Nutrition

Minimize Dumping Syndrome

- Eat 6 small meals - Avoid concentrated sweets (high carbs) - Eat slowly - Avoid fluids during meals - Eat a low carb, high protein, high fat small meal - Lie down for 30 minutes after meals. (slow down digestion, walking speeds it up!!) if you have dumping syndrome and hypotension you need to be laying down

A nurse is administering a bolus enteral feedings to a client who has malnutrition. Which of the following are appropriate nursing interventions? A. Verify the presence of bowel sounds B. Flush the feeding tube with warm water C. Elevate the HOB 20 degrees D. Administer the feeding at room temperature E. Instill the formula over 60 minutes

A, B, D A. Verify the presence of bowel sounds (ensures bowel is working) B. Flush the feeding tube with warm water (ensures patency) C. Elevate the HOB 20 degrees (must be 30 to prevent aspiration) D. Administer the feeding at room temperature (give at room temp to prevent abdominal cramping) E.Instill the formula over 60 minutes (shorter time 5-30 minutes)

A nurse is assessing a client who is postoperative from a gastric bypass and who just finished eating a meal. Which of the following findings are manifestations of dumping syndrome? A. Bradycardia B. Dizziness C. Dry skin D. Hypotension E. Diarrhea

A. Bradycardia (Tachycardia due to a decrease in circulating volume) B. Dizziness (when a portion of the stomach is no longer available to serve a reservoir, a large amount of food is dumped into the small intestine, and fluid shifts from general circulation into the intestine Dizziness occurs due to a decrease in circulating volume) C. Dry skin (sweating) D. Hypotension (decrease in circulating volume) E. Diarrhea (from increased peristalsis)

A nurse is providing dietary teaching for a client who has a new diagnosis of celiac disease. Which of the following statements made by the client indicates an understanding of the teaching? A. I can return to my regular diet when I am free of symptoms. B. I will need to avoid taking vitamin supplements while on this diet. C. I will eat beans to ensure I get enough fiber in my diet. D. I need to avoid drinking liquids with my meals while on this diet.

A. I can return to my regular diet when I am free of symptoms. (Celiac is autoimmune causing changes to the intestinal track, resulting in intolerance to gluten, which is found in wheat, barley, and rye. Client should avoid eating foods that contain gluten even when free of symptoms) B. I will need to avoid taking vitamin supplements while on this diet.(Clients are at risk for malabsorption of vitamins and minerals- will be taking them for life) C. I will eat beans to ensure I get enough fiber in my diet. (clients should eat beans, nuts, fruits, and vegetables to ensure adequate fiber) D. I need to avoid drinking liquids with my meals while on this diet. (Clients who have dumping syndrome should avoid drinking liquids with their meals to slow the movement of food through the intestinal tract.)

A nurse is providing discharge instructions for a client who is postop following a gastrectomy. Which of the following foods should the nurse encourage the client to include in their diet to reduce the risk for dumping syndrome? Ice cream Eggs Grape juice Honey

A. Ice cream (Avoid high in sugar and fat) B. Eggs (instruct client to increase dietary intake of protein containing foods, such as eggs, to decrease the manifestations of dumping syndrome. Should eat protein at each meal) C. Grape juice (avoid sweetened fruit juice) D. Honey (avoid consuming honey and other simple sugars)

A nurse is planning care for a client who has ESRD. Which of the following should the nurse include in a plan of care? A. Monitor the client's weight daily B. Encourage the client to comply with fluid restriction C. Evaluate intake and output D. Instruct the client on restricting calories from carbohydrates E. Monitor for constipation

A. Monitor the client's weight daily (determines fluid retention) B. Encourage the client to comply with fluid restriction (slows fluid retention) C. Evaluate intake and output (determines fluid status) D. Instruct the client on restricting calories from carbohydrates (maintain CHO to prevent protein breakdown) E. Monitor for constipation (can result from fluid restriction) *goal of nutritional therapy is to maintain appropriate fluid status, blood pressure, and blood chemistries *low protein, low phos (dairy foods, eggs, milk), low potassium, low sodium (2-3 g/day), fluid restriction protein broken into crt by kidney, hard for kidneys

A nurse is instructing a client who has celiac disease about foods to avoid. Which of the following foods should the nurse include in the teaching? A. Potatoes B. Graham crackers C. Wild rice D. Canned pears

A. Potatoes (gluten free) B. Graham crackers (made from wheat flour; clients who have celiac must avoid gluten. . Gluten is found in wheat, rye, barley) C. Wild rice (gluten free) D. Canned pears (gluten free) *eat foods that are gluten-free (milk, cheese, rice, corn, eggs, potatoes, fruits, vegetables, fresh meat, fish, dried beans)

A nurse is planning care for a client who has anorexia due to cancer treatment. Which of the following interventions should the nurse include? A. Serve food at warm or hot temperatures B. Offer the client low-density foods C. Make sure the client lies supine after meals D. Limit drinking liquids with food

A. Serve food at warm or hot temperatures (cold or room temp) B. Offer the client low-density foods (high protein, high calorie, nutrient dense foods; eat nutrient dense first at meals) C. . Make sure the client lies supine after meals (to reduce nausea, sit upright for 1 hour after meals. Rest before meals to conserve energy) D. Limit drinking liquids with food (drinking beverages with foods leads to early satiety and bloating which results in consuming fewer calories) offer high density, nutritious foods - ensure shakes - cottage cheese sitting up for an hour reduced nausea, limit liquids with food

A nurse is instructing a client on how to administer cyclic (longer length) enteral feedings at home. Which of the following information should the nurse include? A. Give a feeding every 6 hours B. Set the feeding up before you go to bed. C. Weigh yourself daily D. Flush the tube with a carbonated beverage to dislodge clogs. E. Ensure the head is elevated to 15 degrees during administration

B, C Set the feeding up before you go to bed (many clients administer cyclic feedings during sleeping hours so they are free during the day) Weigh yourself daily

Complications: Refeeding Syndrome

Can occur anytime a malnourished patient starts aggressive nutritional support Body is rapidly changing from a catabolic state to an anabolic state Characterized by fluid retention and electrolyte imbalances (hypophosphatemia, hypokalemia, hypomagnesemia) goes back into cell suddenly pulling fluid Causes dysrhythmias, respiratory arrest, and neuro problems.

Dumping Syndrome

Dumping Syndrome: is a term that refers to a constellation of vasomotor symptoms after eating, especially following a Billiroth II procedure. This syndrome is believed to be caused because of the rapid emptying of the stomach contents into the small intestine, which shifts fluid into the gut, causing abdominal distention. Early manifestations occur within 30 minutes of eating. Manifestations: Weakness Faintness Palpitations Fullness Discomfort Nausea diarrhea Late dumping syndrome occurs 90 minutes to 3 hours after eating, and is caused by a release of an excessive amount of insulin. The insulin release follows a rapid rise in the blood glucose level that results from the rapid entry of high carbohydrate food into the jejunum. Symptoms include dizziness, light-headedness, palpatations, diaphoresis, and confusion.

A nurse is teaching a client who has constipation about a high fiber, low fat diet. Which of the following food choices by the client indicates an understanding of the teaching? Peanut butter Peeled apples Hard boiled eggs Brown rice

Peanut butter (high fat) Peeled apples (source of fiber) Hard boiled eggs (egg yolk high in fat) Brown rice (good source of fiber and low in fat)

A nurse is providing discharge teaching to a client who will be receiving TPN at home. Which of the following instructions should the nurse include? A. Keep the TPN refrigerated when not in use. B. Infuse 10% dextrose and water if the solution runs out. C. Shake the TPN bag with fat emulsion if precipitate is present. D. Stop the TPN once weight gain is achieved. E. Maintain TPN infusion rate when behind schedule.

a, b, e A. Keep the TPN refrigerated when not in use (keep in fridge to maintain integrity of substances) B. Infuse 10% dextrose and water if the solution runs out. C. Shake the TPN bag with fat emulsion if precipitate is present (if precipitate is present, such as white crystals, it should not be used) D. Stop the TPN once weight gain is achieved (weight gain or weight loss should be reported to physician, never abruptly discontinue) E. Maintain TPN infusion rate when behind schedule (slowly increase or decrease-worried about hyper and hypoglycemia)

A nurse is reviewing the laboratory reports of a client who is receiving enteral feedings. Which of the following values indicates a complication of enteral feeding that the nurse should report to the provider? A. Sodium 143 B. Potassium 4.2 C. BUN 25 D. Glucose 185

c A. Sodium 143 (135-145) B. Potassium 4.2 (3.5-5) C. BUN 25 (12-24; indicates dehydration which is a complication) D. Glucose 185 (casual blood glucose <200)

A nurse is caring for a client who is receiving total parenteral nutrition and develops refeeding syndrome. The nurse should expect which of the following laboratory findings? A. Hypermagnesemia B. Hyperkalemia C. Hyponatremia D. Hypophosphatemia

d

answer

edema- because albumin is a protein b,c,e

Enteral and Parenteral Nutrition

enteral- feeding gut, NG, G tube --- always first choice, less risk of infection and continuing to use the gut, less chance of gut illnesses -- can't use if GI rest needed, chrons, ulcerative colitis, tumor in colon parenteral- IV, TPN (central line, all needs, infection risk!! lots of glucose), PPN (peripheral, not as much blood flow and absorption)

A nurse is teaching a client who is recovering from pancreatitis about a low fat diet. Which of the following foods should the nurse recommend? Ribeye steak Oatmeal Ice cream Canned peaches Pretzels

pancreas makes lipase, lipase breaks down fats, what are low fat foods Ribeye steak Oatmeal Ice cream Canned peaches Pretzels