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CCN 3 Flashcards

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1
Q

_____ is the balance between a patient’s current nutritional supply and demand.

A

Nutritional status

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2
Q

________ identifies patients who are malnourished or nutritionally at risk and should be completed by the nurse within 24 hours of hospital admission.

A

Nutritional screening

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3
Q

All patients identified by screening to be at nutritional risk receive a ________. Evaluating nutritional status is essential to determine whether a hyper metabolic or catabolic state exists.

A

Comprehensive Nutritional Assessment

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4
Q

refers to a state where your metabolism is working at an unusually fast or excessively high rate, burning more calories than normal to support increased energy demands.

A

Hypermetabolic

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5
Q

is a metabolic process where complex molecules in the body, such as fat and muscle, are broken down into simpler substances to release energy.

A

Catabolic State

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6
Q

Purposes of a Nutritional Assessment in the Critically Ill Patient

A
  • Document baseline subjective and objective nutritional parameters
  • Determine nutritional risk factors
  • Identify nutritional deficits
  • Establish nutritional needs for patients
  • Identify medical, psychosocial, and socioeconomic factors that may influence the administration of nutrition support therapy
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7
Q

Assessment of Nutritional Status

A

Initial: Collection of subjective and objective data.

Nurse determines (patient):
- alert and oriented
- has an adequate gag reflex
- can swallow without difficulty

Additional assessments
(determining nutritional deficits):
- muscle or adipose tissue loss
- appearance of wasting associated with chronic disease
- patient is retaining fluid

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8
Q

When a patient is retaining fluid, it could be related to a _____

A

Protein Deficit

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9
Q

Normal BMI Classification

A

18.5 - 24.9

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10
Q

Overweight BMI Classification

A

25.0 - 29.9

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11
Q

Obese BMI Classification

A

30.0 - 39.9

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12
Q

Extreme Obesity BMI Classification

A

+ 40.0

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13
Q

Waist circumference greater than 35 inches in woman and greater than 40 inches in men is an indication of ________.

A

Abdominal Obesity

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14
Q

Abdominal Obesity increases a patient’s risk for _____ and _____

A

CAD and Type 2 Diabetes

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15
Q

refers to the delivery of nutrients into the GI tract, which is the preferred route of nutrient administration unless contraindicated

A

Enteral Nutrition (EN)

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16
Q

Considerations for EN

A
  • effectiveness of gastric emptying
  • GI anatomy
  • aspiration risk
  • intact bowel that is able to absorb nutrients
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17
Q

All feeding tubes require _____ of placement prior to use

A

Radiological confirmation

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18
Q

can be used for administration of enteral nutrition, medication administration, or decompression of the gut

A

Large-bore nasogastric (NG) tubes

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19
Q

may be inserted in place of large bore tubes for feedings when a patient does not tolerate gastric feeding tube placement

A

A flexible small-bore tube (usually 5 to 12 French)

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20
Q

is better tolerated because of its size, flexibility, and location in the duodenum; it also reduces the risk of nasal tissue necrosis.

A

The small-bore tube

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21
Q

can be used in short-term situations, usually no more than 6 weeks.

A

Nasally inserted, small-bore tubes (nasojejunal)

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22
Q

is often inserted because placement does not require general anesthesia, and it allows feedings to begin soon after placement.

A

A percutaneous endoscopic gastrostomy (PEG) tube

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23
Q

A jejunostomy tube can only be placed during a _____

A

Laparotomy

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24
Q

EN in the critical care area is typically administered continuously via a ________

A

Feeding pump

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25
The intermittent feeding is ordered at intervals _____
Every 4 hours, based on the patient’s needs.
26
GRV is checked every _______
4 hours
26
Feeding tubes are routinely flushed with _______, every 4 hours during the continuous feedings, and before and after intermittent feedings and medication administration.
30 mL of water
27
Tubes used to assess GRV easily
Large-bore gastric tubes
28
When assessing GRV is sometimes collapse
Small-bore tubes
29
GRVs of _____ to _____ should be of concern, and a promotility agent may be ordered.
200 mL to 250 mL
30
If GRV is greater than _______ , the feedings should be held, and patient assessed for other signs of intolerance.
500 mL
31
Signs of intolerance include:
- nausea or vomiting - absent bowel sounds - abdominal distension - cramping
32
Tolerance of feedings includes the presence of bowel sounds in four quadrants, as determined by:
- auscultation - presence of bowel motility or bowel movements - palpation of a soft abdomen - percussion of the abdomen revealing tympanic findings
33
Patients may require more fluid intake than provided by enteral nutrition, and it is given in the form of _______
Free water
34
How to assess tube obstruction?
- Flush feeding tube with at least 30 mL of water every 4 hours during continuous feeding, after medications, after intermittent feedings, and before and after gastric residuals are checked. - Administer medications in elixir diluted with water whenever possible. - Irrigate tube with warm water or pancreatic enzymes to relieve obstruction.
35
How to assess improper tube placement?
- Verify the position of all feeding tubes by x-ray before initiating feedings; auscultatory methods of assessment are inaccurate. - Identify patients at risk for malposition of the tube, such as those with impaired gag/cough reflex, those who are obtunded or heavily sedated, and those receiving neuromuscular blocking agents.
36
How to assess Diarrhea?
- Review medications that may increase the likelihood of diarrhea: sorbitol, laxatives, digitalis, antibiotics. - Assess for Clostridium difficile; obtain order for stool sample culture. - If infection is not the cause of the diarrhea, administer fiber-enriched formulas or bulking agents to normalize stool consistency (psyllium) - Prevent bacterial contamination - Administer feedings at room or body temperature. * Limit bolus feedings to < 300 mL.
37
How to assess Dumping Syndrome?
Slow the rate and frequency of feeding bolus if abdominal distention or cramping occurs.
38
How to assess Hyperglycemia?
- Administer insulin as ordered, usually per sliding scale. - Monitor fluid status closely.
39
How to assess Electrolyte Imbalance?
- Monitor electrolytes for changes.
40
How to assess Aspiration?
- Mark feeding tube at exit site to monitor for proper tube placement; assess placement every 4 hours. - Monitor gastric residual volume (GRV) every 4 hours. - Attempting to aspirate gastric contents may be difficult because small-bore tubes collapse easily; it may be helpful to inject 30 mL of air into tube before assessing residuals. It may also be helpful to re position the patient when assessing GRV. - If gastric residual volume >200 to 250 mL consider a promotility agent. - If gastric residual volume >500 mL hold feeding and assess patient for other signs of intolerance; con sider small bowel feedings. - Do not use blue dye in enteral formulas to assess for aspiration; it is an unreliable indicator and may cause death. - To prevent reflux, keep head of bed elevated at least 30 degrees (preferably 45 degrees) during feedings. - Monitor abdominal girth measurements for signs of distention. - Assess bowel sounds.
41
refers to the infusion of nutrient solutions into the bloodstream by some form of central intravenous access catheter.
Parenteral Nutrition (PN)
42
Other term for Parenteral Nutrition (PN)
HYPERALIMENTATION
43
is defined as a line placed into the vascular system with the distal tip in the superior vena cava, right atrium, or inferior vena cava.
A central catheter (or central line)
44
It is an external tunneled catheter or a subcutaneous port that is included in the central catheter options
Peripherally Inserted Central Catheter (PICC)
45
Placement of lines in PN is verified by _____ immediately after insertion
Chest Radiograph
46
Two options for PN administration available are:
Peripheral Parenteral Nutrition (PPN) Total Parenteral Nutrition (TPN)
47
PPN are appropriate for ______
Peripheral Administration
48
What type of solution is PPN?
Isotonic Parenteral Solution
49
TPN can only be administered _____
Centrally
50
What type of solution is TPN?
Hypertonic
51
TPN is administered can only be administered centrally due to the risk of ______
- Phlebitis - Potential for vascular damage
52
Parenteral nutrition is a successful method to provide nutrients to patients who are unable to tolerate enteral therapy because of:
- GI obstruction - intractable vomiting or diarrhea - because they must have nothing by mouth for an extended period, usually for longer than 1 week - also be used if patients are unable to meet their nutritional needs with EN alone
53
Factors for PN
- based on the length of time the patient will receive parenteral nutrition - vascular access history - venous anatomy, - coagulation status related to central line site selection
54
PN formulation that is compounded is inspected for:
- signs of gross particulate contamination - discoloration, particulate formation - phase separation at the time of compounding
55
Maintaining the sterility of the setup is essential. All tubing is changed every _______.
24 hours
56
The TPN or PPN line is a dedicated line for only parenteral nutrition; no intravenous push or infusion medications are given in this line except ______.
Lipid Infusions
57
_______ must be meticulous because of the infection risk related to the administration of high glucose content of TPN and use of an invasive line.
Intravenous site care
58
PPN Assessment includes
- Monitor for fluid and electrolyte imbalance - Chemistry panels - Glucose levels - Monitoring for early signs of infection or signs of thrombosis are important aspects of nursing care because of the potential for adverse outcomes.
59
Patients receiving parenteral nutrition have blood glucose monitoring at least every _______.
6 hours
60
_______ is also added to the TPN solution; the amount of insulin is adjusted daily based on the patient’s glucose values over the previous 24 hours.
Insulin
61
Specialized nutritional formulas in PN
Immune-enhancing formula
62
Immune-enhancing formula are recommended in patient with:
- burns on more than 30% of the body - head and neck cancer - trauma injuries - major elective gastrointestinal surgery - need for mechanical ventilation without severe sepsis
63
Immune-enhancing formulas have been demonstrated to decrease:
- length of stay - duration of mechanical ventilation - hospital costs - infection risk - improve wound healing in specified patient populations
64
Enteral nutrition is preferred to parenteral nutrition in most cases to:
- preserve gut integrity - modulate the systemic immune response and stress - commonly selected for patients with neuromuscular impairment - cannot meet their nutritional needs by oral intake alone - hypercatabolic - unable to eat as a result of their underlying illness (receiving mechanical ventilation, hypoperfusion states) - associated with a significantly lower risk for infection - relatively inexpensive - placement of a feeding tube in the correct site is relatively easy
65
A medical problem related to how the gut functions is called
Gastroparesis
66
Administration of enteral feedings, even if the gut cannot tolerate a full enteral feeding schedule, is advantageous because it prevents:
- bacterial overgrowth - potential bacterial migration across the intestinal wall and into the bloodstream.
67
EN feedings have been used successfully in almost all situations including the presence of _____ and _____ in patients.
Ileus and Pancreatitis
68
_____ can be used in combination with enteral nutrition to meet the nutritional needs of the patient whose GI tract cannot tolerate the full caloric load of enteral feeding.
TPN
69
______ and _______ are essential nutrients that act as coenzymes and cofactors in metabolism.
Vitamins and trace elements
70
Whenever medications are administered via an enteral feeding tube, the tube should be flushed with ________ before and after each medication is administered.
30 mL of water
71
Patients requiring a fluid restriction may receive ______ for flush.
15 mL
72
Bioavailability of some medications such as ______ is reduced when administered with enteral feedings.
Phenytoin
73
_______ are preferred for administration via the enteral feeding tube.
Liquid medication formulations
74
__________ must not be crushed and given via a feeding tube because of the potential for overdose.
Sustained-release medications
75
Administration of insulin when TPN is temporarily discontinued can lead to _______.
Hypoglycemia
76
Patients receiving intravenous fat emulsion require evaluation and monitoring of ________ until they are stable.
Serum Triglyceride Levels
77
A lipid-based sedative anesthetic agent that needs to be monitored when changes are made to the lipid content
Propofol
78
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