RNSG 1310 Raising the Bar for Success First Semester | RNSG 1310 Raising the Bar for Success First Semester

Raising the Bar for Success First Semester Nutrition What is the definition of nutrition? • Process by which body ingests, absorbs, transports, uses, and eliminates nutrients and food Understand the nutritional requirements: • during exercise o higher intake necessary due to higher energy expenditure • during illness o clear/full liquid diets, soft, pureed depending on conditions o therapeutic diets: low salt, low fat, calorie reduction, ↑fiber o tube feedings if issues with GI tract • maintaining health o renal, diabetic, cardiac diets • to promote weight loss o varied food groups, lower calorie, fat intake, o exercise What are the psychosocial aspects related to nutrition including cultural, and the corresponding nursing interventions to be considered? • Cultural – dietary preferences or religious restrictions - provide alternatives Name nutritional guidelines and programs, and their purpose. • Healthy People 2020, choose my plate • Provide guidelines for proper nutrition Understand the concept of nitrogen balance related to protein. • Positive nitrogen balance = input of protein output of protein What are the recommended daily percentages of carbohydrates, protein and fat from dietary sources? • Fats: No more than 20-35% w/ 10% from sat fats and 300 mg of cholesterol • Protein: 10-35%,;1 g/lb of body weight • Carbs: 45-65% recommended by USDA & DHHS, mostly complex Know primary prevention related to metabolism. • Healthy diet • Physical activity: 30 min most days of week Know types of enteral feedings; symptoms of intolerance and related nursing interventions. • Alternate form of feeding where a tube is passed into GI tract to allow instillation of appropriate formula • NG, NI, PEG, J-tube • Confirming placement of tube before beginning feeding/instilling liquids and at regular intervals during continuous feedings • Ensure tip of tube is situated in stomach or intestine, preventing placement of substances into wrong place • Misplaced tube puts pt. at risk for aspiration • Radiographic examination, measurement of aspirate pH, visually assessing aspirate, measuring tube length and marking, and monitoring CO2 are used to confirm placement • Radiograph is standard procedure for initial verification: but exposes pt. to radiation, must be interpreted by MD, costly, harder to access • Aspirate pH and visual assessment: pH less helpful in continuous feedings (formula buffers) o Aspirating through tubes is easier in small-bore tubes with multiple ports • Measuring tube length and its marking (mark @ nostril w/ indelible marker) • CO2 monitor (capnograph/colorimetric end-tidal CO2 detector) – can’t determine where tube ends What are the nursing responsibilities related to NG tube feedings? • Promote pt. safety – check tube placement w/ multiple techniques • Check gastric residual q4-6h during continuous feeding o Gastric residual 200-250+mL associated w/ high risk for aspiration & aspiration-related pneumonia o Record residual pattern and amount and flush w/ water to prevent tube occlusions o Assess abdomen for abnormalities and BS once/shift o Indicators of how well pt is tolerating feeding:  Gastric distention, abdominal girth, nausea, vomiting, bloating, or pain o Keep pt. upright during feeding (at least 30 degrees) and at least 1 hr after feeding to prevent reflux and aspiration; pause during repositioning or if needing to lay flat • Prevent contamination by maintaining integrity of system and using proper technique o Hand hygiene and gloves before preparing, assembling, and handling o Disinfect opening/rim of any cans before opening o Label equipment w/ pt’s name, date, and time of hanging o Cap/cover disconnected tubing o Clean reusable feeding w/ soap and water q24h o Replace disposable apparatus for open systems q24h, closed systems q48h • Monitor for complications o Clogging/obstruction – flush w/ 30-50 mL of water before & after each feeding or intro of meds, q4h during cont. feeding, and after aspirating gastric contents; document I/O after flushing o If occluded, flush w/ 30-60 mL of warm water • Provide comfort measures o Pts often have discomfort d/t irritation of nasal and throat mucosa and drying of oral mucous membranes o Admin. oral hygiene q2-4h to prevent drying of tissues and relieve thirst & lubricate lips o Keep nares clean around tube where secretions accumulate (lubricant after cleaning nares) o Help ctrl. local irritation from tube in throat (analgesic lozenges or anesthetic sprays) o Encourage pt to verbalize (if able) concerns about tube feeding/presence of tube