Question

Pls help!

1.     What order will you complete the 4 steps of the abdominal assessment?

2.     List at least 3 laboratory assessments that will help you determine a patient's nutritional status?

3.     Identify at least 4 possible complications of enteral tube feedings and the possible cause.

4. Explain how the concepts of Fluid & Electrolyte and Nutrition are interrelated?

Answer 1

Abdominal enamination IA > Basic four steps to be followed to complete abdominal assesment are inspection, auscultation, percussion and palpatation Positioning > Before abdominal assesment the patient should be Instructed to die in the supine position if he hands are cold warn the patient before only Inspection : > Note any sears, striae, vascular changes leg: caput medusae) cor) protrusions. ale Auscultation : » Purpose: To note bowel sounds. > Usually performed before percussion, palpatation, Ausculate over four quadrants s listen for bruits. Normal findings & Guogling bowel sounds for 10-15 sec.

• Percussion Purpose: To determine sige and location of intraabdominal Organs Normal findings . Tympanie sound over air filled stomach / intestinal sections ; muffled sounds over fluid - filled cor) solid organs cliver, spleen). Palpation is To identify any source of pain if present) and evaluate internal organs - Superficial palpation - To evaluate abdominal wall process - Deep palpations - To evaluate intraabdominal organs - Palpation of liver - keep fingers on right upper quadrant - Palpation of spleen - Keep, and move eft upper quadrant, - Palpation of inguinal lymph nodes. VU unguna

in lab tests to determine the nutritional statusi. .. Serum proteins (albumin, transferrin, pre albumin, Metinol-binding protein) are most widely used lab measures of nutritional status. - There are hepatically produced negative acute phase reactants with reduced levels during systemic inflammation - In the absence of inflammation, a low concentration of these proteins strongly relate with malnutrition. 34) Complications of Enteral tube feeding : dogo Major cause is delayed Nausea and vomiting gastric emptying. 2-63% Constipation Majorly due to inactivity & bowel motility, & fluid intake, lack of dietary fiber.

Malabsorption Mal digestion. Aspiration 1-40) Gluten sensitive enteropathy, Theron Crohn's disease, diverticular disease, enteral fistulas | Pulmonary aspiration is major complication due to entry of food particles from enteral tube into lungs. Use of small - bowel feeding wober, promotility agents, periodic asserment of gastric residuals reduce risk. GI bleeding, perforation Majorly due tube malposition and tube clogging. so proper training, cleaning of enteral tubes will reduce riske Refeeding syndr sundrome One of major metabolic complication with low arculatory potassium, magner -sium phosphate levels.

Hay Nutrition and fluid and electrolyte balance are linked through ingestion, digestions and intermediary metabolism. Mans utrition ventricably labsorption physiological capacity to encrete encers salt and water is limited to normal conditions only. It is further he duced by starration and injury, so that patients are easily over loaded resulting in increased complications of illness, surgery or Return of AI function to normal after post operatively is delayed due to salune over loade Illness not only influences external flowd and the electrolyte balance but also internal balance b/w the intravascular and extravascular components of the salt and water is en acerbated of entracellular space. I Retention by starvation and the Retention of a response to injury. Some of to engary sponse

interstitial salt and water load may be an inevitable consequence of resuscitation from shook, but encers saline infusion for daily maintenance of urine output should not be continued provided plasma and extracellular fluid volumes are normal, This is best acheined by water (or) sdo dentrose, with only that amount of sodium which replaces losel. Salt encretion depoud on seduced secration of renin, angiotensin, aldosterone. Natriurehe peptide is responsive to acute intravascular volume increase but not to an encers in saline load. CG may be important in this aspect as Nat encretion. High ca to nat nations may cause hyperchloraemic acidosis which altere protein catabolism.