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nutrition > chapter 21 > Flashcards

chapter 21 Flashcards

1
Q

hypermetaboic stress after physical stress

A

increased energy outpit

catabolksm occurs, causing rapi breakfdown of energy reserves to provide glucsoe and other substances neecessaryt for anoblic phase of wound healing and tissue maintenance

proteins, fat, and mienrals are lost n catablic phase just when tehre is an icnreased need for htem to rebuild tissue

condition includes hemorrahge and vomiting

sufficient nurients, fluids, and cal are required asap to repalce losses, build and repair tissue, and return the body to homesostasis

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2
Q

protein-energy malnutrition

A

problem among hospitalized clients esp eldery
delays wound healing, contributes to eanemia, depresses immune system, increases susceptibility oto ifnection
sypmtosm includew t loss and dry, pale skin

if malnutrition occurs as a result of hsotialization, iatrogenic malnutrtion

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3
Q

extra protein needed for what after sugery

A

wound healing
tissue building
blood regeratione

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4
Q

extra carb needed for what after sugery

A

convereted to gycogen and stored to help provide energy after surgery when clients amy be unable to eat normally

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5
Q

B vitamins needed for what after sugery

A

increased metabolism

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6
Q

vitmina A and C and zinc needed for what after sugery

A

wound healing

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7
Q

vitmain D needed for what after sugery

A

absorption of calcium

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8
Q

vitamin K needed for what after sugery

A

proper clotting of blood

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9
Q

iron needed for what after sugery

A

blood building

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10
Q

calcium phoosphorous needed for what after sugery

A

for bones

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11
Q

other minerals needed for what after sugery

A

acid-base, electroyte, and fluid balance

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12
Q

why NPO before sirgery

A

ensures stomach contain no food which could be regurigiated and the naspiratired into lungs

if GI, low-residue for a ew days before surgery

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13
Q

what is postsurgical diet

A

24 hours immediatley after - IV solutions (water, 5-10% dextroe, elecytoytes, vitamins, and medication, max cal is 400-500 cal)
- estimated requirement is 35-45 cal per kg
- protein requirement range from 1.5-2 g/kg body weight
- ice chips when peristalsis returns then clear-liquid diet

avg client can take food within one to four days after surgery

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14
Q

dumping syndrome

A

after gastric surgery
1503- min after eating

characterized by dizziness, weakness, cramps, vomiting, and diarrhea

food moving too quickly from stomach into small intestine

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15
Q

how to prevent dumping syndrome

A

smaller more frequent meals sould be eaten and sugary drinks, sweets, and dried fruits should be avoided

fluids should be limited to 4 oz at meals or restricted completely s has not to fill up stomach w fluids instead of nutrients

fluids can taken 30 min after meals

some clinets dont tolerate milk well after gastric surgery

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16
Q

eneteral nutrtion

A

forms of feeding that brings nutrition directly into digestive tract

eetarla feedings prefered over parenteral nutrition bc there ar many physiolgic benefits of keeping gut functioning such as improved immune status

tube feedings may be necessary bc unconsciousness, surgery, stroke, severe malnutrition, or extensive burns

usually not onger than 6 weeks - NG tube
longer than 4-6 weeks then esophostomy, gastrostomy, or jejunostomy

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17
Q

percutanesu endoscopic gaststomy tube (PEG)

A

placed at somtach if patient is not at risk for aspiration

esophagostomy tube might be placed at side of neck at level of cervical spine after head and neck surgery

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18
Q

percutaneosu endoscopic jejunostomy (JPEG)

A

wegithed feeding tube (from PEG insertion) passed into duodenum

indicated for pt who cant tolerate gastric feedings due to a history of reflux or aspiration or those who may gastric obstruction or function problems of stomach

sometimes there is direct tube placement at the jejunum

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19
Q

polymeric formulas

A

clients who are able to digest and absorb nutrients

(1-2 cal/ mL)

contains intact proteins, carbs, and fats

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20
Q

elemental or hydrolyzed formulas (1 cal/mL)

A

limited ability to digest or absorb nutrients

contains products of digestion of protein, carb, and fats, and lactose free

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21
Q

modular formulas

A

3.8-4 cal/mL
supplements to other formulas or for developing customized formulas for certian clients (such as those w extensive wound-healing needs)

use of modular ofrmuals have been decreasing due to development of high-rpteoin formulas

disease-specific formuals have been developed to be used in cute setting and for a short period (for renal failure, respiratory, fair, or liver failure)

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22
Q

methods for administering tube feedings

A

continuos
intermittent 0 administer tube feeding at night w solid foods eaten during day (if food-drug interaction such as w phenytoin (Dilantin), TF should be stopepd 1 hour beofre and restarted 1 hour after adm of med via tube)
bolus - daily cal divided to 6 servings per day (400cc at time), 15 min span and folllowed by 25-60 mL of water, usually w PEG tube but could be done w NG tube

23
Q

how are feedigns adminstered

A

continuous during a 16-to-24 hour period

start slowly such as 20-25 mL per hour

may be increased by 10-25 mL every 4 hours until toerlance

24
Q

signs of interolance w feeding

A

abdominal distetntion, or if client is verbal, verbalization of issues w cramping or nausea, diarrhea, delayed GI motility

tube fedings dont ned to be held until residuals reach 500 mL then gradual return to roal feedings

25
Q

osmolality of liquid

A

number of particles per kg of solution

higher osmolality = more pressure and attract water from fluids w lower osmolality

26
Q

osmolality and food

A

when formula w high osmolaity reaches intestines body may draw fluid from blood to dilute th formula whic hcan cause weakness and diaarrhea

liquid med containing sorbitol or C. diff. can cause diarrhea

27
Q

aspiration w enteral nutritio n

A

formula eneters lung = pneumonia

tube becomes clugged or client may pull out tube

admiinstier flush solution and raise head of bed before begining tube foding

28
Q

parenteral nutritio n

A

provision of nutrients IV

used if GI tact isnt functional or if normal feeding isnt adequate

used alone or part of dietary plan that includes oral or tube feeding

used to provide nutrition w/o GI tract = total parenteral nutrition (TPN) or hyperalimentation - combo of dextroe, amino acids, and lipids, electroyltes, and trace elements

administedred via central vein or peripheral vein (if less than 2 weeks)

solution for TPN combined just before entry to vein

29
Q

how to administer TPN for extended time

A

central vein; Cather into subclavian or superior vena cava

vena cava bc high blood flow = quick dilution of highly concentrated TPN which reduced possiblity of phlebitis and thrombosis

30
Q

how to wean off parenteral nurition

A

gradual transfer toroal diet

given tube feeding before roal feeding

daily oral fluid and cal goal must be close to being met before weaning

parenteral nutriton infusion volume may be decreased on a daily basis or there may be reduction in number of day of week the nifsuio takes place

assessment is done via oral intake, stool, urine output analysis

31
Q

sepsis

A

infection occur at site of catherter and enter bloodstream

infection of the blood

bacterial or fungal infection can develop in solution if its unrefrigerated for over 24 hours

abn elecytrolye levels may develop as can phlebitis or blood clots

32
Q

what do serious burns cause loss of

A

enermuous loss of fluids, elecyroyles, and proteins from loss of skin surface

water moves from other tissues to burn site in an efort to compensate for the loss which compoinds issue
- reduce blood volume and thus bp and urine outpit

33
Q

how to treat after burns

A

fluids and elecyrolytes are replaced by IV

not glucose included in these fluids for first 2-3 days after burn to avoid hyperglycemia

hypermetabolic state after serious burn contiues until skin is largely healed so enormous increase in energy needed to heal

34
Q

chldren encessary protein after burn

A

2.5-3g/ kg

35
Q

provide ___% of nonprotien cal fro fat after burns

A

12-15

36
Q

extra nutrient after burns

A

high protein
high cal
increaed need for vitamin C, zinc, b, vitamin A
amin acodsi arginine and glutaine (immune functioning and would healing)
arginine - wond healing by aiding in collagen formation and intrenge retention
glutamine - help prevent baceterial infection, improve immune function, and preserve gut integrity

sufficient to help kidneys

37
Q

feeding after burns

A

oral feedings if possible

liquid commerical feedings at first
solid foods during second week after burn

tube feedings immediatley if client is unable to eat

parenteral feeding in some cases

38
Q

infection and food

A

fever is hypermetablic state in which h eage degree of fever on fahrentheit scale raises BMR by 7%

extra cal are not provided during fever, the body first uses supply of glycogen then its stored fat and the nmuscle tissue

protein intake should be increased bc sepsis and need to replace body tissues and produce antibodies

minerals are needed to help build and repair body tissue and maintain acid-base, elecytoylte and fluid balance

extra cal for icnreased metablic rate and to fight infection causing fever

extra fluid to replace that lost thorugh perspiration, vomiting, or diarrhea which often accompany infection

39
Q

appetiet for clients w fever

A

v poor appetites

will often accept ice water, fruit juice, and carbonated beverages

broth, jello, popsicles

progress from liquid to regular diet w freuent, small meals

high in protein, cal and vitamins

40
Q

antibiotics during fever

A

high dose of antiiotics can lead to oral thrust

thrush = decreased appetite due to pain on tingue during eating (treatment is not needed,clients can take acidophilus capsules or eat uogourt containing acidophilus to speed recovery)

41
Q

HIV

A

invades t cels

t cells cant function normally = body has no resistance to opprtountistic infections (caused by organisms that are rpresent but dont affect ppl w healthy immune systems(

ultimetale leads to AIDS

transmitted via bodily fludis

42
Q

symptoms as HIV progresses

A

fatigue
skin rashes
headache
night sweats
diarrhea
wt loss
oral lesions
cough
fevers

increase metabli.c rate and nutrient and calorie needs and decrease appetite and bodysability t oabsorb nutrients

oral infection = change in taste and dysphagia

fever, pain and depression depress appetite

dysphagia and dementia also contribute to anorexia

43
Q

HIV wasting syndrome

A

serious protein -energy malnutrition (PEM)
body wasting
hypoalbuminemia and wt loss

44
Q

causesof nutrient loss in AIDS clients

A

anorexia
cancer
dairrhea
increased metablism due to fever
certain meds
malabsorption caused by cancer or diarrhea
protein-energy malnutriotn

45
Q

methods to imrpove appetite of aids client

A

med after meals
soft foods
avoid spicy, acidic, and extremely hot or cold foods
serve frequent, small meals
add sugar, and flavorings to liquid supplements
take advantage of good days and offer any food client tolerates
talk w client to help ease concerns about fiancnes, family and riends

46
Q

what might dietitian do if decrease intake of food

A

inform client about nutritional needs
offer supplement or other foods

invite friends and relatives to bring some of favorite foods

47
Q

feeding blind client

A

appeitizing descirption of meal to create desire to eat

help w self feeding by arranging good as if plate were face of clock

48
Q

pressure ulcers

A

areas where unreleived pressure on skin prevents blood from brining nutrients and oxyen and removing waste

healing requires treatment of ulcer relief ofpressure, high-cal diet w sufficient protein, and itamin C and zinc

49
Q

cause of constipation

A

inadequate fiber, fluid, or execise
mediciation
reduced peristalisis
former abuse of laxatives

50
Q

caue of diarrhea

A

digestive disorders
meidcation
viruses
bacteria
other sources

cause reduced absoroptj of nurtietns and can contribute to dehtdration

51
Q

sense of smell and appatiet

A

decliens w age

52
Q

reduction sense of taste

A

caused by medication
disease
merinal deficiencies
xerostomia (drymouth) - caused by disease or med

addition of spices, herbs, salt, and sugar can help

drinking water, eating requent small meals, sugar-free gum or hard candies

inadequate amt of saliva can cause tooth decay

53
Q

dysphagia

A

difficulty in swallowing

caused by stroke, closed head trauma, head or neck cancer, surgery or alzheimers

tgickened liquids

always in upright poition w chin tuckedtoward their chest when eating to prevent aspiration

cut food into small pieces `

54
Q
A

nutrition (21 decks)

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