Nutrition: Less Than Body Requirements Lecture Notes

Vocabulary term and definition flashcards covering undernutrition, feeding methods, and pharmacological management based on nursing lecture notes.

Undernutrition BMI Threshold

A Body Mass Index (BMI) of less than $18.5$ is considered a risk factor for undernutrition.

Mini-Nutritional Assessment (MNA)

A nutritional screening tool used as part of the physical assessment to identify undernutrition.

Failure to Thrive (FTT)

A state in an older adult formerly active but now socially withdrawn and depressed, characterized by weight loss of $> 5\%$ of baseline, decreased appetite, and inactivity.

Cachexia

Loss of muscle with or without loss of fat, defined by unintentional weight loss of $> 5\%$ in $6$ to $12$ months, and a BMI $< 20$ (for under $65$ years) or $< 22$ (for over $65$ years).

Megestrol acetate (Megace)

A progestin pharmacological agent used as an appetite stimulant in the management of cachexia.

Cannabinoids (Dronabinol/Nabilone)

Pharmacological agents used for appetite stimulation and management of cachexia.

OPQRSTUV

A mnemonic for assessing nausea and vomiting: Onset, Provoking/Palliating, Quality, Region, Severity, Treatment, Understanding, and Values.

Serotonin Receptor Antagonists

A class of anti-emetic agents with the suffix "-setron" (e.g., ondansetron) used to treat nausea; side effects include headache, dizziness, and dysrhythmias.

Xerostomia

The medical term for dry mouth, which can cause altered taste sensations, particularly in advanced age or due to medications.

Nasogastric Tube (NGT) Duration

A short-term enteral feeding method intended to be used for no more than $4$ weeks.

Dobbhoff

A specific type of small-bore feeding tube used for enteral nutrition which must have placement verified by X-ray, measurement, or pH.

Percutaneous Endoscopic Gastrostomy (PEG)

A long-term enteral feeding support method where the tube is placed directly into the stomach.

Feeding Tube Flush Volume

The amount of water used to flush a feeding tube after administering crushed medications, typically $15$ to $30\,mL$.

Cyclic Feeding

A continuous enteral feeding schedule typically administered overnight to promote eating during the day if the patient is able.

Standard Formula

An enteral formula containing whole protein, carbohydrates, and fats, used for patients with normal digestion and absorption.

Hydrolyzed Formula

An enteral formula where proteins and nutrients are in simple forms, requiring little to no digestion; used for impaired digestion or absorption.

Total Parenteral Nutrition (TPN)

A highly concentrated, hypertonic nutrient solution (high in protein and dextrose) administered via a central line for long-term intensive nutritional support.

Peripheral Parenteral Nutrition (PPN)

An isotonic, less concentrated nutritional solution administered via a peripheral vein for short-term support (less than $2$ weeks).

Refeeding Syndrome

A potential complication of both enteral and parenteral nutrition occurring when nutritional support is reintroduced to a malnourished patient.

Parenteral Nutrition (PN) Preparation

Nursing management requires Two RN verification before hanging, use of a pump, a dedicated lumen, a filter, and removal from refrigeration $60$ minutes prior to administration.

Total Parenteral Nutrition (TPN)\n\n

A highly concentrated, hypertonic nutrient solution (high in protein and dextrose) administered via a central line for long-term intensive nutritional support. TPN is typically used when the gastrointestinal tract is non-functional or when a patient cannot meet their nutritional needs orally or through enteral feeding.

Complications of TPN\n\n

Potential complications of TPN include infection (due to the use of central venous catheters), metabolic disturbances (such as hyperglycemia and electrolyte imbalances), liver dysfunction, and refeeding syndrome, which can occur when feeding is reintroduced to a malnourished individual.

Indications for TPN\n\n

TPN is indicated for patients with conditions such as gastrointestinal obstruction, severe pancreatitis, inflammatory bowel disease, or when oral or enteral feeding is not feasible for an extended period (more than 7-10 days). It provides essential macro- and micronutrients needed for recovery and maintenance of health.

Components of TPN\n\n

Components of TPN solutions typically include carbohydrates (usually in the form of dextrose), proteins (amino acids), fats (lipid emulsions), electrolytes, vitamins, and trace elements. The specific composition is tailored to the individual patient's needs and can change based on ongoing assessments.

Percutaneous Endoscopic Gastrostomy (PEG) Tube\n\n

A long-term enteral feeding support method where a tube is placed directly into the stomach through the abdominal wall. The PEG tube is used for patients requiring prolonged nutritional support due to conditions affecting swallowing or digestion.

Indications for PEG Tube Placement\n\n

PEG tubes are indicated for patients who are unable to meet their nutritional needs through oral intake for extended periods, such as those with neurological disorders, head and neck cancers, or severe swallowing difficulties.

Advantages of PEG Tubes\n\n

PEG tubes are preferable for long-term feeding as they provide a direct pathway for nutrition, reducing the risk of aspiration compared to oral feeding. They also allow for a more comfortable and cosmetic solution for patients requiring tube feeding.

Care and Maintenance of PEG Tubes\n\n

Proper care and maintenance include regular cleaning of the insertion site to prevent infection, ensuring tube patency, and monitoring for complications such as blockage or dislodgment. It is essential to flush the PEG tube with water before and after feeding or medication administration.

Peripheral Parenteral Nutrition (PPN)\n\n

An isotonic, less concentrated nutritional solution administered via a peripheral vein for short-term support (less than $2$ weeks). PPN is used for patients who need nutritional support but whose gastrointestinal tract is functional, allowing for some oral intake.

Indications for PPN\n\n

PPN is indicated for patients who require short-term nutritional support when enteral feeding is not possible. Common indications include mild to moderate malnutrition, post-operative recovery, or conditions that temporarily impair the ability to consume adequate oral nutrition.

Composition of PPN\n\n

PPN solutions typically include carbohydrates (usually dextrose), proteins (amino acids), fats (lipid emulsions), electrolytes, vitamins, and trace elements to ensure a comprehensive nutritional profile. The formulation is customized based on individual patient needs and is generally lower in calories compared to TPN.

Administration of PPN\n\n

PPN is usually administered through a peripheral intravenous (IV) line. Care must be taken to prevent complications such as phlebitis and infiltration, as PPN solutions can be hyperosmolar depending on the concentration of nutrients.

Complications of PPN\n\n

Potential complications of PPN include infection, thrombophlebitis due to peripheral IV use, metabolic imbalances (such as hyperglycemia), and fluid overload, particularly in patients with heart failure or renal impairment.

Nasogastric Tube (NGT)\n\n

A short-term enteral feeding method intended to be used for no more than $4$ weeks. The NGT is passed through the nose, down the esophagus, and into the stomach and is used for nutritional support in patients who cannot take food orally.

Indications for NGT Placement\n\n

NG tubes are indicated for patients who require temporary nutritional support, such as those with swallowing difficulties, gastrointestinal obstructions, or conditions resulting in decreased appetite.

Care and Maintenance of NGTs\n\n

Proper care includes regular monitoring for tube placement, ensuring the tube remains patent, and checking for any signs of complications such as displacement, blockage, or irritation of the nasal passages. Periodic assessment of patient tolerance and feeding schedules is also crucial.

Complications of NGT Placement\n\n

Potential complications include nasal irritation or ulceration, esophageal erosion, aspiration pneumonia if tube feeding is not tolerated, and inadvertent placement in the lungs or trachea. Regular assessment is necessary to minimize these risks.