ATI Nutrition Proctored Exam 2019 Overview

nutrition ATI RN 2019 how do you calculate percentage weight change ? previous weight-current weight / previous weight x 100 what is significant weight loss percentage ? > 2 % in week OR > 7.5 % in 3 months How do you calculate BMI? weight (kg) / height (m^2) What are the BMI ranges? underweight: <18.5 normal: 18.5-24.9 overweight: 25-29.9 obese: >30 how many calories are in one pound ? 3,500 calories what should you do to lose one pound a week ? decrease your daily calories by 500 calories patient teaching for weight loss monitor hunger on a 0-10 scale before eating certain foods should not be "forbidden" do not weigh yourself daily ( weight loss will not be consistent. weight will fluctuate) eat meals free of distraction make lifelong/ temporary changes dietary guideline for Americans: eat 5 or more fruits and veggies a day servings of fruits and veggies: dietary guideline for Americans: monounsaturated and polyunsaturated goal is to eat <7 % from saturated fats best type of fat to consume: dietary guidelines for Americans: consume less than 2,300 mg/day of salt recommended salt intake: Dietary Guidelines for Americans: up to 1/ drink a day for women up too 2 /drinks a day for men # of alcoholic drinks per day: weight bearing exercise- prevents osteoporosis exercise recommendations for adults 2.5 hours/ week of moderate aerobic activity 1.25 hours/week of vigorous aerobic activity exercise for children/adolescents 60 minutes/day of physical activity Food labels must contain calories calories from fat saturated fat trans fat cholesterol sodium total carbohydrates dietary fiber sugars protein vitamin A vitamin C calcium iron common foods that cause food borne illness raw/undercooked meat raw sprouts unpasteurized fruit juice raw fruits/veggies (veggies contaminated with animal feces) raw milk products common food borne illnesses salmonella, E. coli 0157:H7, Listeria, Norovirus dietary concerns during pregnancy (patient teaching) eat dry crackers or toast (low-fat carbohydrates) avoid drinking water with meals avoid caffeine, fatty foods, spicy foods Nausea/Vomiting 1 / 25 serve foods at room temperature or chilled maintain good oral hygiene dietary concerns during pregnancy (patient teaching) increase fiber (including cellulose) increase fluid intake engage in physical mobility (increase bowel motility) constipation avoid high protein foods (meat, fish, eggs, poultry, nuts, dairy products) dietary concerns during pregnancy (patient teaching) maternal phenylketonuria (PKU) monitor levels during pregnancy dietary recommendations during pregnancy for fluid intake 2-3 Liters of fluid/day dietary recommendations during pregnancy for alcohol intake NONE dietary recommendations during pregnancy for caffeine intake limit caffeine intake to 300 mg/day or less dietary recommendations during pregnancy for folic acid intake 600 mcg/day recommended to prevent neural tube defects dietary recommendations during pregnancy for iron intake iron requirements increase during pregnancy increase during pregnancy, supplement recommended dietary recommendations during pregnancy for fish consumption fish and shellfish should be avoided due to mercury levels neurological conditions that cause dysphagia stroke cerebral palsy MS Parkinson's disease nursing care for patients with dysphagia lightly stroke chin/throat to promote swallowing thicken liquids check for food pockets in mouth before feeding encourage patient to tuck their chin when swallowing monitor client during meals, have suction ready Parenteral Nutrition (PN) nursing considerations for safe administration use micron filter on PN IV tubing if the next PN is unavailable, administer 10-20 % dextrose in water until it arrives if PN solution looks oily or has a layer of fat at the top, throw it out! verify PN prescription with second RN prior to administration change PN bag and tubing every 24 hours monitor I & Os, daily weights, electrolytes, blood glucose PN can be discontinued when oral intake is at least 60 % of daily caloric requirements. Discontinue PN gradually to prevent hypoglycemia nursing care for patients who are malnourished or suffer from nausea, early satiety offer several, small meals limit liquids at mealtime cold or room temperature foods are less aromatic, and less likely to cause nausea provide oral care before and after meals provide supplement drinks between meals consume more food in the morning, when appetite is better avoid low-calorie food consume small amounts of high-protein, high-calorie, nutrient dense foods metabolic syndrome increases risk of increases risk for diabetes and heart disease diagnosis: presence of 3/5 following factors: How is metabolic syndrome diagnosed? increased abdominal girth (greater than 40" for men, 35" for women) elevated triglycerides >=150mg/dl decreased HDL (less than 40 mg/dl for men, less than 50 mg/dl for women) hypertension (SBP >=130, DBP >= 85) elevated fast blood glucose. (> 100mg/dl) 2 / 25 What is Basil Metabolic Rate? energy required for involuntary activities in the body within a 24 hour period. (heart function, respirations, temperature regulation) what increases the BMR male gender increased muscle mass stress periods of growth (childhood, puberty) pregnancy/lactation exposure to cold disease/illness (hyperthyroidism, sepsis, cancer, burns, fever, surgery) what decreases BMR female gender short stature less muscle mass (more fat) starvation older age (60 +) hypothyroidism what is catabolism breaking down of substances, resulting a release of energy What is anabolism? use of energy to build/repair substances what is the recommended intake of water per day 2-3 L per day minimum intake for bodily function is 1.5 L/day intake should approx. match output Sensible fluid loss can be measured (urine, vomit) insensible fluid loss fluid loss from the lungs, skin, and water excreted in feces who is at the highest risk for dehydration? older adults and children signs of dehydration poor skin turgor confusion hypotension decreased urinary output increased urine osmolality dry mucous membranes thirst irons function in the body used to make hemoglobin (component in RBCs) Foods high in iron meat, fish, grains, legumes side effects of iron supplements constipation (increase fiber and fluids) GI upset tooth discoloration Vitamin C increases absorption Vitamin D decreases absorption use Z-track method for IM injections What is iodine's function? used in synthesis of thyroxine (thyroid hormone) RDA=100-150 mcg foods high in iodine table salt seafood fluorides function in the body protects against cavities source of fluoride water zincs function immune function foods high in zinc nuts, meat, beans, fortified cereal phosphorous functions bone and teeth formation Foods high in phosphorus dairy (including cheese) dark green veggies meat fish 3 / 25 eggs legumes relationship between calcium and phosphorous if calcium is high, phosphorous will be low, and vice versa (inverse relationship) symptoms of hyperphosphatemia signs of hypocalcemiapositive chvostek's sign positive Trousseau's sign muscle spasms tingling in lips and fingers normal phosphorous level 3-4.5 what is potassium's function in the body maintains ICF (intracellular fluid balance) nerve function regulates muscle and heart contractions food high in K + bananas potatoes tomatoes oranges cantaloupe avocados dark green veggies signs of hyperkalemia dysrhythmias, muscle weakness, numbness/tingling, nausea/vomiting, and confusion signs of hypokalemia dysrhythmias, muscle cramps, constipation Normal K+ levels are ____. 3.5-5.0 mEq/L What is sodium's role in the body? maintains fluid balance nerve and muscle function what is a normal sodium level 136-145 what are some foods high in sodium salt processed foods signs of hypernatremia hypervolemia , hypertension signs of hyponatremia confusion (common in elderly) muscle cramping fatigue nausea, vomiting headache what is vitamin Ds function in the body helps with absorption of calcium and phosphorous bone mineralization food/sources of vitamin D sunlight fortified milk fatty fish eggs defiance of vitamin D rickets, bone loss what is vitamin Es function antioxidant (protects cells from damage) foods high in vitamin E fat containing foods (veggie oil, nuts) dark green veggies whole grains Vitamin E deficiency rare ! muscle pain/weakness poor balance what is vitamin Ks function blood clotting, bone maintenance Foods high in vitamin K carrots, eggs, DARK green veggies vitamin K deficiency increased bleeding time What is the antidote for warfarin? Vitamin K 4 / 25 what is vitamin As function in the body vision health skeletal and soft tissue development/strength foods high in vitamin A orange/yellow fruits and veggies (carrots, cantaloupe, apricots) fatty fish eggs liver dairy products Vitamin A deficiency vision issues xerophthalmia (dry/thickened conductiva and cornea) what is calciums function in the body? bone/teeth formation nerve and muscle function clotting blood pressure what is a normal calcium level 9-10.5 what foods are rich in calcium dairy products dark green veggies fortified foods Signs of hypercalcemia are lethargy constipation decreased DTRs kidney stones Signs of hypocalcemia include positive Chvostek's sign positive Triusseau's sign muscle spasms tingling in lips and fingers what is vitamin Cs function tissue building iron absorption metabolism foods high in vitamin C citrus fruits/juices tomatoes green leafy veggies peppers when to increase vitamin C? smokers need more vitamin C deficiency of vitamin C Scurvy (joint pain, bleeding, swollen gums) B complex vitamins function metabolism, energy, nerve function foods rich in B-complex vitamins meats milk enriched grains whole grains legumes green leafy veggies Deficiency of Thiamin Beriberi, common in those with alcohol use disorder deficiency of riboflavin cheilosis (cracking at corners of the mouth) glossitis (smooth/swollen red tongue) Deficiency of Folate can result in neural rube defects in utero defiance of cobalamin pernicious anemia affects strict vegans and those lacking intrinsic factor (need for absorption of B12) nutrition recommendations for anorexia remove unpleasant odors from environment eat small/frequent meals avoid fatty foods drink supplement drinks between meals oral care before and after meals 5 / 25 nutrition recommendations for constipation increase fiber and fluid intake increase exercise avoid chronic use of laxatives Dumping syndrome is when the stomach contents rapidly empty into the small intestine. can led to hypoglycemia, iron-deficient anemia, steatorrhea (oily stools), osteomalacia symptoms of dumping syndrome abdominal cramping nausea diarrhea diaphoresis tachycardia hypotension nutritional recommendations for dumping syndrome small frequent meals include protein and fat in each meal avoid dairy and concentrated sugars do NOT drink liquids with meals lie down 20-30 minutes after meals nutritional recommendations for heart failure limit sodium (2,000 mg/day or less) restrict fluid intake (2L/day) increase protein intake eat small/frequent meals nutritional recommendations for MI avoid caffeine eat small/frequent meals follow heart-healthy diet dietary considerations for orthodox jewish kosher kitchens do not eat meat with dairy no pork products or shellfish dietary considerations for Muslims no caffeine (coffee, tea, soda) fasting during Ramadan dietary considerations for Mormons no caffeine (coffee, tea, soda) dietary considerations for catholics no eat on Ash Wednesday and Fridays during Lent Identify the water soluble vitamins C and B complex (thiamin B1, Riboflavin B2, Niacin B3, Pyridoxine B6, Pantothenic acid, Biotin, Folate, Cobalamin B12) Identify the fat soluble vitamins A, D, E, K fat soluble vitamins have a rash of toxicity since they are stored in the body for a long time conditions that impart absorption of fat soluble vitamins CF celiac disease Crohn's disease Protein percentage of calories proteins should make up 10-35 % of calories (0.8/kg) what is proteins function supports tissue building, metabolism, immune function, maintain nitrogen balance. Important for wound healing! What is a complete protein? contains sufficient amounts of 9 essential amino acids (animal sources, soy) What is an incomplete protein? Can be combined to make a complete portion (plant sources) energy provided by proteins? proteins provide 4 calories/gram of energy examples of protein energy malnutrition (PEM) Kwashiorkor, Marasmus nutritional recommendations for patients with cancer increased protein and calories goal is to maintain weight during therapy add calories to recipes! use whole milk vs. water, add milk/cheese to dishes, use peanut butter as a spread, top fruit with yogurt nutritional recommendations for patients with HIV/AIDS consume small, frequent, high-protein, high-calorie, nutrient-dense meals 6 / 25 how is HIV-associated wasting deficient weight loss of 10 % and one following for 30 days: diarrhea, fever, chronic weakness nutrition for cancer prevention adequate fiber decreases colon cancer risk no smoking to prevent lung cancer eat 5 servings of fruits/veggies a day eat whole grains vs. processed/refined grains do not eat pickled, smoked, grilled, or nitrate-containing foods choose polyunsaturated and monounsaturated fats (vs. saturated) reduce alcohol consumption nutrition and lifestyle changes for patients with diabetes increase intake of fiber (beans, veggies, whole grains) limit simple carbohydrates no smoking or tobacco decrease intake of saturated fat (<7 % of calories) decrease intake of trans fat (<1 % of calories) decrease intake of cholesterol (200-300 mg/day) goal HgbA1C <7 increase exercise, encourage weight loss monitor blood glucose levels carefully count carbs: 45-75 mg/meal (ex: 4 carb servings/meal for 1600-2000 daily calorie intake) hyperglycemia blood glucose levels of greater than 200 mg/dl symptoms of hyperglycemia polyuria polydipsia polyphagia Kussmaul respirations fruity breath headache decreased LOC dehydration What is Somogyi phenomenon? morning hyperglycemia, due to untreated overnight hypoglycemia provide bedtime snack and insulin to help prevent Somogyi's phenomenon hypoglycemia blood glucose levels less than 70 mg/dl symptoms of hypoglycemia shakiness, diaphoresis, confusion, headache nutritional interventions for hypoglycemia provide 10-20 mg carbohydrate (4 oz juice or regular soda) retest blood glucose in 15 min. if it is under 70 mg/dl, repeat above) after blood glucose levels have stabilized, provide a snack with carbohydrates and protein nutritional recommendations for AKI limit protein intake (0.6/kg for dialysis patients, 1-1.5 g/kg for dialysis patients) restrict fluid intake to daily urine output + 500 ml during oliguria phase potassium, sodium intake dependent on phase nutritional recommendations for nephrotic syndrome sufficient protein intake (0.7 to 0.8 g/kg/day) emphasis on soy based protein low sodium diet (to control hypertension, edema) food preparation and risks: African Americans (soul food) food preparation and risks: Asian Americans (Chinese food) food preparation and risks: Latino American (Mexican food) food preparation often includes frying in animal fats foods can be high in fat and sodium increased risks of type 2 diabetes, heart disease, hypertension food preparation often includes a great deal of salt, resulting in high sodium intake food prep often includes frying in lard/oil acculturation has resulted in replacement of corn tortillas w/ wheat and bread products. increased risk of type two diabetes. 7 / 25 bariatric surgery nutritional recommendations start each meal with protein eat 5 small meals a day allow for 30-60 minutes to eat chew foods thoroughly and slowly DO NOT consume liquids with meals watch for symptoms of dumping syndrome (abd. cramping, nausea, diarrhea, diaphoresis, tachycardia, hypotension) what is magnesiums function nerve and muscle function, bone formation. critical for may biochemical reactions in the body what is a normal magnesium level 1.3-2.1 mEq/L Foods high in magnesium nuts dark green veggies whole grains meat milk Signs of hypermagnesemia nausea and vomiting hypotension muscle weakness lethargy respiratory and cardiac arrest signs of hypomagnesemia dysrhythmias tremors seizures confusion increased DTRs celiac disease inability to digest gluten symptoms of celiac disease diarrhea, steatorrhea(oily stool), bloating, anemia, abdominal pain nutritional recommendations for celiac disease avoid foods containing, wheat, rye, barley read labels on processed foods, as many contain gluten (ex: gravy mixes, deli met, cold cuts, soups) OK to eat: dairy, rice, corn, potatoes, eggs, fruits, and veggies nutrition during infancy birth weight doubles by 6 months, triples by 1 year of age breast milk (or formula) ONLY for first 4-6 months introduce solid foods when baby can sit up and has head control (~4months) iron-fortified cereal should be the first solid food introduced new foods introduced one at a time over 5-7 days to assess for allergies of intolerance cow's milk should only be given after 1 year of age what is chlorides function digestion, maintenance of ICF and ECF balance foods high in chloride salt Signs of hyperchloremia nausea and vomiting Signs of hypochloremia muscle cramps, GI upset normal chloride level 98-106 mEq/L nursing care for patients with anorexia nervosa and bulemia weigh patient at the same time each day stay with patient an hour after meals avoid caffeinated beverages provide privileges based on calories consumed and/or weight gain vegan diet no animal products at all (no meat, dairy, or eggs) lacto-vegetarian dairy products are OK lacto-ovo-vegetarian diary products and eggs OK special concerns for vegan diets make sure individuals following a vegan diet get enough: vitamin D 8 / 25 Vitamin B-12 Omega-3 fatty acids Acculturation adopting the traits of the dominant culture ethncentrism The belief that one's ethnic group is superior to others. View world from their own cultural viewpoint. Nurses should not demonstrate ethnocentrism nursing care for Enteral Feeding Tubes verify tube placement with x-ray before feeding measure tube each shift and before each feeding verify presence of bowel sounds before each feeding discard bags/tubing every 24 hours measure gastric residual every 4-6 hours, return residuals to stomach. hold feeding for residual amount over hospital policy (~500 ml) flush feeding tubes with 30 ml water every 4 hours formula should be at room temperature key teaching to prevent food borne illness frequent hand hygiene refrigerate perishable products within 2 hours (or within 1 hour when temperature is 90 degrees or more) prevent cross-contamination during food prep cook foods to recommended temperatures grapefruit juice affects metabolism of MANY medications, including statins Foods high in vitamin K interferes with effectiveness of warfarin High-protein foods interferes with absorption of Levodopa (Parkinson's medication) Tyramine-rich foods can cause hypertensive crisis in patients taking MAOIs includes: smoked meats, cheese, avocado, wine, chocolate, bananas, peanuts Potassium rich foods can cause potassium levels to be too high in patients taking ACE inhibitors or potassium-sparing diuretics nutritional recommendations for stomatitis do not use alcohol-based mouthwash use a soft toothbrush; clean teeth after meals and at bedtime avoid acidic, spicy, dry, crunchy foods scrambled eggs are a good choice! consume cold or room temperature foods cut food into smaller bites use a straw Nephrolithiasis (Kidney Stones) risk factors excess protein, sodium, calcium, and oxalate intake. inadequate fluid intake nutritional recommendations for nephrolithiasis (kidney stones) increase fluid intake (2-3 L/day) decrease intake of animal protein, sodium, alcohol, caffeine for stones made of calcium oxalate: limit foods high in oxalates: spinach, rhubarb, strawberries, beets, chocolate, nuts, tea for stones made of uric acid: limit foods high in purines: meat, whole grains, legumes the body requires iron, B12, and folic acid to synthesize RBCs. Increase intake of those three components: nutritional recommendations for anemia iron:meat, green leafy veggies, who grain, beef, tofu. (vitamin C increases absorption of iron) B12: meat, eggs, milk Folic acid: leafy green veggies, citrus fruits, beans, fortified cereal/bread, chicken liver nutritional recommendations for Chronic Kidney Disease limit protein intake : 0.8-1 g/kg/day limit phosphorous intake: limit dairy (including cheese), dark green veggies, meat, fish, eggs, legumes, cola, beer, chocolate limit potassium intake: limit bananas, potatoes, tomatoes, or9 / 25 anges, cantaloupe, avocados, dark green leafy veggies limit sodium intake: to control hypertension additional calories needed during pregnancy additional 340 cal/day during second trimester, additional 450 cal/day during the third trimester additional calories needed during lactation additional 330 cal/day for first 6 months, additional 400 cal/day after that weight gain expected for each trimester first trimester: 1-4 lbs TOTAL second and third trimester: 2-4 lbs per month total expected weight gain during pregnancy normal weight patients: 25-35 lbs underweight patients: 28-40 lbs overweight patients: 15-25 lbs nutritional recommendations for End Stage Renal Diseases encourage high protein intake. protein intake should increase after dialysis begins (due to protein loss in dialysis) limit phosphorous intake. Take phosphate binders with meals and snacks limit potassium intake limit sodium, fluids provide calcium and vitamin D supplements nutritional recommendations for heart disease low fat, low cholesterol diet (less than 200 mg of cholesterol) avoid saturated and trans fat use liquid oils. avoid frying foods increase fiber intake decrease red meat consumption (choose lean meats like turkey or chicken) increase omega-3 fatty acids (fish, nuts/seeds, plant oils) lower homocysteine levels teach patient how to read food labels arrange for meal delivery services education for economically disadvantaged families (or lack access frozen fruits and veggies are more affordable and last longer in the to healthy food) freezer avoid canned, boxed, processes foods, which tend to be high in calories, fat, and sodium Breast milk storage/patient teaching discard unused breast milk after feeding store in fridge for 5-8 days do NOT microwave breastmilk can be frozen for up to 6 months (or 12 months in a deep freezer) used thawed milk within 24 hours. Do not refreeze thawed milk nutrition and lifestyle recommendations for hypertension Dash diet: low NA +, high K+, high calcium limit sodium to 1,500 mcg ( 2,300 mcg at first) avoid foods high in sodium (canned foods, smoked meats, pretzels/chips, processed foods) increase intake of low-fat dairy, fruits and veggies, whole grains limit alcohol intake nutrition recommendations for taste alterations eat more tart foods, such as citrus fruits/juices eat small, frequent meals use plastic utensils to eat (to decrease metallic taste) suck on mints, candy or chew gum. Gargle with mouth wash try seasonings or sauces to improve taste of foods liquid consistency- Thin all beverages, no restrictions nectar thick liquids heavy syrup consistency. can drink through straw (ex. cream soup, thin milk shake) honey thick liquids pourable. can be eaten with a spoon, but can't drink with straw. (ex. yogurt) spoon thick liquids thickened such that they maintain their shape. Needed to be eaten w/spoon (ex. custard, pudding) 10 / 25 mechanical soft diet indications- chewing difficulties, no teeth (edentulous), dysphagia foods: those that require minimal chewing (ground meat, cooked veggies, canned fruit) Dysphagia diet level 1: (pureed): foods w/ pudding-like texture level 2: (mech. altered): moist, semi-solid foods with soft texture level 3: (advanced): moist, near-normal texture foods. No hard, stick crusty foods. nutritional recommendations for diverticulitis for acute exacerbation: clear liquid diet is recommended (low fiber intake) after inflammation is reduced, a high fiber, low-fat diet is recommended avoid seeds, husks (popcorn, tomatoes, berries) nutritional recommendations for IBD avoid nicotine a low-residue (low fiber), high protein, high-calorie diet is recommended oral replacement fluids may be needed TPN may be needed during acute phase Lipids/fats function in the body stored energy in the body, provides padding and insulation. important for hormone production and absorption of fat-soluble vitamins Lipids/fats percentage of calories fats should make up 20-35 % of calories (less than 10 % should come from saturated fat, with a goal of less than 7 %) recommended cholesterol intake in a day cholesterol should be limited to 200-300 mg/day energy provided by fat fats provide 9 calories/gram of energy carbohydrates percentage of energy carbohydrates should make up 45-65 % of calories Carbohydrates function energy, regulate fat/protein metabolism, and are important for cardiac and CNS functioning Glycogen stored carbohydrate energy in the liver and the muscles, released in between meals to maintain blood glucose levels energy provided by carbohydrates carbs provide 4 calories/gram of energy recommended fiber intake men vs. women 25 g/day for women 38g/day for men what does a nitrogen balance indicate component of amino acids (found in protein sources) Nitrogen balance = nitrogen intake minus nitrogen excretion adults should have a neutral nitrogen balance positive nitrogen balance occurs during periods of growth (childhood, puberty, pregnancy, lactation) negative nitrogen balance indicates insufficient protein intake (due to illness, malnutrition, aging) patient is using protein faster than it is being synthesized Nasogastric tube (NG tube) short-term use goes from nose to stomach gastrostomy tube (G-tube) long term use tube inserted directly into stomach (or intestines) standard formula contains whole proteins, requires fully functioning GI tract hydrolyzed formula contains partially digested proteins, use for impaired GI tract indications for PN GI disorders, cancer, critical illness, trauma, burns Components of PN dextrose electrolytes vitamins trace elements lipids (fat) protein 11 / 25 When are IV lipids contraindicated? lipids are contraindicated for patients with allergies to soybean oil, eggs, or safflower oil. Also, patients with hyperlipidemia or hepatic disease should not get IV lipids nutritional recommendations for lactose intolerance limit foods w/lactolose (I.e. dairy products), such as milk, cheese, chocolate, pudding. suggest use of lactase enzyme nutritional recommendations for ostomies increase fluid and soluble fiber intake avoid gas and odor-causing foods (beans, carbonated drinks, eggs, fish, garlic) avoid foods that can cause stoma blockage (nuts, carrots, popcorn) increase protein and calorie intake to help heal the stoma prepare meals on a schedule to promote regular bowel elimination Signs of malnutrition wasted appearance, poor wound healing, dry patches on skin, hair loss, dry/brittle hair, weakness, poor coordination, low prealbumin and albumin normal range of prealbumin 15-36 mg/dL normal range of albumin 3.5-5 g/dL ways to increase protein and calorie intake add milk powder to milk; use whole milk add high-calorie foods to diet (cheese, peanut butter, eggs, nuts) encourage use of supplements collaborate with dietician/nutritionist nutritional recommendations for cholecystitis consume a low-fat diet nutritional recommendations for pancreatitis consume a low-fat, high-protein, high-carbohydrate diet NPO recommended during acute exacerbations, TPN may be needed For chronic pancreatitis, encourage high calorie snacks and taking enzyme preparations with meals to assist with absorption nutritional recommendations for liver disease no alcohol, nicotine, caffeine vitamin and mineral supplements may be needed nursing care of Internal Feeding Tubes elevate HOB to 30 degrees during feeding, and for 30-60 min. after feeding flush tubing with 15-30 ml of water before, after, and in between medications cover and label unused formula with patient's information refrigerate for up to 24 hours fill feeding bags with only 4 hours worth of formula to prevent bacterial contamination slowly increase volume/rate to desired level. Wean off of enteral feeding as oral consumption increases infant nutriton concerns: Colic persistent crying for 3 hr or more per day usually resolves by 3 months old if breastfeeding, try eliminating cruciferous veggies, cow's milk, onion, and chocolate infant nutrition concerns: gas, abdominal distention, and diarrhea. used soy-based or casein hydrolysate formulas lactose intolerance infant nutrition concerns: Diarrhea often caused by rotavirus. use oral rehydration solutions signs of dehydration: lethargy, sunken eyes, sunken fontanels, decreased tears, decreased urine output, dry mucous membranes insulin can be added to prevent hyperglycemia (from the dextrose) what medication can be added to PN bags Heparin can be added to prevent clot formation on the IV catheter tip administration of meds through PN IV line 12 / 25 DO NOT administer any medications though the PN IV line/port. need a separate line! nutrition and lifestyle recommendations for gastritis and peptic ulcer disease reduce stress avoid NSAIDs, alcohol, smoking AVOID eating frequent meals, as the increases gastric acid and secretion avoid black pepper, spicy foods, caffeine GERD nutrition and lifestyle recommendations avoid tight-fitting clothing do not lie down for 2 hours after meals avoid large meals avoid these foods: citrus fruit/juice, spicy foods, fatty foods, caffeine, chocolate, alcohol, carbonated beverages, peppermint/spearmint lose weight, do not smoke soft diet indication: transition from full liquid to regular diet foods: no raw fruits/veggies, no foods that cause gas (beans), no coarse breads or cereals pureed diet indications: oral/facial surgery, wired jaws, chewing difficulties foods: fods/liquids pureed to liquid forms clear liquid diet indications: GI disorders, post-operatively foods: water, tea, coffee, broth, clear juices, jello, ginger ale, carbonated beverages full liquid diet indications: Transition from clear liquid to soft diet foods: clear liquids (above) plus milk, pudding, soups, ice cream, sherbet, fruit juice, vegetable juice older adult nutrition concerns older adults have lower BMR (need to reduce calorie intake) dehydration is common in older adults (due to decreased thirst, medication side effects) older adults have decreased absorption of B12, folic acid, and calcium Mince/chop food for difficulty chewing. Thicken liquids for difficulty swallowing childhood nutrition concerns children gain about 5 lbs per year choking hazards: popcorn, raisins, peanuts, grapes, celery, raw carrots, hot dogs, peanut butter, candy, tough meat limit juice intake to 4-6 oz per day vitamin D is important for bone development limit milk intake to 24 oz, because overconsumption can lead to iron deficiency anemia. increase intake of iron-rich foods, vitamin C increases absorption of iron TPN (total parenteral nutrition) administered through dental vein, longer term therapy (>7 days), can have up to 70 % dextrose PPN administered through peripheral vein, short-term therapy (7-10 days), solution must be isotonic and cannot contain more than 10 % dextrose. When does bone lose begin boss lose begins at 35 years old Caucasian women have the highest risk patient teaching for osteoporosis increase intake of calcium and vitamin D engage in weight-bearing excursive (swimming is NON-weight bearing) limit alcohol consumption very low density lipoproteins (VLDL) carry triglycerides to the cells low-density lipoprotein (LDL) carry cholesterol to the tissue cells High-density lipoprotein (HDL) remove excess cholesterol from the cells, and transport it to the liver for disposal Major source of Magnesium tuna 13 / 25 Non-heme sources of iron dried beans Heme sources of iron ground beef, turkey, salmon energy nutrients are metabolized to provide carbon dioxide, water, and adenosine triphosphate (ATP) The liver removed nitrogen from amino acids, and the remaining product is converted to glucose or fat for energy. Body cells are first available ATP for growth and repair, then use glycogen and stored fat Resting Metabolic Rate (RMR) also called REE refers to calories needed for involuntary activities of the body at rest. This rate does not consider the 12 hour fast criteria increased metabolism fever involuntary muscle tremors (shivering, Parkinson's) hyperthyroidisms cancer cardiac failure burns surgery/wound healing HIV/AIDS medication that will increase the metabolism Levothyroxine fluids I + O adults: 2-3 L/day total average output: 1,750 to 3,000 ml/day nursing care for obese low fowlers to maximize chest expansion monitor respiratory status supplement oxygen as needed monitor BP monitor frequently for medication adverse effects use bariatric equipment screening to eval for CVD, Diabetes, thyroid disorders, fatty liver disease -total cholesterol -triglycerides -fasting blood sugar -glycosylated hemoglobin -AST -ALT Orlistat prevents digestion of fats adverse effects: oily discharge, reduced food and vitamin absorption; decreased bile flow; loose, oily stools; abdominal cramps; fecal incontinence Lorcaserin stimulates serotonin receptors in the hypothalamus in the brain to curb appetite adverse effects: headache, dry mouth, fatigue, nausea suppresses the appetite and induces feeling of satiety adverse effects: dry mouth, constipation, nausea, change in taste, dizziness, insomnia, numbness and tingling in extremities Phentermine-topiramate contraindications: hyperthyroidism, glaucoma, taking an MAO inhibitor lab value that indicates the client is in a catabolic state negative nitrogen balance essential nutrients for normal functioning of the nervous system calcium, sodium, Thiamin, Vitamin B12 food safety requirements Proper food storage Proper handling Proper preparation maintain fridge temp at 40 degrees F 14 / 25 Food Storage Guidelines: fresh meat food storage: Bacon can store for 7 days food storage: 3 months- unopened 3 weeks- opened summer sausage food storage: 3-5 days steaks, chops, roasts (beef, veal,lamb, or pork) food storage: 1-2 days chicken or turkey maintain fridge temp at 40 degrees F or colder lean or fatty: 1-2 days smoked: 14 days fresh shellfish: 1-2 days canned: 3 to 4 days (after opening) 5 years (pantry) Food storage: Fish Food Storage: store in the fridge for 4 to 5 weeks in shell, and 1 week if hard-boiled eggs food storage: refrigerate perishable fruits and veggies, all pre-cut, pre, peeled in fridge as well at 40 degrees F fruits and veggies food storage: perishables do not leave at room temp for more than 2 hr (1 hr if temp is 90 degrees or above) food storage: canned goods check for rusting, crushing, and denting. observe for stickiness outside of can. do not use canned foods that are damaged preparation guidelines roast and steaks: 145 F chicken: 165 F ground beef: 160 F products that contain eggs: 160 F Norovirus viral infection caused by consuming contaminated fruits/veggies, salads, oysters, and contaminated water. onset 24-48 hrs very contagious manifestations: projectile vomiting, fever, myalgia, watery diarrhea, headache food allergy a condition in which the body's immune system reacts to substances in some foods (release of serotonin and histamine) food intolerance doesn't occur consistently depends on the amount of food eaten medications that cause gastric irritation take with food to prevent ibuprofen, amoxicillin, some antidepressants (bupropion) is unpasteurized fruit a common cause of food borne illness? YES if a patient is taking phenelzine, what food could cause a hypertensive crisis? smoked fish greek yogurt will increase the metabolism of levodopa (high in protein) infants who react to which of the following foods typically outgrow the sensitivity 15 / 25 soy cows milk Hispanic/Latinx predominant minority population in the U.S., with the largest percentage clients being of Mexican heritage certain foods are considered hot or cold and can be used to provide balance for healing cinnamon and teas (mint and chamomile) can be used as part of the healing Hispanic/Latinx nutrition-related concerns high intake of fruit, dark green, orange veggies, legumes increased intake of saturated fat and sodium decreased intake of whole grains and milk high prevalence of obesity diabetes mellitus type 2 as a leading cause of death African Americans Second largest minority group in the US most can identify a west African heritage or ancestors who immigrated though the Caribbean, Central America, Eastern Africa food habits: related to personal factors (work schedule, location, socioeconomic status) most are OK with the larger body type nutrition related concerns for African Americans increased risk of hypertension (usually uncontrolled) increase rates of diabetes with increased risk of complications highest prevalence rates of obesity lower intake of whole gains, milk, veggies higher intake of sodium and saturated fat just under the national average on USDA healthy eating scores (total and saturated fat, sodium, cholesterol intake) Asian Americans third largest minority group in the US includes 37 different ethic groups the Chinese population is the largest subgroup of asian American people common food patterns include devoting considerable skill and time to food preparation, and consumption of rice and veggies more than meats belief of the balance of yin and yang. when food is digested, it turns into one of these components. Yin is treated by yang. and vice versa. Yin foods seaweed, many fruits and veggies, cold beverages yang foods fried foods, coffee, spice, meat, meat broths nutrition. related concerns for asian Americans lowest prevalence of obesity highest life expectancy (asian American females) highest risk of diabetes type two when body fat increases American diet foods are prepared quickly or expected to be made fast foods made at home are often premed ingredients or packaged kits American nutritional health risks high in sodium, low in fiber portion sizes on packaged meals are often small, leading to consuming more than one serving meals and snacks eaten away from home are low in veggies, fruit, dairy, and whole grains. high in fat, sugar, and sodium soul food origins in southern and Western Africa adopted in southern US more common in socioeconomic and rural areas soul food: traditional foods rice, grits, cornbread, hominy, okra, greens, sweet potatoes, apples, peaches, buttermilk, pudding, cheddar or American cheese, ham, pork, chicken, catfish, black-eyed peas, red and pinto beans, peanuts, soft drinks, fatback 16 / 25 soul food: buying convenience rather than preparing homemade increased milk consumption possible reduced intake of fruits and veggies acculturation soul food nutritional health risks high in fat, protein, and sodium low in potassium, calcium, and fiber (protective nutrients) many foods are fried Mexican Spanish and Native American cultures have influenced traditional Mexican diets mexican: traditional foods rice, corn, tortillas, tropical fruits, veggies, nuts, legumes, eggs, cheese, seafood, poultry, infrequent sweets and red meat -tortillas eaten at most meals -animal protein from ground poultry, pork, and goat -veggies are incorporated into main dish Mexican: acculturation decreased intake of veggies intake of corn-based products are replaced with tortilla based increased milk intake or replaced with low-fat options red meat intake increased, legume intake decreased increased use of fats (butter, margarine, salad dressings) increased use of high-sugar, low nutrient beverages (replacing fruit juice with carbonated sodas) Chinese largest asian American subgroup wheats (northern) rice (Southern) noodles fruits land and sea veggies nuts/seeds soy foods (tofu) nut/seed oils fish shellfish seafood tea, beer Chinese: traditional foods tofu, and soups made form bones, and fish contains small bones contain the most calcium Chinese : acculturation increased intake of wheat-based foods increased intake of raw veggies and replacement of traditional veggies increased fruit intake increased intake of dairy, meat, ethnic dishes, and fast food Chinese nutrition related health risks most foods are cooked, with exception of occasional fresh fruit risk of increased sodium is possible due to salting/drying to preserve foods and use of salt-based condiments raw vegan diet abse don consuming uncooked plant-based foods macrobiotic diet diet is a whole-foods diet based on locally grown plants with occasional fish or seafood the dietary laws for Orthodox Judaism are outlines in the Torah two protestant christian faiths prescribe dietary laws (mormon and seventh-day adventists) the Qur'an contains food laws for Islamic Faith. Foods are either permitted (Halal) or prohibited (haram) hindu and Buddhist religions have values related to not harming living creatures (ahimsa), which lends to followers practicing vegetarianism 17 / 25 during passover, Judaism calls consumption of unleaven bread only islam calls for fasting during Ramadan Roman Catholicism calls for refraining from meat consumption during Lent and to avoid food or beverage intake 1 hr before communion Seventh day adventism recommends a 5-6 hr interval between meals Judaism calls for a 24 hr fast during Yom Kippur Orthodox Judaism prohibits food preparation on the Sabbath cultures that eat specific food to balance forces in the body during healing asian culture Hispanic/Latinx culture donor milk should be considered in certain circumstances: consider infant's age and health the FDA recommends that if an infant is to be fed human milk from a source other than the infants parent, used only from a source that has screened its donors and takes other precautions to ensure safety of the milk nutritional advantages of breast milk carbs, protein, and fats in breast milk are predigested for ready absorption breast milk is high in omega 3 fatty acids breast milk is low in sodium iron, zinc, and magnesium found in breast milk are highly absorbable calcium absorption is enhanced, as the calcium-to-phosphorous ratio is 2:1 breast feeding teaching offered breastmilk immediately after birth. there should be 8-12 feedings in a 24 hr period instruct client to demand-feed the infant and to assess for hunger cues. These could include rooting, suckling on hands and fingers, and rapid eye movement. crying is a late indicator of hunger the newborn should nurse up to 15 min of each breast findings that indicate the newborn has completed a feeding include slowing of suckling, softened breast, or sleeping. eventually the newborn will empty a breast within 5-10 minutes, but might need to continue to suck for comfort do not offer newborn supplements, unless indicated by physician frequent feed (Q2) and manual expression to initiate milk flow can be needed awaken the infant to feed every 3 hrs during the day, and every 4 during the night encourage clients to express breast milk for supplementation if extra fluids or calories are required expressed milk can be refrigerated in sterile bottles or storage bags and labeled with date and time. it can be maintained in the fridge for 24 hr or frozen in sterile bottle for 3 months thaw milk in fridge, can be stored up to 24 hr while thawed do not defrost or heat in microwave do not refreeze thawed milk unused breast milk must be discarded limit alcohol and caffeine begin manual expression or use great pump when infants can't breast feed. 18 / 25 Formula feeding commercial formula is modified from cow's milk if formula fed, an iron-fortified formula is recommended for at least the first 12 months fluoride supplements can be required follow mixing directions bottles of mixed formula open cans need to be refrigerated do not use formula if it has been left at room temp longer than 2 hrs do not reuse partially emptied bottled always give formula at approx. the same temp (chilled, warm, or at room temp) infant should not drink more than 32 oz of formula in a 24 hr period, unless requested by physician bottle feeding had infant, with head slightly elevated tilt the bottle to maintain liquid in the nipple, and prevent swallowing of air do not prop bottle or put infant to bed with a bottle, this will cause tooth decay appropriate finger foods for infants ripe bananas toast strips graham crackers cheese cubes noodles peeled chunks of apples pears or peaches open jars of infant food can be stored in fridge up to 24 hrs do not feed infant honey due to risk of botulism defined as: inadequate gains in weight and height in comparison to established growth and developmental norms (weight-length: less than 5 percentile, weight for age: less than 3 rd percentile) assess for findings of congenital defects, CNS disorders, or partial intestinal obstruction monitor for swallowing or sucking problems identify feeding patterns observe for psychosocial problems high calorie, high protein diet pro vide supportive parenting guidance failure to thrive-nutrition related problems attitudes toward food and general food habits are established at 5 yrs old gain 5-6 lbs a year limit 100 % juice to 4-6 oz/day food serving size is 1 tbsp for each year of age exposure to new food might be needed 15-20 times before child develops acceptance regular meal times & nutritious snacks toddlers prefer finger foods and plain foods snacks/desserts high in sugar, fat, or sodium should be avoided children are at an increased risk for choking until age 4 always provide adult supervision during snacks/mealtime cut small, bite-sized pieces DO NOT allow the child to engage in drinking or eating during play activities or while lying nutrition guidelines for toddlers iron deficiency anemia is the most common nutritional deficiency disorder in children Preschoolers need to consume 13-19 g/day of compete protein tend to dislike strong-tasting veggies like many raw veggies food jags food preferences and patterns are learned form parents then 19 / 25 peers around age 5 encourage daily exercise can switch to skim or 1 % low fat after 2 yrs of age risk for iron defunct anemia and led poisoning occurs because objects are placed on the mouth, and contain led. the chidden have a higher rate of intestinal absorption feed children at frequent intervals because more led is absorbed on an empty stomach. inadequate intake of calories, calcium, iron, zinc, and phosphorus can increase susceptibility led poisoning all adults should exercise at a moderate or vigorous pace for 150 min a week. if not, the adult should be as physically active as tolerated nutritional counseling for older adult clients include: -the need for vitamin/minerals increase -up to 35 % of cals should come from fat -at least 45 % of cals should come from carbs -fruits and veggies should make up half the plate -protein requirements do not increase 6 month old with lactose intolerance. what should the nurse expect? -abd. distention -occasional diarrhea -flatus healthy snack food choices for adolescents carrot sticks with low-fat dip cheese and crackers unbuttered popcorn clear liquid diet: consists of foods & fluids that have no residue and are liquid at room temp primarily used to prevent dehydration and relieve thirst non-gas forming indicated for: acute illness, reduction of colon fecal material prior to certain diagnostic tests and procedures, acute gastrointestinal disorders, and some postoperative recovery acceptable foods: water, tea, coffee, fat-free broth, carbonated beverages, clear juices, clear juices, ginger ale, gelatin full liquid diet consists of food that are liquid at room temp. requires supplementation of cals/protein is used more than 3 days many dietary manuals have removed the diet pureed diet composition and consistency of diet varies depends on patient needs adding broth, gravy, milk, cream, soup, tomato sauce, or fruit juice will provide nutritional value and additional calories each food is pureed separately to preserve individual flavor indicated for: clients who have chewing or swallowing difficulties, oral or facial surgery, and wired jaws soft diet foods that are low in fiber, lightly seasoned, and easily digested food supplements or snacks in between meals add calories smooth, creamy, crisp food textures predisposes client to constipation indicated in: acute infects, difficulty chewing, GI disorders mechanical soft diet foods that require minimal chewing before swallowing (ground meat, canned fruits, softly-cooked veggies) butter, gravies, sugar, or honey can be added to increase calorie intake excludes harder foods indications: limited chewing abilities, dysphagia, poorly fitting dentures, and clients with no teeth. Surgery to head neck or mouth. and strictures of the intestinal tract nurses should assess for the return of bowel function, before advancing a clients diet. auscultation of bowel sounds and flatus 20 / 25 discontinue NPO, advance diet as tolerated chicken broth & cranberry juice When is EN contraindicated? when the GI tract is non-functional (paralytic ileus or intestinal obstruction) when is EN administered (what circumstances) burns, trauma, prolonged intubation, eating disorders, radiation therapy, chemotherapy, liver or renal dysfunction, infection, IBD, neuromuscular repaired, and those who cannot chew or swallow food when the infant is too weak for sucking, unable to coordinate swallowing, and lacks a gag reflex. why is EN feeding or Gavage feeding used for an infant? gavage feeding is implemented to conserve energy when an infant is attempting to breast feed or bottle feed, but becomes fatigued, weak, or cyanotic nasoduodenal tube tube passes from the nose through the stomach and in the end in the jejunum nasojejunal tube passes from the nose through the stomach and end in the jejunum for an infant, a feeding tube is inserted from the nares or mouth into the stomach. This flexible tube can remain taped in place for up to 30 days Ostomies placed for clients requiring long term enternal feeding, who are at high risk for aspiration or when nasal obstruction that makes insertion through the nose impossible ostomies are surgically created openings (stoma); can be used to dleiver feedings directly into the stomach or intestines gastrostromy tube endoscopically or surgically inserted into the stomach. feedings are usually well-tolerated PEG tube placed with endoscope skin-level gastrostomy tube, "low profile" fully immersible in water, longer-lasting, and comfortable checking residual is difficult Jejunostomy tube (J-tube) tubes are surgicall placed into the jejunal portion of the small intestine ET tube feedings standard formulas ET tube feedings Elemental formulas polymeric or intact composed of whole proteins (milk, meat, eggs) or protein isolates they require a functioning gastrointestinal tract most provide 1-2 cal/ml made up of nutrients that are partially or fully hydrolyzed or broken down made for partially functioning GI tract, impaired ability to digest, and absorb food provide 1-1.5 cal/ml high cal formulas provide: 1.5-2 cal/ml Packaging for ET formulas: packed in cans or prefilled bags discarded every 24 hours cans can be used to add formula to a generic bag to infuse via pump or the feedings directly from the syringe calorie density determines the volume of the formula necessary to meet the caloric needs of a client (1-1.2 cal/ml) water content should be 850 ml/ 1L of formula higher-cal formulas have lower water content the client may need additional water for hydration osmalality determined by the amount of dissolved particles of sugar, amino acids, and electrolytes increased when the formula contains more digested formula 21 / 25 lactose free predigested formulas are high in osmolality too fiber and residual content hydolyzed formulas-residue free standard formula-low residue continuous infusion method - administered at a continuous rate over 24 hrs -infusion pumps help ensure consistent rates many facilities require measuring every 4-6 hrs -feeding tubes should be flushed every 4 hrs with 20-50 ml of warm water (keeps tube patency and hydration) policy for withholding feedings because of GRV: -more than 250 ml on two consectutive measurements for adults -more than 1/4 th the prescribed volume for children Cyclic feedings -formula is administered at a continuos rate for 8-20 hrs, often during sleeping hours -used for transiiton from total EN to oral intake Intermittent tube feedings -administered ever 4- 6 hrs in equal protions of 250-400 ml, typically over 30-60 min time frame by gravity drip or electronic pump feeding times can range from 20-90 minutes used for noncritical patients, home tube feedings, and clients in rehab feeding resmebles normal pattern of nutrient intake bolus feeding uses large syringe attached to feeding tube a large volume of formula (700 ml max, usual volume is 250-400 ml) is administered over a short perid of time (5-30 min) four to six times daily the rate of administration for a premature or small infant should be no greater than 5 ml every 10 minutes, and 10 ml/minute in older infants and children bolus feedings are delivered directly into the stomach they are contraindicated for Jtubes an duodenun tubes can be poorly tolerated and cause dumping syndrome client prep for ET feedings measure the tube each shift and prior to each feeding verify the prescence of bowel sounds to maintain tube patency, flush it routinely with warm water check gastric residual if required every 4-6 hrs returning residual contents to the stomach prevents electrolyte and fluid imbalance. however, returning large volumes could increase the risk for complications elevate HOB to at least 30 degrees, and for at least 30-60 min after the feeding administer feeding at room temp, prevents gastric discomfort DO NOT heat in microwave baseline parameters for ET feeding obtain ht, wt, and BMI monitor: BUN, H+H, glucose, and electrolyte levels verify GI function ongoing care for an ET tube - monitor I+O and daily weights obtain GR every 4-6 hrs monitor electrolytes, BUN, creatinine, minerals, CBC monitor site for infection monitor bowel movements feeding should be STOPPED prior to administration of meds tube should be flushed with 15-30 ml of water after meds are admin. liquid medications should be used when possible for infant/child- the volume of water to flush is 1.5 X the amount predetermined to flush an unused feeding tube the same size - begin by stopping the EN 1 hr before the meal slowly increase the frequency of meals, until client is able to eat 22 / 25 transitioning from EN to oral diet six small meals a day when oral intake = 500-750 cal/day, the continuous tube feeding is administered only during the night GI complications during EN feedings: nurse actions -consider a change in formula -decrease the flow rate or total volume of infusion -increase the volume of free water if constipated -adminster the EN at room temp Refeeding syndrome potentailly fata complication that occurs when a client who is in a starvation state is started on eternal nutrition. fill generic bags of formula with only 4 hrs worth a nurse is providing bolus internal feeding to a client who has malnutrition. what are some nurse interventions? -flush feeding tube with warm water -verify presence of bowel sounds -administer feeding at room temp TPN used for long-term therapy or when solution to be admin. is hypertonic (composed of greater than 10 % dextrose) nutritonally complete solution can only be administered through the central vein PPN administered for up to 14 days into a peripheral vein low dextrose content nutritionally complete short-term, with fewer cals/day the solution must be isotonic and contain no more than 10 % DEXTROSE AND 5 % AMINO ACIDS what are the components of a parenteral solution - carbs/dextrose electrolytes, vitamins, trace elements lipids (IV lipids are contraindicated in patients with hyperlipidemia, severe hepatic disease, or an allergy to soybean oil, eggs, or safflower oil) protein insulin can be added to prevent potential hyperglycemia heparin can be added to preven fibrin buildup glutamin, antioxidants, prebiotics, and probiotics might be prescribed prealbumin level 15-36 prep for a client who is recieving PN review weight, BMI, nutritional status, diagnosis, and labs assess the clients educational needs use electronic infusion device a micron filter on the IV tubing is required when administering PN solution, the filter is not added to IV tubing when administering a lipid emulsion eval allergies to soybeans, safflower, eggs, if lipids are prescribed maintain strict aseptic tech. ensure lipid infusion is stopped 12 hr before obtaining a blood specimen for triglycerides discontinuation of PN solution should be done gradually this prevents rebound hypoglycemia complications of PN infection and sepsis metabolic complications and fluid overload mechanical complications refeeding syndrome (shallow respirations, confusion, seizures,weaknes, cardiac rhythm changes, fluid retention, acidosis a nurse is planning for a client who has a new prscription of PPN, which of the following should the nurse include in her plan of care (answers) -examine trends in weight loss -review prealbumin finding -add micron filter to IV tubing -use an IV infusion pump -concentration of lipid emulsion can be up to 30 % -adding lipid emulsion gives the solution a milky appearance 23 / 25 a nurse is providing info about fat emulsion added to TPN to a group of nurses. which of the following is an appropiate response (answers) -check for allergies to soybean oil -lipid emulsion prevents essential fatty acid defiency how to administer certrain meds with a patient taking TPN -heaprin-injected directly into port a nurse is caring for a client who is recieving TPN through central -administer 20 % dextrose in water IV until the next bag is ready venous access device, but the next bag of TPN is not available. to prevent hypoglycemia what should the nurse do? a nurse is planning care for a client who is recieving treatment for malnutrition. The client is scheduled for discharge to their home where they live alone. what should the nurse include? -encourge pt to purchase nonperishable boxed meals -advise pt to buy frozen fruits and veggies -recommend drinking a supplement in between meals -educate the client on how to read nutrition labels nursing care for mech. fixation of the jaw -encourage of fluids -help the client determine where to insert a straw through a space between the jaws -work with dietician to prepare a liquid diet children who have low iron intake can experience shorrt attention span and display poor intellectual performance before anemia begins Vitamin B deficient anemia -pallor jaundice weaknes/fatigue -glossitis 0anorexia indigestion weight loss decreased concentration paresthesia (numbness) of hands and feet decreased sense of body position poor muscle coordination increased irritablilty delirium therapeutic nutrition for CHD high fiber, low cholesterol diet excercise and weight management cholesterol intake should be less than 200 mg/day saturated fat should be limited to less than 7 % daily trim visible fats from foods limit red meats, choose lean (turkey, chicken) remove skin from meat broil, bake, steak, or grill low fat or non fat dairy use spices in place of butter use liquid oils (olive or canola) avoid trans fat increase intake of oily fish therapuetic nutrition for hypertension -decrease sodium (canned soups/sauces, potato chips, pretzels, smoked meats, seasoning, processed foods) -low fat dairy fruits and veggies rich in K + (apricots, bananas, tomatoes, potatoes) limit drinking heart failure- therapuetic nutrition reduce sodium intake monitor fluids (possibly restric to 2 L/day or less) increase protein intake to 1.12g/kg small, frequent meals that are soft, easy to chew therapeutic nutrition for MI liquid diet is best for first 24 hrs aftre infarction avoid caffeine small, frequent meals heart-healthy diet 24 / 25 natural sources of vitamin b 12 fish, meat, poultry, eggs, milk folic acid sources green leafy veggies dried peas and beans seeds orange juice cereals and breads fortified with folic acid GERD-client education avoid tight fitting clothing avoid eating 3 hrs before lying down attempt weight loss elevate body on pillows avoid caffeine, fatty foods, chocolate, alcohol, smoking, peppermint/spearmint avoid trigger foods adjustable gastric banding restricts stomach capacity to 15-30 mlwith an inflatable band that incircles the uppermost portion of the stomach. roux-en-Y-gastric bypass ingested food bypasses 95 % of the stomach, duodenum, and a small portion of the proximal jejunum. weight loss is achieved through malabsorption and dumping syndrome sleeve gastrectomy longitudinal portion of the stomach is removed to create a "sleeve" a nurse is caring for a patient who is recovering from pancreatitis. which of the follwoing foods should the nurse recommend? oatmeal, canned peaches, pretzels a nurse is collecting data on a client who has PUD. what should the nurse expect? anemia, tarry stools, epigastric pain a nurse is planning care for a client who has ESKD. what should the nurse include in her plan of care -monitor weight daily encourage client to comply with fluid restrictions eval I+ O monitor for constipation a nurse is teaching a client on dialysis about protein needs. what should be included: consume 35 kcal/kg of body weight increased biologic sources of protein (eggs, milk, soy) take phosphate binders with protein rich food a nurse is talking with a client who has a new diagnosis of diabetes mellitus type 2. which of the following should the nurse include as a zero-cal sweetner? aspartame sucralose dietary teaching for patient with type 2 diabetes -carbs should compromise 55 %of daily calorie intake -you can add table sugar to cereals -eat something if you choose to drink use same portion sizes to exchange carbs nutritional guidelines for cancer prevention eat foods high in vitamin A add cruciferous veggies a nurse is collecting data from a client who has suspected HIVassociated wasting. What supports this diagnosis? report of fever for 30 days 25 / 25