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NUR 333: > Nutrition > Flashcards

Nutrition Flashcards

1
Q

3 main functions of GI system

A
  • transportation
  • digestion
  • absorption
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2
Q

importance of good nutrition

A
  • helps maintain healthy weight
  • reduces risk of chronic disease
  • promotes overall health
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3
Q

risks of malnourishment

A

greater risk of disease
- dysrhythmias
- skin breakdown
- sepsis
- hemorrhage
- inc length of stay
- delay surgical healing

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4
Q

dietary guideline

A

consume the proper daily values (myplate)

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5
Q

healthy eating patterns

A
  1. follow a healthy eating pattern across a lifespan
  2. focus on variety, nutrient dense foods, amount
  3. limit calories w added sugars, sat fats, reduce Na
  4. shit to healthier food and beverage choice
  5. support healthy eating patterns
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6
Q

factors influencing nutrition

A
  • appetite
  • negative experience
  • disease, illness
  • medications
  • env factors (income, edu, physical function, transportation, food cost)
  • developmental needs
  • alternative food patterns (religion, culture, health beliefs, personal preference)
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7
Q

older adults diet

A
  • need the same amount of vitamins and minerals of younger adults
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8
Q

nursing considerations for older adults

A
  • presence of chronic illnesses
  • meds
  • GI changes (dec HCl)
  • dec metabolic rate
  • cognitive impairments
  • available transportation
  • functional ability
  • fixed income
  • Ca supplements
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9
Q

cultural considerations

A
  • considerate of cultural and ethnic backgrounds
  • dietary restrictions secondary to religious beliefs
  • dont assume q culture is the same
  • habits often customs of their family
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10
Q

assessment of pt nutrition

A

sub/obj data
- risk of malnutrition
- standardized tools

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11
Q

assessment: anthropometry

A

-measure size and make of body
- ht and wt
- ideal body line
- BMI
- skin fold measure
- fat percentage
- RD can assist

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12
Q

nutrition lab test

A

no lab tests

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13
Q

factors that affect nutrition labs

A
  • fluid balance
  • liver and kidney function
  • presence of disease
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14
Q

total protein

A

combination of albumin and globulin
- normal 6.4- 8.3

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15
Q

albumin

A

makes up 60% of total PRO
- better indication of chronic disease
- synthesized in the liver
- half life 21 days
- normal (3.5-5.0)

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16
Q

prealbumin

A

preferred for acute conditions
- half life 2 days
- normal 15-36

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17
Q

hemoglobin

A

protein responsible for transporting o2 in the blood
- normal male (14-18 g/dL)
- normal female (12-16 g/dL)
if low may benefit from eating foods with Fe

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18
Q

assessment of nutrition history

A

-diet history (intake preference, allergies, etc)
- health history (illness, activity level, meds, etc)
- other history (age, socioeconomic, etc)

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19
Q

healthy nutrition physical exam

A
  • alert, erect
  • normal BMI
  • EMV: 15, 2+ reflexes
  • cardio: stable VS
  • GI: no problems
  • muscoskeletal: strong
  • moist skin, good color
  • nails are firm and pink
  • no swelling in face
  • mouth and teeth pink w no decay
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20
Q

malnutrition physical exam

A
  • fatigue, apathetic, sagging shoulders
  • obese, underweight
  • EMV: inattentive, irritable, confused, dec reflexes
  • cardio: stable VS
  • GI: anorexia, indigestion, constipation, diarrhea
  • muscoskeletal: weak, poor tone, wasted appearance, bowlegged, visible ribs
  • rough dry scaly pale skin
  • spoon shaped brittle nails
  • swollen face and sucken eyes
  • pale conjunctiva
  • red swollen dry lips
  • spongy receding, easily bleeding gums
  • welling tongue, teeth are missing and broken, oral mucosa swollen
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21
Q

nutritional nursing problems

A
  • imbalances nutrition: low nutrients, high nutrients
  • impaired swallowing
  • risk for aspiration
  • D/C/N
  • impaired dentition
  • fatigue
  • risk of unstable glucose
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22
Q

planning nutrition

A
  • individualized approach
  • goals and outcomes reasonable and reachable
  • setting priorities w pt understanding
  • teamwork and collaboration
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23
Q

nursing implementation

A
  • health promotion
  • advancing diet
  • measuring i and os
  • diet selection
  • care of common nutritional
  • obtaining ht and wt
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24
Q

health promotion for implementation of health promotion

A
  • pt education
  • early identification of concerns
  • assist w meals for all nutritional needs
  • educate food safety
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25
Q

implementation: diet selection

A
  • amount needed
  • ability to eat
  • any alterations in GI system
  • special considerations based on health status
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26
Q

types of diets

A
  • regular
  • liquid
  • modifies texture
  • therapeutic diets and modified nutrition
  • supplements
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27
Q

regular diet

A

no restrictions or signs of intolerance
- regular consistency
- aim to provide well balanced meal

28
Q

modified texture

A

used for pt w choking issues (dysphagia, weakness chewing)
- mechanical soft: foods soft and easy to eat (no fruits, veggies)
- pureed: no chewing like pudding
- minced: chopped small (1/8th in)
- ground: 1/4 in (rice)
- chopped: 1/2 in (elbow macaroni)

29
Q

clear liquid diet

A

usually for medical procedure or to rest the gut
- water, coffee/tea (nothing added), broth, jello, popsicles, sport drinks, lemonade (no pulp)
- no residuals in them

30
Q

liquid diet foods

A

transition back to reg diet
- juice, milk, coffee, tea, sports drinks, broth and soup, sorbet, yogurt

31
Q

liquid diet, fluid retention

A

limit amount of fluid/day often for ppl retaining excess water (heart and kidney failure)
- strict i and os
- better measurement is weigh every day in am
- watch for low serum Na

32
Q

modified consistency of liquid

A
  • thin liquid
  • thickened liquid (often for person who has had stroke)
33
Q

thickness of liquids

A
  • thin
  • nectar
  • honey
  • spoon
34
Q

therapuetic diet orders

A
  • consistent carb
  • cardiac or heart healthy
  • low residual
  • high fiber
  • gluten free
  • lactose free
  • bland
35
Q

NPO diet

A

nothing to eat/drink by mouth
- ordered for medical procedures or pt condition like resting gut or need it to wake up after med procedure
- can be after midnight or after midnight except meds
- NPO for more than 5-7 days risk nutritional health

36
Q

advancing diets

A

common is to have advance as tolerated
- tolerated = no nausea, vomiting, distention, active bowel sounds
- typical progression: clear –> full –> low residue if needed –> regular

37
Q

common nutritional issues

A
  • anorexia
  • inability to feed self
  • dysphagia
  • nausea and vomiting
38
Q

anorexia

A

lack or loss of appetite
- caused by pain, fatigue, effects of medication, emotional stress

39
Q

treatment of anorexia

A

-treat the cause
- use creative ways to stimulate appetite
- good env to eat in
- smaller more frequent meals
- have preferences available
- oral hygiene
- plus others

40
Q

assisting pt w oral feeding

A
  • protect, safety, independence, dignity
  • make sure tray is in reach
  • assess risk of aspiration
  • do they need to be supervised
  • any visual deficits
  • decreased motor skills
  • special utensils that OT helps w, use plate as a clock
41
Q

dysphagia

A

difficulty swallowing
- pts should be screened by nurse for risk
- typically cause by stroke
- warning signs like drooling, pocketing
- silent aspiration

42
Q

silent aspiration

A

food or fluid goes into airway and can cause things like pneumonia

43
Q

complications of dysphagia

A
  • aspiration pneumonia
  • dehydration
  • malnutrition
  • wt loss
  • if suspected refer to speech path and RD to preform swallowing eval
44
Q

do for pt w dysphagia

A
  • high fowlers, minimize distractions, allow time bw bites
  • check for pocketing, chin tuck, double swallowing
  • have suction available, oral care, monitor for chocking/coughing
45
Q

dont for pt w dysphagia

A

feed when altered LOC
- leave unattended
- administer sedatives or hypnotics
- use a straw

46
Q

diet for dysphagia

A

recommended by speech path
- stages like slightly thicken etc
- position of pt
- aspiration precaution

47
Q

strict i and os

A

measure of all intake and output
- recorded in medical record
- measured in ml or occurrences
- incontinence would need catheter for i and os

48
Q

who needs strict i and os

A

critical care, unstable pt, post op, catheters/lines/drains/tubes, history of heart/kidney/renal failure, malnourished who are NPO, receiving diuretics, changes in wt

49
Q

what counts as intake

A
  • oral intake
  • IV fluids
  • blood products
  • tube feeding
  • flushes
50
Q

what counts as output

A
  • urine
  • bowel movements
  • emesis
  • drainage tubes (JP, chest tubes)
51
Q

interventions for obtaining ht and wt

A
  • must have accurate info
  • weight should be the same and accurate
  • ht
  • assess trend
52
Q

enteral

A

provide nutrients via GI. tract
- preferred method if pt cant swallow and gut is functioning
- received through nasogastric, jejunal, gastric tube that deliver to gastric of jejunum
- risk for gastric reflux –> jejunum feedings
- must confirm placement

53
Q

parenteral

A

form of specialized nutrition support provided IV

54
Q

indications for enteral nutrition

A
  • prolonged anorexia
  • severe protein energy malnutrition
  • coma
  • impaired swallowing
  • critical illness
55
Q

benefits of EN over PN

A
  • reduces sepsis
  • minimizes the hyper-metabolic response to trauma
  • decreases hospital mortality
  • maintains intestinal structure and function
56
Q

administration of tube feeding

A
  • start at full strength, slow rate
  • inc per RD and HCP recommendations like inc q 8-12 hrs, inc until goal reached, inc w no intolerance
57
Q

signs of tube feeding intolerance

A
  • high gastric residual
  • nausea
  • cramping
  • vomiting
  • diarrhea
58
Q

types of tube feeding

A

bolus –> intermittent
pump –> continuous

59
Q

complications of tube feeding

A
  • pulmonary aspiration
  • diarrhea
  • constipation
  • cramping, nausea
  • tube occlusion
  • delayed gastric emptying
  • serum electrolyte imbalance
  • fluid overload
  • hyperosmolar dehydration
60
Q

tube feeding placement

A
  • through the nose (nasogastric/nasointestinal)
  • surgically (gastronomy/jejunostomy)
  • endoscopically (PEG/PEJ)
61
Q

nurses role in feeding tube placement

A
  • insert NG tube using water soluble lubricant
  • landmarks: nose, ear, xiphoid process
62
Q

confirming tube placement

A
  • xray
  • ongoing placement verified w pH test
63
Q

nasogastric or nasojejunal

A

typically for less than 4 wks
- large and small bore
- come w stylet
- connectors are not standard for EN feeding tubes

64
Q

surgically or endoscopically placed tubes

A
  • preferred for long term feeding
  • more than 6 wks
65
Q

nursing care for feeding tubes

A
  • abd focused assessment
  • check skin for breakdown
  • assess nutritional status, intolerance, i and os, monitor labs
  • head og bed greater than 45
66
Q

checking residual

A
  • for continuous: q 4-6 hours
  • for intermittent: immediately before
  • high gastric residual can indicate delayed gastric emptying
  • more than 250 then hold for an hr and recheck
  • more than 500 notify HCP
67
Q

feeding tube administration

A
  • follow 5 rights for med administration
  • ensure med can be administered
  • always verify placement
  • flush w water before and after
  • administer one med at a time

NUR 333: (10 decks)

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