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nursing 20030 > nutritional therapy > Flashcards

nutritional therapy Flashcards

1
Q

what is nutrition science

A

-the study of how food nourishes the body
-physiology, pschology, and socioeconomics

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2
Q

what are nutrients

A

specific biochemical substances used by the body to operate

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3
Q

which is more vital to life? water or food? and why?

A

water is more vital to life than food bc it provides the medium necessary for all chemical reactions and it is not stored in the body

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4
Q

which vitamin affects visual acuity in dim ligth, formation and maintenance of skin and mucous membranes, and immune function?

A

vitamin A

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5
Q

which vitamin provides calcium and phosphorus metabolism and stimulate calcium absorption

A

vitamin D

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6
Q

whih vitamin is an antioxidant that protects vitamin A

A

vitamin E

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7
Q

what vitamin helps the synthesis of ceratin proteins necessary for blood clotting

A

vitamin K

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8
Q

how do you determine ideal body weight for adult females

A

100lb (for height of 5ft) +/- 5lb for each additional inch over 5ft

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9
Q

how do you determine ideal body weight for adult males

A

106lbs (for height of 5 ft) +/- 6lb for each additional inch over 5 ft

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10
Q

why do males have a higher BMR

A

larger muscle mass
-BMR is about 1 cal/kg of body wieght per hour for men
-BMR is about 0.9 cal/kg of body weight per hour for women

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11
Q

what factors increase BMR

A

growth, infections, fever, emotional tension, extreme envirnmental temperatures, elevated levels of certain hormones

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12
Q

what factors decrease BMR

A

aging, prolonged fasting, and sleep

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13
Q

what factors effect oral intake

A

-developmental considerations
-state of health
-alcohol abuse
-medications
-economic factors
-religion
-culture

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14
Q

what are some neurological/neuromuscular causes of dysphagia

A

-CVA
-ALS
-PD
-myasthenia gravis

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15
Q

what are some traumatic/surgical causes of dysphagia

A

-oral/throat surgery
-cancer therapy
-ingestion of caustic substances

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16
Q

what are some signs and symptoms of dysphagia

A

-coughing or gagging while eating
-choking
-aspiration (can be silent w/o sx)
-drooling
-pockets of food retained in the mouth
-gargly sounding food
-sensation of food getting stuck in the throat

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17
Q

what are some interventions for dysphagia

(aspiration precautions)

A

-have suction set up and O2 available
-HOB at 45 degrees at all times
-HOB at 90 degrees (or in chair) for meals and for 30 mins after meal
-provide appropriate level of assistance or supervision at meal times

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18
Q

describe providing appropriate level of assistance or supervision at meal tie for aspiration precautions

A

-know what time clients tray arrives
-allow sufficient time to assist the client
-head tilted slightly forward
-encourage small bites
-feed slowly in a relaxed atmoshpere
-discourage talking while chewing
-place food in the unaffected side of the mouth

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19
Q

what are some thickened liquids

A

-milkshake
-slushy

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20
Q

what are some pureed/smooth food

A

-pudding
-mashed potatoes

21
Q

name some easy to swallow foods

A

-cooked veggies
-ground meat
-creamed soup
-iced fruit

22
Q

name some different types of therapeutic diets and describe em a little

A

-NPO (most restrictive, can vary)
-clear liqs (see through and liq at room temp)
-full liqs (anything liq at room temp)
-GI soft/low residue (gentle to digest)
-high fiber (whole grain foods)
-low sodium (<2g sodium per day)
-low cholesterol (low animal fat diet, lean meats)
-diabetic (ADA) (carb controlled/sugar controleld)
-regular (anything and everything)
-pureed (baby food like)
-mechaincal soft (easy to chew)
-enteral feeding (tube feed, can be used to supplement PO intake)

23
Q

describe enteral feeding

A

-used when PO consumption can not occur or is not enough
-nasogastric
-gastrostomy
-jejunostomy

24
Q

describe parenteral nutrition

A

-administered through IV
-total parenteral nutrition (TPN)

25
Q

purpose of enteral tubes

feeding

A

administration of nutritional formula via tube in the digestive system

26
Q

purpose of enteral tubes

lavage

A

-remove of stomach content
-accidental poisoning, overdose
-may instill NS to “wash” the stomach

27
Q

purpose of enteral tubes

decompression

A

-connected to low intermittent wall suction
-treats: bowel obstructions, paralytic ileus,and prevents distention

28
Q

describe NG tube - levin/salem sump

A

-clear, larger, frim plastic tube
-manipulate to soften tubing
-check placement (gastric pH, tube length, visualization of contents)
-confrom placement only with Xray
-14-18 French is normal (smaller # = thinner)

29
Q

what supplies will you need for NG tube placement

A

-NG tube
-emesis basin
-tissues
-water based lube
-cup w water and straw
-tube securement shit
-skin protectant
-syringe
-safety pin

30
Q

describe the process of NG tube placement

A

-gather supplies, ID pt, provide instructions, wash hands, provide privacy
-place pt in fowlers position
-determine length for NG tube
-mark tubing or note striped marking on tube
-glove, lubricate tube (3-4 inches)
-first have pt tilt head back to pick nostril
-have pt tilt head forward
-instruct pt procedure will be uncomfy
-advance tube while asking patient to swallow
-secure to nose
-follow hospital policy for placement verification

31
Q

describe NG tube - dobbhoff/corpak

A

-smaller tube diameter
-softer plastic (soak in an ice bath to firm up plastic for easier insertion)
-used only for feeding (can not aspirate or tube will collapse)
-confirm placement only with Xray
-can be used up to six months

32
Q

describe gastrostomy

A

-G tube, PEG tube
-inserted through the abdominal wall directly into the stomach
-surgical procedure (difference from PEG tube how they are inserted)
-incision in the abdomen
-sutured in place
-for long term use, can be permanently
-norml to have leakage while healing

33
Q

describe jejunostomy

A

-J tube
-tube inserted through the abdominal wall directly into the jejunum
-regurgitation and aspiration is prevented (stomach is bypassed)
-emesis may still occur (only bile and stomach contents not food)

34
Q

what are some nursing responsibilities r.t enteral tubes

A

-monitor I and O
-provide nasal and oral care
-always assess tube placement before use
-maintain patency (irrigate with 30-60ml of warm water several times a day)
-if ordered, maintain suction

35
Q

how do you determine the length needed for NG tube placement

A

measure from
-tip of nose to
-helix or tip of ear to
-the xiphoid process

36
Q

when should you shut of suction to eneteral tubes

A

-for abdominal assessment
-30min after administering meds

37
Q

describe tube feeding administration

A

-fowlers position (verify placement and check residual)
-clean technique
-forula should be kept at room temo (hang only enough to infuse in 8 or less hours)
-formula may be diluted
-label administration tubing/syringe with date and time

38
Q

what us a person at high risk for when getting tube feeds

A

aspiration

39
Q

how can tube feeds be administered

A

bolus or continuous

40
Q

describe checking gastric residual volume (GRV)

A

-aspirate gastric content via the tube (measure the amount aspirated)
-return aspirated contents to the stomach
-check MD order for acceptable residual amount prior to feeding (usually notify providor if residual is greater than 200ml (pt at risk for aspiration and absorption deficiency)

41
Q

complications of tube feeding

A

-diarrhea (most common and more frequent with continuous feedings)
-dry mouth
-aspiration
-displacement of tube
-mucosal/skin irritaion
-electrolytes imbalance
-elevated blood glucose levels
-gastric distention
-occlusion

42
Q

describe medication administration with tube feeding

A

-liquid form of med is preferred
-many tablets can be crushed and dissolved in water
-do not crush eneteric coated or time released capsules
-many capsules can be opened and dissolved in water, check drug guide

43
Q

describe medication administration enteral route

A

-use a bulb/piston 60ml syringe or an oral/enteral syringe (gather 60ml warm water. 30ml to flush before and 30ml for after)
-follow three checks, triple checks and six rights. use 2 patients identifiers
-crush and dilute medications in warm water
-perform necessary assessments
-elevate HOB to 30-45 degrees. place chux ot towel under tube
-put on gloves and insert syringe into tube
-if pt has been receiving tube feedings, check institutional policy regarding residual aspirate
-you can test the stomach contents for acidity by using pH paper
-close off NG tube by bending it back. if using PEG, use clamp to close off tube
-holding the tube and syringe in nondominant hand, unbend NGT or release clamp and flush the tube
-pour med into syringe. if the pt shows discomfort, stop procedure and wait until patient is relaxed
-after all the med flows in, flush with 30ml of water
-shut the tube bending it back or clamping, remove syringe
-either clamp the tube or restart feedings
-if NGT is being used for decompression, wait at least 20-30mins before resuming suction
-leave HOB elevated at least 30-60mins

44
Q

describe TPN

A

-aka hyperalimentation
-infused into central line
-hypertonic solution

45
Q

who is TPN used for

A

those with…
-difficulty absorbing nutrients
-persistent nausea and vomiting
-need for complete bowel rest

46
Q

what are some complications associated with TPN

A

infection, fluid overload, metabolic imbalances

47
Q

nursing responsibilities TPN

A

-I&O
-daily weights
-assess and manage central line
-monitor lab values

48
Q

what lab values are important to monitor with TPN

A

-glucose (may experience increased glucose while feeding and decreased afterwards)
-urine ketones and specific gravity
-BUN, liver function
-electrolytes

nursing 20030 (31 decks)

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