Nutrition Flashcards
3 main functions of GI system
- transportation
- digestion
- absorption
importance of good nutrition
- helps maintain healthy weight
- reduces risk of chronic disease
- promotes overall health
risks of malnourishment
greater risk of disease
- dysrhythmias
- skin breakdown
- sepsis
- hemorrhage
- inc length of stay
- delay surgical healing
dietary guideline
consume the proper daily values (myplate)
healthy eating patterns
- follow a healthy eating pattern across a lifespan
- focus on variety, nutrient dense foods, amount
- limit calories w added sugars, sat fats, reduce Na
- shit to healthier food and beverage choice
- support healthy eating patterns
factors influencing nutrition
- appetite
- negative experience
- disease, illness
- medications
- env factors (income, edu, physical function, transportation, food cost)
- developmental needs
- alternative food patterns (religion, culture, health beliefs, personal preference)
older adults diet
- need the same amount of vitamins and minerals of younger adults
nursing considerations for older adults
- presence of chronic illnesses
- meds
- GI changes (dec HCl)
- dec metabolic rate
- cognitive impairments
- available transportation
- functional ability
- fixed income
- Ca supplements
cultural considerations
- considerate of cultural and ethnic backgrounds
- dietary restrictions secondary to religious beliefs
- dont assume q culture is the same
- habits often customs of their family
assessment of pt nutrition
sub/obj data
- risk of malnutrition
- standardized tools
assessment: anthropometry
-measure size and make of body
- ht and wt
- ideal body line
- BMI
- skin fold measure
- fat percentage
- RD can assist
nutrition lab test
no lab tests
factors that affect nutrition labs
- fluid balance
- liver and kidney function
- presence of disease
total protein
combination of albumin and globulin
- normal 6.4- 8.3
albumin
makes up 60% of total PRO
- better indication of chronic disease
- synthesized in the liver
- half life 21 days
- normal (3.5-5.0)
prealbumin
preferred for acute conditions
- half life 2 days
- normal 15-36
hemoglobin
protein responsible for transporting o2 in the blood
- normal male (14-18 g/dL)
- normal female (12-16 g/dL)
if low may benefit from eating foods with Fe
assessment of nutrition history
-diet history (intake preference, allergies, etc)
- health history (illness, activity level, meds, etc)
- other history (age, socioeconomic, etc)
healthy nutrition physical exam
- alert, erect
- normal BMI
- EMV: 15, 2+ reflexes
- cardio: stable VS
- GI: no problems
- muscoskeletal: strong
- moist skin, good color
- nails are firm and pink
- no swelling in face
- mouth and teeth pink w no decay
malnutrition physical exam
- fatigue, apathetic, sagging shoulders
- obese, underweight
- EMV: inattentive, irritable, confused, dec reflexes
- cardio: stable VS
- GI: anorexia, indigestion, constipation, diarrhea
- muscoskeletal: weak, poor tone, wasted appearance, bowlegged, visible ribs
- rough dry scaly pale skin
- spoon shaped brittle nails
- swollen face and sucken eyes
- pale conjunctiva
- red swollen dry lips
- spongy receding, easily bleeding gums
- welling tongue, teeth are missing and broken, oral mucosa swollen
nutritional nursing problems
- imbalances nutrition: low nutrients, high nutrients
- impaired swallowing
- risk for aspiration
- D/C/N
- impaired dentition
- fatigue
- risk of unstable glucose
planning nutrition
- individualized approach
- goals and outcomes reasonable and reachable
- setting priorities w pt understanding
- teamwork and collaboration
nursing implementation
- health promotion
- advancing diet
- measuring i and os
- diet selection
- care of common nutritional
- obtaining ht and wt
health promotion for implementation of health promotion
- pt education
- early identification of concerns
- assist w meals for all nutritional needs
- educate food safety
implementation: diet selection
- amount needed
- ability to eat
- any alterations in GI system
- special considerations based on health status
types of diets
- regular
- liquid
- modifies texture
- therapeutic diets and modified nutrition
- supplements
regular diet
no restrictions or signs of intolerance
- regular consistency
- aim to provide well balanced meal
modified texture
used for pt w choking issues (dysphagia, weakness chewing)
- mechanical soft: foods soft and easy to eat (no fruits, veggies)
- pureed: no chewing like pudding
- minced: chopped small (1/8th in)
- ground: 1/4 in (rice)
- chopped: 1/2 in (elbow macaroni)
clear liquid diet
usually for medical procedure or to rest the gut
- water, coffee/tea (nothing added), broth, jello, popsicles, sport drinks, lemonade (no pulp)
- no residuals in them
liquid diet foods
transition back to reg diet
- juice, milk, coffee, tea, sports drinks, broth and soup, sorbet, yogurt
liquid diet, fluid retention
limit amount of fluid/day often for ppl retaining excess water (heart and kidney failure)
- strict i and os
- better measurement is weigh every day in am
- watch for low serum Na
modified consistency of liquid
- thin liquid
- thickened liquid (often for person who has had stroke)
thickness of liquids
- thin
- nectar
- honey
- spoon
therapuetic diet orders
- consistent carb
- cardiac or heart healthy
- low residual
- high fiber
- gluten free
- lactose free
- bland
NPO diet
nothing to eat/drink by mouth
- ordered for medical procedures or pt condition like resting gut or need it to wake up after med procedure
- can be after midnight or after midnight except meds
- NPO for more than 5-7 days risk nutritional health
advancing diets
common is to have advance as tolerated
- tolerated = no nausea, vomiting, distention, active bowel sounds
- typical progression: clear –> full –> low residue if needed –> regular
common nutritional issues
- anorexia
- inability to feed self
- dysphagia
- nausea and vomiting
anorexia
lack or loss of appetite
- caused by pain, fatigue, effects of medication, emotional stress
treatment of anorexia
-treat the cause
- use creative ways to stimulate appetite
- good env to eat in
- smaller more frequent meals
- have preferences available
- oral hygiene
- plus others
assisting pt w oral feeding
- protect, safety, independence, dignity
- make sure tray is in reach
- assess risk of aspiration
- do they need to be supervised
- any visual deficits
- decreased motor skills
- special utensils that OT helps w, use plate as a clock
dysphagia
difficulty swallowing
- pts should be screened by nurse for risk
- typically cause by stroke
- warning signs like drooling, pocketing
- silent aspiration
silent aspiration
food or fluid goes into airway and can cause things like pneumonia
complications of dysphagia
- aspiration pneumonia
- dehydration
- malnutrition
- wt loss
- if suspected refer to speech path and RD to preform swallowing eval
do for pt w dysphagia
- high fowlers, minimize distractions, allow time bw bites
- check for pocketing, chin tuck, double swallowing
- have suction available, oral care, monitor for chocking/coughing
dont for pt w dysphagia
feed when altered LOC
- leave unattended
- administer sedatives or hypnotics
- use a straw
diet for dysphagia
recommended by speech path
- stages like slightly thicken etc
- position of pt
- aspiration precaution
strict i and os
measure of all intake and output
- recorded in medical record
- measured in ml or occurrences
- incontinence would need catheter for i and os
who needs strict i and os
critical care, unstable pt, post op, catheters/lines/drains/tubes, history of heart/kidney/renal failure, malnourished who are NPO, receiving diuretics, changes in wt
what counts as intake
- oral intake
- IV fluids
- blood products
- tube feeding
- flushes
what counts as output
- urine
- bowel movements
- emesis
- drainage tubes (JP, chest tubes)
interventions for obtaining ht and wt
- must have accurate info
- weight should be the same and accurate
- ht
- assess trend
enteral
provide nutrients via GI. tract
- preferred method if pt cant swallow and gut is functioning
- received through nasogastric, jejunal, gastric tube that deliver to gastric of jejunum
- risk for gastric reflux –> jejunum feedings
- must confirm placement
parenteral
form of specialized nutrition support provided IV
indications for enteral nutrition
- prolonged anorexia
- severe protein energy malnutrition
- coma
- impaired swallowing
- critical illness
benefits of EN over PN
- reduces sepsis
- minimizes the hyper-metabolic response to trauma
- decreases hospital mortality
- maintains intestinal structure and function
administration of tube feeding
- start at full strength, slow rate
- inc per RD and HCP recommendations like inc q 8-12 hrs, inc until goal reached, inc w no intolerance
signs of tube feeding intolerance
- high gastric residual
- nausea
- cramping
- vomiting
- diarrhea
types of tube feeding
bolus –> intermittent
pump –> continuous
complications of tube feeding
- pulmonary aspiration
- diarrhea
- constipation
- cramping, nausea
- tube occlusion
- delayed gastric emptying
- serum electrolyte imbalance
- fluid overload
- hyperosmolar dehydration
tube feeding placement
- through the nose (nasogastric/nasointestinal)
- surgically (gastronomy/jejunostomy)
- endoscopically (PEG/PEJ)
nurses role in feeding tube placement
- insert NG tube using water soluble lubricant
- landmarks: nose, ear, xiphoid process
confirming tube placement
- xray
- ongoing placement verified w pH test
nasogastric or nasojejunal
typically for less than 4 wks
- large and small bore
- come w stylet
- connectors are not standard for EN feeding tubes
surgically or endoscopically placed tubes
- preferred for long term feeding
- more than 6 wks
nursing care for feeding tubes
- abd focused assessment
- check skin for breakdown
- assess nutritional status, intolerance, i and os, monitor labs
- head og bed greater than 45
checking residual
- for continuous: q 4-6 hours
- for intermittent: immediately before
- high gastric residual can indicate delayed gastric emptying
- more than 250 then hold for an hr and recheck
- more than 500 notify HCP
feeding tube administration
- follow 5 rights for med administration
- ensure med can be administered
- always verify placement
- flush w water before and after
- administer one med at a time
