Nutrition and Obesity Flashcards

1
Q

under or over nutrition

A

malnutrition

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2
Q

causes of malnutrition

A
  • lower socioeconomic status
  • illness (physical or psychological)
  • impaired swallowing
  • impaired GI absorption
  • inadequate diet
  • drug-nutrient interactions
  • drug and alcohol use
  • older adults
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3
Q

describe risk of malnutrition in older adults

A

higher risk for malnutrition and less able to regain weight after it occurs

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4
Q

clinical manifestations of malnutrition

A
  • dry skin, hair, and nails and hair loss
  • delayed wound healing
  • weakness and decreased muscle mass
  • prominence of bony structures
  • amenorrhea
  • increased risk of infeciton
  • confusion and irritability
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5
Q

diagnostic tests for malnutrition

A
  • diet Hx
  • albumin (lags 2 weeks behind malnutrition)
  • prealbumin (more up to date -> 2 day half life)
  • transferrin (protein that carries iron -> decreases w/ lack of protein)
  • RBC, Hgb and Hct (decreased if lack of iron and folic acid)
  • liver enzymes (liver damage due to malnutrition)
  • anthropometric measurements (thickness of skin folds to measure fat) and BMI
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6
Q

BMI levels

A
  • <18.5 is underweight
  • 18.5-24.9 is normal
  • 25-29.9 is overweight
  • > 30 is obese
  • > 40 is morbidly obese
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7
Q

nursing management of malnutrition

A
  • multiple small high calorie/high protein meals
  • registered dietitian (RD) referral
  • daily weights
  • diet diary for several days
  • dietary supplement (Ensure or Boost) between meals -> don’t replace meals
  • appetite enhancers
  • Tube feeding and TPN
  • understand what is preventing older adults from getting nutrition
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8
Q

examples of appetite enhancers

A
  • Megaestrol acetate (Megace)

- Dronabinol (Marinol)

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9
Q

nutritional support for functional GI tract

A

tube feedings -> enteral

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10
Q

types of enteral tube feedings

A
  • long term: G-tube or J-tube (surgically placed)
  • short term: NG, nasoduodenal, or nasojejunal tube
  • intermittent (stable)
  • continuous (critical care)
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11
Q

nutritional support for nonfunctional GI tract

A

TPN (parenteral)

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12
Q

reasons to use TPN

A
  • “bowel rest”
  • bowel obstruction
  • acute pancreatitis
  • intractable vomiting
  • short-bowel syndrome
  • malabsorption
  • severe anorexia nervosa
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13
Q

reasons to need enteral tube feedings with functional GI tract

A
  • inability to eat or take in enough nutrients
  • anorexia nervosa
  • head or neck cancer
  • facial fractures
  • ALS
  • chemo/radiation
  • burn patient
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14
Q

most important precaution for tube feedings

A

aspiration precautions

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15
Q

tube feeding procedures

A
  • increase HOB during and for 1 hour after feeding (at least 30 degrees)
  • tube patency and position
  • residual volumes (orders based on amount pulled back -> wether to continue feeds or not)
  • water flushes before and after feeding and meds
  • correct formula (given at room temp)
  • increased gradually first 24-48 hours (prevent diarrhea)
  • bag and tubing change (every 24 hours)
  • assess bowel sounds before feedings
  • use liquid meds rather than pills -> if use pills, dissolve well
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16
Q

T/F: you want to put the residual volumes pulled out of a tube feeding back into the patient

A

True

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17
Q

how much of the feedings should you put in a tube feeding bag a time

A

no more than 8 hours worth -> prevent bacteria growth

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18
Q

what is included in total parenteral nutrition (TPN)

A
  • hypertonic solution
  • calories (dextrose and fat)
  • amino acids (protein)
  • fat emulsion (lipids)
  • minerals, electrolytes, and trace elements
  • vitamins
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19
Q

what type of line is TPN given in

A
  • usually central line or PICC line

- can be difficult on peripheral veins

20
Q

what are patients getting TPN at increased risk for

A

infection due to central line and large amounts of sugar in feedings

21
Q

procedures for TPN

A
  • ordered daily and prepared by pharmacist
  • bag is only good for 24 hours (remove if not finished after 24 hours)
  • keep refrigerated
  • don’t add drugs or IV piggybacks to the feeding - has its own port in central line
22
Q

TPN complications

A
  • infection
  • hyperglycemia or hypoglycemia
  • increase BUN and Cr (too much protein)
  • electrolyte excess/deficits
  • hyperlipidemia
  • embolus or phlebitis around central line site
  • refeeding syndrome
23
Q

describe refeeding syndrome

A
  • caused by patient being fed too fast after period of malnutrition
  • fluid retention
  • decreased K
  • decreased phosphorus
  • decreased Mg
  • increased glucose
24
Q

nursing management of TPN

A
  • check label on bag w/ order
  • 24 hours infusion time (stop when time period is over)
  • tubing is changed every 24 hours and dressing is changed every week or is soiled or non-occlusive
  • accuchecks every 6 hours (even if not diabetic)
  • assess signs of infection or pheblitis
25
labs done during TPN
- BMP (electrolytes) - hepatic functional panel - CBC (infection) - lipid profile
26
what other factors determines if a patient is obese besides BMI
- age - gender - body build
27
risk factors for obesity
- genetic predisposition - prepackaged food, fast food, soft drinks, and increased portion sizes - sedentary lifestyle, lack of physical activity/exercises - low SES - psychosocial factors (food as comfort, overeating habits, socialization around food) -> usually develops at early age
28
health risks associated w/ apple-shaped body
- obesity located in ABD - risk of heart disease - DM - breast and endometrial cancer
29
health risks associated w/ pear-shaped body
- obesity located in hips, thighs and buttocks - determined by genetics - varicose veins - cellulitis - osteoporosis
30
nutritional therapy for obesity
- 800-1200 calories (low calorie diet) - <800 calories: very low calorie diet -> not recommended long term - avoid skipping meals - avoid fad diets - focus on fruits, vegetables, whole grains, and seafood - fat free and low fat dairy products - consume less Na, trans fats, and refined sugars - bake, broil, or steam instead of frying
31
portion sizes for food
- fruits and vegetables (woman's fist or baseball) - meat (human's palm or deck of cards) - cheese (thumb or six dice)
32
nursing implementation for obesity
- 1-2 lbs per week - slower weight loss -> better cosmetic results - weigh once/week (same time of day and same clothes) - exercise - weight reduction programs and support groups
33
criteria for bariatric surgery
- BMI > 40 or > 35 plus one or more obesity-related complications - tried or failed other ways to lose weight - must be screened for physical and behavioral conditions associated w/ poor surgical outcomes
34
physical and behavioral conditions associated w/ poor surgical outcomes
- untreated depression - binge eating disorders - drug and alcohol abuse - advanced cancer - ESRD, liver disease, or cardiopulmonary disease - severe coagulopathy - inability to comply w/ nutritional recommendations
35
describe adjustable gastric banding (AGB)
- inflatable band around the stomach to create a small pouch -> help the patient feel full quicker - subcutaneous port allows band to be inflated or deflated - least invasive surgery and reversible
36
describe a sleeve gastrectomy
- 75% of the stomach is removed - elimination of hunger producing hormones - still allows for normal digestion - not reversible
37
describe gastric plication
- folding stomach wall inward and suturing in place - minimally invasive - decreases stomach volume size by about 70%
38
describe intragastric balloons
- balloon occupies space in stomach | - done via endoscopy then filled w/ saline
39
describe a roux-en-Y
- most common procedure (gold standard) - reduce stomach size to 20-30 mL - bypass most of stomach, all of duodenum and part of jejunum - new small gastric pouch anastomosis to jejunum (non-reversible)
40
results of roux-en-Y
- sustains long term weight loss - can result in loss of DM, decreased BP, and decreased total cholesterol and triglyceride levels - also lessens GERD and sleep apnea
41
possibly complications of roux-en-y
- anemia and vitamin deficiencies (iron and B12 supplements) - dumping syndrome - small bowel obstruction - excess skin (cosmetic surgery after weight loss stabilized)
42
describe dumping syndrome
- gastric contents empty too rapidly into small intestine -> overwhelms small intestine - N/V/D - dizziness - advised to not eat sweets to prevent
43
collaborative care post op bariatric surgery
- most are laparoscopic - assess for increased pain and anastomosis leak - 1st 24 hours -> water and sugar free clear liquids 30 mL every 2 hours - high protein liquid diet before discharge - eat slowly and stop when full - eat several small meals throughout the day - no liquids w/ solid food (can cause them to feel full quickly and cause vomiting and malnutrition)
44
post op long term diet after bariatric surgery
- high protein, low carb - low fat and low roughage - 6 small meals per day - no fluids w/ meals
45
psychologic issues after bariatric surgery
- guilt that weight loss achieved by surgical intervention rather than willpower - potential over eating problems that were present before surgery