Term
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Definition
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Term
| What happens when you don't use the gut? |
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Definition
| It alters the normal flora of the gut. Higher risk for ulcers and risk of atrophy of the stomach |
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Term
| What is the best route for nutrition? |
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Definition
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Term
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Definition
| Ensure, puddings, supplements |
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Term
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Definition
Nasogastric (NG or OG)
Gastrostomy (G/PEG)
Jejunostomy (J-tube) |
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Term
| How many calories per gram of fat? |
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Definition
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Term
| How many calories per gram of carbs? |
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Definition
| 4 (primary source of energy 50% of diet) |
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Term
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Definition
-Thru nares or mouth to stomach
-still using gut
-continuous
-can use whole foods
-still using stomach
-administer meds (NOT extended release)
-can use almost immediately after putting in |
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Term
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Definition
-Sits in stomach
-still using gut
-continuous
-can use whole foods
-still using stomach
-administer meds (NOT extended release)
-can use almost immediately after putting in |
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Term
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Definition
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Term
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Definition
-Bypasses the stomach and liver (where enzymes get secreted in the bowel)
-Surgically put in
-No meds
-Foods in elemental form (amino acids) |
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Term
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Definition
| should not be more than 2x the hourly |
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Term
| Position during tube feedings |
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Definition
| HOB greater than 30 degress due to risk for aspiration |
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Term
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Definition
| ...patient should be sitting up for 30-60 minutes with tubes (not J-tube) |
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Term
| How often should you change feeding tubes? |
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Definition
| Every 24 hours with bottle change |
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Term
| How should you check for positioning of tubes? |
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Definition
| 30 cc of air--hear swish or x-ray initially before starting to use |
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Term
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Definition
| Functions include metabolism, bile synthesis, glycogen storage, clotting factor |
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Term
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Definition
| Secretes amylase and lipase |
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Term
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Definition
| Concentrates and stores biles |
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Term
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Definition
| Stores and mixes food with gastric secretions |
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Term
|
Definition
| Hollow, muscular tube with peristaltic waves moves food to stomach |
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Term
| Function of small intestine |
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Definition
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Term
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Definition
| Absorption of water and electrolytes |
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Term
| How many ccs should you start tube feeding? |
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Definition
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Term
| What temp should tube feeding be given? |
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Definition
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Term
| What is risk of concentrated tube feedings? |
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Definition
Diarrhea (pulls fluid into bowel)
Risk for dehydration--free water flush |
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Term
| Tube feeding complications |
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Definition
-Vomiting & aspiration--hear crackles--aspiration pneumonia=normally right side of lung
-Diarrhea - hyperosmolar feeding
-Constipation - will generally correct itself even after 5 days
-Dehydration-free water flushes |
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Term
| Types of Parenteral Nutrition |
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Definition
TPN-given thru central line
PPN-given thru peripheral line |
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Term
|
Definition
70% glucose
40 meq potassium
1 g mag |
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Term
| Labs are ____ for first 3 days. |
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Definition
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Term
|
Definition
-Infection due to high glucose
-Fluid overload
-Tubing change every 24 hours
-Need filter at end of tubing (filter out flat globules) |
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Term
| If a patient is on tube feedings, they should have _____ weights. |
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Definition
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Term
|
Definition
-Psych component (need to control)
-often abuse in history
-s/s lenugo, absent menstrual cycle, compulsive exercise, may have constipation
-Labs-Fe deficiency anemia; High BUN - dehydrated, breaking down own muscles for protein; depressed immune system |
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Term
|
Definition
-self purging after binge eating
-often abuse in history
-often normal weight or slightly overweight
s/s scratches on knuckles, teeth erosion, broken blood vessels in eyes, peticchiae on cheeks |
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Term
|
Definition
-cardiovascular (HTN, MI, Coronary artery disease)
-Respiratory (sleep apnea risk due to increased weight)
-Diabetes Mellitis (Type II)
-Musculoskeletal (osteoarthritis)
-GI (gallstones, fatty liver)
-cancer (breast, ovarian, cervical, colon) |
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Term
|
Definition
Hi protein - low carb
Ketoacidosis (stresses kidneys breakdown of protein) |
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Term
| Well balanced low calorie diet |
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Definition
1000-1200 cal/day
2/3 plant sources
1/3 lean meats
1 serving fruits/veggies
30 mins exercise/day |
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Term
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Definition
Weigh once a week
1-2 lbs per week |
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Term
|
Definition
| Adipex, Tenuate, Meridia, Xenical |
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Term
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Definition
restrictive-restricting volume consume
malabsorptive-decrease amount of time for food to be absorbed |
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Term
| vertical banded gastroplasty |
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Definition
| restrictive; small stomach pouch; not adjustable; risk for tears/rupture at staples |
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Term
| adjustable gastric binding |
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Definition
| slower more controlled weight loss; restrictive; can adjust pouch size |
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Term
| biliopancreatic diversion |
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Definition
| malabsorption; bypassing first section of small intestine; bypassing enzymes of liver and pancreas |
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Term
| biliopancreatic diversion with duodenal switch |
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Definition
| bypass section of small intestine |
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Term
|
Definition
| gastric bypass; smaller stomach pouch |
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Term
| Good candidate for weight loss surgery |
|
Definition
BMI >40
HTN
Type 2 diabetes
Sleep apnea
heart failure
>18 years old
obese >5 years
psych stability |
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Term
| Weight stabilized after ___ months after surgery. |
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Definition
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Term
| Nutrient deficiencies with weight loss surgeries |
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Definition
| B12, folic acid, iron, calcium |
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Term
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Definition
| fluid seeps into bowel and they get diarrhea; within 20 minutes sweating, cramping, diarrhea; bowel not used to whole foods |
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Term
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Definition
| address co-morbidity ; bariatric equipment at bedside=bariatric bed,large bp cuff, larger gown, wound infection (adipose tissue not a lot of blood) |
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Term
|
Definition
| If admitted, SCD's, DVT prophylaxis |
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Term
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Definition
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Term
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Definition
| initially 1 oz. water and sugar free clear liquids/hour; 2 weeks high protein liquid diet 1-2 oz/2 hrs; 2-4 weeks pureed; 4-6 weeks solid |
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Term
| Ongoing diet after weight loss surgery |
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Definition
| no liquid with meals; less than 1 liter/day fluids; hi protein, low carb/fat diet; 6 small meals/day |
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Term
|
Definition
| central obesity (trunk); high BP; high triglycerides; low HDL; insulin resistance |
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Term
|
Definition
| Prealbumin, albumin, insulin, BUN, creatinine |
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Term
|
Definition
| physiological response to decreased gastric motility |
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Term
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Definition
| neuro stimulates vomiting center in brain; smells, motion (vestibular), pain, bad food |
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Term
|
Definition
| sudden onset of insidious (unaware)occult bleeding, asymptomatic at first |
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Term
| origins of upper gi bleeding |
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Definition
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Term
|
Definition
| s/s slow bleed, nauseaus, poor apetite |
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Term
|
Definition
| s/s vomit profusely, stark red blood, b/p drop |
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Term
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Definition
| venous bleed that's been sitting in belly |
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Term
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Definition
| blood in stool; distinct smell; gelatinous; maroon |
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Term
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Definition
| esophogeal tear; due to chronic distress=ulcer, continous vomiting, alcohol abuse, bulimia |
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Term
|
Definition
| related to liver disease; portal vein pressure increases and veins surrounding esophagus also engorge; if they bleed, big problem; avoid coughing, sneezing, vomiting; massive amount of blood; not bright red blood |
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Term
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Definition
| steroid, NSAIDS, aspirin, h.pylori bacteria, stress related ulcer (surgeries, traumas) |
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Term
| Management of upper gi bleed |
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Definition
2 large IVs (.9%)
labs - H&H NOW; platelets, INR/PTT (FFP to reverse high INR & clotting factors)later |
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Term
| Diagnostic of upper gi bleed |
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Definition
| Guiac stool (dark red blood=upper gi bleed; stark red=lower gi bleed) |
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Term
| Endoscopy for upper gi bleed |
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Definition
-cauterize vessel if slow ooze
-give epinephrine into lining of stomach in area of bleed |
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Term
| Surgery of upper gi bleed |
|
Definition
| remove that portion of stomach |
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