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nutrition Flashcards

1
Q

Nutrition is the study of what?

A

the “study of food and how it affects the human body and influences health”

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2
Q

Nutrients are substances that…(GRD HI nutrients)

A

affect growth, development, reproduction, activity, health maintenance and the body’s ability to recover from illness and injury

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3
Q

Metabolism is the

A

“process by which the body converts food into energy

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4
Q

Essential Nutrients - Macro (CPF)

A

Essential nutrients: Nutrients that must be supplied in diet or supplements
Macro:
Carbohydrate
Protein
Fat

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5
Q

Non-Essential nutrients:

A

Not essential for body function or are synthesized in adequate amounts by the body

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6
Q

Energy balance = (you give me energy, and you take it away)

A

Total energy intake - Total daily expenditure

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7
Q

Amount of energy a person requires dependent on

A

age, sex, activity level, weight, height, and health conditions

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8
Q

Daily caloric requirements: (daily calories when I was 20 - 35)

A

Several formulas available. Simplest:
20 to 35 kcal/kg body weight

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9
Q

Body Mass Index (BMI) - used to measure what?

A

risk of obesity-associated diseases and conditions

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10
Q

CHO - primary source of what?

A

primary source of energy

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11
Q

CNS relies exclusively on what for energy?

A

glucose for energy. Chief protein-sparing energy source
Easier and faster to digest than proteins and fats

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12
Q

All CHO converted to what? Think carbs…

A

glucose for transport in blood

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13
Q

Glucose transported to GI tract, then…(GI is the vein of the liver)

A

GI tract →portal vein → liver for storage

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14
Q

Glycogenesis (genesis is stored in the 80s)

A

excess glucose stored in form of glycogen in liver
Carbohydrates and proteins converted to fat in excess and stored as triglycerides in the liver or fat cells (adipose tissue)

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15
Q

Glycogenolysis: (lysing the glyco)

A

When glycogen is broken down into glucose for energy
Blood glucose regulated by hormones insulin and glucagon

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16
Q

Monosaccharides (simple) (FG one sugar)

A

Single stranded sugar molecule
Glucose
Fructose
Found in fruits and honey

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17
Q

Disaccharides (simple) (SML two)

A

Double stranded sugar molecule
Sucrose (table sugar)
Maltose (malted grains)
Lactose (milk)

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18
Q

Complex carbohydrates (poly is complex) and ex? how much daily?

A

(polysaccharides)
Starches such as cereal grains, starches, and legumes
Ideally 45% to 65% of daily caloric needs
Should include 14 g of fiber/1000 kcal

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19
Q

protein - how many amino acids involved? (protein is NOT 21)

A

Made of 22 variations of amino acids which are the basic building blocks for life:
Essential for formation of all body structures: genes, enzymes, muscle, bone matrix, skin and blood.

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20
Q

Complete proteins: (complete animals)

A

Contains all essential amino acids to support growth
Animal proteins: eggs, dairy, meat

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21
Q

Incomplete proteins: and Ex. (incomplete from age 10) and how much do you need in diet?

A

Lacks one or more amino acids
Plant proteins: grains, legumes, vegetables (some exceptions: soy, buckwheat, hemp, etc. )
10% to 35% of daily caloric needs

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22
Q

Protein metabolism: (protein to amine, to pancrease, to GI, to liver, recombined and released to cells)

A

Ingested protein → broken down to amino acids by pancreatic enzymes in small intestine → absorbed by GI mucosa → liver→recombined into new proteins or release into bloodstream for protein synthesis by tissues and cells
Excess converted to fatty acids or used for fuel

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23
Q

Nitrogen balance (nitro compares intake and excretion)

A

compares protein intake vs protein excretion (loss via urine, stool, hair, nails, skin)

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24
Q

fats

A

Major source of energy
Insoluble in water and blood

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25
Q

unhealthy fats - (unhealthy saturated and trans don’t have friends) solid or liquid?

A

Saturated fat and trans fat Lacks double bonds between carbons leading to solid form at room temp
Animal source
Raises serum cholesterol

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26
Q

healthy fats (unsaturated/unfat have bonds)

A

Unsaturated fat: Mono-and poly-unsaturated fats
Contains at least one double bond between carbons; liquid at room temp
Olive oil, salmon, avocado
Lowers serum cholesterol

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27
Q

fat metabolism - where does it occur? (and what and from where it is secreted?)

A

Occurs in the small intestine
Bile secreted by the gallbladder emulsifies fat for pancreatic lipase to break down fat more efficiently

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28
Q

cholesterol sources - produced where in the body? And essential for what? (cholesterol and bile are steroid blisters in the sun!)

A

produced by the liver and consumption of animal foods
Essential for cell membrane, precursor of steroid hormones and Vitamin D, synthesizes bile acids

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29
Q

LDL - what do high levels do to the body?

A

(low density lipoprotein)
The “bad” cholesterol
High levels lead to plaque buildup → atherosclerosis

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30
Q

HDL - what does it do?

A

(high density lipoprotein
The “good” cholesterol
Carries LDL away from body to liver for processing

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31
Q

trigylcerides - most common what?

A

Most common type of fat

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32
Q

vitamins - do we make them?

A

Organic compounds required for normal metabolism and prevention of diseases related to deficiency
Not made by body; must be consumed

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33
Q

water soluble vitamins

A

vitamin C and B-complex
absorbed directly by the small intestine and into the bloodstream
Not stored; excess excreted in the urine

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34
Q

inadequate vitamins leads to (and what vitamin causes what) and what in adults?

A

deficiency syndromes
Vit C deficiency →Scurvy
Vit D deficiency →Rickets in children; osteomalacia in adults
Folate and Iron → Anemias

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35
Q

minerals - what are they for? (miner body building)
and are they organic or inorganic?

A

Inorganic elements found in nature (food and supplements)
For tissue building, nerve impulse, fluid regulation, bone and blood health

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36
Q

major minerals - macrominerals - in what amount and ex? (CPPS M (ajor) over 100)

A

Major minerals (macrominerals)
Required in amounts of > 100 mg/day
e.g. Calcium, phosphate, sodium, potassium, magnesium

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37
Q

trace minerals - microminerals - in what amount and ex? (IZIF) (Izod micro) -

A

(microminerals)
Essential but in low amounts < 100 mg/day
e.g. Iron, Zinc, Iodine, fluoride

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38
Q

water - how much of body weight is water? And average daily requirements?

A

Water is more vital to life than any other nutrient
Major body constituent in every body cell
Accounts for 50-60% of an adult’s body weight
⅔ in intracellular space
⅓ in extracellular space
Average adult requirement: 2.2 -3L/day

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39
Q

vegetarian - what deficiencies? (VIP vegetarian)

A

Exclusion of meat from diet
Need well-planned diet to avoid vitamin, protein, iron, deficiencies

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40
Q

lacto-ovo vegetarians

A

Plant food diet and occasional dairy products and eggs
Risk for vitamin and mineral deficiencies
Iron deficiency

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41
Q

vegan - can develop what, and what vitamin is required? (vegan on megablast at 12)

A

exclusive plant foods
Can develop megaloblastic anemia and neurologic signs of deficiency
Require fortified foods with Cobalamin (vitamin B12)

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42
Q

common diet orders - cardiac

A

2 gm Na+ diets (Cardiac diet - aka low sodium)

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43
Q

age related affecting nutrition

A

Altered ability to chew (edentulus or poor dentition)
Loss of sense of taste or smell
Decrease peristalsis
GERD
Lower glucose tolerance
Reduction in appetite and thirst sensation
Physical disability
arthritis pain, gout
Social isolation and depression
Food access
Osteoporosis → ↑ risk of osteoporosis and fractures

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44
Q

nutrition assessment- interview

A

Recent weight loss or gain
Appetite and special diets
Chronic conditions
Exercise pattern
Nutrition/food access

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45
Q

nutrition assessment - measure what? (just BMI and dysphage)

A

Assessment
Measure height and weight person for BMI
Assess dysphagia → indication of high aspiration risk

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46
Q

prealbumin - synthesized by what? Half-life? helps identify what problems?

A

A protein synthesized by the liver
half-life of 2-3 days

Better indicator of recent or current nutritional status

Most accurate in identifying early protein or calorie malnutrition

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47
Q

albumin - how far does it lag behind?

A

Albumin value lags behind actual protein changes by > 2 weeks (20-22 days)

Not a good indicator of acute changes in nutritional status

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48
Q

diagnosis

A

Imbalanced nutrition less than body requirement r/t… food security, chronic illness, poor appetite, etc.
Readiness for enhanced nutrition as evidenced by desire to lose weight, reduce alcohol consumption, etc.

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49
Q

planning

A

Collaborate with dietician
Consult social worker for etoh cessation programs
Monitor daily nutritional labs and blood gluocose

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50
Q

Implementation

A

Social worker and dietician ordered for consult
Daily nutritional labs drawn and blood sugar checks before meals
Assisted patient with menu selection

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51
Q

evaluation

A

Evaluate results of planned interventions

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52
Q

routes of nutrition (GO PIE)

A

Enteral
Oral
Gastrointestinal
Parenteral
Intravenous (peripheral or central)

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53
Q

oral feeding - how to sit, and how long after meals to sit up?

A

When patient has normal swallowing reflexes (+ cough and gag)
Completely awake, alert, follows commands
Sit up at 90 degree; preferably in chair
Follow ordered diet
Sit up for at least 30 min after meals

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54
Q

enteral nutrition - what type of feeding? and where is it inserted?

A

Often referred to as tube feeding
Administration of nutritionally balanced liquified food or formula through tube inserted into:
Stomach
Duodenum
Jejunum
Also inserted for medication administration in a sedated/comatosed patient
Provides nutrients alone or is supplement to oral or parenteral nutrition

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55
Q

Enteral vs Parenteral nutrition - infection risk, more for which one?

A

Maintains gut function
Easily administered
Infection risk: Enteral < Parenteral route
Physiologically more efficient than parenteral
Less expensive than parenteral

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56
Q

indications (who should get it) for enteral (enter the anorexic…)

A

Anorexia
Frequent aspirations
Orofacial fractures
Head/neck cancer

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57
Q

PEG (stomach wall) - when to use? and how often is it changed? (I only see Peg every few months for a long time)

A

When longer term enteral feeding is anticipated
More comfortable
Tube replaced every few months
Laparoscopically placed in interventional radiology

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58
Q

Percutaneous Endoscopic Jejunostomy (GAG Juno)

A

A J-tube is considered in the following circumstances:
Gastroparesis
GERD
High risk aspiration
If surgery is needed on stomach/esophagus at later point

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59
Q

insertion of feeding tube

A

Nasogastric and nasointestinal tubes
Inserted through the nasal cavity directly to GI tract
Confirmed by x-ray prior to use
Tube can be inadvertently placed in lungs or sinuses

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60
Q

insertion of feeding tube - Nasogastric and nasointestinal tubes - how to measure?

A

Measure from nose to earlobe to tip of xiphoid process (approximates position of stomach)
Most tubes have cm markings so note approximately how far the tube should go
Ask the patient to flex chin to chest

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61
Q

nasogastric insertion - Ask patient to swallow once the tube passes the

A

nasopharynx to the epiglottis
Insert gently and never force if obstruction is met
Advance the tube as the patient swallows
May be necessary to change the angle and rotate the tip as it is inserted
Observe the patient closely

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62
Q

nasogastric - prior to feeding. what do you need for everything?

A

*Prior to feeding, X-ray confirmation must be done and nursing order ”ok to use”
Do not rely on auscultation of abdomen or pH strips
Record and documented insertion length; use sharpie to mark if tube has no measurement marking

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63
Q

enteral feeding complications - aspirational pneumonia (HOB?)

A

Aspiration pneumonia (most serious)
Insert post pyloric
HOB>30-45°, maintain upright for at least 30 min- 1° after
bolus feed
Check tube placement and residual

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64
Q

Nursing Responsibilities: Enteral Nutrition - assess how often?
how often to assess length of tube?
how often to change tape?

A

Assess for residual per hospital policy (generally every 4-8hrs)
Insertion length verified and documented every shift
Securement tape should also be changed every day to assess skin
Eyeball for same marking before administration of feeding/meds

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65
Q

Nursing Responsibilities: Enteral Nutrition - check for…(enteral needs WD10-40)

A

Check for protocols such as hanging D10 when tube feed nutrition interrupted to prevent hypoglycemia
Will need MD order to restart tube feeding

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66
Q

Nursing Responsibilities Enteral Nutrition - patient position (and what did Phoebe do?)

A

Patient position:
Patient should be sitting or with HOB at 30 to 45° if in bed
HOB remains elevated for 30 to 60 minutes for intermittent delivery
Continuous feedings administered on feeding pump
Aspiration precautions

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67
Q

Nursing Responsibilities Enteral Nutrition - tube patency (openness) - flushing -flush with what?

A

Flush with sterile water before/after each feeding, drug administration and after residual checks
Flush with 5mL of sterile water between meds

If residual is less than hold order, simply document feeding and refeed residual

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68
Q

enteral - delivery modes - Continuous infusion by pump (how to increase) (continous buffy)

A

Usually gradual increase in rate every 8-12hrs
until patient reaches ordered goal rate

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69
Q

enteral - new practice re flushing (flush at 30, 10, and 5)

A

NEW PRACTICE per JCAHO
Flush 30 ml of sterile water before and after med administration / Feeding
Flush 5 ml of sterile water in between meds
10 ml sterile water to dissolve meds
Meds are never combined; not a Nursing scope of practice – considered compounding meds

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70
Q

Enteral Nutrition: Nursing Considerations (enter the weight, bowels, I/O, and dehydration)

A

Daily weights
Assess bowel sounds and abdominal distention
Monitor bowel movements
Accurate intake/output
Check order for free water boluses (for patients with hypernatremia)
Refeeding syndrome
Dehydration

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71
Q

enteral nursing considerations - glucose (label bag with what?)

A

Initial glucose checks
Label enteral bag with patient name, formula type, date and time started

72
Q

refeeding syndrome

A

Starvation of nutrients for many consecutive days or metabolically stressed d/t critical illness - fatal shift in fluids

73
Q

when refeeding, what happens to insulin?

A

Insulin secretion resumes in response to sugar sources

74
Q

preventing refeeding - check for what? (refeed the electrolytes)

A

Identify individuals at risk (just check elctrolytes before starting)
Correct depleted electrolytes before refeeding

75
Q

enteral complications = Gastrostomy or jejunostomy tubes

A

Gastrostomy or jejunostomy tubes
Skin irritation around tube
Skin assessment and care
Tube dislodgement
Teach patient/family about feeding administration, tube care, and complications
Fistulas -entero-cutaneous
Infections: skin, fasciitis, peritonitis
Abdominal wall or intraperitoneal bleeding and bowel perforation
Obstruction or erosion of gastric wall
Gastric mucosa hypertrophy

76
Q

enteral - gerontologic (gerry fluid sugar and volume makes me choke)

A

More vulnerable to complications
Fluid and electrolyte imbalances
Glucose intolerance
Decreased ability to handle large volumes
Increased risk of aspiration

77
Q

Parenteral nutrition (PN)

A

Administration of nutrients by route other than GI tract (i.e. Intravenously)
Used when
GI tract cannot be used for ingestion, digestion, and absorption of essential nutrients

78
Q

Parenteral Nutrition - indications (when it’s needed) (Parents need IVs if they’re vomiting, gi problems, malnurished, panceatitis)

A

Indications:
Chronic or intractable diarrhea and vomiting
Complicated surgery or trauma
Post GI surgery
GI obstruction
GI tract anomalies and fistulae
Sepsis
Severe malnutrition
Malabsorption
Pancreatitis

79
Q

Parenteral Nutrition - composition (parents are composed of everything but carbs)

A

Composition
Base solutions contain dextrose and protein in the form of amino acids
Prescribed electrolytes, vitamins, and trace elements are added to customize patient need
IV fat emulsion is added to complete the nutrients

80
Q

Central Parenteral Nutrition: what is it made of? (the central parent says no more than 25% dextrose on halloween)

A

very concentrated sugar
Base Solution 20-25% dextrose

81
Q

Peripheral Parenteral Nutrition: what is the base solution? (Perry is less than 20% dextrose)

A

Base solution must be < 20% dextrose
Through peripherally inserted catheter

82
Q

Parenteral Nutrition: Complications (parents get hyper and hypo lips)

A

Hyperglycemia and hypoglycemia
Fluid, electrolyte, and acid base imbalances
Hyperlipidemia when lipids used
Phlebitis
Infection and bacteremia

83
Q

nursing management/care - vital signs, weight, glucose, how often to check?

A

Vital signs every 4 to 8 hours
Daily weights
Regular blood glucose monitoring
Check initially every 4 to 6 hours

84
Q

Parenteral Nutrition: Nursing
 Management/Care - assess for what and how often to change dressing? (change parents every week)

A

Assess central access site
Site assessment for phlebitis
Dressing change every 7 days or as needed
Use sterile technique with dressing changes

Infusion pump must be used

85
Q

Parenteral - nursing management - check bag for what before administering? (parents give MLCCCC)

A

Before administering, check label and ingredients against order
Examine bag for signs of contamination, leaks, color, particulate matter, clarity, cracking

86
Q

Parenteral - nursing management - Monitor for infection and bacteremia - what s/s? (the usual)

A

Local infection
Erythema
Tenderness
Exudate at catheter insertion site

87
Q

Parenteral - Pan culture when (and what culture) (parents dip)

A

infection is suspected
Perform DTTP blood cultures when systemic infection is suspected

88
Q

malnutrition

A

Deficit, excess, or imbalance in essential components needed for a balanced diet
Under-nutrition
Poor nourishment due to inadequate consumption or disease process
Over-nutrition
Ingestion of more food than body requires

89
Q

malnutrition - Secondary Protein Calorie Malnutrition (SCM) (the second I get a disease)

A

Disease or injury related malnutrition
Sustained mild to moderate inflammation

90
Q

malnutrition - Primary protein-caloric malnutrition (PCM)

A

Starvation-related malnutrition
Nutritional needs not being met

91
Q

malnutrition - contributing factors

A

Socioeconomic factors – food insecurity
Physical illnesses
Illness, surgery, injury, hospitalization
Malabsorption syndrome
Fever
Incomplete diets, vitamin deficiencies

92
Q

malnutrition - Impaired absorption of nutrients from the GI tract as a result of: (impaired by pancreas and short gut)

A

pancreatitis: ↓ digestive enzymes
Drug side effects
short gut syndrome: ↓ bowel absorption`

93
Q

initially during starvation, process, there is a decreased… (starving slows my BMR to spare muscles and protein breakdown)

A

BMR, sparing of skeletal muscle, and decreased protein breakdown

94
Q

starvation process - prolonged starvation - fat is depleted in (skinny in 4 weeks)

A

97% of calories from fat and protein
Fat stores depleted in 4 to 6 weeks, depending on amount available
Once fat stores used, body protein no longer spared

95
Q

starvation - liver (liver loses pap, fluid shifts, bye Na!)

A

Liver function impaired
Protein synthesis diminished
Low albumin leads to ↓ plasma oncotic pressure
Fluid shifts from vascular space into interstitial space
Na+/K+ pump fails due to deficiency in calories and proteins

96
Q

malnutrition - mild to emaciation (dry skin to crusty mouth to muscle loss to loco)

A

Skin dry and scaly, brittle nails, hair loss
Mouth and tongue: crusting and ulceration,
Muscles-wasting, decreased mass and weakness
CNS -mental status changes such as confusion and irritability

97
Q

malnutrition - con’t

A

Fatigue
Increased susceptibility to infection
Anemia related to deficiencies in iron and folic acid, chronic dx

98
Q

Malnutrition: Nursing Management of Imbalanced Nutrition < Body Requirements = not eating enough. Just eat small meals w/ weed

A

Daily calorie count
High-protein, high-calorie foods or feedings
Multiple, small feedings
Supplements
Appetite stimulants such as Megace and Marinol (weed)

99
Q

Malnutrition: Nursing Management of Imbalanced Nutrition < Body Requirements (diary and dietitian help with imbalance)

A

Regular weight schedule
Diet diary
Dietitian consult
Social work consult for help with purchasing food/meal preparation
Discharge instructions

100
Q

diabetes - where on the list of causes of death?

A

A chronic multisystem disease related to abnormal insulin production, impaired insulin utilization, or both
Affects 25.8 million people; incidence Type II DM on the rise and affecting children
7th leading cause of death

101
Q

diabetes leading cause of (blind me with kidney disease and amputation)

A

Leading cause of
Adult blindness
End-stage kidney disease
Nontraumatic lower limb amputations

102
Q

collaborative care for DM (collaborate for wellbeing and prevent complications by delaying progression)

A

Goals of diabetes management
Decrease symptoms
Promote well-being
Prevent acute complications
Delay onset and progression of 
long-term complications
Need to maintain blood glucose levels as near to normal as possible

103
Q

collaborative care for DM (teach nutrition, drugs, exercise, weight loss)

A

Patient teaching
Nutritional therapy
Drug therapy
Exercise
Self-monitoring of blood glucose
Diet, exercise, and weight loss may be sufficient for patients with type 2 diabetes
All patients with type 1 require insulin

104
Q

oral hypoglycemic

A

Metformin (Glucophage) most commonly used
Reduces glucose production by liver
Enhance insulin sensitivity
Improve glucose transport
May cause weight loss
Also used in prevention of type 2 diabetes
Least likely to cause hypoglycemia

105
Q

oral hypoglycemics

A

Hold med if patient is undergoing surgery or radiologic procedure with contrast medium
24-48 before procedure and at least 48 hours after
Monitor serum creatinine
Contraindications
Renal, liver, cardiac disease
Excessive alcohol intake

106
Q

nutritional therapy - DM

A

ADA healthy food choices for improved metabolic control
Maintain blood glucose levels to as near normal as safely possible
Normal lipid profiles and blood pressure
Prevent or slow complications
Maintain pleasure of eating
Consistent carbohydrate diet

107
Q

nutritional therapy DM - when is meal consistency important?

A

Meal plan is based on individual’s usual food intake and is balanced with insulin and exercise patterns
Day-to-day consistency important for patients using conventional, fixed insulin regimens

108
Q

health promotion DM

A

Ambulatory and home care
Assess patient’s ability to perform BG injection and insulin injection
Assess patient/caregiver knowledge and ability to manage diet, medication, and exercise therapy
Teach manifestations/treatment of hypoglycemia and hyperglycemia

109
Q

health promotion DM

A

Ambulatory and home care
Foot care
Inspect daily
Avoid going barefoot
Proper footwear
How to treat cuts
Travel needs
Medication, supplies, food, activity

110
Q

Energy is measured in Kcal (kilocalorie) - carbs, protein, fat numbers (449)

A

1 gram of carbohydrate = 4 Kcal
1 gram of protein = 4 Kcal
1 gram of fat = 9 Kcal

111
Q

Positive nitrogen balance (and when does it occur?)

A

Positive nitrogen balance (intake > excretion) occurs in growth spurts, pregnancy, lactation, illness recovering

112
Q

Negative nitrogen balance

A

(intake < excretion) occurs with starvation, and conditions such as surgery, illness, trauma, stress when the body is overwhelmed

113
Q

water balance affects

A

renal function
fever, perspiration, tachypnea, severe burns
diarrhea, vomiting
Draining fistulas and drainage tubes
Hemorrhage
Prolonged open abdominal surgery

114
Q

water source

A

fluid and food intake and produced during metabolism of CHO, protein, fat

115
Q

water depletion through

A

urine, stool, insensible loss (breathing and perspiration)

116
Q

When 60% of caloric needs met orally, then

A

you can discontinue PN or EN nutrition

117
Q

albumin helps keep (al loves water)

A

fluid in cells. Once this protein is gone, fluid starts leaking into interstitial fluid.

118
Q

diabetic neuropathy is caused by what type of diet?

A

eating a lot of fat and sugar causes free radicals to form, which damages blood vessels through oxidation.

119
Q

fats - percentage breakdown in diet

A

95% of lipids in diet = triglycerides; 5% are phospholipids and cholesterol
Carriers of essential fatty acids and fat-soluble vitamins
20% to 35% of total daily caloric intake (<10% from saturated and trans fat)
9 kcal/g

120
Q

where are most fats ABSORBED, not metabolized?

A

Most fats absorbed in the lymphatic system and transported to the liver
Only 3% of fats eaten are excreted in the stool
the body has to burn off excess fat

121
Q

excess CHO is converted to what?

A

Liver converts excess CHO as glycogen or triglycerides and stored in adipose tissue

122
Q

Diarrhea – diet

A

Diarrhea – BRAT (Banana, Rice, Apple sauce, Toast/Tea)
Important also to assess for adequate fluid intake for patients having diarrhea
No longer recommended for it is unnecessarily restrictive

123
Q

fluid restriction diet

A

Fluid restriction (common for patients with heart failure or SIADH)

124
Q

Dysphagia diet (can’t choke on thick liquid)

A

For patients with difficulty swallowing or increased risk of aspiration
Need to thicken thin liquids or puree. Thicker consistency like pudding is recommended

125
Q

Renal diet (Renal needs a low pump)

A

(low K and Na diet)
NPO vs strict NPO

126
Q

what labs to assess during a nurtritonal assessment? (PLAITHs are my labs)

A

Nutritional lab studies: albumin, prealbumin, transferrin, Hg, Fe, blood glucose, lipid panel

127
Q

For patients with nutritional deficit: oral feeding

A

High-calorie supplements
Milkshakes
Ensure, Glucerna for DM patients, Nepro for renal failure patients
Consult dietician

128
Q

Nasogastric feeding tube is best choice to use if tube feeding plan is (length of time) (naso less than 6 is pretty)

A

tube feeding plan is < 6 weeks

129
Q

residual hold order

A

Depending on order: usual residual with hold order is >250- 400mL

130
Q

how often to change enteral bags? (change the entry every12-24 hour life)

A

changed every 12-24h
Wear gloves when hanging feeding

131
Q

how is parenteral different than crystalloid? (krystal doesn’t like vitamins)

A

*Different from crystalloid solutions in that crystalloids do not contain amino acids or vitamins

132
Q

where is central parenteral infused?

A

May only be infused via central access due to the risk of thrombophlebitis caused by hypertonic solution of TPN

133
Q

when are PICCs used? (only long haul use piccs)

A

Peripherally inserted central catheters (PICCs) - For longer term nutrition support

134
Q

what labs to check for parenteral feeding? (Parenteral is BLECC)

A

Check labs: Electrolytes, BUN, Creatinine, CBC, liver function enzymes

135
Q

parenteral feeding? how often to replace solution? (parents need to be fed every 24 hrs)

A

MUST replace solution and tubing every 24 hours even if bag hanging is not empty

136
Q

if parenteral feeding bag is not available?

A

If solution is not available, hang D10W to prevent hypoglycemia
Tubing with filter is required for TPN
Do not abruptly discontinue TPN (total parenteral nutrition)
Decrease rate by half for one hr then stop. Check blood sugar in an hr.

137
Q

Hallmark of refeeding syndrome (refeeding makes me lose phosphate)

A

Hypophosphatemia

138
Q

Body completely metabolizes glucose, unlike

A

unlike fats and proteins which leaves behind ketones - toxic byproduct

139
Q

how do vitamins move around? and where is excess stored?

A

Absorbed with fat and carried in the lymphatic circulation; must be attached to a protein to be transported in blood
Excess stored in liver and adipose tissue

140
Q

observe for what with feeding tube? (not skin)

A

Observe for cough, change in voice, respiratory distress
↓ likelihood of regurgitation and aspiration when placed post-pyloric

141
Q

enteral feeding complications - tube migration cuased by what? (just coughing and vomiting)

A

Tube migration: by vigorous vomiting or coughing

142
Q

enteral feeding complications - clogged tube

A

Clogged tube
Flush tube with sterile water per policy
Crush meds finely

143
Q

enteral feeding complications - Nasal or gastrointestinal erosion

A

Check skin under securement

144
Q

enteral feeding complications - Diarrhea (diarrhea at 4 and 8) How much can you hang at once?

A

Do not hang more than 4° (4 hours) worth of modular formula and 8° (8 hours) vol of pre-packaged formula; change system Q 12-24°

145
Q

enteral feeding complications - stoma infection

A

Stoma infection -assess skin and cleanse around stoma

146
Q

enteral - Intermittent - how much is usually given to patient? (enter indie 500)

A

by gravity or syringe
Vol usually 200 to 500 mL per feeding
Remember to flush with 30mL water before after feeding so tube does not clog

147
Q

enteral - Cyclic feedings (infusions are the cycle)

A

by infusion pump

148
Q

refeeding syndrome leads to depletion of…

A

intracellular minerals, especially phosphate
Using fatty acids and amino acids for fuel
Insulin secretion suppressed; glucagon release increase

149
Q

when to use peripheral parenteral nutrition? (perry is a short parent)

A

Short-term
When lower protein and calorie content is required

150
Q

with parenteral, assess for what? (parents refeed me)

A

Assess for refeeding syndrome

151
Q

parenteral pan culture - differential (the difference in infection from the catheter or the blood)

A

Differential time to positivity
Differentiates infection likely source from catheter or blood

152
Q

parenteral - pan culture - chest x-ray and urine

A

Chest X-ray: To check changes in pulmonary status
Urinalysis and Urine culture

153
Q

parenteral - Systemic Infection (s/s)

A

High risk associated with TPN
Fever, chills
Nausea/vomiting
Malaise

154
Q

secondary protein calorie malnutrition ex (the second infection, burn, trauma or head injury)

A

Ex: Major infections, burns, trauma, closed head injury

155
Q

malnutrition In inflammatory states (Luke is inflammed in the 6th and 10th episodes)

A

alterations in expression of proinflammatory (interleukin-6) and antiinflammatory cytokines (interleukin-10).

156
Q

malnutrition - Cytokine (inflammation) changes result in (breakdown protein, more BMR, less protein production)

A

Increased protein and skeletal muscle breakdown
Increased BMR
Decreased protein (albumin, prealbumin) production
Increased C-reactive protein production

157
Q

parenteral pan culture - Samples must be drawn when? (peter pan in 15 min)

A

no more than 15 min apart and collect same amount of blood for each sample

158
Q

parenteral pan culture - If the sample from catheter grows bacteria < 2hrs before peripheral sample, then

A

the likely source of infection is from catheter

159
Q

essential nutrients - micro (a VMW is micro essential)

A

Vitamins
Minerals
Water

160
Q

are minerals broken down by the body?

A

nope

161
Q

refeeding - how to initiate? (I was refed at 25 for 3 days in the morning)

A

Initiate nutrition support at approximately 25% of the estimated goal and advance over 3-5 days to the goal rate
Serum electrolytes and vital signs monitored carefully after initiation

162
Q

parental nutrition causes what? (only parents have issues with gallbladder, liver, and blood clots)

A

Gallbladder and liver disease
Thrombosis

163
Q

indications for enteral (enter the burn victim with deficiencies in vitamins and brains, and psycho on chemo)

A

Burn victims
Nutritional deficiencies
Neurologic conditions
Psychiatric conditions
Chemotherapy

164
Q

during refeeding, Glycogen, fat and protein synthesis requires what? (maggie and friends are needed to refeed)

A

phosphate, mag, and potassium which are already depleted leads to further decrease

165
Q

during refeeding, what happens to fluid retention and electrolyte imbalances?

A

Fluid retention and electrolyte imbalances ensues

166
Q

central parenteral nutrition - where is the catheter? (central downtown is in the jugular)

A

Tip of catheter lies in superior vena cava where vesicant and irritant solutions are safe to be administered
Central catheter to internal jugular vein to superior vena cava

167
Q

Primary protein-caloric malnutrition (PCM) - inflammation or not? And ex?

A

Chronic starvation without inflammation
Anorexia nervosa

168
Q

enteral considerations (enter more calories and less water)

A

More calorically dense, less water contained in formula
High protein content

169
Q

secondary protein calorie malnutrition ex. of disorders (COOAAM in second)

A

Conditions including organ failure, cancer, rheumatoid arthritis and other autoimmune disorders, obesity, and metabolic syndrome

170
Q

*Breaking down protein for energy forms what?

A

ketones which are toxic to the kidneys in excess

171
Q

Diabetes is a major contributing factor to (SHH - the big ones)

A

Major contributing factor
Heart disease
Stroke
Hypertension

172
Q

what types of insulin have the most flexibility with diet?

A

rapid-acting insulin, multiple daily injections, or insulin pump

173
Q

most common type of fat

A

triglycerides

174
Q

parenteral short term don’t need

A

central access

175
Q

wear gloves when you’re…

A

hanging the feeding

176
Q

central pareteral v. peripheral parenteral

A

perri is short term

177
Q

hypo and hyperglycemia numbers

A

hypo - less than 70
hyper - greater than 180

XIO (372 decks)

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