D440 NUT question with answers
Role of RN (Registered Nurse) - -- 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 - --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) - --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 - --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) - -used to evaluate fluid balance whereby intake and
output are measured and documented
-3 METHODS OF NUTRITIONAL SUPPORT - --regular, enteral, parenteral nutrition
-enteral nutrition - -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 - -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
-formula can consist of eggs for fat so need to do a comprehensive allergy
assessment just in case they're allergic
-monitor their blood glucose
COMPLICATIONS:
-Pneumothorax.. still do chest XR
-air embolism
-aspiration- stop feeding when laying flat, raise the HOB
-hyper/hypoglycemia
-infection r/t IV
LOOK AT CH 70 SAUNDERS
Ch 22 Williams textbook
-PKU (phenylketonuria) - -a condition that makes it impossible for babies to
metabolize certain proteins
-S/S: CNS damage, mental retardation, decreased melanin
- formulas that are safe for an infant with PKU is: lofenalac, phenex
-foods to avoid: high protein foods like meat, fish, poultry, dairy, soy, legumes
(dried beans), eggs, nuts
-Type 1 diabetes mellitus/ DIABETES GENERAL - --S/S: 3 Ps: polydipsia, polyphasia,
polyuria
-wt loss
-warm and dry skin
-dehydration (weak pulse, decreased skin turgor)
-fruity breath odor
, -diabetes caused by a total lack of insulin production; usually develops in childhood,
and patients require insulin replacement therapy to control the disorder
-calorie count to consider
-they do have diet restrictions but they can eat like normal
-15/15 rule - --low BG is when it drops below target level
S/S: nausea, dizziness, seizures if severe
-15 grams of fast-acting carbohydrates (simple sugar)
-Repeat in 15 minutes if blood glucose is <60 mg/DL or still symptomatic
-Follow with snack that contains complex carbohydrates
FOODS:
-6-7 hard candies (life savers)
-8 oz of milk (15 g of carbs)
-4 oz of regular not DIET soda
-HYPOGLYCEMIA
S/S - -BG<70 mg/dL
-caused by too much insulin in the blood , decreased food intake w inadequate food
intake, excercise, excess alcohol
-S/S:
-hunger, irritability, confusion, cool and clammy skin, pale/coldclammy—> seizure/
coma
-15/15 rule if pt is conscious!!!
-Routine Hospital Diets: Clear Liquid Diet - --Soup
-clear fatfree broth, bullion
-Fruit and fruit juices that are strained
-Desserts and Gelatin
-fruit flavored gelatin, fruit ices, popsicles
-soft drinks (as tolerated)
-coffee
-tea
-honey
-salt
-hard candy
-Routine House Diets: Full Liquid Diet - --soup
-same as clear, plus strained or blended cream soups
-cereal
-cooked, very thin , refined cereal
-protein foods
-milk,creamers, milk drinks, yogurt
-veggie juices or pureed veggies
-fruit/fruit juices
-fruit juices
Role of RN (Registered Nurse) - -- 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 - --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) - --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 - --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) - -used to evaluate fluid balance whereby intake and
output are measured and documented
-3 METHODS OF NUTRITIONAL SUPPORT - --regular, enteral, parenteral nutrition
-enteral nutrition - -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 - -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
-formula can consist of eggs for fat so need to do a comprehensive allergy
assessment just in case they're allergic
-monitor their blood glucose
COMPLICATIONS:
-Pneumothorax.. still do chest XR
-air embolism
-aspiration- stop feeding when laying flat, raise the HOB
-hyper/hypoglycemia
-infection r/t IV
LOOK AT CH 70 SAUNDERS
Ch 22 Williams textbook
-PKU (phenylketonuria) - -a condition that makes it impossible for babies to
metabolize certain proteins
-S/S: CNS damage, mental retardation, decreased melanin
- formulas that are safe for an infant with PKU is: lofenalac, phenex
-foods to avoid: high protein foods like meat, fish, poultry, dairy, soy, legumes
(dried beans), eggs, nuts
-Type 1 diabetes mellitus/ DIABETES GENERAL - --S/S: 3 Ps: polydipsia, polyphasia,
polyuria
-wt loss
-warm and dry skin
-dehydration (weak pulse, decreased skin turgor)
-fruity breath odor
, -diabetes caused by a total lack of insulin production; usually develops in childhood,
and patients require insulin replacement therapy to control the disorder
-calorie count to consider
-they do have diet restrictions but they can eat like normal
-15/15 rule - --low BG is when it drops below target level
S/S: nausea, dizziness, seizures if severe
-15 grams of fast-acting carbohydrates (simple sugar)
-Repeat in 15 minutes if blood glucose is <60 mg/DL or still symptomatic
-Follow with snack that contains complex carbohydrates
FOODS:
-6-7 hard candies (life savers)
-8 oz of milk (15 g of carbs)
-4 oz of regular not DIET soda
-HYPOGLYCEMIA
S/S - -BG<70 mg/dL
-caused by too much insulin in the blood , decreased food intake w inadequate food
intake, excercise, excess alcohol
-S/S:
-hunger, irritability, confusion, cool and clammy skin, pale/coldclammy—> seizure/
coma
-15/15 rule if pt is conscious!!!
-Routine Hospital Diets: Clear Liquid Diet - --Soup
-clear fatfree broth, bullion
-Fruit and fruit juices that are strained
-Desserts and Gelatin
-fruit flavored gelatin, fruit ices, popsicles
-soft drinks (as tolerated)
-coffee
-tea
-honey
-salt
-hard candy
-Routine House Diets: Full Liquid Diet - --soup
-same as clear, plus strained or blended cream soups
-cereal
-cooked, very thin , refined cereal
-protein foods
-milk,creamers, milk drinks, yogurt
-veggie juices or pureed veggies
-fruit/fruit juices
-fruit juices
