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NU 340 > Ch. 52 > Flashcards

Ch. 52 Flashcards

1
Q

optimal nutrition

A
  • obtained from a varied diet (veggies, fruits, dairy, grains, protein, liquids)
  • desired amounts should be balanced (3 meals a day)
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2
Q

undernutrition

A

less than desired amounts of nutrients

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3
Q

what does undernutrition limit?

A

work capacity
immune system
mental activity

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4
Q

malnutrition

A

deficiencies, excesses, or imbalances in a person’s intake of nutrients
- includes undernutrition and obesity (both experience malnutrition but in different ways

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5
Q

overnutrition

A

excess nutrient and energy intake over time
excessive amounts of nutrient supplements over time
produces harmful gross body weight

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6
Q

protein-calorie/energy undernutrition: 3 forms

A

marasmus
kwashiorkor
starvation

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7
Q

marasmus calorie malnutrition

A

calorie malnutrition in which body fat and protein are wasted and serum proteins are often reserved
- not enough calories, protein, or fats
- low energy level

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8
Q

kwashiorkor

A

lack of protein quantity in presence of adequate calories, normal body weight
- low protein, normal calories, normal energy

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9
Q

starvation

A

complete lack of nutrients, most severe type of PEU
- see bones sticking out/protruding (not typically seen in the US)

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10
Q

physical risk factors for undernutrition

A
  • chronic conditions/illnesses (COPD, emphysema, renal deficiency dialysis patients: SOB, low energy)
  • constipation
  • decreased appetite
  • dentition drugs: N/V side effects from chemo
  • dry mouth (side effect of medications)
  • FTT: (patient must have 3/5 sx: unintentional weight loss, fatigue, weakness, low physical activity level, pain(?))
  • impaired eyesight/teeth
  • pain- acute or persistent
  • weight loss
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11
Q

psychosocial risk factors for undernutrition

A
  • inability to prepare meals due to functional decline, fatigue, memory
  • depression
  • decrease in enjoyment of meals
  • income (ability to afford food)
  • loneliness
  • transportation access
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12
Q

examples of malnutrition problems (sx)

A
  • poor wound healing
  • dry, flaking skin and dermatitis
  • lethargy
  • cachexia
  • weakness
  • decreased muscle mass and cardiac output
  • weight loss
  • protein catabolism exceeds protein intake and synthesis
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13
Q

laboratory assessment of nutrition

A
  • hemoglobin
  • hematocrit
  • serum albumin, thyroxine-binding pre-albumin
  • transferrin
  • cholesterol
  • total lymphocyte count

(undernutrition: all values will be lower)

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14
Q

planning and implementation: how to improve nutrition

A
  • meal management: who cooks/shops, #meals/day
  • nutrition supplements: ensure shakes
  • drug therapy: multi-vitamins, drugs that stimulate appetite
  • total enteral nutrition (TEN)
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15
Q

drug therapy to improve nutrition

A

drugs to stimulate appetite
- periactin
- megace

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16
Q

total enteral nutrition is for patients who

A
  • can eat but cannot maintain adequate nutrition by oral intake of food alone
  • have permanent neuromuscular impairment and cannot swallow
  • patients who do not have neuromuscular impairment but are critically ill and cannot eat because of their condition
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17
Q

total enteral nutrition can be administered through

A
  • a nasoenteric tube (short term: <4 weeks)
  • enterostomal feeding tubes (long term: months-years)
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18
Q

nasoenteric tubes examples

A
  • nasogastric tubes (NG)
  • nasoduodenal tube (NDT)
  • nasojejunal tube (NJT)
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19
Q

enterostomal feeding tubes examples

A

a gastrostomy is performed to place either
- percutaneous endoscopic gastrostomy (PEG)
- dual-access gastrostomy-jejunostomy (PEG/J)

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20
Q

types of tube feedings

A

bolus feeding
continuous feeding
cyclic feeding

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21
Q

bolus feeding

A
  • intermittent feedings at set intervals, ie. 1 can (240mL) over 4 hours
  • only attached to pump during feedings
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22
Q

continuous feeding

A
  • going 24/7, never stopped
  • patient is hooked up to feeding- pump goes with them wherever they go
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23
Q

cyclic feeding

A
  • stop it for a specific amount of time per order, ie stop from 6 AM- 12PM.
  • only attached to pump during feedings
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24
Q

what is the priority for TEN?

A

patient safety

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25
Q

what is the most common problem with TEN?

A

clogged tube
- prevent with flushes: sterile water flush before and esp after giving a med

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26
Q

complications of TEN

A
  • clogged tube* (#1)
  • refeeding syndrome
  • tube misplacement, dislodgement (only secured with tiny piece of tape)
  • abdominal distention with N/V
  • fluid and electrolyte imbalance with diarrhea: fluid overload- new crackles, peripheral edema; daily electrolyte and glucose levels ordered by provider
  • aspiration risk: never put patient supine- HOB elevated at least 30°; shut tube feedings off if patient has to be in a supine position for prolonged time
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27
Q

parenteral nutrition types

A

peripheral parenteral nutrition (PPN)
total parenteral nutrition (TPN)

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28
Q

peripheral parenteral nutrition (PPN)

A

like TPN, but that can go through peripheral line instead of central

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29
Q

total parental nutrition (TPN)

A

does not use GI tract, uses IV route through a central line such as a PICC
- goes through vein in the arm
- osmolarity 1400 (normal is 300- this is why we do central vein insert)

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30
Q

nasogastric tubes (NG)

A
  • can be used for drainage (ie post-op)
  • can be used to infuse tube feedings (ie TEN)
  • inserted into nose to esophagus to stomach
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31
Q

nasoduodenal tube (NDT) & nasojejunal tube

A
  • nose, esophagus, small intestine
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32
Q

percutaneous endoscopic gastrostomy (PEG) tube

A
  • inserted surgically into the abdomen
  • feeding bag and pump connected to PEG tube
  • patients can go home with PEG tubes
  • could be in for months-years
  • make sure it does not clog
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33
Q

complications of parenteral nutrition

A
  • fluid imbalances: fluid volume overload/excess
  • electrolyte imbalances
  • infection at IV insertion site
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34
Q

what percentage of adults are overweight?

A

71.6% of adults ages 20-74 are overweight
- 40% of those people are obese

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35
Q

what percentage of children/adolescents are overweight?

A

center for health statistics states 18.5% of children and adolescents age 2-19 years are obese

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36
Q

obesity: pathophysiology

A
  • dysregulation of adipokines (from adipose tissue)
  • overweight- BMI 25-29.9
  • obesity- BMI of 30+
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37
Q

class I obesity

A

BMI of 30 to <35

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38
Q

class II obesity

A

BMI of 35 to <40

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39
Q

class III obesity

A

BMI of 40 or higher
- sometimes called extreme or severe obesity

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40
Q

obesity: etiology

A
  • environmental factors: home life: soda, cake
  • genetic factors/family
  • behavioral factors: anxious, depressed
  • diet: consuming high-fat, high-cholesterol diets
  • physical inactivity: working in office or remote; technology, cars
  • drug therapy
41
Q

overweight definition

A

increase in body weight for height compared with standard, or up to 10% greater than ideal body weight

42
Q

obesity defintion

A

excess amount of body fat when compared with lean body mass, at least 20% above upper limit of normal range for ideal body weight

43
Q

morbid obesity

A

severe negative effect on health, usually more than 100% above ideal body weight

44
Q

complications of obesity

A
  • HTN
  • hyperlipidemia
  • CAD: risk for MI
  • neuro: stroke
  • peripheral artery disease
  • metabolic syndrome (hyperlipidemia, HTN)
  • obstructive sleep apnea
  • obesity hypoventilation syndrome
  • depression/mental health issues
  • urinary incontinence
  • cholelithiasis
  • gout
  • chronic back pain
  • decreased wound healing
  • early ostoearthritis
45
Q

obesity assessment: history

A
  • appetite (what do you normally eat in a day)
  • attitude towards food
  • presence of any chronic diseases
  • drugs taken (prescribed and OTC, including herbals)
  • physical activity/ functional ability: walk, ride bike, joint pain
  • family history of obesity
  • what forms of weight loss have been tried in the past, results: weight watchers, did it work
46
Q

obesity physical assessment

A
  • height, weight, BMI
  • waist, arm, calf circumference
  • waist-to-hip ratio
  • skin folds for reddened or open areas (abdominal or under breasts)
47
Q

obesity psychosocial assessment

A
  • emotional factors: anxiety, depression
  • perception of weight, weight reduction, health benefits, lifestyle changes
  • support system
48
Q

weight gain causes stress on vitals organs due to ___

A

weight gain, which stress vital organs, due to excessive intake of calories

49
Q

nonsurgical management of obesity

A
  • diet programs
  • nutrition therapy
  • exercise program
  • drug therapy
  • behavioral management
  • complementary and alternative therapies
50
Q

drug therapy for obesity management

A
  • liraglutide: injection diabetic med; can be used for weight loss
  • semaglutide: injection diabetic med; can be used for weight loss
  • orlistat: works by patient has more bowel movements
  • naltrexone- bupropion: weight loss side effect
  • phentermine-topiramate: seizure med; can be used for weight loss
51
Q

complementary and alternative therapies for obesity management

A
  • acupuncture
  • acupressure
  • ayurvedic therapy hypnosis
52
Q

surgical management of obesity

A
  • liposuction
  • bariatrics
53
Q

liposuction

A

sucks the adipose tissue
- patient lost weight and now has flabs of skin, this would be done to suck out some of the “flabs”

54
Q

bariatrics

A

branch of medicine that manages obesity and its related diseases:
- gastric restrictive,
- malabsorption,
- both

55
Q

preoperative care for obesity surgery

A
  • thorough psychologic assessment and testing required
  • assessment of support systems and coping skills
  • role of nurse: reinforce health teaching about lifelong changes after surgery
56
Q

operative procedures for obesity: gastric restriction

A

allows for normal digestion without risk for nutrition deficiencies, both types decrease capacity/size for food

57
Q

operative procedures for obesity: malabsorption surgeries

A
  • gastric bypass
  • roux-en-Y
58
Q

postoperative care for obesity surgery

A

think all body systems
- airway management
- pain management
- patient and staff safety
- care of NG tube
- assess for anastomotic leaks

59
Q

special considerations after bariatric surgery

A
  • abdominal binder
  • position
  • monitor SaO2
  • sequential compression hose and/or heparin
  • assess skin
  • absorbent padding
  • remove urinary catheter within 24 hours
  • assist patient OOB
  • ambulation asap
  • monitor for abdominal girth
  • 6 small feedings and prevent dehydration
  • observe for signs of dumping syndrome
60
Q

dumping syndrome

A

happens within 30 minutes of eating a meal
- eating and rapidly going through system
- nausea, vomiting, diarrhea, tachycardia

  • treatment: want to prevent: 6 small feedings instead of 3
61
Q

what kind of diet helps the body function better?

A

a well-balanced diet

62
Q

nutrition is influenced by

A
  • personal preference
  • age
  • weight
  • gender
  • height
  • demographics
  • cultural norms
  • finances
63
Q

the focus of nutrition is on

A

health promotion and disease prevention

64
Q

nutrition standards for health promotion and maintenance

A
  • dietary guidelines for americans
  • USDA myplate
  • cultural awareness
  • geriatric considerations
65
Q

surveys of the changing food environment indicate:

A
  • fast food restaurants are offering low-fat, health-conscious alternatives
  • chain restaurants are developing new healthier menu items
  • shoppers are using/reading FDA’s nutrition labeling
66
Q

nutrition support settings

A

vary
- can be inpatient or outpatient
- health care team- nurse, registered dietician, and physician
- goal: to provide a balanced nutrition plan that the patient will agree and adhere to follow

67
Q

nutrition care process model

A
  1. nutrition assessment
  2. nutrition diagnosis
  3. nutrition intervention
  4. nutrition monitoring and evaluation
68
Q

nutrition assessment

A
  • initial nutritional screening
  • anthropometric measurements: ht, wt, BMI
  • waist circumference, skin-fold measurements
69
Q

anthropometric measurements: weight

A
  • weigh patients at consistent times
  • weigh patients without shoes in light indoor clothing
  • ask about recent weight loss or gain
70
Q

anthropometric measurements: height

A
  • use fixed stick on wall or moveable measuring rod on platform clinic scale
71
Q

anthropometric measurements: BMI

A

calculate based on height and weight

72
Q

nutritional assessment: biochemical tests

A

serum and urine
- Serum Bun and electrolytes- evaluate renal function
- CBC: evaluates anemia
- Plasma proteins: Serum albumin and prealbumin-indicate protein status
- Protein metabolism
- Basic 24-hour urine tests
- Elevated levels may indicate excess breakdown of body tissue
- Total lymphocyte count-evaluates immune function

73
Q

nutritional assessment: skeletal system integrity

A

status of bone integrity and possible osteoporosis

74
Q

nutritional assessment: GI function

A

tests and procedures used to detect peptic ulcer disease

75
Q

nutritional diagnosis involves

A

involves identification and labeling of nutrition problem

76
Q

nutrition interventions

A
  • food and nutrient delivery
  • nutrition education and counseling
77
Q

nutrition evaluation (at end of nursing process)

A

did interventions work?

78
Q

nutrition assessment: history

A

usual daily food intake
food preferences
food allergies
eating behaviors
change in appetite
weight changes
activity level

79
Q

nutrition assessment: physical assessment

A

head to toe process
- hair, eyes, mouth, tongue
- skin
- feet

80
Q

psychosocial assessment of nutrition includes

A
  • economic status
  • occupation
  • education level
  • gender orientation
  • ethnicity/race
  • living and cooking arrangements
  • mental status
81
Q

BMI is calculated based on

A

height and weight

82
Q

BMI: underweight

A

< 18.5

83
Q

BMI: normal/healthy

A

18.5-24.9

84
Q

complications of undernutrition

A
  • weight loss
  • impaired protein synthesis (cells aren’t making protein)
  • decreased muscle mass, weakness
  • decreased cardiac output
  • lethargy
  • dry flaking skin and dermatitis
  • poor wound healing
85
Q

total enteral nutrition

A

uses GI tract through oral or tube feedings
- goes through nose to stomach

86
Q

how to confirm placement of nasoenteric tubes

A

chest x-ray to confirm in the stomach
- do NOT want in the lungs (aspiration)

87
Q

feedings for nasoenteric tubes (TEN) are determined by and stored where?

A

determined by dietician: calculate type of tube, how many mL/hr and goal, ie start jevity at 15mL/hr with goal of 60mL/hr
- kept in the kitchen
- provider orders

88
Q

how and when to flush nasoenteric tubes

A
  • before and after every medication
  • can use sterile water at room temp or tap water to flush
  • flush on regular basis over a 24 hour period
89
Q

how and why to check residual in nasoenteric tubes

A
  • want to see if patient is absorbing whatever they are receiving
  • should be a standing order of when to check, call HCP if greater than ___mL (determined by HCP)
  • examples: 5mL-10mL is normal residual; 200-300mL is abnormal
90
Q

refeeding syndrome

A
  • life threatening complication r/t fluid and electrolyte shifts during refeeding process in severely malnourished patients
  • not common
  • s/sx of fluid overload: crackles, SOB, peripheral edema
  • labs: hypokalemia, hypophosphatemia
  • treatment: stop tube feedings, call HCP, replace electrolytes
91
Q

TPN preparation/order/pump type

A
  • pharmacy mixes up, physician orders- considered a medication
  • will need to do 3 checks
  • attached to regular IV pump
  • goes through PICC, implanted port, tunneled lumen, triple lumen catheter, etc.
92
Q

how often change bag and tubing for TPN and TEN?

A

change the bag and tubing every 24 hours
- for bacteria build up purposes

93
Q

care of patient with TPN

A
  • monitoring central line insertion complications: infection, redness, drainage, swelling
  • change bag and tubing q24hr
  • daily labs: glucose, electrolytes, BUN, creatinine
  • daily weights: gaining weight
94
Q

what happens if TPN bag runs out?

A

should have standing order of 5% dextrose, 10% dextrose until you get new bag of nutrition
- worried about hypoglycemia

95
Q

malabsorption surgery: roux-en-Y gastric bypass

A

more invasive surgery where stomach, duodenum, and part of the jejunum are bypassed affecting absorption of nutrient

96
Q

postoperative complications with bariatric surgery

A

CV/resp:
- airway management
- bed position: semi fowlers
- monitor resp rate and O2 sat
- clots: sequential compression stockings and anticoagulants

97
Q

GI care post-op with bariatric surgery

A
  • abdominal binder
  • monitor and record abdominal girth
  • care of NG tube
  • assess for anastomotic leaks- common
  • 6 small feedings, progression of diet, encourage fluids to prevent dehydration, vitamins/mineral supplements (multivitamins every day, zinc/iron possible)
  • observe for signs of dumping syndrome
98
Q

post-op care of bariatric surgery

A

GU: remove catheter within 24 hours
Skin: assess skin and folds, use absorbent padding
MS: assist patient out of bed

99
Q

discharge teaching after bariatric surgery

A
  • nutrition (think smaller stomach- eat less bc less room; healthier meals- dietician rec)
  • drug therapy: vitamins (multivitamin)
  • wound care
  • activity level: normal activity without impact on incision
  • s/sx to report: s/ of infection, N/V, diarrhea, fever
  • follow-up care: bariatrics, physicians, support groups

NU 340 (26 decks)

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