NUTRI FINALS Flashcards
TYPES OF ENTERAL FEEDING
this type of feeding may be prepared from regular foods.
Tube Feedings
TYPES OF ENTERAL FEEDING
This type of feeding is fiber-free and high in cholesterol, fat, and sugar. It is a milk- based formulation with sugar and soft cooked eggs.
Standard Tube Feeding
TYPES OF ENTERAL FEEDING
it consists of soft diet allowances which can be blenderized easily.
Blenderized Tube Feeding
TYPES AND EXAMPLES OF READY-TO-USE FORMULA
can be used alone and provides total needs in a specified volume of formula.
Nutritionally complete formulation
TYPES AND EXAMPLES OF READY-TO-USE FORMULA
provides the different nutrients to supplement existing formulas.
Modular formulation
TYPES AND EXAMPLES OF READY-TO-USE FORMULA
meets the therapeutic needs.
Combined formulation
Tube extends from nose into the stomach
Nasogastric
Rapid placement requiring minimal equipment; feedings can be immediately following confirmation of tube placement and bowel sounds; formula can be delivered or continuous infusion
Advantages of Nasogastric
Tube can be easily removed by patient; tube can be inadvertently inserted into trachea, especially among patients with poor gag reflexes. Anomalies in nose and neck (deviated septum, esophageal strictures) may prevent tube placement.
Disadvantages of Nasogastric
tube extends from nose through the pylorus into the duodenum; Tube may be advanced by peristalsis or videofluoroscopy
Nasoduodenal
tube extends from nose through pylorus into the jejunum and is usually placed by videofluoroscopy.
Nasojejunal
Risk for aspiration may be reduced. Feedings are better tolerated by patients with poor tolerance to gastric feedings (gastric retention or reflux) ______ feedings permit enteral feedings in patients with partial gastric outlet obstruction or doudenal fistula.
Advantages of Nasoduodenal or nasojejunal
Dislodgment of tube into the stomach by coughing or vomiting is common (will increase risk of aspiration in patients with altered gastric motility. Administration usually limited to continuous delivery of formula (small intestine does not tolerate bolus feedings or sudden rate changes well. May require use of pump.)
Disadvantages of Nasoduodenal or nasojejunal
Surgical formation of opening into neck through which a feeding tube is placed into esophagus and down into the stomach (sometimes used in patients with head and neck cancer
Esophagostomy
Procedure can be performed under local anesthesia. It does not require opening the abdominal wall. Feeding can begin immediately.
Advantages of Esophagostomy
Route requires surgery and formation of a stoma, which must be carefully maintained. Skin surrounding stoma may become irritated. Wound may become infected. Excessive granulation of tissue surrounding stoma may occur. Accidental dislodgment of tube is common. Requires immediate replacement of tube to prevent closure of stoma. Gastric contents mayy leak around the tube with gastrotomy. Wound dehiscence may occur. GI bleeding and aspiration may occur. Gastrotomy feedings usually cannot be started until up to 72 hours after surgery PEG placement is often difficult or impossible in severe obesity.
Disadvantages of Esophagostomy
Tube is passed through incision in abdominal wall into the stomach PEG. Tube is percutaneously placed in the stomach under endoscopic guidance, secured by rubber “bumpers” or inflated balloon catheter.
Gastrostomy or Percutaneous Endoscopic Gastrostomy (PEG)
Takes advantage of the stomach’s natural function of adjusting osmolarity, mixing, and serving as a reservoir; ensures provided nutrients are allowed maximal opportunity for absorption; closely simulates natural delivery of nutrients into the stomach; eliminates nasal or esophageal irritation, esophageal sphincter closed, may reduced risk of aspiration; tube is unobtrusive; PEG placement can be performed under local anesthesia (less expensive); PEG feedings can be started after approximately 24 hours
Advantages of Gastrostomy or Percutaneous Endoscopic Gastrostomy (PEG)
Types include needle catheter placement, direct tube placement, and creation of jejunal stoma that is catheterized intermittently PEJ: Weighted feeding tube passed endoscopically through as trostomy tube (from PEG insertion) into the duodenum; Peristaltic action advances tube into the jejunum
Jejunostomy or Percutaneous Endoscopic Jejunostomy (PEJ)
Permits feeding in patients with upper GI tract obstruction, esophageal reflux, ulcerative or neoplastic disease of stomach, impaired gastric emptying; reduces risk for aspiration; early postoperative feeding possible jejunum rapidly resumes its function within 12-24 hours)
Advantages of Jejunostomy or Percutaneous Endoscopic Jejunostomy (PEJ)
Surgical procedure is required. Ambulatory patients may find jejunal feeding restrictive because of the need for continuous infusion of formula.
Disadvantages of Jejunostomy or Percutaneous Endoscopic Jejunostomy (PEJ)
This route is intended for patients with mild to moderate nutritional deficiency.
Peripheral Vein Route
This is a long-term nutritional support of 2 weeks for patients who cannot be fed through the GIT.
Parenteral Hyperalimentation (TVH)
COMPLICATIONS OF ENTERAL FEEDING
Nasopharyngeal irritation (Ice chips, topical anesthetic, and decongestant)
Mechanical
COMPLICATIONS OF ENTERAL FEEDING
Mucosal erosions (reposition tube; ice water lavage; remove tube)
Mechanical
COMPLICATIONS OF ENTERAL FEEDING
Tube displacement (replace tube)
Mechanical
COMPLICATIONS OF ENTERAL FEEDING
Aspiration (discontinue tube feeding)
Mechanical
COMPLICATIONS OF ENTERAL FEEDING
Luminal obstruction (Flush; replace tube)
Mechanical
COMPLICATIONS OF ENTERAL FEEDING
Cramping/Distention (change formula; reduce infusion rate)
Gastrointestinal
COMPLICATIONS OF ENTERAL FEEDING
Vomiting/Diarrhea (dilute formula; reduce infusion rate; anti-diarrheal agents)
Gastrointestinal
COMPLICATIONS OF ENTERAL FEEDING
Constipation (promote sufficient fluids and fibers; encourage patient activity)
Gastrointestinal
COMPLICATIONS OF ENTERAL FEEDING
Hypertonic dehydration (increase free water)
Metabolic
COMPLICATIONS OF ENTERAL FEEDING
Glucose intolerance (reduce infusion rate)
Metabolic
COMPLICATIONS OF ENTERAL FEEDING
Cardiac failure (reduce sodium content; fluid restriction)
Metabolic
COMPLICATIONS OF ENTERAL FEEDING
Renal failure (decrease phosphate, magnesium, potassium, protein restriction, essential amino acid solution)
Metabolic
COMPLICATIONS OF ENTERAL FEEDING
Hepatic encephalopathy (decrease amount of protein)
Metabolic
DIFFERENT TYPES OF HOSPITAL DIETS
This is an allowance of tea, coffee or coffee substitute, and fat-free broth. Ginger ale, fruit juices, gelatin, fruit ices, and water gruels are sometimes also given. Small amounts of fluid are offered every hour or two to the patient. The diet is used for 24-48 hours following acute vomiting, diarrhea, or surgery. The primary purpose of this diet is to relieve thirst and to help maintain water balance. Broth provides sodium. Broth and fruit juices contribute potassium. Carbonated beverages, sugar, and fruit juices, when used, furnish a small amount or carbohydrate.
Clear Liquid Diet
DIFFERENT TYPES OF HOSPITAL DIETS
This is a nutritionally adequate diet consisting of liquids and foods that liquefy at body temperature. It is used for acute infections and fever of short duration and for patients who are too ill to chew. It may be ordered as the first progressive from the clear fluid diet following surgery or in the treatment of acute gastrointestinal (GI) upsets. The diet is offered in 6 feedings or more. Initially, amounts smaller than those represented by the plan may be given. To increase the calorie intake, one pint ot light cream may be substituted for one pint of milk. The protein level of the full fluid diet may be increased approximately 30 g by including 3 oz non-fat dry milk each day. This may be added to fresh milk, cream soups, cereal gruels, or custards. Strained meat may be added to broth or hot tomato juice. Raw eggs are sometimes a source of Salmonella infection. Therefore, only pasteurized dried egg powder should be used.
Full Liquid Diet
DIFFERENT TYPES OF HOSPITAL DIETS
A nutritionally adequate diet differs from a normal diet in terms of having reduced fiber content, soft consistency, and bland flavor. It is used immediately between the full fluid diet and the regular diet following surgery, in acute infections and fevers, and in GI disturbances.
Soft Diets
DIFFERENT TYPES OF HOSPITAL DIETS
It measures fat globules in the stools to detect fat absorption as in cases like cystic fibrosis. It consists of 100g fat ingested daily for 3 days prior to fecal collection.
Fecal Fat Determination Test
DIFFERENT TYPES OF HOSPITAL DIETS
It is used to determine GIT bleeding. A 3-day diet excludes ingestion of meat, poultry, and fish.
Meat-free Test
DIFFERENT TYPES OF HOSPITAL DIETS
It is used to determine urinary calcium excretion to diagnose hypercalciuria. The diet requires 1000mg calcium intake (400mg from food sources and 600mg from oral supplements).
Calcium Test
DIFFERENT TYPES OF HOSPITAL DIETS
It is used to detect calcinoid tumors of the intestinal tract. Food rice in serotonin is excluded in the diet.
Serotonin Test
ROLE OF THE NURSE IN NUTRITIONAL CARE
Important functions of the nurse
Observing, listening, and reporting
a factor that eating a large meal at one time is not possible.
Difficulty in breathing
interfere with the appetite.
Feedings between meals
may also affect the patient’s eating habits
Fatigue and poor appetite and many other
By _______, the nurse shows general interest in understanding the patient. Which helps the patient express feelings or “blow off steam.” This way the nurse learns about the patient’s favorites, dislikes, and foods cannot be eaten because of religious beliefs. The nurse becomes aware of the concerns the patient may have about the diet when at home.
listening
is essential to the best of care of the patient. It may be the nurse’s role to directly act on it. More often, it involves reporting to the nursing supervisor, dietitians, or physicians depending on the circumstances.
Acting open the information
The nurse has the opportunity for some _________. Patients often ask questions about their diet. When the patient has been given instructions for the diet to be used at home, the nurse may be able to reinforce this by helping the patient review their diet.
informal teaching
It measures fat globules in the stools to detect fat absorption as in cases like cystic fibrosis.
Fecal Fat Determination Test
It is used to determine GIT bleeding.
Meat-free Test
It is used to determine urinary calcium excretion to diagnose hypercalciuria.
Calcium Test
It is used to detect calcinoid tumors of the intestinal tract.
Serotonin Test
Is an inflammatory bowel disease of the large intestine limited to the rectum and the colon, which causes bloody and profuse diarrhea. It is characterized as severe diarrhea, rectal bleeding, and cramping and abdominal pain, anorexia, and weight loss.
ULCERATIVE COLITIS
Treatment of ULCERATIVE COLITIS
Rest, nutritional therapy, sulfonamides
Diet Therapy of ULCERATIVE COLITIS
1. High Protein
Extensive colon lesions require healing. Protein supplements are used with food sources to supply ___ to ___ grams of protein per day. Milk initially causes some difficulty for some patients. Therefore, it is omitted and added later in cooked form; egg, cheese, and meat are used instead.
120 to 150 grams of protein per day
Diet Therapy of ULCERATIVE COLITIS
2. High Calories
About ____ – ____ calories a day are needed to spare proteins needed for healing and to restore nutrient deficits from daily loss in stools and consequent weight loss.
2500 – 3000 calories a day
Diet Therapy of ULCERATIVE COLITIS
3. Increased Vitamins and Minerals
Supplements of _______ and _______ as well as food sources are tolerated (grains, fruits, vegetables, protein foods.)
Vitamins and Minerals
Diet Therapy of ULCERATIVE COLITIS
4. Low-residue Diet
Fairly low in residue in acute stages is ______, with _______– avoiding only heavy roughage to prevent irritation.
tolerated; gradual increases
is caused by a deficiency of lactase, the enzyme which hydrolyzes lactose, the sugar in milk. The undigested lactose remains in the small intestine and may serve as a substrate for bacterial fermentation. This disorder may either be congenital or may arise from other disease conditions like celiac sprue, where the intestinal mucosa is affected, or can occur after gastric surgery.
LACTOSE INTOLERANCE
Treatment of LACTOSE INTOLERANCE
Nutritional management
are enlarged veins which occur in the lower part of the rectum at the anal opening. External _______ crop up when the rectum meets the skin while internal _______ form completely within the rectum. The causes are constipation, prolonged use of cathartics, childbearing, and enemas.
HEMORRHOIDS
Treatment of HEMORRHOIDS
Nutritional Management
Diet Therapy of HEMORRHOIDS
1. High-fiber Diet – __ to __ g/day to relieve constipation
25 to 35 g/day
Diet Therapy of HEMORRHOIDS
2. Liberal Fluids – _ to __ glasses of water per day
8 to 10 glasses
Diet Therapy of HEMORRHOIDS
3. ________ foods and relishes are to be avoided.
Highly seasoned foods and relishes
Diet Therapy of HEMORRHOIDS
4. _______ is recommended during flare-ups.
Low fiber diet
is the most common cause of heart attacks.
refers to the thickening of the inside walls of the blood vessels. It is caused by the accumulation of fatty materials including a high proportion of cholesterol as well as other substances. The channel through which the blood flows becomes narrower. In such a narrow channel, a small blood clot can cause sufficient clogging that no blood can flow through. The tissue that is supplied by the blood vessel would be unable to receive nutrients or dispose of its wastes and would die.
Atherosclerosis (hardening of the arteries)
Treatment of Atherosclerosis
Drugs and diet
Diet Therapy of Atherosclerosis
1. Low-fat diet, low in _______ and _______
saturated fat and cholesterol
Diet Therapy of Atherosclerosis
2. Increase in ________ to lower plasma total cholesterol and LDL cholesterol levels
monounsaturated fatty acids
Diet Therapy of Atherosclerosis
3. Increase in _________, the omega-6 (corn oil, soybean oil, safflower oil, and sunflower oi) and omega-3 fatty acids (fatty fish like salmon, tuna,
polyunsaturated fats
Diet Therapy of Atherosclerosis
4. A total of ___ mg cholesterol intake per day
a. More egg ______ than egg ______
b. ______ meats taken once a month only
c. ______ consumed occasionally
d. Meat and poultry limited to - oz/day
300;
a. More egg whites than egg yolks
b. Organ meats taken once a month
only
c. Shrimps consumed occasionally
d. Meat and poultry limited to 5-6
oz/day
Diet Therapy of Atherosclerosis
5. Increase in _______ and restriction of _______
complex carbohydrate intake; simple sugars
Diet Therapy of Atherosclerosis
6. Dietary fiber - __-__ g/day
25-30
Diet Therapy of Atherosclerosis
7. Restriction of calories to _____-_____ for women and _____-_____ for men.
1,200-1,600 for women and 2,000-2,500for men.
is circulatory congestion resulting in the heart’s inability to maintain adequate blood supply to meet the oxygen demands.
is characterized by shortness of breath (dyspnea) and abnormal fluid retention, which usually results in swelling (edema) of the feet and legs.
Congestive heart failure (CHF) or cardiac failure
Diet Therapy of Congestive heart failure (CHF) or cardiac failure
1. __________ diet is used primarily for the prevention, control, and elimination of edema.
Sodium-restricted
Diet Therapy of Congestive heart failure (CHF) or cardiac failure
a. Mild restriction (- g Na)
* no added table salt (light use in
cooking)
* no salted foods
* all other foods as desired
2-3 g Na
Diet Therapy of Congestive heart failure (CHF) or cardiac failure
b. Moderate restriction ( ____mg Na)
* same as above plus elimination of salt in cooking and canned vegetables
* basic foods as desired, unprocessed with salt
1,000 mg Na
Diet Therapy of Congestive heart failure (CHF) or cardiac failure
c. Strict restriction ( ___ mg Na)
* Same as that of moderate restriction plus increased control of food with higher amounts of natural sodium (smaller amounts of eggs, meat, milk limited to 2 cups) and vegetables such as leafy greens, beets, carrots, and celery
5oo mg Na
Diet Therapy of Congestive heart failure (CHF) or cardiac failure
d. Severe restriction ( ___ mg Na)
* all the previous restrictions, plus tighter control of natural food sources
* meat limited to 2-3 oz daily
* 2-3 eggs per week
250 mg Na
Is also known as high blood pressure. It is common among males rather than females, 55 years and below.
HYPERTENSION
Treatment of HYPERTENSION
Lifestyle modification, nutritional therapy
Diet Therapy of HYPERTENSION
1. A _____ restriction of sodium and occasionally a ____ mg Na diet may be ordered.
mild; 1000
Diet Therapy of HYPERTENSION
2. _______ may facilitate the lowering of blood pressure.
Weight reduction
Diet Therapy of HYPERTENSION
3. _______ diet with emphasis on unsaturated oils is recommended.
Low fat
Salt is __% sodium. It is the principal source of sodium in the diet. ___ grams of salt would provide _____ mg sodium
40%; Six; 2400
describes a composite of symptoms that can occur as a result of injury to the capillary walls of the glomerulus. It is characterized by massive albuminuria as well as other protein losses in urine are observed. General malnutrition ensues.
NEPHROTIC SYNDROME
Treatment of NEPHROTIC SYNDROME
Nutritional Therapy
Diet Therapy of NEPHROTIC SYNDROME
1. Diet high in protein, ___-___ g daily
100-150
Diet Therapy of NEPHROTIC SYNDROME
2. High _____ intake to spare proteins for tissue synthesis and to provide energy
calorie
Diet Therapy of NEPHROTIC SYNDROME
3. Sodium restriction (___ mg)
500mg
means via the gastrointestinal tract. It’s for patients whose digestive systems still function, but who can’t eat enough or can’t chew.
Enteral
usually comes as a drink. The first _____ nutrition drinks were actually developed for astronauts. ______ nutrition can also be administered through a stomach tube.
Enteral nutrition
Patients whose gastrointestinal tracts do not function receives
parenteral nutrition
