Nutrition (Exam 2) Flashcards
Enteral Nutrition
Nutrition by the way of the GI tract
Feeding tube
Parenteral Nutrition
Feeding someone outside of the GI tract. IV or TPN feedings
3 main functions of the GI System
Transportation, Digestion, Absorption
Importance of good nutrition
Helps use reach and maintain a healthy weight
reduce risk of chronic disease (CVD, HTN)
Importance of Nutrition
-Early recognition of someone who is malnourished is key
-Patients who are malnourished upon admission are at greater risk of complications
Dietary Guidelines
-Provides average daily consumption of five food groups
Factors influencing Nutrition
-Appetite
-Negative experiences
-Illness
-Medications
-Environmental Factors (Income. Education level. Physical function level. transportation. availability of food.
-Developmental needs
-Alternative food patterns
Nutrition: Older Adults
-Older adults need the same amount of Vit. Minerals as younger adults
Older Adult Nutrition: What the nurse must consider
-Presence of chronic illnesses
-Medications
-Gastrointestinal changes
-Slower metabolic rate
-Cognitive impairments
-Available transporation
-Functional
Cultural Considerations
-Be considerate of pt.’s cultural and ethnic backgrounds
-consider dietary restrictions secondary to religious belief’s
-Don’t assume a each individual in each culture is the same
Nursing Assessment: Screening
-Essential part of nursing assessment
-Nutrition screening tools. Subjective and objective measures
-Identify risk factors of malnutrition
Nursing Assessment: Anthropometry
-A form of assessment. Study of measurments and porportions of the human body
-Heigh and Weight
-Ideal body weight
-BMI (Weight that they are taking into account their height)
-Registered dieticians
Nursing Assessment: Laboratory and Biochemical test
-No single lab test to meet standards
-facotrs that affect lab results:
-Fluid balance
-Liver and kidney problems
-presence of disease
Common nutritional labs in fundamentals
-Total Protein
-Albumin
-Prealbumin
-Hemoglobin
Total Protein
-Combination of albumin and globulin constitute
-Normal: 6.4-8.3
Albumin
-Makes up 60% of total PRO
-Better indicator of chronic illnesses
-Synthesized in the liver
-Half-life-21 days
-Normal: 3.5-5.0
Prealbumin
-Preferred for acute conditions
-Half-life-2days
-Normal: 15-36
Albumin is a colloid
Colloid creates pulling power in intravascular system. Keeps fluid inside intravascular space
Nutrition Labs: Hemoglobin
-Protein responsible for transporting O2 in blood
-Normal: 14-18 male. 12-16 Female
If Hg is low then patients might benefit from eating what kinds of food
Food that are rich in iron
Nutrition Assessment: History
Diet History
Health History
Other History
Health Nutrition vs Malnutrition chart
Cachectic
Very gout and skinny
Nutrition Nursing Problems
-Poor Nutrition
-Imbalanced Nutrition
-Impaired swallowing
-Risk for Aspiration
-DCN
-Impaired Dentition
-fatigue
-risk of unstable blood glucose
Nutrition Planning
-Make it an individualized approach
-Create Goals and Outcome
-Set priorities
-Teamwork and Collaboration
Nursing Implementation: Health Promotion
-Patient Educations
-early identifications of nutritional concerns
-Assisting with meal planning for all nutritional needs
Nursing Implementation: Diet Selection
-Amount needed
-Ability to eat
-Any alterations in their GI system
-Any special considerations based on their health statues
Types of Diets (P/P Box)
-regular
-Liquid
-modified texture
-therapeutic
-supplements
Regular Diet
No restrictions and encourage healthy choices
Aim to provide a well-balanced diet to meet nutritional needs
Modified Texture Diets
-Mechanical Soft Diet (soft and small in size. Easier to eat and soft in texture) (Blended or Chopped)
-Pureed Diet: Smooth like pudding that their is no chewing
-Minced Diet: Chopped up to 1/8 inch big which is similar to a sesame seed
Ground diet: Like rice 1/4 inches
Chopped diet: 1/2 inch
Clear and Full Liquid Diet
Clear: Before medical procedure or need to rest gut. Associated with acute illness and you are trying to leave little residue in the GI tract. Anything that you can see through. Broth, Juice, Pulp free Orange juice, black coffee, popsicle, gelatin
Full: Typically transition from clear to regular diet. Any juice, milk, frozen yogurt, everything on clear and things measured in mL
Fluid Restriction Diet
Limiting amount of fluid per day
Patients who have heart failure or kidney failure. They are retaining water.
Patients who have lower serum sodium. Hyponatremic
Modified Consistency of Liquid
-Any who has Dysphagia patient. Someone who has stroke and cant swallow like normal
Best way to measure fluid volume statues in a patient
Weighing them daily is better that keep tract of I/O’s
NO DIFFERENT TYPES OF LIQUDS
Therapeutic Diet Orders
-Consistent Carbohydrate (DM)
-Cardiac Diet or Heart Healthy Diet (Low salt, Low Sat, Low Chol)
-Low Residue (low ruffage) (low fiber)(Limit dairy)(People with Ulcertivie colitlts. Chrons.)
-High fiber: Improve Chol levels.
-Gluten Free: Celica’s disease
-Lactose Free: People who dont digest sugar in dairy products well
-Bland Diet: Avoid irritation and decrease peristalsis
NPO Diet
Nothing by mouth
-Before procedure or coming back from procedure. Medical problems
NPO after midnight except meds
NPO risk
Nutritional risk if it last more than 5-7 days. TPN (Central Line)
Advance Diet as Tolerated
Clear Liquid. full liquid. Low residue. Regular diet
-Only if patient is tolerating. Do assessments first
Common Nutritional Issues
Anorexia
Inability to feed self
dysphagia
nausea and vomiting
Anorexia
Loss or lack of appetite
Pain
fatigue
Effects of medications
Increasing Anorexia Appetite
-Treat cause
-Use creative approaches t stimulate appetite
-Environment
-Smaller meals and more frequent
-Allow for food preferences
-Season
-Oral hygiene
-Ensure comfort
-Provide medication
Assisting Patient With Oral Feedinds
-Protect Safety, Independence and Dignity?
-Make Sure tray in reach?
-Assess risk of aspiration
-Supervision?
-Motor or visual deficits?
-PLATE AS A CLOCK
Dysphagia
-Nurses should screen for this
-G means swallowing
-Treat causes
Dysphagia Warning Signs
-Slow weak speech
-Non gag reflex
-delay swallowing
Silent Aspiration
food in airway and not stomach. Can lead to PNA
Dysphagia Complications
-Aspiration pneumonia
-Dehydration
-Malnutrition
-Weight loss
WTD if Dysphagia is suspected
Refer to SLP or RD
Preform swallow evaluatons
Nursing care Dysphagia: Do’s
-Sit in high fowlers
-Minimize environmental distractions
-Allow for time in between bites and drinks
-Check for oral pocketing
-Chin tuck
-Double swallowing
-Suction
-Oral Care
-Monitor for choking and coughing
Nursing care dysphagia: Don’t
-Feed when altered LOC
-Leave Unattended
-Administer sedatives or hypnotics
-Use a straw
Dysphagia Diet
-SLP recommends
-Stages
-Position of patient
-Aspiration precautions
chart in PP
Intervention: Strict I/O
-Measuring of all intake and all output
-Mls or Occurrences
Who needs strict I/O
Critical Care patients
Unstable patients
Post-opp
Heart, liver, or kidney failure
Pt’s with tubes
malnourished or npo
pt’s on diuretics
changes in weight issues
Intake
Oral Fluids
IV
Blood Products
Tube feeding
Flushes
anything in mL’s
Output
Urine
Bowel Movements
Emesis
Drainage tubes (JP or Chest)
Nurses Role I/O
Can be delegated
Collaborate with NA
Educate patient and family
Communicate with everything
Assess and monitor trends
Parenteral Nutrition
-Feeding outside of the GI tract. Intravenously, bypassing the usual process of eating and digestion
Enteral Nutrition
Liquid supplemental nutrition is either taken by mouth or is given via a feeding tube. Going to the GI tract
Look and understand the routes of enteral nutrition
Enteral Nutrition
Patient receive formula through nasogastric tubes, jejunal or gastric tubes
Delivered to stomach or jejunum
Risk for gastric reflux.
MUST CONFIRM PLACEMENT.
Indications of EN
-Prolonged anorexia. (will not eat)
-Severe protein energy malnutrition
-Coma
-Impaired swallowing
-Critical Illnesses
Benefits of EN versus PN
-Reduces sepsis
-Minimizes the hypermetabolic response to trauma
-Decreases hospital mortality
-Maintains intestinal structure and function
Nepro
For kidney issues
Administration Rate of Tube Feeding
-Started at full strength, slow rate
-Increase per RD recommendation or HCP order (increase very 8-12 hours, amount of increases is set until reach goal rate, increase if no signs of intolerance)
-Assess for signs of intolerance. (High gastric residuals, NCVD)
Administration of Tube Feeding
Bolus (Intermittent) vs Pump (continuous)
Compilations of Tube feedings (potter and perry)
-Pulmonary aspiration
-Delayed gastric emptying
-Serum electrolyte imbalance
-Fluid overload
Placement of Feeding tubes
Through nose: Nasogastric or Nonintentional (doudenal)
Surgically: gastronomy, jejunostomy
Endoscopically: PEG (Percutaneous Endoscopic gastronomy) and PEJ (Percutaneous Endoscopic Jejunostomy)
Nursing Role in Placement
NG tube us a water soluble lubricant
-landmarks (gastric) - nose- ear- xiphoid process.
-Add 8-10 inches for jejunum
Feeding Tube: Conformation of Placement
-Historically: Insert air into tube and auscultate over stomach for bubbling
-XRAY is the only 100% way to confirm
-Once verified with x-ray, an ongoing placement verification ca be to test the pH
Nasogastric or Nasojejunal Tube
Typically for EN < 4 weeks
Large bore and small bore
Typically for adults; 8-13 Fr, 36-44 inches long
Come with stylet
Connectors are not standard for EN feeding tube
Surgically or endoscopically placed tubes
-Preferred long-term feeding
-More than 6 weeks
Feeding Tube: Assessment and Monitoring
-Abd focused assessment
-Check skin around tube for breakdown
-Assess nutritional status
-Assess for intolerance
-Assess I&O
-Assess and Monitor Labs
Decrease rick of aspiration in tube feeding
Elevate HOB to at least 30 degrees
Checking Gastric Residual
For continuous check every 4-6 hours. For intermittent check immediatley before
High gastric residual can indicate delayed gastric emptying
How much is to much?
> 250 ml gastric residual
Hold for an 1 hour and recheck
> 500 mls
Hold and notify HCP
Tube Feeding Administration of Medication
-Follow 5 rights of med administration
-Ensure med can be administered via tube
-Always verify placement
-Flush with water before and after administration
-Administer on med at a time
