EXAM 2: Nutrition and GIT Flashcards
These nutrients are not synthesized in the body or not enough is made. Instead, they are provided in diet or supplements:
essential nutrients
These nutrients do not have to be supplied by the diet because they are not required by body functions or are made in the body in adequate amounts:
non-essential nutrients
_______ supply energy and and build tissue
Macronutrients (carbs, fats and proteins)
_______ regulate and control body processes
Micronutrients
These nutrients are 4 calories per gram/4kcal/g:
carbohydrates and proteins
This nutrient is 9 calories per gram/9kcal/g
fats
How much of the adult calories should be from carbohydrates?
45-65%
How much of the adult calories should be from protein?
10-35%
How much of adult calories should be from fats?
<10% from saturated fats (bad fats = butters, oils, lard)
This is the most abundant nutrient, the least expensive source of calories, is converted into glucose to provide energy and is also the easiest macronutrient to digest:
Carbohydrates
What is an example of a complete protein? What is an example of a incomplete protein?
animal sources; plant sources
This nutrient improves taste for some foods and delays gastric emptying so it increases fullness:
fats
This is a better source of fat:
unsaturated (olive oil, avocados, nuts)
You need this is small amounts for metabolism of carbs, proteins and fats. It is essential in the diet because the body does not make it (or not in sufficient amounts)
vitamins
What are the water soluble vitamins?
Vitamin C and B
What are the fat soluble vitamins?
Vitamin K, A, D, and E (KADE)
These vitamins need to be attached to a protein to get into the blood circulation
fat soluble
These vitamins are needed daily and are excreted in urine
water soluble
What vitamins create the possibility for toxicity?
fat soluble vitamins A & D
These are found in all body fluids and tissues in the form of salt
minerals
What is the average intake of water adults should be consuming a day?
2,200-3000 mL/day (2-3L/day)
What is the minimum output of water a day in an adult?
30 mL/hr
What should your “plate” of food be made up of?
- fruits
- veggies
- protein
- grains
- dairy
- ** 1/2 plate needs to comes from fruits and veggies***
How can we obtain an nutritional assessment of a patient?
through health history (dietary, medical, & socioeconomic)
What is the formula for BMI and what does it measure?
height/weight; overweight and obesity
What increases a patients chance for chronic diseases?
large waist circumference (W: >35 and M: >40) + higher BMI
What is a normal BMI?
19-25
What is the BMI of an overweight patient?
25-29
What is the BMI of a obese patient?
30+ is obese
What are the 2 main nursing dx for imbalanced nutrition?
- Imbalanced Nutrition: Less Than Body Requirements
- Imbalanced Nutrition: More Than Body Requirements
If a patient has difficulty swallowing or is on a NG tube, what status should they have?
NPO
What is considered a vegetarian diet?
replace meats with legumes, grains, and vegetables (May need to supplement Vit B12, Vit A, and iron)
What is considered a clear liquid diet?
clear fruit juices, clear broth (chicken, beef or veggie), black coffee only, plain tea, jello, gelatin, popsicles
* absolutely NO MILK PRODUCTS*
What is considered a full liquid diet?
includes clear liquids AND milk products, custards, pudding, vegetable juices and ice cream
What is considered a pureed diet?
all foods are allowed, they are just blended to modify texture and consistency
What is considered a mechanically altered diet?
regular diet that excludes most raw fruits, vegetables, seeds, nuts, and dried fruits; food will have to be chopped, ground, mashed or softened
What is considered a DASH/cardiac diet?
a diet low in sodium
What are some short term enteral feedings?
nasogastric tube (Levin or Dobbhoff tube)
What is a dobbhoff tube?
a feeding tube that has weights on the end
What are some long term enteral feedings?
gastrostomy or PEG (is surgically placed=long term feeding every night; less chance of aspiration and regurgitation because of placement)
What angle should patients on enteral feedings be placed in?
45 degree angle (semi-fowlers position)
What is a continuous enteral feeding?
one that is very slow (over 12-18 hours) and allows the patient to get used to the formula
What is a intermittent enteral feeding?
one that has regular intervals and mimic normal feeding patterns
What is cyclic enteral feedings?
usually given at night, therefore the patient has normal actives during the day b/c they are not attached to the pump
What should the pH of stomach contents drawn from a enteral feeding be?
around 5.5
If the stomach content/residual is >250mL twice OR >500mL once, what should you do and why?
call the provider b/c patient is at risk for aspiration; hold the feeding
What should you flush a clogged enteral feeding tube with?
warm water
What is the #1 way to confirm the proper placement of a enteral feeding tube?
x-ray
What complications can occur from an enteral feeding?
- infection
- aspiration (patient should be at 30-45 degrees)
- clogging
What factors contribute to constipation?
- medications (narcotics)
- low fiber diet/dehydration
- low activity levels (immobility)
- diseases/conditions
- stress
- ignoring urge to defecate
What is the proper order of assessing the abdomen?
- inspection
- auscultation
- percussion
- palpation
What does a focused assessment of bowel function look like?
- patterns: frequency, time of day, stool characteristics, straining, impaction
- aids: liquids, laxatives, enemas
- recent changes: color, stool, blood, appearance
- problems: are your bowels causing any problems now?
- artificial orifices (colostomy/ileostomy): usual routine with ostomy, any problems with ostomy, affecting any activities
What is the rating of bowel movement?
- 1-2 = constipation
- 3-5 = ideal
- 6-7 = diarrhea * ileostomy is always a 7 b/c of its location*
What should you tell your patient before a GI diagnostic?
- occult blood is blood you cannot see
- do not use any laxatives, enemas, or suppositories for 3 days before the test because they can irritate the GI system and cause bleeding
- avoid certain medications such as NSAIDS, steroid and iron because they can lead to false positives
- avoid Vitamin C or fresh fruit for 3 days before collecting a specimen because they can interfere with results
What is a endoscopy?
a procedure that goes down the throat
What is a colonoscopy?
a procedure that goes up the anus and upwards recommended to start getting these at age 45-50 to detect cancer
What does the nurse do for a patient who has fecal impaction?
the nurse must digitally remove poop with her fingers (a true impaction will not be relieved by laxatives or other methods)
What is a vasovagal (cardiogenic syncope)?
a drop in HR and BP when the vagal nerve is stimulated in the rectum; this can occur during fecal impaction removal and if it does, you need to stop what your doing immediately
What is considered contipation?
having < 3 BM’s a week (a BM everyday is not necessary) that are hard, dry, small or difficult to pass
What might need to be given to a patient experiencing diarrhea/vomiting?
they might need F&E replacement depending on severity
How can you assess a patient for constipation?
- abdominal distension
- pain
- bloating
- stool characteristics
What are some risk factors for consitpation?
- pregnant women
- recent surgery
- older adults
- lower socioeconomic status
What are some complication of constipation?
- valsalva maneuver
- hemorrhoids
- fissures
- impaction
What are some examples of laxatives?
- bulk forming
- saline agent (BM within 2 hours)
- lubricant
- stimulant (fast working)
- emollient (preferred over laxative; hydrates stool making them easier to pass)
- osmotic (commonly given before a procedure/surgery)
- lubiprostone
What are the different types of enemas?
- tap water (15 minutes)
- normal saline (15 minutes) - safest due to = osmotic pressure
- soap (10-15 minutes) - increases risk for electrolyte imbalance
- hypertonic (5-10 minutes) - used in dehydrated clients or those who cant tolerate high volume
- oil (30 minutes) - lubrication for easier passage of stool
How does enemas work?
solution is introduced into the large intestine via the rectum and the patient needs to hold in the solution. these mostly increase peristalsis.
How will stool be in a person with a colostomy?
stool is formed b/c its at the end of the GIT
How will stool be in a person with a ileostomy?
stool will be liquid
How will stool be in a person with a urostomy?
urine
How should a healthy stoma look?
it should be pink/moist (a beefy red stoma typically means its new but if they have had it a long time, that could be an infection); should be cleaned with mild soap and water and then dried
What is gastritis?
Inflammation of the gastric/stomach mucosa
What are the risk factors for gastritis?
- older adults
- those who use aspirin and NSAIDS
- alcohol consumption
- gastric radiation treatments
- H. Pylori infection
What are the s/sx of acute gastritis?
- epigastric pain
- dyspepsia (indigestion)
- N/V with or without blood
- melena (dark tarry stools)
- hematochezia (blood in stools/anus)
What are the s/sx of chronic gastritis?
- fatigue
- pyrosis (heart burn)
- belching
- sour taste in mouth
- low B12
- no symptoms
How is gastritis diagnosed?
- endoscopy with tissue biopsy
- CBC
- H. Pylori culture
How is gastritis treated?
- medication (antibiotics)
- emergency surgery
- avoid alcohol and food
- smoking cessation
What is the nursing interventions for gastritis?
- reduce anxiety
- relieve pain
- manage N/V and pyrosis
- NPO/IVF
- discourage caffeine, alcohol, smoking
- monitor for hemorrhage
What patient education should be provided to a patient with gastritis?
- stress management
- dietary consolidation/foods to avoid
- medications
- B12 injections
- lifestyle changes
What is a peptic ulcer?
A hollowed area in GIT that forms in the mucosa of the stomach, pyloris, duodenum or esophagus (patho: erosion occurs due to increased activity of acid pepsin or decreased resistance of the normally protective mucosal barrier).
What is a peptic ulcer usually a result of?
- H.Pylori
- NSAID abuse
What are the s/sx of a peptic ulcer?
- no s/sx
- dull, gnawing pain or burning sensation with mid-epigastric area or back
- pain occurs after eating
- N/V, diarrhea and bleeding
How is a peptic ulcer treated?
- with medication for 10-14 days and education to avoid alcohol, smoking and NSAIDs
What kind of pain is always a priority?
acute pain
What are the nursing interventions for a peptic ulcer?
- relieve pain (no NSAIDS)
- reduce anxiety
- IV therapy
- NGT to low intermittent suction (clears everything out)
- dietary education/weight (foods to avoid=spicy food and alcohol)
- monitor for complications (hemorrhage, perforation, obstructions)
What education should be provided for a patient with a peptic ulcer?
- avoid NSAIDS
- avoid alcohol
- stop smoking
What is GERD?
the back-flow of gastric or duodenal content into the esophagus
What causes GERD?
Incompetent lower esophageal sphincter, pyloric stenosis, hiatal hernia or motility disorder
What are the risk factors for GERD?
- age
- IBS
- obstructive airway diseases (asthma, peptic ulcer, angina)
What increases a persons risk for GERD?
- tobacco use
- coffee use
- alcohol use
- H. Pylori infections
What are the s/sx of GERD?
- dysphagia
- pyrosis
- dyspepsia
- regurgitation
- dental issues
- pulmonary complications
- may mimic MI
How is GERD diagnosed and treated?
- endoscopy
- barium swallow (a drink)
- 12-36 hour wireless capsule pH monitoring
What are the nursing interventions for GERD?
- instruct the patient to eat a low fat diet, avoid caffeine, tobacco, beer, milk, mint, carbonated beverages
- do not eat 2hrs before bedtime, elevate HOB at least 30 degrees
- maintain normal body weight and do not wear tight clothing
Where are carbohydrates stored?
in the liver after they have been converted to glucose for blood transfer
