nutritional therapy Flashcards
what is nutrition science
-the study of how food nourishes the body
-physiology, pschology, and socioeconomics
what are nutrients
specific biochemical substances used by the body to operate
which is more vital to life? water or food? and why?
water is more vital to life than food bc it provides the medium necessary for all chemical reactions and it is not stored in the body
which vitamin affects visual acuity in dim ligth, formation and maintenance of skin and mucous membranes, and immune function?
vitamin A
which vitamin provides calcium and phosphorus metabolism and stimulate calcium absorption
vitamin D
whih vitamin is an antioxidant that protects vitamin A
vitamin E
what vitamin helps the synthesis of ceratin proteins necessary for blood clotting
vitamin K
how do you determine ideal body weight for adult females
100lb (for height of 5ft) +/- 5lb for each additional inch over 5ft
how do you determine ideal body weight for adult males
106lbs (for height of 5 ft) +/- 6lb for each additional inch over 5 ft
why do males have a higher BMR
larger muscle mass
-BMR is about 1 cal/kg of body wieght per hour for men
-BMR is about 0.9 cal/kg of body weight per hour for women
what factors increase BMR
growth, infections, fever, emotional tension, extreme envirnmental temperatures, elevated levels of certain hormones
what factors decrease BMR
aging, prolonged fasting, and sleep
what factors effect oral intake
-developmental considerations
-state of health
-alcohol abuse
-medications
-economic factors
-religion
-culture
what are some neurological/neuromuscular causes of dysphagia
-CVA
-ALS
-PD
-myasthenia gravis
what are some traumatic/surgical causes of dysphagia
-oral/throat surgery
-cancer therapy
-ingestion of caustic substances
what are some signs and symptoms of dysphagia
-coughing or gagging while eating
-choking
-aspiration (can be silent w/o sx)
-drooling
-pockets of food retained in the mouth
-gargly sounding food
-sensation of food getting stuck in the throat
what are some interventions for dysphagia
(aspiration precautions)
-have suction set up and O2 available
-HOB at 45 degrees at all times
-HOB at 90 degrees (or in chair) for meals and for 30 mins after meal
-provide appropriate level of assistance or supervision at meal times
describe providing appropriate level of assistance or supervision at meal tie for aspiration precautions
-know what time clients tray arrives
-allow sufficient time to assist the client
-head tilted slightly forward
-encourage small bites
-feed slowly in a relaxed atmoshpere
-discourage talking while chewing
-place food in the unaffected side of the mouth
what are some thickened liquids
-milkshake
-slushy
what are some pureed/smooth food
-pudding
-mashed potatoes
name some easy to swallow foods
-cooked veggies
-ground meat
-creamed soup
-iced fruit
name some different types of therapeutic diets and describe em a little
-NPO (most restrictive, can vary)
-clear liqs (see through and liq at room temp)
-full liqs (anything liq at room temp)
-GI soft/low residue (gentle to digest)
-high fiber (whole grain foods)
-low sodium (<2g sodium per day)
-low cholesterol (low animal fat diet, lean meats)
-diabetic (ADA) (carb controlled/sugar controleld)
-regular (anything and everything)
-pureed (baby food like)
-mechaincal soft (easy to chew)
-enteral feeding (tube feed, can be used to supplement PO intake)
describe enteral feeding
-used when PO consumption can not occur or is not enough
-nasogastric
-gastrostomy
-jejunostomy
describe parenteral nutrition
-administered through IV
-total parenteral nutrition (TPN)
purpose of enteral tubes
feeding
administration of nutritional formula via tube in the digestive system
purpose of enteral tubes
lavage
-remove of stomach content
-accidental poisoning, overdose
-may instill NS to “wash” the stomach
purpose of enteral tubes
decompression
-connected to low intermittent wall suction
-treats: bowel obstructions, paralytic ileus,and prevents distention
describe NG tube - levin/salem sump
-clear, larger, frim plastic tube
-manipulate to soften tubing
-check placement (gastric pH, tube length, visualization of contents)
-confrom placement only with Xray
-14-18 French is normal (smaller # = thinner)
what supplies will you need for NG tube placement
-NG tube
-emesis basin
-tissues
-water based lube
-cup w water and straw
-tube securement shit
-skin protectant
-syringe
-safety pin
describe the process of NG tube placement
-gather supplies, ID pt, provide instructions, wash hands, provide privacy
-place pt in fowlers position
-determine length for NG tube
-mark tubing or note striped marking on tube
-glove, lubricate tube (3-4 inches)
-first have pt tilt head back to pick nostril
-have pt tilt head forward
-instruct pt procedure will be uncomfy
-advance tube while asking patient to swallow
-secure to nose
-follow hospital policy for placement verification
describe NG tube - dobbhoff/corpak
-smaller tube diameter
-softer plastic (soak in an ice bath to firm up plastic for easier insertion)
-used only for feeding (can not aspirate or tube will collapse)
-confirm placement only with Xray
-can be used up to six months
describe gastrostomy
-G tube, PEG tube
-inserted through the abdominal wall directly into the stomach
-surgical procedure (difference from PEG tube how they are inserted)
-incision in the abdomen
-sutured in place
-for long term use, can be permanently
-norml to have leakage while healing
describe jejunostomy
-J tube
-tube inserted through the abdominal wall directly into the jejunum
-regurgitation and aspiration is prevented (stomach is bypassed)
-emesis may still occur (only bile and stomach contents not food)
what are some nursing responsibilities r.t enteral tubes
-monitor I and O
-provide nasal and oral care
-always assess tube placement before use
-maintain patency (irrigate with 30-60ml of warm water several times a day)
-if ordered, maintain suction
how do you determine the length needed for NG tube placement
measure from
-tip of nose to
-helix or tip of ear to
-the xiphoid process
when should you shut of suction to eneteral tubes
-for abdominal assessment
-30min after administering meds
describe tube feeding administration
-fowlers position (verify placement and check residual)
-clean technique
-forula should be kept at room temo (hang only enough to infuse in 8 or less hours)
-formula may be diluted
-label administration tubing/syringe with date and time
what us a person at high risk for when getting tube feeds
aspiration
how can tube feeds be administered
bolus or continuous
describe checking gastric residual volume (GRV)
-aspirate gastric content via the tube (measure the amount aspirated)
-return aspirated contents to the stomach
-check MD order for acceptable residual amount prior to feeding (usually notify providor if residual is greater than 200ml (pt at risk for aspiration and absorption deficiency)
complications of tube feeding
-diarrhea (most common and more frequent with continuous feedings)
-dry mouth
-aspiration
-displacement of tube
-mucosal/skin irritaion
-electrolytes imbalance
-elevated blood glucose levels
-gastric distention
-occlusion
describe medication administration with tube feeding
-liquid form of med is preferred
-many tablets can be crushed and dissolved in water
-do not crush eneteric coated or time released capsules
-many capsules can be opened and dissolved in water, check drug guide
describe medication administration enteral route
-use a bulb/piston 60ml syringe or an oral/enteral syringe (gather 60ml warm water. 30ml to flush before and 30ml for after)
-follow three checks, triple checks and six rights. use 2 patients identifiers
-crush and dilute medications in warm water
-perform necessary assessments
-elevate HOB to 30-45 degrees. place chux ot towel under tube
-put on gloves and insert syringe into tube
-if pt has been receiving tube feedings, check institutional policy regarding residual aspirate
-you can test the stomach contents for acidity by using pH paper
-close off NG tube by bending it back. if using PEG, use clamp to close off tube
-holding the tube and syringe in nondominant hand, unbend NGT or release clamp and flush the tube
-pour med into syringe. if the pt shows discomfort, stop procedure and wait until patient is relaxed
-after all the med flows in, flush with 30ml of water
-shut the tube bending it back or clamping, remove syringe
-either clamp the tube or restart feedings
-if NGT is being used for decompression, wait at least 20-30mins before resuming suction
-leave HOB elevated at least 30-60mins
describe TPN
-aka hyperalimentation
-infused into central line
-hypertonic solution
who is TPN used for
those with…
-difficulty absorbing nutrients
-persistent nausea and vomiting
-need for complete bowel rest
what are some complications associated with TPN
infection, fluid overload, metabolic imbalances
nursing responsibilities TPN
-I&O
-daily weights
-assess and manage central line
-monitor lab values
what lab values are important to monitor with TPN
-glucose (may experience increased glucose while feeding and decreased afterwards)
-urine ketones and specific gravity
-BUN, liver function
-electrolytes
