Nutrition & Bowel Elimination Flashcards
Nutrition is important for
Fighting disease, Preventing injury, Strength for performing ADL’s
Suppressed appetite - for example,
espiratory or sinus infections can reduce sense of taste and smell
Liver disease, GI problems and certain medications can also cause
anorexia (loss of appetite)
Impaired swallowing. Damage to cranial nerves, such as occurs in patients with stroke (CVA) often results in
dysphagia
Swollen passages in the throat, for example with tonsillitis, also cause
dysphagia
inhaling foreign material into the airways. Usually results in pneumonia and increases morbidity, mortality, and length of stay in the hospital
Aspiration
nectar
medium thickness
honey
high thickness
pudding
highest thickness
Prescriptions for these various levels of thickness are written by________________ - they are the “swallowing experts.”
Speech Language Pathologists (SLP)
Patients at risk for aspiration should be in _________________ when eating.
high Fowler’s position
the food should be placed in the unaffected side of the mouth for chewing for what patient
If the patient has hemiplegia
Some diseases, for example ___________, raise the metabolic rate to such a degree that ingesting sufficient “fuel” becomes difficult.
hyperthyroidism
will eat eggs and milk/milk products
Ovolactovegetarians
will eat milk/milk products, but not eggs
Lactovegetarians
will eat NO animal products.
Vegans
whre most all nutrients are absorbed
small intestines
1 kg=
1 liter of fluid
significant weight changes (over a period of a day or two) are much more likely to be due to
fluid retention or loss
nursing problem examples
impaired GI function, nutritionally compromised, non-adherence, fluid and electrolyte imbalance
calculating the number of milliliters (mL) taken in and the number of mL excreted out or removed from the body.
Intake and Output (I&O)
means “nothing by mouth.”
NPO
liquids that are thin and have no solid particles AT BODY TEMPERATURE. For example, fat-free broth/bouillon, coffee, tea, carbonated beverages, clear fruit juices, gelatin, fruit ices, popsicles
Clear liquid
Same as clear liquid, with addition of smooth-textured diary products, strained or blended cream soup, custards, refined cooked cereals, vegetable juice, pureed vegetables, all fruit juices, sherbets, puddings, frozen yogurt.
Full liquid
Foods easily chewed and swallowed. Same as clear and full liquid and pureed, with addition of all cream soups, ground or finely diced meats, flaked fish, cottage cheese, cheese, rice, potatoes, pancakes, light breads, cooked vegetables, cooked or canned fruits, bananas, soups, peanut butter, eggs (not fried)
Mechanical soft
Same as clear and full liquid, with addition of scrambled eggs, pureed meats, vegetables, and fruits, mashed potatoes and gravy
Dysphagia Stages, Thickened Liquids, Pureed
Addition of low-fiber, easily digested foods such as pastas, casseroles, moist tender meats, and canned cooked fruits and vegetables, desserts, cakes, and cookies without nuts or coconut
Soft / Low residue
Addition of fresh uncooked fruits, steamed vegetables, bran, oatmeal, and dried fruits
High Fiber
Necessary for some heart, kidney, or liver patients because high sodium intake promotes fluid retention.
Low Sodium
Protein, sodium and potassium are restricted.
Renal
Impaired kidneys lose the ability to regulate products of
protein breakdown
focus on total energy, nutrient and food distribution; include a balanced intake of carbohydrates, fats, and proteins; varied caloric recommendations to accommodate patient’s metabolic demands
Diabetic
Low Cholesterol - ___mg/day cholesterol, in keeping with American Heart Association guidelines for serum lipid reduction.
300
Eliminates wheat, oats, rye, barley, and their derivatives.
Gluten Free
No restrictions unless specified.
Regular
gastrostomy or G-tube
Stomach
Primarily used for gastric decompression but CAN be used for feeding.
Large bore nasogastric (NG) tube
Percutaneous endoscopic gastronomy
under the skin
orogastric
tube into the mouth
if NG tube is hooked up to suction
low intermittent suction not continous
What do do with an NG tube to avoid pulling on it
use a clip to attach to patients gown
verification of NG tube in the right place
Xray, visualization of aspiration contents, and Gastic pH testing
Number one way to verify correct placement of NG tube
XRAY
Tubes inserted via the nose are intended for short term use (usually no more than________)
6 weeks
These tubes can be used long term
Stomach (gastrostomy or G-tube)
Jejunum (jejunostomy or J-tube)
constant drip rate using tubing and electric feeding pump (like IV pump but for feedings
Continuous feeding
dripped in over short periods of time, several time per day to mimic normal “eating patterns.
Intermittent feeding
poured directly into the tube using a 60 mL syringe with the plunger removed. It infuses as rapidly as gravity will permit. Because the jejunum has such a small volume of space available, j-tube feedings are restricted. Up to 400mL
Bolus feeding
partially pre-digested simple nutrients that leave very little residue and require minimal digestive work by patient. Giving extra water via the tube, slowing the rate of administration, or diluting the formula often helps with diarrhea. Usually used for patients with bowel diseases that interfere with digestion of complex nutrients.
Elemental
single-nutrient preparations (either protein, glucose, or fat) given as supplements. They are not nutritionally adequate by themselves.
Modular
more complex nutrients that more closely resemble usual dietary intake. Less hyperosmolar; less diarrhea. Can be “homemade” by mixing regular food into milk base or commercial product
Polymeric
designed to provide certain nutrients in high quantities. Used for the treatment of specific diseases.
Specialty
what to do when we put a tub in a patient
trace all lines
tubing and solution need to be changed every
24 hr
Lipids need to be changed
12 hr
everyone who is on TPN is monitored for
blood glucose levels and fluid volume overload
Cannot stop this abruptly
TPN
If the “gut” or GI tract can be used, meaning - it is functioning, USE the gut! ___________is preferred to parenteral route
Enteral route
Do not use these techniques while verifying NG tubes
air bolus technique or tube in glass of water technique
How to help with enteral feeding that experience abdominal cramps
Give feedings at room temperature and diluting the concentration of the feeding
Flush the nasogastric (NG) tube with at least _____of water every 4 hours during continuous feeding or before and after intermittent feedings.
30 mL
Flush with at least ______ of water before and after administration of each medication, taking into account the patient’s volume status
15 mL
form of specialized nutritional support provided intravenously that is used for patients that are unable to digest or absorb enteral nutrition.
Parenteral Nutrition also known as Total Parenteral Nutrition (TPN)
Because an extremely nutrient-dense “broth” is going directly into the circulation, ___________ is a major danger, and lines and bottles must be cared for scrupulously.
sepsis (severe infection)
Factors Influencing Bowel Elimination
Age, Diet, Fluid Intake, Physical Activity, Psychological Factors, Position During Defecation, Pain, Medication, Hydration status, and Surgery and Anesthesia
the first few stools produced by newborns. They are sticky and black due to digested amniotic fluid swallowed buy the neonate. Does NOT indicate blood in the stool.
Meconium
abnormally hard and dry feces that becomes difficult to expel. The longer stool remains in the intestine without being expelled, the harder and dry it becomes.
Constipation
a large, constipated mass of stool that becomes so hard that it can’t be passed. Often the frequent passage of small amounts of liquid stool in a patient who feels extremely constipated signals the presence of an impaction
Impaction
rapid movement of feces through GI tract resulting in poor absorption of water and nutrients and producing frequent watery stools; often accompanied by cramping.
Diarrhea
fecal incontinence is the inability to control the passage of feces and gas from the anus.
Incontinence
grayish stool with visible fat. Results from poor fat digestion. Stool with very high fat content “floats.”
Steatorrhea
is a common cause of abdominal fullness, pain, and cramping.
Flatulence
are dilated, engorged veins in the lining of the rectum. They can be either external or internal.
Hemorrhoids
LARGE AMOUNTS of digested blood in the lower GI tract makes blood look black and tarry.
melena
direct visualization via a mechanical or fiberoptic scope inserted into the GI tract by a physician. Patients are sedated for this procedure.
Endoscopy
involves an endoscopic exam of the stomach.
Gastroscopy
involves an endoscopic exam of the sigmoid portion of the colon
Sigmoidoscopy
involves an endoscopic exam of the entire colon.
Colonoscopy
commn stool softeners
Docusate sodium and Senna
Osmotic Diuretic examples
Mirilax, Lactulose, Magnesium Hydroxide, Magnesium Citrate
Stimulate laxatives
Bisacodyl and Senna
What does the waste look like coming out of an ileostomy
very liquid bowel coming out of it
Do not give this to patients will an ileostomy
laxatives
What does the waste look like coming out of an colostomy
more formed stool
