Electrolyte Imbalance and Dysphagia
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Questions and Answers

What process involves the intake and absorption of electrolytes?

  • Electrolyte disruption
  • Electrolyte intake and absorption (correct)
  • Electrolyte regulation
  • Electrolyte output

    • Which factor can lead to the shift of potassium (K+) into cells?

  • Polyuria
  • Oliguria
  • Insulin (correct)
  • Hyperkalemia

    • How does aldosterone influence potassium (K+) levels?

  • It enhances potassium absorption
  • It inhibits renal excretion
  • It increases renal potassium excretion (correct)
  • It decreases potassium retention

    • What is a consequence of hypomagnesemia related to potassium levels?

    <p>Increased renal potassium excretion</p> Signup and view all the answers

    Which condition may cause a shift of potassium (K+) out of cells?

    <p>Acidosis</p> Signup and view all the answers

    What is a primary source of dietary potassium intake?

    <p>Fruits and vegetables</p> Signup and view all the answers

    How does polyuria affect potassium levels?

    <p>Increases renal excretion of potassium</p> Signup and view all the answers

    What effect does insulin have on potassium levels in the bloodstream?

    <p>Reduces potassium levels through cell uptake</p> Signup and view all the answers

    What is the recommended procedure for measuring a patient's weight?

    <p>Measure at the same time of day with the same scale and similar clothing.</p> Signup and view all the answers

    Which of the following is a cause of myogenic dysphagia?

    <p>Muscular dystrophy</p> Signup and view all the answers

    Which sign may indicate a patient is experiencing dysphagia?

    <p>Coughing during eating</p> Signup and view all the answers

    What is classified as a clear liquid diet?

    <p>Broth and gelatin</p> Signup and view all the answers

    What critical action should be taken if a patient experiences a weight change of 3 or more pounds in a day?

    <p>Assess for fluid retention or dehydration.</p> Signup and view all the answers

    Which of the following conditions is neurogenic dysphagia linked to?

    <p>Parkinson's Disease</p> Signup and view all the answers

    Which condition is NOT typically associated with dysphagia symptoms?

    <p>Improved muscle coordination</p> Signup and view all the answers

    What is considered silent aspiration?

    <p>Aspiration that occurs without coughing due to decreased sensory function.</p> Signup and view all the answers

    What is the primary responsibility of a nurse regarding aspiration precautions during feeding?

    <p>Assessing the patient's risk for aspiration</p> Signup and view all the answers

    Why is it important to identify the patient using at least two identifiers?

    <p>To prevent feeding errors and ensure correct patient</p> Signup and view all the answers

    Which of the following conditions should be assessed as part of evaluating dysphagia risks?

    <p>Use of sedatives or agents that dry oral secretions</p> Signup and view all the answers

    What should be done immediately if a patient shows signs of coughing or gagging during feeding?

    <p>Report to the nurse right away</p> Signup and view all the answers

    What rationale supports assessing a patient’s mental status during feeding?

    <p>To assess the risk of dysphagia due to disorientation</p> Signup and view all the answers

    What should assistive personnel do while feeding a patient at risk for aspiration?

    <p>Explain feeding techniques as directed by the nurse</p> Signup and view all the answers

    Which action is necessary before feeding a patient to help prevent infection?

    <p>Performing hand hygiene</p> Signup and view all the answers

    What is assessed to determine if a further swallow evaluation is needed?

    <p>Signs and symptoms of dysphagia</p> Signup and view all the answers

    What is the primary benefit of adjusting the rate of feeding and size of bites for a patient?

    <p>Reduces the risk of aspirating food</p> Signup and view all the answers

    Why is verbal coaching important during mealtime for patients with dysphagia?

    <p>It enhances the patient's focus on the swallowing process</p> Signup and view all the answers

    What is a recommended practice concerning food textures when feeding a patient with dysphagia?

    <p>Maintain single textures to facilitate swallowing</p> Signup and view all the answers

    What should be monitored during feeding to identify potential swallowing difficulties?

    <p>Signs of coughing, choking, or gagging</p> Signup and view all the answers

    What is a critical environmental consideration during meals for patients with swallowing difficulties?

    <p>Minimizing distractions and noise</p> Signup and view all the answers

    How do sauces and gravies benefit a patient with dysphagia?

    <p>Facilitate the formation of cohesive food boluses</p> Signup and view all the answers

    What role does educating the patient and family caregiver about swallowing techniques play?

    <p>It ensures caregivers can assist effectively at home</p> Signup and view all the answers

    When is it appropriate to delegate feeding responsibilities to an assistive person (AP)?

    <p>If the patient is stable and shows no difficulty</p> Signup and view all the answers

    What is the main reason for asking a patient to remain upright for 30 to 60 minutes after a meal?

    <p>It reduces the chance of aspiration.</p> Signup and view all the answers

    Why is rigorous oral hygiene important after meals?

    <p>It reduces plaque and bacteria, preventing pneumonia.</p> Signup and view all the answers

    What is the purpose of monitoring pulse oximetry during eating for high-risk patients?

    <p>To observe for signs of aspiration.</p> Signup and view all the answers

    What should be assessed to determine a patient's nutritional status over time?

    <p>Weight and fluid output.</p> Signup and view all the answers

    What does observing the patient's oral cavity after meals help determine?

    <p>The presence of food pockets.</p> Signup and view all the answers

    Placing the nurse call system within the patient's reach serves what purpose?

    <p>To ensure the patient can call for assistance.</p> Signup and view all the answers

    What is the role of Teach-Back in patient education about swallowing risks?

    <p>To verify comprehension of safety measures.</p> Signup and view all the answers

    Why is it important to return the patient's meal tray to the appropriate place?

    <p>To prevent the spread of microorganisms.</p> Signup and view all the answers

    Which function of the human body does NOT require protein?

    <p>Muscle contraction</p> Signup and view all the answers

    What percentage of total body weight is made up of water in a lean individual?

    <p>60-70%</p> Signup and view all the answers

    Which of the following is NOT a factor that affects nutrition?

    <p>Personal preferences</p> Signup and view all the answers

    How does the body primarily release fluids?

    <p>Through multiple processes including urination and sweating</p> Signup and view all the answers

    What role do enzymes play in digestion?

    <p>Act as a catalyst</p> Signup and view all the answers

    What will most likely occur if electrolyte intake exceeds output?

    <p>Plasma electrolyte excess</p> Signup and view all the answers

    How does a shift of electrolytes from bones into the extracellular fluid (ECF) affect plasma levels?

    <p>Results in a plasma electrolyte excess</p> Signup and view all the answers

    What leads to a blood plasma deficit concerning electrolyte balance?

    <p>Shift of electrolytes from the ECF into cells and bones</p> Signup and view all the answers

    Which of the following factors can influence electrolyte imbalance in a patient?

    <p>Medications</p> Signup and view all the answers

    What physiological response occurs if blood calcium levels rise?

    <p>Decrease in blood levels of phosphates</p> Signup and view all the answers

    What is the normal daily fluid intake range for a healthy individual?

    <p>2200-2700 mL</p> Signup and view all the answers

    What physiological trigger increases the conscious desire for water?

    <p>Increased plasma osmolality</p> Signup and view all the answers

    Which of the following methods is NOT a way to achieve fluid intake?

    <p>Excessive sweating</p> Signup and view all the answers

    What is the expected range of fluid output through urine for a healthy person?

    <p>1200-1500 mL</p> Signup and view all the answers

    During prolonged heavy fluid loss, which fluid replacement is essential?

    <p>Na+-containing fluid</p> Signup and view all the answers

    What constitutes the majority of normal daily fluid intake from food?

    <p>800-1000 mL</p> Signup and view all the answers

    What is the typical loss of insensible fluid through skin and sweat in a day?

    <p>400 mL</p> Signup and view all the answers

    What variable can significantly affect daily fluid output through an individual's gastrointestinal system?

    <p>Hydration status</p> Signup and view all the answers

    What is the main reason for ensuring the patient remains upright for 30 to 60 minutes after eating?

    <p>To prevent aspiration by allowing food particles in the pharynx to clear.</p> Signup and view all the answers

    Why is rigorous oral hygiene important after meals for patients at risk for pneumonia?

    <p>It reduces the incidence of plaque and bacteria in the mouth.</p> Signup and view all the answers

    What is an essential action to take before initializing feeding for a patient at risk of dysphagia?

    <p>Ensure the patient is comfortable in an upright position.</p> Signup and view all the answers

    What does monitoring a patient's pulse oximetry during eating help to indicate?

    <p>Deteriorating oxygen saturation levels that may indicate aspiration.</p> Signup and view all the answers

    Which of the following is NOT a recommended action after a meal?

    <p>Allow the patient to immediately lie down.</p> Signup and view all the answers

    What is the purpose of placing the nurse call system within easy reach of the patient?

    <p>To ensure quick access to assistance if needed.</p> Signup and view all the answers

    What rationale supports the evaluation of a patient's oral cavity after meals?

    <p>To determine the presence of food particles in the mouth.</p> Signup and view all the answers

    What is the importance of using the Teach-Back method during patient education about swallowing risks?

    <p>To verify the patient's understanding of critical information.</p> Signup and view all the answers

    What is the primary purpose of assessing a patient's height, weight, hydration status, electrolyte balance, caloric needs, and I&O before enteral feedings?

    <p>To provide baseline information for nutritional improvement</p> Signup and view all the answers

    What should be examined in each naris before tube placement?

    <p>Patency and skin breakdown</p> Signup and view all the answers

    Why is it important to assess a patient’s mental status before enteral tube insertion?

    <p>To identify any risk factors for inadvertent tube placement</p> Signup and view all the answers

    What action should be performed after examining the naris for potential issues?

    <p>Dispose of gloves if they were used</p> Signup and view all the answers

    What is a key reason for performing hand hygiene in the context of enteral feeding?

    <p>To reduce transmission of microorganisms</p> Signup and view all the answers

    What must be recognized before performing a blind placement of a feeding tube?

    <p>Situations that pose an unacceptable risk for placement</p> Signup and view all the answers

    What should be assessed to determine a patient's knowledge and expectations regarding the feeding tube insertion procedure?

    <p>Prior experience with similar procedures</p> Signup and view all the answers

    What sensation should be explained to the patient prior to the tube insertion procedure?

    <p>Potential burning in the nasal passages</p> Signup and view all the answers

    Which of the following symptoms is commonly associated with malnutrition?

    <p>Poor posture</p> Signup and view all the answers

    What is a major consequence of decreased health in aging individuals?

    <p>Inability to balance medication and food costs</p> Signup and view all the answers

    Which physical sign may indicate malnutrition related to hair health?

    <p>Brittle and thin hair</p> Signup and view all the answers

    Which nutrient deficiency could manifest as a swollen, raw tongue?

    <p>Vitamin B12 deficiency</p> Signup and view all the answers

    In the context of nutrition, what does anthropometry primarily involve?

    <p>Measuring aspects of body size and composition</p> Signup and view all the answers

    Which of the following factors is most likely to discourage eating in older adults?

    <p>High cost of medications</p> Signup and view all the answers

    What mental status change is typically associated with malnutrition?

    <p>Confusion and irritability</p> Signup and view all the answers

    What is a likely physical sign of malnutrition affecting the gastrointestinal system?

    <p>Constipation or diarrhea</p> Signup and view all the answers

    What is the primary influence of vitamin D on calcium absorption?

    <p>It enhances the absorption of calcium in the intestines.</p> Signup and view all the answers

    What effect does chronic diarrhea have on calcium excretion?

    <p>It increases fecal calcium excretion.</p> Signup and view all the answers

    How does parathyroid hormone (PTH) influence calcium levels in the body?

    <p>It shifts calcium into the extracellular fluid.</p> Signup and view all the answers

    What role does calcitonin play concerning blood calcium levels?

    <p>It shifts calcium into the bones.</p> Signup and view all the answers

    What is the expected consequence of low calcium levels in the extracellular fluid?

    <p>Increased muscle excitability and spasms.</p> Signup and view all the answers

    Which nutrient is vital for the adequate absorption of calcium?

    <p>Vitamin D</p> Signup and view all the answers

    What can undigested fat in the intestines lead to in terms of calcium absorption?

    <p>It prevents calcium absorption.</p> Signup and view all the answers

    What is the impact of thiazide diuretics on renal calcium excretion?

    <p>They prevent calcium from being excreted.</p> Signup and view all the answers

    What is the primary rationale for explaining to the patient how to communicate during intubation?

    <p>To increase the patient's cooperation and decrease anxiety</p> Signup and view all the answers

    Why should a pulse oximeter and capnograph be applied before inserting a feeding tube?

    <p>To establish a baseline for respiratory status</p> Signup and view all the answers

    What is the correct position for a patient during intubation to reduce the risk of aspiration?

    <p>High-Fowler position with the head elevated</p> Signup and view all the answers

    What should be used to measure the length of a feeding tube to be inserted?

    <p>Distance from the earlobe to the xiphoid process</p> Signup and view all the answers

    What is a crucial step to take if the patient shows an increase in end-tidal CO2 during intubation?

    <p>Determine the stability of the patient before proceeding</p> Signup and view all the answers

    What is the rationale for applying hand hygiene before performing intubation?

    <p>To reduce transmission of microorganisms</p> Signup and view all the answers

    How should the patient be positioned if they are comatose during the feeding tube insertion?

    <p>In semi-Fowler position with head tipped forward</p> Signup and view all the answers

    What is the purpose of placing a bath towel over the patient’s chest during tube insertion?

    <p>To prevent soiling of the gown</p> Signup and view all the answers

    What condition results from a sodium and water intake being less than output, leading to a decrease in extracellular fluid volume?

    <p>Extracellular Fluid Volume Deficit</p> Signup and view all the answers

    Which of the following is a physical symptom of extracellular fluid volume excess?

    <p>Edema in dependent areas</p> Signup and view all the answers

    In the context of isosmotic imbalances, which factor can lead to dehydration and hypernatremia?

    <p>Increased gastrointestinal output</p> Signup and view all the answers

    What distinguishes hypernatremia from hyponatremia?

    <p>Water deficit with serum Na+ above 145 mEq/L</p> Signup and view all the answers

    Which laboratory finding typically indicates extracellular fluid volume deficit?

    <p>Increased BUN above 20 mg/dL</p> Signup and view all the answers

    Which condition may lead to hypernatremia due to a gain of more salt than water?

    <p>Inability to access water</p> Signup and view all the answers

    What is the primary rationale for providing small bites to a patient during feeding?

    <p>To provide tactile cues for swallowing</p> Signup and view all the answers

    Excessive water intake leading to hyponatremia can be caused by what condition?

    <p>Psychogenic polydipsia</p> Signup and view all the answers

    Why is verbal coaching important during mealtime for patients with dysphagia?

    <p>It keeps the patient focused on normal swallowing.</p> Signup and view all the answers

    In cases of clinical dehydration, what happens to body fluids?

    <p>They become concentrated with an increase in osmolality</p> Signup and view all the answers

    What is a recommended practice concerning food textures when feeding a patient with dysphagia?

    <p>Alternate liquids and bites of food to aid swallowing.</p> Signup and view all the answers

    What does a high urine specific gravity indicate in the context of extracellular fluid volume deficit?

    <p>Concentration of waste products</p> Signup and view all the answers

    What should be monitored during feeding to identify potential swallowing difficulties?

    <p>Signs of throat clearing, coughing, or choking</p> Signup and view all the answers

    Which physiological response is expected in hyponatremia?

    <p>Cellular swelling and confusion</p> Signup and view all the answers

    What role does educating the patient and family caregiver about swallowing techniques play?

    <p>It enhances their ability to use techniques effectively at home.</p> Signup and view all the answers

    Which condition is characterized by the loss of relatively more water than salt, leading to concentrated body fluids?

    <p>Hypernatremia</p> Signup and view all the answers

    What is a critical environmental consideration during meals for patients with swallowing difficulties?

    <p>Minimizing distractions and conversations.</p> Signup and view all the answers

    When is it appropriate to delegate feeding responsibilities to an assistive person?

    <p>When the patient is stable and not having swallowing difficulties.</p> Signup and view all the answers

    What is a likely cause of combined volume and osmolality imbalance?

    <p>Fluid loss with inadequate water consumption</p> Signup and view all the answers

    What is the benefit of using sauces, condiments, and gravies for a patient with dysphagia?

    <p>They help in forming a cohesive food bolus.</p> Signup and view all the answers

    What is a significant sign of hyponatremia during a physical examination?

    <p>Decreased level of consciousness</p> Signup and view all the answers

    Excessive administration of which type of IV fluid may lead to extracellular fluid volume excess?

    <p>Isotonic saline</p> Signup and view all the answers

    Which organ primarily excretes all acids except carbonic acid?

    <p>Kidneys</p> Signup and view all the answers

    What happens when PaCO2 levels increase in the blood?

    <p>Respiratory rate and depth increases</p> Signup and view all the answers

    What is a consequence of respiratory disease related to carbon dioxide?

    <p>Increased blood acidity</p> Signup and view all the answers

    Which buffer system prevents urine from becoming overly acidic in the kidneys?

    <p>Phosphate buffers</p> Signup and view all the answers

    What condition triggers the lungs to increase respiratory rate and depth?

    <p>Accumulation of metabolic acids</p> Signup and view all the answers

    What is the primary compartment where intracellular fluid (ICF) is located?

    <p>Inside cells</p> Signup and view all the answers

    Which of the following ions is classified as an anion?

    <p>Chloride (Cl-)</p> Signup and view all the answers

    What is the normal range for osmolality in human body fluids?

    <p>285-295 mOsm/kg</p> Signup and view all the answers

    Which condition is related to a deficit of extracellular volume?

    <p>Hypovolemia</p> Signup and view all the answers

    What is the primary effect of hyperkalemia on the body?

    <p>Heart arrhythmias</p> Signup and view all the answers

    Which fluid is NOT considered a part of extracellular fluid (ECF)?

    <p>Intracellular fluid</p> Signup and view all the answers

    What is the normal range for bicarbonate (HCO3-) in arterial blood gases?

    <p>21-28 mEq/L</p> Signup and view all the answers

    What best describes the term 'osmotic pressure'?

    <p>The pressure exerted by dissolved particles in a fluid</p> Signup and view all the answers

    What is the main benefit of adjusting the rate of feeding and size of bites for a patient?

    <p>It helps the patient swallow more effectively.</p> Signup and view all the answers

    Why should verbal coaching be provided to a patient during mealtime?

    <p>To enhance concentration on swallowing.</p> Signup and view all the answers

    What is an important practice regarding food textures when feeding a patient with dysphagia?

    <p>Alternating bites of food with liquids.</p> Signup and view all the answers

    What is the rationale for minimizing distractions during mealtime for a patient with dysphagia?

    <p>Distractions increase the likelihood of aspiration.</p> Signup and view all the answers

    How can sauces, condiments, and gravies assist patients with dysphagia?

    <p>They help create a cohesive food bolus.</p> Signup and view all the answers

    Why is it important to educate both the patient and caregiver about swallowing techniques?

    <p>It enhances the ability to use techniques effectively at home.</p> Signup and view all the answers

    What should be monitored during feeding to identify potential swallowing difficulties?

    <p>Swallowing sounds, throat clearing, and coughing.</p> Signup and view all the answers

    When is it appropriate to delegate feeding responsibilities to assistive personnel (AP)?

    <p>When the patient is stable and has shown no difficulties.</p> Signup and view all the answers

    What should a nurse do if a patient experiences a weight change of 3 or more pounds in a 24-hour period?

    <p>Assess for signs of fluid retention or dehydration.</p> Signup and view all the answers

    Which of the following is a primary characteristic of a clear liquid diet?

    <p>Comprises broth, clear fruit juices, and gelatin.</p> Signup and view all the answers

    Which condition is NOT typically classified as an obstructive cause of dysphagia?

    <p>Cerebral palsy</p> Signup and view all the answers

    What is one of the warning signs of dysphagia a patient may exhibit?

    <p>Change in voice tone after swallowing</p> Signup and view all the answers

    What additional component differentiates a full liquid diet from a clear liquid diet?

    <p>Inclusion of smooth textured dairy products</p> Signup and view all the answers

    Which of the following conditions is associated with myogenic dysphagia?

    <p>Myasthenia gravis</p> Signup and view all the answers

    What characterizes silent aspiration in patients?

    <p>Occurs without any observable signs.</p> Signup and view all the answers

    What is a likely consequence of prolonged IV fluid administration without adequate nutrition in acute care?

    <p>Nutritional deficiency risk</p> Signup and view all the answers

    What is the primary reason for verifying the health care provider's order before inserting a nasoenteric tube?

    <p>To determine the type of tube and feeding schedule</p> Signup and view all the answers

    Which of the following is a critical factor to assess in a patient's medical history before the insertion of a nasoenteric tube?

    <p>History of anticoagulant therapy</p> Signup and view all the answers

    What is an appropriate action if a patient is at risk for intracranial passage of a tube?

    <p>Consult with a healthcare provider for alternative methods</p> Signup and view all the answers

    Why is it important to assess the patient's or family caregiver's health literacy?

    <p>To ensure they can manage post-procedure care</p> Signup and view all the answers

    What is a risk factor for developing a medical adhesive-related skin injury (MARSI)?

    <p>Age and chronic conditions</p> Signup and view all the answers

    Which action should be taken to ensure correct patient identification before a procedure?

    <p>Identify the patient using at least two identifiers</p> Signup and view all the answers

    What should a healthcare provider do if they find nasal problems during patient assessment?

    <p>Select the oral route for the tube placement</p> Signup and view all the answers

    Which of the following best describes the role of prokinetic agents before tube placement?

    <p>They assist in advancing the tube into the intestine</p> Signup and view all the answers

    What is a physiological response to increased metabolic acids accumulating in the blood?

    <p>Hyperventilation</p> Signup and view all the answers

    Which of the following factors may lead to gastrointestinal output imbalances?

    <p>Vomiting</p> Signup and view all the answers

    Which condition is associated with chronic disease that increases the risk of fluid and electrolyte imbalances?

    <p>COPD</p> Signup and view all the answers

    What is the likely result of a sodium-rich diet on fluid balance?

    <p>Increased extracellular volume</p> Signup and view all the answers

    Which of the following therapies can put a patient at risk for electrolyte deficiencies?

    <p>Diuretics</p> Signup and view all the answers

    What are the potential contraindications for enteral fluid replacement?

    <p>Severe Nausea</p> Signup and view all the answers

    Which solution is categorized as normal saline?

    <p>0.9% NaCl</p> Signup and view all the answers

    What is the primary energy source provided by proteins?

    <p>4 Kcal/g</p> Signup and view all the answers

    Which of the following is a type of parenteral nutrition?

    <p>Electrolyte therapy</p> Signup and view all the answers

    What may result from impaired swallowing in patients?

    <p>Risk of aspiration</p> Signup and view all the answers

    Which IV solution contains dextrose and normal saline?

    <p>Dextrose 5% in 0.9% NaCl</p> Signup and view all the answers

    Which factor does NOT affect a person's energy requirements?

    <p>Shoe size</p> Signup and view all the answers

    What is the primary function of protein in the body?

    <p>Tissue growth and repair</p> Signup and view all the answers

    What is a potential cause of obstructive dysphagia?

    <p>Candidiasis</p> Signup and view all the answers

    Which of the following is a sign that may indicate dysphagia?

    <p>Cough during eating</p> Signup and view all the answers

    How should Body Mass Index (BMI) be calculated?

    <p>Weight in kilograms divided by height in meters squared</p> Signup and view all the answers

    What should clinicians do if a patient experiences a weight change of 3 or more pounds in a 24-hour period?

    <p>Assess for fluid retention or dehydration</p> Signup and view all the answers

    Which condition is classified under neurogenic dysphagia?

    <p>Guillain-Barre Syndrome</p> Signup and view all the answers

    What is included in a clear liquid diet?

    <p>Broth and carbonated beverages</p> Signup and view all the answers

    What should patients in acute care receiving standard IV fluids for over 5-7 days be considered?

    <p>At high nutritional risk</p> Signup and view all the answers

    Which of the following is NOT a warning sign for dysphagia?

    <p>Unexplained weight gain</p> Signup and view all the answers

    What is the primary reason for assessing a patient's mental status prior to inserting a feeding tube?

    <p>To identify risk factors for incorrect tube placement</p> Signup and view all the answers

    Why is hand hygiene emphasized before examining the patient's nares?

    <p>To minimize transmission of microorganisms</p> Signup and view all the answers

    Which of the following assessments provides critical baseline information regarding the patient's nutritional status?

    <p>Height, weight, and hydration status</p> Signup and view all the answers

    What should be done to check for an existing pressure injury before placing a feeding tube?

    <p>Evaluate the nares for patency and skin breakdown</p> Signup and view all the answers

    What is the effect of sedation on a patient during feeding tube placement?

    <p>Increases the risk of aspiration</p> Signup and view all the answers

    Which action is critical when preparing to insert a feeding tube to enhance patient safety?

    <p>Use advanced imaging techniques for placement</p> Signup and view all the answers

    What should be included in patient education regarding the feeding tube insertion procedure?

    <p>The sensations experienced during insertion</p> Signup and view all the answers

    Which of the following factors does NOT contribute to safe feeding tube placement?

    <p>Assessing the patient's electrolyte balance</p> Signup and view all the answers

    What is the primary rationale for explaining to a patient how to communicate during intubation?

    <p>To alleviate stress and enhance cooperation.</p> Signup and view all the answers

    Which position is preferred for intubation to reduce the risk of aspiration?

    <p>High-Fowler position.</p> Signup and view all the answers

    What should be done if a patient exhibits decreased oxygen saturation during tube insertion?

    <p>Determine the patient's stability before proceeding.</p> Signup and view all the answers

    Why is it important to measure and mark the length of the feeding tube before insertion?

    <p>To estimate the proper length to insert into the patient.</p> Signup and view all the answers

    What is the purpose of applying pulse oximetry during the intubation process?

    <p>To provide continuous feedback on oxygen saturation.</p> Signup and view all the answers

    What should be done prior to the insertion of a small-bore feeding tube?

    <p>Gather and organize all necessary equipment.</p> Signup and view all the answers

    If the patient is confused or comatose, what should be done to assist with positioning?

    <p>Have an assistant help with positioning.</p> Signup and view all the answers

    What is the effect of positioning the patient's head forward with a pillow during intubation?

    <p>It facilitates closure of the airway and eases tube passage.</p> Signup and view all the answers

    What condition is primarily characterized by the kidneys' inability to excrete metabolic acids, leading to accumulation in the blood?

    <p>Metabolic Acidosis</p> Signup and view all the answers

    Which risk factor contributes to electrolyte deficits in patients?

    <p>Age</p> Signup and view all the answers

    In cases of respiratory acidosis, which physiological change is primarily responsible for compensating the increased CO2 levels?

    <p>Kidney excretion of metabolic acids</p> Signup and view all the answers

    What is a common consequence of diarrhea concerning fluid and electrolyte balance?

    <p>Clinical dehydration</p> Signup and view all the answers

    Which therapy is typically associated with a risk of causing fluid imbalances in patients?

    <p>IV Therapy</p> Signup and view all the answers

    What is one of the key functions that requires protein in the human body?

    <p>Blood clotting</p> Signup and view all the answers

    Which factor directly contributes to a greater percentage of water in lean individuals?

    <p>Muscle mass</p> Signup and view all the answers

    What physiological process does not occur as a direct result of protein functions in the body?

    <p>Cellular respiration</p> Signup and view all the answers

    What is a significant effect of aging on nutritional needs for older adults?

    <p>Unchanged vitamin and mineral requirements</p> Signup and view all the answers

    Which process is not involved in the mechanical digestion of food?

    <p>Mixing with enzymes</p> Signup and view all the answers

    What is the primary reason for assessing a patient's mental status before feeding tube insertion?

    <p>To determine the risk of inadvertent tube placement</p> Signup and view all the answers

    What is an important rationale for performing hand hygiene before the procedure?

    <p>To reduce the risk of microorganism transmission</p> Signup and view all the answers

    Why is it crucial to assess a patient's electrolyte balance before enteral feeding?

    <p>To establish a baseline for nutritional improvement</p> Signup and view all the answers

    When assessing nasal patency, which condition should be specifically checked for?

    <p>Obstruction or irritation in the nares</p> Signup and view all the answers

    What should be the nurse's primary focus during the assessment of the patient's abdomen?

    <p>Detecting signs of medical problems that contraindicate feeding</p> Signup and view all the answers

    Why is it important to assess a patient's previous experiences with feeding tube insertion?

    <p>To determine the need for additional patient education</p> Signup and view all the answers

    What is the main purpose of informing the patient about the sensations experienced during tube insertion?

    <p>To psychologically prepare the patient for discomfort</p> Signup and view all the answers

    What should a clinician be cautious about when performing blind placement of a feeding tube?

    <p>The potential for device-related pressure injury</p> Signup and view all the answers

    Which condition is an indication for the use of parenteral nutrition (PN)?

    <p>Paralytic ileus</p> Signup and view all the answers

    What is the significance of monitoring a patient for up to 24 hours after tube insertion for PN?

    <p>Monitoring for tension pneumothorax</p> Signup and view all the answers

    A patient is classified as malnourished if their weight is what percentage below their ideal body weight?

    <p>20%</p> Signup and view all the answers

    Which of the following is NOT a characteristic physical assessment finding in nutritional deficiency?

    <p>Increased energy levels</p> Signup and view all the answers

    What dietary habit can contribute to a significantly lower caloric intake?

    <p>Regularly skipping meals</p> Signup and view all the answers

    Which factor is least associated with impaired nutritional intake?

    <p>High levels of physical activity</p> Signup and view all the answers

    What specific aspect of nutrition therapy is designed to treat illnesses, injuries, or conditions?

    <p>Medical nutrition therapy</p> Signup and view all the answers

    In the nutritional assessment of a patient, what is the primary purpose of evaluating 24-hour food and fluid intake?

    <p>To determine caloric deficiency</p> Signup and view all the answers

    Which psychological factor can significantly affect a patient's nutritional intake?

    <p>Loss of a spouse</p> Signup and view all the answers

    Which of the following best describes potential signs of malnutrition in a patient?

    <p>Fatigue and hair loss</p> Signup and view all the answers

    What is the primary reason for positioning the patient in a high-Fowler position during tube insertion?

    <p>To improve airway closure and tube passage.</p> Signup and view all the answers

    Why is it necessary to apply a pulse oximeter or capnograph during the intubation process?

    <p>To assess respiratory status continuously.</p> Signup and view all the answers

    What is the purpose of marking the tube length before insertion?

    <p>To estimate the correct depth of insertion.</p> Signup and view all the answers

    What should be done if a patient shows an increase in end-tidal carbon dioxide during intubation?

    <p>Reassess the patient's stability before proceeding.</p> Signup and view all the answers

    What rationale supports keeping a towel over the patient's chest during the procedure?

    <p>To avoid soiling the gown.</p> Signup and view all the answers

    Which action enhances patient communication during intubation?

    <p>Instructing the patient to raise their index finger.</p> Signup and view all the answers

    What is a critical factor to consider for a comatose patient during tube insertion?

    <p>Positioning adjustments to improve airway access.</p> Signup and view all the answers

    What is the significance of closing the room door and bedside curtain during the procedure?

    <p>To provide patient privacy.</p> Signup and view all the answers

    Study Notes

    Electrolyte Imbalance

    • Three processes involved: Intake and absorption, disruption, and output.

    Electrolyte Intake and Absorption

    • Potassium (K+) is a key electrolyte with functions in skeletal, smooth, and cardiac muscle.
    • Foods rich in potassium include fruits, potatoes, instant coffee, molasses, and Brazil nuts.
    • Potassium absorption is easily achieved but can be disrupted by conditions like acidosis and alkalosis.

    Dysphagia (Difficult Swallowing)

    • Myogenic dysphagia can be caused by conditions like Myasthenia gravis, aging, muscular dystrophy, and polymyositis.
    • Neurogenic dysphagia can be caused by conditions like stroke, cerebral palsy, Guillain-Barre Syndrome, Multiple Sclerosis, Amyotrophic Lateral Sclerosis, Diabetic Neuropathy, and Parkinson's Disease.
    • Obstructive dysphagia can be caused by conditions like benign peptic stricture, lower esophageal ring, Candidiasis, head and neck cancer, inflammatory masses, and trauma/surgical restriction.
    • Other causes include gastrointestinal or esophageal resection, rheumatological disorders, connective tissue disorders, and vagotomy.

    Silent Aspiration

    • A common occurrence in patients with neurological problems that leads to decreased sensation.

    Diet Progression & Therapeutic Diets

    • Clear Liquid Diet consists of broth, bouillon, coffee, tea, carbonated beverages, clear fruit juices, gelatin, fruit ices, and popsicles.
    • Full Liquid Diet includes all clear liquids plus smooth textured dairy products.

    Aspiration Precautions

    • Positioning plays a critical role.
    • Nurses are responsible for assessing patient risk for aspiration.
    • Assistive personnel can be delegated the task of feeding but the nurse must supervise and direct care.

    Aspiration Precautions Steps

    • Identify patient using two identifiers.
    • Review medical history, nutritional risks, and screening results to identify factors that could cause dysphagia.
    • Assess current medications for medications that may impair swallowing and coughing reflexes.
    • Assess patient for signs and symptoms of dysphagia, and refer to a speech-language pathologist (SLP) or registered dietitian (RD) if needed.
    • Assess patient's health literacy to ensure they understand the information.
    • Assess patient's mental status.
    • Apply gloves.
    • Provide verbal coaching to remind the patient to chew and swallow.
    • Avoid mixing different textures in the same mouthful.
    • Monitor swallowing and observe for respiratory difficulty.
    • Minimize distractions and allow adequate time for chewing and swallowing.
    • Use sauces and condiments to facilitate cohesive food bolus formation.
    • Ask the patient to remain upright for at least 30-60 minutes after a meal.
    • Provide thorough oral hygiene after meals.
    • Ensure the patient is comfortable in an upright position.
    • Perform hand hygiene.

    Evaluation

    • Observe the patient's ability to swallow food and fluids of various textures.
    • Monitor pulse oximetry readings for high-risk patients during eating.
    • Monitor intake and output, calorie count, and food intake.
    • Weigh the patient daily or weekly.
    • Observe the patient's oral cavity after meals.
    • Use teach-back to ensure the patient and family caregiver understand the information.

    Fluid Intake and Output

    • Normal daily fluid intake is between 2200-2700mL
    • Normal daily fluid output is between 2200-2700mL
    • During prolonged heavy exercise, fluid intake can range between 300-1150mL/hour
    • Prolonged heavy exercise can increase fluid output to 340-3120mL/hour
    • Rehydration with sodium-containing fluids is necessary after prolonged vigorous exercise

    Thirst

    • Is a conscious desire for water
    • Is an important regulator of fluid intake when plasma osmolality increases or blood volume decreases
    • Fibroblast growth factor 23 (FGF-23) decreases renal excretion of phosphate
    • Rising blood calcium levels decrease phosphate in blood, and vice versa

    Factors Affecting Electrolyte Imbalance

    • Diarrhea
    • Endocrine Disorders
    • Medications

    Factors of Protein

    • Blood clotting
    • Fluid regulation
    • Acid-base balance

    Water

    • Accounts for 60-70% of total body weight
    • Lean people have a greater percentage of water
    • Muscle contains more water than any other tissue except blood

    Fluid Release

    • Respiration
    • Sweating
    • Urine
    • Stools
    • Fever
    • Vomiting
    • Trauma (blood loss)
    • Clinical Dehydration
    • Medications

    Digestion of Food

    • Mechanical breakdown through chewing, churning, and mixing with fluid
    • Chemical reactions reduce food to its simplest form

    Enzymes

    • Protein-like substances that speed up chemical reactions
    • Essential for digestion

    Factors that Affect Nutrition

    • Environmental factors contribute to obesity
    • 68.7% of Americans are overweight or obese
    • Overweight: BMI 25 to 29
    • Obese: BMI 30 or greater
    • Cost of healthy food is increasing, making it difficult for some to afford
    • Fewer safe places to walk and play
    • Age: Older adults (65 and up) have a decreased need for energy due to slower metabolic rate
    • Vitamin and mineral requirements remain unchanged with age

    Intubation Procedure

    • Rationale:
      • Increase patient cooperation and decrease anxiety
      • Provide a method for communication during intubation to alleviate stress and enhance cooperation
      • Preserve patient privacy
      • Ensure efficient procedure

    Intubation Implementation

    • Perform Hand Hygiene:
      • Reduces transmission of microorganisms
      • Allows easier manipulation of tube
    • Positioning:
      • Place patient in upright high-Fowler position (unless contraindicated)
      • If comatose, raise head of bed as tolerated in semi-Fowler position with head tipped forward using a pillow chin to chest
      • If patient is forced to lie supine, place in reverse Trendelenburg position
      • Fowler position reduces risk of aspiration and promotes swallowing
      • Forward head position helps to close airway and allows for passage of tube into esophagus
    • Vital Sign Monitoring:
      • Apply pulse oximeter/capnograph and monitor vital signs continuously
      • Provides baseline for objective assessment of respiratory status during and after tube insertion
      • Reduced oxygen saturation or increased end-tidal CO2 can indicate tube misplacement into the lungs or moving out of the stomach into lungs
    • Clinical Judgment:
      • If there is an increase in end-tidal carbon dioxide or decrease in oxygen saturation, do not insert the tube until patient stability is determined
    • Prepare Patient:
      • Place a bath towel over the patient's chest to prevent soiling of the gown
      • Keep facial tissues within reach for tearing that may happen during the procedure
    • Mark Tube Length:
      • Determine the tube length to be inserted and mark the appropriate location with tape or indelible ink
      • Ensures organized procedure and estimation of length to be inserted
      • Option - Adult Method: Measure distance from tip of nose to earlobe to xyphoid process (NEX) of sternum, which approximates distance from nose to stomach. Mark this distance on the tube with tape.

    Body Fluid Composition

    • Adult males have 60% body weight as water, decreasing to 50% in older individuals.
    • Body fluid is divided into two compartments: extracellular fluid (ECF) and intracellular fluid (ICF).
    • ECF is found outside cells and further divided into intravascular fluid (liquid part of blood) and interstitial fluid (between cells).
    • Transcellular fluid, secreted by epithelial cells, includes cerebrospinal fluid, pleural, peritoneal, and synovial fluids.

    Body Fluid Electrolytes

    • Body fluids contain ions, with positively charged ions called cations:
      • Sodium (Na+)
      • Potassium (K+)
      • Calcium (Ca+)
      • Magnesium (Mg2+)
    • Negatively charged ions are called anions:
      • Chloride (Cl-)
      • Bicarbonate (HCO3-)
    • Cations and anions combine to form salts.

    Normal Lab Values

    • Osmolality: 285-295 mOsm/kg
    • Electrolytes:
      • Sodium (Na+): 136-145 mEq/L
      • Potassium (K+): 3.5-5.0 mEq/L
      • Chloride (Cl-): 98-106 mEq/L
      • Total CO2: 23-30 mEq/L
      • Bicarbonate (HCO3-): 21-28 mEq/L
      • Total Calcium (Ca2+): 9.0-10.5 mg/dL
      • Ionized Calcium (Ca2+): 4.5-5.6 mg/dL
      • Magnesium (Mg2+): 1.3-2.1 mEq/L
      • Phosphate: 3.0-4.5 mg/dL
      • Anion Gap: 6+/-4 mEq/L
    • Arterial Blood Gases (ABG's):
      • pH: 7.35 to 7.45
      • PaCO2: 35 to 45 mmHg
      • PaO2: 80-100 mmHg
      • HCO3-: 21 to 28 mEq/L
      • O2 Saturation: 95% to 100%
      • Base Excess: -2 to +2 mmEq/L

    Osmolality and Osmotic Pressure

    • Osmolality: The number of particles per kg of water. Sodium (Na+) does not easily pass through the cell membrane
    • Osmotic pressure: Force that pushes a fluid through a membrane

    Acid-Base Balance

    • The body maintains a neutral pH (7.35-7.45).
    • Buffers, like bicarbonate (HCO3-), help regulate pH in extracelluar fluid aiding in regulating metabolic acid.
    • Acid excretion:
      • Lungs: Responsible for respiratory/carbonic acid excretion.
      • Kidneys: Responsible for metabolic/non-carbonic acid excretion.

    Acid-Base Imbalances

    • Acidosis: A decrease in pH.
    • Alkalosis: An increase in base (bicarbonate).
    • Two types of acidosis:
      • Respiratory acidosis: Caused by impaired lung function.
      • Metabolic acidosis: Caused by kidney failure.
    • Two types of alkalosis:
      • Respiratory alkalosis: Caused by hyperventilation.
      • Metabolic alkalosis: Caused by excessive loss of acid, particularly from vomiting.
    • Both lungs and kidneys have compensatory mechanisms to help rebalance the acid-base balance.

    Dysphagia (Difficulty Swallowing)

    • Causes of dysphagia:
      • Myogenic (Muscle-related): Myasthenia gravis, aging, muscular dystrophy, polymyositis.
      • Neurogenic (Nerve-related): Stroke, cerebral palsy, Guillain-Barré syndrome, multiple sclerosis, amyotrophic lateral sclerosis, diabetic neuropathy, Parkinson's disease.
      • Obstructive (Physical blockage): Benign peptic stricture, lower esophageal ring, candidiasis, head and neck cancer, inflammatory masses, trauma/surgical restriction.
      • Other: Gastrointestinal or esophageal resection, rheumatological disorders, connective tissue disorders, vagotomy.

    Dysphagia Signs and Monitoring

    • Warning signs: Coughing during eating, change in voice tone, abnormal mouth or tongue movements, slow speech, abnormal gag reflex, delayed swallowing, food pocketing, regurgitation, pharyngeal pooling, delayed swallow trigger, inability to speak.
    • Silent aspiration: Aspiration that occurs without obvious signs, common in neurological conditions.
    • Monitor for signs of dysphagia, such as throat clearing, coughing, choking, gagging, and drooling. Suction airway as needed.

    Nutritional Support

    • Patients receiving standard IV fluids for more than 5-7 days are at high nutritional risk.
    • Diet Progression & Therapeutic Diets:
      • Clear Liquid: Broth, bouillon, coffee, tea, clear juices, gelatin, fruit ices.
      • Full Liquid: Clear liquid plus dairy products, smooth textured foods.

    Nasoenteric Tube Insertion and Removal

    • Verify health care provider's order for tube type and feeding schedule, and check for prokinetic agent orders.
    • Identify patient using two identifiers.
    • Review patient's medical history (e.g., basilar skull fracture, nasal problems, anticoagulant therapy). This information may require a change of tube route.
    • Assess patient's risk for developing a medical adhesive-related skin injury (MARSI), considering factors like age, dehydration, underlying conditions.
    • Assess health literacy of patient or family caregiver.
    • Determine patient's allergies, focusing on foods and adhesives.
    • Explain the procedure to the patient and family caregiver. Teach-back to ensure understanding.
    • Monitor the patient for signs of aspiration.

    Swallowing and Feeding Techniques

    • Use a chin-down maneuver, head-turn-plus-chin-down maneuver, and a small bite approach to help with swallowing.
    • Provide verbal coaching, "Think about swallowing, Close your mouth, Cough to clear your airway" etc.
    • Avoid mixing textures in the same mouthful and alternate liquids and bites of food.
    • Minimize distractions during meals, allow time for chewing, and provide rest periods during meals.
    • Use sauces and gravies to facilitate food bolus formation.

    Metabolic Acidosis

    • Metabolic acidosis is characterized by increased metabolic acids in the blood and decreased bicarbonate levels.
    • Kidneys are unable to excrete these acids, leading to their accumulation in the blood.
    • Common causes include diarrhea, where bicarbonate is directly removed from the body.
    • Anion gap, a measure of the difference between positively and negatively charged ions in the blood, can be helpful in diagnosis.
    • Decreased pH triggers chemoreceptors, leading to lung compensation through hyperventilation.

    Respiratory Acidosis

    • Respiratory acidosis occurs when excessive carbon dioxide (CO2) accumulates, leading to increased partial pressure of CO2 (PaCO2).
    • This is often a result of hypoventilation, where breathing is insufficient.
    • Kidneys compensate by increasing the excretion of acids in urine.

    Risk Factors for Fluid, Electrolyte, or Acid-Base Imbalances

    • Age
      • Young individuals may experience extracellular volume (ECV) deficits, osmolality imbalances, and clinical dehydration.
      • Older individuals can experience both ECV excess and deficit, as well as osmolality imbalances.
    • Environment
      • Sodium-rich diets can lead to ECV excess.
      • Electrolyte-poor diets contribute to electrolyte deficits.
      • Hot weather can increase the risk of clinical dehydration.
    • Gastrointestinal Output
      • Diarrhea, drainage, and vomiting can significantly impact fluid and electrolyte balance.
    • Chronic Diseases
      • Cancer, COPD, cirrhosis, heart failure, oliguric renal disease can disrupt fluid and electrolyte balance.
    • Trauma
      • Burns, crashes, head injuries, hemorrhage can lead to various imbalances.
    • Therapies
      • Diuretics, IV therapy, and parenteral nutrition (PN) can influence fluid and electrolyte balance.

    Fluid Imbalance

    • Dehydration and ECV excess are common fluid imbalances.

    Enteral Fluid Replacement

    • Enteral fluid replacement involves providing fluids by mouth.
    • Ice chips are considered half the volume. If a patient consumes 240 mL of ice chips, the actual intake is 120 mL.
    • Contraindications for enteral fluid replacement include mechanical obstruction of the gastrointestinal tract, severe nausea, increased risk of aspiration, and impaired swallowing.

    Parenteral Fluid Replacement

    • Parenteral fluid replacement involves administering fluids through IV.
    • Types include:
      • Parenteral Nutrition (PN)
      • Electrolyte therapy
      • Blood
      • Blood components

    Types of IV Solutions

    • Dextrose in Water
      • D5W: Dextrose 5% in water
      • D10W: Dextrose 10% in water
    • Saline Chloride (NaCl) in Water Solution
      • 0.225% NaCl (1/4 Normal Saline)
      • 0.45% NaCl (1/2 Normal Saline)
      • 0.9% NaCl (Normal Saline)
      • 3-5% NaCl (Hypertonic Saline)
    • Dextrose in Saline Solution
      • Dextrose 5% in 0.45% NaCl (1/2 Normal Saline)
      • Dextrose 5% in 0.9% NaCl (D5NS)
    • Multiple Electrolyte Solutions
      • Lactated Ringers (LR)
      • Dextrose 5% (LR, D5LR)

    Nutrition Key Terms

    • Albumin: A plasma protein essential for maintaining blood volume and pressure.
    • Anorexia Nervosa: An eating disorder characterized by extreme weight loss, distorted body image, and fear of gaining weight.
    • Basal Metabolic Rate (BMR): The minimum amount of energy required to sustain life at rest.
    • Body Mass Index (BMI): A measure of body fat based on height and weight.
    • Bulimia Nervosa: An eating disorder characterized by binge eating followed by purging behaviors.
    • Carbohydrates: Organic compounds composed of carbon, hydrogen, and oxygen, serving as the primary energy source for the body.
    • Catabolism: The breakdown of complex molecules into simpler ones, releasing energy.
    • Daily Values: Recommended dietary intake based on daily nutrient needs.
    • Dietary Reference Intakes (DRIs): A set of nutrient recommendations for healthy individuals.
    • Dispensable Amino Acids: Amino acids that the body can synthesize from other sources.
    • Dysphagia: Difficulty swallowing.
    • Enteral Nutrition (EN): Providing nutritional support through the gastrointestinal tract by tube feeding or oral supplements.
    • Fat-soluble Vitamins: Vitamins that dissolve in fat and are stored in the body (e.g., vitamins A, D, E, K).
    • Fiber: Indigestible plant material that aids digestion and promotes bowel regularity.
    • Food Security: Access to safe, nutritious food in sufficient quantities to meet dietary needs and preferences.
    • Hypervitaminosis: Toxicity due to excessive intake of vitamins.
    • Ideal Body Weight (IBW): A healthy weight range based on height and sex.
    • Indispensable Amino Acids: Essential amino acids that the body cannot synthesize and must be obtained from the diet.
    • Insulin: A hormone that regulates blood glucose levels.
    • Intravenous: Administration of fluids or medications directly into a vein.
    • Ketones: Energy-producing byproducts of fat metabolism.
    • Kilocalories: Units of energy defined as the amount of heat required to raise the temperature of 1 kg of water by 1 degree Celsius.
    • Lipids: Fats and oils that are essential components of cell membranes and serve as energy reserves.
    • Macrominerals: Minerals required in relatively large amounts (e.g., calcium, phosphorus, magnesium, sodium, potassium, chloride).
    • Malabsorption: Impaired absorption of nutrients from the gastrointestinal tract.
    • Malnutrition: A nutritional deficiency caused by inadequate intake, absorption, or utilization of nutrients.
    • Medical Nutrition Therapy (MNT): Nutritional counseling and treatment by a registered dietitian.
    • Metabolism: All chemical processes occurring within the body, including the breakdown and synthesis of molecules.
    • Minerals: Inorganic substances that are essential for various bodily functions.
    • Nitrogen Balance: The balance between nitrogen intake and output, reflecting protein metabolism.
    • Parenteral Nutrition (PN): Providing nutritional support directly into the bloodstream, bypassing the gastrointestinal tract.
    • Peristalsis: Wave-like muscle contractions that propel food through the digestive tract.
    • Resting Energy Expenditure (REE): The energy needed to sustain life at rest, excluding the energy used for physical activity.
    • Simple Carbohydrates: Sugars that are easily and quickly absorbed by the body.
    • Trace Elements: Minerals required in very small amounts (e.g., iron, zinc, copper, iodine).
    • Triglycerides: The main type of fat found in the body and food.
    • Vitamins: Organic compounds required in small amounts for various bodily functions.
    • Water-soluble Vitamins: Vitamins that dissolve in water and are not stored in the body (e.g., vitamin C, B vitamins).
    • Villi: Small, finger-like projections in the small intestine that increase surface area for nutrient absorption.

    Biochemical Units of Nutrition

    • The body requires fuel for cellular metabolism, repair, organ function, growth, and movement.

    Factors Affecting Energy Requirements

    • Age
    • Body Mass
    • Gender
    • Fever
    • Starvation
    • Menstruation
    • Illness
    • Injury
    • Infection
    • Activity
    • Level of Thyroid Function

    Factors Affecting Metabolism

    • Illness
    • Pregnancy
    • Lactation
    • Activity Level

    Proteins

    • Provide energy at 4kcal/g.
    • Essential for growth, maintenance, and repair of body tissues.
    • Components of collagen, hormones, enzymes, immune cells, DNA, and RNA.

    Weight

    • Daily weight measurements should be taken at the same time each day, using the same scale and comparable clothing.
    • Significant weight loss or gain (3 or more pounds in 24 hours) should prompt assessment for fluid retention or dehydration.

    Body Mass Index (BMI)

    • Calculate BMI by dividing weight in kilograms by height in meters squared.
    • (i.e., 180 lbs / 2.2 / 5.6 or 1.67 m² = 29.34)
    • A BMI of 29.34 indicates overweight and nearing obesity.

    Laboratory and Biochemical Tests

    • Used to diagnose malnutrition, fluid balance, liver function, kidney function, and the presence of disease.

    Dysphagia (Difficult Swallowing) Causes

    • Myogenic
      • Myasthenia gravis
      • Aging
      • Muscular dystrophy
      • Polymyositis
    • Neurogenic
      • Stroke
      • Cerebral palsy
      • Guillain-Barré Syndrome
      • Multiple sclerosis
      • Amyotrophic lateral sclerosis
      • Diabetic neuropathy
      • Parkinson's disease
    • Obstructive
      • Benign peptic stricture
      • Lower esophageal ring
      • Candidiasis
      • Head and neck cancer
      • Inflammatory masses
      • Trauma/surgical restriction
    • Other
      • Gastrointestinal or esophageal resection
      • Rheumatological disorders
      • Connective tissue disorders
      • Vagotomy

    Silent Aspiration

    • Silent aspiration is a particular risk for neurological patients, as it occurs without the typical signs of aspiration.
    • It can lead to decreased sensation and increased vulnerability.

    Diet Progression & Therapeutic Diets

    • Clear Liquid: Broth, bouillon, coffee, tea, clear fruit juices, gelatin, fruit ices, popsicles.
    • Full Liquid: Includes all clear liquid items plus smooth dairy products.

    Enteral Tube Insertion - Assessment Considerations

    • Allergies: Communication of patient allergies ensures safety.
    • Medical Adhesive: If used to anchor the enteral tube to the nose, monitor for medical device-related pressure injury (MDRPI).
    • Height and Weight: Provides baseline data for nutritional improvement.
    • Hydration, Electrolytes, and Caloric Needs: Assessment of hydration status, electrolyte balance, and caloric needs is crucial.
    • Intake and Output (I&O): Monitoring I&O is essential for fluid balance.
    • Nasal Examination: Inspect each nostril for patency, irritation, skin breakdown, and signs of previous NG tube placement (MDRPI).
    • Abdominal Assessment: Check for bowel sounds, pain, tenderness, or distention, as these may indicate medical problems.
    • Mental Status: Evaluate the patient's ability to cooperate, sedation level, and any potential cognitive impairment.
    • Cough and Gag Reflex: Determine the presence and effectiveness of these protective mechanisms.
    • Swallowing Ability: Evaluate the patient's ability to swallow safely.
    • Artificial Airway: Assess for the presence of an artificial airway, as it can complicate tube placement.
    • Patient Knowledge and Experience: Assess the patient's understanding, prior experience, and feelings about the procedure.
    • Patient Goals and Preferences: Individualize care by considering the patient's preferences.

    Enteral Tube Insertion - Planning Considerations

    • Explanation of Procedure: Describe the procedure and the sensations the patient may experience.
    • Communication During Intubation: Explain how the patient can communicate during the insertion (e.g., raising a finger to indicate discomfort).
    • Privacy: Ensure patient privacy by closing the door and bedside curtain.
    • Equipment Preparation: Obtain and organize necessary equipment for the procedure at the bedside.

    Enteral Tube Insertion - Implementation Considerations

    • Hand Hygiene: Perform thorough hand hygiene.
    • Positioning: Position the patient upright in high-Fowler's position (unless contraindicated).
    • Fowler's Position: Fowler's position reduces aspiration risk and promotes effective swallowing.
    • Pulse Oximetry/Capnography: Apply and monitor pulse oximetry or capnography continuously.
    • Safety Precautions: Do not insert the tube if there is a decrease in oxygen saturation or an increase in end-tidal carbon dioxide until patient stability is assessed.
    • Protection: Place a towel over the patient's chest to prevent soiling of their gown.
    • Tube Length Determination and Marking: Determine the appropriate length of the tube and mark it with tape or indelible ink.
    • NEX Measurement: Measure the distance from the tip of the nose to the earlobe to the xyphoid process (NEX) of the sternum. Mark this length on the tube.

    Enteral Tube Insertion - Clinical Judgment

    • Alternative Techniques: If blind placement poses an unacceptable risk, use techniques such as CO2 sensors or electromagnetic tracking devices, or consider visualization or imaging techniques for tube placement by trained clinicians.

    Metabolic Acidosis

    • Increased metabolic acids or decreased base bicarbonate in the blood causing decreased pH.
    • Kidneys fail to excrete metabolic acids, leading to their accumulation in the blood.
    • Bicarbonate can be removed directly from the body through diarrhea.
    • Decreased pH triggers chemoreceptors, which cause hyperventilation to compensate.

    Respiratory Acidosis

    • Increased CO2 and PaCO2 levels due to hypoventilation.
    • Kidneys compensate by excreting metabolic acids in the urine.

    Risk Factors for Fluid, Electrolyte, and Acid Alterations

    • Age:
      • Infants are susceptible to fluid and electrolyte imbalances due to their lower body weight and immature kidney function.
      • Older adults are prone to imbalances due to declining kidney function and changes in fluid needs.
    • Environmental Factors:
      • Sodium-rich diets can lead to fluid excess.
      • Electrolyte-poor diets can result in electrolyte deficits.
      • Hot weather can lead to dehydration.
    • Gastrointestinal Output:
      • Diarrhea, drainage, vomiting, and excessive sweating can deplete fluids and electrolytes.
    • Chronic Diseases:
      • Conditions like cancer, COPD, cirrhosis, heart failure, and chronic kidney disease can disrupt fluid and electrolyte balance.
    • Trauma:
      • Burns, crash injuries, head injuries, hemorrhage, and other trauma can cause fluid loss and electrolyte shifts.
    • Therapies:
      • Diuretics can lead to fluid and electrolyte loss.
      • Intravenous therapy and parenteral nutrition can alter fluid balance.

    Fluid Imbalance - Nursing Diagnoses

    • Fluid Imbalance
    • Dehydration
    • Acid Base Imbalance
    • Lack of knowledge of fluid regimen

    Enteral Fluid Replacement

    • Ice chips are equivalent to half the volume of liquid.

    Protein Factors: Key Functions

    • Blood Clotting
    • Fluid Regulation
    • Acid-Base Balance

    Water

    • Essential for all cell function
    • Accounts for 60% to 70% of total body weight.
    • Lean individuals have a higher percentage of body water due to the water content of muscle.

    Fluid Release

    • Respiration
    • Sweating
    • Urine
    • Stools
    • Fever
    • Vomiting
    • Trauma (Blood loss)
    • Clinical Dehydration
    • Medications

    Digestion of Food

    • Mechanical breakdown involves chewing, churning, and mixing with fluids.
    • Chemical reactions break down food into its simplest forms.

    Enzymes

    • Protein-like substances that catalyze chemical reactions.
    • Critical for digestion.

    Factors Affecting Nutrition

    • Environmental Factors:
      • Obesity is a growing concern, with 68.7% of Americans being overweight or obese.
      • Overweight is defined as a BMI of 25 to 29.
      • Obesity is defined as a BMI of 30 or greater.
      • Access to affordable, healthy food and safe physical environments are crucial determinants of dietary choices.
    • Age:
      • Older adults (65+) have a decreased energy requirement due to a slower metabolic rate.
      • However, their vitamin and mineral needs remain the same.

    Indications for Parenteral Nutrition (PN)

    • Nonfunctioning Gastrointestinal Tract:
      • Massive small bowel resection
      • Gastrointestinal surgery
      • Gastrointestinal bleeding
      • Paralytic ileus
      • Intestinal obstruction
      • Trauma to the abdomen, head, or neck
      • Severe malabsorption
      • Intolerance to enteral feeding
      • Chemotherapy, radiation, and bone marrow transplants

    PN Complications

    • Tension pneumothorax is a potential complication associated with tube insertion and may occur up to 24 hours after placement.

    Transitioning from PN/EN Feeding

    • Patients can transition from PN/EN feeding when they achieve 1/3 to 1/2 of their daily caloric intake per day via enteral feeding.

    Impaired or Low Nutritional Intake Assessment: Key Findings

    • Changes in Weight:
      • Significant weight loss, especially more than 20% below ideal body weight
    • Body Mass Index (BMI):
      • Value below 18.5 indicates underweight.
    • 24-Hour Food and Fluid History:
      • Inadequate caloric intake
      • Limited fluid intake
    • Physical Assessment:
      • Poor muscle tone
      • Fatigue
      • Hair loss
      • Dry, scaly skin
      • Pale conjunctiva and mucous membranes
    • Medication History:
      • Medications that can affect appetite or nutrient absorption.
    • Social History:
      • Factors affecting the individual's ability to cook or access food.

    Medical Nutrition Therapy (MNT)

    • The use of specific nutritional therapies to manage illnesses, injuries, or conditions.
    • MNT is essential for safe and effective patient care.

    Enteral Tube Insertion: Essential Considerations

    • Communication of patient allergies is crucial to avoid adverse reactions.
    • Secure enteral tube placement to prevent accidental removal.
    • Assessment Activities
      • Height, weight, hydration status, electrolyte balance, caloric needs, and intake and output (I&O)
        • Provides baseline data to monitor nutritional progress.
      • Assess patency of nostrils, skin integrity, and any signs of medical device-related pressure injury (MDRPI).
        • Ensures proper tube placement and minimizes risks of complications.
      • Conduct a physical assessment of the abdomen (see Chapter 30).
        • Identifies potential contraindications to enteral feedings.
      • Assess mental status, gag reflex, swallowing ability, presence of critical illness, and artificial airway status.
        • Identifies potential complications like accidental tube placement in the lungs.
      • Assess patient knowledge, experience with tube insertion, and feelings about the procedure.
        • Provides appropriate patient education and support.
      • Determine patient goals and preferences for the procedure.
        • Personalizes care to meet individual needs.
    • Planning
      • Explain the procedure to the patient and describe sensations they may experience.
        • Reduces anxiety and increases cooperation.
      • Instruct the patient on how to communicate during the procedure (e.g., raising index finger to signal gagging or discomfort).
        • Allows the patient to express discomfort during the procedure.
      • Ensure privacy during the procedure.
      • Gather necessary equipment for tube insertion.
        • Ensures a smooth and organized procedure.
    • Implementation
      • Perform hand hygiene and position the patient upright in a high-Fowler's position (unless contraindicated).
        • Reduces risk of aspiration and promotes effective swallowing.
      • If the patient is comatose, raise the head of the bed as tolerated in a semi-Fowler's position with the head tipped forward.
        • Helps with airway closure and passage of the tube into the esophagus.
      • Monitor vital signs, including pulse oximetry or capnography.
        • Provides baseline respiratory status monitoring.
      • Place a bath towel over the patient's chest and have facial tissues readily available.
        • Protects the gown from soiling and assists in managing excessive secretions.
      • Measure tube length using the nose-earlobe-xyphoid process (NEX) method and mark it on the tube.
        • Ensures the correct tube length for placement.
      • Monitor patient closely during and after tube insertion for any signs of respiratory distress, including decreased oxygen saturation or increased end-tidal carbon dioxide levels.
        • Indicates potential complications like tube malpositioning or aspiration.
    • Clinical Judgment:
      • Be cautious about blind tube placement, especially in high-risk patients.
      • Consider using visualization or imaging techniques when performing tube insertions.
      • Use devices designed to detect pulmonary intubation (e.g., capnography) to enhance patient safety.

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    Study Guide for Exam 3 - Nutrition and Fluid Balance PDF

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    This quiz explores the processes involved in electrolyte imbalance, focusing on potassium's role in muscle function and the factors affecting its absorption. Additionally, it covers different types of dysphagia, including myogenic, neurogenic, and obstructive causes, along with their associated conditions.

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