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154 Cards in this Set

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Vitamin C
(ascirbic acid) 60mg
(60-100 mg for smokers)

sources:
citrus fruits
green pepper
strawberries
greens
Vitamin C
(ascirbic acid) 60mg
(60-100 mg for smokers)

functions:
collagen formation
antioxidant
enhances iron absorption
Vitamin C
(ascirbic acid) 60mg
(60-100 mg for smokers)

s/s of deficiency:
scurvy
hemorrhaging
delayed wound healing
Vitamin C
(ascirbic acid) 60mg
(60-100 mg for smokers)

s/s of excess:
kidney stones
scurvy on withdrawal
nausea
diarrhea
vitamin B complex
thiamin

sources:
pork
liver
whole and enriched grains
legumes
vitamin B complex
thiamin

functions:
coenzyme in key energy reactions
vitamin B complex
thiamin

s/s of deficiency
fatigue
beriberi
mental confusion (especially in alcoholism)
vitamin B complex
thiamin

s/s of excess
none known
Riboflavin sources
dairy
organ meats
enriched grains
greens
Riboflavin functions
nutrient metabolism
Riboflavin s/s of deficiency
inflammation
poor healing
Riboflavin s/s of excess
none known
Niacin sources
grains
lean meat
nuts
Niacin functions
nutrient metabolism
Niacin s/s of deficiency:
pellagra
dermatitis
Niacin s/s of excess:
flushing
itching
nausea
vomiting
B6 (pyridoxine)sources:
fruit
dark green vegetables
B6 (pyridoxine)functions:
coenxyme in metabolism
B6 (pyridoxine)s/s of deficiency
anemia
CNS problems
confusion
B6 (pyridoxine)s/s of excess:
difficulty walking
numbness of feet and hands
Folate (180-200 mcg) sources:
green leafy vegetables
liver
Folate (180-200 mcg) functions:
RNA and DNA synthesis

formation and maturation of RBC
Folate (180-200 mcg) s/s of deficiency:
macroxytic anemia
fatigue
weakness
pallor
fetal risk of spina bifida
Folate (180-200 mcg) s/s of excess:
none known
B12 (cobalamin) sources:
only animal and fortified foods:

organ meats
meat
seafood
B12 (cobalamin) functions:
coenzyme in protein metabolism

formation of heme portion of hemoglobin
B12 (cobalamin) s/s of deficiency:
pernicious anemia due to lack of intrinsic factor or alcoholism
B12 (cobalamin) s/s of excess:
none knonw
water soluble vitamins:
Vitamin C
Bitamin B Complex (Thiamin)
Riboflavin
Niacin
B6 (pyridoxine)
Folate
B 12
Fat soluble vitamins:
Vitamin A
Vitamin D
Vitamin E
Vitamin K
Vitamin A (retinol, retinal, retinoic acid) 800-1000 Retinal equivalent

sources:
liver
carrots
egg yolk
fortified milk
Vitamin A (retinol, retinal, retinoic acid) 800-1000 Retinal equivalent

functions:
visual acuity
healthy skin and mucous membranes
Vitamin A (retinol, retinal, retinoic acid) 800-1000 Retinal equivalent

s/s of deficieny:
night blindness
rough skin
Vitamin A (retinol, retinal, retinoic acid) 800-1000 Retinal equivalent

s/s of excess:
anorexia
loss of hair
dry skin
bone pain
Vitamin D (cholecalciferol, ergosterol)

sources:
sunlight
fortified milk
fish liver oils
Vitamin D (cholecalciferol, ergosterol)

functions:
calcium and phosphorus metabolism

stimulates calcium absorption
Vitamin D (cholecalciferol, ergosterol)

s/s of defeciency:
retarded bone growth
bone malformation
Vitamin D (cholecalciferol, ergosterol)

s/s of excess:
excessive calcification of bones

renal calculi
Vitamin E sources:
vegetable oils
wheat germ
whole grain products
Vitamin E functions
antioxidant
protexts vitamin A
heme synthesis
Vitamin E s/s of defeciency:
anemia
vitamin E s/s of excess:
large doses can cause fatigue diarrhea
Vitamin K 65-80 mcg
sources:
dark green leafy vegetables

synthesized in intestines from gut bacteria
vitamin K 65-80 mcg
functions:
blood clotting
vitamin K 65-80 mcg s/s of deficiency:
hemorrhagic disease of newborn, delayed blood clotting
Vitamin K 65-80 mcg
s/s of excess:
hemolytic anemia & liver damage w/ synthetic vitamin K
Calcium (at least 800 mg)


lab data:
9.5-10.5 mg/dL
4.5-5.3 mEq/L
Calcium (at least 800 mg)

sources:
dairy
canned fish with bones
greens
Calcium (at least 800 mg)

functions:
bone and tooth formation
blood clotting
nerve transmission
muscle contraction
Calcium (at least 800 mg)

s/s of deficiency:
tetany
osteoporosis
Calcium (at least 800 mg)

s/s of excess:
renal calculi in susceptible people
Phosphorus lab data:
3.0-4.5 mg/L
Phosphorus sources:
soft drinks, processed foods, dairy
Phosphorus functions:
bone and tooth formation
acid-base balance
energy metabolism
Phosphorus s/s of deficiency:
hypophosphatemia: muscle weakness
Phosphorus s/s of excess:
hyperphosphatemia: symptoms of hypocalcemic tetany
Magnesium lab data:
1.3-2.1 mEq/L

1.4-1.9 mg/dL
Magnesium sources:
green leafy vegetables
nuts
beans
grains
Magnesium functions:
bone and tooth formation
protein synthesis
metabolism
Magnesium s/s of deficiency:
hypomagnesemia: poor heart function, Torsades de Pointe
Vitamin K 65-80 mcg
s/s of excess:
hemolytic anemia & liver damage w/ synthetic vitamin K
Calcium (at least 800 mg)


lab data:
9.5-10.5 mg/dL
4.5-5.3 mEq/L
Calcium (at least 800 mg)

sources:
dairy
canned fish with bones
greens
Calcium (at least 800 mg)

functions:
bone and tooth formation
blood clotting
nerve transmission
muscle contraction
Calcium (at least 800 mg)

s/s of deficiency:
tetany
osteoporosis
Calcium (at least 800 mg)

s/s of excess:
renal calculi in susceptible people
Phosphorus lab data:
3.0-4.5 mg/L
Phosphorus sources:
soft drinks, processed foods, dairy
Phosphorus functions:
bone and tooth formation
acid-base balance
energy metabolism
Phosphorus s/s of deficiency:
hypophosphatemia: muscle weakness
Phosphorus s/s of excess:
hyperphosphatemia: symptoms of hypocalcemic tetany
Magnesium lab data:
1.3-2.1 mEq/L

1.4-1.9 mg/dL
Magnesium sources:
green leafy vegetables
nuts
beans
grains
Magnesium functions:
bone and tooth formation
protein synthesis
metabolism
Magnesium s/s of deficiency:
hypomagnesemia: poor heart function, Torsades de Pointe
Magnesium s/s of excess:
CNS depression
coma
hypotension
Sodium (500 mg) lab values:
136-145 mEq/L
Sodium (500 mg) sources:
salt and *"hidden sodium"

IV saline
Sodium (500 mg) functions:
major ion of extracellular fluid
sodium (500 mg) s/s of deficiency:
skin clammy/ cold
agitated/ confusion
leg cramps
too little Na+
Sodium (500 mg) s/s of excess:
Edema
Thirst
Pattern of weight gain
High BP

*(E.T. Phone Home)
Potassium (1600-2000 mg) lab values:
3.5-5.0 mEq/L
Potassium (1600-2000 mg)sources:
whole grains
fruits
leafy vegetable
Potassium (1600-2000 mg)functions:
major ion of intracellular fluid
Potassium (1600-2000 mg)s/s of deficiency:
hypokalemia:

muscle cramps and weakness
irregular heart beats
EKG: u-wave
Potassium (1600-2000 mg) s/s of excess:
Hypekalemia:

irritability
ventricular dysrrhythmia
heart block
tall, tented T's
Iron (10-15 mg) sources:
lean and organ meats

enriched and whole grain breads and cereals
Iron (10-15 mg) functions:
oxygen transport by way of hemoglobin

constituent of enzyme systems
Iron (10-15 mg) s/s of deficiency:
microcytic anemia
pallor
fatigue
Iron (10-15 mg) s/s of excess:
hemosiderosis
acute iron poisoning
GI symptoms
shock
Iodine sources:
iodized salt
seafood
food additives
Iodine function:
component of thyroid hormones
Iodine s/s of deficiency:
goiter
Iodine s/s of excess:
acne-like lesions
What is the reccommmended to cut back sodium in persons with high blood pressure?
2 grams/2000 mg or less
medical nutrition therapy:
is prescribed for an individual by a physician or (when delegated by MD) by the dietitian or certified diatary educator in some states for disease control
____% to _____% of hospital patients are starving- not receiving adequate nutrition.
40-55

* a primary role of a RN is to keep pt. from starving in the hospital
Nutritional Screning:
Self-reported check-list (inexpensive)

Calculation of BMI (inexpensive, more objective than self-reported check list)

Limited anthropometric data (somewhat more expensive, not a good way to estimate- done by pinching fat. not good to use on children)

*screening especially useful for very young and the elderly
What foods do dilantin and tetracyclines interact with that should not be given with these meds?
dairy
What kind of juice interacts with a number of meds and the nurse should be cautious about"?
grapefruit juice
What do greens contain that interact with a number of meds?
iron
Anthropometry
height and wight
BMI
Body fat measurement
ideal body weight for males =
106 lbs for 5 feet + 6lbs per inch over 5 feet
ideal body weight for women =
100 lbs for 5 feet plus 5 lbs per inch over 5 feet
Albumin
3.5-5g/dL is normal

*cheap test for nutritional level- takes at least 1 week for it to fall if patient is malnourished
total lumphocyte count
1800-3000
transferrin
iron stores- done after an anemic blood count
total iron-binding capacity and hemoglobin
250-460mcg/dL

if <250 indicates poor nutrition
prealbumin
15-36 mg/dl

a sensitive indicator of protein status.

shorter half-life:2-3 days, most useful
mild malnutrition prealbumin levels
10-15 mg/dl
moderate malnutrition prealbumin levels:
5-10 mg/dl
severe malnutrition prealbumin levels:
<5 mg/dl
Carbohydrates should be __________% of your intake unless you're trying to lose weight
50-60
Good fiber level
25-30 g/day
How would you need to increase a patient's fiber intake?
slowly, to decrease bloating, flatulence, and diarrhea (increase fluid intake should accompany increased fiber intake
Sources of carbohydrates
grain products
fruits
vegetables (corn, potatoes, dried beans, peas)
milk/dairy products
refined sugars
Carbohydrates: Water soluble fiber effects on body:
slows gastric emptying/lower serum cholesterol

delays glucose absorption which helps in persons with diabetes

soluble fiber adds weight to stool (but no bulk to aid elimination, so may still need laxative)
Carbohydrates: Water insoluble fiber effects on body:
absorbs water to increase fecal bulk in the large intestine and to aid elimination

decreases intestinal transit time

may also reduce fat absorption (and indirectly lower cholesterol)
Very-low density lipoproteins function
transport triglycerides from liver to tissue

VLDLs
Low density lipoproteins function
plasma proteins with triglyceride components that carry cholesterol to cells (bad cholesterol)
High density lipoproteins
plasma proteins that carry fat in bloodstream to tissue or to liver to be excreted.


cardioprotective- "good cholesterol"

1:3 ratio
VAP analysis
a way to genetically determine risk factor for heart disease.

*genetics play into it because our liver produces cholesterol
clear liquid diet-
you can see through them- no milk! ex. coffee is clear if drank black
full liquid diet:
same as clear liquid but can add dairy (so liquid doesn't have to be see-through)

transition between clear and soft
pureed diet used for:
patients who have difficulty chewing/swallowing
mechanical soft diet used for:
patients with poor dentition
soft diet:
ex. easily digested foods (like mashed potatoes)
dysphagia diet
thickened diet provided for clients with difficulty swalling

ex. buttermilk consistency, pudding consistency, etc.
gastric by-pass diet:
small meals, low fat, high protein, no carbonated bverages, or high fiber

a restrictive/modified diet. is long-term.
low residue diet:
minimizes elimination, restrict high fiber foods, fried foods, pepper, alcohol, heavy seasonings

a restrictive/modified diet, is long-term
fat-controlled diet:
diet for malabsorption, chronic pancreatitis, gallbladder disease or clients with CVD, CHF

a restrictive/modified diet, is long-term
Protein=controlled diet
for patients with renal disease (ex. renal failure, ESRD, dialysis, and transplant) and liver diesase (liver failure, hepatic encephalopathy, cirrhosis, transplant, and hepatitis)

a restrictive/modified diet- is long-term
food allergy diet-
ex. an egg free diet for clients with known sensitivity

ex. glyten-restricted for celiac disease (malabsorption syndrome)

etc.

is a restrictive/modified diet- is long-term
purine-controlled diet
due to elevated uric acid levelsfor gout, tumor lysis syndrome, multiple myeloma

use dairy products.

restrict organ meats, anchovies, alcohol, and seafood.

a restrictive/modified diet- is long-term
sodium-controlled diet
usually 2400mg/day to as low as 500mg/day in renal failure

used to treat hypertension, fluid restrictions, CVD

is a restrictive/modified diet, is long-term
carbohydrate-controlled diet
diabetes mellitus

a restrictive/modified diet. is long-term
high fiber diet
includes complex carbs; low fat, wholegrain products; vegetables/fruits to promote normal bowel function

is a supplemental/enhanced diet
high-potassium diet
includes orange juice, apricots, cantaloupes, and bananas

for clients with K+ losses

is a supplemental/enhanced diet
high-calcium diet
includes milk/dairy products

for clients with low Ca++ losses (i.e. osteoporosis, kidney failure)

is a supplemental/enhanced diet
high protein diet:
for atheletes

dietician or MD needs to prescribed (because can be metabolized into ketones)

is a supplemental/enhanced diet
neutropenic diet
for those who have impaired immune function

restricts: fresh fruits, raw vegetables, nuts, seeds, dried fruits, black pepper, any foods that carry pseudomonas aeruginosa

heat treat ALL foods to destrow bacteria. so for ex., can't give raw fruits/veggies
Cancer chemotherapy/radiation:

1.Radiation intended to destroy _______
2. may also destroy ____ of ____ ______.
3. can cause these problems in GI:
4. Can cause these problems in Head/neck
1.malignant cells
2. lining of GI tract
3. anorexia, stomatitis, severe diarrhea, strictures of intesines, and pain
4. can distort taste, smell, salivation, & can cause dysphagia.
Nutrition care in cancer: chemotherapy and radiation
small, frequent meals

nutrient dense high calorie, high protein meals

add extra nutrient dense food such as honey, powdered skim milk, peanut butter, cheese

limit liquids with meals- contribute to nausea
conditions causing nausea and/or poor appetite may also respond to:
-avoid spicy, gas-forming, or hard-to-digest foods
-small frequent meals or snacks
-pay attention to nutrient density and individual preferences
-make eating experience social if desired
- take anti-nausea meds prior to eating
- control environment (smells, excess stimulation)
- appetite stimulants such as Megace, MArinol, Periactin, or small glass of wine may help
Nutritional problems with HIV/AIDS:
-inadequate intake, body wasting, severe weight loss
- anorexia, stomatitis, oral thrush, N/V, severe diarrhea, GI malabsorption
-altered metabolism- greater risk for systemic infections
-medications to treat HIV/AIDS cause side effects that alter nutrition
Nutritional Interventions w/ HIV/AIDS
-monitor weight, protein status (serum albumin, prealbimin, transferrin, and total lymphocyte count)
-good handwashing, food safety, low-fat diets, and small frequent nutrient-dense meals
-possible neutropenic diet
Client GI upset problems from N/V/D
-dehydration
-loss of electrolytes
- metabolic alkalosis
-metabolic acidosis
-malabsorption/malnutrition
Interventions for GI upset from N/V/D
- progress diet as tolerated
- NPO- progress to clear liquids to rest intestine
-bland diet & small frequent meals
- eliminate coffee, alcohol, pepper, spicy foods
-BRAT diet
- Provide limited protein and fat food for energy
- replace fluid and electrolytes, limit sugars
-daily weights
- I&O
BRAT diet
Bananas
Rice
Applesauce
Toast

*good for peds
*used in GI upset
Surgical client problems with nutrition:
-anesthesia stops/decreases peristalsis
-auscultate for bowel sounds
- place on progressive diet- begin with ice chips/ clear liquids & progress as tolerated (to prove they're able to use peristalsis)
-hunger is a good indication to start food back- don't have to auscultate bowel sounds to give ice chips/clear liquids
Nutritional Routs:
1. oral
2. Enteral (gastrostomy, jejunostomy, nasogastric)
3. Parenteral (cannot give any thing but lipids and TPN through it!)
Parenteral nutrition
-TPN or hyperalimintation of lipids
-for clients who are unable to digest or absorb enteral nutrition
-administration site- IV peripheral or CVL but central venous line is preferred
- solutions: <10% dextrose can be given peripherally. >10% must be given in CVL (most ~D70W)
-components: glucose, amino acids, vitamins/minerals, lipids
Parenteral nutrition interventions:
-verify TPN w/ 2 RN's
-5 Rights
- inspect bag integrity before hanging
- infuse with infusion pump only
-do not abruptly d/c- hypoglycemia can occur.
-follow policy if it runs out- may hang D10W or D20W!
-Inspect IV site for s/s of infection- very high risk of sepsis
- assess for allergic reaction
-assess Labs: phosphorus, Na, K, Cl, CO2, BUN, creatinine, blood glucose.
IV lipids
-used to provide essential fatty acids
-exists in different concentrations 10-30%
-considered isotonic
- clients allergic to eggs should not get this soln.