NRSG 126 - Week 6 Flashcards
(108 cards)
1
Q
What does N/V, PI, IAD, NPO mean?
A
- N/V – nausea and vomiting
- PI – pressure injury
- IAD – incontinence associated dermatitis
- NPO – nothing per os – AKA nothing by mouth – patient is not allowed to eat or cannot eat
2
Q
Canada’s food Guide other tips
A
o Try not to eat alone
o Be mindful of habits
o Limit processed food & cook more
o Use resources- dietician is available 811
3
Q
Daily intake of carbs, protien, and fat
A
carbs: 45% to 65%
Fat: 20% to 35%
Protein: 10% to 35%
4
Q
Daily intake can depend on…
A
o Quality of food
o Personal goals
o Activity
As well as…
- Wound healing- increase the clients protein and calories.
- Weight loss- lower carbs and increase protein and fats,
- Weight gain- increase carbs, weight loss increase protein.
5
Q
Carbohydrates
A
- Main source of energy
- Controls blood glucose and insulin metabolism
- Includes: sugar, starch and fiber
- Soluble and insoluble fiber- lowers LDL
- Take away:
o we need carbs for energy, there are choices for better carbs or quality carbs vs less quality carbs. Impact things such as elimination, blood sugars, cholesterol, weight and of course energy. Mostly from plant food.
6
Q
what are simple carbs
A
o free sugars are added to food and occur in honey, syrup and fruit juice.
7
Q
what are complex carbs
A
o plant food- starch
8
Q
what does soluble fiber mean and do
A
It can be broken down/dissolves in water
o lowers cholesterol and blood sugars. Turns into gel by absorbing water! Can help with diarrhea.
absorbs water and turns to gel, helps with blood sugars and cholesterol. Bran, barley, nuts, seeds, beans, lentils, peas and some fruits and veggies.
Too much is never a good thing! Can lead to constipation.
9
Q
What is insoluble fiber?
A
(not digestible- does not dissolve in water) and promotes the movement of material through your digestive system and increases stool bulk, so it can be of benefit to those who struggle with constipation or irregular stools. Pulls water into the stool. Can help with constipation.
Insoluble fiber- adds bulk to stool and can help it to pass, helps with constipation. Whole grains, vegetables, wheat bran.
Too much is never a good thing! Can lead to constipation.
Too much is never a good thing! Can lead to constipation.
10
Q
What can fiber help with
A
- Fiber can help with cholesterol (fiber attaches and moves it thru the GI tract), keep blood sugars stable (not easily absorbed, doesn’t contribute to increased sugar) and promotes colon health. Need to drink water with fiber.
11
Q
what is the glycemic index
A
- The glycemic index is a value assigned to foods based on how slowly or how quickly those foods cause increases in blood glucose levels.
- The glycemic index: High= quick, Low= slow
12
Q
White bread
A
o High glycemic index
o Starch
o trace insoluble fiber
o (added sugar)
13
Q
brown bread
A
o Insoluble fiber
o Starch
14
Q
cookies, chips, fries, candy
A
simple sugar/carbs
15
Q
barley
A
o Low glycemic index
o Soluble fiber
o Starch
16
Q
vegetables
A
o Complex carb
o Fiber
o Starch
17
Q
apples
A
o Fructose
18
Q
simple carbs info
A
o sugar is added to so much food!
Soda, cakes and pastries, white breads, breakfast cereal, fruit juice.
Simple sugars are in fruits as well! Like apples (fructose)
Complex carbs more filing, better to eat in general and for weight loss.
19
Q
fruits and veggies
A
o some have more starch (potatoes, bananas) than others (green veggies- lettuce, peas, squash), some are soluble (apples, pears, carrots) and some are insoluble (carrots, peppers, cucumber) fibers- yes carrots have both!
20
Q
What type of fiber is good for diabetics
A
- What about diabetics? Foods with a low glycemic index= better blood sugar control.
21
Q
Proteins
A
- Tissue growth, maintenance and repair!
- Essential and nonessential amino acids
- Complete (animal) vs incomplete protein
- Nitrogen balance
- Take away:
o needed for building blocks, assist with many processes within the body. Blood pressure, healing, growth and development. We need MORE when we are healing!
o You can eat different complementary proteins within a day to make incomplete proteins complete!
o A negative protein balance occurs from lack of protein in the body due to decreased intake, injury (burn, trauma), fever, starvation, infection. Immobility readings- decreased appetite from immobility and metabolic change increasing protein breakdown.
22
Q
essential amino acids
A
9 of the them and we need to eat them
23
Q
Non-essential
A
synthesized in our body
24
Q
what is complete protein
A
(usually animals) has all 9 essential amino acids.
o Example: Milk, eggs, chicken, pig, soybeans, buckwheat, quinoa.
25
what are incomplete proteins
Plant foods are considered incomplete proteins because they are low or lacking in one or more of the amino acids we need to build cells. Incomplete proteins found in plant foods can be mixed together to make a complete protein.
o Example: cereal, legume, vegetables.
26
Why is protein needed
(needed for low albumin, hemoglobin and zinc)- helps to form collagen (also needs Vit C), zinc helps with collagen and epithelialization.
o Amino acids are the building blocks of protein
Collagen, hormones, enzymes, immune cells, DNA and RNA are all made of protein. Blood clotting, fluid regulation and acid-base balance require protein.
27
what are polypeptides
amino acids linked with a peptide bond
28
what are simple proteins
- Simple proteins include insulin, albumin in our body. Insulin helps to manage blood sugars and albumin helps keep fluid in our vascular space (BP control and management).
29
what are lipoproteins?
- Lipoproteins are complex fat and protein
30
Nitrogen balance
o Healthy adults usually maintain constant lean body mass and neither accumulate protein nor lose protein mass. Since their combined nitrogen intake (mainly as protein) more or less equals their nitrogen losses, they are said to be in nitrogen balance. Too little is often due to intake, injury such as a burn/head injury/trauma, or fever, starvation or infection. Nitrogen is utilized same as protein in the body to help with tissue repair, wound healing, growth etc.
31
What is a normal BMI?
Normal BMI is under 25 but under 18.5 is underweight. Overweight 25-30, over 30=obese.
32
increase requirements
o Infection, Burn, Fever, Starvation, Head injury , Trauma
33
Increase losses
o Urine (increased with acute kidney failure),
Feces (protein losing enteropathy- compromised gastrointestinal (GI) mucosa as a result of GI mucosal diseases, GI tract infections, as well as from disruptions of venous and lymphatic outflow), diarrhea
Sweat, Bleeding, Vomiting
34
What does fat do?
o Makes energy, fat cushions organs, lubricate body tissues, insulates and protects cell membranes.
35
what are monounsaturated fats?
(such as olive oil, nuts and seeds) plant based fats
are good fats and can help lower risk of heart disease.
Research shows that consumption of plant-based monounsaturated fats may help lower your risk for cardiovascular disease and overall mortality.
Foods that are highest in monounsaturated fats include: olive oil, peanut oil, Avocados, most nuts, most seeds
36
what are polyunsaturated fats
(Omega-3 fatty acids for example).
They need to be eaten, are good for heart health, muscle movement, blood clotting. Fatty fish- tuna, flaxseed, oyster are some examples.
Your body needs polyunsaturated fats to function. Polyunsaturated fats help with muscle movement and blood clotting. Since your body doesn’t make this type of fat, you have to get it through your diet.
Polyunsaturated fats can be further divided into two types: omega-3 and omega-6 fatty acids.
Omega-3 fatty acids are beneficial for heart health.
The best sources of omega-3 fatty acids are: fatty fish, such as sardines, tuna, salmon, trout, mackerel, and herring ground flax and flaxseed oil, soybeans, oysters, walnuts, sunflower seeds, chia seeds, hemp seeds
36
what do high triglycerides do?
High triglycerides contribute to atherosclerosis “hardening of the arteries”, especially when LDLs are also high- this increases risk of MI, stroke.
37
what are saturated fatty acids?
o lack double bonds between the individual carbon atoms, while in unsaturated fatty acids there is at least one double bond in the fatty acid chain. Saturated fats tend to be solid at room temperature and from animal sources, while unsaturated fats are usually liquid and from plant sources.
38
sources of saturated fat
o fatty pieces of meat such as beef and lamb, some pork and chicken products, dairy products including cream, whole milk, butter, shortening, and cheese, coconut and palm oils
39
what is unsaturated fat?
o Unsaturated fats are loosely packed. They tend to be liquid at room temperature.
o There are two main types of unsaturated fat
40
what are trans fats?
o There are two broad types of trans fats found in foods: naturally-occurring and artificial trans fats. Naturally-occurring trans fats are produced in the gut of some animals and foods made from these animals (e.g., milk and meat products) may contain small quantities of these fats. Artificial trans fats (or trans fatty acids) are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid.
o The primary dietary source for trans fats in processed food is “partially hydrogenated oils."
o Trans fats raise your bad (LDL) cholesterol levels and lower your good (HDL) cholesterol levels. Eating trans fats increases your risk of developing heart disease and stroke. It’s also associated with a higher risk of developing type 2 diabetes.
41
What is cholesterol?
o Cholesterol is a waxy substance. It’s not inherently “bad.” Your body needs it to build cells and make vitamins and other hormones. But too much cholesterol can pose a problem.
o Two sources: Liver (regulates and produces) and Food (animal products including milk).
o Saturated fat can contribute to cholesterol
o High cholesterol contributes to a higher risk of cardiovascular diseases, such as heart disease and stroke. That’s why it’s important to have your cholesterol tested, so you can know your levels.
o The two types of cholesterol are: LDL cholesterol, which is bad, and HDL, which is good. Too much of the bad kind, or not enough of the good kind, increases the risk cholesterol will slowly build up in the inner walls of the arteries that feed the heart and brain.
42
What are the most common type of fat in the body
- Triglycerides are the most common type of fat in the body. They store excess energy from your diet.
43
What other health conditions can high triglycerides be a sign of? What medications can impact it?
health conditions
o Type 2 diabetes or prediabetes
o Metabolic syndrome — a condition when high blood pressure, obesity and high blood sugar occur together, increasing your risk of heart disease
o Low levels of thyroid hormones (hypothyroidism)
o Certain rare genetic conditions that affect how your body converts fat to energy
meds:
o Diuretics
o Estrogen and progestin
o Retinoids
o Steroids
o Beta blockers
o Some immunosuppressants
o Some HIV medications
44
water
- Cells depend on a fluid environment
- Body temperature
- Solvent
- Most adults need 3L/day
- Fluid restrictions – HF, CKD
- Fluid loss – sweating, elimination, and respiration
o Maintain hydration to support wound healing
o Kidneys can filter over 170 litres of fluid per day
- 60%-70% water body weight.
Muscle (70-75% water) holds more water than fat and any other tissue.
- Can survive for a few days with out it.
Connect to CAM- dehydration= delirium risk.
45
why is water important?
- Water protects our tissue, cushions joints and helps muscles to work properly. It also removes waste products (GI and GU systems)
- Digestion:
o helps with absorption of nutrients by dissolving them to be absorbed into the blood stream and to keep stools soft.
- brain health/CVS/Renal.
o Dehydration impacts cells in the brain and can cause trouble concentrating and confusion. It also helps to maintain BP which in-turn also ensures appropriate pressure for renal functioning and waste elimination.
- Water moves freely between membranes and is often needed for protein transport.
46
How do we gain or lose fluids
GAIN: intake of actual water or foods with water in them, intravenous fluids
LOSS: also if there are wounds, burns, any tubes or drains
47
How much urine should healthy kidneys produce per day?
o Keep your kidneys well hydrated and healthy. Some of this water is reabsorbed so do not think you have to drink that much! We urinate 1-2L/day.
48
vitamins
o Essential to metabolism
o Antioxidants
o Fat-soluble (A, D, E, K)
o Water-soluble (B & C)
49
minerals
o Catalysts for biochemical reactions
o Macrominerals (Ca, Na, K)
o Microminerals (Fe, Mg)
50
System- Metabolic- Hazards of Immobility.
Should take lots of protein and high-calorie to rebuild tissue. Also Vitamin C (skin integrity and wound healing) and vitamin B (energy metabolism).
51
Which vitamins are fat soluble
Stored in fat- A, D, E, K
o Derived from fatty and oily parts of certain foods
o Stored in fatty tissue and liver until needed
52
vitamin A
vision, maintains immune system, cell regrowth, hair growth (liver, fish liver oil, butter)
53
vitamin D
bone health and immune system (sunlight, fish, fish oil, mushrooms, may be added)
54
vitamin E
antioxidant- protects from free radicles and premature ageing. Protects fatty acids from free radicles. High amount can be a blood thinner. (vegetable oil, seeds, nuts)
55
vitamin K
blood clotting, supports bone health and CVS health (leafy greens and small amounts in egg yolks, butter and liver)
56
Which vitamins are water soluble?
B and C
o Derived from the water components of foods
o Distributed throughout water compartments of the body
o Not stored – excreted with concentration becomes too high
57
vitamin B
needed to produce energy from glucose, amino acids, and fat
58
vitamin B6
helps maintain cellular integrity and helps form blood cells
59
thiamine (vitamin B1) and riboflavin (B2)
needed for cross-linking and collagenation,
60
vitamin B12
RBC formation
61
how are vitamins and minerals a catalysts for biochemical reactions
o means they help with digestion of the 3 major macronutrients (carbs, protein and fat)- helps us to use the energy.
62
macrominerals and trace minerals
- You need larger amounts of macrominerals.
o They include calcium, phosphorus, magnesium, sodium, potassium, chloride and sulfur.
- You only need small amounts of trace minerals.
o They include iron, manganese, copper, iodine, zinc, cobalt, fluoride and selenium.
63
3 important minerals (K, Na, Ca)
o K (potassium): heart health. Needs to be the right levels or it can cause cardiac abnormalities- ECG changes.
o Na (sodium): is important for more than one reason but if it is too low (or high- low is more common) it can cause confusion and delirium. If really low can lead to seizures.
o Ca (calcium): remember the importance of Ca on the MSLK system- bone health, muscle contraction, blood clotting and some hormones. PTH or parathyroid (calcitonin and calcitrol)- if low PTH tells the body to take it from bones or tells the kidneys and intestines to absorb more.
64
Nutrition and Older Persons
- Follow nutritional advice that aligns with health status.
- May need more fiber and vitamins.
- Changes that occur to the body impact eating
- Social – economical challenges
- Change in senses (taste, smell)
- Older adults have an increased risk of malnutrition.
- Depending on co-morbidities or medications.
- Otherwise, there are no MAJOR dietary requirements are needed with age.
- May need to supplement calcium, vit D and Phosphorous (in bones and teeth).
- Changes like tooth loss, impaired sense of taste and smell, decreased saliva and gastric juice secretion can also impact nutrition
- Difficulty chewing, lowered glucose tolerance decreased social interactions, loss of appetite – loss of smell and taste senses limited income and poor sleeping at night
- Some older people who live alone may not want to cook
- Think of some of the changes with income, education, functional status, presence of disease, GI changes (gums and teeth, less saliva, less thirst, reduced gag reflex)
65
how does an incision heal?
ACUTE. Heals by primary intention
66
how does a skin tear heal
ACUTE. Heals by secondary intention
67
how does an unstageable PI heal?
CHRONIC. Heals by tertiary intention, OR goal is to decrease bacterial burden and maintain.
68
how does a burn heal?
likely ACUTE. Heals by secondary intention
69
what is primary intention
o little tissue lost or closed by surgery.
o Tissue surfaces are closed (by stitches, staples, skin glue, or steri-strips)
o Little tissue loss
o Increased healing speed
o Lower risk of infection
Ex. Surgical incision
70
what is secondary intention?
o loss of tissue and edges not together.
o Great loss of tissue/edges can't be brought together
o Longer repair/healing time
o Greater chances of scarring
o Increased chance of infections
Ex. Burn, pressure injury, severe laceration, skin tear, surgical wound dehiscence- all could lead to tertiary!
71
what is tertiary intention?
o infection often- is open and sometimes kept open on purpose to clean- takes a lot longer and will always be chronic.
o Needs to be kept open- contaminated (occurs when there is a need to delay closing a wound, such as when there is poor circulation in the wound area or infection.)
o Great risk of infection
o More connective scar tissue
o Often require surgical closure
Ex Pressure injury with infection. Wound kept open to allow for drainage, (diabetic with back wound)
72
what are acute wounds?
o Sudden onset
o Heal rapidly (as long as the cause of the wound is removed)
Ex. Surgery would, skin tear
73
what are chronic wounds?
o Delayed healing
o Cause of wound is often not removed
Ex. Venous ulcers and diabetic ulcers (caused by health conditions – source cannot be removed. Often the plan of care is about “decreasing bacterial burden” and “wound maintenance” but not healing. Without being able to remove the source or cause we cannot heal the wound.), PIs can become chronic
74
Timeframe for healing
o This varies depending on the wound.
Generally an open wound (from hemostasis to proliferative phase of healing) is up to 24 days. So consider this acute and anything more chronic. Any delay due to vascular compromise, inflammation or repetitive tissue insult is chronic.
75
skin tear (risks)
- Epidermis thins = risk for tear
- Dehydration, poor nutrition, certain illnesses & steroid use can increase risk of breakdown
- Careful when transferring
- ANY open area is at risk for infection
- Aging increases risk of skin tears as the epidermis thins
- Caution with tape- we often use a paper tape with older adults. The regular tape can peel the skin right off if it is fragile!
Caution with friction and sheer- consider what you learned in lab about repositioning and in lab this week you will discuss this more
76
The wound healing process for secondary intention is different from primary intention in three ways:
1) Longer repair and healing time
2) Greater chances of scarring
3) More connective scar tissue than other intentions. (more jagged scar compared to the clean scar of a primary wound)
- There’s an increased chance of infections, With severe scarring the tissue function is impacted permanently.
- If the wound cannot heal with secondary, we move to tertiary!
77
What is the risk with this wound? If it does not heal and continues to worsen?
o Can end up chronic (just preventing infection is the goal), May require surgery (flap), can cause worsening infection such as osteomyelitis as it is close to bone, and sepsis as it is deep and bacteria can easily get into the blood stream!
o Increases mortality and morbidity
78
Stages of wound healing
- Bleeding – blood clot
- Inflammatory – fibroblast, macrophage, scab
- Proliferative – fibroblasts proliferating, subcutaneous fast
- Remodeling – freshly healed epidermis, freshing healed dermis
o Bleeding (hemostasis) is part of inflammation. You will see here I have it separate- it occurs FIRST!
79
what affects the bleeding stage?
o Anticoagulants
o NSAIDS
o liver damage
o bone marrow (leukemia)
80
what affects the inflammatory stage (3 days)
o Meds
Steroids (anti-inflammatory),
o Treatments
Chemotherapy (weakens immune system)
o Immunity
i.e. HIV/AIDS, organ transplant (due to immunosuppressant medications)
o Age
Advanced age – normal changes (T-cell function, circulation)
o Health
Health conditions – Diabetes, cancer
81
what affects the proliferative stage (2 to 24 days)
o Systemic factors- age, anemia, hypoproteinemia (low protein), zinc deficiency
82
what affects remodelling (up to 2 years)
o Systemic factors- age, anemia, hypoproteinemia (low protein), zinc deficiency
o Remodeling or maturation is for full-thickness wounds
NOTE: If it is a partial-thickness wound this phase is simply migration. Cells migrate across wound bed.
83
Factors that delay the inflammatory response
- Necrotic tissue – the cells are dead may need to be removed.
- Repeated pressure – no chance to breathe.
- Trauma – if you have altered blood flow due to trauma, things will not heal well.
- Foreign bodies – need to remove what is causing the damage
- Uncontrolled infection – so it keeps damaging the area
- Poor nutrition – nutrition is needed for hydration, tissue regrowth, immune function
ETOH, drug and cigs – can be associated with poor nutrition, cause vasoconstriction
- Until these factors are treated or removed they will continue to delay healing
84
wound healing: proliferation
- Debridement
o Mechanical: NSWOC (nurse specialized in would, ostomy, and continence)
o Chemical wound care products
- Introduction of granulation tissue
o Firm, red, pebbly
- Epithelialization
o Repaired surface
- Slough = bacteria/dead tissue
- We can also have hyper-granulation (VAC therapy) = increasing pain, bleeding, increased risk of infection, impacts epithelialization.
It is pink to dark red and shiny.
- VAC therapy is a vacuum attached to a sponge (the sponge is the dressing) that is use to promote healing. It causes suction to the wound and is only used on healthy wounds!
85
Partial – thickness (heals quicker)
o Epidermis and maybe into dermis
o Regernation occurs through:
Hemostasis
Inflammation
Epithelial Proliferation
Migration (epidermal re-establishment)
o Ex. superficial skin tear, stage 2 PI, abrasions (road rash), IAD
o Typically has a much quicker healing time as it is superficial and only needs epithelial regrowth. OTA (open to air) can heal in 6-7 days, and with moisture can heal in 4 days.
86
Full – thickness (takes longer)
o Extend into dermis – deeper wound
o Regeneration occurs through:
Hemostasis
Inflammation
Proliferation
Remodeling (up to 2 years)
o Ex. Stage 3 and 4 PI
o involves granulation, wound contraction and epithelialization.
87
Remember with inflammation we will have redness and swelling? Remember why?
Vascular response: vasodilation= heat, increased permeability= swelling and redness. Leukocytes can cause pain (Leukocytes= immunity, T and B cells, neuts, basophils and eosinophils, lymphocytes) Made in the bone marrow! Help with phagocytosis.
88
Pressure injury (PI)
- AKA – Pressure ulcers/sore, decubitus ulcer, bed sore
- A change in or a break in the skin caused by an injury or trauma related to pressure
- Localized to skin and underlying tissue
- Usually over a bony prominence
- Result of pressure, shear, or friction or all 3
- Affected by moisture, perfusion, comorbidities
89
When looking at severity we stage it. Can never be back-staged.
o If a PI is bad enough to be a stage 3 then it is always a stage 3. Even as it is healing and getting smaller we never change it to stage 2 or 1 as it heals. It gives us an idea of how bad it was!
90
what does Low pressure over a long period OR High pressure over a short period do
o Occludes blood flow
o Occludes nutrients
o Cell death
- $44,000-$90,000 to treat
91
risk factors for PIs
o Impaired Sensory Perception
o Impaired Mobility
o Alteration of LOC
o Tissue Perfusion
o Infection
o Age
o Psychosocial Impact of Wounds (stress on the system)
o Shearing
o Friction
o Moisture
o Pain
o Nutrition (inadequate nutritional intake NPO for surgery)
o Incontinent of urine/stool
o Age related changes we have discussed related to integumentary system, mobility and nutrition are all going to affect risk for PI.
o Activity: A client on bedrest or unable to independently change positions, this may be further impacted by LOC (or LOC may affect nutritional intake).
92
Incontinence Associated Dermatitis (IAD)
- Dermatitis = skin inflammation
- Redness with/without blistering,
erosion, or loss of the barrier
function
- Result of chronic or repeated
exposure of the skin to urine or
fecal matter
93
The problem with urine?
o Exposure to urine and feces ↑pH alkaline which allows micro-organisms to thrive and ↑ risk of infection.
94
The problem with feces?
o Feces contain lipid- and protein- digesting enzymes capable of damaging the SC
o This can be painful (burning, stinging) and embarrassing and is a risk factor for PIs
95
Can IAD contribute to PI development?
yes!
96
IADs and PIs
- IAD confused with stage I or II PIs
- Both have common risk factors
- IAD = high risk for PI; ↑ risk of infection & morbidity
- Different etiologies: IAD “top down” injury while PIs are believed to be “bottom up” injuries
- Incontinence is a risk factor for both….IAD can occur in the absence of any PI associated risk factors and vice versa.
- The challenge for health care providers is that these lesions can occur in the same location or in very close proximity, making classification problematic
- Both have common risk factors e.g. incontinence, poor health, immobility
- The risk of developing PIs has also been found to increase as the severity score for IAD increases
97
Differentiating IAD vs. PIs
- IAD
o Cause:
Urinary and/or fecal incontinence
o Location:
Pain, burning, itching, tingling
o Subjective:
Pain, burning, itching, tingling
o Objective:
Area is diffuse with poorly defined edges
Intact skin with erythema, with/without superficial, partial thickness skin loss
Secondary superficial skin infection may be present
- PI
o Cause:
Exposure to pressure/sheer
o Location:
Bony prominence or association with a medical device
o Subjective:
May be pain
o Objective
Varies from intact skin with non-blanchable erythema to full thickness skin loss
Distinct edges or margins
Secondary soft tissue infection may be present
98
Different etiologies
o IAD is a “top down” injury…damage is initiated on the surface of the skin,
o PI are believed to be a “bottom up” injury, where damage is initiated by changes within the soft tissues below and within the skin.
o *Can occur top down- when? *
medical devices pushing on skin from outside.
99
Nutritional Screening
o pinpoint individuals who are malnourished or at nutritional risk.
100
integument screening
o pinpoint individuals who are immobile, incontinent, malnourished or at risk due to medical devices.
101
Assessment nutrition
- Malnutrition and integumentary challenges are associated with increased length of stay, costs, and morbidity/mortality
- BMI- Weight and body composition change with age
- Weight peaks in 60’s and decreases beyond 70’s
- Proportion of body fat increases with age
- BMI is not perfect- patient may have Normal BMI but poor nutrition, and Not great for persons with ++ muscle mass = high BMI
o Anthropometry- measurement system for size and makeup of body
102
what does too much nutrition do?
Increases stress on the body
o Increases risk for CVS disease, Diabetes, sleep apnea, gall bladder disease and some cancers
103
what does too little nutrition do?
o Integ: Integumentary issues- PI, IAD, ulcers, infection in wound or invasive device.
104
Who can support skin and nutrition?
- Dietician
- SLP
- NSWOC
- PT and OT
- Physician
- Nutritionist
- Naturopath
- Supports can help:
o Increase physical strength
o Speed recovery/wound closure,
o Decrease the risk of infection.
105
PEG/PEJ and NG/GJ
P= percutaneous (through the skin)
E= endoscopic (how it is placed)
G= gastrostomy (there the end of the feeding tube is placed)
J-Jejunostomy (there the end of the feeding tube is placed)
NG or NJ- inserted into the nose. The N is for Naso and the G and the J are the same as above.
o PEG/PEJ (PEG and PEJ- inserted in the abdomen into the stomach or small intestine)
o Patient cannot swallow or is too high risk of aspiration to safely eat.
o feed- can be a permanent intervention. Required placement of PEG or PEG as NG or NJ are only temporary.
106
Total parenteral nutrition (TPN)
o Patient cannot digest/absorb appropriately or TF is not an option.
Is not a permanent option, typically uses an advanced line (typically) inserted by an IV specialist, increased risk of infection. Can use regular IV in some circumstances.
107
Evaluation: As always is based on the plan and implementation.
- May include:
o Weights
o Calorie counts
o Evaluation of healing
o Monitoring lab values (fluids, electrolytes, proteins)
o Evaluating vital signs
o Assessing symptoms of diagnosis
