NUR120 Week 11 - Nutritional Assessment: Exam 5

B12

found in animal proteins: fish, meat, poultry, eggs, milk products

70 to 100 mg/dL

normal blood sugar ranges

factors affecting nutrition and metabolism

- religion and culture
- environmental
- financial issues
- appetite
- medications
- disease/illness
- age

nutritional assessment

includes food safety, history of food intake, adequate hydration, weight/height calculations (BMI 25 or less), medical history, socioeconomic issues, lab data, malnutrition screening tool

Healthy - 18.5 - 24.9
Overweight - 25 - 29.9
Obese - 30 - 34.9
Class 1 - 35 - 39.9
Class 2 - 40
Class 3 - >40

BMI ranges

carbohydrates

sugars and starches; provides energy

protein

lean meats, lentils, eggs
provides energy

Fats (lipids)

butter, lard, olive oil

omega-3 fatty acids

polyunsaturated fatty acids commonly found in fish oils that are beneficial to cardiovascular health
Certain fish and seafood (e.g. mackerel, salmon, sardines)
Vegetable oils (e.g. flaxseed oil, canola oil)
Nuts (especially walnuts)
Flaxseeds
Leafy vegetables
Seaweed
Chia seeds
Tofu
Shellfish
Avocados

water soluble vitamins

B and C

fat soluble vitamins

A, D, E, K

St. John's Wort

depression
SSRIs

folate

found in greens, legumes, eggs, citrus

thiamine

found in wheat germ, beef/pork/trout/tuna, eggs, legumes, nuts, seeds

ETOH abuse

can cause folic acid and thiamine deficiency

Hypoproliferative anemia

defect in production of RBCs
Caused by iron, vitamin B12, or folate deficiency, decreased erythropoietin production(renal dysfunction), or damage to bone marrow (leukemia)

iron deficiency anemia

anemia caused by inadequate iron intake, iron malabsorption (gastrectomy), or blood loss (ulcers, GI tumor, fgastritis, IBD, menorrhagia)

take oral iron supplements one hour before or 2 hours after meal, increase intake of vitamin C, eat foods high in fiber, stools dark

patient education for using oral iron supplements

hematopoiesis

blood cell formation

organ meats, beans, eggs, dried fruits, legumes, dark green leafy vegetables, raisons, molasses, whole grains, enriched breads, cereals

iron rich foods

infants, children, adolescents

increase protein due to high energy requirements
needed during rapid growth and tissue healing

pregnant women

increase calories, protein, vitamins, minerals

older adults

slower metabolic rate (decreased calories), decreased thirst/hunger/taste, calcium important, need more bulk for GI function, fixed income

recommended dietary intake

vegetables: 2 1/2 cups everyday
fruits: 2 cups every day
grains: 6 ounces every day
dairy: 3 cups every day
protein: 5 1/2 ounces every day

Metabolism

Chemical processes converting food into energy.

Anthropometric Measurements

Body measurements assessing nutritional status.

Food Deserts

Areas with limited access to affordable, healthy food.

BMI

Body Mass Index; weight-to-height ratio.
weight lbs divided by heigh in^2
weight kg divided by height m^2

Triglycerides

Type of fat found in blood; energy source.

Vitamin C

Water-soluble vitamin; enhances iron absorption, promotes wound healing, and is an antioxidant

Folic Acid

B vitamin; crucial for red blood cell production.

NPO Status

Nothing by mouth; dietary restriction in patients.

Involuntary Weight Loss

Loss of 10% or more body weight in 6 months.

signs of malnutrition

- involuntary weight loss of 10% or more of body weight within 6 months
- BMI < 18.5
- inadequate oral intake < 50% of energy requirements for over 5 days
- NPO /CL over 4 days

Malnutrition Screening Tool (MST)

Has the pt lost weight recently without trying?
- if yes, 1-5 kg - 1
- 5-10 kg - 2
- 11-15 kg - 3
- >15 kg - 4
Has the pt been eating poorly? (<3/4 usual intake)
- Yes - 1
greater than or equal to 2 = likely to be underweight and at risk for malnutrition

cachectic

Extremely skinny, bony, malnourished

Dysphagia

Difficulty swallowing food or liquids.

Waist Circumference

Measurement indicating visceral fat and disease risk
> 40 inches men or > 35 in women = increased risk

Waist to Hip Ratio

Ratio indicating body fat distribution and risk
waist circumference divided by hip circumference
greater than or equal to 1 in men or greater than or equal to 0.8 in women = disease risk, increased mortality

Skin-fold Thickness

Measurement of subcutaneous fat using calipers.

Mid Upper Arm Muscle Circumference (MAMC)

Indicator of muscle and fat reserves.

cancer, chronic heart failure, tuberculosis, rheumatoid arthritis

causes of cachexia

cachexia

a condition of physical wasting away due to the loss of weight and muscle mass that occurs in patients with diseases such as advanced cancer or AIDS

keratosis

any skin growth, such as a wart or a callus, in which there is overgrowth and thickening of the skin

erythema

redness of the skin

stomatis

inflammation of the mouth

ascites

abnormal accumulation of fluid in the abdomen

paresthesia

abnormal sensation of numbness and tingling without objective cause

jaundice, high bilirubin

signs of liver damage in eyes

stomatitis, bleeding gums, cracks, dryness

chemo symptoms in mouth

spoon-shaped, brittle or ridged

symptoms of vitamin deficiency - nails

serum proteins

albumin, pre-albumin, transferrin, total protein

Total Protein

Overview of protein stores in the body.

Albumin

Protein indicating nutritional and liver health
Long half life (18-30 days)
not most reliable of current nutritional status

Pre-albumin

Short half-life (2 days) protein; current nutritional status indicator; more reliable than albumin, but reliability is questioned

Transferrin

Protein that transports iron in the blood
half life 9 days

Hematocrit

Percentage of red blood cells in blood.

Decrease

Is there a decrease or increase in hemoglobin, hematocrit, iron, folate, and B12 in poor nutrition pts?

hemoglobin

iron-containing protein in red blood cells that carries oxygen for delivery to cells

observe intake and food choices, maintain calorie count, dietary teaching, food labels, promote appetite, medication education, assist with feeding, prevent aspiration, ensure proper foods based on diet order, maintain fluid balance

nursing interventions and patient education for nutrition

skinless poultry, avocado, plant-based proteins, fish, skim milk, nuts and seeds

low fat and low cholesterol foods

preserve lean body mass, maintain or improve immunity, prevent hospital acquired malnutrition, wound healing, energy

benefits of nutrition

Enteral Nutrition

Nutritional support via gastrointestinal tract.

Parenteral Nutrition

Nutritional support via intravenous route.

indications for enteral nutrition

-Cancer (head, neck and upper GI)
-Inability to swallow (CVA, dysphagia, head trauma, comatose, dementia)
-Degenerative diseases ( Huntington's chorea, Parkinson's, Demyelinating diseases:: MS, ALS)
-Hypermetabolism or inadequate oral intake >5 days (sepsis, intubation within 48 hrs, malnutrition, surgery, burns, organ failure)

benefits of enteral nutrition

-Maintain GI barrier and immunologic function
-Can decrease severity of metabolic stress response
-Maintains mucosal immune function
-More cost effective
-Decreased risk of infectious complications
-Improve wound healing
- Maintains normal GI pH and flora
- Prevents bacterial overgrowth
- Portal system supplies the liver with nutrients and hormones

Residual Volume

Amount of formula remaining in stomach.

Every 4 hours

How often should residuals be checked for continuous with gastric tube>

stop feeding and assess for signs of intolerance, slowly replace up to 200 mLs aspirant, Reglan- recheck residual in 2 hours

What should you do if the residual volume is greater than 500 mL?

not longer than 48 hours

closed system formula hang time

not longer than 8 hours

open system formula hang time

30-60 mL after each feeding or every 6-8 hours with continuous feedings, following medications, if feedings are stopped

How often and when should feeding tubes be irrigated?

pump water flushes

- tube patency and hydration
- flush 30 mL with IVFs every 40 hours
- increased fluid needs

Tube Patency

Ensuring feeding tube is unobstructed.

nasogastric feeding tube

a flexible tube with a rounded end that is passed through the nasal cavity to the stomach

Levothyroxine and Phenytoin (Dilantin)

hold tube feeding 2 hours before and 2 hours after
treats hypothyroidism

Fluoroquinolone (Ciprofloxacin)

hold 1 hour before and 2 hours after

B12

include supporting red blood cell production, maintaining nerve health, and aiding in DNA synthesis.

folic acid

include supporting DNA synthesis, preventing neural tube defects in pregnancy, and aiding in red blood cell formation.

Vitamin D

promotes calcium absorption, supports bone health, and enhances immune function.

vitamin A

includes supporting vision, promoting skin health, and functioning as an antioxidant.

gastronomy tube

is a medical device used to deliver nutrition directly to the stomach through the abdominal wall, often used for patients who cannot eat by mouth. good for long term use

foods rich in potassium

include bananas, oranges, potatoes, and spinach, which help regulate fluid balance, muscle contractions, and nerve signals.

foods rich in iron

include red meat, beans, lentils, and fortified cereals, which are essential for the production of hemoglobin and overall energy levels.
also leafy green veggeis

foods rich in protein

include meat, fish, eggs, dairy products, and legumes, which are vital for building and repairing tissues, producing enzymes and hormones, and supporting overall growth and development.

foods rich in Vitamin K

include leafy greens, potatoes, beans, tomatoes, and avocados which are important for blood clotting and bone health.

fiber rich foods

include fruits, vegetables, whole grains, and legumes, which aid in digestion, help maintain a healthy weight, and lower the risk of chronic diseases.

sodium rich foods

include table salt, processed foods, and deli meats, which are essential for maintaining fluid balance, nerve function, and muscle contractions.

complex carbohydrates

are found in foods like whole grains, legumes, and starchy vegetables, providing a steady source of energy and essential nutrients.

saturated fat

is primarily found in animal products and some plant oils, contributing to increased cholesterol levels and potential heart disease risk
dairy products, butter

magnesium rich foods

include nuts, seeds, whole grains, and leafy green vegetables, playing a vital role in muscle function, nerve transmission, and energy production.

basal metabolic rate (BMR)

the number of calories your body needs to maintain basic physiological functions at rest, such as breathing and circulation

1800 to 2400 a day

average calorie requirement

clear liquids

cranberry juice, apple juice, water, broth, coffee, tea, gelatin popsicles
(foods that become fluid at body temperature)

jejunostomy

a surgical opening created in the jejunum to allow for feeding directly into the small intestine

reasons for a jejunostomy

to bypass the stomach for feeding, manage digestive disorders, or provide nutrition when oral intake is not possible.

vegetarians, lactating or pregnant clients, adolescents

people that are prone to vitamin deficiencies

increased BMR

increased muscle mass, fever, or hyperthyroidism can result in an:

xray

What confirms correct tube placement

dehyration

what causes increases in BUN, creatinine, and hematocrit?