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35 Cards in this Set
- Front
- Back
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Deficit, excess, or imbalance in essential components of a balanced diet.
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Malnutrition
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Poor nourishment due to inadequate diet or disease.
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Under-nutrition
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Ingestion of more food than required.
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Over-nutrition
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Most common form of under-nutrition.
Primary = nutritional needs not met. Secondary = issue with ingestion, digestion, adsorption or metabolism. Causes: income, knowledge, living alone, pain or problem. |
Protein-Calorie Malnutrition (PCM)
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Protein-Calorie Malnutrition (PCM): Pathophysiology
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Carbohydrate stores = liver and muscles.
After 18hrs stores are depleted; body begins to convert protein in muscle to glucose. 5-9 days = body fat supplies much of energy. Liver function impaired and decrease in protein synthesis Plasma onconic pressure is lower with loss of protein. Shift of body fluids occurs = edema Blood volume reduced = dry and wrinkled skin |
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PCM: Clinical Manifestations
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Edema
Skin dry and wrinkled Lethargy Low tolerance to cold Susceptible to infection |
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PCM: Diagnostic studies
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Pre-albumin (indicator of "what's happening now")
Serum albumin Serum transferrin Electrolyte levels CBC |
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5 Criteria of Nutrition Screening
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Joint Commission requires w/in 24hrs of admission
24hr or 3 day recall Weight Chewing or swallowing issues Supplements |
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PCM: Planning / Goals
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Achieve weight (muscle mass)
Consume specific amount of calories No adverse consequences |
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PCM: Interventions
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Assessment if over or under nourished
Calorie count Education Supplements Frequent, smaller meals |
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Administration of liquefied food or formula through tube. AKA tube feeding
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Enteral Feeding
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3 Targets to insert feeding tube
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Stomach
Duodenum Jejunum |
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4 Methods of Enteral Feeding
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Nasogastric / Nasointestinal
Gastrostomy / Jejunostomy Percutaneous Endoscopic Gastrostomy (PEG) Mic-Key Button (low profile) |
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Enteral Feeding: Patient Position
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30-45 degrees; semi-fowler
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Enteral Feeding: Tube Patency
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Flush tube; 30mL; after meds and food
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Enteral Feeding: Formula
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Sterile
Special disease formula |
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Enteral Feeding: Administration
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Pump
Gravity |
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Enteral Feeding: Med Administration
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Each med separately
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Enteral Feeding: General Considerations
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Glucose levels
Label everything Formula longer than 24hrs = bacteria |
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Enteral Feeding: Complications
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calorie dense = less water; protein content > 16% can cause dehydration
Skin irritation; pulling out tube Misconnection |
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IV administration of dextrose, protein (amino acids), electrolytes, vitamins, minerals, fat emulsions. Used when complications of ingestion, digestion or absorption.
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Parenteral Feeding
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Parenteral Feeding: Methods of Administration
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Central Parenteral Nutrition (tip lies in S. vena cava) - allows for more concentrated fluid.
Peripheral Parenteral Nutrition |
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Parenteral Feeding: Central Solution Tonicity
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Central & Peripheral solutions are hypertonic
Central vein can handle high glucose; 20 - 50% Peripheral veins can handle glucose up to 20% |
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Parenteral Feeding: Solution Preparation
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Prepared by pharmacist or trained tech under strict aseptic techniques. (e.g. Laminar flow hood)
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Parenteral Feeding: Catheter Placement
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Sterile conditions by DR or advanced practice nurse
Isotonic solution infused until x-ray confirms placement Site covered with sterile dressing; labeled |
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Parenteral Feeding: Management
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Dressing change 24-72hrs; facility rules
Electrolyte levels every day Administered by pump |
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If the next bag of Parenteral Feeding is not available?
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Central - administer 10 - 20% dextrose (based on original solution)
Peripheral - administer 5% dextrose |
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Parenteral Feeding: Complications
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Infection
Metabolic Problems: hyper & hypoglycemia Mechanical Problems: Insertion; air embolism, pneumothorax, hemothorax |
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Used to treat morbid obesity.Currently only successful treatment and lasting impact for sustained weight loss. Criteria = BMI>40 or >35 (with one or more obesity related issues)
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Bariatric Surgery
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Bariatric Surgery: 3 Categories
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Restrictive
Malabsorptive Combination |
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Bariatric Surgery: Restrictive
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Reduces size of stomach
Feel fuller quicker Normal digestion and absorption |
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Bariatric Surgery: Malabsorptive
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Bypasses various lengths of small intestine so less food is absorbed.
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Bariatric Surgery: Combination
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Most common
Roux-en-Y Low complications Excellent pt tolerance Stomach size reduced; gastric pouch anastomosis empties directly into jejunum Food bypasses 90% of stomach, duodenum & small segment of jejunum |
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Bariatric Surgery: Post-Op Care
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Bed = Semi-Fowler
Early, frequent (3-4qd) and increasing ambulation Compression devices Low dose heparin Splint incision Water & clear liquids (30mL q2h) |
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Bariatric Surgery: Home Care
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Diet: high - protein; low - fat, carbs & roughage
6 small meals Fluids NOT consumed while eating. |
