Nutritional Modalities Flashcards
What is the definition of nutrition?
the science of optimal cellular metabolism and its impact on health and disease
What nutritional assessments can be done?
- Nutritional screening
- Calorie count
- Height
- Weight
- BMI
- General assessment
What laboratory diagnostics can be used to assess a patients nutrition?
- CBC
- Serum glucose
- Serum albumin and total protein
- Cholesterol levels
What is gastrointestinal intubation used for?
- Decompress the stomach
- Lavage the stomach
- Diagnose GI disorders
- Administer medications and feeding
- Compress a bleeding site
- Aspirate gastric contents for analysis
What types of tubes are there?
Lavage and enteric tubes
What two types of lavage tubes are there?
Levin and gastric
What type of levin tube is there?
Single lumen
What types of gastric tubes are there?
Double lumen and radiopaque
What should the nurse do when inserting an NG tube?
- Determine length to be inserted
- Lubricate tip for easier insertion
- Place patient in Fowler’s position with towel or bib on chest
- Insert tube and ask patient to take small sips of water to facilitate passage
To facilitate passage of the NG tube what should you as the patient to do?
Take small sips of water
How should you initially confirm placement of the NG tube?
by X-ray
Other than X-ray what are the ways to confirm placement of the NG tube?
- Measure tube length
- Visual assessment of aspirate
- pH aspirate-acidic
- Auscultate abdomen over stomach while injecting are
What should you do to the NG after the correct position is confirmed?
Secure it
What are Enteric tubes used for?
Nutrition
What is it called when using enteric tubes?
GI intubation
Where do enteric tubes stay?
in duodenum or jejunum
Where are enteric tubes inserted and how long does it take to get to the intestines?
Inserted in stomach and takes 24 hours to pass through to intestines
What side should you place a patient on when inserting an enteric tube and why?
Laying on right side to facilitate passage
How is the placement of an enteric tube verified?
By radiography
What is the purpose of a gastrostomy?
To administer foods, fluids, or medications, or for gastric decompression
What is a gastrostomy?
An opening in the stomach
What is a PEG tube?
A percutaneous endoscopic gastrostomy
When would a PEG tube be clamped?
Between feedings
What are the two types of nutritional support?
Enteral and Parenteral
Parenteral nutritional support goes directly into what part of the body?
The circulatory system
Enteral nutritional support goes directly into what part of the body?
The Gastro-intestinal tract
What is the purpose of enteral feedings?
Meet nutritional requirements when oral intake is inadequate or not possible and the GI tract is functioning
What are the advantages of enteral feedings?
- Safe and cost effective
- Preserve GI integrity
- Preserve the normal sequence of intestinal and hepatic metabolism
- Maintain fat metabolism and lipoprotein synthesis
- Maintain normal insulin and glucagon ratios
Tube feedings are delivered where?
To stomach or to distal duodenum or proximal jejunum
High osmolality of enteric nutrition may cause what?
Dumping syndrome
Tube feeding formulas may include what?
- Chemical composition of nutrient source
- Caloric density
- Osmolality
- Residue
- Bacteriologic safety
- Vitamins and minerals
What are the types of tubes?
- Nasogastric
- Nasoenteral
- Gastrostomy
- Jejunostomy
What types of methods are used for tube feedings?
- Intermittent bolus feedings
- Intermittent gravity drip
- Continuous infusion
- Cyclic feeding
What is nasoenteric feeding controlled by?
Continuous Controlled Pump
What is the nursing care required for patient with a nasogastric, nasoenteric, gastrostomy, or jejunostomy tube?
- Patient education and preparation
- Tube insertion
- Confirming placement
- Clearing tube obstruction
- Monitoring the patient
- Maintaining tube function
- Oral and nasal care
- Monitory, preventing, and managing complications
- Tube removal
What nursing assessment needs to be done on a patient receiving enteral feedings?
- Nutritional status and assessment
- Weights
- Factors or illnesses that increase metabolic needs
- Hydration and fluid needs, I & O
- Digestive tract function
- Renal function and electrolyte status
- Medications and other therapies that affect nutrition intake and function of GI tract
- Compare the dietary prescription with the patients needs.
What are the potential complications of enteral tube feedings?
- Diarrhea
- Nausea and vomiting
- Gas, bloating, cramping
- Dumping syndrome
- Aspiration pneumonia
- Tube displacement
- Tube obstruction
- Nasopharyngeal irritation
- Hyperglycemia
- Dehydration and azotemia
In order to insure enteral tube safety what are the nutritional mangements?
- Initate enteral feedings as prescribed
- Advance tube feedings as tolerated
- Monitor for tolerance
What are the aspiration precautions for enteral tube safety?
- Position with head of bed elevated a minimum of 30 degrees
- Check tube placement every 4 to 6 hours
- Check gastric residual volume every 4 hours
When should you administer water in order to maintain nutrition balance and tube function?
- Before and after each medication and feeding
- Before and after checking residual
- Every 4-6 hours
- Whenever the tube feeding is discontinued or interrupted
What should you NOT mix with tube feedings?
medications
What size syringe should you use to check residual on a tube feeding?
30 mL or larger
In order to avoid bacterial contamination of the tube function what should you not do?
Hang more than 4 hours of feeding in an open system
What position should the patient's head be in when receiving a tube feeding to prevent aspiration? A. Flat B. 10 to 20 degrees of elevation C. 30 to 45 degrees of elevation D. 45 to 90 degrees of elevation
C. 30 to 45 degrees of elevation
How is parenteral nutrition described?
A method to provide nutrients to the body by an IV route
What does Parenteral nutrition contain?
A complex mixture of proteins, carbohydrates, electrolytes, vitamins, trace minerals, and sterile water in a single container
What my be piggybacked when administering parenteral nutrition?
Fats
What is the goal of parenteral nutrition?
Improve nutritional status and to attain a positive nitrogen status
How is parenteral nutrition delivered?
Peripherally or via a central line
How is it decided whether to administer parenteral nutrition peripherally or via a central line?
It depends on the solutions toxicity
What are the indications for parenteral nutrition?
- Intake is insufficient to maintain anabolic state
- Ability to ingest food orally or by tube is impaired
- patient in not interest or is unwilling to ingest adequate nutrients
- The underlying medical condition precludes oral or tube feeding.
- Preoperative and postoperative nutritional needs are prolonged
What do you need to monitor on a patient receiving parenteral nutrition?
- Nutrition status
- Daily weights
- Hydration status
- I and O
- Electrolytes
- Signs and symptoms of hypoglycemia or hyperglycemia
- Monitor blood glucose
What should a nurse be checking to assess for potential complications in patients receiving parenteral nutrition?
- -Vital signs
- Temperature q 4hours or by protocol
- WBC
What are the nursing diagnoses for a patient receiving parenteral nutrition?
- Imbalanced nutrition
- Risk for infection
- Risk for excess or deficient fluid
- Risk for immobility
What are the two delivery options for parenteral therapy?
Peripheral method and central method
What are the ways of central method delivery for parenteral therapy?
- Nontunneled catheter
- Peripherally inserted central catheter
- Tunneled central catheter
- Implanted ports
What are the potential complications of parenteral therapy?
- Pneumothorax
- Clotted or displaced catheter
- Sepsis
- Hyperglycemia
- Rebound hypoglycemia
- Fluid overload
- Thrombosis, embolism
What are ways to prevent infection in those who are undergoing parenteral therapies?
- Appropriate catheter and IV site care
- Strict sterile technique for dressing changes
- Wear make when changing the dressing
- Assess insertion site
- Assess for indicators of infection
- Proper IV and tubing care
What are ways to maintain proper fluid balance in patient who receive parenteral therapies?
- Use infusion pumps so flow rates are not increased or decreased rapidly
- Monitor indicators of fluid balance and electrolyte levels
- I and O
- Weights
- Monitor blood glucose levels
