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GI Nutrition

by: Katelyn Paccione

GI Nutrition NUR 220

Katelyn Paccione
GPA 3.2
Essentials of Nursing Practice II
Kirby and Keubler

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About this Document

Notes for Exam 2. Lecture 1. GI nutrition and nurse management.
Essentials of Nursing Practice II
Kirby and Keubler
Class Notes
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This 4 page Class Notes was uploaded by Katelyn Paccione on Saturday February 14, 2015. The Class Notes belongs to NUR 220 at Purdue University taught by Kirby and Keubler in Fall. Since its upload, it has received 72 views. For similar materials see Essentials of Nursing Practice II in Nursing and Health Sciences at Purdue University.

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Date Created: 02/14/15
Lecture 2102015 Gastrointestinal GI Nutrition DETERMINE Diseases 0 Example a patient with cancer will not have the same appetite as a healthy individual 0 Eating poorly 0 There is a reason for why someone is eating certain things such as junk food Find out why they are eating these things Tooth health 0 Do they have bad teeth This will in uence what you eat based on if it hurts your teeth or if the consistency of the food is too solid 0 Economic hardship 0 Where do they live They may not have the resources to always have fresh produce etc For those who have low incomes or on tight budgets are not buying what is necessarily healthy but what is affordable Reduce social contact 0 You tend to eat more when you are with other people The elderly are more at risk because they tend to have less family friendsspouses may have deceased Memory impairment may cause people to forget to eat or that they have eaten at all 0 Multiple medications o Polypharmacy multiple meds can cause nausea vomiting diarrhea and these symptoms suppresses the desire to feed Involuntary weight lossgain 0 Those who loss or gain weight rapidly what rst comes to mind Cancer is the rst thing people expect if that individual is not trying to lose weight Paradoxically if gaining weight what do we think Diabetes Weight loss or gain needs to be followed up especially if it39s unintentional Needs assistance in self care 0 They may have problems grocery shopping mobility etc Elder years above 0 More at risk for decline in nutritional management lmbalanced Nutrition 0 Less than body requirements 0 Anorexia and bulimia concerns 0 More than body requirements 0 Obesity overweight 0 Most know what they should be eating but choose to not eat that stuff 0 Don t make weight your priority in terms of nursing care the change in lifestyle modi cations develops over a long period of time but will not change unless they nd it in their best interest 0 Risk for imbalanced nutrition 0 Just don39t have good eating habits skipping meals dieting etc 0 TEST QUESTION What can we look at in a patient s chart to observe poor nutrition or at risk for poor nutrition Look at the lab reports Types of specialized nutrition 0 Oral Supplements 0 High calorie supplements 0 These are used in addition to meals Examples 0 Milk shakes pudding Ensure etc 0 Tube Feeding o NG nasogastric tubes the least invasive Types 0 Salem Sump 0 Temporary use 0 Used for decompression taking uids out irrigating the stomach Dobhoff 0 Used for patients that are NPO o The tube itself is very narrow in size and can allow feed directly to the intestines Pros and Cons Advantages 0 Easy to place 0 Weighted tip Disadvantages 0 Small diameter clogs easily 0 Can be dislodged by coughing or vomiting 0 Can knot or kink in GI tract 0 PEG percutaneous endoscopic gastrostomy tube This tube may only be used if the GI is fully intact Feedings start when bowel sounds are present Pro 0 More comfortable than the NG tube 0 Can remain in place for a longer time 0 Nursing Management Before using the tube check the placement of the tube Assess bowel sounds before feeding Check residual before each bolus feeding Elevate the head of the bed before feeding Flush the feeding before between and after with water When administering medications liquids are preferred When tablets are to be used crush until they are a ne power Medications should not be used in combination with feedings Assess the patient for aspiration during feedings any abdominal distention hyperglycemia and diarrhea Oral hygiene should be performed Preventinfectioncontamination 0 Due to high glucose content good environment for bacteria to frow Follow precautions needing to be taken with care and insertion of the tube Continuous versus intermittent Continuous means all 24 hours Monitor bowel fx frequently Placement checks 0 Where is the end of the tube Don39t want the tube to be misplaced or moved to an area for example the lung Parenteral IV Nutrition 0 Primarily dextrose and fat emulsion Dextrose 1 gram 34 calories Fat 1 caloriesml for 10 2 caloriesml for 20 o What determines the need for parenteral nutrition Pancreatitis GI obstruction Severe surgery or trauma Severe anorexia Severe malabsorption 0 Types TPN Total Parenteral Nutrition Nutritionally complete 0 25 dextrose MUST HAVE A CENTRAL LINE 0 Hickman Insertion through a jugular vein in the neck run the IV tube to the chest 0 PICC Peripherally Inserted Central Catheter Basilic vein or cephalic vein in the upper arm 0 Subclavian Subclavian vein underneath the clavicle 0 Port Placed underneath the skin Purpose prevent wear and tear of the vein 0 Hang D10W MONITOR BS PPN Peripheral Parenteral Nutrition Nutritionally complete 0 5 dextrose Hang D5W 0 Nursing Management Nurse sensitive outcomes 0 Pressure ulcers 0 Turning the patient every couple hours to prevent Foley catheter related UTIs Staph aureus septicemia 0 Air embolism Blood incompatibility Retention of problems during surgery Watch for these infections 0 Signs local 0 Erythema redness o Tenderness o Exudate drainage at insertion site 0 Signs systemic o Fever 0 Chills o Nauseavomiting o Malaise fatigue Take vital signs every 4 to 8 hours Measure weight daily Strict input and output Measure 0 Blood glucose 0 Tight glycemic control Electrolytes BUN CBC Hepatic enzymes Change dressings when appropriate and observe condition while changing the dressing Must use the infusion pump at a steady rate 0 Table 403 lists all minerals elements that calls for complete nutrition 0 Complications Infection Hyperglycemia Hyperlipidemia Electrolyte imbalance Mineral imbalance Fatty acid imbalance Central line complications Blood clots in the vein that the insertion site is to be inserted


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