Nutrition (333E2) Flashcards
what are the 3 main functions of the GI system
transportation, digestion & absorption
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
factors influencing nutrition
appetite, negative experiences, disease & illness, medications, environmental factors (income, location, education), developmental needs, alternative food patterns (beliefs, religion, preference)
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
assessment of nutritional status
screening, anthropometry, lab & biochemical tests, diet & health hx, physical exam
risk for malnutrition
unintentional weight loss, presence of a modified diet for a long time, altered nutritional symptoms (n/v/d/c), decreased intake
lab & biochemical tests that relate to nutrition
-fluid balance
-liver and kidney function
-presence of disease
-common labs: total protein, albumin, pre albumin, hemoglobin
total protein
-combination of albumin & globulin constitute
-normal: 6.4-8.3 g/dL (UKHC 6.3-7.9)
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)
prealbumin
-preferred for acute conditions
-half life= 2 days
-normal: 15-36mg/dL (UKHC 20-41)
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)
implementation of health promotion for nutrition
-pt ed
-early identification of nutritional concerns
-assist w/ meal planning for needs
-education on food safety
diet selection
-amount needed
-ability to eat
-any alterations in their GI system
-any special considerations based on their health status
modified texture diets: mechanical soft
-smaller portions of soft food (blended, ground, pureed, or finely chopped)
-do not give raw fruits, vegetables, nuts, seeds
modified texture diets: pureed diet
pudding like, no chewing
modified texture diets: minced diet
food is 1/8th inch big, minced very small
modified texture diets: ground
like rice, anything that is 1/4th inch
modified texture diets: chopped
half inch size like a macaroni
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)
when would you use a clear liquid diet
-pre opt
-acute illness
-low residual
full liquid diet
-all juices
-milk
-coffee or tea
-sports drinks
-broth or soup
-sorbet or frozen yogurt
-**some policies include pudding, yogurt & grits
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)
normal serum sodium
135-145
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
nurses role in fluid restriction
-spacing out the milliliters allowed throughout the 24 hour period (needs to consider meals, meds, & sleep)
-Is&Os
-noncompliance
