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NUR202 > Nutrition > Flashcards

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

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2
Q

Complications of malnutrition?

A

Delayed wound healing, muscle atrophy, impaired immune function, infection, death

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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

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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

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5
Q

Advantages of Enteral Feeding?

A

Helps maintain normal GI function

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6
Q

Contraindications - Enteral Feeding?

A

Peritonitis, Intestinal obstruction , Intractable vomiting/diarrhea, Paralytic ileus, GI ischemia

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7
Q

Types of Enteral Feeding Tubes?

A

Oral Gastric Tube (OGT), Nasogastric Tube (NGT), Gastrostomy Tube, Percutaneous Endoscopic Gastrostomy Tube (PEG), Jejunostomy Tube

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8
Q

Types of Enteral Feeding?

A

Bolus, Intermittent, Continuous infusion, Cyclic feedings

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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

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10
Q

What tube is used for short-term nutritional support?

A

NGT

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11
Q

What tube is used for long-term nutritional support?

A

Gastrostomy & jejunostomy

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12
Q

What type of enteral feeding is more tolerated?

A

continuous

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13
Q

What type components of nutrition does enteral feed provide?

A

carbs, proteins, lipids, vitamins, minerals

fiber, free water

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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

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15
Q

Medications that can be given through enteral feeding?

A

liquid form, finely crushed & dissolved in liquid

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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

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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

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18
Q

First thing to think of before crushing meds for enteral tube?

A

can I crush the meds or not

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19
Q

Types of meds that cannot be crushed before given in enteral tube?

A

enteric coated or time-released

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20
Q

What to do before and after med administration of enteral tube?

A

flush tube with 30 mL water

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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

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22
Q

What to check for placing of enteral feeding tube?

A

pH lower than intestines (4), marking at nares, chest x-ray, residual

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23
Q

How often to check gastric residuals for enteral feeding?

A

every 4-6 hours

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24
Q

How high to keep HOB before enteral feeding?

A

more than 30 degrees

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25
Q

When introducing enteral feedings…

A

small volumes at start, increase volume as tolerated

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26
Q

What temp should enteral feedings be?

A

Room temp

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27
Q

How often to change enteral feed bag and tubing?

A

every 24 hours

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28
Q

What to assess and monitor while on enteral feeding?

A

abdominal assessment, daily weights, input and output, calorie counts, labs, tube related ulcer/infection, character/how many poops

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29
Q

What is parenteral nutrition?

A

nutrients provided via intravenous route

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30
Q

What is needed to give parenteral nutrition?

A

IV pump, micron filter

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31
Q

What type of solution can cause what complication?

A

high dextrose causes bacterial growth and infection risk

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32
Q

Why need parenteral nutrition?

A

for not working or not good enough GI function, can’t tolerate enteral nutrition

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33
Q

What state of patient to need parenteral nutrition?

A

undernourished, <50% metabolic needs met more than 7 days

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34
Q

Types of parenteral nutrition?

A

PPN and TPN

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35
Q

What is total parenteral nutrition for?

A

for higher caloric needs and therapy longer than 7 days

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36
Q

Where must TPN be administered?

A

central line

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37
Q

Where is PPN administered?

A

peripheral IV

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38
Q

Many of what are not compatible with parenteral nutrition formulas?

A

Medications

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39
Q

What meds can be added to parenteral nutrition solution?

A

Insulin, heparin, ranitidine

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40
Q

What type of solution is TPN?

A

hypertonic, >10% dextrose

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41
Q

What does TPN provide?

A

calories, glucose, nutrients, trace elements

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42
Q

Should TPN be stopped abruptly? Why?

A

NO - hypoglycemia

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43
Q

Why PPN?

A

for mild nutritional deficit (lower cal needs), very temporary

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44
Q

Type of solution of PPN?

A

(lower osmolality than TPN) Isotonic, no more than 10% dextrose, 5% amino acids

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45
Q

What is good about PPN?

A

Has less risks and complications

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46
Q

What is bad about PPN?

A

Need large peripheral veins and rotating sites, high risk phlebitis

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47
Q

Parenteral nutrition complications?

A

IV incompatibility, mechanical, thromboembolism (most common), infectious, metabolic

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48
Q

What are mechanical parenteral nutrition complications?

A

incorrect catheter placement, pneumothorax, hemothorax, hydrothorax

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49
Q

A thromboembolism complication of parenteral nutrition?

A

air embolism

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50
Q

Infectious complication of parenteral nutrition?

A

sepsis

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51
Q

Metabolic early complications of parenteral nutrition?

A

fluid volume overload, *refeeding syndrome, hyperglycemia or hypoglycemia

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52
Q

Metabolic late complications of parenteral nutrition?

A

fatty acid, mineral, and vitamin deficiencies. metabolic bone disease or demineralization, hepatic steatosis, gallbladder complications

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53
Q

Prevention of early metabolic complications of parenteral nutrition?

A

monitoring, adjust infusion rate, and composition of formula

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54
Q

Parenteral nutrition solution directions

A

Needs refrigerated and let sit for 1 hour before infuse. Will break down, if does call pharmacy for new

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55
Q

What to use when TPN is not available and why?

A

D10 to prevent hypoglycemia while waiting for solution

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56
Q

How to prevent infection during parenteral nutrition infusion?

A

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

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57
Q

How often change parenteral nutrition bag and tubing with filter?

A

q24hr

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58
Q

“cracking” of TPN solution

A

fats separate in solution and cannot give

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59
Q

What labs to monitor while on parenteral nutrition?

A

glucose, accuchecks, WBCs

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60
Q

What to monitor for pt receiving parenteral nutrition?

A

vital signs (fever), *daily weights, input and output, labs, IV site (infection), “cracking” of solution

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61
Q

Goal for daily weights on parenteral nutrition?

A

1 kg per day

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62
Q

When does refeeding syndrome happen?

A

when nutritional support given to severely malnourished pt

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63
Q

What does refeeding syndrome look like?

A

dehydration, electrolyte imbalance, hyperglycemia

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64
Q

Severe refeeding syndrome?

A

confusion, seizures, coma

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65
Q

What to do for refeeding syndrome?

A

find who’s high risk for it, fix electrolyte abnormals before starting nutrition, need careful monitoring (vitals, input and output, labs)

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66
Q

How should feed to prevent refeeding syndrome and dumping syndrome?

A

start feeding very slowly - continuous feeding

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67
Q

What is patho of dumping syndrome?

A

sudden influx of feeding into GI tract cause sudden shift in fluids (bc high osmotic gradient) to intestine

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68
Q

Symptoms of dumping syndrome?

A

increased HR, decreased BP, pale, sweating, weak, dizziness, abdominal distention, fullness, cramping, nausea vomiting, diarrhea

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69
Q

How does feeding cause dumping syndrome?

A

when feeding administered too quickly

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70
Q

How can prevent dumping syndrome?

A

continuous tube feeding

71
Q

What labs to help know nutritional status?

A

total serum protein, *albumin, *prealbumin, globulin, CBC, CMP

72
Q

What is total serum protein? What does it monitor?

A

combo of prealbumin, albumin, and globulins. related to determine osmotic pressure in vascular space

73
Q

What does albumin do?

A

helps to maintain colloidal osmotic pressure

74
Q

What is prealbumin and what does it do?

A

major plasma protein, sensitive to change in protein synthesis and metabolism.

75
Q

What is a strong marker for nutritional status?

A

**prealbumin

76
Q

What is globulin?

A

key building blocks of antibodies

77
Q

What labs are decreased in malnourished patients?

A

**albumin and globulin

78
Q

What does CBC monitor for nutrition state?

A

anemia

79
Q

What does CMP monitor for nutrition state?

A

electrolytes and mineral levels

80
Q

What does metabolic cart determine?

A

caloric requirements based on respiratory output, energy intake and needs for critically ill

81
Q

What does metabolic cart measure?

A

metabolism - helps guide nutritional support

82
Q

What is indirect calorimetry used to measure? (metabolic cart)

A

Resting Energy Expenditure – **by measuring O2 consumption and CO2 production (ex. vent patients)

83
Q

Why is metabolic cart useful?

A

helps to calculate to prevent overfeeding and underfeeding

84
Q

What nutrition problems happen in critically ill patient?

A

hyper-metabolism, increased muscle breakdown from liver protein synthesis, wounds and immune cells, increased gluconeogenesis (making glucose from non-glucose), lipolysis (fat breakdown)

85
Q

How early nutritional support to improve patient outcomes of critically ill?

A

within 24 hours admit

86
Q

What type of critically ill need high caloric needs? How much?

A

burn patients – 5000 kcal

87
Q

Patho of malnourished patient

A

decreased albumin from lack of amino acids for protein synthesis

88
Q

What do large blood transfusions do to critically ill patient?

A

decrease Ca levels from citrate added to blood for anticoagulation, binds to free calcium in pt blood

89
Q

Main reason for malnutrition affecting mechanically vented patients?

A

failure to wean from loss of respiratory muscle strength and mass

90
Q

Patho of malnutrition in vent patient

A

leads to weak muscles (diaphragm), to ineffective breathing, to fatigue, to inability to wean

91
Q

What can impact muscle function on vent patients? Monitor what?

A

electrolyte abnormals, K, Ca, Mg, Phosphorous

92
Q

What slows the weaning process on vent patients

A

malnutrition and anemia

93
Q

What type of vent patient at increased risk for malnutrition?

A

ARDS pt

94
Q

How to fix ARDS pt risk for malnutrition?

A

start enteral feeds or parenteral nutrition ASAP!

95
Q

Patho behind malnutrition of ARDS on mech vent?

A

decreased respiratory function and decreased immune response

96
Q

Complications on mech vent?

A

stress ulcers (systemic infection risk), paralytic ileus, infections (VAP, aspiration)

97
Q

Why paralytic ileus from mech vent? What will need?

A

changes in chest wall and abdominal cavity pressure – give short term parenteral nutrition

98
Q

What to do for VAP and aspiration risk of mech vent patient?

A

pulmonary toilet (oral hygiene, suctioning)

99
Q

What type of diet for COPD patient? Why?

A

decreased carbs because produces excess CO2 – give high fat, protein and nutritional supplements

100
Q

What happens if give excess carbs to COPD pt?

A

increases CO2 production – can’t exhale – to hypercarbic respiratory failure

101
Q

Patho of burn patient

A

metabolic stress and inflammatory response increases catabolism – capillary leak syndrome (leaks of fld, electrolytes, proteins to interstitial space)

102
Q

Expected labs of burn patient?

A

decreased – albumin, total protein

103
Q

What does decreased skin surface area of burn patient contribute to?

A

decreased activation of vitamin D

104
Q

Associated complications of burn patient?

A

Curling’s ulcer, *paralytic ileus

105
Q

Burn patient experiences what metabolic state?

A

hypermetabolism – needs high calorie needs – 5000 kcal per day

106
Q

Help tissue breakdown of burn patient

A

need high protein for wound healing – minimize tissue losses

107
Q

What nutrition needs for burn patient?

A

hydration, early enteral feedings, Vit A, Vit C, zinc

108
Q

What type of feeding route to use for burn patient? Start when?

A

Enteral (if gut works) – within 4 hours of fld resuscitation

109
Q

Role of vitamin A for burn patients?

A

Form and maintain healthy skin

110
Q

Role of vitamin C for burn patients?

A

grow and repair tissue, heal wounds, form scar tissue

111
Q

Role of zinc for burn patients?

A

cell division, growth, healing

112
Q

Why paralytic ileus in burn patients? When resolve?

A

vascular becomes dry, fld shifts to skin – 24 hours

113
Q

What will burn patient look like indicating need for nutritional support?

A

depressed, wasted

114
Q

Patho nutritional deficit for AKI?

A

increased rate of protein breakdown

115
Q

What type of diet for AKI patient?

A

increased protein needs, restore fld and electrolytes

116
Q

What diet restricts in AKI patient? and when?

A

potassium, phosphate, magnesium – oliguric phase

117
Q

What varies depending on stage of AKI patient?

A

K and Na

118
Q

What lab changes in CKD?

A

decreased calcium, RBCs, H/H, increased phosphorous

119
Q

What diet restrictions in CKD patient?

A

Na, K, Phos, Mg, and protein, and fluids

120
Q

What diet restriction depends on GFR for CKD patient?

A

protein

121
Q

What type of diet for CKD?

A

high carbs, decreased protein, flds restrict

122
Q

If CKD is having dialysis what to increase in diet? Why?

A

protein – loss during procedure

123
Q

What should be eaten with meals?

A

phosphate binders

124
Q

What supplements to give to CKD patient?

A

Iron, Calcium, Vitamin D

125
Q

What to monitor daily for CKD patients and why?

A

Daily weights for fld retention

126
Q

What type of liver complications need diet changes?

A

fatty liver, cirrhosis, hepatitis

127
Q

What labs decreased with liver problems? Causes what?

A

albumin – decrease serum colloid osmotic pressure – fluid shifts to ascites

128
Q

With decreased bile production in liver what does this cause?

A

decreased absorption fat-soluble vitamins (A,D,E,K)

129
Q

Lab changes with liver problems?

A

decreased total protein, albumin, prothrombin (cause increased PT, INR), calcium (half is bound to albumin)

130
Q

What type of diet and size of meals for liver problems?

A

low sodium (decreased fld shift–ascites), small frequent meals, vitamin supplements, high carbs, protein, moderate fats

131
Q

What vitamin supplements to give to liver problems?

A

thiamine, folate (water soluble), multivitamin

132
Q

How much protein if ammonia increase in liver problems? Why?

A

moderate protein, can turn into encephalopathy

133
Q

What type of diet for hepatic encephalopathy?

A

high protein

134
Q

What to monitor daily for complication of liver problems?

A

daily weights – ascites

135
Q

Give what medication to decrease ammonia levels?

A

lactulose

136
Q

What can pancreatitis do?

A

protein and fat malabsorption – weight loss, decreased muscle mass

137
Q

What route of feeding is preferred for pancreatitis? Why?

A

Enteral – prevent hyperglycemia

138
Q

What type of diet for pancreatitis?

A

increased calories, increased carbs and protein

139
Q

What diet restriction for pancreatitis? Why?

A

increased fat foods – diarrhea and steatorrhea

140
Q

What to monitor for pancreatitis?

A

blood glucose – hyperglycemia

141
Q

What lab results for pancreatitis? Why?

A

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
Q

What therapy to prevent malnutrition in pancreatitis?

A

Pancreatic enzyme replacement therapy – prevent malnutrition, malabsorption, excessive weight loss

143
Q

What does PERT for pancreatitis contain?

A

amylase, lipase, protease

144
Q

What diet initially for pancreatitis?

A

NPO, then clear liquids–increase as tolerated

145
Q

What to do if >24-48 hrs NPO for pancreatitis?

A

start jejunal feed –if gut is working

146
Q

What to include to increase caloric intake of pancreatitis?

A

liquid supplements

147
Q

What to avoid with pancreatitis?

A

ETOH and stimulants (caffeine)

148
Q

What diet if tolerating PO for pancreatitis?

A

small frequent meals, moderate to high carbs, high protein, low fat, bland-little spice, no GI stimulants or ETOH

149
Q

Patho for anemia?

A

decreased RBCs. decreased O2 carrying capacity

150
Q

What nutrients affect RBC production?

A

Iron, folate, B12, Vit E, B6, Vit C

151
Q

What deficiency can also contribute to anemia?

A

protein-energy malnutrition

152
Q

What labs to monitor for anemia?

A

H/H, RBC, serum iron, ferritin, transferrin, total iron binding capacity

153
Q

What key nutrition fact to correct anemia?

A

Identify cause and correct

154
Q

What type of diet for anemia?

A

rich in nutrients, vitamin supplements

155
Q

How does Vit C help with anemia?

A

aids with iron absorption

156
Q

Sources of potassium?

A

fruits, veggies, beans, dairy (avocado, bananas, watermelon, oranges, dried nuts, tomato, potato, squashes, salt substitutes)

157
Q

Sources of phosphorous?

A

whole grains, nuts, seeds, beans, dairy, chocolate, (oatmeal, peanut butter, bran)

158
Q

Sources of sodium?

A

salt, processed foods (meats, cheeses)

159
Q

Sources of calcium?

A

dairy, broccoli, kale, grains, egg yolks

160
Q

Sources of magnesium?

A

green leafy vegetables, nuts, fortified grains, meat, milk

161
Q

Sources of protein?

A

meats, poultry, fish, eggs, dairy, nuts, seeds, beans

162
Q

Sources of iron?

A

red meat, organ meat, egg yolks, kidney beans, leafy green vegetables, raisins

163
Q

Sources of zinc?

A

beef, pork, lamb, nuts, whole grains, legumes, yeast

164
Q

What are water soluble vitamins?

A

Vit C, E

165
Q

What are fat soluble vitamins?

A

Vit A, D, E, K

166
Q

Sources of B1 (thiamine)?

A

fortified grains, wheat germ, beef, liver, pork, eggs, legumes, nuts

167
Q

Sources of B6 (pyridine)?

A

grains, fortified cereals, starchy vegetables, fruit (no citrus), liver, fish, meats (beef, poultry, liver, organ meats), eggs

168
Q

Sources of B12 (cyanocobalamin)?

A

animal proteins (meat and fish), eggs, dairy products

169
Q

Sources of folic acid (folate)?

A

green leafy veggies, liver, yeast, dried beans, nuts

170
Q

Sources of Vit A?

A

meat, fish, poultry, eggs, dairy, orange and yellow veggies and fruit, broccoli, spinach, dark leafy greens

171
Q

Sources of Vit C?

A

citrus fruits and juices, strawberries and dark colored berries, melons, peppers, green veggies, tomatoes, tomato juice

172
Q

Sources of Vit D?

A

fortified milk, cod liver oil, eggs

173
Q

Sources of Vit E?

A

vegetable oils, nuts

174
Q

Sources of Vit K?

A

green leafy veggies, broccoli, Brussel sprouts, cabbage, cauliflower, soybean, fish, liver, meat, eggs, cereals

NUR202 (8 decks)

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