Medical Nutrition Therapy and Enteral Feedings

Flashcards covering medical nutrition therapy, special diets, enteral feedings, herbal supplements, and parenteral nutrition.

What are the three primary goals of nutritional therapy?

Treat and manage disease, prevent complications, and restore health.

Where is a patient's specific diet prescribed?

On the physician's order sheet.

Which patient groups may require feeding assistance according to the lecture?

Patients with paralysis of the arms, visual impairment, intravenous lines in their hands, severely impaired or weak patients, and confused patients.

To whom may the task of feeding a patient be delegated?

A nursing assistant or family member.

How many hours before a procedure are preoperative patients usually kept NPO?

$6\,to\,8\,hours$.

What is the typical progression of diets for a postoperative patient starting from liquids?

From a clear liquid to a full liquid diet, then to a soft diet before advancing to a general or regular diet.

When is a liquid diet usually initiated for a postoperative patient?

When bowel sounds return (determined by auscultation).

What risks are decreased by starting a postoperative patient on a liquid diet?

Abdominal discomfort, nausea, and vomiting.

What do the four letters in the ABCD nutritional assessment framework represent?

Anthropometric, Biochemical, Clinical, and Dietary.

What condition does skin jaundice indicate during a physical assessment?

Liver disease or damage (curable if treated early).

What skin color change during physical assessment is associated with issues in Diabetes Mellitus (DM)?

Darkening of the skin.

What risks does Altered Mental Status (ALM) present regarding a patient's nutrition?

Puts patients at risk for aspiration and malnourishment.

Hair loss noted during a head and neck assessment points to which nutritional deficiencies?

Protein or iron deficiency.

A goiter identified during a physical assessment is caused by a deficiency in which element?

Iodine deficiency.

A swollen tongue observed during physical assessment indicates which type of deficiency?

Vitamin deficiency.

Diarrhea places a patient at risk for which acid-base imbalance?

Acidosis.

Muscle wasting observed during a musculoskeletal assessment usually indicates what condition?

Malabsorption.

What is the definition of anthropometric assessment?

Measurements of humans, including weight, height, % weight change over a given time period, BMI, % ideal body weight, and head circumference in pediatrics.

Which four laboratory tests assess liver function under GI biochemical testing?

Albumin, Ammonia, total bilirubin, and total protein.

What is the treatment for jaundice in newborn babies?

Phototherapy.

Which lab test is used in biochemical assessment to evaluate Diabetes Mellitus?

$HgbA1C$.

Which lab tests are included in a renal profile assessment?

GFR, BUN, Creatinine, and Electrolytes.

Which components are tested in a lipid profile?

Triglycerides, cholesterol, HDL, and LDL.

Which three dietary markers are checked when evaluating for anemia?

Iron, B12, and thiamine.

Which two specific proteins are evaluated in biochemical assessment for protein status?

Albumin and prealbumin.

What three tools or methods are used to gather dietary history data?

Food journaling for $3\,days$, 24-hour recall, and diet history.

What does the abbreviation NPO stand for, and what are its strict rules?

Nothing per oral / nothing by mouth; no food, no water, no ice chips (except a sip of water for PO medications).

When is NPO status typically initiated before surgery?

Usually after $12\,am$.

For which medical conditions besides surgery is NPO ordered?

Dysphagia, bowel obstruction, and gastroparesis.

What assessment must always be performed before initiating any special diet?

Assess bowel sounds.

What defines a clear liquid diet?

Liquids that are transparent at room temperature and easily digestible foods.

What are examples of items permitted on a clear liquid diet?

Clear juice, Jello, water, broth, gelatin, Popsicles, carbonated water, clear candies, tea, and coffee.

What defines a full liquid diet?

Liquids at room temperature that do not have to be transparent, including dairy products.

What foods are permitted on a full liquid diet?

Milk/milk beverages, yogurt, eggnog, pudding, custard, ice cream, puréed meat and vegetables in cream soups, cooked refined cereals, strained gruel, and all other juices.

How does nectar-thickness liquid compare to water?

Nectar thickness is thicker than water.

What utensil should NOT be used for patients consuming dysphagia liquids?

Straws.

How should a patient with dysphagia position their head while eating?

Tilt head forward.

Which patient populations commonly require fluid restrictions?

Patients on dialysis, Heart Failure (HF), and prolonged tracheostomy.

What consists of a puréed dysphagia diet?

Full liquids plus anything that can go in a blender (meat, eggs, fruits).

What foods are included in a mechanical soft diet?

Full liquids plus ground, chopped, or diced foods (soft foods requiring less chewing, ground/chopped meat, soft fruits/veggies, soft breads).

For which medical conditions is a high fiber/high residue diet recommended?

Constipation, diarrhea, diverticulosis, and hemorrhoids.

How much daily fiber is permitted on a soft/low fiber/low residue diet?

Less than $10\,g$ of fiber daily.

Which patients benefit from a soft/low fiber/low residue diet?

Patients with chewing issues and GI patients (diverticulitis, Crohn's disease, ulcerative colitis).

Which foods must be strictly excluded from a soft/low fiber/low residue diet?

Raw fruits and vegetables, nuts, seeds, and whole wheat or grains.

For which medical conditions is a bland diet ordered, and what items must be avoided?

Gastric and duodenal ulcers, Crohn's disease, and IBS; avoid alcohol, caffeine, spices, tea, and soft drinks.

What four grains are excluded in a gluten-free diet according to the acronym BROW?

Barley, Rye, Oats, and Wheat.

What is the sodium restriction for a low sodium diet?

No added salt or less than $2\,g$ of Na daily.

How much sodium is contained in 1 teaspoon of salt?

$2300\,mg$ of sodium.

What weight gain threshold in Heart Failure requires notifying the healthcare provider (HCP)?

$3\,lb$ in $2\,days$.

Which high-potassium foods should be recommended to patients on potassium-wasting diuretics?

Bananas, potatoes with skin, oranges, tomatoes, avocados, apricots, dates, and cantaloupes.

What is the daily cholesterol limit on a low cholesterol diet?

Less than $300\,mg$ cholesterol daily.

What are the normal target lab values for total cholesterol, LDL, triglycerides, and HDL?

Total cholesterol $<200\,mg/dL$, LDL $<100\,mg/dL$, triglycerides $<150\,mg/dL$, and HDL $40\,mg/dL$ or more.

What is the daily fat limit for a low fat diet?

Less than $50\,g$ per day.

What is Diabetes Mellitus?

Disturbance of carbohydrate metabolism and glucose utilization caused by insulin resistance.

Which two ethnic groups carry the highest risk for developing Diabetes Mellitus?

African Americans and Hispanics.

What fasting blood glucose level confirms a diagnosis of Diabetes Mellitus?

$126\,mg/dL$ or more on an empty stomach.

What range should serum glucose be maintained at through diet therapy in Diabetes Mellitus?

$75\,to\,115\,mg/dL$.

What percentage distribution of carbohydrates, protein, and fat/fiber should a diabetic meal contain?

$45\%\,to\,60\%$ carbohydrates, $20\%\,to\,25\%$ protein, and $20\%\,to\,25\%$ fat and fiber.

What type of carbohydrates should diabetic patients consume, and which should be eliminated?

Consume complex carbohydrates; eliminate simple carbohydrates.

What are the standard dietary components of a non-dialysis renal diet vs a dialysis diet?

Non-dialysis renal diet requires low protein, low Na, low K, low Phosphate; dialysis requires high protein.

Which foods are high in phosphorus and should be restricted on renal diets?

Meats, fish, nuts, dairy, beans, dark colas, and sports drinks.

What blood pH level indicates renal failure / metabolic acidosis?

Blood pH $<7.35$.

How does Vitamin K interact with Coumadin (Warfarin)?

Vitamin K counteracts Coumadin (Warfarin).

Which dark green leafy vegetables should patients on Coumadin/Warfarin avoid consuming in large amounts?

Kale, broccoli, Brussels sprouts, cabbage, and cauliflower.

What causes gout, and which joint is most susceptible?

Crystallization of excess uric acid in joints; the big toe is most susceptible.

Which alcoholic beverage contains the highest level of purines?

Beer.

What is the action and key teaching points for Allopurinol in gout?

Inhibits uric acid production; stop if mild rash occurs, take with H2O, increase fluids, monitor liver/renal functions.

When is Colchicine administered during gout management?

During the acute stage (prevents leukocytes from invading joints).

What daily fluid intake level is recommended for patients taking gout medications?

$3\,L/day$.

What is the difference between osteopenia and osteomalacia?

Osteopenia is loss of bone mass/weak bones (stage before osteoporosis); osteomalacia is softening of bones due to severe Vitamin D deficiency.

How should alendronate be taken to prevent esophagitis?

Take with $8\,oz$ of water and remain sitting upright for $30\,minutes$.

What is the maximum single dose for Calcium carbonate, and how should it be taken?

$500\,mg$ max in one dose, taken with food.

What clinical features are often present in HIV/AIDS patients, and what diet therapy is used?

Severe diarrhea, profound weight loss, muscle wasting; neutropenic diet.

What percentage of adults in the United States are obese, and where does obesity rank in preventable death?

Approximately $39.8\%$; second leading cause of preventable death in the US.

What is recommended for pregnancy weight gain during the first trimester versus the second and third trimesters?

$2\,to\,4\,lb$ total in 1st trimester, and $1\,lb/week$ during 2nd and 3rd trimesters.

How should iron supplements be administered, and what side effect is expected?

Take with Vitamin C (at different time) on an empty stomach, separate from food/meds; dark or black stool is expected.

What is the lifespan of a sickled red blood cell compared to a normal red blood cell?

Sickle cell lifespan is $3\,weeks$; normal red blood cells live $4\,months$.

What does the acronym HOP stand for in managing a sickle cell crisis?

Hydration, Oxygen, Pain management.

What causes Pernicious anemia, and what is its signature tongue symptom?

Lack of B12 due to deficiency of intrinsic factor secreted by gastric mucosa; Glossitis (inflamed red smooth tongue).

What percentage below normal weight characterizes extreme weight loss in Anorexia Nervosa?

$25\%$ below normal weight.

Which mental disorder has the highest mortality rate of all mental disorders?

Anorexia Nervosa.

How long should a patient with Bulimia Nervosa be monitored after each meal?

$1\,to\,2\,hours$ after each meal.

What is the difference between DSM and ICD manuals?

DSM is created by the APA for mental health diagnoses; ICD is created by WHO for all health conditions and global coding.

What caloric increase is recommended during the first trimester versus the second and third trimesters of pregnancy?

No caloric increase in the first trimester, then $300\,calories/day$ in the second and third trimesters.

Which vitamin and mineral deficiencies are commonly seen in patients with alcohol abuse?

Thiamine (Vitamin B1) deficiency and Magnesium (Mg) deficiency.

What dietary recommendations are provided for patients with a history of substance abuse?

High-calorie, high-carbohydrate diet with dietary fat restriction if liver function is impaired.

What are the four categories of food supplements described in the lecture?

Polymeric (milk-based whole nutrient), Modular (singular macronutrient), Elemental (predigested nutrients), and Specialty (for specific conditions).

How long before surgery should herbal supplements be discontinued?

$2\,to\,3\,weeks$ before surgery.

Which herbal supplements increase the risk of bleeding?

Vitamin E, ginger, garlic, ginkgo biloba, ginseng, and Omega-3.

What drug interactions are associated with St. John's Wort?

Reduces effectiveness of birth control pills and increases risk of serotonin syndrome when taken with antidepressants (SSRIs).

What is Saw Palmetto commonly used for?

Benign prostatic hyperplasia (BPH).

What is Milk Thistle used for, and what can it interfere with?

Hepatic dysfunction (gallbladder and liver issues); interferes with liver enzyme activity and medication breakdown.

If a bedridden patient cannot get out of bed, what position and duration should be maintained after eating?

High Fowler's position, maintained for $1\,hour$ after eating.

What flush volume is used for tube patency and between medications in enteral feeding?

Flush with $30\,mL$ to ensure patency; rinse with $15\,mL$ between medications.

At what residual fluid volume should intermittent and continuous tube feedings be held?

Hold intermittent feeding if residual exceeds $100\,mL$ over $2\,hours$; hold continuous feeding if residual exceeds $250\,mL$ over $1\,hour$.

What medication formulations must NEVER be crushed or given via enteral tubes?

ER (extended release), EC (enteric coated), and XR (extended release) coated medications.

What fluid pH values verify placement of enteral tubes in gastric, intestinal, and respiratory locations?

Gastric pH: $1.5\,to\,4$; Intestinal pH: $6$; Respiratory pH: greater than $7$.

What is the prescribed volume range for an intermittent tube feeding?

Ranges from $240\,mL\,to\,360\,mL$ per feeding.

How long does a PEG tube tract take to mature, and what is the rule regarding reinsertion?

Takes $4\,to\,6\,weeks$ to mature; nurses must never reinsert tubes themselves and should follow hospital protocol.

What is the difference between CPN and PPN in Total Parenteral Nutrition?

CPN (Central Parenteral Nutrition) delivers higher concentrations via the Superior Vena Cava; PPN (Peripheral Parenteral Nutrition) uses a small peripheral vein in the neck or limb.