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89 Cards in this Set
- Front
- Back
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pressure is greatest where |
sacrum, coccyx, hips and heels |
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what increases risk of pressure ulcers |
friction, shear and excess moisture |
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protein energy malnutrition |
proteins are used for energy if other energy sources are not available. -the body does its best to sincere protein
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what has an impact on the development and healing of pressure ulcers |
weight loss, malnutrition, dehydration |
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dining with pressure ulcers |
assit to eat adaptive feeding devices soft/ ground/ pureed, small frequent feeds *food first |
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increased needs with pressure ulcer |
calories and protein |
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hydration with pressure ulcers |
must meet needs! 1 mL per calorie consumed or 30 mL/ kg body weight per day or minimum of 1500 mL fluid per day
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signs of dehydration with pressure ulcers |
poor skin turgor flushed dry skin coated tongue concentrated urine irritability confusion |
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calories needs with pressure ulcers |
normal-1146 pressure ulcers- 1635-1900 |
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protein needs with pressure ulcers |
normal- 55 Pressure ulcers- 68-82 |
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conditions that cause respiratory alterations |
premature infants, anorexia nervosa, drug overdose, older adults and severe osteoporosis |
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pulmonary disorders |
asthma, CF, emphysema |
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major function of pulmonary system |
obtain oxygen remove co2 filter, warm and humidify air regulate acid base balance synthesize arachidonic acid convert angio I to angio II immune function |
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in the pul system, what protects lungs from oxidative injury? |
antioxidant nutrients ex- vit C |
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impact of malnutrition on pul system |
decrease protein and Fe decreas ca, mg, ph and k low prot decrease surfactant
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impact of malnutrition on PD |
supporting connective tissues of lungs are comprised of collagen -airway mucus -wt loss from inadequate intake= poor prognosis in those with PD -malnutrition decrease immune fxn and increase rest infections |
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foods most likely to be aspirated |
liquids round shape- nuts, popcorn, hotdog pieces -chucks of food -enteral feedings |
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asthma |
bronchial hyperresponsiveness and inflammation= airflow obstruction -caused by genetic, environmental and immunological factors
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nutritional factors of asthma |
maternal diet during preg length of breastfeeding diet during infancy and toddler years obesity in adolescents and adults
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common signs of asthma |
mouth breathing in children -can cause oral malformation and affect biting into foods |
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MNT in asthma |
omega 3 and 6 -antioxidants, protect airways from stress -Mg++ anti-inflammatory agent and smooth muscle relaxant -methylxanthines- bronchodilator |
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asthma nutritional side effects of meds |
bronchodilators and anti-inflammatory agents -dry mouth and throat, diarrhea, increase glucose levels, sodium retention, hypokalemia, tremors, headaches and dizziness
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main goals of asthma |
diet of wholesome foods, monitor nutritional imbalances, monitor drug-nutrient interactions |
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BPD |
found in newborns premature or LBW lungs unable to respond yo adverse conditions inability to syththesize surfactant
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treatment for BPD |
optimal nutritional status of pregnant women |
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BPD- reasons for growth failure |
increased energy needs, inadequate dietary intake, gastroesophageal reflux, chronic hypoxia, emotional deprivation |
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goals of nutrition care with BPD |
adequate nutrients intakes promote linear growth maintain fluid balance develop age-appropriate feeding skills
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BPD |
those with growth failure are on the 50% greater end of he spectrum
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vit and minerals for BPD |
vit K essential for bone development antioxidants (A C E, inositol and selenium) |
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strategies for feeding with BPD |
barriers: anorexia, fatigue, poor coordination of breathing and swallowing, weakness of suck -small frequent meals, concentrated formulas
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feeding strategies with BPD |
soft nipple NG or G-tube
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COPD |
slow progressive obstruction of the airways -emphysema and chronic bronchitis are the two forms -smoking, air pollution and genetics are main factors -emphysema pts are normally thing, cachectic and older -chronic bronchitis normal weight or over weight
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COPD Stage I: MILD |
80% normal lung function |
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COPD Stage II: Moderate COPD |
50-80% normal lung function |
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COPD Stage III: severe COPD |
30-50% normal function |
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COPD Stage IV: very severe COPD |
less than 30% normal lung functioning |
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emphysema "pink puffer" |
high CO 2 retention -minimal cyanosis purse lip breathing dyspnea chest percussion orthoneic barrel chest extertional dyspnea prolonged expiratory time short jerky sentences anxious use of accessory muscles to breath thing |
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chronic bronchitis "blue bloater" |
color dusky recurrent cough hypoxia hypercapnia resp. acidosis high hbg high resp rate exertional dyspnea heavy smokers digital clubbing cardiac enlargement use of accessory muscles to breather leads to right sides failure |
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MNT COPD |
assessment -assess fluid balance and requirements -assess energy needs -must assess E expenditure and intake accurately -decreased food intake is common -headache and confusion common from high co2 levels in blood |
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what to look for with MNT in COPD |
anorexia, fatigue, difficult chewing or swallowing from SOB, constipation from low fiber, diarrhea from impaired peristalsis |
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why is energy expenditure usually increased in COPD |
degree of airflow obstruction co2 retention reduced resp. strength and endurance increases muscle fatigue assess body composition to see if they are wasting LBM and determine hydration status |
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COPD Macronutrients |
protein- 1.2-1.7 g/kd of dry body wt CHO 40-55 percent of kcal fat 30-45 % of kcal maintain satifactory RQ maintain is goal, not over feeding
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vitamins and minerals in COPD |
smoking= extra vit C MG and Ca are important for smooth muscle contraction and relaxation in COPD -MG and Ph need to be monitored b/c of their role in ATP production -bone mineral density is an issue( exercise and nutrition are important, additional vitamin K may be needed |
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what to increase with diuretics and COPD |
vit K |
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feeding strategies in COPD |
modified oral diet usually prescribed -easy to chew dietary fiber, enhance GI motility -if bloating is a problem, may limited gas forming foods periodically |
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tips for increasing food intake with COPD |
rest before meals eat small portions of nutrient dense foods use O2 at meals and eat slow get help with shopping and prep enteral supp. may be necessary |
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CF |
disorder of the exocrine glands -gene restricted to epithelial cells -abnormally thick mucis -obstructs glands and ducts |
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systems affected by CF |
resp. tract sweat and salivary glands intestines pancreas live reproductive tract |
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pulmonary complications with CF |
acute and chronic bronc. pneumonia bronchial scarring
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diagnosis of CF |
sweat tests -elevated levels of Na and Cl |
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85-90 percent of CF patients have |
pancreatic insufficiency -plugs of thick mucus reduce quintet digestive enzymes -causes maldigestion and absorption of food -decreased bicarb secretions further decrease digestive enzyme activity -descreased bile resorption contributes to fat malabsorption -excessive mucus in small intestines decreases absorption by microvilli
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complications of pancreatic insufficiency with CF |
bulky foul smelling stools cramping and intestinal obstruction rectal prolapse (tissue that lines the rectum falls outs of anus)
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as CF progresses it can cause damage to |
endocrine portion of pancreas -results in impaired glu tolerance -development of CF related to DM |
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factors interfering with adequate intake with CF |
dyspnea due to coughing vomiting GI discomfort anorexia due to infection impaired taste and smell glucosuria -results in growth retardation and difficulty painting height and weight
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main treatment of CF |
enzyme treatment
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adequacy of CF determined by |
fecal fat and N2 balance -as long as one is still having symptoms may need to keep tweaking the enzyme dose given |
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CF intolerance shown by |
increase in stools greasy stools ab cramping |
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protein needs with CF |
15-20% (normal amount) |
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CF vit and Min |
water soluble vitamins are not usually a problem -fat soluble vitamins usually inadequatly absorbed (A D E and K) -sodium requirements may be higher due to sweat loss
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cystic fibrosis feeding strageties |
breast feeding concentrated formulas if nec. baby formula sup with mct oil pancreatic enzymes necessary regular enjoyable mealtimes high nut dense foods sup by feeding tube at night is nec |
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lung cancer nut. implications |
resp. fatigue and diminished residual capacity -decrease wt, antro and labs -purchasing and prep foods= overwhelming -eating is unenjoyable due to pain -increase kcal with high kcal supp
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resp failure |
when pulmonary system can't perform its functions (result of trauma, surgery or med) -requires CO2 from nasal canal or vent |
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weight with RF |
underweight due to hypermetabolism -accurte interpretation of labs can be difficult due to- fluid balance issues, meds, vent
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RF goals |
meet basic nutrition needs, preserve LBM, restore resp muscles and strength, maintain fluid balance, improve resistance to infection, facilitate weaning from vent by not overfeeding patient |
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RF feeding |
indirect cal to avoid overfeeding on vent= 25 kcal/kg restore nitrogen balance pro intake 1.5-2.0 g/kg of dry body weight divide NPC between CHO and Fat
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RF vit and min |
meet DRI and provide adding for repletion if needed -monitor fluids and electrolytes carefully
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trauma- ebb |
right after event- everything decreased -insulin falls because glucagon increases because of hyperglycemia |
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trauma- flow |
once you have fluids and restoration of O2, everything is increased |
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trauma- glucagon |
promotes gluconeogenesis, AA uptake, ureagenesis and protein metabolism |
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physiologically after trauma |
increase in glucose production, FFA release, circulating insulin, catecholamines, glucagon and cortisol -increase in flow of substrates but poor utilization of pro, cho, fat and o2
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metabolic stress response in trauma |
-energy production becomes more protein dependent, especially the BCAA - isolucine and leucine and valine are preferred BCAA sources of fuel -oxidized from skeletal muscle as a source of N2 for muscle and C skeletons for glucose alanine cycle and glutamine synthesis -mobilization of these acute phase proteins results in: rapid loss of LBM |
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what else happens in metabolic stress response |
loss of urinary K, PO4 and MG -Hyperglycemia -increased glue production -conserve wter and Na to circulating blood volume |
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what are released in metabolic stress |
cytokines- proinflammatory proteins |
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in starvation (compared to metabolic stress) |
loss of muscle is much slower -body adapts to preserve lbm -glycogen is main fuel
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sepsis |
infection with known organism
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sirs |
widepsread inlammation occurs -site of infection established and at least two of the following are present -low body temp, heart rate>90 hypervent. |
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complication of sirs |
multigrain dysfunction syndrom -enteric bacterial translocation due to disruption of gut function -disruption of galt
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factors to consider when screening icu patient |
preadmission nut status organ function use of agents, vasopressors and other paralytic agents -ability to predict clinical course -need to enteral or parenteral nutrition |
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mnt goals with trauma |
minimize starvation correct deficiencies dont overfeed but good calories, fluid and electo nutrition support as soon as hemodynamically stable
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energy for trauma
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25-30 kcal/kg dont overfeed b/c of hyperglycemia, fatty liver and excess co2 production |
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feeding routes in trauma |
preferred route is oral but usually use combo of tpn, en and po |
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formulas for truama |
trauma and metabolisc stress formula -bcaa and higher protein -immune inhancing, may decrease hosp. stay and costs)
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traumatic brain injury energy needs |
up to 40% greater |
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traumatic brain injury protein |
will be in neg N2 balance for 2-3 weeks |
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30% of TBI have |
dysphasia |
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burn h20 lose |
2-3.1 ml/kg of BW per 24 hrs -thermal blankets and heat lamps -antacides used to decrease stress related ulcers |
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lipids and burns |
limit 12-15% initially to avoid intolerance and immunosuppression |
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blood protein |
angiotensinogen |
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