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Which diet is considered the healthiest
Mediterranean due to high consumption of fish
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what blood test shows anemia
H&H (show O2 carrying capacity)
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what does total serum protein test do
combines total albumin and globulin
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what urine studies can be done
Creatinine, thiamine, riboflavin, niacin and iodine (any low value means low nutritional intake)
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NG tube
nasogastrional tube (aspiration risk is greatest concern)
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Peg tube
goes directly into stomach (duodenum or jejunum)
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intermittent feeding characteristics
usually by gravity and can be done at home 3 to 4 times a day bolus
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Continuous feeding characteristics
keep steady amount without over extending stomach, into duodenum and jejunum about 100mls an hour Gastro reflux a major concern
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Flushes
needed with all feedings to keep fluid balance and keep tube patent. NOT A STERILE PROCEDURE. Watch flush amount for patient on tube feeding. 150-300mls per shift
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what can tube cause (side effect)
High blood sugar may need BGM's twice per shift
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what to look out for before placing G-tube in stomach
bowel sounds must be present
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complications of tube feeding (what is priority)
aspiration pneumonia is priority
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what to check for with aspiration pneumonia
lung sounds, HOB 30 degrees, gagging, oral secretions, respiratory distress
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to prevent electrolyte imbalances
always return aspirated residuals, check blood work and BGMs
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hypertonics feedings can cause
diarrhea by pulling water into intestines (give lomodel to help and preform good skin care) change feeding to isotonic or add fiber to feeding. SLOW RATE then gradually increase.
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hypotonic feedings can help
dehydration
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most common feeding
isotonic feeding
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Infection of GI (NG tube) from tube feeding
change tubing, change tubing (q24), use sterile water for new G-tube (not for NG tube)
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Infection from G-tube (directly into stomach)
sterile dressing (for new G-tube), use antibacterial oitment, check for fungal infection (under the disk on stomach)
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Abdominal distention (complication)
check for bowel sounds, decrease rate if you have to, check for residuals (don't add more if residual is more than 100) check for bowel movements) hold feeding and call doctor.
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Nausea as a tube feeding complication
hypertonic solution draws fluid into intestine and makes you nauseated...cause is usually flow rate is to fast or allergy (treat the cause)
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Fecal impaction (complication)
usually from hypoosmolar solution or hypotonic formula. body is sucking too much water out of stool. need mote water intake, or more flushes
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Dehydration (as a complication)
hyperosmolar/hypertonic formula not enough water add more flushes, change formula
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hyperglycemia (as a complication)
too much carbohydrates (CHO) treatment BGM's q6 and/or change formula. some pts may be on BGM sliding scale
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Dumping syndrome (as a complication)
formula too concentrated (hyperosmotic) water leaves vascular compartment to enter stomach and intestines to dilute formula (diarrhea, nausean increased pulse, decreased BP, sweating, weakness, cramping) dilute formula and add water
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tube patency (as a complication)
suspect obstruction if you cant aspirate or flush, if you see formula leaking or formula wont flow...give manual flush...avoid crushed meds
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flush for tube patency with meds
30ml flush, meds then 10ml between each med then 30ml after flush with warm water
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What do anemias do
affect red blood cells. blood does not have amount of O2 needed
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four different anemias
- Iron deficiency anemia (Microcytic)
- pernicious anemia (Macrocytic)
- folic acid anemia (Macrocytic)
- Thalassemia anemia (Microcytic)
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Macrocytic anemia
Cells too big and can't carry a lot of O2
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Microcytic anemia
small pale RBC's with low level of hemoglobin
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TPN means
using a central line or PICC line (for ppl who can't eat orally)
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Iron deficiency anemia
RBC's are microcytic and contain low levels of HGB. Cause is low iron supply which leads to low formation of red blood cells. causes, severe prolonged anemia, malabsorbtion disease, pica, lead poisoning or parasites.
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two macrocytic anemias
Pernicious and Folic acid
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two microcytic anemias
Iron deficiency and thalassemia
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S&S of iron deficiency
in babies look for poor muscle development (chubby babies too), babies will also be prone to infection. Children and adults will have fatigue, weakness, shortness of breath. Pulse rate may be higher, glossitis (sore tongue) fragile fingernails and inflamed mucous membranes. elderly increased dementia or confused state
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foods for iron deficiency anemia
organ meats, dried legumes, nuts, shellfish, muscle meats (steak, beef, chicken), green vegetables, unsweetened chocolate, whole wheat & enriched flour breads also increase protein intake and vit C. Limit milk intake to one quart/day
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Drug therapy for iron deficiency anemia
oral iron supplement, give with citrus juice, administer liquid form by straw or dropper, brush teeth after liquid dose (stools will be black)
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complications of IV therapy
iron poisoning....if OD gastric lavage, NA (sodium) bicarbonate, exchange transfusion
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Pernicious anemia (subtle and gradual)
Macrocytic/megablastic (big cells)
due to lack of intrinsic factor (I.F. is produced in stomach) which is needed for absorption of vit B12 caused by GI disturbance, surgery, alcoholism or familial w/aging...very subtle and gradual...parietal cells produce intrinsic factor. they are in stomach, if they get destroyed then P.A. occurs
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S&S of Pernicious anemia
Jaundiced, Glossitis, pallar, spinal cord degeneration, anorexia, N&V, Diarrhea, loss of weight, unsteady gait, mental depression, weakness, apathy/irritability, numbness and tingling peripherally. (Think of Mrs. Malics dad and the gas story)
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If inadequate intake of B12 teach to eat (not Pernicious anemia) you can have a B12 deficiency
meat, liver, kidney, milk, eggs, cheese
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Test for Pernicious anemia
Shillings test after low B12
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with Pernicious anemia you have to get the shot to bypass
the GI tract because no intrinsic factor (oral B12 will not work due to no parietal cells)
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If untreated Pernicious anemia could have
permanent neurological damage
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folic acid anemia is
- a nutritional macrocytic/megaloblastic (big cells) anemia
- Cause inadequate dietary intake (reason why pregnant women are given supplements), alcoholism, or can be secondary to another disease
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you can have low B12 without having Pernicious anemia. if that is the case then you can help with
Dietary changes
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S&S of folic acid anemia
- Diarrhea
- glossitis
- symptoms similiar to vit B12 deficiencies (both may coexist)
- no neurological s&s
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Foods high in folic acid
- Green leafy vegetables
- liver
- kidney
- yeast
- lean beef/veal
- eggs
- whole grain cereals
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folic acid drug therapy
- oral - folvite
- IM- calcium Leucevarin
- IM- sodium folvite
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Complications of folic acid deficiency
Pregnancy: neural tube defects
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Thalassemia is
A autosomal recessive genetic disorder (parents both have to have it) Microcytic (small red blood cells) they are hemolyzed (being destroyed) Mediterranean origin most often affected
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Thalassemia minor
child just has the trait (one trait from parent) one gene is normal and one is trait. asymptomatic, child is a carrier, pregnancy you will see severe anemia if you have the trait, genetic studies recommended
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Thalassemia major
severe (child has trait from both parents) homozygous, severe anemia, marked hemolysis, ineffective production of erythrocytes. hepatomegaly and splenomegaly
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Diagnostic screenings for thalassemia
- genetic studies
- H&H and CBC
- RBC w distinctive appearance
- hepatomegaly and splenomegaly
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post op care (for thalassemia) may include
removal of part of spleen
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Cardiac hemochromatesis
build up of iron in bloodgoing to heart
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BMI indexes
- > 25 = overweight
- > 30 = obese
- > 40 = morbid obesity
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PICA is
compulsive digestion of non food items
- cause nutritional deficits
- psyche or emotional problems
- during pregnancy
- cultural customs
- hunger or starvation
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S&S of PICA
- decreased physical development
- hepatosplenomegaly
- anorexia
- Fe deficiency anemia
- craving for non-food items
- most common sign = chewing ice
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PICA dx studies
intestinal biopsy w/villous atrophy
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nursing implementations for PICA
- diet w protien, iron & calories
- counseling
- determine underlying cause
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complications of PICA
- intestinal infections or blockages
- malnutrition
- lead poisoning
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