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NUR 201 Week 9 > Malnutrition > Flashcards

Malnutrition Flashcards

1
Q

?

Results when the body’s need for protein &/or energy is not supplied in adequate quantity by dietary intake

e.g., kwashiorkor, marasmus, marasmic kwashiorkor

A

Protein-Energy Malnutrition (PEM)

> Can occur as a result of infection, stress, or injury
Could be chronic in pts that have cancer, end-stage kidney/liver dz or chronic neurologic dz

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2
Q

Etiology & Risk Factors

  • What causes malnutrition?
    > Decreased intake
    > Decreased absorption
    > Increased body needs
A

> Rx’s
Physical problems
Knowledge deficit

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3
Q

Malnutrition Assessment

i.e., MST, MUST, MNA, NRS, SGA

A
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4
Q

Assessment - History

  • Conduct a culturally sensitive & relevant interview while avoiding stereotyping
  • Routine physical or a problem-focused exam
  • Collect medical, surgical, family, & social hx
  • Pertinent q’s
    > Appetite, food intake, weight changes, loss of appetite, & changes in bowel patterns
A

Physical Examination

  • Inspection - Auscultation - Percussion - Palpation
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5
Q

Assessments & Clinical Manifestations

  • Cardiac
  • Pulmonary
  • Immune
  • Integumentary/wound healing
  • Skeletal muscle
  • GI/GU function
A

Diagnostic Labs

  • Hgb/Hct
  • Serum albumin
  • Pre-albumin
  • Transferrin
  • TIBC
  • Cholesterol
  • Total Lymphocyte Count
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6
Q

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This lab value reflects nutritional status a few weeks before testing & is NOT the most sensitive protein study

A

Serum albumin

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7
Q

The thyroxine-binding pre-albumin, PAB, is a more sensitive indicator b/c it has a half-life of 2 days

A
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8
Q

Analysis - Nursing Diagnoses

  • Imbalanced Nutrition: Less Than Body Requirements
  • Risk for Impaired Skin Integrity (r/t altered nutritional status)
A
  • Risk for Infection (r/t malnutrition)
  • Risk for Disturbed Body Image (r/t biophysical changes from weight loss)
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9
Q

Interventions

“The preferred route for feeding is through the GI tract because it enhances the immune system and is safer, easier, less expensive, and enjoyable”

A

> May need to consult w/RDN on these

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10
Q
  • Ensure that the diet includes foods high in fiber content to prevent constipation
  • Monitor & record intake for nutritional content & calories
  • Weigh pt at appropriate intervals
A
  • Encourage pt to wear properly fitted dentures &/or obtain dental care
  • Determine pt’s ability to meet nutritional needs
  • Provide appropriate info about nutritional needs & how to meet them
  • Assist pt in receiving help from appropriate community nutritional programs, as needed
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11
Q

Management

Nutritional Supplements
> Ensure, Boost, Carnation Instant Breakfast

A

Rx Therapy

  • Cyproheptadine - antihistamine ↑ appetite
  • megestrol acetate - ↑ appetite
  • metoclopramide - prokinetic
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12
Q
  • dronabinol - (THC) - appetite stimulation in HIV/AIDS, chemo
  • ondansetron - serotonin blockers - N/V assoc w/chemo
A
  • Anticholinergics can help to reduce N/V
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13
Q

Special Nutritional Modalities

  • TEN
  • TPN (via CVC, PICC)
A
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14
Q

?

  • Is for those pts who can eat but cannot maintain adequate nutrition by oral intake of food alone
  • Have permanent neuromuscular impairment & cannot swallow
    > MS, ALS, Parkinson’s
  • Who do not have permanent neuromuscular impairment but are critically ill & cannot eat b/c of their condition
A

Total Enteral Nutrition (TEN)

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15
Q

Intercostal: Feeding Tubes

  • Gastrostomy
  • Percutaneous endoscopic gastrostomy
  • Low-profile gastrostomy device (LPGD)
  • Jejunostomy
A
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16
Q

Purposes of GI Intubation (aka NG tube placement)

> Decompress the stomach
Lavage the stomach
Diagnose GI disorders

A

> Administer rx’s & feeding
To treat an obstruction
To compress a bleeding site
To aspirate gastric contents for analysis

17
Q

Administration of Tube Feedings

  • Bolus feeding
  • Continuous feeding
  • Cyclic feeding
A
18
Q

Enteral Nutrition - General nursing considerations

  • Daily weights
  • Assess for bowel sounds <feedings (assess & auscultate)
  • Accurate I&O
A
  • Initial glucose checks
  • Label w/date & time started
  • Pump tubing changed q24
19
Q
  • Administer feeding @ prescribed rate & method & according to pt tolerance
  • Check residual prior to intermittent feedings & every 4-6 hrs during continuous feedings (or per facility policy)
  • Admin water (typically 30mL) before & after each rx & each feeding, w/e the tube feeding is discontinued or interrupted
A
  • Do not mix rx’s w/feedings
  • Use a 30mL or larger syringe (change syringe daily)
  • Maintain delivery system as req’d; to avoid bacterial contamination, do not hang more than 4 hrs of feeding in an open system
20
Q

Reduce Risk for Aspiration

Elevate HOB of bed how much and for how long after feedings?

> Monitor residual volumes

A

30-45°, @ least 1 hr

21
Q

Complications of Total Enteral Nutrition (TEN)

  • Refeeding syndrome
  • Tube misplacement & dislodgement
  • Abd distention, n/v/d
  • Fluid & electrolyte imbalances
A
  • Aspiration pneumonia
  • Tube displacement/obstruction
  • Nasopharyngeal irritation
  • Hyperglycemia
22
Q

?

Is a life-threatening metabolic complication
> Occurs in pts that have been starving; they break down fat & protein for energy rather than carbs. This leads to muscle & cell loss in major organs like the heart, liver, & lungs

> Body loses electrolytes like potassium & phosphate into plasma; insulin secretion decreases; then process is restarted, insulin production resumes, & cells take up glucose & electrolyte from the bloodstream, which depletes serum lvls
This creates a severe electrolyte shift & can cause cardiovascular, respiratory, & neurological problems

A

Refeeding syndrome

23
Q

Refeeding syndrome

> Shallow respirations, weakness, acute confusion, seizures, an inc in bleeding tendencies

  • Bolus feedings can also result in __ __, which is a rapid distention of the jejunum when hypertonic solutions are given too fast
    > Results in lightheadedness, dizziness, rapid HR, anxiety, n/v/d
A

dumping syndrome

24
Q

Aspiration pneumonia can occur if the pt aspirates during the feed

A

Another complication is tube displacement or obstruction & hyperglycemia

25
Q

Proper Tube Care

  • Use appropriate dressing (i.e., Drain Sponge)
  • Skin care, assessment, & documentation of area around the tube
A
  • Manipulation of the stabilizing disk prevents skin breakdown
26
Q

Potential Nursing Diagnoses (r/t TPN/TEN)

> Imbalanced nutrition
Risk for diarrhea
Risk for ineffective airway clearance
Risk for deficient fluid

A

> Risk for ineffective coping
Risk for ineffective therapeutic regimen management
Deficient knowledge
Risk for impaired skin integrity

27
Q

Nursing Process - Planning Outcomes

> Major outcomes include attaining an optimal level of nutrition, preventing infection, maintaining skin integrity, enhancing coping skills, adjusting to changes in body image, acquiring knowledge of & skill in self-care, & preventing complications

A
28
Q

?

Needed when pts cannot effectively utilize the GI tract for nutrition either partial or TPN may improve nutritional status
> Diff from regular IV therapy in that it may include any & all nutrients (carbs, proteins, fats, vitamins, minerals, & trace elements)

A

Parenteral Nutrition

1L of D5W = 170 kcal > 500-700 kcal/per day

29
Q

?

  • Requires catheter in a large distal vein, i.e., PICC
  • May be able to eat but not able to take in needed nutrients; able to tolerate large volumes of fluid
  • IV fat emulsions &/or amino acid dextrose solutions (separate or together)
    > AADex considered more stable & may contain vitamins, minerals, electrolytes, trace elements
A

Partial Parenteral Nutrition

MUST INFUSE ON IV PUMPS

> Is usually needed for less than 13 days

30
Q

?

Must be administered to central veins via PICC, subclavian, or internal jugular veins

  • Higher concentrations of dextrose & proteins (hyperosmotic) 3-6x blood
    > Electrolytes, minerals, trace elements, & insulin may be added by pharmacy to base solutions r/t pt’s specific needs
A

Total Parenteral Nutrition (TPN)

MUST BE INFUSED VIA INFUSION PUMPS

! No TPN infused into peripheral circulation b/c it can damage blood cells & the endothelial lining of veins & decrease perfusion; ALWAYS into a central vein

31
Q

Assessment

  • Assist in identifying pts who are candidates for PN
  • Nutrition status, hydration status, electrolytes
A
  • S/S of hypoglycemia/hyperglycemia
    > Monitor blood glucose
  • Assess for potential complications
    > VS inc temperature every 4 hrs or according to facility policy
32
Q

Collaborative Problems & Potential Complications

! Pneumothorax
! Clotted or displaced catheter
! Sepsis

A

! Hyperglycemia
! Rebound hypoglycemia
! Fluid overload

33
Q

Nursing Management - Parenteral Therapy

  • Administer parenteral nutrition
  • Prevent complications
    > Mechanical: pump/VAD issues
    > Metabolic: refeeding or dumping syndromes
A
  • Prevent infections
  • Evaluation on nutritional interventions
34
Q

Potential Nursing Diagnoses

  • Imbalanced nutrition
  • Risk for infection
  • Risk for excess or deficient fluid
  • Risk for immobility
  • Risk of ineffective therapeutic regimen
A

Goals

Major goals may include attaining an optimal lvl of nutrition, absence of infection, adequate fluid volume, optimal lvl of activity, knowledge of self-care, & absence of complications

NUR 201 Week 9 (4 decks)

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