Questions And Answers
-tbetsuretpatienttisttoiletedtandtreceivestmouthtcaretbeforetmealtime
-tmaketsuretpatientthastglasses/hearingtaidstintplacetduringtmeals
-removetbedpans,turinals,temesistbasinstfromtsight
-
tgivetanalgesicsttotcontroltpaintandt/ortantiemeticstfortnauseatattleastt1thourtbeforetmealtim
e
-remindtUAPttothavetpatienttsittintchair,tiftpossible,tattmealtime
-iftneeded,topentcartonstandtpackagestandtcuttuptfoodt
-asktpatientstabouttfoodtpreferences
-tdecreasetdistractionstandtmaketenvironmenttrelaxingtandtcomfortable
-ensuretthattmealstaretvisuallytappealing,tappetizing,tappropriatelytwarmtortcold
-appropriatettimetshouldtbetallowedtsotthattthetpatienttdoestnottfeeltrushedtthroughtatmealt-
tCORRECTttANSWER-
waysttotencouragetandtpromotetnutritionaltintaketintmalnourishedtilltpatients
-tpatienttistmaintainedtontNPOtintearlytstages
-patientstwithtseveretpancreatitistandtaretunablettoteattfort24-
48thourstaftertillnesstonsettmaytbegintjejunalttubetfeedingtunlesstparlytictileustistpresent.t
-TENtistpreferredtovertTPNtbecausetittcausestfewertepisodestoftglucosetelevation
-whentfoodtisttoleratedtduringtthethealingtphase,tsmalltfrequenttmoderate-to-
hightcarbohydrate,thigh-protein,tlow-fattmealstaretprescribed
-foodstshouldtbetblandtwithtlittletspice
-GItstimulantstsuchtastcaffeinetandtalcoholtshouldtbetavoided.t
-tcommercialtliquidtnutritionaltpreparationstmaytbetaddedttotboosttcalorictintake
-intchronictpancreatitistPancreatic-enzymetreplacementttherapyt(PERT)tmaytbetneededt
-chronictpatientstmaytalsotneedtantincreasedtnumbertoftcaloriest(4000-
6000)ttotmaintaintweight)t-tCORRECTttANSWER-Pancreatitistnutritionalttherapy
-
checkteachtbagtoftTPNtsolutiontfortaccuracytbytcomparingtittwithtthetphysicianstortpharmac
iststprescription
-monitortIVtpumptfortaccuracytintdeliveringtthetprescribedthourlytrate
-
iftthetTPNtsolutiontisttemporarilytunavailable,tgivet10%tdextrose/watertort20%tdextrose/wat
ertuntiltsolutiontcantbetobtained.t
,-
iftthetTPNtadministrationtistnottonttimet("behind")tdotnottattemptttot"catchtup"tbytincreasingtt
hetrate
-monitortpatientstweighttdaily
-monitortserumtelectrolytestandtglucosetdailytortpertfacilitytprotocol
-monitortandtcarefullytrecordtpatientstintaketandtoutput
-assesstIVtsitetfortsignstoftinfectiontortinfiltration
-ChangetIVttubingteveryt24thourstortpertfacilitytprotocol
-ChangetdressingtaroundtIVtsiteteveryt48-72thourstortpertfacilitytprotocolt
-
beforetadministeringtTPN,thavetatsecondtnursetchecktthetprescriptiontandtsolutionttotpreve
nttpatienttharmt-tCORRECTttANSWER-NursingtinterventionstfortTPN
-controltoftproteintintake
-fluidtintaketlimitation
-restrictiontoftpotassium,tsodium,tandtphosphorustintake;
-takingtvitamintandtmineraltsupplements
-eatingtenoughtcaloriesttotmeettmetabolictneedst-tCORRECTttANSWER-
generaltdietarytchangestfortpatientstwithtCKD
-
diettshouldtbethightintcarbohydratestandtcaloriestwithtmoderatetamountstoftfattandtproteint(l
imittfattiftsteatorrheatistpresent)
-smalltfrequenttmealstaretoftentpreferablettotthreetstandardtmeals
-2500-3000mL/daytfluids
-
vitaminstandtmineralstincludetmultivitamintincludingtBtcomplext(especiallytthiamine,tvitami
ntB12),tvitamintK,tVitamintC,tandtzinct-tCORRECTttANSWER-HepatitistNutritionalttherapy
-
flushttubetwitht20ttot30mLtwatertattleastteveryt4thourstwithtcontinuousttubetfeeding,tbeforet
andtafterteachtintermittentttubetfeeding,tbeforetandtaftertdrugtadministration,tandtaftertchec
kingtresidualtvolume
-
ifttubetbecomestclogged,tuset30mLtoftwatertfortflushing,tapplyingtgentletpressuretwithtat50
mLtpistontsyringe
-
avoidtthetusetoftcarbonatedtbeverage,texcepttfortexistingtclogstwhentwatertistnotteffective.t
Dotnottusetcranberrytjuice.t
-
whenevertpossible,tusetliquidtmedicationstinsteadtoftcrushedttabletstunlesstliquidtformstca
usetdiarrheat-tCORRECTttANSWER-
interventionsttotmaintaintpatenttfeedingttubetwithtTEN
-sodiumtrestrictiont1-2g/day
-1.2-1.5tg/kgtproteintrecommended
, -maytneedttotrestricttfluidsttot1200mL/day
-vitamintsupplementstsuchtastthiamine,tfolate,tandtb12
-Thiaminetistfoundtintpork,tnuts,twholetgraintcereals,tandtlegumes.t-tCORRECTttANSWER-
Cirrhosistnutritionalttherapy
13.0-17.0tg/dLt-tCORRECTttANSWER-normaltrangetforthemoglobin
15-35tmg/dLt-tCORRECTttANSWER-normaltrangetfortprealbumin
160-200tmg/dLt-tCORRECTttANSWER-normaltcholesteroltlevels
3.5-5tg/dLt-tCORRECTttANSWER-normaltserumtalbumintlevel
38-50%t-tCORRECTttANSWER-normaltrangetforthematocrit
4tkcalt-tCORRECTttANSWER-
Proteinstandtcarbohydratestprovidethowtmanytkcaltoftenergytpertgramtingested?
9tkcalt-tCORRECTttANSWER-fatstprovidethowtmanytkcaltoftenergytpertgramtingested?
Atclienttwithtantactivetinfectiont(suchtastbacterialtpneumonia)trequirestwhattkindtoftdiet?t-
tCORRECTttANSWER-hightcalorictdiet
-caloriesthelptcombattinfection
atweighttlosstoft5%tortmoretint30days,tatweighttlosstoft10%tint6tmonths,tortatweighttthattistbe
lowtidealt-tCORRECTttANSWER-clinicaltdescriptiontoftmalnutrition
abdominaltdistention,tnausea,tandtvomitingtduringttubetfeedingstaretoftentcausedtbytoverf
eeding.ttotpreventtoverfeeding,tchecktgastrictresidualtvolumesteveryt4-
6thours.tAmericantSocietytoftParenteraltandtEnteraltNutritiont(ASPEN)trecommendstholdin
gtatfeedingtiftthetgastrictresidualtvolumestaretmoretthant200mLtonttwotconsecutivetassess
mentst-tCORRECTttANSWER-
interventionsttotpreventtabdominaltdistentiontandtnausea/vomitingtwithtTEN
acutetcholectisistdietarytrecommedationst-tCORRECTttANSWER-
bakedtfishtandttomatoestwithtlettuce
AcutetPEMt-tCORRECTttANSWER-
typetoftPEMtthattdevelopstintpatientstwhotweretadequatelytnourishedtbeforethospitalization
tbuttexperiencetstarvationtwhiletintatcatabolictstatetfromtinfection,tstress,tortinjury
additionaltcalorictenergytneedstfortbreastfeedingtwoment-tCORRECTttANSWER-
Duringtthetfirstt6tmonthstaftertbirth,tthetenergytneedstfortmilktproductiontistestimatedtattanta
dditionalt500tcaloriestpertday,tthetamounttdecreasesttot400tcaloriestatdaytaftertthetfirstt6tmo
nthstoftlactation