Adult Health- Care of Patients with Malnutrition Chapter 60 Flashcards
What does proper nutrition do?
regulates body temperature, respirations, cardiac output, muscle function, metabolism
What is energy balance?
relationship between energy used and energy stored
Which population is at risk for malnutrition?
: older adults (60 and up) due to hormonal changes feel les hungry. At risk for malnutrition
What are the dietary guidelines for Americans?
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
What are the top 3 vegetarian diets?
lacto-vegetarians, lacto-ovo, vegan
What are Lacto-vegetarians?
consume milk and milk products
What are lacto-ovo?
includes milk and eggs
what is vegan?
only plant origin food.
Vegetarians are at risk for developing _______ anemia?
B12
Must ensure that vegetarians consume adequate amounts of what?
Ca, Iron, Zinc, Vitamin D & B12
What is nutritional status?
reflects the balance between nutrient intake and requirements- Affected by age, gender, disease, economic factors, eating behaviors cultural influence and emotional balance
JCT requires nutritional screening on all hospitalized patients within the first ______ hours?
24
What is included in a nutritional screening?
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
What is marasmus?
fat and protein are wasted (serum protein OK)
What is Kawashiorkor?
low protein quantity and quality (serum protein Low)
What are the 3 protein energy malnutrition things?
Marasmus, Kawashiorkor and a combo of both—- all of these negatively affect the functions of the liver, heart, lungs, and the GI tract
What are the common complications of malnutrition?
Muscle wasting, Low activity tolerance Lethargy Cold intolerance Edema Dry flaky skin Poor wound healing Infections
2 disease contributing to malnutrition are?
anorexia and bulimia
Describe a malnutrition assessment,
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
What are some labs that would go along with a malnutrition assessment?
Low H&H (anemias, hemorrhage, liver issues)
Thyroxine binding prealbumin (nutritional deficiency)
Cholesterol less then 160
Total lymphocyte count (TLC) low
Immune function measurement
What are some nursing interventions for malnourishment?
-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
What are specialized nutrition support?
TEN or TPN
What is listed under TEN?
Nasogastric tube
Nasoduodenal tube
PEG tube
PEG/J tube
What are some TEN complications?
Obstructed tube, refeeding, tube displacement, abdominal distension, fluid and electrolyte imbalance
What do you do if you have an obstructed tube?
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
What is refeeding?
Due to aggressive re-nourishment
Start slow
What do you do with tube displacement and what can happen?
Can cause aspiration Fever, tachycardia, dehydration, low output Listen to lungs q 4-8 hours Pull the tube out X-ray to confirm placement
What do you do if you have abdominal distension and what usually causes it?
Overfeeding
Check residual q 4-8 hours
If >200ml during 2 consecutive checks hold feedings
Problem with checking may indicate clogged tube
What causes the fluid and electrolyte imbalance?
Due to comorbidities (cardiac, kidney)
Caution with osmolal ity of feeding liquid
Hyperkalemia and hypernatrimia
Describe PPN
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
Describe TPN
Picc line Infusion pump Fluid imbalances Daily weights Serum electrolyte levels
Describe Obesity
Occurs because patient does not consume enough healthy nutrients
Overweight 10% over ideal BMI
Obesity 20% over ideal BMI
What are the risk factors for obesity?
Risk factors: high fat and cholesterol diet. Inactivity, medications: steroids, hormones, antihypertensive medicine
What are some complications for obesity?
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…..
What is included in an obesity assessment?
Nutrition History 24 hour food intake Height, Weight, BMI Skin assessment – panniculus Yeast infections Diets
What is panniculus?
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.
What are some nursing interventions for obesity?
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
Describe obesity drug therapy
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
Describe surgical management for obesity.
BMI >35 & comorbidities Plastic surgery Bariatric surgery Restrictive Malabsorption Combination Preoperative Multi-team approach
Describe post operative care for obesity
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
Describe the complications to look for after surgical management.
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
