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109 Cards in this Set
- Front
- Back
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what vitamin is malabsorbed when on meds that reduce stomach acid?
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vitamin B12
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what are the complications of tubefeedings?
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aspiration, clogged tube, constipation, diarrhea, fluid and electrolyte imbalances, irritation or inflammation of skin or mucous membranes, and nausea/vomiting/cramps
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what are the 2 types of dysphagia?
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oropharyngeal / esophageal
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what are the distinct characteristics of the 2 types of dysphagia?
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neuromuscular condition; difficulty swallowing, coughing, and nasal regurgitation -- wet voice, bad breath, or speech disorder.
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MNT COPD
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correct malnutrition, promote healthy weight, and prevent muscle wasting
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which substances weaken LES pressure?
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fatty and fried foods, spicy foods, citrus fruit, tomato, onions, chocolate, mint, caffeine, alcohol
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what are some suggestions for the tx of dry mouth?
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chewing gum, drinking water/sugar free juices, sucking candy
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MNT for diarrhea
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methylcellulose supplement; also low residue, low fat, lactose free diet
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MNT for constipation
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increase fiber intake to 25g/day; methylcellulose, polycarbophil supplements can help
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which meds cause unintended weight gain?
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antipsychotics, antidepressants, and corticosteroids
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what are the principles and uses of clear, liquid diets (w example)?
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filler
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what percentage of pts are malnourished?
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38-62%
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how quickly does screening for malnutrition need to be done?
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within 24 hrs of admit
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what are the different methods of nutrient intake? (5)
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24 hr intake recall / food frequency / food record / direct observation / survey
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what anthropometric data are relevant?
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BMI / height+weight / circumference of waist+limbs
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which labs are ordered?
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RBC (CBC), Hb, Hct, MCV, MCHC
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fluid levels (adema, dehydration) can affect lab readings (T/F)
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TRUE
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what conditions contribute to odd lab values?
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fever, sweating, vomit, diarrhea, burns
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NPO means...
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nothing orally; non-PO MNT
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which diet is appropriate for impaired swallowing?
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mechanically altered diet
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sodium controlled diets are for which groups of pts?
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hypertensive, renal failure
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which type of diet is appropriate for wired jaws / nonfunctional jaws?
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blenderized
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before and after surg, what type of diet is appropriate?
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clear liquid (gelatin, chicken broth, etc)
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when is a fiber restricted diet indicated?
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diverticulitis
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meds can increase or decrease a pts appetite (T/F)
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TRUE
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meds can alter metabolism (T/F)
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TRUE
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what is a relevant side fx of bile acid binders?
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while they bind cholesterol, they also bind fat-soluble vitamins
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which two drugs bind calcium?
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tetracycline / ciprofloxacin
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which 3 vitamins alter stomach acidity?
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B12, folate, iron
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methotrexate displaces what?
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folate; methotrexate is an antimetabolite / antifolate drug used in cancer
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what common drink can affect serum conc of certain drugs?
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grapefruit juice
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which food type's taste is mainly altered when undergoing chemo?
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meat
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dexatrim is repackaged what?
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amphetamine
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which meds stimulate food intake?
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antipsychotics / antidepressants / steroids
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steroids and immunosuppressants mimic which endogenous compound?
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cortisol
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what are some side fx of taking steroids?
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wt gain / muscle wasting / bone loss / hyperglycemia / eventual development of osteoporosis and diabetes
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which meds modify excretion rates?
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diuretics
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tyramine interacts with what class of drugs?
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MAOIs
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which foods are high in tyramine content?
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cheese, fruit, processed food, meat and fish, soy products
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what alternative meds are popular and interact with many drugs?
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kava kava, st johns wort, valerian / garlic, gingko, ginseng
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what type of diet is best admin in small frequent meals?
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high protein, high kcal
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what are the 4 types of enteral foods?
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1. formula, intact proteins / 2. alimental or hydrolyzed, uses amino acids / 3. disease specific, contents are specialized / 4. modular, contain 1-2 macronutrients
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what is the protein content of these formulas?
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12-20%
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how many kcals/mL are allowed in tubefeedings?
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0.5-2.0 kcals/mL (1.0-1.2 kcals/mL std)
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formulas with higher energy density
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good for fluid restrictions (CHF, renal failure)
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what is osmolality?
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the # of particle in a solution (ideal: isotonic w plasma)
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what does a hypertonic solution cause?
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diarrhea
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who are tubefeeds indicated in?
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neuro pt / swallowing problems / dec. appetite pt / GI obstructions / GI resections / alzheimers / mentally incapable / pt on ventilator
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what are the 3 types of tubefeedings?
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nasogastric / nasoduodenal / nasojejunal
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which type of tubefeed is used in infants?
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orogastric
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what are gastric feedings at risk for?
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aspiration
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what is a french unit?
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1 french = 1/3 mm
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what goes into determining the size of a tube?
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age / medical problems / nutritional status / ability to digest / energy and protein requirements
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how long can an open system be hung?
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8-12 hours
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how long can a closed system be hung?
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24-48 hours
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what needs to be checked when tubefeeding?
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check fluid pH, make sure head of bed is elevated 30-45 degrees
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intermittent formula delivery amounts
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250-400 mL over 20-40 mins, admin gastric
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bolus formula delivery amounts
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250-500 mL over 3-4 hours in 15 min spurts / admin gastric -- major risk of aspiration, abdominal discomfort
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continuous delivery considerations
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flush before and after meds, feeds / stop feeding 15 mins before and after
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what are the 2 types of parenteral nutrition?
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PPN/PICC -- TPN/CVC
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who requires parenteral nutrition?
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short bowel syndrome / pancreatitis / crohns / fistula / burns / bone marrow transplant
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what is PPN for?
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short-term support, average nutrient needs
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what is TPN for?
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long-term support -- snaked into right subclavian vein (basilic > cephalic > subclavian)
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what is total nutrient admixture?
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TNA -- 3 in 1, less desirable (uses omega 6 fats, immunosuppressant)
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which macronutrient is separated from the others in a 2 in 1 solution?
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fat; 2 in 1 is preferred to TNA
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TPN kcals -- 1g dextrose/protein/lipid = x kcal/mL?
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1g dextrose = 3.4 kcal/mL / 1g protein = 4 kcal/mL / 1g lipid = 2 kcal/mL
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how many kcals are in 10%/20%/30% lipid TPN?
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10%: 1.1 kcal/mL; 20: 2 kcal/mL; 30%: 3 kcal/mL
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5 classic inflammatory signs
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swelling / pain / redness / warmth / loss of function
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how do hyperglycemic pt nutrient needs change?
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50% kcals from lipids; can inc infection rates
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ARDS stands for?
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acute respiratory distress syndrome
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multiple organ failure occurs when?
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when >=2 organ systems fail
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multiple organ failure is the cause of death in what pct of the ICU pop?
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50%
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how does multiple organ failure progress?
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1 lungs > 2 liver > 3 kidneys > 4 GI/heart
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what is xerostomia?
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dry mouth, caused by reduced salivary flow, Sjorgan's syndrome
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dysphagia, telltale signs
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wet voice, coughing during eating; can be caused by CBA/CVA
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signs of peptic ulcers
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increased HCl, pepsin
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high GI PUD sign
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black and tarry stool
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low GI PUD signs
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red stool
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PUD generic signs
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burning sensation, coffee grounds vomit, increased HCl and pepsin
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postgastrectomy diet
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avoid sugar, admin liquids between meals
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dumping syndrome
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rapid gastric emptying; causes fat malabsorption, bone disease (low Ca and vitD), anemia
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for otherwise healthy pt, what causes constipation?
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low fiber diets, inactivity, and certain medical conditions (hypothyroid, MS, renal failure, diabetes, parkinsons, spinal cord lesions)
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what are some good sources of fiber?
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bran (bran cereal), fruits (prunes), and vegetables
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when adding fiber to the diet, what else needs to be added?
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water
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in otherwise healthy pt, what causes intestinal gas?
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high fiber diets, sorbitol, beans, and swallowed air
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diarrhea is marked by?
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frequent, watery stool
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what are the 3 types of diarrhea?
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osmotic, motility, secretory (c diff)
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what are 3 foods that can lessen diarrhea?
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apple sauce, bananas, boiled rice and toast (BRAT diet)
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oral hydration therapy consists of
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.5 tsp salt, .75 tsp baking soda, 1.333 tbs sugar, and 1 qt water
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if bacterial overgrowth occurs, what are the side fx?
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dec fat-soluble vit abs, impaired GI motility, reduced gastric acid secretions
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steatorrhea is
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excess fat in stool
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signs of steatorrhea
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floating stool, oily appearance, and exceptionally pungent
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malabsorptive disorders
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celiac, CF, IBS, and short bowel syndrome
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what are the symptoms of lactose intolerance
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gas, diarrhea and GI discomfort
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acute pancreatitis orders and causes
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NPO, caused by gallstones / vastly inc alcohol / high TGs / high toxins
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chronic pancreatitis orders and causes
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permanent tissue damage, 70% alcohol induced -- pt avoids food and is malnourished
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nutritional needs in CF
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liberal amounts of salt; pancreatic enzyme replacement for meals; protein energy malnutrition often
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affected organ systems in CF
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lungs / pancreas / copious sweating
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celiac disease is
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abnormal immune response to protein fraction (from BROW)
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BROW stands for (celiac)
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barley, rye, oats, wheat (rice is OK)
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2 IBDs
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crohn's, ulcerative colitis
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crohn's is located where, and requires what diet?
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usually in the small intestine, and requires high protein/high kcal
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ulcerative colitis is located where and requires what considerations during an attack?
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occurs in the rectum and colon, and requires low fiber + NPO during flare up
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IBS is
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an excessive response to meals, GI hormones, and stress
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IBS signs/symptoms
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diarrhea/constipation, gas, bloating, and GI distention
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easy accommodation for diverticular disease pt
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add bran cereal to diet; caused by a bad diet across the lifespan; dec motility, inc pressure; high fiber diet can be preventative
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diverticulitis is marked by
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alternating diarrhea and constipation
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4 foods that can reduce odors (associated with ostomies)
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1 cranberry juice / 2 buttermilk / 3 yogurt w culture / 4 parsley
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foods associated with odors (ostomies)
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fish, eggs, beans, peas, onions, garlic, beer
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