Nutritional Problems Upper GI

Nutritional Problems/Upper GI Module 3 Nutrition • Process by which body uses food for energy, growth, maintenance, and repair of body tissue • Food pyramid – Carbohydrates (CHO) – Fats – Proteins – Vitamins – Minerals Carbohydrates • Body’s primary source of energy • 4 kilocalories per gram – Simple • • • • Monosaccarides i.e. glucose, fructose Disaccarides i.e. sucrose, maltose Complex (starches) i.e. cereal grains, potatoes ½ of body’s energy needs should come from CHO Fats • • • • • US people consume high levels of fats 1 gram yields 9 kcal of energy Stored as adipose tissue Fats used for energy, thermoregulation Carrier of essential fatty acids and vitamins Protein • • • • • Obtained from plant and animal sources 15-20% caloric needs 1 gm yields 4 kcalories Complex nitrogenous compounds 22 amino acids-fundamental unit – 9 Essential-cannot be synthesized – 13 Nonessential Protein • Complete protein contain all essential amino acids – Milk – Milk products – Eggs – Fish – Meats – Poultry Protein • Essential for tissue growth/repair/maintenance • Body regulatory functions • Energy production Vitamins • Organic compounds • Needed for normal metabolism • Enzyme reactions that facilitate metabolism of fats, amino acids, carbohydrates • Water soluable (B and C) • Fat soluable (A, D, E, K) Minerals • Major – Mg,Ca, K, Na • Trace elements-present in small amounts – Zinc, Iron, Copper • Necessary for building tissue, regulate body fluids Vegetarian Diet • Exclusion of red meat from diet – Vegans• Eat only plant food • At risk for B 12 deficiency, iron, protein deficiency – Lacto-ovo• Eat plant food and dairy products/eggs • At risk for iron, protein deficiency – Alternate foods high in iron • Enriched farina • Fortified oatmeal • Cooked soybeans Malnutrition • Excess, deficit, or imbalance of a balanced diet – Undernutrition – Overnutrition – Dietary deficiencies • Rickets-Inadequate Vitamin D • Scurvy-Inadequate Vitamin C • Malnutrition is common in hospitalized patients/elderly Types of Malnutrition • Protein-calorie • Marasumus • Kwashiorkor Protein-Calorie Malnutrition • Most common form of undernutrition – Primary • Poor eating Habits – Secondary • Alteration in ingestion, digestion, absorption, metabolism • i.e. Cancer, obstruction,Crohn’s Marasumus • Concomitant deficiency of caloric and protein • Generalized loss of body fat and muscle • Client appear ―wasted‖ or emaciated • May have normal serum protein levels Kwashiorkor • Deficiency of protein with a catabolic state – i.e. surgical procedure, GI obstruction – Client may appear well nourished but have low protein levels Pathophysiology of Malnutrition • Starvation process – Early • Body uses carbohydrates rather than fat or muscles • After carbohydrates depleted, protein is used • Negative nitrogen balance in 5-9 days – Later • • • • Fat stores used in 4-6 weeks Proteins are rapidly used (albumin) Liver becomes impaired Fluid shifts as albumin levels decrease (severe depletion <2.5 g/L) • Edema • Skin dry, wrinkled • Ions shift Malnutrition and Wound Healing • Clients with wounds/ulcer may require the following to promote wound healing: – High protein diet – Increased calories – Vitamin C – Zinc Specialized Nutritional Feeding • Tube feeding – NGT – Gastrostomy/Jejunostomy – TPN Etiology of Malnutrition • Many factors – SES – Cultural – Religious – Psychological – Physical conditions i.e. Cancer – Physical treatments i.e. Surgery – Malabsorption syndrome – ETOH, medications, NPO Malabsorption Syndrome • Impaired absorption of nutrients from GI tract – Decreased amounts of enzymes – Reduced amount of bowel surface area – Food-drug interactions Clinical Manifestations of ProteinCalorie Deficiency • • • • • • • • • • • • Brittle nails/pigment changes Loss of hair, decreased luster Cheilosis Raw, beefy tongue Protruding abdomen Decreased immune system Altered mental status Decreased urinary output Amenorrhea Decreased BUN, creatinine Decreased muscle mass Cachetic Tube Feeding • Administration of feeding liquefied food through tube inserted into stomach, duodenum, jejunum • Indications – – – – Anorexia Oral fractures Cancer head/neck Physical/psychiatric conditions that prohibit oral ingestion i.e. aspiration risk, CVA, etc. – Chemo/Radiation/burns Tube Feeding vs. Parenteral Nutrition • Tube feeding – Easier administration – Cost – Safer – More efficient • Methods of tube feed – Continuous – Gravity/Intermittent NGT Feeding vs. Gastrostomy/Jejunostomy • NGT – Shorter term – Easier clogged – Higher risk of aspiration (easier dislodged) – Can be inserted by nurse • Gastrostomy/Jejunostomy – Usually inserted surgically/endoscopy Procedure for Tube Feeding • HOB 45 degrees during feeding and 30-60 minutes after • Check for placement/residual before each feed or every 8 hours with continuous • Irrigate with water before and after • Use pump for continuous infusion • HOB should never be flat during continuous feed-turn off pump if placing client supine Procedure for Tube feeding • Feeding at room temperature • Weigh client q day • Hold feedings for residual (amount per MD orders or institutional policy) • For med administration – Same as for feeding – Crush meds into fine powder, water before and after med administration – DO NOT crush extended release Complications of Tube Feeding • • • • • Vomiting/aspiration Diarrhea Constipation Dehydration Skin irritation with gastrostomy/jejunostomy • Potential for fluid volume depletion/ overload Total Parenteral Nutrition • If GI system cannot be utilized for ingestion, digestion, absorption, metabolism • Administration of nutrition other than GI tract • Delivery of hypertonic solution IV • Goal – Meet nutritional needs – Allow growth of body tissue Total Parenteral Nutrition • Composition – Made individually for each client, prepared under sterile conditions by pharmacist – Electrolytes – Usually high concentration of dextrose – Protein, amino acids – Vitamins – Trace elements – Fats – Insulin Total Parenteral Nutrition— Methods of Administration • Peripheral – Usually lower concentrations of dextrose (10%) • Central catheter – Higher concentrations of glucose • Triple lumen (physician inserted), PICC line (trained nurse) – Catheter is confirmed by x-ray placement Complications of Central Catheter Insertion • • • • Pneumothorax Air embolism Hemorrhage Thrombosis Complications of TPN • Infection – Bacterial/fungal infections – Metabolic • • • • Hyperglycemia Hypoglycemia if TPN stopped abruptly Electrolyte/mineral imbalances Mechanical – Complications related to IV therapy peripheral and/or central Nursing Considerations For the Client Receiving TPN • • • • • Accuchecks Monitor lab values, electrolytes,CBC Monitor weight Sterile dressings to central lines Monitor for signs/symptoms of infection – Local – Systemic Obesity • • • • Abnormal increase in proportion of fat BMI > 30 kg/m2 Waist to hip ratio >1 men, >0.8 women Morbid obesity-weight exceeds ideal body weight by 100% Etiology of Obesity • • • • • Environmental Genetic Lifestyle Psychological Social Nursing Care for the Obese Client • • • • • Psychosocial/emotional support Nutritional counseling Exercise Behavior modification Pharmacological – – – – Redux/Pondimen taken off market Meridia-inhibits serotonin-suppress appetite Xenical-nutrient absorption blocking, steatorrhea Surgical intervention Surgical Intervention for Obesity • Mechanical – Lipectomy/Liposuction – Nutrient intake limiting (gastric bypass) – Criteria for surgery • • • • Obesity > 5 years Morbid obesity Absence of other medical conditions Psychiatric stability Lipectomy/Liposuction • Removal of adipose tissue • Cosmetic in nature • Complications – Infection – Fat embolism – Complications from anesthesia Gastric Bypass • Roux-en-Y most common • Creation of gastric pouch • Complications – Dumping syndrome • Gastric contents empty rapidly into small intestine – Malabsorption • Need vitamin supplementation (B 12), iron, calcium • Others? Gastric Bypass Post-op Care • • • • • • • • • • Monitor for wound infection Monitor electrolytes T, C, D, B NGT to low suction IV for nutrition immediate post op DVT prophylaxis Pain management Psychosocial Skin care Nutritional consulting Eating Disorders • Anorexia nervosa – – – – – – – – – – – – Self imposed weight loss Psychological implications Fear of gaining weight Refusal to eat Compulsive exercise Iron deficiency Elevated BUN Potassium deficiency Muscle weakness Cardiac dysrhythmias Renal failure Death Eating Disorders • Bulimia Nervosa – Frequent binge eating, Self induced vomiting―Binge and Purge‖ – Loss of control over eating – Persistent concern with body image – Signs of frequent vomiting • Dental problems, sores on mouth