Chapter 44 Nutrition Problems Flashcards
What is nutrition the sum of?
Processes by which one takes in and uses nutrients
Nutrition encompasses ingestion, absorption, digestion, and metabolism of nutrients.
What are the three categories of nutrition status?
Undernutrition, normal nutrition, overnutrition
These categories reflect the continuum of nutritional health.
What can cause nutrition problems?
Any change in nutrient intake or use
Nutrition problems can arise from various factors affecting food consumption and utilization.
Are nutrition problems limited to specific demographics?
No, they occur in all ages, cultures, ethnic groups, and socioeconomic classes
Nutrition issues are universal and not confined to any particular group.
What influences our attitudes towards food?
Cultural or religious practices, financial status, community resources
These factors shape individual dietary habits and choices.
What is the importance of nutrition?
Energy, growth, maintaining and repairing body tissues
Proper nutrition is fundamental for overall health and bodily functions.
What results from optimal nutrition in the absence of disease?
Eating a balanced diet
A balanced diet includes appropriate proportions of macronutrients and micronutrients.
List the major components of the basic food groups.
- Macronutrients (carbohydrates, fats, proteins)
- Micronutrients (vitamins, minerals, electrolytes)
- Water
These components are essential for maintaining health.
What factors influence a person’s daily caloric requirements?
- Body type
- Age
- Gender
- Medications
- Physical activity
- Presence of disease
Each of these factors can alter energy needs.
What equation calculates daily adult energy requirements?
Mifflin-St. Jeor equation
This equation is based on resting metabolic rate.
How can one estimate daily caloric needs simply?
Kilocalories per kilogram (kcal/kg)
A common recommendation is 20 to 25 cal/kg body weight.
Fill in the blank: Optimal nutrition and daily physical activity are essential for _______.
[health]
Both nutrition and physical activity play critical roles in overall well-being.
What is the calorie intake recommended for weight loss?
Around 20 to 25 cal/kg.
What is the calorie intake recommended for weight maintenance?
25 to 30 cal/kg.
What calorie intake may those with injury or illness need?
At least 30 to 35 cal/kg.
What is the main source of energy for the body?
Carbohydrates.
How many calories do carbohydrates yield per gram?
4 cal/g.
What are the two classifications of carbohydrates?
Simple and complex.
What are monosaccharides?
Single sugar units such as glucose and fructose.
What are disaccharides?
Two sugar units such as sucrose, maltose, and lactose.
What are polysaccharides?
Complex carbohydrates such as starches.
What percentage of total calories should come from carbohydrates according to DRI?
45% to 65%.
How much fiber should a person consume per 1000 calories?
Around 14 g.
What is the recommended daily fiber intake for a 2000-calorie diet?
28 to 30 g.
What is the calorie yield of one gram of fat?
9 calories.
What percentage of total calories should fats comprise?
20% to 35%.
What are the two types of fats?
Potentially harmful fats and healthier fats.
What type of fat may be especially beneficial to heart health?
Omega-3 fatty acids.
What is the recommended daily limit of saturated fat in a 2000-calorie diet?
Less than 10% of calories, about 20 g.
What are proteins essential for?
Tissue growth, repair, maintenance, regulatory functions, and energy production.
What percentage of daily caloric needs should come from protein?
10% to 35%.
What is the recommended daily protein intake for an average person?
0.8 to 1 g/kg of body weight.
How many calories does one gram of protein yield?
4 calories.
What are the basic units of protein structure?
Amino acids.
How many essential amino acids are there?
9 essential amino acids.
What are complete proteins?
Proteins that contain all essential amino acids.
What are vitamins needed for?
Normal metabolism.
What are the two categories of vitamins?
Water-soluble and fat-soluble vitamins.
Which vitamins are fat-soluble?
Vitamins A, D, E, and K.
What are mineral salts needed for?
Building and repairing tissues, regulating body fluids, and assisting in various functions.
What are major minerals?
Minerals needed in amounts greater than 100 mg/day.
What are trace elements?
Minerals present in minute amounts.
What can happen if fat-soluble vitamins are consumed in excess?
Toxicity.
What is the range of trace minerals to major minerals in a well-balanced diet?
From a few micrograms of trace minerals to 1 g or more of major minerals such as calcium, phosphorus, and sodium.
What is a common characteristic among all vegetarians?
The exclusion of red meat from the diet.
What are the two main types of vegetarians?
- Vegans (pure or total vegetarians who eat only plants)
- Lacto-ovo-vegetarians (eat plants, dairy products, and eggs)
What is a potential risk for vegetarians without a well-planned diet?
Vitamin or protein deficiencies.
How can the nutritional value of plant proteins be increased?
By combining different vegetable protein foods, such as cornmeal and kidney beans.
What is an excellent protein source for vegetarians that should be calcium fortified?
Milk made from soybeans or almonds.
What is the main deficiency for strict vegans?
A lack of cobalamin (vitamin B12).
What can develop in vegans not using cobalamin supplements?
Megaloblastic anemia and neurologic signs of cobalamin deficiency.
What other deficiencies may vegans and lacto-ovo-vegetarians face?
- Calcium
- Zinc
- Vitamins A and D
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?
The ingestion of more food than is required for body needs, as in obesity.
What occurs during undernutrition?
Nutrition reserves are depleted and nutrient and energy intake are not sufficient to meet daily needs or added metabolic stress.
What is the prevalence range of malnutrition in hospital settings?
30% to 50%.
What is the prevalence of malnutrition among community-dwelling older adults?
About 6%.
What is the prevalence of malnutrition in rehabilitation settings for older adults?
Up to 50%.
What cultural factors can influence a person’s diet?
Beliefs and behaviors related to food, including religion.
What should be assessed in a patient’s diet history?
The extent to which they adhere to diet practices.
True or False: Acculturation can affect diet practices.
True.
What is an example of dietary adjustment for a Jewish patient?
Ensuring that an enteral feeding formula is Kosher.
What adjustment may be needed for a Muslim patient during Ramadan?
Meal plans should be adjusted to accommodate fasting during daylight hours.
Fill in the blank: Malnutrition affects _______ and functional status.
body composition
What is starvation-related malnutrition?
Occurs when nutrition needs are not met with chronic starvation without inflammation
Example: anorexia nervosa
What characterizes chronic disease-related malnutrition?
Diet intake does not meet tissue needs due to sustained mild to moderate inflammation
Examples: organ failure, cancer, rheumatoid arthritis, obesity
What is acute disease-related or injury-related malnutrition?
Related to acute disease or injury states with marked inflammatory response
Example: major infection, burns, trauma, surgery
List four contributing factors to malnutrition.
- Socio-economic factors
- Physical illnesses
- Incomplete diets
- Drug-nutrient interactions
What is food insecurity?
Inadequate access to food, affecting the quality and nutritional value of available food
Often leads to choosing less expensive, energy-dense foods
What are safety net programs?
Programs that help people obtain food, including food assistance and housing subsidies
Examples: Meals on Wheels, food pantries
What does the ‘heat or eat’ phenomenon refer to?
Struggle of individuals with limited economic resources to pay for bills or food
Older adults on fixed incomes face this dilemma
How can prolonged illness contribute to malnutrition?
It can lead to undernutrition, which worsens pathologic conditions
Examples: major surgery, sepsis, draining wounds
What are some conditions that increase the risk for malnutrition?
- Chronic alcohol use
- Decreased mobility
- Dementia
- Depression
- Drugs with antinutrient properties
- Excess dieting
- Need for increased nutrients due to hypermetabolism
- No oral intake for extended periods
- Nutrient losses from malabsorption
- Swallowing problems
Fill in the blank: Malnutrition is a common consequence of _______.
[illness, surgery, injury, or hospitalization]
What is the recommended daily intake of Vitamin A (retinol) for men?
900 mcg/retinol equivalents
This refers to the dietary reference intake for adult men.
What is the recommended daily intake of Vitamin A (retinol) for women?
700 mcg/retinol equivalents
This refers to the dietary reference intake for adult women.
What is the recommended daily intake of Vitamin D for adults aged 19-70?
600 IU
IU stands for International Units, a measure of vitamin potency.
What is the recommended daily intake of Vitamin D for adults over 70?
800 IU
This increase accounts for changes in metabolism with age.
What is the recommended daily intake of Vitamin E for adults?
15 mg
Vitamin E is important for immune function and skin health.
What is the recommended daily intake of Vitamin K for men?
120 mcg
Vitamin K is essential for blood coagulation.
What is the recommended daily intake of Vitamin K for women?
90 mcg
This amount supports bone health and blood clotting.
List 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
These symptoms highlight the importance of Vitamin A in immune function and vision.
List the manifestations of Vitamin D deficiency.
- Muscular weakness
- Excessive sweating
- Diarrhea and other GI problems
- Bone pain
- Active or healed rickets
- Osteomalacia
Vitamin D is crucial for calcium absorption and bone health.
List the manifestations of Vitamin E deficiency.
- Neurologic deficits
- Blood coagulation problems
Vitamin E acts as an antioxidant and supports neurological function.
What is the recommended daily intake of Vitamin B1 (thiamine) for men?
1.2 mg
Thiamine is important for energy metabolism.
What is the recommended daily intake of Vitamin B1 (thiamine) for women?
1.1 mg
This vitamin is vital for nerve function and carbohydrate metabolism.
What are the manifestations of Vitamin B6 (pyridoxine) deficiency?
- Seizures
- Dermatitis
- Anemia
- Neuropathy with motor weakness
- Anorexia
Vitamin B6 is involved in amino acid metabolism and neurotransmitter synthesis.
What is the recommended daily intake of Vitamin B12 (cobalamin) for adults?
2.4 mcg
Vitamin B12 is essential for red blood cell formation and neurological function.
List 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
These symptoms can indicate severe deficiencies affecting blood and nerve health.
What is the recommended daily intake of Folate (folic acid) for men?
90 mg
Folate is critical for DNA synthesis and cell division.
What is the recommended daily intake of Folate (folic acid) for women?
75 mg
Folate is especially important for women of childbearing age to prevent neural tube defects.
What are the manifestations of Folate deficiency?
- Impaired cell division and protein synthesis
- Megaloblastic anemia
- Anorexia
- Fatigue
- Sore tongue
- Diarrhea
- Forgetfulness
These symptoms underscore the role of folate in cellular processes.
What is the recommended daily intake of Vitamin A (retinol) for men?
900 mcg/retinol equivalents
This refers to the dietary reference intake for adult men.
What is the recommended daily intake of Vitamin A (retinol) for women?
700 mcg/retinol equivalents
This refers to the dietary reference intake for adult women.
What is the recommended daily intake of Vitamin D for adults aged 19-70?
600 IU
IU stands for International Units, a measure of vitamin potency.
What is the recommended daily intake of Vitamin D for adults over 70?
800 IU
This increase accounts for changes in metabolism with age.
What is the recommended daily intake of Vitamin E for adults?
15 mg
Vitamin E is important for immune function and skin health.
What is the recommended daily intake of Vitamin K for men?
120 mcg
Vitamin K is essential for blood coagulation.
What is the recommended daily intake of Vitamin K for women?
90 mcg
This amount supports bone health and blood clotting.
List 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
These symptoms highlight the importance of Vitamin A in immune function and vision.
List the manifestations of Vitamin D deficiency.
- Muscular weakness
- Excessive sweating
- Diarrhea and other GI problems
- Bone pain
- Active or healed rickets
- Osteomalacia
Vitamin D is crucial for calcium absorption and bone health.
List the manifestations of Vitamin E deficiency.
- Neurologic deficits
- Blood coagulation problems
Vitamin E acts as an antioxidant and supports neurological function.
What is the recommended daily intake of Vitamin B1 (thiamine) for men?
1.2 mg
Thiamine is important for energy metabolism.
What is the recommended daily intake of Vitamin B1 (thiamine) for women?
1.1 mg
This vitamin is vital for nerve function and carbohydrate metabolism.
What are the manifestations of Vitamin B6 (pyridoxine) deficiency?
- Seizures
- Dermatitis
- Anemia
- Neuropathy with motor weakness
- Anorexia
Vitamin B6 is involved in amino acid metabolism and neurotransmitter synthesis.
What is the recommended daily intake of Vitamin B12 (cobalamin) for adults?
2.4 mcg
Vitamin B12 is essential for red blood cell formation and neurological function.
List 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
These symptoms can indicate severe deficiencies affecting blood and nerve health.
What is the recommended daily intake of Folate (folic acid) for men?
90 mg
Folate is critical for DNA synthesis and cell division.
What is the recommended daily intake of Folate (folic acid) for women?
75 mg
Folate is especially important for women of childbearing age to prevent neural tube defects.
What are the manifestations of Folate deficiency?
- Impaired cell division and protein synthesis
- Megaloblastic anemia
- Anorexia
- Fatigue
- Sore tongue
- Diarrhea
- Forgetfulness
These symptoms underscore the role of folate in cellular processes.
What is the conversion factor of retinol equivalent to international units of vitamin A activity?
1 retinol equivalent = 10 international units of vitamin A activity
This conversion is essential for understanding vitamin A dosages.
What symptoms may accompany gastrointestinal disease?
- Anorexia
- Nausea
- Vomiting
- Diarrhea
- Abdominal distention
- Abdominal cramping
These symptoms can interfere with normal food intake and metabolism.
What is malabsorption syndrome?
Impaired absorption of nutrients from the GI tract
This condition can result from decreases in digestive enzymes or bowel processes.
How do antibiotics affect biotin production?
Antibiotics can change the normal flora of the intestines, decreasing the body’s ability to make biotin
Biotin is a B-complex vitamin dependent on gut flora for its production.
What effect does fever have on basal metabolic rate (BMR)?
Each degree of temperature increase raises BMR by about 7%
Increased BMR leads to nitrogen loss and protein depletion if caloric intake does not increase.
What risk do patients undergoing diagnostic studies face regarding nutrition?
Patients can become malnourished due to diet restrictions imposed by multiple diagnostic studies
This occurs even if patients are nutritionally fit upon entering the hospital.
In which populations are vitamin deficiencies likely to occur?
- Persons with alcohol and drug use patterns
- Chronically ill individuals
- Those who follow poor dietary practices
- Individuals who have had GI tract surgery
Surgery, like ileum resection, can increase the risk of deficiencies in fat-soluble vitamins.
What are the manifestations of vitamin imbalances?
Manifestations can range from skin problems to neurologic signs
The severity and type of symptoms depend on which vitamins are imbalanced.
What defines a drug-nutrient interaction?
A drug affects the use of nutrients in the body
These interactions can lead to adverse effects like altered drug effectiveness and impaired nutrition.
How can grapefruit juice affect drug absorption?
Grapefruit juice can increase the absorption of some drugs, enhancing their effect
This interaction is important to monitor in clinical settings.
What is the pathophysiology of starvation?
Physiologic changes occur in the body during starvation
Understanding these changes can help in managing patients who are malnourished.
What does the body primarily use to meet metabolic needs during early malnutrition?
Carbohydrates (glycogen)
Carbohydrate stores are minimal and can be depleted within 18 hours.
What process does the body initiate once carbohydrate stores are depleted?
Gluconeogenesis
The liver converts skeletal protein to glucose for energy.
Which amino acids are the first used in gluconeogenesis?
- Alanine
- Glutamine
What happens to nitrogen balance when amino acids are used as energy sources?
Negative nitrogen balance occurs
Nitrogen excretion exceeds nitrogen intake.
Within how many days does the body start using fat to supply energy during starvation?
5 to 9 days
What percentage of calories can fat provide in prolonged starvation?
Up to 97%
What happens to body proteins once fat stores are depleted?
Visceral and body proteins are used as energy
This includes proteins in internal organs and plasma.
What effect does surgery, physical trauma, or infection have on a malnourished patient?
Increased metabolic energy expenditure
What occurs as protein depletion continues in a malnourished patient?
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 happens to body fluids when plasma oncotic pressure decreases?
Body fluids shift from the vascular space into the interstitial compartment.
What observable sign can result from fluid leaking into the interstitial space?
Edema
Edema in the face and legs can mask underlying muscle wasting.
What happens to sodium and potassium concentrations during malnutrition?
- Sodium concentration increases in the cell
- Potassium shifts to the extracellular space
What percentage of calories does the sodium-potassium exchange pump use?
20% to 50%
What organ loses the most mass during protein deprivation?
Liver
What happens to the liver due to decreased synthesis of lipoproteins?
Fat gradually infiltrates the liver.
What is a significant outcome if a malnourished person does not receive protein and necessary nutrients?
Death will rapidly ensue.
How does inflammation affect nutrient metabolism?
It increases protein and skeletal muscle breakdown and increases BMR.
What are proinflammatory cytokines related to inflammation?
- Interleukin-6 (IL-6)
What are anti-inflammatory cytokines related to inflammation?
- IL-10
What are some clinical manifestations of malnutrition?
- Dry and scaly skin
- Brittle nails
- Rashes
- Hair loss
- Crusting and ulceration in the mouth
- Decreased muscle mass and weakness
- Mental changes
What factors affect the speed at which malnutrition develops?
- Quantity and quality of protein intake
- Caloric value
- Illness
- Person’s age
What is the best way to determine malnutrition?
Assessment of nutrient intake, functional status, and body composition.
What laboratory tests can reflect changes in malnutrition?
- Serum electrolyte levels
- RBC count
- Hemoglobin level
- Total lymphocyte count
What happens to the total lymphocyte count with malnutrition?
It decreases.
What are important health history factors related to malnutrition?
- Severe burns
- Major trauma
- Hemorrhage
- Draining wounds
- Bone fractures with prolonged immobility
- Chronic renal or liver disease
- Cancer
- Malabsorption syndromes
- Gastrointestinal obstruction
- Infectious diseases
- Acute trauma
- Sepsis
- Chronic inflammatory conditions (e.g., rheumatoid arthritis)
These factors can significantly impact nutritional status and contribute to malnutrition.
Which medications are associated with malnutrition?
- Corticosteroids
- Chemotherapy
- Diet pills
- Diet supplements
- Herbs
Certain medications can affect appetite, nutrient absorption, and metabolism.
What surgical or treatment history factors are relevant for malnutrition assessment?
- Recent surgery
- Radiation
Surgical interventions can influence nutritional needs and absorption.
What are subjective data indicators of malnutrition in health perception?
- Alcohol or drug use
- Malaise
These factors can affect overall health management and nutritional status.
List indicators of nutritional-metabolic changes in malnutrition assessment.
- Increase or decrease in weight
- Weight problems
- Increase or decrease in appetite
- Typical diet intake
- Food preferences and aversions
- Food allergies or intolerance
- Ill-fitting or absent dentures
- Dry mouth
- Problems chewing or swallowing
- Bloating or gas
- Sensitivity to cold
- Delayed wound healing
These indicators help assess the nutritional needs and challenges faced by the individual.
What elimination patterns may indicate malnutrition?
- Constipation
- Diarrhea
- Nocturia
- Decreased urine output
Changes in elimination patterns can reflect underlying nutritional issues.
What activity-exercise changes can suggest malnutrition?
- Increase or decrease in activity
- Weakness
- Fatigue
- Decreased endurance
These changes may indicate a lack of energy or nutrients necessary for physical performance.
What cognitive-perceptual symptoms are associated with malnutrition?
- Pain in mouth
- Paresthesias
- Loss of position sense
- Loss of vibratory sense
Neurological symptoms can arise from nutritional deficiencies.
What role-relationship factors may affect nutritional status?
- Change in family (e.g., loss of a spouse)
- Financial resources
- Food availability
Social factors can greatly influence access to and the ability to maintain a nutritious diet.
What sexual-reproductive issues may indicate malnutrition?
- Amenorrhea
- Impotence
- Decreased libido
These issues can stem from hormonal imbalances related to nutritional deficiencies.
What are general objective data signs of malnutrition?
- Listless
- Cachectic
- Underweight for height
Physical appearance can provide immediate insight into nutritional status.
What cardiovascular signs may indicate malnutrition?
- Low heart rate
- Low blood pressure
- Dysrhythmias
- Peripheral edema
Cardiovascular health can be compromised due to malnutrition.
What eye symptoms are indicative of malnutrition?
- Pale or red conjunctivae
- Gray keratinized epithelium on conjunctiva (Bitot spots)
- Dryness and dull appearance of conjunctivae and cornea
- Soft cornea
- Blood vessel growth in cornea
- Redness and fissuring of eyelid corners
These signs can reflect vitamin deficiencies, particularly vitamin A.
What gastrointestinal signs may suggest malnutrition?
- Swollen, smooth, raw, beefy red tongue (glossitis)
- Hypertrophic or atrophic papillae
- Dental cavities
- Absent or loose teeth
- Discolored tooth enamel
- Spongy, pale, receded gums
- Ulcerations, white patches, or plaques
- Distended abdomen
- Ascites
- Hepatomegaly
- Decreased bowel sounds
- Steatorrhea
These symptoms can indicate deficiencies in essential nutrients.
What musculoskeletal signs are associated with malnutrition?
- Decreased muscle mass
- Poor tone
- Wasted appearance
- Bowlegs
- Knock-knees
- Beaded ribs
- Chest deformity
- Prominent bony structures
Musculoskeletal changes can reflect inadequate protein and caloric intake.
What neurologic signs may indicate malnutrition?
- Decreased or loss of reflexes
- Tremor
- Irritability
- Confusion
- Syncope
- Peripheral neuropathy
Neurological issues can arise from deficiencies in B vitamins and other nutrients.
What respiratory signs may be present in malnutrition?
- Increased respiratory rate
- Decreased vital capacity
- Crackles
- Weak cough
- Slight cyanosis
Respiratory function can be affected by malnutrition, leading to increased risk of respiratory illnesses.
What skin signs may indicate malnutrition?
- Dry, brittle, sparse hair
- Color changes in hair
- Alopecia
- Dry, scaly lips
- Fever blisters
- Angular crusts and lesions at corners of mouth (cheilosis)
- Brittle, ridged nails
- Decreased tone and elasticity of skin
- Cool, rough, dry, scaly skin
- Brown-gray pigment changes
- Reddened, scaly dermatitis
- Scrotal dermatitis
Skin changes can reflect deficiencies in essential fatty acids, vitamins, and minerals.
What are possible diagnostic findings in malnutrition?
- Low hemoglobin and hematocrit
- Increased mean corpuscular volume (MCV)
- Altered serum electrolyte levels (especially hyperkalemia)
- Increased BUN and creatinine
- Low serum albumin
- Low transferrin
- Low prealbumin
- Increased C-reactive protein
- Low lymphocytes
- Increased liver enzymes
- Low serum vitamin levels
These laboratory findings can help confirm the diagnosis of malnutrition and guide treatment.
What are important health history factors related to malnutrition?
- Severe burns
- Major trauma
- Hemorrhage
- Draining wounds
- Bone fractures with prolonged immobility
- Chronic renal or liver disease
- Cancer
- Malabsorption syndromes
- Gastrointestinal obstruction
- Infectious diseases
- Acute trauma
- Sepsis
- Chronic inflammatory conditions (e.g., rheumatoid arthritis)
These factors can significantly impact nutritional status and contribute to malnutrition.
Which medications are associated with malnutrition?
- Corticosteroids
- Chemotherapy
- Diet pills
- Diet supplements
- Herbs
Certain medications can affect appetite, nutrient absorption, and metabolism.
What surgical or treatment history factors are relevant for malnutrition assessment?
- Recent surgery
- Radiation
Surgical interventions can influence nutritional needs and absorption.
What are subjective data indicators of malnutrition in health perception?
- Alcohol or drug use
- Malaise
These factors can affect overall health management and nutritional status.
List indicators of nutritional-metabolic changes in malnutrition assessment.
- Increase or decrease in weight
- Weight problems
- Increase or decrease in appetite
- Typical diet intake
- Food preferences and aversions
- Food allergies or intolerance
- Ill-fitting or absent dentures
- Dry mouth
- Problems chewing or swallowing
- Bloating or gas
- Sensitivity to cold
- Delayed wound healing
These indicators help assess the nutritional needs and challenges faced by the individual.
What elimination patterns may indicate malnutrition?
- Constipation
- Diarrhea
- Nocturia
- Decreased urine output
Changes in elimination patterns can reflect underlying nutritional issues.
What activity-exercise changes can suggest malnutrition?
- Increase or decrease in activity
- Weakness
- Fatigue
- Decreased endurance
These changes may indicate a lack of energy or nutrients necessary for physical performance.
What cognitive-perceptual symptoms are associated with malnutrition?
- Pain in mouth
- Paresthesias
- Loss of position sense
- Loss of vibratory sense
Neurological symptoms can arise from nutritional deficiencies.
What role-relationship factors may affect nutritional status?
- Change in family (e.g., loss of a spouse)
- Financial resources
- Food availability
Social factors can greatly influence access to and the ability to maintain a nutritious diet.
What sexual-reproductive issues may indicate malnutrition?
- Amenorrhea
- Impotence
- Decreased libido
These issues can stem from hormonal imbalances related to nutritional deficiencies.
What are general objective data signs of malnutrition?
- Listless
- Cachectic
- Underweight for height
Physical appearance can provide immediate insight into nutritional status.
What cardiovascular signs may indicate malnutrition?
- Low heart rate
- Low blood pressure
- Dysrhythmias
- Peripheral edema
Cardiovascular health can be compromised due to malnutrition.
What eye symptoms are indicative of malnutrition?
- Pale or red conjunctivae
- Gray keratinized epithelium on conjunctiva (Bitot spots)
- Dryness and dull appearance of conjunctivae and cornea
- Soft cornea
- Blood vessel growth in cornea
- Redness and fissuring of eyelid corners
These signs can reflect vitamin deficiencies, particularly vitamin A.
What gastrointestinal signs may suggest malnutrition?
- Swollen, smooth, raw, beefy red tongue (glossitis)
- Hypertrophic or atrophic papillae
- Dental cavities
- Absent or loose teeth
- Discolored tooth enamel
- Spongy, pale, receded gums
- Ulcerations, white patches, or plaques
- Distended abdomen
- Ascites
- Hepatomegaly
- Decreased bowel sounds
- Steatorrhea
These symptoms can indicate deficiencies in essential nutrients.
What musculoskeletal signs are associated with malnutrition?
- Decreased muscle mass
- Poor tone
- Wasted appearance
- Bowlegs
- Knock-knees
- Beaded ribs
- Chest deformity
- Prominent bony structures
Musculoskeletal changes can reflect inadequate protein and caloric intake.
What neurologic signs may indicate malnutrition?
- Decreased or loss of reflexes
- Tremor
- Irritability
- Confusion
- Syncope
- Peripheral neuropathy
Neurological issues can arise from deficiencies in B vitamins and other nutrients.
What respiratory signs may be present in malnutrition?
- Increased respiratory rate
- Decreased vital capacity
- Crackles
- Weak cough
- Slight cyanosis
Respiratory function can be affected by malnutrition, leading to increased risk of respiratory illnesses.
What skin signs may indicate malnutrition?
- Dry, brittle, sparse hair
- Color changes in hair
- Alopecia
- Dry, scaly lips
- Fever blisters
- Angular crusts and lesions at corners of mouth (cheilosis)
- Brittle, ridged nails
- Decreased tone and elasticity of skin
- Cool, rough, dry, scaly skin
- Brown-gray pigment changes
- Reddened, scaly dermatitis
- Scrotal dermatitis
Skin changes can reflect deficiencies in essential fatty acids, vitamins, and minerals.
What are possible diagnostic findings in malnutrition?
- Low hemoglobin and hematocrit
- Increased mean corpuscular volume (MCV)
- Altered serum electrolyte levels (especially hyperkalemia)
- Increased BUN and creatinine
- Low serum albumin
- Low transferrin
- Low prealbumin
- Increased C-reactive protein
- Low lymphocytes
- Increased liver enzymes
- Low serum vitamin levels
These laboratory findings can help confirm the diagnosis of malnutrition and guide treatment.
What happens to liver enzyme levels in cases of malnutrition?
Liver enzyme levels may increase.
Elevated liver enzymes can indicate liver dysfunction or damage associated with malnutrition.
How are serum levels of fat-soluble vitamins affected in malnutrition?
Serum levels of fat-soluble vitamins usually decrease.
Low serum levels of fat-soluble vitamins correlate with the presence of steatorrhea (fatty stools).
What are albumin and prealbumin classified as during an inflammatory response?
Negative acute phase proteins.
Their levels decrease during inflammation, indicating potential malnutrition.
What do low levels of albumin and prealbumin indicate?
The presence of inflammation and potential malnutrition.
They are useful in identifying patients at risk for poor outcomes.
What is the nurse’s responsibility regarding nutrition in care settings?
Nutrition screening across care settings.
This helps identify those who are malnourished or at risk for malnutrition.
What does the Joint Commission require for all patients upon admission?
Nutrition screening within 24 hours.
A detailed nutrition assessment is required if a patient is identified as at risk.
What is the purpose of using valid and reliable tools in nutrition screening?
To accurately identify those at risk for malnutrition.
Standard approaches ensure consistency in screening.
What common admission assessment data is reviewed in hospital-specific screening tools?
History of weight loss, intake before admission, use of nutrition support, chewing or swallowing issues, and skin breakdown.
These factors help determine a patient’s nutritional risk.
What is the Malnutrition Universal Screening Tool used for?
It assesses nutrition status in adults in acute care.
This tool helps identify malnutrition risk in hospitalized patients.
Which tool is used to assess nutrition status in older adults?
MNA (Mini Nutritional Assessment).
This tool is specifically designed for geriatric populations.
What form is used in long-term care to obtain nutrition information?
Minimum Data Set (MDS) form.
This form collects comprehensive data on residents’ nutritional status.
Which assessment tool is used in home care settings?
Outcome and Assessment Information Set (OASIS).
OASIS collects information on diet, oral intake, dental health, swallowing problems, and meal assistance needs.
What should be done if screening identifies a person at risk for malnutrition?
Perform a full nutrition assessment.
This assessment includes medical, nutrition, and medication histories, physical assessment, and anthropometric measurements.
What is the purpose of a nutrition assessment?
Provides the basis for nutrition intervention.
What should be obtained to assess a patient’s diet habits?
A complete diet history from the patient or caregiver.
Why is it important to assess foods eaten over the past week?
Reveals a great deal about the patient’s diet habits and knowledge of good nutrition.
How can a patient’s nutrition state impact medical care?
It may be a contributing factor to the problem and have an impact on management and recovery.
What anthropometric measurements should be obtained?
Height, weight, and girth measurements.
How is body mass index (BMI) calculated?
By measuring weight for height.
What are critical measurements for assessing nutrition status?
Waist circumference and hip-to-waist ratio.
What is a critical indicator for further assessment in older adults regarding weight?
A loss of more than 5% of usual body weight over 6 months.
What should be determined if involuntary weight loss exceeds 10% of the usual weight?
The reason for the weight loss.
What is the significance of unintentional weight loss in obese individuals?
Malnutrition can be present despite excess body weight.
What is the BMI range for underweight?
Less than 18.5 kg/m².
What is the BMI range for normal weight?
Between 18.5 and 24.9 kg/m².
What is the BMI range for overweight?
Between 25 and 29.9 kg/m².
What BMI value is considered obese?
A BMI of 30 kg/m² or greater.
What should be noted when assessing a patient’s weight history?
Weight loss and whether it was intentional.
What is an alternative to standing height measurements for bedridden patients?
Using a Luft ruler.
What is the arm demi-span measurement?
Distance from the suprasternal notch to the web between the middle and ring fingers.
What BMI value is considered obese?
A BMI of 30 or greater
BMIs outside the normal weight range are associated with increased mortality.
What indicators are used to assess subcutaneous fat stores?
Skintold thickness at various sites
The most reflective sites include those over the biceps, triceps, below the scapula, above the iliac crest, and over the upper thigh.
Which measurements can indicate protein stores?
Midarm muscle circumference
Both skinfold thickness and midarm circumference may decrease in malnutrition.
What is the focus of functional assessment in nutrition?
Performance of activities of daily living (ADLs)
Tools used include the Katz Index and Lawton Scale.
How can physical functional status be assessed?
By measuring muscle strength
Handgrip strength can be measured with a hand dynamometer.
What are common clinical problems associated with malnutrition?
- Nutritionally compromised
- Body weight problem
- Risk for impaired tissue integrity
- Inadequate community resources
What are the overall goals for a patient 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 nutrition therapies
What is the purpose of MyPlate?
A visual guide for sensible meal planning
It helps Americans eat healthfully and make good food choices.
What are the five food groups represented in MyPlate?
- Grains
- Protein
- Fruits
- Vegetables
- Dairy
What resources are available for determining nutrition information?
Electronic and print sources
Many food products have Nutrition Facts labels.
What should a patient do to track their nutrition and physical activity?
Use interactive web-based programs and mobile device applications
Some applications include built-in barcode scanners to scan foods quickly.
What is crucial for patients with malnutrition undergoing surgery?
Increased protein and calorie intake preoperatively
This is essential to promote healing after surgery.
What should be discussed with patients regarding their nutrition?
The importance of good nutrition
Discuss daily weights, intake, and output.
What does ongoing recording of body weight gain or loss indicate?
Shifts in fluid balance
Rapid gains and losses usually reflect changes in fluid rather than actual body mass.
What additional information is needed alongside body weight to assess a patient’s nutrition state?
Accurate recording of food and fluid intake
What type of foods should be selected for patients who can eat by mouth?
High-calorie and high-protein foods
Unless medically contraindicated.
How can patient food intake be enhanced?
Offering foods preferred by the patient
What should caregivers do to improve eating conditions for the patient?
Bring the patient’s favorite foods from home
What is essential for creating a conducive environment for eating?
A quiet environment
What hygiene practices should be offered to patients before meals?
Oral hygiene and hand hygiene
What should be done to ensure the patient is comfortable during meals?
Help the patient to a comfortable position and adjust the bedside table height
What items should be kept out of sight to maintain a pleasant mealtime environment?
Urinals, bedpans, and emesis basins
What should be done to protect mealtime from interruptions?
Perform nonurgent care before or after mealtime
What do undernourished patients typically need in addition to regular meals?
Between-meal supplements
What can these between-meal supplements consist of?
Items prepared in the dietary department or commercially prepared products
What is the purpose of eating between-meal supplements?
To provide extra calories, proteins, fluids, and nutrients
What should be considered if a patient cannot consume enough nutrition through a high-calorie, high-protein diet?
Adding oral liquid supplements
Fill in the blank: Oral liquid supplements are widely used as an adjunct to meals and fluid intake in patients whose intake is _______.
deficient
What are some examples of products that provide advanced nutrition and calories?
Milkshakes, puddings, Carnation Instant Breakfast, Ensure, Boost
These products are often used in long-term care to increase caloric intake.
What is the role of appetite stimulants in nutrition therapy?
To improve intake in patients who may have low appetite
Examples include megestrol acetate and dronabinol (Marinol).
What is enteral nutrition (EN)?
A method of delivering nutrition directly into the gastrointestinal tract
Used for patients unable to take in sufficient calories orally.
What should be considered if enteral nutrition (EN) is not possible?
Starting parenteral nutrition (PN)
PN is an alternative for patients who cannot receive EN.
What is refeeding syndrome?
The body’s response to the switch from starvation to a fed state during nutrition therapy
It occurs in patients who are severely malnourished.
What are some conditions that predispose patients to refeeding syndrome?
- Chronic alcohol use
- Cancer
- Trauma
- Inflammatory bowel disease
- Major surgery
These conditions increase the risk of complications during nutritional replenishment.
What is the hallmark of refeeding syndrome?
Hypophosphatemia
This condition indicates low phosphate levels in the blood.
What are some manifestations of refeeding syndrome?
- Hyperglycemia
- Fluid retention
- Hypokalemia
- Hypomagnesemia
These symptoms can lead to serious complications.
What are some serious outcomes of refeeding syndrome?
- Dysrhythmias
- Respiratory arrest
These outcomes can be life-threatening.
When starting feeding in at-risk patients, what should the initial rates be?
No more than 50% of their usual energy requirements
Gradual increases are recommended to prevent complications.
What is essential for patients discharged on a therapeutic diet?
Proper discharge preparation for both the patient and caregiver
This includes education on managing their nutritional needs.
What should patients and caregivers be taught about undernourishment?
Causes of the undernourished state and ways to avoid the problem in the future
Understanding this helps in maintaining proper nutrition.
How long may it take to fully restore a normal nutrition state after undernourishment?
Many months
Adhering to a diet for a few weeks is often insufficient.
What factors should be assessed when determining a patient’s ability to follow diet instructions?
- Past eating habits
- Religious and ethnic preferences
- Age
- Income
- Resources
- State of health
These factors influence dietary adherence.
What community resources can help provide meals?
- Meals on Wheels
- Senior congregate feeding sites
- Supplemental Nutrition Assistance Program (SNAP)
These resources help support food access for those in need.
What does SNAP allow low-income households to do?
Buy more food of a greater variety
This program helps improve food security.
What is one method for analyzing and reinforcing healthful eating patterns?
Keeping a diet diary for 3 days at a time
This helps in tracking and improving dietary habits.
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 indicate successful nutritional rehabilitation.
How does nutrition affect older adults?
It affects quality of life, functional status, and health
Older adults are particularly vulnerable to malnutrition.
What are some complications faced by older hospitalized adults with malnutrition?
- Poor wound healing
- Pressure injuries
- Infections
- Decreased muscle strength
- Postoperative complications
- Increased mortality
These complications highlight the importance of addressing malnutrition.
What factors may contribute to poor nutrition in older adults?
- Little or no appetite
- Problems with eating or swallowing
- Inadequate servings of nutrients
- Fewer than 2 meals per day
These factors can lead to malnutrition.
What role does social isolation play in nutrition among older adults?
It may decrease their desire to cook and contribute to decreased appetite
Living alone can exacerbate nutritional issues.
What chronic illnesses associated with aging can affect nutrition status?
- Depression
- Dysphagia (from a stroke)
These conditions can significantly impact dietary intake.
What is a common oral health issue in older adults that affects nutrition?
Gum disease and missing teeth
Poor oral health can hinder the ability to eat properly.
What can impair the ability to chew and swallow in older adults?
Teeth issues or dry mouth
Medications can cause dry mouth, change the taste of food, or decrease appetite.
What is the daily vitamin D requirement for older adults?
Higher than younger adults
Refer to Table 44.6 for specific values.
What should initial care strategies focus on for older adults?
Improving oral intake and providing a pleasant meal environment
Special strategies may include adaptive devices and proper positioning.
What physiologic changes occur with aging?
Decrease in lean body mass and redistribution of fat
This can decrease caloric requirements.
What is sarcopenia?
Loss of lean body mass with aging
It affects muscle strength and function.
How does bed rest affect older adults compared to younger adults?
Older adults lose more lean body mass
Prolonged inactivity exacerbates this loss.
What changes can affect appetite in older adults?
Changes in smell and taste
These changes can result from medications, nutrient deficiencies, or taste-bud atrophy.
Who are nutritionally at-risk older adults vulnerable to?
Malnutrition when discharged from the hospital
They may struggle to shop for or prepare foods during recovery.
What should be consulted to ensure access to food upon discharge?
Social worker and dietitian
This is crucial for older adults recovering at home.
Fill in the blank: Older adults may need to increase their _______ to prevent loss of muscle mass.
Caloric intake
True or False: Older adults with dementia face unique challenges regarding eating and feeding.
True
What are some nutrition support therapies for older adults unable to consent?
Enteral Nutrition (EN) and Parenteral Nutrition (PN)
Review advance directives regarding artificial nutrition and hydration.
What is the purpose of community nutrition programs?
To improve meal intake and make mealtime a pleasant, social event.
What is specialized nutrition support?
Nutrition support needed when patients cannot maintain or achieve adequate nutrition status.
Who are key members of a nutrition support team?
- Nutrition support nurse
- Healthcare provider (HCP)
- Dietitian
- Pharmacist
What is enteral nutrition (EN)?
Nutrition delivered through a tube, catheter, or stoma directly into the GI tract.
When is enteral nutrition used?
For patients with a functioning GI tract who cannot take oral nourishment safely or adequately.
List some indications for enteral nutrition.
- Anorexia
- Orofacial fractures
- Head and neck cancer
- Neurologic or psychiatric conditions
- Extensive burns
- Critical illness requiring mechanical ventilation
- Chemotherapy or radiation therapy
What are contraindications for enteral nutrition?
- GI obstruction
- Prolonged ileus
- Severe diarrhea or vomiting
- Enterocutaneous fistula
How does enteral nutrition compare to parenteral nutrition (PN)?
EN is easier to administer, safer, more physiologically efficient, and less expensive than PN.
What factors vary among enteral nutrition formulas?
- Concentration
- Flavor
- Osmolality
- Amounts of protein, sodium, and fat
What is the osmolality of an enteral nutrition formula determined by?
The number and size of particles in the formula.
Fill in the blank: A formula with high sodium content is contraindicated in patients with _______.
[cardiovascular problems, such as heart failure]
What are common delivery options for enteral nutrition?
- Continuous infusion
- Intermittent (bolus) feedings by infusion pump
- Bolus feedings by gravity
- Bolus feedings by syringe
What factors influence the type of enteral nutrition access?
- Anticipated length of time EN is needed
- Risk for aspiration
- Patient’s clinical status
- Adequacy of digestion and absorption
- Patient’s anatomy
What are the types of tubes used for short-term enteral feeding?
- Orogastric
- Nasogastric (NG)
- Nasoduodenal
- Nasojejunal
What is the purpose of transpyloric tubes?
To feed the patient below the pyloric sphincter.
What materials are commonly used for feeding tubes?
- Polyurethane
- Silicone
What is a complication that can arise from using a stylet for tube placement?
Perforation.
What are some disadvantages of smaller feeding tubes?
- They clog easily
- Harder to check residual volume (RV)
- Prone to occlusion if oral drugs are not properly prepared
- Can become knotted or kinked
What types of tubes can be used for extended feeding?
- Gastrostomy
- Jejunostomy
Fill in the blank: A gastrostomy tube can be placed _______.
[surgically, radiologically]
What is a gastrostomy tube?
A tube inserted through the esophagus into the stomach for feeding
It is placed via percutaneous endoscopic gastrostomy (PEG) or surgical methods.
What is the purpose of a retention disk and bumper?
To secure the gastrostomy tube in place
They help prevent dislodgement of the tube.
What is required for PEG tube placement?
An intact, unobstructed GI tract and a wide esophageal lumen
These conditions ensure the endoscope can pass through safely.
What are the benefits of PEG and radiologically placed gastrostomy tubes compared to surgical placement?
They have fewer risks
These methods are less invasive.
What sedation is required for the procedure of placing a gastrostomy tube?
IV sedation and local anesthesia
IV antibiotics are also given before the procedure.
When can feedings start after placing a surgically placed gastrostomy or jejunostomy tube?
Within 24 hours
Feedings can start without waiting for flatus or bowel movement.
How soon can most PEG tube feedings start after insertion?
Within 4 hours
Agency policies may vary regarding this timeline.
What are critical safety concerns in enteral nutrition (EN)?
Aspiration and dislodged tubes
These issues can lead to complications.
What should be done to confirm the position of newly inserted nasal or orogastric tubes?
Obtain x-ray confirmation
This ensures proper placement before starting feedings or medications.
What method should not be used to determine tube placement?
Auscultation method
It is not reliable for confirming tube position.
What can capnography help determine?
Tube placement in the respiratory tract
It monitors breath-to-breath CO2 levels.
What is the recommended head elevation to decrease aspiration risk during feedings?
30 to 45 degrees
Reverse Trendelenburg position can be used if backrest elevation is not tolerated.
What should be assessed to determine if a small bowel tube has dislocated?
Aspirate color and pH
These assessments help confirm tube placement.
What does an increase in VR indicate?
Potential displacement of a small intestine tube into the stomach
Monitoring VR volume is important for assessing tube position.
What should be checked before feeding and medication administration in enteral nutrition?
Tube placement
This ensures that the tube is in the correct position to prevent complications such as aspiration.
What should be assessed before feeding a patient receiving enteral nutrition?
Bowel sounds
Assessing bowel sounds helps determine the gastrointestinal readiness for feeding.
What is a necessary action to take for NG or gastrostomy tubes as needed?
Flush the tube
Flushing helps maintain tube patency and prevents clogging.
What should be evaluated in patients receiving enteral feedings?
Nutrition status
Regular evaluation ensures that the patient’s nutritional needs are being met.
True or False: Medications should be added directly to enteral feeding formula.
False
Adding medications directly can alter the absorption and effectiveness of both the medication and the formula.
What type of medications should be used for enteral nutrition?
Liquid medications designated safe for enteral use
These medications are specifically formulated to be compatible with enteral feeding.
What is the recommended position for the patient during enteral feeding to decrease aspiration risk?
30- to 45-degree angle
Keeping the head elevated helps prevent aspiration pneumonia.
What should be done if using tablets for enteral feeding?
Use immediate-release forms and crush to a fine powder
This ensures that the medication can be effectively absorbed.
What complications should be regularly assessed in patients receiving enteral feedings?
- Aspiration
- Diarrhea
- Abdominal distention
- Hyperglycemia
- Fecal impaction
Regular assessment helps prevent and manage potential complications.
What actions can a Licensed Practical/Vocational Nurse (LPN/VN) perform for stable patients?
- Insert NG tube
- Flush NG and gastrostomy tubes
- Give bolus or continuous enteral feeding
- Remove NG tube
- Give medications through NG or gastrostomy tube
- Provide skin care around tubes
These tasks are within the scope of practice for LPN/VN when caring for stable patients.
What responsibilities does Assistive Personnel (AP) have regarding patients with enteral nutrition?
- Provide oral care
- Weigh patient
- Keep head of bed elevated
- Report symptoms indicating problems
- Alert RN or LPN about infusion pump alarms
- Empty drainage devices and measure output
Assistive personnel play a supportive role in maintaining patient safety and comfort.
What should be done in collaboration with a dietitian for patients receiving enteral nutrition?
- Evaluate nutrition status
- Select appropriate EN formula
- Monitor and manage complications
- Teach about home EN
Collaboration with a dietitian ensures that nutritional needs are met and complications are managed effectively.
What is a pharmacist’s role in enteral nutrition?
Evaluate each medication being given enterally
Pharmacists ensure that medications are safe and effective for enteral administration.
Fill in the blank: Medications must be given _______ if required.
Separately
Some medications may interact adversely with enteral formulas and require separate administration.
What is a common cause of constipation in patients?
Decreased fluid intake
Other causes include inactivity and formula composition.
What is the recommended fluid intake for managing constipation?
30 mL/kg body weight
This should be done if not contraindicated.
What dietary change can help alleviate constipation?
Change formula to one with more fiber content
Laxatives may also be administered as needed.
List two management strategies for dehydration.
- Decrease rate or change formula
- Increase intake and check amount and number of feedings
Administer supplemental tube, oral, or IV fluids if appropriate.
What should be checked if a patient is dehydrated?
Drugs that the patient is receiving, especially antibiotics
This is to avoid complications from medication interactions.
What is a management strategy for hyperosmotic diuresis?
Check blood glucose levels often
Also, change formula to one with less glucose.
What are common causes of diarrhea in patients?
- Contaminated formula
- Feeding too fast
- Infection
- Medications
- Tube moving distally
Each of these factors can contribute to gastrointestinal issues.
How long can ready-to-feed formulas be left standing?
8 hours
This is the guideline for cans of ready-to-feed formulas.
What is the recommended action if a formula is left standing for longer than the manufacturer’s guidelines?
Discard outdated formula
This is critical to avoid contamination.
What management strategy can be used if vomiting is due to delayed gastric emptying?
Consult with HCP about a prokinetic drug
This may help improve gastric motility.
True or False: The tube position should be checked before each bolus feeding.
True
It should also be checked every 4 hours if continuous feedings are used.
What should be done if a tube is improperly placed?
Replace tube in proper position
Ensure to check placement before each feeding.
Fill in the blank: To prevent bacterial contamination, formula and equipment should be ______.
avoided from contamination
This includes proper storage and handling.
What is critical when lowering the head of the bed for a procedure?
Quickly returning the patient to at least 30 degrees
This is essential to ensure patient safety and comfort during feeding procedures.
What should be followed regarding feeding while the patient is supine?
Agency policy
Each facility may have specific guidelines on this matter.
How long should the head be elevated after bolus feedings?
30 to 60 minutes
This helps reduce the risk of aspiration.
What is the debate surrounding checking RV when giving feedings into the stomach?
Increased RV increases the risk for aspiration vs. other research not supporting the practice
The practice may vary based on institutional protocols and current research.
What does common protocol call for when checking RV in non-critically ill patients?
Every 6 to 8 hours and before each bolus feeding
This aims to minimize the risk of aspiration and ensure patient safety.
What are some measures to decrease aspiration risk during enteral feeding?
Measures include:
* Giving feedings continuously
* Minimizing the use of sedation
* Performing frequent oral suctioning if needed
* Using promotility drugs like erythromycin or metoclopramide
Why is skin care around gastrostomy and jejunostomy tube sites important?
Digestive juices irritate the skin, so skin care is essential to prevent irritation and injury.
How should the skin around a feeding tube be initially cared for?
Rinse with sterile water, dry it, and apply a dressing until healed.
What is the recommended flushing protocol for feeding tubes in adults?
Flush with 30 mL of warm tap water every 4 hours during continuous feedings or before and after each bolus feeding.
What should be used to flush feeding tubes in immunocompromised and critically ill patients?
Use sterile water.
What is an enteral feeding misconnection?
An inadvertent connection between an enteral feeding system and a nonenteral system, leading to severe patient injury or death.
What are some complications of enteral nutrition in older patients?
Complications include:
* Fluid and electrolyte imbalances
* Dehydration from diarrhea
* Increased risk of hyperglycemia
* Increased risk for aspiration
What changes in older adults increase their risk for complications during enteral nutrition?
Physiologic changes such as decreased thirst perception and impaired cognitive function.
What is parenteral nutrition (PN)?
The administration of nutrients directly into the bloodstream when the GI tract cannot be used.
How is parenteral nutrition customized?
It is reformulated to meet the changing needs of each patient.
What are some components commonly found in commercially prepared PN base solutions?
Components include:
* Dextrose
* Protein in the form of amino acids
* IV fat emulsion in total nutrient admixture
What standard electrolytes are available in some premixed PN solutions?
Electrolytes include:
* Sodium
* Potassium
* Chloride
* Calcium
* Magnesium
* Phosphate
What additional elements may be added to parenteral nutrition to meet patient needs?
Vitamins and trace elements such as:
* Zinc
* Copper
* Chromium
* Selenium
* Manganese
What should visitors, LPN/VNs, and AP do if an enteral feeding line becomes disconnected?
Notify the nurse and do not reconnect any line
This is crucial to prevent misconnections that could lead to patient harm.
Why should IV or feeding devices not be changed or adapted?
It may compromise the safety features that are part of the design
Maintaining the integrity of the devices is essential for patient safety.
Can an IV pump or IV tubing be used to deliver enteral feeding?
No
Using IV equipment for enteral feeding can lead to serious complications.
What should be done when making a reconnection or connecting a new device?
Trace lines back to their origins and ensure connections are secure
This helps to avoid misconnections and ensures proper delivery of nutrition.
What is important to do when a patient arrives on a new unit or during shift handoff?
Recheck connections and trace all tubes
This step is vital for ensuring the safety of the patient’s enteral feeding.
How should tubes and catheters with different purposes be routed?
In unique and standardized directions
For example, route IV lines toward the patient’s head and enteral lines toward the feet.
What is a recommended practice for labeling feeding tubes and connectors?
Label or color-code them
This aids in quick identification and reduces the risk of misconnection.
What should be done when there are multiple access points and/or several bags hanging?
Place proximal and distal labels on all tubings
This helps to clarify the purpose of each line and reduces confusion.
What should be checked after making any connection?
The patient’s vital signs
Monitoring vital signs can help identify any immediate complications.
What is important to confirm about a solution’s label?
Identify and confirm the label to avoid confusion between solutions
A 3-in-1 PN solution can resemble an enteral nutrition formulation.
What type of labeling should be used for bags intended for enteral use?
Large, bold statements such as ‘WARNING! For Enteral Use Only—NOT for IV Use’
This helps to prevent serious errors in administration.
Under what conditions should connections be made?
Under proper lighting conditions
Adequate lighting is crucial for accurately making connections and ensuring safety.
What are the main sources of calories in parenteral nutrition (PN)?
Carbohydrates in the form of dextrose and fat in the form of fat emulsion
Dextrose provides 3.4 calories per gram, while oral carbohydrates provide 4 calories.
What is the recommended energy intake for a nonobese patient receiving PN?
20 to 30 cal/kg/day
What is the protein-sparing effect of dextrose?
It allows the use of amino acids for wound healing instead of for energy.
What are the available concentrations of fat-emulsion solutions?
10%, 20%, and 30%
How many calories do fat emulsions provide per mL for 10% and 20% solutions?
- 10% solution: 1 cal/mL
- 20% solution: 2 cal/mL
What is the maximum recommended fat emulsion intake for stable patients?
1 g/kg/day
What is the initial infusion rate for IV fat emulsions?
0.5 mL/kg/hr
What distinguishes central PN from peripheral parenteral nutrition (PPN)?
Central PN is hypertonic and indicated for long-term support; PPN is less hypertonic and used for short-term needs.
What is the osmolality of central PN solutions?
At least 1600 mOsm/L
What are the indications for using peripheral parenteral nutrition (PPN)?
- Short-term nutrition support
- Low protein and caloric requirements
- High risk for central catheter
- Supplement inadequate oral intake
What are the risks associated with peripheral parenteral nutrition (PPN)?
- Phlebitis
- Fluid overload
What is the protein intake range for patients receiving PN?
0.8 to 1.5 g/kg/day
In which patient populations might protein requirements exceed 150 g/day?
- Septic patients
- Critically ill patients
- Burn patients
- Multiple trauma patients
What are the average daily electrolyte requirements for adult patients without renal or liver impairment?
- Sodium: 1 to 2 mEq/kg
- Potassium: 1 to 2 mEq/kg
- Magnesium: 8 to 20 mEq
- Calcium: 10 to 15 mEq
- Phosphate: 20 to 40 mmol
What trace elements are added to PN according to patient needs?
- Zinc
- Copper
- Manganese
- Selenium
- Chromium
What is the importance of multivitamin preparation in PN?
It generally meets the vitamin requirements.
What factors must be considered for home nutrition support?
- Patient’s nutritional needs
- Caregiver education
- Cost and reimbursement criteria
- Quality of life impact
What are eating disorders characterized by?
Psychiatric conditions associated with physiological alterations and risk for death.
What are the 3 most common types of eating disorders?
Anorexia nervosa, bulimia nervosa, binge-eating disorder
Binge-eating disorder is less severe than bulimia nervosa and anorexia nervosa.
What is a key characteristic of binge-eating disorder?
Individuals do not have a distorted body image and are often overweight or obese
Unlike anorexia and bulimia, binge-eating disorder does not involve significant weight loss or purging behaviors.
List some risk factors for eating disorders.
- Biologic issues
- Psychologic issues
- Sociocultural issues
Common psychologic issues include anxiety and perfectionism, while sociocultural issues may involve bullying or a limited social network.
True or False: Eating disorders can occur in health-conscious individuals.
True
For example, men with bigorexia may develop eating disorders due to an extreme concern with becoming more muscular.
What is bigorexia?
An extreme concern with becoming more muscular
Individuals with bigorexia may use steroids, supplements, and protein shakes to increase muscle mass.
What is the female athlete triad?
A syndrome that includes eating disorders, amenorrhea, and osteoporosis
The triad occurs in females participating in sports that emphasize leanness and low body weight.
What health issues may arise from eating disorders?
- Fluid and electrolyte problems
- Dysrhythmias
- Nutrition problems
- Endocrine problems
- Metabolic problems
Menstrual problems may also occur in women of childbearing age.
Fill in the blank: Binge-eating disorder is _______ than bulimia nervosa and anorexia nervosa.
less severe
This indicates a difference in the severity and health risks associated with binge-eating disorder compared to the other two disorders.
What may individuals with bigorexia use to increase muscle mass?
- Steroids
- Other drugs
- Supplements
- Protein shakes
These substances are often used in an attempt to achieve a more muscular physique.
Who is responsible for preparing PN solutions?
A pharmacist or trained technician
Must use strict aseptic techniques under a laminar flow hood.
What should not be added to PN solutions after preparation?
Nothing
This is to maintain sterility and safety.
What is the purpose of limiting the number of people involved in PN preparation?
To reduce risk for infection.
How often are PN solutions ordered?
Daily
This is to adjust to the patient’s current needs.
What information is included on a PN solution label?
Nutrient content, all additives, time mixed, and expiration date and time.
How should PN solutions be stored before use?
Refrigerated until 30 min before use.
What is the maximum time a PN solution can be at room temperature?
24 hours.
What type of filter should be used with parenteral solutions not containing fat emulsion?
0.22-micron filter.
What type of filter should be used with solutions containing fat emulsion?
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 if a multilumen catheter is present?
Use a dedicated line for PN.
Is it permissible to draw blood from a line dedicated for PN?
No, unless absolutely necessary.
What should be used to control the infusion rate of PN?
An infusion pump.
What should you do periodically during PN infusion?
Check the volume infused.
What should be verified before starting PN?
The label and ingredients in the solution.
Who should verify infusion pump settings before beginning PN?
A second RN.
What should be checked for the quality of the PN solution?
Leaks, color changes, particulate matter, clarity, and fat emulsions separating.
What should be done if a PN bag is not empty at the end of 24 hours?
Discontinue the PN solution and replace it with a new solution.
What is the preferred delivery method for fat emulsions infused separately from PN?
Continuous low volume delivered over 12 hours.
How often should glucose levels be checked for patients on PN?
Every 4-6 hours.
What is the target glucose range to maintain during PN?
140-180 mg/dL.
What can be given to prevent hypoglycemia if a PN formula bag empties?
10% or 20% dextrose solution or 5% dextrose solution.
What are local manifestations of catheter-related infections?
Redness, tenderness, and exudate at the catheter insertion site.
What are systemic manifestations of catheter-related infections?
Fever, chills, nausea, vomiting, and malaise.
Who is at high risk for catheter-related infections?
Immunosuppressed patients.
What should be done if an infection is suspected during a dressing change?
Send a culture specimen and notify the HCP.
What should be monitored to assess the effectiveness of PN?
Initial vital signs, weight, intake and output, blood levels of glucose, electrolytes, and urea nitrogen.
How often should CBC and hepatic enzyme studies be obtained until stable?
A minimum of 3 times per week.
What is a general rule for transitioning to oral nutrition?
60% of caloric needs should be met orally or through EN.
What should be the starting point for transitioning to oral nutrition?
Clear liquids.
What is anorexia nervosa characterized by?
Restricting energy intake, difficulty maintaining appropriate weight, intense fear of gaining weight, and distorted body image
Anorexia nervosa is often associated with significant psychological distress.
What age group is most commonly affected by anorexia nervosa?
Ages 13 to 19
Up to 90% of those affected are female.
What are common behaviors exhibited by individuals with anorexia nervosa?
- Restricting calorie intake
- Compulsive exercise
- Purging via vomiting or laxatives
- Binge eating
- Unwillingness to maintain a healthy weight
- Detailed food rituals
- Avoiding social situations
These behaviors often lead to significant health issues.
What are common assessment findings in patients with anorexia nervosa?
- Signs of malnutrition
- Significant weight loss or low BMI (under 17)
- Hypothermia
- Muscle weakness
Diagnostic studies may reveal additional complications.
What are potential diagnostic study findings for anorexia nervosa?
- Osteopenia or osteoporosis
- Iron-deficiency anemia
- High blood urea nitrogen level
- Abnormal renal function
- Decreased potassium levels
These findings can indicate severe physiological stress.
What complications may arise from decreased potassium intake in anorexia nervosa?
- Muscle weakness
- Dysrhythmias
- Renal failure
These complications highlight the importance of monitoring electrolyte levels.
What is the recommended approach to treatment for anorexia nervosa?
- Nutrition support
- Psychiatric care
- Family-based therapy
- Behavior- and emotion-focused therapy
Building rapport with the patient is essential due to anxiety around treatment.
What is refeeding syndrome?
A rare but serious complication of refeeding programs
It can occur when nutritional replenishment is initiated too rapidly.
What characterizes bulimia nervosa?
Recurrent episodes of binge eating followed by inappropriate compensatory behaviors
These behaviors may include vomiting, laxative misuse, or overexercise.
What physical signs may indicate bulimia nervosa?
- Macerated knuckles
- Swollen salivary glands
- Broken blood vessels in the eyes
- Dental problems
These signs are often a result of frequent vomiting.
What abnormal laboratory values may be associated with bulimia nervosa?
- Hypokalemia
- Metabolic alkalosis
- Increased serum amylase
These values can indicate the physiological consequences of the disorder.
What types of therapy are recommended for treating bulimia nervosa?
- Psychologic counseling (cognitive behavioral therapy)
- Family therapy
- Nutrition counseling
A combination of these therapies is essential for effective treatment.
Which antidepressant is FDA-approved for the treatment of bulimia nervosa?
Fluoxetine (Prozac)
It is the only FDA-approved medication specifically for this condition.
What is a potential catheter-related problem associated with PN?
Air embolus
An air embolus occurs when air bubbles enter the bloodstream, potentially causing serious complications.
Name a complication of PN related to infection.
Catheter-related sepsis
This refers to a bloodstream infection that occurs due to contamination of the catheter used for PN.
What complication can occur if a catheter is not properly secured?
Dislodgment
Dislodgment refers to the catheter moving from its intended position, which can lead to complications.
Identify a complication of PN that involves bleeding.
Hemorrhage
Hemorrhage can occur at the catheter insertion site or elsewhere in the body.
What issue can prevent the flow of nutrients in PN?
Occlusion
Occlusion occurs when the catheter is blocked, hindering nutrient delivery.
What is a common inflammatory complication associated with catheter use?
Phlebitis
Phlebitis is the inflammation of the vein where the catheter is placed.
What are potential complications of PN related to the lungs?
Pneumothorax, hemothorax, and hydrothorax
These conditions refer to air, blood, or fluid accumulation in the thoracic cavity, respectively.
What vascular complication can arise from PN?
Thrombosis of vein
Thrombosis involves the formation of a blood clot in the vein, which can impede blood flow.
What metabolic problem can arise from PN affecting the kidneys?
Altered renal function
This refers to changes in how well the kidneys are functioning, which can be affected by nutrient imbalances.
What deficiency can result from inadequate nutrition in PN?
Essential fatty acid deficiency
This deficiency can lead to various health issues, including skin problems and immune dysfunction.
What metabolic complication involves abnormal blood sugar levels?
Hyperglycemia, hypoglycemia
Hyperglycemia refers to high blood sugar, while hypoglycemia refers to low blood sugar, both of which can occur with PN.
What condition characterized by high lipid levels can occur with PN?
Hyperlipidemia
Hyperlipidemia is an elevation of lipids in the bloodstream, which can result from excessive lipid administration.
What liver-related complication can develop from PN?
Liver dysfunction
Liver dysfunction can occur due to the metabolic effects of PN and the composition of the nutrients provided.
Fill in the blank: _______ syndrome can occur after the reintroduction of feeding.
Refeeding
Refeeding syndrome is a dangerous condition that can occur when feeding is restarted after a period of malnutrition.
