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Lewis’s Medical Surgical Nursing > Chapter 44 Nutrition Problems > Flashcards

Chapter 44 Nutrition Problems Flashcards

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1
Q

What is nutrition the sum of?

A

Processes by which one takes in and uses nutrients

Nutrition encompasses ingestion, absorption, digestion, and metabolism of nutrients.

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2
Q

What are the three categories of nutrition status?

A

Undernutrition, normal nutrition, overnutrition

These categories reflect the continuum of nutritional health.

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3
Q

What can cause nutrition problems?

A

Any change in nutrient intake or use

Nutrition problems can arise from various factors affecting food consumption and utilization.

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4
Q

Are nutrition problems limited to specific demographics?

A

No, they occur in all ages, cultures, ethnic groups, and socioeconomic classes

Nutrition issues are universal and not confined to any particular group.

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5
Q

What influences our attitudes towards food?

A

Cultural or religious practices, financial status, community resources

These factors shape individual dietary habits and choices.

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6
Q

What is the importance of nutrition?

A

Energy, growth, maintaining and repairing body tissues

Proper nutrition is fundamental for overall health and bodily functions.

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7
Q

What results from optimal nutrition in the absence of disease?

A

Eating a balanced diet

A balanced diet includes appropriate proportions of macronutrients and micronutrients.

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8
Q

List the major components of the basic food groups.

A
  • Macronutrients (carbohydrates, fats, proteins)
  • Micronutrients (vitamins, minerals, electrolytes)
  • Water

These components are essential for maintaining health.

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9
Q

What factors influence a person’s daily caloric requirements?

A
  • Body type
  • Age
  • Gender
  • Medications
  • Physical activity
  • Presence of disease

Each of these factors can alter energy needs.

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10
Q

What equation calculates daily adult energy requirements?

A

Mifflin-St. Jeor equation

This equation is based on resting metabolic rate.

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11
Q

How can one estimate daily caloric needs simply?

A

Kilocalories per kilogram (kcal/kg)

A common recommendation is 20 to 25 cal/kg body weight.

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12
Q

Fill in the blank: Optimal nutrition and daily physical activity are essential for _______.

A

[health]

Both nutrition and physical activity play critical roles in overall well-being.

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13
Q

What is the calorie intake recommended for weight loss?

A

Around 20 to 25 cal/kg.

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14
Q

What is the calorie intake recommended for weight maintenance?

A

25 to 30 cal/kg.

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15
Q

What calorie intake may those with injury or illness need?

A

At least 30 to 35 cal/kg.

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16
Q

What is the main source of energy for the body?

A

Carbohydrates.

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17
Q

How many calories do carbohydrates yield per gram?

A

4 cal/g.

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18
Q

What are the two classifications of carbohydrates?

A

Simple and complex.

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19
Q

What are monosaccharides?

A

Single sugar units such as glucose and fructose.

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20
Q

What are disaccharides?

A

Two sugar units such as sucrose, maltose, and lactose.

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21
Q

What are polysaccharides?

A

Complex carbohydrates such as starches.

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22
Q

What percentage of total calories should come from carbohydrates according to DRI?

A

45% to 65%.

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23
Q

How much fiber should a person consume per 1000 calories?

A

Around 14 g.

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24
Q

What is the recommended daily fiber intake for a 2000-calorie diet?

A

28 to 30 g.

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25
What is the calorie yield of one gram of fat?
9 calories.
26
What percentage of total calories should fats comprise?
20% to 35%.
27
What are the two types of fats?
Potentially harmful fats and healthier fats.
28
What type of fat may be especially beneficial to heart health?
Omega-3 fatty acids.
29
What is the recommended daily limit of saturated fat in a 2000-calorie diet?
Less than 10% of calories, about 20 g.
30
What are proteins essential for?
Tissue growth, repair, maintenance, regulatory functions, and energy production.
31
What percentage of daily caloric needs should come from protein?
10% to 35%.
32
What is the recommended daily protein intake for an average person?
0.8 to 1 g/kg of body weight.
33
How many calories does one gram of protein yield?
4 calories.
34
What are the basic units of protein structure?
Amino acids.
35
How many essential amino acids are there?
9 essential amino acids.
36
What are complete proteins?
Proteins that contain all essential amino acids.
37
What are vitamins needed for?
Normal metabolism.
38
What are the two categories of vitamins?
Water-soluble and fat-soluble vitamins.
39
Which vitamins are fat-soluble?
Vitamins A, D, E, and K.
40
What are mineral salts needed for?
Building and repairing tissues, regulating body fluids, and assisting in various functions.
41
What are major minerals?
Minerals needed in amounts greater than 100 mg/day.
42
What are trace elements?
Minerals present in minute amounts.
43
What can happen if fat-soluble vitamins are consumed in excess?
Toxicity.
44
What is the range of trace minerals to major minerals in a well-balanced diet?
From a few micrograms of trace minerals to 1 g or more of major minerals such as calcium, phosphorus, and sodium.
45
What is a common characteristic among all vegetarians?
The exclusion of red meat from the diet.
46
What are the two main types of vegetarians?
* Vegans (pure or total vegetarians who eat only plants) * Lacto-ovo-vegetarians (eat plants, dairy products, and eggs)
47
What is a potential risk for vegetarians without a well-planned diet?
Vitamin or protein deficiencies.
48
How can the nutritional value of plant proteins be increased?
By combining different vegetable protein foods, such as cornmeal and kidney beans.
49
What is an excellent protein source for vegetarians that should be calcium fortified?
Milk made from soybeans or almonds.
50
What is the main deficiency for strict vegans?
A lack of cobalamin (vitamin B12).
51
What can develop in vegans not using cobalamin supplements?
Megaloblastic anemia and neurologic signs of cobalamin deficiency.
52
What other deficiencies may vegans and lacto-ovo-vegetarians face?
* Calcium * Zinc * Vitamins A and D
53
What is malnutrition?
A deficit, excess, or imbalance in a person's intake of energy and/or nutrients.
54
What are the two terms often used interchangeably with malnutrition?
* Undernutrition * Overnutrition
55
What does overnutrition refer to?
The ingestion of more food than is required for body needs, as in obesity.
56
What occurs during undernutrition?
Nutrition reserves are depleted and nutrient and energy intake are not sufficient to meet daily needs or added metabolic stress.
57
What is the prevalence range of malnutrition in hospital settings?
30% to 50%.
58
What is the prevalence of malnutrition among community-dwelling older adults?
About 6%.
59
What is the prevalence of malnutrition in rehabilitation settings for older adults?
Up to 50%.
60
What cultural factors can influence a person's diet?
Beliefs and behaviors related to food, including religion.
61
What should be assessed in a patient's diet history?
The extent to which they adhere to diet practices.
62
True or False: Acculturation can affect diet practices.
True.
63
What is an example of dietary adjustment for a Jewish patient?
Ensuring that an enteral feeding formula is Kosher.
64
What adjustment may be needed for a Muslim patient during Ramadan?
Meal plans should be adjusted to accommodate fasting during daylight hours.
65
Fill in the blank: Malnutrition affects _______ and functional status.
body composition
66
What is starvation-related malnutrition?
Occurs when nutrition needs are not met with chronic starvation without inflammation ## Footnote Example: anorexia nervosa
67
What characterizes chronic disease-related malnutrition?
Diet intake does not meet tissue needs due to sustained mild to moderate inflammation ## Footnote Examples: organ failure, cancer, rheumatoid arthritis, obesity
68
What is acute disease-related or injury-related malnutrition?
Related to acute disease or injury states with marked inflammatory response ## Footnote Example: major infection, burns, trauma, surgery
69
List four contributing factors to malnutrition.
* Socio-economic factors * Physical illnesses * Incomplete diets * Drug-nutrient interactions
70
What is food insecurity?
Inadequate access to food, affecting the quality and nutritional value of available food ## Footnote Often leads to choosing less expensive, energy-dense foods
71
What are safety net programs?
Programs that help people obtain food, including food assistance and housing subsidies ## Footnote Examples: Meals on Wheels, food pantries
72
What does the 'heat or eat' phenomenon refer to?
Struggle of individuals with limited economic resources to pay for bills or food ## Footnote Older adults on fixed incomes face this dilemma
73
How can prolonged illness contribute to malnutrition?
It can lead to undernutrition, which worsens pathologic conditions ## Footnote Examples: major surgery, sepsis, draining wounds
74
What are some conditions that increase the risk for malnutrition?
* Chronic alcohol use * Decreased mobility * Dementia * Depression * Drugs with antinutrient properties * Excess dieting * Need for increased nutrients due to hypermetabolism * No oral intake for extended periods * Nutrient losses from malabsorption * Swallowing problems
75
Fill in the blank: Malnutrition is a common consequence of _______.
[illness, surgery, injury, or hospitalization]
76
What is the recommended daily intake of Vitamin A (retinol) for men?
900 mcg/retinol equivalents ## Footnote This refers to the dietary reference intake for adult men.
77
What is the recommended daily intake of Vitamin A (retinol) for women?
700 mcg/retinol equivalents ## Footnote This refers to the dietary reference intake for adult women.
78
What is the recommended daily intake of Vitamin D for adults aged 19-70?
600 IU ## Footnote IU stands for International Units, a measure of vitamin potency.
79
What is the recommended daily intake of Vitamin D for adults over 70?
800 IU ## Footnote This increase accounts for changes in metabolism with age.
80
What is the recommended daily intake of Vitamin E for adults?
15 mg ## Footnote Vitamin E is important for immune function and skin health.
81
What is the recommended daily intake of Vitamin K for men?
120 mcg ## Footnote Vitamin K is essential for blood coagulation.
82
What is the recommended daily intake of Vitamin K for women?
90 mcg ## Footnote This amount supports bone health and blood clotting.
83
List the manifestations of Vitamin A deficiency.
* Dry, scaly skin * Increased susceptibility to infection * Night blindness * Anorexia * Eye irritation * Keratinization of respiratory and GI mucosa * Bladder stones * Anemia * Retarded growth ## Footnote These symptoms highlight the importance of Vitamin A in immune function and vision.
84
List the manifestations of Vitamin D deficiency.
* Muscular weakness * Excessive sweating * Diarrhea and other GI problems * Bone pain * Active or healed rickets * Osteomalacia ## Footnote Vitamin D is crucial for calcium absorption and bone health.
85
List the manifestations of Vitamin E deficiency.
* Neurologic deficits * Blood coagulation problems ## Footnote Vitamin E acts as an antioxidant and supports neurological function.
86
What is the recommended daily intake of Vitamin B1 (thiamine) for men?
1.2 mg ## Footnote Thiamine is important for energy metabolism.
87
What is the recommended daily intake of Vitamin B1 (thiamine) for women?
1.1 mg ## Footnote This vitamin is vital for nerve function and carbohydrate metabolism.
88
What are the manifestations of Vitamin B6 (pyridoxine) deficiency?
* Seizures * Dermatitis * Anemia * Neuropathy with motor weakness * Anorexia ## Footnote Vitamin B6 is involved in amino acid metabolism and neurotransmitter synthesis.
89
What is the recommended daily intake of Vitamin B12 (cobalamin) for adults?
2.4 mcg ## Footnote Vitamin B12 is essential for red blood cell formation and neurological function.
90
List the manifestations of Vitamin B12 deficiency.
* Megaloblastic anemia * Anorexia * Glossitis * Sore mouth and tongue * Pallor * Neurologic problems (e.g., depression, dizziness) * Weight loss * Nausea * Constipation ## Footnote These symptoms can indicate severe deficiencies affecting blood and nerve health.
91
What is the recommended daily intake of Folate (folic acid) for men?
90 mg ## Footnote Folate is critical for DNA synthesis and cell division.
92
What is the recommended daily intake of Folate (folic acid) for women?
75 mg ## Footnote Folate is especially important for women of childbearing age to prevent neural tube defects.
93
What are the manifestations of Folate deficiency?
* Impaired cell division and protein synthesis * Megaloblastic anemia * Anorexia * Fatigue * Sore tongue * Diarrhea * Forgetfulness ## Footnote These symptoms underscore the role of folate in cellular processes.
94
What is the recommended daily intake of Vitamin A (retinol) for men?
900 mcg/retinol equivalents ## Footnote This refers to the dietary reference intake for adult men.
95
What is the recommended daily intake of Vitamin A (retinol) for women?
700 mcg/retinol equivalents ## Footnote This refers to the dietary reference intake for adult women.
96
What is the recommended daily intake of Vitamin D for adults aged 19-70?
600 IU ## Footnote IU stands for International Units, a measure of vitamin potency.
97
What is the recommended daily intake of Vitamin D for adults over 70?
800 IU ## Footnote This increase accounts for changes in metabolism with age.
98
What is the recommended daily intake of Vitamin E for adults?
15 mg ## Footnote Vitamin E is important for immune function and skin health.
99
What is the recommended daily intake of Vitamin K for men?
120 mcg ## Footnote Vitamin K is essential for blood coagulation.
100
What is the recommended daily intake of Vitamin K for women?
90 mcg ## Footnote This amount supports bone health and blood clotting.
101
List the manifestations of Vitamin A deficiency.
* Dry, scaly skin * Increased susceptibility to infection * Night blindness * Anorexia * Eye irritation * Keratinization of respiratory and GI mucosa * Bladder stones * Anemia * Retarded growth ## Footnote These symptoms highlight the importance of Vitamin A in immune function and vision.
102
List the manifestations of Vitamin D deficiency.
* Muscular weakness * Excessive sweating * Diarrhea and other GI problems * Bone pain * Active or healed rickets * Osteomalacia ## Footnote Vitamin D is crucial for calcium absorption and bone health.
103
List the manifestations of Vitamin E deficiency.
* Neurologic deficits * Blood coagulation problems ## Footnote Vitamin E acts as an antioxidant and supports neurological function.
104
What is the recommended daily intake of Vitamin B1 (thiamine) for men?
1.2 mg ## Footnote Thiamine is important for energy metabolism.
105
What is the recommended daily intake of Vitamin B1 (thiamine) for women?
1.1 mg ## Footnote This vitamin is vital for nerve function and carbohydrate metabolism.
106
What are the manifestations of Vitamin B6 (pyridoxine) deficiency?
* Seizures * Dermatitis * Anemia * Neuropathy with motor weakness * Anorexia ## Footnote Vitamin B6 is involved in amino acid metabolism and neurotransmitter synthesis.
107
What is the recommended daily intake of Vitamin B12 (cobalamin) for adults?
2.4 mcg ## Footnote Vitamin B12 is essential for red blood cell formation and neurological function.
108
List the manifestations of Vitamin B12 deficiency.
* Megaloblastic anemia * Anorexia * Glossitis * Sore mouth and tongue * Pallor * Neurologic problems (e.g., depression, dizziness) * Weight loss * Nausea * Constipation ## Footnote These symptoms can indicate severe deficiencies affecting blood and nerve health.
109
What is the recommended daily intake of Folate (folic acid) for men?
90 mg ## Footnote Folate is critical for DNA synthesis and cell division.
110
What is the recommended daily intake of Folate (folic acid) for women?
75 mg ## Footnote Folate is especially important for women of childbearing age to prevent neural tube defects.
111
What are the manifestations of Folate deficiency?
* Impaired cell division and protein synthesis * Megaloblastic anemia * Anorexia * Fatigue * Sore tongue * Diarrhea * Forgetfulness ## Footnote These symptoms underscore the role of folate in cellular processes.
112
What is the conversion factor of retinol equivalent to international units of vitamin A activity?
1 retinol equivalent = 10 international units of vitamin A activity ## Footnote This conversion is essential for understanding vitamin A dosages.
113
What symptoms may accompany gastrointestinal disease?
* Anorexia * Nausea * Vomiting * Diarrhea * Abdominal distention * Abdominal cramping ## Footnote These symptoms can interfere with normal food intake and metabolism.
114
What is malabsorption syndrome?
Impaired absorption of nutrients from the GI tract ## Footnote This condition can result from decreases in digestive enzymes or bowel processes.
115
How do antibiotics affect biotin production?
Antibiotics can change the normal flora of the intestines, decreasing the body's ability to make biotin ## Footnote Biotin is a B-complex vitamin dependent on gut flora for its production.
116
What effect does fever have on basal metabolic rate (BMR)?
Each degree of temperature increase raises BMR by about 7% ## Footnote Increased BMR leads to nitrogen loss and protein depletion if caloric intake does not increase.
117
What risk do patients undergoing diagnostic studies face regarding nutrition?
Patients can become malnourished due to diet restrictions imposed by multiple diagnostic studies ## Footnote This occurs even if patients are nutritionally fit upon entering the hospital.
118
In which populations are vitamin deficiencies likely to occur?
* Persons with alcohol and drug use patterns * Chronically ill individuals * Those who follow poor dietary practices * Individuals who have had GI tract surgery ## Footnote Surgery, like ileum resection, can increase the risk of deficiencies in fat-soluble vitamins.
119
What are the manifestations of vitamin imbalances?
Manifestations can range from skin problems to neurologic signs ## Footnote The severity and type of symptoms depend on which vitamins are imbalanced.
120
What defines a drug-nutrient interaction?
A drug affects the use of nutrients in the body ## Footnote These interactions can lead to adverse effects like altered drug effectiveness and impaired nutrition.
121
How can grapefruit juice affect drug absorption?
Grapefruit juice can increase the absorption of some drugs, enhancing their effect ## Footnote This interaction is important to monitor in clinical settings.
122
What is the pathophysiology of starvation?
Physiologic changes occur in the body during starvation ## Footnote Understanding these changes can help in managing patients who are malnourished.
123
What does the body primarily use to meet metabolic needs during early malnutrition?
Carbohydrates (glycogen) ## Footnote Carbohydrate stores are minimal and can be depleted within 18 hours.
124
What process does the body initiate once carbohydrate stores are depleted?
Gluconeogenesis ## Footnote The liver converts skeletal protein to glucose for energy.
125
Which amino acids are the first used in gluconeogenesis?
* Alanine * Glutamine
126
What happens to nitrogen balance when amino acids are used as energy sources?
Negative nitrogen balance occurs ## Footnote Nitrogen excretion exceeds nitrogen intake.
127
Within how many days does the body start using fat to supply energy during starvation?
5 to 9 days
128
What percentage of calories can fat provide in prolonged starvation?
Up to 97%
129
What happens to body proteins once fat stores are depleted?
Visceral and body proteins are used as energy ## Footnote This includes proteins in internal organs and plasma.
130
What effect does surgery, physical trauma, or infection have on a malnourished patient?
Increased metabolic energy expenditure
131
What occurs as protein depletion continues in a malnourished patient?
Liver function becomes impaired and protein synthesis decreases.
132
What is the major function of plasma proteins, primarily albumin?
To maintain the osmotic pressure of blood.
133
What happens to body fluids when plasma oncotic pressure decreases?
Body fluids shift from the vascular space into the interstitial compartment.
134
What observable sign can result from fluid leaking into the interstitial space?
Edema ## Footnote Edema in the face and legs can mask underlying muscle wasting.
135
What happens to sodium and potassium concentrations during malnutrition?
* Sodium concentration increases in the cell * Potassium shifts to the extracellular space
136
What percentage of calories does the sodium-potassium exchange pump use?
20% to 50%
137
What organ loses the most mass during protein deprivation?
Liver
138
What happens to the liver due to decreased synthesis of lipoproteins?
Fat gradually infiltrates the liver.
139
What is a significant outcome if a malnourished person does not receive protein and necessary nutrients?
Death will rapidly ensue.
140
How does inflammation affect nutrient metabolism?
It increases protein and skeletal muscle breakdown and increases BMR.
141
What are proinflammatory cytokines related to inflammation?
* Interleukin-6 (IL-6)
142
What are anti-inflammatory cytokines related to inflammation?
* IL-10
143
What are some clinical manifestations of malnutrition?
* Dry and scaly skin * Brittle nails * Rashes * Hair loss * Crusting and ulceration in the mouth * Decreased muscle mass and weakness * Mental changes
144
What factors affect the speed at which malnutrition develops?
* Quantity and quality of protein intake * Caloric value * Illness * Person's age
145
What is the best way to determine malnutrition?
Assessment of nutrient intake, functional status, and body composition.
146
What laboratory tests can reflect changes in malnutrition?
* Serum electrolyte levels * RBC count * Hemoglobin level * Total lymphocyte count
147
What happens to the total lymphocyte count with malnutrition?
It decreases.
148
What are important health history factors related to malnutrition?
* Severe burns * Major trauma * Hemorrhage * Draining wounds * Bone fractures with prolonged immobility * Chronic renal or liver disease * Cancer * Malabsorption syndromes * Gastrointestinal obstruction * Infectious diseases * Acute trauma * Sepsis * Chronic inflammatory conditions (e.g., rheumatoid arthritis) ## Footnote These factors can significantly impact nutritional status and contribute to malnutrition.
149
Which medications are associated with malnutrition?
* Corticosteroids * Chemotherapy * Diet pills * Diet supplements * Herbs ## Footnote Certain medications can affect appetite, nutrient absorption, and metabolism.
150
What surgical or treatment history factors are relevant for malnutrition assessment?
* Recent surgery * Radiation ## Footnote Surgical interventions can influence nutritional needs and absorption.
151
What are subjective data indicators of malnutrition in health perception?
* Alcohol or drug use * Malaise ## Footnote These factors can affect overall health management and nutritional status.
152
List indicators of nutritional-metabolic changes in malnutrition assessment.
* Increase or decrease in weight * Weight problems * Increase or decrease in appetite * Typical diet intake * Food preferences and aversions * Food allergies or intolerance * Ill-fitting or absent dentures * Dry mouth * Problems chewing or swallowing * Bloating or gas * Sensitivity to cold * Delayed wound healing ## Footnote These indicators help assess the nutritional needs and challenges faced by the individual.
153
What elimination patterns may indicate malnutrition?
* Constipation * Diarrhea * Nocturia * Decreased urine output ## Footnote Changes in elimination patterns can reflect underlying nutritional issues.
154
What activity-exercise changes can suggest malnutrition?
* Increase or decrease in activity * Weakness * Fatigue * Decreased endurance ## Footnote These changes may indicate a lack of energy or nutrients necessary for physical performance.
155
What cognitive-perceptual symptoms are associated with malnutrition?
* Pain in mouth * Paresthesias * Loss of position sense * Loss of vibratory sense ## Footnote Neurological symptoms can arise from nutritional deficiencies.
156
What role-relationship factors may affect nutritional status?
* Change in family (e.g., loss of a spouse) * Financial resources * Food availability ## Footnote Social factors can greatly influence access to and the ability to maintain a nutritious diet.
157
What sexual-reproductive issues may indicate malnutrition?
* Amenorrhea * Impotence * Decreased libido ## Footnote These issues can stem from hormonal imbalances related to nutritional deficiencies.
158
What are general objective data signs of malnutrition?
* Listless * Cachectic * Underweight for height ## Footnote Physical appearance can provide immediate insight into nutritional status.
159
What cardiovascular signs may indicate malnutrition?
* Low heart rate * Low blood pressure * Dysrhythmias * Peripheral edema ## Footnote Cardiovascular health can be compromised due to malnutrition.
160
What eye symptoms are indicative of malnutrition?
* Pale or red conjunctivae * Gray keratinized epithelium on conjunctiva (Bitot spots) * Dryness and dull appearance of conjunctivae and cornea * Soft cornea * Blood vessel growth in cornea * Redness and fissuring of eyelid corners ## Footnote These signs can reflect vitamin deficiencies, particularly vitamin A.
161
What gastrointestinal signs may suggest malnutrition?
* Swollen, smooth, raw, beefy red tongue (glossitis) * Hypertrophic or atrophic papillae * Dental cavities * Absent or loose teeth * Discolored tooth enamel * Spongy, pale, receded gums * Ulcerations, white patches, or plaques * Distended abdomen * Ascites * Hepatomegaly * Decreased bowel sounds * Steatorrhea ## Footnote These symptoms can indicate deficiencies in essential nutrients.
162
What musculoskeletal signs are associated with malnutrition?
* Decreased muscle mass * Poor tone * Wasted appearance * Bowlegs * Knock-knees * Beaded ribs * Chest deformity * Prominent bony structures ## Footnote Musculoskeletal changes can reflect inadequate protein and caloric intake.
163
What neurologic signs may indicate malnutrition?
* Decreased or loss of reflexes * Tremor * Irritability * Confusion * Syncope * Peripheral neuropathy ## Footnote Neurological issues can arise from deficiencies in B vitamins and other nutrients.
164
What respiratory signs may be present in malnutrition?
* Increased respiratory rate * Decreased vital capacity * Crackles * Weak cough * Slight cyanosis ## Footnote Respiratory function can be affected by malnutrition, leading to increased risk of respiratory illnesses.
165
What skin signs may indicate malnutrition?
* Dry, brittle, sparse hair * Color changes in hair * Alopecia * Dry, scaly lips * Fever blisters * Angular crusts and lesions at corners of mouth (cheilosis) * Brittle, ridged nails * Decreased tone and elasticity of skin * Cool, rough, dry, scaly skin * Brown-gray pigment changes * Reddened, scaly dermatitis * Scrotal dermatitis ## Footnote Skin changes can reflect deficiencies in essential fatty acids, vitamins, and minerals.
166
What are possible diagnostic findings in malnutrition?
* Low hemoglobin and hematocrit * Increased mean corpuscular volume (MCV) * Altered serum electrolyte levels (especially hyperkalemia) * Increased BUN and creatinine * Low serum albumin * Low transferrin * Low prealbumin * Increased C-reactive protein * Low lymphocytes * Increased liver enzymes * Low serum vitamin levels ## Footnote These laboratory findings can help confirm the diagnosis of malnutrition and guide treatment.
167
What are important health history factors related to malnutrition?
* Severe burns * Major trauma * Hemorrhage * Draining wounds * Bone fractures with prolonged immobility * Chronic renal or liver disease * Cancer * Malabsorption syndromes * Gastrointestinal obstruction * Infectious diseases * Acute trauma * Sepsis * Chronic inflammatory conditions (e.g., rheumatoid arthritis) ## Footnote These factors can significantly impact nutritional status and contribute to malnutrition.
168
Which medications are associated with malnutrition?
* Corticosteroids * Chemotherapy * Diet pills * Diet supplements * Herbs ## Footnote Certain medications can affect appetite, nutrient absorption, and metabolism.
169
What surgical or treatment history factors are relevant for malnutrition assessment?
* Recent surgery * Radiation ## Footnote Surgical interventions can influence nutritional needs and absorption.
170
What are subjective data indicators of malnutrition in health perception?
* Alcohol or drug use * Malaise ## Footnote These factors can affect overall health management and nutritional status.
171
List indicators of nutritional-metabolic changes in malnutrition assessment.
* Increase or decrease in weight * Weight problems * Increase or decrease in appetite * Typical diet intake * Food preferences and aversions * Food allergies or intolerance * Ill-fitting or absent dentures * Dry mouth * Problems chewing or swallowing * Bloating or gas * Sensitivity to cold * Delayed wound healing ## Footnote These indicators help assess the nutritional needs and challenges faced by the individual.
172
What elimination patterns may indicate malnutrition?
* Constipation * Diarrhea * Nocturia * Decreased urine output ## Footnote Changes in elimination patterns can reflect underlying nutritional issues.
173
What activity-exercise changes can suggest malnutrition?
* Increase or decrease in activity * Weakness * Fatigue * Decreased endurance ## Footnote These changes may indicate a lack of energy or nutrients necessary for physical performance.
174
What cognitive-perceptual symptoms are associated with malnutrition?
* Pain in mouth * Paresthesias * Loss of position sense * Loss of vibratory sense ## Footnote Neurological symptoms can arise from nutritional deficiencies.
175
What role-relationship factors may affect nutritional status?
* Change in family (e.g., loss of a spouse) * Financial resources * Food availability ## Footnote Social factors can greatly influence access to and the ability to maintain a nutritious diet.
176
What sexual-reproductive issues may indicate malnutrition?
* Amenorrhea * Impotence * Decreased libido ## Footnote These issues can stem from hormonal imbalances related to nutritional deficiencies.
177
What are general objective data signs of malnutrition?
* Listless * Cachectic * Underweight for height ## Footnote Physical appearance can provide immediate insight into nutritional status.
178
What cardiovascular signs may indicate malnutrition?
* Low heart rate * Low blood pressure * Dysrhythmias * Peripheral edema ## Footnote Cardiovascular health can be compromised due to malnutrition.
179
What eye symptoms are indicative of malnutrition?
* Pale or red conjunctivae * Gray keratinized epithelium on conjunctiva (Bitot spots) * Dryness and dull appearance of conjunctivae and cornea * Soft cornea * Blood vessel growth in cornea * Redness and fissuring of eyelid corners ## Footnote These signs can reflect vitamin deficiencies, particularly vitamin A.
180
What gastrointestinal signs may suggest malnutrition?
* Swollen, smooth, raw, beefy red tongue (glossitis) * Hypertrophic or atrophic papillae * Dental cavities * Absent or loose teeth * Discolored tooth enamel * Spongy, pale, receded gums * Ulcerations, white patches, or plaques * Distended abdomen * Ascites * Hepatomegaly * Decreased bowel sounds * Steatorrhea ## Footnote These symptoms can indicate deficiencies in essential nutrients.
181
What musculoskeletal signs are associated with malnutrition?
* Decreased muscle mass * Poor tone * Wasted appearance * Bowlegs * Knock-knees * Beaded ribs * Chest deformity * Prominent bony structures ## Footnote Musculoskeletal changes can reflect inadequate protein and caloric intake.
182
What neurologic signs may indicate malnutrition?
* Decreased or loss of reflexes * Tremor * Irritability * Confusion * Syncope * Peripheral neuropathy ## Footnote Neurological issues can arise from deficiencies in B vitamins and other nutrients.
183
What respiratory signs may be present in malnutrition?
* Increased respiratory rate * Decreased vital capacity * Crackles * Weak cough * Slight cyanosis ## Footnote Respiratory function can be affected by malnutrition, leading to increased risk of respiratory illnesses.
184
What skin signs may indicate malnutrition?
* Dry, brittle, sparse hair * Color changes in hair * Alopecia * Dry, scaly lips * Fever blisters * Angular crusts and lesions at corners of mouth (cheilosis) * Brittle, ridged nails * Decreased tone and elasticity of skin * Cool, rough, dry, scaly skin * Brown-gray pigment changes * Reddened, scaly dermatitis * Scrotal dermatitis ## Footnote Skin changes can reflect deficiencies in essential fatty acids, vitamins, and minerals.
185
What are possible diagnostic findings in malnutrition?
* Low hemoglobin and hematocrit * Increased mean corpuscular volume (MCV) * Altered serum electrolyte levels (especially hyperkalemia) * Increased BUN and creatinine * Low serum albumin * Low transferrin * Low prealbumin * Increased C-reactive protein * Low lymphocytes * Increased liver enzymes * Low serum vitamin levels ## Footnote These laboratory findings can help confirm the diagnosis of malnutrition and guide treatment.
186
What happens to liver enzyme levels in cases of malnutrition?
Liver enzyme levels may increase. ## Footnote Elevated liver enzymes can indicate liver dysfunction or damage associated with malnutrition.
187
How are serum levels of fat-soluble vitamins affected in malnutrition?
Serum levels of fat-soluble vitamins usually decrease. ## Footnote Low serum levels of fat-soluble vitamins correlate with the presence of steatorrhea (fatty stools).
188
What are albumin and prealbumin classified as during an inflammatory response?
Negative acute phase proteins. ## Footnote Their levels decrease during inflammation, indicating potential malnutrition.
189
What do low levels of albumin and prealbumin indicate?
The presence of inflammation and potential malnutrition. ## Footnote They are useful in identifying patients at risk for poor outcomes.
190
What is the nurse's responsibility regarding nutrition in care settings?
Nutrition screening across care settings. ## Footnote This helps identify those who are malnourished or at risk for malnutrition.
191
What does the Joint Commission require for all patients upon admission?
Nutrition screening within 24 hours. ## Footnote A detailed nutrition assessment is required if a patient is identified as at risk.
192
What is the purpose of using valid and reliable tools in nutrition screening?
To accurately identify those at risk for malnutrition. ## Footnote Standard approaches ensure consistency in screening.
193
What common admission assessment data is reviewed in hospital-specific screening tools?
History of weight loss, intake before admission, use of nutrition support, chewing or swallowing issues, and skin breakdown. ## Footnote These factors help determine a patient's nutritional risk.
194
What is the Malnutrition Universal Screening Tool used for?
It assesses nutrition status in adults in acute care. ## Footnote This tool helps identify malnutrition risk in hospitalized patients.
195
Which tool is used to assess nutrition status in older adults?
MNA (Mini Nutritional Assessment). ## Footnote This tool is specifically designed for geriatric populations.
196
What form is used in long-term care to obtain nutrition information?
Minimum Data Set (MDS) form. ## Footnote This form collects comprehensive data on residents' nutritional status.
197
Which assessment tool is used in home care settings?
Outcome and Assessment Information Set (OASIS). ## Footnote OASIS collects information on diet, oral intake, dental health, swallowing problems, and meal assistance needs.
198
What should be done if screening identifies a person at risk for malnutrition?
Perform a full nutrition assessment. ## Footnote This assessment includes medical, nutrition, and medication histories, physical assessment, and anthropometric measurements.
199
What is the purpose of a nutrition assessment?
Provides the basis for nutrition intervention.
200
What should be obtained to assess a patient's diet habits?
A complete diet history from the patient or caregiver.
201
Why is it important to assess foods eaten over the past week?
Reveals a great deal about the patient's diet habits and knowledge of good nutrition.
202
How can a patient's nutrition state impact medical care?
It may be a contributing factor to the problem and have an impact on management and recovery.
203
What anthropometric measurements should be obtained?
Height, weight, and girth measurements.
204
How is body mass index (BMI) calculated?
By measuring weight for height.
205
What are critical measurements for assessing nutrition status?
Waist circumference and hip-to-waist ratio.
206
What is a critical indicator for further assessment in older adults regarding weight?
A loss of more than 5% of usual body weight over 6 months.
207
What should be determined if involuntary weight loss exceeds 10% of the usual weight?
The reason for the weight loss.
208
What is the significance of unintentional weight loss in obese individuals?
Malnutrition can be present despite excess body weight.
209
What is the BMI range for underweight?
Less than 18.5 kg/m².
210
What is the BMI range for normal weight?
Between 18.5 and 24.9 kg/m².
211
What is the BMI range for overweight?
Between 25 and 29.9 kg/m².
212
What BMI value is considered obese?
A BMI of 30 kg/m² or greater.
213
What should be noted when assessing a patient's weight history?
Weight loss and whether it was intentional.
214
What is an alternative to standing height measurements for bedridden patients?
Using a Luft ruler.
215
What is the arm demi-span measurement?
Distance from the suprasternal notch to the web between the middle and ring fingers.
216
What BMI value is considered obese?
A BMI of 30 or greater ## Footnote BMIs outside the normal weight range are associated with increased mortality.
217
What indicators are used to assess subcutaneous fat stores?
Skintold thickness at various sites ## Footnote The most reflective sites include those over the biceps, triceps, below the scapula, above the iliac crest, and over the upper thigh.
218
Which measurements can indicate protein stores?
Midarm muscle circumference ## Footnote Both skinfold thickness and midarm circumference may decrease in malnutrition.
219
What is the focus of functional assessment in nutrition?
Performance of activities of daily living (ADLs) ## Footnote Tools used include the Katz Index and Lawton Scale.
220
How can physical functional status be assessed?
By measuring muscle strength ## Footnote Handgrip strength can be measured with a hand dynamometer.
221
What are common clinical problems associated with malnutrition?
* Nutritionally compromised * Body weight problem * Risk for impaired tissue integrity * Inadequate community resources
222
What are the overall goals for a patient with malnutrition?
* Achieve an appropriate weight * Consume a specified number of calories per day on an individualized diet * Have no adverse consequences related to malnutrition or nutrition therapies
223
What is the purpose of MyPlate?
A visual guide for sensible meal planning ## Footnote It helps Americans eat healthfully and make good food choices.
224
What are the five food groups represented in MyPlate?
* Grains * Protein * Fruits * Vegetables * Dairy
225
What resources are available for determining nutrition information?
Electronic and print sources ## Footnote Many food products have Nutrition Facts labels.
226
What should a patient do to track their nutrition and physical activity?
Use interactive web-based programs and mobile device applications ## Footnote Some applications include built-in barcode scanners to scan foods quickly.
227
What is crucial for patients with malnutrition undergoing surgery?
Increased protein and calorie intake preoperatively ## Footnote This is essential to promote healing after surgery.
228
What should be discussed with patients regarding their nutrition?
The importance of good nutrition ## Footnote Discuss daily weights, intake, and output.
229
What does ongoing recording of body weight gain or loss indicate?
Shifts in fluid balance ## Footnote Rapid gains and losses usually reflect changes in fluid rather than actual body mass.
230
What additional information is needed alongside body weight to assess a patient's nutrition state?
Accurate recording of food and fluid intake
231
What type of foods should be selected for patients who can eat by mouth?
High-calorie and high-protein foods ## Footnote Unless medically contraindicated.
232
How can patient food intake be enhanced?
Offering foods preferred by the patient
233
What should caregivers do to improve eating conditions for the patient?
Bring the patient's favorite foods from home
234
What is essential for creating a conducive environment for eating?
A quiet environment
235
What hygiene practices should be offered to patients before meals?
Oral hygiene and hand hygiene
236
What should be done to ensure the patient is comfortable during meals?
Help the patient to a comfortable position and adjust the bedside table height
237
What items should be kept out of sight to maintain a pleasant mealtime environment?
Urinals, bedpans, and emesis basins
238
What should be done to protect mealtime from interruptions?
Perform nonurgent care before or after mealtime
239
What do undernourished patients typically need in addition to regular meals?
Between-meal supplements
240
What can these between-meal supplements consist of?
Items prepared in the dietary department or commercially prepared products
241
What is the purpose of eating between-meal supplements?
To provide extra calories, proteins, fluids, and nutrients
242
What should be considered if a patient cannot consume enough nutrition through a high-calorie, high-protein diet?
Adding oral liquid supplements
243
Fill in the blank: Oral liquid supplements are widely used as an adjunct to meals and fluid intake in patients whose intake is _______.
deficient
244
What are some examples of products that provide advanced nutrition and calories?
Milkshakes, puddings, Carnation Instant Breakfast, Ensure, Boost ## Footnote These products are often used in long-term care to increase caloric intake.
245
What is the role of appetite stimulants in nutrition therapy?
To improve intake in patients who may have low appetite ## Footnote Examples include megestrol acetate and dronabinol (Marinol).
246
What is enteral nutrition (EN)?
A method of delivering nutrition directly into the gastrointestinal tract ## Footnote Used for patients unable to take in sufficient calories orally.
247
What should be considered if enteral nutrition (EN) is not possible?
Starting parenteral nutrition (PN) ## Footnote PN is an alternative for patients who cannot receive EN.
248
What is refeeding syndrome?
The body's response to the switch from starvation to a fed state during nutrition therapy ## Footnote It occurs in patients who are severely malnourished.
249
What are some conditions that predispose patients to refeeding syndrome?
* Chronic alcohol use * Cancer * Trauma * Inflammatory bowel disease * Major surgery ## Footnote These conditions increase the risk of complications during nutritional replenishment.
250
What is the hallmark of refeeding syndrome?
Hypophosphatemia ## Footnote This condition indicates low phosphate levels in the blood.
251
What are some manifestations of refeeding syndrome?
* Hyperglycemia * Fluid retention * Hypokalemia * Hypomagnesemia ## Footnote These symptoms can lead to serious complications.
252
What are some serious outcomes of refeeding syndrome?
* Dysrhythmias * Respiratory arrest ## Footnote These outcomes can be life-threatening.
253
When starting feeding in at-risk patients, what should the initial rates be?
No more than 50% of their usual energy requirements ## Footnote Gradual increases are recommended to prevent complications.
254
What is essential for patients discharged on a therapeutic diet?
Proper discharge preparation for both the patient and caregiver ## Footnote This includes education on managing their nutritional needs.
255
What should patients and caregivers be taught about undernourishment?
Causes of the undernourished state and ways to avoid the problem in the future ## Footnote Understanding this helps in maintaining proper nutrition.
256
How long may it take to fully restore a normal nutrition state after undernourishment?
Many months ## Footnote Adhering to a diet for a few weeks is often insufficient.
257
What factors should be assessed when determining a patient's ability to follow diet instructions?
* Past eating habits * Religious and ethnic preferences * Age * Income * Resources * State of health ## Footnote These factors influence dietary adherence.
258
What community resources can help provide meals?
* Meals on Wheels * Senior congregate feeding sites * Supplemental Nutrition Assistance Program (SNAP) ## Footnote These resources help support food access for those in need.
259
What does SNAP allow low-income households to do?
Buy more food of a greater variety ## Footnote This program helps improve food security.
260
What is one method for analyzing and reinforcing healthful eating patterns?
Keeping a diet diary for 3 days at a time ## Footnote This helps in tracking and improving dietary habits.
261
What are the expected outcomes for a malnourished patient?
* Achieve and maintain optimal body weight * Consume a well-balanced diet * Have no adverse outcomes related to malnutrition * Maintain optimal physical functioning ## Footnote These outcomes indicate successful nutritional rehabilitation.
262
How does nutrition affect older adults?
It affects quality of life, functional status, and health ## Footnote Older adults are particularly vulnerable to malnutrition.
263
What are some complications faced by older hospitalized adults with malnutrition?
* Poor wound healing * Pressure injuries * Infections * Decreased muscle strength * Postoperative complications * Increased mortality ## Footnote These complications highlight the importance of addressing malnutrition.
264
What factors may contribute to poor nutrition in older adults?
* Little or no appetite * Problems with eating or swallowing * Inadequate servings of nutrients * Fewer than 2 meals per day ## Footnote These factors can lead to malnutrition.
265
What role does social isolation play in nutrition among older adults?
It may decrease their desire to cook and contribute to decreased appetite ## Footnote Living alone can exacerbate nutritional issues.
266
What chronic illnesses associated with aging can affect nutrition status?
* Depression * Dysphagia (from a stroke) ## Footnote These conditions can significantly impact dietary intake.
267
What is a common oral health issue in older adults that affects nutrition?
Gum disease and missing teeth ## Footnote Poor oral health can hinder the ability to eat properly.
268
What can impair the ability to chew and swallow in older adults?
Teeth issues or dry mouth ## Footnote Medications can cause dry mouth, change the taste of food, or decrease appetite.
269
What is the daily vitamin D requirement for older adults?
Higher than younger adults ## Footnote Refer to Table 44.6 for specific values.
270
What should initial care strategies focus on for older adults?
Improving oral intake and providing a pleasant meal environment ## Footnote Special strategies may include adaptive devices and proper positioning.
271
What physiologic changes occur with aging?
Decrease in lean body mass and redistribution of fat ## Footnote This can decrease caloric requirements.
272
What is sarcopenia?
Loss of lean body mass with aging ## Footnote It affects muscle strength and function.
273
How does bed rest affect older adults compared to younger adults?
Older adults lose more lean body mass ## Footnote Prolonged inactivity exacerbates this loss.
274
What changes can affect appetite in older adults?
Changes in smell and taste ## Footnote These changes can result from medications, nutrient deficiencies, or taste-bud atrophy.
275
Who are nutritionally at-risk older adults vulnerable to?
Malnutrition when discharged from the hospital ## Footnote They may struggle to shop for or prepare foods during recovery.
276
What should be consulted to ensure access to food upon discharge?
Social worker and dietitian ## Footnote This is crucial for older adults recovering at home.
277
Fill in the blank: Older adults may need to increase their _______ to prevent loss of muscle mass.
Caloric intake
278
True or False: Older adults with dementia face unique challenges regarding eating and feeding.
True
279
What are some nutrition support therapies for older adults unable to consent?
Enteral Nutrition (EN) and Parenteral Nutrition (PN) ## Footnote Review advance directives regarding artificial nutrition and hydration.
280
What is the purpose of community nutrition programs?
To improve meal intake and make mealtime a pleasant, social event.
281
What is specialized nutrition support?
Nutrition support needed when patients cannot maintain or achieve adequate nutrition status.
282
Who are key members of a nutrition support team?
* Nutrition support nurse * Healthcare provider (HCP) * Dietitian * Pharmacist
283
What is enteral nutrition (EN)?
Nutrition delivered through a tube, catheter, or stoma directly into the GI tract.
284
When is enteral nutrition used?
For patients with a functioning GI tract who cannot take oral nourishment safely or adequately.
285
List some indications for enteral nutrition.
* Anorexia * Orofacial fractures * Head and neck cancer * Neurologic or psychiatric conditions * Extensive burns * Critical illness requiring mechanical ventilation * Chemotherapy or radiation therapy
286
What are contraindications for enteral nutrition?
* GI obstruction * Prolonged ileus * Severe diarrhea or vomiting * Enterocutaneous fistula
287
How does enteral nutrition compare to parenteral nutrition (PN)?
EN is easier to administer, safer, more physiologically efficient, and less expensive than PN.
288
What factors vary among enteral nutrition formulas?
* Concentration * Flavor * Osmolality * Amounts of protein, sodium, and fat
289
What is the osmolality of an enteral nutrition formula determined by?
The number and size of particles in the formula.
290
Fill in the blank: A formula with high sodium content is contraindicated in patients with _______.
[cardiovascular problems, such as heart failure]
291
What are common delivery options for enteral nutrition?
* Continuous infusion * Intermittent (bolus) feedings by infusion pump * Bolus feedings by gravity * Bolus feedings by syringe
292
What factors influence the type of enteral nutrition access?
* Anticipated length of time EN is needed * Risk for aspiration * Patient's clinical status * Adequacy of digestion and absorption * Patient's anatomy
293
What are the types of tubes used for short-term enteral feeding?
* Orogastric * Nasogastric (NG) * Nasoduodenal * Nasojejunal
294
What is the purpose of transpyloric tubes?
To feed the patient below the pyloric sphincter.
295
What materials are commonly used for feeding tubes?
* Polyurethane * Silicone
296
What is a complication that can arise from using a stylet for tube placement?
Perforation.
297
What are some disadvantages of smaller feeding tubes?
* They clog easily * Harder to check residual volume (RV) * Prone to occlusion if oral drugs are not properly prepared * Can become knotted or kinked
298
What types of tubes can be used for extended feeding?
* Gastrostomy * Jejunostomy
299
Fill in the blank: A gastrostomy tube can be placed _______.
[surgically, radiologically]
300
What is a gastrostomy tube?
A tube inserted through the esophagus into the stomach for feeding ## Footnote It is placed via percutaneous endoscopic gastrostomy (PEG) or surgical methods.
301
What is the purpose of a retention disk and bumper?
To secure the gastrostomy tube in place ## Footnote They help prevent dislodgement of the tube.
302
What is required for PEG tube placement?
An intact, unobstructed GI tract and a wide esophageal lumen ## Footnote These conditions ensure the endoscope can pass through safely.
303
What are the benefits of PEG and radiologically placed gastrostomy tubes compared to surgical placement?
They have fewer risks ## Footnote These methods are less invasive.
304
What sedation is required for the procedure of placing a gastrostomy tube?
IV sedation and local anesthesia ## Footnote IV antibiotics are also given before the procedure.
305
When can feedings start after placing a surgically placed gastrostomy or jejunostomy tube?
Within 24 hours ## Footnote Feedings can start without waiting for flatus or bowel movement.
306
How soon can most PEG tube feedings start after insertion?
Within 4 hours ## Footnote Agency policies may vary regarding this timeline.
307
What are critical safety concerns in enteral nutrition (EN)?
Aspiration and dislodged tubes ## Footnote These issues can lead to complications.
308
What should be done to confirm the position of newly inserted nasal or orogastric tubes?
Obtain x-ray confirmation ## Footnote This ensures proper placement before starting feedings or medications.
309
What method should not be used to determine tube placement?
Auscultation method ## Footnote It is not reliable for confirming tube position.
310
What can capnography help determine?
Tube placement in the respiratory tract ## Footnote It monitors breath-to-breath CO2 levels.
311
What is the recommended head elevation to decrease aspiration risk during feedings?
30 to 45 degrees ## Footnote Reverse Trendelenburg position can be used if backrest elevation is not tolerated.
312
What should be assessed to determine if a small bowel tube has dislocated?
Aspirate color and pH ## Footnote These assessments help confirm tube placement.
313
What does an increase in VR indicate?
Potential displacement of a small intestine tube into the stomach ## Footnote Monitoring VR volume is important for assessing tube position.
314
What should be checked before feeding and medication administration in enteral nutrition?
Tube placement ## Footnote This ensures that the tube is in the correct position to prevent complications such as aspiration.
315
What should be assessed before feeding a patient receiving enteral nutrition?
Bowel sounds ## Footnote Assessing bowel sounds helps determine the gastrointestinal readiness for feeding.
316
What is a necessary action to take for NG or gastrostomy tubes as needed?
Flush the tube ## Footnote Flushing helps maintain tube patency and prevents clogging.
317
What should be evaluated in patients receiving enteral feedings?
Nutrition status ## Footnote Regular evaluation ensures that the patient's nutritional needs are being met.
318
True or False: Medications should be added directly to enteral feeding formula.
False ## Footnote Adding medications directly can alter the absorption and effectiveness of both the medication and the formula.
319
What type of medications should be used for enteral nutrition?
Liquid medications designated safe for enteral use ## Footnote These medications are specifically formulated to be compatible with enteral feeding.
320
What is the recommended position for the patient during enteral feeding to decrease aspiration risk?
30- to 45-degree angle ## Footnote Keeping the head elevated helps prevent aspiration pneumonia.
321
What should be done if using tablets for enteral feeding?
Use immediate-release forms and crush to a fine powder ## Footnote This ensures that the medication can be effectively absorbed.
322
What complications should be regularly assessed in patients receiving enteral feedings?
* Aspiration * Diarrhea * Abdominal distention * Hyperglycemia * Fecal impaction ## Footnote Regular assessment helps prevent and manage potential complications.
323
What actions can a Licensed Practical/Vocational Nurse (LPN/VN) perform for stable patients?
* Insert NG tube * Flush NG and gastrostomy tubes * Give bolus or continuous enteral feeding * Remove NG tube * Give medications through NG or gastrostomy tube * Provide skin care around tubes ## Footnote These tasks are within the scope of practice for LPN/VN when caring for stable patients.
324
What responsibilities does Assistive Personnel (AP) have regarding patients with enteral nutrition?
* Provide oral care * Weigh patient * Keep head of bed elevated * Report symptoms indicating problems * Alert RN or LPN about infusion pump alarms * Empty drainage devices and measure output ## Footnote Assistive personnel play a supportive role in maintaining patient safety and comfort.
325
What should be done in collaboration with a dietitian for patients receiving enteral nutrition?
* Evaluate nutrition status * Select appropriate EN formula * Monitor and manage complications * Teach about home EN ## Footnote Collaboration with a dietitian ensures that nutritional needs are met and complications are managed effectively.
326
What is a pharmacist's role in enteral nutrition?
Evaluate each medication being given enterally ## Footnote Pharmacists ensure that medications are safe and effective for enteral administration.
327
Fill in the blank: Medications must be given _______ if required.
Separately ## Footnote Some medications may interact adversely with enteral formulas and require separate administration.
328
What is a common cause of constipation in patients?
Decreased fluid intake ## Footnote Other causes include inactivity and formula composition.
329
What is the recommended fluid intake for managing constipation?
30 mL/kg body weight ## Footnote This should be done if not contraindicated.
330
What dietary change can help alleviate constipation?
Change formula to one with more fiber content ## Footnote Laxatives may also be administered as needed.
331
List two management strategies for dehydration.
* Decrease rate or change formula * Increase intake and check amount and number of feedings ## Footnote Administer supplemental tube, oral, or IV fluids if appropriate.
332
What should be checked if a patient is dehydrated?
Drugs that the patient is receiving, especially antibiotics ## Footnote This is to avoid complications from medication interactions.
333
What is a management strategy for hyperosmotic diuresis?
Check blood glucose levels often ## Footnote Also, change formula to one with less glucose.
334
What are common causes of diarrhea in patients?
* Contaminated formula * Feeding too fast * Infection * Medications * Tube moving distally ## Footnote Each of these factors can contribute to gastrointestinal issues.
335
How long can ready-to-feed formulas be left standing?
8 hours ## Footnote This is the guideline for cans of ready-to-feed formulas.
336
What is the recommended action if a formula is left standing for longer than the manufacturer's guidelines?
Discard outdated formula ## Footnote This is critical to avoid contamination.
337
What management strategy can be used if vomiting is due to delayed gastric emptying?
Consult with HCP about a prokinetic drug ## Footnote This may help improve gastric motility.
338
True or False: The tube position should be checked before each bolus feeding.
True ## Footnote It should also be checked every 4 hours if continuous feedings are used.
339
What should be done if a tube is improperly placed?
Replace tube in proper position ## Footnote Ensure to check placement before each feeding.
340
Fill in the blank: To prevent bacterial contamination, formula and equipment should be ______.
avoided from contamination ## Footnote This includes proper storage and handling.
341
What is critical when lowering the head of the bed for a procedure?
Quickly returning the patient to at least 30 degrees ## Footnote This is essential to ensure patient safety and comfort during feeding procedures.
342
What should be followed regarding feeding while the patient is supine?
Agency policy ## Footnote Each facility may have specific guidelines on this matter.
343
How long should the head be elevated after bolus feedings?
30 to 60 minutes ## Footnote This helps reduce the risk of aspiration.
344
What is the debate surrounding checking RV when giving feedings into the stomach?
Increased RV increases the risk for aspiration vs. other research not supporting the practice ## Footnote The practice may vary based on institutional protocols and current research.
345
What does common protocol call for when checking RV in non-critically ill patients?
Every 6 to 8 hours and before each bolus feeding ## Footnote This aims to minimize the risk of aspiration and ensure patient safety.
346
What are some measures to decrease aspiration risk during enteral feeding?
Measures include: * Giving feedings continuously * Minimizing the use of sedation * Performing frequent oral suctioning if needed * Using promotility drugs like erythromycin or metoclopramide
347
Why is skin care around gastrostomy and jejunostomy tube sites important?
Digestive juices irritate the skin, so skin care is essential to prevent irritation and injury.
348
How should the skin around a feeding tube be initially cared for?
Rinse with sterile water, dry it, and apply a dressing until healed.
349
What is the recommended flushing protocol for feeding tubes in adults?
Flush with 30 mL of warm tap water every 4 hours during continuous feedings or before and after each bolus feeding.
350
What should be used to flush feeding tubes in immunocompromised and critically ill patients?
Use sterile water.
351
What is an enteral feeding misconnection?
An inadvertent connection between an enteral feeding system and a nonenteral system, leading to severe patient injury or death.
352
What are some complications of enteral nutrition in older patients?
Complications include: * Fluid and electrolyte imbalances * Dehydration from diarrhea * Increased risk of hyperglycemia * Increased risk for aspiration
353
What changes in older adults increase their risk for complications during enteral nutrition?
Physiologic changes such as decreased thirst perception and impaired cognitive function.
354
What is parenteral nutrition (PN)?
The administration of nutrients directly into the bloodstream when the GI tract cannot be used.
355
How is parenteral nutrition customized?
It is reformulated to meet the changing needs of each patient.
356
What are some components commonly found in commercially prepared PN base solutions?
Components include: * Dextrose * Protein in the form of amino acids * IV fat emulsion in total nutrient admixture
357
What standard electrolytes are available in some premixed PN solutions?
Electrolytes include: * Sodium * Potassium * Chloride * Calcium * Magnesium * Phosphate
358
What additional elements may be added to parenteral nutrition to meet patient needs?
Vitamins and trace elements such as: * Zinc * Copper * Chromium * Selenium * Manganese
359
What should visitors, LPN/VNs, and AP do if an enteral feeding line becomes disconnected?
Notify the nurse and do not reconnect any line ## Footnote This is crucial to prevent misconnections that could lead to patient harm.
360
Why should IV or feeding devices not be changed or adapted?
It may compromise the safety features that are part of the design ## Footnote Maintaining the integrity of the devices is essential for patient safety.
361
Can an IV pump or IV tubing be used to deliver enteral feeding?
No ## Footnote Using IV equipment for enteral feeding can lead to serious complications.
362
What should be done when making a reconnection or connecting a new device?
Trace lines back to their origins and ensure connections are secure ## Footnote This helps to avoid misconnections and ensures proper delivery of nutrition.
363
What is important to do when a patient arrives on a new unit or during shift handoff?
Recheck connections and trace all tubes ## Footnote This step is vital for ensuring the safety of the patient's enteral feeding.
364
How should tubes and catheters with different purposes be routed?
In unique and standardized directions ## Footnote For example, route IV lines toward the patient's head and enteral lines toward the feet.
365
What is a recommended practice for labeling feeding tubes and connectors?
Label or color-code them ## Footnote This aids in quick identification and reduces the risk of misconnection.
366
What should be done when there are multiple access points and/or several bags hanging?
Place proximal and distal labels on all tubings ## Footnote This helps to clarify the purpose of each line and reduces confusion.
367
What should be checked after making any connection?
The patient's vital signs ## Footnote Monitoring vital signs can help identify any immediate complications.
368
What is important to confirm about a solution's label?
Identify and confirm the label to avoid confusion between solutions ## Footnote A 3-in-1 PN solution can resemble an enteral nutrition formulation.
369
What type of labeling should be used for bags intended for enteral use?
Large, bold statements such as 'WARNING! For Enteral Use Only—NOT for IV Use' ## Footnote This helps to prevent serious errors in administration.
370
Under what conditions should connections be made?
Under proper lighting conditions ## Footnote Adequate lighting is crucial for accurately making connections and ensuring safety.
371
What are the main sources of calories in parenteral nutrition (PN)?
Carbohydrates in the form of dextrose and fat in the form of fat emulsion ## Footnote Dextrose provides 3.4 calories per gram, while oral carbohydrates provide 4 calories.
372
What is the recommended energy intake for a nonobese patient receiving PN?
20 to 30 cal/kg/day
373
What is the protein-sparing effect of dextrose?
It allows the use of amino acids for wound healing instead of for energy.
374
What are the available concentrations of fat-emulsion solutions?
10%, 20%, and 30%
375
How many calories do fat emulsions provide per mL for 10% and 20% solutions?
* 10% solution: 1 cal/mL * 20% solution: 2 cal/mL
376
What is the maximum recommended fat emulsion intake for stable patients?
1 g/kg/day
377
What is the initial infusion rate for IV fat emulsions?
0.5 mL/kg/hr
378
What distinguishes central PN from peripheral parenteral nutrition (PPN)?
Central PN is hypertonic and indicated for long-term support; PPN is less hypertonic and used for short-term needs.
379
What is the osmolality of central PN solutions?
At least 1600 mOsm/L
380
What are the indications for using peripheral parenteral nutrition (PPN)?
* Short-term nutrition support * Low protein and caloric requirements * High risk for central catheter * Supplement inadequate oral intake
381
What are the risks associated with peripheral parenteral nutrition (PPN)?
* Phlebitis * Fluid overload
382
What is the protein intake range for patients receiving PN?
0.8 to 1.5 g/kg/day
383
In which patient populations might protein requirements exceed 150 g/day?
* Septic patients * Critically ill patients * Burn patients * Multiple trauma patients
384
What are the average daily electrolyte requirements for adult patients without renal or liver impairment?
* Sodium: 1 to 2 mEq/kg * Potassium: 1 to 2 mEq/kg * Magnesium: 8 to 20 mEq * Calcium: 10 to 15 mEq * Phosphate: 20 to 40 mmol
385
What trace elements are added to PN according to patient needs?
* Zinc * Copper * Manganese * Selenium * Chromium
386
What is the importance of multivitamin preparation in PN?
It generally meets the vitamin requirements.
387
What factors must be considered for home nutrition support?
* Patient's nutritional needs * Caregiver education * Cost and reimbursement criteria * Quality of life impact
388
What are eating disorders characterized by?
Psychiatric conditions associated with physiological alterations and risk for death.
389
What are the 3 most common types of eating disorders?
Anorexia nervosa, bulimia nervosa, binge-eating disorder ## Footnote Binge-eating disorder is less severe than bulimia nervosa and anorexia nervosa.
390
What is a key characteristic of binge-eating disorder?
Individuals do not have a distorted body image and are often overweight or obese ## Footnote Unlike anorexia and bulimia, binge-eating disorder does not involve significant weight loss or purging behaviors.
391
List some risk factors for eating disorders.
* Biologic issues * Psychologic issues * Sociocultural issues ## Footnote Common psychologic issues include anxiety and perfectionism, while sociocultural issues may involve bullying or a limited social network.
392
True or False: Eating disorders can occur in health-conscious individuals.
True ## Footnote For example, men with bigorexia may develop eating disorders due to an extreme concern with becoming more muscular.
393
What is bigorexia?
An extreme concern with becoming more muscular ## Footnote Individuals with bigorexia may use steroids, supplements, and protein shakes to increase muscle mass.
394
What is the female athlete triad?
A syndrome that includes eating disorders, amenorrhea, and osteoporosis ## Footnote The triad occurs in females participating in sports that emphasize leanness and low body weight.
395
What health issues may arise from eating disorders?
* Fluid and electrolyte problems * Dysrhythmias * Nutrition problems * Endocrine problems * Metabolic problems ## Footnote Menstrual problems may also occur in women of childbearing age.
396
Fill in the blank: Binge-eating disorder is _______ than bulimia nervosa and anorexia nervosa.
less severe ## Footnote This indicates a difference in the severity and health risks associated with binge-eating disorder compared to the other two disorders.
397
What may individuals with bigorexia use to increase muscle mass?
* Steroids * Other drugs * Supplements * Protein shakes ## Footnote These substances are often used in an attempt to achieve a more muscular physique.
398
Who is responsible for preparing PN solutions?
A pharmacist or trained technician ## Footnote Must use strict aseptic techniques under a laminar flow hood.
399
What should not be added to PN solutions after preparation?
Nothing ## Footnote This is to maintain sterility and safety.
400
What is the purpose of limiting the number of people involved in PN preparation?
To reduce risk for infection.
401
How often are PN solutions ordered?
Daily ## Footnote This is to adjust to the patient's current needs.
402
What information is included on a PN solution label?
Nutrient content, all additives, time mixed, and expiration date and time.
403
How should PN solutions be stored before use?
Refrigerated until 30 min before use.
404
What is the maximum time a PN solution can be at room temperature?
24 hours.
405
What type of filter should be used with parenteral solutions not containing fat emulsion?
0.22-micron filter.
406
What type of filter should be used with solutions containing fat emulsion?
1.2-micron filter.
407
How often should filters and IV tubing be changed?
With each new PN container or every 24 hours.
408
What should be done if a multilumen catheter is present?
Use a dedicated line for PN.
409
Is it permissible to draw blood from a line dedicated for PN?
No, unless absolutely necessary.
410
What should be used to control the infusion rate of PN?
An infusion pump.
411
What should you do periodically during PN infusion?
Check the volume infused.
412
What should be verified before starting PN?
The label and ingredients in the solution.
413
Who should verify infusion pump settings before beginning PN?
A second RN.
414
What should be checked for the quality of the PN solution?
Leaks, color changes, particulate matter, clarity, and fat emulsions separating.
415
What should be done if a PN bag is not empty at the end of 24 hours?
Discontinue the PN solution and replace it with a new solution.
416
What is the preferred delivery method for fat emulsions infused separately from PN?
Continuous low volume delivered over 12 hours.
417
How often should glucose levels be checked for patients on PN?
Every 4-6 hours.
418
What is the target glucose range to maintain during PN?
140-180 mg/dL.
419
What can be given to prevent hypoglycemia if a PN formula bag empties?
10% or 20% dextrose solution or 5% dextrose solution.
420
What are local manifestations of catheter-related infections?
Redness, tenderness, and exudate at the catheter insertion site.
421
What are systemic manifestations of catheter-related infections?
Fever, chills, nausea, vomiting, and malaise.
422
Who is at high risk for catheter-related infections?
Immunosuppressed patients.
423
What should be done if an infection is suspected during a dressing change?
Send a culture specimen and notify the HCP.
424
What should be monitored to assess the effectiveness of PN?
Initial vital signs, weight, intake and output, blood levels of glucose, electrolytes, and urea nitrogen.
425
How often should CBC and hepatic enzyme studies be obtained until stable?
A minimum of 3 times per week.
426
What is a general rule for transitioning to oral nutrition?
60% of caloric needs should be met orally or through EN.
427
What should be the starting point for transitioning to oral nutrition?
Clear liquids.
428
What is anorexia nervosa characterized by?
Restricting energy intake, difficulty maintaining appropriate weight, intense fear of gaining weight, and distorted body image ## Footnote Anorexia nervosa is often associated with significant psychological distress.
429
What age group is most commonly affected by anorexia nervosa?
Ages 13 to 19 ## Footnote Up to 90% of those affected are female.
430
What are common behaviors exhibited by individuals with anorexia nervosa?
* Restricting calorie intake * Compulsive exercise * Purging via vomiting or laxatives * Binge eating * Unwillingness to maintain a healthy weight * Detailed food rituals * Avoiding social situations ## Footnote These behaviors often lead to significant health issues.
431
What are common assessment findings in patients with anorexia nervosa?
* Signs of malnutrition * Significant weight loss or low BMI (under 17) * Hypothermia * Muscle weakness ## Footnote Diagnostic studies may reveal additional complications.
432
What are potential diagnostic study findings for anorexia nervosa?
* Osteopenia or osteoporosis * Iron-deficiency anemia * High blood urea nitrogen level * Abnormal renal function * Decreased potassium levels ## Footnote These findings can indicate severe physiological stress.
433
What complications may arise from decreased potassium intake in anorexia nervosa?
* Muscle weakness * Dysrhythmias * Renal failure ## Footnote These complications highlight the importance of monitoring electrolyte levels.
434
What is the recommended approach to treatment for anorexia nervosa?
* Nutrition support * Psychiatric care * Family-based therapy * Behavior- and emotion-focused therapy ## Footnote Building rapport with the patient is essential due to anxiety around treatment.
435
What is refeeding syndrome?
A rare but serious complication of refeeding programs ## Footnote It can occur when nutritional replenishment is initiated too rapidly.
436
What characterizes bulimia nervosa?
Recurrent episodes of binge eating followed by inappropriate compensatory behaviors ## Footnote These behaviors may include vomiting, laxative misuse, or overexercise.
437
What physical signs may indicate bulimia nervosa?
* Macerated knuckles * Swollen salivary glands * Broken blood vessels in the eyes * Dental problems ## Footnote These signs are often a result of frequent vomiting.
438
What abnormal laboratory values may be associated with bulimia nervosa?
* Hypokalemia * Metabolic alkalosis * Increased serum amylase ## Footnote These values can indicate the physiological consequences of the disorder.
439
What types of therapy are recommended for treating bulimia nervosa?
* Psychologic counseling (cognitive behavioral therapy) * Family therapy * Nutrition counseling ## Footnote A combination of these therapies is essential for effective treatment.
440
Which antidepressant is FDA-approved for the treatment of bulimia nervosa?
Fluoxetine (Prozac) ## Footnote It is the only FDA-approved medication specifically for this condition.
441
What is a potential catheter-related problem associated with PN?
Air embolus ## Footnote An air embolus occurs when air bubbles enter the bloodstream, potentially causing serious complications.
442
Name a complication of PN related to infection.
Catheter-related sepsis ## Footnote This refers to a bloodstream infection that occurs due to contamination of the catheter used for PN.
443
What complication can occur if a catheter is not properly secured?
Dislodgment ## Footnote Dislodgment refers to the catheter moving from its intended position, which can lead to complications.
444
Identify a complication of PN that involves bleeding.
Hemorrhage ## Footnote Hemorrhage can occur at the catheter insertion site or elsewhere in the body.
445
What issue can prevent the flow of nutrients in PN?
Occlusion ## Footnote Occlusion occurs when the catheter is blocked, hindering nutrient delivery.
446
What is a common inflammatory complication associated with catheter use?
Phlebitis ## Footnote Phlebitis is the inflammation of the vein where the catheter is placed.
447
What are potential complications of PN related to the lungs?
Pneumothorax, hemothorax, and hydrothorax ## Footnote These conditions refer to air, blood, or fluid accumulation in the thoracic cavity, respectively.
448
What vascular complication can arise from PN?
Thrombosis of vein ## Footnote Thrombosis involves the formation of a blood clot in the vein, which can impede blood flow.
449
What metabolic problem can arise from PN affecting the kidneys?
Altered renal function ## Footnote This refers to changes in how well the kidneys are functioning, which can be affected by nutrient imbalances.
450
What deficiency can result from inadequate nutrition in PN?
Essential fatty acid deficiency ## Footnote This deficiency can lead to various health issues, including skin problems and immune dysfunction.
451
What metabolic complication involves abnormal blood sugar levels?
Hyperglycemia, hypoglycemia ## Footnote Hyperglycemia refers to high blood sugar, while hypoglycemia refers to low blood sugar, both of which can occur with PN.
452
What condition characterized by high lipid levels can occur with PN?
Hyperlipidemia ## Footnote Hyperlipidemia is an elevation of lipids in the bloodstream, which can result from excessive lipid administration.
453
What liver-related complication can develop from PN?
Liver dysfunction ## Footnote Liver dysfunction can occur due to the metabolic effects of PN and the composition of the nutrients provided.
454
Fill in the blank: _______ syndrome can occur after the reintroduction of feeding.
Refeeding ## Footnote Refeeding syndrome is a dangerous condition that can occur when feeding is restarted after a period of malnutrition.

Lewis’s Medical Surgical Nursing (10 decks)

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