Nutriton/ undernutrition

46問 • 2年前

問題一覧

Select the GI changes with age.

Dental changes (missing teeth/dentures), Dry mucous membranes and Dysphagia, Decreased secretion of hydrochloride acid decreased absorption of iron and B12, Decreased peristalsis, Decreased lipase production, Decreased liver enzymes

Select statements that are true for an initial nutrition screening.

Needs to occur w/in 24 hrs of adm. for those identified to be at risk, Measured height/weight, Weight history (was weight loss intentional), Ability to chew and swallow, Recent changes in appetite or food intake, Mini nutritional assessment tool

Select what is included in a nutrition assessment.

Review of nutrition history, Food and fluid intake record (diary), Notation of access to appropriate sources of nutrition, Lab data, Food-drug interactions, Health history and phys assessment, Anthropemtric measurements, Psychosocial assessment

Select what is included in anthropometric measures.

Obtaining height&weight (BMI), Skin fold measurements, Body surface area

Laboratory Assessment

Cholesterol, Hemoglobin, Serum albumin, Thyroxine-binding prealbumin, Transferrin

What is the normal range of albumin.

3.5-5

What is the normal pre-albumin range.

15-36

What is PEU?

Protien energy undernutrition

A type of PEU that is characterized by calorie malnutrition, body fat and protien are wasted, serum protien will be normal.

Marasmus

A type of PEU that is characterized by a lack of protein quantity/ quality in the presence of adequate calories, serum protien low.

Kwashiorkor

A type of PEU that is characterized by both calorie malnutrition and lack of protien,

Marasmic-kwashiorkor

Protien endergy undernutriton results in what?

Weight loss/cachexia, Decreased activity tolerance, Lethargy, Cold intolerance, Edema, Dry flaky skin, Poor wound healing, Infection, Possible death

What is the common cardiovascular complication of undernutrition?

Reduced cardiac output

What is the common endocrine complication of under nutrition?

Cold intolerance

What are the common Gastrointestinal complications of undernutrition?

Anorexia, Diarrhea, Impaired protien synthesis, Malabsorption, Vomiting, Weight loss

Select the common immunologic complication of under nutrition.

Susceptibility to infectious disease

Select the common integumentary complications of undernutrition.

Dry, flaky skin, Various types of dermatitis, Poor wound healing

Select the common musculoskeletal complications of undernutriton.

Cachexia, Decreased activity tolerance, Decreased muscle mass, Impaired functional ability

Select the common neurological complication of undernutrition.

Weakness

Select the common respiratory complication of undernutrition.

Reduced vital capacity

Select physical assessment data of undernutrition.

Alopecia or hair that easily falls out, Dry eyes, Stomatitis, Glossitis or magenta tongue, Swollen bleeding gums, Fissured tongue, Dry scaly skin, Petechiae, Edema, Bone pain, Muscle washing, Disorientation, Cardiac dysrythmias

Select lab data of under nutrition.

Hemoglobin, Hematocrit, Cholesterol, Serum albumin, Thyroxine binding pre-albumin, Transferin

Select the physical concerns for undernutriton with older adults.

Chronic conditions/illnesses, Constipation, Decreased appetite, Dentition, Drugs that impair taste or appetite, Dry mouth, Failure to thrive, Impaired eyesight, Pain, Weight loss

Select the psychosocial concerns for undernutrition for older adults.

Ability to prepare meals, Decrease in enjoyment of meals, Depression, Income, Loneliness, Transportation access

Select interventions for undernutriton

Meal management, Meal supplements, Nutritional supplements, Drug therapy, Total enteral nutrition, TPN

Select the methods of total enteral nutrition.

PEG- stomach, PEGJ- jejunum, DPEJ- duodenum

Select the statement true to nasogastric tubes.

Extend into stomach, Levin: single lumen, Salem sump tube: double lumen; keep pigtail poor patent usually attached to suction., May be used for short term enteral feedings, but have high risk of aspiration., Removed when bowel sounds present and tolerating PO

Select the true statements of nasodudenal tubes.

Extend into duodenum, Dobhoff tube: short term feeding use; less likely to cause aspiration, Verify placement by x-ray

Select the true statements of long term enteral feeding tubes.

Percutanous endoscopic gastrostomy tube (PEG) Inserted into stomach through abdominal wall, Percutaneous endoscopic jejunostomy (PEJ) Inserted into jejunem through abdominal wall

Select the complications of enteral feedings.

Tube obstruction, Tube displacement or dislodgment, Abdominal distention, N/V, Diarrhea, F&E imbalances K+

Eneteral feeding tubes can be misplaced or dislodged. What is the life threatening complication?

Aspiration pneumonia!

Select the symptoms of aspiration pneumonia.

Fever, Signs of dehydration, Diminished breath sounds (auscultate lungs q4-6hrs), Shortness of breath, Chest discomfort

What is I.V. administration of nutrition can be partial or total?

Parenteral nutrition (total=TPN)

Select the complications of parenteral nutrition.

Central line infections at the site, Bactremia, Fat overload syndrome, Pts with renal or cardia dysfunctions can develop problems with fluid and electrolyte imbalances. Fluid overload, Heart failure, Pulmonary edema.

Select the signs and symptoms of refeeding disorder, and what do we do to manage/prevent this complication?

Heart failure, Peripheral edema, Rhabdomyolysis, Seizures, Hemolysis, Hypophophatemia, Hypokalemia, Slowly refeed and supplement during TPN.

Select the etiology of obesity.

Eating high fat and high cholesterol diets, Physical inactivity, Drugs and can effect: Corticosteroids, Estrogen and certain progestins, NSAIDS, Antihypertensives, Antiepilectics, Certain oral anti diabetics.

Select the Complications of obesity.

Delayed wound healing, Obesity hyponetilation syndrom, Sleep apnea OSA, Type 2 DM, CAD, Hyperlipidemia, HTN, PAD, Erectile dysfunction, menstrual irregularities

Select what would be collected during an obesity assessment.

Appetite, Attitude toward food, Presence of any chronic disease, Drugs taken, Physical activity/functional ability, Family history of obesity, What forms of weight loss have been tried on the past and what were the results, Economic status, Usual food intake, Eating behavior, Cultural background

What questions would be asked during a psychosocial assessment for obesity?

What does food mean to you?, Do you want to lose weight?, What prevents you from losing weight?, What do you think will motivate you to lose weight?, How do you think you might benefit from losing weight?, Do you have a support system in place that will encourage you during weight loss?, Coping strategies?, Environmetal/personal stressors

Select non surgical management of obesity.

Diet programs, Nutriton programs, Exercise programs, Drug therapy, Cryolipolysis, Behavioral management, Complimentary health: Accupuncture, acupressure, hypnosis

Select the statements true to surgical management of obesity.

Have to be eligible: do not respond to traditional intervenetions, Have a BMI of 40 or greater, Have a BMI if 35 or greater with other health risk factors

Select surgical interventions for obesity.

Cosmetic: liposuction, not solution for morbidly obese, Gastric bypass (malabsorption), maintains 60-70% of loss, Gastric resection (normal digestion) no risk of nutritional deficiencies,often regain some weight, Banding restriction (normal digestion) not commonly done anymore

Select the statements true to post bariatric surgery care.

Primary focus: airway management (could develope hypoventilation syndrome), Patient and staff safety (bariatric room and equipment), Liq/pureed diet for 6 weeks, Abd binder, 6 small meals/day plenty of fluids, Bowel changes norm, Vit/min supp often needed, Additinal surg may be needed

What is an anastomotic leak and what are the symptoms that you should be very worried about?

When a surgical anastomosis fails and contents of reconnected body channel leak from the surgical connection., Elevated h.r. over 120 consistently, Elevated temperature

Select bariatric post-op care.

CV: semi fowlers position, monitor/provide O2, SCDs tp prev. DVT&PE, GI: Abd. binder to prev. dehiscence, observe for signs of dumping syndrome, splint when coughing, GU: remove catheter within 24 hrs, Integumentary: obs. skin folds for breakdown, use absorbent padding in folds, Ensure tubes and catheters are not causing pressure, Musculoskeletal: Colab with PT for transfer/ambulation assistance, Encourage turning q2hrs

Select the statements true to dumping syndrome.

Caused by food entering small intestine instead of stomach after gastric bypass., Characterized by tachycardia, nausea, diarrhea, abdominal cramping, Flu like feeling

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