nutrition Flashcards
Nutrition is the study of what?
the “study of food and how it affects the human body and influences health”
Nutrients are substances that…(GRD HI nutrients)
affect growth, development, reproduction, activity, health maintenance and the body’s ability to recover from illness and injury
Metabolism is the
“process by which the body converts food into energy
Essential Nutrients - Macro (CPF)
Essential nutrients: Nutrients that must be supplied in diet or supplements
Macro:
Carbohydrate
Protein
Fat
Non-Essential nutrients:
Not essential for body function or are synthesized in adequate amounts by the body
Energy balance = (you give me energy, and you take it away)
Total energy intake - Total daily expenditure
Amount of energy a person requires dependent on
age, sex, activity level, weight, height, and health conditions
Daily caloric requirements: (daily calories when I was 20 - 35)
Several formulas available. Simplest:
20 to 35 kcal/kg body weight
Body Mass Index (BMI) - used to measure what?
risk of obesity-associated diseases and conditions
CHO - primary source of what?
primary source of energy
CNS relies exclusively on what for energy?
glucose for energy. Chief protein-sparing energy source
Easier and faster to digest than proteins and fats
All CHO converted to what? Think carbs…
glucose for transport in blood
Glucose transported to GI tract, then…(GI is the vein of the liver)
GI tract →portal vein → liver for storage
Glycogenesis (genesis is stored in the 80s)
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)
Glycogenolysis: (lysing the glyco)
When glycogen is broken down into glucose for energy
Blood glucose regulated by hormones insulin and glucagon
Monosaccharides (simple) (FG one sugar)
Single stranded sugar molecule
Glucose
Fructose
Found in fruits and honey
Disaccharides (simple) (SML two)
Double stranded sugar molecule
Sucrose (table sugar)
Maltose (malted grains)
Lactose (milk)
Complex carbohydrates (poly is complex) and ex? how much daily?
(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
protein - how many amino acids involved? (protein is NOT 21)
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.
Complete proteins: (complete animals)
Contains all essential amino acids to support growth
Animal proteins: eggs, dairy, meat
Incomplete proteins: and Ex. (incomplete from age 10) and how much do you need in diet?
Lacks one or more amino acids
Plant proteins: grains, legumes, vegetables (some exceptions: soy, buckwheat, hemp, etc. )
10% to 35% of daily caloric needs
Protein metabolism: (protein to amine, to pancrease, to GI, to liver, recombined and released to cells)
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
Nitrogen balance (nitro compares intake and excretion)
compares protein intake vs protein excretion (loss via urine, stool, hair, nails, skin)
fats
Major source of energy
Insoluble in water and blood
unhealthy fats - (unhealthy saturated and trans don’t have friends) solid or liquid?
Saturated fat and trans fat Lacks double bonds between carbons leading to solid form at room temp
Animal source
Raises serum cholesterol
healthy fats (unsaturated/unfat have bonds)
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
fat metabolism - where does it occur? (and what and from where it is secreted?)
Occurs in the small intestine
Bile secreted by the gallbladder emulsifies fat for pancreatic lipase to break down fat more efficiently
cholesterol sources - produced where in the body? And essential for what? (cholesterol and bile are steroid blisters in the sun!)
produced by the liver and consumption of animal foods
Essential for cell membrane, precursor of steroid hormones and Vitamin D, synthesizes bile acids
LDL - what do high levels do to the body?
(low density lipoprotein)
The “bad” cholesterol
High levels lead to plaque buildup → atherosclerosis
HDL - what does it do?
(high density lipoprotein
The “good” cholesterol
Carries LDL away from body to liver for processing
trigylcerides - most common what?
Most common type of fat
vitamins - do we make them?
Organic compounds required for normal metabolism and prevention of diseases related to deficiency
Not made by body; must be consumed
water soluble vitamins
vitamin C and B-complex
absorbed directly by the small intestine and into the bloodstream
Not stored; excess excreted in the urine
inadequate vitamins leads to (and what vitamin causes what) and what in adults?
deficiency syndromes
Vit C deficiency →Scurvy
Vit D deficiency →Rickets in children; osteomalacia in adults
Folate and Iron → Anemias
minerals - what are they for? (miner body building)
and are they organic or inorganic?
Inorganic elements found in nature (food and supplements)
For tissue building, nerve impulse, fluid regulation, bone and blood health
major minerals - macrominerals - in what amount and ex? (CPPS M (ajor) over 100)
Major minerals (macrominerals)
Required in amounts of > 100 mg/day
e.g. Calcium, phosphate, sodium, potassium, magnesium
trace minerals - microminerals - in what amount and ex? (IZIF) (Izod micro) -
(microminerals)
Essential but in low amounts < 100 mg/day
e.g. Iron, Zinc, Iodine, fluoride
water - how much of body weight is water? And average daily requirements?
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
vegetarian - what deficiencies? (VIP vegetarian)
Exclusion of meat from diet
Need well-planned diet to avoid vitamin, protein, iron, deficiencies
lacto-ovo vegetarians
Plant food diet and occasional dairy products and eggs
Risk for vitamin and mineral deficiencies
Iron deficiency
vegan - can develop what, and what vitamin is required? (vegan on megablast at 12)
exclusive plant foods
Can develop megaloblastic anemia and neurologic signs of deficiency
Require fortified foods with Cobalamin (vitamin B12)
common diet orders - cardiac
2 gm Na+ diets (Cardiac diet - aka low sodium)
age related affecting nutrition
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
nutrition assessment- interview
Recent weight loss or gain
Appetite and special diets
Chronic conditions
Exercise pattern
Nutrition/food access
nutrition assessment - measure what? (just BMI and dysphage)
Assessment
Measure height and weight person for BMI
Assess dysphagia → indication of high aspiration risk
prealbumin - synthesized by what? Half-life? helps identify what problems?
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
albumin - how far does it lag behind?
Albumin value lags behind actual protein changes by > 2 weeks (20-22 days)
Not a good indicator of acute changes in nutritional status
diagnosis
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.
planning
Collaborate with dietician
Consult social worker for etoh cessation programs
Monitor daily nutritional labs and blood gluocose
Implementation
Social worker and dietician ordered for consult
Daily nutritional labs drawn and blood sugar checks before meals
Assisted patient with menu selection
evaluation
Evaluate results of planned interventions
routes of nutrition (GO PIE)
Enteral
Oral
Gastrointestinal
Parenteral
Intravenous (peripheral or central)
oral feeding - how to sit, and how long after meals to sit up?
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
enteral nutrition - what type of feeding? and where is it inserted?
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
Enteral vs Parenteral nutrition - infection risk, more for which one?
Maintains gut function
Easily administered
Infection risk: Enteral < Parenteral route
Physiologically more efficient than parenteral
Less expensive than parenteral
indications (who should get it) for enteral (enter the anorexic…)
Anorexia
Frequent aspirations
Orofacial fractures
Head/neck cancer
PEG (stomach wall) - when to use? and how often is it changed? (I only see Peg every few months for a long time)
When longer term enteral feeding is anticipated
More comfortable
Tube replaced every few months
Laparoscopically placed in interventional radiology
Percutaneous Endoscopic Jejunostomy (GAG Juno)
A J-tube is considered in the following circumstances:
Gastroparesis
GERD
High risk aspiration
If surgery is needed on stomach/esophagus at later point
insertion of feeding tube
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
insertion of feeding tube - Nasogastric and nasointestinal tubes - how to measure?
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
nasogastric insertion - Ask patient to swallow once the tube passes the
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
nasogastric - prior to feeding. what do you need for everything?
*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
enteral feeding complications - aspirational pneumonia (HOB?)
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
Nursing Responsibilities: Enteral Nutrition - assess how often?
how often to assess length of tube?
how often to change tape?
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
Nursing Responsibilities: Enteral Nutrition - check for…(enteral needs WD10-40)
Check for protocols such as hanging D10 when tube feed nutrition interrupted to prevent hypoglycemia
Will need MD order to restart tube feeding
Nursing Responsibilities Enteral Nutrition - patient position (and what did Phoebe do?)
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
Nursing Responsibilities Enteral Nutrition - tube patency (openness) - flushing -flush with what?
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
enteral - delivery modes - Continuous infusion by pump (how to increase) (continous buffy)
Usually gradual increase in rate every 8-12hrs
until patient reaches ordered goal rate
enteral - new practice re flushing (flush at 30, 10, and 5)
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
Enteral Nutrition: Nursing Considerations (enter the weight, bowels, I/O, and dehydration)
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
enteral nursing considerations - glucose (label bag with what?)
Initial glucose checks
Label enteral bag with patient name, formula type, date and time started
refeeding syndrome
Starvation of nutrients for many consecutive days or metabolically stressed d/t critical illness - fatal shift in fluids
when refeeding, what happens to insulin?
Insulin secretion resumes in response to sugar sources
preventing refeeding - check for what? (refeed the electrolytes)
Identify individuals at risk (just check elctrolytes before starting)
Correct depleted electrolytes before refeeding
enteral complications = Gastrostomy or jejunostomy tubes
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
enteral - gerontologic (gerry fluid sugar and volume makes me choke)
More vulnerable to complications
Fluid and electrolyte imbalances
Glucose intolerance
Decreased ability to handle large volumes
Increased risk of aspiration
Parenteral nutrition (PN)
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
Parenteral Nutrition - indications (when it’s needed) (Parents need IVs if they’re vomiting, gi problems, malnurished, panceatitis)
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
Parenteral Nutrition - composition (parents are composed of everything but carbs)
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
Central Parenteral Nutrition: what is it made of? (the central parent says no more than 25% dextrose on halloween)
very concentrated sugar
Base Solution 20-25% dextrose
Peripheral Parenteral Nutrition: what is the base solution? (Perry is less than 20% dextrose)
Base solution must be < 20% dextrose
Through peripherally inserted catheter
Parenteral Nutrition: Complications (parents get hyper and hypo lips)
Hyperglycemia and hypoglycemia
Fluid, electrolyte, and acid base imbalances
Hyperlipidemia when lipids used
Phlebitis
Infection and bacteremia
nursing management/care - vital signs, weight, glucose, how often to check?
Vital signs every 4 to 8 hours
Daily weights
Regular blood glucose monitoring
Check initially every 4 to 6 hours
Parenteral Nutrition: Nursing Management/Care - assess for what and how often to change dressing? (change parents every week)
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
Parenteral - nursing management - check bag for what before administering? (parents give MLCCCC)
Before administering, check label and ingredients against order
Examine bag for signs of contamination, leaks, color, particulate matter, clarity, cracking
Parenteral - nursing management - Monitor for infection and bacteremia - what s/s? (the usual)
Local infection
Erythema
Tenderness
Exudate at catheter insertion site
Parenteral - Pan culture when (and what culture) (parents dip)
infection is suspected
Perform DTTP blood cultures when systemic infection is suspected
malnutrition
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
malnutrition - Secondary Protein Calorie Malnutrition (SCM) (the second I get a disease)
Disease or injury related malnutrition
Sustained mild to moderate inflammation
malnutrition - Primary protein-caloric malnutrition (PCM)
Starvation-related malnutrition
Nutritional needs not being met
malnutrition - contributing factors
Socioeconomic factors – food insecurity
Physical illnesses
Illness, surgery, injury, hospitalization
Malabsorption syndrome
Fever
Incomplete diets, vitamin deficiencies
malnutrition - Impaired absorption of nutrients from the GI tract as a result of: (impaired by pancreas and short gut)
pancreatitis: ↓ digestive enzymes
Drug side effects
short gut syndrome: ↓ bowel absorption`
initially during starvation, process, there is a decreased… (starving slows my BMR to spare muscles and protein breakdown)
BMR, sparing of skeletal muscle, and decreased protein breakdown
starvation process - prolonged starvation - fat is depleted in (skinny in 4 weeks)
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
starvation - liver (liver loses pap, fluid shifts, bye Na!)
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
malnutrition - mild to emaciation (dry skin to crusty mouth to muscle loss to loco)
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
malnutrition - con’t
Fatigue
Increased susceptibility to infection
Anemia related to deficiencies in iron and folic acid, chronic dx
Malnutrition: Nursing Management of Imbalanced Nutrition < Body Requirements = not eating enough. Just eat small meals w/ weed
Daily calorie count
High-protein, high-calorie foods or feedings
Multiple, small feedings
Supplements
Appetite stimulants such as Megace and Marinol (weed)
Malnutrition: Nursing Management of Imbalanced Nutrition < Body Requirements (diary and dietitian help with imbalance)
Regular weight schedule
Diet diary
Dietitian consult
Social work consult for help with purchasing food/meal preparation
Discharge instructions
diabetes - where on the list of causes of death?
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
diabetes leading cause of (blind me with kidney disease and amputation)
Leading cause of
Adult blindness
End-stage kidney disease
Nontraumatic lower limb amputations
collaborative care for DM (collaborate for wellbeing and prevent complications by delaying progression)
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
collaborative care for DM (teach nutrition, drugs, exercise, weight loss)
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
oral hypoglycemic
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
oral hypoglycemics
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
nutritional therapy - DM
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
nutritional therapy DM - when is meal consistency important?
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
health promotion DM
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
health promotion DM
Ambulatory and home care
Foot care
Inspect daily
Avoid going barefoot
Proper footwear
How to treat cuts
Travel needs
Medication, supplies, food, activity
Energy is measured in Kcal (kilocalorie) - carbs, protein, fat numbers (449)
1 gram of carbohydrate = 4 Kcal
1 gram of protein = 4 Kcal
1 gram of fat = 9 Kcal
Positive nitrogen balance (and when does it occur?)
Positive nitrogen balance (intake > excretion) occurs in growth spurts, pregnancy, lactation, illness recovering
Negative nitrogen balance
(intake < excretion) occurs with starvation, and conditions such as surgery, illness, trauma, stress when the body is overwhelmed
water balance affects
renal function
fever, perspiration, tachypnea, severe burns
diarrhea, vomiting
Draining fistulas and drainage tubes
Hemorrhage
Prolonged open abdominal surgery
water source
fluid and food intake and produced during metabolism of CHO, protein, fat
water depletion through
urine, stool, insensible loss (breathing and perspiration)
When 60% of caloric needs met orally, then
you can discontinue PN or EN nutrition
albumin helps keep (al loves water)
fluid in cells. Once this protein is gone, fluid starts leaking into interstitial fluid.
diabetic neuropathy is caused by what type of diet?
eating a lot of fat and sugar causes free radicals to form, which damages blood vessels through oxidation.
fats - percentage breakdown in diet
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
where are most fats ABSORBED, not metabolized?
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
excess CHO is converted to what?
Liver converts excess CHO as glycogen or triglycerides and stored in adipose tissue
Diarrhea – diet
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
fluid restriction diet
Fluid restriction (common for patients with heart failure or SIADH)
Dysphagia diet (can’t choke on thick liquid)
For patients with difficulty swallowing or increased risk of aspiration
Need to thicken thin liquids or puree. Thicker consistency like pudding is recommended
Renal diet (Renal needs a low pump)
(low K and Na diet)
NPO vs strict NPO
what labs to assess during a nurtritonal assessment? (PLAITHs are my labs)
Nutritional lab studies: albumin, prealbumin, transferrin, Hg, Fe, blood glucose, lipid panel
For patients with nutritional deficit: oral feeding
High-calorie supplements
Milkshakes
Ensure, Glucerna for DM patients, Nepro for renal failure patients
Consult dietician
Nasogastric feeding tube is best choice to use if tube feeding plan is (length of time) (naso less than 6 is pretty)
tube feeding plan is < 6 weeks
residual hold order
Depending on order: usual residual with hold order is >250- 400mL
how often to change enteral bags? (change the entry every12-24 hour life)
changed every 12-24h
Wear gloves when hanging feeding
how is parenteral different than crystalloid? (krystal doesn’t like vitamins)
*Different from crystalloid solutions in that crystalloids do not contain amino acids or vitamins
where is central parenteral infused?
May only be infused via central access due to the risk of thrombophlebitis caused by hypertonic solution of TPN
when are PICCs used? (only long haul use piccs)
Peripherally inserted central catheters (PICCs) - For longer term nutrition support
what labs to check for parenteral feeding? (Parenteral is BLECC)
Check labs: Electrolytes, BUN, Creatinine, CBC, liver function enzymes
parenteral feeding? how often to replace solution? (parents need to be fed every 24 hrs)
MUST replace solution and tubing every 24 hours even if bag hanging is not empty
if parenteral feeding bag is not available?
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.
Hallmark of refeeding syndrome (refeeding makes me lose phosphate)
Hypophosphatemia
Body completely metabolizes glucose, unlike
unlike fats and proteins which leaves behind ketones - toxic byproduct
how do vitamins move around? and where is excess stored?
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
observe for what with feeding tube? (not skin)
Observe for cough, change in voice, respiratory distress
↓ likelihood of regurgitation and aspiration when placed post-pyloric
enteral feeding complications - tube migration cuased by what? (just coughing and vomiting)
Tube migration: by vigorous vomiting or coughing
enteral feeding complications - clogged tube
Clogged tube
Flush tube with sterile water per policy
Crush meds finely
enteral feeding complications - Nasal or gastrointestinal erosion
Check skin under securement
enteral feeding complications - Diarrhea (diarrhea at 4 and 8) How much can you hang at once?
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°
enteral feeding complications - stoma infection
Stoma infection -assess skin and cleanse around stoma
enteral - Intermittent - how much is usually given to patient? (enter indie 500)
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
enteral - Cyclic feedings (infusions are the cycle)
by infusion pump
refeeding syndrome leads to depletion of…
intracellular minerals, especially phosphate
Using fatty acids and amino acids for fuel
Insulin secretion suppressed; glucagon release increase
when to use peripheral parenteral nutrition? (perry is a short parent)
Short-term
When lower protein and calorie content is required
with parenteral, assess for what? (parents refeed me)
Assess for refeeding syndrome
parenteral pan culture - differential (the difference in infection from the catheter or the blood)
Differential time to positivity
Differentiates infection likely source from catheter or blood
parenteral - pan culture - chest x-ray and urine
Chest X-ray: To check changes in pulmonary status
Urinalysis and Urine culture
parenteral - Systemic Infection (s/s)
High risk associated with TPN
Fever, chills
Nausea/vomiting
Malaise
secondary protein calorie malnutrition ex (the second infection, burn, trauma or head injury)
Ex: Major infections, burns, trauma, closed head injury
malnutrition In inflammatory states (Luke is inflammed in the 6th and 10th episodes)
alterations in expression of proinflammatory (interleukin-6) and antiinflammatory cytokines (interleukin-10).
malnutrition - Cytokine (inflammation) changes result in (breakdown protein, more BMR, less protein production)
Increased protein and skeletal muscle breakdown
Increased BMR
Decreased protein (albumin, prealbumin) production
Increased C-reactive protein production
parenteral pan culture - Samples must be drawn when? (peter pan in 15 min)
no more than 15 min apart and collect same amount of blood for each sample
parenteral pan culture - If the sample from catheter grows bacteria < 2hrs before peripheral sample, then
the likely source of infection is from catheter
essential nutrients - micro (a VMW is micro essential)
Vitamins
Minerals
Water
are minerals broken down by the body?
nope
refeeding - how to initiate? (I was refed at 25 for 3 days in the morning)
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
parental nutrition causes what? (only parents have issues with gallbladder, liver, and blood clots)
Gallbladder and liver disease
Thrombosis
indications for enteral (enter the burn victim with deficiencies in vitamins and brains, and psycho on chemo)
Burn victims
Nutritional deficiencies
Neurologic conditions
Psychiatric conditions
Chemotherapy
during refeeding, Glycogen, fat and protein synthesis requires what? (maggie and friends are needed to refeed)
phosphate, mag, and potassium which are already depleted leads to further decrease
during refeeding, what happens to fluid retention and electrolyte imbalances?
Fluid retention and electrolyte imbalances ensues
central parenteral nutrition - where is the catheter? (central downtown is in the jugular)
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
Primary protein-caloric malnutrition (PCM) - inflammation or not? And ex?
Chronic starvation without inflammation
Anorexia nervosa
enteral considerations (enter more calories and less water)
More calorically dense, less water contained in formula
High protein content
secondary protein calorie malnutrition ex. of disorders (COOAAM in second)
Conditions including organ failure, cancer, rheumatoid arthritis and other autoimmune disorders, obesity, and metabolic syndrome
*Breaking down protein for energy forms what?
ketones which are toxic to the kidneys in excess
Diabetes is a major contributing factor to (SHH - the big ones)
Major contributing factor
Heart disease
Stroke
Hypertension
what types of insulin have the most flexibility with diet?
rapid-acting insulin, multiple daily injections, or insulin pump
most common type of fat
triglycerides
parenteral short term don’t need
central access
wear gloves when you’re…
hanging the feeding
central pareteral v. peripheral parenteral
perri is short term
hypo and hyperglycemia numbers
hypo - less than 70
hyper - greater than 180
