M6 Nutrition Flashcards
Failure to thrive can be caused by 2 categories of illnesses
Physical
Psychological
Failure to thrive manifestations
Underweight
Dry skin
Prominent bony stature
Mental confusion
Drop in reflexes
Failure to thrive
Hx
Diet changes
Apathy
Food intolerance
Functional ability
Strength
Environmental (can person afford food)
Diagnostic labs for failure to thrive
Albumin/prealbumin
Liver enzymes
BUN/Creatinine
Lytes
CBC
Visual diagnostics for failure to thrive
Abdominal ultrasound
Abdominal CT
Radiology studies for swallowing
Nurse interventions for FTT
Nutrition intake assessment
Nutrition support/supplements
Daily weight
Daily I&O
FTT collaborative interventions
Psych counseling
Dietician
Enteral/parenteral nutrition
Meds for FTT
Appetite stimulants
Vitamins
Mineral supplements
Impaired liver function 101
results in
Impaired PROTEIN metabolism
Decreased ALBUMIN and CLOTTING factors
Reduced BILE production
Impaired metabolism of STEROIDS and GLUCOSE
Liver failure cause
CIRRHOSIS 101
Alcohol
Biliary problems
Nonalcoholic fatty liver
Posthepatic liver failure problems
Hepatitis B and C
Chronic viral hepatitis
High risk behaviors that can cause liver failure
Alcohol use
Injectable drugs
Exposure to toxins
Live failure S/S
decay
Malnutrition
Muscle wasting
Jaundice
Gastritis/anorexia/diarrhea
Bleeding
Liver failure S/S
things expanding
Edema
Ascites
Splenomegaly
Encephalopathy
Collaborative care for Cirrhosis
Holistic addressing
physiology
psychology
spirituality
Counseling
Job coaching
Behavior therapy
Nutrition
Lab exams for liver function
AST ALT
CBC
Coagulation studies (liver helps coagulation)
What serums will change with liver cirrhosis
Lytes
Bilirubin
Albumin
Ammonia
Glucose
Cholesterol
Bilirubin
yellow pigment
breakdown of RBCs
Albumin
liver protein
low level means malnutrition
Ammonia
15-45u
if high means liver failure
Visual exams for cirrhosis
Abdominal ultrasound
Esophagoscopy
Liver biopsy
Meds for cirrhosis
Diuretics
Beta blockers
Oxazepam
Nutrition supplements
stuff to reduce nitrogenous waste and ammonia
Nutrition supplements
Ferrous sulfate
Flic acid
Vit K
Antacids
Meds to reduce nitrogenous waste and lower ammonia
Lactulose
Neomycin
Oxazepam
benzodiazepine
helps with liver inflammation in critical citations
Drugs to avoid with cirrhosis
Barbituates
Sedatives
Hypnotics
Acetaminophen
Alcohol
Nutritional therapy for liver cirrhosis
Sodium down to 2g
Fluids down to 1500ml
Protein down to 60g
Moderate fat
Supplements
Cirrhosis emergency nutrition
Parenteral nutrition
Surgical/procedural therapy for cirrhosis
Transplant
Paracentesis
Balloon tamponade
Transjugular intrahepatic portosystemic shunt (TIPS)
Paracentesis
Perforation of a hollow cavity to remove fluid
Balloon temponade
Multiple lumen NG tube
inflates balloon on sides of tube to provide pressure on bleeding varices in GI
TIPS
Transjugular intrahepatic portosystemic shunt
Relieves portal hypertension fixing varices and ascites
Shunt is left between portal and hepatic vein allowing better perfusion
Nursing S/S assessment cirrhosis
Weight loss
Anorexia
Bleeding
Pruritus
Abdominal pain
Nursing Hx assessment cirrhosis
Liver/gallbladder disease
Alcohol and drug use
OTC meds
Nursing physical manifestations of cirrhosis
Mental status
Abdominal girth
Edema
Bruises
Jaundice
Cirrhosis results in what problems
aka diagnosis
Excess fluid volume
LOC changes
Impaired skin
Nutrition less than body requirements
Outcome goals for cirrhosis
Maintain hydration
Maintain diet
Regular elimination
Easiest monitoring
DAILY WEIGHT
What concepts can be impaired due to cirrhosis
Mobility
F/E
Perfusion
Clotting
Nutrition
Major functions of the liver
Filter blood
Detox drugs
Produce coagulants
Metabolism
Patho of cirrhosis
buildup of fibrotic tissue impairs perfusion
First systems to be affected by cirrhosis
Metabolic abnormalities
Clotting
Liver can regenerate it self but this results in further
scarring tissue that can not be perfused
Decompensated cirrhosis results in
Portal hypertension
Bleeding varices
Hepatorenal syndrome
ascites/peritonitis
encephalopathy
Liver pain locations
Dull right upper quadrant pain
Palpable liver
Epigastric pain
Urine with liver failure
Bowel
DARK
Drop in output
light colored (gray or tan) stool
Liver failure and lungs
Rapid shallow breathing
MOST common cirrhosis findings
Edema
Ascites
testicular atrophy and loss of libido
Cachexia
Liver failure symptoms
wasting of extremities
Due to loss of nutrition with cirrhosis, wound healing will be
Delayed
Since the liver produces clotting factors, cirrhosis can result in
H&H DECREASE
gum bleeding
gut bleeding in emesis or stool
easy bleeding at IV sites
etc
K+ and liver function
DECREASE
Areas that have edema ascites and pruritus are particularly prone to
SKIN BREAKDOWN
Portal hypertension in liver failure will result in
Hyperaldosteronism
Increase in fluid volume
Antiemetics to prevent nausea with cirrhosis
AVOID
liver can not process them
Meals frequency
Self care
small frequent meals
Frequent oral hygiene
Skin integrity care
trim nails short
NO alkaline soap
support areas with edema
Keep linen clean dry and wrinkle free
TURN pt q2h
Why does hemorrhage occur with cirrhosis
liver makes clotting factors
NO LIVER FUNCTIN = NO CLOTTING
Nutritional management for encephalopathy
Small frequent meals
Daily protein between 1.2-1.5 g/kg
protein is good
Lytes with encephalopathy
what to do
Hypokalemia
give lactulose
Why does encephalopathy occur with cirrhosis
Liver cant metabolize ammonia to urea for excretion
BUILD UP OF AMMONIA = Encephalopathy
With encephalopathy and increasing ammonia first symptom is
LOC - SLEEPINESS
stupor
impaired thinking
Second encephalopathy S/S are
neuromuscular
Asterixis - liver shakes
Hyperreflexia
MOST life threatening complications of cirrhosis
BLEEDING ESOPHAGEAL VARICES
To lower ammonia limit
Physical activity
Pancreas 101
behind stomach
exocrine and endocrine function
Exocrine function of pancrease
Enzymes for digesting
fat protein and carbs
most abundant enzyme trypsin
Trypsin
helps in breaking down protein
Endocrine pancrease function
Islets of Langerhans secrete
Beta (insulin)
Alpha (glucagon)
Delta (somatostatin)
Risk factors for pancreatitis
Trauma
Obstruction
Familial probs
Alcohol/drugs
Ulcers
Acute pancreatitis
Auto-digestion of the gland
Trypsin cant get out so it starts to digest the pancreas
Phospholipase A and pancreatitis
Activated by trypsin
results in fat necrosis in pancreas
Alcohol and pancreatitis
increases inflammation of pancreas
creating stenosis of ducts
Causes of pancreatitis
BAD HITS
BIlliary
Alcohol
Drugs
Hypertriglyceridemia/hypercalcemia
Idiopathic
Trauma
Scorpion sting
Meds that can cause pancreatitis
Steroids
NSAIDs
Thiazieds
Acute pancreatitis manifestations
Jaundice
Abdominal tenderness/rigidity
Guarding
Pancreatic ascites
Cullens sign
Turners sign
red/purple around umbilics
Gray on side of belly
Pancreatitis complications
Hypovolemia
Hemorrhage
Acute kidney failure
Paralytic ileus
Hypovolemic/septic shock
Lungs and pancreatitis
Pleural effusion
Resp distress syndrome
Penumonia
Life threatening pancreatitis complications
MODs
DIC
Nursing assessments for Pancreatitis
Hx
Diet
Abdominal (look listen feel)
farts are good
Pain
Weight loss
What to monitor the most with pancreatitis
Respiratory
Vital signs
Position for pancreatitis pain management
Fetal
Pancreatitis pain management other interventions
Morphine
IV fluids
NG tube
Rest gut
Antibiotics
Early nutrition for pancreatitis
NPO 2-5 days
Diet for pancreatitis when permitted
High carb
moderate protein
moderate fat
Severe pancreatitis diet
Jejunal feeding
Low fat formula
or standard formula
If pt can not tolerate feedings with pancreatitis
TPN
Central TPN
Peripheral TPN
how long to use
Max 7 days
Max 10 days
How often to feed with pancreatitis
small frequent meals
When to start diet
pain is subsided
lipase and amylase have decreased in concentration
Fat consumption for pancreatitis less than
50g a day
Cooking oils or pancreatitis
Coconut
Palm kernel
MCT
Protein amount for pancreatitis
1.5 g at least
Nursing management of diet with pancreatitis
no stimulant foods
give antiemetics for N/V
zofran, phenergan
patient outcomes for pancreatitis
good
elimination, nutrition, perfusion
no abdominal pain
Chronic pancreatitis 101
Progressive destructive disease of the pancreas
Remissions and exacerbations
Chronic pancreatitis complications
Hemorrhage
Infection
Bowel obstruction
Abscess
Fistulas
Pancreatitis manifestations
Left upper abdominal pain
radiating to back
Intense continued gnawing burning pain
S/S of chronic pancreatitis same as acute +
steatorrhea
Bowel rest and enteral nutrition results
Fewer infection sand decreased hospital stays
ON TEST
Nursing management for Chronic Pancreatitis
Same as acute
When to give Pancreatic enzymes
With EVERY MEAL
DO NOT crush or chew
Calcium in pancreatitis
K+ in pacreatitis
WILL DECREASE
WILL INCREASE
Labs with pancreatitis
Lipase
Trypsin
WBC
Glucose
Bilirubin
elevated
Imaging for Pancreatitis
ABD ultrasounds
CT Scan w/contrast
ERCP
Biopsy
Surgical measurements for pancreatitis
care
NG tube insertion preop
Post op monitor
drainage
skin integrity
Primary prevention of pancreatitis
fat limits
20g fat daily max
no meal should be over 10g of fat
Primary prevention of pancreatitis other
No alcohol
No spicy food
Healthy weight
Cholelithiasis or biliary obstruction should be treated
IMMEDIATELY
prevents panreatitis
Secondary prevention of pancreatitis
Total body system assessment
VS and Labs - CBC, BMP, Lytes
Assess for causative illnesses
Causative illnesses for Pancreatitis
Peptic ulcers
Renal failure
Vascular disorders
Hyperparathyroidism
Hyperlipidemia
Caloric requirement for Pancreatitis patients
4000-6000
Food will not absorb
hence the enzyme replacements with every meal
Home and after care for pancreatitis
home health
monitoring -
diet
meds
skin
follow up appts
Labs
Where are pancreatic enzymes supposed to activate?
Small intestine ONLY
Biggest goals of pancreatitis
SEVERE pain management
Keep stomach EMPTY and DRY
Why infections with pancreatitis
Autodigestion = release of toxic enzyme byproducts
Pancreatitis bed rest position
Keep pt UP
When you GI suction Pancreatitis pt A/B
Alkalosis
Pancreatitis abdomen
Abdomen ridged and board like =
Bleeding
Cullen and Turner signs are related to
Pancreatitis GI Bleeding
Pancreatitis lab value INDICATOR
AMYLASE
Lipase
Serum bilirubin is relate to
Liver
What form of fentanyl do we treat pancreatic pain with
Patch
What meds dry people up
given for
Anticholinergics
Pancreatitis
If pt is on TPN should they be loosing weight
NO
Treatment SPECIFIC to chronic pancreatitis
Digestive enzymes
FTC and pacemakers
pacemaker will have a line going down on EKG
if there is no PQRS after that is
Failure to capture
MOST IMPORTANT LIVER FUNCTIONS
Detoxify body
Detoxify drugs
Blood coagulation
Synthesizes albumin (metabolism)
What to do with med doses when liver is shot
Half them
Liver cant metabolize drugs
Give patients with Tylenol OD
Acetylcysteine
Mucomyst (carbonated drink)
When blood backs up due to liver scaring this is called hepatic hypertension. This blood backs in to
Esophageal varices (Bleeding)
BEST vasodilator for portal hypertension
Octreotide, ON TEST
With balloon tamponade, pt tries to pull out device, resulting in airway obstruction. what to do
Deflate balloon
if not
Cut it
With new tech, varices can now be
Cut or burned
Due to all the issues with Liver and blood not being cleaned, what another complicationscould happen
Splenomegaly
(spleen cleans)
if liver cant, then spleen works double time
Ammonia acts like a
SEDATIVE
on test
sleepiness
Treat ammonia with
LACTULOSE
converts ammonia to urea in gut
Asterixes
ON TEST
Liver related extremity flapping
Patient shaking due to high Ammonia
Ascites happens due to low
Albumin
Protein that holds liquid in vascular space
Prep pt for parasentisis
Void
High fowler
Parasentisis can result in
Hypovolemic shock
removing volume that is already third spaced from body
Ultimate diagnosis of liver cirrhosis
Biopsy
Liver biopsy procedure
pt lay flat
raise right hand
take deep breath
hold
then we puncture
After liver biopsy
lay on right side for pressure
Why does IG blood aggrivate ammonia?
Blood is a form of protein
will further INCREASE ammonia
TIPS shunts prevent parasentisis but this results in
More circulating ammonia
Fetor smell
in Cirrhosis pt rooms
Ammonia escaping the body
Fresh cut grass/nail polish remover
With pacemaker surgery, to prevent pt from moving affected side arm put arm in
SLING
Demand pacemaker
Only turns on when pace drops bellow a certain rate
Keep pacemakers away from
MAGNETS
Cushings and addisons are problems related to the
Adrenal cortex
Addsions disease 101
Not enough steroids
S/S of addisons
Fatigue
N/V/D
Weight loss
Anorexia
Confusion
Shock
Lytes with addisons
Hyperkalemia
Hypoglycemia
Hyponatremia
With addisons add
Steroids
Hyper or hypo tension with addisons
HYPOtension
Loss of sodium, loss of water
Addisons skin
White hyperpigmentation (vitiligo)
Focused treatment for addisons is based on
SHOCK (hypovolemia)
When you lose sodium and water what hormone do you think of
Not enough ALDOSTERONE
Should we increase Sodium and addisons
Increase
Task to delegate to AP with addisons
Daily I&O
Daily weight
Daily BP
Addisons clients will be in a fluid volume _
Deficit
ADDisons treatment
Glucocorticoids (prednisone, hydrocortisone)
Mineralocorticoids (aldosterone aka fludrocortisone)
Steroids for addisons are given in what dosage
2 half dose increments
1 morning, 1 evening
For addisons do med doses stay the same
NO, depends on pt
Can you stop steroids abruptly
NO, need to be tapered
1 problem with addisons disease
Addisonian crisis - FATAL shock
Addisonian crisis is what kind of shock
Hypovolemia
Addisons low corticosteroids will lead to hypoglycemia, S/S of hypoglycemia
Emotional lability!
Hangry
Shaking
Sweating
If addisons patient feels like they are going into a crisis they carry a injection pen of what?
Cortisol
Cushings 101
too much
steroids
Cushings appearance
Boonfaced
Buffalo hump
Skinny arms and legs
Cushings S/S
Weight gain
Fluid volume overload
Hypertension
Hyperglycemia
Hypernatremia
Cushings aldosterone is _
And serum potassium will be _
HIGH
LOW
Urinalysis with Cushings will have
High level of cortisol
Treatment of Cushings
Adrenalectomy (removal surgery)
Adrenalectomy is done unilaterally or bilaterally. If bilaterally, what will happen
Addisons = lifelong replacement
With too many steroids will person be calm?, need…
NO
Calm environment
Diet pretreatment for Cushings
Sodium decrease
Glucose decrease
Calcium INCREASE
Protein INCREASE
Why increase calcium and protein with cushings
High metabolism and breakdown or protein and bone
Steroids and calcium, like prednisone, increase or decrease
Decrease in calcium
Steroid 3 side effects
Osteoporosis
Hyperglycemia
Bad immune system
What values may appear in urine with long term steroid use
Glucose
Ketones (fat byproduct)
What is used to diagnose Cushings
Urinalysis
Drug to give for afib
Cardizem drip
Prolonged use of steroids can shift patient into
Cushings syndrome
Due to fluid volume overload, cushings patients are put on
Diuretics, Fluid restriction
What to give for high ammonia
Lactulose ON TEST
Too much lactulose would be indicated by
Diarrhea
Hypokalemia
Dehydration
How do you know lactulose is working
2-3 soft stools per day ***
Test for cushings
Dexamethasone suppression test
given at night
pee cortisone in morning
