Chapter 60

Question 1

Pg 1213

Chart 60-1

Questions one might ask in nutrition screening?

Answer 1

Loose stools?

Wt loss?

Fever, burns sepsis?

NPO?

Diet?

Allergies

Drug therapy

N/v

Difficulty chewing / swallowing

Heart issues

Chewing or swallowing issues

Independence with ADLs

Fluid I and O equal to each other?

Ostomy?

Oxygen?

Resp issues?

Rashes

Skin turgor

Mucous membrane dry?

Pressure to sacrum, hope, heels, ankles

Edema - pedal

Cachexia - weakness and wasting body

Question 2

How long should nutrition screening be done upon hospital admission

Answer 2

24 hours

Consist of height and weight, wait history, usually eating habits, ability to chill, swallowing, appetite

Question 3

BMI does not factor in muscle mass

Answer 3

True

Question 4

Normal BMI pg 1215

Answer 4

23-27

Question 5

Skin fold measurements done by who

Answer 5

Dietitian

Question 6

Why would one have poor wound healing in malnutrition ?

Answer 6

Lack of protein (albumin) which promotes wound healing

Question 7

Mulnitrition in the older adult

Answer 7

Limited income
Lack of transport

Low appetite 
Dentition
Poor eyesight
Dry mouth
Depression
Chronic or acute pain 

Pg.1216
60-2

Question 8

Length of stay is 3x higher for those who are malnourished

Who promotes assesment prior

Answer 8

True

Joint commission

Question 9

**Malnutrition labs to look at

Answer 9

Hemoglobin - anemia

Hcg- high=dehydration
Low- anemia , hemorrhage, fluid overload

Serum albumin normal 3.5-5
Plasma protein - reflects nutritional status and can be falsely high or low depending on fluid volume

Prealbumin - 15-36
Plasma protein is more sensitive indicator of nutritional deficiency

Question 10

Who should have total enteral nutrition for worst case Scenario

How else can we improve nutrition ?

Answer 10

Any patient not meeting their calorie and protein needs

Nutrition supplements

Multivitamins, zinc , iron

Calorie counts, dietician plans calorie intake and texture

Question 11

TEN is given via how?

Short term

Long term?

Which one can a nurse place ?

Answer 11

Naso gastric tube (NG tube) less than 4 weeks - nurse can place

Percutaneous endoscopic gastrostomy (PEG) tube - surgically placed

Question 12

How to administer TEN feeding

Answer 12

N/D- can mean too much too fast

Bloating

Change bag and tubing every 24 hours

HOB elevates 30 degrees

Check for residuals every 4-6 hours

Continuous or bolus with free water

Question 13

What to do for TEN clogged tube

Answer 13

Flush regularly or will get clogged

Push - pause method - to create turbulence

NO carbonated beverages !

Question 14

Most common problem with TeN

Others?

Answer 14

Clogged tube

Aspiration

Referring syndrome - severe electrolyte shifts to start action state - it happens slowly restart nutrition feeding

Tube misolacement or dislodged- first stop feeding

Abdominal distention with n/v - means overfed -200 or more hold feeding

Fluid and electrolyte imbalance-if too concentrated- with leads to diarrhea- which leads to dehydration-Hyperkalemia and hyponatremia are most common electrolyte imbalance -

Question 15

PN or PPN is given how?

Used when gi tract can not be used

Answer 15

PICC or central line only

Filtered tubing change every 24 hours

With fat emulsion/ lipids q 12 hrs

Question 16

**More concentrated nutrition with higher osmolality - central line

Give with insulin

Glucose checks ; check for fluid over load; electrolytes and daily weights

Why would be check for fluid overload???

Answer 16

TPN - In vein

It’s more concentrated and has higher osmolarity

Question 17

If on iron with peg tube inform patient about what??

Who all may be involved with discharge of this client

Home health or family support if can’t care for self

Answer 17

May cause constipation - drink water, fiber , exercise

Nurse , doctor, dietitian , pharmacist, case manager

Question 18

*Overweight BMI-

Obese BMI -

Morbidly obese BMI -

Muscle doesn’t count with BMI

Answer 18

Overweight - 25-29

Obese - 30 or more

Morbidly obese- 40 or more

Question 19

Obese patho

Answer 19

Adipokines- hormones

Leptin resistance- hormone

Environment

Genetics

Behavior, ignorance

Diet high in saturated fat

Sedentary lifestyle

Medications

Question 20

Main physical assessment with obesity

Answer 20

Skin assessment

Question 21

Surgery for obesity that limits the amount of food aten at once

Quick wt loss, gastric bypass, more invasive with complications

Patients need to agree to lifestyle modifications to keep wt off

Answer 21

Gastric restriction

Malabsorption

Question 22

Why doctors want people to loose wt before bariatric surgery?

Priority after surgery ?

Answer 22

Obese ppl are often at risk for post surgical clots/ DVT and decreased airways

Airway

Place in semi flowers, monitor o2 sat, remove cath with in 24 hours, asses skin, and binder, absorbent padding compression hose and or heparin

Question 23

Bariatric surgery post surgery

Answer 23

DVT- get up and ambulated ASAP post op

Watch for abdominal girth-Astomatic leaks- from surgical site (and pain, radiate to shoulder , fever, high pulse , decreased urine)

6 small feeding and prevent dehydration post op

Dumping syndrome can occur- food moves too quickly to stomach - high pulse , and abd cramping, nasuea , loose stools

Question 24

Page 1231

Chart 60-7

Identify behavior patterns to maintain the weight loss

Diet progression

Vitamin and mineral supplements guidelines

Meal planning

Know s/s of complications

Answer 24

Notify provider with - fever, pain, draining , red, hot , DVT , chest pain , breathing issues, n/v

Question 25

Malnutrition risks

Answer 25

Decreased appetite 
Wt loss 
Poor fitting dentures 
Dry mouth 
General weakness 
Difficulty ambulation 

Prealbumin low example :13

Question 26

Failure to thrive risks

Answer 26

Weakness
Unintentional wt loss
Slow walking
Exhaustion

Question 27

How to help promote oral nutrition intake

Answer 27

Delegate UAP to feed patient

Provide mouth care before each meal

Assist the patient to sit upright in chair

Order foods that patient likes