Nutrition Flashcards
What are the major methods of nutritional assessment?
- Developmental stage
- Measurement –> height, weight (BMI)
- Diet history
- Vitamins –> are they eating a lot of vitamins?
- Frequently used lab tests:
- Hemoglobin –> iron production
- Transferrin level/total iron - binding capacity = proteins available to bind & cary iron
- Albumin, globulin, total protein
- BUN –> tests how well your kidneys are working
- Creatinine = reflects muscle metabolism
Who needs Supplemental Therapy?
- Rapid growth
- Pregnancy, lactation
- Debilitating illness
- cancer, diseases which cause increased BMR/ basal metabolic rate.
- massive injuries, major surgery, burns. - Illness which interferes w/ absorption or utilization of nutrients
- malabsorption, inflammatory bowel, liver, renal diseases, chronic diarrhea, G-I surg - Inadequate diets
- alcoholics, poverty elderly, homeless
Who are the 7 patients with nutritional risk?
- Obese
- Anorexia nervosa –> don’t eat bc they view themselves as fat even tho they’re supper skinny
- Bulimia –> binge eat; often vomit, excessive fasting, teeth decay
- Surgery –> they aren’t able to eat
- Immobilize patients –> not have desire to eat/move. bones will calcify (calcium gets out of bones so you get excess calcium in blood stream)
- Cancer patients
- Pregnant/lactating
What are some of the nursing problems related to people with nutrition issues?
- Altered nutrition: less than body requirements, or more than body requirements (eating less/more than they need to)
- Self-care deficit: feeding –> can’t feed themselves. you need to cut up the food
- Impaired swallowing
- DYSPHAGIA (problem swallowing); SIGNS: coughing during eating, change in voice tone after swallowing, abnormal movements of the mouth, the tongue, or the lips; pocket food, regurge (throw up)
What are the 8 Hospital Diets?
- NPO (nothing by mouth): cannot eat anything & can’t use the gut
- Clear liquid: any liquid you can see thru
- EX: broths, jellos, popsicles, teas, sprite (clear sodas), coffee without creamers, apple & cranberry juice
- Full liquid: anything that’s liquid at body temp.
- EX: cream-based soups (tomato soups), ice-cream, milkshakes, pudding
- Pureed: something that’s put on the blender (no need to chew them)
- EX: pudding, mashed potatoes, yogurt
- Mechanically soft: not allowed anything that’s hard to chew (ONLY SOFT allowed)
- EX: Soft cooked veggies. no raw food & veggies
- Bland: no spices, fried foods, fatty foods, acids
- Low residue (low fiber): easy to digest
- EX: no raw food & veggies, nuts, seeds nor fried foods. Only things that are cooked well
- Regular: you’re allowed to select what you want
What are some Special Diets?
- 1800 calorie ADA (American Diabetes Association) –> people with diabetes trying to control their cal intake
- 2 Gm Na (2 gram sodium)–> moderate restriction of salt; somebody with hypertension
- Low cholesterol –> cardiac patients who are trying to limit the amnt. of animal products or fat & oil.
- High protein –> ppl that have little albumin level.
- Low fat & Gluten free diet (celiac disease)
- Renal diet (Low Na, controlled amnt. of phosphorus & protein) –> their kidneys aren’t able to move the phosphorus well & in this diet, they try to limit the amount of phosphorus
- Cardiac diet –> somebody w/ hypertension who are trying to limit the AMOUNT OF SALT
What are the nursing interventions for people related to nutrition?
- Control odors –> bland food & not have a lot of odor
- Small attractive meals
- Don’t do procedures just before or just after meals
- Provide good oral care
- Assess ability to feed themselves
- Prepare patients for meals : cut food & open packages-
- Safety considerations include:
- Position –> HIGH-FOWLERS to prevent aspirations
- Assess swallowing ability
What are some alternative therapies?
Enteral nutrition - using the gut
1. NG tube (lasts 1 month & not long term)
- check residuals to make sure there’s no build up
- High risk of aspiration
- sits in the stomach
2. Dob Hoff tube (1 month & not long term)
- High risk of aspiration
- Sits in the post pyloric
3. Gastrotomy or PEG tube
- Directly into the stomach & for long term/forever
4. Jejunostomy or “J-tube’
- Little risk of aspiration bc it’s all the way in the small intestine (if it’s in the stomach, then there’s higher risk of aspiration) & DON’T need to check for residual
- Bypass the stomach & goes directly into the small intestine/jejunum
- Last for longer than 6 weeks
Which type of feeding tube has a low risk of aspiration???
Jejunostomy or J-tube!!
Because it’s all the way in the jejunum!
What are the nursing care of tubes?
- Check placement
- Check pH of gastric contents. Should be low = acidic
- X-ray of abdomen is the most reliable method
- Air-bolus - Check residuals at least EVERY 4 HOURS!! if it’s over 150ml, hold the tube and recheck it again in an hour
- Elevate HOB @ least 30 degrees!!
- Must crush PO meds or give liquid form
- Flush tube with meds
- Advancing rate of tube feed protocols
- Check bowel sound –> if they have hypoactive bowel sound, then they have a high residual bc that means they’re not digesting as fast as they should!!!
What is the most reliable method of checking the placement of NG & gastronomy tubes?
X-ray
How many times do you check residuals ??
every 4 hours!! if it’s over 150ml, hold the tube and recheck it again in an hour
What are indications for Enteral nutrition? (who should get enteral feeding?)
1) Respiratory failure w/ prolonged intubation –> when they’re on a ventilator and aren’t able to eat
2) Head, Neck, Upper GI cancer
3) Neurological disorders – CVA (hard time swallowing), Dementia
4) Inflammatory bowel disease
5) Inadequate oral intake
6) Dysphagia/Aspiration
What should you know about Total Parenteral Nutrition (TPN)?
(Uses an IV line thru the veins)
1. Patients unable to digest or absorb enteral feedings or highly stressed physiological states
2. Indicated when GI tract can’t be used for more than 1 week
- IV solutions greater than 10% dextrose
- Central vein/line REQUIRED –> SUBCLAVIAN OR JUGULAR VEIN
- Placement confirmed by radiology
4. Fat emulsions – Amino acids & lipids
- given: Y-site or peripherally or mixed
- HYPERTONIC solutions containing glucose, amino acids, electrolytes, fat emulsions (lipids)!!!
- Glass bottles for
A. Amino acids: be sure the fluid is not cloudy
B. Lipids: can be run peripherally or piggyback with TPN - Insulin may be added to check blood sugar (bc ppl on TPN receive high concentration of sugar from TPN) monitor blood glucose q6h
- Look for oil droplets or oil layer in the IV solutions because that shouldn’t be there!
Which vein do you use for Total parenteral nutrition (TPN)?
SUBCLAVIAN OR JUGULAR VEIN
