Ch 8, 9 nutrition and lect 20

Gastrostomy tubes

endoscopically or surgically inserted into the stomach. Gastrostomy tube feedings are generally well-tolerated because the stomach chamber holds and releases feedings in a physiologic manner that promotes effective digestion. As a result, dumping syndrome is usually avoided.

metabolic syndrome raises the risk of

group of conditions that together raise risk of CAD, DM, stroke, and other serious health problems

metabolic syndrome diagnosis

have to have 3 or more of the following: large waistline, htn, High blood sugar levels, High blood triglycerides, Low HDL cholesterol

cardiac diet

low fat, low cholesterol, low sodium Saturated fat <7% Cholesterol <200mg/day Sodium 2-3g/day Limit caffeine

Nasoenteric tubes; used when? Types list

short-term (less than 3 to 4 weeks). Types Nasogastric (NG) Nasoduodenal Nasojejunal

Foods containing b12

"Meat, fish, eggs, and dairy Vegetarians, people who are pregnant or nurs-ing, and others who are at risk of deficiency may need to take supplements. Vitamin B12 is an essential nutrient that your body can't make on so you need to get it from your diet or from supplements.

diarrhea help

(Address electrolyte loss) Increase fluid/ fiber Stress management

nocturnal tube feeding

A type of cyclic feeding in which en is administered overnight via a feeding pump

Blenderized liquid (pureed) diet

- liquids and foods that are pureed to liquid form Indications: clients who have chewing or swallowing difficulties, oral or facial surgery, and wired jaws Appropriate foods: any food with added broth, milk, gravy, cream, soup, tomato sauce, water, or fruit juice to puree.

Enteral feeding formulas

-Commercial products are preferred over home-blended ingredients b/c the nutrient composition, consistency and safety can be better insured -Standard and hydrolyzed formulas are the two primary types of enteral feeding formulas available, they are categorized by the complexity of the protein included

Weaning enteral feeding

-Enteral feedings can be discontinued when the client consumes two-thirds of protein and calorie needs orally for 3 to 5 days -Transitioning from EN to an oral diet requires the client to receive adequate nutrition as food items are reintroduced. -Begin the transition process by stopping the EN for 1 hr before a meal. -Slowly increase the frequency of the meals until the client is eating up to six small meals daily. -When oral intake equals 500 to 750 cal/day, the continuous tube feeding is administered only during the night.

Before each enteral feeding

-Measure the tube each shift and prior to each feeding -Verify the presence of bowel sounds -flushed routinely with warm water -Check gastric residuals if typically every 4 to 6 hr -head of the bed should be elevated at least 30º during feedings and for at least 30 to 60 min afterward -solution at room temperature

Two types of fiber

-SolubleFiberdissolves in h20,slows digestion. Can lower bad cholesterol and regulate Bld sug. find in Apple Bean -InsolubleFiberdoes not dissolve in h20 but pulls h20 and creates soft stool. Insoluble fiber helps food pass through body in whole grains

Residuals: Volume for intervention, returning contents

-The volume that indicates a need for intervention for adults ranges from 100 to 500 mL in a single measurement, or at least 250 mL on two consecutive checks. Returning residual contents to the stomach prevents electrolyte and fluid imbalance. However, returning large volumes could increase the risk for complications.

protein and kidney disease

-Too much protein can make the kidneys work harder, so decrease protein in chronic kidney disease - once on dialysis - Increase ProteinOnce a person has started hemodialysis a higher amount of protein in the diet is necessary to help maintain blood protein levels and improve health. Dialysis removes protein waste from the blood, so a low protein diet is no longer needed.

Early dumping syndrome symptoms

-abdominal cramps, bloating -diarrhea -flushing, sweating -lightheadedness -nausea and vomiting -rapid heartbeat -weakness, feeling faint Desire to lay down after meal

healthy kidney functions

-sodium and water removal -waste removal -hormone production

Heme vs non-heme iron

1. Heme: found in animal foods, derived from hemoglobin (absorbs better than nonheme) 2. None-heme: found in plant foods such as lentils and beans (most common type found in dietary iron)

Bolus feeding

A variation of intermittent feeding using a large syringe attached to the feeding tube. The rate of administration and volume varies depending upon the client's needs and tolerance. Volumes ranging from 250 to 400 mL can be administered over a period of at least 15 min four to six times daily - delivered directly to stomach, not for jejunum or duodenum

People with diabetes mellitus should get what % of calories from carbohydrates each day

55% For females, they recommend 3-4 servings of carbohydrates, at 15 grams (g) per serving. For males, they recommend a slightly higher amount of 4-5 servings. This is equivalent to 45-75 g each meal.

This vitamin helps with myelin production

B12 Myelin shields the nerves and helps them transmit sensations. Without sufficient myelin, nerves are more prone to damage. Problems are more common in the nerves in the hands and feet, which are called peripheral nerves.

dysphagia

Aspiration precautions: Id bracelet, bedside sign, no straw, thickened liquids, adequate chew time, consult speech therapist, oral care, increase HOB w meals

what to avoid in celiac disease

Avoid all products with barley, rye, triticale (a cross between wheat and rye), farina, graham flour, semolina, and any other kind of flour, including self-rising and durum, not labeled gluten-free. Be careful of corn and rice products

Nausea/ vomit help

Clear-> full liquid Advance with easy to digest high carb foods Avoid fat/ spice Promote oral hygiene

consistent carbohydrate diet

Complex carbs- 45-65% calories (min130g/day) Exchange lists Promote fiber intake Fats: restrict cholesterol, sat fat<7% Protein 15-20% cal

Nursing actions mechanical complications et feeding

Confirm tube placement prior to feedings. Elevate the head of the bed at least 30º during feedings and maintain the client in this position for approximately 60 min following completion of the feeding. Administer bolus feedings over a period of at least 15 min and according to client tolerance. Flush the tubing with at least 30 mL of water every 4 hr for continuous infusion, after measuring gastric residual, before and after bolus feedings, and between each medication administration. Unclog tubing using gentle pressure with 30 to 50 mL warm water in a 60 mL piston syringe. Carbonated beverages are not approved for fixing a clogged tube. Commercially made products are available and have been shown to effectively dissolve clotted formula. Do not mix medications with the formula.

Nursing actions for complications et feeding

Consider a change in formula. Decrease the flow rate or total volume of the infusion. Increase the volume of free water if constipated. Administer the EN at room temperature. Take measures to prevent bacterial contamination.

Full liquid diet

Consists of foods that are liquid at room temperature including plain ice cream and strained cereals. Some facilities include pureed vegetables. Indications include a transition from liquid to soft diets, postoperative recovery, acute gastritis, febrile conditions, and intolerance of solid foods.

GI complications of et feeding

Constipation, diarrhea, cramping, pain, abdominal distention, dumping syndrome, nausea, and vomiting.

Hypertension management diet

DASH diet Low sodium<2300(hf <2000 & limit fluids) High potassium High calcium Lifestyle changes Smoking cessation

DASH diet

Dietary Approaches to Stop Hypertension, limit salt to 2300mg or 1 tsp a day. There is a lower sodium dash 1500mg a day

hypoglycemia treatment

Eat or drink 15 grams of fast-acting carbs to raise blood sugar.After 15 minutes, re-check blood sugar.If it's still below 70 mg/dL, give another 15 grams of fast-acting carbs. Repeat until blood sugar is at least 70 mg/dL.

constipation help

Exercise, increase fluids and fiber

Medications Through a Feeding Tube

Feeding should be stopped prior to administering medications. The tubing should be flushed with water (15 to 30 mL) before and after the medication is administered, and between each medication if more than one is administered. Medications should only be dissolved in water. Liquid medications should be used when possible. For an infant or child, the volume of water to flush is 1.5 times the amount predetermined to flush an unused feeding tube of the same size. More water can be required to flush the tubing following some medications (suspensions).

Diverticulitis acute

Fever, tach, chills, pain NPO or clear liquid or low residual Antibiotics, iv fluids, pain management Complications: abscess, peritonitis, obstruction May require surgical intervention

cyclic feeding enteral

Formula is administered at a continuous rate for 8 to 20 hr, often during sleeping hours. Often used for transition from total EN to oral intake.

continuous infusion enteral

Formula is administered at a continuous rate over a 24-hr period via infusion pump Feeding tubes should be flushed with at least 30 mL of water every 4 hr to maintain tube patency and provide hydration.

Intermittent tube feeding

Formula is administered every 4 to 6 hr in equal portions, typically over a 30- to 60-min time frame, usually by gravity drip or an electronic pump. Feeding times can range from 20 to 90 min. -noncritical clients, home tube feedings, and clients in rehabilitation. Feeding resembles normal pattern of nutrient intake.

hydrolyzed protein formula

Formula that contains enzymatically digested protein, or single amino acids, rather than protein as it naturally occurs in foods. - better digestion, good for acid reflux

cause of peptic ulcers

Helicobacter pylori and prolonged used nsaids Stress and spicy foods do not cause peptic ulcers. However, they can make your symptoms worse.

diverticulosis help

High fiber, avoid foods get trapped- seeds/ husks

Therapeutic Nutrition cancer

Increase cal 25-35kcal/kg Inc protein

Therapeutic Nutrition HIV/ AIDS

Increase calories, protein Vitamins Liberal fluid intake

Preventative nutrition cancer

Increase fiber, vit A&C, cruciferous veggies, whole grains, fresh meat

Clear liquid diet

It is made up of clear liquids and foods that are liquid at room temperature. acute illness, reduction of colon fecal material prior to certain diagnostic tests and procedures, acute gastrointestinal disorders, and some postoperative recovery.

dysphasia diet- levels liquid

Level 0 (Thin): Liquid that flows like water, can be consumed through cup or a straw as age appropriate. Level 1 (slightly thick): Liquids that are thin enough to sip through a straw but thicker than water. Level 2 (Mildly thick): Liquids that do not maintain their shape when poured but are thickened. They can be eaten with a spoon but require considerable effort to be sipped through a straw. Level 3 (moderately thick): Liquids with smooth texture and no lumps, can be consumed from a cup or spoon but not a fork. Level 4 (extremely thick): Liquids thickened to maintain their shape and need to be eaten with a spoon, not sticky, does not require chewing.

Levels of solid textures dysphasia diet

Level 3 (LIQUIDIZED): Same as Level 3 moderately thick above. Level 4 (PUREED): Same as Level 4 extremely thick, above. Level 5 (MINCED AND MOIST): Soft, visible lumps, can be consumed with a fork or spoon if lumps are easy to mash with tongue. Level 6 (SOFT AND BITE-SIZED): Soft-textured, moist, semi-solid foods that are easily chewed and swallowed. Level 7 (EASY TO CHEW): Near-normal textured foods that are moist, can include mixed consistency. Hard, sticky foods are eliminated. OR LEVEL 7 (REGULAR): Normal everyday foods, vary in texture, developmentally age appropriate.

Bariatric Diet

Liquid diet 1-2 weeks Clear liquid wk 1 Full liquid wk 2&3 Soft food wk 4&5 Solid food wk 6 (small frequent nutrient dense) Continuous nutrition counseling

Ongoing care et

Monitor daily weights and I&O. Obtain gastric residuals every 4 to 6 hr. Monitor electrolytes, BUN, creatinine, minerals, and CBC. Monitor the tube site for infection or intolerance (pain, redness, swelling, drainage). Monitor the character and frequency of bowel movements. When appropriate, administer medications through a feeding tube

nasoenteric tube types: nasogastric, nasoduodenal, nasojejunal

Nasogastric (NG) tubes are passed through the nose to the stomach. Nasoduodenal tubes pass from the nose through the stomach and end in the duodenum. Nasojejunal tubes pass from the nose through the stomach and end in the jejunum. Nasoduodenal and nasojejunal tubes are used in clients who are at risk for aspiration or who have delayed gastric emptying (gastroparesis).

Osmolarity of enteral feedings

Osmolality is increased if the formula contains more digested protein. Hydrolyzed or partially hydrolyzed (predigested) formulas are higher in osmolality than standard formulas. They are also lactose-free.

Ostomies

Ostomies are placed for clients requiring long-term enteral feeding, who are at high risk for aspiration or when a nasal obstruction makes insertion through the nose impossible. An ostomy is a surgically created opening (stoma); ostomies can be used to deliver feedings directly into the stomach or intestines.

Hypoglycemia S/S

Pale, shaky, sweating, headache, hunger, nausea, irregular/ fast heartbeat, fatigue, irritability, anxiety

Electrolyte restricted for hemodialysis

Potassium builds up between dialysis treatments and can cause problems such as weakness, muscle cramps, tiredness, irregular heartbeat and even heart attack. Potassium is found mostly in fruits, vegetables and dairy products.

Nursing actions metabolic complications

Provide adequate amounts of free water. Consider changing formula to one that is isotonic. Restrict fluids if fluid overload occurs. Monitor electrolytes, blood glucose, and weights. Monitor respiratory, cardiovascular, and neurologic status. Administer insulin per prescribed protocol for hyperglycemia.

Fiber and residual content enteral feedings

Standard formulas are low in residue which makes them less likely to produce abdominal distention or gas. These products are optimal for clients who have been on bowel rest, are postoperative following bowel surgery, or have GI related disease processes. Hydrolyzed formulas are considered residue-free. Standard formulas that are enriched with fiber are recommended for clients who have constipation or diarrhea to normalize bowel movements.

Standard formulas vs Hydrolyzed formulas (enteral feeding)

Standard; composed of whole proteins (milk, meat, eggs) or protein isolates. -They require a functioning gastrointestinal tract. Hydrolyzed; partially or fully hydrolyzed or broken down -partially functioning gastrointestinal tract, or those who have an impaired ability to digest and absorb foods

Jejunostomy tubes

Surgically inserted into the jejunum

Parkinson's disease can interfere with these two important things

Swallowing and communication. Risk of aspiration

Measure the tube each shift and prior to each feeding to check?

To ensure the tube has not migrated

bariatric interventions

Treatment morbid obesity Reduce DM, HTN, Hyperlipidemia, mortality

mechanical complications et feedings

Tube misplacement or dislodgement; aspiration; irritation and leakage at the insertion site; irritation of the nose, esophagus, and mucosa; and clogging of the feeding tube.

Cancer tx taste changes: how to help

Use plastic utensils and glass cookware to lessen a metallic taste. Try sugar-free gum or hard candies with flavors such as mint, lemon, or orange. These flavors can help mask a bitter or metallic taste in the mouth. AND Ginger ale addresses nausea

Iron supplements- take/ don't take with it

Vit c helps absorption of iron Calcium hinders absorption of iron

In oncology settings, some studies reported that late-stage breast cancer patients have lower serum ____ levels

Vitamin A diets richer in micronutrients including vitamin A can improve immune functioning and prognosis in head and neck cancer patients, and reduce the risk of oral and pharyngeal cancers.

Prevent bacterial contamination et feeding

Wash hands before handling formula or enteral products. Clean equipment and tops of formula cans. Use closed feeding systems. Cover and label open cans with unused portions with the client's name, room number, date, and time of opening. Replace the feeding bag, administration tubing, and any equipment used to mix the formula every 24 hr. Fill generic bags with only 4 hr worth of formula.

GERD help

Weight loss Avoid late meals No supine <2hr after meal Avoid etoh, spicy, fatty, citrus, carbonated, caffeine Contributing factors: obesity, pregnancy, meds, smoke, genetics

Soft (bland, low-fiber) diet

Whole foods that are low in fiber, lightly seasoned and easily digested. transitioning between full liquid and regular diets, and those who have acute infections, chewing difficulties, or gastrointestinal disorders. (Predispose pt to constipation)

Mechanical soft diet

clear and full liquids + diced or ground foods chewing ability; dysphagia, poorly fitting dentures, and clients who are edentulous (without teeth); surgery to the head, neck, or mouth; and strictures of the intestinal tract.

mechanical soft diet- foods to choose

clear and full liquids + diced or ground foods Ground cooked meat and poultry. Baked, poached or broiled fish. Casseroles with ground or 1/4 inch diced meat. Eggs. Cottage cheese. Sandwich with soft bread. Shaved deli turkey or ham. Tuna salad or egg salad without celery or raw veges

Enternal nutrition

client cannot consume adequate nutrients and calories orally but has a gastrointestinal (GI) system that functions at least partially Condition that hinders nutritional status or when a client has neuromuscular impairment and cannot chew or swallow food.

Metabolic complications et feeding

dehydration, hyperglycemia, electrolyte imbalances, fluid overload, refeeding syndrome, rapid weight gain

Dumping syndrome

due to rapid emptying of the formula into the small intestine, resulting in a fluid shift. Manifestations include dizziness, rapid pulse, diaphoresis, pallor, and lightheadedness.

unhealthy kidney problems

fluid overload, elevated wastes such as urea, creatinine, potassium, changes in hormone level controlling: blood pressure, making red blood cells, uptake of calcium

Exchange system carbohydrates

foods with a similar amount of carbohydrate per serving size are grouped together. The foods within each list can be "ex-changed" for one another during meal planning, and you end up with about the same amount of carbohydrate.One carbohydrate exchange equals 15 grams of carbohydrate.

renal calculi diet

increased fluids Maintenance k levels low oxalate food (spinach, rhubarb, chocolate, nuts) Limit organ meats, excess na, caffeine, alcohol low Na+ low Vit C

Stomatitis

inflammation of the oral mucosa can lead to pain and difficulty talking, eating, and sleeping. Stomatitis can affect the inner cheeks, gums, inner lips, and tongue.

dietary fiber health benefits

lower choles-terol, lower high bp and support the good bacteria in your gut. Fiber also helps ward off constipation and promotes weight loss by helping you feel full longer

Refeeding syndrome

metabolic alterations that may occur during nutritional repletion of starved patients: potentially fatal

baseline parameters for ET feeding

obtain ht, wt, and BMI monitor: BUN, H+H, glucose, and electrolyte levels verify GI function

end-stage renal disease (ESRD)

occurs when the kidneys are no longer able to work at a level needed for day-to-day life Most common causes in the US are DM and htn. They affect your kidneys. ESRD usually comes after chronic kidney disease.

PEG

percutaneous endoscopic gastrostomy tube

renal disease diet/ end stage kd disease

restricted Na+, K+, protein and fluids and phosphorus On dialysis: increase protein Supplement vit D and calcium

artificial sweeteners

saccharin, aspartame, sucralose, stevia Used in moderation, artificial sweeteners can be safe for people with diabetes, and they can be used to reduce both calorie and carbohydrate intake. Sugar substitutes also can help curb those cravings pts may have for something sweet

Prior to instilling enteral feeding

tube placement should be verified by radiography. The tube should then be marked with indelible ink or adhesive tape where it exits the nose and documented.

wasting syndrome

unwanted weight loss of more than 10 percent of a person's body weight, with either diarrhea or weakness and fever that have lasted at least 30 days