pathopharm clinical nutrition

clear liquid diet

-no residual and liquid at room temp

-short term!!

-prevents dehydration

-nutritionally inadequate

ex) water, tea, broth, juices and etc

therapeutic nutrition

the role of food and nutrition in the treatment of diseases and disorders.

full liquid diet

more variety, still liquid at room temp

-short term!!

-nutritionally inadequate

-transition from liquids

ex) ice cream, strained cereal and pureed vegetables

pureed diets

-foods pureed to liquid form

-consistency varies

-for clients w/ chewing and swallowing difficulties

-nutritionally adequate

soft (bland, low fiber) diet

-whole foods, low fiber, (low residual) → not alot of fiber, easily digested

-smooth, creamy, non-gas forming

mechanical soft

-regular diet that is modified in texture

-minimal chewing

-excludes harder foods

vegetarian

-no food made from animals

ovo lacto

plant based with eggs and milk

vegan

plan based, no animal at all, came from or made from

pescatarian

-no red meat or chicken

-yes fish (maybe eggs and meat)

macrobiotic

plant based with sea food

kosher

guided by laws regarding preparation and eating of foods but not type

(dont mix dairy and meats together)

flexitarian

plant based with occasional consumption of fish, meat and dairy

dysphagia diets

-prescribed when swallowing is impaired ex: after stroke

what are manifestations sof dysphagia?

drooling, pocketing food, choking or gagging

what are the levels of liquid consistencies

level 0- thin

level 4- extremely thick

what are the levels of solid textures

level 3- liquidized

level 7- easy to chew

nursing actions in dysphagia diets

-HOB is in high fowlers (>60 degrees)

-no straws for liquids

-tilt head. forward when swallowing

-small bites throughly chew

ongoing assessment parameters

check daily weights, prescribed lab test, an evaluation of clients nutritional and energy needs and response to diet therapy

(can check albumin level or nitrogen balance or serum which looks at proteins)

-look at 7 days of nutrition

nurses should asses for _____ before advancing a clients diet.

-return of bowel function

(check for bowel sounds, may have passed gas which means bowl is awake n passing stool)

what are indicators of protein calorie malnourishment and need for clinical feedings

low protein: fatigue, weight loss, dry, brittle hair n nails

fluid shifts and edema ( low albumin and increased vascular permeability)

muscle mass and immunodef and illness

enteral feeding

used when a client cannot consume adequate nutrients and calories orally but has a GI system that functions partially.

-administer tube thru stomach

how do you know that the gut works?

listen for bowel sounds

nasoenteric tubes are used for how long?

less than 3-4 weeks (which is short term)

nasogastric

passed thru nose to stomach

nasoduodenal

passed from nose thru stomach and ends in duodenum

-used in pts who have high risk for aspirations/ delayed gastric emptying

nasojejunal

pass from nose thru stomach and ends in jejunum

-used in pts who have high risk for aspirations/ delayed gastric emptying

how long can the tube remain taped in place for?

30 days

which enteral feeding routes are long term

ostomies

gastrostomy tubes

jejunostomy tubes

ostomies

placed for clients requiring long term enteral feeding, who are high risk for aspiration or when a nasal obstruction makes insertion through the nose impossible.

-ostomy is a surgically created opening (stoma)

-can be used to deliver feedings directly in stomach or intestines

gastrostomy tubes

-endoscopically or surgically inserted into stomach

-gastrostomy feedings are well tolerated bc stomach chamber holds and releases feedings in physiologic manner which promotes effective digestion.

-dumping is usually avoided

jejunostomy tubes

-are surgically inserted into the jejunal portion of the small intestine (jejunum)

entereal formulas

feedings categorized by the complexity of the proteins

-GI tract must be functioning

standard feedings

composed of whole proteins

ex) meat, milk and eggs

hydrolyzed feedings

broken down (makes food easier to digest)

ex:people who have bowel disease or liver problems

disease specific feedings

has lower protein or potassium component

ex) kidney disease

modular formulas feedings

contains singular nutrients

ex) just protein or just carbs

-supplement for who cant get one specific nutrient

dumping syndrome

a condition in which food, especially foods high in sugar, moves from your stomach into ur small bowel too quickly.

side effects: diarrhea, nausea, vomiting, dizzy, stomach cramping and heart palpitations

continuous delivery method

continuous rate over 24 hrs

-on feeding pump

-recommended for critically ill patients, lower risk of aspirations, keep energy at consistent lvl

cyclic delivery method

continuous rate for 8-20hrs usually during sleep

-used when not enough calories are needed

intermittent delivery method

every 4-6 hrs in equal portions (typically over a 30-60 mins time frame)

-thru syringe or IV pump

-cut up throughout the day

bolus delivery method

larger volumes over 15 mins for 4-6 times a day

-given with a large syringe directing in feeding tube

can use syringe of cans of food

preparing for feeding by…

verify presence of bowel sounds

verify tube placement and placement

make sure hob is at 30 degrees

residuals should be checked how often

every 4-6 hrs

steps for residual

1) stop feeding

2) determine total vol since last res check

3) draw back using 60 mL syringe

4) draw until empty (resistance)

5) if total is MORE than ½ total (need orders to adjust/slow/stop for a time)

if total is LESS than ½ total (continue feeding as ordered)

6) ALWAYS put feeding back that u withdrew

gastrointestinal complications

-constipation, diarrhea, cramping, pain

nursing action for gi complications

consider changing formula

decrease formula, increase free water

formula should be at room temp

mechanical complications

-tube replacement, dislodgment, aspiration, irritation, clogging (NOT PATENT)

mechanical nursing actions

-confirm placement prior to feedings

-elevate hob to 30 degrees or higher

-bolus over 15 min

-flush tube with 30 ml water every 4 hrs

-check residuals every 4-6 hrs

-dont mix formula with meds

metabolic complications

dehydration, hyperglycemia, electrolyte imbalance, fluid overload, refeeding syndrome

refeeding syndrome

starvation state to feeding -can be fatal

food contamination actions

wash hands before, clean equipment, replace feeding, tube, and any equipment every 24 hrs!!

fill generic bags with only 4 hrs worth of formula

when gi is not working use _____ feeding

parental

-given thru blood stream (vein)

total parenteral (TPN)

central

-long term use

-in the inferior or super vena cava

-used for more complete nutrition

peripheral parenteral nutrition (PPN)

short term use

can only go to 10% dextrose

not nutritionally complete

if hypertonic (>10% dextrose) must be administered through ______

central vein

you should only use bloodstream when stomach cannot be used. true or false?

true

carbs (dextrose) for PPN

-2.5-10%

carbs (dextrose) for TPN

>10% (up to 70%)

lipids for parenteral nutrition

10-30%

what functions determine the amount of protein provided?

clients estimated requirements and liver n kidney function

insulin can be added

to reduce potential for hyperglycemia

heparin can be added

to prevent fibrin buildup on the catheter tip

glutamine can be added

based on individual client needs

pn can be used when….

client is unable to consume enough calories

prep of the client

review the clients weight, bmi, nutritional status, diagnosis and current lab data

nursing care is..

focused on preventing complications thru consistent monitoring

when monitoring ongoing care you should…

-verify solution with second RN

-change bag and tubing every 24 hrs

nursing actions & complications

monitor for effectiveness

protein= albumin levels !!

feed enterally whenever possible. true or false?

true! (if gut works use it)