SPRING 2022 FUNDAMENTALS OF NURSING EXAM 3 PRACTICE SOLUTION
Causes & Risk Factors for Altered Nutrition - ANS IS Age
Older adults: same nutrients, less caloric need; age-related GI r
Young: strong food preferences
Religious & Cultural Practices
Finances, Resources, & Access
Alterations in absorption, metabolism, or intake
GI tract-associated disease or illness
Systemic disease or illness states
Malabsorption/Malnutrition
Eating Disorders
Oral health & r in dentition
Medications (drug-nutrient interaxns)
△ in appetite, smell, or taste
Alternative food patterns/diet modifications
Functional ability, including dysphagia
Causes & Risk Factors for Altered Bowel Elimination - ANS IS Age
Co-Morbidities
Medications
Opioids: â peristalsis
Abx: wipes out normal flora
Anticholinergic: â GI motility & secretion
NSAIDs: prostaglandin inhibition; ulceration & GI bleed
Iron supplements: constipation
Surgery/Anesthesia
Unsafe weight loss techniques
Lack of knowledge re: laxative use
,Poor diet
Low fiber
Limited H2O intake
Physical inactivity
Pain
Physiologic and psychologic stress
what are signs of dysphagia (difficulty swallowing)? - ANS IS coughing when drinking
pocketing food in cheeks
change in voice after swallowing
A patient with ulcerative colitis experienced diarrhea for the past 24 hours. What condition are they most
at risk for? - ANS IS metabolic acidosis
Bristol Stool Chart - ANS IS Medical aid to classify stool. Types 1 and 2 indicate constipation, Types 3
and 4 indicate ideal stools, Types 5, 6 and 7 indicate diarrhea.
Interventions for Managing Dysphagia - ANS IS §Tuck chin while swallowing
§Swallow twice with effortful swallow for each bite
§Position in high fowler's or in chair
§Observe feeding
§Minimize distractions
§Inspect mouth for pockets of food
§Thicken food to consistency of mashed potato
§Observe for coughing, choking, gagging, or drooling
§Don't rush feeding
§Small bites/chew thoroughly
§Place food on side of mouth that is strongest
§Head rotation to side of impairment
,§Consultation with SLP for individualized strategies
§Keep in semi-fowler's for at least 1 hr s/p meals
enteral tube feeding - ANS IS a method of feeding by providing a liquid diet directly to the stomach or
intestine through a tube placed down the throat or through the wall of the GI tract
percutaneous endoscopic gastrostomy (PEG) tube - ANS IS a tube passed into a patient's stomach through
the abdominal wall
Gastrojejunal (G-J) tube - ANS IS This is a surgically placed tube that allows access to the stomach as well
as the jejunum, permitting some portion of the feeds to bypass the stomach, thereby decreasing the risk of
reflux
Contraindications to insertion of Enteral Feeding Tube - ANS IS basilar skull functions
facial trauma
esophageal surgery
deviated septum
what is the gold standard to verify enteral tube placement? - ANS IS x-ray
managing enteral tube feedings - ANS IS §Can be administered slow gravity or slow push
§Height of feed by gravity matters!
§Cramping = lower bag
§Try to obtain liquid formulations rather than crushing pills
§Do not mix medications in tube feeding
§Flush between each med with 15 - 30 ml to prevent clogging
§Flush with 30 - 60 ml when done with med administration
§Caution with flush amount in patients with fluid restrictions or at risk for overload
§Can use warm water for flush
§Verify tube location is compatible with medication absorption
, §If medication is to be given on an empty stomach, allow at least 30 minutes before or after feeding
§Risk of drug-drug interactions is higher
Management of Parenteral Nutrition - ANS IS §Require supplemental Vitamin K
§Always start low and gradually increase to goal
§Never abruptly discontinue- always weaned to decreasing hourly rate before stopping- why???
§Carefully compare TPN bag contents to orders
§Verify placement of central line via x-ray and order clearing use of line prior to initiating TPN
§Requires continuous monitoring & assessments
Parenteral Nutrition (PN) - ANS IS the intravenous infusion of nutrients administered directly into the
bloodstream, bypassing the digestive system
enteral nutrition - ANS IS alternate form of feeding that involves passing a tube into the gastrointestinal
tract to allow instillation of the appropriate formula
what are the types of parenteral nutrition? - ANS IS PPN: peripheral parenteral nutrition (less frequent)
TPN: total parenteral nutrition (more common)
total parenteral nutrition (TPN) - ANS IS Providing 100% of a patient's nutrition intravenously.
§Amino acids, dextrose, electrolytes, vitamins, minerals
§Lipids
§Requires central line catheter & in-line filter
Use a dedicated line- never infuse another substance into TPN line
TPN limit: 24 hours
Causes & Risk Factors for Altered Nutrition - ANS IS Age
Older adults: same nutrients, less caloric need; age-related GI r
Young: strong food preferences
Religious & Cultural Practices
Finances, Resources, & Access
Alterations in absorption, metabolism, or intake
GI tract-associated disease or illness
Systemic disease or illness states
Malabsorption/Malnutrition
Eating Disorders
Oral health & r in dentition
Medications (drug-nutrient interaxns)
△ in appetite, smell, or taste
Alternative food patterns/diet modifications
Functional ability, including dysphagia
Causes & Risk Factors for Altered Bowel Elimination - ANS IS Age
Co-Morbidities
Medications
Opioids: â peristalsis
Abx: wipes out normal flora
Anticholinergic: â GI motility & secretion
NSAIDs: prostaglandin inhibition; ulceration & GI bleed
Iron supplements: constipation
Surgery/Anesthesia
Unsafe weight loss techniques
Lack of knowledge re: laxative use
,Poor diet
Low fiber
Limited H2O intake
Physical inactivity
Pain
Physiologic and psychologic stress
what are signs of dysphagia (difficulty swallowing)? - ANS IS coughing when drinking
pocketing food in cheeks
change in voice after swallowing
A patient with ulcerative colitis experienced diarrhea for the past 24 hours. What condition are they most
at risk for? - ANS IS metabolic acidosis
Bristol Stool Chart - ANS IS Medical aid to classify stool. Types 1 and 2 indicate constipation, Types 3
and 4 indicate ideal stools, Types 5, 6 and 7 indicate diarrhea.
Interventions for Managing Dysphagia - ANS IS §Tuck chin while swallowing
§Swallow twice with effortful swallow for each bite
§Position in high fowler's or in chair
§Observe feeding
§Minimize distractions
§Inspect mouth for pockets of food
§Thicken food to consistency of mashed potato
§Observe for coughing, choking, gagging, or drooling
§Don't rush feeding
§Small bites/chew thoroughly
§Place food on side of mouth that is strongest
§Head rotation to side of impairment
,§Consultation with SLP for individualized strategies
§Keep in semi-fowler's for at least 1 hr s/p meals
enteral tube feeding - ANS IS a method of feeding by providing a liquid diet directly to the stomach or
intestine through a tube placed down the throat or through the wall of the GI tract
percutaneous endoscopic gastrostomy (PEG) tube - ANS IS a tube passed into a patient's stomach through
the abdominal wall
Gastrojejunal (G-J) tube - ANS IS This is a surgically placed tube that allows access to the stomach as well
as the jejunum, permitting some portion of the feeds to bypass the stomach, thereby decreasing the risk of
reflux
Contraindications to insertion of Enteral Feeding Tube - ANS IS basilar skull functions
facial trauma
esophageal surgery
deviated septum
what is the gold standard to verify enteral tube placement? - ANS IS x-ray
managing enteral tube feedings - ANS IS §Can be administered slow gravity or slow push
§Height of feed by gravity matters!
§Cramping = lower bag
§Try to obtain liquid formulations rather than crushing pills
§Do not mix medications in tube feeding
§Flush between each med with 15 - 30 ml to prevent clogging
§Flush with 30 - 60 ml when done with med administration
§Caution with flush amount in patients with fluid restrictions or at risk for overload
§Can use warm water for flush
§Verify tube location is compatible with medication absorption
, §If medication is to be given on an empty stomach, allow at least 30 minutes before or after feeding
§Risk of drug-drug interactions is higher
Management of Parenteral Nutrition - ANS IS §Require supplemental Vitamin K
§Always start low and gradually increase to goal
§Never abruptly discontinue- always weaned to decreasing hourly rate before stopping- why???
§Carefully compare TPN bag contents to orders
§Verify placement of central line via x-ray and order clearing use of line prior to initiating TPN
§Requires continuous monitoring & assessments
Parenteral Nutrition (PN) - ANS IS the intravenous infusion of nutrients administered directly into the
bloodstream, bypassing the digestive system
enteral nutrition - ANS IS alternate form of feeding that involves passing a tube into the gastrointestinal
tract to allow instillation of the appropriate formula
what are the types of parenteral nutrition? - ANS IS PPN: peripheral parenteral nutrition (less frequent)
TPN: total parenteral nutrition (more common)
total parenteral nutrition (TPN) - ANS IS Providing 100% of a patient's nutrition intravenously.
§Amino acids, dextrose, electrolytes, vitamins, minerals
§Lipids
§Requires central line catheter & in-line filter
Use a dedicated line- never infuse another substance into TPN line
TPN limit: 24 hours
