Nursing Fundamentals Study Notes

NURSING FUNDAMENTALS

Overview

  • Content derived from ATI CH 39, 43, 44, & 54 (Enteral)
  • Key topics include: Nutrition, Elimination - Bowel & Urinary, Diets, Intake & Output (I&O), and Enemas.

DIETS

Factors Affecting Ordered Diet

  • Disease Process: Conditions affecting dietary needs.

    • Recent Surgery: Recovery may necessitate dietary changes.
    • Diabetes: Requires carbohydrate restrictions.
    • Heart Disease: Requires sodium and cholesterol restrictions.
    • Malnutrition: May require an increase in calories and supplements.

  • Ability to Chew and Swallow: Influences dietary modifications.

    • Dysphagia: Difficulty swallowing that may require changes in food and liquid consistencies.
    • Issues like missing teeth or ill-fitting dentures can contribute.
Types of Diets Ordered

  • Regular Diet: No restrictions; standard meals.

  • Clear Liquid Diet: Includes:

    • Clear fat-free broth
    • Bouillon
    • Coffee and tea
    • Carbonated beverages
    • Clear fruit juices
    • Gelatin and fruit ices
    • Popsicles

  • Full Liquid Diet: Encompasses clear liquids plus:

    • Smooth-textured dairy products (e.g. ice cream)
    • Strained or blended cream soups
    • Custards
    • Refined cooked cereals
    • Vegetable juice
    • Pureed vegetables
    • All fruit juices
    • Sherbets and puddings
    • Frozen yogurt

  • Dysphagia Diets: Progression through stages.

    • Thickened Liquids: Honey thick and nectar thick options.
    • Pureed Diet: Includes clear and full liquids with additions such as:
    • Scrambled eggs
    • Pureed meats, vegetables, and fruits
    • Mashed potatoes with gravy.

  • Mechanical Soft Diet: Variation of clear and full diets with:

    • Creamed soups
    • Ground or finely diced meats
    • Flaked fish
    • Cottage cheese
    • Rice, tender vegetables, etc.

  • Soft/Low Residual Diet: Features low-fiber foods:

    • Pastas, casseroles, desserts without nuts/coconut.

  • High Fiber Diet: Includes:

    • Fresh uncooked fruits, steamed vegetables, bran, oatmeal, and dried fruits.

  • Low Sodium Diet: Variations include:

    • 4-g (no added salt), 2-g, 1-g or 500mg of sodium.
    • Aimed at decreasing fluid retention/blood pressure.

  • Low Cholesterol Diet: Limits cholesterol intake to 300 mg/day, aligning with American Heart Association guidelines.

  • Diabetic Diet: Follows recommendations from the American Diabetic Association:

    • Focus on total energy and balanced intake of nutrients, food distribution.

  • Gluten Free Diet: Excludes wheat, oats, rye, barley, and respective derivatives.

  • Patient Preference Diet: Includes vegetarian, vegan, or kosher options, based on availability.

INTAKE AND OUTPUT (I&O)

Purpose of I&O
  • Evaluate Bladder Emptying: Assessment of urinary function.
  • Evaluate Renal Function: Important for assessing kidney health.
  • Assess Fluid and Electrolyte Balance: Maintain homeostasis.
Assessment of I&O
  • Requires cooperation from patients and families.
  • Use of measuring containers to ensure accuracy.
  • Documented in the metric system.
  • Knowledge of conversions essential for accuracy.
Intake Categories
  • Fluids Consumed:
    • Orally
    • Gastrically via tubes
    • Intravenously
    • Includes fluids, medications, blood products, and instillations.
Output Categories
  • Fluids Excreted:
    • Urine
    • Watery diarrhea
    • Gastric suctioning
    • Bleeding or drainage
    • Wounds and drains
    • Vomiting

ENEMAS

Purpose of Enemas
  • Definition: An enema involves the instillation of a solution into the rectum and sigmoid colon.
  • Primary Reasons:
    • Promote defecation by stimulating peristalsis.
    • Relief from constipation.
    • Bowel emptying for diagnostic or surgical procedures.
    • Initiating bowel training programs.
  • Enemas can also provide localized medication to the rectal mucosa.
Types of Enemas

  • Cleansing Enema: Intended for complete fecal evacuation.

    • Solutions include: tap water, normal saline, soap suds, low-volume hypertonic saline.
    • Tap Water: Hypotonic solution that stimulates defecation but caution needed for toxicity with repeated use.
    • Normal Saline: Considered safest due to isotonic nature relevant to bowel fluids; reduces risk of fluid absorption issues.

  • Hypertonic Solutions: Draw fluid from interstitial spaces into the bowel, facilitating defecation; suitable for patients unable to tolerate large volumes.

  • Soapsuds Enema: Combines castile soap with water/normal saline to irritate intestines, promoting peristalsis; caution needed especially in pregnant/elderly patients due to potential electrolyte imbalances.

Other Types of Enemas
  • Oil Retention Enema: Aids in lubricating stools for easier passage by softening feces.
  • Carminative Enema: Intended to relieve gaseous distension.
  • Medicated Enema: Contains drugs like kayexalate to reduce potassium levels or steroids and antibiotics for inflammation and bacteria management respectively.
Administration of Enemas
  • Equipment Required:
    • Clean gloves, water-soluble lubricant, waterproof absorbent pad, bedpan.
    • Enema bag or prepackaged enema container.
  • Fluid Preparation:
    • Correct volume (700-1000 mL for adults) of tepid fluid.
    • Use caution with fluid temperatures to prevent cramping/injury.
Patient Positioning and Techniques
  • Recommended Position: Left lateral Sims position for optimal fluid administration.
  • Administration Technique:
    • Lubricate the rectal tube tip.
    • Insert the tube while instructing the patient to relax.
    • Hold the tubing until completion of fluid instillation.
    • Monitor for any patient discomfort during administration and adjust as necessary (i.e., slow the fluid instillation during cramping).
Post-Administration Considerations
  • Instruct the patient to retain the enema as long as possible for maximum effect.
  • Provide immediate access to a bedpan or bathroom for expected evacuation.
  • Observe the characteristics of any expelled stool and enema solution (do not flush).