LU Kozier notes
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| metabolism | all biochemical and physiological processes by which the body grows and maintains itself
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| BMR | basal metabolic rate, rate at which the body metabolizes food to maintain the energy requirements of a person at rest or awake
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| Ideal Body Weight | optimal weight recommended for optimal health
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| BMI | indicator of changes in body fat stores and whether a persons weight is appropriate for height. Normal 18.5-24.9
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| Factors affect nutrition | development, gender, ethnicity and culture, beliefs, preferences, religion, lifestyle, economics, meds, health, alcohol, advertising
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| Gender | men need more calories and proteins, women need more iron
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| development | those in growth periods need more, older people need less
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| ethnics, culture, preferences, beliefs, and religion | ask the patient if they have food needs
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| lifestyle | healthy eating or not, exercise or not
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| economics | main cause of malnutrition in kids and elderly is the cost of healthy food
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| alcohol | depresses appetite, upset intestines, empty calories, Vitamin B
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| Young adults | patterns are already set from childhood
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| elders | decreased saliva- risk for choking, affects the ability to swallow
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| malnutrition | remember by the textbook can be over or undernutrition
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| assessment | nutrition, height/weight, hair, skin, mucous, ask what they eat
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| dyshphagia | difficulty swallowing
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| Grapefruit | can cause toxicity when taken with some meds. cisapride, diazepam, cyclosporine, verapamil, amiodarone, lovastatin and others
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| vitamin K | effects coumadin
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| milk | interferes with tetracycline antibitotics
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| aspirin | decreases folate, increases loss of Vit C, thiamine, potassium, amino acids and glucose
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| antacids | decrease absorption of calcium and Vit D, increases excretion of Na, K, Cl, Ca, Mg, Zinc and Riboflavin
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| Thiazide diuretics | decrease Vit B absorption, gi effects
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| Potassium Chloride | increses excretion of K, Mg, Ca, gi problems, incompatible with protein hydrolsates
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| laxatives | cause Ca an K depletion, mineral oil adn Ex Lax decrease vitamin absorption
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| antihypertensives | Gi issues, dry mouth, gi Issues, Vit B and Folate
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| anti-inflammatory | decreases absorption of Vitm Ca, phosphorus and others
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| antidepressant | amitriptyline increases food intake, large amounts suppress intake
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| cancer meds | gi issues
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| tyramine (aged cheese, beer, dried sausage, soy, and sauerkraut) | causes headaches, increased pulse and bp, and death
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| Elders and nutrition | difficulty chewing, lowered glucose tolerance, decreased social interaction, loss of appetite, smell and taste, limited income, difficulty sleeping
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| overnutrition | refers to a caloric intake in excess of daily energy requirements
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| overweight | BMI between 25 and 29.9
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| obese | BMI greater than 30
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| undernutrition | intake of nutrients insufficient to meet daily energy requirments
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| Signs of malnutrition | marked weight loss, generalized weakness, altered functional abilities, delayed wound healing, increased risk of infection, lowered immune system, impaired lung function, longer hospital stays
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| 24 hour food recall | client is asked to recall all the food and beverages the client comsumes on a regular day
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| food diary | detailed record of all intake in 3 to 7 days
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| Clear liquid diet | 24-36 hours, after surgery or acute stages of infection. Relieve thirst, prevent dehydration, minimize stimulation of GI tract
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| Full liquid diet | only liquids or foods that turn to liquid at body temp. Gi disturbances or otherwise unable to tolerate solid or semisolids
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| soft diet | easily chewed and digested, patients who have difficulty chewing and swallowing.
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| pureed diet | modification of soft diet, liquid is added to food and then it is blended
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| DAT | diet as tolerated
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| Ways to improve appetite | provide food patient likes, avoid uncomfortable treatments before meals, provide clean environment, oral hygeine, treat symptoms when possible, reduce stress
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| feeding patients | help patient feed themselves if possible, appear unhurried, sitting at the bedside, ask which order they would like to eat, allow ample time between bites, offer fluids after every 3 to 4 bites, converse with patient
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| enteral nutrition | through the gastrointestinal system. Provided throught an NG tube or a peg tube
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| NG tube | inserted through one of the nostrils, down the nasopharynx and into the alimentary tract. Generally used for nutrition, sometimes used to prevent GI problem after surgery, removal of stomach contents, to wash the stomach in cases of overdose
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| Insertion of NG tube | High Fowlers, measure tube from tip of nose to tip of ear to xiphoid process, lube with water soluble, insert tip, hyperextend neck advance tube, slight pressure and twist, reaches oral cavity, bend neck down and take sips of water, advance till marking.
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| Verify tube placement | aspirate stomach contents and check pH(should be less than 6), x-ray, inject air and listen for whoosh
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| Removing a tube | detach the tube, ask client to take deep breath and hold, pinch tube, withdraw, check for intactness
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| Admin meds through tube | flush before and after with 30cc, crush pills (after verifying they are crushable), liquid meds are best
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| intermittent feedings | 300-500 mL of formula several times a day,
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| continuous feedings | uses infusion pump (kangaroo)to run constant
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| Open System feedings | 8-12 hours of formula at a time, discard remaining feeding, rinse system before new feeding, replace bag and tubing every 24 hours
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| Prefilled system feedings | hang safely for 48 hours if sterile
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| Giving Tube Feeding | have patient in at least 30 degrees,assess tube placement, assess residual stomach contents (continous feeding check 4-6 hours), give the feeding, flush when done, remain sitting for at least 30 min. If shallow breaths and dusky color turn off feeding.
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| TPN | total parenteral nutrition, given by IV, always hypertonic, only into central veins. given for severe malnutrition, severe burns, bowel disease, renal, hepatic failure, cancer or major surgery
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