Calcium helps the heart to work

CALCUIM normal level is 8.5-10. We need calcium for bone and teeth formation. We also must have calcium for blood coagulation. If we do not have calcium we will die. The bottom line here “we will die”. I am not kidding. Calcium is used for blood coagulation if we don’t have calcium we will not clot.

Another form that calcium is very important is muscle contraction. If we don’t have calcium we will die as I said before because our muscle will not contract nerve impulses will not occur. We will die.

How the calcium helps the heart to work? In our heart we have a fiber known as actin-myosin fiber (they live one top to the other). The filament theory they slide one top to another that is why every time it happens that’s the time the heart contracts.

However, in order for the actin-myosin fiber to slide one another and the heart to contract we must have a molecule of calcium that floats through that stimulate the contraction. If we do not have the molecule of calcium floating through we don’t get the neural impulse, we don’t get the heart to contract. We will die. Very simple.

Enteral feeding nursing responsibilities

ENTERAL NUTRITION

Purpose of enteral nutrition is to supplement the oral intake not to take the place of but to supplement the oral intake and to help provide total nutritional support. There are a lot of nursing responsibilities that we should do with this one.

1.Use small bore tube when giving NGT use 10 french or less
2.Check the pH of the gastric contents
3.Check tube placement.

a. X-ray – is the best or indication for tube placement especially if using Levine tube that has little mercury at the end.

b. Aspirate the content and check the pH and put back the aspirate.
c. Inject air and auscultate over the gastric area for sounds of the air you just put in.

4.Administer tube feeding at room temperature. Rationale: too cold will cause hypothermic shock.

5.Do not give the food that is hung more than 4 hours. Rationale: it gets sour and the stool will cause sour smell.

6.If the patient is to have 60 cc per hour you just hang 240cc.

7.If patient is in continuous feeding you hang it for 4 hours if it is consumed monitor residual. If the residual is more than 100cc-150cc it indicates delayed gastric emptying and you need to tell the doctor about it.

8.If patient is on feeding every 4 hours then it is not consumed you give some more you just check the residual and also check the pump if on continuous pump feeding.

9.During the feeding position the head of the bed should be elevated 30 degrees and until 1 hour after. If the patient is on continuous feeding the bed elevation should stay on 30 degrees.

10.Feeding set should be changed every 24 hours.

11.Check residual every 4 hours and rinse the bag out. Rationale: you don’t want the ensure or osmolite that is in to sour up.

12.If the patient has 6-tube either gastrostomy or jejustomy tube you need to skin skin around for signs and symptoms of infection.

13.Do not mix medications with enteral feeding. You crush the medication, diluted in warm water.

14.When to flash the tube? NCLEX Question

• Before and after every medication administration
• Before and after change of tube feeding.
• After checking for residual volume
• Every 4 hours during continuous feeding.
Rationale: by flashing the tube you maintain the patency of the tube.

15.Give the patient water. Rationale : because the tube feeding is hyperosmolites or thick, it pulls fluid out of the cells and dehydrate the patient that will to kidney failure. The blood becomes viscous and fluid with sugar, so it is important to give patient water.

Low residue Diet

LOW RESIDUE DIET - is given for colon, perineal and rectal surgery prep before and after. The purpose is to decrease the pressure of the operative site. (NCLEX question). If the patient is given high residue diet there is a lot of residue sitting in the intestine causing pressure on the operative site. During post op low residue diet is given to decrease the pressure on that site and it is also used for prep before doing rectal or colon visualization. There will be less residue sitting in the bowel to visualize the bowel a lot better.

It is also used for Crohn’s and Ulcerative Disease both will have 20-50x bowels a day. So to promote or increase absorption of nutrients Low residue diet is needed because the residue sitting a little longer and pass slower in the small intestine where more absorption occurs. Patient should avoid high fiber food like nuts, seeds, food with skin, milk and milk products.

Purine Diet

PURINE DIET – is used for gout, increased uric acid and kidney stones. The purpose of it is to decrease the amount of purine. Purine is the precursor of uric acid. Purine is found in lobster, organ meats, lintels, dry peas, nuts, oat meals and whole wheat. We should do health teachings to them and avoid the food stated above.

PKU DIET

PKU DIET – The purpose of this diet is control the intake of Phenylalanine. Phenylalanine is found in nutri-sweet products like diet soda. It is one example of NCLEX question. Food that needs to be avoided: bread, meat, poultry products, legumes, cheese nuts, and eggs.All babies born should have PKU test. It is mandated that all babies should have Newborn Screening and that includes PKU. Babies should not leave in the hospital with out the result usually 24-48 hours after.

If the baby is positive for PKU he/she should on PKU diet until 6 years old otherwise if not having that diet it could cause mental retardation. They can be given with Lofenalac drugs it will help. We should teach the family to use low protein flour and avoid all nutri-sweet products.

GLUTEN-FREE DIET

GLUTEN-FREE DIET – It is the diet for patients who have Celiac Disease. What happens in this is there is inability to digest gluten. It is our responsibility as nurses to teach them to avoid things that contain gluten. Gluten is a protein that can’t be digested by the body. They need to avoid food like barley, rye, oats and wheat (BROW). Bread is okay unless it is made of corn, rice or soya or flour. Nursing interventions: we should teach the patient to read all the labels of prepared food. We might be over powered how many food contains gluten because we use gluten as a filler.

Diabetic Diet

There are many people around the globe who are diabetic. It is really necessary to know about their diet.

DIABETIC DIET – The purpose of it is to maintain the normal ideal body weight and to get that plasma glucose level close to normal as possible. According to the ADA (American diet Association) come up with little change in this. This one maintains normal plasma glucose level. The reality of getting it close normal is impossible with diabetes. What the ADA recommends now is not normal but steady. We don’t want 110 today and 300 tomorrow. Steady if it end up 150, 160 but steady is much better than 110 today and 180 tomorrow.

The principle is to avoid sweets, avoid food high in simple sugars like jams, jelly, and cakes, cream, cookies and pies.
Complex carbohydrates like rice, pasta, bread are good but cake is not good. As nurses it is our responsibility to teach diabetic patients to use he exchange list (the normal to make their lives the more compliant they will be).