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55 Cards in this Set

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  • Back
What helps balance out the acidosis or alkalosis in the blood?
The lungs (respiratory) and kidneys (metabolic)
What do the lungs control?
Carbonic acid!
What do the kidneys control?
What is the normal pH range?
7.35 to 7.45
If the pH levels are BELOW the normal range (below 7.35), what state is the patient in?
If the pH levels are ABOVE the normal range (above 7.45), what state is the patient in?
With pH questions- what are the two steps?
1. Determine acidosis or alkalosis
2. Determine respiratory (lungs) vs. metabolic (kidneys)
pCO2 correlates with _______.
HCO3 correlates with _______.
pCO2: Lungs
HCO3: Kidneys
What foods are high in K+?
*Dark leafy greens, citrus, tomatoes, potatoes, oranges, etc.
What is water intoxication, why can it be fatal?
-Excessive water and intracellular fluid volume= osmolar dilution results
-Cells swell, especially brain cells
-Can cause headache, nausea, vomiting, muscle twitching, convulsions, stupor
-If untreated, can be fatal
-If someone drinks a lot of water that doesn't have a lot of electrolytes...Then it can dilute sodium levels to a point where it is fatal to the body.
How is water regulated in the body?
Osmo receptors that pick up on concentration changes- High concentration (of particles to water in cell) provokes drive to drink water.
What is the role of the brain and water regulation? Kidneys?
*Brain: Regulates water through ventromedial and anterior hypothalamus (near pituitary gland, which regulates ADH); high concentration of electrolytes = thirsty.
*Kidneys: Respond to antidiuretic hormone involved (ADH); Renal tubules absorb more water in response to ADH.
What are the different compartments in the body where water is held?
Common causes of respiratory alk.
Hyperventilation or excessive exercise
Common causes of metabolic acidosis?
Uncontrolled diabetes
Common causes of metabolic alkalosis?
COPD and emphysema
What is significant weight change?
What is the maximum age to use growth charts?
20 years
What are the parameters for degrees of malnutrition?
5% of body weight lost within 30 days.
Positive acute phase respondents?
C Reactive Protein (CRP)
*It's levels go UP with trauma, stress, etc.
*When trauma/stress goes away, CRP levels go down.
Negative acute phase respondents?
Albumin, transferrin
*Levels go DOWN with trauma, stress, etc.
*When things go back to normal, levels go back up.
If albumin is really low, what might you notice about the patient?
Skin exam- Edema or pitting!
What labs are drawn for CBC?
Complete blood count:
-Red blood cells
-Hemoglobin concentration
-Mean cell volume
-Mean cell hemoglobin
-Mean cell hemoglobin concentration
-White blood cell count
What labs are drawn for BMP?
Basic metabolic panel:
-CO2 (carbon dioxide, bicarbonate)
-Blood urea nitrogen (BUN)
What labs are drawn for CMP?
Comprehensive metabolic panel:
-CO2 (carbon dioxide, bicarbonate)
-Blood urea nitrogen (BUN)
-Total protein
-Alkaline phosphate (ALP)
-Alanine aminotransferase (ALT)
-Aspartate aminotransferase (AST)
What are the differences between macrocytic and microcytic anemia?
Macro- person is low in B12 and folate
Micro- iron related!
Which labs are indicative of cardiovascular inflammation or increased risk for CVD?
Homocystine: marker of inflammation
*To improve homocystine levels, what vitamins/minerals need to be taken?
How is albumin used in nutrition assessment?
What is pharmacodynamics?
The study of the physiologic and biochemical effects of a drug or combination of drugs.
*Food-drug interaction
What is pharmacokinetics?
The movement of a drug through the body by absorption, distribution, metabolism, and excretion.
What is an excipient?
A substance added to a drug, such as a buffer, binder, filler, diluent, disintegrant, glidant, flavoring, dye, preservation, suspending agent, or coating.
***Also called inactive ingredient.
What can be problematic regarding excipients?
(ppt 16?)
Several common excipients have potential for interactions in persons with an allergy or enzyme deficiency.
*Lactose and glucose sensitivities
*Ex: Fat in proprofol puts you to sleep quickly
How does a low albumin level affect drug action/absorption?
If one has a low albumin there are less binding sites for the drug, more drug in the blood serum

*Most at risk are elderly, less than 3.0
What is the best way to administer drugs through a feeding tube?
Recommendations to separate phenytoin suspension from tube-feeding formulas are common. Stopping the tube feeding before and after the phenytoin dose is generally suggested, but recommendations vary from 1 to 4 hours intervals. The most common is a 2-hour feeding-free interval before and after the dose of phenytoin is administered.
How does grapefruit juice interfere with medication metabolism?
A substance found in grapefruit and grapefruit juice can inhibit the intestinal metabolism of drugs (such as calcium channel blockers that are dihydropyridine derivatives and/or some HMG coenzyme A reductase inhibitors such as simvastatin).
**Also inhibits the cytochrome P-450 3A4 enzyme in the intestinal wall responsible for the oxidative metabolism of many orally administered drugs.
What can be problematic with tetracycline?
Reduces the amount of calcium available for absorption
What can be problematic with methotrexate?
Used to treat rheumatoid arthritis or cancer- CAUSES A LOWERING OF FOLATE
What can be problematic with corticosteroids (prednisone)?
Cause insulin resistance and inhibit glucose uptake.
What can be problematic with MAOI's?
Cause vasoconstriction, headache, high blood pressure, and death.
What can be problematic with coumadin?
*Coumadin thins the blood.
*Vitamin K interacts with coumadin.
*If patients are taking coumadin, tell them to keep vitamin K levels steady and consistent.
What can be problematic with propofol?
Puts you to sleep quickly (if taken with fat?)
May provide a significant amount of sodium, so may be contraindicated for patients who need to limit sodium.
What can be problematic with narcotics (codeine, morphine)?
Constipation or diarrhea
What are the steps of a physical assessment?
What are the steps of an abdominal exam?
What is a critical pathway?
Certain elements that should occur in a patient's care and the timeframe.
What is utilization management?
Eliminating or reducing unnecessary tests
What is case management?
Assessing, evaluating, planning, implementing, coordinating, and monitoring care.
What are DRG's?
The hospital recieves payment based on patient diagnosis, comordibities, surgeries, age, and gender.
What is a managed care company?
Mechanism for financing and organizing health care delivery in which providers and payers have predetermined payments for care provided.
*Medicare is NOTTTT considered one, nor Medicaid because it's the government.
*Blue Cross Blue Shield, United, etc.
What demographic trends are affecting healthcare?
Who reimburses for MNT? What disease states will they reimburse for?
Medicare reimburses!!!
*Only reimburses for renal (kidneys) and diabetes
How much do they pay for initial assessment, follow-up or group session?
Initial assessment: $17.92 for 15 mins
Group: $7.09 per member per 30 mins
What are the basics of hospital diets?
Regular diet (house diet): Usually 1600-2200 kcals, 60-80 g protein, 30-100 g fat, 180-300 g CHO

Soft diet: Transition from liquid to regular. Low in cellulose or connective tissue. Postoperative or GI problems.

Liquid diet: Used for easy digestion or minimal residue- Used briefly.
What is palliative care?
Encourages the alleviation of physical symptoms, anxiety, and fear while attempting to maintain the patient's ability to function independently.
*Comfort measures for terminally ill patients; Focus on quality of life and communication with family members
What is a SOAP note? What information is typically found under each section of a SOAP note?
It is a charting/documentation tool.
S- subjective (info provided by patient)
O- objective (factual observations; lab/clinical data)
A- assessment (interpretation of sub & ob info)
P- plan (studies & data needed; MNT goals)