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HNSC 2170 nutrition Final exam > week 9 supplemental nutrition > Flashcards

week 9 supplemental nutrition Flashcards

1
Q

Why would someone need to take a vitamin/supplement?

A
  1. ppl with not enough of that vitamin or mineral in their diet
  2. Preggers/elderly
  3. illness, addiction - conditions that limit intake
  4. Vegitarians/vegans
  5. lactose intolerance
  6. infants
  7. not enough sun or heavy pigment skin
  8. macular degeneration
  9. med interactions
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2
Q

What do Natural health products needs to have as part of Canadian regulations?

A
  1. Product licence- NPN or DIN-HM
  2. detailed info like medicinal ingredients, source, dose, potency, non-med ingredients , recommended uses
  3. evidence of clinical trials/research
  4. site licencing
  5. good manufacturing practice
  6. adverse reactions
  7. advorsories, warnings, recalls
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3
Q

What is enteral nutrition?

A
  • oral feeding (dense nutrition suppliments)
  • tube feeding using GI tract
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4
Q

what is Parenteral nutrition?

A
  • nutrients given intravenously
  • peripheral vein - short term
  • central vein - long term
  • can’t use GI tract
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5
Q

Why do we give tube feeding?

A

to prevent risk of malnutrition due to protein-energy deficiency
- can supplement oral or replace it

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6
Q

How to improve oral supplement adherence

A
  1. Try diff options and pick what they like
  2. serve it attractively
  3. offer cold (boost etc)
  4. cover the top to decrease smell
  5. offer small amounts through the day
  6. close to the bed - easy access
  7. if person stops enjoying - suggest something else (have list ready)
  8. Add syrup to improve taste
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7
Q

What are advantages of transnasal feeding? (into stomach)

A
  1. short term
  2. no surgery
  3. placed by nurse or skilled dietician
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8
Q

What are disadvantages of transnasal feeding?

A
  1. tube may irritate nose, throat, esophagus
  2. disoriented patients might remove them
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9
Q

What are advantages of nasogastric tube feeding?

A
  1. most common route for normal
    GI function
  2. tube easy to insert and maintain
  3. intermittent & no infusion pump
  4. least expensive
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10
Q

What is the most common route for normal GI function peeps for tube feeding?

A

nasogastric

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11
Q

What are the disadvantages of nasogastric tube feeding?

A
  1. tube migration to SI
  2. risk of aspiration in compromised patients
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12
Q

What are the advantages of nasoduodenal and nasojejunal feeding tubes?

A
  1. good for peeps with gastric issues (bypasses stomach)
  2. lower risk of aspiration
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13
Q

What are the disadvantages of nasoduodenal and nasojejunal feeding tubes?

A
  1. harder to insert
  2. Risk of it going back to the stomach
  3. need infusion pump
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14
Q

What are the advantages of enterostomies tubes? (long term/>4 weeks)

A
  1. more comfortable
  2. hidden under clothing
  3. esophagus not bothered
  4. lowers risk of aspiration
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15
Q

what are the disadvantages of enterostomies tubes ?

A
  1. placed by dr. or surgeon
  2. may need general anesthesia
  3. infection risk from procedure
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16
Q

What are the advantages of gastrostomy?

A
    • most common for long term use with normal stomach emptying*
  2. placement easier than jejunostomy
  3. intermittent and no infusion pump
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17
Q

What is the most common tube feed method for long term use with normal stomach emptying abilitiy?

A

gastrostomy

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18
Q

What are the disadvantages of gastrostomy?

A
  1. surgery so feedings held for 24-48 hrs before
  2. surgery so feeding held after for 48-72 hours
  3. moderate risk of aspiration in high risk patients
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19
Q

What are the advantages of jejunostomy?

A
  1. feed peeps with gastric issues
  2. don’t have to wait as long to feed as you do with gastrostomy
  3. lowest risk of aspiration
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20
Q

What are the disadvantages of jejunostomy ?

A
  1. most difficult insersion
  2. need infusion pump
  3. expensive
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21
Q

What are the 4 enteral formulas?

A
  1. standard
  2. elemental
  3. specialized
  4. modular
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22
Q

What is standard enteral formula?

A
  1. polymeric
  2. easy to digest and absorb nutrients
  3. proteins - from milk or soybeans
  4. carbs - corn starch, glucose polymers and sugars
  5. whole foods blended up
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23
Q

What is elemental formulas?

A
  1. hydrolyzed
  2. for compromised digestive or absorptive functions
  3. proteins and carbs already partly broken down
  4. low fat and fat from med-chain triglycerides to help digest and absorb
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24
Q

What are specialized formulas?

A
  1. disease specific
  2. to help ppl with illness
  3. liver, kidney, lung disease, glucose intolerance, severe wounds, metabolic stress
  4. expensive and effectiveness is controversial
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25
Q

What enteral formula is good for people with different illnesses?

A

Specialized formulas

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26
Q

What are modular formulas?

A
  1. individual macronutrient preparations - modules
  2. ppl who need specific nutrient combos
  3. include vitamins and minerals to meet all nutrient needs
  4. sometimes these are added to other enteral formuals to adjust nutrient composition
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27
Q

Which formula is sometimes added to others because of its vitamin and mineral robustness?

A

Modular formulas

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28
Q

What 4 factors are chosen formulas based on?

A
  1. Patient medical condition
  2. digestive/absorptive capabilites
  3. nutrient status
  4. individual tolerance
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29
Q

What are 2 reasons why intermittent feeding is good?

A
  1. similar to normal eating pattern
  2. better into the stomach, not intestine
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30
Q

What are 2 reasons why intermittent feeding not great?

A
  1. higher volume = harder to tolerate
  2. Higher risk of aspiration
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31
Q

What are 2 reasons why intermittent feeding not great?

A
  1. higher volume = harder to tolerate
  2. Higher risk of aspiration
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32
Q

What are 2 reasons why bolus feeding is good?

A
  1. rapid - given 3-4 hrs using syringe
  2. greater independence for ppl
33
Q

What are 2 reasons why bolus feeding isn’t great?

A
  1. abdominal discomfort, nausea, cramping
  2. greater risk for aspiration
34
Q

What feeding method is used only when the person is ambulatory, not critically ill?

A

Bolus

35
Q

What are 3 advantages to continuous feeding?

A
  1. easier to tolerate b/c slower
  2. good for critially ill patients who can’t do intermittent feeding
  3. good for intestinal feedings
36
Q

What are 2 reasons continuous feeding isn’t great?

A
  1. freedom is limited
  2. more expensive
37
Q

What is cyclic feeding and what are the advantages?

A
  1. diff method of continuous
  2. 8-18 hours (shorter period)
  3. more patient mobility
  4. GI rest
  5. transition to intermittent feedings or oral diet
38
Q

What are the 3 possible causes of aspiration of formula?

A
  1. wrong tube placing
  2. delayed gastric emptying
  3. excessive sedation
39
Q

How to help aspiration b/c of delayed gastric emptying

A
  1. elevate head of bead during and after feeding
  2. less delivery rate
  3. change to intestinal feedings in high risk patients
40
Q

What are 2 possible reasons for clogged feeding tube?

A
  1. formula is too thick
  2. meds administered improperly
41
Q

What are 4 possible reasons for constipation with tube feeding?

A
  1. not enough fiber
  2. Dehydrated
  3. lack of exercise
  4. medication side effect
42
Q

What are 5 possible reasons for diarrhea with tube feeding?

A
  1. med intolerance
  2. infection in GI tract
  3. formula is contaminated
  4. formula given too fast
  5. lactose/gluten intolerance
43
Q

What are 4 reasons for fluid and electrolyte imbalances with tube feeding?

A
  1. Diarrhea
  2. fluid intake not good or excessive loss of fluid
  3. insulin, diuretic or other med not appropirate
  4. nutrient intake not right
44
Q

What are 4 reasons that nausea, vomiting and cramps can happen with tube feeding?

A
  1. delayed stomach emptying
  2. formula intolerance
  3. med intolerance
  4. disease or disease treatment issues
45
Q

What is important to monitor with feedings?

A
  1. patient tolerance
  2. nutrition and metabolic labs & weight
46
Q

What is the difference between peripheral parenteral nutrition and total parenteral nutrition?

A

Peripheral - veins in arm or hand
- <2 weeks - short term
- not for high nutrient needs
- solutions are less concentrated so need more volume

Total parenteral nutrition (TPN) - Central veins
- long term
- going through peripheral to central is less invasive

47
Q

What is parenteral solution composed of?

A
  1. amino acids
  2. Carbs
  3. lipids
  4. Fluids/electrolytes
  5. vitamins/trace minerals
48
Q

TNA means total nutrient mixture. What are the diff types?

A

3 in 1 (all in one)
- lipids, dextrose, amino acids
2 in 1 means
- amino acids and dextrose

49
Q

Considerations for vitamins/trace minerals in formula

A
  1. don’t give vitamin K if person is on warfarin
  2. includes chromium, copper, magneaese, seleium, zinc
  3. NO IRON - destablizes lipid emulsion solutions (not for 3 in 1)
50
Q

Options for metabolic complications due to parenteral feeding

A
  1. catheter issues- use other site
  2. watch for signs of infection
  3. start slow and increase
  4. give full volume on day one and advance as tolerated
  5. acute ill patients = 24 hour continuous
  6. long erm parenteral get cyclic
  7. monitor tube for contamination
  8. test glucose, lipids, lytes (tolerance)
51
Q

What are the 7 metabolic complications of intravenous infusions?

A
  1. hyperglycemia
  2. hypoglycemia
  3. hypertriglyceridemia
  4. refeeding syndrome
  5. Liver disease
  6. Gallbladder disease
  7. Metabolic bone disease
52
Q

What are the symptoms of refeeding syndrome?

A

Edema
cardiac arrhythmias
muscle weakness
fatigue

53
Q

What is refeeding syndrome?

A
  1. occurs as a complication of intravenous infusions
  2. fluid/electroylite imbalances
  3. hyperglycemia
  4. happens to severely malnourished people who are fed too aggressively
  5. happens because dextrose infusions raise levels of circulating insulin and the removes phosphate, potassium, magnesium from the blood
  6. causes organ changes like heart failure and respiratory failure
54
Q

Who are at highest risk for refeeding syndrome?

A
  1. chronic malnutrition
  2. substantial weight loss (bariatric)
55
Q

Who is at risk for hyperglycemia with intravenous infusions?

A
  1. glucose intolerant
  2. too much dextrose or energy
  3. severe metabolic stress
  4. corticosteroid meds
56
Q

When does hypoglycemia occur during intravenous infusions?

A
  1. when perenteral nutrition is interrupted or discontinued
  2. if excessive insulin is given
57
Q

What causes hypertriglyceridemia?

A
  1. dextrose overfeeding
  2. too rapid infusions of lipid emulsion
58
Q

Who is at risk for hypertriglyceridemia from intravenous feeding?

A
  1. severe infection
  2. liver disease
  3. kidney failure
  4. pancreatitis
  5. hyperclycemia
  6. immunosuppressant
  7. corticosteroid meds
59
Q

How can fatty liver disease be treated during intravenous infusions?

A
  1. avoid excess energy in dextrose or lipids
  2. monitor liver enzyme levels weekly
  3. cyclic infusions are sometimes better
  4. sometimes oral feeds can help reduce parenteral need
60
Q

What happens with metabolic bone disease from intravenous infusions?

A
  1. lower bone mineralization and bone density
  2. altered intakes and metabolism of
    - calcium
    - phosphorus
    -magnesium
    - vitamin D
61
Q

What happens with metabolic bone disease from intravenous infusions?

A
  1. lower bone mineralization and bone density
  2. altered intakes and metabolism of
    - calcium
    - phosphorus
    -magnesium
    - vitamin D
62
Q

Where do patients struggle to move food if they have oropharyngeal dysphagia?

A

mouth and pharynx to esophagus

63
Q

Who typically struggles with oropharyngeal dysphagia?

A
  1. older folks
  2. post stroke
64
Q

Where go patients struggle to move food if they have esophageal dysphasia?

A

esophageal lumen to the stomach

65
Q

Who typically struggles with esophageal dysphagia?

A
  1. cancer patients
  2. spasms
  3. tumours
  4. strictures
  5. obstruction disorder
  6. motility disorder
66
Q

What happens with neuromuscular or structural disorder and dysphagia?

A
  1. can’t do swallowing reflex
  2. strength is impaired
  3. can’t coordinate swallowing muscles
66
Q

What happens with neuromuscular or structural disorder and dysphagia?

A
  1. can’t do swallowing reflex
  2. strength is impaired
  3. can’t coordinate swallowing muscles
67
Q

What happens with neuromuscular or structural disorder and dysphagia?

A
  1. can’t do swallowing reflex
  2. strength is impaired
  3. can’t coordinate swallowing muscles
68
Q

What happens with obstruction or motility disorder and dysphagia?

A
  1. narrowing, tumour, or compression of esophagus
  2. liquid can get around obstruction
  3. motility disorder hinders both solids and liquids
69
Q

What are the complications of dysphagia?

A

aspiration (PN, lung infections)
dehydration
loss of enjoyment for eating weight loss
malnutrition

70
Q

How are finger foods prepared?

A
  1. do not require a utensil
  2. easy to pick up
  3. nothing blended
  4. things that are liquid go in a cup for easy sipping
71
Q

How is soft food prepared?

A
  1. soft to chew
  2. nothing dry or hard
72
Q

How is soft/minced prepared?

A

all soft food but with some minced meat if soft meat and veggies isn’t a go
- can puree fruit if needed

73
Q

How is minced diced prepared?

A

Everything is minced

74
Q

How is total minced diet prepared?

A

fibre may be less than 15g/day so watch for this
- food must go through an actual mincer
- no breads, hard cereals or pastas, hard cheeses, cake etc.

75
Q

How is total pureed prepared?

A

only liquid or pureed foods with a smooth similar texture

76
Q

what is contraindicated in thick fluid (nectar) diet?

A

anything that melts
canned fruit in juice

77
Q

What is contraindicated in thick fluid (honey) diet?

A

anything that melts
canned fruit in juice

78
Q

What does a blenderized diet look like?

A

everything in liquid form

HNSC 2170 nutrition Final exam (9 decks)

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