Nutrition Flashcards
What is enteral nutrition?
Nutrition via tube
What is parenteral nutrition?
Nutrition via IV
When are people fed?
As soon as they have bowel sounds
Characteristics of carbohydrates
Main source of energy Readily broken down Simple sugars - honey, fruit milk Complex sugars - starch 50-60% of calories Glycogen is body's stored CHO
Characteristics of proteins
Polymers of amino acids
Essential for tissue growth, maintenance, repair
Collagen, enzymes, hormones, immune cells are made of protein
20% of calories
Characteristics of fats
Lipids
Provides insulation, protects vital organs, provides energy vitamin absorption and transport
25-30% of calories
Saturated fats - 5-6%
Thought to lead to higher LDL and atherosclerosis
- Trans fats - <1%
What factors affect nutrition?
Lifespan consideration
Cultural considerations
Intake
Ability to use digested nutrients
What are characteristics of a well-nourished person?
Normal weight and height Adequate appetite Active, alert Firm, healthy skin and mucous membranes Erect posture Well-developed muscles without excess body fat Healthy teeth and gums Normal excretion, sleep patterns, hemoglobin, hematocrit, and serum protein levels
What are signs of poor nutrition?
Cachectic (skeletal) appearance Flaccid muscle tone Weak muscles Subq fat loss Mental inattention Paresthesia - abnormal dermal sensation (tingling, prickling) with no apparent cause Anorexia Rapid heart rate Easily fatigued Dull, dry brittle hair; lips – dry and scaly; gums – spongy and bleed easily Tooth loss Eyes - pale conjunctiva
What is a clear liquid diet?
Transparent liquid - gelatin, clear juices, broth, bouillon, popsicles
1 ounce = 30 ml/cc
What is a full liquid diet?
Addition of smooth-textured dairy products, cream soups, custard, refined hot cereals, all juices, frozen yogurts, pureed vegetables
What is a soft pureed diet?
All of full liquid diet + scrambled eggs, pureed meats, vegetables and fruits; mashed potatoes and gravy
Where are soft pureed diets frequently seen?
Geriatric/nursing homes
What is a mechanical soft diet?
All of soft pureed diet plus finely diced meats, cheeses, potatoes, flaked fish, pancakes, rice, cooked and canned fruits and veggies
Small-bore feeding tube (NG)
Usually into stomach or duodenum (first part of small intestine)
Generally short term
Risk of aspiration
Percutaneous feeding tube
Feeding tube is surgically fed into stomach through abdomen (PEG) or jejunum (PEJ)
When is a PEJ used?
When there are stomach issues
What is TPN?
Total parenteral nutrition
Liquid food via IV
Good for people with Crohn’s disease because their bowel is inflamed
What is a Salem-sump tube?
A wide tube put in to decompress stomach and drain gastric fluid
Normally used when there’s decreased motility in GI tract
What is dysphagia?
Difficulty swallowing
What are the causes of dysphagia?
Myasthenia gravis, aging, stroke, multiple sclerosis, cancers, dementia
What are the complications of dysphagia?
Aspiration pneumonia, dehydration, decreased nutritional status and weight loss (malnutrition)
What are the warning signs of dysphagia?
Coughing or frequent clearing of throat during eating.
Change in voice after swallowing.
Abnormal movements of the mouth, tongue or lips.
Prolonged eating time
Oral pocketing.
Abnormal gag or delayed or absent trigger of swallowing.
Pharyngeal pooling.
How do you obtain a more in depth assessment for a dysphagic patient?
Referral to a speech pathologist
What are some dysphagia interventions?
Soft, smooth foods are better tolerated.
Sit patient upright (90 degrees)
Encourage patient to focus on act of swallowing. Be alert to signs of fatigue.
Place food in the strong side of the mouth.
Feed the patient slowly, allowing enough time to chew thoroughly and swallow. Provide rest periods
Encourage the patient to remain upright for 30 minutes following the meal.
Thicken liquids - added to liquids
Give emotional support
Percutaneous endoscopic gastronomy
Surgically inserted
Preferred for long-term feeding (comfortable and secure) OR pts with facial and neck tumors or surgery.
Percutaneous endoscopic jejunostomy
Tube is placed beyond the stomach into jejunum
Patients with gastroparesis, GERD, or a history of aspiration pneumonia.
Patients with decreased innervation to the stomach - gastroparesis that results in delayed gastric emptying OR esophageal reflux OR history of aspiration pneumonia
What is aspiration?
When something comes up from the stomach and down the trachea and ends up in respiratory tracts
How do you care for an enteral tube?
Check tube placement via x-ray before beginning feedings to prevent accidental aspiration
Can check pH of secretions on the tube (1-4 pH for gastric juice)
Maintain head of bed (HOB) minimum 30 degrees during feeding and 30 min after
Confirm bowel sounds are present/assess respiratory status
Dye should not be used
Use GRV to assess tolerance of enteral feedings
Flush with 30-60 cc warm water
How can you identify an intolerance to feeding?
High GRV Abdominal distention Nausea Cramping Vomiting
How to check the GRV?
Gather supplies
Connect syringe to end of feeding tube
Slowly and gently pull back to aspirate gastric contents and place into graduated cylinder
Repeat process until no further content can be aspirated
Note and document amount
Fat soluble vitamins
Vit A, Vit D, Vit K
Vitamin A
Vision
Vitamin D
Calcium
Vitamin K
Liver, prothrombin
Water soluble vitamins
Vit B2, Vit B3, Vit B12, Vit C
Vitamin B2
Protein and carb metabolism
Vitamin B3
Glycogen metabolism, tissue regeneration, fat synthesis
Vitamin B12
Formation of RBC
Vitamin C
Protection against infection
Minerals
Calcium Sodium Potassium Iodine Fluoride Water
Calcium
Conversion of prothrombin to thrombin
Sodium
Maintains fluid and acid-base balance
Potassium
Protein synthesis, fluid balance, muscle contraction
Iodine
Thyroid
Fluoride
Bone structure
Water
Normal cell function
Digestive tract
Mouth, pharynx, esophagus, stomach, small intestine, large intestine
Adduction
moving a joint or extremity toward the midline of the body
Abduction
moving a joint or extremity away from the midline of the body
Internal rotation
turning a joint or extremity on its axis toward the body’s midline
External rotation
turning a joint or extremity on its axis from the body’s midline
Supination
turning the body or a body part to face upward
Pronation
turning the body or a body part to face downward
Circumduction
moving a body part in widening circles
