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Nutrition med/surg

Terms in this set (82)

Nutritional assessment
malnourished, well nourished, obese, physical presentation, lab studies (prealbumin), influences for status
influences for nutritional status
age, culture, socioeconomic status
Nutrition standards for health promotion and maintence
dietary guidelines for american, USDA MyPlate, Cultural awareness, Geriatric considerations
Transferin is an indictor for
iron status
low prealbumin indicates
malnourishment
what are examples of solids fats
cheese, butter
well balanced diet should include
less than 300mg cholesterol, variety of protein foods, reduce coloric intake from solid fats and added sugars, limit foods with refined grains and increase vegi and fruit intake
sodium intake
less than 2300mg/day
51 and older and AA or HTN patients, should reduce to 1500mg/day
Three forms of PCM
Marasmus, Kwashiorkor, Marasmic-Kwashiorkor
Marasmus
a calorie malnutrition; where body fat and protein are wasted but serum proteins are often preserved.....thin skin, turgor, hair loss, alaphagia
Kwashiorkor
lack protein quanity and quality in the presenced of adequate calories; body weight is somewhat normla and serum proteins are low; anemic, skin turgor, pale, lethargic; activity intolerance
Marasmus-Kwashiorkor
protein and nutrition and energy malnutrition that often presents clinically when metabolic stress is imposed on a chronically starved patient; hair loss can occur
anorexia nervoa
self induced starvation
bulimia nervosa
binge eating and purging (laxative) throwing up
TPN (total parenteral nutrition)
prolonged status of alteration ingest, digestion and absorption; given IV; labs include electrolytes and minerals
eating disorder patients have
psychosocial problems; altered self image
PPN provides
protein, carbs, vitamins, minerals
TPN provides
lipids, dextrose, amino acid, minerals (solution is white)
Aspiration
elevate bed 30 degrees, residual check for too much, cont. or cyclic
patient centered collaborative care for nutrition
history and physical, psychosocial
labs to do
viseral protein: Hb, HCT, serum albumin, thyroxin binding serum albumin, prealbumin, and tersferrin, Cholesterol levels, total lymphocyte count
TEN (tube feeding)
NET, NGT, NJT (contin./cyclic) enterostomal feeding, gastrostomy feeding, PEG, PEG/J Educate patient!
complications of TEN
Refeeding syndrome, clogging, abdominal distention, fluid/electrolyte imbalance, diarrhea/constipation, Aspiration, too much residual, placement, injury, position of tube length, clamped (right rate?)
PPN inserted into
large veins or peripherally inserted central catheter (PICC)
TPN inserted in
central veins (Dextrose, amino acids, lipids, minerals)
For parenteral nutrition assess
I&O, electrolytes, glucose, protein, carb, albumin
over weight
an increase body weight for heigh compared to reference standard, or up to 10% greater than ideal body weight
obesity
excess amount of body fat when compared with lean body mass and weighs above 20% of upper limit of the normal range for ideal body weight
Morbid obesity
100% above IBW, extreme obesity, refers to a weight that has a severely negative effect on health
complications of obesity
DM, HTN, hyperlipidemia, CAD, stroke, PAD, Metabolic syndrome, Obstructive sleep apnea, Hypoventilation, depression, urinary incontinence, gall stones (excessive cholesterol), gout, chronic back pain, early osteoarthritis, decreased wound healing, physhosocial-binge and purge, altered self image, depression
Assessment of BMI
assess height and weight to calculate <18.5 or >25 health risk
Gastric operative procedures
Gastric restriction, malabsorption surgery, gastric bypass
Post operative care
Airway management (o2,vent, CPAP); pain control, nutrition, auscultate bowels, progress nutrition, measure abd, prevent dumping syndrome, position semi fowlers, apply SCD, administer anticoagulant for DVT, prevention infection and skin breakdown, remove urinary cath within 24 hours, ambulate the patient as soon as possible
SCD( sequential compressive device)
increase venous return from lower extremities to heart; prevent DVT
special considerations after bariatric surgery
abdominal binger; postition (semi fowlers); Sa02 monitoring; sequential compression hose and or heparin, skin assessment, absorbent padding on abd, removal or cath within 24 hours
--Airway, pain, educate patient on pain med pump
special considerations after baratric surgery cont.
orthostatic hypotension (assist with getting up); ambulate ASAP, monitor abd girth, 6 SMALL FEEDINGS, prevent dehydration; observe for signs of dumping syndrome.
dumping syndrome
constellation of vasomotor symptoms that typicaaly occur within 30 minutes after eating; believed to occur as a result of rapid emptying of gastric contents into small intestines, which shifts fluid into the gut and causes abd distention. early manifestations are vertigo, tachycardio, syncope, sweating, pallor, palpitations.
DS need what kind of meals to prevent
small frequent meals, no mixing liquids with foods
Orthostatic hypotension
VS before getting up; dangle at bedside (maybe check BP again); slowly stand if pt is able
Recipe for clear liquid diet
water, broth, gelatin plain, clear juices with no pulp, clear sodas, honey, ice pops without fruit, tea and coffee.
pureed diet
potted meat substances
discharge teaching nutrition
diet progression, nutritients and supplements, hydration guidelines
drug therapy discharge teaching
analgesics and antiemetic
wound care teaching
clean procedure, for open or laparoscopic wounds, cover during showers
S/S to report
pain, swelling, fever, difficulty in breathing, NV, changes in stool (melena)
carbohydrates
chief source of energy
Fats
furnish calories for survival; most concentrated source of energy and carrier for fat-soluabel vitamins
Proteins
Contain amino acids necessary for growth and development of body tissues
Vitamins
essential for growth and maintence of functioning of body processes
Minerals
essential for metabolic processes
elements that should be included in nutritional analysis
physical factors, height/weight (BMI), lab values, nutritional intake, meal patters, presence of disease, sociocultural-relgious factors, elimination patterns
Nursing diagnosis that could be used when a nutritional problem is evident
Nutrition imalance less than or more than body requirements; knowledge def.; risk for aspiration; detention impaired
actions the nurse carries our in preparation for serving food tray
relieve pain, arrange attractive manner, oral hygeine, right temp, empty bladder, odors
Low protein diets are indicated for clients with
cirrhosis and progressive HF
Foods low in cholesterol include
chicken, fruit, vegis.
fat restricted diets allow
chicken, fish, bread
Diverticulosis
low fiber diet
diverticulitis
no fiber diet
divericuli
fiber can be in diet
Foods high in sodium
butter, shellfish, frozen entrees
foods high in potassium
green vegis, orange juice, dried dates
Vitamin C
citrus fruits, tomatoes
B1, thyamine
whole grain cerals, lean pork and beef
Vitamin A
yellow vegis, green vegis, milk
Vitamin E
green vegtables
one serving of meat should weigh
2-3 oz.
when feeding a client you should
talk with client during the meal, asking the order in which he wants the food, alternate foods
cirrhosis of live diet
low protein, low sodium
renal disease diet
low protein. potassium, sodium
foods rich in fat-soluble vitamins
whole milk, yellow vegies.
low potassium diet, limit
fish, raw apples
to insert a nasogastric tube how do you measure the length
tip of nose, tip of ear lobe, to zyphoid process
how to check tube placement
pH levels less than 5; pH being the most accurate
small bore feeding tubes are for
long term; continuous feedings
aspirating residual, what do you do next?
replace aspirate and begin feeding.
High potassium
fruits, potato, green vegies
high iron
red meat, organ meat, green vegis, eggs
high sodium
frozen entrees
low sodium
fruits, bread, red meat, organ meats, green vegis, eggs
high protein
red meat, organ meat, eggs
high cholesterol
red meat, organ meat, eggs
high carbohydrates
fruits, bread, potato
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