a breakdown of the body’s communion wafers, vitamin supplements), which also protein stores. can have gluten as an ingredient. Carbohydrates are generally not restricted, as they are an important source of calories. Bariatric surgery Caloric requirements might need to be increased based This is considered the most e ecti e treatment for on an evaluation of the client’s stage of disease, weight, managing obesity and related conditions ene ts include and general health status. reduction of diabetes mellitus, hypertension, dyslipidemia, Multivitamins (especially vitamins B, C, and K) and and mortality rates as well as improved quality of life. mineral supplements might be necessary. Bariatric surgery works best in combination with Alcohol, nicotine, and ca eine should be eliminated diet and lifestyle changes. Nutritional counseling is essential. Protein intake of 60 g/day is required to Celiac disease prevent protein-calorie malnutrition. Celiac disease is also known as gluten-sensitive CLIENT EDUCATION: Dramatic changes in food intake enteropathy, celiac sprue, and gluten intolerance. and regular physical activity will be necessary for It is a chronic, inherited, genetic disorder with successful long-term weight control. autoimmune characteristics. Clients who have celiac Adjustable gastric banding restricts stomach capacity disease are unable to digest the protein gluten. They to to mL ith an in atable band that encircles the lack the digestive enzyme DPP-IV, which is required to uppermost portion of the stomach, similar to a belt to break down the gluten into molecules small enough to create an outlet that can be adjusted as needed. be used by the body. In celiac disease, gluten is broken CLIENT EDUCATION down into peptide strands instead of molecules. The ◯ Diet will gradually increase from liquids to pureed to body is not able to metabolize the peptides. If untreated, soft foods. the client ill su er destruction of the illa and the ◯ Chew foods thoroughly, slowly, and in small amounts. walls of the small intestine. Celiac disease can go undiagnosed in both children and adults. Roux-en-Y gastric bypass: Ingested food bypasses 95% Manifestations vary widely. Children who have celiac of the stomach, the duodenum, and a small portion of disease have diarrhea, steatorrhea, anemia, abdominal the proximal jejunum. Weight loss is achieved through distention, impaired growth, lack of appetite, and malabsorption and dumping syndrome and the altering of fatigue. Typical manifestations in adults include the hormone ghrelin which decreases hunger. diarrhea, abdominal pain, bloating, anemia, steatorrhea, Possible postoperative complications include and osteomalacia. anastomotic leaks, internal hernias, GI bleeding, stomal stenosis, gallstones. icronutrient de ciencies are common long term Sleeve gastrectomy is a procedure in which a longitudinal portion of the stomach is removed to create a “sleeve” e ect This reduces production of the hormone ghrelin, which decreases hunger. NUTRITION FOR NURSING CHAPTER 13 GASTROINTESTINAL DISORDERS 81  Application Exercises Active Learning Scenario 1. A nurse is teaching a client who is recovering A nurse is providing instructions to the guardian of a from pancreatitis about following a low-fat child who has lactose intolerance. What should the nurse diet. Which of the following foods should the include in the teaching? Use the ATI Active Learning nurse recommend? (Select all that apply.) Template: System Disorder to complete this item. A. Ribeye steak CLIENT EDUCATION B. Oatmeal Describe the underlying cause of lactose intolerance. C. Ice cream Identify two manifestations of lactose intolerance. D. Canned peaches Identify three foods the child should E. Pretzels limit or eliminate from their diet. 2. A nurse is teaching a client who has constipation about a high-fiber, low-fat diet. Which of the following food choices by the client indicates understanding of the teaching? A. Peanut butter B. Peeled apples C. Hardboiled egg D. Brown rice 3. A nurse is assessing a client who is postoperative from a gastric bypass and who just finished eating a meal. Which of the following findings are manifestations of dumping syndrome? (Select all that apply.) A. Bradycardia B. Dizziness C. Dry skin D. Hypotension E. Diarrhea 4. A nurse is collecting data from a client who has peptic ulcer disease (PUD). Which of the following findings should the nurse expect? (Select all that apply.) A. Steatorrhea B. Anemia C. Tarry stools D. Epigastric pain E. Swollen lymph nodes 5. A nurse is instructing a client who has celiac disease about foods to avoid. Which of the following foods should the nurse include in the teaching? A. Potatoes B. Graham crackers C. Wild rice D. Canned pears 82 CHAPTER 13 GASTROINTESTINAL DISORDERS CONTENT MASTERY SERIES  Application Exercises Key Active Learning Scenario Key 1. A. Ribeye steak is not a low-fat food source. Using the ATI Active Learning Template: System Disorder B. CORRECT: Oatmeal is a source of easily CLIENT EDUCATION digested carbohydrate that is low in fat. C. Ice cream is not a low-fat food source. The underlying cause of lactose intolerance is an inadequate D. CORRECT: Canned peaches are a source of easily level of lactase. The enzyme that converts lactose into digested carbohydrate that is low in fat. glucose and galactose is absent or insufficient. E. CORRECT: Pretzels are a source of easily Manifestations digested carbohydrate that is low in fat. Abdominal distension ◯ NCLEX® Connection: Basic Care and Comfort, Cramps ◯ Nutrition and Oral Hydration Flatus ◯ Diarrhea ◯ Foods to limit or avoid include milk, soft cheese, 2. A. Peanut butter is high in fat. ice cream, cream soups, puddings. B. Unpeeled fruit is a better source of fiber. C. Egg yolk is high in fat. NCLEX® Connection: Physiological Adaptation, D. CORRECT: Brown rice is a good source Illness Management of fiber and is low in fat. NCLEX® Connection: Basic Care and Comfort, Elimination 3. A. Tachycardia due to a decrease in circulating volume is a manifestation of dumping syndrome. B. CORRECT: When a portion of the stomach is no longer available to serve as a reservoir, a large amount of food is rapidly dumped into the small intestine, and fluid shifts from general circulation into the intestine. Dizziness occurs due to a decrease in circulating volume. C. Sweating is a manifestation of dumping syndrome. D. CORRECT: Hypotension occurs due to a decrease in circulating volume. E. CORRECT: Diarrhea from increased peristalsis is a manifestation of dumping syndrome. NCLEX® Connection: Basic Care and Comfort, Elimination 4. A. Steatorrhea is a clinical finding in the presence celiac disease. B. CORRECT: Iron deficiency anemia due to blood loss is a clinical finding of PUD. C. CORRECT: Tarry stools due to intestinal bleeding is a clinical finding of PUD. D. CORRECT: Epigastric pain described as a gnawing or burning sensation is a clinical manifestation of PUD. E. Swollen lymph nodes are a clinical manifestation of many conditions and infections, but not of PUD. NCLEX® Connection: Basic Care and Comfort, Elimination 5. A. Potatoes are gluten-free and a good choice for a client who has celiac disease. B. CORRECT: Graham crackers are made from wheat flour. A client who has celiac disease should avoid products that are made from wheat flour. C. Wild rice is gluten-free and a good choice for a client who has celiac disease. D. Fruits and vegetables without a sauce are gluten-free and are good choices for a client who has celiac disease. NCLEX® Connection: Basic Care and Comfort, Nutrition and Oral Hydration NUTRITION FOR NURSING CHAPTER 13 GASTROINTESTINAL DISORDERS 83 84 CHAPTER 13 GASTROINTESTINAL DISORDERS CONTENT MASTERY SERIES