Nutrition Malic

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Author:
Michealbledsoe
ID:
210610
Filename:
Nutrition Malic
Updated:
2013-04-01 00:00:16
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Nutrition Malic
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Description:
Nutrition Malic thru nasogastric or gastric tubes
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  1. Which diet is considered the healthiest
    Mediterranean due to high consumption of fish
  2. what blood test shows anemia
    H&H (show O2 carrying capacity)
  3. what does total serum protein test do
    combines total albumin and globulin
  4. what urine studies can be done
    Creatinine, thiamine, riboflavin, niacin and iodine (any low value means low nutritional intake)
  5. NG tube
    nasogastrional tube (aspiration risk is greatest concern)
  6. Peg tube
    goes directly into stomach (duodenum or jejunum)
  7. intermittent feeding characteristics
    usually by gravity and can be done at home 3 to 4 times a day bolus
  8. Continuous feeding characteristics
    keep steady amount without over extending stomach, into duodenum and jejunum about 100mls an hour Gastro reflux a major concern
  9. Flushes
    needed with all feedings to keep fluid balance and keep tube patent.  NOT A STERILE PROCEDURE.  Watch flush amount for patient on tube feeding. 150-300mls per shift
  10. what can tube cause (side effect)
    High blood sugar may need BGM's twice per shift
  11. what to look out for before placing G-tube in stomach
    bowel sounds must be present
  12. complications of tube feeding (what is priority)
    aspiration pneumonia is priority
  13. what to check for with aspiration pneumonia
    lung sounds, HOB 30 degrees, gagging, oral secretions, respiratory distress
  14. to prevent electrolyte imbalances
    always return aspirated residuals, check blood work and BGMs
  15. hypertonics feedings can cause
    diarrhea by pulling water into intestines (give lomodel to help and preform good skin care) change feeding to isotonic or add fiber to feeding.  SLOW RATE then gradually increase.
  16. hypotonic feedings can help
    dehydration
  17. most common feeding
    isotonic feeding
  18. Infection of GI (NG tube) from tube feeding
    change tubing, change tubing (q24), use sterile water for new G-tube (not for NG tube)
  19. Infection from G-tube (directly into stomach)
    sterile dressing (for new G-tube), use antibacterial oitment, check for fungal infection (under the disk on stomach)
  20. Abdominal distention (complication)
    check for bowel sounds, decrease rate if you have to, check for residuals (don't add more if residual is more than 100) check for bowel movements) hold feeding and call doctor.
  21. Nausea as a tube feeding complication
    hypertonic solution draws fluid into intestine and makes you nauseated...cause is usually flow rate is to fast or allergy (treat the cause)
  22. Fecal impaction (complication)
    usually from hypoosmolar solution or hypotonic formula. body is sucking too much water out of stool. need mote water intake, or more flushes
  23. Dehydration (as a complication)
    hyperosmolar/hypertonic formula not enough water  add more flushes, change formula
  24. hyperglycemia (as a complication)
    too much carbohydrates (CHO) treatment BGM's q6 and/or change formula. some pts may be on BGM sliding scale
  25. Dumping syndrome (as a complication)
    formula too concentrated (hyperosmotic) water leaves vascular compartment to enter stomach and intestines to dilute formula (diarrhea, nausean increased pulse, decreased BP, sweating, weakness, cramping) dilute formula and add water
  26. tube patency (as a complication)
    suspect obstruction if you cant aspirate or flush, if you see formula leaking or formula wont flow...give manual flush...avoid crushed meds
  27. flush for tube patency with meds
    30ml flush, meds then 10ml between each med then 30ml after flush with warm water
  28. What do anemias do
    affect red blood cells. blood does not have amount of O2 needed
  29. four different anemias
    • Iron deficiency anemia (Microcytic)
    • pernicious anemia (Macrocytic)
    • folic acid anemia (Macrocytic)
    • Thalassemia anemia (Microcytic)
  30. Macrocytic anemia
    Cells too big and can't carry a lot of O2
  31. Microcytic anemia
    small pale RBC's with low level of hemoglobin
  32. TPN means
    using a central line or PICC line (for ppl who can't eat orally)
  33. Iron deficiency anemia
    RBC's are microcytic and contain low levels of HGB.  Cause is low iron supply which leads to low formation of red blood cells. causes, severe prolonged anemia, malabsorbtion disease, pica, lead poisoning or parasites.
  34. two macrocytic anemias
    Pernicious and Folic acid
  35. two microcytic anemias
    Iron deficiency and thalassemia
  36. S&S of iron deficiency
    in babies look for poor muscle development (chubby babies too), babies will also be prone to infection. Children and adults will have fatigue, weakness, shortness of breath. Pulse rate may be higher, glossitis (sore tongue) fragile fingernails and inflamed mucous membranes. elderly increased dementia or confused state
  37. foods for iron deficiency anemia
    organ meats, dried legumes, nuts, shellfish, muscle meats (steak, beef, chicken), green vegetables, unsweetened chocolate, whole wheat & enriched flour breads also increase protein intake and vit C. Limit milk intake to one quart/day
  38. Drug therapy for iron deficiency anemia
    oral iron supplement, give with citrus juice, administer liquid form by straw or dropper, brush teeth after liquid dose (stools will be black)
  39. complications of IV therapy
    iron poisoning....if OD gastric lavage, NA (sodium) bicarbonate, exchange transfusion
  40. Pernicious anemia (subtle and gradual)
    Macrocytic/megablastic (big cells)

    due to lack of intrinsic factor   (I.F. is produced in stomach) which is needed for absorption of vit B12 caused by GI disturbance, surgery, alcoholism or familial w/aging...very subtle and gradual...parietal cells produce intrinsic factor.  they are in stomach, if they get destroyed then P.A. occurs
  41. S&S of Pernicious anemia
    Jaundiced, Glossitis, pallar, spinal cord degeneration, anorexia, N&V, Diarrhea, loss of weight, unsteady gait, mental depression, weakness, apathy/irritability, numbness and tingling peripherally. (Think of Mrs. Malics dad and the gas story)
  42. If inadequate intake of B12 teach to eat (not Pernicious anemia) you can have a B12 deficiency
    meat, liver, kidney, milk, eggs, cheese
  43. Test for Pernicious anemia
    Shillings test after low B12
  44. with Pernicious anemia you have to get the shot to bypass
    the GI tract because no intrinsic factor (oral B12 will not work due to no parietal cells)
  45. If untreated Pernicious anemia could have
    permanent neurological damage
  46. folic acid anemia is
    • a nutritional macrocytic/megaloblastic (big cells) anemia
    • Cause inadequate dietary intake (reason why pregnant women are given supplements), alcoholism, or can be secondary to another disease
  47. you can have low B12 without having Pernicious anemia. if that is the case then you can help with
    Dietary changes
  48. S&S of folic acid anemia
    • Diarrhea
    • glossitis
    • symptoms similiar to vit B12 deficiencies (both may coexist)
    • no neurological s&s
  49. Foods high in folic acid
    • Green leafy vegetables
    • liver
    • kidney
    • yeast
    • lean beef/veal
    • eggs
    • whole grain cereals
  50. folic acid drug therapy
    • oral - folvite
    • IM- calcium Leucevarin
    • IM- sodium folvite
  51. Complications of folic acid deficiency
    Pregnancy: neural tube defects
  52. Thalassemia is
    A autosomal recessive genetic disorder (parents both have to have it) Microcytic (small red blood cells) they are hemolyzed (being destroyed) Mediterranean origin most often affected
  53. Thalassemia minor
    child just has the trait (one trait from parent) one gene is normal and one is trait. asymptomatic, child is a carrier, pregnancy you will see severe anemia if you have the trait, genetic studies recommended
  54. Thalassemia major
    severe (child has trait from both parents) homozygous, severe anemia, marked hemolysis, ineffective production of erythrocytes. hepatomegaly and splenomegaly
  55. Diagnostic screenings for thalassemia
    • genetic studies
    • H&H and CBC
    • RBC w distinctive appearance
    • hepatomegaly and splenomegaly
  56. post op care (for thalassemia) may include
    removal of part of spleen
  57. Cardiac hemochromatesis
    build up of iron in bloodgoing to heart
  58. BMI indexes
    • > 25 = overweight
    • > 30 = obese
    • > 40 = morbid obesity
  59. PICA is
    compulsive digestion of non food items

    • cause nutritional deficits
    • psyche or emotional problems
    • during pregnancy
    • cultural customs
    • hunger or starvation
  60. S&S of PICA
    • decreased physical development
    • hepatosplenomegaly
    • anorexia
    • Fe deficiency anemia
    • craving for non-food items
    • most common sign = chewing ice
  61. PICA dx studies
    intestinal biopsy w/villous atrophy
  62. nursing implementations for PICA
    • diet w protien, iron & calories
    • counseling
    • determine underlying cause
  63. complications of PICA
    • intestinal infections or blockages
    • malnutrition
    • lead poisoning

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