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47 Cards in this Set
- Front
- Back
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What are some nursing interventions to improve oral intake?
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A happy patient is an eating patient:
1. family visitation 2. malodorous environmental stimuli 3. no late or cold trays also: perform mealtime rounds schedule pt to have 'staff breaks' small frequent meals OOB to chair sit at eye level mouth care |
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When should specialized nutrition support be started?
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If the patient cant, shouldn't, or won't eat adequately and if benefits of nutrition outweigh any associated risks
*determine advance directives first |
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When should you use oral supplements?
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they should not replace meals, but be provided between meals, and not within the hour preceeding a meal, and not before bedtime
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What is refeeding syndrome?
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metabolic and physiologic consequences of depletion, repletion, and departmental shifts. You should carefully monitor patients the first week of agressive nutritional repletion.
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What should be done if a patient has refeeding syndrome?
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assess and correct electrolyte imbalances: hypophoshatemia, hypokalemia, hypomagnesemia, hyper and hypoglycemia.
Also, assess fluid status and ensure caloric goals are reached slowly overa 3-4 day period |
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What is an example of a monosaccaride?
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glucose
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What is an example of a disaccaride?
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Lactose (glucose+galactose)
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What is an example of a polysaccharide?
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starch, dextrin, glycogen, pectin, and cellulose
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How many kcals are in 1 gram of carbs?
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4
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What is an example of a soluble fiber?
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pectin
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what is an example of an insoluble fiber?
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cellulose
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How many kcals are in 1gm of fat/lipids?
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9
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What are simple lipids?
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fatty acids, triglycerides, waxes
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What are compound lipids?
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phospholipids
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How many kcals are in 1gm of protein?
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4
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What are peptides comprised of?
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amino acids
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What is enteral mean?
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within or by the way of the GI tract
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What are oral supplements and when do you use them?
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liquid meals. When there is an inability to meet nutritional needs through diet alone. Also if the patient is dysphagic. Consider the patients taste preference.
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What are medical foods?
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MF are distinguished from other foods for special dietary purposes, or foods which make health claims by the requirement that they be used under medical supervision
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What does a food need to be considered a medical food?
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the prodect is labeled for the dietary managemnt of a medical disorder, disease, or condition.
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How are patients reimbursed for medical foods?
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medicare part b- prostetic device benefit provision.
patients must have a permanently inoperative internal body organ or function thereof. Nutritoinal supplementation is NOT covered under medicare part b |
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What are the categories of nutritional supplements? (enteral feedings)
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blenderized foods
polymeric solutions monomeric solutions solutions for specific metabolic needs modular solutions hydration solution |
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What are blenderized foods?
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natural foods that are commercially available or made at home. they are usually more expensive and have a limited use
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What are macronutrients found in polymeric formulas?
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intact proteins, triglycerides, carbohydrate polymers, and fats
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What else do you need to know about polymeric formulas?
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they are lactose free.
Implications: require close follow up, associated with dehydration and electrolyte imbalances |
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What are macronutrients found in monomeric solutions?
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proteins, carbs, fat
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Does polymeric or monomeric solutions have higher osmolality?
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monomeric
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When do you use monomeric solutions?
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impaired digestion, such as pancreatic insufficiency or short bowel syndrome
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What formulas do you give in hepatic encephalopathy?
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formulas with higher branched chain amino acids and lower aromatic amino acids
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What formulas do you give in renal failure?
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Higher caloric density with minimal volume, preferably 2cal/cc
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What formula specifications are needed in the diabetic patient?
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lower carbs, higher fat, more fiber
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What specifications are needed in PO feeding a pt with COPD?
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frequent feedings with higher caloric density
**carbs tend to elevate the respiratory quotient, and elevated caloric intake increases oxygen consumptin and carbon dioxide production- which is an added burden on failing lungs. carbs require more O2 consumption and produce more CO2 than fat |
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What are modular solutions?
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they provide macronutrients singly, and are not recommend to be prescribed unless you are followed by a NST or RD who will individually tailor nutrient intake for the patient
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When are hydration solutions given and what are examples?
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acute diarrhea to prevent dehydration. Pedialyte and enterolyte.
Isotonic sollution, 224-311 mmol/L |
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What is involved in tolerance?
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-functional capacity of the GI tract
-rate of infusion -type of formula -medicaitons (especially sorbitol based) |
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what are special considerations for feeding dementia patients?
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1. Maintain an environment conducive to meal times. encourage them to eat in a dining room, do not administer treatments or peform other activities during meals, used standardized dinnerware (no plastic), dont feed them in the wheel chair or bed
2. minimize environmental noise |
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What are special considerations for feeding patients with dysphagia?
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provide 30 min rest prior to feeding, a rest person will have less difficulty swallowing.
sit them upright in a chair slightly flex the pts head to chin down position, this is helpful to reduce aspiration. swallowing studies can be performed to determine best positon adjust the rate of feeding and the size of bites to the persons tolerance do not rush or force feeding |
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What is RDA?
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recommended dietary allowance
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What is DRI?
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dietary reference intake
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What is EAR?
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estimated average requirement
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What is AI?
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adequate intake
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What is UL?
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tolerable upper level
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At what age do reference standards change in needs?
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50
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What age groups are DRIs made for?
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under 50, 51-70, and over 70
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What are RDA and AI used for?
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dietary assessment, health promotion and risk reduction in older adults
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What is the Mifflin-St.Jeor equation?
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it estimates daily adult engery requriements based on resting metabolic rate. The equation uses actual weight andis considered to be the most accurate estimate of resting metabolic rate for overweight and obese individuals.
Men: energy expidenture= 5+10(weight in kg)+6.25(ht in cm) -5(age) Women: energy expenditure= -161 + 10(weight in kg) + 6.25 (ht in cm) -5(age) |
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How many kcal/kg/day should the sedentary adult eat?
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25
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