Infant & Elderly (Gastrostomy and Enteral Feedings)
Starvation – Failure to Thrive
Infant Nutrition (Breast/Bottle)
Daily Recommended Requirements
Percentages for Carbohydrates, Proteins, and Fats
Calories per kilogram for weight management (lose, maintain, gain).
Diabetic and Heart Healthy Diets
Heart-healthy diet - steps to benefit those with diabetes and cardiac disease:
Control portion sizes.
Eat more vegetables and fruits.
Select whole grains.
Limit simple carbs.
Limit unhealthy fats.
Choose low-fat protein sources.
Reduce sodium intake.
Plan ahead with daily menus.
Allow occasional treats.
Example Heart Healthy Diet
Breakfast:
1 cup cooked oatmeal with 1 tablespoon chopped walnuts and 1 teaspoon cinnamon.
1 banana.
1 cup whole milk.
Lunch:
1 cup low-fat (1 percent or lower) plain yogurt with 1 teaspoon ground flaxseed.
1/2 cup peach halves, canned in juice.
1/2 cup Fritos.
1 cup raw broccoli and cauliflower.
2 tablespoons low-fat cream cheese (plain or vegetable flavor) for crackers or vegetable dip.
Sparkling water.
Dinner:
4 ounces salmon.
1/2 cup green beans with 1 tablespoon toasted almonds.
2 cups mixed salad greens with 2 tablespoons salad dressing.
1 tablespoon sunflower seeds.
1 cup skim milk.
1 small orange.
Snack:
1 cup skim milk.
9 animal crackers.
Example Diabetic Diet
Breakfast (294 calories, 41 g carbohydrates):
1/2 cup oats cooked in 1/2 cup each 2% milk and water.
1 medium plum, chopped.
4 walnut halves, chopped.
A.M. Snack (96 calories, 18 g carbohydrates):
3/4 cup blueberries.
1/4 non-fat, plain Greek yogurt.
Lunch (319 calories, 37 g carbohydrates):
Turkey & Apple Cheddar Melt:
2 slices whole-wheat bread.
2 tsp. whole-grain mustard, divided.
1/2 medium apple, sliced.
2 oz. low-sodium deli turkey.
2 Tbsp. shredded Cheddar cheese, divided.
1 cup mixed greens.
Dinner (417 calories, 54 g carbohydrates):
2 1/2 cups canned vegetable soup.
1 serving Goat Cheese Toast.
P.M. Snack (58 calories, 16 g carbohydrates):
1/2 medium apple, sliced.
1/2 tsp. honey.
Pinch of cinnamon.
Gastroesophageal Reflux Disease (GERD)
Pathophysiology of GERD
In a healthy individual, the lower esophageal sphincter (LES) remains closed, preventing stomach contents from refluxing into the esophagus.
In GERD, the LES is open, allowing reflux.
Risk Factors for GERD
Obesity: increases intra-abdominal pressure.
Age over 50: may cause delayed gastric emptying.
White race.
Low socioeconomic status.
Sleep Apnea
Nasogastric tube
Smoking
Contributing Factors to GERD
Hiatal hernia.
Increased abdominal pressure.
Increased gastric acid production.
Connective tissue disorders, such as scleroderma.
Prolonged abdominal distention.
Excessive consumption of foods that relax the LES.
Medications that relax the LES.
Lying flat.
Cues and Symptoms of GERD
Heartburn: A burning sensation in the chest, usually after eating, lasting 20 minutes to 2 hours, especially after consuming offending foods or liquids.
Indigestion (dyspepsia).
Chest pain: Retrosternal burning, radiating pain to the neck, jaw, or back, potentially mimicking a heart attack.
Pain relief: Relief almost immediately by drinking water, sitting upright, or taking antacids.
Throat irritation: Chronic cough, laryngitis.
Pain on swallowing (odynophagia).
Chronic GERD can lead to dysphagia.
Regurgitation of food: Bitter taste in mouth.
Increased flatus and burping (eructation).
Dental caries.
Sleep disturbances at night.
Diagnostic Tools for GERD
History and Physical (H&P).
Tests to rule out cardiac etiology if presenting with chest pain.
Esophagogastroduodenoscopy (EGD) or Upper GI Endoscopy with biopsy.
Anti-ulcer medications: Provide a protective layer against acid (e.g., Carafate, Pepto-Bismol).
Pro-kinetic agents: Block the effect of dopamine (metoclopramide/Reglan).
Surgical modifications: Enhance the function of the LES.
Peptic Ulcer Disease (PUD)
Pathophysiology of PUD
Risk Factors for Ulcer Development
Helicobacter pylori (H. pylori) infection.
NSAID use.
Hypersecretory states.
Pepsin.
Lifestyle factors.
O Blood type.
Family tendency.
Pancreatic tumors.
Chronic pulmonary or kidney disease.
Pernicious anemia.
Clinical Manifestations
General: bloating, Nausea/Vomiting (N/V), and early fullness.
Ulcers can be SILENT and lead to serious complications.
Gastric, Duodenal, Esophageal.
Diagnostic Studies
Endoscopy: Determine presence and location of ulcer.
Tissue specimen for H. pylori.
Barium swallow study, if unable to have endoscopy.
Stool and breath testing for H. pylori.
Stool for occult blood.
Blood tests.
Plan of Care
Encourage rest periods.
Regular exercise.
Avoid or eliminate NSAIDs; if ASA needed, enteric coated may be given with misoprostol, PPI, or H₂ Blocker.
Smoking cessation.
Avoiding alcohol consumption.
Decreasing/managing stress.
Consume a balanced diet – avoid triggers.
Monitor for signs of perforation.
Drug Therapy
Goal of drug treatment:
Alleviate symptoms
Promote healing
Prevent complications
Prevent recurrence
Medication Classes:
Antibiotics – treat H. pylori
Antisecretory agents reduce acid secretion
PPIs
H₂ Receptor Antagonists
Mucosal Protectants
Antisecretory agents that enhance mucosal defenses
Antacids
Pro-kinetics
Surgical Therapy
Gastrectomy
Antrectomy
Gastrojejunostomy
Vagotomy
Pyloroplasty
Complications
Malnutrition
Malnutrition - a continuum
Undernutrition
Overnutrition
Malnutrition Risk Factors
Incomplete diets
Alcohol/drug abuse
Eating disorders/fad diets
Chronic Illness
Prior GI surgery
Socioeconomic factors
Food-Drug interactions
Malabsorption Syndrome
Burns
Trauma
Sepsis
Malnutrition Types
Undernourishment
Starvation
Failure to thrive
Malabsorption syndromes
Starvation
Pathophysiology of starvation
Cues of Starvation
Failure to Thrive
FTT is a term used in infants, children, and adults.
Causes: organic or inorganic.
Risk factors: depression, mental illness, post traumatic stress disorder, poor food availability, poor water supply, medical causes, chromosomal abnormalities, dysfunctional interrelationships with caregivers, maternal emotional state, and socio- economic factors.
Malabsorption Syndrome
Malabsorption syndrome, another malnutrition, is caused by impaired (insufficient) absorption of fats, carbs, proteins, minerals, and vitamins.
Most common cues: weight loss, diarrhea, and steatorrhea.
Affects all ages
Malnutrition - Malabsorption syndrome
BRISTOL STOOL CHART
Type 1: Separate hard lumps - Very constipated
Type 2: Lumpy and sausage like - Slightly constipated
Type 3: A sausage shape with cracks in the surface - Normal
Type 4: Like a smooth, soft sausage or snake - Normal
Type 5: Soft blobs with clear-cut edges - Lacking fibre
Type 6: Mushy consistency with ragged edges - Inflammation
Type 7: Liquid consistency with no solid pieces - Inflammation
Malnutrition - Lab work for Undernourishment
Serum albumin
Pre-albumin
C-reactive protein (CRP)
Malnutrition - Treatments for Undernourishment
megestrol acetate/Megace
dronabinol/Marinol
Balanced oral diet
Multivitamin supplement
Correction of fluid and electrolyte imbalances
Enteral or parenteral nutrition
The pathophysiology of the problem directs the treatments. Consider the patient’s environment, comfort level, and functional ability related to feeding and nutrition.
Supplemental Nutrition
Nasogastric tube and PEG feeding tube.
Enteral Nutrition
Goal: prevent or correct nutritional deficits with liquefied food or formula
Preserves the structure and function of the gastric mucosa and stops movement of gastric bacteria across the intestinal wall into the blood stream.
Nursing considerations.
Parenteral Nutrition
Used when the enteral route is contraindicated or will not provide adequate nutrition.
Paralytic ileus, diffuse peritonitis, intestinal obstruction, pancreatitis, GI ischemia, abdominal trauma or surgery, severe burns, anemia, and diarrhea, prolonged and severe illness, and short bowel syndrome.
Parenteral Nutrition
PN is an IV administration of a complex, highly concentrated solution containing nutrients and electrolytes formulated for specific patient needs.
Base solution contains dextrose and protein.
Pharmacy adds prescribed electrolytes, vitamins, and trace elements.
Calories mostly supplied from carbohydrates.
High Osmolality- TPN/Central Line-For long term
Low Osmolality- PPN/Peripheral Line-For short term
Administered directly into the blood stream
Parenteral Nutrition - Nursing considerations
REQUIRED TO BE CHECKED BY TWO NURSES!
Management of Parenteral Nutrition
Limit number of personnel involved to reduce possibility of infection
Verify label with the physician order prior to administration
Examine solution for particulate matter
Change filters (not used with lipids) and IV tubing every 24 hours and hang a new bag every 24 hours, label all lines
Give via an infusion pump, dedicate one line of multi-lumen catheter
Change dressing per facility protocol, observe site for infection, document
If bag empties prior to next solution is ready, hang 10% or 20% dextrose to prevent hypoglycemia
Refeeding Syndrome
Occurs in severely malnourished patients
Bodies response from going from starvation to fed
Greater risk with parenteral nutrition
Predisposed conditions: chronic alcohol use, cancer, trauma, IBD, major surgery
Hallmark lab: hypophosphatemia
Labs show- hyperglycemia, fluid retention, hypokalemia, and hypomagnesemia
Cues include edema, confusion, shallow respirations, heart failure, seizures, coma, and death.