NUTRITION NCLEX

Diets
Herbs
Tube feeds
Nutrition

 Food
 Vitamins
B1,6,9,12
 Enteral feedings
 Parenteral feedings
G tube versus J tube
 Special diets
Food pyramid

 Fruits/vegs 3 to 5
 Meat/poultry/fish 2 to 3
 Bread/cereal 6 to 11
 Milk/milk products 2 to 3
 Increase milk children 2 to 3
 teens 4 or more
 pregnancy 3 or more
 lactating 4 or more
 ***Special diets
 Celiac/Gluten free No BROW
 Renal
 Diabetic
 Immunosuppressed
 Low purine : no shellfish, alcohol, organ meats
 PKU low protein
 Religions:Kosher
 GI Dumping syndrome:no Flds,Fiber,Carbs with meals
 Anorexia Nervosa caution Lo K
 Lactose intolerance
 Vegeterian: veggies,Lacto/milk,ova/eggs
Avoid Purine
 Precursor for uric acid
 High in purine
 Meat extracts & gravies
 Liver, organ meats
 Sardines, mussels
 Chicken, turkey
 Beans, lentils, peas
 Gout: Rich man’s dx avoid shellfish, organ
meats, etoh
AlloPUrinal: prevent Gout
Colchicine: Tx Gout
PKU

 Low protein, unable to digest Phenalylaline

leads to brain damage
 Assess newborn Guthrie blood test/heel
test
 **Bottlefeed: lab test 2 to 3 days after
birth
 **Breastfeed: lab test 5 to 7 days after
birth
 Special formula: Lofenalac
Tyramine foods
 **Tyramine – release
catcholemines
 Food aged cheeses salami

imported beers avocados raisins

banana pods of broad beans
(fava beans) soy sauce, yeast
fermented & aged
Special diets/Religion

 Kosher: no shellfish, no pig,

no meat & milk together
 No scavenger fish & no 3 hoof animals or
birds of prey
 Islam/Muslem :no pork, no stimulants
all vegeterian is halal
 Seven Day Adventists :no stimulants, no meat
Special diets: Celiac

 ***Celiac nontropical sprue/Gluten

free
 No BROW: Barley, rye, oats,
wheat
 Give: soy, corn, rice, & millet
 Malabsorption cramps & diarrhea
 Baby first solid food RICE CEREAL
Food pyramid

 Sparingly Fats, oils, sweets

 Limit egg yolks **cholesterol
whites protein
statin med administer eve time
choleystramine/Questran: mix with
water & drink to lower cholesterol
 Avoid grapefruit juice with certain meds
grapefruit juice alters absorption of meds
Toxicity
Food sources

 Carbohydrates/Sugar
 NO for children under 2 Honey:
Botulism
NO for children under 3 years grapes,
popcorn, hot dogs
 Lactose milk caution milk intolerances
 Cellulose bran, apples, beans
 Starches: wheat, corn, oats, potatoes, beets,
carrots, peas
Food sources

 Fats saturated beef, butter

 Polyunsaturated fats: sunflower oil, corn oil
 Monounsaturated fats: olive &peanut oils
 Eggs: yellow cholesterol,white protein allergic
 Cholesterol animal products, egg yolks,
 Organ meats, alcohol, shellfish
caution:Purine restricted
Food sources

 Protein/meat versus nonanimal protein

caution low protein with Liver & Kidney dx
 Lean meat to decrease fat
 Dairy products
 Cereal products
 Dried beans
 Tofu for protein
****Vitamins Water B & C
 Water soluble
 C ascorbic acid citrus , tomatoes,
 broccoli, cabbage
 B1 Thiamine pork & nuts whole grain cereal,
legumes, organ meats
etoh
 B3 Niacin meat, poultry, fish, beans
lowers cholesterol
 B6 Pryidoxine (withTB med) yeast, corn, meat
poultry, fish
 B12 Cobalamin meat & liver
Pernicious Anemia
***Vitamins Fat

 ADEK
 A vision liver, egg yolk ,whole milk,
veggies orange, yellow,& green
 D bones fortified milk, fish oils, cereals
 E antioxidant veg oils, green leafy vegs
 K clotting: green leafy vegs,
cauliflower, cabbage
Minerals

 Sodium
 Potassium
 Calcium
 Magnesium
 Phosphorous
 Iron
Sodium 135 to 145

 PMS =Salty
 Processed, canned
 Moo milk products
 Salty snack foods
 Salt, soy sauce, bacon, beans
 Vegetables with SALT……… grow in ground
 Risk of seizures………… Lo sodium levels
Sodium

 Hypernatremia
 Decrease heart function, weak muscles
 Orthostatic with dehydration
 Confusion, agitation seizures with LO NA
 Decrease urine output ,increase specific
gravity
 Treat: fluid replacement
Sodium

 Hyponatremia
 Weak thready pulses,Resp shallow weak
 CHF
 Hyper active bowels
 Confusion
 Seizures with Na under 120
suction, oxygen, padded siderails, post ictal…..

 Treat: underlying cause

 Potassium 3.5 to 5

 Raisins,Pork, beef, fish

 Spinach, carrots, potatoes, tomatoes
 Strawberries, bananas
 **Lo K weaK, flat T wave, U wave, abnormal pulse
 Tx with Potassium infusion, never IVP
 IV KCL 10meq/100mL over one hour on pump
 **Hi K weak, high T low pulse
 TX sodium polystyrene/Kayexelate, Sodium
Bicarb, Insulin & D50 IVP
First :Calcium Gluconate to stabilize heart
Magnesium 1.6 to 2.6

 CNS depressant slows down

 Hi mag: depressant resp depression
 Check reflexes DTR
 stop MAG, Antidote: Calcium Gluconate
 Lo mag: increase activity tremor, seizures
Tx: Magnesium infusions
 Common foods green leafy vegs, pork, beef,
chicken, milk, peas
Calcium

 Calcium calm & cows

 4.5 to 5.5 meq
 8.5 to 10 mg
 Milk caution with tetracycline decreases
absorption
 Milk increases gastric acid juices
increases secretions
 Milk neutralizes for overdoses
 Calcium

 Milk products, cheese, ice cream, yogurt

 spinach, broccoli, green beans, tofu, carrots

 Calcium up PO4 down

 Calcium down PO4 up

 Hi calcium: decrease activity, ataxia, flaccid

Risk for Injury & Safety
Tx: Fluids & Lasix
 Lo calcium: increase activity twitch, tremor, seizure
Tx: Calcium bolus infusion
 SZ: Padded siderails & Suction & Oxygen at bedside
Iron

 Meat fish, poultry

 Raisins, prunes
 Beans kidney
 Spinach
 Cereal bran & oat
 Peanuts
Ash

 Ash
 Acid ash purpose to decrease pH
 Alkali ash purpose to increase pH
Acid ash

 CPP
 Cranberries, plums, prunes, blueberries
 Eggs
 Meat
 Fish
 Poultry
 Oysters
Alkali ash - Milk

 Citrus fruits
 Fruits except CPP
 Rhubarb
 Vegs
Special religion diets

 Seven day Adventist: No stimulants & no

meat & No Alcohol
 Muslim: No pork & no stimulants
Special diets

 Diabetic: Carbohydrates caution

 GI:
 gastric surgery Give B12 IM once a month
 diverticular dx: Give Hi fiber
 ** Dumping syndrome
no FLUIDS, Fiber, or Carbs with meals
Lie Flat after EAT
 Anorexia & Bulimia
caution Lo K
Special diets RENAL

 Renal
 Avoid fluids, protein, potassium
 sodium, magnesium,
 phosphorous
 Add calcium & iron
Immunosupression problems

 Well cooked food, No raw meat

 No fresh fruits & vegetables
 No fresh flowers/plants
 No ground pepper
 Glass of water at bedside no more
than 15 minutes uncovered/Risk for
infection
Vegetarians

 Vegans plant food only

 Others include LACTOVEG = dairy products,
OVOVEG= eggs
 Others poultry & fish
 But not beef, lamb or pork
 Proteins in plant food incomplete
 Vegans combine with different plant food to
get complete protein example : peanut
butter, dried beans & peas
 Tofu
Complete protein

 Grains & Legumes

 Legumes & nuts & seeds
 Grains, legumes ,nuts, or seeds with
milk product
 Black eyed peas & rice
 Lentil soup with whole wheat bread
 Macaroni & cheese
Vegetarians

 Vegans avoid all animal origin

foods
 Ovo lacto vegetarian
 Ovoveg eggs avoid fish & dairy
 Lactoveg dairy products avoid fish
& eggs
 Protein replace: soy, tofu, iron rich
vegs
 ***Herbs

 Bleeding Potential herbs that begin with G

 Garlic
 Ginseng
 Gingko
 Ginger
 Green Tea
 OTHER Herbs
 Ma Huang/Stimulant
 Ephedrine/Stimulant
More herbs
 Echinecca

 St. John’s Wort

 Cohosh: Black PMS

Blue bad bleed never with pregnancy
Tube feeds
 Ng tube Keofeed small tube
 Peg tube G tube or J tube
 Placement ph less than 4 (ACID)
 Residual more than ½ the hourly volume hold
feedings
 Prepackaged/commercial prep/ closed container
 Dietary prepare/open:Room temp/open for 4 to 6
hours only
 Risk infection
 Position upright patient
 Tube feeds Enteral complications

 Most serious Aspiration

 Most common Diarrhea
 Vomit potential:
 increase residual
 electrolyte abnormalities
 hyperosmolar
 **Dumping syndrome: n/v/d cramps
palpitations, flush
 Hyperosmolar feed
Parenteral

 IV
 PPN :Peripheral 5 to 10% dextrose with
 amino acids & electrolytes & vitamins
 add once a day lipid solution
 TPN: Central 10 to 50% dextrose with AA/vits & lipid

Central line risk of infection

Hi risk of Hyperglycemia

 Parenteral

 IV complications: Central line

 IV insertion PTX
 **Air embolism turn on left side with right up
in Trendlenburg
 Infection: sterile nursing care with dsg/tubing
 Hyperosmolar
 Dextrose 10% if no more TPN/PN available
 TPN/PN
 Evaluation improving/Patient is getting better
 Weight increase 1 to 2 lbs /week
 Albumin increase to norm 3.5 to 5
 Transferrin changes quicker than albumin
protein depletion
 Vitals: increase bp pulse ??? no temp
 LOC alert/orient
 Blood sugar
Baby feed

 Bottle need iron supplements

 Breast need fluoride supplements
 Milk whole after one
 First food cereal rice
 Food add one new food once a week
 Least allergic first
 Wait peanuts, shellfish, strawberries, eggs,
OJ, chocolate
 Other issues

 Alcoholism B1 , B9, B12 Give PO/IV/diet

 Anorexia low potassium, weight
 Dysphagia swallow
 sit up
 chin tuck to chest
 flex forward for food
 avoid liquids & milk & straws to decrease
aspiration
Healthy eating
 Select diets with major food groups
 Protein, meat, milk, veggie & fruit
 Select healthy