Transcript Albumin

Nutrition
Vema Sweitzer, MN, RN
1
Independent learning
– The factors influencing Nutrition of the older adults (pg
1003)
– The five components of a nutrition assessment:
•
•
•
•
•
Screening for malnutrition for risk factors
Anthropometry
BMI
Labs and tests
Dietary history
2
Nursing Knowledge Base
• Factors influencing nutrition
– Environmental factors
– Developmental needs
• Infants through school age
• Adolescents
• Young and middle adults
• Older adults
Page 1002
3
Alternative Food Patterns
• Based on religion, cultural background,
ethics, health beliefs, and preference (Table
44-3),
• Vegetarian diet consists predominantly of
plant foods
4
Assessment
• Screening a patient is a quick method of identifying
malnutrition or risk of malnutrition using sample tools:
– Height
– Weight
– Weight change
– Primary diagnosis
– Comorbidities
– Screening tools
• Combine multiple objective measures with subjective
measures r/t nutrition to adequately screen for
nutritional problems.
5
Assessment
• Assess patients for malnutrition
– Conditions that interfere with their ability to ingest,
digest, or absorb adequate nutrients.
– Congenital anomalies and surgical revisions of the GI tract
– Only IV therapy
– Chronic diseases or increased metabolic requirements
– Infants and older adults are at great risk
6
Assessment
– An ideal body weight (IBW) provides an estimate of
what a person should weigh.
– Body mass index (BMI) measures weight corrected for
height and serves as an alternative to traditional
height-weight relationships.
• Laboratory
– Albumin: 3.5-5.0 g/dL (half life 21 days)
– Transferrin and total iron-binding capacity (TIBC)
– Hemoglobin (12-18%)
– Prealbumin (half life 1.9 days)
7
Assessment
• Dietary and health history
– Health status; age; cultural background; religious food
patterns; socioeconomic status; personal food
preferences; psychological factors; use of alcohol or
illegal drugs; use of vitamin, mineral, or herbal
supplements; prescription or over-the-counter (OTC)
drugs; and the patient’s general nutrition knowledge
• Physical examination
• Dysphagia (difficulty swallowing)
8
Dysphagia
• Dysphagia refers to difficulty swallowing.
9
Acute Care
• The nutritional care of acutely ill patients requires monitoring.
– Patients are interrupted at meal time
– NPO status
– Poor appetites
– Fatigued or feel uncomfortable
– Patient who are NPO and receive only IV fluids for more
than 4-7 days are at nutritional risk.
page 1016
10
Advancing Diets
Box 44-10 pg 1017
• Clear liquids: broth, coffee, tea, clear soda & juice,
jello, popsicle
• Full: above + smooth dairy
• Pureed: above + scrambled eggs, pureed meat –
vegetables –fruits, mashed potatoes
• Mechanical soft: above + diced meats, flaked fish,
cottage cheese, rice, potatoes, etc.
• Soft/low residue: low fiber foods, pasta, tender
meat, canned fruits/vegetables
11
Nutrition: Types of Diets
• High fiber: fresh fruit, steamed vegetables, bran,
oatmeal, dried fruit
• Low sodium: 4 g, 2 g, 1 g
• Low cholesterol: 300 mg/day
• Diabetic: usually 1800 cal/day
• Regular: no restrictions
• In your learning group, identify the Nursing
Diagnosis and outcome for a patient who is
eating poorly.
Enteral Tube Feedings
• Enteral nutrition (EN) provides nutrients into
the GI tract.
• Feedings are provided for patients who can
not swallow and have a functioning GI tract.
• Feedings can be delivered through a
nasogastric (NGT), jejunal (JT) or gastric tube
(GT).
13
Enteral Tube Feedings
Procedure:
• Start at full strength
• Slow rate
• Increase every 8-12 hours as ordered
• Assess for signs of intolerance
• High gastric residuals, nausea, cramping, vomiting and
diarrhea
• Assess for complications
• Aspiration, Diarrhea, Bacterial contamination, Tube
occlusion, delayed gastric emptying
14
Tube Placement
• The most reliable method for verification of
placement of small-bore feeding tubes is x-ray film
examination.
• Check pH of gastric aspirate, < 4
• Observe aspirate color
• Do not use auscultation method
15
Parenteral Nutrition
• Parenteral nutrition (PN) is a form of specialized nutrition
support in which nutrients are provided intravenously.
• A basic PN formula is a combination of amino acids,
hypertonic dextrose (10-50%), electrolytes, vitamins, and
trace elements.
• Fat emulsions: provides calories and fatty acids
– Delivered through
• Central venous catheter
• Peripheral line
pg 1021
16
Parenteral Nutrition
• If using a CVC that has multiple lumens, use a
port that is exclusively dedicated for the TPN.
Label it!
• Verify the HCP’s order
• Inspect the solution for particulate matter
• Always use an infusion pump
• First 24-48 hrs: delivers 50% of estimated
needs and then rate has will be increased
17
Parenteral Nutrition: Complications
• Catheter-related Problems
– Pneumonthorax
• Sudden sharp chest pain, dyspnea, and coughing
• Monitor for 24 hrs
– Air embolus
• Occurs during insertion of the catheter or when
changing the tubing or cap.
• Turn pt to left side and have pt perform a Valsalva
maneuver (hold breath and bear down during catheter
insertion to help prevent air embolus
• Keep IV system closed
18
Parenteral Nutrition: Complications
• Catheter-related Problems
– Catheter occlusion
• If sluggish or no flow, stop infusion and flush with NS or
heparin (per protocol).
• Attempt to aspirate clot or follow protocol for thrombolytic
agent (urokinase)
– Sepsis
• Fever, chills, or glucose intolerance and positive blood
culture
• Change tubing q 24 hrs
• Hang bag for only 24 hr; lipids 12 hrs
• Check to see if solution needs a filter
19
Parenteral Nutrition: Complications
• Metabolic alterations
– Electrolyte and mineral imbalances
– Hyperglycemia
• Thirst, HA, lethargy, increased urination.
• Monitor BS q 6 hrs
• Give insulin
– Hypoglycemia
•
•
•
•
Diaphoresis, shakiness, confusion, loss of consciousness
Do not abruptly discontinue TPN
Taper rate
Give IV bolus of dextrose
– Dehydration
20