exam 4 wellness and plan

Types of barriers

Physical and socioeconomic

types of physical barriers

Poor dentition, dysphagia, mechanical jaw fixation, altered sensory perception, medical conditions (COPD, cancer, HIV/AIDS, burns)

What are common socioeconomic barriers to nutrition?

Low income, food insecurity, lack of transportation, cognitive disorders (dementia), misinformation/ lack of nutrition knowledge

If a patient has a mechanical jaw fixation, what would a nurse suggest?

liquid diet only

poor dentition leads to pain with chewing so what would a nurse suggest?

avoid hard foods

what happens when a patient has altered sensory perception

their vision or taste changes

Dysphagia is at risk for?

aspiration

what is the primary risk with dysphagia?

aspiration pneumonia

what is the priority nursing intervention for dysphagia?

• high fowler’s position during meals and 30 mins after

• chin to chest posture

• small bites and slow eating

• speech therapy and thickened liquids

what must always be at bedside for mechanical jaw fixation patient’s

wire cutters in case they vomit

what food diet must a patient with a mechanical jaw fixation have?

• liquid only diet - blended/pureed foods via syringe/straw

• high-calorie liquid supplements (ensure, boost)

• frequent oral care every 2 hrs

what is the #1 deficiency in chronic alcohol use?

thiamine (vitamin B1)

what can a thiamine deficency lead to?

Wernicke’s encephalopathy (confusion, ataxia, eye problems)

what is the critical deficiency in COPD?

Vitamins A, C, E; phosphorus

what is the deficiency in COPD lead to?

• increased calorie needs (high work of breathing)

• dyspnea during eating

what deficiency is seen in cystic fibrosis?

fat-soluble vitamins (A,D,E,K)

what does the deficiency from cystic fibrosis lead to?

• pancreatic insufficiency- fat malabsorption

• must take enzyme replacements

what is deficiency is commonly found in patients with HIV/AIDs

• protein- calorie (wasting), B12, selenium, zinc, iron

what is commonly found in patients with HIV/AIDs and what does it lead to

• Wasting syndrome common.

• Malabsorption from GI infections. High protein, high calorie goals

what is a common deficiency with chronic kidney disease

phosphorus and potassium excess ( must restrict), calcium and b vitamins are depleted

what lab is best for recent/acute nutritional status?

prealbumin

what lab reflects long-term/chronic nutritional status

albumin

expected finding in malnutrition for prealbumin, albumin, transferrin, total lymphocyte count, and hemoglobin/hematocrit

they are all decreased values

prealbumin values?

• normal value: 15-36 mg/dl

albumin values

• normal value: 3.5-5 g/dL

expected finding in malnutrition: transferrin

• 250-370 mg/dL

• protein malnutrition since iron transport protein (low iron)

expected finding in malnutrition: lymphocyte count

• 1500-4000 mm3

• impaired immune function due to protein/nutrient deficit

expected finding in malnutrition: hemoglobin/hematocrit

• varies by sex

• anemia from inadequate iron, protein, and vitamins

what is the feeding priority order?

oral → enteral → parenteral

what is refeeding syndrome?

electrolyte imbalance (especially hypophosphatemia) when malnourished patients are refed too quickly

high calorie food examples for malnourished clients?

• avocado, nuts, seeds, olive/coconut oil, full-fat dairy, nutritional supplements, fortified cereals, eggs, lean meats, beans, greek yogurt

all bariatric patients need?

lifelong vitamin supplementation: B12, calcium + vitamin D, iron, folate

Bariatric Surgery indications

BMI ≥ 40 OR BMI ≥ 35 with obesity-related comorbidity (Type 2 DM, HTN, sleep apnea, severe GERD)

types of bariatric surgeries?

• roux en y gastric bypass

• sleeve gastrectomy

• adjustable gastric band

tips for patients with dumping syndrome

small meals, NO fluids WITH meals, avoid simple sugars

METABOLIC SYNDROME

Diagnosed with 3 of 5 criteria:

• Abdominal obesity

• Triglycerides ≥150

• Low HDL

• HTN ≥130/80

• Fasting glucose ≥100 mg/dL. Dramatically increases DM + CVD risk!

Total cholestrol info

• <200 mg/dl

• elevated - CVD increased risk

• you want it LOW

LDL info

• < 100 mg/dL

• deposits cholestrol in artery walls

• you want it LOW - L = lousy

HDL info

• >40 (men) / > 50 women

• removes cholestrol from arteries

• you want it HIGH

trigylcerides info

• < 150 mg/dL

• elevated - increased CVD

• you want it LOW

hypertension

• Sustained BP > 130/80 mmHg.

• Major risk factor for MI, stroke, kidney disease, and heart failure

Dash diet

• low sodium

• high potassium

• high calcium

• high fiber

• low saturated fat

where can sodium be hidden in?

canned or processed foods

Heart Failure (CHF) Diet

• sodium: <3000 mg/day (mild) or <2000 mg/day (severe)

• fluid restriction: ~2L/day (ALL fluids: water, broth, gelatin, ice cream)

• increases protein - maintain cardiac muscle

• daily weight monitoring

• avoiding canned soups, processed meals, and salty snacks

Post Myocardial Infarction Diet

• low saturated fat and cholesterol - reduce athersclerosis

• low sodium

• increase omegas-3

• increase fiber

• small frequent meals

• avoid caffeine and alcohol

3 different anemias?

• iron defiency

• vitamin B12 deficiency

• folic acid deficiency

ALL anemias share: fatigue, pallor, tachycardia

what helps with iron absorption? what decreases it?

• Vitamin C INCREASES absorption

• Calcium and tannins (tea/coffee) DECREASE

• Give iron on empty stomach with orange juice for best results

anemia defiency’s symptoms

• B12 UNIQUE = neurological symptoms.

• Iron UNIQUE = spoon nails (koilonychia) + cold intolerance.

• Folic acid CRITICAL in pregnancy → neural tube defects!

What is the diet progression after vomiting?

Clear liquids → Full liquids → BRAT diet

What foods worsen GERD?

Caffeine, alcohol, chocolate, citrus, peppermint, fatty foods

GERD safe foods

• Oatmeal and whole grains

• Bananas and melons (non-citrus)

• Lean proteins (baked chicken, fish)

• Steamed vegetables •

• Low-fat dairy

• Rice and couscous

Key GERD teaching?

• no eating 2-3 hrs before bedtime

• elevate HOB 6-8 inches and elevate while and 30 min after eating

PUD - Acute gastritis

• primary cause: NSAIDs, alcohol, corticosteroids, stress

• Avoid NSAIDs (use acetaminophen instead), avoid alcohol and spicy/fatty foods, small frequent meals

PUD / chronic gastritis

• primary cause: H. PYLORI infection (80% of PUD cases)

• solution: COMPLETE the full antibiotic triple therapy course; Avoid NSAIDs, caffeine, spicy foods, alcohol.

How to prevent constipation?

Increase fiber (25-39 g), fluids (64 oz/8 cups H20), exercise

what does not help constipation

use of stimulant laxatives daily — causes dependency and worsens long-term constipation

lactose intolerance def

Deficiency in lactase enzyme → cannot digest lactose (milk sugar)

causes: bloating, gas, cramping, diarrhea after dairy intake

what to look out for in a person who is lactose intolerant

• use lactose-free dairy or plant based alternative (almond, soy, oat milk)

• monitor for calcium and vitamin D deficiences

Ostomies- client education on foods

• blockage foods

• gas-forming food

• odor-causing foods

diverticulosis

(No inflammation)

• high fiber diet

• adequate fluid intake

• fruit, veggies, whole grian

diverticulitis

(active infection)

• low fiber diet/ clear liquid diet

• allows bowel to rest and inflammation

• NPO ifi perforation suspected

Cholecystitis diet?

• gallbladder inflammation

• low fat diet

• avoid: fried foos, high-fat meats, full fat dairy, butter

• NPO during acute episodes

Celiac Disease diet

• (Gluten Intolerance)

• no wheat, barley, rye

• safe: rice, corn, quinoa, potatoes, fruits, meats, vegetables

• monitor: iron, calcium, B12, fat soluble vitamin deficiencies

CKD Risk Factors

• Diabetes (leading cause!) → Hypertension (2nd cause!) → Glomerulonephritis, polycystic kidney disease, recurrent UTIs, NSAIDs and nephrotoxic medications

CKD labs

• BUN (normal 8-20 mg/dL) ↑ + Creatinine (normal 0.6-1.2 mg/dL) ↑ + eGFR ↓ = worsening kidney function. In ESRD: HIGH creatinine + LOW eGFR is the expected pattern.

what happens to eGFR in CKD

it decreases and kidney functions worsen

What happens to creatinine in CKD?

Increases

When is dialysis required for CKD?

Stage 5 (eGFR <15)

What electrolytes must be restricted in CKD?

Potassium, phosphorus, sodium

Protein intake in CKD?

Decrease early, increase on dialysis

Why restrict potassium for ppl w CKD?

prevents life-threatening arrhythmias

#1 prevention for kidney stones?

Increase fluids (2.5–3 L/day)

what are other kidney stone preventions

• limit high oxalate foods (spinach, nuts, beets, chocolate, tea)

• do not severly restrict calcium

• limit sodium and animal protein

• monitor I&O; closely. Urine output < 0.5 mL/kg/hr = OLIGURIA → notify provider immediately

type 1 diabetes

• Autoimmune destruction of pancreatic beta cells

• ALWAYS requires insulin

• Usually diagnosed in childhood/young adults

• Often normal or underweight at diagnosis

• Primary complication: DKA (diabetic ketoacidosis)

type 2 diabetes

• Insulin resistance + relative insulin deficiency

• Most common type (~90% of all diabetes cases)

• Risk: obesity, sedentary lifestyle, family history, metabolic syndrome

• Managed with lifestyle, oral meds (metformin), then insulin

• Primary complication: HHS (hyperosmolar hyperglycemic state)

Fasting glucose for diabetes?

≥126 mg/dL

HbA1c goal?

<7%

Hypoglycemia level?

<70 mg/dL

Hypoglycemia symptoms?

Pale, sweating, tachycardia, confusion, rapid onset

Hyperglycemia symptoms?

Polyuria, polydipsia, polyphagia, gradual onset, fatigue, fruity breath

HYPOGLYCEMIA = "3 P's of LOW signs

Pale, Perspiring, Pounding hear

HYPERGLYCEMIA = "3 P's of HIGH"

Polyuria, Polydipsia, Polyphagia

What is the 15-15 rule?

15g carbs (4 glucose tabs, 5 hard candies, ½ cup of juice/soda, 1 tbsp of honey/sugar) → recheck blood glucose in 15 min

UNCONSCIOUS patient with hypoglycemia

NEVER give oral food or fluids (aspiration risk!)

• administer IV dextrose (D50W) or glucagon IM/SQ as ordered.

1 carb seving

15 g of carbs

Net carbs formula

= Total carbs - Dietary fiber

• 60g total - 6g fiber = 54g net ÷ 15 = 3.6 servings

what does execrise do?

LOWERS blood glucose - it carries fast-acting carbs during activity. Avoid exercise if BG > 250 mg/dL!

cancer modifiable risk factors

• smoking

• obesity and overweight

• sedentary life

• high fat, low fiber

• excessive alchohol

• h. plyori infection

• UV radiation exposure/environ.

cancer preventive diet

• Increase fruits, vegetables, and whole grains

• Limit red/processed meats, alcohol, and high-fat foods

• Maintain a healthy body weight

chemotherapy side effects

• anorexia

• neutropenia

• stomatitis (mouth sores)

• taste changes/metallic

• nausea

• fatigue

• diarrhea

Neutropenic diet rule?

No raw, unpasteurized, or undercooked foods

Stomatitis care?

Soft toothbrush, no alcohol mouthwash/lemon swabs, cool/bland foods

• dry and irritate mucosa if not followed