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PN2 RN > Chapter 60 > Flashcards

Chapter 60 Flashcards

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1
Q

Pg 1213

Chart 60-1

Questions one might ask in nutrition screening?

A

Loose stools?

Wt loss?

Fever, burns sepsis?

NPO?

Diet?

Allergies

Drug therapy

N/v

Difficulty chewing / swallowing

Heart issues

Chewing or swallowing issues

Independence with ADLs

Fluid I and O equal to each other?

Ostomy?

Oxygen?

Resp issues?

Rashes

Skin turgor

Mucous membrane dry?

Pressure to sacrum, hope, heels, ankles

Edema - pedal

Cachexia - weakness and wasting body

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2
Q

How long should nutrition screening be done upon hospital admission

A

24 hours

Consist of height and weight, wait history, usually eating habits, ability to chill, swallowing, appetite

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3
Q

BMI does not factor in muscle mass

A

True

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4
Q

Normal BMI pg 1215

A

23-27

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5
Q

Skin fold measurements done by who

A

Dietitian

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6
Q

Why would one have poor wound healing in malnutrition ?

A

Lack of protein (albumin) which promotes wound healing

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7
Q

Mulnitrition in the older adult

A

Limited income
Lack of transport

Low appetite 
Dentition
Poor eyesight
Dry mouth
Depression
Chronic or acute pain

Pg.1216
60-2

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8
Q

Length of stay is 3x higher for those who are malnourished

Who promotes assesment prior

A

True

Joint commission

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9
Q

**Malnutrition labs to look at

A

Hemoglobin - anemia

Hcg- high=dehydration
Low- anemia , hemorrhage, fluid overload

Serum albumin normal 3.5-5
Plasma protein - reflects nutritional status and can be falsely high or low depending on fluid volume

Prealbumin - 15-36
Plasma protein is more sensitive indicator of nutritional deficiency

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10
Q

Who should have total enteral nutrition for worst case Scenario

How else can we improve nutrition ?

A

Any patient not meeting their calorie and protein needs

Nutrition supplements

Multivitamins, zinc , iron

Calorie counts, dietician plans calorie intake and texture

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11
Q

TEN is given via how?

Short term

Long term?

Which one can a nurse place ?

A

Naso gastric tube (NG tube) less than 4 weeks - nurse can place

Percutaneous endoscopic gastrostomy (PEG) tube - surgically placed

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12
Q

How to administer TEN feeding

A

N/D- can mean too much too fast

Bloating

Change bag and tubing every 24 hours

HOB elevates 30 degrees

Check for residuals every 4-6 hours

Continuous or bolus with free water

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13
Q

What to do for TEN clogged tube

A

Flush regularly or will get clogged

Push - pause method - to create turbulence

NO carbonated beverages !

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14
Q

Most common problem with TeN

Others?

A

Clogged tube

Aspiration

Referring syndrome - severe electrolyte shifts to start action state - it happens slowly restart nutrition feeding

Tube misolacement or dislodged- first stop feeding

Abdominal distention with n/v - means overfed -200 or more hold feeding

Fluid and electrolyte imbalance-if too concentrated- with leads to diarrhea- which leads to dehydration-Hyperkalemia and hyponatremia are most common electrolyte imbalance -

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15
Q

PN or PPN is given how?

Used when gi tract can not be used

A

PICC or central line only

Filtered tubing change every 24 hours

With fat emulsion/ lipids q 12 hrs

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16
Q

**More concentrated nutrition with higher osmolality - central line

Give with insulin

Glucose checks ; check for fluid over load; electrolytes and daily weights

Why would be check for fluid overload???

A

TPN - In vein

It’s more concentrated and has higher osmolarity

17
Q

If on iron with peg tube inform patient about what??

Who all may be involved with discharge of this client

Home health or family support if can’t care for self

A

May cause constipation - drink water, fiber , exercise

Nurse , doctor, dietitian , pharmacist, case manager

18
Q

*Overweight BMI-

Obese BMI -

Morbidly obese BMI -

Muscle doesn’t count with BMI

A

Overweight - 25-29

Obese - 30 or more

Morbidly obese- 40 or more

19
Q

Obese patho

A

Adipokines- hormones

Leptin resistance- hormone

Environment

Genetics

Behavior, ignorance

Diet high in saturated fat

Sedentary lifestyle

Medications

20
Q

Main physical assessment with obesity

A

Skin assessment

21
Q

Surgery for obesity that limits the amount of food aten at once

Quick wt loss, gastric bypass, more invasive with complications

Patients need to agree to lifestyle modifications to keep wt off

A

Gastric restriction

Malabsorption

22
Q

Why doctors want people to loose wt before bariatric surgery?

Priority after surgery ?

A

Obese ppl are often at risk for post surgical clots/ DVT and decreased airways

Airway

Place in semi flowers, monitor o2 sat, remove cath with in 24 hours, asses skin, and binder, absorbent padding compression hose and or heparin

23
Q

Bariatric surgery post surgery

A

DVT- get up and ambulated ASAP post op

Watch for abdominal girth-Astomatic leaks- from surgical site (and pain, radiate to shoulder , fever, high pulse , decreased urine)

6 small feeding and prevent dehydration post op

Dumping syndrome can occur- food moves too quickly to stomach - high pulse , and abd cramping, nasuea , loose stools

24
Q

Page 1231

Chart 60-7

Identify behavior patterns to maintain the weight loss

Diet progression

Vitamin and mineral supplements guidelines

Meal planning

Know s/s of complications

A

Notify provider with - fever, pain, draining , red, hot , DVT , chest pain , breathing issues, n/v

25
Q

Malnutrition risks

A 
Decreased appetite 
Wt loss 
Poor fitting dentures 
Dry mouth 
General weakness 
Difficulty ambulation

Prealbumin low example :13

26
Q

Failure to thrive risks

A

Weakness
Unintentional wt loss
Slow walking
Exhaustion

27
Q

How to help promote oral nutrition intake

A

Delegate UAP to feed patient

Provide mouth care before each meal

Assist the patient to sit upright in chair

Order foods that patient likes

PN2 RN (17 decks)

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