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health assessement
nutrition
| Question | Answer |
|---|---|
| essential nutrients | not synthesized in the body or made in insufficient amounts, must be provided via diet/supplements |
| macronutrients | supply energy and build tissue carb, fats and proteins |
| micronutrients | regulate/control body processes vitamins, minerals and water |
| carbohydrates | provide energy absorb water to increase fecal bulk, slow gastric emptying |
| proteins | tissue growth and repair |
| fats | provide energy and structure insulation, cushion, absorption of fat soluble vitamins |
| fat soluble vitamins | vitamin A, D, E, K |
| vitamins | organic compounds needed in small amounts (no calories) metabolism of carbs/proteins/fats |
| water soluble proteins | C, B complex vitamins not stored in the body |
| how are vitamins absorbed | absorbed via intestinal wall into bloodstream |
| minerals | organic elements in all body fluids and tissues structural support vs regulate body process |
| B vitamins | B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6, B7 (biotin), B9 (folate), B12 (cobalamin) |
| macrominerals | calcium, phosphorus, sulfur, sodium, chloride, potassium, magnesium |
| microminerals | iron, zinc, manganese, chromium, copper, molybdenum, selenium, fluoride, iodine |
| water | 50-60% total weight 40% intracellular/20% extracellular (plasma/interstitial fluids) fluid medium for chemical reactions solvent in digestion/absorption/circulation/excretion |
| hemoglobin (Hgb) | normal range 12-18 g/dL |
| HCT | decreased = anemia increased = dehydration |
| serum prealbumin | decreased levels lead to high risk for morbidity/mortality, malnutrition, malabsorptions |
| BUN | increased = starvation/high protein intake/severe dehydration decreased = malnutrition/overhydration |
| serum creatinine | increased = dehydration decreased = reduction in total muscle mass/severe malnutrition |
| factors affecting nutritional status | malabsorption conditions appetite conditions physical limitation/fatigue/weakness conditions dysphagia EtOH use medications alter mental status no caregiver/social support |
| nursing interventions for nutrition | teaching nutritional information monitoring nutritional status stimulate appetite assist with eating providing long term nutritional support |
| assessment prior to assistance with nutrition | confirm ordered diet plan assess food allergies/religious and cultural preferences avoid impact with lab/diagnostic studies assessment of dysphagia/weakness/fatigue assessment of abdomen for distension/tenderness |
| expected outcome for assistance with eating | consuming foods consistent with diet avoidance of aspiration during/after meals contentment with eating |
| regular diet | healthy meal plan w/o restriction low in unhealthy fat/salt/added sugar |
| heart healthy diet | aka cardiac diet reduced sodium/fat/cholesterol intake (HTN/HLD diet) |
| low sodium diet | limited sodium intake from 1.5-2.4g/daily conditions like HTN or cirrhosis |
| low protein diet | decreased protein diet tx of inherited metabolic disorder, renal/liver disease |
| renal disease | diet for CKD/dialysis balance fluid/electrolyte/minerals |
| mechanical soft | mashed/pureed/finely chopped and low fiber easy chewing for GI issue ie. crohns |
| low residue (fiber) diet | decreased fiber intake to reduce BM frequency/size |
| high residue (fiber) diet | foods high in fiber |
| residue | basically fiber, undigested material in intestines to promote BMs |
| lactose free | eliminate/restrict lactose foods |
| consistent carbohydrate diet | consistent total carb content with general nutritional balance high fiber/heart healthy fats with limited sodium and saturated fats for DM/gestational DM/impaired glucose tolerance |
| thickeners | swallowing difficulties in individuals w/ aspiration risk |
| levels of thickened fluids | thin nectar thick honey thick pudding thick (hold own shape) |
| aspiration precaution | individuals w/ dysphagia = high risk for aspiration |
| nursing interventions for aspiration precaution | assess dysphagia risk and obtain speech/swallow consult before feeding ensure alert prior to feeding HOB at 90 dg at mealtimes and 30 dg after eating O2 and suction equipment check for pocketing AVOID THIN LIQUIDS |
| diet advancement | NPO -> clear liquid diet -> full liquid diet -> GI mechanical soft -> usual diets |
| diet alterations for fluid/electrolyte balance | ie. hyperkalemia to avoid leafy green veggies |
| tyramine avoidance | migraine, MOAI intake, PKU |
| celiac disease diet alterations | BROW and gluten avoidance Barley Rye Oats Wheats |
| renal disease diet alterations | limit sodium, phosphorus and proteins |
| cultural/religious dietary considerations | kosher, halal, pescatarian |
| sensitivities/intolerance/allergen considerations | gluten free, dairy free, nut allergies |
| preferential considerations | vegan, vegetarian |
| alternate methods of nutritional intake | NG tube (nasogastric) G tube (gastric) J tube (jejunum) |
| NG tube indication | tube feeding via stomach as food reservoir decompress/drain unwanted fluid/air from stomach monitor bleeding remove lavage (ie poison) tx for obstruction |
| lavage | washing out stomach to remove undesirable substances such as poison |
| documentation of NG tube placmeent | document type of tube placed (NG/G/J tubes) record criteria for proper placement -tube length (in/cm) - XR confirmation - aspiration of contents/pH during intermittent feeding |
| continuous feeding | external feeding pump regulate flow of formula |
| intermittent feeding | delivered at regular intervals via gravity or feeding pump at set times possibly given as bolus |
| bolus | feeding formulations given in one large amount via syringe |
| tube feeding unexpected situations/associated interventions | NG tube not found in stomach/intestine = tube replacement aspiration of large amounts of fluid = risk of vomiting/aspiration (need to check w/ PCP) clogged tubes -> warm water + gentle pressure to remove clog |
| expected outcome for tube feeds | pt tolerate tube feeds sufficient for nutritional need no signs of irritation/excoriation/infection at tube insertion site |
| excoriation | skin irritation/breakdown d/t leakage of gastric content |
Created by:
sleepingbear