1010- Test 5 Gi Assessment And Nutrition

Front 1

Abdominal sounds should sound _____.

Back 1

tympanic

Front 2

When inspecting we look for ____.

Back 2

symmetry

Front 3

Use the ____ of the stethoscope to auscultate.

Back 3

diaphragm

Front 4

Percussion is used to

Back 4

look for fluid levels.

Front 5

Palpation is only light and can indicate _____.

Back 5

peritonitis

Front 6

Lab studies used during GI assessment are

Back 6

-visceral proteins
-nitrogen balance

Front 7

Visceral proteins are

Back 7

albumin
prealbumin

Front 8

____ is a major carrier protein and indicator for malnutrition.

Back 8

Albumin

Front 9

When a patient is in the hospital and we are monitoring nutritional status we look at their ____ levels.

Back 9

prealbumin

Front 10

Protein deficiency can lead to

Back 10

anemia and immunosuppression.

Front 11

3 major types of malnutrition are

Back 11

-obesity
-protein-calorie
-protein

Front 12

____ malnutrition occurs when there is an excess of adipose or fat tissue d/t consuming empty calories.

Back 12

Obesity

Front 13

____ malnutrition is what most hospital patients suffer from.

Back 13

Protein-calorie malnutrition

Front 14

____ malnutrition is a chronic protein deficiency with adequate calories.

Back 14

Protein (kwashiorkor)

Front 15

_____ is inadequate intake of calories.

Back 15

Malnutrition

Front 16

Risk factors for malnutrition include:

Back 16

-age (older)
-poor
-oral/GI/functional problems
-meds or treatments that affect appetite
-chronic illness
-pain
-depression

Front 17

Malnutrition results in _____.

Back 17

immunosuppression

Front 18

Complications of malnutrition include:

Back 18

-impaired mobility
-skin/tissue breakdown with delayed healing
-increased infection (low lymphocytes)
-decreased cardiac output

Front 19

Tx of malnutrition includes:

Back 19

-correct fluid and electrolyte imbalances
-re-introduce proteins/calories (gradual refeeding)
-add fats and lactose last

Front 20

____ contributes to breast cancer for women and colon cancer for the general population.

Back 20

Obesity

Front 21

Obesity results from _____.

Back 21

excess energy intake (consumption>expenditure)

Front 22

The appetite is regulated by the ____ and emotional factors.

Back 22

hypothalamus

Front 23

Obesity is a BMI>___ or 30lbs overweight.

Back 23

30

Front 24

Hormones that regulate obesity are:

Back 24

thyroid, insulin, leptin

Front 25

____ is a peptide produced by fat tissue that suppresses appetite and increases energy expenditure.

Back 25

Leptin

Front 26

Risk factors for obesity include

Back 26

-heredity
-inactivity
-environment
-psychological factors

Front 27

Obesity related problems include:

Back 27

-cardiovascular (HTN, CVA)
-sleep apnea
-GI (gallstones, colon cancer)
-osteoarthritis
-insulin resistance, T2DM
-polycystic ovary disease, endometrial cancer, low androgen levels
-stress incontinence
-depression, eating d/o

Front 28

Tx of obesity is aimed at

Back 28

diet, exercise and behavior modification

Front 29

1lb body fat= ____ kcal.

Back 29

3500

Front 30

Medications that can help promote weight loss are

Back 30

-appetite suppressants (prob w/ heart)
-lipase inhibitors (Alli)
-bulk forming agents

Front 31

Surgical Tx for obesity is limited to

Back 31

the morbidly obese.

Front 32

Morbidly obese is defined as
____ over IBW
BMI>__ for women
BMI>__ for men

Back 32

100%
35
40

Front 33

The most dramatic, irreversible, but definite results weight loss surgery is _____.

Back 33

Roux-en-Y

Front 34

____ is a weight loss surgery that involves placement of an adjustable band around the top part of the stomach.

Back 34

Lap banding

Front 35

_____ is weight loss surgery done through endoscopy where the stomach is stapled off to create a smaller one.

Back 35

Vertical banding gastroplasty

Front 36

The major problem with a Roux-en-Y is

Back 36

dumping syndrome

Front 37

The problem with lap banding is that it can

Back 37

come lose, slide, or cause erosion in the stomach.

Front 38

All weight loss surgeries have the potential complication of ____.

Back 38

B12 anemia

Front 39

A major complication of bariatric surgery is ____ which causes vomiting which then causes Mallory Weiss tears (Upper GI bleed).

Back 39

overeating

Front 40

Other complications of bariatric surgery include:

Back 40

-vomiting
-leaking from staple lines
-bleeding
-dumping syndrome
-DVT risk
-hernias
-nutritional deficiencies (Fe, Ca, B-12)
-avoid pregnancy 1 year

Front 41

4 strategies to increase oral intake when patients can't meet daily caloric needs include:

Back 41

-calculate a 3 day calorie count
-offer high calorie and high protein foods
-offer oral supplements
-add modular products

Front 42

____ is administration of liquid formula via a tube into the GI tract.

Back 42

Enteral nutrition

Front 43

Benefits of enteral nutrition are

Back 43

it uses the gut so that it doesn't atrophy and it is cheaper than parenteral.

Front 44

Indications for enteral nutrition-

Back 44

the patient must have a working gut

Front 45

Enteral nutrition is contraindicated for

Back 45

acute/chronic pancreatitis, SBO, NVD, short gut syndrome

Front 46

Gastric formulas are fed

Back 46

into the stomach.

Front 47

_____ are already broken down enough that the bowel can just suck it right up.

Back 47

Small bowel formulas

Front 48

Diseases that have specific enteral formulas include

Back 48

renal, hepatic, pulmonary, critical care/trauma, glucose intolerant, HIV/AIDS

Front 49

A renal enteral formula should consist of

Back 49

low potassium with complete proteins.

Front 50

If tube feeding is going to be longer than 3 months, use a

Back 50

PEG tube or j jeunostomy tube

Front 51

If tube feeding is going to be less than 3 months, use a

Back 51

tube thru the nose and into the stomach.

Front 52

Never push air down a tube to verify _____. All tube fed patients can aspirate.

Back 52

placement

Front 53

____ are small bore tubes that should be x-rayed for placement, are susceptible to clogging and collapse.

Back 53

Nasoenteric tubes (NET)

Front 54

Nasoenteric tubes can be placed in the _____ or ____.

Back 54

gastric or small bowel

Front 55

Use at least a ___cc syringe with NET tubes.

Back 55

30

Front 56

2 types of post pyloric NET tubes are

Back 56

jejunostomy and duodenal

Front 57

With NET tubes, use ____mL of sterile H2O before, between, and after meds.

Back 57

30

Front 58

A _____ tube is a large bore tube usually placed percutaneous endoscopically or radiologically (PEG) into the stomach.

Back 58

gastrostomy

Front 59

Gastric feedings can be...

Back 59

continuous, intermittent or bolus.

Front 60

_____ feedings are NEVER bolus. They are only continuous.

Back 60

Post-pyloric

Front 61

Only ____ tubes can be aspirated.

Back 61

gastrostomy

Front 62

Always check for ____ prior to tube feeding.

Back 62

residual

Front 63

Mechanical complications with tube feedings include:

Back 63

-tube obstruction- flush
-respiratory placement
-aspiration pneumonia (HOB>45)

Front 64

GI complications with tube feedings are:

Back 64

-diarrhea (fiber, rate)
-delayed gastric emptying (increase HOB, give meds- Reglan)
-constipation- (fiber, water)

Front 65

Metabolic complications with tube feedings are:

Back 65

hyperglycemia
hyponatremia d/t diarrhea and low Na formulas
dehydration

Front 66

Parenteral nutrition is delivered via ___ into the ____.

Back 66

IV, blood stream

Front 67

Parenteral nutrition is IV administration of ___, ____, ____ and ____.

Back 67

dextrose, amino acids, fats, vitamins/minerals

Front 68

Benefits of TPN are

Back 68

can be tailored to individual needs and does not use the gut.

Front 69

TPN is indicated for people who can't use their gut

Back 69

short gut syndrome, SBO, NV

Front 70

TPN is contraindicated for people with

Back 70

a functioning gut.

Front 71

A central line is used for delivery of

Back 71

TPN/hyperalimentation

Front 72

___ is parenteral nutrition through a regular IV cannula.

Back 72

PPN

Front 73

TPN access can be

Back 73

non-tunneled catheters
tunneled catheters
implanted ports
PICC line

Front 74

Continuous TPN is delivered ____.

Back 74

24 hours per day

Front 75

Cyclic TPN is delivered

Back 75

less than 24 hours per day. It is tapered on and off at one half the maintenance rate.

Front 76

If patient is on TPN, check ____ and use ____.

Back 76

BG q6h and use sliding scale insulin prn.

Front 77

Infections during TPN are predominately with the _____.

Back 77

central line

Front 78

Redness, swelling, and drainage indicate a _____.

Back 78

local infection

Front 79

High fever, chills, and general malaise indicate a ______.

Back 79

systemic infection

Front 80

The most common catheter colonization is _____.

Back 80

yeast

Front 81

If a patient has a central line the nurse should observe the _____, ___, and ____.

Back 81

arm, shoulder, and neck

Front 82

Chronic catheter colonization may result in a systemic ____.

Back 82

yeast infection

Front 83

____ is a collapsed lung d/t escaped air into the pleural cavity that can occur when the physician is trying to place a central line in the subclavian vein.

Back 83

Pneumothorax

Front 84

____ is blood bleeding from the lung causing it to collapse.

Back 84

Hemothorax

Front 85

____ is the most common complication with central line placement therefore we always want to do a chest xray to confirm placement.

Back 85

Pneumothorax

Front 86

A central line that ends up in the R atria can cause _____.

Back 86

arrhythmias

Front 87

Occlusion of a central line can be due to

Back 87

drug precipitate, fibrin sheath, intraluminal blood occlusion, and thrombosis.

Front 88

Redness, warmth and tenderness at the site of central line insertion is _____.

Back 88

phlebitis

Front 89

___cc of air in an artery can kill a person.

Back 89

5

Front 90

____ cc of air in a vein can kill someone.

Back 90

30

Front 91

Central line placement is always checked with ____ to confirm placement.

Back 91

chest x-ray

Front 92

Metabolic complications of TPN include:

Back 92

hyperglycemia and hypoglycemia.

Front 93

If pt is hyperglycemic,

Back 93

cover with sliding scale insulin- Regular or Humalog

Front 94

After coming of TPN, pt often becomes

Back 94

hypoglycemic.

Front 95

S/Sx of hypoglycemia are:

Back 95

-hunger, nausea, anxiety, shaky
-pale, cool skin and sweating
-irritable
-rapid pulse
-hypotension
-h/a, poor concentration
-slurred speech, blurred vision
-decreased LOC, seizures, coma