Chapter 36 Nutrition Flashcards
1
Q
if a patient can attempt eating regular meals during the day and is prepared to ambulate and resume activities, supplemental feedings should be provided by?
A
Cyclic feeding
2
Q
A nutritional therapy for patients who have nonfunctional gastrointestinal tracts or who are comatose
A
TPN
3
Q
Describe clear liquid diet and give examples
A
foods that are clear liquids at room temperature. Eg. gelatins, fat-free bouillon, ice pops, clear juices
4
Q
what is a full liquid diet and give examples
A
All liquids that can be poured at room temperature, such as clear liquids plus milk. Eg. cereal gruels, pasteurized eggs, frozen desserts.
high-proten, high-calorie supplements are recommend if use for more than 3 days.
5
Q
describe a soft diet
A
regular diets that have been modified to eliminate foods taht are hard to digest and chew. can be used long term
6
Q
List the classes of nutrients
A
Carbohydrates Protein fats vitamins minerals and water
7
Q
explain the significance of Carbohydrates
A
supply energy
easy to produce and store, simple sugars and starch, prevent ketosis from inefficient fat metabolism, spare protein so it can be used for other functions
low intake can cause ketosis
8
Q
what are the functions and significance of cellulose and other water insoluble fibers
A
Absorb water to increase fecal bulk, decrease intestinal transit time, help relieve constipation.
excess intake can cause gas, distention and diarrhea
9
Q
explain the functions and significance of water soluble fibers
A
slow gastric emptying, lower serum cholesterol level.
delay glucose absorption.
help improve glucose tolerance in diabetics
10
Q
explain the function and significance of protein
A
tissue growth and repair, helps regulate fluid balance through oncotic pressure, transports fat and other substance through the body. provides energy when carbohydrate intake is inadequate.
deficiency increased the risk for infections and high mortality.
11
Q
what are characteristics of protein deficiency
A
edema, retarded growth and maturation, muscle wasting, changes in the hair and skin, diarrhea, malabsorption, fatty infiltration of the liver.
12
Q
what are the functions and significance of fat
A
Provides energy, structure, insulates the body, cushions internal organs. Necessary for the absorption of fat-soluble vitamins.
High-fat diets increase the risk for heart disease and obesity and are correlated with an increase risk for colon and breast cancers.
13
Q
Lactose
A
The only animal source of carbohydrate in the diet (milk sugar)
14
Q
how many grams of carbohydrate are need daily to prevent ketosis?
A
50 -100 g
15
Q
what happens when glycogen stores are adequate?
A
The body converts excess glucose to fat and stores it as triglycerides in adipose tissue.
16
Q
when the supply of glucose exceeds what is need for energy and for maintaining serum level, it is stored as?
A
glycogen
17
Q
An abnormal accumulations of ketone bodies that is frequently associated with acidosis (by product of fat break down)
A
ketosis
18
Q
What is the only plant protein that is considered as complete
A
soy
19
Q
Essential nutrients
A
must be provided in the diet or through supplements (fats, protein, carbohydrates)
20
Q
Type of nutrients do not have to be supplied through dietary sources because they are either not required for body functioning or are synthesized in the body in adequate amounts.
A
nonessential nutrients
21
Q
The body converts excess carbohydrates, protein into fats and stores them as
A
triglycerides
22
Q
catabolism
A
break down of tissues
23
Q
build up of tissues
A
anabolism
24
Q
positive nitrogen balance
A
occurs when nitrogen intake is greater than excretion
25
Occurs when more nitrogen is excreted than is ingested
Negative nitrogen balance
26
saturated fats
tend to raises serum cholesterol
contain more hydrogen
most animal fats
have a solid consistency at room temperature.
27
unsaturated fats
most vegetable fats
lower serum cholesterol levels
remain liquid at room temperature
28
Cholesterol
found in animal product
component of cell membranes
abundant in brain and nerve cells.
used to synthesize bile acids.
precursor of the steroid hormones and vitamin D
high serum levels are associated with an increased risk for atherosclerosis.
29
Fat digestion occurs largely in?
small intestine
30
which nutrients is most concentrated source of energy in the diet?
fat 1 g = 9kcal
31
develop a POC for a patient with hypertension and high cholesterol.
eating less total fat especially saturated and trans fat.
eating more unsaturated fat.
increasing fiber intake, which increase fecal excretion of cholesterol.
weight loss
32
explain the functions and significance of vitamins
needed for metabolism of carbohydrates, proteins and fat.
| The absence or insufficient in the body causes specific deficiency syndromes.
33
what are the water-soluble vitamins and their significance
vitamin C - collagen formation, antioxidant, enhance iron absorption.
Vitamin B complex- coenzyme in protein, fat and carbohydrate metabolism
Not store in the body.
34
Fat soluble vitamins
A, D, E and K
absorbed with fat into the lymphatic circulation
must be attached to a protein to be transported through the blood.
the body stores excesses in the liver and adipose tissue.
daily intake is not imperative and deficiency may take weeks
35
SxS of excessive vitamin A intake
Anorexia, loss of hair, dry skin, bone pain, vomiting, birth defects.
36
SxS of vitamin A deficiency
night blindness, rough skin, bone growth ceases
37
SxS of vitamin D deficiency
retarded bone growth, bone malformation
38
what are some SxS of excess vitamin D intake
excessive calcification of bones, renal calculi, nausea, headache
39
SxS of vitamin C deficiency
scurvy, hemorrhaging, delayed wound healing
40
Excess Vitamin C intake
hot flashes, headache, nausea, diarrhea
41
What are signs and symptoms of Vitamin B deficiency
beriberi, mental confusion, fatigue
42
what are the functions and significance of minerals
organic elements, some function to provide structure in the body, others help regulate body processes.
43
list macrominerals needed by the body in amounts greater than 100 mg/day
calcium, phosphorus and magnesium
44
what are the functions of calcium
bone and tooth formation, blood clotting, nerve transmission and muscle contraction.
45
what are signs and symptoms of calcium deficiency
tetany and osteoporosis
46
signs and symptoms of excess calcium intake
renal calculi in susceptible people
47
what are the functions of phosphorus
bone and tooth formation, acid-base balance, energy metabolism
48
SxS of phosphorus deficiency
hypophosphatemia (anorexia, muscle weakness)
49
SxS of excessive phosphorus intake
hyperphosphatemia, symptoms of hypocalcemic (tetany)
50
what are the functions of magnesium
bone and tooth formation, protein synthesis, carbohydrate metabolism
51
what are SxS of excessive intake of magnesium
hypermagnesemia (CNS depression, coma, hypotension)
52
SxS of magnesium deficiency
hypomagnesemia (weakness, muscle pain, poor heart function)
53
Functions of Sodium
major ion of ECF, fluid balance, acid-base balance
54
sodium deficiency
hyponatremia (muscle cramps, cold and clammy skin)
55
excessive intake of sodium
edema, weight gain, high BP
56
functions of potassium
major ion of ICF, fluid and acid-base balance
57
hypokalemia
muscle cramps and weakness, irregular heartbeat
58
hyperkalemia
(irritability, anxiety, cardiac arrhythmia, heart block)
59
list some microminerals
iron, zinc, manganese and iodine
60
iron deficiency
microcytic anemia, pallor, decreased work capacity, fatigue, weakness
61
SxS of excessive iron intake
hemosiderosis; acute iron poisoning from accidental overdose leads to GI symptoms and possible shock
62
function of iron
O2 transport by way of hgb
| constituent of enzyme systems
63
Goiter
Iodine deficiency
64
signs and symptoms of excessive iodine intake
acne-like lesions
65
what are some signs and symptoms of zine deficiency
impaired growth, sexual maturation, immune system functioning
66
SxS of excessive zinc intake
Anorexia, N/V, diarrhea, muscle pain, lethergy
67
eating disorder characterized by extreme weight loss, muscle wasting, arrested sexual development, refusal to eat and bizarre eating habits
Anorexia nervosa
68
bulimia
eating disorder characterized by gorging followed by purging with self-induced vomiting, diuretics and laxative
69
How does nutrition influences adulthood
fewer calories is required because of decrease in BMR
70
factors that affects the older adults nutrition
decrease in BMR, physical activity, loss of lean body mass, energy expenditure, loss of teeth, periodontal disease making chewing more difficult.
decrease in peristalsis, loss of taste between salty and sweet. decrease thirst sensation, degenerative disease and medication use.
71
measurements used to determine body dimensions
Anthropometric data
72
difficulty swallowing or the inability to swallow. increase risk for aspiration
dysphagia
73
which laboratory test is a good indicator of a patient's nutritional status, chronic problems?
serum albumin levels
74
which laboratory test can be used to detect daily changes in a patient's protein status
prealbumin levels
75
This type of lab test indicate short term nutritional status
prealbumin (23-24 mg/dL)
76
which twenty-four-hour urine test are used to measure protein metabolism
creatinine and BUN
77
what are implications for creatinine?
0.4-1.5 mg/dL
directly proportional to body's muscle mass.
reduction is severe malnutrition
78
what are nutritional implications for BUN
17-18 mg/dL
increase=starvation, hight protein intake, severe dehydration.
decrease=malnutrition, overhydration
79
Mini nutritional assessment tool (MNA)
used to detect elderly person at risk for malnutrition before changes in albumin level and the BMI
80
BMI
weight in poundsx703/ height in inches x heights in inches
81
Normal BMI
18.5-24.9
82
overweight (BMI)
25-29.9
83
obese (BMI)
30-39.9
84
Extreme obesity (BMI)
40-54
85
measurement of waist circumference
good indicator of abdominal fat.
relative risk for heart disease, diabetes and HTN
male greater 40
females greater 35
86
type of diet used after oral or facial surgery
pureed diet
87
type of diet use for patients with limited chewing ability or who have surgery to head, neck or mouth
mechanical soft diet
88
Factors to assess for nutritional satus
```
usual dietary intake
food allergies or intolerances
food preparation and storage
dietary practices
eating disorder patterns
```
89
Factors related to selection of a feeding tube
aspiration risk, anticipated duration, function of the GI and the patient's overall condition and prognosis
90
what is a disadvantage of using NG
risk for aspiration
91
which patients are not candidates for NG feeding
dysfunctional gag reflex, high risk of aspiration, gastric stasis, gastroesophageal reflux, nasal injuries, and those who are unable to have the HOD elevated during feedings
92
tube that passes through the nose and into the upper portion of the small intestine
Nasointestinal (IN) tube
93
which tube feeding may be indicated for a patient with increased risk for aspiration due to diminished gag reflex or slow gastric motility?
Nasointestinal tube
94
what are signs of symptoms of dumping syndrome
distention of the small intestine, gas, bloating, N/V, cramping, diarrhea and lightheadedness
95
dumping sydrome
rapid administration of hypertonic feeding solution into the proximal small intestine causing the movement of ECF from the vascular system into the small intestine.
96
means anabolic and catabolic metabolism of protein is in equilibrium
Nitrogen balance
97
what are some ways to confirm feeding tube placement?
radiographic examination, measurement of aspirate Ph, visual assessment of aspirate, measurement of tube length and measurement of tube marking.
monitoring of carbondioxide.
98
when should the nurse verify correct placement of NG tube
after the initial insertion.
| before beginning a feeding or instilling liquids, and at regular intervals during continuos feedings
99
If a tube is connected to suction what action should the nurse take?
keep the tube disconnected from the suction and clamped for 20 to 30 minutes after administration of the medication to allow absorption.
100
how much ml of water should be mixed with crushed medications before delivery through an enteral feeding tube
15 to 30 ml
101
how much ml of water should be flush before giving medication and immediately after?
15 to 30 ml
102
why is giving medications separately and flushing with water between each drug important?
some medications may interact with each other or become less effective if mixed with other drugs.
103
stomach pH
less than 5.5
| if the patient is taking an acid-inhibiting agent the range may be 4.0-6.0
104
intestine pH
7.0 or higher
105
Respiratory tract pH
6.0 or higher
106
what degree should the HOD be during oral feeding
45-90 degrees during and 60 minutes following feeding.
107
Any increase in the length of expose tube may indicate?
dislodgment
108
what is a good way to make ensure a tube has not become displaced?
marking the tube with an indelible marker at the nostril and assessing the marking each time the tube is used.
109
confirming Nasointestinal tube placement
x-ray
pH of aspirate 7 or higher
bile-stained ranging in color from light to golden yellow or brownish-green
110
in long-term feeding situations in which gastric problems exist what is an alternate method through which nutrition can be delivered
Jejunostomy
111
Percutaneous endoscopic gastrostomy (PEG)
usually does not require general anesthesia
| requires an intact function GI
112
feeding are delivered at regular intervals in equal portion.
formula is introduced gradually over a set period of time via gravity or a feeding pump.
allow the patient freedom of movement between feedings.
preferred method for gastric feeding
intermittent feedings
113
involves administering continuos feedings for a portion of the 24 hour period.
Routine is to feed the patient for 12 to 16 hours, most often overnight.
allows the patient to attempt eating regular meals during the day if possible.
ambulation and activity are easy.
cyclic feeding
114
what is the best way to improve tolerance for patient on enteral feeding
starting the feeding at a slower rate
115
Criteria to consider when evaluating patient feeding tolerance
absence of N/V, diarrhea and constipation,abdominal pain and distention.
minimal or no gastric residual.
presence of bowel sounds within normal limits
116
high gastric residual volumes (200 to 250 ml or greater) can be associated with?
high risk for aspiration and aspiration-related pneumonia
117
A residual of more than 10% to 20 % above the hourly rate for the feeding may indicate?
feedings should be interrupted or delayed
118
feeding remaining in the stomach
residual
119
when should the nurse check residual?
every 4 to 6 hours during continuous feeding (according to institution policy)
120
which degree should the HOB be during tube feeding
30 degrees during feeding and 1 hour afterward to prevent reflux and aspiration
121
how long can a closed system feeing be used
48 hours
122
when should a disposable feeding apparatus for open system be replaced
24 hours
123
How long should an open system be hang
8 hours
124
nursing interventions for accidental removal or tube
anchor tube adequately with tape
check on patient frequently
measure external length of tubing at regular intervals
restrain patient only if necessary, with physician's order
125
nursing interventions for clogged tube
flush tube before and after feeding, q4h during continuos feeding and after withdrawing aspirate
instill 30 ml of warm water with 50 or 60 ml syringe to attempt to unclog tube
126
preventive interventions for nasal erosion
keep nasal clean
| check for pressure ulcer q4-8h
127
less concentrated nutrient solution
for patients who have a malfunctioning GI and need short-term nutrition lasting less than 2 weeks
administered through a peripheral vein
peripheral parenteral nutrition (PPN)
128
what actions should the nurse take when gagging and coughing persist during NG insertion
stop advancing the tube and check placement of tube with tongue blade and flashlight
129
during insertion of an NG tube, patient shows sighs of gasping, coughing, cyanosis, and inability to speak or hum. Which action should the nurse take
discontinue procedure and remove the tube.
| tube is in the airway (trachea)
130
what to do when no gastric contents can be aspirated if patient is comatose
check oral cavity, if tube is in gastric area, small air boluses may need to be given until gastric contents can be aspirated.
131
within 2 hours after NG tube removal, patient's abdomen is showing signs of distention
notify physician. May order NG tube replacement.
132
Epistaxis occurs with removal of NG tube. Interventions?
occlude both nares until bleeding has subsided. Ensure that patient is in upright position.
Document epistaxis in patient's medical record.
