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39 Cards in this Set
- Front
- Back
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relative risks for nutrition problems
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1. unintentional wt loss or wt change
2. dec appetite and intake |
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5 validated screening tools:
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1. nut risk screeing (NRS)
2. simiple 2-pt screening tool 3. malnut screening tool (MST) 4. malnut universal screening tool (MUST) 5. mini nut assessment-short form (MNA-SF) JCAHO requires nut screen w/in 24 hrs of admission |
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nutritional screening:
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1. illness/cond changed kind/amt of food eaten
2. <2 meals/d 3. few fruits/veggies/milk prods 4. >3 drinks of alcohol/d 5. tooth/mouth problems make hard to eat 6. not enough money to eat 7. eat alone 8. >3 rx'd/OTC drugs/d 9. lost/gained 10 lbs in past 6 mos w/o wanting 10. can't physically shop/cook/feed |
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4 steps of nutritional care process
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1. assessment
2. dx 3. intervention 4. monitoring/eval |
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assessment components
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1. food/nut hx
2. biochem data, med tests, procedures 3. anthropometric measures 4. PE findings 5. client hx |
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risk factors for malnutrition
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1. unintentional wt loss
2. sx to GIT 3. altered dentition 4. impaired swallowing 5. nausea 6. pain |
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oral cavity disorder
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1. poor lip closure
2. poor dentition 3. gingivitis 4. periodontal ds 5. excessive saliva 6. xerostomia 7. stomatitis (sore mouth) 8. dysgeusia (mouth blindness) |
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anorexia
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- small, freq meals
- cool foods - avoid strong smelling food/areas - nutritional supplements - pleasant eating environment |
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n/v
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- wait till subsided
- cool, easy to digest food - small, frequent - nutritional supplements - avoid fats/strong seasoning - rx'd anti-emetics |
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dysphagia
1. indications 2. tx |
1. cough while eating; clearing throat; excessive swallowing; pooling food in mouth
2. pureed/groud consistency - national dysphagia diet - liquid consistency - swallow eval by speech ther. |
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GERD diet
1. triggers 2. tx |
1. EtOH/caffeine/fats/spicy/ peppermint/spearmint/chocolate/ large meals/ smoking
2. stay upright 3 hrs s/p eating; wt loss as needed |
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PUD
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- no evidence that diet related
- check for H. pylori - nSAID use - monitor wt loss/ IDA |
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PUD after n/v subsides
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1. low fat/carb foods
2. liquids b/w meals 3. avoid EtOH/coffee/pepper 4. avoid eating 2 hrs b4 bed |
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duodenal ulcer
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1. p w/ eating
2. high soluble fiber diet |
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soluble fiber foods
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apple
pear oats bean/legumes |
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dumping syndrome
1. cause 2. symptoms 3. management |
1. s/p gastrectomy/ gastric bypss
2. n/v/weak/dizzy/hypoglyc 3. - small, freq meals - controlled CHO - avoid concentrated sweets - add protein & small amt fats - liquids 1 hr before/1 hr after |
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constipation
1. cause 2. management |
1. meds, irregular eating patterns, inactivity, chronic laxitive use, tumors, inadequate fibers/fluids
2. inc fiber gradually & fluids |
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fibrous foods for constipation
AI in men/women? |
fruits
veggies whole grains legumes flax seeds m = 38 g/d; w = 25 g/d |
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diarrhea
1. criteria 2. risk 3. management |
1. >3 BM or liquid/semi-liq stool/d
2. dehyd, malabsorp, maldig 3. restore fluid/electrolyte; inc K+ rich foods; avoid juices; pedialyte 3. LOW fiber/fat/lactose |
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malabsorption:
1. sxs 2. causes --a. management |
steatorrhea - tx w/ dec total fat intake; fat soluble vit supp
lactose intolerance - lactase def; bloat; crap; flatulence;d a. red lactose intake; lowest tolerable level |
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IBD
1. monitor for 2. management |
1. malnutrition, anemia, dehyd
2. high cal; high protein -- low fiber (lactose free) -- 3 meals/3 snacks -- PO supplements -- TPN diet liberalized during remission |
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celiac ds
1. symp 2. management |
1. d/constip/wt loss/ weak/ abdp/v
2. gluten free diet (wheat, rye, barley, oats) |
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short bowel syndrome
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sx shortening of bowel -> absorptive abilities reduced
- crohn's; abd injury; resection malig tumor management: TPN initially - progress to 6-8 small meals/d - low fat/lactose/fiber/sugar |
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short bowel syndrome vs. diarrhea management
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diarrhea - low fiber/fat/lactose
SBS - low fiber/fat/lactose/sugar |
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IBS
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MC dx in US
abdp; alternating constip/d; bloating; mucus in stool management: pre/probiotics; high fiber, red fat |
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diverticular ds: management
- diverticulosis - diverticulitis (acute) |
- high fiber, no nuts/seeds/popcrn
- NPO -> CL -> low fiber -- once filly resolved, slow progression to high fiber but NO nuts/seeds/popcorn |
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ileostomaies/colostomies
1. results in 2. management |
1. dec fat, bile acid, vit b-12 absorption
- considerable fluid/electrolyte loss 2. minimize sxs, replenish losses, low fiber at first, reg diet as tolderated (6-8wks post op) - 8-10 cups fluid/d |
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hepatitis
- management cirrhosis - management |
- balanced eating; 4-6 small meals; multi vit/min
- salt restriction (ascites); multi-vit/min, adequate calories, monitor glucose intol |
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liver disease: transplant
1. mnt prior 2. mnt post 3. monitor for 4. long term complications |
1. improve nut status, correct def
2. individ, high calories & proteins 3. refeeding syndrome (hypo -phos, -mg, -na, -k) 4. unwanted wt gain, HTN, hyperlipid, osteopenia, DM - food safety emphasis |
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pancreatitis
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NPO -> CL -> low fat
jejunal tube feeding > TPN management: low fat/high protein no etoh panc enzymes control hyperglycemia |
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diverticulitis vs. pancreatitis initial tx
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diverticulitis - NPO > CL > low fiber
pancreatitis - NPO > CL > low fat |
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gallbladder ds
- management |
- low fat, inc soluble fibers
- <30% cals from fat - 1800 kcal(3) = 540 kcal/9 = 60 g/d - avoid high fat/fried foods - intolerant to gassy veggies |
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nutrition support - ASPEN
indications |
- NPO or inadeq PO intake
- malnourished, unable to eat >5-7d - nL nourished but unable to eat >7-9d - enteral > parenteral |
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enteral
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- tubefeeding > PPN/TPN
- when GIT partially fnxnl, accessible, safe - NG, PEG, PEJ - standard - intact nut - hydrolyzed - partially/totally predigested nutrients |
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parenteral
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- directly into bloodstream
- when GIT non-fnxnl - PO/enteral intake inadequate for pts needs |
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PPN
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peripheral parenteral nut
- less freq used d/t low [dextrose] = inadeq kcals |
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TPN
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total parenteral nutrition
- provide 100% kcal, pro, vits & mineral needs |
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TPN/PPN risks
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- metabolic
- infectious - mechanical - discontinue asap |
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Is nutrition support team available?
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1. complete nut test
2. determine need: En vs. PN 3. determine method -- EN: NG, PEG, PEJ -- PN: PPN vs. TPN 4. formula: standard v. special 5. monitor tolerance, labs 6. monitor signs of refeeding synd 7. better to underfeed initially 3-5d |
