Fundamentals Session 8:

This session covers mostly nutrition, hygiene, falls, and safety. The content is reasonable and the notes became a little light at the end due to common sense should get you through the test. In those areas I just wrote what the teacher emphasized, what was harder to understand, or not as intuitive. Thanks for reading!

-Peter

Session 8:

Nutrition and Altered Bowel Function, Interventional Hygiene, Fall Risk, and Safety

Nutrition and Altered Bowel Function

Important for all patients

Swallowing ability is crucial

meds that affect:

  • steroids increase appetite
  • insulin
  • Chemotherapy

subjective data:

  • 24 hour recall
  • Dx processes

objective data:

  • observations
  • height, weight
  • arm circumference
  • skin folds
  • Calorie count

serum albumin vs prealbumin

  • SA is > ½ of the body’s total protein, assess the long term protein stores.
  • Prealbumin has a shorter life and can test the short term protein stores.

types of diets

  • NPO – none through mouth
  • clear diet
  • full liquid
    • liquid at room temperature (ICE CREAM!! 🙂
  • Soft
  • diet as tolerated
  • Restrictive (Na, renal, ADA, reduced calorie diet)

why do we with hold food?

  • before surgery
    • prevent aspiration

We can have a pt NPO for up to 24-48 hours

Renal diet

  • low protein, K, Na, and fluid restriction

Liver Dx

  • early, only low Na
  • Late in Dx, low protein(lactulose can get the ammonia out of the blood), Na, and fluid

CHF – restrict Calories and fluid

CAD – lower Na, calories, Sat fat, and cholesterol

Burns- fluid replacement early, high protein, calories, Vit C and B

Respiratory – soft, high calorie and protein

HTN – restrict sodium

Normal bowel function

body pulls fluid from GI tract first if needed

narcotics and pain management can cause impaction and constipation

If you have a pt that chronically uses laxatives they need teaching to show them that taking them that frequently is not optimal.

Diarrhea can cause fluid and electrolyte imbalances

Ostomies

  • temporary or permanent
  • continent or incontinent
  • stoma or artificial opening
  • colostomy in the colon
  • ileostomy  
  • challenge body image

Enemas – cleanse bowel of stool

  • use warm water
  • cramping will occur if too fast infusion

Nutrition and tube feeding

different tube sizes

  • the large bore gastric tube is not used for too long due to the

Naso gastric – nose to stomach

  • large bore
    • salem sump tube
  • can suction and feed
  • placed by nurse
  • less than 4 weeks (short term)
  • hard to place, tuck the chin to avoid the trachea
    • can spray back of throat with medication to lessen the gag reflex
  • If connected to suction measure I/O’s

Dobb-hoff

  • nose to illium
  • white opaque, small
  • no suction only feedings
  • placed by radiology
  • weighted end that can be visualized in radiology

Jejunostomy tube

  • surgically
  • long term
  • small intestine out at stomach

Confirm placement before putting anything in the tube with x-ray

The rate of the feeding should not feed faster than the pt can digest

Checking gastric residuals volume Only for gastro, not small intestine, if the residual amount is over ½ of the previous bolus, then the rate of nutrition may be too fast.

There are pumps that can select the feeding rate

  • you ramp up to the rate you want and ween off when done.

Medications can go through these tubes

  • crush meds (some meds cannot be crushed, enteric coating and extended release drugs)

If the Patient is laying down flat there is a risk for aspiration

Parenteral Nutrition

not through the GI

TPN ALWAYS goes through a central line

    • large volumes
    • contains nutrients, insulin, and/or PPIs
  • BAG and LINE are changed every 24 hours
  • have to use a pump, and it is always continuous infusion
  • filter in the line

PPN Peripheral Parenteral Nutrition – same as TPN, but lower amounts, and in the peripheral vein

  • supplementally for short periods of time
  • may not have lipids

both of these are specific to patient

Complications:

  • Risk of infection
  • High Glucose levels

Interventional hygiene

Very important for the rapport with the patient and the patient’s family, shows that you care.

Patient safety:

positioning:

  • they all have risks and values

Left sided sims is a good position for an enema

reposition an immobile patient every 2 hours

Assess every single patient for fall risk

  • Age, hypotension, meds that depress CNS, or diuretics because of the need to get up a lot, post op, highly tethered patients, weakness, confusion

educate the patient and the family about their risk and how to deal with it.

Make sure the patients have their call light.

Restraints

    • they are dangerous and there needs to be an order
  • you must document the sefer ways that have been tried first before restraints are used
  • use measured interventions to lead up to restraints.
  • document the skin integrity, circulation, and status every 2 hours
  • Mitts to stop the patient from pulling things out.
  • Quick release knots are imperative and required to know how to tie.
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