CHAPTER 27 – DIET THERAPY AND ASSISTED FEEDING – Flashcards

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To treat and manage disease, prevent complications, restore health through appropriate diet
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What is the goal of diet therapy
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Through a physicians order
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How is the diet therapy obtained
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Food and Fluid intake should be monitored; Weight Gain or loss; Percentage of meals eaten; and Ability to tolerate the diet should be included in documentation
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What factors Can assist in goals by a complete nutritional assessment
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Have paralysis of the arms; Visually impaired Have IV line in their hand or arm; and Severely impaired or weak
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What type of patients need assistance with food
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NPO
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What type of diet is usually prescribed for Pre operative patients
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Clear liquid diet
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What type of diet is usually prescribed for Post operative patients
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no food/drink 6 to 8 hours before procedure
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what are the NPO standard for Pre-operative patients
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risk of vomiting while under anesthesia which could lead to aspiration of stomach contents.
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What are the risks if a patient doesn't follow NPO pre-operatively
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Clear liquid diet
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What type of diet is usually prescribed for Post operative patients
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when the patient can tolerate them without nausea, or abdominal discomfort; and once the patient has passed gas.
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When are solids usually added and prescribed post operative
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Grape, Apple, and Cranberry Juice
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Clear liquid diet
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part of a clear liquid diet
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Strained Fruit Juice is considered to be
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part of a clear liquid diet
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Vegetable Broth, Clear broth, Carbonated Water, Clear fruit flavored drinks, Coffee and Tea
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Jello, popsicles, clear candies
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Clear liquid diet
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Introduce fluids with low residue: remains after digestion • easily digested• low risk of causing abdominal discomfort
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Factors why a clear liquid diet would be introduced
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can cause injury to surgical incision
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What risk factors are associated with abdominal stress post operative
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small amounts of protein and electrolytes
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Why would Bouillons (broth) be a choice over jello
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Clear carbonated drinks such as lime soda or ginger ale
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What kind of carbonated drinks are acceptable
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Full liquid diet
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What type of diet is usually prescribed for Post operative patients once a liquid diet has been tolerated
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Long Term
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Full liquid diet can usually be used
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Milk and milk beverages, cream, butter, margerines, Yogart, eggnog, pudding, Custard and ice cream, Sherbet, Popsicles
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Full liquid diet
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part of a Full liquid diet
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Pureed meats and veggies in cream soup; Strained Fruit Juice; Veg. Juice are considered to be
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part of a Full liquid diet
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Sweetened plain gelatin; Cooked refined cereals; Strained or blended gruel and Other Beverages are considered to be
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are low in fiber, and foods have a soft consistency
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Soft Diets are typically
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Diet includes: eggs, breads without seeds, boiled or mashed potatoes, soups, fruits, juices, tender cooked vegetables, ground or softly cooked meats, cooked cereals, and milk products.
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Foods that part of a Soft Diet
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no specific diet, has no specific restrictions unless required because of a patients specific disease process.
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A General Diet has
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mental disorder characterized by a refusal to maintain a normal minimum body weight, or becoming obsess, and a severe disturbance in body image.
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Anorexia Nervosa is a
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Prevalent among adolescent and young women obsessed with being thin and Are extremely underweight
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Anorexia Nervosa
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May refuse to eat, or food intake is dangerously low
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Anorexia Nervosa
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Anorexia Nervosa
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What Disorder can be fatal if not corrected
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patient must have the willingness to remain in psychological therapy and follow nutritional recommendations to achieve treatment success
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Treatment for Anorexia Nervosa states that
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an eating disorder characterized by episodic binge, eating
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Bulimia is
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Purging, fasting, and the Use of laxatives and excessive exercise
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Behaviors associated with Bulimia to prevent weight gain are
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PUD, Esophageal ulcers: due to gastric exposures
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Medical conditions that arise from Bulimia
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Includes: •Psychological treatment is necessary followed by nutritional supplements; Teaching should include principles of healthy weight maintenance, components or a healthy diet.
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Treatment for Bulimia
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defined as excessive accumulation of fat
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Define Obesity
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Genetics, environment, poor eating habits, lack of knowledge about good nutrition, body physiology, age and gender
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What are the factors that contribute to obesity
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individualized
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Diet therapy is typically
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Cardiovascular disease, Diabetes Melittus, Hypertension, gallbladder disease, and joint disease.
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What risk factors are associated with Obesity
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a person is 20-30% above ideal weight
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What is characterized as mildly obese
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a person is 100lbs over ideal weight
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What is characterized as morbidly obese
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Nutritional status prior to pregnancy, age, and number of pregnancies
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What factors need to be considered when counseling a pregnant woman
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2-4 lbs
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What is the ideal weight gain during the first trimester
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1 lb per week
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What is the ideal weight gain during the second and third trimester
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an increase of 300 calories
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What is ideal calorie intake per day during the second and third trimester
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by decreasing appetite, decreasing financial resources for food, substitution of alcohol calories for food calories
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How does substance abuse interfere with food intake
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Lead to impaired absorption and reduced storage and use of nutrients, as well as increased metabolic needs
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Substance abuse
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alcohol abuse
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Thiamine deficiency is often present with
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alcohol and substance abuse
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Liver damage is common in substance abuse
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includes disease of blood vessels, hypertension, MI, CHF
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Common Cardiovascular Disease include
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Diet therapy is focused on reduction of fat and sodium intake
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Diet therapy ideal for those with cardiovascular disease
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can lead to Atherosclerosis
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Excessive fat intake
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the accumulation of fatty deposits on the walls of the blood vessels and Leads to the narrowing of the vessel diameter, = decreased blood supply to major organs.
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Atherosclerosis is
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HDL -(High Density lipoprotein); LDL - (Low Density Lipoprotein); and VLDL - (Very Low Density Lipoprotein)
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Three Types of Cholesterol in Blood
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High Density Lipoprotein
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HDL
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Low Density Lipoprotein
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LDL
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Very Low Density Lipoprotein
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VLDL
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Good Cholesterol
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HDL
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bad Cholesterol
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LDL
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Type of fat that contributes to atherosclerosis and coronary artery disease.
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Triglycerides
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Poor disease mangement
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Increased levels of Triglycerides may indicate
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Management of cardiovascular disease
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Control of Sodium Diet can also be use as
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= fluid retention
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Large amounts of Na
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results in respiratory distress, edema in legs and feet, Hypertension
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Increased fluid volume in CHF =
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Dietary Approaches to stop Hypertension
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DASH
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low sodium high in fruits and veggies
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DASH diet includes
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Vegetables, nuts, seeds, legumes, low fat dairy
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Low Sodium Diet includes
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2300mg
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1tsp of salt is how many mg
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250mg - 2g
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Sodium restriction is
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the Disturbance of metabolism of carbohydrates and use of glucose by the body.
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Diabetes Mellitus is characterized as
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Insulin dependant DM
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DM Type 1
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Non-insulin dependent
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DM Type 2
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DM Type 2
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Develops usually after age 40 (adult onset diabetes)
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African American and Hispanic greatest risk
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Which demographics are predominately at risk for Diabetes Mellitus
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70-100mg/ dL
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What is the normal blood glucose level
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180mg/dL
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What is an acceptable blood glucose level following a meal
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Complex
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Diabetics should consume what type of carbohydrates
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Brown rice, pasta, whole-grain food, legumes
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Complex Carbohydrates include
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lowering blood sugar level
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Fiber delays absorption of glucose by
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Cardiovascular Disease, HTN, kidnesy disease, blindness and stroke
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DM patients are in a higher risk
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severe diarrhea, profound weight loss, and muscle wasting
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HIV/AIDS can be associated with
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Multiple infections, loss of appetite, malignancies, and GI disorders
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What result of 50% of the body weight an HIV/AIDS result in
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Fluids and electrolytes, weight gain, replacement of muscle mass through protein intake and maintaining strength of immune system
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Diet therapy is directed toward replacement of
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Emphasis on protein
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Calorie intake with HIV/AIDS patients should be increased with an
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Milkshakes with added calories, proteins and supplements such has Ensure and Sustacal
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Dietary considerations for AIDS/HIV are:
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difficulty swallowing
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Dysphagia is
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Placed into the small intestine: Dudenal, Jejunostomy, ileum
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Gastrostomy Tube/ Percutaneous endoscopic gastrostomy (PEG) tube
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tube placement is usually temporary to provide nutritional support
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Nasogastric and Enteral Tubes
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Decompression of stomach post surgery; Obtaining specimen for lab; Gastric lavage for patients with GI bleeding, or GI toxin removal; and Medications
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What are the purpose of NG Tube and Enteral Tubes
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8-10 FR
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Size of a Small bore feeding tubes may be inserted
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30-90 degrees or High Fowlers position
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What position is used during Enteral Feeding and Medication Administration
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from the tip of the nose to the ear to the xiphoid process
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How do you measure an NG Tube
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should be 1-4
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Verify pH of aspirated gastric fluid to check for placement
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Usually 30-60ml of normal saline solution is sufficient to flush the tube when irrigating.
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Tube placement should be checked prior to each feeding and administering medications.
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Reduced procedure time, cost, and recovery time; General anesthesia needed; Via endoscopy; Freedom to ambulate; Easily removal
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What are the advantages of a PEG tube
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placement should be checked by aspirating for residual gastric fluid
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What should be done before each feeding and administering medication for both NG and PEG tubes
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2000ml
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How much fluid is generally sufficient to meet nutritional requirements
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Glycosuria
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Tube feedings contain high level of glucose to provide calories which can cause this
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Sugar in Urine
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Glycosuria
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via gravity and not be pushed as a bolus
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Feeding Formula should flow how
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24hrs
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How often is the Feeding bag and tubes changed
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through a PICC line
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How is a TPN (Total Parenteral Nutrition) Administered
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Massive burns, intestinal obstruction, IBS, AIDS, cancer chemotherapy
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TPN May be used for patients receiving long term therapy such as
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1000 - 2000 ml
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For TPN how much fluid administered the first 24 hours
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infection, blood clot, fluid overload, increased glucose level, crackles
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Complications of TP
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risk for edema, resp. distress, hyperglycemia
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Fluid overload
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check blood glucose level
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What do you check for hyperglycemia
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