Chapter 44 Flashcards
What is nutrition?
Nutrition is the sum of processes by which one takes in and utilizes nutrients.
Nutrition encompasses the intake, absorption, and metabolism of food components.
What are the three categories of nutrition status?
The three categories are:
* Denutrition
* Normal nutrition
* Overnutrition
These categories reflect the range of nutrient intake and its effects on health.
What factors can influence nutrition problems?
Nutrition problems can occur due to:
* Age
* Culture
* Ethnic group
* Socioeconomic class
* Education
* Financial status
* Community resources
These factors can affect access to food and nutritional education.
Why is optimal nutrition important?
Optimal nutrition is important for:
* Energy
* Growth
* Maintaining and repairing body tissues
It is essential for overall health and well-being.
What are the major components of the basic food groups?
The major components are:
* Macronutrients (carbohydrates, fats, proteins)
* Micronutrients (vitamins, minerals, electrolytes)
* Water
These components are crucial for a balanced diet.
What influences a person’s daily caloric requirements?
Daily caloric requirements are influenced by:
* Body type
* Age
* Gender
* Medications
* Physical activity
* Presence of disease
These factors can change an individual’s nutritional needs.
What is the Mifflin-St. Jeor equation used for?
The Mifflin-St. Jeor equation is used to calculate daily adult energy (calorie) requirements based on resting metabolic rate.
This equation helps estimate caloric needs for maintaining weight.
How can daily calorie needs be estimated simply?
Daily calorie needs can be estimated by kilocalories per kilogram (kcal/kg). An average adult should consume 20 to 25 cal/kg body weight.
This method provides a basic guideline for caloric intake.
What are the health impacts of a well-balanced diet?
- Reduces risk for anemia
- Maintains normal body weight and prevents obesity
- Maintains good bone health and reduces risk for osteoporosis
- Lowers the risk for developing high cholesterol and type 2 diabetes
- Decreases the risk for heart disease, hypertension, and some cancers
What is the Mifflin-St. Jeor Equation for calculating energy expenditure in men?
10 x weight (kg) + 6.25 x height (cm) - 5 x age (year) + 5
What is the Mifflin-St. Jeor Equation for calculating energy expenditure in women?
10 x weight (kg) + 6.25 x height (cm) - 5 x age (year) - 161
What are the activity factors used to determine total daily calorie needs?
- 1.200 = sedentary (little or no exercise)
- 1.375 = lightly active (light exercise/sports 1-3 days/week)
- 1.550 = moderately active (moderate exercise/sports 3-5 days/week)
- 1.725 = very active (hard exercise/sports 6-7 days a week)
- 1.900 = extra active (very hard exercise/sports and physical job)
What is the recommended daily fiber intake based on a 2000-calorie diet?
28 to 30 g
What are the two forms of simple carbohydrates?
- Monosaccharides (e.g., glucose, fructose)
- Disaccharides (e.g., sucrose, maltose, lactose)
What percentage of total calories should come from carbohydrates according to the Dietary Reference Intake (DRI)?
45% to 65%
How many calories does one gram of fat yield?
9 calories
What are the two types of fats?
- Potentially harmful (saturated fat and trans fat)
- Healthier diet fat (monounsaturated and polyunsaturated)
What are the sources of complete proteins?
- Eggs
- Fish
- Meats
- Milk and milk products (e.g., cheese)
- Poultry
What are the sources of incomplete proteins?
- Grains (e.g., corn)
- Legumes (e.g., navy beans, soybeans, peas)
- Nuts (e.g., peanuts)
- Seeds (e.g., sesame seeds, sunflower seeds)
What is the recommended daily protein intake for the average healthy person?
0.8 g/kg of body weight
What are the two categories of vitamins?
- Water-soluble vitamins (e.g., vitamin C, B-complex)
- Fat-soluble vitamins (e.g., vitamins A, D, E, K)
What constitutes major minerals and trace elements?
- Major minerals: needed in amounts greater than 100 mg/day
- Trace elements: present in minute amounts
What are some functions of minerals in the body?
- Build and repair tissues
- Regulate body fluids
- Assist in various functions
What is the main source of energy for the body?
Carbohydrates
What are the characteristics of essential amino acids?
The body cannot produce them; they must be obtained from the diet
What are the major minerals listed?
- Calcium
- Chloride
- Magnesium
- Phosphorus
- Potassium
- Sodium
- Sulfur
Major minerals are needed in larger amounts compared to trace elements.
What are the trace elements listed?
- Chromium
- Copper
- Fluoride
- Iodine
- Iron
- Manganese
- Molybdenum
- Selenium
- Zinc
Trace elements are required in smaller amounts but are still essential for health.
What is the common element among all vegetarians?
Exclusion of red meat from the diet.
What do vegans eat?
Only plants.
What do lacto-ovo-vegetarians eat?
- Plants
- Dairy products
- Eggs
Lacto-ovo-vegetarians include both animal-derived foods and plant-based foods.
What is a potential deficiency concern for vegetarians?
Vitamin or protein deficiencies.
How can vegetarians enhance the nutritional value of plant protein?
By combining vegetable protein foods.
What is an excellent protein source for vegetarians?
Milk made from soybeans or almonds.
What vitamin is primarily deficient in strict vegans?
Cobalamin (vitamin B12).
What can result from a deficiency in cobalamin?
Megaloblastic anemia and neurologic signs.
What other deficiencies may strict vegans experience?
- Calcium
- Zinc
- Vitamins A and D
These deficiencies can lead to various health issues.
What is malnutrition?
A deficit, excess, or imbalance in a person’s intake of energy and/or nutrients.
What are the two terms often used interchangeably with malnutrition?
- Undernutrition
- Overnutrition
What does overnutrition refer to?
Ingestion of more food than is required for body needs.
What does undernutrition occur from?
Depletion of nutrition reserves and insufficient nutrient and energy intake.
What is the prevalence of malnutrition in the hospital setting?
Rates range from 30% to 50%.
What is the prevalence of malnutrition in older adults?
Ranges from about 6% (community-dwelling) to 50% (rehabilitation settings).
What cultural factors can influence dietary practices?
Beliefs, behaviors, and specific laws related to food.
What is acculturation?
The process by which a person adopts the lifestyle of a new culture.
What dietary adjustments might be needed for a Jewish patient?
Provide Kosher food options.
What dietary adjustments might be needed for a Muslim patient during Ramadan?
Adjust meal plans to accommodate fasting during daylight hours.
What are examples of foods high in iron?
- Farina (enriched)
- Oatmeal (fortified)
- Beef liver (braised)
- Chicken or turkey liver (braised)
- Clams (steamed, boiled, or canned)
- Oysters (baked, broiled, or steamed)
- Soybeans (cooked)
These foods provide 25% - 39% of the Dietary Reference Intake (DRI) of iron.
What is starvation-related malnutrition also known as?
Primary PCM
What characterizes starvation-related malnutrition?
Chronic starvation without inflammation
What is chronic disease-related malnutrition also known as?
Secondary PCM
What conditions are associated with secondary PCM?
- Organ failure
- Cancer
- Rheumatoid arthritis
- Obesity
What is acute disease-related malnutrition related to?
Acute disease or injury states with marked inflammatory response
What are some contributing factors to malnutrition?
- Socio-economic factors
- Physical illnesses
- Incomplete diets
- Drug-nutrient interactions
What is food insecurity?
Inadequate access to food
What type of foods do those with food insecurity typically choose?
Less expensive ‘filling’ foods that are energy dense and lack nutritional value
What are ‘safety net programs’?
Programs that help obtain food, such as food assistance and subsidies
List some conditions that increase the risk for malnutrition.
- Chronic alcohol use
- Dementia
- Decreased mobility
- Depression
- Excess dieting
- Swallowing problems
What is a common risk for hospitalized patients, especially older adults?
Becoming malnourished
What can prolonged illness and major surgery contribute to?
Malnutrition
How can undernutrition affect a pathologic condition?
It can worsen the condition
What is the recommended dietary intake of Vitamin A for men?
900 mcg/retinol equivalents
What are the manifestations of Vitamin A deficiency?
- Dry, scaly skin
- Increased susceptibility to infection
- Night blindness
- Anorexia
- Eye irritation
- Keratinization of respiratory and GI mucosa
- Bladder stones
- Anemia
- Retarded growth
What is the recommended dietary intake of Vitamin A for women?
700 mcg/retinol equivalents
What is the recommended dietary intake of Vitamin D for adults ages 19-70?
600 IU
What are the manifestations of Vitamin D deficiency?
- Muscular weakness
- Excessive sweating
- Diarrhea and other GI problems
- Bone pain
- Active or healed rickets
- Osteomalacia
What is the recommended dietary intake of Vitamin B1 (thiamine) for men?
1.2 mg
What are the manifestations of Vitamin B1 deficiency?
- Anorexia
- Fatigue
- Nervous irritability
- Constipation
- Paresthesias
- Insomnia
What is the recommended dietary intake of Vitamin B12 (cobalamin) for adults?
2.4 mcg
What are the manifestations of Vitamin B12 deficiency?
- Megaloblastic anemia
- Anorexia
- Glossitis
- Sore mouth and tongue
- Pallor
- Neurologic problems (e.g., depression, dizziness)
- Weight loss
- Nausea
- Constipation
What is the recommended dietary intake of folate (folic acid) for adults?
400 mcg
What are the manifestations of folate deficiency?
- Bleeding gums
- Loose teeth
- Easy bruising
- Poor wound healing
- Scurvy
- Dry, itchy skin
- Impaired cell division and protein synthesis
- Megaloblastic anemia
- Anorexia
- Fatigue
- Sore tongue
- Diarrhea
- Forgetfulness
What is malabsorption syndrome?
Impaired absorption of nutrients from the GI tract
What may lead to vitamin deficiencies in individuals?
- Poor diet practices
- Chronic illness
- Alcohol and drug use
- Surgery on the GI tract
How does fever affect basal metabolic rate (BMR)?
Each degree of temperature increase raises the BMR by about 7%
What is a drug-nutrient interaction?
Occurs when a drug affects the use of nutrients in the body
What are some potential adverse interactions in drug-nutrient interactions?
- Incompatibilities
- Altered drug effectiveness
- Impaired nutrition
What can grapefruit juice do in relation to drug absorption?
Increase the absorption of some drugs, enhancing their effect
What happens to protein stores during starvation?
The body uses protein stores to supply calories
What is the recommended dietary intake of Vitamin E for adults?
15 mg
What are the manifestations of Vitamin E deficiency?
- Neurologic deficits
- Blood coagulation problems
What dietary pattern may put individuals at risk for vitamin deficiencies?
Fad diets or poorly planned vegetarian diets
What is the initial metabolic response of the body to malnutrition?
The body selectively uses carbohydrates (glycogen) rather than fat and protein
How quickly can carbohydrate stores be depleted during starvation?
Within 18 hours
What role does protein play during the early phase of starvation?
Used in its normal role in cellular metabolism
What process does the body use to convert skeletal protein to glucose for energy?
Gluconeogenesis
Which amino acids are primarily used in gluconeogenesis?
- Alanine
- Glutamine
What occurs when amino acids are used as energy sources?
The person may be in negative nitrogen balance
During prolonged starvation, what percentage of calories does fat provide?
Up to 97%
What happens to fat stores during starvation?
They are generally used up in 4 to 6 weeks
What happens to protein stores if a malnourished patient undergoes surgery or experiences trauma?
The body uses protein stores for energy to meet increased metabolic energy expenditure
How does protein depletion affect liver function?
Liver function becomes impaired and protein synthesis decreases
What is the major function of plasma proteins, primarily albumin?
To maintain the osmotic pressure of blood
What observable condition results from decreased oncotic pressure?
Edema
What happens to sodium and potassium levels during malnutrition?
- Sodium concentration increases in the cell
- Potassium and magnesium shift to the extracellular space
What percentage of all calories ingested does the sodium-potassium exchange pump use?
20% to 50%
What happens to the liver during protein deprivation?
The liver loses the most mass and fat gradually infiltrates it
What is the effect of inflammation on nutrient metabolism?
It increases protein and skeletal muscle breakdown and increases BMR
What cytokines are involved in inflammatory states?
- Proinflammatory cytokines (e.g., interleukin-6 [IL-6])
- Anti-inflammatory cytokines (e.g., IL-10)
What are common clinical manifestations of malnutrition?
- Dry and scaly skin
- Crusting and ulceration
- Weakness
- Mental changes
What can decreased protein availability lead to?
- Delayed wound healing
- Increased susceptibility to infections
How is the diagnosis of malnutrition best determined?
By nutrient intake, functional status, and body composition
What lab results may indicate malnutrition?
- Increased serum potassium level
- Decreased total lymphocyte count
What is the significance of the RBC count and hemoglobin level in malnutrition?
They indicate the presence and degree of anemia
What is the purpose of nutrition screening in nursing?
To identify those who are malnourished or at risk for malnutrition
The Joint Commission requires nutrition screening for all patients within 24 hours of admission.
What are negative acute phase proteins that indicate inflammation?
Albumin and prealbumin
Low or below-normal levels indicate the presence of inflammation.
What are some common tools used for nutrition screening in acute care?
- Malnutrition Universal Screening Tool (MUST)
- Nutrition Risk Screening (NRS)
- Mini Nutritional Assessment (MNA)
These tools are used to assess nutrition status in adults and older adults.
What are some objective data indicators of malnutrition in the cardiovascular system?
- Low heart rate
- Low blood pressure
- Dysrhythmias
- Peripheral edema
Liver enzyme levels may also increase.
What are signs of malnutrition in the eyes?
- Pale or red conjunctivae
- Gray keratinized epithelium on conjunctiva
- Dryness and dull appearance of conjunctivae
- Blood vessel growth in cornea
- Redness and fissuring of eyelid corners
These signs indicate potential nutritional deficiencies.
What symptoms might be observed in the gastrointestinal system due to malnutrition?
- Swollen, smooth, raw, beefy red tongue (glossitis)
- Hypertrophic or atrophic papillae
- Dental cavities and periodontal disease
- Distended, tympanic abdomen
- Ascites and steatorrhea
These symptoms reflect nutritional deficiencies affecting the GI tract.
What are some neurological signs of malnutrition?
- Decreased or loss of reflexes
- Tremor
- Irritability
- Confusion
- Peripheral neuropathy
Neurological symptoms can indicate severe malnutrition.
What are signs of malnutrition in the skin?
- Dry, brittle hair
- Alopecia
- Dry, scaly lips
- Brittle, ridged nails
- Cool, rough, dry, scaly skin
Skin changes can reflect underlying nutritional deficiencies.
What is the purpose of a full nutrition assessment?
To provide a comprehensive approach that includes medical, nutrition, and medication histories, physical assessment, and anthropometric measurements
This is performed if screening identifies a person at risk.
What are potential diagnostic findings associated with malnutrition?
- Low hemoglobin and hematocrit
- Altered serum electrolyte levels
- Low serum albumin, transferrin, and prealbumin
- Increased liver enzymes
- Decreased serum vitamin levels
These findings can help in diagnosing malnutrition.
What are the key components of anthropometric measurements in nutrition assessment?
• Height and weight
• Body mass index (BMI)
• Rate of weight change
• Amount of weight loss
Anthropometric measurements help evaluate nutritional status and identify potential health risks.
What aspects are evaluated in the physical assessment of nutrition?
• Physical appearance
• Muscle mass and strength
• Dental and oral health
These factors can indicate the overall nutritional health of an individual.
What laboratory data are important in a nutrition assessment?
• Glucose
• Electrolytes
• Lipid profile
• Blood urea nitrogen (BUN)
• Albumin, prealbumin, C-reactive protein
Laboratory data provides insight into metabolic and nutritional status.
What does functional status refer to in the context of nutrition assessment?
• Ability to perform basic and instrumental activities of daily living
• Handgrip strength
• Performance tests (e.g., timed walk tests)
Functional status reflects the individual’s ability to maintain independence and perform daily activities.
What is the significance of obtaining a complete diet history from a patient?
It reveals a great deal about the patient’s diet habits and knowledge of good nutrition.
Diet history can help identify nutritional deficiencies or excesses that may not be the primary reason for medical care.
What is the BMI classification for underweight individuals?
A BMI of less than 18.5 kg/m² is considered underweight.
BMI is a widely used measure to categorize weight status.
What is considered normal weight according to BMI?
A BMI between 18.5 and 24.9 kg/m² is considered normal weight.
Maintaining a normal BMI is associated with lower health risks.
What BMI range classifies an individual as overweight?
A BMI between 25 and 29.9 kg/m² is classified as overweight.
Overweight individuals are at increased risk for various health issues.
What BMI value indicates obesity?
A BMI of 30 kg/m² or greater indicates obesity.
Obesity is linked to numerous health complications, including diabetes and heart disease.
What should be assessed regarding weight loss in patients?
Determine whether weight loss is intentional or unintentional, and assess the period over which it occurred.
Unintentional weight loss can be a sign of underlying health issues.
What are some clinical problems for patients with malnutrition?
- Body weight problem
- Risk for impaired tissue integrity
- Inadequate community resources
What are the overall goals for patients with malnutrition?
- Achieve an appropriate weight
- Consume a specified number of calories per day on an individualized diet
- Have no adverse consequences related to malnutrition or nutritional therapies
What is MyPlate?
A visual guide for sensible meal planning that helps Americans eat healthfully and make good food choices.
What are the five food groups emphasized by MyPlate?
- Grains
- Protein
- Fruits
- Vegetables
- Dairy
Where can health professionals find resources related to MyPlate?
At www.myplate.gov, where daily food plans, sample menus, and tips for physical activity are available.
What is the purpose of Nutrition Facts labels?
To provide consumers with nutrition information about commonly consumed foods.
What online resources can help patients find evidence-based food and nutrition recommendations?
Reliable Internet sources and interactive web-based programs.
What are some benefits of mobile device applications related to nutrition?
- Track physical activity, calories, nutrients, and foods eaten
- Use built-in barcode scanners for nutrition facts
- Compare items for nutrition benefit and cost
- Provide information on portion sizes and adjustments needed
What should be assessed during the evaluation of a patient with malnutrition?
Nutrition during the assessment of the patient’s other physical problems.
Why do patients with increased stress, such as surgery or severe trauma, need more calories and protein?
To promote healing and support increased protein synthesis.
What is the importance of daily weights for patients with malnutrition?
Daily weights help monitor the patient’s nutrition status and progress.
What is the serving size mentioned in the nutrition facts?
2/3 cup (55g)
How many calories are in one serving?
230 calories
What is the first tip for a healthy lifestyle according to MyPlate?
Balance calories
What should you do to balance your calories?
Find out how many calories you need for a day and be physically active
What is the recommended action when enjoying your food?
Take the time to enjoy your food as you eat it
How can you avoid oversized portions?
Use a smaller plate, bowl, and glass; portion out foods before eating
List foods to eat more often.
- Vegetables
- Fruits
- Whole grains
- Fat-free or 1% milk and dairy products
What types of vegetables should be included in meals?
Red, orange, and dark-green vegetables
What is a benefit of switching to fat-free or low-fat milk?
Fewer calories and less saturated fat
What should you substitute to eat more whole grains?
A whole-grain product for a refined product
List foods to eat less often.
- Foods high in solid fats
- Added sugars
- Salt
What is the purpose of using the Nutrition Facts label?
To choose lower sodium versions of foods
What is recommended to drink instead of sugary drinks?
Water or unsweetened beverages
What do undernourished patients typically need?
Between-meal supplements
What are oral liquid supplements used for?
To provide extra calories, proteins, fluids, and nutrients
What is the significance of the % Daily Value (DV)?
It tells you how much a nutrient in a serving of food contributes to a daily diet
What should you do to help create a conducive eating environment?
Provide a quiet environment and ensure the patient’s comfort
What is an example of a high-calorie, high-protein food?
Foods preferred by the patient
What are some examples of foods that provide advanced nutrition and calories?
- Milkshakes
- Puddings
- Commercially available products (e.g., Carnation Instant Breakfast, Ensure, Boost)
These products are often used in long-term care to increase caloric intake.
What is refeeding syndrome?
The body’s response to the switch from starvation to a fed state in malnourished patients
It can lead to serious complications such as dysrhythmias and respiratory arrest.
What are the hallmark and other manifestations of refeeding syndrome?
Hallmark: Hypophosphatemia
Other manifestations: * Hyperglycemia
* Fluid retention
* Hypokalemia
* Hypomagnesemia
These conditions can arise during the initial phase of nutrition therapy.
What should be monitored in patients at risk for refeeding syndrome?
- Electrolyte values
- ECG monitoring
Supplements of phosphate, potassium, magnesium, and B vitamins may be necessary.
What are the expected outcomes for a malnourished patient?
- Achieve and maintain optimal body weight
- Consume a well-balanced diet
- Have no adverse outcomes related to malnutrition
- Maintain optimal physical functioning
These outcomes are critical for effective nutrition therapy.
What factors should be assessed in older adults regarding nutrition risk?
- Appetite
- Eating or swallowing problems
- Nutrient intake
- Meal frequency
- Income
- Social isolation
- Functional limitations
- Chronic illnesses
These factors can significantly affect their nutritional status.
What role does social isolation play in the nutrition of older adults?
It may decrease their desire to cook and can lead to a reduced appetite.
Older adults living alone are particularly vulnerable to these issues.
What is the impact of malnutrition on older hospitalized adults?
- Poor wound healing
- Pressure injuries
- Infections
- Decreased muscle strength
- Postoperative complications
- Increased mortality
Malnutrition can severely affect recovery and health outcomes.
What is an important aspect of discharge preparation for malnourished patients?
Teaching about the cause of the undernourished state and ways to prevent it in the future
Awareness of recurring undernourishment is crucial for long-term health.
What community resources can assist with nutrition after hospital discharge?
- Meals on Wheels
- Senior congregate feeding sites
- Supplemental Nutrition Assistance Program (SNAP)
These resources help provide nutritious meals to those in need.
What is the significance of keeping a diet diary for patients?
It helps analyze and reinforce healthful eating patterns and is useful in follow-up care.
Regular self-assessment encourages accountability in dietary habits.
What are common oral conditions that can impair the ability to chew and swallow food in older adults?
Dry mouth and changes in taste
Medications can cause dry mouth, change the taste of food, or decrease appetite.
What unique challenges do older adults with dementia or a stroke face regarding nutrition?
Eating and feeding difficulties
These conditions can complicate the nutrition support process.
What physiologic changes occur with aging that affect caloric requirements?
Decrease in lean body mass and redistribution of fat
This can lead to decreased caloric needs.
What is sarcopenia?
Loss of lean body mass with aging
It affects muscle strength and function.
How does prolonged inactivity affect older adults compared to younger adults?
Older adults lose more lean body mass
This is especially true for those on bed rest.
What changes in the senses can affect the appetite of older adults?
Changes in smell and taste
These can result from medications, nutrient deficiencies, or taste-bud atrophy.
What general nutrition guidelines apply to older adults?
Requirements may vary based on malnutrition and physiologic stress
It is important to assess individual needs.
What may older adults need to do to prevent loss of muscle mass?
Increase their caloric intake
This is crucial for maintaining function.
What should be considered when discharging malnourished older adults from the hospital?
Their ability to access food during recovery
They may not be able to shop for or prepare foods.
Who should be consulted to ensure access to food upon discharge for older adults?
Social worker and dietitian
This helps ensure adequate nutrition support.
What is Enteral Nutrition (EN)?
A method of delivering nutrients directly into the gastrointestinal tract via a feeding tube.
What are the indications for Enteral Nutrition?
- Inability to take oral nourishment
- Anorexia
- Orofacial injuries
- Head and neck cancer
- Neurologic or psychiatric conditions
- Extensive burns
- Critical illness requiring mechanical ventilation
- Chemotherapy or radiation therapy
What are the contraindications for Enteral Nutrition?
- Gastrointestinal obstruction
- Prolonged ileus
- Severe diarrhea
- Enterocutaneous fistula
What are the main advantages of Enteral Nutrition?
- Easier administration
- Safer
- More physiologically efficient
- Less expensive
What factors affect the choice of Enteral Nutrition formula?
- Concentration
- Osmolality
- Protein content
- Sodium content
- Fat content
What are the typical caloric concentrations for Enteral Nutrition formulas?
- Standard formulas: 1 to 1.5 cal/ml
- More calorically dense formulas: 1 to 2 cal/ml
What delivery methods are commonly used for Enteral Nutrition?
- Continuous infusion
- Intermittent (bolus) feedings by infusion pump
- Bolus feedings by gravity
- Bolus feedings by syringe
What factors determine the type of Enteral Nutrition access?
- Anticipated length of time EN will be needed
- Risk for aspiration
- Patient’s clinical status
- Adequacy of digestion and absorption
- Patient’s anatomy
What are the types of feeding tubes suitable for short-term feeding?
- Orogastric tubes
- Nasogastric (NG) tubes
- Nasoduodenal tubes
- Nasojejunal tubes
What is the purpose of transpyloric tubes?
To feed patients below the pyloric sphincter, decreasing the chance of regurgitation and aspiration.
What materials are commonly used for feeding tubes?
- Polyurethane
- Silicone
What are potential complications of using a stylet for tube placement?
Perforation.
What are some disadvantages of smaller feeding tubes?
- They clog easily
- Harder to check residual volume
- Prone to occlusion if drugs are not properly administered
- Can be dislodged by vomiting or coughing
- May become knotted or kinked
What are the options for long-term feeding tube placement?
- Gastrostomy tubes
- Jejunostomy tubes
How can a gastrostomy tube be placed?
- Surgically
- Radiologically
Or endoscopically
What is the purpose of a percutaneous endoscopic gastrostomy (PEG) tube?
To provide enteral nutrition by inserting a tube through the esophagus into the stomach.
What type of anesthesia is required for PEG tube placement?
IV sedation and local anesthesia.
What should be confirmed before starting feedings through a newly inserted nasogastric tube?
Obtain x-ray confirmation of proper tube position.
What are the risks associated with enteral nutrition (EN)?
Aspiration and dislodged tubes.
What type of feeding tube may be necessary for a patient with chronic reflux?
Jejunostomy (J-tube).
What is the function of combination gastrojejunostomy (G-J) tubes?
To allow for simultaneous gastric decompression and small bowel feeding.
When can feedings typically start after a surgically placed gastrostomy or jejunostomy tube?
Within 24 hours after placement.
What method should not be used to determine tube placement?
Auscultation method.
What can capnography help monitor in relation to tube placement?
Breath-to-breath CO2 levels.
What should be done to maintain proper placement of the feeding tube after starting feedings?
Mark the exit site of the tube and check the external length at regular intervals.
What position should the head of the bed be in to decrease the risk for aspiration during enteral feeding?
Elevated 30 to 45 degrees.
What should be assessed to determine if a small bowel tube has dislocated?
Aspirate color and pH.
What is a critical role of nursing in the administration of enteral nutrition?
To ensure that EN is administered safely.
What is the importance of marking the skin insertion site of a G-J tube?
To identify the gastric and jejunal ports.
What are the common problems in patients receiving enteral nutrition?
Accidental tube removal and delayed feedings.
What intervention can be used for patients who try to pull out their feeding tube?
Apply a nasal bridle.
What is the risk associated with a significant increase in the external length of a feeding tube?
Possible dislocation of the tube.
What should be done before feeding a patient receiving enteral nutrition?
Assess for bowel sounds before feeding
What is a key safety measure for administering medications with enteral feeding?
Do not add medications to enteral feeding formula
What should medications be converted to before administering through enteral feeding?
Crush to a fine powder and dissolve in 30-60 ml of purified water
What angle should the head of the bed be elevated to decrease aspiration risk?
30 to 45 degrees
What should be checked according to agency policy during enteral feeding?
Residual volume (RV)
What should be taught to patients and caregivers regarding enteral nutrition?
Home EN and tube care
What is the role of Assistive Personnel (AP) in managing patients receiving enteral nutrition?
Supervise and assist with various tasks such as weighing patients and providing oral care
What should be done for a patient experiencing constipation while on enteral nutrition?
Increase fluid intake and consider changing to a high-fiber formula
What is a management strategy for dehydration in patients receiving enteral nutrition?
Increase fluid intake and check the amount and number of feedings
What should be monitored in patients receiving enteral nutrition to prevent diarrhea?
Check for contaminated formula and medications that may cause diarrhea
What action should be taken if a patient is vomiting during enteral feeding?
Consult with HCP about a prokinetic drug and check tube placement
How often should residual volume be checked in non-critically ill patients?
Every 6 to 8 hours
What should be done with unused enteral formula?
Refrigerate and record the date opened
What is the maximum time a ready-to-feed formula can be left standing?
8 hours
What is a complication related to high-protein enteral formula?
Hyperosmotic diuresis
What should be done if a patient is receiving antibiotics and experiencing diarrhea?
Check the medications being administered and consider changing the formula
What is a critical nursing intervention after bolus feeding?
Keep the head elevated for 30 to 60 minutes
Who must prepare all PN solutions?
A pharmacist or trained technician using strict aseptic techniques.
What is the purpose of the laminar flow hood in PN solution preparation?
To reduce the risk for infection.
How often are PN solutions ordered?
Daily to adjust to the patient’s current needs.
What information is included on a PN solution label?
- Nutrient content
- Date and time mixed
- Expiration date and time
How long can PN solutions be kept at room temperature?
24 hours.
What type of filter should be used with parenteral solutions not containing fat emulsion?
A 0.22-micron filter.
What is the required filter for solutions containing fat emulsion?
A 1.2-micron filter.
How often should filters and IV tubing be changed?
With each new PN container or every 24 hours.
What should be done before starting PN?
Check label and ingredients in solution to ensure they match the HCP order.
What is the recommended glucose range for patients on PN?
140-180 mg/dL.
What should be done if a PN solution bag is not empty after 24 hours?
Discontinue the PN solution and replace it with a new solution.
What are systemic manifestations of catheter-related infections?
- Fever
- Chills
- Nausea
- Vomiting
- Malaise
What is the general rule for transitioning from PN to oral nutrition?
60% of caloric needs should be met orally or through EN.
What initial monitoring is required for assessing effectiveness of PN?
Monitor initial vital signs every 4-8 hours.
What is the female athlete triad?
A syndrome involving eating disorders, amenorrhea, and osteoporosis.
What are the three most common types of eating disorders?
- Anorexia nervosa
- Bulimia nervosa
- Binge-eating disorder
What is bigorexia or muscle dysmorphia?
An extreme concern with becoming more muscular.
What should be done if a catheter-related infection is suspected?
Draw blood cultures and perform a chest x-ray.
What should be monitored to assess hydration status?
Weight patients daily.
What is the preferred delivery method for fat emulsions when infused separately?
Continuous low volume delivered over 12 hours.
What should be assessed in patients receiving PN regarding glucose levels?
Check glucose levels at bedside every 4-6 hours.
What characteristic changes in PN solutions should be monitored?
- Leaks
- Color changes
- Particulate matter
- Clarity
- Fat emulsions separating
What are some complications of Parenteral Nutrition (PN)?
- Air embolus
- Catheter-related sepsis
- Dislodgment
- Hemorrhage
- Occlusion
- Phlebitis
- Pleurothorax, hemothorax, and hydrothorax
- Thrombosis of vein
Complications can arise from the use of catheters for PN, leading to various medical issues.
What metabolic problems can occur with Parenteral Nutrition?
- Altered renal function
- Essential fatty acid deficiency
- Hyperglycemia
- Hypoglycemia
- Hyperlipidemia
- Liver dysfunction
- Refeeding syndrome
Metabolic issues can arise due to the composition and management of PN.
What characterizes Anorexia Nervosa (AN)?
- Restricting energy intake
- Difficulty maintaining appropriate weight
- Intense fear of gaining weight
- Distorted body image
AN primarily affects adolescents, particularly females aged 13 to 19.
What are common assessment findings in patients with Anorexia Nervosa?
- Signs of malnutrition
- Significant weight loss or low BMI (under 17)
- Hypothermia
- Muscle weakness
These findings are critical for diagnosing and assessing the severity of AN.
What diagnostic studies are often seen in Anorexia Nervosa?
- Osteopenia or osteoporosis
- Iron-deficiency anemia
- High blood urea nitrogen level
- Abnormal renal function
These studies help in understanding the physiological impact of AN on the body.
What are manifestations of decreased potassium in Anorexia Nervosa?
- Muscle weakness
- Dysrhythmias
- Renal failure
Potassium levels can significantly impact heart and muscle function.
What is a key element in treating patients with Anorexia Nervosa?
Building rapport with the patient
Patients often have anxiety about treatment due to their fear of gaining weight.
What does the treatment for Anorexia Nervosa involve?
- Nutrition support
- Psychiatric care
- Reaching and maintaining a healthy weight
- Normal eating patterns
Treatment often requires close supervision by a specialist.
What complications can arise from refeeding programs in Anorexia Nervosa?
Refeeding syndrome
This syndrome is a rare but serious condition that can occur during nutritional replenishment.
What characterizes Bulimia Nervosa (BN)?
- Recurrent episodes of binge eating
- Inappropriate compensatory behaviors (vomiting, laxative misuse, overexercise)
- Concern with body image
BN can occur in individuals of normal weight or those who fluctuate in weight.
What are common signs associated with frequent vomiting in Bulimia Nervosa?
- Macerated knuckles
- Swollen salivary glands
- Broken blood vessels in the eyes
- Dental problems
These signs indicate the physical toll of BN on the body.
What laboratory values may be abnormal in Bulimia Nervosa?
- Hypokalemia
- Metabolic alkalosis
- Increased serum amylase
These abnormalities result from the physiological effects of bingeing and purging.
What is the recommended treatment for Bulimia Nervosa?
- Psychologic counseling (cognitive behavioral and family therapy)
- Nutrition counseling
- Fluoxetine (Prozac)
Fluoxetine is the only FDA-approved antidepressant for BN.
