Nutrition Flashcards
1
Q
What is the percentage of malnourished patients upon admission?
A
35-50%
2
Q
Malnutrition affects:
A
- illness
- recovery
- wound healing
- infections are prolonged
3
Q
Important factor for the hospitalized patient:
A
-intake of nutritious food (can shorter hospitalized stays)
4
Q
What is the percentage of obesity in the U.S?
A
30.5% with a BMI > or = 30
5
Q
Impacts of obesity
A
- obese pts stay an average of 1.5 days longer
- wound healing is impaired (diminished tissue perfusion)
- obesity carries a nearly 6-fold increase in MORTALITY rate
6
Q
Challenges with obese pts
A
- respiratory (sleep apnea)
- challenging x-ray reading
- entubating is difficult
7
Q
Basal Metabolism
A
Energy required to carry on the involuntary activities of the body at rest (maintaining body T *, muscle tone, secretions, inflating lungs…)
8
Q
Factors for BMR increase
A
- growth
- infection
- fever
- emotional tension
- elevated hormones
9
Q
Factors for BMR decrease
A
- aging
- prolonged fasting
- sleep
10
Q
RDA
A
Recommended Dietary Allowance
11
Q
Role of Vitamins
A
Needed for metabolism of carbohydrates, proteins and fats.
12
Q
Water-soluble Vitamins
A
Vitamin C: collagen formation,enhances iron absorption
Vitamin B Complex: coenzyme helps glucose (B6, B12)
Riboflavin: carb, protein, fat metabolism
Niacin: carb, protein, fat metabolism
13
Q
Fat-soluble Vitamins
A
A, D, E, K!
A: visual acuity
D: calcium absorption
E: antioxidant
K: help clotting
14
Q
CARBOHYDRATES
A
- sugar and starches
- most abundant and least expensive
- 90% of carb intake is ingested
- turned into GLUCOSE to provide energy transported through blood
- RDA intake 50-60 % of total cal
15
Q
PROTEINS
A
- required for formation of all body structures
- labeled “complete” or “incomplete” based on amino acid composition. Ex: animal proteins are complete, plants are incomplete. (Exceptions: soy and quinoa = complete proteins)
- RDA intake 10-20% total cal
16
Q
KETOSIS
A
Is a metabolism of fats, it occurs when the liver is low in glycogen (stored glucose). In inappropriate intake of glucose, the body will utilize fats to provide energy.
As a result, ketones are often found in urine.
Often associated to acidosis.
17
Q
FATS (LIPIDS)
A
- 95% of lipids in diet are triglycerides = VDLs
- digested in small intestine
- RDA should be < 30% cal intake
18
Q
Excess Vitamin Consumption
A
Can result in kidney dysfunction
19
Q
Importance of Folate vitamin in pregnant women?
A
Help proper neurological development in fetus
20
Q
Factors affecting NUTRITION in adults:
A
- decline BMR
- decrease in calorie intake
- lactating women: need increase in nutrients to support growth and maintain maternal homeostasis
21
Q
What are Anthropometric measurements used for?
A
To determine body measurements (body protein and fat storage)
22
Q
Dysphagia =
A
Difficulty swallowing or inability to swallow –> will increase risk of aspiration
23
Q
Dysphagia can result from:
A
- poor health
- cancer
- neurological disease
- Parkinson’s
- Dementia
24
Q
Signs and Symptoms of poor nutritional status
A
- Fatigue,
- Overweight/underweight,
- Dark circles under eyes,
- Swollen lips
- Beefy red tongue
- Cavities
- Enlargement of thyroid gland
- Skin is dry, flaky, petechiae, bruises…
- Poor posture
- Wasted muscle
- Swollen abdomen
- CNS: loss of ankle and knee reflexes, mental confusion, depression,sensory loss, motor weakness
- Cardio: tachycardia, abnormal BP, cardiac enlargement
- GI: enlarged liver or spleen
25
Diet Orders
| 1) Clear liquids
Anything that is clear at room T *
Ex: jello, Popsicles, tea, ginger ale, bouillon, fruit juice (w/ no pulp)
NO milk or juices w/ pulp
26
Diet Orders
| 2)Full liquids
Things you can poor at room T *
| Ex: milkshakes, soups, custards (NO jam, fruit, or solid foods)
27
Diet Orders
| 3) Soft diet
No fats, low in fiber, no salt or seasoning
Ex: all full liquids, cooked vegetables, canned fruit, banana, avocado, potatoes, rice, lean meats and fish, eggs, yogurt.
28
Diet Orders
| 4) Puréed
Thickness and viscosity based on pt's tolerance
Ex: mashed potatoes, puréed vegetables, shakes (everything that can be blended)
--> good for stroke patients
29
Diet Orders
| 5) Mechanical soft
Softer foods that can be cut up. Good for pts w/ chewing ability.
Ex: mashed, soft ripened fruit such as bananas, peaches, pears, cooked mashed soft veggies
30
Diet Orders
| 6) NPO
Nothing By Mouth
31
Lab Data
| Hemoglobin:
12-18 g/dL
32
Lab data
| Hematocrit:
40-50%
| High levels = Dehydration
33
Lab data
| Albumin:
3.5-5.5 g/dL
| Decreased level --> malnutrition (prolonged protein depletion), malabsorption
34
Lab data
| Prealbumin:
23-43 mg/dL
* If levels fall below 15 mg/dL = severe malnourishment, unsafe
35
Lab data
| Transferrin:
240-480 mg/dL
High level means low iron
Low level means elevated iron, protein deficiency
36
Lab data
| BUN:
10-20 mg/dL
37
Lab data
| Creatinine:
0.4-1.5 mg/dL
Increased--> dehydration
Decreased--> reduction in total muscle mass, severe malnutrition
38
Low lab value of H & H can be a sign of?
Anemia = poor dietary intake
39
What does the BUN measure?
The nitrogen balance = which is the balance between Catabolism and Anabolism
40
What does a + or - BUN value indicates?
It indicates:
- kidney function
- dietary intake
- nutritional status
Increased BUN --> starvation, high protein intake, severe dehydration
Decreased BUN --> malnutrition, overhydration
41
Total Blood Cholesterol measurements:
200 mg/dL = normal
200-239 mg/dL = borderline high
> 240 mg/dL = high
42
Desirable LDL level:
| Bad cholesterol
< 100 mg/dL (newer target of < 70 can be considered in high risk patients)
43
HDL level:
| Good cholesterol
> 60 mg/dL
44
Triglycerides level:
< 150 Normal range, low risk
44
When can a diet be advanced?
When the patient reports no nausea experience and can consume at least 50% of tray
45
IMPLEMENTING
Teach about nutritional info
- tailor diet instructions
- food safety issues
- teach pt to cook at safe T *
- nutrition management
- nutrition therapy
- nutrition monitoring
- exercise promotion
- weight management
46
IMPLEMENTING --> special considerations to the older adult
Consider: loss of senses, GI reflux, slow intestinal peristalsis, lower glucose tolerance, physical handicaps, low income, drug/food interactions.
47
Oral Feeding Safety:
- Ensure gag reflex is functioning
- Feed small amounts and ensure swallowing and tolerance
- HOB elevated 45-90 * and 60 min following feeding
- involve pt to maintain dignity
* Encourage oral feeding as much as possible before opting for TPN
48
When is enteral nutrition (feeding) recommended?
| Short term
- Cancer
- Neuro or muscular disorders
- GI disorders
- Prolonged intubation
- Inadequate oral intake
49
What is "enteric"?
= stomach or small intestine (feeding)
50
What is "parenteral"?
= through vascular system
51
What are the 2 Enteral Nutrition options for short term (< 6 weeks)?
NG tube through nose into stomach
- -> stomach regulates amounts released into small intestine
* High risk of Aspiration!
NI tube into Small Intestine
- -> minimal risk for aspiration
- -> HIGH risk for Dumping Syndrome
52
Signs and Symptoms of Dumping Syndrome?
- Overdistention of abdomen
- Nausea
- Diarrhea
- Cramping
- Light headedness
53
Why choose an NI tube versus NG tube?
- No gag reflex
| - Slow gastric motility
54
What are the 2 Enteral Nutrition options for long term (> 6 weeks)?
- Tube is inserted surgically through opening created into:
1) Jejunum = JT jejunomy
2) Stomach = GT gastronomy
* If GI tract normal functioning --> PEG (percutaneous endoscopic gastronomy)
55
When is long term enteral feeding appropriate?
- Coma
- Trauma to esophagus (Cancer)
- ALS
- Lost swallow ability (Dysphagia)
56
Maintenance of NG equipment?
Open system, bag and tubing: Change Q 24 h
Closed system: Change Q 48 h
Feeding solution (food): 8 h MAX at room T * and 24 h after opening if refrigirated
57
What is the purpose of Continual Feeding in stomach?
Promotes maximal absorption
* Risk of reflux and aspiration
58
What is the purpose of Continuous Feeding in the intestine?
Avoids triggering "Dumping Syndrome"
| --> installed via gravity or feeding pump
59
What is the purpose of Intermittent Feeding in stomach?
Preferred method to avoid reflux and aspiration
60
What is the purpose of Cyclic Feeding?
Continuous feeding for a portion of the 24 h, usually for 12-16 h
--> Allows pt to attempt eating regular meals during the day
61
Unexpected situations when inserting a NG tube?
- Gag reflex (normal) --> pause and have pt put chin down and take sips of water
- Nurse unable to pass tube --> inspect nostril and throat (tube could be coiled)
- Signs of resp distress --> tube in lungs!
- No gastric content can be aspirated --> move pt onto side, tube might be against gastric ruggae
- Epistaxis
62
How to confirm NG placement?
- X rays --> most reliable
- Visual assessment (markings on tube)
- pH measurement of aspirate
- Check exposed tube length
* Comatose pts have to be xrayed for confirmation
63
Patient Safety when on NG tube:
- Check tube placement
- Check residual --> should be interrupted if 10-20% above hourly rate
- HOB at least 30 * during feeding and for 1 hour after to prevent reflux and aspiration
- Prevent contamination
64
Preventive interventions for potential complications with Enteral Feeding:
- Clogged tube: flush tube with sterile water before and after feeding and medication, also every 4 h (can use warm water 30 mL)
- Check nostrils every shift for signs of pressure
- Clean and moisten nares Q 4-8 h
- Start feeding at a slow rate
- Check residual Q 4 h when on continuous feeding
- Clean stoma every shift with warm soap and water
- Assess for S x S of infection at stoma (consult w/ wound care specialist)
65
What is "Refeeding Syndrome"?
An electrolyte and metabolic disorder that occurs when a nutritionally depleted pt is fed enterally and parenterally.
66
What are the S x S of "Refeeding Syndrome"?
- Muscle weakness
- Low K + level
* Administer K + and Phosphorous if needed
67
What is TPN?
Total Parenteral Nutrition --> highly concentrated, hypertonic nutrient solution that
- provides calories (carbs, proteins, fats), restores nitrogen balance,
- replaces essential fluids, electrolytes, vitamins and minerals
68
What is PPN?
Peripheral Parenteral Nutrition that is less concentrated than TPN for malfunctioning GI tract pts, solution is isotonic and is administered through a peripheral vein.
69
How many kcal are in carbohydrates, proteins and fats per 1 gram?
```
Carbs = 4kcal
Proteins = 4 kcal
Fats = 9 kcal
```
* Fats will provide more energy than carbs and proteins with the same amount.
70
What is the color of aspirate obtained from the following?
1) Stomach
2) Intestines
3) Respiratory tract
1) Stomach - grassy green, bloody or brown
2) Intestines - yellow, may be greenish brown if stained w/ bile
3) Respiratory tract - off white or clear
70
Factors to assess proper nutrition:
- usual dietary intake
- food allergies or tolerance
- type of dietary practices
- eating disorder patterns
70
Nutritional Screening: D-E-T-E-R-M-I-N-E
D-isease: illness, chronic condition
E-ating poorly: too little/too much
T-ooth loss/mouth pain: interfere with feeding
E-conomic hardship: spending less on food
R-educed social contact: being with people has a + effect on eating and well being
M-ultiple medicines: polypharmacy
I-nvoluntary weight loss: sign of serious health problems
N-eeds assistance in self-care
E-lderly years above 80: increase in health pbs
70
Considerations with the older adult:
- low serum of albumin and hemoglobin
- vitamin and mineral use
- OTC to assess food/drug interactions
70
Factors affecting food habits:
Physical: geographic, location, income, food technology
Physiologic: health, hunger, stage of development
Psychosocial: culture, religion, education, social status
70
Eating disorders such as anorexia and bulimia can result in?
Electrolyte imbalance
70
Chemotherapy and Radiation risk?
Decrease in appetite (calories should be increased when ill)
70
BMI
Body Mass Index
```
BMI = [weight in pounds/(height in inches) x (height in inches)] x 703
BMI = weight in kg/(height in m) x (height in m)
```
Know weight and height of pt for:
- medication dosage
- measure I & Os
- baseline data
- to calculate BMI
70
* BMI scale:
Normal = 18.5-24.9
Overweight = 25-29.9
Obese = 30-39.9
Extreme obesity = 40-54
70
What does the waist circumference indicate?
- risk of heart disease, diabetes and hypertension.
75
What is the role of vitamin A in relation to wound healing?
Vitamin A is necessary for collagen synthesis and epithelialization.
76
What is the role of vitamin B complex in relation to wound healing?
Vitamin B complex serves as a cofactor of enzyme reactions needed for wound healing.
77
What is the role of vitamin C in relation to wound healing?
Vitamin C is needed for collagen synthesis, capillary formation and resistance to infection.
78
What is the role of vitamin K in relation to wound healing?
Vitamin K is needed for the synthesis of prothrombin which helps in clotting.
79
What are the S x S of aspiration?
- Coughing
- Cyanosis
- Choking
- Gurgling
80
What is the right procedure when gastric contents leak?
- Clean
- Reinflate balloon
- Call physician
