Foundations

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Author:
alyn217
ID:
161749
Filename:
Foundations
Updated:
2012-07-09 14:46:50
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FT4 Nutrition tubes
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Description:
Nutrition and Tubes
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  1. Dietary considerations when treating illness
    • Proteins - Essential for synthesis of body tissue growth, maintenance, and repair
    • Essential amino acids must be provided    for by dietary intake
    • Nitrogen Balance -
    •  Intake of Nitrogen = Output of Nitrogen 

    • POSITIVE NITROGEN BALANCE NEEDED FOR HEALING
    •    “IT DOES A BODY GOOD”
  2. Nutritional considerations with the elderly
    • Older Adults Nutritional Screening Required
    • Metabolic rate slows with age: vitamin and mineral requirements remained unchanged  may require supplementation
  3. Nutrient absorption in the elderly
    • Alcohol consumption (oz./day)
    •         Liver Mass
    •         Renal function
    •         G.I. Peristalsis
    •         HCl and digestive enzymes
    • Polypharmacy/ Chronic medications
  4. Identifying nutritional imbalances
    • Complete physical examination – remember from Health Assessment: 
    • General survey
    • Alterations in vital signs
    • Poor skin turgor, wound healing
    • Concave abdomen/ ascites
    • Change in muscle mass
    • Laboratory results: 
    • Changes in blood glucose, serum albumin
  5. Diet Progression
    • DAT – diet as tolerated
    • NPO – nothing by mouth
    • Diet after procedure / surgery –
    • --Clear liquids
    • --Full liquids – liquids such as milk shake. Also includes ice cream and custards. 
    • --Pureed – puree food with liquid
    • --Ground-for those with chewing/swallowing difficulties
    • --Mechanical soft – more calories than full but little chewing involved
    • --Soft – little or no chewing
    • --Regular – YEAH!
  6. How can you Stimulate Appetite
    • Frequent small meals
    • Restrict liquid intake with meals
    • Keep environment tidy
    • Provide nutrient dense foods
    • Patient preferences
    • Pain Control
    • Food tray considerations
    • Patient Positioning
    • Oral Hygiene
    • Nutritional Supplements
  7. Diets and their restrictions
  8. When your patient cant eat
    • Enteral feedings: Nutrients given via the GI Tract
    • Parenteral Feedings: Accomplished via central venous access when gut access is prohibitive 
  9. Gastrointestinal intubation
    • NG (nasogastric) tube –
    • Why might you insert?
    • Provision of nutrition in a functional GI tract
    • Removal of GI secretions – giving the gut a rest / obstruction/ hyperemesis
  10. Enteral Nutrition
    • Nutrients provided via: Tubes
    • NG
    • Jejunal 
    • Gastric tube(PEG)
    • Preferred route with a functioning GI tract
    • Formulas differ in nutrient density and composition and are disease specific
  11. Short term NG therapy
    • NG tube –
    • Salem sump for suctioning (S=suction)
    • Dobhoff for feeding (D=dinner)
  12. Proper prep of NG tubes
    • Determine level of cooperation with procedure
    • Positioning of patient-chin to chest
    • Measure correctly
    • Supplies –
    • Tube
    • Water
    • Tape
    • Towels
    • Lubricant
    • Syringe
    • Checking placement
  13. Assessing placement of NG tubes
    • Gold standard is by radiology – tubes actually have a radiopague strip or a wire that can be seen on x-ray. Must do for eteral feeding tubes
    • Aspirate contents and check pH level: 0-4 
    • You will still see insertion of air and ausculation the stomach – not as accurate
  14. Tube care and pt comfort
    • Nare care – saline drops? No vaseline! Keep it clean!
    • Oral hygiene – remember this can be a source of infection if oral care isn’t done
    • Patency – make sure the suctioning is working and the line is patent
    • Secure the line – tape but remember assess the skin first and document
    • Drainage-Color/amount
  15. What's a PEG tube?
    • Long –Term
    •  Nutrition Therapy
    • Gastrostomy (PEG) tube
    • Jejunostomy
    • Require Incisional assessment & care
    • Check for residual q4h. Should be <100ml.
  16. Enteral feeding tube assessment
    • Change feeding container and tubing q24h
    • Only hang 4 hours worth of solution 
  17. Adminstering Enteral feedings
    • Assessment
    • Tube feeding (amount)
    • Should be in high Fowlers
    • Bolus vs continuous
    • Water
    • Continuous Infusion pump & pole
    • Bolus infusion - syringe or bag         
    • Gravity considerations
    • Medication administration
  18. Preventing aspiration
    • Prevention of aspiration is key!!! 
    • Tube Placement & Residual s
    • Observe for distention Auscultate BS 
    • Positioning of patient
    • HOB elevated 30 degrees.
  19. Removal of tubes
    • Have pt take a deep breath and hold it to close epiglotis to prevent aspiration.
    • Pull hand over hand 

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