Chapter 30 - Nutrition Study Guide Flashcards
protein and caloric deficiency
marasmus
physical wasting
cachexia
difficulty in swallowing
dysphagia
use of energy to change simple materials into complex body substances
anabolism
inhalation of fluid or foreign matter into the lungs and bronchi
aspiration
breaking down of substances from complex to simple, resulting in a release of energy
catabolism
minimum amount of energy required to maintain bodily functions at rest while awake
basal metabolic rate
process of chemically changing nutrients, such as fats and proteins, into end products that are used to meet energy needs of the body or stored for future use
metabolism
what are the macronutrients and micronutrients
Nutrients are necessary substances obtained from ingested food that supply the body with energy; build and maintain bones, muscles and skin, and aid in the normal growth and function of each body system. Macronutrients are water, carbs, fats, and proteins. Micronutrients are vitamins and minerals
What is the difference between simple and complex carbohydrates
Simples carbs are broken down and absorbed quickly, providing a quick source of energy. Complex carbs are composed of starches, glycogen, and fiber. They take longer to break down before absorption and utilization by the body’s cells
Examples of simple and complex carbs
Simple: sugars such as those derived from fruit (fructose), table sugar (sucrose), milk products (lactose), and blood sugar (glucose). Complex: bread, rice, pasta, legumes such as dried beans, peas and lentils, starchy veggies such as corn, pumpkin, green peas and potatoes
Fats
Fats include fatty acids, cholesterol, and phospholipids. Total fat intake should be tween 25% and 35% of total caloric intake. Fat-soluble vitamins are A, D, E, K Examples of essential fatty acids include linolenic (omega-3) and linoleum (omega-6)
Examples of saturated fat
Crackers, cheese, ice-cream
What role do proteins play in your body
Proteins are necessary in the body for the development, maintenance, and repair of the body’s tissues, organs, and cells. Hemoglobin (protein) is responsible for transporting oxygen throughout the body. Prothrombin is the protein necessary for clotting blood. Other tasks include the production of hair and nails, muscles movement, nerve conduction, digestion, and defense against bacteria and viruses
Decreased water in the body is at risk for
An individual with water (fluid) deficiency is anticipated to have signs of dehydration - headache, loss of concentration dry mucous membranes, decreased BP, and decreased urinary output
Examples of foods hight in vitamin A are
carrots, pumpkin, green, leafy veggies
how can the nurse help the patient to eat healthier foods
Determining the patient’s knowledge about nutrients and food sources Having the patient examine his or her own dietary needs Teaching about reading food labels Using fresh rather than processed foods Eating smaller portions Eating fruits, veggies, whole grains, and lean meats Drinking water
The nurse instructs the patient that Vit. C is important in the body for
synthesizing protein collagen (would healing, prepare of bones), antioxidant effects, and antibody production
What is the general role of the B-complex vitamin
to form RBCs, act as coenzymes, and facilitate energy production in the body
Coffee contains a significant amount of which B Vt.?
B3 (Niacin)
The patient is on a diuretic and losing potassium. He should increase dietary intake of?
Bananas, tomatoes, and orange juice. Dietary sources of potassium include: milk, bananas, legumes, green leaf vegetables, orange juice, tomatoes, vegetable juice, avocados, and cantaloupe
Antioxidants are thought to prevent the development of what problems
heart disease, cancer, and diabetes
Vit. E can act as an antioxidant. Identify at least two food sources of this vitamin
Olives, soybeans, corn oil, nuts whole grains, legumes, and dark leafy veggies
For the child with a milk allergy or other digestive difficulty, what type of formulas will be recommended
soy based or hydrolyzed protein formula
How can individual’s culture influence nutritional intake
Food preferences
What effects occur to the musculoskeletal system from nutritional deficiency
softening of the bone due to vitamin D deficiency (osteomalacia), osteopenia, or osteoporosis, with increased bone fragility and greater risk of fractures
What effects occur to the cardiopulmonary system from nutritional deficiency
atherosclerotic heart disease (ASHD) with potential for cardia damage or heart attack
What is true regarding obesity
The prevalence of obesity in the US more than tripled amount children and adolescents from 1980-2008 A person with a BMI greater than 40 is classified as morbidly obese High BMI levels increase the risk for hypertension
Identify the primary treatment option for individuals with eating disorders
develop a sense of control and positive body image, build relationships, and improve nutritional intake
Two common ways to obtain info about a patients food intake
24 hour recall or 3-5 day journal of foods eaten amounts, an dhow the foods were prepared
A focused physical assessment for nutritional status should include
Measurement of height and weight, calculation of bed mass index, review of laboratory values, and identification of unanticipated findings (poor skin condition etc.). IN addition waist circumference, vital signs, medical history , medications, and activity level can determine risk factors
BMI interpretation 1. 61kg-1.65m 2. 72kg-1.8m 3. 95kg-1.7m
- normal weight 2. normal weight 3. obese, class 1
What indicators are associated with metabolic syndrome
Insulin resistance Abdominal fat Increased blood glucose, triglycerides, serum cholesterol Hypertension
Symptoms associated with nutritional deficit
Dry, stiff hair, Constipation, Decreased albumin level, Petechiae
How can a nurse prevent aspiration
Following orders for dietary consistencies and textures Following the manufacturer’s instructions and facility policies and procedures for sickening of liquids as ordered Elevating the head of the bed to 45 degrees or higher during eating and for a minimum of 45 minutes after eating Keeping the head of the bed elevated at 30 degrees at all other times, including during enteral feeding Encouraging slow eating patterns Instructing the patient to avoid eating or drinking for 2-3 hours before sleep Administering GI medications as orders Inspecting the patient’s mouth for pocketing of food Observing the patient for swallowing between bites of food and fluids Instructing the patient to alternate between bites of food and sips of fluids to facilitate swallowing Maintaining the patient’s status of no food or fluids by mouth following procedures in which the throat was anesthetized until a gag reflux has been verified.
The patient has an iron deficiency. What foods should the nurse recommend
Iron is found in liver dark green leafy veggies, seafood, and bran
For the Quality and Safety Education for Nurses (QSEN) competency of teamwork and collaboration, who should be included in the planning of care for a patient with an identified nutritional concern
nutritionist or registered dietitian, case manager, speech therapist (impaired swallowing), psychologist (eating disorders) and UAPs
S/S of dysphagia
coughing, incomplete lip closure, poor tongue control, excessive chewing, gagging before swallowing, failure to swallow, foods held in the cheek, or refusal to eat
For the patient who is a vegetarian, what foods whould the nurse recommend in t
When assessing the patient for dysphagia, what are the s/s and how can the nurse assist an adult with feeding
S/S; caughing, incomplete lip cosure poor tounue control, excessive chewing, gagging before swallowing, failure to swallow, foods held in cheek, or refusal to eat
Assistance: Provide oral care before and after feeding
Ensure that dentures, if worn, are in place and well fitted
Elevate teh patient’s head at least 30-45 degrees unless contraindicated
Special caution should be taken if the patient has impaired swallowing
If the patient has one sided muscle weakness, have the patient turn the head to the afected side to assist in airway protection
Chin tucking may help prevent aspiration
Follow the occupational or nutrition therapy guidlines or the manufacturers inscructions for use of any assistive devises
Position yourself so that the patient can see you
Allow at least thirty min. for reach meal. Offer small bites (1/2 to 1 tsp)
Wait at least 10 minutes between bites
Avoid unnecessary use of straws to prevent air ingestion
Observe for rise and fall of teh patients larynx to verify swallowing
Check teh pateints mouth frequently to prevent retention of food in the cheeks (pocketing)
The patient’s percuaneous endogastric (PEG) tuve becomes occluded. What actions should the nurse take to try to remove the occlusion?
Flush the PEG tube with small amount of air. If this does not work, then use 50-60 mL syringe to flush the tube with 20-30 mL of warm water, carbonated beverages, or pine apple juice (if not contraindicated)
For total parenteral nutrition (TPN) which patients may benefit from this option? What monitoring is done regularly? What complications can occur?
Patients who can benefit from total parenteral nutrition are those who do not have a functioning GI tract or are unable to ingest, digest, or absob essential nutrients due to conditions such as some stages of Crohn disease or ulcerative gastritis, GI obstruction, diarrhea unresponsive to treatment, abdominal trauma, or post operative status
Monitering should lnclude weight, CBC, electrolytes, and BUN, plasma glucose and electrolytes, I/O, and presence of complications
Complications include: site infections, air embolism, catheter related infections, and dislodgment or occlusion of tubing. Metabolic complications can range from common glucose abnormalities to adverse reactions to the lipid formula, liver dysfunction, metabolic bone disease, gallbladder dysfunction (cholelithiasis, choleocystitis), and other metabolic abnormalities
For insertion of a nasogastric tube, what position should the patient be in for the insertion? What should the nurse do if resistance is felt? How should the tuve be anchored after insertion?
The patient should be placed in high Fowler position ( or as far as the patient can tolerate up to that position)
If resistence is felt, the procedure should be stopped and the following done
Rotate the tube because this may enable easier insertion
Ensure that the patient is swallowing when the tube being inserted
Ensure proper positioning of the patient and the tube
Withdraw the tube, and reapply water soluble lubricant
Attempt insertion in the other naris
If indicated, the tube may be placed orally
Notify the PCP if the tube cannot be placed properly
To anchor the tube:
If using tape, apply a skin prep or adhesive if needed. Attach one end of the prepared pieve of tape at a time to secure the ends of teh tape on the bridge of the nose, forming a sling for the tube. Secure the tube away from the nasal mucosa
If using a tube fixation device (a winged bandage is described here), apply a skin prep or adhesive if needed; remove the backing from the bandage and place it over the bridge of the nose. Insert the tube into the clamp of the fixation device, and close the clamp
For nasogastric tube feeding
The nurse can proceed with the next feeding if the residual is less than 100 mL
Continuous feedings are usually administered with the use of a feeding pump
Gravity feedings, in addition to the formula, requre teh use of a 50-60 mL syringe and graduated container
The patient has had throat surgery and is able to have clear liquid oral intake. The nurse should offer?
orange juice
chicken noodle soup
apple juice
oatmeal
apple juice
The nurse is discussing dietary intake with a patient who is on a renal diet. The nurse informs the patient that the diet will specifically include
restriction of potassium, phosphorous, protein, and sodium
When introducing a feeding to a patient with an indwelling tube for enteral nutrition, the nurse should first
verify measured placement tape markings
A patient is having a nasogastric tube removed. The nurse should
ask the patient to take a a deep breath and hold it in
Following a surgical procedure, the patient is advanced up to a full liquid diet. The nurse is able to recommend
yogurt
A nasogastric tube is inserted in order for the patient to receive intermittent tube feedings. After radiologic verification, the next most reliable method of checking for tube placement is for the nurse to
measure the pH of aspirated secretions
inborn error of metabolism with a failure to properly metabolize amino acids
phenylketonuria
Which of the following techniques used by the new staff nurse for administering medications via an enteral tube requires correction by the charge nurse
Giving medications in their liquid form?
Adding the medications to the tube feeding
Dissolving powdered medications in sterile water
Flushin with 15-30 mL of sterile water after administration
adding medications to the tube feeding
Which waist circumference size puts a man in the high risk category for heart disease
40 inches
Healthy People 2020
Choosing nutrient rich foods helps or enutritents from ingested calories, resulting in better nutritional intake and fewer calories consumed
Providing pateitns and families with dietary information and by taking a positive approach that focuses on teh total nutritional quality of foods without overcalorie consumtpin, individuals can achieve better health
teh minimum amount of energy requied to maintain bodily functions at rest while awake
BMR
Interpreting the Language of food labels
Introduced in 1994
Consistent link between eating healthier and reading labels
Used significantly less by children, adolescents, older adults, ethnic minorities, and individuals wiht lower socioeconomic status
What is necessary for helping control body temp, maintaining acid base balance, regulating fluid and electrolytes, and transporting nutrient and waste products
water
two thrids of body’s fluid are within cells
intracellular fluids
blood components, interstitial fluid, and within structures
extracellular fluid
when wanter is lost without replacement
oxygen, nutrients, and wastes cannot be moved
antioxidents
protect body cells against the effects of free radicals
slow or prevent the oxidative (damage) process from oxygen caused by free radicals, which can lead to heart disease, cancer, diabetes, and other diseases
May help immunce function and perhaps lower risk for infection and cancer
Antioxidant food sources
Beta carotene, selenium, Vit. C, and Vit. E
loss of appetite
anorexia
a very serious disorder in which the person exhibits life threatening practices as a result of an altered mental state
anorexia nervosa
Screening of malnutrion in older adults
DETERMINE
D - disease
E - eating poorly
T - tooth loss
E - economic hardship
R - reduced social contact
M - Multiple meds
I - Involuntary weight loss
N - needs assistance in self care
E - Elderly above 89 years
the study of measurement of the human body
anthropometry
Measurements (anthropometry) must be accurate to be valid. What do you measure in infants and adults
Infants - height (or length), weight, head circumference,
Adults - height, weight, BMI, waist to hip ration
Skinfold measurements can determine body fat percentage
Persons at risk for aspiration should be monitered closely for
coughing, wheezing dyspnea, apnea bradycardia, and hypotension
dysphagia places patient at risk for
aspirating food and fluids into their lungs, may need swallow study.
Risidual effects of stroke or other injury may cause dysphagia or choking
Aspiratoin precautions are taken to prevent the following materials form enter the lungs of at risk patients instead of being swallowed
Food
FLuid
Saliva
Other foreign objects
To determine risk of aspiration, consult
nutritional specialist, speech therapist, swallow study
Conditions that place patient at risk for aspiration are
Seizures, CVA, dementia, GERD, cerebral palsy, muscular dystrophy, MS, parkinson disease, endoscopy procedures, medications with sedative or muscle relaxant effect including anesthesia, feeding of patient by anotehr person, eating too fast, other disease affecting mobility
Lab Test prealbumin
measure of the amount of protein contained in the internal organs
Lab test albumin
determin liver function
lab test transferrin
sensitive to a decrease in protein and iron stores
Lab test hemoglobin and hematocrit
Identify the number and percentage of curculating RBCs, their ability to provide oxygen to the cells and the body’s iron store status
Hemoglobin - pretein in RBCs that carries oxygen
Hematocrit - inidcates the umber and size of RBCs. Expressed as a percentage of total blood volume
may result from high fat intake use of artificial sweeteners, and excessive intake of insoluble fibers
diarrhea
Special diet clear liquid
no pulp
special diet full liquid
foods tha are liquid at body temp
special diet pureed
“blended”
special diet mechanical soft
modifeid food consistency
special diet thickened liquids
for dysphagia and risk of aspiration
regular or general diet
“as tolerated”
Diebetic diet (ADA)
control carb intake
cardiac diet
low cholesterol, low sodium
renal diet
restrict potassium, sodium, protein, phosphurus
Safe practice alert assistance with feeding
Do not feed in supine position
Eleveate bed 30-45 degrees
have suction machine at bedside at all times
When patients are NPO, importan nursing interventions to help keep the oral mucosa moist and aid in swallowing
Brushing teeth, flossing, mouthwash
Unconscious patients need special attention
Place patient on side to allow drainage
Enteral feedings Safe Practice Alert!
always check to make sure the tube feedings are properly connected to enteral tubes only!
Accidently hooking up an enteral feeding to a patient’s intravenous line can be fatal!!!
Take time to ensrue safe practice by following each tube from its point of origin to its destination prio to initiating intravenous or enteral therapy
What is the most reliable method of confirming enteral tube placement
radiographic confirmation
is using on pH and the appearance of aspirate fro the newly inserted tuve a safe method of verifying proper gastric tube placement
No. Especially in patients receiving antacid medications
Is auscultation of an air bolus to assesss tube placement recognized as a reliable source in determing gastric tube placement?
Nope
tube used to infuse food directly into the stomach
percutaneous endogastric gastrostomy (PEG)
The PEG tube is placed in the stomach (or stomach and small intestine) trhough the
abdominal wall
The PEG is a ______ feeding option
long term
Traditional PEG tube is placed in the
stomach
Double lumen gastrojejunostomy tube (GJ) is placed
One lumen (the gastrotomy or G tube) is placed in teh stomach for feeding
The other lumen (the jejunostomy or J tube) is placed in the jejunum for decompression
Can medications be added direction to a tube feeding?
NO
They are given in liqued form or ground into powder (as permitted depending on medication) and dissolved in 15-30 mL of sterile water prior to instillation into the tube
Total parenteral nutrition (TPN) is given through
a peripherally inserted central catheter (PICC) line or central venous catheter (CVC) by means of an infustion pump
What do you monitor with TPN
Weight, CBC, glucose, electrolytes, BUN, I/O
Should NOT be used with patients with an intact GI tracted because it causes more complications than interal nutrition
Potential complications are numerous
