T2-Nutrition (based off PPT) Flashcards
When is the nutritional screening completed?
Within first 24 hours of admission
What does the nutritional screening identify?
Those at risk of nutritional problems
What are some factors affecting nutrition?
- Age
- Gender
- Lifestyle/habits
- Ethnicity, culture, religious practices
- Physical factors (inability to chew or swallow, economic resources, pregnancy or lactation)
What age group is the most at risk for drug nutrient interactions?
Elderly
Why are elderly more at risk for drug-nutrient interactions?
- More drugs for longer periods of time
- Drugs more toxic
- Variable response to drugs
- Handle drugs less efficiently
- Increased liklihood of current malnutrition
- Increased errors in self-care
What are 5 ways drugs have effects on food intake?
Increased appetite Decreased appetite Taste changes Nausea Bulking agents
What are 5 ways drugs have effects on nutrient absorption and metabolism?
Increase absorption Decrease absorption Mineral depletion Vitamin depletion Special adverse reactions
What all is included in the assessment of nutritional history?
- 24 hour recall
- Food-frequency questionnaire
- Food record
- Diet history
Assessment for nutritional status: what do you look for in hair?
Shiny, dull, or patchy
Assessment for nutritional status: what are you looking for with skin?
Poor or good skin tugor
Assessment of nutritional status: what are you look for with eyes?
Bright/clear or swollen/pale
Assessment of nutritional status: What are you looking for with the tongue?
Pink/moist or pale
Assessment of nutritional status: What are you looking for with mucous membranes?
Pale or pink/moist
Assessment of nutritional status: What are you looking for with CV?
Tachycardia/hypertension or WNL/reg
*WNL=within normal limits
Assessment of nutritional status: What are you looking for with muscles?
Poor or firm tone
Assessment of nutritional status: What are you looking for with GI?
Anorexia or appetite WNL
Assessment of nutritional status: What are you looking for with neuro?
Reflexes WNTL/alert or decreased reflexes
Assessment of nutritional status: What are you looking for with vitality?
Tired or energy needs met
Assessment of nutritional status: What are you looking for with weight?
WNL or increased or decreased
What are indicators of normal nutrition?
Ideal body weight
Normal physical status
Normal lab values
What are manifestations of altered nutrition?
- Abnormal body weight
- Recent significant weight gain or loss
- Decrease energy
- Abnormal bowl paterns
- Altered skin, teeth, hair, and mucous membranes
Ask do they look healthy? What is their general health?
What are some common causes of inadequate intake?
- inability to acquire or prepare food
- inadequate knowledge
- impaired swelling
- discomfort during or after eating
- anorexia, N/V
- fatigue
Why do nurses scree for altered nutrition in the general public?
To detect obesity, malnutrition, and anorexia
What can swallowing issues lead to?
Getting a GI tube
Bad GI tracts (someone who has short bowel syndrome or Chrones disease), may lead to the patient having to go on TPN. What is TPN?
Total parental nutrition
What do we do for nutrition during the physical exam?
I&O
Anthropometric measurements
What is anthropometrics?
Weight Height BMI Body frame size Body measurements
What can be given in a clear liquid diet?
Diet is limited to:
- Water
- Tea
- Coffee
- Clear broths
- Ginger ale (or other carbonated beverages)
- Strained and clear juices
- Plain gelatin
If a patient has just had surgery and is on a clear liquid diet, is it okay to give them a carbonated beverage?
Its not the best choice
What does a full liquid diet contain?
Only liquids or foods that turn to liquid at bod temp
Is ice cream full liquid or clear liquid?
Full
Is a popsicle full liquid or clear liquid?
Clear
What food can be given for mechanical soft diet?
Easily chewed and digested foods
Low residue (low fiber)
Few uncooked foods
What foods are given for a bland diet?
Regular food with out spices and a lot of grease
Ex. Rice, bananas
What is aspiration most commonly caused by?
Dysphagia
Aspiration can lead to increased ____ & _____
Morbidity and mortality
Aspiration is associated with increased ____ and increased _____
Length of stay and hospital costs
What are the two types of dysphagia?
Oropharyngeal
Esophangeal
Dysphagia: Oropharyngeal?
Relates to problems with the oral or voluntary part of swallowing
Dysphagia: Esophageal?
Involuntary phase of stalling (obstructive disorders, altered GI motility)
There are a lot of physical findings for dysphagia. Here they are…(try and name as many as you can-there are 13)
- Cough or voice change after swallowing
- Abnormal lip closure and tongue mvnt.
- Lingual discoordination
- Hoarse voice
- Slow, weak, imprecise or uncoordinated speech
- Abnormal gag
- Volatile cough
- Delated transit time
- Incomplete oral clearance
- Regurgitation
- Pooling
- Inability to speak consistently
- Delayed trigger to swallow
What is silent aspiration?
Aspiration that occurs without a cough
Are there any immediate signs to indicate the patient has aspirated during silent aspiration?
No
If you patient begins vomiting, what position do you put them in?
Side lying
Who determines how well a patient can swallow?
Speech therapists–they bring in different foods of different thickness and they determine what the patient can swallow, so we have a better indication of what they are able to handle
What are some things that need to be done when assisting patients with dysphagia to eat?
- Select appropriate foods
- Identify appropriate positioning for swallowing
- Maintain relaxed plce
- Instruct patient not to talk until a few seconds after swallowing
- Take small bites/sips
-If patient is weak or paralyzed on one side of face, place the utensil on unaffected side of mouth
How many times should a patient with dysphagia swallow after each bite?
2
What do we need to check for in patients with dysphagia when they are eating?
Check for “pocketed” or left food on affected sdie
What do we need to caution dysphagia patients about?
Caution patient NOT to “wash down” food with liquids
What should we advise our patient with dysphagia to do after they are done eating?
Advise them to sit up for 15-30 minutes after completing the meal to prevent reflux and possible subsequent aspiration
What are easily swallowed foods for patients with dysphagia?
- Thickened liquids (milkshake, slushes, “thick-it” added liquids)
- Hot or cold temp foods
- Easily chewed foods (cooked veg, ground meat)
- Soft, smooth foods (pureed fruit, pudding)
What are foods that may cause choking for patients with dysphagia?
- Thin, watery liquids (water, tea)
- Neutral temp foods and fluid
- Tough, stringy hard or dry foods (roast beef, nuts, dry crackers)
- Sticky foods (PB, thick mashed potato)
There are lots of problems affecting oral intake. Here they are (there are 12, try and name as many as you can)
- Physical impairments
- Denition
- Dentures
- Oral lesions
- Oral infections
- Impaired digestion
- Trauma
- Illness
- Debilitation
- Cognition
- Culture/religious practices
- Equipment
Our assessment of a patient should include what 5 things?
- Functioning GI tract
- Presence of impairments
- Ability to swallow
- Actual physical assessment
- Food preferences
What do we ask during the diagnosis?
What are the real or potential problems?
What are the outcomes we want?
Tolerance of prescribed diet
Maintains stable weight or shows progress in meeting desired weight
Maintain sufficient intake to meet metabolic needs
Lab values normal
Easts desired percentage of each meal
Oral fluid intake of 2-3 L/d
What is the correct position for a client who is eating?
Up in chair/up at bedside
HOB= Greater than 45 degree
What if the patient can’t sit up. How do we position them?
Elevated HOB 30 degree and turn on side
Side lying if flat in bed with suction available
Can feeding a patient be delegated?
Yes
Can assessment of a patient be delegated?
No
How should we cut up patients food?
Bite size
What is important about nutrition and family?
Teaching the family the right techniques about feeding their loved ones
How long should we wait after patient eats to put them back in a position of comfort?
30 minutes–some time for the food to digest
