NURS 330 Exam 2

challenges of acute care or post acute care setting

-meals served on different schedule that may not coincide with their preference -types of food, timing sequence of meals -diet order, texture, type,timing, etc ask have you gained or lost weight decrease in food intake or appetitie? based on answers EHR will place nutrition consult if needed NPO status may be placed for pre, post op or for bowel rest advocate for change in diet order if patient is in NPO for a long time, patient status changed or if surgery is even gonna happen

urinary incontinence

1 in 2 suffer form urinary incontinence 1in 1- american men have urinary incontinence with rates rising in men over 60 years and older

the effects of bedrest on nutrition

1. short-term bed rest or disuse accelerates the loss of muscle ass, function, and glucose tolerance 2. emerging evidence suggests that low-intensity exercise and leucine-supplemented meals may partially and temporarily protect skeletal musch. Leucine-rich foods include whey protein, milk, beef, chicken, yogurt, peanuts and soy foods 3. skin integrity may be compromised after just 24 hours of immobilization

a nurse is calculating body mass index for several patients the nurse should recognize which of the following patients BMI's as normal 24 30 40 32

24

urinary tract infections

A urinary tract infection (UTI) is an infection of the urinary system. This type of infection can involve your urethra (a condition called urethritis), kidneys (a condition called pyelonephritis) or bladder, (a condition called cystitis). lower UTI cystitis prostatitis urethritis upper UTI pyelonephritis: acute and chronic interstitial nephritis renal abscess and perirenal abscess

nursing care plan: risk for aspiration

ASSESSMENT: 82 year old female, NG tube placed for tube feedings Dx: priority concern for aspiration related to tube feedings PLAN 1. Patient will maintain patent airway and clear lung sounds before and after feedings 2. patient will tolerate tube feedings well by having less than 30 cc of residual throughout hospitalization 3. pt head of bed will be greater than or equal to 45' degrees for 60 minutes after feedings INTERVENTIONS: keep the HB elevated at 45 degrees during feeding and keep the head elevated for an hour after eating EVUALUATION

Anita Hoffman Case study

Anita Hoffman, a 32 year old woman is admitted to the medical/surgical unit with a 4 month history of diarrhea and abdominal pain that has become much worse over the past 3 days. earlier she had been diagosed with irritable bowel syndrome. the pain occurs before bowel movements and is crampy over the past 4 months she has lost 11 lbs she is admitted wiht a diagnosis of possible inflammatory bowel disease patient interveiw ms hoffman reports very little oral intake over the past 3 days due to diarrhea and loss of appetite part 1 Ms. Hoffman asks the nurse what caused her IBD what is the most accurate response for the nurse to make a. IBD is an infection of the lining of the digestive system b. IBD is genetic condition. do you have any family members with IBD C. IBD is caused by severe stress d. IBD is caused by the body's immune system attacking the intestine CORRECT ANSWER: IBD is caused by the bodys immune system attacking the intestine PART 2: HOSPITAL TREATMENT Ms. Hoffman's lab results show WBC 11,000/mm, Hgb 10.8 g/dl, Hct 35%, Na 153 meq/l, K+ 4.7 BUN 40 and creatinine 1.6 -high WBC count -hct and hbg okay -bun and creatine elevated prioritization knowledge you are developing a plan of care for ms. hoffman what is the highest priority problem a. malnutrition related to decreased PO intake b. hemorrhage related to intestinal bleeding c. fluid volume deficit related to decrease PO intake d. change in body image related to weight loss CORRECT RESPONSE: fluid volume deficit related to diarrhea and decreased fluid intake Ms. Hoffman asked you why she is not allowed to eat or drink what is the reason for keeping ms hoffman NPO a. the nurse should call the provider to clarify the order b. the nurse can educate her that it is okay to drink fluids while NPO c. IBD is caused by food allergies, so she needs to ramin NPO to have allergy testing d. NPO will provide bowel rest and permit more rapid reduction of flare-ups PART 4 Ms. Hoffman was diagnosed with ulcerative colitis based on colonoscopy results. a year later ms hoffman is again admitted to the medical/surgical unit. Despite adjustments in her medications, she has been having increasing exacerbations with bouts of diarrhea often bloody after administration Ms. Hoffman develops fever of 39 degress C . her blood pressure is 89/51 mm HG and heart rate is 123 bpm. her abdomen is distended and bowel sounds are absent what is the most likely explaination for Ms. Hoffman's joint pain a. the joint pain is an attention seeking device Ms. Hoffman is using to cope with having a chronic disease b. the joint pain is a manifestation of Ms. Hoffman's IBD c. the joint pain is caused by Ms. Hoffman's decreased activity level d. patients who have one autoimmune disease often develop a second automminue disorder. the joint pain is caused by another autoimmune disorder CORRECT ANSWER: the joint pain is a manifestation of Ms. Hoffman's IBD because ti can cause arthritis, uveitis, sclerosing cholangitis, gallstones nad kidney stones. not considered to be a separate disorder but a complication of IBD, arthritis is complicaiton of IBD, not of inactivity

components of nutritional assessment

Body mass index (BMI) waist circumference ( 40< in men or 35< in women may indicate disease) biochemical measurements clinical findings dietary data more than one pound a day may be excess fluid weight

assessment and diagnostic findings

CBC serum chemistries urinalysis stool examination endoscopy or barium enema

maintaining normal bowel elimination for patients receiving an enteral feeding

CONSIDER selection of TF formula; consider fiber, osmolality, and fluid content PREVENT prevent contamination of TF; maintain closed system; do not hang more than 4 hours TF is an open system MAINTAIN maintain proper nutritional intake ASSESS assess for reason for diarrhea and obtain treatment as needed ADMINISTER administer TF slowly to prevent dumping syndrome AVOID avoid cold TF

common bowel elimination problems

CONSTIPATION symptom not disease DIARRHEA associated with disorders affecting digestion, absorption and secretion in GI tract FLATULENCE accumulation of gas in the intestines causing the walls to stretch IMPACTION results form unrelieved constipation INCONTINENCE inability to control passage of feces and gas to the anus HEMORRHOIDS dilated engorged veins in the lining of rectum

serum renal function tests

CREATININE LEVEL .6-1.2 mg/dL measures effectiveness of renal function. creatinine is the end product of muscle energy metabolism. in normal function the level of creatinine, which is regulated and excreted by the kidneys, remains fairly constant in the body BUN 7-18mg/dl index of renal function. urea is the nirogenous end product of protein metabolism test values are affected by protein intake, tissue breakdown and fluid volume changes BUN to creatinine ratio 10:1 evaluates hydration status. an elevated ratio is seen in hypovolemia: a normal ratio with an elevated BUN and creatinine is seen with intrinsic kidney disease

____ is a chronic functional disorder characterized by recurrent abdominal pain associated with diarrhea constipation or both

IBS

Physical assessment of urinary functioning

KIDNEYS palpation of the kidneys is usually performed by an advanced health care practitioner as part of a more detailed assessment urinary bladder: palpate and percuss the bladder or use a bedside scanner urethral orifice: inspect for signs of infection, discharge, or order SKIN assess for color, texture, turgor and excretion of wastes URINE: assess for color, odor, clarity and sediment

UTI in males

UTIs in the absence of a urinary catheter in men are considered complicated because they are usually associated with obstructive pathology such as renal stones strictures enlarged prostate in the absence of these risk factors, UTI is rare other cuases of urinary symptoms in males: prostatitis, epididymitis, sexually transmitted infections

water

accounts for between 50-60% of adults total weight two thirds of body water is contained within the cells intracellular fluid remainder of body water is extracellular fluid, body fluids (plasma, interstitial fluid) provides fluid medium necessary for all chemical reactions in teh body acts as a solvent and aids digestion, absorption, circulation and excretion

Which action would the nurse take first when a 78 year old client comes to the health clinic presenting with fatigue, and laboratory results indicate a hematocrit of 32% (.32) and hemoglobin of 10.5 g/dl (105 mmol/L)? conduct a complete nutritional assessment educate the patient about iron supplements schedule the patient to return to the clinic in 3 months for repeat labs explain that mild anemia is a normal age-related change

always complete assessment first before we do any education!!! answer is conduct a complete nutritional assessment

terminology

anuria bacturia oliguria hematuria incontinence polyuria proteinuria

chrons disease

anywhere in Gi tract (from gum to bum) patches of inflammation (found in large sections of the bowel) burning typically in the lower right abdomen ulcers penetrate the entire thickness (several layers) of the abdomen lining

gastrostomy tubes

bolus gastrostomy feeding by gravity if it doesnt go down you should not be feeding

major minerals

calcium, phosphorous, magnesium, potassium, sulfur, sodium, chlorine calcium: keeps the nervous system working well and is needed for blood clotting, osteoporosis is disease caused by calcium deficiency sodium and potassium help regualte the passage of fluids in and out of cells. too much sodium in the diet may aggravate high blood pressure or hypertension, increasing the risk of heart attack, stroke, or kidney disease table salt is one source of sodium in the diet, most sodium comes in food, deficiency of potassium can lead to muscle weakness and abnormal heartbeat

6 types of nutrients

carbohydrates (starches and sugars) fats (saturated, monosaturated and polyunsaturated) proteins (amino acids) vitamins (fat soluble and water soluble) minerals (catalysts for biochemical reactions) water (cells depend on a fluid environment)

fiber

categorized as carbohydrate found in plant foods that is indigestible (cellulose) important for bowel elimination by adding bulk to the stool and stimulation of peristalsis to ease elimination 25g/day for women 35g/day for men

inflammatory bowel disease

chron's disease (regional enteritis) ulcerative colitis

irritable bowel syndrome

chronic functional disorder characterized by recurrent abdominal pain associated with disordered bowel movements, which may include diarrhea, constipation or both 15% of adults in the united states report symptoms of IBS; more common in women than men triggers: chronic stress, sleep deprivation, surgery, infections, diverticulitis and some foods

purposes of gastrointestinal intubation

decompress the stomach lavage the stomach administer medications and feeding compress a bleeding site aspirate gastric contents for analysis make sure suction is at correct level make sure tube is still draining, consistency, color, amount

genitourinary systems-older adults

decreased filtration rate diminished tubular function with less efficiency in reabsorbing and concentrating the urine slower restoration of acid-base balance in response to stress male: benign prostatic hyperplasia female: relaxed perineal muscles, detrusor instability (urge incontinence) urethral dysfunction (stress urinary incontinence)

gastrointestinal systems-older adults

decreased sense of thirst smell, taste decreased salivation difficulty chewing and swallowing food delayed esophageal gastric emptying diminished secretion of gastric acid and pepsin reduced gastrointestinal motility

constipation

defined as fewer than three bowel movements weekly or bowel movements that are hard, dry, small difficult to pass causes include medications, chronic laxative use, weakness, immobility, fatigue, inability to increase intra-abdominal pressure, diet, ignoring urge to defecate and lack of regular exercise perceived constipation: subjective problem in which person's elimination pattern is non consistent with what he or she believes is normal

in crohn's disease the most common clinical manifestation include abdominal pain and ___

diarrhea

dietary modifications

dietary approaches to stop hypertension (DASH) diet for IBD -low FODMAP diet, elimination diet -limit/eliminate apples, artichokes, asparagus, broccoli, cabbage, garlic, onions, peaches, peas, other foods free fructose, cherrys, mangos, pairs, honey, watermelon, high fructose cornsyrup, dairy products diet for celiac disease -no gluten, grains, wheat, barly, rye bc it illicits immune system to attack and damage small intestine diets for diabetes diet for kidney disease -purpose is to reduce waste in blood which negatively effects electrolyte imabalance and increases disease -restriciton of protein intake to prevent uremia, -high quality protein foods, poultry, eggs, fish, selfish, dairy, limit red meat -reduce sodium and potassium to avoid hyperkalameia diets for dementia -mine diet -mediterrian dash diet -brain healthy good groups, green leafy veggies, nuts, whole grains, beans, fish, olive oil -no redmeat, butter, cheese, pastrys, fried foods -at least 3 servings of whole grains, salad and one other veggie every day, snack on nuts, eat beans, -poultry, berries and fish at least once a week -limit, butter, cheese and fried foods to have real shot at avoiding alzheimers

celiac disease

disorder of malabsorption caused by autoimmune response to consumption of products that contain the protein gluten gluten is most commonly found in wheat, barley, rye and other grains malt, dextrin and brewer's yeast celiac disease has become more common in past decade with an estimated prevalence of 1% in the united states women are afflicted twice as often as men type 1 diabetes, down syndrome, turner syndrome

fat soluble vitamins

dissolve fat and can be stored in the body vitamin A vitamin D vitamin E vitamin K

water soluble vitamins

dissolve in water not stored by the body to any extent foods rich in these vitamins must be eaten more often than foods with fat-soluble vitamins good sources -fruits: lemon, oranges, limes, grapefruit -vegetables: broccoli, collard greens, spinich, turnip greens, kale water soluble vitamins are: thiamin (B1), riboflavin (B2), niacin, vitamin B 6, folacin (folic acid), vitamin B12, pantothenic acid, biotin, vitamin C (asorbic acid)

diverticular disease

diverticulum: sac like herniation of the lining of the bowel that extends through a defect in the muscle layer may occur anywhere in the intestine but most common in sigmoid colon diverticulosis: multiple diverticula without inflammation diverticulitis: infection and inflammation of diverticula diverticular disease increases with age and is associated with a low fiber diet diagnosis is usually by colonoscopy

chloesterol

eating foods high in fats, especially saturated fats may increase the level of cholesterol, a waxy fat-like substance produced by the body part of cell membranes and nerve tissues, used by body to form vitamin D and other hormones, found only in foods that come from animals such as butter, eggs, meats. NOT AN essential nutrient because the body produces cholesterol in liver too much increases risk of heart disease

interventions: anorectal condition

encourage intake of at least 2 L of water a day promote urinary elimination educate on self care recommend high fiber foods hygiene and sitz baths bulk laxatives, stool softeners and topical medications monitor for complicaitons

waist circumference

excess abdominal fat males waist circumference >40 inches females' waist circumference > 35 inches high waist circumferences risk for diabetes risk for dylipidemia risk for hypertension risk for heart attack risk for stroke

vegetarian diets

focuses on plants for foods, vegan excludes all meat and animal products lacto vegetarian: includes diary products lacto-ovo vegetarian: includes dairy products and eggs

dietary data

food record 24 hour food recall conducting dietary interview religious cultural considerations

clinical exam

general appearance (height/weight) skin, hair, nails mouth (includes teeth, tongue, gums) mucous membranes neck (includes thyroid) musculoskeletal abdomen

nursing process: care of the patient with intestinal obstruction-planning

goals maintaining the function of the nasogastric tube assessing and measuring the nasogastric output assessing for fluid and electrolyte imbalance monitoring nutritional status and assessing for manifestations consistent with resolution (return of normal bowel sounds, decreased abdominal distention, subjective improvement in abdominal pain and tenderness, passage of flatus or stool)

nursing process: care of patient with appendicitis-planning

goals include relieving pain preventing fluid volume deficit reducing anxiety preventing or treating surgical site infection preventing atelectasis maintaining skin integrity attaining optimal nutrition

vitamin k

green leafy vegetables, liver, kale, cabbage, made in body by intestinal bacterial assists in normal clotting of blood signs of toxicity: anemia signs of deficiency: slow clotting of blood, hemorrhage especially in newborns

nursing process: the care of the patient with inflammatory bowel disease-assessment

health history to identify onset, duration and characteristics of pain, diarrhea, urgency, tenesmus, nausea, anorexia, weight loss, bleeding and family history discuss dietary patterns, alcohol, caffeine and nicotine use assess bowel elimination patterns and stool abdominal assessment

mr james is 87 year old man with a history of hypertension. he has been unable to take medications for past 2 years because of high cost of medications and unpleasant side effects. smokes one pack of cigarettes per day but does not drink alcohol. presents to clinic becauase he has been tired and had a headache for past few days

height 5' 9" weight 165 pounds Bp 178/94 mm Hg, pulse 92 ive been really tired lately and Ive had this headache that will not go away i dont cook so i usually eat frozen meals for breakfast and dinner based on patients 24 hour recall he consumes about 1500 kcal/day BMI? any other physcial concers, underlying conditions, appettite, dental health, medications, eyesight, pain, weight increase/decrease in last 3 months, ability to prepare meals, energy level, does he eat alone, transportation? decrease environmentla distractions oral care accesory devices eat at bedside table, chair/table temperature of food, visual apearance, support open packages, limit interruptisons

dash diet

high protein high fiber reduces risk of heart disease primary includes whole grains vegetables fruits low fat dairy foods lean protein (poultry, red meat, fish, nuts, beans)

factors that influence nutrition

hospitalization physical problems or limitations limited fixed incomes cultural influence medications

diarrhea

increased frequency of bowel movements (more than three per day) with altered consistency (increased liquidity) of stool usually associated with urgency, parianal discomfort, incontinence or a combination of these factors may be acute, persistent or chronic causes include infections, medications, tube feeding formulas, metabolic and endocrine disorders, various disease processes

full liquid

indications transition after surgery, difficulty swallowing, chewing nursing considerations lacks calories, poor energy source, short term, transitional diet, protein supplements may be needed more variety and nutritional support than clear liquid, same as clear plus, all forms of milk, soups, vegetable, fruit juices plain icecream, sherbert, refined cereals and pudding careful with dysphagia

carb consistent

indications: DM, hyperglycemia, hypoglycemia and obesity nursing considerations: carb counting and consistency

sodium restricted diet

indications: HTN, HF, renal disease, cardiac disease, liver disease nursing considerations: ex 4G Na+ daily 2-3 G Na+ daily, 1g of Na+ daily, or severe restriction of 500g Na+ daily

cardiac diet

indications: HTN, HF, renal failure, atherosclerosis, DM, MI, Hyperlipidemia nursing considerations: teach Dash Diet, restricts total fat, cholesterol and sodium

renal diet

indications: acute/chronic kidney injury, dialysis nursing considerations: monitor protein, daily weight

clear liquid diet

indications: bowel preparations for surgery and diagnostics provide electrolytes and fluid to prevent dehydration nursing considerations lacks calories poor energy source short term transitional diet water tea, fat free broth, clear juices, ginger ales, gelatin limit caffeine consumption

indications for parenteral nutrition

intake is insufficient to maintain anabolic state ability to ingest food orally or by tube is impaired patient is not interested or is unwilling to ingest adequate nutrients underlying medical condition precludes oral or tube feeding preoperative and postoperative nutritional needs are prolonged

intestinal obstruction

intestinal obstruction exists when blockage prevents the normal flow of intestinal contents through the intestinal tract mechanical obstruction intraluminal obstruction or mural obstruction from pressure on the intestinal wall functional or paralytic obstruction the intestinal musculature cannot propel the contents along the bowel the blockage also can be temporary and the result of manipulation of the bowel during surgery

trace minerals

iron, iodine, manganese, zinc, copper, fluroine the majority of the minerals needed for the body to function are only required in very small, or trace amounts IRON IODINE

ulcerative colitis

limited to the large intestine/colon infammed areas are continuous with no patchiness burning typically in lower left abdomen ulcers penetrate the inner lining of the abdomen only common blood during bowel movements

IBS: patient learning needs

medication management complimentary medicine dietary changes food diary adequate fluid intake avoid alcohol and smoking relaxation techniques

parenteral nutrition

method to provide nutrients to the body by an IV route more expensive, higher risk, not long term solution you would need central line for adequate nutrition complex mixture containing proteins, carbohydrates, fats, electrolytes, vitamins, trace minerals, sterile water is administered in a single container the goals of parenteral nutrition are to improve nutritional status, establish a positive nitrogen balance, maintain muscle mass, promote weight maintenance or gain and enhance the healing process may be delivered peripherally or via a central line, depending on the solution's hypertonicity

vitamin D

milk, eggs, liver, exposure of skin to sun's ultraviolent rays promotes absorption of phosphorus and calcium to build and maintain bones signs of toxicity: loss of appetite, headache, nausea, weakness, calcification of bone and soft tissue signs of deficiency: rickets (poor bone development) malformation of teeth

appendicitis

most frequent cause of acute abdomen in united states, most common reason for emergency abdominal surgery appendix becomes inflamed and edematous as a result of becoming kinked inflammatory process increases intraluminal pressure, causing edema and obstruction of the orifice once obstructed, appendix becomes ischemic, bacterial overgrowth occurs, eventually gangrene or perforation occurs

UI screening and evaluation

multifactorial evaluation comorbidity function medication questions to ask do you have any problems with baldder control do you have any problems making it to the bathroom on time do you ever leak urine

iodine

needed for thyroid gland to function properly thyroid gland produces hormones that control how quickly chemical reactions occur in body too little iodine-thyroid gland enlarged. primary sources are seafood and iodized table salt

sources of nutrition

nutrients absorbed in the diet determine, to a large degree , the health of the body deficiencies or excesses can contribute to a poor state of health essential nutrients are those that the body cannot manufacture

vitamin A

orange, yellow, green vegetables, liver, margarine, egg yolk maintains healthy eyes, skin, bone growth and tooth development, possible aid in cancer protection signs of toxicity: nausea, vomiting, dry skin, rashes, hair loss, headache, fatigue signs of deficiency: night blindness, eye infections, rough skin, respiratory infections

nursing process the care of the patient with a gastrostomy or jejunostomy -assessment

patient knowledge and ability to learn self-care ability and support skin condition nutrition and fluid status inspection of the tube patient education and preparation tube insertion confirming placement clearing tube obstruction monitoring the patient maintaining tube function oral and nasal care monitoring, preventing and managing complications Test it for pH, blood, clots, normal color is yellowish, clear, green tint, undigested food dont use for people with head injuries

calorie count

percentage of food eaten by patient

collaborative problems and potential complications r/t parenteral nutrition

pneumothorax air embolism clotted or displaced catheter sepsis hyperglycemia rebound hypoglycemia fluid overload

anorectal conditions

proctitis anal fissure anorectal abscess hemorrhoids anal fistula pilonidal sinus or cyst

body mass index

ratio based on body weight and height compared to standards but trends are more useful than isolated measurements BMI less than 18.5=increased risk of problems associated with poor nutrition BMI between 25 and 29.9=considered overweight BMI of 30 or more=obese BMI greater than 40= morbidily obese must take ethnicity into account

diarrhea: patient learning needs

recognition of need for medical treatment rest diet and fluid intake avoid irritating foods, including caffeine, carbonated beverages, very hot and cold foods perianal skin care medications may need to avoid milk, fat, whole grains, fresh fruit, and vegetables lactose intolerance

constipation: PATIENT LEARNING NEEDS

refer to chart 47-7 normal variations of bowel patterns establishment of normal pattern dietary fiber and fluid intake responding to urge to defecate exercise and activity laxative use

urine specimens

routine urinalysis clean-catch or midstream specimens sterile specimens form a urinary diversion 24-hour urine specimen specimens from infants and children point of care urine testing

mini nutritional assessment (MNA)

screening tool for older adults has food intake declined over last 3 months weight loss during the last 3 months mobility psychological stress or acute disease in the past 3 months neuropsychological problems BMI living situation medications pressure sores or skin ulcers how many full meals does the patient eat daily selected consumption markers for protein intake consumes two or more servings of fruit or vegetables per day how much fluid is consumed per day mode of feeding self view of nutritional status in comparison with other people of the same age how does the patient consider his/her health status mid-arm circumference in cm calf circumference in CM

biochemical assessment

serum prealbumin and albumin (may not be best indicator of current nutritional status, prealbumin is better) serum transferrin and retinol binding protein complete blood count electrolytes urine tests

new nutritional label

serving size appears in larger bold font and some serving sizes have been updated calories are now displayed in larger, bolder font dialy values have been updated added sugars, vitamin D and potassium are now listed, manufacturers must declare amount in addition to percent daily value for vitamins and minerals

carbohydrates

simple: different forms of sugar, which are easy for the body to process, fructose, glucose which are in fruits and vegetables, sucrose (refined sugar), lactose (milk) glucose that is not needed immediately is converted by the body to glycogen starches are complex carbohydrates that are made up of many units of glucose, or other sugars which form long chains dietary fiber complex carbohydrate which comes from nondigestible parts of plants

fats

small daily intake of fat is required one gram of fat provides more than twice as much energy as one gram of carbohydrate part of many body tissues and are important as carriers of other nutrients such as vitamins diet high in saturated fats can lead to an increased chance of heart and blood vessel disease, obesity and some types of cancer

gerontologic considerations

some older adults may require an ostomy but have difficulty managing care due to -decreased vision -impaired hearing -difficulty with fine motor coordination skin care is a major concern in older patients wiht an ostomy because of the skin changes that occur with aging- the epithelial and subcutaneous fatty layers become thin and the skin is irritated easily

proteins

substances found in every cell, body needs proteins to build and repair all body tissues important part of blood cells, made up of carbon, hydrogen, oxygen and nitrogen atoms that are formed into basic units called amino acids there are 20 different amino acids, 9 of them are essential and the other 11 amino acids can be produced by the body

nursing interventions

teaching nutritional information monitoring nutritional status stimulating appetite assisting with eating providing oral nutrition providing long term nutritional support

prioritization knowledge

the patient has just returned to the medical unit to begin supplemental feedings through an NG tube. Which of the nurses' assessments addresses this patients most significant potential complication of feeding answer choices -frequent assessment of the patients abdominal girth -frequent lung auscultation -monitoring of the frequency and character of bowel movements correct answer: frequent lung auscultation aspiration s/sx, oxygen saturation wil change, potential increase work of breathing, hear changes in lung sounds

geriatric considerations

total body protein decreases as aging progresses food purchasing/prepreparation difficulties impaired acuity of taste and smell living arrangements loss of partner taking multiple medications poverty nerve disorder dental health

true or false diarrhea is defined as the increased frequency of more than 3 bowel movements per day

true

nursing process: the care of the patient receiving an enteral feeding-assessment

tube placement patients ability to tolerate formula and amount clinical response signs of dehydration elevated blood glucose level, decreased urinary output, sudden weight gain, periorbital or dependent edema infection control practices I &O weekly weights, dietician consult

purposes and advantages of enteral feedings

tubes: nasogastric or nasoenteral tubes, gastrostomy or jejunostomy tubes for long-term feeding worry about skin, worry about nare because it can create a pressure injury methods: intermittent bolus feedings intermittent gravity drip continuous infusion cyclic feeding

24 hour food recall

use open-ended questions tell me the first thing you ate yesterday when was the first time you ate or drank anything yesterday did you have anything else to eat or drink at the time what was the next thing you had to eat or drink use comparisions, golf, size of fist

iron

vital part of hemoglobin- a substance in red blood cells that carries oxygen to all parts of the body insufficient may cause anemia, disease in which the body has either too few red blood cells ort too little hemoglobin as result too little oxygen is carried to cells of the body

absent bowel sounds in all four quadrants= reason to notify provider

we can vent the GI tube or get them up and moving if they have distention and gas to get them to burp or pass gass

cultural considerations

what foods are eaten during stress, trauma or illness to prevent illness what are the common food preferences likes or dislikes in what context is the food purchased, prepared, served and eaten what are the food nutrients and what are acceptable versus prohibited foods waht are the accepted food combinations how do foods facilitate communication and relationships within cultures what geographic or environmental influence sexist

Nursing Process: the care of the patient with a UTI- ADPIE

what should a nurse ask to assess a patients dysuria do you have pain when you urinate what are the different assessment findings between a lower UTi and an upper UTI major goals relief of pain and discomfort increased knowledge of preventive measure and treatment modalities absence of complications

vitamin E

wheat germ, whole grains, vegetable oils, legumes, nuts, dark green leafy vegetables protects red blood cells, stabilizes cell membranes signs of toxicity: general digestive discomfort signs of deficiency: rupture of red blood cells, anemia, nerve abnormalities