Nutrition (333E2)

Question 1

what are the 3 main functions of the GI system

Answer 1

transportation, digestion & absorption

Question 2

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

Answer 2

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

Question 3

factors influencing nutrition

Answer 3

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

Question 4

nursing consideration for older adults

Answer 4

-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

Question 5

assessment of nutritional status

Answer 5

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

Question 6

risk for malnutrition

Answer 6

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

Question 7

lab & biochemical tests that relate to nutrition

Answer 7

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

Question 8

total protein

Answer 8

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

Question 9

albumin

Answer 9

-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)

Question 10

prealbumin

Answer 10

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

Question 11

hemoglobin

Answer 11

-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)

Question 12

implementation of health promotion for nutrition

Answer 12

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

Question 13

diet selection

Answer 13

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

Question 14

modified texture diets: mechanical soft

Answer 14

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

Question 15

modified texture diets: pureed diet

Answer 15

pudding like, no chewing

Question 16

modified texture diets: minced diet

Answer 16

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

Question 17

modified texture diets: ground

Answer 17

like rice, anything that is 1/4th inch

Question 18

modified texture diets: chopped

Answer 18

half inch size like a macaroni

Question 19

what is considered a clear liquid diet

Answer 19

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

Question 20

when would you use a clear liquid diet

Answer 20

-pre opt
-acute illness
-low residual

Question 21

full liquid diet

Answer 21

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

Question 22

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

Answer 22

-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)

Question 23

normal serum sodium

Answer 23

135-145

Question 24

nurses role in fluid restriction

Answer 24

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

Question 24

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

Answer 24

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

Question 25

thicken liquids

Answer 25

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

Question 26

what does cardiac diet / heart healthy diet mean

Answer 26

low salt, sat fat and cholesterol

Question 27

low residue diet

Answer 27

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

Question 28

who would be put on a bland diet

Answer 28

-gastric reflux
-ulcer

Question 29

being NPO for how many days is a high nutritional risk

Answer 29

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

Question 30

typical diet progression

Answer 30

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

Question 31

how do you determine tolerance of a diet

Answer 31

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

Question 32

anorexia definition

Answer 32

lack or loss of appetite

Question 33

nursing care to increase appetite

Answer 33

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

Question 34

assisting w/ oral feeding

Answer 34

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

Question 35

signs of dysphagia

Answer 35

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

Question 36

silent aspiration

Answer 36

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

Question 37

how do you determine if someone has silent aspiration

Answer 37

adventitious lung sounds within 24 hours

Question 38

dysphagia complications

Answer 38

-aspiration pneumonia
-dehydration
-malnutrition
-wt loss

Question 39

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

Answer 39

occurence
“pt urinated x1” “bowel movement x1”

Question 40

can you do Is&O2 on an incontinent pt

Answer 40

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

Question 41

who needs strict I&O

Answer 41

-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

Question 42

what is considered intake

Answer 42

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

Question 43

what is considered output

Answer 43

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

Question 44

can I&O be delegated

Answer 44

yes -> collab w/ nursing assistant

Question 45

what is a key factor of I&Os

Answer 45

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

Question 46

what vein does tpn go into

Answer 46

central vein

Question 47

when would you have both a peg and a pej

Answer 47

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

Question 48

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

Answer 48

gastric reflux

Question 49

indications of EN

Answer 49

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

Question 50

benefits of EN vs PN

Answer 50

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

Question 51

how to initiate a tube feed

Answer 51

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

Question 52

signs of EN tube feed intolerance

Answer 52

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

Question 53

why do tube feedings cause diarrhea

Answer 53

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

Question 54

hyperosmolar dehydration

Answer 54

fail to give free water in tube feeding

Question 55

how to measure NG tube length

Answer 55

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

Question 56

how to confirm NG placement

Answer 56

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

Question 57

NG/NJ characterists

Answer 57

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

Question 58

PEG/PEJ indications

Answer 58

feeding >6 wk

Question 59

feeding tube assessment & monitoring

Answer 59

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

Question 60

how often should gastric residual be checked

Answer 60

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

Question 61

high gastric residuals indicate

Answer 61

delayed gastric emptying

Question 62

how much gastric residuals is too much

Answer 62

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

Question 63

administration of meds through feeding tube

Answer 63

-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