nutrition Flashcards
3 Main Functions of Gastrointestinal System
Transportation, Digestion, & Absorption
Patients who are malnourished upon admission are a greater risk of what 6 complications
Dysrhythmias Skin breakdown Sepsis Hemorrhage Increase length of stay Delayed surgical healing
what are food guidelines
Provides average daily consumption of five food groups
5 dietary guidelines
- Follow a healthy eating pattern across the lifespan.
- Focus on variety, nutrient density, & amount.
- Limit calories from added sugars & saturated fats & reduce sodium intake.
- Shift to healthier food & beverage choices
- Support healthy eating patterns for all
7 factors influencing nutrition
Appetite Negative Experiences Disease & Illness Medications Environmental Factors - Income -Education level -Physical function level -Transportation -Availability of foods Developmental Needs Alternative Food Patterns -Religion -Cultural background -Health beliefs -Personal preferences
What must nurses consider during older adult nutritioin
Presence of chronic illnesses
Medications
Gastrointestinal changes
Slower metabolic rate
Cognitive impairments
Available transportation
Functional ability
Fixed income
Many need calcium
supplementation
Name 4 nutrition screening tools
Subjective screening
Objective measures
Identify risk factors of
malnutrition
Standardized tools
Name 3 standardized tools for screening
Subjective Global
Assessment (SGA)
Mini-nutritional
Assessment (MNA)
Malnutrition Screening Tools (MST)
Anthropometry Assessment
Measure of size and make up of body:
Height & Weight
Ideal Body Weight
Body Mass Index
Skin Fold Measures
Fat Percentage
Registered Dieticians can assist
Factors that affect lab results
Fluid balance
Liver & kidney function
Presence of disease
Common labs discussed in FUNDAMENTALS
Total Protein
Albumin
Prealbumin
Hemoglobin
Total Protein
Combination of albumin & globulin constitute
Normal: 6.4-8.3 g/dL (UKHC 6.3-7.9 g/dL)
Albumin
Makes up 60% of total PRO Better indicator of chronic illnesses Synthesized in the liver Half-life- 21 days Normal: 3.5-5.0 g/dL (UKHC 3.3-4.6
prealbumin
Preferred for acute conditions
Half-life- 2 days
Normal: 15-36 mg/dL (UKHC 20-41)
what is Hemoglobin
Protein responsible for transporting oxygen in the blood
Normal levels of hemoglobin
Male 14-18g/dL (UKHC 13.7-17.5)
Female 12-16g/dL (UKHC 11.2-15.7)
If hemoglobin is low what may a patient benefit from?
Eating foods rich in iron
Factors of Diet History (8)
Dietary intake Food preferences intolerances Unpleasant symptoms Allergies Taste, chewing, swallowing Appetite Weight
Factors of health history (4)
Illness
Activity level
Health status
Medications:
factors of other history in nutrition history
Age Socioeconomic status Cultural background Religious beliefs Transportation Psychological factors
8 nutrition nursing problems
Imbalanced Nutrition: Less than body requirements – or simply poor nutrition or the like
Imbalanced Nutrition: More than body requirements – or Overweight/Obesity
Impaired swallowing
Risk for aspiration
Diarrhea, Constipation, Nausea
Impaired Dentition
Fatigue
Risk of unstable blood glucose
4 categories of Planning
INDIVIDUALIZED approach
Goals & Outcomes
Setting priorities
Teamwork & Collaboration
5 categories of assessment of nutritional status
Screening
Anthropometry
Laboratory & Biochemical Tests
Diet & Health
History
Physical
Examination
6 areas of nutritional nursing implementation
Health Promotion
Diet Selection
Advancing Diet
Care of Common Nutritional Issues
Measuring Intake & Output (I&O)
Obtaining Height & Weight
4 areas of Diet selection
Amt needed
Ability to eat
GI alterations?
Any special consideration based on health status
5 Types of Diets
Regular
Liquid Diets & Special Considerations
Modified Texture diets
Therapeutic Diets
Modified for Nutrients
Supplements
What is a Regular Diet and it’s aim?
No restrictions & no signs of intolerances
Pt. has no comorbidities
Encourage healthy choices
Regular consistency
Aim is to provide a well-balanced diet to meet nutritional needs
5 types of modified texture diets
Mechanical Soft
Pureed
Minced
Ground
Chopped
What is the differences between clear and full liquid diet
Clear liquid diet is any liquid you can see through
Full liquid diet is anything liquid
What are the 2 special considerateions for liquid diet
fluid restriction
Modified consistency of liquid
Purpose of clear liquid diet
surgery
digestive problems
acute illness
leave little fiber in GI tract
full liquid diet is usually used for what?
Transition to regular diet
3 types of patients on fluid restriction
heart failure
renal failure
low serum sodium
Best indicator of patient fluid status
weight of patient everyday at same time in same clothes
6 types of therapeutic diet orders
Consistent Carbohydrate
Cardiac Diet or Heart Healthy Diet
Low residue
High Fiber
Gluten Free
Lactose Free
Bland
who would have low residue diet
ulcerative colitis
chrons disease
who would have a high fiber diet
improving cholesterol
prevent colon cancer
constipation
NPO means
Nothing by mouth
T/F Being NPO for more than 5-7 days are high nutritional risk
True
What are 4 common nutritional issues
Anorexia
Inability to feed self
Dysphagia
Nausea & Vomiting
what does anorexia mean
lack or loss of appetite
causes of anorexia
pain
fatigue
effects of medications
9 approaches to increase appetite
Treat the cause
Use creative approaches to stimulate appetite
Environment
Smaller meals, more frequent meals
Allow for food preferences
Seasonings to improve taste
Provide oral hygiene
Ensure patient is comfortable
Medications for appetite stimulation
6 steps to assisting patients with oral feedings
Protect safety, independence & dignity
Make sure tray is within reach
Assess risk of aspiration
Does patient need to be supervised
Any visual deficits?
Decreased motor skills
Dysphagia complications
Aspiration pneumonia
Dehydration
Malnutrition s/t decreased intake
Weight loss
If dysphagia is suspected
Make referrals to Speech Language Pathologist (SLP) & Registered Dietician (RD)
Perform swallow evaluations
The Do’s of Dysphagia (11)
Sit in high fowlers Minimize environmental distractions Allow for time in between bites and drinks Check for oral pocketing Chin tuck Double swallowing Have suction available Perform oral care Monitor for choking and coughing
The Don’ts of Dysphagia (4)
Feed when altered LOC
Leave unattended
Administer sedatives or hypnotics
Use a straw
7 stages of Dysphagia diet
0 - Thin 1sligtly thick 2midly thick 3moderately thick/liquidised 4exremely thick/pureed 5minced 6 soft 7- regular/easy chew
Strick I&O
Measurement of all intake and all output
Record in patient medical record
Can measure in amount (mls) or in occurrences
who needs strict I&Os
Critical care patients Unstable patients Post-Operative patients Pt.’s who have catheters, lines, drains, tubes Patient’s with history of/ or current Heart failure, liver failure, renal failure Malnourished or patients who are NPO Receiving medications such as diuretics Changes in weight
what is considered intake 5
Oral intake IV Fluids Blood products Tube feeding Flushes
what is considered output 4
Urine
Bowel movements
Emesis
Drainage tubes
What is enteral nutrition
Provides nutrients in GI tract
Preferred method if patient cannot swallow & gut is functioning
what is parenteral nutrition
Form of specialized nutrition support provided intravenously
Characteristics of enteral nutrition
Receive formula through nasogastric tubes, jejunal or gastric tubes
Delivered to gastric or jejunum
Risk for gastric reflux_ jejunum feedings
When placed MUST CONFIRM PLACEMENT
indications of EN
Prolonged anorexia Some patients simply WILL NOT eat Severe protein-energy malnutrition Coma Impaired swallowing Critical illnesses
Benefits of EN vs PN
Reduce sepsis
Minimizes the hypermetabolic response to trauma
Decreases hospital mortality
Maintains intestinal structure & function
Signs of Tube feeding intolerance
High gastric residuals Nausea Cramping Vomiting Diarrhea
complications of tube feeding
Pulmonary aspiration Diarrhea Constipation Abd cramping, nausea, vomiting Tube occlusion or displacement Delayed gastric emptying Serum electrolyte imbalance Fluid overload Hyperosmolar dehydration
placement of feeding tubes
Through the nose
Nasogastric or nasointestinal (duodenal)
Surgically
Gastronomy
Jejunostomy
Endoscopically
Percutaneous Endoscopic Gastronomy (PEG)
Percutaneous Endoscopic Jejunostomy (PEJ)
nurse role in tube placement
Insert NG tube using water soluble lubricant
Landmarks (gastric)- nose_ ear_ xiphoid process
Add 8-10 inches for jejenum
Nasogastric or Nasojejunal
characteristics
Typically for EN < 4 weeks
Large bore & small bore
Typical for adults: 8-12 Fr, 36-44 inches long
Come with a stylet
Connectors are not standard for EN feeding tubes
surgically or endo tube characteristics
Preferred long-term feeding
More than 6 weeks
checking gastric residual
Continuous- Every 4-6 hours
Intermittent- immediately before
High gastric residual can indicate delayed gastric emptying
How much is too much?
Know hospital policy as well as KNOW your patient
> 250 ml_ hold for 1 hour and recheck
> 500 mls_ hold and notify HCP
