Nutritional Support and Dietary Solutions for Various Health Conditions, Exams of Nursing

Download Nutritional Support and Dietary Solutions for Various Health Conditions and more Exams Nursing in PDF only on Docsity! 2024 latest updateNutrition D440 Study Material A+ GUARANTEEE Role of RN (Registered Nurse) - Solution - assess pt for clinical manesfestations of fluid and electrolyte disturbance -determine if ordered IV therapy is appropriate - choose appropriate catheters/ infusion devices Role of LPN/LVN - Solution -administer IV fluids and meds to stable pts -adjust the flow rate for stable pts according to HCP orders -Insert IV catheters -monitor clinical manisfestations of adverse reactions to IV fluids or meds Role of Unlicensed Assistive Personnel (UAP) - Solution -Measure and record oral intake and output -report swelling or redness at the IV site -report pt complaints of discomfort at IV site to the RN General Dietary Management - Solution -MNT will depend on pt nutrition status when they arrive, the metabolic results of condition, the pt ability to eat food -routine IV fluids are used to supply hydration needs and electrolytes but CANT sustain energy and nutrient balance. PT would need 10x the amount. -for pt only recieving IV fluids, they should return to regular eating and maintain as tolerated intake and output (I&O) - Solution used to evaluate fluid balance whereby intake and output are measured and documented 3 METHODS OF NUTRITIONAL SUPPORT - Solution -regular, enteral, parenteral nutrition enteral nutrition - Solution Indications: -impaired nutrient INGESTION (inadequate eating/malnutrition) -wasting -GI is functioning -allows gut preservation (the gut is functioning normal and we want to prevent it from declining) -prevents atrophy of the stomach TYPES: -NG TUBES: less than 4 weeks (ends in stomach) -duodenal/jujenum (ends there) -PEG and PEJ (nurse don't put this in) (long term) Administration types: cyclic, intermittent, bolus, continuous Aspiration precautions: sit HOB 30-45 Degrees before and after feedings Immediate measures to take: NEX, make a mark Verify placement via chest XR before administration Conditions that require it: -dysphasia, conditions preventing oral nutrition, coma, hyperemesis gravidarum, severe anorexia nervousa, malnutrition Nurse considerations: s/s diarrhea, vomiting, abdominal distention, overall gastric motility -you can give meds through the NG and PEG tubes you are going to crush them, make sure to flush with water (document intake) Parenteral Nutrition - Solution administration of nutrients intravenously TYPES: Peripheral (PICC into arm into vena cava.. some nurses can insert this) , central line (TPN...inserted by surgeon) Indications: -GI incompetence -critical illness -last resort Nurse considerations: -If bag goes dry and need a refill, without pt special prescribed formula, you will need to give 10- 20% of Dextrose until it arrives to prevent a HYPOGLYCEMIC CRISIS -same as clear, plus sherbet, icecream, puddings, custards, frozen yogurt, margarine Routine House Diets: Mechanical soft - Solution -soup -same as clear and full, plus all cream soups -cereal -cooked cereal, corn flakes, noodels, macaroni, spaghetti -Bread -white bread, crackers, melba toast -Protein foods -same as full plus eggs, mild cheese, cottageg and cream, cheeses poultry, fish tender beef, veal, lamb liver -Veggies -potatoes:baked, mashed, creamed, steamed, scalloped -tender cooked veggies -fresh lettuce and tomatoes Low residue foods - Solution Uses: reduces bulk, A low residue diet is typically recommended for people with inflammatory bowel disease (IBD) flares, for bowel surgery and colonoscopy prep, and for people with infectious colitis or acute diverticulitis. FOODS: -ripe bananas -COOKED veggies -spaghetti/pasta -milk, yogurt, custard, icecream -white bread (without nuts / seeds) -french toast -white rice high residue foods - Solution -development of bulk, the high fiber-high residue diet is often prescribed for the treatment of constipation, diverticular disease during non-acute phase, colic and irritable colon may respond to moderate increases in fiber. The high fiber-high residue has been suggested. -graham crackers -cornbread -granola type cereals -apples -raw fruit in general -nuts and jams (high roughage) -anything with seeds -nuts -frankfurters have fillers that are high residue -coconut -jam, -pickles, olives, relish and horseradish -all desserts containing nuts, seeds, dried fruit, coconut or made from whole grains or bran -candy made with nuts or seeds -popcorn -raw or dried fruit -all berries -prune juice -beans Client asks for diet review what should pt do based on fat diet? (caloric value of fat=total grams of fat x 38 kJ/g) (total ft calories/total calories x 100= % of fat) normal range 20-35% - Solution Gas-forming foods - Solution -HIGH FIBER FOODS -FODMAPS prunes peaches apples pears aspargus brussel sprouts kale cauliflower cabbage beans broccoli wheat onions garlic dairy products sugar alcohols fizzy drinks Low Purine Diet - Solution Indication: reduce uric acid levels for gout flareup prevention and pain from the arthritis associated with it. FOODS TO EAT: -veggies, fruit, milk, grains (except oats) -rice, pasta, cereals -meatless soup -eggs, nuts peaunt butter - FOODS TO AVOID: BEER/LIQUOR MEATS: organ meats, liver SEAFOOD: sardines, anchovies SAUCES: gravy Periodontitis (Mouth Inflammation) Diet & foods to avoid - Solution FOODS: -Vitamin C (healing) foods: guava, strawberries, oranges other citrus, tomatoes, leafy greens, milk, yogurt, cheese -nuts and seeds -Omega 3 polyunsaturated FAs (leafy greens, fish , veggie oils) -Vitamin D (assists with calcium absorption) -calcium AVOID: Sugary foods, drinks, sports drinks, acidic foods, coffee , potato chips, fruit juices, sodas PROBLEM; thirst and oral dryness - Solution Solution: lubricate lips chew sugarless gum brush teeth rinse mouth frquently PROBLEM: tube discomfort - Solution Solution: gargle w warm water/mouthwash blow nose -rice -yogurt -eggs -sesame seed bun and lentils Metabolic syndrome - Solution a medical condition associated with obesity, diabetes, high cholesterol, and hypertension. It's characterized by obesity, insulin resistance, and increases risks of other ailments (stroke, heart disease, diabetes) -S/S: HTN , increased LDL and triglycerides, decreased HDL (good cholesterol), increased waist circumference Bariatric Surgery - Solution surgical reduction of gastric capacity to treat morbid obesity -MONITOR: -S/S of dumpling syndrome -> abdominal cramping, tachycardia, nausea, diarrhea, diaphoresis (sweating).. just thinking stomach is cut smaller so time that food travels is even faster -PT: -chew food slower and completely -eat 6 small meals a day -do NOT drink liquids with meals -recline HOB after meals to slow gastric emptying -avoid sugary foods, fat, and carb foods -take vitamins/supplements as needed Peritoneal Dialysis - Solution -procedure for removing toxic wastes when the kidney is unable to do so -monitor serum albumin levels because pt is at risk of excessive protein loss so they'll need higher intake of protein DIET: High protein, low calorie hypertension (HTN) - Solution DASH diet: high in whole grain, low fat dairy, calcium, potassium, Magnesium -low in red meat, sweets and sugary beverages -low in sat and trans fat -less than 1500 mg sodium -use herbs over seasonings Watch out for potassium salt subs (Mrs DASH) -onion powder, garlic powder Waist circumference men is more that 40 in , women 35 - Solution a way to assess and classify a pt weight health risks increase if the waist circumference is greater than 40 in in men and 35 in in women -BMI may not be the ideal means of assessing health risks associated with weight. To increase accuracy of assessing chronic disease and mortality risk, the use of waist circumference is included because the greater the amount of adipose tissue stored within the abdominal region, the higher the risk for disease and all-cause mortality. pt who have visceral fat with truncal obesity are increased risk of CVD & Metabolic syndrome Aspiration pneumonia causes - Solution decreased LOC (seizure, anesthesia, head injury, stroke, alcohol) difficulty swallowing insert of NG tube without tube feeding gag and cough reflexes are depressed Strategy for TYPE ONE diabetes - Solution -dont decrease energy intake -increase frequency and number of feedings -have planned food to prevent low BG -extra food for unusual exercise - GERD Diet therapy - Solution -decrease alcohol, chocolate, fat intake -avoid smoking -increase protein intake for healing PEPTIC ULCER diet therapy - Solution -increase iron in diet r/t blood loss from ulcers -increase protein and vitamin C for healing -small frequent meals -avoid meds like aspirin, ibuprofen Dumping syndrome DIET therapy - Solution -dumping syndrome (nausea, weakness, sweating, palpitations, diarrhea, happens post-gastrectomy) -eat small frequent meals -decrease intake of simple carbs R/T breaking down easier and causes irritation faster -drink fluids 45-hr before or after meals lay down 15-20mins afetr eating to decrease s/s of dumping IBS , Malabsorption disorders like Chrons disease, Ulcerative Colitis DIET Therapy - Solution -high calorie, high protein, low fat, low fiber -may be NPO for bowel rest TPN (Severe cases) Celiac Disease - Solution -characterized by bowel irritation on exposure to protein gluten -CHILDREN W THIS DISEASE ARE COMMONLY ANEMIC (emphasize foods in folate, iron, vit b12) -impairs body to be able to handle gluten -BROW (BARLEY, RYE, WHEAT OAT) -meals that are high in protein and carbs, but LOW in fats -high fiber foods should be avoided FOODS ALLOWED (GLUTEN FREE MEALS) -hamburger patty without the bun, fries - FOODS NOT ALLOWED -Spaghetti -high fiber foods -hydrolyzed foods (have a lot of gluten) -meatballs (may use bread crumbs) Diverticulitis diets - Solution -clear liquid diet -progression to high fiber dieting FOODS -avoid foods that may obstruct the diverticula -fiber should be digestible (whole grains, cooked fruits and veggies) -milk and eggs have no fiber, but good sources of protein -nuts and seeds are ok CONDIMENTS Cushing's disease - Solution Addison's disease - Solution A rare, chronic endocrine disorder in which the adrenal glands do not produce sufficient steroid hormones. -diminished mineralcorticoid secretion -S/S of hyponatremia -DIET: -increase salt intake -low sugar -restrict high potassium foods -fluids are not restricted -protein is not omitted Burns Diet - Solution high protein, high caloric, increase in Vitamin C. -this increases adequate protein for increased BMR related to burns for tissue repair FOODS: -cheeseburger -milkshakes -VIT C : OJ Cancer diet - Solution high calorie, high protein, vitamin supplementation -limit fats and carbohydrates esp for pancreatic cancer -cancer treatments can affect the appetite by causing nausea, vomiting--> decreased weight -high calorie= helps to make up for decreased appetite DIET: -milkshakes, smoothies -small meals every 2 hrs -add butter, oils, cheese, high calorie condiments to meals Gastric ulcer diet - Solution A bland, low-fiber diet GOUT diet (musculoskeletal disorder) - Solution -a type of inflammatory arthritis, buildup of uric acid in the blood -If you produce too much uric acid or your kidneys don't filter enough out, it can build up and cause tiny sharp crystals to form in and around joints. These crystals can cause the joint to become inflamed (red and swollen) and painful. FOODS TO AVOID: -red/organ meat -fish: anchovies, sardines, shell fish, shrimp, lobster -fructose drinks -alcohol/beer -yeast -gravy -foods high in fat FOODS TO CONSUME: -cheese -low fat/ fat free dairy -yogurt -eggs (moderation) -salmon (moderation) Nursing interventions for obese - Solution if pt is overweight, recommend low-calorie diet -recommend decreasing saturated animal fats and increasing polyunsat (veggie oils) -teach to limit cholesterol to less than 300 mg/d -encourage to use food labels to see sodium content of foods (limit nacl to less than 4 g/d) -limit processed/ refined sugar -encourage intake of fresh fruits, natural carbs, fish, poultry, legumes, fresh veggies, and grains of healthy balanced diet NG TUBE: pt begins to cough, gag, choke WHAT TO DO? - Solution - withdraw slightly DO NOT REMOVE and stop tube advancement. -instruct patient to breathe and take sips of water to ease the gagging and reduce risk of aspiration Vitamin A (Retinol, Beta-carotene) functions - Solution Functions: -helps with vision -major task of the retina in the eye. Rhodopsin helps the eye to adjust to different levels of light -growth/cell growth -retinoic acid and retinol are involved with in skeletal and soft tissue growth through both of their roles in protein synthesis and cell membrane stabilization -the constant need to replace old cells that are in the bone matrix requres and good amnt of VitA -tissue strength -these tissues (skin, gi tract, eyes, throat, etc) act as a barrier to primary infection -immunity - serves as an antioxidant to prevent free radical damage -helps w the production of immune cells to fight back viral attacks in the body Vitamin A (Retinol, Beta-carotene) Foods - Solution -two basic forms of vitA found in foods (preformed vit A/ retinol and Provitamin A or Betacarotene) ORANGE/YELLOW VEGGIES: -orange veggies (carotene pigments that carry no oxygen) -yellow veggies and fruits (does carry O2) -carrots -apricots, tangerine -pumpkin -squash butternaut -melons -sweet potatoes/yams -cantaloupe -mango, grapefruit, watermelone ORGAN MEAT: -cashews -hazelnuts JUICE: -orange juice (fortified vit D) GRAINS: -Fortified cereals DAIRY PRODUCTS: -soy milk (vitamin D fortified) -low-fat milk -rice milk Vitamin D (cholecalciferol) DEFICIENCY TOXICITY - Solution DEFICIENCY: -related to lack in diet, poor absorption, not having metabolic need for higher amounts, not enough sun exposure for long periods -people who have inflammatory bowel (gut) diseases/ surgeries (ulcerative colitis, chrons disease, gastric or stomach bypass surgery) that affect absorption of dietary fat (vit D is fat soluable) -S/S DEFICIENCY: -rickets (soft long bones) in children preventing children from reaching their peak bone mass -Osteomalacia in adults if left untreated in children but can be reversed with supplementation -osteoporosis (porous bones, brittle)--condition is irreversible VITAMIN D TOXICITY: -S/S: -anorexia -weight loss -irregular heart beat -hardening of the blood vessels and tissues due to increased blood levels of calcium (d increase % of damage to the heart and the kidneys) -fragile bones -calcification of soft tissues -kidney stones (hypercalemia) Vitamin E (Tocopherol) TOCO-TO BRING PHEROL (LIFE) Functions - Solution FUNCTION: -most abundant antioxidant, helps to prevent free radicals and preserve lung and red blood cell membranes to prevent blood clots -cell signaling that rives gene expression -immune function enhancement -metabolism (works with the trace mineral selenium as a second line defense free radical and antioxidant effects to protect polyunsaturated fats from being destroyed) Vitamin E (Tocopherol) Foods - Solution VEGGIE OILS (mostly polyunsat fats) -wheat germ oil -THE THREE S's: soybean oil, safflower oil, sunflower oil NUTS -Almonds -peanut butter -hazelnuts sunflower seeds FRUITS/ VEGGIES: -apricots -mangoes -avocado -spinach -turnip greens, beet greens, collard -red bell pepper -asparagus -pumpkin Vitamin E (Tocopherol) DEFICIENCY TOXICITY - Solution DEFICIENCY: -related to digestive disorders that prevent fat absorption properly (pancreatitis, cystic fibrosis, celiac disease) S/S OF DEFICIENCY: -retinopathy (damage to the retina of the eyes impairing vision) -peripheral neuropathy (damage to peripheral nerves, usually hands and feet causing weakness/ pain) -ataxia (loss of control of body movements) -decreased immune function S/S OF TOXICITY: -impaired clotting and increased risk of bleeding -***dont want to be taking anticoag medicine (warfarin) or too much vitamin K because it can induce more bleeding Vitamin K Function - Solution FUNCTIONS: -helps to make proteins needed for blood clotting and building of the bones -prothrombin is vit K dependent and directly involved with blood clotting -osteocalcin protein requires vitamin K to produce healthy bone tissue. -antidote to warfarin (anticoag) Vitamin K Foods - Solution FOODS: -phylloquinnoes (leafy greens) -collard greens -mustard greens -swiss chard -kale -spinach -brocolli -turnips -cabbage -lettuce -avocado OILS: -Soybean oil -canola Oil MEATS: -Pork tenderloin, lean, fresh -ham SEAFOOD: -salmon fish -*certain foods and beverages like tea, shellfish, clams, and raw fish contain thiaminases, or enzymes that deactivate thiamine, but developing a thiamin deficiency due to eating these foods is extremely rare. LEGUMES: -lentils -black beans -macadamia nuts -walnuts OATS (whole/ enriched grains): -fortified breakfast cereals -oat blenders with honey and almond cereal -wheat bran flakes -ready to eat cereal VEGGIES: -asparagus -peas Vitamin B1 (Thiamin) DEFICIENCY TOXICITY - Solution DEFICIENCY: -since it is heavily involved with ATP(ENERGY) having a deficiency will have downstream effects on the systems described that energy needs (GI, CNS, CVS) -r/t conditions like celiac disease or bariatric surgery where the GI system absorption is compromised S/S: -GI: constipation, indigestion, poor appetite -CNS: Alertness, reflexes decrease causing apathy, fatigue, and irritability -CNS: if def progresses-> nerve irritation, pain, prickly, numbing sensations (peripheral neuropathy of feet and hands)--> PARALYSIS -Paralyzing disease: BERIBERI r/t chronic alcoholism and poor diet. Alcohol blocks absorption of thiamin--> can cause brain disorder Wernicke encephalopathy (affects mental alertness, short term memory, muscle coordination) Vitamin B2 (Riboflavin) Function - Solution FUNCTION: -naturally in foods -key component of coenzymes involved with the growth of cells, energy production (ATP), breakdown of fats, steroids, and medications Vitamin B2 Foods - Solution DAIRY: -cow's milk -skim milk -yogurt -cheese -eggs MEATS: -beef liver -chicken liver -lean beef and pork -chicken breast -salmon LEGUMES: -soybeans -almonds GRAINS: -enriched -cereal Malt-o-meal -wheat bran flakes VEGGIES: -spinach Vitamin B2 (Riboflavin) DEFICIENCY TOXICITY - Solution DEFICIENCY: -rare in the US -disorders of thyroid -malnutrition -vegans/ vegetarians -S/S: -CHEILOSIS-> cracked lips esp. at corners of the mouth -sore throat -red tongue -swelling of the mouth and throat -hair loss -anemia -itchy red eyes -poor wound healing -severe, cataracts TOXICITY: NONE Vitamin B3 (Niacin) Functions - Solution -found naturally in foods -works in the body as a coenzyme for a lot of reactions to occur -helps convert nutrients--> ATP (energy) -repair DNA -antioxidant effects Vitamin B3 (Niacin) Foods - Solution MEATS: -red meat: beef, beef liver, pork -poultry (chicken, chicken breast) -Fish (tuna, yellowfin) LEGUMES -nuts , seeds -peanuts GRAINS/CEREAL: -DNA synthesis, cell division -heme synthesis (HGB) -Reduces blood homocysteine concentration -DNA/ RNA metabolism -protein metabolism -produce healthy RBC, critical in periods of rapid growth (pregnancy + fetal development) Vitamin B9 (Folate) foods - Solution MEATS: -chicken liver -turkey liver -eggs GRAINS: -whole grains -grape nute ready 2 eat cereal -wheat bran flakes -quacker cereal related FRUITS: -fresh fruits -fruit juices -orange juice VEGGIES: -dark leafy greens ( turnip greens, spinach romaine lettuce, asparagus, brussel sprouts, broccoli) LEGUMES: -peanuts -sunflower seeds -beans (garbanzo) -lentils -chickpeas Vitamin B9 (Folate) DEFICIENCY TOXICITY - Solution DEFICIENCY: -RARE -conditions like alcoholism, pregnancy, GIS surgeries, celiac, IBS can influence the higher need for folate and absorption levels -S/S -megaloblastic anemia (less RBC production) -weakness, fatigue--> neuropathy if left untreated -hair loss -pale skin BABIES DEF S/S: -- Anencephaly, neural tube defects, spina bifida TOXICITY: -can mask vit 12 deficiency because of the nerve damage involved UL:1000 MCG/D Vitamin B12 (Cobalamin) function - Solution -DNA synthesis (gene expression) -cell division -reduces blood homocysteine levels -involved in the "heme" part of HGB synthesis Vitamin B12 (Cobalamin) foods - Solution MEATS: -beef liver -red meats -eggs -poultry (chicken) SEAFOOD: -oysters -clams -mussels DAIRY: -soy milk, tofu -rice milk -yeast -milk, cheese yogurt Vitamin B12 (Cobalamin) DEFICIENCY TOXICITY - Solution DEFICIENCY -caused by lack of intrinsic factor (IF) which is crucial for Vit B12 to be absorbed--> PERNICOUS/MEGALOBLASTIC ANEMIA S/S: fatigue, weakness, nerve damage/ numbness tingling in hands/feet (peripheral neuropathy), memory loss, confusion, depression, dementia, seizures -Neurological damage -older age adults have a decreased amnt of stomach acid -meds that suppress stomach acid for things like GERD or PUD (PPIs, H2 blockers, metformin) -GI surgeries that affect the stomach (Bariatric) -celiac disease, chrons TOXICITY: -Vitamin B12 is water soluable so unused will exit via urine -UL 1000mcg/d CALCIUM Function - Solution FUNCTION -healthy bones and teeth -role in blood clotting -helps muscles to contract -regulate normal heart rhythms -99 % of calcium is stored in the bones -Vitamin D helps with absorption of calcium -involved in absorption of Vitamin B12 -involved in secretion of insulin via pancreas -if body doesnt get enough Ca from food itll get it from the bones Calcium foods - Solution DAIRY: -milk (esp used in soups, sauces, pudding) -cheese -yogurt MEAT: -salmon -beef -chicken VEGGIES: -spinach -white potato FRUIT: -banana -raisins (dried) Potassium (K+) FUNCTION - Solution - essential mineral needed by all tissues in body -main role is to help maintain normal levels of fluid inside of our cells -helps muscle contraction -supports normal BP Interaction w Sodium: -they are interconnected because while K+ interacts with ICF, sodium affects ECF -while too much sodium increases BP, too much potassium relaxes blood vessels and excretes sodium while DECREASING BP Potassium (K+) Deficiency Toxicity - Solution DEFICIENCY -kidneys work by flushing the excess amount through the urine, also stool and sweat is where its excreted -vomiting, diarrhea, diseases where they experience diarrhea/ malabsorption (Chron's Disease, ulcerative colitis) , and also diuretics can lead to hypokalemia -S/S: fatigue, malaise, muscle cramps, weakness, constipation, *muscle paralysis* (severe) TOXICITY -hyperkalemia r/t advanced kidney disease taking meds that retain K+, ppl w compromised kidneys who eat a high potassium diet or use potassium based salt substitutes S/s: weakness, fatigue, nausea, vomiting, SOB, chest pain, heart palpitations, HEART CAN STOP Potassium (K+) Foods - Solution SALT (SODIUM) SUBSTITUTES -made from potassium chloride which replaces some or all of sodium chloride in table salt, check w doctor with this replacement because although pts on a salt-restricted diet may benefit from this alternative, potassium can be dangerous for certain pts who are taking meds/ have diseases that cause them to retain too much potassium in the blood VEGGIES: -leafy greens (spinach, broccoli, Beet greens) -dried fruits (raisins, apricots) -potatoes -winter squash -avocado -tomatoes FRUITS -oranges (OJ juice) -tomato juice -prune juice -cantaloupe -BANANA DAIRY -soy, almond milk -milk -yogurt Legumes -beans, lentils -kidney beans MEATS: -chicken -salmon Iron (Fe) Function - Solution -important for blood -major component of HGB (a type of protein in RBC) -Component of myoglobin (muscle) -important for brain development and growth in children, normal production of cells need iron -comes from two types of foods (HEME/NON-HEME) HEME= only animal flesh (meat, fish, poultry, seafood) NON-HEME= Plants, fortified foods Iron (Fe) FOODS - Solution HEME (MEAT) -oysters, clan, mussels, beef chicken, liver, sardines, poultry, tuna NON-HEME (plant, fortified foods) -fortified breakfast cereals -nuts, seeds -enriched rice/ bread -molasses Potato w skin -spinach -lentils, dark chocolate -beans *want to avoid coffee or tea within 1 hr of iron intake bc it reduces non- heme absorption*