Nutrition Flashcards
Main functions of GI tract
Transportation, digestion, absorption
Good nutrition helps…
Reach healthy weight, decrease risk of chronic disease, recognize early signs of malnutrition
Dietary guidelines
Eat nutrient dense foods, limit calories from fatty foods, shift healthier foods from less healthy
Factors influencing nutrition
Appetite, personal experiences, disease and illness, meds, environmental factors like income, education, physical functioning level, transportation, availability, cultural food patterns (don’t assume all people from a culture are the same), fasting
Older people vitamins and minerals
Need the same as younger people
Anthropometry
Study of body measurements—size and makeup of body, height and weight, ideal weight, BMI, skin fold measures, fat %
Nutritional assessment
Screening tools, subjective and objective changes, weight change, diet intolerances
Total protein
Combined albumin and globulin constitute; normal 6.4-8.3 g/dL
Albumin
Normal is 3.5-5; Indicator of chronic malnutrition; 60% of total protein; synthesized in liver, 21 day half life; is a colloid—creates pulling in the vascular system
Prealbumin
15-36 mg; measure of acute malnutrition; 2 day half life
Hemoglobin
Transports oxygen in the blood; normal is 14-18 M, 12-16 F; if low, eat foods rich in iron
What does nutritional history include?
food intake, tolerance, allergies, swallowing, appetite, health history, social indicators
What are some nutritional nursing problems?
RIsk for aspiration, impaired swallowing, fatigue, risk for unstable BG, imbalance nutrition
4 areas to consider for patient diets
amount needed, ability to eat, alterations in GI system, special considerations based on health status
Regular diet
no intolerance, normal consistencies
Mechanical soft diet
soft and smaller in size, no raw fruit veg, nuts, finely ground
Pureed
spoon foods, no chewing
Minced diet
1/8 inch, food chopped in bits
Ground diet
1/4 inch pieces
Chopped diet
1/2 inch
Goal of liquid diets
Leave little residue
Clear liquid diet
broth, water, black coffee, OJ without pulp, popsicles, jello, soda
Full liquid diet
sorbet and froyo, ice cream, juice with bits
Who may need a fluid restriction
retaining water, heart failure, kidney failure, low serum sodium levels
Who are thickened liquids for?
dysphagia, stroke, aspiration risk
Consistent carb diet
formerly diabetic diet
Cardiac diet/healthy heart
low sodium, low fat
Low residue diet
low ruffage/low fiber–limit diary and undigested food (Crohns and ulcerative colitis)
Bland diet
avoid GI irritation and decreases peristalsis, have ulcers
Advancement of diet
clear liquids–full liquid–low residue (watch for bowel sounds and not if they are hungry)
Anorexia causes
cause by hurt, tired, SOB, emo, meds
Nursing care for anorexia
treat cause, change environment (move to chair), smaller frequent meals, allow for food preference, oral hygiene, seasonings, meds for appetite; assist with feedings
What counts as input?
oral, OVF, blood, tubes, flushes
What counts as output?
urine, BM, emesis, drainage tubes
Symptoms of dysphagia
pocketing food, regurgitate, food stuck in through, discomfort in chest and throat, voice change, cough or choke while eating
silent aspiration
may hear breath adventitious breath sounds w/i 24 hours
Complications of dysphagia
aspiration, dehydration, malnutrition, weight loss
Do’s of dysphagia
sit in high fowlers, minimize enviro, double swallow, chin tuck, check for pocketing, leave time between bites, have suction nearby, oral care, monitor for choking
Don’ts of dysphagia
feed with altered LOC, leave unattended, use straw, give sedatives during feeding
Elements of dysphagia diet
aspiration precautions, pt position, advance in stages, thicker liquids, strict I&O
Who needs strict I&O?
critical care, unstable, post-op, taking diuretics, malnourished, pt with catheter, lines, drains, history of heart fail, liver, or renal failure
Parenteral nutrition (TPN)
feeding that isn’t through the GI tract; thru central or peripheral IV
Gastrostomy
tube surgically implanted thru artificial opening into the stomach
Jejunostomy
feeding tube inserted surgically thru external opening in small intestine
Naso feeding tube
Nasogastric (Salem sump), nasoduodenal, or nasojejunal inserted through the nose and terminating at one of these areas
What is a risk of jejunal feedings?
gastric reflux
What must you do after inserting a feeding tube?
Confirm placement with a chest xray; continue to confirm placement with pH of secretions
Indications for feeding tube
anorexia, coma, critically ill, impaired swallowing, protein malnourishment
Benefits of feeding tubes
decreased sepsis, decreased hypermetabolic response to trauma, dec hospital mortality, maintains intestinal struc/fxn
How to administer enterally?
start formula at full strength, slow rate and gradually increase per RD or HCP over 8-12 hours until goal is met if no signs of intolerance
Signs of feeding tube intolerance
high gastric residual, N/V/D, cramps
complications of feeding tubes
pulmonary aspiration, diarrhea, constipation, cramps, N/V/D, tube occlusion, delayed gastric emptying, serum electrolyte imbalance, fluid overload, hyperosmolar dehydration
How does the nurse insert a feeding tube?
with lubricant; use xiphoid process as landmark and add 8-10 inches for jejunum
PEG
Percutaneous endoscopic gastronomy; inserted ENDOSCOPICALLY directly into stomach through artificial opening; can be used for suction if patient also has a PEJ
PEJ
Percutaneous endoscopic jejunostomy; inserted ENDOSCOPICALLY through artificial opening into small intestine
Enteral nutrition
Formula sent through tubes into the body
When is a naso tube preferred?
Shorter duration (less than 4 weeks); come with a stylus and not a connector
When is a surgical or endoscopic tube preferred?
long-term; over 6 weeks
Feeding tube assessments
abdominal focused, check skin b/d, nutritional status, I&O, monitor labs, intolerance, head of bed above 30 degrees at any time
Gastric residual check frequency
Checking the amount of stuff in the stomach and putting it back in the stomach; for continuous feeding, check every 4-6 hours; for intermittent, check right before feeding
What do if more than 500 mL tube feed?
Hold residual and notify HCP
What do if more than 250 mL tube feed?
Hold for 1 hour and recheck
