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48 Cards in this Set
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- Back
- 3rd side (hint)
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CHOs
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Minimum amount to fuel brain is 130 g/day
Provide energy for cellular work Help regulate protein and fat metabolism Essential for normal cardiac and CNS functioning. |
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Complex CHO
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Easily absorbed into intestine and bloodstream
Uses pancreatic and intestinal enzymes Stored in liver and muscles for energy needs as glycogen Provides 4 cal/g of energy |
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Fiber
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Indigestible plant foods
Adds bulk to feces Stimulates peristalsis Helps lower cholesterol Decreases incidence of cancer |
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Proteins
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Provided by plant and animal sources
Necessary for tissue building and maintenance Balance of nitrogen and water Support the immune system Undernutrition can lead to protein malnutrition --Kwashiorkor or marasmus |
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Lipids
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Chemical group of fats
Divided into following categories Triglycerides Phospholipids Cholesterol Saturated fats Metabolism in small intestine gallbladder secretes concentrated bile Breaks down fat into smaller particles Pancreas secretes pancreatic lipase |
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Vitamins
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Organic substances
Necessary for many enzymatic reactions Main function is to be a catalyst for metabolic functions and chemical reactions Water soluble vs. fat soluble (see handout) |
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Basal metabolic Rate: BMR
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Amount of energy that is used while body is at rest
Affected by lean body mass and hormones Men>women |
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Catabolic illness
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Surgery; burns
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Nitrogen balance
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Indicator of tissue integrity
Negative nitrogen balance Excretion of nitrogen > intake Not initially seen Eventually Muscle wasting Impaired organ function Increase susceptibility to infection |
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Clinical signs of malnutrition
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Pitting edema
Hair loss Wasted appearance |
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Prealbumin (mg/dL) (transthyretin.)
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Normal: 20-40
Mild depletion 10-15 Moderate depletion 5-9 Severe depletion <5 |
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Albumin
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Normal: 3.5-5.5
Mild Depletion: 2.8-3.4 Moderate Depletion: 2.1-2.7 Severe Depletion: <2.1 Decrease in plasma volume = falsely elevated albumin Expanded plasma volume (heart failure or renal disease) = falsely decreased albumin |
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Transferrin
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Protein synthesized by liver
Used to transport iron Decreases during states of protein deficiency |
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Transferrin saturation
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Men: 10%–50%
Women: 15%–50% |
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Total iron-binding capacity (TIBC)
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250–400 mcg/dL
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Risk Factors for Inadequate Nutrition
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Biophysical Factors
Medical disease/conditions/treatment HTN HIV/AIDS Surgery Genetic predisposition Lactose intolerance Osteoporosis Age |
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Psychological Factors for Inadequate Nutrition
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Mental illness
Clinical depression Excessive stress Negative self-concept Use of comfort foods |
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Socioeconomic Factors for Inadequate Nutrition
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Poverty
Alcohol and drug abuse Fad or “special” diets Food preferences Cultural Ethnic Religious |
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problem with diuretic and low-sodium diet.
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Diuretics can cause sodium and potassium imbalances
Low-sodium diet may be unappetizing and cause inadequate consumption |
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Osteoporosis has many modifiable risk factors
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Calcium and vitamin D intake
Inactive lifestyle Cigarette smoking Alcohol intake |
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Salmonella
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Undercooked or raw meat, poultry, eggs
Fish Fruit Dairy products |
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Salmonella S/S
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h/a
Fever abdominal cramping n/v Condition can be fatal |
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Escherichia coli
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Raw of undercooked meat; especially hamburger
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Shigella
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Poor personal hygiene
Dairy products and salads |
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Types of Therapeutic Diets
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Clear liquid
-Indications -Acceptable foods Full liquid Blenderized liquid (Pureed) Diet Soft -Bland -Low-fiber Mechanical soft Regular -DAT |
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Starvation Process
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Early phase
-CHO stores depleted within 18 hours Intermediate -Protein converted to glucose (gluconeogenesis) -Negative nitrogen balance -Body fat fully utilized within 5-9 days Final Phase -Protein depletion ongoing Impaired liver function Plasma proteins decreased Especially albumin which normally maintains osmotic pressure in blood Fluid shifts into interstitial compartment Visible edema; masks muscle wasting |
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Conditions That Increase Risk for Malnutrition
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Chronic alcoholism
Decreased mobility; limiting factors to obtain food Nutrients lost due to malabsorption, dialysis, fistulas or wounds Certain medications; corticosteroids/oral antibiotics Hypermetabolism or stresses; i.e., infection, burns, trauma, or fever No po intake and/or receiving standard IV (D5W) for >5 days. |
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Oral supplemental feedings
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Sustacal
Ensure |
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Delivery options
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Continuous via infusion pump
-Kangaroo pump Intermittent cyclic feedings -Mimics typical feeding pattern for patient -Feed only during day Gravity via syringe -250cc at a time -Seen more in long term facilities |
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Nasogastric Tubes
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Gastric (Salem) tube
Enteric Tubes; also known as duodenal tubes (Duotubes; Dobbhoff) |
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Nasogastric Tube Insertion
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-Measurements
-Inspection of nasal airways -Obtain necessary equipment Flashlight NGT/Lubrifax Cup of water Tissues Towel/emesis basin Tape/safety pin |
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Continuous feedings
Goals |
Small amounts over long periods
Achieve + nitrogen balance and weight maintenance Reduce incidence of abdominal cramps/diarrhea |
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Maintaining delivery system
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Make sure pump is working correctly
Change bag q 24 or hospital policy Only keep enough in bag for 4 hour period -Unless premixed bottles |
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Reglan (metoclopramide)
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Uses: gastroparesis, GI reflux, antiemetic
Po 5-10mg po ac and hs or (liquid form for tube feeds) IV 10mg IVP over 2 minutes GI stimulant: increases motility of the upper GI tract Relaxes pyloric sphincter s/e: drowsiness, restlessness, confusion |
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Parenteral Nutrition Complications
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Bacterial Infection
Liver Failure Fluid overload Hyperglycemia |
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A patient asks why her waist circumference measurement is needed. Which of the following is the nurse's best response to this patient?
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A. "It helps determine if the BMI is accurate."
B. "It is more reliable that using skinfold measurements." C. "It is the only tool that can reliably provide information on nutritional status." D. "It helps in determining the risk for cardiovascular disease." |
D.* "It helps in determining the risk for cardiovascular disease."
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The nurse has identified a nutritional learning need for a patient. Which of the following is the best instruction for the nurse to give this patient?
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A. Use the WAVE or REAP tool.
B. Ask the patient to complete a 1-day food diary. C. Discuss the importance of skinfold testing. D. Provide the results of laboratory data |
A.* Use the WAVE or REAP tool.
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A nurse is conducting a nutrition assessment on a client who is admitted for hip replacement surgery. The client reports that he is Jewish and follows the kosher dietary tradition. Which of the following statements by the nurse will have the greatest impact on the client's nutritional health during his hospitalization?
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A. "I'll arrange for a dietitian to come and discuss your food requirements with you."
B. "Would you be more comfortable with having your family bring you food from home?" C. "Remember that you will need to increase your protein input postsurgery." D. "Please tell me more about your preferred eating habits." |
D.* "Please tell me more about your preferred eating habits."
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A nurse is advising a client who is concerned about losing weight. When discussing daily nutritional requirements, the client reports hating vegetables. Which of the following statements best reflects the nurse's understanding of the current recommendations appropriate for this client?
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A. "Would you consider drinking a vegetable juice in place of whole vegetables?"
B. "If you want to maintain a healthy weight, eating vegetables will help tremendously." C. "Vegetables are generally low in calories, and should be incorporated in the daily diet." D. "Can you try eating a serving of carrots or spinach either cooked or in a salad daily?" |
D.* "Can you try eating a serving of carrots or spinach either cooked or in a salad daily?"
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A patient of childbearing age asks the nurse what the most important thing she can do to improve her nutritional status is. The nurse should suggest that the patient:
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A. Consume low-fat milk products.
B. Choose foods with little salt. C. Ask her doctor if she has iron deficiency anemia; if so, begin treatment. D. Be physically active every day. |
C.* Ask her doctor if she has iron deficiency anemia; if so, begin treatment.
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The nurse has been asked to review written material on nutrition that is being distributed at a senior citizen center. The nurse recognizes that which of the following statements does not accurately reflect the Healthy People 2010 Nutrition Objectives and should be revised?
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A. The typical diet should contain at least three whole-grain choices daily.
B. Sodium intake should be less than 2400 mg daily. C. An adult should consume at least two servings of fruit daily. D. Saturated fats should account for no more than 30% of one's daily calories. |
D.* Saturated fats should account for no more than 30% of one's daily calories.
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The nurse is planning care for a postoperative patient. Which of the following should be included when planning for this patient's nutritional needs?
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A. Protein intake should be restricted.
B. Calories should be limited because of reduced activity. C. Carbohydrate intake should be restricted. D. Daily caloric intake should be increased. |
D.* Daily caloric intake should be increased.
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A patient undergoing treatment for cancer is admitted to the burn unit. To support this patient's nutritional needs, the nurse should:
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A. Monitor the patient for signs of deteriorating nutritional status.
B. Discuss nutritional needs with a dietitian to ensure all physiological needs are met. C. Plan to provide extra protein to support the burn injuries. D. Restrict protein while increasing calories. |
B.* Discuss nutritional needs with a dietitian to ensure all physiological needs are met.
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The nurse is caring for a client receiving an extensive regime of chemotherapy. The nurse recognizes that the client's ability to avoid muscle wasting during this treatment is most affected by:
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A. His pretreatment nutritional status.
B. The management of any nausea and vomiting. C. His general attitude related to food. D. The nutritional value of the foods the client is likely to eat. |
A.* His pretreatment nutritional status.
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A patient is admitted with celiac sprue. Which of the following should be done to address this patient's nutritional needs?
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A. Instruct the patient to consume products identified as "new and improved."
B. Encourage the use of distilled vinegar. C. Limit iron and B vitamin intake. D. Identify gluten-containing foods and eliminate them from the diet. |
D.* Identify gluten-containing foods and eliminate them from the diet.
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The nurse is evaluating the client's knowledge related to healthy food choices appropriate for a weight-loss diet. The nurse recognizes a need for further education when the client selects which of the following from the dinner menu?
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A. Baked rosemary chicken and sautéed spinach
B. Grilled tuna and green salad C. Pork sparerib and garlic mashed potatoes D. Pasta with olive oil, tomatoes, and garlic |
C.* Pork sparerib and garlic mashed potatoes
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1. When positioned properly the tip of a central venous catheter should lie in the
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a. Superior vena cava
b. Basilic vein c. Jugular vein d. Subclavian vein |
a. Superior vena cava
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2. When a central venous catheter dressing becomes moist or loose, what should the nurse do first?
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a. Draw a circle around the moist spot and note the date and time
b. Notify the physician c. Remove the catheter, check for catheter integrity, and send the tip for culture d. Remove the dressing, clean the site, and apply a new dressing |
d. Remove the dressing, clean the site, and apply a new dressing
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