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Nursing 2016 > Adult Health- Care of Patients with Malnutrition Chapter 60 > Flashcards

Adult Health- Care of Patients with Malnutrition Chapter 60 Flashcards

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1
Q

What does proper nutrition do?

A

regulates body temperature, respirations, cardiac output, muscle function, metabolism

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2
Q

What is energy balance?

A

relationship between energy used and energy stored

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3
Q

Which population is at risk for malnutrition?

A

: older adults (60 and up) due to hormonal changes feel les hungry. At risk for malnutrition

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4
Q

What are the dietary guidelines for Americans?

A

The 2010 Dietary Guidelines was designed to help people choose a healthy diet. It emphasizes 3 major goals for Americans:
Balance calories with physical activity to manage weight
Consume more of certain foods and nutrients such as fruits, vegetables, whole grains, fat-free and low-fat dairy products, and seafood
Consume fewer foods with sodium (salt), saturated fats, trans fats, cholesterol, added sugars, and refined grains

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5
Q

What are the top 3 vegetarian diets?

A

lacto-vegetarians, lacto-ovo, vegan

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6
Q

What are Lacto-vegetarians?

A

consume milk and milk products

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7
Q

What are lacto-ovo?

A

includes milk and eggs

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8
Q

what is vegan?

A

only plant origin food.

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9
Q

Vegetarians are at risk for developing _______ anemia?

A

B12

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10
Q

Must ensure that vegetarians consume adequate amounts of what?

A

Ca, Iron, Zinc, Vitamin D & B12

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11
Q

What is nutritional status?

A

reflects the balance between nutrient intake and requirements- Affected by age, gender, disease, economic factors, eating behaviors cultural influence and emotional balance

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12
Q

JCT requires nutritional screening on all hospitalized patients within the first ______ hours?

A

24

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13
Q

What is included in a nutritional screening?

A 
Review of nutrition history
Food and fluid intake
Labs
Food-drug interactions
Anthropometric measures ( Height, Weight, BMI)
Psychosocial assessment 
BMI= Weight in Kg/ height in m2
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14
Q

What is marasmus?

A

fat and protein are wasted (serum protein OK)

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15
Q

What is Kawashiorkor?

A

low protein quantity and quality (serum protein Low)

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16
Q

What are the 3 protein energy malnutrition things?

A

Marasmus, Kawashiorkor and a combo of both—- all of these negatively affect the functions of the liver, heart, lungs, and the GI tract

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17
Q

What are the common complications of malnutrition?

A 
Muscle wasting,
Low activity tolerance
Lethargy
Cold intolerance
Edema
Dry flaky skin
Poor wound healing
Infections
18
Q

2 disease contributing to malnutrition are?

A

anorexia and bulimia

19
Q

Describe a malnutrition assessment,

A 
Ask about appetite and any weight changes
Hair ( hair loss)
Skin ( dry, flaky, slow healing wounds
Nails (brittle, discolored)
Eyes
Oral cavity
Assess difficulty swallowing (pain with chewing)
Neurologic status
20
Q

What are some labs that would go along with a malnutrition assessment?

A

Low H&H (anemias, hemorrhage, liver issues)
Thyroxine binding prealbumin (nutritional deficiency)
Cholesterol less then 160
Total lymphocyte count (TLC) low
Immune function measurement

21
Q

What are some nursing interventions for malnourishment?

A

-Collaborative effort to improve nutritional status
-High calorie high protein food
-6 small meals per day
-Nutritional supplements
-Special supplements for diabetics, kidney and liver patients
Multivitamins
-Iron-constipation
-Zinc- nausea and vomiting
Can also incorperate bolus, continuous and cyclic feedings

22
Q

What are specialized nutrition support?

A

TEN or TPN

23
Q

What is listed under TEN?

A

Nasogastric tube
Nasoduodenal tube
PEG tube
PEG/J tube

24
Q

What are some TEN complications?

A

Obstructed tube, refeeding, tube displacement, abdominal distension, fluid and electrolyte imbalance

25
Q

What do you do if you have an obstructed tube?

A

Flush the tube with 20-30 ml H2O q4 hours, before and after each feeding & drug administration
If clogged use 30 ml H2O and flush

26
Q

What is refeeding?

A

Due to aggressive re-nourishment

Start slow

27
Q

What do you do with tube displacement and what can happen?

A 
Can cause aspiration
Fever, tachycardia, dehydration, low output 
Listen to lungs q 4-8 hours
Pull the tube out
X-ray to confirm placement
28
Q

What do you do if you have abdominal distension and what usually causes it?

A

Overfeeding
Check residual q 4-8 hours
If >200ml during 2 consecutive checks hold feedings
Problem with checking may indicate clogged tube

29
Q

What causes the fluid and electrolyte imbalance?

A

Due to comorbidities (cardiac, kidney)
Caution with osmolal ity of feeding liquid
Hyperkalemia and hypernatrimia

30
Q

Describe PPN

A

Picc line
IV fat emulsion IVFE ( isotonic)
Amino acid dextrose solution
Home care: collaborative teaching of diet and nutrition
Enteral or parenteral nutrition-home services

31
Q

Describe TPN

A 
Picc line
Infusion pump
Fluid imbalances 
Daily weights 
Serum electrolyte levels
32
Q

Describe Obesity

A

Occurs because patient does not consume enough healthy nutrients
Overweight 10% over ideal BMI
Obesity 20% over ideal BMI

33
Q

What are the risk factors for obesity?

A

Risk factors: high fat and cholesterol diet. Inactivity, medications: steroids, hormones, antihypertensive medicine

34
Q

What are some complications for obesity?

A 
Type 2 diabetes mellitus
Hypertension
Hyperlipidemia
CAD
Stroke
Peripheral artery disease
Metabolic syndrome
Depression /mental disturbances
Urinary incontinence
Cholelithiasis
Gout
Back pain (musculoskeletal degeneration)
Decreased wound healing…..
35
Q

What is included in an obesity assessment?

A 
Nutrition History
24 hour food intake
Height, Weight, BMI
Skin assessment – panniculus
Yeast infections
 Diets
36
Q

What is panniculus?

A

is a medical term describing a dense layer of fatty tissue growth, consisting of subcutaneous fat in the lower abdominal area. It can be a result of obesity and can be mistaken for a tumor or hernia.

37
Q

What are some nursing interventions for obesity?

A 
Diet programs
Short term fasting program 
Protein sparing and liquid formulas
low calorie diets 
200-800 calories
Requires medical supervision 
Nutritional education
Unbalanced low energy diets
Atkins, south beach
Restriction of one or more nutrients
Novelty diets
Grapefruit diet
Nutritionally inadequate
Nutritionally balanced diet
1200 calories (vitamins and nutrients)
Weight watchers 
Behavioral modifications
Food diary
Counseling
Exercises
Structured program
30-40 minute walk 5 days a week
Nutritional therapy
Nutritionist develops a plan based on age, gender
Lose 1-2 pounds per week
38
Q

Describe obesity drug therapy

A

Anorectic drugs- suppress appetite
Oristat
-Inhibits lipase leading to partial hydrolisis or triglicerides
-GI upset, Loose stools, cramps nausea
Lorcaserin
-Activates serotonin 2L- makes body feel full
-Headache dizziness, dry mouth, constipation
Phentermine-topiramate
-Combination of weight loss medication and seizure medication
-Tachycardia, tingling, dizziness, constipation

39
Q

Describe surgical management for obesity.

A 
BMI >35 & comorbidities
Plastic surgery
Bariatric surgery
Restrictive
Malabsorption
Combination
Preoperative 
Multi-team approach
40
Q

Describe post operative care for obesity

A 
Airway management
Pain
Semi-fowler position
Sequential devices
Skin break down
NG tubes
Diet
Clear liquids 1oz
48 hours pureed foods, soup, milk ( up to 6 weeks)
Progress to regular diet
41
Q

Describe the complications to look for after surgical management.

A 
Anastomotic leak
       -Life-threatening complication
       -Back, shoulder or abdominal pain
      -Restlessness,
      - tachycardia
       -olyguria
Ambulation
       -Q 4 hours up to 6 weeks
Dumping syndrome
        -Food goes straight into   small bowel
        -Tachycardia
        -Diarrhea
        -Cramping

Nursing 2016 (20 decks)

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