D440 NUT

intake and output (I&O)

used to evaluate fluid balance whereby intake and output are measured and documented

PROBLEM: nausea

- aspirate gastric residue -nausea can be a sign of delayed gastric emptying -the nurse should aspirate the pt gastric residue to check the volume. -based on volume, place feeding on hold, have rate decreased or continue -do NOT lower HOB -kinks in tube causes blockage NOT nausea

Role of RN (Registered Nurse)

- assess pt for clinical manesfestations of fluid and electrolyte disturbance -determine if ordered IV therapy is appropriate - choose appropriate catheters/ infusion devices

Potassium (K+) FUNCTION

- essential mineral needed by all tissues in body -main role is to help maintain normal levels of fluid inside of our cells -helps muscle contraction -supports normal BP Interaction w Sodium: -they are interconnected because while K+ interacts with ICF, sodium affects ECF -while too much sodium increases BP, too much potassium relaxes blood vessels and excretes sodium while DECREASING BP

Renal failure diets

- high calorie, high carb, low protein -control sodium, potassium and phosphorus -may be on a low protein diet, low sodium and potassium diet r/t the kidneys not being able to secrete it -Foods could include: -avoid salt substitutes bc high in potassium

Magnesium Function

- involved in many chemical reactions in the body -involved in protein synthesis -bone strength blood sugar regulation -BP regulation -muscle and nerve function -more than half of Mg is stored in the bones while the rest is stored in tissues

Vitamin B12 (Cobalamin) function

-DNA synthesis (gene expression) -cell division -reduces blood homocysteine levels -involved in the "heme" part of HGB synthesis

Vitamin B3 (Niacin) DEFICIENCY TOXICITY

DEFICIENCY: -S/S -weakness -poor appetite -indigestion -dark, scaly, dematitis -disorders of the skin and the central nervous system (since its involved with ATP) -THE FOUR D's: Dermatitis, Diarrhea, Dementia, DEATH =PELLAGRA TOXICITY: RARE, but can have red flushed skin. itchiness or tingling of the face, arms and chest. -can be a risk factor for gout patients because too much niacin increases uric acid levels

PROBLEM: tube discomfort

Solution: gargle w warm water/mouthwash blow nose clean tube with water lubricant request smaller tubing

Vitamin B1 (Thiamin) Foods

YEAST -yogurt RICE/NOODLES MEATS: -Pork tenderloin, lean, fresh -ham SEAFOOD: -salmon fish -*certain foods and beverages like tea, shellfish, clams, and raw fish contain thiaminases, or enzymes that deactivate thiamine, but developing a thiamin deficiency due to eating these foods is extremely rare. LEGUMES: -lentils -black beans -macadamia nuts -walnuts OATS (whole/ enriched grains): -fortified breakfast cereals -oat blenders with honey and almond cereal -wheat bran flakes -ready to eat cereal VEGGIES: -asparagus -peas

Tube feeding safety r/t gatstric residual volume check

check every 4 hours during first 48 hrs of gastric feeding

Burns Diet

high protein, high caloric, increase in Vitamin C. -this increases adequate protein for increased BMR related to burns for tissue repair FOODS: -cheeseburger -milkshakes -VIT C : OJ

GERD Diet therapy

-decrease alcohol, chocolate, fat intake -avoid smoking -increase protein intake for healing

high residue foods

-development of bulk, the high fiber-high residue diet is often prescribed for the treatment of constipation, diverticular disease during non-acute phase, colic and irritable colon may respond to moderate increases in fiber. The high fiber-high residue has been suggested. -graham crackers -cornbread -granola type cereals -apples -raw fruit in general -nuts and jams (high roughage) -anything with seeds -nuts -frankfurters have fillers that are high residue -coconut -jam, -pickles, olives, relish and horseradish -all desserts containing nuts, seeds, dried fruit, coconut or made from whole grains or bran -candy made with nuts or seeds -popcorn -raw or dried fruit -all berries -prune juice -beans

Strategy for TYPE ONE diabetes

-dont decrease energy intake -increase frequency and number of feedings -have planned food to prevent low BG -extra food for unusual exercise -

Dumping syndrome DIET therapy

-dumping syndrome (nausea, weakness, sweating, palpitations, diarrhea, happens post-gastrectomy) -eat small frequent meals -decrease intake of simple carbs R/T breaking down easier and causes irritation faster -drink fluids 45-hr before or after meals lay down 15-20mins afetr eating to decrease s/s of dumping

Vitamin B3 (Niacin) Functions

-found naturally in foods -works in the body as a coenzyme for a lot of reactions to occur -helps convert nutrients--> ATP (energy) -repair DNA -antioxidant effects

IBS , Malabsorption disorders like Chrons disease, Ulcerative Colitis DIET Therapy

-high calorie, high protein, low fat, low fiber -may be NPO for bowel rest TPN (Severe cases)

Routine House Diets: Mechanical soft

-soup -same as clear and full, plus all cream soups -cereal -cooked cereal, corn flakes, noodels, macaroni, spaghetti -Bread -white bread, crackers, melba toast -Protein foods -same as full plus eggs, mild cheese, cottageg and cream, cheeses poultry, fish tender beef, veal, lamb liver -Veggies -potatoes:baked, mashed, creamed, steamed, scalloped -tender cooked veggies -fresh lettuce and tomatoes

Gastric ulcer diet

A bland, low-fiber diet

Aspiration pneumonia causes

decreased LOC (seizure, anesthesia, head injury, stroke, alcohol) difficulty swallowing insert of NG tube without tube feeding gag and cough reflexes are depressed

Cancer diet

high calorie, high protein, vitamin supplementation -limit fats and carbohydrates esp for pancreatic cancer -cancer treatments can affect the appetite by causing nausea, vomiting--> decreased weight -high calorie= helps to make up for decreased appetite DIET: -milkshakes, smoothies -small meals every 2 hrs -add butter, oils, cheese, high calorie condiments to meals

Nursing interventions for obese

if pt is overweight, recommend low-calorie diet -recommend decreasing saturated animal fats and increasing polyunsat (veggie oils) -teach to limit cholesterol to less than 300 mg/d -encourage to use food labels to see sodium content of foods (limit nacl to less than 4 g/d) -limit processed/ refined sugar -encourage intake of fresh fruits, natural carbs, fish, poultry, legumes, fresh veggies, and grains of healthy balanced diet

pregnancy dietary recommendations

increase protein, iron,folate, increase calories, fruits veggies (apricots) AVOID: -avoid fish high in mercury - soft cheeses, cold meats (listeria) -shellfish -herbal supplements (unless prescribed), -soft-scrambled eggs (r/t Salmonella)

Bariatric Surgery

surgical reduction of gastric capacity to treat morbid obesity -MONITOR: -S/S of dumpling syndrome -> abdominal cramping, tachycardia, nausea, diarrhea, diaphoresis (sweating).. just thinking stomach is cut smaller so time that food travels is even faster -PT: -chew food slower and completely -eat 6 small meals a day -do NOT drink liquids with meals -recline HOB after meals to slow gastric emptying -avoid sugary foods, fat, and carb foods -take vitamins/supplements as needed

2 G sodium restricted diet

-for pts who need to limit the total amount of sodium they eat or drink to 2 grams (2000 mg) daily. -keep in mind that one teaspoon of salt contains 2300 mg of sodium so pt need to take in less than that. -this diet can manage heart disease, Hypertension, kidney disease, poor liver functioning, wt gain from water retention (leg swelling) -always recommend to the pt to read the nutrition facts label - FOODS/ advice to RECOMMENDED LOW SODIUM: -don't add salt, use herbs (fresh garlic, onions, lemon juice) -Mrs. Dash (salt free) alternative * be mindful of potassium alternatives for pts who should also be restricting their potassium lvls FOOD BREAKFAST -OJ, coffee, tea, low fat milk -hard boiled egg, seven-grain toast, jam/ jelly LUNCH -low sodium pea soup -turkey sandwhich (low sodium turkey breast) -lettuce & tomato, mustard, mayo -fresh fruit SNACKS: Graham crackers, no salt added peanut butter DINNER: baked salmon, broccoli, carrots

Calcium DEFICIENCY TOXICITY normal (9-10.5 mEq/L)

-if during growth periods, can cause bone deformities (ex. Rickets in children--> osteoporosis in adults, esp postmenopausal women) -HypOcalcemia (low calcium in blood) results in muscle spasms and tetany -S/S of low Ca+ -postive chvostek's (cheek) and Trousseau's sign, muscle spasms, paresthesia (burning/prickly sensation) PTS you may want to watch Ca+ levels for: -Kidney disease -thyroid disease (PTH affects calcium) -Bone -intestinal diseases affecting absorption TOXICITY: -unlikely -UL 2000-3000mg/d -HypERcalcemia--> calcification of soft tissue and decreased bioavailability of certain nutrients (zinc, iron) -S/S: kidney stones, GI upset, constipation, bone pain, muscle weakness, confusion, weakness/fatigue, chest pain, SOB , heart palpitations

Iron (Fe) Function

-important for blood -major component of HGB (a type of protein in RBC) -Component of myoglobin (muscle) -important for brain development and growth in children, normal production of cells need iron -comes from two types of foods (HEME/NON-HEME) HEME= only animal flesh (meat, fish, poultry, seafood) NON-HEME= Plants, fortified foods

PEPTIC ULCER diet therapy

-increase iron in diet r/t blood loss from ulcers -increase protein and vitamin C for healing -small frequent meals -avoid meds like aspirin, ibuprofen

15/15 rule

-low BG is when it drops below target level S/S: nausea, dizziness, seizures if severe -15 grams of fast-acting carbohydrates (simple sugar) -Repeat in 15 minutes if blood glucose is <60 mg/DL or still symptomatic -Follow with snack that contains complex carbohydrates FOODS: -6-7 hard candies (life savers) -8 oz of milk (15 g of carbs) -4 oz of regular not DIET soda

Vitamin B6 (Pyridoxine) functions FOODS DEFICIENCY, TOXICITY

-maintains homocysteine levels (decreases chance of CVD) -protein/AA metabolism -synthesis of heme in HGB -NIACIN-> TRYPTOPHAN -breakdown proteins, carbs, and fats -Immune function support -brain health FOODS: GRAINS -cereals FRUITS/ VEGGIES: -banana -potato -oranges -cantaloupe -dark leafy greens MEATS: -beef liver -chicken -chickpeas garbanzo beans -salmon -tuna DEFICIENCY: -microcytic anemia (bc of heme function) -CNS: irritability, neuritis, peripheral neuropathy

Peritoneal Dialysis

-procedure for removing toxic wastes when the kidney is unable to do so -monitor serum albumin levels because pt is at risk of excessive protein loss so they'll need higher intake of protein DIET: High protein, low calorie

3 METHODS OF NUTRITIONAL SUPPORT

-regular, enteral, parenteral nutrition

Routine House Diets: Full Liquid Diet

-soup -same as clear, plus strained or blended cream soups -cereal -cooked, very thin , refined cereal -protein foods -milk,creamers, milk drinks, yogurt -veggie juices or pureed veggies -fruit/fruit juices -fruit juices -desserts and gelatin -same as clear, plus sherbet, icecream, puddings, custards, frozen yogurt, margarine

Vitamin A (Retinol, Beta-carotene) Foods

-two basic forms of vitA found in foods (preformed vit A/ retinol and Provitamin A or Betacarotene) ORANGE/YELLOW VEGGIES: -orange veggies (carotene pigments that carry no oxygen) -yellow veggies and fruits (does carry O2) -carrots -apricots, tangerine -pumpkin -squash butternaut -melons -sweet potatoes/yams -cantaloupe -mango, grapefruit, watermelone ORGAN MEAT: -liver (beef liver, chicken liver, cod liver) -cod liver oil -salmon -bluefish tuna GRAINS: -fortified cereals -cream of wheat -Malt-O-Meal SEAFOOD: -Fish DAIRY: - (Milk fat) -skim milk -eggs yolk -butter/margarine -cream GREEN VEGGIES: -dark leafy greens (collard greens, kale, spinach) -brocolli -turnip greens

Vitamin B5 (Pantothenic Acid) Functions Foods DEFICIENCT/TOXICITY

-used to make Coenzyme A which helps to build and break down fats -lower cholesterol levels FOODS: -Organ meats (liver, kidney) -beef, chicken -potatoes, brocolli, avocados, mushrooms -fortified cereals, brown rice, nuts seeds, oats -Dairy milk, eggs yogurt DEFICIENCY: RARE TOXICICTY: RARE

Giving Medication via NG tube

-water (30 ml) flush -crush med (non enteric coated) mix with water and draw up with a syringe -put medication from syringe into tube -flush again (30 ml) -clamp/close the feeding tube Nurse considerations: -never mix meds with enteral formula -each med should be inserted separately -flush to keep tube free of clogging

NG TUBE: pt begins to cough, gag, choke WHAT TO DO?

-withdraw slightly DO NOT REMOVE and stop tube advancement. -instruct patient to breathe and take sips of water to ease the gagging and reduce risk of aspiration

Addison's disease

A rare, chronic endocrine disorder in which the adrenal glands do not produce sufficient steroid hormones. -diminished mineralcorticoid secretion -S/S of hyponatremia -DIET: -increase salt intake -low sugar -restrict high potassium foods -fluids are not restricted -protein is not omitted

HYPOGLYCEMIA S/S

BG<70 mg/dL -caused by too much insulin in the blood , decreased food intake w inadequate food intake, excercise, excess alcohol -S/S: -hunger, irritability, confusion, cool and clammy skin, pale/coldclammy—> seizure/ coma -15/15 rule if pt is conscious!!!

Vitamin B2 Foods

DAIRY: -cow's milk -skim milk -yogurt -cheese -eggs MEATS: -beef liver -chicken liver -lean beef and pork -chicken breast -salmon LEGUMES: -soybeans -almonds GRAINS: -enriched -cereal Malt-o-meal -wheat bran flakes VEGGIES: -spinach

Calcium foods

DAIRY: -milk (esp used in soups, sauces, pudding) -cheese -yogurt -icecream SEAFOOD: -canned sardines -salmon -fish w edible bones WHEAT/GRAIN: -cream of wheat cereal -bagel -tortilla LEGUMES: -almonds -soybeans -tofu VEGGIES: -leafy greens (collard, mustard, turnip, kale, spinach) -winter squash -rhubarb -beet greens FRUIT JUICES -orange juice

hypertension (HTN)

DASH diet: high in whole grain, low fat dairy, calcium, potassium, Magnesium -low in red meat, sweets and sugary beverages -low in sat and trans fat -less than 1500 mg sodium -use herbs over seasonings Watch out for potassium salt subs (Mrs DASH) -onion powder, garlic powder

Vitamin B12 (Cobalamin) DEFICIENCY TOXICITY

DEFICIENCY -caused by lack of intrinsic factor (IF) which is crucial for Vit B12 to be absorbed--> PERNICOUS/MEGALOBLASTIC ANEMIA S/S: fatigue, weakness, nerve damage/ numbness tingling in hands/feet (peripheral neuropathy), memory loss, confusion, depression, dementia, seizures -Neurological damage -older age adults have a decreased amnt of stomach acid -meds that suppress stomach acid for things like GERD or PUD (PPIs, H2 blockers, metformin) -GI surgeries that affect the stomach (Bariatric) -celiac disease, chrons TOXICITY: -Vitamin B12 is water soluable so unused will exit via urine -UL 1000mcg/d

Potassium (K+) Deficiency Toxicity

DEFICIENCY -kidneys work by flushing the excess amount through the urine, also stool and sweat is where its excreted -vomiting, diarrhea, diseases where they experience diarrhea/ malabsorption (Chron's Disease, ulcerative colitis) , and also diuretics can lead to hypokalemia -S/S: fatigue, malaise, muscle cramps, weakness, constipation, *muscle paralysis* (severe) TOXICITY -hyperkalemia r/t advanced kidney disease taking meds that retain K+, ppl w compromised kidneys who eat a high potassium diet or use potassium based salt substitutes S/s: weakness, fatigue, nausea, vomiting, SOB, chest pain, heart palpitations, HEART CAN STOP

Vitamin K DEFICIENCY TOXICITY

DEFICIENCY S/S: -Bleeding -hemmorhaging -longer clotting time or prothrombin time osteopenia/osteoporosis -secondary disorders primarily lead to deficiencies (hypothrombinemia, severe malabsorption disorders like chrons disease) -Antibiotics can destroy vit K in the gut so it can decrease levels as well -babies will need a shot bc they dont have that vit k gut yet TOXICITY: RARE

Vitamin B9 (Folate) DEFICIENCY TOXICITY

DEFICIENCY: -RARE -conditions like alcoholism, pregnancy, GIS surgeries, celiac, IBS can influence the higher need for folate and absorption levels -S/S -megaloblastic anemia (less RBC production) -weakness, fatigue--> neuropathy if left untreated -hair loss -pale skin BABIES DEF S/S: -- Anencephaly, neural tube defects, spina bifida TOXICITY: -can mask vit 12 deficiency because of the nerve damage involved UL:1000 MCG/D

Vitamin C (Ascorbic Acid) DEFICIENCY TOXICITY

DEFICIENCY: -RARE but can happen r/t limited diet for long periods -S/S: -scurvy r/t loss of collagen that weakens connective tissues -skin spots of broken blood vessels -swelling/bleeding gums -hair loss -fatigue/malaise -delayed healing of skin wounds -iron deficiency anemia r/t decreased absorption of non-heme iron TOXICITY: -GI disturbances (nausea, abd. cramps, diarrhea)

Vitamin E (Tocopherol) DEFICIENCY TOXICITY

DEFICIENCY: -related to digestive disorders that prevent fat absorption properly (pancreatitis, cystic fibrosis, celiac disease) S/S OF DEFICIENCY: -retinopathy (damage to the retina of the eyes impairing vision) -peripheral neuropathy (damage to peripheral nerves, usually hands and feet causing weakness/ pain) -ataxia (loss of control of body movements) -decreased immune function S/S OF TOXICITY: -impaired clotting and increased risk of bleeding -***dont want to be taking anticoag medicine (warfarin) or too much vitamin K because it can induce more bleeding

Vitamin D (cholecalciferol) DEFICIENCY TOXICITY

DEFICIENCY: -related to lack in diet, poor absorption, not having metabolic need for higher amounts, not enough sun exposure for long periods -people who have inflammatory bowel (gut) diseases/ surgeries (ulcerative colitis, chrons disease, gastric or stomach bypass surgery) that affect absorption of dietary fat (vit D is fat soluable) -S/S DEFICIENCY: -rickets (soft long bones) in children preventing children from reaching their peak bone mass -Osteomalacia in adults if left untreated in children but can be reversed with supplementation -osteoporosis (porous bones, brittle)--condition is irreversible VITAMIN D TOXICITY: -S/S: -anorexia -weight loss -irregular heart beat -hardening of the blood vessels and tissues due to increased blood levels of calcium (d increase % of damage to the heart and the kidneys) -fragile bones -calcification of soft tissues -kidney stones (hypercalemia)

Vitamin B1 (Thiamin) DEFICIENCY TOXICITY

DEFICIENCY: -since it is heavily involved with ATP(ENERGY) having a deficiency will have downstream effects on the systems described that energy needs (GI, CNS, CVS) -r/t conditions like celiac disease or bariatric surgery where the GI system absorption is compromised S/S: -GI: constipation, indigestion, poor appetite -CNS: Alertness, reflexes decrease causing apathy, fatigue, and irritability -CNS: if def progresses-> nerve irritation, pain, prickly, numbing sensations (peripheral neuropathy of feet and hands)--> PARALYSIS -Paralyzing disease: BERIBERI r/t chronic alcoholism and poor diet. Alcohol blocks absorption of thiamin--> can cause brain disorder Wernicke encephalopathy (affects mental alertness, short term memory, muscle coordination)

Vitamin B2 (Riboflavin) DEFICIENCY TOXICITY

DEFICIENCY: -rare in the US -disorders of thyroid -malnutrition -vegans/ vegetarians -S/S: -CHEILOSIS-> cracked lips esp. at corners of the mouth -sore throat -red tongue -swelling of the mouth and throat -hair loss -anemia -itchy red eyes -poor wound healing -severe, cataracts TOXICITY: NONE

Vitamin A (Retinol, beta carotene) Deficiency Toxicity

Deficiency s/s: -inadequate vitA disrupts the production of rhodopsin causing vision problems -left untreated leads to conjuctival changes (eye dryness) and corneal changes -xerothalmia (begins with night blindness, slow adaptation to darkness) -Bitot Spots -persistant progression of deficiency leads to corneal xerosis, ulceration, keratomalacia -immunity issues (sickness) TOXICITY: -hypervitaminosis -s/s -bone pain -dry skin -fatigue, anorexia, hair loss -liver injury & ascites (fluid accumulation) because it is mostly metabolized by the liver ***TERATOGEN: pregnant pt shouldnt take acne treatments that have high vitA because it is contraindicated in pregnancy. (ex. Retinol, Retin-A).. can cause miscarriage/ birth defects

Low calcium diet

FOODS -baked chicken -mashed potatoes FOODS TO AVOID -pudding made w dairy -vanilla icecream w chocolate syrup -cheese

Periodontitis (Mouth Inflammation) Diet & foods to avoid

FOODS: -Vitamin C (healing) foods: guava, strawberries, oranges other citrus, tomatoes, leafy greens, milk, yogurt, cheese -nuts and seeds -Omega 3 polyunsaturated FAs (leafy greens, fish , veggie oils) -Vitamin D (assists with calcium absorption) -calcium AVOID: Sugary foods, drinks, sports drinks, acidic foods, coffee , potato chips, fruit juices, sodas

Vitamin K Foods

FOODS: -phylloquinnoes (leafy greens) -collard greens -mustard greens -swiss chard -kale -spinach -brocolli -turnips -cabbage -lettuce -avocado OILS: -Soybean oil -canola Oil -olive oil -salad dressing with these oils meat, cheese eggs (smaller amount)

Vitamin C (Ascorbic acid) Foods

FRUITS (citrus): -kiwi -lemon -orange -pineapple -strawberries -grapefruit VEGGIES: -mustard spinach -bell peppers -cruciferous veggies like broccoli, brussel sprouts, cabbage, cauliflower -white potatoes -tomatoes

CALCIUM Function

FUNCTION -healthy bones and teeth -role in blood clotting -helps muscles to contract -regulate normal heart rhythms -99 % of calcium is stored in the bones -Vitamin D helps with absorption of calcium -involved in absorption of Vitamin B12 -involved in secretion of insulin via pancreas -if body doesnt get enough Ca from food itll get it from the bones

Vitamin B1 (Thiamin) Function

FUNCTION: -growth and function of cells -involved in several metabolic reactions that ultimately provide the body with adenosine triphosphate (ATP) ENERGY -useful for every organ that needs ATP (GI tract, nervous system, CV system)

Vitamin E (Tocopherol) TOCO-TO BRING PHEROL (LIFE) Functions

FUNCTION: -most abundant antioxidant, helps to prevent free radicals and preserve lung and red blood cell membranes to prevent blood clots -cell signaling that rives gene expression -immune function enhancement -metabolism (works with the trace mineral selenium as a second line defense free radical and antioxidant effects to protect polyunsaturated fats from being destroyed)

Vitamin B2 (Riboflavin) Function

FUNCTION: -naturally in foods -key component of coenzymes involved with the growth of cells, energy production (ATP), breakdown of fats, steroids, and medications

Vitamin K Function

FUNCTIONS: -helps to make proteins needed for blood clotting and building of the bones -prothrombin is vit K dependent and directly involved with blood clotting -osteocalcin protein requires vitamin K to produce healthy bone tissue. -antidote to warfarin (anticoag)

Vitamin B9 (Folate) Function

Function -DNA synthesis, cell division -heme synthesis (HGB) -Reduces blood homocysteine concentration -DNA/ RNA metabolism -protein metabolism -produce healthy RBC, critical in periods of rapid growth (pregnancy + fetal development)

Vitamin D (Calciferol) Functions

Function: -helps with calcium absorption/ reabsorption because at the bone, the PTH acts with active vitamin D (calcitriol) to release calcium into the bones -helps w phosphorus absorption/and reabsorption -Sunlight allows the body to absorb vitamin D through the skin -bone mineralization -homeostasis of calcium and phosphorus -immune function, neuromuscular function, cell proliferation, differentiation, apoptosis

Vitamin C (Ascorbic Acid) Functions

Functions: -control infections, stimulates the activities of WBCs -wound healing -powerful antioxidant to prevent free radicals -needed to make collagen for ligaments, tendons, connective tissues.. even the blood vessel walls so that it can handle the blood moving through them -general body metabolism (tryptophan--> folate) -improves non-heme IRON Absorption increases with vitamin c helping to prevent iron def. anemia *smokers need more vitamin c

Vitamin A (Retinol, Beta-carotene) functions

Functions: -helps with vision -major task of the retina in the eye. Rhodopsin helps the eye to adjust to different levels of light -growth/cell growth -retinoic acid and retinol are involved with in skeletal and soft tissue growth through both of their roles in protein synthesis and cell membrane stabilization -the constant need to replace old cells that are in the bone matrix requres and good amnt of VitA -tissue strength -these tissues (skin, gi tract, eyes, throat, etc) act as a barrier to primary infection -immunity - serves as an antioxidant to prevent free radical damage -helps w the production of immune cells to fight back viral attacks in the body

Low Purine Diet

Indication: reduce uric acid levels for gout flareup prevention and pain from the arthritis associated with it. FOODS TO EAT: -veggies, fruit, milk, grains (except oats) -rice, pasta, cereals -meatless soup -eggs, nuts peaunt butter - FOODS TO AVOID: BEER/LIQUOR MEATS: organ meats, liver SEAFOOD: sardines, anchovies SAUCES: gravy

enteral nutrition

Indications: -impaired nutrient INGESTION (inadequate eating/malnutrition) -wasting -GI is functioning -allows gut preservation (the gut is functioning normal and we want to prevent it from declining) -prevents atrophy of the stomach TYPES: -NG TUBES: less than 4 weeks (ends in stomach) -duodenal/jujenum (ends there) -PEG and PEJ (nurse don't put this in) (long term) Administration types: cyclic, intermittent, bolus, continuous Aspiration precautions: sit HOB 30-45 Degrees before and after feedings Immediate measures to take: NEX, make a mark Verify placement via chest XR before administration Conditions that require it: -dysphasia, conditions preventing oral nutrition, coma, hyperemesis gravidarum, severe anorexia nervousa, malnutrition Nurse considerations: s/s diarrhea, vomiting, abdominal distention, overall gastric motility -you can give meds through the NG and PEG tubes you are going to crush them, make sure to flush with water (document intake)

Magnesium (Mg+) Foods

LEGUMES: -almonds -peanuts -cashews -pumpkin seeds -beans (kidney) DARK CHOCOLATE DAIRY: -milk -yogurt MEAT: -salmon -beef -chicken VEGGIES: -spinach -white potato FRUIT: -banana -raisins (dried)

Vitamin D (calciferol) Foods

MEATS: -Beef liver -egg YOLK -red meats **SEAFOOD (oily fish): -salmon sockeye -mackerel -tuna fish -swordfish -whitefish -sardines -fish oil -cod liver LEGUMES: -cashews -hazelnuts JUICE: -orange juice (fortified vit D) GRAINS: -Fortified cereals DAIRY PRODUCTS: -soy milk (vitamin D fortified) -low-fat milk -rice milk

Vitamin B12 (Cobalamin) foods

MEATS: -beef liver -red meats -eggs -poultry (chicken) SEAFOOD: -oysters -clams -mussels DAIRY: -soy milk, tofu -rice milk -yeast -milk, cheese yogurt

Vitamin B9 (Folate) foods

MEATS: -chicken liver -turkey liver -eggs GRAINS: -whole grains -grape nute ready 2 eat cereal -wheat bran flakes -quacker cereal related FRUITS: -fresh fruits -fruit juices -orange juice VEGGIES: -dark leafy greens ( turnip greens, spinach romaine lettuce, asparagus, brussel sprouts, broccoli) LEGUMES: -peanuts -sunflower seeds -beans (garbanzo) -lentils -chickpeas

Vitamin B3 (Niacin) Foods

MEATS: -red meat: beef, beef liver, pork -poultry (chicken, chicken breast) -Fish (tuna, yellowfin) LEGUMES -nuts , seeds -peanuts GRAINS/CEREAL: -brown rice -wheaties cereal -cornned tortilla FRUITS: -bananas

Potassium (K+) Foods

SALT (SODIUM) SUBSTITUTES -made from potassium chloride which replaces some or all of sodium chloride in table salt, check w doctor with this replacement because although pts on a salt-restricted diet may benefit from this alternative, potassium can be dangerous for certain pts who are taking meds/ have diseases that cause them to retain too much potassium in the blood VEGGIES: -leafy greens (spinach, broccoli, Beet greens) -dried fruits (raisins, apricots) -potatoes -winter squash -avocado -tomatoes FRUITS -oranges (OJ juice) -tomato juice -prune juice -cantaloupe -BANANA DAIRY -soy, almond milk -milk -yogurt Legumes -beans, lentils -kidney beans MEATS: -chicken -salmon

PROBLEM: Diarrhea

Solution: antidiarrheal meds if bacterial infections ruled out avoid sorbitol/ hypertonic solutions continous instead of bolus

PROBLEM: Reflux/aspiration

Solution: life head of bead (HOB) 30-45 degrees

PROBLEM; thirst and oral dryness

Solution: lubricate lips chew sugarless gum brush teeth rinse mouth frquently

PROBLEM: tension and fullness

Solution: relax and breathe deeply after each feeding

PROBLEM: Constipation

Solution: use fiber containing formula assess for adequate fluid intake

Low residue foods

Uses: reduces bulk, A low residue diet is typically recommended for people with inflammatory bowel disease (IBD) flares, for bowel surgery and colonoscopy prep, and for people with infectious colitis or acute diverticulitis. FOODS: -ripe bananas -COOKED veggies -spaghetti/pasta -milk, yogurt, custard, icecream -white bread (without nuts / seeds) -french toast -white rice

Vitamin E (Tocopherol) Foods

VEGGIE OILS (mostly polyunsat fats) -wheat germ oil -THE THREE S's: soybean oil, safflower oil, sunflower oil NUTS -Almonds -peanut butter -hazelnuts sunflower seeds FRUITS/ VEGGIES: -apricots -mangoes -avocado -spinach -turnip greens, beet greens, collard -red bell pepper -asparagus -pumpkin

PKU (phenylketonuria)

a condition that makes it impossible for babies to metabolize certain proteins -S/S: CNS damage, mental retardation, decreased melanin - formulas that are safe for an infant with PKU is: lofenalac, phenex -foods to avoid: high protein foods like meat, fish, poultry, dairy, soy, legumes (dried beans), eggs, nuts

Metabolic syndrome

a medical condition associated with obesity, diabetes, high cholesterol, and hypertension. It's characterized by obesity, insulin resistance, and increases risks of other ailments (stroke, heart disease, diabetes) -S/S: HTN , increased LDL and triglycerides, decreased HDL (good cholesterol), increased waist circumference

Waist circumference men is more that 40 in , women 35

a way to assess and classify a pt weight health risks increase if the waist circumference is greater than 40 in in men and 35 in in women -BMI may not be the ideal means of assessing health risks associated with weight. To increase accuracy of assessing chronic disease and mortality risk, the use of waist circumference is included because the greater the amount of adipose tissue stored within the abdominal region, the higher the risk for disease and all-cause mortality. pt who have visceral fat with truncal obesity are increased risk of CVD & Metabolic syndrome

Parenteral Nutrition

administration of nutrients intravenously TYPES: Peripheral (PICC into arm into vena cava.. some nurses can insert this) , central line (TPN...inserted by surgeon) Indications: -GI incompetence -critical illness -last resort Nurse considerations: -If bag goes dry and need a refill, without pt special prescribed formula, you will need to give 10- 20% of Dextrose until it arrives to prevent a HYPOGLYCEMIC CRISIS -formula can consist of eggs for fat so need to do a comprehensive allergy assessment just in case they're allergic -monitor their blood glucose COMPLICATIONS: -Pneumothorax.. still do chest XR -air embolism -aspiration- stop feeding when laying flat, raise the HOB -hyper/hypoglycemia -infection r/t IV LOOK AT CH 70 SAUNDERS Ch 22 Williams textbook

Problem: Edema

-Edema is an excess accumulation of fluid in the interstitial space; it occurs as a result of alterations in oncotic pressure, hydrostatic pressure, capillary permeability, and lymphatic obstruction -the kidneys play a major role in controlling balance and fluid and electrolytes -edema is caused by fluid volume excess -edema can be r/t smoking, CHF, CVD, kidney disease, lung disease, metabolic problems, severely overwt, pregnancy, poor nutrition -protein tends to pull water in the blood vessels so if you're deficient it can cause the fluid to go into the ICF and cause you to swell -if blood volume is diluted with too much water (hypervolemia) the water moves into the ICF causing edema and also hyponatremia (low sodium in the blood) -foods high in sodium or salt will cause buildup of fluid. salt causes body to retain water (water follows solute) so the water gets to be too muhc and leaks into tissues -foods to avoid: fast/processed food and meats, Swiss chard, gravies/ savory sauces, potato chips, ketchup sauce, garlic salt, onion salt, canned food

2G sodium restricted diet (CONT)

-FOODS to avoid/ limit DAIRY -buttermilk -milk -yogurt -ice-cream -instant cocoa mixes -Cheese: American, Swiss, cottage MEATS/FISH -smoked, cured, dried, pickled, canned -frozen processed meats -deli meats (frankfurters, bologna) -sardines, canned tuna STARCHES/ BREADS -breads, rolls, crackers w added salt -ready-2-eat cereals -pizza VEGGIES -veggie juices -pickles -olives -tomato juice -canned soups/ broth, bouillon CONDIMENTS

Gas-forming foods

-HIGH FIBER FOODS -FODMAPS prunes peaches apples pears aspargus brussel sprouts kale cauliflower cabbage beans broccoli wheat onions garlic dairy products sugar alcohols fizzy drinks

General Dietary Management

-MNT will depend on pt nutrition status when they arrive, the metabolic results of condition, the pt ability to eat food -routine IV fluids are used to supply hydration needs and electrolytes but CANT sustain energy and nutrient balance. PT would need 10x the amount. -for pt only recieving IV fluids, they should return to regular eating and maintain as tolerated

Role of Unlicensed Assistive Personnel (UAP)

-Measure and record oral intake and output -report swelling or redness at the IV site -report pt complaints of discomfort at IV site to the RN

Type 1 diabetes mellitus/ DIABETES GENERAL

-S/S: 3 Ps: polydipsia, polyphasia, polyuria -wt loss -warm and dry skin -dehydration (weak pulse, decreased skin turgor) -fruity breath odor -diabetes caused by a total lack of insulin production; usually develops in childhood, and patients require insulin replacement therapy to control the disorder -calorie count to consider -they do have diet restrictions but they can eat like normal

Routine Hospital Diets: Clear Liquid Diet

-Soup -clear fatfree broth, bullion -Fruit and fruit juices that are strained -Desserts and Gelatin -fruit flavored gelatin, fruit ices, popsicles -soft drinks (as tolerated) -coffee -tea -honey -salt -hard candy

GOUT diet (musculoskeletal disorder)

-a type of inflammatory arthritis, buildup of uric acid in the blood -If you produce too much uric acid or your kidneys don't filter enough out, it can build up and cause tiny sharp crystals to form in and around joints. These crystals can cause the joint to become inflamed (red and swollen) and painful. FOODS TO AVOID: -red/organ meat -fish: anchovies, sardines, shell fish, shrimp, lobster -fructose drinks -alcohol/beer -yeast -gravy -foods high in fat FOODS TO CONSUME: -cheese -low fat/ fat free dairy -yogurt -eggs (moderation) -salmon (moderation)

Role of LPN/LVN

-administer IV fluids and meds to stable pts -adjust the flow rate for stable pts according to HCP orders -Insert IV catheters -monitor clinical manisfestations of adverse reactions to IV fluids or meds

ESSENTIAL PROTEINS

-amino acids not produced by the body that must be obtained from food -foods to consider: -lean meats; beef lamb, veal -poultry: chicken, turkey -fish and seafood -grains and legumes -grains and milk -seeds -rice -yogurt -eggs -sesame seed bun and lentils

Tube feeding safety

-aspiration and dislodged tubes are safety concerns -elevate HOB at a MINIMUM of30 degrees (preferably 45) tp prevent aspiration -if intermittent feeding, HOB should remain elevated up to an hr after feeding -with increased residual volume, there is an increase in risk of aspiration to form in the lungs

Celiac Disease

-characterized by bowel irritation on exposure to protein gluten -CHILDREN W THIS DISEASE ARE COMMONLY ANEMIC (emphasize foods in folate, iron, vit b12) -impairs body to be able to handle gluten -BROW (BARLEY, RYE, WHEAT OAT) -meals that are high in protein and carbs, but LOW in fats -high fiber foods should be avoided FOODS ALLOWED (GLUTEN FREE MEALS) -hamburger patty without the bun, fries - FOODS NOT ALLOWED -Spaghetti -high fiber foods -hydrolyzed foods (have a lot of gluten) -meatballs (may use bread crumbs)

Diverticulitis diets

-clear liquid diet -progression to high fiber dieting FOODS -avoid foods that may obstruct the diverticula -fiber should be digestible (whole grains, cooked fruits and veggies) -milk and eggs have no fiber, but good sources of protein -nuts and seeds are ok -decrease fats and red meats