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Clinical Nutrition12
Ch12. Food Related Issues
| Question | Answer |
|---|---|
| Who orders diets in hospital? | Doctors, under the assessment of the registered dietician |
| In what two ways might a diet be modified? | Qualitative and quantitative |
| What does it mean if a diet has had a qualitative modification? | There has been changes to consistency, texture, or nutrients |
| What does it mean if a diet has had a quantitative modification? | The number or size of meals have been changed, or amounts of certain nutrients ie low sodium |
| What are the indications of a (clear) liquid diet? | Prep for certain diagnostic tests such as colonoscopy; acute GI disturbances |
| What should be considered with a clear liquid diet? | Does not have all necessary nutrients and cannot be a long term diet. Should not be used for more than 24 hours. |
| What are the indications of a full liquid diet? | Transition period after surgery, mandibular fractures, patients with chewing and swallowing difficulties |
| True or False; A full liquid diet can be nutritionally complete if planned correctly | True |
| What are the indications of a pureed diet? | Stroke, swallowing difficulty, ulcerations of the oral cavity, head and neck abnormalities, fractured jaw |
| What are the indications of a mechanical soft diet? | Poorly fitting dentures, limited chewing or swallowing ability, dysphagia, strictures, radiation to the oral cavity, progression of diet |
| What are the indications of a soft diet? | Debilitated patients unable to consume a regular diet, mild GI problems |
| Describe a soft diet. | Foods that require chewing but are not hard or crunchy |
| Describe a minced diet. | Foods that are chopped into small pieces, fruits/veg are mashed, minced or soft. No coarse textures |
| Describe a mechanical feeding difficulty diet. | Foods that require very little chewing, are moist, soft, and easy to swallow; meats and veg are ground; fruit is blended; no bread products |
| Describe a pureed diet. | Foods that are smooth, semi-solid, and does not require chewing |
| What are the signs of dysphagia? | Drooling, pocketing food, choking, gagging, taking longer than 2-10 seconds to swallow |
| What are the levels of the national dysphasia diet? | Pureed, Mechanically altered, Advanced, General |
| What signifies a true food allergy? | The release of histamine and serotonin |
| What are the most common symptoms of food allergies? | Diarrhea, nausea, vomiting, cramping, abdominal distension, and pain |
| What are the 8 foods that are known to be major allergy triggers in adults? | Eggs, milk, wheat, soy, fish, shellfish, peanuts, and tree nuts |
| What is a food intolerance? | A nonallergic reaction; may be caused by toxins, drugs, or conditions such as lactose and gluten intolerances |
| What are the most important factors in prevention of food-borne illnesses? | Personal hygiene and hans washing |
| Any protein rich foods should be discarded if left at room temperature longer than how many hours? | 2 hours |
| What signifies a food-borne outbreak? | When two or more individuals have the same symptoms over the same period of time (nausea, vomiting, diarrhea, chills, fever, etc) |
| Name two of the top causes of food poisoning. | Norovirus, salmonella, clostridium perfringens, campylobacter spp., staphylococcus aureus |
| What does TCAM stand for? | Traditional, Complementary, and Alternative Medicine |
| What does TCAM consist of? | The use of non-western healing approaches being used at the same time as conventional medicine |
| What is the purpose of GMO foods? | To increase the longevity of the food and improve quality |
| What is enteral nutrition? | Any time the GI tract is used to provide nourishment. This includes, liquid, soft, and solid diets, as well as nutritionally complete formulas (oral or via tube) |
| When may enteral nutrition be contraindicated? | Hemodynamic stability, bowel obstruction, high-output fistula |
| What are the benefits of starting enteral nutrition early? | Less risk of malnutrition, few complications, faster wound healing, shorter hospital stay |
| What are polymeric formulas? | Formulas that are composed of intact nutrients. Requires a functioning GI tract for digestion and absorption of nutrients |
| What is a normocaloric formula? | A polymeric formula that is 1 kcal/ml, has low osmolality and are generally well tolerated, contains fiber which aids in normal bowel function. |
| What is a hypercaloric formula? | A polymeric formula that is 1.5-2 kcal/ml, they are designed to meet calorie and protein demands in a reduced volume. Have low to moderate osmolality. |
| What are elemental formulas? | Also known as predigested or hydrolyzed formulas, composed of partially or fully hydrolyzed nutrients. Are hyperosmolar. |
| When might elemental formulas be used? | When patients have a partially functioning GI tract, impaired capacity to digest foods or absorb nutrients, have pancreatic insufficiency, or bile salt deficiency. |
| How many kcal/ml in elemental formulas? | 1-1.3 kcal/ml |
| What are modular formulas? | Formulas that are single macronutrients (glucose, protein,lipids) and thus are not nutritionally complete. Are added to other foods or products to change composition when nutritional needs cannot otherwise be met. |
| How many kcal/ml in modular formulas? | 3.8-4 kcal/ml |
| What are speciality formulas? | Formulas that are designed to meet specific nutrient demands for specific disease states such as diabetes, renal failure, liver failure etc. |
| How many kcal/ml in speciality formulas? | 1-2 kcal/ml |
| Describe the placement of a nasogastric tube. | Tube is passed through the nose into the stomach. |
| Describe the placement of a nasoduodenal tube. | Tube is passed through the nose into the duodenum |
| Describe the placement of a nasojejunal tube. | Tube is passed through the nose into the jejunum |
| Describe the placement of a esophagostomy. | Tube is surgically inserted into the neck and extends into the stomach |
| Describe the placement of a gastrostomy. | Tube is surgically inserted into the stomach |
| Describe the placement of a jejunostomy. | Tube us surgically inserted into the small intestine |
| True or false; a feeding tube placed into the small intestine creates less risk for aspiration. | True |
| What are the advantages of a nasogastric tube? | Easy to place and remove, less expensive, medications can be administered |
| What are the disadvantages of a nasogastric tube? | Greater risk of aspiration, gastric emptying should be monitored |
| What are the advantages of a nasoduodenal or nasojejunal tube? | Less aspiration risk, helpful in patients with gastroparesis |
| What are the disadvantages of a nasoduodenal or nasojejunal tube? | Requires placement via endoscopy, gastric motility cannot be monitored |
| What are the advantages of a gastrostomy or PEG tube? | Allows for intermediate or bolus feedings, allows for medication administration and/or gastric decompression |
| What are the disadvantages of a gastrostomy or PEG tube? | Increased risk of aspiration in some individuals , stoma care required, potential dislodgement of tube |
| What are the advantages of a jejunostomy or percutaneous endoscopic jejunostomy tube? | Allows for early post-op feeding, decreased aspiration risk |
| What are the disadvantages of a jejunostomy or percutaneous endoscopic jejunostomy tube? | Smaller tubes may be used and thus clog more easily, stoma care required, intraperitoneal leakage may be possible |
| What degree should the head of the bed be at for patients with tube feedings and why? | 30-45 degrees to decrease risk of aspiration and reflux |
| What are the indications of continuous feedings? | Patients who have not eaten for a significant period of time, debiltated patients, patients with impaired GI function, controlled DM1, intestinal feedings |
| What are intermittent feedings? | Feedings that are infused at specific intervals throughout the day |
| When are bolus feedings appropriate? | Only appropriate when feeding into the stomach |
| What are the disadvantages of bolus feedings? | They are associated with an increased risk of aspiration and regurgitation, GI side effects common, not appropriate for post-pyloric feedings |
| High osmolality of a hypertonic formula can lead to what? | Intestinal distension and osmotic diarrhea |
| What is TPN? | The provision of energy and nutrients into the superior vena cava or subclavian vein |
| What are the components of TPN? | Carbohydrates, amino acids, fats; electrolytes and vitamins can also be added |
| What is the most common carbohydrate in TPN? | dextrose monohydrate |
| What concentration are dextrose solutions available in? | 5%-70% |
| When might high glucose concentrations be beneficial? | When a patient's fluids need to be restricted |
| When might a low glucose concentration be beneficial? | When a patient is experiencing hyperglycemia |
| What is a total nutrient admixture? | A three in one mixture that contains dextrose, amino acids, and a lipid emulsion |
| When can tube feedings be discontinued? | When oral intake consistently exceeds two thirds of energy requirements |
Created by:
Mika.LeB