NUTRITION Flashcards
nutrition science
the study of how food nourishes the body.
nutrients
specific biochemical substances used by the body to operate
vitamin A
affects visual acuity, skin and mucous membranes, and immune function.
vitamin D
provides calcium and phosphorus metabolism and stimulates calcium absorption.
vitamin E
is an antioxidant that protects Vitamin A.
vitamin K
helps the synthesis of certain proteins necessary for blood clotting
determining body weight female
100 lb (for height of 5 ft.) ± 5 lb. for each additional inch over 5 ft
determining body weight males
106 lb (for height of 5 ft.) ± 6 lb. for each additional inch over 5 ft.
basal metabolic rate
Amount of calories needed to carry out the involuntary activities of the body while it rests.
BMR men and women
BMR is about 1 cal/kg of body weight per hour for men
BMR is about 0.9 cal/kg of body weight per hour for women
factors that increase BMR
Growth, infections, fever, emotional tension, extreme environmental temperatures, elevated levels of certain hormones (epinephrine, thyroid hormones)
factors that decrease BMR
Aging, prolonged fasting, and sleep
factors that effect oral intake
Developmental Considerations
State of Health: increase need
Alcohol Abuse: altered absorption of nutrients. Increased need for vitamin B
Medications: interact with meds to change absorption
Economic Factors: healthier foods cost more. Use seasonal produce and remind to considered cost per serving
Religion: periods of fasting
Culture: how its prepared and related to eating.
dysphagia: neuro
CVA: cerebral vascular accident/ stroke
50% who experienced CVA experiences dysphagia
ALS: amyotrophic lateral sclerosis or Lou gehrig’s diseases
PD: parkinson’s disease
Myasthenia gravis
dysphagia: traumatic/surgical
Oral/throat surgery
Cancer therapy
Ingestion of caustic substances
- Maintain NPO don’t give aspirin. Until you can observe their experience of swallowing
s/sx of dysphagia
Coughing or gagging while eating
Choking
Aspiration: passage of food or fluid from the esophagus from the trachea. Leads to aspiration pneumonia → leads to death
- May exhibit
coughing, trouble
breathing.etc.
Frequently silent without symptoms
Drooling
Pockets of food retained in the mouth
Gargly sounding voice
Sensation of food getting stuck in the throat
interventions for dysphagia
Have suction set up, and oxygen available
HOB at 45⁰ at all times
HOB at 90⁰ (or in a chair) for meals and for 30 minutes after meal
Provide appropriate level of assistance or supervision at meal times
Know what time the client’s tray arrives
Allow sufficient time to assist the client
Head tilted slightly forward
Encourage small bites
Feed slowly in a relaxed atmosphere
Discourage talking while chewing
Place food in the unaffected side of the mouth
thickened liquids
Milkshake
Slushy
- Nutritional substance gets added
pureed/ smooth food
Pudding
Mashed potatoes
foods easy to swallow
Cooked veggies
Ground meat
Creamed soup
Iced fruit
NPO diet
Can be strict but can take medications, can have ice chips. Depends on the circumstance of the pt.
clear liquids/ full liquids diet
Jello, black coffee, anything clear you can see through. Liquid at room temperature
GI soft/ low residue
Gentle to digest
- White rice, tea, applesauce, bananas, toast
high fiber diet
Whole grain foods. Fruits and veggies 25 grams of fiber per day
low sodium/ low cholesterol diet
3.4 grams of sodium a day. Used a preservative and can be found in processed meats
Low cholesterol: lean meats
diabetic diet ADA
No added sugar diet. Carb controlled diet
regular diet
No restrictions. Can eat mcdonalds lol
pureed diet
Unable to chew food. Similar to baby food
mechanical soft
Easy to chew but may have missing teeth or some reason can’t chew regular food
enteral feeding
tube feeding. Could be a supplemental order
enteral feeding
administration of a liquid formula through a tube into the GI tract.
- Nasogastric
- Gastrostomy
- Jejunostomy
parenteral nutrition
Total Parenteral Nutrition (TPN): administered nutrition directly into the bloodstream. through an IV central line.
feeding enteral tube
Administration of nutritional formula via tube in the digestive system
lavage enteral tube
Removal of stomach content.
- Accidental poisoning, overdose
- May instill NS to “wash” the stomach
decompression enteral tube
Connected to low intermittent wall suction.
Treats: bowel obstructions, Paralytic ileus, and prevents distention
NG tube placement
Can go into trachea. Pt may experience coughing, not being able to talk, SOB
- gastric pH: aspirating and gastric content comes out
- tube length: tube goes in at 60 length but you come back and its at 15 and about to fall out
- visualization of contents: can listen with stethoscope
Dobbhoff/Corpak
Smaller tube diameter
Softer plastic
Soak in an ice bath to firm up plastic for easier insertion
Used only for feeding
Can not aspirate or tube will collapse
Confirm placement only with X-ray
Gastrostomy- G tube/ PEG tube
Inserted through the abdominal wall directly into the stomach
- Surgical procedure (difference from PEG tube is how they are inserted)
- Incision in the abdominal wall
- Sutured in place
For long term use
Jejunostomy - j tube
Tube inserted through the abdominal wall directly into the jejunum
Regurgitation and aspiration is prevented
- The stomach is bypassed
Emesis may still occur
Maintain patency
Irrigate with 30-60 ml of warm water
maintain suction
Shut off suction for abdominal assessment
Shut off for 30 min after administering meds to assure we do not suction out meds
tube feeding adminastrion
Fowler’s position
Verify placement
Check residual*
Clean technique
Formula should be kept at room temperature
Hang only enough to infuse in 8 or less hours.*
Formula may be diluted*
Label administration tubing/syringe with the date and time*
bolus feeding
Every so many of hours the pt will be fed.
formula feeding
is a bag of nutrition and the pt. Is connected to pump throughout the day
checking gastric residual volume
Aspirate gastric content via the tube
- Measure the amount aspirated
Return aspirated contents to the stomach
Check MD order for acceptable residual amount prior to feeding
- Usually notify provider if residual is greater than 200ml (pt at risk for aspiration and absorption deficiency)
complications
Diarrhea
- Most common
- More frequent with continuous feedings
- Frequent perineal care therefore high risk for aspiration
Dry mouth
Aspiration
Displacement of tube
Mucosal/skin irritation
Electrolyte imbalance
Elevated blood glucose levels
Gastric distention
Occlusion
medication administration
Liquid form of medication is preferred
Many tablets can be crushed and dissolved in water
**Do not crush enteric coated or time released capsules
Many capsules can be opened and dissolved in water, check drug guide
medication administration enteral route
se a bulb/piston 60 mL syringe or an oral/enteral syringe.
**Gather 60 ml warm water. 30 ml water will be needed to flush before and after med administration
Follow the three checks, triple checks and six rights. Use 2 patient identifiers
Crush and dilute medications in warm water
Perform any necessary assessments (vital signs, apical pulse, skin integrity).
Elevate HOB to 30-45 degrees. Place chux or towel under the tube.
TPN
Also known as hyperalimentation
Infused into a central line.
Hypertonic Solution
Larger solution over a short period of time.
Used for those with
- Difficulty absorbing nutrients
- Persistent nausea and vomiting
- Need for complete bowel rest
Individually created for that specific pt. Make it costly and have a special health care team.
complications with TPN
Complications: infection, fluid overload, metabolic imbalances, pulmonary edema
nursing responsibilities TPN
I & O- increased urinary output
Daily weights- evaluate nutritional status
Assess and manage central line- prevent infections
Monitor lab values
- Glucose- during
- hyperglycemia. When its finished hypoglycemia
- Urine ketones and specific gravity
- BUN, Liver function
- Electrolytes
