Lab 7 Flashcards by Declan Hobbs

Basic GI tract (flow parts)

Mouth
Esophagus
Stomach
SI
LI
Rectum
Anus

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Factors affecting nutrition

Culture, income, food insecurity

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What are some factors that affect a persons nutritional status (8)

Stage of development
Culture
Diet
Religion
Mental health
Food insecurity
Medications
Health

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How does this affect nutrition status: stage of development

Infants, adolescents, and adults have different nutritional requirements and guidelines

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How does this affect nutrition status: culture

Dietary restrictions
Traditional spices and techniques

Food is an important part of culture

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How does this affect nutrition status: diet culture

Food fads

Diets
Advertising

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How does this affect nutrition status: religious practices

Food prep (kosher, halal)

Types of meats

Caffiene and alcohol

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How does this affect nutrition status: mental health

Disordered eating

Emotional state and relationship with food

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How does this affect nutrition status: food insecurity

Socioeconomic status and access to food

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How does this affect nutrition status: medications

Taste perception

Appetite increase or decrease

Nutrient absorption

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How does this affect nutrition status: health

Oral health

Dentures

Decreased bite force and saliva production

GI surgeries or conditions

Substance use

Chronic conditions like diabetes

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Nutritional assessment is a process to identify an individual who is:

At risk for malnutrition

Is malnourished
Likely to benefit from further nutrition

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Swallowing assessments are conducted by

Speech language pathologists

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What happens during a swallowing assessment

Palpation of larynx to ensure up and down movement

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YSP

Yale swallow protocol

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Dysphasia

Difficulty swallowing

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Symptoms of dysphasia

Choking
Coughing
Weak voice
Aspirating
Excessive saliva
Hard time chewing

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Pocketing

Storing food in corners of the mouth

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Risk factors for dysphasia

Oral cancers
Strokes
Local trauma
Dyspnea

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Managing dysphasia

Use of thickened fluids so liquid can pass down esophagus more easily
Nectar, honey, pudding (textures)

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Types of diets

General/regular
Clear fluid
Full fluid
Puréed diet
Soft diet

All these diets can also be diabetic, renal, low sodium, etc

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Considerations for positioning while feeding

Chair
- upright in high Fowlers
- body aligned
- feed from strong side if relevant

In bed
- high flowers (60 degrees plus
- pillow may be used

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Nursing considerations during feeding

Ensure tray s correct
Encourage autonomy
Small amounts
Go at client pace
Wait for them to swallow
Don’t wash down with fluids
Watch for signs of dysphasia like pocketing
Offer nutrient rich food first

Nursing considerations after feeding

Help with oral care
Keep client upright for 30-45 mins to aid in digestion and decrease risk of aspiration
If they must lie down, spider position
Complete doccumentation

Aspiration

Food or fluid going into the lungs

Promoting independence

Use adaptive devices Use clock method to describe where food is on plate Protect clothing Sit at same height Involve in preferences

Anorexia nervous

Restriction of energy intake leading to low body weight Fear of gaining weight

Bulimia nervosa

Binge eating Compensatory behaviours like self induced vomiting, use of laxatives, strict dieting, etc

Bradycardia with pulse under 50 bpm =

Cardiovascular instability

Adults over 65 have a ______ need for energy because the metabolic rate is slower

Decreased

Vitamin and mineral intake remain ________ as you get older

The same

Semi or partial vegetarian

May eat some daily eggs chicken fish but primarily plant based foods

Pesco vegetarian

Avid meat and poultry, included fish eggs and dairy

Lacto-ovo-vegetarian

Avoids meat poultry and fish, eats egg and dairy

Lacto-vegetarian

Avoids meat fish poultry and eggs

Two questions from the Canadian nutritional screening tool

Have you lost weight in the past 6 months without trying? Have you been eating less than usual for more than a week If both yes, indication of nutrition risk

Dietary history components

Food practices - amount Allergies Symptoms - heartburn, gas, etc Tracking - in depth log of food and drink in a set period Chewing Hunger Elimination patterns Chemical substances - medication? Knowledge - beliefs on current diet

Observation in nutritional assessment

Observe for signs of nutritional alterations Examples - brittle hair - swollen face - dry lips - easy bleed gums - poor muscle tone

Aspiration precautions

Patients screened for dysphagia HOB up to 90 if possible Watch for pocketing

Before assisting with feeding:

Assess risk of aspiration Patient upright Glasses/aids/dentures in Clothing protected

During assist with feeding

If hemiplegic, feed from strong side Observe for pocketing

After feeding considerations:

Patient upright for 30-45 mins Check for pocketing again Intake noted and doccumented Oral hygiene

Diet: clear liquid

Broth, coffee, tea, etc

Diet: thickened liquefied

All liquids Must be thickened to necessary point

Diet: full liquid

Basically puréed diet but excluding meats eggs and stuff like that

Diet: puréed

Everything blended

Diet: mechanically soft

Included all puréed stuff + ground meats, fish, cheese, rice, potatoes, etc

Diet: soft of low residue

Low fibre, easy digest foods like pastas

Diet: high fibre

Fresh fruits, bran, oatmeal etc

Diet: low sodium

Limited to 4g of salt or less a day

Diet: low cholesterol

Under 200mg a day

Diet: diabetic

Decreased fat intake

Malnutrition

Under nutrition, inadequate vitamins or minerals, overweight, obese

Feeding height (chair and bed)

High fowlers In bed, 60 minimum

Oral hygiene practice

All common sense Do not rinse with water

Oral hygiene performed regularly for patients who are:

Intubated or ventilated Have a. Tracheostomy High aspiration risk NPO