skills exam 7 Flashcards
BUN normal value
10-20
Crt (creatinine) normal value
0.6-1.2
eGFR normal value
> 60
Glucose normal value
70-100
AST normal value
0-35
ALT normal value
4-36
ALP normal value
30-120
Albumin normal value
3.5-5.0 (same as potassium)
Total protein normal value
6.4-8.3
Define dysphagia
difficulty swallowing
Signs of dysphagia
- Cough during eating
- Change in voice tone or quality after swallowing
- Abnormal movements of the mouth, tongue, or lips
- Slow, weak, imprecise or uncoordinated speech
- Inability to speak consistently
- Abnormal gag, delayed swallowing
- Incomplete oral clearance or pocketing
- Regurgitation
- Delayed or absent trigger of swallow
Complications of dysphagia
- Aspiration pneumonia
- Dehydration
- Decreased nutritional status
- Weight loss
How to assess nutrition?
- Assess daily weights
- Laboratory tests: liver function, kidney function, and glucose
- Assess diet and health history
- Assess ability to ingest, digest, or absorb nutrients (and possible conditions that interfere with this)
Nursing role in nutrition?
- Review ordered diet
- Advance diet as tolerated by patient (Gradual progression of dietary intake or therapeutic diet to manage illness)
- Assist with oral feedings if necessary, but promote independence
- Use weighted silverware
NPO ordered diet
- Nothing by mouth
- If a patient is NPO for a prolonged period of time, ensure they are receiving fluids intravenously to maintain hydration status
- Part of “advance as tolerated” diet
Clear liquid ordered diet
- Only clear fluids or clear solids that become clear liquids easily at room temperature
- Clear fat-free broth, bouillon, coffee, tea, carbonated beverages, clear fruit juices, gelatin/jello, fruit ices, popsicles, soda, tea, water
- Part of “advance as tolerated” diet
Full liquid ordered diet
- Same as clear liquid (clear fat-free broth, bouillon, coffee, tea, carbonated beverages, clear fruit juices, gelatin/jello, fruit ices, popsicles, soda, tea, water)
- With addition of smooth-textured dairy products (e.g., ice cream), strained or blended cream soups, custards, refined cooked cereals, vegetable juice, pureed vegetables, all fruit juices, sherbets, puddings, frozen yogurt
- Part of “advance as tolerated” diet
Dysphagia Stages (Thickened Liquids, Pureed) diet
- Patients with dysphagia have trouble chewing and swallowing without choking, so liquids need to be thickened
- Clear liquid with thickener if patient is unable to tolerate (clear fat-free broth, bouillon, coffee, tea, carbonated beverages, clear fruit juices, gelatin/jello, fruit ices, popsicles, soda, tea, water)
- Full liquid with thickener if patient is unable to tolerate (smooth-textured dairy products (e.g., ice cream), strained or blended cream soups, custards, refined cooked cereals, vegetable juice, pureed vegetables, all fruit juices, sherbets, puddings, frozen yogurt)
- With addition of scrambled eggs; pureed meats, vegetables, and fruits; mashed potatoes and gravy
- Not part of “advance as tolerated” diet, patient may be on this diet continuously
Mechanical soft diet
- Foods that are mashed up by a machine and made soft
- As for 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)
Diabetic diet
- Nutrition recommendations by the American Diabetes Association: 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
Gluten free diet
- Eliminates wheat, oats, rye, barley, and their derivatives
Kidney function labs
BUN, Crt, eGFR
Liver function labs
AST, ALT, ALP, Albumin, and total protein
Small-bore NG tube size and purpose
- <12 French
- for medication administration and enteral feedings
Large-bore NG tube size and purpose
- 12 French and above
- for gastric decompression or removal of gastric contents