Nix 5 & 6 Reading

early feedings should be initiated how long after surgery

- 24 hours

Digoxin (Lanoxin)

Digoxin is a type of medicine called a cardiac glycoside. It's used to control some heart problems, such as irregular heartbeats (arrhythmias) including atrial fibrillation. It can also help to manage the symptoms of heart failure, usually with other medicines. Digoxin is only available on prescription.

Later (65 years to death)

integrity vs despair looking back over one's life and accepting its meaning sense of integrity and fulfillment dissatisfaction with life

early adulthood (20-35)

intimacy vs isolation establishing intimate bonds of love and friendship ability to deeply love Unsucessful: emotional isiolation; egocentricity

with a gastrectomy you should start with what type of feedings initally

j-tube feedings, after healing frequent small meals

ileostomy stool

less formed stool

colostomy stool

like a regular BM

foods that are easily digested

liquids BRAT diet (Bananas, Rice, Applesauce, Toast) Taking liquids separate to help prevent dumping syndrome

a lot of patients who need surgery are already what

malnourished

pts with a gastrectomy typically are what

malnourished

What is the most common route of enteral nutrition?

nasogastric tube

Euvolemia

normal blood volume

blenderized feedings are what

not steril

Oral feedings

nourishment though the regular GI route by oral feedings; may include a variety of diet plans, textures, and meal replacement liquid supplements

with burns the worse the burn is, the more what you need?

nutrition

Late onset dumping syndrome

occurs 1-3 hours after eating

Early onset dumping syndrome

occurs 10-20 minutes after eating

Intermediate dumping syndrome

occurs 20-30 minutes after eating

What is the best route of nutrition

oral

Long term aspirin use may lead to

poor iron absorption

Complication with lack of protein

poor wound healing, rupture of suture lines, delayed healing of fractures, depressed heart and lung function, anemia, the failure of GI stomas, reduced resistance to infection, liver damage, weight loss, and increased mortality

What two things are lost during catabolism (the breakdown of complex molecules in living organisms to form simpler ones, together with the release of energy; destructive metabolism.)

potassium and phosphorus

what type of deficiency is most common amount surgical pts

protein

Dumping syndrome

rapid emptying of gastric contents into small intestines; symptoms include cramping and full feeling, rapid pulse rate, a wave of weakness, cold sweating, and dizziness

deep partial thickness burn

2nd degree, involves the dermis

acute or slow phase usually begins in how many hours

48-72 hours - metabolism increases

How long before surgery does NPO begin?

8 hours

Bolus feeding

A volume of feeding from 250 mL to 500 mL over a short period of time (usually 10 to 15 minutes) that is given via several feedings per day

Erikson's Stages of Psychosocial Development

According to the theory, successful completion of each stage results in a healthy personality and the acquisition of basic virtues. Basic virtues are characteristic strengths which the ego can use to resolve subsequent crises.

Continuous feeding

An enteral feeding schedule with which the formula is infused via a pump over a 24-hour period; used for critically ill patients

Amiodarone (Cordarone)

Antidysrhythmic agent. Prolongs repolarization, relaxes smooth muscles, decreases vascular resistance. For ventricular fibrillation and unstable ventricular tachycardia. Incompatible with heparin, may be given in PO maintenance dose, monitor for respiratory complications.

Early childhood (18 months to 3 years)

Autonomy vs. shame and doubt To gain some self-control and independence within the environment Unsuccessful resolution: Independence/ fear conflict severe feeling of self doubt

increasing protein can help aid in what?

- edema - preventing shock

what kind of nutrition would you use on a pt who had head, neck, or throat surgery

- enteral tube feedings

What are sources of Vitamin C

- orange juice - broccoli - brussel sprouts - spinach - cabbage - cauliflower - sweet/white potatoes - tomatoes

post surgical protein deficiency can cause what?

- poor wound healing - rupture of suture lines (dehiscence)

What needs increased before surgery

- protein - vitamins - minerals - Macro/Micro nutrients - energy intake

Parenteral Feedings (Continued)

-2 types: ->Peripheral Parenteral Nutrition (PPN-goes into peripheral veins-can stay in 10-14 days MAX; only use for the short term!) ->Central Parenteral Nutrition (for larger nutrient needs or for longer periods of time-used when GI tract can't work at all or handle any kind of formula) -You must discuss this w/ the pt & family first -Want to get GI tract back to working normally

Why is protein necessary?

-Building tissue for wound healing -Replaces losses from: ->tissue breakdown & blood loss ->body fluid loss from exudates -Controlling edema (deals w/ cells) -Controlling shock by maintaining blood volume -Healing bone: protein is essential -Resisting infection: protein is a major component of the immune system -Transporting lipids: fat is an important component of tissue structure

Enteral Feedings (Continued)

-Could be a NGT-nasalduodenal or nasal jejunal (for ppl w/ risk of aspiration, severe reflux, or continuously vomiting)-verify placement w/ an x-ray; can then test the pH (gastric aspiration-would expect it to be lower #s=more acidic) -Could be surgically placed (PEG Tube)

Non-Oral Feeding Routes

-Enteral: a mode of feeding that makes use of the GI tract through oral or tube feedings -Parenteral: a mode of feeding that does NOT involve the GI tract but that instead supports nutrition support via intravenous delivery (through veins as IV)

Oral Feeding After Surgery

-Food gives us the energy needed to heal -Includes a variety of diet plans -Allows more nutrients to be added -Stimulates normal actions of the GI tract (always try to give feedings via GI tract if possible) -Early feedings associated w/ reduced complications, infections, & even hospital stay -Progresses from clear or full liquids to a soft or regular diet (Clear liquid: anything you can see through; Full liquid: anything opaque; Mechanical soft diet: softer foods for ppl who can't chew as well) ->Advance as tolerated

Dietary Considerations in Surgical Clients: Perioperative Nutrition

-Perioperative Nutrition: during or right around surgery ->Client monitoring

If a pt has poor protein after surgery, what can happen?

-Poor wound healing -Dehiscence (a surgical wound that comes apart) -Delayed healing -Depressed heart & lung function -Anemia -Can basically keep your body from building back up

Dietary Considerations in Surgical Clients: Postoperative Nutrition

-Postoperative Nutrition: after surgery ->IV fluids (b/c you lose blood & fluids during surgery) ->Diet advancement (as tolerated-start on a bland diet & advance as pt tolerates it) ->Catabolism (where tissue breakdown exceeds tissue rebuild-tissue was broken down during surgery, so they don't have the ability to build it up quickly (help pt understand good sources of protein so they can eat that when they feel up to it-protein is responsible for building muscle & wound healing)

Dietary Considerations in Surgical Clients-Preoperative Nutrition

-Preoperative Nutrition: 2-3 weeks before surgery ->If it is required for the pt to lose weight before the surgery, they would have a longer time frame -> deficiencies/modify diet ->Low residue diets (not a lot of fatty stuff; really healthy) ->Low fiber diet for 2-3 days (b/c it can leave a residue in the gut) -Antibiotic prophylaxis: Can give prophylactic antibiotics (given before surgery to kill any bacteria in the intestines that could potentially create an infection) ->Bowel cleansing protocol (individualized to pt)

superficial partial thickness burn

2nd degree burn

Bariatric Surgery

-Weight loss (Ex: gastric bypass surgery) -Making area that holds & contains food smaller so they're not eating as much -Typical deficiencies in several micronutrients -Start at clear liquid & progress (takes about 6 weeks to get back to a regular diet-nurses educate pts on this & how to advance diet before they leave the hospital) -Thereafter pts are limited to about 1 cup of food per meal (everything they're eating combined) -Pts should avoid using a straw to reduce air swallowing, which can cause discomfort (gas pains) -Subject to Dumping Syndrome (if they eat something bad, esp. carbs, their body tries to reject it & get it out-kinda throws the body into shock-lots of cramping, feeling of fullness, weakness, dizziness & break out in a cold sweat, abdominal pain, diarrhea [b/c carbs are being flushed through fast in the system-can happen 10 min. to 3 hrs after eating] ->This leads to the pt eating fewer food-nurses should educate & encourage pts to eat protein instead of carbs -****Helps for the pt to sit upright after meals b/c it encourages peristalsis & avoiding liquids w/ meals [liquid encourage solubility of carbs-soaks it up & makes it easier to pass through] tell pt to eat their food & wait an hour or 2 to drink liquids)

Changes in teeth in older adult

-salivary gland secrete less saliva -dental caries -dentures can block taste secretions -prone to periodontal (gum) disease resulting in bone loss

Parenteral nutrition patient characteristics

-they do not have sufficient GI tract function -they are unable to meet nutrient needs after 7-10 days of enteral nutrition -there is a need for bowel rest -they do not have access to feeding tube placement -they pull out their feeding tube

Enteral nutrition patient characteristics

-they have enough functions GI tract to allow adequate digestion and absorption -they cannot eat enough to meet their needs orally -they are at risk for malnutrition without nutrition support

Nutrition interventions shown to be effective in weight management programs include

1. individualized reduced energy diet 2. total energy intake distributed throughout the day, with the consumption of 4-5 meal/snacks per day including breakfast 3. portion control emphasized 4. meal replacements for persons who have difficulty with self -selection and/or portion control

Healthy People 2020

1.Access to health services 2.Clinical preventative services 3.Environmental quality 4.Injury & violence 5.Maternal, infant & child health 6.Mental health 7.Nutrition, physical activity & obesity 8.Oral health 9.Reproductive & sexual health 10.Social determinants 11.Substance abuse12.Tobacco

Healthy People 2020 Goals

1.Attain high-quality, longer lives free of preventable disease, disability, injury & premature death 2.Achieve health equity, eliminate disparities & improve the health of all groups 3.Create a social & physical environment that promote good health for all 4.Promote quality of life, healthy development, & healthy behaviors across all life stages

School Age (6-12 years)

Industry vs. inferiority to achieve a sense of self-confidence by learning, competing, performing successfully, and receiving recognition from significant others, peers , and acquaintances. Unsuccessful resoultion: senes of inferiority; difficulty learning and working

Late Childhood (3-6 years)

Initiative vs. guilt to develop a sense of purpose and the ability to initiate and direct own activities become purposeful and directice Unsuccessful resolution: aggression/fear conflict sense of inadequacy of guilt

iron deficiency anemia may develop from blood loss or inadequate absorption of what?

Iron

Furosemide (Lasix)

Loop diuretic Block Na and Cl reabsorption in ascending loop Can be used w/ renal impairment Used for pulmonary edema, edema caused by liver/cardiac/kidney disease, htn Also used for hypercalcemia related to kidney stone formation Can cause dehydration, hyponatremia, hypochloremia, hypotension, ototoxicity, hypokalemia (and hyperglycemia, hyperuricemia, decreased Ca and Mg) Can cause dig toxicity due to hypokalemia, lithium toxicity due to hyponatremia Antihypertensives have an additive effect NSAIDs reduce the diuretic effect Daily weights and I/O Take early in the day

patients need to be what before surgery

NPO

Why should you not use pureed foods for tube feedings?

Physical form: foods that are broken down in a blender yield a sticky, larger-particle mixture that does not pass through small feeding tubes easily Safety: can carry bacterial growth and cause infection Digestion and absorption: pureed foods require a fully functioning GI system to digest the food and absorb and release its nutrients

Cognitive Theory (Piaget)

Piaget's stage theory describes the cognitive development of children. Cognitive development involves changes in cognitive processes and abilities. Emphasized cognitive milestones in the development •All stages must be accomplished in the correct order •A child's greatest task is to make sense of the world around him or her

Dietary Considerations in Surgical Clients:

Poor Nutrition Status & the Following Are Well Documented (What can happen when you have poor nutrition before & after surgery) -Impaired wound healing & an increased risk of infection -Increased need for enteral or parenteral nutrition support -Longer hospital stay & increased medical cost -Increased morbidity & mortality rate -Reduced quality of life

tissue catabolism may produce what deficiencies

Potassium and phosphorus do what

Vagotomy

The cutting of the vagus nerve, which supplies a major stimulus for gastric secretions

Why is it necessary to avoid eating 8 hrs before sugery?

To prevent aspiration

Infancy (birth to 18 months)

Trust vs. Mistrust; Feeding; Children develop a sense of trust when caregivers provide reliability, care, and affection. A lack of this will lead to mistrust. Unsuccessful resolution: General difficulties relating to others effectively, suspicious, trust fear of the future.

Atonic

Without normal muscle tone or strength

full thickness burn

a burn involving destruction of the entire skin; extends into subcutaneous fat, muscle, or bone and often causes severe scarring; commonly called a third-degree burn

Parenteral

a mode of feeding that does not involve that gastrointestinal tract but that instead provides nutrition support via the intravenous delivery of nutrient solutions

Enteral

a mode of feeding that makes use of the gastrointestinal tract through oral or tube feedings

Elemental formuals

a nutrition support formula composed of simple elemental nutrient components that require no further digestive breakdown and are thus readily absorbed (e.g. glucose, amino acids, medium-chain triglycerides)

Malnutrition increases with

advanced age, disease status, and length of hospital stay

what would use a mechanical soft diet

anyone that has chewing difficulties

elemental formula

broken down into the simplest form so it can be broken down quicker

Functions of protein

building tissue, controlling edema, controlling shock, healing bone, resisting infection, transporting liquids

central parenteral nutrition

can be used months at a time, TPN. - proteins, vitamins, minerals, and high concentration

What macrinutrient is the most important intake

carbs. - helps spare proteins from being broken down

Most common GI complication of enteral nutrition

diarrhea; can be caused by medications, bacterial overgrowth, infections

What can be an indication to increase protein

edema

middle adulthood (35-65)

generativity vs stagnation fulfilling life goals that involve family, career, and society ability to give and care unsuccessful: self absorption; inability to grow as person

Jejunostomy tube

goes into the jejunum

peripheral parenteral nutrition (PPN)

good for less than 10-14 days - does not provide fats, lipids, and is less concentrated

burn shock or ebb phase is an immediate loss of what

heat, water, electrolytes, protein

full liquids

ice cream, milk, cream soup, yogurt, sherbert

adolescence (12-20)

identity vs role confusion Developing a sense of identity Unsuccessful: confusion about who one is

Diuresis

increased excretion of urine

Burn shock or ebb phase TX

initial tx of burns with nutrition is fluids for 24-48 hours

what type of fluid is used with burn shock or ebb phase

salt solution or lactated ringers - isotonic solution

with dumping syndrome you should avoid what

simple sugars; cakes, cookies, donuts

fluid loss affects what minerals

sodium and chloride

commerical formula feedings are what

sterile

superficial burn example

sunburn

object permanence

the awareness that things continue to exist even when not perceived

Exudate

various materials such as cells, cellular debris, and fluids that have escaped from the blood vessels and that are deposited in or on the surface tissues, usually as a result of inflammation; the protein content in this substance is high

Mechanical soft diet

whole foods that are easy to chew and swallow; high-fiber foods are often omitted in this diet; recommended for people with difficulty in chewing or swallowing

Health Maintenance Organizations (HMOs)

•Are limited to only the services, health care providers, and hospitals associated with the HMO •Kaiser Permanente •Goals: to keep clients healthy & out of the hospital •are a part of low-cost health care system•provide me a health care service for a prepaid amount

Medicaid

•Eligible to low-income children & uninsured pregnant women •Cover services during pregnancy •Programs provide financial coverage to older clients & programs also pay for home care nursing •Many services may not be covered or may require a copayment

Medicare

•Eligible to people older than 65 years, disabled individuals, on dialysis •Must be entitled to social security •Payment for this program is deducted from the individual's monthly Social Security check. •Physical therapy must be restorative •Hospice care (acute care, symptom control) Omnibus Budget Reconciliation Act (OBRA) •Instituted significant Medi requirements for documentation. The Affordable Care Act: 3 goals: to increase access to care, reduce costs, and protect clients from insurance companies inappropriate actions

Home Health

•It is skilled and compassionate care provided on a one-to-one basis in the comforting and familiar surroundings of the home. Role of LPN staffing coordinator, intake coordinator, & medical chart audit. •Under supervision of an RN •Team nursing approach •RN initial evaluation & admission •Medicare reimburse personal care

Preferred Provider Organizations (PPOs)

•Offer a discount on fees in return for a large pool of potential clients. •Larger # of physicians