Nutrition and Elimination Flashcards
(217 cards)
1
Q
What are associated factors of malnutrition?
A
- Unintentional weight loss
- Health declines progressively
- Reduces in physical & cognitive status
- Seeks more health care services
- Premature moving into other living arrangements
- Increased morbidity & mortality
These factors highlight the complex relationship between age and malnutrition, emphasizing the need for early intervention and support.
2
Q
What is unintentional weight loss?
A
A significant decrease in body weight that occurs without trying to lose weight.
This can be a critical indicator of malnutrition and may suggest underlying health issues.
3
Q
How does health decline relate to malnutrition?
A
Health declines progressively contribute to malnutrition by affecting nutrient intake and absorption.
Progressive health issues can lead to difficulties in eating, digestion, and nutrient utilization.
4
Q
What is meant by ‘reduces in physical & cognitive status’?
A
Deterioration in physical abilities and cognitive functions due to malnutrition.
This reduction can lead to decreased independence and increased reliance on caregivers.
5
Q
What does ‘seeks more health care services’ imply in the context of malnutrition?
A
An increase in health care utilization often due to complications arising from malnutrition.
This can include more frequent doctor visits or hospitalizations.
6
Q
What are examples of premature moving into other living arrangements?
A
- Convalescent home
- Assisted living
These arrangements often become necessary when individuals can no longer care for themselves due to health declines.
7
Q
What is a convalescent home?
A
A facility that provides care for individuals recovering from illness, surgery, or injury.
This type of home focuses on rehabilitation and restoring health.
8
Q
What is assisted living?
A
A type of housing designed for people who require assistance with daily activities but do not need full-time medical care.
It typically includes a combination of housing, support services, and health care.
9
Q
What are the consequences of malnutrition in older adults?
A
- Increased morbidity
- Increased mortality
These consequences highlight the critical need for nutritional support and interventions in older populations.
10
Q
What is one risk factor for malnutrition related to oral health?
A
Tooth loss
Tooth loss can lead to difficulties in chewing and swallowing food.
11
Q
What condition related to the gums can increase the risk of malnutrition?
A
Gum disease, tooth infection
These conditions can affect the ability to eat properly.
12
Q
What happens to body mass as a risk factor for malnutrition?
A
Body mass
A decrease in body mass can indicate inadequate nutritional intake.
13
Q
What physical capability decreases with age that can contribute to malnutrition?
A
Low muscle strength
Reduced muscle strength can hinder physical activity and overall health.
14
Q
How does physical activity level change with age impacting nutrition?
A
Activity level
A lower activity level may lead to decreased caloric and nutrient needs.
15
Q
What happens to energy distribution as a risk factor for malnutrition?
A
Low energy distribution
This can affect how nutrients are absorbed and utilized in the body.
16
Q
What is one gastrointestinal change that can occur with aging?
A
GI enzymes
A decrease in gastrointestinal enzymes can impair digestion.
17
Q
What change occurs in gastric emptying that can affect nutrition?
A
Delay gastric emptying
Delayed gastric emptying can lead to feelings of fullness and reduced food intake.
18
Q
What is a common appetite-related change in older adults?
A
Appetite
A decreased appetite can lead to insufficient food intake.
19
Q
What sensory changes can impact eating habits as people age?
A
Diminish senses of smell & taste
Reduced senses can make food less appealing, affecting intake.
20
Q
How does gastrointestinal motility change with age?
A
GI motility
Decreased motility can lead to constipation and discomfort.
21
Q
What are some gastrointestinal function disorders that can increase with age?
A
Increase in GI function disorders
Disorders may include dysphagia, dyspepsia, and anorexia.
22
Q
What is dysphagia?
A
Difficulty swallowing
This condition can severely affect food intake and nutrition.
23
Q
What is dyspepsia?
A
Stomach discomfort
Dyspepsia can deter individuals from eating properly.
24
Q
What condition refers to a loss of appetite?
A
Anorexia
In older adults, anorexia can lead to significant weight loss and malnutrition.
25
What happens to hepatic function as a risk factor for malnutrition?
Hepatic function
## Footnote
Reduced liver function can affect metabolism and nutrient processing.
26
What changes occur in liver volume and blood flow with aging?
Decrease liver volume, blood flow & drug metabolism
## Footnote
These changes can impact the body’s ability to process nutrients and medications.
27
What are psychosocial risk factors for malnutrition?
Psychosocial factors include loneliness, depression, and non-compliance
## Footnote
These factors can significantly impact an individual's ability to maintain proper nutrition.
28
List financial risk factors associated with malnutrition.
* Limited income
* Shopping difficulties
* Lack of transportation
* Cooking challenges
* Inability to prepare meals
* Functional decline
## Footnote
Financial constraints can affect access to nutritious food.
29
True or False: Institutional food can be a risk factor for malnutrition.
True
## Footnote
Institutional food may not meet the dietary needs or preferences of individuals.
30
What ethnic/cultural factors can influence malnutrition?
* Specific cultural foods
* Food references
## Footnote
Cultural preferences and practices can affect dietary choices.
31
What lifestyle changes are considered risk factors for malnutrition?
Experience of acute or chronic pain
## Footnote
Pain can hinder the ability to eat and prepare meals properly.
32
Fill in the blank: _______ is a psychosocial factor that can lead to malnutrition.
Loneliness
## Footnote
Loneliness can lead to decreased motivation to prepare and consume meals.
33
Name a financial factor that can limit access to food.
Limited income
## Footnote
A limited budget can restrict the ability to purchase healthy food options.
34
What is a consequence of functional decline related to malnutrition?
Inability to prepare meals
## Footnote
Functional decline can impair daily living activities, including meal preparation.
35
True or False: Depression is a risk factor that can contribute to malnutrition.
True
## Footnote
Depression can affect appetite and motivation to eat.
36
What is a nasoenteric tube?
Inserted from nasally into GI tract
## Footnote
Used for delivering nutrition directly to the gastrointestinal tract
37
What is a nasoduodenal tube?
Nasally advanced to stomach pyloric sphincter and into duodenum
## Footnote
This tube is used when feeding directly into the duodenum is required
38
What is a jejunostomy tube?
Bypass stomach and advanced into jejunum site
## Footnote
It is used for patients who cannot tolerate gastric feeding
39
What is a Percutaneous Endoscopic Gastrostomy (PEG)?
Created from abdominal wall to stomach
## Footnote
This method allows for long-term enteral nutrition through the abdominal wall
40
What is a potential complication of refeeding?
Refeeding Syndrome
## Footnote
Refeeding syndrome is a dangerous condition that can occur when feeding resumes after a period of malnutrition or fasting.
41
What state can result from prolonged starvation?
Starvation state
## Footnote
A starvation state leads the body to break down fat and protein for energy.
42
What does the body break down during a starvation state instead of carbohydrates?
Fat & protein
## Footnote
In a starvation state, the body utilizes fat and protein as primary energy sources.
43
What can occur as a result of muscle and cell loss in vital organs?
Loss in heart, liver & lungs
## Footnote
Muscle and cell loss can severely impact the function of essential organs.
44
What is a risk associated with tube feeding?
Tube Misplacement
## Footnote
Tube misplacement can lead to serious complications if the feeding tube enters the trachea or peritoneal cavity.
45
What can tube misplacement lead to?
Aspiration pneumonia, infection
## Footnote
Aspiration pneumonia can occur if feed enters the lungs, leading to infection.
46
What are common gastrointestinal complications associated with feeding?
Abdominal distention, N/V
A distended stomach with a feeding tube, also known as bloating or fullness, can be a common issue, especially with PEG (percutaneous endoscopic gastrostomy) tubes. Several factors can contribute, including excessive gas buildup, improper
## Footnote
Nausea and vomiting (N/V) are common symptoms indicating feeding intolerance.
47
What complications can arise from overfeeding?
Associated to over feeding
## Footnote
Overfeeding can lead to several complications, including gastrointestinal distress.
48
What is a possible outcome of feeding intolerance?
Diarrhea
## Footnote
Diarrhea can be a sign that the diet is not tolerated by the patient.
49
What type of imbalance can occur due to feeding complications?
Fluid & Electrolyte Imbalance
## Footnote
An imbalance can lead to severe health issues if not corrected.
50
What types of feeding products can lead to complications?
Isotonic & hypertonic products
## Footnote
The type of feeding product can influence the likelihood of complications occurring.
51
What is the gold standard for tube placement verification?
X-ray
## Footnote
X-ray is the most reliable method to confirm the correct placement of a feeding tube.
52
What should be assessed at the insertion site of a feeding tube?
Infection or excoriation (skin breakdown)
## Footnote
Regular assessment of the insertion site is crucial for preventing complications.
53
What is the recommended head of bed (HOB) angle during tube feeding?
30 degrees
## Footnote
Keeping the HOB elevated helps reduce the risk of aspiration.
54
How often should residual checks be performed during tube feeding?
Q4 hrs or before each feeding
## Footnote
Checking residuals helps assess gastric emptying and tolerance to feedings.
55
How often should the feeding bag and tubing be changed to prevent infection?
Q24 hrs
## Footnote
Regular changing of feeding supplies is essential for maintaining hygiene.
56
What should be checked before each administration of tube feeding?
Placement of the tube
## Footnote
Confirming tube placement is critical to ensure safe feeding.
57
What patient laboratory level should be monitored during tube feeding?
Albumin level
## Footnote
Monitoring albumin can provide insights into the patient's nutritional status.
58
What is bolus feeding?
Specific amount of nutrient at set interval (e.g. 4-6 hrs)
## Footnote
Bolus feeding involves delivering a defined volume of nutrients at intervals.
59
What is continuous feeding?
About 24 hours
## Footnote
Continuous feeding provides a steady supply of nutrients over an extended period.
60
What is cyclic feeding?
Set amount with down time or stop time
## Footnote
Cyclic feeding allows for periods of feeding followed by breaks.
61
What is the purpose of nasogastric suction?
Access to stomach for irrigation, suction, and/or feeding
## Footnote
Nasogastric suction is used to manage various gastrointestinal conditions.
62
List three indications for using an orogastric/nasogastric tube.
* Access to stomach
* Treatment for bowel obstructions
* Prolonged ileus
63
True or False: Nasogastric tubes can be used for short-term nutrition/feeding.
True
## Footnote
Nasogastric tubes are often employed for short-term nutritional support.
64
Fill in the blank: Nasogastric tubes are indicated for relieving _______.
distention
65
What are the uses of nasogastric tubes in relation to nausea and vomiting?
To relieve nausea and vomiting
## Footnote
Nasogastric suction can help manage symptoms by emptying gastric contents.
66
What is one indication for nasogastric tubes related to gastric content?
Emptying gastric content
## Footnote
This is particularly useful in cases of obstruction or ileus.
67
What is the Salem (Double Lumen) pump commonly used for?
Irrigation, feeding, suctioning, giving meds
68
What is the most common type of nasogastric tube?
Salem (Double Lumen) pump
69
What are the primary uses of the Salem (Double Lumen) pump?
Irrigation of the stomach and tube feedings
70
What sizes are the sites for the Salem (Double Lumen) pump?
14-18 French
71
What is the length of the Salem (Double Lumen) pump?
120 cm
72
What should you connect to if suction is needed with the Salem (Double Lumen) pump?
Larger bore to suction
73
What is the purpose of the blue vent in the Salem (Double Lumen) pump?
Always open to air for continuous atmospheric irrigation
74
How can reflux be prevented when using the Salem (Double Lumen) pump?
Have the blue port vent above the patient's waist
75
What is a Dobhoff tube?
A Dobhoff tube has an infusion NGT and a weighted tip to hold the tube in place
## Footnote
Dobhoff tubes are designed for enteral feeding.
76
What type of suction does a small bore feeding tube have?
Continuous suction and intermittent interval suction
## Footnote
Intermittent interval suction is recommended for use.
77
What is a Salem pump?
A Salem pump has a larger double bore lumen and is used for suction/bolus NGT
## Footnote
It is commonly utilized in gastrointestinal management.
78
What are nasogastric (NG) tubes used for?
Administering total enteral nutrition (TEN) and withdrawing gastric contents
## Footnote
NG tubes are inserted through a nostril into the stomach.
79
How can NG tubes affect esophageal sphincter function?
They can decrease esophageal sphincter function by keeping the cardiac sphincter open
## Footnote
This allows acidic contents from the stomach to enter the esophagus.
80
When is a large-bore NG tube used?
After open surgery for hiatal hernia repair
## Footnote
It prevents the fundoplication wrap from becoming too tight around the esophagus.
81
Why is monitoring NG tube patency important?
To keep the stomach decompressed and prevent retching or vomiting
## Footnote
Retching or vomiting could strain or rupture stomach sutures.
82
What is the duration of use for nasoenteric tubes?
Short-term feeding, less than 4 weeks
## Footnote
They are used primarily for enteral nutrition.
83
What are the methods of administering tube feedings (TEN)?
Bolus feeding, continuous feeding, and cyclic feeding
## Footnote
Each method has different infusion patterns and timing.
84
How is continuous feeding administered?
Infused continuously by gravity drip or by a pump over a specified time
## Footnote
Continuous feeding ensures a steady intake of nutrients.
85
What is cyclic feeding?
Similar to continuous feeding but with a stopping period ('down time')
## Footnote
This allows for breaks in the feeding schedule.
86
What ensures the enteral product is infused at the prescribed rate during continuous or cyclic feeding?
A feeding pump
## Footnote
Feeding pumps are critical for accurate nutrient delivery.
87
What is Gastroesophageal Reflux Disease (GERD)?
The most common upper gastrointestinal disorder in the United States characterized by persistent gastroesophageal reflux (GER), leading to inflammation of the esophageal mucosa.
88
What are the common symptoms of GERD?
Symptoms include dyspepsia, regurgitation, abdominal discomfort, nausea, flatulence, eructation(belching; burping), bloating, and pyrosis(heartburn).
89
What factors contribute to the development of GERD?
* Compromised lower esophageal sphincter (LES)
* Eating large meals
* Certain drugs
* Smoking
* Alcohol use
* Increased intra-abdominal pressure
* Obesity
* Pregnancy
90
What is Barrett's esophagus?
A condition where Barrett's epithelium replaces normal squamous cell epithelium in the lower esophagus, associated with an increased risk of cancer.
91
What are the complications associated with chronic GERD?
* Atypical chest pain
* Asthma (acid reflux can trigger asthma attacks)
* Laryngitis (inflamed vocal cords/larynx)
* Dental decay
* Hemorrhage (When stomach acid refluxes into the esophagus, it can cause inflammation (esophagitis) and ulcers, which may lead to bleeding. This bleeding can manifest as blood in vomit, bloody or dark stools, or less apparent symptoms like weakness, fatigue, and unexplained weight loss. )
* Aspiration pneumonia (stomach acid flows back up into the esophagus, and if this acid reflux reaches the back of the throat, it can be aspirated into the lungs.)
92
What is the primary focus of interprofessional collaborative care for GERD?
To optimize nutrition, decrease symptoms, and prevent complications.
93
What lifestyle changes can help manage GERD?
* Avoiding alcohol and tobacco
* Managing weight
* Avoiding heavy lifting and straining
* Wearing non-restrictive clothing
* Sleeping with the head elevated
94
Fill in the blank: GERD is characterized by the backward flow of _______ into the esophagus.
GI contents
95
What is a Type I hiatal hernia?
A sliding hernia where the esophagogastric junction and part of the fundus slide upward through the esophageal hiatus into the chest.
96
What diagnostic test is most specific for identifying a hiatal hernia?
Barium swallow study with fluoroscopy.
97
What are the symptoms of hiatal hernias?
Most patients are asymptomatic, but some may experience symptoms similar to GERD, worsening after meals or when supine.
98
What is the common surgical procedure for severe GERD?
Fundoplication, specifically laparoscopic Nissen fundoplication (LNF).
99
True or False: Long-term use of proton pump inhibitors (PPIs) has been linked to increased risk for community-acquired pneumonia.
True
100
What is the main concern associated with Type II through IV hiatal hernias?
High risks for complications including volvulus(An obstruction due to twisting or knotting of the gastrointestinal tract), obstruction, strangulation, and perforation.
101
What is the role of nutrition therapy in managing GERD?
Limiting foods that decrease LES pressure or irritate inflamed tissue, and recommending smaller, more frequent meals.
102
Fill in the blank: Patients should avoid eating within _______ hours before going to bed to minimize nighttime reflux.
3
103
What are the common drug therapies for GERD?
* Antacids
* Histamine blockers
* Proton pump inhibitors (PPIs)
104
What is the significance of a nasogastric (NG) tube in post-operative care for hiatal hernia repair?
To prevent the fundoplication wrap from becoming too tight around the esophagus.
105
What is the typical progression of diet after fundoplication surgery?
Patients gradually progress from clear fluids to a near-normal diet over 4 to 6 weeks.
106
What can excessive relaxation of the lower esophageal sphincter (LES) lead to?
Increased risk of gastroesophageal reflux and associated complications.
107
What is the typical heritability percentage of GERD according to twin and family studies?
Approximately 31%.
108
What lifestyle modification can help reduce nighttime reflux for patients with GERD?
Sleeping with the head of the bed elevated at least 30 degrees.
109
What is aerophagia?
Air swallowing that can lead to gas bloat syndrome after fundoplication surgery.
110
What is the standard surgical approach for severe GERD?
Laparoscopic Nissen Fundoplication (LNF)
## Footnote
LNF is preferred due to fewer complications compared to open surgery.
111
What is a primary focus of postoperative care following open surgery for hiatal hernia repair?
Preventing respiratory complications
## Footnote
This includes elevating the head of the bed and promoting early ambulation.
112
What is the purpose of a large-bore nasogastric (NG) tube after conventional open surgery for hiatal hernia repair?
To prevent the fundoplication wrap from becoming too tight around the esophagus
113
What should initial NG drainage look like after hiatal hernia surgery?
Dark brown with old blood, becoming yellowish green within 8 hours
114
Fill in the blank: Patients after fundoplication surgery should gradually progress from clear fluids to a _______ over 4 to 6 weeks.
near-normal diet
115
What is a common postoperative symptom experienced by patients after fundoplication surgery?
Temporary dysphagia
116
What device is implanted to augment the LES closure pressure in GERD management?
LINX Reflux Management System
117
What dietary recommendations are given to patients with diverticulosis?
High-fiber diet including cellulose and hemicellulose types of fiber
## Footnote
Sources include wheat bran, whole-grain breads, cereals, fresh fruits, and vegetables.
118
What is diverticulosis?
The presence of many abnormal pouchlike herniations, called diverticula, in the wall of the intestine
119
What can lead to the formation of diverticula?
High intraluminal pressure and muscle weakness
## Footnote
Muscle weakness may develop due to aging or lack of fiber in the diet.
120
What are common symptoms of diverticulosis?
Usually asymptomatic but may cause intermittent pain in the left lower quadrant and a history of constipation
121
How is diverticulosis typically diagnosed?
During a routine colonoscopy
122
What can occur if food or bacteria become trapped in a diverticulum?
Diverticulitis
123
What are the symptoms of diverticulitis?
Low-grade fever, nausea, and abdominal pain localized to the left lower quadrant, distention, tenderness (rebound)
124
What is the typical management approach for patients with diverticulitis?
A combination of drug and nutrition therapy with rest
125
What should patients with diverticulitis avoid in their diet?
High-fiber foods
## Footnote
Fiber can be irritating during active inflammation.
126
What complications can arise from diverticulitis?
Perforation, local abscess, lower GI bleeding
## Footnote
Severe complications may require emergency surgery.
127
What is the most common surgical procedure for complicated diverticulitis?
Colon resection
128
What is essential patient education regarding diverticulitis?
Recognizing manifestations such as fever, abdominal pain, and bloody stools
129
True or False: Patients with diverticulosis typically require laboratory studies for diagnosis.
False
130
What is the recommended daily fiber intake for patients with diverticulosis?
25 to 35 grams
131
Fill in the blank: Patients should drink plenty of fluids to help prevent _______ that may occur with a high-fiber diet.
bloating
132
What are the contributing factors of GERD?
• Obese/overweight
• Increased intra-abdominal pressure
• Night time prolonged reflux
• Hx of hiatal hernias
• Consume large meals
• Gastric distention & delayed emptying
• Esophageal stricture
• Caffeine, alcohol
• Citrus fruits, tomatoes
• Present of nasogastric tube
• Sphincter opens & acidic contents reflex
• Pregnancy or wearing tight belts
• Lower esophageal sphincter stress
• Ascites, bending over
## Footnote
Each factor contributes to the risk or severity of GERD symptoms.
133
Which diagnostic methods are used for GERD?
• pH monitoring/Bravo
• Esophageal Manometry
• Gastric Emptying Study
## Footnote
These tests help assess the severity and nature of GERD.
134
What lifestyle changes are recommended for GERD management?
• Lose weight
• Consume small/frequent meals
• No alcohol/caffeine
## Footnote
Lifestyle modifications can significantly alleviate GERD symptoms.
135
What types of drug therapy are available for GERD?
• Antacids (Maalox)
• Histamine blockers (Pepcid)
• Proton pump inhibitors (Protonix)
## Footnote
These medications help reduce stomach acid and manage GERD symptoms.
136
When is surgery considered for GERD patients?
When patients fail medical treatment and develop complications
## Footnote
Surgical options may be necessary for severe cases of GERD.
137
Fill in the blank: Increased _______ pressure is a contributing factor of GERD.
[intra-abdominal]
138
True or False: Caffeine and alcohol can exacerbate GERD symptoms.
True
## Footnote
These substances can relax the lower esophageal sphincter, worsening reflux.
139
What is a common dietary recommendation for GERD patients?
Avoid large meals
## Footnote
Large meals can increase stomach pressure and promote reflux.
140
What is another name for a hiatal hernia?
Diaphragmatic Hernia
141
What is the pathophysiology of a hiatal hernia?
Protrusion of stomach through esophageal hiatus of diaphragm into thorax
142
What are the two types of hiatal hernias?
* Sliding hernias
* Paraesophageal (rolling) hernias
143
What occurs in a sliding hiatal hernia?
Esophageal junction & portion of stomach slide upward through esophagus
144
What characterizes a paraesophageal (rolling) hiatal hernia?
Fundus rolls through esophageal into chest beside esophagus
145
What are common clinical manifestations of a hiatal hernia?
* Dyspepsia/indigestion
* Regurgitation
* Abdominal pain
* Fullness
* Nausea
* Burping
146
When does pain from a hiatal hernia typically worsen?
When laying or bending over
147
What type of pressure may be experienced after a meal in a patient with a hiatal hernia?
Substernal pressure
148
Where may pain radiate in patients with a hiatal hernia?
Back, neck, or jaw
149
What is one etiology of hiatal hernia?
Abdominal muscle weakness
## Footnote
Other contributing factors include increased abdominal pressure and heredity.
150
Name a factor that can increase abdominal pressure leading to hiatal hernia.
Coughing
## Footnote
Other factors include straining/constipation and sudden overexertion.
151
What lifestyle factor is associated with the development of hiatal hernia?
Pregnancy/obesity
## Footnote
Frequent bending/heavy lifting and smoking/stress are also associated.
152
What is the most specific diagnostic test to identify a hiatal hernia?
Barium Swallow Study with Fluoroscopy
## Footnote
This test helps visualize the hiatal hernia effectively.
153
What does EGD provide in the context of diagnosing hiatal hernia?
Provides image of esophagus & gastric lining
## Footnote
This helps assess any damage or abnormalities in the upper gastrointestinal tract.
154
What should patients avoid to manage GERD and hiatal hernia?
Eating late
## Footnote
Other recommendations include losing weight and following a restricted diet.
155
Fill in the blank: Patients should maintain _______ regularly to help manage symptoms.
exercise
## Footnote
Regular physical activity can help alleviate symptoms.
156
What position is recommended for sleeping to manage hiatal hernia symptoms?
Sleeping with head of bed 6 inches elevated
## Footnote
This position can help prevent acid reflux.
157
What dietary change is suggested for patients with hiatal hernia?
Eat small frequent meals
## Footnote
This helps reduce pressure on the stomach and esophagus.
158
True or False: Wearing tight clothing is recommended for patients with hiatal hernia.
False
## Footnote
Patients are advised to refrain from wearing tight clothing.
159
What should patients do after meals to manage their symptoms?
Maintain an upright position
## Footnote
This helps prevent reflux and discomfort.
160
What are diverticula?
Pouchlike herniations of mucosa in the colon
## Footnote
Diverticula are small bulges that can form in the lining of the colon.
161
Define diverticulosis.
Presence of many pouchlike herniations
## Footnote
Diverticulosis is often asymptomatic.
162
What factors contribute to the pathophysiology of diverticulosis?
* Aging process
* Low fiber diets
* Chronic constipation
* Weaken colon muscle
## Footnote
These factors can lead to the formation of diverticula in the colon.
163
What occurs during diverticulitis?
Diverticula become inflamed
## Footnote
Inflammation can lead to complications such as abscess or perforation.
164
What factors contribute to the pathophysiology of diverticulitis?
* Diverticulum trapped with undigested foods, bacteria
*diverticula becomes inflamed
* Decreased blood supply
* Bacteria invades
* Local abscess, perforated
## Footnote
These factors can worsen the inflammation and lead to serious complications.
165
What are common clinical manifestations of diverticulosis?
* Often no symptoms
* History of constipation
* Intermittent LLQ pain
## Footnote
LLQ pain refers to pain in the lower left quadrant of the abdomen.
166
List the clinical manifestations of diverticulitis.
* Nausea/Vomiting
* Abdominal pain
* Low-grade fever
* Possible rectal bleed
* Distention, tenderness
## Footnote
Symptoms can vary in severity and may indicate the need for medical attention.
167
What is a sign of peritonitis?
Sudden changes in level of consciousness (LOC)
Hypotension
Shock
## Footnote
This condition can be life-threatening and requires urgent medical care.
168
What diagnostic tests are used for diverticulitis?
* Elevated WBC
* Decreased hemoglobin/hematocrit (H/H)
* Possible positive occult blood (OB)
* Abdominal x-rays
-eval for free air or fluid, indicates perforation
* CT scan, abdominal ultrasound
-ID absences or thickening of bowel
* Colonoscopy
Assess for LOC
## Footnote
These tests help assess the presence of diverticulitis and any complications.
169
What treatment options are available for diverticulitis?
* Broad-spectrum antibiotics
* Analgesics
* IV fluids
* NGT for N/V, decompression
* Colon resection with colostomy vs. without colostomy
## Footnote
Treatment depends on the severity of the condition and any complications.
170
Fill in the blank: During the acute phase of diverticulitis, patients should avoid _______.
[laxatives/enemas]
## Footnote
These can exacerbate symptoms and increase the risk of perforation.
171
What activities should be refrained from to prevent diverticulum perforation?
* Lifting
* Coughing
* Bending
## Footnote
These activities can increase intra-abdominal pressure.
172
What dietary recommendations are made during the acute phase of diverticulitis?
* Low fiber
* Clear liquid diets
| bowel rest
## Footnote
These diets help reduce bowel irritation during flare-ups.
173
What dietary changes are recommended when inflammation resolves in diverticulitis?
| Maintenance Phase
* High fiber
* Fluid intake
* Whole grains
* Wheat bran products without seeds
* Fruits and steamed vegetables
* No alcohol or foods with seeds
* Eliminate fried and high-fat foods
## Footnote
These dietary changes help maintain bowel health and prevent future episodes.
174
What is refeeding syndrome?
A potentially life-threatening complication that can occur when severely malnourished individuals resume feeding.
174
What is refeeding syndrome?
A potentially life-threatening complication that can occur when severely malnourished individuals resume feeding.
175
What happens during the starvation state?
The body switches from using carbohydrates to using fat and protein stores for energy, leading to decreased insulin secretion and depletion of intracellular electrolytes and vitamins.
175
What happens during the starvation state?
The body switches from using carbohydrates to using fat and protein stores for energy, leading to decreased insulin secretion and depletion of intracellular electrolytes and vitamins.
176
What triggers the metabolic shift during refeeding?
The resumption of feeding, especially with carbohydrates, which increases insulin levels rapidly.
176
What triggers the metabolic shift during refeeding?
The resumption of feeding, especially with carbohydrates, which increases insulin levels rapidly.
177
What is the hallmark of refeeding syndrome?
Hypophosphatemia (low phosphate).
177
What is the hallmark of refeeding syndrome?
Hypophosphatemia (low phosphate).
178
What are the consequences of increased insulin levels during refeeding?
Stimulates the uptake of glucose, electrolytes, and other nutrients into cells for energy production and tissue repair.
178
What are the consequences of increased insulin levels during refeeding?
Stimulates the uptake of glucose, electrolytes, and other nutrients into cells for energy production and tissue repair.
179
What electrolyte imbalances can occur during refeeding syndrome?
* Hypophosphatemia (low phosphate)
* Hypokalemia (low potassium)
* Hypomagnesemia (low magnesium)
179
What electrolyte imbalances can occur during refeeding syndrome?
* Hypophosphatemia (low phosphate)
* Hypokalemia (low potassium)
* Hypomagnesemia (low magnesium)
180
What other issues can occur alongside electrolyte shifts in refeeding syndrome?
* Sodium and water retention
* Thiamine deficiency
* Glucose imbalances
180
What other issues can occur alongside electrolyte shifts in refeeding syndrome?
* Sodium and water retention
* Thiamine deficiency
* Glucose imbalances
181
What are some cardiac issues that can arise from refeeding syndrome?
* Arrhythmias
* Heart failure
* Low blood pressure
181
What are some cardiac issues that can arise from refeeding syndrome?
* Arrhythmias
* Heart failure
* Low blood pressure
182
What respiratory problems can occur as a complication of refeeding syndrome?
* Difficulty breathing
* Respiratory failure
182
What respiratory problems can occur as a complication of refeeding syndrome?
* Difficulty breathing
* Respiratory failure
183
What neurological issues are associated with refeeding syndrome?
* Confusion
* Seizures
* Muscle weakness
* Coma (in severe cases)
183
What neurological issues are associated with refeeding syndrome?
* Confusion
* Seizures
* Muscle weakness
* Coma (in severe cases)
184
What are some other symptoms of refeeding syndrome?
* Edema (swelling)
* Fatigue
* Nausea
* Vomiting
184
What are some other symptoms of refeeding syndrome?
* Edema (swelling)
* Fatigue
* Nausea
* Vomiting
185
Why is medical supervision important in preventing refeeding syndrome?
It is preventable and manageable with careful monitoring and interventions.
185
Why is medical supervision important in preventing refeeding syndrome?
It is preventable and manageable with careful monitoring and interventions.
186
What strategies are crucial for preventing or mitigating refeeding syndrome?
* Gradual increase in calorie intake
* Careful monitoring of electrolyte levels
* Supplementation with vitamins (especially thiamine) and minerals
* Prompt correction of any imbalances
186
What strategies are crucial for preventing or mitigating refeeding syndrome?
* Gradual increase in calorie intake
* Careful monitoring of electrolyte levels
* Supplementation with vitamins (especially thiamine) and minerals
* Prompt correction of any imbalances
187
What is intermittent feeding?
Delivering nutrition multiple times a day over short periods (e.g., 20-60 minutes) using a feeding pump, syringe, or gravity drip.
188
What is cyclic feeding?
Delivering nutrition over a period less than 24 hours, usually with a pump.
189
How does intermittent feeding differ from bolus feeding?
Intermittent feeding lasts longer (20-60 minutes) compared to bolus feeding (4-10 minutes).
190
What is the typical frequency of intermittent feeding?
Multiple feeding sessions throughout the day.
191
What is the typical duration for cyclic feeding?
Administered for a specific duration (e.g., 8-12 hours overnight).
192
What are the delivery methods for intermittent and cyclic feeding?
Both can be delivered with a feeding pump or gravity drip.
193
What are the physiological benefits of intermittent and cyclic feeding?
They may be more physiologically similar to normal eating patterns compared to continuous feeding.
194
Why might intermittent feeding be more convenient for patients?
It allows for mobility between feedings.
195
What is a potential risk of intermittent feeding in critically ill patients?
Higher risk of feeding intolerance.
196
What are the cost considerations of intermittent feeding?
It may be more practical due to its simplicity and lower cost.
197
What nutritional goals can intermittent feeding help achieve?
It may help improve muscle protein synthesis.
198
What is intermittent feeding?
Nutrition delivered in boluses over a shorter period.
## Footnote
This type of feeding can increase the risk of feeding intolerance.
199
What are the risks associated with intermittent feeding?
Increased risk of feeding intolerance, diarrhea, vomiting, abdominal distension.
## Footnote
These issues arise due to potential overload on the digestive system.
200
What is bolus feeding?
Delivering larger volumes of nutrients in a shorter amount of time.
## Footnote
This method can overwhelm the digestive system.
201
What is delayed gastric emptying?
The stomach takes longer to empty its contents into the small intestine.
## Footnote
This condition can be more common in critically ill patients receiving intermittent feeding.
202
How does delayed gastric emptying affect the risk of aspiration?
It increases the volume of stomach contents, raising the risk of aspiration pneumonia.
## Footnote
Aspiration pneumonia can occur if stomach contents enter the lungs.
203
How can intermittent feeding affect gastrointestinal hormones?
It can affect the release of hormones involved in digestion and absorption.
## Footnote
Hormonal changes can influence overall digestive efficiency.
204
What individual factors can affect the risk of feeding intolerance?
Age, health condition, specific feeding formula used.
## Footnote
These factors can significantly influence how well a patient tolerates feeding.
