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A & E Final > Nutrition and Dysphagia > Flashcards

Nutrition and Dysphagia Flashcards

1
Q

dysphagia could be due to what of three places

A
  1. oral
  2. pharyngneal
  3. esophageal
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2
Q

common causes of dysphagia
give examples of each thing
3 main points

A
  • neuromuscular disorder- like ALS, parkinson and dementia
  • anatomical- radiation or cancer of head and neck, injury or surgeries, medications can slow down the swallowing like opiates
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3
Q

some people with dementia advance stages will do what

2 things

A
  • forget to eat

- cant swallow food or water

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4
Q

clinical manifestations of dysphagia
7 things
what will happen to the person
what will they refuse to do? 2 things

A
  • hard to swallow
  • hard to control food in the mouth
  • hard to control slavia in the mouth- drooling or dribbling
  • chocking or coughing when eating or drinking
  • inc nasal or oral congestion or secretions after a meal
  • weak voice during eating an meal- wet, gurling or hoarse voice
  • retention or pocketing of food in the mouth
  • wont take a large bite of food
  • refusal to open mouth or accept a large
  • weight loss
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5
Q

pt with inc risk of aspiration

4

A
  • decreased loss of consciousness
  • confusion
  • uncooperative or agitated
  • absent or no gag reflex
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6
Q

feeding stroke pt 2 points to remember

A

inspect mouth for food

put food on the strong side

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7
Q

pt care for people with dysphagia

5

A
  • screen
  • vital signs
  • monitor intake and output
  • suction equipment at the bedside for secretions
  • collaborative effort- use speech therapist etc
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8
Q

preventing aspiration in older adults

A

screening tool that access dysphagia

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9
Q

dysphasia can lead to what 2 things

A

aspiration and pnemoniona

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10
Q

pnemonia in an older adult 3 things

A
  • confusion
  • delirium
  • fall
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11
Q

pnemonia in younger person 2 symptoms

A

tachypnea, coughing,

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12
Q

when someone is on a ventilator what kind of medications do we give them
and why?

A
  • meds to decrease mobility we dont want them to even have the urge to get up and move to protect them from wanting to get up
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13
Q

preventing aspiration

7

A
  • 30 degree bed and even higher is better, sometimes when someone had head and neck injury they wont be able to be at that high
  • give them a 30 min rest period prior to feeding
  • chin down or chin tucked position- not feasible for everyone but it closes off the airway, the layrnx all the contants go into the esophagus not the airway
  • adjust rate of feeding and size of bites to the person’s tolerance and alternate solid and liquid
  • if left side paralysis give them food on the right side
  • determine the food viscosity that can be tolerated
  • add thickening agents to the person’s drinks
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14
Q

three types of thickeners

what could using thickeners lead to?

A
  1. necter
  2. honey
  3. pudding

these might have liquid intake low bc pt find this hard to drink

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15
Q

what kind of issues require there to be a tube feeding

-9 things

A
  • orofacial fractures
  • head/neck cancer
  • burns
  • nutritional deficiencies
  • neurological conditions like AD, stroke, ALS
  • psychiatric conditions like anorexia
  • chemotherapy
  • radiation therapy
    coma
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16
Q

tube feedings are also called what
what is tube feeding
what three locations can they be put in?

A

external nutrition

  • administration of nutritionally balanced liquid food or formula through a tube that could have placed in one of three locations
    1. stomach
    2. duodenum
    3. jejunum
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17
Q

G- tube

A

goes into the stomach

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18
Q

J tube

A

goes into the small intestine either the duodenum or the jejunum

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19
Q

why would someone have a J- tube

4 reasons

A

the is more expensive

  • high risk for gastric reflex which could lead to aspiration
  • stomach issues like obstruction
  • pancreas issue - don’t want the hormones to be released bc you kinda wanna rest the pancreas
  • ascites you can not go in the stomach or the small intestine
20
Q

pH testing

A

in stomach will be under 5
in the lungs above 6
in the small intestine is above 6

21
Q

Nasogastric tube

A
  • short term use
  • through the nose, ask them to swallow water to help you get the tube down the correct tube
  • speaking after is good sign that the procedure was done correctly
22
Q

what is the best way to assess placement of the tubes

A

X- ray

23
Q

length of the

A

tip of the nose, earlobe to the xphoid process

24
Q

repositioning and tube feedings

A
  • should never be done together could because could aspirate
    15 min wait period
25
Q

tube feeding complications

A
  • pulmonary aspiration
  • vomiting
  • diarrhea or constipation
  • tube occlusion or displacement
  • electrolyte imbalance or dehydration
26
Q

checking the placement of the NGT

A

syringe test
X- ray
pH

27
Q

syringe test

A

whoosh test checks the placement of the tube by using a stethoscope by listening to the whooshing sound when you put in some air but the sound of the air is still the same as it would be if the tube was in the lungs

28
Q

practice pearls

A

oral care
check residual volume
head of bed at least at 30
calorie count

29
Q

percutaneous endoscopic gastrostomy

A

PEG
-gastrostomy tube placement via persuatneous endoscopy
- put an endoscope through the mouth doen to the stomach
insert a needle through the skin into the stomach and that will be a tube
in order to have the bumper inside they will pull the tube you put through the skin all the way up and attach a bumped and pull it back down and then attach another bumper on the outside part

30
Q

some compilations of a G-Tube

A
  • Gastric juices leak into he skin and cause breakdown

- Don’t wanna use cut your own gauze bc you might have loose fibers into the stomach

31
Q

PEG tube feeding basics

A
  • feedings can be started when bowl sounds are present -usually takes 24 hours
  • tube is marked at the skin insertion site
  • insertion length should be checked regularly
  • measure it!
32
Q

When will we not use an endoscope

A

when the PT has clotting issues so they will open up the person

33
Q

what might the PT get before the procedures

A

Anti-botics

mild anesthesia

34
Q

goals for the PEG

A
  • tolerance of the formula prescribed
  • min risk for dysphagia and aspiration
  • weight gain which is what you want
  • no infections
  • oral care
  • maintain skin integrity
  • avoid complications from feeding
35
Q

diabetes and PEG tube

K

A
  • you are giving alot of calories and they might be getting hyperglycemic
  • if they arent tolerating the formula they may become hypoglycemic
  • bc they are getting pumped with so much stuff they will be HYPO K
36
Q

how should you maintain the tube patency

A

irrigated with water before and after each feeding, drug admin, residual checks

37
Q

patient position with tubes

A
  • head of the bed should remain elevated

- espically for the 30- 60 mins after intermittent feedings

38
Q

nursing interventions for tube feedings

6

A
  • have pt talk about how they feel
  • conserve the PT energy
  • follow instruction protocol and monitoring
  • oral care
  • check gastric residual volume
    inspect insertion site
39
Q

TPN

  • through which line?
  • what does it have?
  • osmolaity?
  • short or long term?
A

-total parenteral nutrition
-this will be in the central line ends in the superior vena cava
-hypertonic solution
-has proteins, dextrose, AA, vitamines, electrolytes
long term

40
Q

PPN

  • how is it given?
  • short or long?
  • what kind of person gets this?
  • concentration?
A
  • peripheral parenteral nutrition
  • short term
  • peripheral vein used
  • person can have some oral feedings but cannot ingest enough of the food as needed
  • will not be as hypertonic wil have to be low concentration
41
Q

can someone with a G-tube eat?

A

yes they can eat

42
Q

where are alot of the vitamins absorbed?

A
  • in the small intestine
43
Q

parenteral nutrition

  • who prepare it?
  • how long is it good for?
  • special thing to do with it?
A
  • prepared by the pharmacist or trained technician under strict aseptic technique
  • nothing is added or anything to the formula
  • solutions are good for 24 hours
  • must be refrigerated until 30 mins before use
  • labled
44
Q

common indications for PN

6 occurrences

A
  • chronic diarrhea
  • chronic vomiting
  • complicated surgery or trauma
  • malnutrition
  • GI obstruction
  • gastrointestinal tract anomalies and fistulae
45
Q

PN

8 complications

A
  • CLASBSI- central line associated bloodstream infection
  • metabolic problems
  • mechanical problems- infiltration, embolis, excoration
  • dislodgment
  • thrombosis
  • phlebitis
46
Q

nursing diagnosis for feeding tubes

7

A
  • social isolation
  • imbalanced nurtion
  • impaired oral care
  • diarhhea
  • knowledge def
  • impaired swallowing
  • risk for infection

A & E Final (3 decks)

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