Abruptio placentae: Causes Risk Factors Diagnostic Study and Treatment

  Malabsorption Syndrome 

Malabsorption syndrome is a group of symptoms and physical signs that occur because of poor nutrient absorption in the small intestine, particularly fat absorption, with a resultant decrease in absorption of fat-soluble vitamins A, D, E, and K. Poor absorption of other nutrients, including carbohydrates, minerals, and other vitamins and proteins, may also occur. Celiac sprue and lactose intolerance are common types of malabsorption syndromes.

Pathophysiology and Etiology of Malabsorption

Malabsorption has multiple etiologies, including gallbladder, liver, or pancreatic disease, lymphatic obstruction, vascular impairment, and bowel resection. Two common causes:

 1. Celiac sprue—malabsorption of nutrients resulting from atrophy of villi and microvilli of the small intestine because of an intolerance to gluten found in common grains, such as wheat, rye, oats, and barley.

 2. Lactose intolerance—typically of genetic origin, this digestive enzyme deficiency prevents the digestion of lactose found in milk, causing osmosis of water into the lumen of the intestine.

Abruptio placentae: Causes Risk Factors Diagnostic Study and Treatment

Clinical Manifestations of Malabsorption

 1. Steatorrhea.

 2. Abdominal distention and pain.

 3. Flatulence.

 4. Anorexia, weight loss, edema.

 5. Vitamin deficiency—fat-soluble (A, D, E, K).

 6. Protein deficiency and negative nitrogen balance.

 7. Anemia, weakness, and fatigue due to poor absorption of iron, folic acid, and vitamin B12.

Diagnostic Evaluation of Malabsorption

 1. Fecal fat analysis—72-hour stool collection; fecal fat may be increased.

 2. M2A Imaging System—a device that provides images via a receiver and recorder tracing the transit of a capsule that is swallowed by the patient. Used to evaluate and diagnose malabsorption syndromes as well as other gastrointestinal diseases.

 3. Lower GI series (barium enema)—may be used to evaluate the colon.

 4. Serum measurement of vitamin levels, total protein, and albumin may be decreased.

 5. Prothrombin time may be prolonged because of vitamin K deficiency.

Management of Malabsorption

 1. Treatment of the underlying cause, if possible, by eliminating causative agents, such as grains or milk.

 2. Promotion of adequate nutritional intake through a carefully designed diet that substitutes alternatives to the offending agent and that ensures replacement of deficient nutrients through oral, enteral, or parenteral therapy.

 3. Medications such as pancreatic enzymes.

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Complications of Malabsorption

 1. Dehydration.

 2. Electrolyte imbalance with possible cardiac dysrhythmias.

 3. Protein deficiency with muscle atrophy and edema.

 4. Vitamin deficiency with tetany, bleeding, anemia, and osteoporosis.

 5. Skin breakdown.

Nursing Assessment of Malabsorption

 1. Assess fluid and electrolyte status through careful monitoring of intake and output, daily weight, serum electrolytes, vital signs, and other signs and symptoms of dehydration and electrolyte imbalance.

 2. Assess GI function through observation of frequency and characteristics of stool, bowel sounds, distention, pain, and other associated symptoms.

 3. Assess nutritional status.

Nursing Diagnoses

1. Imbalanced Nutrition: Less Than Body Requirements related to malabsorption of nutrients.

2. Deficient Fluid Volume related to loss of fluid through stool.

3. Acute Pain related to abdominal distention and cramps.

4. Risk for Impaired Skin Integrity related to irritation of the anal area by stool.

Nursing Interventions

Improving Nutritional Status

 1. Ensure that diet is free from causative agents, such as dairy or wheat products.

 2. Provide a diet high in missing nutrients, including proteins, carbohydrates, fats, vitamins, and minerals.

 3. Teach patients to use substitute products for causative agents, such as gluten-free flour, corn, soybean, and lactose-free milk substitutes.

 4. Monitor weight and characteristics of stool closely. 

Restoring Fluid Balance 

1. Monitor intake and output and urine-specific gravity.

       a. Include watery stool in output.

       b. Be aware that edema is caused by low serum proteins, not fluid overload.

2. Monitor vital signs frequently, based on condition.

 3. Be alert for dehydration—orthostatic hypotension, tachycardia, decreased skin turgor, dry mucous membranes, thirst, oliguria.

 4. Observe for signs and symptoms of potential electrolyte disturbances—nausea, vomiting, dysrhythmias, tremors, seizures, anorexia, weakness—and report abnormal results of serum electrolytes.

 5. Administer IV fluids or parenteral or enteral nutrition, as ordered.

Relieving Pain

     1. Assess timing, frequency, and character of pain and its relationship to food.

     2. Encourage Fowler’s position and frequent change in position for comfort.

     3. Administer analgesics, antidiarrheals, and antiflatulents, as ordered.

Maintaining Tissue Integrity

 1. Provide meticulous perineal care after each stool with the application of hydrophobic ointments, if necessary, to prevent skin breakdown.

 2. Give careful attention to general skin condition, assessing for redness, breakdown, and poor turgor, and maintain general skin integrity through cleanliness, lubrication, padding of bony prominences, frequent turning, and adequate hydration and nutrition.

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Patient Education and Health Maintenance

 1. Provide nutritional counseling for patient and family, particularly if symptoms are secondary to food intolerance; stress which foods to avoid and the importance of carefully reading all food labels, recommend appropriate food substitutions, and necessary nutritional supplements.

 2. Advice regarding signs and symptoms that indicate worsening of disease—increased frequency of stool, diarrhea or steatorrhea, increased pain.

Evaluation: Expected Outcomes

1. Maintains weight and energy level.

2. Vital signs stable; urinary output adequate.

3. Verbalizes decreased pain after meals.

4. No skin breakdown noted.