Nursing Interventions
Describe TPN and its purpose.
Total parenteral nutrition is the administration of a hypertonic IV solution that prevents/corrects nutritional deficiencies when malnourishment is a concern.
What lab would indicate PKU in a pediatric patient.
Phenylalanine levels, because it will build up due to lack of an enzyme to properly break down the amino acid.
How can you identify Inborn Errors of Metabolism in an infant?
Assess for failure to thrive, poor weight gain, lethargy, poor feeding, and vomiting.
One of your patients is worried that their new colostomy will smell bad and is wondering if you know how to prevent odor. What dietary recommendations can you make to your patient to prevent odor?
Increasing yogurt and maintaining adequate water intake.
When you have a drug that undergoes hepatic metabolism, what are your most important labs to monitor?
ALT and AST.
What are your primary interventions to avoid refeeding syndrome in a malnourished patient?
Frequent monitoring of all lab values, especially electrolytes, and sticking to the RDN created dietary intake plan. Double check that the rate is slow, and if it isn’t contact the provider.
What lab values would you see in a patient who has cachexia from malnutrition?
Cachexia is muscle wasting, so you would see low albumin, high CRP, and vitamin deficiencies.
What diagnostic test will allow identification of PKU in an infant?
A blood spot screen, which is federally mandated.
You have a patient who has been experiencing nausea and vomiting for 2 days, and has been unable to keep any food down. What clinical manifestations are you likely to see in this patient?
Manifestations of metabolic alkalosis (confusion, shallow breathing, muscle weakness), and signs of electrolyte imbalances (paresthesia, muscle weakness, cramping).
What is the target of most eating disorder treatment?
Treating the underlying condition/s (anxiety, depression, mood disorders).
What are your priority interventions for a patient who is experiencing a thyroid storm?
Cooling down their body temperature and administering acetaminophen as an antipyretic.
What does a Hgb A1C of 9.1% indicate about a patient's carbohydrate metabolism?
It indicates that there is poor glycemic control due to insulin resistance that inhibits the uptake of glucose, leaving it in the bloodstream to be attached to hemoglobin molecules.
What is the name of the questionnaire assessment tool used to help diagnose eating disorders?
The SCOFF assessment.
A woman is brought to the ER d/t increasing lethargy and confusion over the past few days. Her history includes hypothyroidism and hyperlipidemia. Her assessment reveals: 95.2F, HR 48 bpm, RR 8/min with shallow effort, BP 88/56, and O2 of 82% on room air. The patient’s skin is dry, puffy around the eyes, and pale.
What complication of hypothyroidism is this patient experiencing?
Myxedema Coma
What is your first line drug for hyperthyroidism and why?
Methimazole, because it doesn’t cause any liver damage like PTU does.
When would nasogastric decompression be indicated?
In any disorder that causes mechanical or functional trauma to the bowel and creates a blockage. It is used to relieve abdominal distension.
Your patients lab results come back as follows:
Low TSH
Elevated T4
What condition is this? Is it primary or secondary?
This is most likely Grave’s disease (hyperthyroidism). It is a primary disorder because the issue is at the level of the gland, despite down regulation of TSH to attempt to stop further production of T4.
What are 4 of the 5 characteristics of metabolic syndrome?
Abdominal obesity
Hypertension
Hyperlipidemia
Low HDL levels
Fasting hyperglycemia
You have a patient with hypothyroidism who is prescribed a 100 mcg dose of Sinthroid once daily. The provider wants to change the medication to Levoxyl, which is a different brand that is cheaper. What is your concern?
You should never switch brands of levothyroxine, because they all have different specific formulations.
A patient with newly diagnosed hypothyroidism weighs 84 kg. The provider prescribes levothyroxine 1.6 mcg/kg/day PO. The medication is available as levothyroxine 100 mcg tablets.
How many tablets would you administer in one day (assuming that you can split the pill exactly)?
1.3 tablets
1.6mcg×84kg=134.4mcg/day divided by 100 = 1.344
You have a patient who presents to the ER with Russel's sign, low blood pressure, bradycardia, and dental erosion. Which eating disorder are you on alert for and what follow up tests would you anticipate being ordered?
Bulimia Nervosa: Metabolic panel, kidney function tests, ABG.
What is the relationship of Cushing Disease to macronutrient metabolism.
Hypercortisolism causes alterations in the breakdown and absorption of fats, and increase the breakdown of protein especially in the muscle tissue.
Diagnostic assessments are being ordered for a client with BED. Which of the following procedures are anticipated?
Metabolic panel
Upper endoscopy
Complete lipid profile
ECG
Hgb A1C
Gastric emptying study
A C D E
A nurse is caring for a client who is admitted with metabolic alkalosis due to bulimia nervosa. The lab values are as follows:
Na: 130
K: 2.7
Mg: 2.0
What is your priority nursing action?
Initiate telemetry monitoring! Cardiac complications are likely due to both the bulimia and the electrolyte imbalances.
What is the use of Olanzapine in eating disorder treatment?
Olanzapine is an atypical antipsychotic that is used to help stabilize mood and reduce obsessive thoughts, like those surrounding body image or food.