nutrition Flashcards
nutrition is essential for
normal growth and development, tissue maintenance and repair, cellular metabolism, and organ function
nutrition assessments
daily weights ast, alt, alp albumin, total protein BUN, creatinine, eGFR glucose diet and health history
what is dysphagia
difficulty swallowing
signs of dysphagia
cough during eating
change in voice tone or quality after swallowing
abnormal movements of the mouth, tongue, or lips
slow, weak, imprecise, or uncoordinated speech
inability to speak consistently
abnormal gag
delayed swallowing
incomplete oral clearance or pocketing
regurgitation
delayed or absent trigger of swallow
to assess for dysphagia…
assess for signs of dysphagia,
attempt to have patient take a small sip of water while sitting up in bed
if difficulties present, notify physician and request registered dietician consult
list complications of dysphagia
aspiration pneumonia
dehydration
decreased nutritional status
weight loss
dysphagia leads to
disability or decreased functional status, increased length of stay and health care costs, increased likelihood of discharge to institutionalized care, and increased mortality
dysphagia often leads to inadequate amount of food intake which results in
malnutrition
patients with dysphagia become
frustrated with eating and show decrease in albumin levels
malnutrition significantly slows what
swallowing recovery and may increase mortality
nursing role for nutrition in patients
review ordered diet
advancing diets as tolerated by the patient
gradual progression of dietary intake or therapeutic diet to manage illness
promoting appetite
assisting with oral feedings if necessary
promote independence
use weighted silverware
NPO (ordered diet)
nothing by mouth
if a patient is NPO for a prolonged period of time, what should the nurse ensure
that they are receiving fluids intravenously or nutrition through a nasogastric tube to maintain hydration status
clear liquid (ordered diet)
only clear liquids or clear solids that become clear liquids easily at room temperature
clear liquid diet options
clear fat-free broth bouillon coffee tea carbonated beverages clear fruit juices gelatin/jello ices popsicles soda tea water
full liquid diet
as for clear liquid, with addition of smooth textured dairy products
full liquid diet options
ice cream strained or blended cream soups custards refined cooked cereals vegetable juice pureed vegetables all fruit juices sherberts puddings frozen yogurt
dysphagia stages, thickened liquids, pureed (ordered diet)
as for clear and full liquid, with addition of scrambled eggs, pureed meats, vegetables, and fruits, mashed potatoes and gravy
mechanical soft (ordered diet)
foods that are mashed up by a machine and made soft
mechanical soft ordered diet options
as for clear and full liquid and pureed, all cream soups ground or finely diced meats flaked fish cottage cheese cheese rice potatoes pancakes light breads cooked vegetables cooked or canned fruits bananas soups peanut butter eggs (not fried)
low sodium ordered diet
4 g (no added salt) 2g 1g 500 mg vary from no added salt to severe sodium restriction (500 mg sodium diet) which requires selective food purchases
low cholesterol ordered diet
300 mg/day
in keeping with American Heart Association guidelines for serum lipid reduction
diabetic ordered diet
nutrition recommendations by the American Diabetes Association:
focus on total energy, nutrient and food distribution; include a balanced intake of carbohydrates, fats, and proteins; varied caloric recommendations to accommodate patient’s metabolic demands
cardiac ordered diet
low sodium, low cholesterol, low fat, high fiber
gluten free ordered diet
eliminates what, oats, rye, barley, and their derivatives
regular ordered diet
no restrictions unless specified
what is enteral nutrition
nutrition delivered directly to the stomach
also known as tube feeding
enteral nutrition provides nutrients through the what
GI tract
why might enteral nutrition need to be provided
if patient is unable to swallow or if they have dysphagia
enteral nutrition complications
aspiration risk
not alert enough
patients receiving enteral nutrition will receive formula through what
nasogastric, jejunal, or gastric tubes
where do gastric tubes reside
enter the nasal or oral cavity, pass through esophagus, and the tip of the tube sits in the stomach
types of gastric tubes
nasogastric (nose)
orogastric (mouth)
are gastric tubes short term or long term
short term, usually placed in the acute care setting
if needed long term, a permanent tube will be placed
purposes of gastric tubes
enteral feeding and medication administration
decompression
lavage (stomach irrigation or pumping)
NG tube sizes
small bore <12 French - for medication administration and enteral feedings
large bore 12, 14, 16, 18 French - for gastric decompression or removal of gastric contents
nasoenteric, gastrostomy, and jejunostomy tubes are tubes that can deliver what
enteral nutrition to the patient who is unable to consume nutrients by mouth
nasoenteric tubes
nasogastric (NGT)
naswjejunal (NJT)
orogastric tubes are usually chosen if what
the patient is intubated or has nasal trauma (broken nose or septum)
surgical tubes
gastrostomy tubes
jejunostomy tubes
(-ostomy) refers to a surgical creation of an opening in an organ
more permanent
gastrostomy tubes
percutaneous endoscopic gastrostomy (PEG tube)
jejunostomy tubes
percutaneous endoscopic jejonostomy (PEJ tube)
what should you consider with tube choice
aspiration risk
if patient is at high risk for reflux or aspiration, jejunal feeding is preferred
types of gastric tubing
salem sump
levin
both tubes can be used for feedings, medication administration, and decompression
salem sump
dual lumen blue tube is an air vent keep blue tube open do not connect suction tubing to the air vent, do not administer medications through the air vent preferable, used more commonly
levin
single lumen
know how to insert nasogastric tube
video on canvas
what is supine position
lying flat, face up
what is high fowlers position
upright, spine straight
60-90 degrees
what should you monitor while inserting NG tube
respiratory complications SOB inability to speak color change if these occur, remove tube immediately
can you give water to a dysphagia patient while inserting NG tube
no, nor if their are NPO
only give water if they are alert and not NPO or dysphagia
what’s the rationale for putting patients chin to chest after NG tube reaches back of throat
to prevent tube from going into the trachea
documentation of NGT insertion
size of NGT
which naris it was placed in
where it was secure (cm)
placement verification (xray)
gastric content residuals, amount, color, consistency
patient tolerated (without voiced complaint, reports pain)
current condition (clamped, suction, meds)
management of NGT
verify position hasn’t moved - check measurement at nostril or gum line
keep tube secured to nostril or mouth
ensure tube remains patent - always flush tube with at least 30 ml of water before and after use
ensure head of bed is elevated min 30 degrees
ensure tube stays above stomach level
assess nares frequently for skin breakdown, lube nostrils PRN
assess oral mucosa integrity and moisture, offer oral swabs and chapstick PRN
percutaneous endoscopic gastrostomy (PEG tube) specifics
flexible feeding tube is placed through the abdominal wall and into the stomach - requires surgical procedure
who benefits from PEG
patients who have difficulty swallowing, problems with their appetite, or an inability to take adequate nutrition through the mouth
manage area of PEG
clean site once a day with diluted soap and water or normal saline and keep site dry b/w cleanings
no special dressing or covering needed, sometimes covered with split sponge
PEG complications
pain at site
leakage of stomach contents around tube site
dislodgement or malfunction of tube
how long can PEG tubes last
months or years, can break down or become clogged over extended periods of time and may need to be replaced
may see replacement of tube with an indwelling catheter
NGT and PEG tube med admin
prepare meds - use liquid form if possible, crush tabs into a fine powder unless contraindicated, open capsules to disperse contents unless contraindicated, dissolve meds if possible, administer meds using enteral tube syringe
GI assessment - inspect, auscultate, palpate - ensure bowels are functioning before giving anything
ask about N/V
always confirm placement of tube by aspirating gastric contents
check residual before feeding or meds by connecting syringe to port and pulling back contents - return residuals to stomach
if residuals exceed 500 ml, hold feeing or meds for 2 hours and recheck
NGT and PEG tube med admin, after assessing residuals,
flush tube with 30 ml of room temp water
administer meds
flush tube with 30 ml of water after med admin
document meds given and how much fluid was delivered
keep patient in semi high fowlers for at least 1 hour after meds are given
NGT and PEG tube feedings
when patients are unable to ingest food PO but can still digest and absorb nutrients
enteral formula ordered based on
patient’s condition and needs
complications of NGT and PEG tube feedings
aspiration of contents that can lead to pneumonia, respiratory distress
be sure patient is in an appropriate position throughout feeding and for at least an hour after feeding
NGT and PEG feedings can be
continuous or bolus
continuous NGT/PEG feedings are
delivered over the course of hours, with small amount given each hour
continuous feedings can increase serum glucose levels
nurses’ responsibility to assess patient during feedings, check residuals and increase feedings per orders as tolerated by patient
feedings can cause abdominal cramping/discomfort if administered too quickly - slow rate of feeding as needed
nurse may be required to assess routinely of NG tube feedings why
even if patient is not diabetic because blood glucose levels can increase
assess for s/s of hyperglycemia
bolus ng/peg tube feedings are
given by syringe, to the flow of gravity, admin is similar to med admin
can you delegate blood sugar checks
yes
cannot delegate NG tube insertion, gastric contents, only making sure bed is elevated
gastric tube removal indications
temp tube being removed bc permanent is being placed (-ostomy tube)
bowel obstruction resolved
bowel sounds changed from absent to active
out of coma
lavage completed
dysphagia resolved
gastric tube removal process
flush tube with 30ml of air
educate patient to hold their breath during removal
detach all tape holding tube securely - don’t let go of tube
swiftly remove tube while patient holds breath, coiling in hand
what is the rationale of flushing tube with 30 ml of air
clears any contents from the tube and decreases risk of aspiration during removal
