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Adult 1 > Nutritional Problems > Flashcards

Nutritional Problems Flashcards

1
Q

Parenteral nutrition (PN)

A

Administration of nutrients by routes that are not the GI tract
Used when the GI tract cannot function appropriately

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2
Q

What are common indications for the administration of PN?

A

Chronic severe diarrhea and vomiting
Complicated surgery or trauma
GI obstruction
GI tract anomalies and fistulae
Intractable diarrhea
Severe anorexia nervosa
Severe malabsorption
Short bowel syndrome

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3
Q

What role does the nurse play in he preparation of PN solutions?

A

Making sure they are refrigerated until 30 minutes before us and made daily
Solutions are only good for 24 hours
Must be labeled properly (content, additives, time mixed, expiration)

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4
Q

What are metabolic complications of PN?

A

Altered renal function
Essential fatty acid deficiency
Hyperglycemia or hypoglycemia
Hyperlipidemia
Liver dysfunction
Refeeding syndrome

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5
Q

What are catheter-related complications of PN?

A

Air embolus
Catheter-related sepsis
Dislodgement
Hemorrhage
Occlusion
Phlebitis
Pneumothorax, hemothorax, hydrothorax
Thrombosis of vein

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6
Q

What assessment must the nurse make for a patient receiving PN?

A

Vital signs every 4-8 hours
Daily weights
Blood glucose every 4-6 hours
Electrolytes
BUN
CBC
Liver enzymes
Dressing change per policy
Refeeding syndrome
Infusion pump used must be checked frequently
Monitor for infections

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7
Q

What assessments are used for obesity?

A

BMI
Waist circumference
Waist to hip ratio
Body shape

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8
Q

What can the body shape “apple” indicate about potential health problems?

A

Heart disease
Diabetes mellitus
Hypertension

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9
Q

What can the body shape “pear” indicate about potential health problems?

A

Osteoporosis
Varicose veins

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10
Q

What are elements of treatment planning for obesity?

A

Meal planning
Exercise
Behavior modification
Support groups

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11
Q

What is bariatric surgery?

A

Surgery which alters portions of the GI tract in order to treat extreme cases of obesity

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12
Q

What are the criteria guidelines for bariatric surgery?

A

BMI greater than or equal to 40 kg/m2 OR 35 kg/m2 with one or more significant co-morbidities
Not always covered by insurance
Screened for psychological issues associated with poor outcomes

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13
Q

What are the three categories of bariatric surgery?

A

Restrictive - stomach size or amount entering is reduced
Malabsorptive - small intestine is shortened
Combination

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14
Q

Restrictive bariatric surgery: gastric banding

A

Limits the size of the stomach with an inflatable, adjustable band (via fluid injection)
Creates sense of fullness
Delays in stomach emptying
Can be modified or reversed later

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15
Q

Restrictive bariatric surgery: sleeve gastrectomy

A

75% of the stomach is removed
Stomach function is preserved
Eliminates hormones made in the stomach that stimulates hunger
Currently requires a surgical incision
Leakage related to stapling or sutures is possible
NOT reversible

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16
Q

Restrictive bariatric surgery: plication

A

Sleeve created by suturing rather than removing part of the stomach
Minimally invasive surgery
Involves folding stomach wall inward, reducing the stomach volume
Requires hospital stay
Nausea is common after the procedure
Blockage may occur from swelling or fold too tight
reversible

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17
Q

Restrictive bariatric surgery: intragastric balloon

A

Balloon occupies space in the stomach
Natural anatomy of the stomach is not altered
Patients feel more full, appetite decreased
Less invasive, placed using endoscope
Balloon filled with saline, varying amounts can be used (400-700 mL) OR nitrogen gas
can only be left in for 6 months

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18
Q

Roux-en-Y gastric bypass

A

Stomach pouch is created, connect to jejunum, rest of stomach and the first part of the small intestine are bypassed
Low complication rates and excellent patient tolerance

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19
Q

What are possible complications of the Roux-en-Y gastric bypass surgery?

A

Dumping syndrome
Leak at anastomosis site
Anemia

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20
Q

What pre-operative care is necessary for patients undergoing bariatric surgeries?

A

Team: medical specialists, PT and RT
Room: larger bp cuff, larger gown, patient transfer equipment, accessible wheelchair
Equipment for wound care
Breathing techniques: coughing, deep breathing, turning
Patent venous access
Mechanical ventilation

21
Q

What post-operative care is important for patients undergoing bariatric surgeries?

A

Close observation for complications
Transfer with someone trained
Stabilize airway
Anesthetic agents in adipose tissue means the patient may take longer to wake up
Manage pain
Elevate HOB 35-40 degrees
Turning and ambulation
Compression materials
Monitor for DVT, infections, respiratory and cardiovascular complications
Ensure proper placement of NG tube
Careful transition to new diet

22
Q

What diet is prescribed to patients who have undergone bariatric surgery?

A

High protein
Low carbohydrates
Low fats
Low roughage
6 small feedings throughout the day
Fluids not to be ingested with meals (below 1000 mL/day)

23
Q

What are later complications which can arise from bariatric surgery?

A

Anemia
Vitamin deficiencies
Diarrhea
Psychologic problems
Peptic ulcer formation
Dumping syndrome
Small bowel obstruction

24
Q

GI Review

A

Structures in each quadrant

25
Q

Barium swallow (upper GI)

A

Used to detect structural changes in the esophagus, stomach, duodenum/small intestine
Prep: NPO status
Post: fluids/laxatives, monitor stool for passage of barium

26
Q

Barium enema (lower GI)

A

Used to detect anatomical changes
Prep: clear liquids, NPΟ, bowel prep
Post: fluids/laxatives, monitor for passage of contrast

27
Q

Abdominal ultrasound

A

Used to detect solid masses, cysts, or abdominal ascites
Prep: NPO for 8 to 12 hours
Post: none

28
Q

Gallbladder ultrasound

A

Used to detect masses, cysts, tumors, or cirrhosis of the liver or biliary tract
Prep: NPO 8 to 12 hours
Post: none

29
Q

Esophagogastroduodenoscopy (EGD)

A

Used for direct visualization of mucosa. of esophagus and duodenum with a tube that can perform biopsy or sclerotherapy
Prep: NPO 6 to 12 hours, consent, meds, sedation
Post: NPO until gag returns, assess for bleeding if biopsy performed

30
Q

Sigmoidoscopy

A

Used for direct visualization of mucosa of colon to ileocecal valve versus rectum/sigmoid colon only
Prep: clear liquids 1 to 2 days before, NPO 8 to 12 hours, consent, bowel prep, sedation
Post: assess rectal bleeding, signs of perforation, need to pass gas

31
Q

Capsule endoscopy

A

Used to capture images of the stomach and small intestine
Prep: NPO 8 to 12 hours after swallow
Post: patient passes capsule through bowel movements and images are downloaded

32
Q

Percutaneous cholangiography

A

Local anesthesia is administered before injecting fluoroscopy contrast into the hepatic and biliary ducts in the liver
Prep: NPO
Post: assess for bleeding or bile leakage

33
Q

What laboratory studies may be assessed as part of GI diagnostic studies?

A

Stool cultures
Fecal analysis
Liver function studies
Serum amylase
Serum lipase
Ammonia levels
Serum protein levels

34
Q

What should be assessed and recorded for reports of nausea and vomiting?

A

Lethargy
Sunken eyeballs
Pallor
Dry mucous membranes
Poor skin turgor
Amount/frequency/character/color
Decreased urinary output
S/S of electrolyte disturbances (hypokalemia and metabolic alkalosis)

35
Q

Cyclic vomiting syndrome

A

Disorder that causes recurrent episodes of nausea, vomiting, and lethargy which can last anywhere from an hour to 10 days
Common triggers: emotional excitement and infection

36
Q

What inter-professional care techniques should be performed for patients experiencing nausea and vomiting?

A

NPO and IV fluids to maintain fluid and electrolyte balance
May require an NG tube
Record input and output, and vital signs
Provide a quiet and odor-free environment to minimize triggers
Monitor their mental status and risk for aspiration

37
Q

What gerontologic considerations must be taken into account regarding nausea and vomiting?

A

More likely to have pre-existing cardiac and renal insufficiency
Greater risk for fluid and electrolyte imbalances
Increased susceptibility to CNS side effect of antiemetic drugs
Alteration in LOC - increased risk for aspiration

38
Q

What are the two main types of oral cancers?

A

Oral cavity
Oropharyngeal

39
Q

What are clinical manifestations of oral cancer?

A

Leukoplakia
Erythroplasia
Ulcer
Soreness of tongue
Chronic sore throat
Later stages: dysphagia, increased salivation, jaw movement, slurred speech, tooth/earache

40
Q

What surgeries exist to treat oral cancer?

A

Mandibulectomy
Radial neck dissection with tracheostomy
Glossectomy

41
Q

What are important considerations follow surgery for oral cancers?

A

Airway maintenance
Communication
Nutrition (PEG tube)
Pain relief
Body image alterations

42
Q

What are the clinical manifestations of GERD?

A

Heartburn (pyrosis)
Dyspepsia (pain)
Regurgitations
Hyper-salivation
Non-cardiac chest pain

Additionally: wheezing, coughing, dyspnea, hoarseness, sore throat, lump in throat, choking, regurgitation

43
Q

What are complications associated with GERD?

A

Esophagitis
Barrett’s esophagus
Respiratory - cough, bronchospasm, laryngospasm
Dental erosion

44
Q

What diagnostic studies can be used for GERD?

A

Endoscopy to assess pressure of LES
Esophageal motility studies

45
Q

What are some general nursing management techniques which can be used for GERD?

A

Avoid irritating factors which can cause reflux
Weight reduction (if appropriate)
Small, frequent meals, avoid eating late at night
Fluids between meals

46
Q

What drugs can be used to treat GERD?

A

Antacids
Histamine (H2) receptor blockers
Proton pump inhibitors
Cholinergic
Prokinetics
Antiulcer

47
Q

What is a Nissen fundoplication?

A

The stomach is wrapped around the esophagus

48
Q

What is the LINX reflux management system?

A

A small loop of magnetic beads are placed around the LES to aid in strengthening the hold the LES has in preventing the return of gastric acid to the esophagus

49
Q

Hiatal hernia

A

Adult 1 (2 decks)

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