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103 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Infant Fluid Needs
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at least 6 wet diapers a day; Breast milk is adequate for the first 6 months of life then rice cereal should be added bc it will likely not be an allergen
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Infant Protein Needs
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2.2 gm/kg/day
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Pregnancy Dietary needs
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add per day: 300 calories, 15 mg iron, 30 g protein, 400 g calcium, and 200 ug folic acid
lactation - add 500 calories and 2 quarts extra fluid per day |
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Elderly Nutrition Needs
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if over 65 adequate protein is needed to keep up immune system
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Carbs
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Sugars, starches, fibers
Protein sparer Gives the body most of its energy 4kcal/gram fuels brain, peripheral nerves, WBCs, RBCs, and healing wounds |
Plant sources except lactose
Extra will be stored as fat so 50-60%of calories should be complex carbs |
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Lipids
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unsaturated fat-veggies
saturated-animal polyunsaturated are essential-linoleic and linolenic most concentrated source of energy (9 kcal/gram) major form of stored energy insulation component of cell membranes carries fat-soluble vitamins A, D, E and K |
deficiency leads to skin, blood, and artery problems
recommended intake total fat intake should not exceed 30% of daily calories with saturated fats not exceeding 10% of total daily caloric intake |
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Proteins
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secondary energy source (4 kcal/gram)
essential for cell growth efficiency can affect all of body - organs, tissues, skin, muscles recommended protein intake: 0.8 grams per kg of body weight per day the body's only source of nitrogen negative nitrogen balance can occur with infection, burns, fever, starvation, and injury |
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Vitamins
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organic substances essential for body growth and metabolism
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Vitamin Types; Water soluble
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vitamin C and B-complex vitamins (thiamin, riboflavin, niacin, pantothenic acid, biotin, B6, folate, B12)
cannot be stored in body require daily intake |
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Vitamin Types; Fat soluble
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A,D,E, K
stored primarily in the liver and adipose tissues absorbed by the body from the intestinal tract |
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Minerals
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inorganic substances essential as catalysts in biochemical reactions
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Mineral Functions
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catalyst of acid-base balance, help cells metabolize, tissues absorb nutrients, and heart muscle respond
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Mineral type-Major
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calcium, magnesium, sodium, potassium, phosphorus, sulfur, chlorine
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Mineral Type -Trace
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trace minerals - iron, copper, iodine, manganese, cobalt, zinc and molybdenum
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Cation-Sodium
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most abundant cation in extracellular fluid
regulates cell size via osmosis essential in maintaining water balance, transmitting nerve impulses, and contracting muscles regulates acid-base balance by exchanging hydrogen ions for sodium ions in kidney normal lab value for serum sodium is 135 to 145 mEq/L sodium is regulated by salt intake, aldosterone, and urinary output sources include table salt, processed meats, snacks and canned food |
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Cation-Potassium
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most abundant cation of intracellular fluid
potassium pump draws potassium into cell essential for polarization and repolarization of nerve and muscle fibers regulates neuromuscular excitability and muscle contraction sources include whole grains, meat, legumes, fruits and vegetables regulated by kidneys normal lab value for serum potassium is 3.5 to 5.3 mEq/L |
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Cation-Calcium
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essential for healthy bones and teeth, cell membrane integrity, blood clotting, cardiac contraction, blood pressure, functioning of nerves and muscles and maintaining immune defenses
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Cation-Magnesium
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normal constituent of bone; cofactor for enzymes in energy metabolism, neurochemical activities, muscular excitability
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Anion-Chloride
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most abundant anion in extracellular fluid; part of hydrochloric acid found in stomach and necessary for proper digestion; helps balance sodium; normal lab value for serum chloride is 100 to 106 mEq/L
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Anion-Bicarbonate
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part of bicarbonate buffer system; limits the drop in pH by combining with an acid to form carbonic acid and a salt
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Anion-Phosphate
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participates in cellular energy metabolism, combines with calcium in bone, assists in structure of genetic material
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Osmoreceptor
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regulates water output system, stimulated by dehydration and activates thirst center, and stimulates ADH
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Thirst center
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located in hypothalamus
stimulated by increased plasma osmolality angiotensin II dry pharyngeal mucous membranes decreased plasma volume depleted potassium psychological factors |
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Aldosterone
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Mineral corticoid- when extracellular fluid sodium decreases or potassium levels increase
adrenal cortex secretes aldosterone kidneys stimulated by aldosterone to increase reabsorption of sodium and decrease reabsorption of potassium results in water reabsorption and increased blood volume |
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Renin/Angiotensin
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hormone affecting renal tubule reabsorption of water
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Atrial natriuretic Peptide
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hormone affecting renal tubule reabsorption of water
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Parathyroid
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secretes parathyroid hormone (PTH), also called parathormone
stimulates release of calcium from bone, reabsorption in small intestine and kidney tubules when serum calcium level is low, PTH secretion increases when serum calcium level rises, PTH secretion falls high levels of active vitamin D inhibit PTH and low levels or magnesium stimulate PTH secretion |
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Goals of Diabetic Nutrition Management
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providing all essential nutrients
meeting energy needs achieving and maintaining a reasonable weight preventing wide daily fluctuations in blood glucose levels decreasing serum lipid levels |
diet individualized according to client's age, build, weight, and activity level
recommended caloric distribution: 50-60% carbohydrates, 20-30% fat, and 10-20% protein |
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Low Protein Diet
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for renal disease such as pyelonephritis, uremia, kidney failure
limit protein less than 40 g/day (0.5 g/kg/day) instead of normal protein intake of 40 to 60 g/day (1g/kg/day) restricted foods: meats and other foods high in protein such as legumes, fish, dairy |
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High Protein Diet
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for conditions such as burns, anemia, malabsorption syndromes, ulcerative colitis
include high quality proteins or protein supplements such as Sustagen® promote high protein intake more than 60 g/day (1.5 g/kg/day) instead of normal protein intake of 40 to 60 g/day (1g/kg/day) |
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Low Calcium Diet
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limit to 400 mg per day instead of normal 800 mg
restricts dried fruits and vegetables, shell fish, cheese, nuts |
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Acid Ash Diet
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prevents kidney stone formation
restricts carbonated beverages, dried fruits, banana, figs, chocolate, nuts, olives, pickles |
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Low Purine/ Gout Diet
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prevents uric acid stone; used for clients with gout
lowers levels of purine, the precursor of uric acid restricts glandular meats, gravies, fowl, anchovies, beer and wine |
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Gluten free/restricted Diet
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used for people with sensitivity to glutens (proteins) in wheat, oats, rye, and barley
may eat rice, corn and millet products |
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Low Cholesterol Diet
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used for cardiovascular disease, high serum cholesterol levels
normal amount of cholesterol intake - 250 to 300 mg/day restricts eggs, beef, liver, lobster, ice cream |
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Low Sodium Diet
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used in congestive heart failure, hypertension
used for correcting the retention of sodium and water levels of restriction mild (2 g sodium) moderate (1000 mg sodium) strict (500 mg sodium) restricts table salt, canned vegetables, smoked meats, butter, cheese |
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High Fiber Diet
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used to correct constipation, lower risk of colon cancer
30 to 40 gram fiber/day recommended increased intake of fruits, vegetables, bran cereals |
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Low Residue Diet
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used for conditions such as diarrhea, diverticulitis
reduce fiber intake: canned fruit, refined carbohydrates, pasta, strained vegetables foods high in refined carbohydrates are usually low fiber increased use of ground meat, fish, broiled chicken without skin, white bread |
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Mechanical Soft Diet
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used with difficulty in chewing, such as poorly fitted dentures or endentulous clients (no teeth)
includes any foods which can be easily broken down by chewing |
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Puree Diet
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used with dysphagia or difficulty in chewing
used for tube feedings, small babies food is blended to smooth consistency |
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Low Calcium Diet
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limit to 400 mg per day instead of normal 800 mg
restricts dried fruits and vegetables, shell fish, cheese, nuts |
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Acid Ash Diet
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prevents kidney stone formation
restricts carbonated beverages, dried fruits, banana, figs, chocolate, nuts, olives, pickles |
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Low Purine/ Gout Diet
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prevents uric acid stone; used for clients with gout
lowers levels of purine, the precursor of uric acid restricts glandular meats, gravies, fowl, anchovies, beer and wine |
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Gluten free/restricted Diet
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used for people with sensitivity to glutens (proteins) in wheat, oats, rye, and barley
may eat rice, corn and millet products |
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Low Cholesterol Diet
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used for cardiovascular disease, high serum cholesterol levels
normal amount of cholesterol intake - 250 to 300 mg/day restricts eggs, beef, liver, lobster, ice cream |
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Low Sodium Diet
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used in congestive heart failure, hypertension
used for correcting the retention of sodium and water levels of restriction mild (2 g sodium) moderate (1000 mg sodium) strict (500 mg sodium) restricts table salt, canned vegetables, smoked meats, butter, cheese |
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High Fiber Diet
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used to correct constipation, lower risk of colon cancer
30 to 40 gram fiber/day recommended increased intake of fruits, vegetables, bran cereals |
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Low Residue Diet
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used for conditions such as diarrhea, diverticulitis
reduce fiber intake: canned fruit, refined carbohydrates, pasta, strained vegetables foods high in refined carbohydrates are usually low fiber increased use of ground meat, fish, broiled chicken without skin, white bread |
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Mechanical Soft Diet
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used with difficulty in chewing, such as poorly fitted dentures or endentulous clients (no teeth)
includes any foods which can be easily broken down by chewing |
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Puree Diet
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used with dysphagia or difficulty in chewing
used for tube feedings, small babies food is blended to smooth consistency |
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Low Fluid Diet
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clear liquid: coffee without cream, tea, popsicles, fruit juices, including apple, cranberry, grape, and carbonated beverages
full liquid: includes all clear liquids plus milk, cream, ice cream, pudding, yogurt, vegetable juice, creamy peanut butter |
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Nutritional Assessment
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weight change
appetite food intolerance chewing and swallowing indigestion elimination habits eating behaviors nutrient-drug interactions anthropometric measurements |
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Feeding Tubes
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inability to ingest, chew, or swallow food, but GI tract intact
tube inserted through nose into stomach or small bowel; or inserted endoscopically; gastrostomy tube or PEG tube, jejunostomy tube |
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Small Bore Feeding Tube
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8 to 12 Fr and 36 to 43 inches long
difficult to aspirate stomach contents may be impossible to auscultate an air bolus or air bolus may be heard even when tube is not in stomach tubes may become displaced even when securely taped hard to verify placement; therefore best initial method is by x-ray; thereafter routine check of stomach contents pH |
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Enteral Feeding Tubes
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keep head of bed raised at least 30 degrees, to prevent aspiration
assess placement of tube by xray |
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Administration of Enteral Feeding Tubes
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may be continuous or intermittent
to prevent bacterial growth, change bag and tubing every 24 hours and tube feeding formula every 4 to 8 hours to prevent fluid and electrolyte imbalances, administer tube feedings at a rate of no more than 300 mL/hr assess every 4 hours if continuous feeding or before you begin intermittent feedings |
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Enteral Tube feeding complications
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aspiration
gastrointestinal complications (diarrhea) electrolyte or metabolic problems |
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Nutritional Supplements for Dehydration
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infants: Infalyte, Pedialyte®, Ricelyte®
older children: sports electrolyte replacement drinks infant formulas: standard and high-calorie specialty formulas: predigested, e.g., Pregestimil, Nutramigen high-calorie supplements, e.g., Scandishake, Carnation Instant Breakfast |
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Ileostomy
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liquid to semi-formed stool, dependent upon amount of bowel removed
may skew fluid and electrolyte balance, especially potassium and sodium digestive enzymes in stool irritate skin do not give laxatives ileostomy lavage may be done if needed to clear food blockage may not require appliance; if continent ileal reservoir or Kock pouch |
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Colostomy
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ascending - must wear appliance -semi-liquid stool
transverse - wear appliance - semi-formed stool loop stoma double barrel sigmoid-formed stool bowel can be regulated so appliance not needed may be irrigated |
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Stoma assessment
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Stoma assessment
color - should be same color as mucous membranes edema - common after surgery bleeding - slight bleeding common after surgery |
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Psych diagnosis of having a stoma
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disturbed body image
anxiety related to feared rejection ineffective coping related to ostomy care |
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Types of Insomnia
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initial insomnia: difficulty falling asleep
intermittent insomnia: difficulty remaining asleep terminal insomnia: difficulty going back to sleep |
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Nursing care for sleep restoration
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Comfort measures
Pharmacologic: sedatives, hypnotics Sleep routine Encourage daytime activity Eliminate naps Relaxation techniques Environmental control Limit alcohol, caffeine, and nicotine in evening |
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Somatic Pain
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Source:
the nerves (nociceptors) that detect somatic pain are located in the skin and deep tissues, picking up sensations related to temperature, vibration and swelling tissues such as skin, muscle, joints, bones, and ligaments often described as musculoskeletal pain |
Characteristics: often sharp and well localized
sharp and well-localized tends to be intense Examples: fibromyalgia, tension headaches, chronic back pain (not caused by nerve damage), arthritis |
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Visceral Pain
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Source:
comes from the internal organs specific receptors for stretch, inflammation, and oxygen starvation (ischemia) are involved |
Characteristics
often poorly localized may feel like a vague, deep ache that involves a cramping sensation frequently produces referred pain to the back (but it is not in a direct nerve distribution), e.g., gallbladder pain can radiate to the scapula Examples: irritable bowel syndrome, cystitis, endometriosis pain, prostate pain |
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Neuropathic Pain
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Source: caused by damage to or dysfunction of the nerves, spinal cord, or brain (the central nervous system)
often coexists with nociceptive pain follows nerve distribution path also known as a "pinched nerve" |
Characteristics
the signals are interpreted by the brain as pain and are commonly described as shooting, burning or hypersensitive the client may also state that there is numbness, tingling and weakness involved in the area of referred pain there is often referred pain |
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Neuropathic Pain Causes
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nerve compression, as with a tumor or ruptured intervertebral disk
nerve damage, as occurs in metabolic disorders such as diabetes mellitus abnormal or disrupted processing of pain signals by the brain and spinal cord Examples: diabetic neuropathy, trigeminal neuralgia, postherpetic zoster pain, thalamic pain syndrome, sciatica |
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Sympathetic Pain
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Source: due to possible over-active sympathetic nervous system and central/peripheral nervous system
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Characteristics:
presents as extreme hypersensitivity in the skin and around the injury and also peripherally in the limb the limb is usually so painful that the client will refuse to use it, which can cause secondary problems like muscle wasting and joint contractures |
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Sympathetic Pain Causes
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occurs more commonly after a fracture and soft tissue injuries of the arms and legs, and these injuries may lead to Complex Regional Pain Syndrome (CPRS), which is also called Reflex Sympathtic Dystrophy (RSD)
Examples: neuropathy, neuralgia, neuritis |
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Non-nociceptive/ nerve Pain
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arises from within the peripheral and central nervous systems; pain is generated by nerve cell dysfunction or damage. Faulty signals are sent to the brain and are experienced as pain.
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Neuropathic, Sympathetic
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Brocha's Aphasia
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arises from within the peripheral and central nervous systems; pain is generated by nerve cell dysfunction or damage. Faulty signals are sent to the brain and are experienced as pain.
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Wernicke's Aphasia
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inability to understand the meaning of spoken words and reading and writing is impaired; able to speak but speech is not normal
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Specific gravity levels
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1.010-1.030
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Creatinine levels
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0.7-1.4 mg/dL
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Anuria definition and level
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suppression of elimination
total output <100mL/24hrs |
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Oliguria definition and level
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scant urination
total output 100-400 mL/24 hr |
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Polyuria definition and level
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increased output
total output >2000 ml/24 hr |
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Dysuria definition
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painful or difficult voiding
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Pyelonephritis Assessment
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chills, fever, malaise, flank pain , urinary frequency, dysuria, CVA tenderness
inflammation of kidney caused by bacterial infection |
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Pyelonephritis Interventions
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bedrest during acute phase, antibiotic therapy, antiseptics, analgesics
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Pyelonephritis causes
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UTI, pregnancy, tumor, urinary obstruction , E. coli
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Glomerulonephritis assessment
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fever, chills, hematuria, red cell casts, proteinuria, dark colored urine
weakness,pallor dyspnea, wt gain, lung rales, fluid overload anorexia, n/v edema; facial & general mod-severe HTN headache, decreased LOC, confusion abd or flank pain oliguria with fixd specific gravity antistreptolysin-O titers |
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Glomerulonephritis interventions
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antibiotics, corticosteroids, antihypertensives, immunosuppressive agents, diuretics
restrict sodium and water daily wts, I/O, and K+ bedrest high calorie, low protein diet dialysis |
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phantom limb pain treatment
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Residual limb desensitization with kneading massage
Distraction and activity TENS, ultrasound, local anesthetic Beta blocker: dull, burning sensation Anticonvulsant: stabbing & cramping sensation Antispasmodic: muscle cramps or cramping |
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What is a complete fracture
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A [complete] break across the entire cross-section of bone
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What is an incomplete fracture
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A break through a portion of the bone
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What is a closed Fracture
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no external communication
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What is an open fracture
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a break through the skin
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Splinting
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immobilization of the affectted part to prevent the soft tissue from being damaged by bony fragments
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Internal fixation
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use of metal screws, plates, nails, and pins to stabilize reduced fracture
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Open reduction
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surgical dissection and exposure of the fracture for reduction and alignment; open the area for manipulation/surgery
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Closed reduction
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manual manipulation or traction of fracture; popping it back into place or using traction and cast to set
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Purpose of traction
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Reduce the fracture
Alleviate pain and muscle spasm prevent or correct deformities promote healing |
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Skin Traction
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Buck's, Russell's Pelvic
pulling force applied to the skin |
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Skeletal Traction
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Halo, crutchfield tongs
pulling force applied to the bone |
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Care for traction
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maintain straight alignment of ropes and pulleys
assure wts hang free frequently inspect for skin breakdown maintain position for countertraction move unaffected areas clean pins with half strength peroxide or saline and sterile swabs 1-2 times a day if ordered |
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Buck's Traction
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Relieves muscular spasm of legs and back
If no fracture-free to move on either side If fracture-turn to unaffected side Elevate foot of bed for countertraction Use trapeze to move Place pillow under lower leg, NOT HEEL Do NOT elevate knee gatch |
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Russell's Traction
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"Pulls" Contracted muscles
elevate foot of bed with shok blocks for countertraction loosen sling for care, check popliteal pulse , pillows under lower leg-heel off the bed DO NOT turn from waist down Lift patient not leg to give assistance |
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Halo vest
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Immobilizes cervical spine; pins maintain traction
cleanse around pins using sterile technique at insertion site; if Rx use half strength peroxide or saline and sterile swabs a couple times a day |
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Contusion
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ecchymosis and hematoma
injury of soft tissue |
Treat with cold app for 24 hours followed by moist heat; apply elastic bandage
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Strains/Sprains
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Pain and swelling
Strain:muscle and/or tendon pull or tear Sprain: torn or stretched ligament |
trat with rest and elevation of affected part
ice compress for 24 hours, followed by heat application; apply elastic pressure bandage and minimize use |
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Joint dislocation
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Pain and deformity
displacement of jouint bones so their articulating surfaces lose all contact |
orthopedic emergency; immobilize and reduction (put back in place under anesthesia) bandages and splints used to immobilize until healed
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