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Lewis: Med Surg > Chapter 40: Nutrition Problems > Flashcards

Chapter 40: Nutrition Problems Flashcards

1
Q

Mifflin–St. Jeor equation

A

recommended to
estimate daily adult energy (calorie) requirements based on
resting metabolic rate for individuals

A more convenient way to estimate daily calories is based on
kilocalories per kilogram (kcal/kg).

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2
Q

average adult

requires an estimated 20 to 35 cal/kg of body weight per day

A

Rule-of-thumb estimations are that an
individual should consume 20 to 25 cal/kg body weight to lose
weight, 25 to 30 cal/kg to maintain body weight, and 30 to
35 cal/kg to gain weight.

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3
Q

Major Minerals

A
  • Calcium
  • Chloride
  • Magnesium
  • Phosphorus
  • Potassium
  • Sodium
  • Sulfur
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4
Q

Trace Elements

A
  • Chromium
  • Copper
  • Fluoride
  • Iodine
  • Iron
  • Manganese
  • Molybdenum
  • Selenium
  • Zinc
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5
Q

watersoluble

vitamins

A

(vitamin C and the B-complex vitamins)

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6
Q

fat-soluble vitamins

A

(vitamins A, D, E, and K)

Because the body
stores excess fat-soluble vitamins, there is the potential for toxicity
when too much is consumed.

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7
Q

Minerals are necessary for the body

A

to build and repair
tissues, regulate body fluids, and assist in various functions.
Some minerals are stored and can be toxic if taken in excess
amounts.

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8
Q

The primary deficiency for a strict vegan is lack of

A

cobalamin.
This vitamin can be obtained only from animal protein,
special supplements, or foods that have been fortified with the
vitamin
Vegans not using cobalamin supplements are susceptible
to the development of megaloblastic anemia and the neurologic
signs of cobalamin deficiency.

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9
Q

A Jewish patient who

eats only Kosher food may be comforted

A

knowing that
most enteral formulas are manufactured Kosher and are labeled
as such.

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10
Q

Socioeconomic Factors

A

Food security refers to access by all
people, at all times, to sufficient food for an active and healthy
lifestyle.2 Individuals or families with limited financial resources
may have food insecurity (inadequate access). Food insecurity is
problematic because it affects the overall quality of food that is
available in both quantity and nutritional value

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11
Q

CONDITIONS THAT INCREASE

THE RISK FOR MALNUTRITION

A

• Dementia
• Depression
• Chronic alcoholism
• Excessive dieting to lose weight
• Swallowing disorders (e.g., head and neck cancer)
• Decreased mobility that limits access to food or its preparation
• Nutrient losses from malabsorption, dialysis, fistulas, or wounds
• Drugs with antinutrient or catabolic properties such as
corticosteroids and oral antibiotics
• Extreme need for nutrients because of hypermetabolism or
stresses such as infection, burns, trauma, or fever
• No oral intake and/or receiving standard IV solutions (5% dextrose)
for 10 days (adults) or for 5 days (older adults)

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12
Q

As the total blood volume is reduced, the skin appears dry
and wrinkled. As fluids shift to the interstitial space, ions also
move.

A

Sodium (a predominant extracellular ion) is found in
increased amounts within the cell, and potassium (a predominant
intracellular ion) and magnesium are shifted to the extracellular
space.

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13
Q

Many malnourished individuals are

A

anemic, generally as a
result of nutritional deficiencies in iron and folic acid, the necessary
building blocks for red blood cells (RBCs).

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14
Q

Prealbumin

A

a protein synthesized by the liver, has a half-life
of 2 days and is a better indicator of recent or current nutritional
status. Serum transferrin level is another indicator of protein
status. Transferrin, a protein synthesized by the liver and used
to transport iron, decreases when protein is deficient.

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15
Q

Hospital-specific screening tools based on common

admission assessment criteria include

A

history of weight loss,
prior intake before admission, use of nutritional support,
chewing or swallowing issues, and skin breakdown.

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16
Q

……a critical

indicator for further assessment, especially in the older adult

A

A loss of more than 5% of usual body weight over

6 months, whether intentional or unintentional

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17
Q

The arm demi-span is the

A

distance
from a point on the midline at the suprasternal notch to the web
between the middle and ring fingers with the arm horizontally
outstretched

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18
Q

Body mass index (BMI) is a measure of weight for height

A

A BMI of less than 18.5 kg/m2 is considered
underweight, normal weight is a BMI between 18.5 and 24.9 kg/
m2, and overweight is a BMI between 25 and 29.9 kg/m2. A
BMI of 30 kg/m2 or greater is obese. BMIs outside the normal
weight range are associated with increased morbidity and
mortality

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19
Q

Nursing diagnoses for the patient with malnutrition include,

but are not limited to, the following: pg894

A

• Imbalanced nutrition: less than body requirements related
to decreased access, ingestion, digestion, or absorption
of food or related to anorexia, dysphagia, or increased
metabolic needs
• Feeding self-care deficit related to decreased strength and
endurance, fatigue, and apathy
• Deficient fluid volume related to factors affecting access
to or absorption of fluids
• Risk for impaired skin integrity related to poor nutritional
state
• Noncompliance related to alteration in perception, lack of
motivation, or incompatibility of regimen with lifestyle or
resources

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20
Q

Anthropometric

Measurements

A
  • Height and weight
  • Body mass index (BMI)
  • Rate of weight change
  • Amount of weight loss
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21
Q

Diet History

A
  • Chewing and swallowing ability
  • Changes in appetite or taste
  • Food and nutrient intake
  • Availability of food
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22
Q

Physical Examination

A
  • Physical appearance
  • Muscle mass and strength
  • Dental and oral health
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23
Q

Laboratory Data

A
  • Glucose
  • Electrolytes
  • Lipid profile
  • Blood urea nitrogen (BUN)
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24
Q

Health History

A 
• Personal and family history
• Acute or chronic illnesses
• Current medications,
herbs, supplements
• Cognitive status,
depression
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25
Q

Functional Status

A 
• Ability to perform basic and
instrumental activities of daily living
• Handgrip strength
• Performance tests (e.g., timed
walk tests)
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26
Q

Health Impact of a Well-Balanced Diet

A

• Reduces incidence of anemia
• Maintains normal body weight and prevents obesity
• Maintains good bone health and reduces risk of osteoporosis
• Lowers the risk of developing elevated cholesterol and type 2 diabetes
mellitus
• Decreases the risk of heart disease, hypertension, and certain types
of cancers

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27
Q

For patients undergoing

major surgery or those with or at risk for malnutrition

A

several
weeks of increased protein and calorie intake are needed preoperatively
to promote healing postoperatively.

fever is present, the metabolic rate is increased

28
Q

Some patients may benefit from appetite stimulants such as

A 
megestrol acetate (Megace) or dronabinol (Marinol) to improve
nutritional intake
29
Q

Keeping a diet diary for 3 days at a time is one way to analyze
and reinforce healthful eating patterns.

A

helpful to the health care team in the follow-up care. Encourage
self-assessment of progress by having the patient weigh himself
or herself once or twice a week and keep a weight record

30
Q

Daily requirements for healthy older adults for weight maintenance
include

A

30 cal/kg of body weight, and 0.8 to 1 g/kg of

protein per day, with no more than 30% of calories from fat

31
Q

Contraindications to enteral nutrition

A 
• Intestinal obstruction
• Ileus
• Peritonitis
• Bowel ischemia
• Intractable vomiting
and diarrhea
32
Q

Enteral Nutrition long term

A

Gastrostomy

Jejunostomy

33
Q

enteral nutrition short term

A

Nasogastric
Nasoduodenal
Nasojejunal

34
Q 
Enteral nutrition (EN), also known as tube feeding, is defined
as nutrition
A

provided through the GI tract via a tube, catheter, or

stoma that delivers nutrients distal to the oral cavity.

35
Q

EN indications

A

persons with anorexia, orofacial
fractures, head and neck cancer, neurologic or psychiatric
conditions that prevent oral intake, extensive burns, or critical
illness (especially if mechanical ventilation is required), and
those who are receiving chemotherapy or radiation therapy

36
Q

Nasally and orally placed tubes

A

(orogastric, nasogastric
[NG], nasoduodenal, or nasojejunal) are most commonly used
for short-term feeding (less than 4 weeks).

37
Q

Nasoduodenal and

nasojejunal tubes are transpyloric tubes

A

These tubes are used
when pathophysiologic conditions such as risk of aspiration
warrant feeding the patient below the pyloric sphincter

38
Q

Failure to flush the tubing before and

after both drug administration and residual volume determinations

A

can result in tube clogging. When the tube becomes
clogged, it may necessitate removal and insertion of a new tube,
adding to cost and patient discomfort. The tubes can become
dislodged by vomiting or coughing and can also become knotted
or kinked.

39
Q

Capnography,

A

a direct monitor of breath-to-breath carbon dioxide level, may be
used to detect inadvertent entry of tube into the trachea during
insertion. X-ray confirmation is still needed to verify location
before feeding. When in doubt, request an x-ray to determine
tube location.

40
Q

Assess the skin around the feeding tube daily

A

for signs of

redness and maceration. To keep the skin clean and dry

41
Q

DELEGATION DECISIONS
Nasogastric and Gastric Tubes
and Enteral Feedings
Role of Registered Nurse (RN)

A

• Insert nasogastric (NG) tube for unstable patient.
• Irrigate NG or gastrostomy tube for unstable patient.
• Insert nasointestinal tube.
• After tube placement is verified, administer bolus or continuous
enteral feeding for unstable patient.
• Administer medications through the NG or gastrostomy tube to
unstable patient.
• Evaluate nutritional status of patient receiving enteral feedings.
• Monitor for complications related to tubes and enteral feedings.
• Develop plan for gastrostomy or jejunostomy tube care.
• Teach patient and caregiver about home enteral feeding and gastrostomy
or jejunostomy tube care.
• Evaluate for therapeutic effect of NG tube connected to suction (e.g.,
decreased nausea or distention

42
Q

Role of Licensed Practical/Vocational Nurse (LPN/LVN)

A

• Insert NG tube for stable patient.
• Irrigate NG and gastrostomy tubes.
• Administer bolus or continuous enteral feeding for stable patient.
• Remove NG tube.
• Administer medications through NG or gastrostomy tube to stable
patient.
• Provide skin care around gastrostomy or jejunostomy tubes.

43
Q

Role of Unlicensed Assistive Personnel (UAP)

A

• Provide oral care to patient with NG, gastrostomy, or jejunostomy
tube.
• Weigh patient who is receiving enteral feeding.
• Position and maintain patient receiving enteral feeding with the head
of bed elevated.
• Notify RN or LPN about patient symptoms (e.g., nausea, diarrhea)
that may indicate problems with enteral feedings.
• Alert RN or LPN about enteral feeding infusion pump alarms.
• Empty drainage devices and measure output.

44
Q

With aging, there is an increased risk of

A

glucose intolerance.
As a result, the older patient may be more susceptible to hyperglycemia
in response to the high carbohydrate load

45
Q

It is becoming more common to administer lipid-free PN

for the first 3 to 5 days of a critical illness

A

because of the
potential for omega-6 fatty acids to produce proinflammatory
mediators

46
Q

The following are ranges for average
daily electrolyte requirements for adult patients without renal
or hepatic impairment

A
  • Potassium: 1 to 2 mEq/kg
  • Chloride: as needed to maintain acid-base balance
  • Magnesium: 8 to 20 mEq
  • Calcium: 10 to 15 mEq
  • Phosphate: 20 to 40 mmol
47
Q

Catheter-Related Problems

A 
• Air embolus
• Pneumothorax, hemothorax,
and hydrothorax
• Hemorrhage
• Dislodgment
• Thrombosis of vein
• Phlebitis
48
Q

Anorexia nervosa is characterized

A

by a self-imposed weight
loss, endocrine dysfunction, and a distorted psychopathologic
attitude toward weight and eating

49
Q

lanugo

A

(soft, downy hair covering the body except the palms and soles)

50
Q

The percentage of daily calories for a healthy individual consists of

A

50% carbohydrates, 25% protein, 25% fat, and <10% of fat from
saturated fatty acids.

51
Q

During starvation, the order in which the body obtains substrate
for energy is

A

glycogen, skeletal protein, fat stores, visceral protein.

52
Q

A patient with anorexia nervosa shows signs of malnutrition.

During initial refeeding, the nurse carefully assesses the patient for

A

d. hypophosphatemia.

53
Q

prealbumin level more accurately reflects the patient’s nutritional status

A

Prealbumin has a half-life of 2 days and is a better indicator of recent or current nutritional status. Serum albumin has a half-life of approximately 20 to 22 days. The serum level may lag behind actual protein changes by more than 2 weeks and is therefore not a good indicator of acute changes in nutritional status.

54
Q

The nurse should flush feeding tubes with

A

30 mL of water (not normal saline) every 4 hours and before and after medication administration during continuous feeding or before and after intermittent feeding. Flushes of 100 mL are excessive and may cause fluid overload in the patient.

55
Q

The nurse recognizes that the majority of patients’ caloric needs should come from which source?

A

Carbohydrates should constitute between 45% and 65% of caloric needs, compared with 20% to 35% from fats and 10% to 35% from proteins. Polysaccharides are the complex carbohydrates that are contained in breads and grains. Monosaccharides are simple sugars.

56
Q

parenteral nutrition (PN). Which principle should guide the nurse’s administration of the patient’s nutrition?

A

Central PN is hypertonic and requires rapid dilution in a large volume of blood. Because PN is an excellent medium for microbial growth, aseptic technique is necessary during administration. Administration through a central line is preferred over the use of peripheral PN, and the nurse may not add any medications to PN.

57
Q

Which care could the RN delegate to the LPN

A

For the stable patient, the LPN can administer bolus or continuous feedings and administer medications through the gastrostomy. The RN must evaluate the nutritional status of the patient, monitor for complications related to the tube and the enteral feeding, and teach the caregiver about feeding via the gastrostomy tube at home.

58
Q

she reports bleeding gums, loose teeth, and dry, itchy skin. The nurse should know that this patient is most likely lacking which vitamin?

A

This patient is lacking Vitamin C as evidenced by the bleeding gums, loose teeth, and dry, itchy skin. Clinical manifestations of folic acid deficiency include megaloblastic anemia, anorexia, fatigue, sore tongue, diarrhea, or forgetfulness. Clinical manifestations of Vitamin D deficiency include muscular weakness, excess sweating, diarrhea, bone pain, rickets, or osteomalacia. Clinical manifestations of Vitamin K deficiency include defective blood coagulation.

59
Q

The patient has parenteral nutrition infusing with amino acids and dextrose. In report, the oncoming nurse is told that the tubing, the bag, and the dressing were changed 22 hours ago. What care should the nurse coming on be prepared to do

A

The nurse should check the amount of feeding left in the bag, and that the next bag has been ordered to be sure the solution will not run out before the next bag is available. Parenteral nutrition solutions are only good for 24 hours and usually take some time for the pharmacy to mix for each patient. The label on the bag should be checked to ensure that the ingredients and solution are what was ordered. The patient would only receive insulin if the patient is experiencing hyperglycemia and was receiving sliding scale insulin or had diabetes mellitus. The insertion site should be checked, but the tubing is only changed every 72 hours unless lipids are being used.

60
Q

• Three etiologies of adult malnutrition

A

are starvation-related malnutrition, chronic disease-related malnutrition, and acute disease or injury related-malnutrition

61
Q

• Evidence-based procedures for EN therapy include the following:

A

o Positioning patient with head elevated at least 30 degrees.
o Flushing feeding tubes to maintain patency.
o Checking tube position on insertion and prior to feeding.
o Monitoring for aspiration.
o Using sterile, liquid EN formula with closed-systems are preferred.
o Monitoring nutrition status and tolerance of EN.

62
Q

• Central parenteral nutrition is the delivery of a

A

nutritionally adequate hypertonic solution consisting of glucose, crystalline amino acids, fat emulsion, minerals, and vitamins using a central venous route

63
Q

are monitored a minimum of three times per week until stable and then weekly as the patient’s condition warrants

A

• Blood levels of glucose, electrolytes, and urea nitrogen; a complete blood count; and hepatic enzyme

64
Q

• Refeeding syndrome is characterized by

A

fluid retention and electrolyte imbalances including hypophosphatemia, hypokalemia, and hypomagnesemia

65
Q

Hypophosphatemia (serum phosphate level less than 2.4 mg/dL)

A

is the hallmark of refeeding syndrome and could result in cardiac dysrhythmias, respiratory arrest, and neurologic problems.

Lewis: Med Surg (6 decks)

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