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123 Cards in this Set
- Front
- Back
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Nutrition:
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process the body metabolizes and utilizes food
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Metabolism:
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biochemical reactons within cells of the body
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Anabolism:
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"building" - lean muscle is added through diet & exercise. Amino acids form tissues, hormone, enzymes.
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Catabolism:
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break down of biochemical substances into simpler substances.
-occurs when body is in negative nitrogen balance |
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Basal Metabolic Rate (BMR):
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energy requirement of a person at rest
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Resting Energy Expenditure (REE):
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measurment that accounts for BMR + energy to digest meals and perform mild activity
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Nutrients:
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elements necessary for body processes and function
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Nutritional Needs: Nutrients
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-Carbohydrates
-Preoteins -Fats -Vitamins -Minerals -Water |
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Carbohydrates:
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Major source of energy
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How may grams of carbs does an adult need to consume daily?
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50-100 grams
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Simple Carbs:
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water soluble
can't be broken down futher -fructose, dextrose, glucose |
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Complex Carbs:
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insoluble in water
can be broken down further -starches |
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Insoluble Fiber:
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not digestible
includes cellulose |
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Soluble Fiber:
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digestible
prevents some diseases includes pectin, guar hum, & mucilage |
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Protein:
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building blocks for tissue growth, maintenance, & repair
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Essential or indespensible Amino Acids:
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body can't synthesize but must have in diet
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Nonessential Amino Acids:
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synthesized by the body
-albumin, insulin |
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Nitrogen Balance:
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occurs when intake & output of nitrogen equal
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Positive Nitrogen Balance:
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-intake exceeds output
-essential for growth, maintence of lean muscle mass & vital organs, normal pregnancy, & wound healing |
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Negative Nitrogen Balance
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occurs when body uses more than it takes in
-infection, sepsis, burns, fever, starvation, head injury, trauma -need increased protein intake w/these conditions |
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In what nutrient is nitrogen found?
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protein
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Fats (lipids):
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compose of triglycerides & fatty acids
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Triglycerides:
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circulate in blood
made up of 3 (tri) fatty acids attached to a glycerol |
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Fatty Acids:
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chains of carbon & hydrogen atoms wih an acid on one end an a methl groupon the other
-can be saturated or unsaturated -can be mono or polysaturated |
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Water may need to be _______ in patients with fever or GI loss.
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increased
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Fluid may need to be ________ in someonewith decreased ability to excrete fluid due to cardiopulmonary or renal disease.
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restricted
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Water:
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critical component of the body
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Water comproses _______% of total body weight
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60-70
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Vitamins:
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-organic substances present in small amounts in foods
-essential for normal metabolism, used as catalysts in biochemical reactions |
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Fat Soluble Vitamins:
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A, D, E, & K
can be stored |
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Water Soluble Vitamins:
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C & B Complex
-must be provided daily in food as can't be stored in body |
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Minerals:
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-inorganic elements
-build body tissue -regulate body processes -fluid balance, acid-base balance, nerve cell transmission, muscle contraction, vitamin, enzyme, & hormonal activity |
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Digestion:
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mechanical breakdown of food, moves through GI tract by peristalsis
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Where does most digestion take place?
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small intestine
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What do the villi in the small intestine do?
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absorb nutrients
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Where are electrolytes & minerals absorped?
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colon
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Dietary Guidlines of Healthy Diet:
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-fruits, veggies, whole grains, fat-free or low-ft milk & milk products
-lean meats, poultr, fish, beans, eggs, & nuts -low in saturated fats, trans fats, cholsterol, salt (sodium), & added sugars |
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Geriatric Considerations:
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-adults over 65 have decreased need for energy as metabolic rate slows, but still require vitamins & minerals
-malnutrition due to income, decreased ADL ability, loneliness -adverse effects of medications -cognitive impairment -decreased ability to obtain, prepare, & eat healthy foods |
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Vegetarian:
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diet primarily plant food
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Ovolactovegetarian:
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eat eggs & milk
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Lactovegetarian:
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eat diary
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Islam Dietary Restrictions:
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no pork, alcohol, caffiene, fasting during Ramadan, ritualized animal slaughter
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Hindu Dietary Restrictions:
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no meat, alcohol
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Judiasm (Orthodox) Dietary Restrictions:
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no pork, predatory fowl, shellfish, require kosher food preparations, no milk w/meat
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Protect patient safety, dignity & indpendence by:
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-prepare table so pt can feed self, if able
-protect pt clothes, bedding -risk of aspiration w/ decreased LOC |
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Help with feeding if aspiration risk or functonal impairment by:
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-check gag reflex, seat upright
-place food on stronger side of mouth, use thicker foods, no straws & feed slowly -speech therapist evaluation, prn |
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If patient has visual impairment:
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tell patient where items are on plate
e.g. vegetable @ 2 o'clock |
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__________ with client while feeding
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socialize
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Wellness Promotion:
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encurage gradual improvements in diet if pt does not follow recommended guidelines or requires specialized diet
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Nutritonal Screening should include:
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-weight changes
-appetite or dietary habit changes -difficulty feeding self, eating, chewing, swallowing -N/V/D -food likes & dislikes -who eat with -vitamins & supplements -diet |
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Decreased nutrients =:
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decreased blood cell production
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Weight Changes:
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weight is indicator of nutritional & fluid status
**most important |
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Intake & Output:
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-recording I & O provides infomation about fluid balance
-best for short-term fluid monitoring in pts whom acute changes are critical -often inaccurate |
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Intake requirements:
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-minimum o 6-8 glasses/d
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Output requirements:
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-minimum should be 1/2 ml/kg/hr
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Decreased Output:
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CHF, dehydration
-check skin turgor, mucous membranes |
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Increased Output:
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medication, caffeine,increased fluid intake
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Planning & Implementation:
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plan interventions to improve nutrtional status
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Maalox or Mylana/ TUMS Functional Classification:
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-Antiacid
-Antiulcer -hypophosphatemic |
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Maalox or Mylana/ TUMS Action:
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-rapid action; neutralizes stomach acid, stimuates mucous, prostaglandin & bicarbonate production
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Maalox or Mylana/ TUMS Contraindications/Precautions:
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-severe renal failure
-GI obstruction |
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Maalox or Mylana/ TUMS Monitoring:
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-abdominal pain, distention, sx GI bleed or obstruction
-monitor phosphate, potassium, calcium levels periodically (elctrolyte & minerals) |
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Maalox or Mylana/ TUMS Side Effects:
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-rebound acidity, constipation (with aluminum & calcium products), diarrhea (magnesum products), alkalosis, toxicity (pH levels get too high)
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Pepcid / famotidine functional classification:
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antiulcer
H2 histamine receptor antagonist |
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Pepcid Action:
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inhibits histamin at H2 receptr site, decreasing gastric secretions
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Pepcid Uses:
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Treatment or prevention of gastric, duodenal ulcers, GERD, heartburn
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Pepcid Unlabeled Uses:
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GI disorders in those on NSAIDS, urticaria
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Pepcid Interactions:
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-decreases absorption of ketoconazole
-antacids will decrease famotidine absorption -give 1 hr before or 2 hr after |
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Pepcid monitoring:
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sx GI bleed, bleeding, bruising fatigue
smoking diminishes effectiveness |
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Antiacids prototype:
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Mylanta or Maalox, TUMS
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H2 antagonists prototype:
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Pepcid
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Proton Pump Inhibitor (functional classification) prototype:
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Protonix
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Protonix/pantaprozole Action:
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binds to an enzyme in the presence of acidic gastric pH, preventing the final transport of hydrogen ion in the gastric lumen; increasing pH, decreasing acid
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Protonix Indications:
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-GERD, server erosive esophagitis
-healing of duodenal ulcers -decreases acid secretion in hypersecretory conditiions |
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Protonix Absorption:
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ocurs only after tablet leaves the stomach
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Protonix protein binding:
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98%
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Protonix SE:
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abdominal pain, D, euctatin, flatulence
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Protonix Nursing Implications:
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-assess for epigastric or abdominal pain and GI bleed
-may cause abnormal liver function test |
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Protonix Teaching:
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-take medication for full course of therapy
-Avoid alcohol, aspirin, or NSAIDS, and food that cause GI irritation -report black tarry stools, D,or abdominal pain (indicates drug is not working) |
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Antiemetics Category:
emetics =N & V |
-anticholinergics
-antihistamines -neuroleptic agents -prokinetic agents -serotonin blockers -tetrahydrocannibioid |
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Anticholinergics:
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Scopolamine transdermal
-use for motion sickness, secretion reduction before surgery & in terminally ill -SE: dizziness, drowsiness, dry mouth, blurred vision, difficult urination, constipation |
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Antihistamines:
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Antivert, Bonine (meclizine)
-used for motion sickness, vertigo -SE:dizziness, drowsiness, dry mouth, blurred vision, difficult urination, constipation |
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Benadryl Action:
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blocks H1 (histamine) receptors preventing cholinergic stimulaton of vestibular & reticular systems
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Neuroleptic agents:
Compazine/prochlorperizine |
block N&V by blocking dopamine receptor on the CTZ.
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Prokinetic agents:
Reglan/metochlopramide |
block dopamine in the CTZ or stimulate ACh receptorsin the GI tract & stimulates peristalsis
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Serotonin blockers:
Zofran/ondansetron |
block serotonin (5-HT3) receptors in the GI tract, CTZ, & vomiting center
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Tetrahydrocannibinoid:
Marinol |
inhibitory effect on reticular formation, thalmus, & cereral cortex
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Kidney Basic Function:
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filtration of waste products of metabolism
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Kidney Nephron:
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-basic functional unit
-each kidney contains about 1.2 million -not regenreated if damaged |
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Renal Corpuscle Structure:
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-Bowmans capsule
-Glomerulus |
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Renal Tubules:
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-Proximal convoluted tubule
-Loop of Henle -Distal convoluted tubule -Collecting tubule |
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Kidneys help maintain BP by:
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-Reducing supply to kidneys causes release of enzyme renin which converts Angiotensin 1 to Angiotensin 2
-Stimulates vasoconstriction & aldosterone release -Retains water, increasing blood volume & BP |
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Kidneys play a key role in ______.
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fluid & electrolyte balance
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Kidney's produce hormone _________ which stimulates RBC production.
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erythropoeitin
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Ureters:
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-Urine enters renal pelvis from collecting ducts & travels to the bladder through ureters in peristaltic waves
-enter bladder at obliqu angle through posterior wall *prevents reflux during micturition |
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Adult bladder can store up to ____ml.
Urge to void felt at ____ml. |
-600
-150-200 |
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Urethra:
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-urine travels from bladder through urethra & passes out of body through urinary meatus
-descends through pelvic floor muscles which control urine flow |
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5 diseases or conditions which may affect renal function or urine elimination
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-Nephrotoxic agents; gentamycin, vancomycin
-transfusion reactions -disease of glomuruli -renal neoplasm -systemic diseas; diabetes mellitus -infections -decreased LOC -sprinal cord injury |
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3 sociocultural or psychological factors which may affect urination
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-privacy
-social expectation -anxiety -emotional tension |
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Kidney Age Factors:
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-decrease blood flow to kidneys result in decreased ability to conserve Na, dilute and/or concentrate urine & excrete acid load
-20-30% decrease in kidney wt b/w age 30 & 90 -30-50% of glomeruli lose function by 7th decade -striated muscles relax resulting in increased urethral irritation = urethral and bladder uinfections & urinary incontinence |
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Kidney Age Factor in Women:
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-decreased estrogen levels in females result in decreased elasticity in tissues including bladder and urethra resulting in decreased blood supply
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Kindey Age Factor in Men:
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prostate gland in men enlarges with age resulting in hesitancy, retention, slow stream & UTI
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Kidney Impairment
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Any condition that reduces blood flow to kidneys
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Alterations in Urinary Retention:
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Urine elimination problems not related to kidney function are generally due to inability to store urine or fully empty bladder
-impaired bladder function -obstruction to urine flow -inability to control micturition |
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Factors Affecting Urination:
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age, environment factors, meds, psych factors, muscle tone, fluid balance, current surgical or diagnostic procedures, disease conditions, bowel elimination environment, indwelling catheter
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GFR (Glomerular Filtration Rate):
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the best overall index of kidney function
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Catheter Care; reducing risk of infection:
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-avoid advancing catheter into urethra
-fluids 2000-2500ml/d -maintain closed system -clean spigot with alcohol after emptying -don't hold bag above bladder |
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Functions of colon:
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-absorption
-secretion -elimination |
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Constipation:
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-infrequent BM
-diffiuculty evacuating -need to strain -hard feces |
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Diarrhea:
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passage of liquid, unformed feces
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Diarrhea Causes:
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-disorders of digestion, absorption, antibiotic use, enteral feedings, food allergies, pathogens
-contents pass too quickly to allow absorption of water & nutrients |
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Incontinence:
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involuntary passage of feces & gas
-may be related to cognitive impairment or disease process |
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Laxatives:
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used for treatment of constipation
-need to determine underlying cause first |
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What should you asess before administering laxative medications or cathartics?
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s/sx of bowel obstruction, abdominal pain, distention, dec. bowel sounds, N & V
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Laxative Types:
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-bulk forming -only type for long term use
-emollient or wetting -saline -stimulant cathartics -lubricants |
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Bulk Forming Laxative; Metamucil;
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-absorb water & increase bulk in bowel
-stretch intestinal wall to stimulate peristalsis -must mix with at least 1c water & swallow quickly or may cause obstruction. -can also be used to relieve mild diarrhea |
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Emollient (stool softeners); docuate sodium (Colace):
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-lower surface tension of feces, so more water & fat can penetrate
-short term use to prevent straining after surgery, MI, pregnancy |
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Saline laxatives; magnesium citrate, MOM, fleet phosphosoda, fleet enema:
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-increased osmotic pressure in small intestine by inhibiting water absorption & increased water & electrolyte secretions from bowel wall
*promotes peristalsis, lubricate feces -used for bowel prep before diagnostic procedure or surgery -dont use on renal pts or those on fluid restriction |
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Stimulant Cathartics; bisacodyl (Dulcolax):
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-irritate intestinal mucosa to increase motility
-decrease absorption in small bowel & colon -may cause sever cramping -generally used to prepare bowel for diagnostic procedure -not for long-term use, may cause F&E imbalance -dont use during pregnancy or lactation |
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Lubricant Laxatives; Haley's M-O:
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-coat fecal contents allowing for easier passage
-reduce water absorption in colon -prevent straining on defecation -risks; **dec. absorption of fat-soluble vitamins **may cause aspiration pneumonia **if taken w/emollients or mineral oil, increased risk of fat emboli |
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Antidiarrheal Agents:
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-treat underlying cause
-decrease intestinal muscle tone to slow passage of feces |
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Immodium:
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OTC
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Lomotil (diphenoxylate):
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opiate Rx.
-inhibit peristaltic waves, but increase segmental contractions to increase water absorption |
