lewis ch 39 - nutritional problems Flashcards
indications for enteral nutrition (8)
- anorexia
- orofacial fractures
- head/neck cancer
- neurologic or psychiatric conditions
- extensive burns
- critical illness
- chemotherapy
- radiation therapy
nursing considerations and assessments to monitor with enteral nutrition (6)
- daily weights
- assess for bowel sounds before feedings
- accurate I&O
- initial glucose checks
- label with date nad time started (change pump tubing q24h)
- elevate HOB 30-45 degrees
what can be delegated to the UAP with enteral nutrition (4)
- weigh patient
- offer ordered nutritional supplements
- provide oral care
- HOB 30-45 degrees
what can be delegated to the LPN/LVN with enteral nutrition (4)
- insert NGT in stable patient
- irrigate NGT
- remove NGT
- give meds through NGT to stable patient
how often should you check gastric residuals for patient with feeding tube
q4h for first 48 hours
when should you hold a feeding for patient with enteral nutrition
if residual is >500 mL
3 possible complications of enteral nutrition
- clogged tube
- improper tube positioning
- aspiration
how to prevent clogged tubes with enteral nutrition (3)
- crush pills into powder
- use liquid meds instead of pills
- flush per protocol/order
how to prevent improper tube positioning with enteral nutrition (2)
- confirm placement via initial xray
- mark exit length on tube after xray
how to prevent aspiration with enteral nutrition (3)
- assess for crackles in lungs or shortness of breath
- elevate HOB 30-45 degrees
- check gastric residuals
common indications for parenteral nutrition (8)
- chronic severe vomiting and diarrhea
- complicated surgery or trauma
- GI obstruction
- GI tract anomalies and fistulae
- intractable diarrhea
- severe anorexia
- severe malabsorption
- short bowel syndrome
how many minimum calories does the normal adult require per day
1200-1500
how often should you check blood glucose levels with parenteral nutrition
q4-6h
how often should you check vital signs for patient with parenteral nutrition
q4-8h
what range should the patients glucose stay within while receiving parenteral nutrition
110-150
when should you discontinue parenteral nutrition solutions
at end of 24 hours
what lab values should you monitor for patient with parenteral nutrition
electrolytes
BUN
CBC
liver enzymes
3 possible complications with parenteral nutrition
- refeeding syndrome
- infection
- septicemia
- can occur in patients receiving parenteral nutrition
- characterized by fluid retention, electrolyte imbalances and hyperglycemia
refeeding syndrom
conditions that predispose patients to refeeding syndrome (4)
- chronic alcoholism
- vomiting and diarrhea
- chemotherapy
- major surgery
when should a nutritional screening be done on a patient
within 24 hours of admission
assessment tools for nutrition screening (3)
- mini nutritional assessment (MNA)
- minimum data set (MDS)
- outcome and assessment information set (OASIS)
when would the mini nutritional assessment be used
older adults
when would the minimum data set be used
for long-term care
when would OASIS be used
home care settings
visual guide for sensible meal planning
MyPlate
appetite stimulants (2)
- megestrol acetate (megace)
- dronabinol (marinol)
some suggestions of foods for high-calorie, high-protein diet
- muffins, bread
- granola
- fried veggies
- dried fruit
- fried meats
- peanut butter
- ice cream, milkshakes
- whole milk
