Nutrition - Part 2
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| Act as catalysts in biochemical reactions | minerals
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| Grains | 6 oz every day
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| Vegetables | 2 ½ cups each day
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| Fruits | 2 cups every day
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| Milk | 3 cups every day
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| Meat and Beans | Eat 5 ½ oz every day
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| Vegan, Zen macrobiotic | brown rice, grains, herb tea only
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| Islam | no pork, alcohol, caffeine
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| Hindu | no meat, alcohol
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| Judaism (orthodox) | no pork, predatory fowl, shellfish, require kosher food preparation, no milk w/ meat
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| LDS (Mormon) | no alcohol, tobacco, caffeine
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| 3-5 day food diary more accurate than recall Why? | more accurate and give actual picture of what they eat.
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| Anthropometry | a measurement system of the size and makeup of the body - measurements that help in identifying nutritional problems include the ratio of height to wrist circumference, mid-upper arm circumference
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| A client is considered overweight if the BMI is | 25 to 30
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| Metabolic half-life of albumin is __ days | 21
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| Metabolic half-life of transferring is __ days | 8
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| Metabolic half-life of prealbumin is __ days | 2
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| Metabolic half-life of retinol binding protein is __ hours | 12
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| Common lab rests used to study nutritional status | plasma proteins (albumin), transferring, prealbumin, retinol binding protein, total iron-binding capacity, and hemoglobin.
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| Factors that affect serum albumin levels include | hydration, hemorrhage, renal or hepatic disease, drainiage from wounds, drains, burns, GI
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| Albumin level is a better indicator for | chronic illness
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| Prealbumin level study is preferred for | acute conditions
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| Nitrogen balance is important to establishing | serum protein status
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| A positive ___g nitrogen balance is necessary for anabolism. | 2-3 g
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| Negative nitrogen balance is present when __ states exist. | catabolic
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| BMI over __considered obese | 30
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| When should you weigh patients? | In the morning after they have voided to do a “dry weight”
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| I & O is often inaccurate – Why? | because the measurement is somewhat subjective and open to numerous errors of measurement. Inaccurate readings, insensible water loss, forgetting to record intake and output.
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| Who might require fluid restriction? | renal patients, liver patients, SIADH
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| Minimum fluid output should be half a ml/kg/hour | means their kidneys are adequately perfusing
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| What might cause an increased fluid output? | diuretics, diabetes insipidus, diarrhea, shock
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| What are 5 s/sx you may see in someone who’s nutritionally impaired | basic signs like – pale, underweight, anorexic, tired, dry skin, constipated, confused, irritable, nails (spoon shaped for iron deficiency).
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| RUMBA | Realistic, Understandable, Measurable, Believable, and Achievable.
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| Diabetic diet (ADA) | calories per MD – Recommended food exchanges by the American Diabetic Association - around 1800 calories. The diet needs to include a balanced intake of carbohydrates, fats, and proteins.
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| Low cholesterol | common with cardiac patients, ordered by physician, foods low in cholesterol - less than 300 mg/day cholesterol, in keeping with American Heart Association guidelines for serum lipid reduction.
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| Soft, low residue diet | Addition of low-fiber, easily digested foods, such as pastas, casseroles, moist tender meats, and canned cooked fruits and vegetables. Desserts, cakes, and cookies without nuts or coconut. – food is soft and easy to chew.
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| Full liquid | liquid with addition of smooth-textured dairy products (e.g., ice cream), custards, refined cooked cereals, vegetable juice, pureed vegetables, all fruit juices.
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| Diet to enhance immune system | Protein, vitamins A, C, B12, B6, folic acid, thiamin, biotin, riboflavin, niacin, etc
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| Enteral nutrition (EN) used for | clients with a functional GI tract who are unable to safely swallow due to cancer of head or neck; trauma, Neuro or Muscular disorders
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| TPN (Total Parenteral Nutrition) or PPN (Partial Parenteral Nutrition) | are needed for pts. with a non- functioning GI tract or someone that needs to rest GI tract.
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| NG tube(nasogastric) | Most common tube - small bore tube used because it is less traumatic - inserted down nose into stomach or intestine (nasojejunal) - low risk of gastric reflux receive gastric feedings; however, if there is a risk of gastric reflux, which leads to aspirati
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| G-tube(gastrostomy) | tube inserted through stoma into stomach, changed periodically – surgically created hole in stomach.
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| Button | appliance flush with skin, attach extension to feed - often with kids – no external tubes for kids to pull.
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| Jejunostomy tube | tube inserted into jejunum by surgeon. Used for pts. With gastroparesis, reflux or aspiration risk. – lost peristalsis.
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| PEG or PEJ tube | percutaneously inserted G-tube - permanent tube inserted by surgeon endoscopically
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| Bolus | you stand there the whole time – rapid delivery feeding – poured into tube – about 20 minutes or so.
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| Intermittent Drip | feeding pump “kangaroo pump”, may last 30 – 45 minutes ex: ever 4 – 6 hours. Periodic feeding.
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| Continuous | receiving feeding 24 hours a day – hooked up to the pump.
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| Draw back on syringe, and obtain __ mL of gastric aspirate. | 5 to 10
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| Histimine H2 antagonists | decrease acid production by inhibiting acid production in the stomach – on parietal cells – histamine directly inhibit histamine action and decreases stomach acid – histamine is located on parietal cells in the stomach. Administered before meals.
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