SN provided skilled teaching related to management of bloating and promotion of normal digestion. Baseline: patient reports intermittent bloating and fullness, states fluid intake is “a few glasses a day” and eats limited fruits, vegetables, and whole grains.

SN instructed patient on maintaining adequate hydration to support normal bowel function and reduce bloating. Patient encouraged to increase fluid intake as tolerated throughout the day, unless otherwise restricted by provider. Education provided on gradually increasing dietary fiber by adding fiber‑rich foods such as fruits, vegetables, and whole grains. SN emphasized increasing fiber slowly over several days to reduce risk of gas, cramping, and discomfort, and pairing fiber increases with adequate fluid intake.

SN reviewed monitoring for any worsening or new gastrointestinal symptoms, including increased bloating, abdominal pain, nausea, vomiting, constipation, diarrhea, or blood in stool. Patient was advised to contact the healthcare provider if bloating persists, worsens, or is accompanied by pain, nausea, vomiting, or changes in bowel habits, and to seek urgent or emergency care for severe pain, persistent vomiting, or other concerning symptoms per provider instructions.

Patient was asked to:

• State how she plans to increase daily fluid intake.
• List at least three fiber‑rich foods she can add to her diet.
• Explain why fiber should be increased gradually.
• Describe when she should call the healthcare provider about bloating.

Patient verbalized plan to drink water regularly through the day and add an extra glass with meals, and correctly identified fruits, vegetables, and whole grain bread as fiber sources. Patient stated that increasing fiber slowly “helps my stomach get used to it so I do not get more gas or cramps.” Patient correctly stated she would call the provider if bloating does not improve or is accompanied by pain, nausea, vomiting, or changes in bowel habits. Minimal cueing required.

Skilled nursing remains medically necessary to provide GI assessment, reinforce dietary and hydration education using teach‑back, monitor for changes in symptoms, and coordinate with healthcare provider regarding any ongoing or worsening gastrointestinal issues.