NURS 341 - Test #3 - Nutrition

Oxygenation and perfusion

If alveoli are filled with fluid, what will not be adequate?

Protein

Adequate levels of what are necessary for healing?

Anthropometric measurements

Body size, BMI, weight, height, etc.

Physical exam

Skin, hair, nail appearance, amount of subcutaneous fat, etc.

Health history

Diabetes, surgical history, allergies, family history, liver function, kidney function, etc.

Liver

What synthesizes protein?

Kidney function

What allows protein to stay within the blood flow?

Poor kidney function

What allows protein to leak into the urine?

No

Should there be protein in urine?

Diet history

Nutritional status, diet followed - vegan, vegetarian, etc.

Functional status

Teeth, intact swallow mechanism, dysphagia, ability to cook, etc.

Is there anything from a cultural or spiritual standpoint that I should know to better my care?

Important question to ask every patient

Mini nutritional assessment

- Should be done for every patient upon admission

- Determines if a dietician referral should be made

Hematocrit and Hemoglobin

Iron, vitamin B12, folic acid, and protein are needed to make RBCs

MCV, MCH, MCHC

Determines size of red blood cells

Mean corpuscle volume (MCV)

Normal sized RBC are needed to carry oxygen

Low iron levels

What causes small RBCs?

Low vitamin B12 level

What causes big RBCs?

Serum electrolytes and serum vitamins

Vitamins and electrolytes come from the diet

BUN and creatinine

- Kidneys filter out these products

- They are the byproduct of protein synthesis in urine

Serum albumin

Maintains oncotic pressure

Low serum albumin

What causes leaky capillaries in the interstitial space causing edema and will cause the patient to be SOB?

Trasferrin

- Plasma protein that carry's oxygen

- Measures anemia

- Important for iron balance

Prealbumin

- Indicator of protein calorie malnutrition

- Short half-life expectancy

- Most sensitive measures for nutritional interventions

- Ex.) supplements, more protein in diet, etc.

- <18 indicates protein calorie malnutrition

Lymphocytes

Cannot be made without enough proteins

Liver enzymes

Determines liver function

Malnutrition

A deficit, excess, or imbalance of essential nutrients

Undernutrition

Not enough nutrition to maintain homeostasis

Malnutrition Universal Screening Tool

MUST

- Will be done by the dietician to every patient prior to admission

Starvation-related malnutrtion

Patients at risk include poor patients, babies and kids, elderly, unhoused patients - anyone that does not have access to adequate nutrition

Chronic disease related malnutrition

Patients at risk include cancer, GI issue, liver disease, chronic kidney disease, etc.

Acute disease or injury related malnutrition

Patients at risk include sepsis or trauma related accidents

CRP

What increases when any patient is experiencing active inflammation?

Socioeconomic factors

Can't afford food means inadequate nutrition

Physical illness

Inflammation or pain

Incomplete diets

Inadequate protein, vitamin C., iron, etc.

Food-drug interactions

- Grapefruit juice has many interactions with drugs

- Alcohol affects the liver and causes chronic inflammation of the GI tract leading to impaired absorption of nutrients

- Warfarin and Vitamin K

- Avoid calcium containing foods while taking iron as it will decrease amount of stomach acid

Clear liquid

- Pre-procedure such as colonoscopy

- Post-procedure

Full liquid

- Post-op procedures such as gallbladder removal

- Follows clear liquid diet

Sodium restricted

- Edema

- CHF

- Kidney disease

High-roughage, high fiber

- Constipated

- Low bowel motility

Low-residue

- Inflammatory bowel disease (IBS)

- Active Chron's disease

- Active ulcer colitis flare up

High-protein

- Liver disease

- Active inflammatory process

- Fighting infection

Renal diet

- Kidney disease

Lactose-free

- Lactose intolerant

- Dairy allergy

- IBS

Gluten-free

- Celiac disease

Clear liquid, full liquid, pureed dysphasia), mechanical soft (dysphasia), soft, regular

What is the diet progression?

Stroke patients and past intubation

Who are patients at risk of dysphasia?

Speech therapy

Who must evaluate swallowing of patients?

Coughing

What is a main indication of aspiration?

NPO and evaluation

What do you do if patient is experiencing aspiration?

Eternal feeding

Food provided through GI tract via tube, catheter or stoma distal to the oral cavity

- Examples: Patient with muscular dystrophy, intubation, stroke, brain/head injury

- Orogastric, nasogastric, naso intestinal

- Gastrostomy and jejunostomy (jejunum)

- USED IF BOWEL WORKS

Jejunostomy tube

What will be placed if the stomach is not working?

Eternal feedings

What are better for the patient because there is less complications?

Vomiting and aspiration

What will occur if the patient is eating too fast and too much and the head of the bead is not 30 degrees?

Dehydration

What will occur when the patient cannot drink enough fluids?

Diarrhea

What will occur because the solutions are hypertonic?

Constipation

What will occur because the patient is not taking enough fluids in?

X-ray

Do not put something in until the tube placement is verified by what?

Mark tubing

What is important to do to determine that eternal tube is for feeding?

Parenteral nutrition

- Administration of nutrition by a route other than the GI tract and bloodstream

- USED WHEN STOMACH AND GUT ARE NOT WORKING

- Composed of calories (dextrose), protein, electrolytes, trace elements, and vitamins

- At risk for infection due to high amounts of sugar and re-feedng syndrome

Slowly at 10mL/hr

How do you start TPN?