Adult Health- Care of Patients with Malnutrition Chapter 60

Question 1

What does proper nutrition do?

Answer 1

regulates body temperature, respirations, cardiac output, muscle function, metabolism

Question 2

What is energy balance?

Answer 2

relationship between energy used and energy stored

Question 3

Which population is at risk for malnutrition?

Answer 3

: older adults (60 and up) due to hormonal changes feel les hungry. At risk for malnutrition

Question 4

What are the dietary guidelines for Americans?

Answer 4

The 2010 Dietary Guidelines was designed to help people choose a healthy diet. It emphasizes 3 major goals for Americans:
Balance calories with physical activity to manage weight
Consume more of certain foods and nutrients such as fruits, vegetables, whole grains, fat-free and low-fat dairy products, and seafood
Consume fewer foods with sodium (salt), saturated fats, trans fats, cholesterol, added sugars, and refined grains

Question 5

What are the top 3 vegetarian diets?

Answer 5

lacto-vegetarians, lacto-ovo, vegan

Question 6

What are Lacto-vegetarians?

Answer 6

consume milk and milk products

Question 7

What are lacto-ovo?

Answer 7

includes milk and eggs

Question 8

what is vegan?

Answer 8

only plant origin food.

Question 9

Vegetarians are at risk for developing _______ anemia?

Answer 9

B12

Question 10

Must ensure that vegetarians consume adequate amounts of what?

Answer 10

Ca, Iron, Zinc, Vitamin D & B12

Question 11

What is nutritional status?

Answer 11

reflects the balance between nutrient intake and requirements- Affected by age, gender, disease, economic factors, eating behaviors cultural influence and emotional balance

Question 12

JCT requires nutritional screening on all hospitalized patients within the first ______ hours?

Answer 12

24

Question 13

What is included in a nutritional screening?

Answer 13

Review of nutrition history
Food and fluid intake
Labs
Food-drug interactions
Anthropometric measures ( Height, Weight, BMI)
Psychosocial assessment 
BMI= Weight in Kg/ height in m2

Question 14

What is marasmus?

Answer 14

fat and protein are wasted (serum protein OK)

Question 15

What is Kawashiorkor?

Answer 15

low protein quantity and quality (serum protein Low)

Question 16

What are the 3 protein energy malnutrition things?

Answer 16

Marasmus, Kawashiorkor and a combo of both—- all of these negatively affect the functions of the liver, heart, lungs, and the GI tract

Question 17

What are the common complications of malnutrition?

Answer 17

Muscle wasting,
Low activity tolerance
Lethargy
Cold intolerance
Edema
Dry flaky skin
Poor wound healing
Infections

Question 18

2 disease contributing to malnutrition are?

Answer 18

anorexia and bulimia

Question 19

Describe a malnutrition assessment,

Answer 19

Ask about appetite and any weight changes
Hair ( hair loss)
Skin ( dry, flaky, slow healing wounds
Nails (brittle, discolored)
Eyes
Oral cavity
Assess difficulty swallowing (pain with chewing)
Neurologic status

Question 20

What are some labs that would go along with a malnutrition assessment?

Answer 20

Low H&H (anemias, hemorrhage, liver issues)
Thyroxine binding prealbumin (nutritional deficiency)
Cholesterol less then 160
Total lymphocyte count (TLC) low
Immune function measurement

Question 21

What are some nursing interventions for malnourishment?

Answer 21

-Collaborative effort to improve nutritional status
-High calorie high protein food
-6 small meals per day
-Nutritional supplements
-Special supplements for diabetics, kidney and liver patients
Multivitamins
-Iron-constipation
-Zinc- nausea and vomiting
Can also incorperate bolus, continuous and cyclic feedings

Question 22

What are specialized nutrition support?

Answer 22

TEN or TPN

Question 23

What is listed under TEN?

Answer 23

Nasogastric tube
Nasoduodenal tube
PEG tube
PEG/J tube

Question 24

What are some TEN complications?

Answer 24

Obstructed tube, refeeding, tube displacement, abdominal distension, fluid and electrolyte imbalance

Question 25

What do you do if you have an obstructed tube?

Answer 25

Flush the tube with 20-30 ml H2O q4 hours, before and after each feeding & drug administration If clogged use 30 ml H2O and flush

Question 26

What is refeeding?

Answer 26

Due to aggressive re-nourishment | Start slow

Question 27

What do you do with tube displacement and what can happen?

Answer 27

``` Can cause aspiration Fever, tachycardia, dehydration, low output Listen to lungs q 4-8 hours Pull the tube out X-ray to confirm placement ```

Question 28

What do you do if you have abdominal distension and what usually causes it?

Answer 28

Overfeeding Check residual q 4-8 hours If >200ml during 2 consecutive checks hold feedings Problem with checking may indicate clogged tube

Question 29

What causes the fluid and electrolyte imbalance?

Answer 29

Due to comorbidities (cardiac, kidney) Caution with osmolal ity of feeding liquid Hyperkalemia and hypernatrimia

Question 30

Describe PPN

Answer 30

Picc line IV fat emulsion IVFE ( isotonic) Amino acid dextrose solution Home care: collaborative teaching of diet and nutrition Enteral or parenteral nutrition-home services

Question 31

Describe TPN

Answer 31

``` Picc line Infusion pump Fluid imbalances Daily weights Serum electrolyte levels ```

Question 32

Describe Obesity

Answer 32

Occurs because patient does not consume enough healthy nutrients Overweight 10% over ideal BMI Obesity 20% over ideal BMI

Question 33

What are the risk factors for obesity?

Answer 33

Risk factors: high fat and cholesterol diet. Inactivity, medications: steroids, hormones, antihypertensive medicine

Question 34

What are some complications for obesity?

Answer 34

``` Type 2 diabetes mellitus Hypertension Hyperlipidemia CAD Stroke Peripheral artery disease Metabolic syndrome Depression /mental disturbances Urinary incontinence Cholelithiasis Gout Back pain (musculoskeletal degeneration) Decreased wound healing….. ```

Question 35

What is included in an obesity assessment?

Answer 35

``` Nutrition History 24 hour food intake Height, Weight, BMI Skin assessment – panniculus Yeast infections Diets ```

Question 36

What is panniculus?

Answer 36

is a medical term describing a dense layer of fatty tissue growth, consisting of subcutaneous fat in the lower abdominal area. It can be a result of obesity and can be mistaken for a tumor or hernia.

Question 37

What are some nursing interventions for obesity?

Answer 37

``` Diet programs Short term fasting program Protein sparing and liquid formulas low calorie diets 200-800 calories Requires medical supervision Nutritional education Unbalanced low energy diets Atkins, south beach Restriction of one or more nutrients Novelty diets Grapefruit diet Nutritionally inadequate Nutritionally balanced diet 1200 calories (vitamins and nutrients) Weight watchers Behavioral modifications Food diary Counseling Exercises Structured program 30-40 minute walk 5 days a week Nutritional therapy Nutritionist develops a plan based on age, gender Lose 1-2 pounds per week ```

Question 38

Describe obesity drug therapy

Answer 38

Anorectic drugs- suppress appetite Oristat -Inhibits lipase leading to partial hydrolisis or triglicerides -GI upset, Loose stools, cramps nausea Lorcaserin -Activates serotonin 2L- makes body feel full -Headache dizziness, dry mouth, constipation Phentermine-topiramate -Combination of weight loss medication and seizure medication -Tachycardia, tingling, dizziness, constipation

Question 39

Describe surgical management for obesity.

Answer 39

``` BMI >35 & comorbidities Plastic surgery Bariatric surgery Restrictive Malabsorption Combination Preoperative Multi-team approach ```

Question 40

Describe post operative care for obesity

Answer 40

``` Airway management Pain Semi-fowler position Sequential devices Skin break down NG tubes Diet Clear liquids 1oz 48 hours pureed foods, soup, milk ( up to 6 weeks) Progress to regular diet ```

Question 41

Describe the complications to look for after surgical management.

Answer 41

``` Anastomotic leak -Life-threatening complication -Back, shoulder or abdominal pain -Restlessness, - tachycardia -olyguria Ambulation -Q 4 hours up to 6 weeks Dumping syndrome -Food goes straight into small bowel -Tachycardia -Diarrhea -Cramping ```