flash cards

Chapter 46 Nutrition

Term Definition Nutritional requirements depend on • Age • Gender • Level of activity • Pregnancy/lactation According to MyPlate, what amount of vegetables should an average adult include in the daily diet? 2? cups Set of four reference values • Estimated Average Requirement (EAR) • Recommended Dietary Allowances (RDAs) • Adequate Intake (AI) • Tolerable Upper Intake Level (UL) Recommended Dietary Allowances (RDAs) List average daily dietary intake levels sufficient to meet nutrient requirements of healthy individuals in a group Recommended to maintain BMI range range of 18- 25 Physical activity levels recommended • low—30 minutes daily • Moderate intensity—60 to 90 minutes daily • High intensity—20 to 30 minutes four to seven times weekly Macronutrients— carbohydrates, fiber, fats, proteins needed to provide energy Kilocalories (kcal): measure of energy Daily caloric needs • 45% to 65% of calories should come from carbohydrates • 20% to 35% of calories should come from fats • 10% to 35% of calories should come from proteins Carbohydrates —sugars; major source of energy • Simple = monosaccharides and disaccharides • Complex = polysaccharides. Major source of energy • Dietary fiber —derived from plant sources • • Total fiber = dietary fiber + functional fiber Functional fiber —indigestible carbohydrates • Sources of fiber —cereal bran and vegetables • Total fiber = dietary fiber + functional fiber Fats: lipids ; body’s major form of stored energy Monounsaturated —decrease LDL; increase HDL Polyunsaturated —decrease LDL; increase HDL Saturated —increase LDL; increase HDL Trans— increase LDL; decrease HDL Proteins: molecules composed of amino acids• Essential—from external sources • Nonessential—can be synthesized Which food contains trans fats? c) Stick margarine • Water-soluble (9) vitamins C, B1, B2, B3, B5, B6, B12, folic acid, biotin Fat-soluble (4)— vitamins A, D, E, K Water accounts for 60% to 83% of body weight Marasmus —lack of calories and protein Kwashiorkor —protein deficiency Mixed kwashiorkor-marasmus —inadequate protein and wasting of fat stores and muscle Physical changes • Muscle atrophy; dry, dull hair; dry, flaky skin; fat depletion in waist, arms, legs; edema Nutrition supplementation • Enteral —administered orally or through feeding tube Nutrition supplementation • Parenteral —administered intravenously COMMON LABORATORY TESTS • Prescribed before initiating parenteral or enteral feeding Blood tests: serum prealbumin; albumin; urea nitrogen; creatinine; electrolytes; hemoglobin; hematocrit; lipids; liver function studies; glucose; total lymphocyte count; ferritin; transferrin • Urine tests: specific gravity; ketones NURSING PROCESS: NUTRITIONAL HISTORY • Socioeconomic factors • Cultural/religious factors • 24-hour recall of foods and fluids taken • Physical conditions that alter patient’s ability to swallow and ingest food, risk of aspiration PHYSICAL CHANGES RELATED TO MALNOURISHMENT • Height, weight, skinfold thickness • Skin integrity, muscle mass, fat distribution • Cardiovascular alterations • Respiratory alterations • Neurologic alterations • Abdominal/GI alterations • Thyroid function ENTERAL FEEDING • Actions Provide nutrients through GI tract by nasogastric, nasoduodenal, or nasojejunal tube, feeding gastrostomy or jejunostomy ENTERAL FEEDING Uses • When oral consumption is either inadequate or contraindicated (e.g., neck surgery, esophageal obstruction, stroke, etc.) ENTERAL FEEDING • Common adverse effects effects include Hyperglycemia ENTERAL FEEDING Serious adverse effects effects include Pulmonary complications, diarrhea, constipation, hypersensitivity ENTERAL FEEDINGS Check tube placement and residual volume before each bolus or q 4-8 h for continuous feedings. If residual volume exceeds 100 mL, hold and recheck in 1 hour, resume feeding if < 100 mL ENTERAL FEEDINGS • Provide prescribed amount, type, strength and rate of administration, beginning at lower rates • Monitor weight, I&O, labs to determine effectiveness ENTERAL FEEDING • Change tube feeding apparatus, usually every 24 hours • Prevent bacterial contamination – Store in clean, cool place – Formula usually safe for 12 hours, some agency policies call for shorter hang time PARENTERAL FEEDING Actions • Provide balanced combination of carbohydrates, amino acids, essential fats PARENTERAL FEEDING Uses • Inability to take nutrition enterally for 7 days; intractable vomiting and diarrhea; malabsorption syndromes; bowel surgery; coma; massive wound or burn healing PARENTERAL FEEDING Common adverse effects effects include • Hyperglycemia PARENTERAL FEEDING Serious adverse effects effects include • Hypoglycemia, fluid and electrolyte imbalance Total parenteral nutrition • Orders formulated daily based on patient’s weight, fluid and electrolyte balance • Peripheral parenteral nutrition (PPN) administered using the peripheral veins • Central parenteral nutrition (CPN) administered using central veins Which type of nutrition is delivered through an intravenous line? b) Parenteral MONITORING PARENTERAL FEEDING • Double-check solutions for exp date and bottle # • Check tubing, connections, and flow rates to avoid air embolism or contamination • Assess iv access site for redness, swelling, drainage • Observe for fluid and electrolyte imbalances, hyperglycemia HOME CARE NEEDS FOR PARENTERAL AND ENTERAL NUTRITION • Monitor blood glucose regularly • Assess for refeeding syndrome • Monitor weight, vital signs, required laboratory tests • Have next container of solution prepared • Do not “push” TPN if it gets behind schedule MEDICATION ADMINISTRATION TO THE TUBE-FED PATIENT • Determine tube placement • Administer each drug separately • Stop formula and flush tubing with 15 to 30 mL water • Administer prescribed med, one crushed med at a time, suspended in warm water, then 5-10 mL water • Flush tube with 15-30 mL of water MEDICATION SAFETY: TUBE MEDS • Do not add medications directly to formula • Do not crush enteric-coated, chewable, or SL tablets; obtain liquid form of medications • Do not crush slow-release tablets COMMON ADVERSE EFFECTS OF TUBE FEEDINGS • Pulmonary complications, aspiration • Diarrhea or constipation • Nausea, vomiting, increased residuals • Hypersensitivity • Drug interactions (numerous) enteral tube feeding order of procedure 1. place in fowlers 2. verify placement 3. check residual 4. flush with 30 cc. ** portion size matters when looking at calories of my plate. constipation. calcium can cause degree to which glycemic index is effected baked potato – index of 90 sweet corn – index of 60 diet all about portion control. pancreatitis causes blood glucose to go up. albumin should be > 3.5 and < 5.5 source of zinc beef patty

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