Skills Written Test 2 Study Guide

Dysphagia difficulty swallowing o 30 min rest period

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Dysphagia- difficulty swallowing o 30 min rest period before eating o Upright, seated position o Chin-down position helps prevent aspiration o 4 levels of diet Dysphagia puree Dysphagia mechanically altered Dysphagia advanced Regular o Feed pt slowly with small bites o Warning signs: Cough during eating Change in voice tone/quality after swallowing Abnormal movements of mouth, tongue, or lips Uncoordinated speech Continuous feeding o Measure GRV every 4 to 6 hours o Begin infusion rate at designated rate and advance the rate slowly Intermittent feeding o Measure GRV immediately before feeding o Infuse bolus of formula over 20-30 min via syringe or feeding container o Increase amount of feedings gradually When to stop/withhold feedings: o Stop immediately after aspiration occurs
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o Withhold feedings and reassess pt tolerance if GRV is over 500ml o Routinely evaluate pt for aspiration o Use nursing measures to reduce the risk of aspiration if GRV between 250-500ml Nitrogen balance- achieved when intake and output of nitrogen are equal. o Positive nitrogen balance- more intake than output- required for growth, pregnancy, maintenance of lean muscle mass & vital organs, and wound healing o Negative nitrogen balance- more output than intake- occurs with infection, burns, fever, starvation, head injury, and trauma Diet progression and therapeutic diets: o Clear liquid- coffee, tea, bouillon, carbonated beverages, gelatin, popsicles, clear fruit juices… o Full liquid- clear liquid + smooth-textured dairy products, pureed vegetables… o Pureed- full liquid + scrambled eggs, pureed meats and fruits, mashed potatoes… o Mechanical soft- pureed + ground or finely diced meat, flaked fish, cheese, potatoes, light breads… o Soft/low residue- add low-fiber, easily digestible foods like pasta, pasta, casserole, tender meats, desserts without nuts or coconuts… o High fiber- add uncooked fruits, steamed veggies, bran, oatmeal, and dried fruits o Low sodium- vary from no added salt to severe sodium restriction o Low cholesterol- 300mg/day cholesterol o Diabetic- balanced intake of carbs, fats, and proteins. Caloric recommendations depend on patient o Regular- no restrictions
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