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NUTRITION D440 STUDY MATERIAL
2025 UPDATED GRADED A+
Role of RN (Registered Nurse) - Solution - assess pt for clinical manifestations of fluid and electrolyte disturbance -determine if ordered IV therapy is appropriate
- choose appropriate catheters/ infusion devices Role of LPN/LVN - Solution -administer IV fluids and meds to stable pts -adjust the flow rate for stable pts according to HCP orders -Insert IV catheters -monitor clinical manifestations of adverse reactions to IV fluids or meds Role of Unlicensed Assistive Personnel (UAP) - Solution -Measure and record oral intake and output -report swelling or redness at the IV site -report pt complaints of discomfort at IV site to the RN General Dietary Management - Solution -MNT will depend on pt nutrition status when they arrive, the metabolic results of condition, the pt ability to eat food -routine IV fluids are used to supply hydration needs and electrolytes but CANT sustain energy and nutrient balance. PT would need 10x the amount. -for pt only recieving IV fluids, they should return to regular eating and maintain as tolerated intake and output (I&O) - Solution used to evaluate fluid balance whereby intake and output are measured and documented 3 METHODS OF NUTRITIONAL SUPPORT - Solution -regular, enteral, parenteral nutrition enteral nutrition - Solution Indications: -impaired nutrient INGESTION (inadequate eating/malnutrition) -wasting -GI is functioning
-allows gut preservation (the gut is functioning normal and we want to prevent it from declining) -prevents atrophy of the stomach TYPES: -NG TUBES: less than 4 weeks (ends in stomach) -duodenal/jujenum (ends there) -PEG and PEJ (nurse don't put this in) (long term) Administration types: cyclic, intermittent, bolus, continuous Aspiration precautions: sit HOB 30-45 Degrees before and after feedings Immediate measures to take: NEX, make a mark Verify placement via chest XR before administration Conditions that require it: -dysphasia, conditions preventing oral nutrition, coma, hyperemesis gravidarum, severe anorexia nervousa, malnutrition Nurse considerations: s/s diarrhea, vomiting, abdominal distention, overall gastric motility -you can give meds through the NG and PEG tubes you are going to crush them, make sure to flush with water (document intake) Parenteral Nutrition - Solution administration of nutrients intravenously TYPES: Peripheral (PICC into arm into vena cava.. some nurses can insert this) , central line (TPN...inserted by surgeon) Indications: -GI incompetence -critical illness -last resort Nurse considerations: -If bag goes dry and need a refill, without pt special prescribed formula, you will need to give 10- 20% of Dextrose until it arrives to prevent a HYPOGLYCEMIC CRISIS
-Follow with snack that contains complex carbohydrates FOODS: -6-7 hard candies (life savers) -8 oz of milk (15 g of carbs) -4 oz of regular not DIET soda HYPOGLYCEMIA S/S - Solution BG<70 mg/dL -caused by too much insulin in the blood , decreased food intake w inadequate food intake, excercise, excess alcohol -S/S: -hunger, irritability, confusion, cool and clammy skin, pale/coldclammy—> seizure/ coma -15/15 rule if pt is conscious!!! Routine Hospital Diets: Clear Liquid Diet - Solution -Soup -clear fatfree broth, bullion -Fruit and fruit juices that are strained -Desserts and Gelatin -fruit flavored gelatin, fruit ices, popsicles -soft drinks (as tolerated) -coffee -tea -honey -salt -hard candy Routine House Diets: Full Liquid Diet - Solution -soup -same as clear, plus strained or blended cream soups -cereal -cooked, very thin , refined cereal -protein foods -milk,creamers, milk drinks, yogurt -veggie juices or pureed veggies -fruit/fruit juices -fruit juices -desserts and gelatin
-same as clear, plus sherbet, icecream, puddings, custards, frozen yogurt, margarine Routine House Diets: Mechanical soft - Solution -soup -same as clear and full, plus all cream soups -cereal -cooked cereal, corn flakes, noodels, macaroni, spaghetti -Bread -white bread, crackers, melba toast -Protein foods -same as full plus eggs, mild cheese, cottageg and cream, cheeses poultry, fish tender beef, veal, lamb liver -Veggies -potatoes:baked, mashed, creamed, steamed, scalloped -tender cooked veggies -fresh lettuce and tomatoes Low residue foods - Solution Uses: reduces bulk, A low residue diet is typically recommended for people with inflammatory bowel disease (IBD) flares, for bowel surgery and colonoscopy prep, and for people with infectious colitis or acute diverticulitis. FOODS: -ripe bananas -COOKED veggies -spaghetti/pasta -milk, yogurt, custard, icecream -white bread (without nuts / seeds) -french toast -white rice high residue foods - Solution -development of bulk, the high fiber-high residue diet is often prescribed for the treatment of constipation, diverticular disease during non-acute phase, colic and irritable colon may respond to moderate increases in fiber. The high fiber-high residue has been suggested. -graham crackers -cornbread -granola type cereals -apples
Low Purine Diet - Solution Indication: reduce uric acid levels for gout flareup prevention and pain from the arthritis associated with it. FOODS TO EAT: -veggies, fruit, milk, grains (except oats) -rice, pasta, cereals -meatless soup -eggs, nuts peaunt butter
FOODS TO AVOID: BEER/LIQUOR MEATS: organ meats, liver SEAFOOD: sardines, anchovies SAUCES: gravy Periodontitis (Mouth Inflammation) Diet & foods to avoid - Solution FOODS: -Vitamin C (healing) foods: guava, strawberries, oranges other citrus, tomatoes, leafy greens, milk, yogurt, cheese -nuts and seeds -Omega 3 polyunsaturated FAs (leafy greens, fish , veggie oils) -Vitamin D (assists with calcium absorption) -calcium AVOID: Sugary foods, drinks, sports drinks, acidic foods, coffee , potato chips, fruit juices, sodas PROBLEM; thirst and oral dryness - Solution Solution: lubricate lips chew sugarless gum brush teeth rinse mouth frquently PROBLEM: tube discomfort - Solution Solution: gargle w warm water/mouthwash blow nose
clean tube with water lubricant request smaller tubing PROBLEM: tension and fullness - Solution Solution: relax and breathe deeply after each feeding PROBLEM: Reflux/aspiration - Solution Solution: life head of bead (HOB) 30-45 degrees PROBLEM: Constipation - Solution Solution: use fiber containing formula assess for adequate fluid intake PROBLEM: nausea - Solution - aspirate gastric residue -nausea can be a sign of delayed gastric emptying -the nurse should aspirate the pt gastric residue to check the volume. -based on volume, place feeding on hold, have rate decreased or continue -do NOT lower HOB -kinks in tube causes blockage NOT nausea PROBLEM: Diarrhea - Solution Solution: antidiarrheal meds if bacterial infections ruled out avoid sorbitol/ hypertonic solutions continous instead of bolus Problem: Edema - Solution -Edema is an excess accumulation of fluid in the interstitial space; it occurs as a result of alterations in oncotic pressure, hydrostatic pressure, capillary permeability, and lymphatic obstruction -the kidneys play a major role in controlling balance and fluid and electrolytes -edema is caused by fluid volume excess -edema can be r/t smoking, CHF, CVD, kidney disease, lung disease, metabolic problems, severely overwt, pregnancy, poor nutrition -protein tends to pull water in the blood vessels so if you're deficient it can cause the fluid to go into the ICF and cause you to swell -if blood volume is diluted with too much water (hypervolemia) the water moves into the ICF causing edema and also hyponatremia (low sodium in the blood)
-rice -yogurt -eggs -sesame seed bun and lentils Metabolic syndrome - Solution a medical condition associated with obesity, diabetes, high cholesterol, and hypertension. It's characterized by obesity, insulin resistance, and increases risks of other ailments (stroke, heart disease, diabetes) -S/S: HTN , increased LDL and triglycerides, decreased HDL (good cholesterol), increased waist circumference Bariatric Surgery - Solution surgical reduction of gastric capacity to treat morbid obesity -MONITOR: -S/S of dumpling syndrome -> abdominal cramping, tachycardia, nausea, diarrhea, diaphoresis (sweating).. just thinking stomach is cut smaller so time that food travels is even faster -PT: -chew food slower and completely -eat 6 small meals a day -do NOT drink liquids with meals -recline HOB after meals to slow gastric emptying -avoid sugary foods, fat, and carb foods -take vitamins/supplements as needed Peritoneal Dialysis - Solution -procedure for removing toxic wastes when the kidney is unable to do so -monitor serum albumin levels because pt is at risk of excessive protein loss so they'll need higher intake of protein DIET: High protein, low calorie hypertension (HTN) - Solution DASH diet: high in whole grain, low fat dairy, calcium, potassium, Magnesium -low in red meat, sweets and sugary beverages -low in sat and trans fat -less than 1500 mg sodium
-use herbs over seasonings Watch out for potassium salt subs (Mrs DASH) -onion powder, garlic powder Waist circumference men is more that 40 in , women 35 - Solution a way to assess and classify a pt weight health risks increase if the waist circumference is greater than 40 in in men and 35 in in women -BMI may not be the ideal means of assessing health risks associated with weight. To increase accuracy of assessing chronic disease and mortality risk, the use of waist circumference is included because the greater the amount of adipose tissue stored within the abdominal region, the higher the risk for disease and all-cause mortality. pt who have visceral fat with truncal obesity are increased risk of CVD & Metabolic syndrome Aspiration pneumonia causes - Solution decreased LOC (seizure, anesthesia, head injury, stroke, alcohol) difficulty swallowing insert of NG tube without tube feeding gag and cough reflexes are depressed Strategy for TYPE ONE diabetes - Solution -dont decrease energy intake -increase frequency and number of feedings -have planned food to prevent low BG -extra food for unusual exercise
GERD Diet therapy - Solution -decrease alcohol, chocolate, fat intake -avoid smoking -increase protein intake for healing PEPTIC ULCER diet therapy - Solution -increase iron in diet r/t blood loss from ulcers -increase protein and vitamin C for healing -small frequent meals -avoid meds like aspirin, ibuprofen
-decrease fats and red meats Renal failure diets - Solution - high calorie, high carb, low protein -control sodium, potassium and phosphorus -may be on a low protein diet, low sodium and potassium diet r/t the kidneys not being able to secrete it -Foods could include: -avoid salt substitutes bc high in potassium pregnancy dietary recommendations - Solution increase protein, iron,folate, increase calories, fruits veggies (apricots) AVOID: -avoid fish high in mercury
- soft cheeses, cold meats (listeria) -shellfish -herbal supplements (unless prescribed), -soft-scrambled eggs (r/t Salmonella) Low calcium diet - Solution FOODS -baked chicken -mashed potatoes FOODS TO AVOID -pudding made w dairy -vanilla icecream w chocolate syrup -cheese 2 G sodium restricted diet - Solution -for pts who need to limit the total amount of sodium they eat or drink to 2 grams (2000 mg) daily. -keep in mind that one teaspoon of salt contains 2300 mg of sodium so pt need to take in less than that. -this diet can manage heart disease, Hypertension, kidney disease, poor liver functioning, wt gain from water retention (leg swelling) -always recommend to the pt to read the nutrition facts label
FOODS/ advice to RECOMMENDED LOW SODIUM: -don't add salt, use herbs (fresh garlic, onions, lemon juice)
-Mrs. Dash (salt free) alternative * be mindful of potassium alternatives for pts who should also be restricting their potassium lvls FOOD BREAKFAST -OJ, coffee, tea, low fat milk -hard boiled egg, seven-grain toast, jam/ jelly LUNCH -low sodium pea soup -turkey sandwhich (low sodium turkey breast) -lettuce & tomato, mustard, mayo -fresh fruit SNACKS: Graham crackers, no salt added peanut butter DINNER: baked salmon, broccoli, carrots 2G sodium restricted diet (CONT) - Solution -FOODS to avoid/ limit DAIRY -buttermilk -milk -yogurt -ice-cream -instant cocoa mixes -Cheese: American, Swiss, cottage MEATS/FISH -smoked, cured, dried, pickled, canned -frozen processed meats -deli meats (frankfurters, bologna) -sardines, canned tuna STARCHES/ BREADS -breads, rolls, crackers w added salt -ready-2-eat cereals -pizza VEGGIES -veggie juices -pickles -olives -tomato juice -canned soups/ broth, bouillon
(musculoskeletal disorder) - Solution -a type of inflammatory arthritis, buildup of uric acid in the blood -If you produce too much uric acid or your kidneys don't filter enough out, it can build up and cause tiny sharp crystals to form in and around joints. These crystals can cause the joint to become inflamed (red and swollen) and painful. FOODS TO AVOID: -red/organ meat -fish: anchovies, sardines, shell fish, shrimp, lobster -fructose drinks -alcohol/beer -yeast -gravy -foods high in fat FOODS TO CONSUME: -cheese -low fat/ fat free dairy -yogurt -eggs (moderation) -salmon (moderation) Nursing interventions for obese - Solution if pt is overweight, recommend low-calorie diet -recommend decreasing saturated animal fats and increasing polyunsat (veggie oils) -teach to limit cholesterol to less than 300 mg/d -encourage to use food labels to see sodium content of foods (limit nacl to less than 4 g/d) -limit processed/ refined sugar -encourage intake of fresh fruits, natural carbs, fish, poultry, legumes, fresh veggies, and grains of healthy balanced diet NG TUBE: pt begins to cough, gag, choke WHAT TO DO? - Solution - withdraw slightly DO NOT REMOVE and stop tube advancement. -instruct patient to breathe and take sips of water to ease the gagging and reduce risk of aspiration
Vitamin A (Retinol, Beta-carotene) functions - Solution Functions: -helps with vision -major task of the retina in the eye. Rhodopsin helps the eye to adjust to different levels of light -growth/cell growth -retinoic acid and retinol are involved with in skeletal and soft tissue growth through both of their roles in protein synthesis and cell membrane stabilization -the constant need to replace old cells that are in the bone matrix requres and good amnt of VitA -tissue strength -these tissues (skin, gi tract, eyes, throat, etc) act as a barrier to primary infection -immunity
- serves as an antioxidant to prevent free radical damage -helps w the production of immune cells to fight back viral attacks in the body Vitamin A (Retinol, Beta-carotene) Foods - Solution -two basic forms of vitA found in foods (preformed vit A/ retinol and Provitamin A or Betacarotene) ORANGE/YELLOW VEGGIES: -orange veggies (carotene pigments that carry no oxygen) -yellow veggies and fruits (does carry O2) -carrots -apricots, tangerine -pumpkin -squash butternaut -melons -sweet potatoes/yams -cantaloupe -mango, grapefruit, watermelone ORGAN MEAT:
-hypervitaminosis -s/s -bone pain -dry skin -fatigue, anorexia, hair loss -liver injury & ascites (fluid accumulation) because it is mostly metabolized by the liver ***TERATOGEN: pregnant pt shouldnt take acne treatments that have high vitA because it is contraindicated in pregnancy. (ex. Retinol, Retin-A).. can cause miscarriage/ birth defects Vitamin D (Calciferol) Functions - Solution Function: -helps with calcium absorption/ reabsorption because at the bone, the PTH acts with active vitamin D (calcitriol) to release calcium into the bones -helps w phosphorus absorption/and reabsorption -Sunlight allows the body to absorb vitamin D through the skin -bone mineralization -homeostasis of calcium and phosphorus -immune function, neuromuscular function, cell proliferation, differentiation, apoptosis Vitamin D (calciferol) Foods - Solution MEATS: -Beef liver -egg YOLK -red meats **SEAFOOD (oily fish): -salmon sockeye -mackerel -tuna fish -swordfish -whitefish -sardines -fish oil -cod liver LEGUMES:
-cashews -hazelnuts JUICE: -orange juice (fortified vit D) GRAINS: -Fortified cereals DAIRY PRODUCTS: -soy milk (vitamin D fortified) -low-fat milk -rice milk Vitamin D (cholecalciferol) DEFICIENCY TOXICITY - Solution DEFICIENCY: -related to lack in diet, poor absorption, not having metabolic need for higher amounts, not enough sun exposure for long periods -people who have inflammatory bowel (gut) diseases/ surgeries (ulcerative colitis, chrons disease, gastric or stomach bypass surgery) that affect absorption of dietary fat (vit D is fat soluable) -S/S DEFICIENCY: -rickets (soft long bones) in children preventing children from reaching their peak bone mass -Osteomalacia in adults if left untreated in children but can be reversed with supplementation -osteoporosis (porous bones, brittle)--condition is irreversible VITAMIN D TOXICITY: -S/S: -anorexia -weight loss -irregular heart beat -hardening of the blood vessels and tissues due to increased blood levels of calcium (d increase % of damage to the heart and the kidneys) -fragile bones -calcification of soft tissues
