A brief method for quickly identifying clients at risk for malnutrition so they can then receive a complete nutritional assessment is called an _____________

A brief method for quickly identifying clients at risk for malnutrition so they can then receive a complete nutritional assessment is called an _____________

Answer: nutrition screening

Which is not a likely cause for malnutrition?

Which is not a likely cause for malnutrition?

Answer: decreased nutrient requirements

How does malnutrition affect the patient?

How does malnutrition affect the patient?

Answer: increase the risk of pressure ulcers

If a client is asked to recount everything eaten in a typical day, assessor is using ____ to collect the data.

If a client is asked to recount everything eaten in a typical day, assessor is using ____ to collect the data.

Answer: 24 hour recall

Which was not included on the "components of nutritional assessment" slide show in class?

Which was not included on the "components of nutritional assessment" slide show in class?

Answer: exercise equivalents

The practitioner reviews a great number of patient charts in which task?

The practitioner reviews a great number of patient charts in which task?

Answer: nutrition screening

Patient height and weight represent which type of data?

Patient height and weight represent which type of data?

Answer: anthropometric data

Laboratory tests fall under which category of nutritional assessment?

Laboratory tests fall under which category of nutritional assessment?

Answer: biochemical data, medical test, and procedures

What are some dietary interventions for ostomy surgeries?

What are some dietary interventions for ostomy surgeries?

- Post-surgery—clear liquids advanced to regular
- Reintroduce foods gradually
- Watch foods that cause obstructions
- Watch gas-producing or strong odor foods
- Encourage fluids

What disorder corresponds with the pyloric sphincter?

What disorder corresponds with the pyloric sphincter?

Answer: dumping syndrome

What disorder corresponds with the lower esophageal sphincter?

What disorder corresponds with the lower esophageal sphincter?

Answer: GERD

What does C. diff stand for?

What does C. diff stand for?

Answer: Clostridium difficile

What is a low-FODMAP diet?

What is a low-FODMAP diet?

Answer: meant to help reduce flatulence, abdominal distention, and diarrhea

Whats does FODMAPS stand for?

Whats does FODMAPS stand for?

fermentable oligosaccharides disaccharides monosaccharides and polyols

What are some dietary interventions for IBS?

What are some dietary interventions for IBS?

-look for individual food intolerances
-a low FODMAP diet can decrease symptoms
-adding foods back in helps to see what foods increased symptoms

What are some symptoms of IBS?

What are some symptoms of IBS?

-abdominal pain
-diarrhea
-flatulence
-constipation
-bloating
-increase in pain when eating
-decreased/relieved after bowel movement

What is irritable bowel syndrome?

What is irritable bowel syndrome?

Answer: an intestinal disorder of unknown causes that disturbs the functioning of the large intestine

What are some dietary interventions for inflammatory bowel disease?

What are some dietary interventions for inflammatory bowel disease?

-high calorie, high protein diets to prevent and treat malnutrition and promote healing
-oral supplements to increase energy intake and improve weight gain
-vitamin and mineral supplements
-some cases may need a feeding tube
-when exacerbated a low fiber, low fat diet is prescribed (small frequent feedings)

What is ulcerative colitis?

What is ulcerative colitis?

-an IBD that involves the rectum and colon
-the inflammation affects the mucosa and submucosa of the intestinal wall

What is Chron's disease?

What is Chron's disease?

-an IBD that usually occurs in the lower portion of the small intestine and the colon
-inflammation may pervade the entire intestinal wall
-may lead to malabsorption

What are the two inflammatory bowel diseases?

What are the two inflammatory bowel diseases?

1. Crohn's disease
2. Ulcerative colitis

What does gluten free on the label imply?

What does gluten free on the label imply?

Answer: contains less than 20 ppm gluten

What are some dietary interventions with someone with celiac disease?

What are some dietary interventions with someone with celiac disease?

-life long gluten free diet
-have to be careful when eating oats due to possible cross contamination

How is celiac disease diagnosed?

How is celiac disease diagnosed?

Two blood tests:
1. serology testing
2. genetic testing

Where does celiac disease commonly affect?

Where does celiac disease commonly affect?

Answer: duodenum

What are the symptoms of celiac disease?

What are the symptoms of celiac disease?

Answer: diarrhea, steatorrhea, flatulence, lactose intolerance

What is celiac disease?

What is celiac disease?

Immune disorder characterized by an abnormal immune response to a protein fraction in wheat gluten and related proteins found in rye and barley (affects the small intestine)

What are some dietary interventions for fat malabsorption?

What are some dietary interventions for fat malabsorption?

-fat restricted diet if steatorrhea continues
-multi-vitamin/mineral supplements
-lean meat, fish, skinless poultry
-dried beans and peas
-egg whites
-fat free milk, yogurt, and other dairy products

What is MCT?

What is MCT?

-do not require lipase or bile for digestion
-can be used as an alternative source of dietary fat
-MCT oil does NOT provide amino acids

What does MCT stand for?

What does MCT stand for?

Answer: medium chain triglycerides

What are nutrition consequences from fat malabsorption?

What are nutrition consequences from fat malabsorption?

-excessive fat in stool "steatorrhea"
-loss of food energy (weight loss and malnutrition)
-loss of essential fatty acids
-loss of fat soluble vitamins and minerals

What is some dietary interventions for diarrhea?

What is some dietary interventions for diarrhea?

-low fiber, low fat, lactose free diet
-a bland diet to return bowels to normal function

What are causes of chronic diarrhea?

What are causes of chronic diarrhea?

-malabsorption disorders
-radiation treatment
-inflammatory disease
-motility disorders

What are causes of acute diarrhea?

What are causes of acute diarrhea?

-viral
-bacterial
-parasitic
-protozoan infections
-can be a side effect to medication

What are causes of diarrhea?

What are causes of diarrhea?

-infections
-medications
-dietary substances
-as a complication of a GI disorder

What is chronic diarrhea?

What is chronic diarrhea?

-long lasting and can cause dehydrations and electrolyte imbalances and it may lead to weight loss and malnutrition
-4 weeks or longer

What is acute diarrhea?

What is acute diarrhea?

starts abruptly and may last for weeks

What is the recommended fiber intake for adults?

What is the recommended fiber intake for adults?

-25 grams a day for women
-38 grams a day for men

What are some medical conditions that cause constipation?

What are some medical conditions that cause constipation?

-diabetes mellitus
-hypothyroidism

What are some neurological conditions that cause constipation?

What are some neurological conditions that cause constipation?

-parkinson's disease
-MS

What are some causes of constipation?

What are some causes of constipation?

-low fiber diet
-low food intake
-inadequate fluid intake
-low levels of physical activity
-medical conditions
-neurological conditions
-pregnancy
-medication side effects and dietary supplements
-calcium channel blockers
-diuretics
-opiate containing analgesics
-calcium and iron supplements

What is constipation?

What is constipation?

-diagnosed when someone has fewer than 3 bowel movements a week
-can be accompanied by excessive straining during bowel movement, the passage of hard stools, and inability to empty bowel completely

What are some lower GI disorders?

What are some lower GI disorders?

-constipation
-diarrhea
-celiac disease
-fat malabsorption
-IBS
-inflammatory bowel disease

What are some dietary interventions for dumping syndrome?

What are some dietary interventions for dumping syndrome?

-eat smaller meals
-reduce foods that increase osmolarity
-restrict fluids during meals
-sugars (including milk sugars) are restricted

How do you get dumping syndrome?

How do you get dumping syndrome?

Answer: it is often a common complication of a gastrectomy because the stomach emptying is no longer regulated

Who are the candidates for a gastrectomy?

Who are the candidates for a gastrectomy?

-gastric cancer
-recurrent ulcer disease
-large duodenal perforations
-bleeding gastric ulcer
-GI stromal tumors
-corrosive stricture of the stomach

Who are candidates for a total gastrectomy?

Who are candidates for a total gastrectomy?

-gastric cancer
-recurrent ulcer disease
-large duodenal perforations
-bleeding gastric ulcer
-GI stromal tumors (GISTs)
-corrosive stricture of the stomach

How should eating habits look like after someone has bariatric surgery?

How should eating habits look like after someone has bariatric surgery?

-consume 3-6 small meals a day
-only small portions of food at each meal
-fluids are consumed separately from meals

What are some dietary interventions for bariatric surgery?

What are some dietary interventions for bariatric surgery?

-initially consume only sugar-free non carbonated clear liquid and low fat broths
-progress to full liquid diet
-then to soft semi solid foods
-then lastly solid foods again
-avoid high fiber foods

What are some non-surgical weight loss methods?

What are some non-surgical weight loss methods?

-exercise
-dietary adjustments
-medications
-behavior modification

Who are the candidates for bariatric surgery?

Who are the candidates for bariatric surgery?

-BMI greater than 40
-BMI between 35-40 is aloud if it accompanied by severe weight related problems such as diabetes, hypertension, or debilitating osteoarthritis
-most have attempted non-surgical weight loss methods
-must understand that even with surgery it requires lifelong management

What are some foods/substances that increase acid secretion or irritate the GI lining that are dietary interventions for PUD?

What are some foods/substances that increase acid secretion or irritate the GI lining that are dietary interventions for PUD?

Answer:

-alcohol
-chocolate
-caffeine containing beverages
-non-caffeinated coffee and tea

How many hours before bedtime should you avoid eating when you have PUD?

How many hours before bedtime should you avoid eating when you have PUD?

Answer: 2 hours

What are some dietary interventions for PUD?

What are some dietary interventions for PUD?

Answer:

-correct nutrient deficiencies
-avoid foods and substances that increase acid secretion or irritate GI lining
-small meals may be better tolerated

What are common causes of PUD?

What are common causes of PUD?

Answer:

-NSAIDs
-the PRIMARY cause is H. pylori infection
-stress (less common cause)

What is PUD?

What is PUD?

Answer: -is an open sore that develops in the GI mucosa when gastric acid and pepsin overwhelm, mucosal defenses and destroy mucosal tissue

What does PUD stand for?

What does PUD stand for?

Answer: peptic ulcer intervention

What are some lifestyle interventions for GERD?

What are some lifestyle interventions for GERD?

Answer:

-elevate head of bed when sleeping
-wear loose fitting clothes
-avoid smoking
-avoid NSAIDs

How many hours before bed should you avoid eating foods when you have GERD?

How many hours before bed should you avoid eating foods when you have GERD?

Answer: 3 hours

What are some foods/substances that weaken the pressure of the lower esophageal sphincter, and are dietary interventions for GERD?

What are some foods/substances that weaken the pressure of the lower esophageal sphincter, and are dietary interventions for GERD?

Answer:

-alcohol
-chocolate
-fried or fatty foods
-peppermint

What are some substance that increase gastric secretion, and are a dietary intervention for GERD?

What are some substance that increase gastric secretion, and are a dietary intervention for GERD?

Answer:


-beer
-coffee
-wine

What are some dietary interventions for GERD?

What are some dietary interventions for GERD?

Answer:

-consume only small meals and drink liquids between meals
-limit foods or substances that increase gastric acid secretion
-limit food or substances that weaken the pressure of the lower esophageal sphincter

What are causes of GERD?

What are causes of GERD?

Answer:


-lower esophageal sphincter muscle is weak or relaxes inappropriately
-high stomach pressure and inadequate acid clearance from the esophagus

What does GERD stand for?

What does GERD stand for?

Answer: gastroesophageal reflux disease
-backflow of gastric contents into the esophagus

What are some dietary interventions for dysphagia?

What are some dietary interventions for dysphagia?

Answer:

-consume foods and beverages that have been physically modified so that they are easier to swallow
-a person's swallowing ability can fluctuate over time so the dietary plan needs frequent reassessment

What are the complications of Dysphagia?

What are the complications of Dysphagia?

Answer:

-it restricts food consumptions
-causes weight loss
-malnutrition may develop
-if someone cannot swallow liquids they are at risk for dehydration
-high risk for aspiration (which causes choking, airway obstructions, or respiratory infections including pneumonia)

What are two examples of NSAID?

What are two examples of NSAID?

Answer:

1. aspirin
2. ibuprofen

What does NSAID stand for?

What does NSAID stand for?

Answer: non-steroidal anti-inflammatory drug

Why is aspiration a concern?

Why is aspiration a concern?

Answer: because it causes choking, airway obstruction, or respiratory infections including pneumonia

What is a symptom of esophageal dysphagia?

What is a symptom of esophageal dysphagia?

Answer:

-the sensation of food sticking in the esophagus after swallowing
-may affect the ability to swallow solid foods, but not liquids

What causes esophageal dysphagia?

What causes esophageal dysphagia?

Answer: difficulty passing materials through the esophageal lumen and into the stomach, usually due to an obstruction in the esophagus or a motility disorder

What is esophageal dysphagia?

What is esophageal dysphagia?

Answer: -has difficulty passing materials through the esophageal lumen into the stomach

What are some symptoms of oropharyngeal dysphagia?

What are some symptoms of oropharyngeal dysphagia?

Answer:

-inability to initiate swallowing
-coughing during or after swallowing (due to aspiration)
-nasal regurgitation

What causes oropharyngeal dysphagia?

What causes oropharyngeal dysphagia?

Answer: -neuromuscular or structural disorder that inhibits the swallowing reflex or impairs the strength of coordination of the muscles involved with swallowing

What is oropharyngeal Dysphagia?

What is oropharyngeal Dysphagia?

Answer: difficulty transferring food from the mouth and pharynx to the esophagus

What are some dietary interventions for mouth ulcers?

What are some dietary interventions for mouth ulcers?

Answer:

-avoid spicy, acidic, and salty foods
-perfer cold over hot foods or beverages
-softer foods

What are mouth ulcers?

What are mouth ulcers?

Answer:

-also known as canker sores
-caused by viral infections or Crohn's disease

What are some dietary interventions with difficulty chewing?

What are some dietary interventions with difficulty chewing?

Answer:

-eat soft foods
-put patient on a puree or soft diet

What are some likely causes of difficulty chewing?

What are some likely causes of difficulty chewing?

Answer:

-dry mouth
-gum disease
-tooth decay
-problems with TMJ

What are some upper GI Disorders?

What are some upper GI Disorders?

Answer:

-difficulty chewing
-Mouth ulcers
-dysphagia

How do you prevent hypoglycemia?

How do you prevent hypoglycemia?

Answer: -in patients at risk, feedings may be tapered off over several hours before discontinuation
-also, infuse a dextrose solution at the same time that parenteral nutrition is interrupted or stopped

What is hypoglycemia?

What is hypoglycemia?

Answer: It is very uncommon, but sometimes occurs when parenteral nutrition is interrupted or discontinued
-if excessive insulin is given

What are dextrose infusions generally limited to?

What are dextrose infusions generally limited to?

Answer: 5 mg/kg of bodyweight per minute in critically ill patients

How can hypoglycemia be prevented?

How can hypoglycemia be prevented?

-providing insulin along with parental solutions
-avoiding overfeeding or overly rapid infusion rates
-restricting the amount of dextrose in the solution

Who usually has hyperglycemia?

Who usually has hyperglycemia?

Answer:

-patients who are glucose intolerant
-receiving excessive energy or dextrose
-undergoing severe metabolic stress
-receiving corticosteroid medications

What is hyperglycemia?

What is hyperglycemia?

Answer: blood glucose levels that exceed 180 mL/d during parenteral nutrition infusions

What nutrients are found in a parenteral solution?

What nutrients are found in a parenteral solution?

Answer:


-amino acids
-carbohydrates
-lipids
-fluids and electrolytes
-vitamins and trace minerals
-medications

Who is a candidate for TPN?

Who is a candidate for TPN?

Answer:

-used in patients with high nutrient needs or fluid restrictions because rapid dilution allows us to use nutrient dense solutions these patients require
-preferred patients who require long term parenteral nutrition

What happens during TPN?

What happens during TPN?

Answer: the central veins carry a large amount of blood and the parenteral solutions are able to be diluted rapidly

What is total parenteral nutrition (TPN)?

What is total parenteral nutrition (TPN)?

Answer:

-the infusion of nutrients into the central vein
-also called central parenteral nutrition (CPN)

How can veins be damaged during PPN?

How can veins be damaged during PPN?

Answer: if the solution is over concentrated phlebitis may develop

What is peripheral parenteral nutrition (PPN)?

What is peripheral parenteral nutrition (PPN)?

-the infusion of nutrients into the peripheral vein (in the arm or hand)
-most often used in patients that require short term nutrition support (less than 2 weeks) and do not have high nutrient needs or fluid restrictions
-cannot use PPN when the veins are too weak for procedure
-it is common to rotate venous access sites to avoid damaging veins

Who are inappropriate candidates for parenteral nutrition?

Who are inappropriate candidates for parenteral nutrition?

Answer:

-patients at risk for fluid overload
-patients with severe hyperglycemia
-patients with significant electrolyte disturbances
-it is also not advised when used for fewer than 7 days in previously well nourished patients

How is parenteral nutrition provided?

How is parenteral nutrition provided?

Answer: It is provided intravenously.


There are two different access sites:

1. the peripheral vein located in the forearm or hand
2. the central vein located near the heart

Who are candidates for parenteral nutrition?

Who are candidates for parenteral nutrition?

Answer:

-intractable vomiting and diarrhea
-severe GI bleeding
-intestinal obstructions or fistulas
-paralytic ileus
-short bowel syndrome
-bone marrow transplants
-severe malnutrition and intolerance to enteral nutrition

What is parenteral nutrition?

What is parenteral nutrition?

Answer: it is recommended for patients who are unable to digest or absorb nutrients and are either malnourished or are likely to become malnourished

What is gastric decompression?

What is gastric decompression?

Answer: The removal of stomach contents in patients with motility problems or obstructions that prevent stomach emptying; the procedure may be used to reduce discomfort, vomiting, or various complications during critical illnesses or after certain surgeries.

How can you check the gastric residual volume for people with a feeding tube?

How can you check the gastric residual volume for people with a feeding tube?

Answer: with a procedure where the gastric contents are gently withdrawn through the feeding tube using a syringe, usually before intermittent feedings and every 4 to 8 hours during continuous feedings in critically ill patients

What is gastric residual volume?

What is gastric residual volume?

Answer: the volume of formula and GI secretion remaining in the stomach after a previous feeding, to ensure the stomach is emptying properly

How often are water flushes administered?

How often are water flushes administered?

Answer:


-they are done before and after feeds
-when continuous feed they are done every 4 hours

How much water is flushed during water flushes?

How much water is flushed during water flushes?

Answer: 20 to 30 milliliters

What are water flushes?

What are water flushes?

Answer:


-water flushes help prevent feeding tubes from clogging
-they assist in meeting a patient's water needs
-the water used for flushes should be included when estimating fluid intake

What is continuous feeding?

What is continuous feeding?

Answer:


-smaller amounts going through the tube continuously
-hourly
-8 to 24 hours
-infusion pump used

What is bolus feeding?

What is bolus feeding?

Answer:

-fed around every 3-4 hours
-250 to 500 mL in 5 to 15 minutes

What is intermittent feeding?

What is intermittent feeding?

Answer:

-relatively large amounts of formula several times a day
-400 mL in 30-45 minutes

What individual tolerances affect what tube feeding formula you use?

What individual tolerances affect what tube feeding formula you use?

Answer:

-food and allergies and sensitivities
-nearly all formulas are lactose-free and gluten-free and can accomodate the needs of patients with lactose intolerance or gluten
-for patients with food allergies, ingredient lists should be checked before providing a formula

How does the need for fiber modifications affect what tube feeding formula you use?

How does the need for fiber modifications affect what tube feeding formula you use?

Answer:


-formulas that provide fiber may be helpful for managing problems such as diarrhea, constipation, and hyperglycemia
-some patients may need to avoid fiber because they have an increased risk of bowel obstruction or other complications

How do fluid requirements affect what tube feeding formula you use?

How do fluid requirements affect what tube feeding formula you use?

-high nutrient needs must be met using the volume of formula a patient can tolerate
-if fluids need to be restricted, the formula should have adequate nutrient and energy densities to provide the required nutrients in the volume

How do nutrient and energy needs affect what tube feeding formula you use?

How do nutrient and energy needs affect what tube feeding formula you use?

Answer:

-as with patients consuming regular diet, the tube feed patients might require adjustments in nutrient and energy intake
-example: patients with diabetes may need to control carbohydrate intake
-critical-care patients may have high protein and energy requirements
-patients with chronic kidney disease may need to limit their intakes of protein and several minerals

How does the GI function affect what tube feeding formula you use?

How does the GI function affect what tube feeding formula you use?

Answer: Although the vast majority of patients can use standard formulas a person with a functional but impaired GI tract may require an elemental formula.

What things should you consider when selecting a tube feeding formula?

What things should you consider when selecting a tube feeding formula?

Answer: GI function, nutrient and energy needs, fluid requirements, the need for fiber modifications, individual intolerances

What should you consider with tube feeding formula?

What should you consider with tube feeding formula?

Answer:

-macro nutrient composition
-energy density
-fiber content
-osmolarity

What are modular tube feeding formulas?

What are modular tube feeding formulas?

Answer: when ideal formulas are unavailable, modular formulas can be prepared by combining individual macronutrient preparations

What is a specialized tube feeding formula?

What is a specialized tube feeding formula?

Answer: include nutrient combinations that may assist in the treatment of certain illnesses

What is an elemental tube feeding formula?

What is an elemental tube feeding formula?

Answer: contains macronutrients that have been broken down to some extent and require less digestion

What is a standard tube feeding formula?

What is a standard tube feeding formula?

Answer: usually contains intact protein and polysaccharides

Which method is tube feeding is usually used for infants?

Which method is tube feeding is usually used for infants?

Answer: the orogastric tube feeding method because a nasogastric tube may hinder the infant's breathing

What is orogastric tube feeding?

What is orogastric tube feeding?

Answer: the tube is inserted into the stomach through the mouth

What is a jejunostomy tube feeding placement?

What is a jejunostomy tube feeding placement?

Answer: an opening into the jejunum through which a feeding tube can be passed. a nonsurgical technique for creating a jejunostomy called percutaneous endoscopic jejunostomy (PEJ) or passed directly into the jejunum (direct PEJ)

What is the gastrostomy tube feeding placement?

What is the gastrostomy tube feeding placement?

Answer: an opening into the stomach through which a feeding tube can be passed. a nonsurgical technique for creating gastrostome under local anesthesia is called percutaneous endoscopic gastrostomy (PEG tube)

What is a enterostomy tube feeding?

What is a enterostomy tube feeding?

Answer: an opening in the GI tract through the intestinal wall

What is the nasojejunal tube feeding placement?

What is the nasojejunal tube feeding placement?

Answer: starts in the nose and ends in the jejunum (small intestine)

What is the nasoduodenal tube feeding placement?

What is the nasoduodenal tube feeding placement?

Answer: starts in the nose and ends in the duodenum (small intestine)

What is the nasogastric tube feeding placement?

What is the nasogastric tube feeding placement?

Answer: starts in the nose and ends in the stomach

What is a transnasal tube feeding?

What is a transnasal tube feeding?

Answer: when the tube is inserted through the nose

What are the different types of tube feeding placements?

What are the different types of tube feeding placements?

Answer: Transnasal, enterostomy, orgastric

When does an ileus occur?

When does an ileus occur?

Answer: when the intestines do not move food through in the normal way. it often occurs after abdominal surgery

What is an ileus?

What is an ileus?

Answer: a temporary and often painful lack of movement in the intestines.

What is a fistula?

What is a fistula?

Answer: abnormal passages between organs or tissues that allow the passage of fluids or secretions

Who are inappropriate candidates for tube feeding?

Who are inappropriate candidates for tube feeding?

-severe GI bleeding
-high output fistulas
-intractable vomiting or diarrhea
-severe malabsorption
-if the expected need for nutrition support is less than 5 to 7 days in a malnourished patient or less than 7 to 9 days in an adequately nourished patient

Who are appropriate candidates for tube feeding?

Who are appropriate candidates for tube feeding?

-severe swallowing disorders
-impaired motility of the upper gi tract
-GI obstructions and fistulas that can be bypassed with a feeding tube
-certain types of intestinal surgeries
-little or no appetite for extended periods (especially if patient is malnourished)
-extremely high nutrition requirements
-mechanical ventilation
-mental incapacitation

When is tube feeding recommended?

When is tube feeding recommended?

Answer: for patients at risk of developing protein-energy malnutrition who are unable to consume adequate food/and or oral supplements to maintain their health

What is a common term used for enteral feedings?

What is a common term used for enteral feedings?

Answer: tube feedings

What is an enteral feeding tube?

What is an enteral feeding tube?

Answer: a thin, flexible tube

What are enteral feedings?

What are enteral feedings?

Answer: the provision of nutrients using the GI tract, which deliver nutrient dense formulas directly to the stomach or small intestine