Nutrition Flashcards
1
Q
3 main functions of GI system
A
transportation, digestion, absorption
2
Q
Importance of good nutrition
A
- helps you maintain a healthy wt
- reduce risk of chronic diseases such as HTN, diabetes, cancer, etc.
3
Q
Importance of nutrition
A
- early recognition of someone who is malnourished is key
- pts who are malnourished upon admission are at greater risk for complications
4
Q
Malnourished complications
A
- skin breakdown
- sepsis
- hemorrhage
- dysrhythmias
- increase length of stay
- delayed surgical healing
5
Q
Dietary guidelines
A
across lifespan
- dairy, grains, oils, fruits, vegetables, protein
limit things aren’t good for us
- sugar, sodium, saturated fats
6
Q
Factors influencing nutrition
A
- appetite
- negative experiences
- disease and illness
- medications
environmental factors - income
- education level
- physical function level
- transportation
- availability of food
- developmental needs
alternative food patterns - religion
- cultural background
- health beliefs
- personal preferences
7
Q
Older adults + nutrition
A
- need same amount of vitamins and minerals as younger adults
nurses must consider: - presence of chronic illnesses
- medications
- GI changes
- slower metabolic rate
- cognitive impairments
- available transportation
- functional ability
- fixed income
- calcium supplementation
8
Q
Cultural considerations
A
- be considerate of pt’s cultural and ethnic backgrounds
9
Q
Assessment of nutritional status
A
- screening
- anthropometry
- lab and biochemical tests
- diet and health history
- physical exam
10
Q
Nutrition screening tools
A
- subjective screening
- objective measures
- identify risk factors of malnutrition
standardized tools - subjective global assessment (SGA)
- Mini-nutritional assessment (MNA)
- malnutrition screening tools (MST)
11
Q
Anthropometry
A
measure size and make up of body
- ht and wt
- ideal body wt
- body mass index
- skin fold measures
- fat percentage
- registered dieticians can assist
12
Q
Lab and biochemical tests
A
- no single lab test
13
Q
Factors that affect lab results
A
- fluid balance
- liver and kidney function
- presence of disease
14
Q
Common labs
A
- total protein
- albumin
- prealbumin
- hemoglobin
15
Q
Total protein
A
combination of albumin and globulin constitute
- normal 6.4-8.3
16
Q
Albumin
A
better indicator of chronic illnesses
- makes up 60% of total PRO
- synthesized in liver
- half-life of 21 days
- normal 3.5-5.0
17
Q
Prealbumin
A
preferred for acute conditions
- half-life of 2 days
- normal 15-36
18
Q
Hemoglobin
A
protein responsible for transporting oxygen in the blood
- male 14-18
- female 12-16
- if low, may benefit from iron-rich foods
19
Q
Diet history
A
- dietary intake
- food preferences
- intolerances
- unpleasant symptoms
- allergies
- taste, chewing, swallowing
- appetite
- weight
20
Q
Health history
A
- illness
- activity level
- health status
- medications: supplements, prescription, OTC, vitamins
21
Q
Other history
A
- age
- socioeconomic status
- cultural backgrounds
- religious beliefs
- transportation
- psychological factors
- drug use and alcohol
22
Q
Malnourished
A
- general appearance and posture = fatigue, apathetic, cachetic (gaunt), sagging shoulders, sunken chest, humpback
- weight = obesity, overweight, underweight
- neuro = inattentive, irritable, confused, decreased reflexes
- cardiovascular = VSS
- GI = anorexia, indigestion, constipation, diarrhea, n/v
- MSK = weak, poor tone, wasted appearance, bowlegged, visible ribs
- skin = rough, dry, scaly, pale
- nails = spoon shape, brittle
- hair = stringy, thin, brittle, dry
- face and neck = swollen, dark skin under eyes
- eyes = pale conjunctiva, dry
- lips = red, swollen, dry
- gums = spongy, receding, easily bleed, inflamed
- tongue = swelling, scarlet, raw
- teeth = missing or broken
- oral mucous membranes = swollen, oral lesions
23
Q
Nursing problems and nutrition
A
- imbalanced nutrition, less than body requirements, more than body requirements
- impaired swallowing
- risk for aspiration
- diarrhea, nausea, constipation
- impaired dentition
- fatigue
- risk of unstable blood glucose
24
Q
Implementation: Health promotion
A
- pt education
- early identification of nutritional concerns
- assist with meal planning
- educate on food safety
25
Implementation: Diet selection
- amount needed
- ability to eat
- any alterations in their GI system
- any special considerations based on their health status
26
Types of diets
- regular
- liquid diets and special considerations
- modified texture diets
- therapeutic diets modified for nutrients
- supplements
27
Regular diet
- no restrictions and no signs of intolerance
- no comorbidities
- encourage healthy choices
- regular consistency
- well balanced
28
Modified texture diets
- mechanical soft
- pureed - pudding
- minced - 1/8 inch
- ground - 1/4 inch
- chopped - 1/2 inch
29
Mechanical soft
no raw vegetables, no nuts, no raw fruits
30
Clear liquid diet
- water, coffee, tea, broth (fat free), popsicles, gelatin, apple juice, grape juice, lemonade or orange juice NO PULP, sports drinks
- HAVE TO SEE THROUGH
- gut rest, surgery, leave little residue or fiber in GI tract
31
Full liquid diet
juice (all kinds), milk, coffee or tea, sports drinks, pudding, yogurt, grits, ice cream, broth or soup without chunks
32
Fluid restricted diet
limiting amount of fluid per day
- number of mls per day pt is allowed
- pts retaining excessive water
- pts that have heart or kidney failure
- hyponatremia (low serum sodium)
- spread out number of mls over 24 hours
33
Daily weight
better indication of fluid volume status
34
Modified consistency of liquid
- dysphagia
- stroke pt
thickened or thin liquids
35
Thin liquids
water, coffee, tea, soda, ices, tomato juice, etc.
36
Nectar-like
liquids that have been thickened to a consistency that coats or drips off a spoon, similar to unset gelatin
37
Spoon-thick
liquids that have been thickened to a pudding consistency, they remain on spoon in soft mass
38
Honey-like
liquids that have been thickened to honey consistency, the liquid flows off of a spoon like a ribbon
39
Therapeutic diet orders
- consistent carbohydrate
- cardiac diet or heart healthy diet
- low residue
- high fiber
- gluten free
- lactose free
- bland
40
Consistent carbohydrate
- diabetic diet
- focus on calories and making sure all needs met
- good balance of carbs, fats, proteins
41
Cardiac diet or heart healthy diet
low salt
low cholesterol
low sat fat
42
Low residue
- low roughage
- low residue = undigested food
- limited dairy products
- pt's with ulcerative colitis, crohn's disease, helps rest the gut
43
High fiber
recommend to prevent constipation and colon cancer
- grains, fruits, veggies, nuts, beans
44
Gluten free
no wheat, barley, rye, oats
45
Bland diet
designed to avoid irritation in the GI tract and decrease peristalsis
- pt with ulcer, reflux
46
NPO
nothing by mouth
- procedure
- coming back from procedure, need gut to wake up
- rest the gut
being NPO for 5-7 days are high nutritional risk
47
Typical NPO orders
- NPO after midnight
- NPO after midnight except meds
- NPO except ice chips
48
Advancing diet
Common order is "advance diet as tolerated"
- clear liquid -> full liquid -> low residue if needed or regular
- tolerate = no n/v/d, abd sounds, no abdominal distention
49
Anorexia
lack or loss of appetite
causes
- pain
- fatigue
- effects of medications
50
How to increase appetite
- treat the cause
- use creative approaches to stimulate appetite
- environment
- smaller, more frequent meals
- allow for food preference
- seasonings to improve taste
- provide oral hygiene
- ensure pt is comfortable
- medications for appetite stimulation
51
Assisting with oral feedings
- protect safety, independence, and dignity
- make sure tray is in reach
- assess risk of aspiration
- does pt need to be supervised?
- any visual deficits? tray as a clock
- decreased motor skills, adaptive utensils available
52
Dysphagia
- nurses should screen for dysphagia
causes
- stroke
- neuro
- muscle
be aware of warning signs
silent aspiration
53
S/S of dysphagia
- voice change
- pocketing of foods
- persistent drooling
- slow speech, uncoordinated
- gag reflex might not be resilient
- feeling of food stuck in throat
- bringing food back up, sometimes through nose
- coughing or choking when eating or drinking
- wt loss/inadequate nutrition
- delay in swallowing
54
Complications of dysphagia
- aspiration pna
- dehydration
- malnutrition s/t decreased intake
- weight loss
55
If dysphagia is suspected
make referrals to SLP or RD
- perform swallow evals
56
Nursing care of pt with dysphagia: DO
- sit in high fowlers
- minimize environmental distractions
- allow for time in between bites
- check for oral pocketing
- chin tuck
- double swallowing
- have suction available
- perform oral care
- monitor for choking and coughing
57
Nursing care of pt with dysphagia: DONT
- feed when altered LOC
- leave unattended
- administer sedatives or hypnotics
- use a straw
58
Intervention: strict I&O
- measurement of all intake and all output
- record in pt's chart
- can measure in amount (mls) or in occurrences
59
Strict I&O
- want exact measurement
- can record as occurrence
- Pt urinated x1
60
Who needs strict I&O
- critical care pts
- unstable pts
- post-op pts
- pts who have catheters, lines, drains, tubes
- pts with hx of/or current
-- heart failure, liver failure, renal failure
- malnourished or pts who are NPO
- receiving meds such as diuretics
- changes in weight
61
Intake
- oral intake
- IV fluids
- blood products
- tube feeding
- flushes
- blood
62
Output
- urine
- BM
- emesis
- drainage tubes: JP, chest tube
63
Nurse's role for I&O
- nurse's responsibility
- educate pt and family
- can be delegated
- communicate through signs
- assess and monitor trends
64
Obtaining ht + wt
- must have accurate information
- KEEP IT SAME
- keep it accurate
- assess trends
65
Enteral options
liquid supplemental nutrition is either taken by mouth or is given via a feeding tube
- nasal or oral feeding tube terminates at: stomach (ng tube), duodenum (nasoduodenal), jejunum (nasojejunal)
- g-tube (gastronomy, into stomach) (PEG tube)
- j-tube (jejunostomy, into small intestine) (PEJ tube)
66
Parenteral nutrition
feeding IV, bypassing the usual process of eating and digestion
- central line
67
Enteral nutrition
- receive formula through ng tubes, jejunal, or gastric tubes
- delivered to gastric or jejunum
- risk for gastric reflux -> jejunum feedings
- when placed, MUST CONFIRM PLACEMENT
68
Indication of EN
- prolonged anorexia (some pts will simply not eat)
- severe protein-energy malnutrition
- coma
- impaired swallowing
- critical illnesses
69
Benefits of EN vs. PN
- reduce sepsis
- minimizes the hypermetabolic response to trauma
- decreases hospital mortality
- maintains intestinal structure and function
70
Administration rate of tube feeding
- start at full strength, slow rate
- increase per RD recommendation or HCP order
- assess for signs of intolerance
71
Signs of intolerance tube feed
- high gastric residuals
- n/v/d
- cramping
72
Tube feed increase
- increase every 8-12 hours
- amount of increase is set until reach goal rate
- increase if no signs of intolerance
73
Administration of tube feeding
bolus (intermittent)(syringe) vs. pump (continuous)
74
Complications of tube feeding
- pulmonary aspiration
- n/v/d
- diarrhea (tube feedings are very hypertonic and concentrated, pulls water into GI tract)
- constipation
- abd cramping
- tube occlusion or displacement
- delayed gastric emptying
- hyperosmolar dehydration
- fluid overload
- serum electrolyte imbalance
75
Placement of feeding tubes
- through the nose (nasogastric or nasointestinal)
- surgically (gastronomy, jejunostomy)
- Endoscopically (PEG or PEJ)
76
Nurse's role in placement
- insert NG tube using water soluble lubricant
- landmarks for gastric = nose -> ear
-> xiphoid process
- add 8-10 inches for jejunum
77
Confirmation of placement for feeding tubes
- XRAY -> only 100% way to confirm
- once verified with x-ray, an ongoing placement verification can be to test pH
78
Nasogastric or nasojejunal
- typically for EN <4 weeks
- large bore and small bore
- adults = 8-12 Fr, 36-44 inches long
- comes with stylet
- connectors are not standard for EN feeding tubes
79
Surgically or endoscopically places tubes
- preferred long-term feeding
- more than 6 wks
80
Assessment and monitoring of feeding tubes
- abd focused assessment
- check skin around tube for breakdown
- assess nutritional status, I&O, intolerance
- assess and monitor labs
- verify placement
- decrease risk of aspiration = HOB elevated at 30-45+
81
Feedings tubes + meds
- can med be crushed?
- verify placement?
- flush before and after with water
- administer one med at a time
