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Deficiency of intestinal lactase, the enzyme required for lactose digestion, can result in symptoms of gastrointestinal malabsorption, or lactose intolerance. The knowledge needed for accurate nursing assessment, diagnostic procedural care, teaching, and referral of affected patients is reviewed.
Mary Rudolph, age 50, experienced abdominal bloating, flatus, and diarrhea periodically for approximately 20 years, especially after eating ice cream or drinking milk. She initially attributed these symptoms to a "delicate" gastrointestinal (GI) tract. However, she was frustrated by bloating, which she said made her feel as if she were "going to pop," and by unpredictable episodes of diarrhea. Elimination of ice cream and milk helped to lessen her symptoms but did not alleviate them.
Ms. Rudolph discussed her concerns with her family physician on several occasions over the years. After performing a stool culture, which was negative for pathogens, the physician told her that she had an irritable bowel and suggested use of diphenoxylate hydrochloride with atropine (Lomotil®) and an anti-gas liquid to control symptoms. Diphenoxylate helped ease the diarrhea, but could not be taken indefinitely. The antigas liquid had no demonstrable effect on her abdominal distention. Mary assumed that she would just have to live with these symptoms, while avoiding milk and ice cream to minimize their occurrence.
Due to a change in her health care insurance plan, Mary began seeing a nurse practitioner for her health care needs. The nurse assessed Mary's history of symptoms and, suspecting lactose intolerance, referred her for a hydrogen breath test. Results of the test were an exhaled hydrogen value of 35 ppm. Based on the hydrogen breath test results, a thorough physical exam, and ongoing symptoms related to dairy intake, the nurse practitioner diagnosed lactose intolerance. Ms. Rudolph received a referral to a nutritionist, who assisted her in identifying foods she could begin to limit in her diet.
Defining the Problem
Lactose intolerance is a very common chronic syndrome caused by impaired digestion of milk sugar, or lactose. Although not a serious threat to health, lactose intolerance causes discomfort, anxiety, and embarrassment for a large number of people worldwide (Gugatschka et al., 2005; Lovelace & Barr, 2005; Roberson, 2005). Individuals with the disorder often go undiagnosed and believe they must live with the sometimes lifestyle-altering effects of...