NLE Gastrointestinal Nursing — Nutritional & Metabolic SupportConcept Map

Concept

Nutritional Assessment

Sub Concepts

• Anthropometric measures (BMI, weight, height, unintentional weight change)
• Biochemical markers (albumin, prealbumin, transferrin, lymphocyte count, electrolytes)
• Clinical assessment (muscle wasting, edema, skin/hair changes, oral intake history)
• BMI categories (normal, overweight, obese — including lower Asian cut-offs for Filipinos)

Relationship To Central

Foundation for identifying nutritional status and determining intervention type

Concept

Obesity Management

Sub Concepts

• Definition and risk stratification (BMI ≥30; Asian ≥27.5)
• Comorbidities (type 2 diabetes, hypertension, OSA, fatty liver, CAD)
• Management ladder (diet + activity + behavior change → pharmacotherapy → bariatric surgery)
• Nursing role (realistic goal-setting, motivational support, non-judgmental care, comorbidity screening)

Relationship To Central

Nutritional intervention for excess adiposity affecting metabolic and cardiometabolic health

Concept

Malnutrition & Refeeding Syndrome

Sub Concepts

• Types (marasmus, kwashiorkor, mixed malnutrition)
• Clinical manifestations (weight loss, wasting, weakness, poor wound healing, edema, infection risk)
• Assessment (BMI, weight loss >5%/month or >10%/6 months, low prealbumin/albumin)
• Refeeding syndrome pathophysiology (insulin surge → intracellular K/PO4/Mg shift → arrhythmias)
• Prevention & management (start LOW and SLOW, thiamine, electrolyte replacement, close monitoring)

Relationship To Central

Critical recognition and safe management of protein-energy deficits and life-threatening electrolyte shifts

Concept

Enteral Nutrition (Tube Feeding)

Sub Concepts

• Routes (nasogastric, nasointestinal short-term; PEG, jejunostomy long-term)
• Safety verification (tube placement: pH ≤5.5, X-ray; never auscultation alone)
• Aspiration prevention (HOB 30–45°, gastric residual checks, flushing, medication protocols)
• Formula types (polymeric, elemental/semi-elemental, disease-specific)
• Delivery methods (bolus/intermittent vs. continuous infusion)
• Complication recognition (aspiration, diarrhea, tube displacement, dumping-type symptoms)

Relationship To Central

Preferred GI-based feeding route when oral intake inadequate but GI function intact

Concept

Total Parenteral Nutrition (TPN)

Sub Concepts

• Indications (bowel resection, ileus, pancreatitis, fistula, intractable vomiting)
• Administration rules (CENTRAL line only, pump, aseptic technique, never abrupt cessation)
• Composition (dextrose, amino acids, lipids, electrolytes, vitamins, trace elements)
• Safety monitoring (blood glucose q4–6h, weight, I&O, electrolytes, line care, dressing changes)
• Complications (catheter sepsis/infection, hyperglycemia, rebound hypoglycemia, air embolism, thrombosis)
• Transitioning off TPN (taper gradually, monitor glucose, advance enteral/oral intake)

Relationship To Central

IV nutritional support when GI tract cannot be used — high-risk therapy requiring strict safety protocols

Concept

Bariatric Surgery Nursing

Sub Concepts

• Common procedures (sleeve gastrectomy, Roux-en-Y bypass)
• Immediate post-op priorities (leak detection, feeding protocol, VTE prevention, airway management)
• Dumping syndrome (pathophysiology, prevention via meal composition and eating habits)
• Lifelong nutritional deficiencies (B12, iron, folate, calcium, vitamin D, thiamine)
• Micronutrient deficiency signs (anemia, neuropathy, night blindness, poor healing)

Relationship To Central

Perioperative and long-term management of severe obesity via surgical intervention

Concept

Professional & Legal Framework

Sub Concepts

• RA 9173 (Philippine Nursing Practice Act — scope of practice, accountability)
• NLE safety-critical topics (TPN rules, refeeding recognition, enteral tube verification)
• Philippine healthcare context (resource availability, bariatric surgery access, GI nursing scope)

Relationship To Central

Regulatory and ethical context for nutritional care delivery in the Philippines

To

Obesity Management

From

Nutritional Assessment

Strength

strong

Relationship

Assessment identifies elevated BMI and body composition; assessment findings guide obesity intervention strategy

To

Malnutrition & Refeeding Syndrome

From

Nutritional Assessment

Strength

strong

Relationship

Assessment detects low albumin, prealbumin, weight loss; triggers malnutrition diagnosis and refeeding risk evaluation

To

Enteral Nutrition (Tube Feeding)

From

Malnutrition & Refeeding Syndrome

Strength

strong

Relationship

Refeeding precautions apply when starting enteral feeding in malnourished patients; slow advancement prevents complications

To

Total Parenteral Nutrition (TPN)

From

Malnutrition & Refeeding Syndrome

Strength

strong

Relationship

TPN is used for severe malnutrition when GI tract cannot be used; refeeding electrolyte monitoring applies to TPN also

To

Total Parenteral Nutrition (TPN)

From

Enteral Nutrition (Tube Feeding)

Strength

strong

Relationship

Enteral feeding is preferred first-line when GI works; TPN reserved for when enteral route is not feasible (gut non-functional)

To

Bariatric Surgery Nursing

From

Obesity Management

Strength

strong

Relationship

Bariatric surgery is offered for severe obesity when conservative measures fail; represents final rung of obesity management ladder

To

Malnutrition & Refeeding Syndrome

From

Bariatric Surgery Nursing

Strength

moderate

Relationship

Post-bariatric patients require lifelong micronutrient supplementation; malabsorption is expected and must be managed long-term

To

Nutritional Assessment

From

Enteral Nutrition (Tube Feeding)

Strength

moderate

Relationship

Ongoing assessment (weight, tolerance, labs) monitors enteral feeding effectiveness and guides adjustments

To

Nutritional Assessment

From

Total Parenteral Nutrition (TPN)

Strength

moderate

Relationship

Daily monitoring of weight, glucose, electrolytes, liver function during TPN assesses nutritional and metabolic response

To

Obesity Management

From

Professional & Legal Framework

Strength

moderate

Relationship

RA 9173 defines scope of nursing practice; nurses deliver obesity education and comorbidity management within legal scope

To

Enteral Nutrition (Tube Feeding)

From

Professional & Legal Framework

Strength

strong

Relationship

RA 9173 and NLE standards specify nursing accountability for tube placement verification and aspiration prevention

To

Total Parenteral Nutrition (TPN)

From

Professional & Legal Framework

Strength

strong

Relationship

NLE safety-critical TPN rules (central line, pump, never abrupt cessation, glucose monitoring) are core competency areas for Philippine nurses

To

Enteral Nutrition (Tube Feeding)

From

Refeeding Syndrome

Strength

strong

Relationship

When starting enteral feeding in malnourished patient: start low rate, advance slowly, monitor PO4/K/Mg daily, give thiamine

To

Total Parenteral Nutrition (TPN)

From

Refeeding Syndrome

Strength

strong

Relationship

Same refeeding precautions apply: slow infusion rate initiation, thiamine supplementation, daily electrolyte monitoring and replacement

To

Nutritional Assessment

From

Obesity Management

Strength

moderate

Relationship

Ongoing assessment (weight, comorbidities, labs) monitors obesity management effectiveness; guides pharmacotherapy or surgical decisions

To

Enteral Nutrition (Tube Feeding)

From

Bariatric Surgery Nursing

Strength

moderate

Relationship

Post-bariatric feeding protocol is a modified form of enteral feeding (small frequent meals advancing per tolerance, similar safety principles)