Nutrition (333E2) Flashcards by Jane Daum

what are the 3 main functions of the GI system

transportation, digestion & absorption

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if a person is malnourished, what are some complications they are at greater risk for

dysrhythmias, skin breakdown, sepsis, hemorrhage, increase length of stay, delayed surgical healing

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factors influencing nutrition

appetite, negative experiences, disease & illness, medications, environmental factors (income, location, education), developmental needs, alternative food patterns (beliefs, religion, preference)

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nursing consideration for older adults

-still need the V&M
-presence of chronic illnesses
-medications
-GI changes (starting at teeth)
-slower metabolic rate
-cognitive impairments
-available transportation
-functional ability
-fixed income
-many need calcium supplementation

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assessment of nutritional status

screening, anthropometry, lab & biochemical tests, diet & health hx, physical exam

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risk for malnutrition

unintentional weight loss, presence of a modified diet for a long time, altered nutritional symptoms (n/v/d/c), decreased intake

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lab & biochemical tests that relate to nutrition

-fluid balance
-liver and kidney function
-presence of disease
-common labs: total protein, albumin, pre albumin, hemoglobin

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total protein

-combination of albumin & globulin constitute
-normal: 6.4-8.3 g/dL (UKHC 6.3-7.9)

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albumin

-makes up 60% of total pro
-better indicator of chronic illness
-synthesized in the liver
-half life = 21 days
-is a colloid and keeps fluid inside the intravascular space
-normal: 3.5-5.0gg/dL (UKHC 3.3-4.6)

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prealbumin

-preferred for acute conditions
-half life= 2 days
-normal: 15-36mg/dL (UKHC 20-41)

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hemoglobin

-protein responsible for transporting oxygen in the blood, is the iron contain pigment of the RBC
-if low, benefit from eating iron rich foods
-normal: M 14-18g/dL (UKHC 13.7-17.5), F 12-16g/dL (UKHC 11.2-15.7)

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implementation of health promotion for nutrition

-pt ed
-early identification of nutritional concerns
-assist w/ meal planning for needs
-education on food safety

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diet selection

-amount needed
-ability to eat
-any alterations in their GI system
-any special considerations based on their health status

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modified texture diets: mechanical soft

-smaller portions of soft food (blended, ground, pureed, or finely chopped)
-do not give raw fruits, vegetables, nuts, seeds

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modified texture diets: pureed diet

pudding like, no chewing

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modified texture diets: minced diet

food is 1/8th inch big, minced very small

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modified texture diets: ground

like rice, anything that is 1/4th inch

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modified texture diets: chopped

half inch size like a macaroni

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what is considered a clear liquid diet

-water, coffee, teas w/ nothing added
-popsicles
-jello
-broth
-sports drinks (gatorade)
-no pulp lemonade
-apple & grape juice (not tomato or orange)

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when would you use a clear liquid diet

-pre opt
-acute illness
-low residual

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full liquid diet

-all juices
-milk
-coffee or tea
-sports drinks
-broth or soup
-sorbet or frozen yogurt
-**some policies include pudding, yogurt & grits

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what type of pt are you most likely to see a fluid restrictive diet on

-heart (not pumping fluid effectively and retaining it)
-kidney failure (not able to urinate effectively)
-low serum sodium ( concentrates the Na in the blood bc there is less volume)

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normal serum sodium

135-145

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nurses role in fluid restriction

-spacing out the milliliters allowed throughout the 24 hour period (needs to consider meals, meds, & sleep)
-Is&Os
-noncompliance

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what is the best way to measure a pt's fluid volume status

daily weights (not Is&Os) *try to keep as consistent as possible*

thicken liquids

-thin: normal -nectar: coats and drips off spoon -spoon thick: pudding -honey like: falls off spoon in a ribbon

what does cardiac diet / heart healthy diet mean

low salt, sat fat and cholesterol

low residue diet

high fiber foods, undigestible foods, low dairy (usually for crohn's or UC)

who would be put on a bland diet

-gastric reflux -ulcer

being NPO for how many days is a high nutritional risk

5-7 days ; consider placing a central line and giving TPN

typical diet progression

npo or baseline -> clear liquids -> full liquid -> low residue if needed -> regular

how do you determine tolerance of a diet

no N/V, abdomen is not distended, pt has bowel sounds

anorexia definition

lack or loss of appetite

nursing care to increase appetite

treat the cause, be creative, environment, SFM, allow personal choices, season food, provide oral hygiene, ensure pt comfort, appetite stimulant meds

assisting w/ oral feeding

-protect safety, independence & dignity -tray in reach -assess for aspiration risk -supervision needed? -any visual deficits? -decreased motor skills?

signs of dysphagia

-reduced speech -decreased gag reflex -swallowing delay -drooling -problems w/ regurgitation

silent aspiration

when the food or fluid accidentally goes into the airway instead of the stomach (can lead to pneumonia) **silent bc pt has decreased sensation and do not cough**

how do you determine if someone has silent aspiration

adventitious lung sounds within 24 hours

dysphagia complications

-aspiration pneumonia -dehydration -malnutrition -wt loss

how would you document Is&Os if you can't measure in mL

occurence "pt urinated x1" "bowel movement x1"

can you do Is&O2 on an incontinent pt

no -> if absolutely needed can put a foley catheter in but we want to avoid foleys d/t risk of infections

who needs strict I&O

-critical care pt -unstable pt -post op pt -pt w/ catheters/lines/drains/tubes -pt w/ hx or currently have heart failure, liver failure, renal failure -malnourished -NPO -diuretics -changes in wt

what is considered intake

-oral intake -IV fluids -blood products -tube feeding -flushes

what is considered output

-urine -bowel movements -emesis -drainage tubes ( JP or chest)

can I&O be delegated

yes -> collab w/ nursing assistant

what is a key factor of I&Os

education! make sure pt and family understands & that all health care staff knows they are on

what vein does tpn go into

central vein

when would you have both a peg and a pej

to keep the stomach completely decompressed -> feed through the pej and suction through the peg

what risk are we avoiding by putting the tube into the jejunum

gastric reflux

indications of EN

-prolonged anorexia -severe protein energy malnutrition -coma -impaired swallowing -critical illnesses

benefits of EN vs PN

-reduces sepsis -minimizes the hyper metabolic response to trauma -decreases hospital mortality -maintain intestinal structure & function

how to initiate a tube feed

start at full strength w/ a slow rate and then increase every 8-12 hr until goal rate is met and there are no signs of intolerance

signs of EN tube feed intolerance

-high gastric residuals -N/V/D -cramping

why do tube feedings cause diarrhea

they are hypertonic so the solution pulls water out of the gut and into the GI tract causing diarrhea

hyperosmolar dehydration

fail to give free water in tube feeding

how to measure NG tube length

measure nose -> ear -> xiphoid process and then add 8-10inches for jejenum

how to confirm NG placement

xray and then after xray -> pH of gastric secretions for monitoring

NG/NJ characterists

-EN<4 wk -large bore & small bore -typical for adults: 8-12 Fr, 36-44 in long -come w/ stylet -connectors are not standard

PEG/PEJ indications

feeding >6 wk

feeding tube assessment & monitoring

-abd focused assessment -check around tube for breakdown -assess nutritional status -assess for intolerance -assess I&O -asses & monitor labs

how often should gastric residual be checked

-continuous feeding: every 4-6 hr -intermittent: immediately before bolus

high gastric residuals indicate

delayed gastric emptying

how much gastric residuals is too much

**know hospital policy & pt trends** >250 ml: hold for 1 hr & recheck >500 ml: hold & notify HCP **put residual back into pt**

administration of meds through feeding tube

-5 rights -ensure med can be administered via tube -always verify placement -flush w/ water before and after admin -administer 1 med at a time