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nutriton
exam 3
| Question | Answer |
|---|---|
| warfarin and vitamin K | Consume green leafy vegetables in moderation; do not eliminate them entirely have a consistent intake |
| what is warfarin and vitamin K a DNI | vit K is antagonist to warfarin |
| Malnutrition Screening Tool (MST) | avoid asking yes or no questions |
| key question for Malnutrition Screening Tool (MST) | "Have you lost weight without trying?" |
| Dysphagia Indicators | excessive drooling, choking or feeling like food is stuck in throat |
| dysphagia pts referred to | SLP |
| Substitute for High-Protein Supplements | More nutrient dense foods- high fat, protein, calories |
| Unreliable Weight Gain Indicator | Edema can falsely suggest nutritional improvement and pts are probable thinner than we think |
| disease states that can be Unreliable Weight Gain Indicator | CHF, ESRD, liver disease, edema |
| Reliable Weight indicator | weight trends, what has the pts weight been overall since being in the hospital |
| Nutrition Screening Timeline | Must be completed within 24 hours of admission of JCO relations |
| Consistent carbohydrate with PM snacks are diets for | someone with T1DM or T2DM |
| what are consistent carbohydrate with PM snacks | consistent amount of carbs at each meal to not have a dip in blood glucose, we want a plateau! |
| easy to digest diets are to | Help reduce gastric activity to promote healing |
| common causes of diarrhea in enteral nutrition | Medications Temperature of EN formula TF rate or TF position |
| temp of EN should be | room temp and not cold or will irritate the bowel |
| hydrolyzed formula | For impaired GI status, contains pre-digested proteins aka partially broken down |
| standard formula | standard macronutrients, not broken down |
| cohorts needing hydrolyzed formula | malabsorption issues, GI issues, don't have a good tolerance with other formulas !pancreatitis, short bowel syndrome, etc |
| jejunostomy tube requires | an infusion pump |
| jejunostomy tube reduces | aspiration risk |
| what can't be used at jejunostomy site | bolus administration |
| TF initiation | Confirm TF tip placement with X-ray before anything else! |
| confirming TF placement with Xray to see | cycle needed, rate needed, and possible formula needed |
| flushing guidelines | Flush 30ml before and after medication administration |
| scheduled feeds types | continuous and cyclic intermittent |
| cyclic feeding provides | nutrition intermittently, allowing some normal intake, as able |
| intermittent feedings | shorter time periods so larger volumes meaning can only be used at gastric site |
| example of a cyclic feed | nocturnal feeds (overnight) |
| continuous drip | reduces aspiration risk, particularly when delivered to the intestine needs pump and electricity and is great for critically ill pts and GERD/reflux pts |
| cyclic and continuous feeds can be done | at all locations - j,d,g |
| intermittent feeds can only be done | in gastric since larger volumes |
| parenteral nutrition administration | Check bag for precipitate Expiration date Confirm administration site Confirm PN Order, since it might change on a daily basis Compare PN order with PN label |
| if PN has to be discontinued, | you have to initiate IV fluids because you don't want pt to become hypoglycemic |
| what is peripheral PN limited by | osmolarity of the solution |
| A hyperosmolar solution in peripheral PN would cause | thrombophlebitis |
| Central Parenteral Nutrition is ideal for | high osmolarity |
| Fat/Lipid PN use | need a balance because don't want Hypertriglyceridemia and want to prevent Fatty Acid Deficiency |
| what does a SMOF lipid contain | soybean oil, medium chain triglyceride, olive oil, fish oil |
| when is PN indicated | when the GI tract is non-functional |
| health complication that would be examples of a non-functional GIT | IBS, gastroparesis, pancreatitis |
| refeeding syndrome occurs when | a pt is in starvation mode and then you initiate nutrition so you can't go full force or else you'll cause this syndrome |
| refeeding syndrome is caused by | electrolyte shifts in and out of the blood which causes cardiac arrythmias |
| what electrolytes need to be monitored in refeeding syndrome | Mg, PO4, K |
| behaviors needed to succeed weight loss | Exercise #/week; Etoh consumption (1 for female, 2 for male), no smoking, and consumption of 5 Fruits and Vegetables daily |
| Phentermine-Topiramate | suppresses appetite and induces satiety |
| Phentermine-Topiramate can only be used for how long | 3 months, whole GLP 1 can be used lifelong |
| Phentermine-Topiramate if used too long | can caused a negative effect of too much weight loss which would then also cause muscle! and fat wasting |
| recommended criteria for weight loss medication | BMI ≥ 30 BMI ≥ 27 with comorbidities waist circumference |
| if not in the BMI categories, then | lifestyle changes (i.e. diet, exercise, etc.) will need to play a role |
| GLP 1 agonist is a | hormone |
| GLP 1 agonist focused disease cohort | type II DM because weight can be a contributing factor while weight isn't really a factor in type I DM |
| weight loss goals | A 5-10% weight reduction improves comorbidities |
| which comorbidities does a 5-10% weight reduction improve | HTN, OSA, HLD, DM Type II, and CV risk |
| “Ideal or Best” Diet for Weight loss | individualize their diet!! everyone is different genetics play a role |
| Gastric Sleeve surgery | staples stomach to be smaller but stomach is not removed so everything is still in tact |
| Gastric Sleeve pros | lower risk of dumping syndrome, shorter recovery time |
| Gastric Sleeve cons | If overeating behavior would occur, stomach may stretch back to baseline size leading to weight gain |
| Laparoscopic Adjustable Gastric Banding (LAGB) | a band around the stomach to decrease stomach size so stomach is still in tact and don't need to worry about vitamin deficiencies |
| Laparoscopic Adjustable Gastric Banding (LAGB) pros | adjustable to manage intake |
| Laparoscopic Adjustable Gastric Banding (LAGB) cons | Stomach may stretch back to baseline if overeating occurs |
| what is required with Laparoscopic Adjustable Gastric Banding (LAGB) | behavior modifications!! |
| Anorexia Nervosa (AN) medical complications | Gastrointestinal;Dermatology; Endocrine;Neurologic;Pulmonary; Hepatic; Cardiovascular slide 14 of chapter 17 pt 2 |
| treatment for Anorexia Nervosa (AN) | High-calorie, small, frequent feedings to help the hypermetabolic to prevent additional weight loss |
| thermic effect of food (TEF) | the energy expenditure, above resting metabolic rate, used to digest, absorb, and metabolize nutrients |
| TEF during the restoration phase | TEF may cause an increased risk of not gaining the desired weight |
| Increased daily calorie intake will be the intervention to help | prevent additional weight loss |
| Bulimia Nervosa (BN) is characterized by | a lack of control over eating; clients may not necessarily be underweight |
| refeeding syndrome guideline to monitor specific lab levels | Mg, PO4, K, and Thiamine supplement these if any are low!! |
| Medical Nutrition Therapy (MNT) for ARDS | High protein/fat; lower CHO intake most ideally through tube feeds bc will also probs be intubated |
| Medical Nutrition Therapy (MNT) for Burns/Thermal Injuries | Higher the protein/kcals the more burns covering the body = need EN to help achieve this due to the higher kcal/protein needs |
| as the % burns increase, so does | the kcals/protein |
| what do you promote healing with | tube feeds |
| rule of nines | the higher the precentage of burns, the more nutritional needs tube feeds are either sole source or additional source |
| vitamins and minerals that may be needed for supplementation | multivitamin with minerals, vitamin C, zinc sulfate, vitamin A |
| multivitamin with minerals purpose | general micronutrient support |
| vitamin C purpose | wound healing, antioxidant |
| zinc sulfate purpose | immune function, tissue repair |
| vitamin A purpose | epithelialization, immune support |
| DERMATOLOGICAL | Dry skin, Lanugo hair |
| GASTROINTESTINAL | Constipation, gastroparesis, SMA, Refeeding pancreatitis |
| ENDOCRINE/METABOLIC | Hypoglycemia, reduced reproductive hormones, thyroid abnormalities, electrolyte abnormalities |
| NEUROLOGIC | cerebral atrophy |
| HEMATOLOGIC | Pancytopenia |
| PULMONARY | Aspiration Pneumonia, respiratory failure |
| CARDIOVASCULAR | Bradycardia, hypotension, arrhythmias (sudden death cause) |
| refeeding phase primary focus | safety and stabilization |
| refeeding phase caloric intake | low and slowly increasing |
| refeeding phase main risk | refeeding syndrome |
| refeeding phase monitoring priority | electrolytes, cardiac rhythm |
| refeeding phase duration | days to weeks (acute) |
| rehabilitation phase primary focus | weight restoration and recovery |
| rehabilitation phase caloric intake | progressive, often high |
| rehabilitation phase main risk | hypermetabolism, psychological status - phase exacerbates which means they need so much food in small, frequent meals |
| rehabilitation phase monitoring priority | weight gain trajectory, psychological status |
| rehabilitation phase duration | weeks to months to years |
Created by:
leh195