Nutrition Flashcards
Enteral, Parenteral, TPN, PPN, Refeeding Syndrome, Dumping Syndrome, Lab Values, Metabolic Cart, (Vent, COPD, Burns, Critically Ill, Renal, Liver, Pancreatitis, Anemia), and Nutrient Sources
1
Q
Indications for nutritional supplementation?
A
Severe *infections, *malnutrition, *bowel rest, *burns/trauma, *CNS/neuromuscular impairment, advanced/premature *age, *chemotherapy, impaired *chew/swallow, *critically ill
2
Q
Complications of malnutrition?
A
Delayed wound healing, muscle atrophy, impaired immune function, infection, death
3
Q
Factors to consider for nutritional support?
A
Primary dx, swallow ability, NPO STATUS GREATER THAN 3 DAYS, Pt prognosis, Nutrition therapy duration, Convenience/cost
4
Q
Important tips for Enteral Feeding?
A
GI TRACT MUST WORK, START W/IN 24-48 HRS, Given to VENT WITH WORKING GI TRACT
5
Q
Advantages of Enteral Feeding?
A
Helps maintain normal GI function
6
Q
Contraindications - Enteral Feeding?
A
Peritonitis, Intestinal obstruction , Intractable vomiting/diarrhea, Paralytic ileus, GI ischemia
7
Q
Types of Enteral Feeding Tubes?
A
Oral Gastric Tube (OGT), Nasogastric Tube (NGT), Gastrostomy Tube, Percutaneous Endoscopic Gastrostomy Tube (PEG), Jejunostomy Tube
8
Q
Types of Enteral Feeding?
A
Bolus, Intermittent, Continuous infusion, Cyclic feedings
9
Q
Why continuous feeding used?
A
Critically ill have decreased residual volumes and helps decrease aspiration risk and diarrhea, *helps to avoid dumping syndrome, *helps wean to normal food
10
Q
What tube is used for short-term nutritional support?
A
NGT
11
Q
What tube is used for long-term nutritional support?
A
Gastrostomy & jejunostomy
12
Q
What type of enteral feeding is more tolerated?
A
continuous
13
Q
What type components of nutrition does enteral feed provide?
A
carbs, proteins, lipids, vitamins, minerals
fiber, free water
14
Q
What are complications of enteral feedings?
A
aspiration, N/V, refeeding syndrome, pressure ulcer at nares/esophagus, dumping syndrome, hyperglycemia, electrolyte imbalance, overhydration, localized infection, sepsis, food poisoning
tube dislodgment/migration
15
Q
Medications that can be given through enteral feeding?
A
liquid form, finely crushed & dissolved in liquid
16
Q
What to be aware of with med admin with enteral feedings? and why
A
Med incompatibilities bc can clog tube
Can bind with feeding formula and affect absorption of meds making less effective
17
Q
What to do with meds that can bind with tube feeding?
A
hold feeding before and after admin of med to lessen interaction between med and formula
18
Q
First thing to think of before crushing meds for enteral tube?
A
can I crush the meds or not
19
Q
Types of meds that cannot be crushed before given in enteral tube?
A
enteric coated or time-released
20
Q
What to do before and after med administration of enteral tube?
A
flush tube with 30 mL water
21
Q
Circumstances to interrupt and pause enteral feeding?
A
Dx tests/procedures/treatments needing NPO status, Med admin, PT/OT, Transport off unit, GI intolerance
22
Q
What to check for placing of enteral feeding tube?
A
pH lower than intestines (4), marking at nares, chest x-ray, residual
23
Q
How often to check gastric residuals for enteral feeding?
A
every 4-6 hours
24
Q
How high to keep HOB before enteral feeding?
A
more than 30 degrees
25
When introducing enteral feedings...
small volumes at start, increase volume as tolerated
26
What temp should enteral feedings be?
Room temp
27
How often to change enteral feed bag and tubing?
every 24 hours
28
What to assess and monitor while on enteral feeding?
abdominal assessment, daily weights, input and output, calorie counts, labs, tube related ulcer/infection, character/how many poops
29
What is parenteral nutrition?
nutrients provided via intravenous route
30
What is needed to give parenteral nutrition?
IV pump, micron filter
31
What type of solution can cause what complication?
high dextrose causes bacterial growth and infection risk
32
Why need parenteral nutrition?
for not working or not good enough GI function, can't tolerate enteral nutrition
33
What state of patient to need parenteral nutrition?
undernourished, <50% metabolic needs met more than 7 days
34
Types of parenteral nutrition?
PPN and TPN
35
What is total parenteral nutrition for?
for higher caloric needs and therapy longer than 7 days
36
Where must TPN be administered?
central line
37
Where is PPN administered?
peripheral IV
38
Many of what are not compatible with parenteral nutrition formulas?
Medications
39
What meds can be added to parenteral nutrition solution?
Insulin, heparin, ranitidine
40
What type of solution is TPN?
hypertonic, >10% dextrose
41
What does TPN provide?
calories, glucose, nutrients, trace elements
42
Should TPN be stopped abruptly? Why?
NO - hypoglycemia
43
Why PPN?
for mild nutritional deficit (lower cal needs), very temporary
44
Type of solution of PPN?
(lower osmolality than TPN) Isotonic, no more than 10% dextrose, 5% amino acids
45
What is good about PPN?
Has less risks and complications
46
What is bad about PPN?
Need large peripheral veins and rotating sites, high risk phlebitis
47
Parenteral nutrition complications?
IV incompatibility, mechanical, thromboembolism (most common), infectious, metabolic
48
What are mechanical parenteral nutrition complications?
incorrect catheter placement, pneumothorax, hemothorax, hydrothorax
49
A thromboembolism complication of parenteral nutrition?
air embolism
50
Infectious complication of parenteral nutrition?
sepsis
51
Metabolic early complications of parenteral nutrition?
fluid volume overload, *refeeding syndrome, hyperglycemia or hypoglycemia
52
Metabolic late complications of parenteral nutrition?
fatty acid, mineral, and vitamin deficiencies. metabolic bone disease or demineralization, hepatic steatosis, gallbladder complications
53
Prevention of early metabolic complications of parenteral nutrition?
monitoring, adjust infusion rate, and composition of formula
54
Parenteral nutrition solution directions
Needs refrigerated and let sit for 1 hour before infuse. Will break down, if does call pharmacy for new
55
What to use when TPN is not available and why?
D10 to prevent hypoglycemia while waiting for solution
56
How to prevent infection during parenteral nutrition infusion?
strict asepsis with IV tubing and dressing changes, wear mask and gloves during dressing change, antimicrobial solution around dressing, sterile sponge over catheter, use occlusive waterproof dressing, keep line only for TPN
57
How often change parenteral nutrition bag and tubing with filter?
q24hr
58
"cracking" of TPN solution
fats separate in solution and cannot give
59
What labs to monitor while on parenteral nutrition?
glucose, accuchecks, WBCs
60
What to monitor for pt receiving parenteral nutrition?
vital signs (fever), *daily weights, input and output, labs, IV site (infection), "cracking" of solution
61
Goal for daily weights on parenteral nutrition?
1 kg per day
62
When does refeeding syndrome happen?
when nutritional support given to severely malnourished pt
63
What does refeeding syndrome look like?
dehydration, electrolyte imbalance, hyperglycemia
64
Severe refeeding syndrome?
confusion, seizures, coma
65
What to do for refeeding syndrome?
find who's high risk for it, fix electrolyte abnormals before starting nutrition, need careful monitoring (vitals, input and output, labs)
66
How should feed to prevent refeeding syndrome and dumping syndrome?
start feeding very slowly - continuous feeding
67
What is patho of dumping syndrome?
sudden influx of feeding into GI tract cause sudden shift in fluids (bc high osmotic gradient) to intestine
68
Symptoms of dumping syndrome?
increased HR, decreased BP, pale, sweating, weak, dizziness, abdominal distention, fullness, cramping, nausea vomiting, diarrhea
69
How does feeding cause dumping syndrome?
when feeding administered too quickly
70
How can prevent dumping syndrome?
continuous tube feeding
71
What labs to help know nutritional status?
total serum protein, *albumin, *prealbumin, globulin, CBC, CMP
72
What is total serum protein? What does it monitor?
combo of prealbumin, albumin, and globulins. related to determine osmotic pressure in vascular space
73
What does albumin do?
helps to maintain colloidal osmotic pressure
74
What is prealbumin and what does it do?
major plasma protein, sensitive to change in protein synthesis and metabolism.
75
What is a strong marker for nutritional status?
**prealbumin
76
What is globulin?
key building blocks of antibodies
77
What labs are decreased in malnourished patients?
**albumin and globulin
78
What does CBC monitor for nutrition state?
anemia
79
What does CMP monitor for nutrition state?
electrolytes and mineral levels
80
What does metabolic cart determine?
caloric requirements based on respiratory output, energy intake and needs for critically ill
81
What does metabolic cart measure?
metabolism - helps guide nutritional support
82
What is indirect calorimetry used to measure? (metabolic cart)
Resting Energy Expenditure -- **by measuring O2 consumption and CO2 production (ex. vent patients)
83
Why is metabolic cart useful?
helps to calculate to prevent overfeeding and underfeeding
84
What nutrition problems happen in critically ill patient?
hyper-metabolism, increased muscle breakdown from liver protein synthesis, wounds and immune cells, increased gluconeogenesis (making glucose from non-glucose), lipolysis (fat breakdown)
85
How early nutritional support to improve patient outcomes of critically ill?
within 24 hours admit
86
What type of critically ill need high caloric needs? How much?
burn patients -- 5000 kcal
87
Patho of malnourished patient
decreased albumin from lack of amino acids for protein synthesis
88
What do large blood transfusions do to critically ill patient?
decrease Ca levels from citrate added to blood for anticoagulation, binds to free calcium in pt blood
89
Main reason for malnutrition affecting mechanically vented patients?
failure to wean from loss of respiratory muscle strength and mass
90
Patho of malnutrition in vent patient
leads to weak muscles (diaphragm), to ineffective breathing, to fatigue, to inability to wean
91
What can impact muscle function on vent patients? Monitor what?
electrolyte abnormals, K, Ca, Mg, Phosphorous
92
What slows the weaning process on vent patients
malnutrition and anemia
93
What type of vent patient at increased risk for malnutrition?
ARDS pt
94
How to fix ARDS pt risk for malnutrition?
start enteral feeds or parenteral nutrition ASAP!
95
Patho behind malnutrition of ARDS on mech vent?
decreased respiratory function and decreased immune response
96
Complications on mech vent?
stress ulcers (systemic infection risk), paralytic ileus, infections (VAP, aspiration)
97
Why paralytic ileus from mech vent? What will need?
changes in chest wall and abdominal cavity pressure -- give short term parenteral nutrition
98
What to do for VAP and aspiration risk of mech vent patient?
pulmonary toilet (oral hygiene, suctioning)
99
What type of diet for COPD patient? Why?
decreased carbs because produces excess CO2 -- give high fat, protein and nutritional supplements
100
What happens if give excess carbs to COPD pt?
increases CO2 production -- can't exhale -- to hypercarbic respiratory failure
101
Patho of burn patient
metabolic stress and inflammatory response increases catabolism -- capillary leak syndrome (leaks of fld, electrolytes, proteins to interstitial space)
102
Expected labs of burn patient?
decreased -- albumin, total protein
103
What does decreased skin surface area of burn patient contribute to?
decreased activation of vitamin D
104
Associated complications of burn patient?
Curling's ulcer, *paralytic ileus
105
Burn patient experiences what metabolic state?
hypermetabolism -- needs high calorie needs -- 5000 kcal per day
106
Help tissue breakdown of burn patient
need high protein for wound healing -- minimize tissue losses
107
What nutrition needs for burn patient?
hydration, early enteral feedings, Vit A, Vit C, zinc
108
What type of feeding route to use for burn patient? Start when?
Enteral (if gut works) -- within 4 hours of fld resuscitation
109
Role of vitamin A for burn patients?
Form and maintain healthy skin
110
Role of vitamin C for burn patients?
grow and repair tissue, heal wounds, form scar tissue
111
Role of zinc for burn patients?
cell division, growth, healing
112
Why paralytic ileus in burn patients? When resolve?
vascular becomes dry, fld shifts to skin -- 24 hours
113
What will burn patient look like indicating need for nutritional support?
depressed, wasted
114
Patho nutritional deficit for AKI?
increased rate of protein breakdown
115
What type of diet for AKI patient?
increased protein needs, restore fld and electrolytes
116
What diet restricts in AKI patient? and when?
potassium, phosphate, magnesium -- oliguric phase
117
What varies depending on stage of AKI patient?
K and Na
118
What lab changes in CKD?
decreased calcium, RBCs, H/H, increased phosphorous
119
What diet restrictions in CKD patient?
Na, K, Phos, Mg, and protein, and fluids
120
What diet restriction depends on GFR for CKD patient?
protein
121
What type of diet for CKD?
high carbs, decreased protein, flds restrict
122
If CKD is having dialysis what to increase in diet? Why?
protein -- loss during procedure
123
What should be eaten with meals?
phosphate binders
124
What supplements to give to CKD patient?
Iron, Calcium, Vitamin D
125
What to monitor daily for CKD patients and why?
Daily weights for fld retention
126
What type of liver complications need diet changes?
fatty liver, cirrhosis, hepatitis
127
What labs decreased with liver problems? Causes what?
albumin -- decrease serum colloid osmotic pressure -- fluid shifts to ascites
128
With decreased bile production in liver what does this cause?
decreased absorption fat-soluble vitamins (A,D,E,K)
129
Lab changes with liver problems?
decreased total protein, albumin, prothrombin (cause increased PT, INR), calcium (half is bound to albumin)
130
What type of diet and size of meals for liver problems?
low sodium (decreased fld shift--ascites), small frequent meals, vitamin supplements, high carbs, protein, moderate fats
131
What vitamin supplements to give to liver problems?
thiamine, folate (water soluble), multivitamin
132
How much protein if ammonia increase in liver problems? Why?
moderate protein, can turn into encephalopathy
133
What type of diet for hepatic encephalopathy?
high protein
134
What to monitor daily for complication of liver problems?
daily weights -- ascites
135
Give what medication to decrease ammonia levels?
lactulose
136
What can pancreatitis do?
protein and fat malabsorption -- weight loss, decreased muscle mass
137
What route of feeding is preferred for pancreatitis? Why?
Enteral -- prevent hyperglycemia
138
What type of diet for pancreatitis?
increased calories, increased carbs and protein
139
What diet restriction for pancreatitis? Why?
increased fat foods -- diarrhea and steatorrhea
140
What to monitor for pancreatitis?
blood glucose -- hyperglycemia
141
What lab results for pancreatitis? Why?
decreased calcium and magnesium (fatty acids combine with Ca-- fat necrosis), increased glucose (injury pancreatic cells--impaired carb metabolism--decrease insulin release), decreased albumin (cytokine release of inflammatory response and binding to Ca)
142
What therapy to prevent malnutrition in pancreatitis?
Pancreatic enzyme replacement therapy -- prevent malnutrition, malabsorption, excessive weight loss
143
What does PERT for pancreatitis contain?
amylase, lipase, protease
144
What diet initially for pancreatitis?
NPO, then clear liquids--increase as tolerated
145
What to do if >24-48 hrs NPO for pancreatitis?
start jejunal feed --if gut is working
146
What to include to increase caloric intake of pancreatitis?
liquid supplements
147
What to avoid with pancreatitis?
ETOH and stimulants (caffeine)
148
What diet if tolerating PO for pancreatitis?
small frequent meals, moderate to high carbs, high protein, low fat, bland-little spice, no GI stimulants or ETOH
149
Patho for anemia?
decreased RBCs. decreased O2 carrying capacity
150
What nutrients affect RBC production?
Iron, folate, B12, Vit E, B6, Vit C
151
What deficiency can also contribute to anemia?
protein-energy malnutrition
152
What labs to monitor for anemia?
H/H, RBC, serum iron, ferritin, transferrin, total iron binding capacity
153
What key nutrition fact to correct anemia?
Identify cause and correct
154
What type of diet for anemia?
rich in nutrients, vitamin supplements
155
How does Vit C help with anemia?
aids with iron absorption
156
Sources of potassium?
fruits, veggies, beans, dairy (avocado, bananas, watermelon, oranges, dried nuts, tomato, potato, squashes, salt substitutes)
157
Sources of phosphorous?
whole grains, nuts, seeds, beans, dairy, chocolate, (oatmeal, peanut butter, bran)
158
Sources of sodium?
salt, processed foods (meats, cheeses)
159
Sources of calcium?
dairy, broccoli, kale, grains, egg yolks
160
Sources of magnesium?
green leafy vegetables, nuts, fortified grains, meat, milk
161
Sources of protein?
meats, poultry, fish, eggs, dairy, nuts, seeds, beans
162
Sources of iron?
red meat, organ meat, egg yolks, kidney beans, leafy green vegetables, raisins
163
Sources of zinc?
beef, pork, lamb, nuts, whole grains, legumes, yeast
164
What are water soluble vitamins?
Vit C, E
165
What are fat soluble vitamins?
Vit A, D, E, K
166
Sources of B1 (thiamine)?
fortified grains, wheat germ, beef, liver, pork, eggs, legumes, nuts
167
Sources of B6 (pyridine)?
grains, fortified cereals, starchy vegetables, fruit (no citrus), liver, fish, meats (beef, poultry, liver, organ meats), eggs
168
Sources of B12 (cyanocobalamin)?
animal proteins (meat and fish), eggs, dairy products
169
Sources of folic acid (folate)?
green leafy veggies, liver, yeast, dried beans, nuts
170
Sources of Vit A?
meat, fish, poultry, eggs, dairy, orange and yellow veggies and fruit, broccoli, spinach, dark leafy greens
171
Sources of Vit C?
citrus fruits and juices, strawberries and dark colored berries, melons, peppers, green veggies, tomatoes, tomato juice
172
Sources of Vit D?
fortified milk, cod liver oil, eggs
173
Sources of Vit E?
vegetable oils, nuts
174
Sources of Vit K?
green leafy veggies, broccoli, Brussel sprouts, cabbage, cauliflower, soybean, fish, liver, meat, eggs, cereals
