E2 Nutrition & Enteral Nutrition Flashcards
3 main functions of GI system
Transportation, Digestion, Absorption
Poor nutrition linked to
Increased readmission rate, mortality rate, and cost
________ of someone who is malnourished is KEY
early recognition
Patients who are malnourished upon admission are at greater risk of complications:
-Dysrhythmias
-Skin breakdown
-Sepsis
-Hemorrhage
-Increased length of stay
-Delayed surgical healing
Healthy lifestyle tips
- Follow a healthy eating pattern across a lifespan
- Focus on variety, nutrient density, and amount
- Limit calories from added sugars, saturated fats, and reduce sodium intake
- Shift to healthier food and beverage choices
- Support healthy eating patterns for all
Factors that influence nutrition
-Appetite
-Negative experience
-Disease/ illness
-Medications
-Environmental factors
-Developmental needs
-Alternative food patterns
What are environmental factors that influence nutrition?
-Income (healthy is expensive)
-Education level
-Physical function level
-Transportation (can you get to grocery store)
-Availability of food (Fast food)
Standardized tools for nutrition assessment
- Subjective Global Assessment (SGA)
- Mini-nutritional Assessment (MNA)
- Malnutrition Screening Tool (MST)
BMI formula
BMI= weight (kg) / Height ^2 (m2)
1kg = ____ Ibs
2.2
Common labs to assess nutrition
- Total protein
- Albumin
- Prealbumin
- Hemoglobin
Factors that effect lab results
-Fluid imbalance
-Live & kidney function
-Presence of disease
Total protein
Combination of albumin & globulin constitute
Normal: 6.4-8.3 g/dL
Albumin
-Makes up 60% of total protein
-Chronic illness
-Synthesized in liver
-Half life 21 days
-Normal: 3.5-5.0 g/dL
Prealbumin
-Acute condition
-Half-life 2 days
-Normal: 15-36 mg/dL
Hemoglobin
Iron containing pigment on RBC that transports oxygen
Normal Male: 14-18 g/dL
Female: 12-16 g/dL
Eat iron rich food if low
Nectar-like consistency
Liquids that have been thickened to a consistency that coats and drips off a spoon, similar to unset gelatin
Spoon-thick consistency
Liquids that have been thickened to a pudding consistency. They remain on the spoon in a soft mass
Honey-like consistency
Liquids that have been thickened to honey consistency. The liquid flows off a spoon in ribbon like honey
CC2 diet
Diabetic diet, balances carbs/fats/proteins, and considers caloric intake
Cardiac diet
low salt, low saturated fats, low cholesterol
Low residue diet
low roughage, low fiber, low dairy, crohns disease, ulcercolitis, decrease hyperactivity of bowels
High fiber diet
-Prevent colon cancer & constipation
-Grains, fruits, veggies
Gluten free diet
-Celiac disease or gluten intolerance
-No wheat, barley, rice, oats
Bland diet
-Avoid irritation in GI and decrease peristalsis
-Acid reflux or ulcers
Being NPO for more than _____ are at high nutritional risk
5-7 days
How would you advance a diet as tolerated?
Clear liquid -> Full liquid -> Low residue (if needed) or regular
Dysphagia
Difficulty swallowing
Warning signs of dysphagia
-Speech: uncoordinated, slow, weak
-Gag reflex less than resilient
-Delay in swallowing
-Drooling or pocketing food
-Problem with regurgitation
-Weight loss/ not eating
-Sign of chest or throat discomfort
Silent aspiration
-Food or fluid accidentally goes in airway instead of stomach
-Cause pneumonia by initiating inflammatory process
-Decreased sensation and don’t cough
-detected by asculating adventitious sound
What counts as intake for I/Os?
-Oral intake
-IV fluids
-Blood product
-Tube feeding
-Flushes
What counts as output for I/Os?
-Urine
-Bowel movements (occurrences)
-Emesis
-Drainage (JP or chest tube)
Parenteral nutrition
Feeding intravenously, bypass the usual process of eating and digestion
-Feed through central vein
Enteral nutrion
Liquid supplemental nutrition is either taken by mouth or is given via a feeding tube
-Preferred method if pt can’t swallow and gut is functioning
Nasal or oral feeding tubes terminates at:
- Stomach (Nasogastric)
- Duodenum (Nasoduodenal)
- Jejunum (Nasojejunal)
PEG
Feeding tube that leads through an artificial external opening into the stomach (Gastrostomy)
PEGJ
Feeding tube that leads through an artificial external opening in to the small intestine (Jejunostomy)
Indications of Enteral nutrition
-Prolonged anorexia
-Severe protein-energy malnourishment
-Coma
-Impaired swallowing
-Critical illnesses
Benefit of Enteral over parenteral nutrition
-Reduce sepsis
-Minimize the hypermetabolic response to trauma
-Decreases hospital mortality
-Maintains intestinal structure and function (will atrophy w/o use)
Signs of Tube feeding intolerance
-High gastric residuals
-Nausea
-Cramping
-Vomiting
-Diarrhea
Compliations of Tube feeding
-Pulmonary aspiration
-DIARRHEA
-Constipation
-Abd cramping with N/V
-Tube occlusion or displacement
-DELAYED gastric emptying
-Serum electrolyte imbalance
-FLUID OVERLOAD
-Hyperosmolar dehydration
Nurses role in placement of Feeding tube
-Insert NG using water soluble lubricant
-Landmarks (gastric)- nose, ear, xiphoid process, add 8-10 inches for jejunum
Nasograstric or Nasojejunal tubes are placed for how long
<4 weeks
Surgically or endoscopically placed tubes are placed for how long
More than 6 weeks
HOB for Tube Feeding patients
Min 30 degrees Best is 45
How often should you check gastric residual in continuous feeding?
Every 4-6 hours
How often should you check gastric residual in intermittent feeding?
Immediately before
What does High gastric residual indicate?
Delayed gastric emptying
What do you do if gastric residue is >250 mLs?
Put back into pt, hold for 1 hour then recheck
What do you do if gastric residue is >500 mLs ?
Put back into pt, Hold and notify HCP
