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nutrition > unit 9- supplemental nutrition > Flashcards

unit 9- supplemental nutrition Flashcards

1
Q

who do vitamin supplements benefit

A

1) those who routinely fail to obtain recommended amounts of vits and mins from diet (i.e. chronic dieter)
2) those with special needs (pregnancy, elderly)

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2
Q

true or false: research in the area of vit/min is conflicting

A

true

some same there is benefit, others say too little evidence

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3
Q

in Canada how many take vits, mins, herbals, homeopathic meds, ect

A

71%

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4
Q

what are these known as and what are they regulated by

A

natural health products

  • under natural health product regulations (jan 1 2004)
  • these regulations were designed to increase safety and efficacy of NHPs
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5
Q

what were the natural health products regulations a result of?

A

-a consultation process with canadian consumers, academics, hcps, and industry stakeholders

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6
Q

what do the regulations include

A
  • provisions on product licensing, site licensing, good manufacturing practices, adverse reaction reporting, clinical trials, and labeling
  • also included is a mandatory, pre-market review of all NHPs to ensure that what is on the label is in the bottle
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7
Q

NHP examples

A
  • vits and mins
  • herbal remedies
  • homeopathic meds
  • chinese traditional meds
  • probitocs
  • aa and essential fa’s
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8
Q

what do approved NHPs have on their bottle

A

-either:
> NPN
>DIN - homeopathic medicine (DIN- HM)

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9
Q

what does an NPN or DIN-HM let the consume know?

A

that the product has undergone and passed a review of its formulation, labelling, and instructions for use, so it is safe product to choose
-health canada has list of approved products on their website

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10
Q

what about NHPs from other countries/over internet

A
  • if they are available in other countries, they do not have to meet these regulations
  • not same assurance of safety
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11
Q

what is the best practice when it comes to supplements

A

-make changes to diet to improve nutrition content and only take supplements as needed
(greater risk of toxicity, expensive, and van give false sense of security about healthfulness of diet)

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12
Q

what can NHPs interact with

A
  • meds, foods and other supplements

- ie grapefruit juice

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13
Q

sometimes, due to illness or medical condition, regular food intake is not able to meet patients needs. What does this result in?

A

need for alternative nutrition support, including enteral or parenteral

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14
Q

enteral nutrition

A

-involves giving nutrients using GI tract either orally or via feeding tubes

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15
Q

parenteral nutrition

A

-giving nutrients IV

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16
Q

what can be used if individual is having difficulty maintaining an adequate food intake

A

-use nutritional supplements
ie Boost, Ensure, and other store brands (life brand, equate, PC ultra shake)
-nutrition content very comparable among brands
-can be in shake form, but also fortified puddings or fruit beverages
-ususally have different shakes (high protein, extra calories, reduced carbs, high fibre)
-all have diff flavours

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17
Q

when is tube feeding useful

A
  • if indie is unable to meet their nutrient needs orally provided that GI tract is functioning
  • not all patients are candidates (i.e. may have severe swallowing disorder, Gi obstructions, intestinal surgeries, etc)
  • it can supplement oral intake or provide all nutrients
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18
Q

tube feeding routes

A
  • nasogastric
  • nasointestinal
  • nasoduodenal
  • nasojejunal
  • patient is frequently awake during transversal
  • these are chosen if less than 4 weeks
  • orogastric (mouth to intestine- infants)
  • if over 4 weeks or cannot access through nose, create direct route through enterostomy (gastrostomy or jejunostomy)
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19
Q

what are the main types of enteral formulas available

A

1) standard- polymeric formulas (for ppl who can absorb nutrients w/o difficulty- have protein isolates, cornstarch or glucose, and sugars)
2) elemental- hydrolyezed, chemically defined or monomeric formulas (for those w compromised digestive or absorptive fxn- contains proteins and carbs that are partially or fully broken down, low in fat)
3) specialized- disease specific
4) modular- created from individual macronutrient preps called modules

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20
Q

formula selection is based on

A

-patints medical condition, digestive/absorptive capabilities, nutrient status, and individual tolerance

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21
Q

what types of systems can formulas be fed thrgouh

A

open or closed

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22
Q

before feedings begin, it is important that:

A

-tube is correctly placed and is securely attached

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23
Q

how can enteral formulas be admined

A

-continuous, intermittent, and bolus feedings, and they each have advantages and disadvantages

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24
Q

open feeding system

A

-formula delivery system that requires the formula to be transferred from its original packaging to a feeding container before being administer through feeding tube

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25
Q

closed feeding system

A

-formulas delivery system in which the formula comes prepackaged in a container that can be attached directly to the feeding tube for admin

26
Q

intermittent feedings

A

-relatively large amounts several times per day

27
Q

continuous feeding

A

-smaller amounts continuously

28
Q

bolus feeding

A

rapid delivery of a large volume of formula into the stomach (over 5-15 mins)

29
Q

what should be monitored throughout tube feeding

A

-patient tolerance, including nutrition and metabolic parameters (such as weight and labs)

30
Q

true or false: many complications can arise during tube feeding

A

true
-ie aspiration of formula, clogged feeding tube, constipation, diarrhea, fluid and electrolyte imbalances, and n/v/cramps

31
Q

if Gi function is impaired how may nutrients be given

A

IV

-there are many conditions where parenteral nutrition is indicated

32
Q

what are contraindications for parenteral nutrition

A
  • GI tract functioning and accessible
  • only short term treatment anticipated (in patients w/o severe malnutrition)- usually less than 7 days
  • risks outweigh benefits
  • palliative care/ terminal
  • patient not stable
  • inability to obtain venous access
33
Q

where can parenteral nutrition be administered

A

-through peripheral or central veins

34
Q

peripheral parenteral nutrtion

A
  • usually short (7-14 days)

- solutions must be less concentrated to prevent damage to the peripheral veins, and therefore higher volumes needed

35
Q

central parenteral nutrition

A

= total parenteral nutrition bc a person’s entire nutrition needs can reliably be provided (larger veins, blood volume greater and nutrient concentrations donned to be limited)

  • used when parenteral nutrition is required longer term
  • solutions more concentrated therefore volume required is lower
36
Q

who works together to determine appropriate parenteral solution that the patient requires

A

-multi-disciplinary team of doctors, nurses, pharmacists, and dieticians

37
Q

prescriptions for parenteral solutions

A
  • very individualized

- can change on daily basis if condition is unstable

38
Q

parenteral solution ratio

A

-either 2-in-1 or 3-in-1 (also called total nutrient admixture)

39
Q

what does a 2-in-1 contain

A

-dextrose and aa, and the lipid emulsion would be administered seperately

40
Q

what does a 2-in-2 contain

A

-dextrose, aa, and lipids

41
Q

how can parenterals be administered

A

-either continuously (over 24 hour time period) or cyclic (over 8-16 hour period)

42
Q

why must parenteral nutrition be continually monitored

A
  • many potential complications
    i. e. refeeding syndrome is of particular concern and can occur when feedings are overly aggressive for severely malnourished individuals
43
Q

symptoms of referring syndrome

A

-fluid and electrolye imbalances, as well as hyperglycemia

44
Q

what are some catheter related complications

A

-air embolism, blood clotting at catheter tip, clogging, infection, phlebitis, ect

45
Q

what are some metabolic complications

A

-electrolyte imbalances, gallbladder disease, liver disease, hyperglycaemia, nutrient deficiencies, and refeeding syndrome

46
Q

dysphagia

A
  • difficulty in swallowing

- affects food and beverage intake, mouth care, medication use, ect

47
Q

what does management of dysphagia require

A

-multidisciplinary team, including speech language pathologist, dietician, OT, nurse, pharmacist, dental specialists and dr

48
Q

symptoms of dysphagia

A
  • drooling
  • choking or coughing during or after meals
  • pocketing food
  • absent gag reflex
  • inability to suck from straw
  • chronic uper resp infection
  • weight loss/ anorexia
  • gurgly voice
49
Q

health conditions associated with oropharyngeal dysphagia

A
  • advanced alzheimers
  • cerebral palsy
  • MS
  • Parkinsons
  • stroke
50
Q

health conditions associated with esophageal dysphagia

A

-esophageal cancer, spasm, or compression; strictures, scleroderma

51
Q

complications of dysphagia

A
  • aspiration, deydration, loss of enjoyment for eating, and weight loss
  • often leads to malnutrition du e to inadequate intake
52
Q

goal of nutrition intervaentions for dysphagia

A

-ensure diet remains nutritionally adequate and palatable in consistencey safely tolerated by pt

53
Q

common management strategies

A

-altering food texture, and altering the viscosity of fluids

54
Q

why are the textures of foods modified

A
  • to make them easier to swallow

- may be minced, pureed, blederized to make easier to swallow

55
Q

what types of foods are easier to swallow

A
  • foods that are naturally soft and form cohesive blous (i.e. mac casseroles, egg dishes, meat loaf) are typically easier to swallow than dry foods
  • adding sauces and gravies to foods may make them easier to swallow and can add additional calories
56
Q

mixed texture foods

A

-ie cereal and milk
-these can be difficult to manage, therefore are blended to single consistency
(this can make it less appealing, but try to improve if possible

57
Q

thin fluids

A

-require most coordination and control to consume, and are therefore easily aspirated into the lungs

58
Q

thickened liquids

A

-easier to swallow

nectar thick: i.e. soups can be sipped through straw (drip off spoon)

honey thick fluids: i.e. tomato sauce hold shape on spoon and are too thick to sip

59
Q

what is a concern when thickened fluids are used

A

-hydration

60
Q

what are other alts for patients with dysphagia

A
  • learn alt feeding tech, such as exercise to strengthen tongue, new methods of swallowing, or changing position
  • often speech lang pathologist or OT involved
61
Q

how to improve acceptance of mech altered foods

A
  • prepare favourites
  • sub brightly coloured veggies for white ones (use contrast)
  • shape the pure so they resemble traditional dish
  • try layer ingredients (looks like fancy casserole)
  • use attractive plates, silverware

nutrition (5 decks)

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