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112 Cards in this Set

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What factors constitute a moderate nutrition risk based on the Nutrition Risk Assessment?
Weight status; loss or gain of <5% wt change in 30 days; <7.5% within 90 days; or <10% within 6 mo. Oral/Nutrition Intake; FOOD - Intake meets 26-75% of estimated needs Oral/Nutrition Intake; FLUIDS - Consumes 1000 - 1499 cc/day Medications; nutrition related - 2-4 drugs/day Relevant conditions and diagnoses - Anemia, infection, CVA, fracture, UTI, alcohol abuse, drug abuse, COPD, edema, surgery, osteoporosis, hx of GI bleed, food intolerances and allergies, poor circulation, constipation, diarrhea, GERD, anorexia, Parkinson's Physical and Mental functioning - Out of bed w/ assistance, motor agitation (tremors, wandering), limited feeding assistance, supervision while eating, chewing or swallowing problems, teeth in poor repair, ill-fitting dentures or refusal to wear dentures, edentulous taste and sensory changes, unable to communicate needs. Lab values - Albumin 3.0-3.4 g/dL, 1-2 other nutrition-related labs abnormal Skin conditions - Stage I/II pressure ulcers or skin tears not healing, hx of pressure ulcers, stasis ulcer, fecal incontinence
What factors constitute a high nutrition risk based on the Nutrition Risk Assessment (NRA)?
Weight status; loss or gain - BMI <19 or >27, >=5% wt change in 30 days; >=7.5% in 90 days; or >=10% within 6 mo Oral/Nutrition intake; FOOD - Intake meets <=25% of estimated needs Oral/Nutrition intake; FLUIDS - Consumes < 1000 cc/day Medications; NUTRITION RELATED - 5 or more drugs/day Relevant conditions and diagnoses - Cancer (advanced), septicemia, liver failure, dialysis, ESRD, Alzheimer's, dementia, depression, dehydration, dysphagia, radiation/chemo, active GI bleed, chronic nausea, vomiting, ostomy, gastrectomy, fecal impaction, uncontrolled diseases or conditions. Physical and mental functioning - Bedridden, inactive, total dependence, etensive or total assistance or dependence while eating, aspirates, tube feeding, TPN, mouth pain Lab values - Albumin less than 3.0 g/dL, 3-5 other nutrition-related labs abnormal Skin conditions - Stage III/IV pressure ulcers or mulitiple impaired areas
How do the following lab values relate to nutrition? -CBC -albumin -BUM -creatinine -electrolytes -glucose -cholesterol -triglycerides
A low red blood cell count and depressed hemoglobin value indicates anemia. The hemoglobin
What is the principle measure in anthropometrics?
Height and Weight
What should be included in health promotion activities?
Tools such as the food guide pyramid
5 disruptive influences on a hospitalized patient's nutrition/appetite.
-Diagnostic Testing -Emotional Stress -Medications -Symptoms associated with illness (pain, nausea, and shortness of breath, etc) -Food presentation (Hot foods that are cold, cold foods that are hot, ) Attention to details in food presentation, meal scheduling, and the patient's difficulties with food will enhance a patient's intake. You help to stimulate a patient's appetite through environmental adaptations, consultation with an RD, attention to food preferences, and patient and family counseling
List five measures to promote nutrition in hospitalized patients.
-Providing a comfortable environment -Assisting patients with feeding -Dysphagia Treatment -Diet Management -Patient Positioning -Enteral Nutrition (EN) -Parenteral Nutrition (PN)
dysphagia
Difficulty in swallowing
Aspiration
The entry of secretions or foreign material into the trachea and lungs
Silent Aspiration
Occurs when foods or liquids are breathed into the lungs but do not produce the typical reaction of coughing. With silent aspiration
Aspiration
Inhaling or breathing in food or other substances into the larynx below the vocal chords toward your lungs. This can lead to aspiration pneumonia
Five Measures to Prevent Aspiration
1. Oral Motor Exercises 2. Swallowing Techniques 3. Positioning During Feeding 4. Diet modification 5. Thickening of Liquids 6. NPO status with enteral feeding (EN) 7. Do not leave the patient unsupervised 8. Patient sits upright to correctly align anatomy of pharynx and esophagus. 9.
Parenteral nutrition therapy
Administration of nutriment intravenously. The administration of nutritional solution into the vascular system.
Enteral Nutrition (EN)
Provision of nutrients through the gastrointestinal tract (GI) when the patient cannot ingest
Gastrostomy Tube
The insertion of a feeding tube
Jejunostomy Tube
Tube inserted into the jejunum through the abdominal wall for administration of liquefied foods to patient who have a hight risk of aspiration.
PEG Tube
A percutaneous endoscopic gastrostomy tube (PEG tube) is generally placed into a patient's stomach as a means of feeding them when they are unable to eat
NG Tube
Nasogastric intubation is a medical process involving the insertion of a plastic tube (nasogastric tube
OG tube
OG tube (orogastric tube): A tube that goes through the mouth into the stomach.
List five nursing measures for patients with a feeding tube.
-Assess for abdominal distention, N&V -Keep HOB at least 30 degrees especially during feedings, for insertion, and removal to prevent aspiration -Total feeding and irrigant should not exceed 450mL -Residual - contents found in the stomach since the last meal - check resid q4-6h -return resid and dig enzymes to stomach -hold feeding if residual exceeds amt given in past 2h
What is the residual feeding?
Contents found in stomach since last meal.
How can you prevent food-borne illness in the hospital/patient area?
Teaching strategies -hand hygiene -cook meat above 180 degrees F -refrigerate foods at 40F within 2h of cooking -Thaw frozen foods in refer etc.....
What are the recommendations for a diabetic (ADA) diet?
The American Diabetes Association recommends that people who suffer from diabetes symptoms eat foods daily from each of the 4 major food groups, which are: Vegetables and fruits including berries, apples, spinach, green beans, etc (see glycemic index list for lots more ideas). Whole grains, breads and cereals like barley, bran, oats, wheat, and brown rice. Dairy products like skim or low-fat milk, yogurt, and low-fat cottage cheese. Proteins including fish, poultry, meats, eggs, nuts, and dried beans Although this diet includes some fat, excessive fat is not a good idea. There are several healthy fats that should be included in your diet including flax seed oil, olive oil and fish oil (found in wild caught salmon, sardines, herring, anchovies). Most other fats, especially animal fats should be limited because increased fat and cholesterol in the diet can result in a higher likelihood of heart disease or hardening of the arteries or both. Suggestions for cutting down on fat include: Pick lean meats rather than fatty meats and be sure to cut away extra fat. Eat less meat and more fish and poultry. With poultry be sure to remove the skin before eating and focus on the lower fat breast rather than legs and thighs. The ADA diet suggests margarine instead of butter (note, newer margarines do not have hydrogenated fat in them (check for this on the label), so are OK, butter in small amounts is probably OK as well). The American Diabetes Association diet proposes skim or low-fat milk rather than whole milk. Eat only up to 3 or 4 eggs per week and occasionally have some liver. Note: It is possible today to get eggs with omega-3 fat in them (chickens are fed flax seed), these are probably the best choice for diabetics. Salt can be a problem as it can make a high blood pressure condition worse. Besides the obvious sources of salt, there are hidden sources of salt in foods such as canned soups, salad dressings, and cheeses. As part of the American Diabetic Association diet, sugar intake should be reduced (again we disagree, we believe you should cut out all sugar from your diet in any of its forms including honey and maple syrup). Pies, frosted cakes, table sugar, honey, and breakfast cereals with sugar coating have a high amount of sugar in them. Did you know that a 12-ounce can of Coke has about 9 teaspoons of sugar? Stay away from alcohol and ask your dietician for advice if you decide on a drink or two. Alcohol acts like sugar in your blood stream so it’s not a good idea for people with diabetes to drink it. The American Diabetes Association recommends that you create a personalized diet by working with your dietician to design a meal plan that’s effective for you and includes enjoyable foods. Your regular eating habits and schedule should be a fit with this diet while you retain a steady weight.
What are the recommendations for an AHA diet?
-Know and limit your fats. -Choose lean meats and poultry without skin and prepare them without added saturated and trans fat. -Eat at least two servings of fish each week. -Select fat-free, 1 percent fat and low-fat dairy products. -Cut back on foods containing partially hydrogenated vegetable oils to reduce trans fat in your diet -Cut back on foods high in dietary cholesterol. -Cut back on beverages and foods with added sugars. -Choose and prepare foods with little or no sodium. -aim to eat less than 1,500 mg of sodium per day. -Cholesterol, fiber and oat bran -Read labels for a healthy heart.
List 7 actions to increase oral supplement intake in undernourished older inpatients.
1.In the long-term care facility, the food service manager and care-givers can often offer individualized suggestions for facilitating food intake 2.remove dietary limitations (e.g., restrictions on intake of salt or high-cholesterol foods). 3.Adding flavor enhancers that amplify the intensity of food odor may be useful in patients with hyposmia.13 Pureed foods and thickened liquids may be needed in patients with dysphagia. 4.Patients may benefit simply from being offered frequent small servings of foods that they like. Large portions may be overwhelming and may actually discourage intake. 5.When possible, physical exercise and even physical therapy should be encouraged because increased activity has been shown to promote appetite and food intake. One study30 found that caloric intake was greater in patients who received both nutritional supplements and exercise than in patients who received only supplements. 6.When liquid calorie supplements are used, they should not be given with meals. Total caloric intake does not improve with this method of administration.31,32 Liquid supplements are preferable to solids.32 With liquids, gastric emptying time is quicker, and total caloric intake is more likely to be maximized. 7.
What is Healthy People 2010?
Healthy People 2010 is a set of health objectives for the Nation to achieve over the first decade of the new century. It can be used by many different people, States, communities, professional organizations, and others to help them develop programs to improve health. Healthy People 2010 builds on initiatives pursued over the past two decades. The 1979 Surgeon General's Report, Healthy People, and Healthy People 2000: National Health Promotion and Disease Prevention Objectives both established national health objectives and served as the basis for the development of State and community plans. Like its predecessors, Healthy People 2010 was developed through a broad consultation process, built on the best scientific knowledge and designed to measure programs over time. Healthy People 2010 challenges individuals, communities, and professionals, indeed all of us to take specific steps to ensure that good health, as well as long life, are enjoyed by all.
What is the glycemic index?
What is the glycemic index?The glycemic index
What are eating disorders?
"Eating disorder" is when a person eats, or refuses to eat, in order to satisfy a psychic need and not a physical need. The person doesn't listen to bodily signals or perhaps is not even aware of them. A normal person eats when hungry and stops eating when the body doesn't need more, when he feels the signal of satisfaction. Eating disorders are usually classified as anorexia nervosa, bulimia nervosa or binge eating disorder in accordance with the symptoms. However, a person may have an eating disorder without belonging exactly to any of these categories. Those who lose weight because of illness, e.g., cancer, are not considered to have an eating disorder.
Describe the 3 most common eating disorders
anorexia nervosa
cachectic
Wasted appearance
myogenic
originating in or produced by a muscle ..i.e. myogenic dysphasia
advantage of enteral nutrition vs. parenteral nutrition
maintenance of structure and function of the GI tract
The most serious complication of tube feeding is
Aspiration To avoid this complication angle the bed @ 30 degrees
The method of choice for long term tube feeding is
Gastrostomy Tube
thirst is
protective mechanism that is an alert to the need for fluids **caution if confused or infants
Caffeinated drinks
Dehydrate you. Caffeine kind of negates the effect of the fluid because of the diuretic effect.
Carbonation
isn't good for your kidneys
Encourage what
other than water
What helps promote healthy bones?
Calcium, magnesium, phosphorus, vitamin D ***Dairy Group Weight bearing exercises
Omega three fatty acids
helps with cancer prevention and comes from NUTS and FISH **limit saturated and polysaturated fats
Nutritionally at risk adult clients
congenital anomalies
If a dietician asks for a diet recall
how many days should it include
During physical assessment observe for
wasted appearance, falling asleep easily, thin, dull and brittle hair, gums that are swollen and bleed easy ***many together may be a nutritional problem, but one or two could be something else i.e. drugs, bad dental work, etc...look at the whole picture of the client
ht/wt
always on the same scales with same clothes on - always do on admission!!
hemoglobin
anemia
serum albumin
protein synthesis
BUN (blood urea nitrogen) and cratinine
Kidney functions tests
Disruptive influences of acute care clients
poor appetite
To promote nutrition
comfy environment
hyperkalemia
high potassium levels **can be caused by licorice interfering with heart medications, diuretics, laxitives, and antidepressants
Diet for patient with constipation. Also known as prevention for colon cancer.
High fiber Greater than 5g/day
Diet for patients with diarrhea
diverticulitis
Nausea and Vomiting Diet
clear liquid advance as tolerated
Anorexia diet
small frequent meals
Congestive Heart Failure (CHF) fluid restriction
no more than 1500cc/24h
Diabetes Mellitus (DM) Diet
-Complex Carbs -Low fat -Limit alcohol -Encourage wt loss -control blood sugar -Vitamin and mineral supplements -Artificial sweeteners acceptable -Regular meals and snacks
Key points about diabetes
-Monitor glucose -Observe for hyper and hypoglycemia (know how to do this)
Key points about Diabetes in the Acute care setting
-give insulin as scheduled (**watch out for sliding scale insulin**) -monitor glucose **usually ac & hs -patients may be on sliding scale insulin - extra insulin given according to glucose level -Learn monitoring procedure in the clinical setting
Diet for Heart Disease
-Low fat, Low Cholesterol -Increased fiber -Avoid saturated fats -Limit red meat -Avoid frying -Low fat dairy
Diet for Kidney disease
-Limit protein and phosphorus -May need increased protein and fluid restriction with dialysis (end stage) -Limit dairy -Restrict sodium and potassium -Vitamin and mineral supp only with provider recomendation **ELIMINATE** alcohol
Never feed a patient that
can't swallow or lacks a gag reflex. ***They could aspirate!!
Red flags for dysphasia
coughing-clearing throat
Watch patients that have been
intubated
**cautions for aspiration**
We swallow 2000 times/day - it only takes 72 hours for muscles to atrophy
Safety tips for aspiration
HOB up, no straws, use thick liquids, 100% supervision and Compliance, Chin tuck/double swallow, Speech therapist screening/asses, modified barium swallow, be sure to check the ID band and read label ***THE WRONG DIET COULD BE JUST AS HAZARDOUS TO A PATIENT'S HEALTH AS A WRONG MED*** don't let NPO patients eat, don't give salt to limited sodium pt, don't give sugar to diabetic...etc..
Parenteral routes
peripheral, central vein, or PICC line. TPN will start after 10 days of parenteral nutrition **Parenteral nutrition will last no longer than 10 days
TPN (Total Parenteral Nutrition)
**in the vein** nutritionally adequate solution with glucose, amino acids, minerals, and vitamins
Enteral Feeding
Tube into the esophagus down to the stomach. PT must be able to absorb nutrients for this Tx. **X-ray is the gold for location of NG tube (aspiration of stomach contents can be unreliable, PH can be unreliable ie meds including antacids) CO2 detector is not yet common practice
Gastrostomy Tube
through an incision into the stomach -Long Term uncommon for this to slip and mislocate
Enteral Feeding
Hanging bags should be discarded q 24h admin at room temp (cold might cramp stomach) monitor for complications begin with small amts and start at half strength **fulll strength may cause vomiting and aspiration**
Bolus feeding
every 4-6 hrs bolus and intermittent are interchangeable terms according to lecture (even though they differ slightly) flush with water done in big-o syringe
Continuous
best for critically ill pt's better residuals less chance for aspiration flush q4h consistent flow rates in hanging bag
Dumping syndrome is avoided with
PEG tubes (percutaneous endoscopic gastrostomy) put in surgically clamp and unclamp or crimp and uncrimp when feeding to prevent loss of contents
Tube obstruction prevention
Dilute meds well flush q4h (20-60mL warm water)
Total NG tube feeding and irrigant
should not be more than 450mL
Hold feeding if:
aspirate exceeds amt given in past 2hrs
7 actions to increase oral supplement intake
Appropriate temperature Make sure it can be opened by the pt Actively monitor Encourage sips Serve as part of med round Encourage frequent meals Nourishing beverage at dinner
Trace Digestion
Trace Absorbtion
**Absorption- primary site of absorption is in the Small Intestine. Upper duodenum absorbs cholesterol
Trace Metabolism
**METABOLISM - nutrients converted into substances for cell function. Refers to all of biochemical and physiological processes. ANABOLISM is the production of more complex chemical substances by synthesis of nutrient. CATABOLSIM is the breakdown of body tissue into simpler substances
Trace Storage
**STORAGE - Energy is stored adipose tissue GLYCOGEN is stored in the liver/muscle tissue. PROTEIN is stored in muscle mass.
Trace Elimination
***ELIMINATION is digestion's end process includes undigestible products.
Nutrient
foods that contain elements necessary for body functions including water
BMR
Basal Metabolic Rate
Carbohydrate
provide energy to cells
Fiber
does not yield energy, indigestible plant parts 1.Insoluble- does not change in water and accelerates GI transit, helps prevent constipation 2. Soluble- becomes a gel in water and delay GI transit time, prevent diarrhea in tube fed pts
Protein
amino acids are the building blocks of protein. Made up of H
Which vegetarians need supplements? Which type of supplement needed?
Vegans
Factors that affect the BMR
energy needs based on activity level
What is the importance of water intake?
Water is the most basic of nutrients. Function of cells depends on aqueous environment.
What is the importance of fiber in a diet?
greater than 5g/day. prevents constipation
How is cholesterol affected by fatty acids? Which fats should be increased and which minimized in the diet?
Indigestion of saturated fatty acids appears to increase blood cholesterol level. Unsaturated fatty acids have minimal affect. Monounsaturated lower cholesterol levels
Give example of how following affects nutrition? Religion and/or culture
socioeconomic status
pt's at risk for nutritional problems:
congenital and surgical revision of GI tract
Lipids
no more than 30% of total calories from fat. Less than 10% from saturated fats. For elevated LDL use monounsaturated fats and soluble fiber
Differentiate between water and fat soluble Vitamins
Water Sol: c, b-complex Fat Sol: ADEK
Minerals
Major-Calcium, phosphorus, sodium, potassium, magnesium, chloride, sulfer Trace Elements-Iron, Iodine, Zinc, Copper, Manganese, Chromium, Cobalt, Molybdenum, Fluoride
Amino Acids
most important components of proteins in the body. Essential for synthesis of body tissue in growth
DRI's
Dietary Reference Intakes are the recommended amounts of nutrients for chronic disease prevention
Ovolactovegetarian
avoid meat
Lactovegetarian
Drink milk
vegans
only food of plant origin
FOOD PYRAMID: GRAINS
6oz half whole grain
FOOD PYRAMID: VEGETABLES
2.5 cups q day
FOOD PYRAMID: FRUITS
2 cups q day
FOOD PYRAMID: MILK
3 cups q day (for kids 2-8 it's 2)
FOOD PYRAMID: MEAT AND BEANS
5.5OZ q day