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NSG 1135 > nutrition > Flashcards

nutrition Flashcards

1
Q

nutrition is essential for

A

normal growth and development, tissue maintenance and repair, cellular metabolism, and organ function

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2
Q

nutrition assessments

A 
daily weights
ast, alt, alp
albumin, total protein
BUN, creatinine, eGFR
glucose
diet and health history
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3
Q

what is dysphagia

A

difficulty swallowing

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4
Q

signs of dysphagia

A

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

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5
Q

to assess for dysphagia…

A

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

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6
Q

list complications of dysphagia

A

aspiration pneumonia
dehydration
decreased nutritional status
weight loss

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7
Q

dysphagia leads to

A

disability or decreased functional status, increased length of stay and health care costs, increased likelihood of discharge to institutionalized care, and increased mortality

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8
Q

dysphagia often leads to inadequate amount of food intake which results in

A

malnutrition

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9
Q

patients with dysphagia become

A

frustrated with eating and show decrease in albumin levels

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10
Q

malnutrition significantly slows what

A

swallowing recovery and may increase mortality

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11
Q

nursing role for nutrition in patients

A

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

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12
Q

NPO (ordered diet)

A

nothing by mouth

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13
Q

if a patient is NPO for a prolonged period of time, what should the nurse ensure

A

that they are receiving fluids intravenously or nutrition through a nasogastric tube to maintain hydration status

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14
Q

clear liquid (ordered diet)

A

only clear liquids or clear solids that become clear liquids easily at room temperature

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15
Q

clear liquid diet options

A 
clear fat-free broth
bouillon
coffee
tea
carbonated beverages
clear fruit juices
gelatin/jello
ices
popsicles
soda
tea
water
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16
Q

full liquid diet

A

as for clear liquid, with addition of smooth textured dairy products

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17
Q

full liquid diet options

A 
ice cream
strained or blended cream soups
custards
refined cooked cereals
vegetable juice
pureed vegetables
all fruit juices
sherberts
puddings
frozen yogurt
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18
Q

dysphagia stages, thickened liquids, pureed (ordered diet)

A

as for clear and full liquid, with addition of scrambled eggs, pureed meats, vegetables, and fruits, mashed potatoes and gravy

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19
Q

mechanical soft (ordered diet)

A

foods that are mashed up by a machine and made soft

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20
Q

mechanical soft ordered diet options

A 
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)
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21
Q

low sodium ordered diet

A 
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
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22
Q

low cholesterol ordered diet

A

300 mg/day

in keeping with American Heart Association guidelines for serum lipid reduction

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23
Q

diabetic ordered diet

A

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

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24
Q

cardiac ordered diet

A

low sodium, low cholesterol, low fat, high fiber

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25
Q

gluten free ordered diet

A

eliminates what, oats, rye, barley, and their derivatives

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26
Q

regular ordered diet

A

no restrictions unless specified

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27
Q

what is enteral nutrition

A

nutrition delivered directly to the stomach

also known as tube feeding

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28
Q

enteral nutrition provides nutrients through the what

A

GI tract

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29
Q

why might enteral nutrition need to be provided

A

if patient is unable to swallow or if they have dysphagia

30
Q

enteral nutrition complications

A

aspiration risk

not alert enough

31
Q

patients receiving enteral nutrition will receive formula through what

A

nasogastric, jejunal, or gastric tubes

32
Q

where do gastric tubes reside

A

enter the nasal or oral cavity, pass through esophagus, and the tip of the tube sits in the stomach

33
Q

types of gastric tubes

A

nasogastric (nose)

orogastric (mouth)

34
Q

are gastric tubes short term or long term

A

short term, usually placed in the acute care setting

if needed long term, a permanent tube will be placed

35
Q

purposes of gastric tubes

A

enteral feeding and medication administration
decompression
lavage (stomach irrigation or pumping)

36
Q

NG tube sizes

A

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

37
Q

nasoenteric, gastrostomy, and jejunostomy tubes are tubes that can deliver what

A

enteral nutrition to the patient who is unable to consume nutrients by mouth

38
Q

nasoenteric tubes

A

nasogastric (NGT)

naswjejunal (NJT)

39
Q

orogastric tubes are usually chosen if what

A

the patient is intubated or has nasal trauma (broken nose or septum)

40
Q

surgical tubes

A

gastrostomy tubes
jejunostomy tubes
(-ostomy) refers to a surgical creation of an opening in an organ
more permanent

41
Q

gastrostomy tubes

A

percutaneous endoscopic gastrostomy (PEG tube)

42
Q

jejunostomy tubes

A

percutaneous endoscopic jejonostomy (PEJ tube)

43
Q

what should you consider with tube choice

A

aspiration risk

if patient is at high risk for reflux or aspiration, jejunal feeding is preferred

44
Q

types of gastric tubing

A

salem sump
levin
both tubes can be used for feedings, medication administration, and decompression

45
Q

salem sump

A 
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
46
Q

levin

A

single lumen

47
Q

know how to insert nasogastric tube

A

video on canvas

48
Q

what is supine position

A

lying flat, face up

49
Q

what is high fowlers position

A

upright, spine straight

60-90 degrees

50
Q

what should you monitor while inserting NG tube

A 
respiratory complications
SOB
inability to speak
color change
if these occur, remove tube immediately
51
Q

can you give water to a dysphagia patient while inserting NG tube

A

no, nor if their are NPO

only give water if they are alert and not NPO or dysphagia

52
Q

what’s the rationale for putting patients chin to chest after NG tube reaches back of throat

A

to prevent tube from going into the trachea

53
Q

documentation of NGT insertion

A

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)

54
Q

management of NGT

A

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

55
Q

percutaneous endoscopic gastrostomy (PEG tube) specifics

A

flexible feeding tube is placed through the abdominal wall and into the stomach - requires surgical procedure

56
Q

who benefits from PEG

A

patients who have difficulty swallowing, problems with their appetite, or an inability to take adequate nutrition through the mouth

57
Q

manage area of PEG

A

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

58
Q

PEG complications

A

pain at site
leakage of stomach contents around tube site
dislodgement or malfunction of tube

59
Q

how long can PEG tubes last

A

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

60
Q

NGT and PEG tube med admin

A

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

61
Q

NGT and PEG tube med admin, after assessing residuals,

A

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

62
Q

NGT and PEG tube feedings

A

when patients are unable to ingest food PO but can still digest and absorb nutrients

63
Q

enteral formula ordered based on

A

patient’s condition and needs

64
Q

complications of NGT and PEG tube feedings

A

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

65
Q

NGT and PEG feedings can be

A

continuous or bolus

66
Q

continuous NGT/PEG feedings are

A

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

67
Q

nurse may be required to assess routinely of NG tube feedings why

A

even if patient is not diabetic because blood glucose levels can increase
assess for s/s of hyperglycemia

68
Q

bolus ng/peg tube feedings are

A

given by syringe, to the flow of gravity, admin is similar to med admin

69
Q

can you delegate blood sugar checks

A

yes

cannot delegate NG tube insertion, gastric contents, only making sure bed is elevated

70
Q

gastric tube removal indications

A

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

71
Q

gastric tube removal process

A

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

72
Q

what is the rationale of flushing tube with 30 ml of air

A

clears any contents from the tube and decreases risk of aspiration during removal

NSG 1135 (3 decks)

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