Unit 5 Nutrition Content

Front 1

Caloric need:

Back 1

infant 600
teenage boys 3,000 more if involved in sports,
lactating women 2700,
teenage girls 1900.

Front 2

6 basic nutrients:

Back 2

1. Carbohydrates
2. Proteins
3. Fats
4. Water
5. Vitamins
6. Minerals

Front 3

CARBOHYDRATES

Back 3

(1gm = 4kcal)
55% - 60% of calories intake
- Most carbs are stored in fat.
- Whole grains and non refined sugars are best.

Front 4

Carbohydrates
- Source

Back 4

- obtained mainly from plant food
ex cereals, vegetables, rice, potatoes, legumes, flour products.

Front 5

Carbohydrates
- Function

Back 5

the main source of energy in the diet, the main source of fuel for the brain, skeletal muscles, RBC and WBC production

Front 6

Carbs are stored in the liver and in muscle as

Back 6

glycogen.

Front 7

Non-digestible carbohydrates =

Back 7

dietary fiber

Front 8

Fiber

Back 8

- Green leafy vegetables, root vegetables, whole grain breads and cereals
- 20-30 gms. Per day
- Reduces colon cancers & promotes peristalsis
- Alternative to strong laxatives in older adults

Front 9

2 sources of carbohydrates:

Back 9

1. Glycogen
2. Fat

Front 10

Glycogen:

Back 10

- found in liver and muscle
- Energy used during fasting

Front 11

Fat:

Back 11

excess carbohydrates stored in this form

Front 12

cho metabolism

Back 12

1. Glycogenolysis
2. GLycogenesis
3. Gluconeogenesis

Front 13

1. GLYCOGENOLYSIS

Back 13

- Glycogen -- Glucose, CO2, H2O

Front 14

2. GLYCOGENESIS

Back 14

Glucose -- glycogen

Front 15

3. GLUCONEOGENESIS

Back 15

Amino acids and glycerol -- glucose for energy

Front 16

PROTEINS

Back 16

- 4 kcal/gm 45-60 gms daily
- contain all the amino acids we need
- Protein supplementation for those with pressure ulcers- needs protein to heel

Front 17

Proteins
- Sources

Back 17

grain, meat, beans, poultry, milk, eggs, cereals, legumes, vegetables

Front 18

Proteins
- Function

Back 18

essential for synthesis of body tissue in growth, maintenance and repair RND, DNA, hormones, enzymes are composed of protein

Front 19

Complete proteins:

Back 19

all essential amino acids

Front 20

Incomplete proteins:

Back 20

- must combine different incomplete to make complete
- ex: carb & legume- rice & beans, lentil soup & rye bread.

Front 21

protrin metabolism

Back 21

- Combined and changed to tissues, hormones, and enzymes.
- Converted to fat for storage
- Catabolized into energy via gluconeogenesis.
- Nitrogen balance: intake and output of nitrogen are equal
- Always want to be in a positive protein balance
- try not to use protein for energy

Front 22

FATS (lipids)

Back 22

- 1gm = 9kcal
- Component of cell structure, production of hormones and padding to protect organs
- Fat intake should be below 30% of caloric intake
- Saturated fat less than 10% daily intake

Front 23

Fat
-Sources

Back 23

animal and vegetable fats

Front 24

Fat
- Function

Back 24

- source of energy storage, important for metabolic process and vitamin absorption.
- Most dense form of energy
- Major component of cell structure, hormones, and padding for the body

Front 25

3 Types of Fats:

Back 25

- Cholesterol
- Fatty acids- composed of chains of carbon and hydrogen atoms with an acid group on one end of the chain and a methyl group on the other
- Triglycerides- circulate in the blood and made uo of 3 fatty acids attached to a glycerol

Front 26

2 Types of fatty acids

Back 26

- saturated
- unsaturated

Front 27

2 Types of unsaturated fatty acids

Back 27

- polyunsaturated
- monounsaturated

Front 28

WATER

Back 28

- composes 60-70% of our body weight.
- We need 2.5 to 3 L of water daily.
- Necessary for substances to be broken down, reformed and used by our bodies
- Intake should equal output

Front 29

Water
- Function

Back 29

water is a critical component of the body because cell function depends on a fluid environment.

Front 30

Water
- Source

Back 30

liquids and solid foods high in liquid content

Front 31

means of transportation for nutrients to and from cells

Back 31

Blood constituent

Front 32

VITAMINS
- Function

Back 32

essential for normal metabolism, vitamins assist other nutrients through processes
-is needed for digestion, absorption, metabolism, and excretion.

Front 33

vitamins
- Source

Back 33

fruits & vegetables

Front 34

- deficiency can cause night blindness, dry skin
- Source- beta-carotene and leafy veggies

Back 34

Vitamin A

Front 35

- deficiency can cause scurvy, bleeding in mouth
- Source- fruits and veggies

Back 35

Vitamin C

Front 36

- deficiency can cause Ricketts, soft bones
- Source- milk, meat, sun

Back 36

Vitamin D

Front 37

- needed for clotting, deficiency can be seen in bleeding because it counteracts anti-coagulant drugs.
- Source- banana

Back 37

Vitamin K

Front 38

C, & B COMPLEX (8 VITAMINS)

Back 38

Water soluble vitamis

Front 39

A, D, E, & K- can have toxic levels

Back 39

Fat Soluble vitamins

Front 40

MINERAL
- sources

Back 40

food

Front 41

mineral
- function

Back 41

essential as a catalyst in biochemical reactions minerals.
- Structural: bones and teeth.
- Affect nature of body fluids, necessary for proper functioning of CNS and muscles, etc

Front 42

there are ____ essential minerals

Back 42

16

Front 43

- we need more that 100mg per day
ex: Calcium, Potassium, & Sodium

Back 43

Major minerals

Front 44

- we need less than 100 mg per day

Back 44

Trace minerals

Front 45

Vitamin deficiencies can cause cellular and organ dysfunction that may result in a slow recovery from illness.

Back 45

When there is enough of any specific vitamin to meet the catalytic demands, the rest of the vitamin supply acts as a free chemical and may be toxic to the body.

Front 46

Sources of fiber:

Back 46

- plant foods
- bran
- barley
- lentil beans

Front 47

Fibers role in nutrition:

Back 47

- disease prevention
- treatment/ prevention of diarrhea
- disease preventer
- those with high fiber diet are less likely to suffer from obesity
- treats constipation & colon cancer

Front 48

State of nitrogen balance & it's segnificance in nutrition:

Back 48

- protein is 16 % nitrogen & serves as the only source of nitrogen for the body
- when the intake of nitrogen exceeds the output, the pody is in a positive nitrogen balance, which is required for growth, normal pregnancy, maintenance of lean muscle mas and vital organs, and wound healing.

Front 49

The nitrogen retained in the body is used for building, repair, and replacement of body tissue

Back 49

Nitrogen balance must be maintained for body growth, maintenance, and repair.

Front 50

Negative nitrogen balance

Back 50

- occurs when the body looses more nitrogen then it gains.
- The decreased nitrogen loss is the result of body-tissue destruction or loss of nitrogen containing body fluids

Front 51

Key points of the 2005 Dietary Guidelines for Americans, & the USDA Food Guide.

Back 51

The FDA food guide pyramid provides a guide to daily food choices. Eating a variety of foods and getting the appropriate number of calories and grams of fat for a healthy weight are recommended.

Front 52

The pyramid recommends

Back 52

- Bread/cereal/rice/pasta- 6-11 servings
- Vegetables- 3-5 servings
- Milk/yogurt/cheese- 2-3 servings
- Meat/ poultry/ fish/ beans/ nut/ eggs- 2-3 servings
- Fats/oils/sweets- use sparingly, limit fat to 30% of calories (30% or less of our calorie intake should be from fat

Front 53

Dietary guidelines for health promotion

Back 53

1) Eat a variety of foods
2) Maintain a healthy weight (balance intake with activity)
3) Choose a diet low in fat, saturated fat, and cholesterol
4) Choose a diet with plenty of fruits, vegetables, and grains
5) Use sugar, salt, and alcohol in moderation

Front 54

Food Labels: Daily Values
- Provides understandable format for public

Back 54

- Reference Daily Intakes (RDI)- Proteins, vitamins and minerals based on RDA
- Daily Reference Values (RDV)- Total fat, saturated fat, cholesterol, carbohydrates, fiber, sodium and potassium

Front 55

What is a Serving?

Back 55

- SLICE OF BREAD, 1/2 CUP PASTA
- 1 CUP RAW LEAFY VEGETABLES
- 1 MEDIUM APPLE, 3/4 C. FRUIT JUICE
- 1 CUP MILK/YOGURT, 1.5 OZ CHEESE
- 2-3 OZ LEAN COOKED MEAT (DECK OF CARDS)

Front 56

information needed to obtain a dietary history

Back 56

- specific diet history to assess the client's actual or potential needs
- focuses on the client's habitual intake of foods and liquids, as well as information about preferences, allergies, and other relevant areas such as the client's ability to obtain food (financially).
- gather information about the client's illness/activity level to determine energy needs and compares this with food intake

Front 57

Components of a nutritional status assessment

Back 57

- albumin
- prealbumin
- total protien lipid profile
- laboratory data
- identifying clinical signs of inadequate nutrition
- hight
- weight
- BMI

Front 58

Nursing assessment of nutrition includes health status, age, cultural background, socioeconomic status, personal preferences, Psychological factors, use of alcohol or illegal drugs, vitamin/ mineral/ herbal remedies, prescription, or over the counter (OTC) remedies.

Back 58

- Review of diet history
- Food and fluid intake record
- Laboratory data
- Food-medication interactions
- Physical examination and health history
- Anthropometric measurements
- Psychosocial assessment

Front 59

Nutrition assessment centers on 5 areas:

Back 59

1. Anthropometry
2. Lab tests
3. Review of dietary history and health history
4. Clinical observations
5. Client expectations

Front 60

1. ANTHROPOMETRY

Back 60

- a measurement of size and makeup of the body
- Mid Upper Arm Circumference(MAC): Skeletal Muscle Mass
- Triceps Skinfold (TSF): Fat content of subcutaneous tissue
- Wrist Circumference: Body Frame

Front 61

- Nursing Interventions for Anthropometry

Back 61

- Obtain baseline anthropometric measurements.
- Obtain anthropometrics every month.

Front 62

2. LAB TESTS

Back 62

- no single lab or biochemical test is diagnostic for malnutrition.
- Test results may be altered by fluid balance, liver/ kidney function, and the presence of disease.
- Nitrogen balance is important to establish serum protein status.

Front 63

Nursing Interventions for lab tests

Back 63

- Assess lab data as ordered by nurse practitioner or physician.
- Report significant changes.
- Instruct patient in purpose of lab tests and procedure
- Obtain lab specimens as ordered

Front 64

Normal Serum cholesterol:

Back 64

160-200 mg/dL

Front 65

Total cholesterol levels:

Back 65

- LDL: less than 130 (we want low LDL L=Low)
- VLDL: 200-400
- HDL: greater than 35(we want high HDL H= happy)

Front 66

Hemoglobin & Hematocrit- can detect

Back 66

iron deficiency anemia

Front 67

Female Hgb & Hct levels

Back 67

- Hgb: 12-16 g/dl
- Hct: 38-47%

Front 68

Male Hgb & Hct levels

Back 68

- Hgb: 13.5-18 g/dl
- Hct: 40-54%

Front 69

Albumin

Back 69

- Indicates body protein status, does NOT detect early changes in nutritional status. Metabolic half life is 21 days.
- Normal serum albumin: >3.5 g/dl
- w/out sufficient amounts, can not heal.

Front 70

Prealbumin

Back 70

- Preferred for protein status in short term or acute conditions.
- Metabolic half life is 2 days
- 10-40 mg/dl

Front 71

Additional Lab Tests

Back 71

- Total Lymphocyte Count (TLC)
- 24 hour urinary urea nitrogen
- Transferrin
- Total Iron Binding Capacity (TIBC)

Front 72

Nursing interventions for lab tests

Back 72

- Assess patient’s nutritional status & document & report signs of inadequate nutrition

Front 73

4. CLINICAL OBSERVATIONS

Back 73

the nurse observes the client for signs of nutritional alterations, food and fluid intake

Front 74

5. CLIENT EXPECTATIONS

Back 74

- clients rely on health care professionals to identify problems which they may not be aware of.
- Most nutritional problems develop over weeks and months not overnight. (psychosocial assessment)

Front 75

Body Mass Index (BMI)

Back 75

- shows weight corrected for height. BMI is determined by dividing a clients weight in Kg by their height in meters squared
- 18.5 – 24.9: Healthy Weight
- 25.0 – 29.9: Overweight
- 30 or above: Obese

Front 76

BMI Calculation

Back 76

Divide weight in pounds by your height in inches squared. & Multiply that total by 703
Ex: A 40 year old female who is 5ft 3in tall and weighs 107 pounds.
~ 107 divided by 3969 = .0269
~ .0269 x 703 = 18.95

Front 77

Ideal Body Weight (IBW)- the rules of 5’s and 6’s

Back 77

- Women- IBW=’s 100lbs + 5lbs for each inch over 60”
- Men- IBW=’s 106lbs+ 6lbs for each inch over 60”
- Both are +/- 10% for large or small bone frame

Front 78

- Nursing Intervention

Back 78

- Obtain patient’s baseline height and weight.
- Weigh patient (daily, weekly, monthly)
- Assess for changes in weight.

Front 79

- HEIGHT

Back 79

- Minimal clothing, no shoes, erect, arms at side
- Can be estimated using arm span if unable to stand
- We overestimate height and underestimate weight

Front 80

- WEIGHT

Back 80

- Upright scale, bed scale, chair scale
- Metropolitan Life Insurance Table
- Same scale, same time, same clothes
- Ideal Body Weight (IBW)
- Rule of “5s and 6s”

Front 81

Clinical signs of inadequate nutrition:

Back 81

1) General appearance- listless, emaciated
2) Sagging posture
3) Flaccid or poor muscle tone
4) Inattention, irritability, confusion
5) Anorexia, diarrhea, constipation
6) Rapid heart rate, elevated BP, abnormal heart rhythm
7) Dull brittle hair, rough dry skin
8) Dry, swollen, cracked lips

Front 82

- Clinical Signs of Poor Nutrition

Back 82

· General appearance: listlessness, cachexia, lack of energy
· Weight: Obesity or below normal weight
· Muscles: flaccid, wasted
· Neurological: irritability, confusion, paresthesia
· GI: nausea, vomiting, diarrhea, constipation, indigestion, anorexia, enlarged liver
· Cardiovascular: heart failure, tachycardia
· Hair: decreased pigmentation, easy pluckability, alopecia

Front 83

- Clinical signs of poor nutrition cont

Back 83

· Skin: dry, scaly, petechiae, pale, subcu fat loss
· Mouth, oral membranes: swollen, boggy mucous membranes, bleeding gums, glossitis, absent teeth, unfilled caries
· Eyes: kerotomalacia, conjunctival xerosis
· Neck (glands): Thyroid enlargement
· Nails: brittleness, ridges
· Extremities: edema, osteomalacia, bone pain, rickets,
· Hematologic: Anemia, leukopenia, low prothrombin time, prolonged clotting time

Front 84

- Nursing Intervention for poor nutrition

Back 84

· Provide appropriate food choices for patient taking into consideration religious and cultural background
· Discuss patient’s food likes and dislikes
· Assess patient’s knowledge regarding nutritional health
· Provide environment that promotes stimulation of appetite
· Order Nutrition consult
· Administer therapeutic diet as ordered
· Collaborate with physician or nurse practitioner re: dietary supplementation

Front 85

influences on nutrition

Back 85

1. religion
2. Values
3. Culture
4. Lifestyle
5. Socioeconomic status
6. Health status
7. Personal preference
8. Alcohol & Drugs
9. Misinformation & Food Fads

Front 86

Things that affect poor nutrition:

Back 86

1) Disease- no energy to eat
2) Eating a poor diet of a no appetizing diet
3) Tooth loss or mouth pain
4) Economic Hardship
5) Need assistance in Self Care
6) Reduced social contact
7) Multiple Medicines
8) Involuntary weight loss/ gain
9) Elder years above age 80

Front 87

Individuals at risk for nutritional problems.

Back 87

- Immobilized patients
- Those who have problems with ingestion, digestion, or absorption
- Older adults
- Individuals who choose alternative food patterns
- Patients who are NPO for more than 5 days
- People with critical illness; cancer, HIV, eating disorders, GI disease, critical illness, malabsorption problems, metabolic disease, renal disease, & those with liver, pancreas, and gallbladder disease.
- Post op patients

Front 88

Ways to assist patients with meals

Back 88

- Minimize odors
- Proper oral hygiene
- Remove reminders of treatment
- Proper positioning for eating
- Serve hot meals within the patients preference as ordered diet allows
- Diet supplements and food the patient likes which is acceptable for them to eat

Front 89

NPO

Back 89

- If there is any question of GI function, absence of bowel sounds, abdominal pain, pre/post op, certain diagnostic tests (CT scan), & those receiving parenteral nutrition

Front 90

Clear fluid

Back 90

- broth, bullion, coffee, tea, carbonated beverages, clear fruit juices, gelatins, popsicles
- Diagnostic tests, surgery prep, restarting oral nutrition
- Diabetics need sugar no diet, b/c no proteins or carbs in clear, need sugar as only source of calories

Front 91

Full liquid

Back 91

- clear fluid and smooth textured dairy products, custards, refined cooked cereals, puréed vegetables, and all fruit juices. Can have full source of nutrition on Full.
- Patients who have difficulty swallowing or chewing solid foods

Front 92

Mechanical Soft

Back 92

- full liquid with the addition of ground or finely diced meats, flaked fish, cottage cheese, rice, cheese, potatoes, pancakes, light breads, cooked vegetables, cooked/canned fruit, soups, bananas, peanut butter

Front 93

Soft

Back 93

- all above with moist tender meat, poultry, fish, soft casseroles, soft fresh fruit, cake, cookies w/out nuts, lettuce, tomatoes
- Require only minimal chewing
- Debilitated patients, mild GI problems

Front 94

Pureed

Back 94

- full liquid with the addition of scrambled eggs, pureed meats, vegetables, fruits, mashed potatoes, and gravy.
- Foods are pureed or strained until the have a smooth consistancy

Front 95

Fluid restriction___ml

Back 95

- the amount of allowable fluid intake for 24 hrs will be stated, strict I&O (includes all fluids such as IV, food trays, & in between meals), used for those with renal disease and heart failure.

Front 96

Low fat

Back 96

- indicated for those with heart disease, the need to reduce weight, gallbladder disorder, and hypertension. Dietary fat 30% or lower (10-15% in unsaturated fatty acids)
- Protein in moderation, w/less emphasis on animal sources

Front 97

Low cholesterol

Back 97

- To lower cholesterol; avoid cheese, milk, meats, fats, and baked goods. 300 mg or less daily.

Front 98

To lower Blood Cholesterol:

Back 98

- Avoid whole milk, cheese, whole milk yogurts
- Avoid Organ meats, heavily marbled meats, cold cuts, frankfurters, all fats- esp. saturated (butter, lard, bacon), coconuts, cream sauces, baked goods, eggs

Front 99

Low Sodium

Back 99

2400 mg or less daily

Front 100

Regular

Back 100

- no restrictions unless specified

Front 101

Diabetic- American Diabetes Association Standard:

Back 101

- Type 1 diabetes mellitus (DM):
- Type 2 DM
- Use of exchange groups
- 50-60% of intake is in form of complex carbohydrates
- Calorie requirements are given
- ex: 1800 Cal ADA Diet
- ex: No added sugar

Front 102

Renal diet

Back 102

- dietary restrictions on protein, fluid, potassium, sodium, phosphorus, vitamin & mineral supplementation (vitamins, iron, calcium & Vitamin D) because the kidneys aren’t working and they aren’t being excreted, thus we want to reduce them.

Front 103

Dysphagia diet

Back 103

- the patient has difficulty swallowing/eating it’s not a nutrient problem, but it is one of food consistency.
- We don’t want patient to choke or aspirate.
- NO thin liquids, liquids must be semi-thick or thick

Front 104

Sodium (Na) Restricted

Back 104

- Average American Na intake is 4-6 gm
- “No added salt”
- 4 GM Na
- 2 gm Na
- 3 gm Na
- Patients with hypertension and heart failure

Front 105

Enteral feedings:

Back 105

- given to individual’s, such as those who are incapable of eating due to injury or disease, or those at risk for aspiration.
- Enteral nutrition is the preferred method of meeting nutritional needs if the client’s GI tract is functioning.
(If the client is unable to ingest food, but is still able to digest and absorb nutrients, enteral feeding is indicated)

Front 106

Enteral feeding is indicated for patients who:

Back 106

1) cannot maintain adequate nutrition via oral intake alone
2) have poor neuromuscular control and cannot swallow
3) are critically ill and can’t eat because of their condition

Front 107

Contraindications for enteral feeding:

Back 107

1) Patients with diffuse peritonitis
2) Patients with severe pancreatitis
3) Intestinal obstruction
4) Intractible vomiting or diarrhea
5) Paralytic ileus

Front 108

Nursing interventions for tube feeding:

Back 108

- Administer enteral feedings as ordered.
- Check residuals q 4 hours.
- Flush tube with 30 cc warm water q 4 hours to maintain patency
- Give medication in liquid form> Avoid crushing medications
- Tube site care daily.
- Assess placement of tube

Front 109

Complications of Enteral Feeds

Back 109

- Dehydration
- Aspiration
- Diarrhea
- Constipation
- Tube occlusion
- Delayed gastric emptying

Front 110

Enteral Vs Parenteral Feedings

Back 110

- Reduce sepsis
- Maintain intestinal structure and function
- Prevent translocation of bacteria

Front 111

3 Types of Tubes

Back 111

1. Small bore nasogastric tubes
2. Gastrostomy
3. Jejunostomy

Front 112

SMALL BORE NASOGASTRIC TUBES:

Back 112

- inserted at bedside
- placement verified by CXR

Front 113

GASTROSTOMY:

Back 113

- PEG:Percutaneous endoscopic gastrostomy
- Surgical placement

Front 114

JEJUNOSTOMY:

Back 114

- bypasses stomach

Front 115

types of formulas for tube feedings

Back 115

1. blenderized
2. Polymeric (milk based & lactose free) client's GI tract must be able to absorb whole nutrients
3. Modular formulas- single macronutrients (ex protien, glucose, polymers, or lipids) preperations and are not nutritonaly complete.
- added to other foods for meeting the client's individual nutritional needs.
- Elemental formulas- contains predigested nutrients that are easier for a particularly dysfunctional GI tract absorb

Front 116

The basic components of the enteral solutions are:

Back 116

1) carbohydrates in the form of dextrose, sucrose, lactose, starch
2) Protein in the form of intact proteins, hydrolyzed proteins, amino acids
3) Fat in the form of corn oil, soybean oil, or safflower oil
4) Water sufficient to maintain hydration

Front 117

(retinol)
- Night vision, bone growth, skin integrity
- Fruits, vegetables, fish, dairy products
- Acon, Aquasol A)

Back 117

Vitamin A

Front 118

(calciferol)
- Prevention of rickets and treatment of osteomalacia
- Increases absorption of dietary calcium and mobilizes calcium from bones
- Overdose can cause hypercalcemia
- Milk, dairy products, margarine
- Calciferol

Back 118

Vitamin D

Front 119

- Protects cellular components from being oxidized
- Oils, margarines, milks, grains, meats

Back 119

Vitamin E

Front 120

- Synthesis of prothrombin and clotting factors
- Green leafy vegetables, meats, eggs, cheese, milk
- Mephyton, aquaMEPHYTON

Back 120

Vitamin K

Front 121

- Absorption of iron , conversion of folic acid, wound healing, tissue repair
- Citrus fruits, green vegetables
- Ascorbic Acid

Back 121

Vitamin C

Front 122

- Necessary for many metabolic processes
- Folic acid (folate)
- DNA synthesis and cellular division, RBC’s, fetal CNS
- Liver, kidney beans, fresh green vegetables

Back 122

Vitamin B complex

Front 123

Minerals

Back 123

- Iron
- Calcium (1,300 mg daily)
- Phosphorus
- Zinc
- Magnesium
- Fluoride
- Iodine
- Selenium

Front 124

Nursing Intervention for vitamins

Back 124

- Assess patient for vitamin and/or mineral deficiency.
- Instruct patient in foods high in deficient vitamin/mineral
- Administer vitamin/mineral replacement as ordered.
- Monitor for therapeutic effects, side effects.
- Instruct patient in therapeutic medication regime

Front 125

Food sources for sodium

Back 125

- Snacks: chips, peanuts, pretzels etc
- Seasonings: MSG
- Soups: especially canned
- Sauces: dried mixes and bottled
- Smoked meats and fish: ham, pork & lox
- Sauerkraut & other pickled foods
- Sodium processed lunch meats
- Canned foods

Front 126

Sodium is a major extracellular cation and it is the major electrolyte that regulates body fluids.

Back 126

Sodium also promotes the transmission/conduction of nerve impulses as it is part of the sodium/potassium pump that causes cellular activity (when sodium shifts into a cell, potassium shifts out to maintain water balance and neuromuscular activity)

Front 127

Food sources for potassium

Back 127

- Apricots, banana, melons, oranges and orange juice, prune juice
- dried fruits,
- Avocado, dried beans and peas
- Potatoes: white and sweet
- Spinach, Swiss chard, tomatoes

Front 128

- Potassium is an important cellular cation (positively charged ion).

Back 128

Potassium is necessary for the transmission and conduction of nerve impulses, and for the contraction of skeletal/smooth/cardiac muscle

Front 129

- Diet counseling and teaching are important before a patient’s discharge because early identification of potential or actual problems is the best way to avoid a more serious problem.

Back 129

Nurses are in a key position to educate a client about good nutritional habits. Nurses assist the client in incorporating knowledge of nutrition into lifestyle which serves to prevent many diseases.

Front 130

2 main function of the GI system:

Back 130

1) Digestion-
2) Absorption

Front 131

Your patient is NPO to rule out bowel obstruction. You enter the room; the wife is feeding the patient and states “He’s starving to death.” What actions would you take?

Back 131

- Ask the wife to stop feeding the patient and explain that the reason for no food for an extended time is due to an upcoming diagnostic test.

Front 132

Good Nutritional help:

Back 132

- Important for positive health care outcomes. (Decreased risk of catastrophic illness ex MI)
- Over a lifetime, decreases the risk of disease
- Saves health care dollars.
- Helps regain optimal function and body repair.
- Many people can eat the same diet, but they need to learn appropriate portion control.
- Nutrition therapy often produces slow results. There is no single laboratory or biochemical test diagnostic for malnutrition.
- Encouraging more frequent oral hygiene may improve appetite.

Front 133

Calcium rich foods:

Back 133

- Skim milk, cheese, custard, yogurt
- Salmon, sardines
- Broccoli, collard greens, okra
- Orange, blackberries, dates, rhubarb

Front 134

Iron rich foods:

Back 134

- Beef: ground, liver, heart, kidneys
- Oyster, scallops, shrimp
- Spinach, beet greens, chick beans, soybeans, kidney beans, dates, prune juice, raisins
- Enriched pasta, bran and oat flakes

Front 135

Antiemetics

Back 135

1. Metoclopromide
2. Prochlorperazine maleate

Front 136

Metoclopromide (Reglan)

Back 136

- Classification: miscellaneous
- Nausea, vomiting, increases gastric and intestinal emptying
- EPS may occur

Front 137

Prochlorperazine maleate (Compazine)

Back 137

- Classification: Phenothiazine
- Drowsiness, dizziness, EPS may occur
- Route: PO, PR, IM

Front 138

Appetite Stimulants

Back 138

Megestrol (Megace)
- Classification: synthetic progestin
- Uses: primarily for palliative management of metastatic endometrial or breast cancer
- Also used in management of anorexia, cachexia, or an unexplained weight loss in patients with AIDS and to stimulate appetite and promote weight gain in patients with cancer

Front 139

Nursing Intervention
for medications

Back 139

Administer medications as ordered for:
- Nausea, vomiting, enhanced gastric motility, increased appetite.
- Monitor patient for therapeutic response to medications
- Assess patient for side effects of medications
- Instruct patient in purpose and scheduling of medications and possible side effects

Front 140

Malnutrition
- Altered Nutrition:

Back 140

Less than Body Requirements related to inadequate food intake or increased nutrient requirements

Front 141

Malnutrition
- Expected Outcome:

Back 141

client will have an adequate intake of all required nutrients on a daily basis and experience no further weight loss or will have a weight increase

Front 142

Interventions for malnutrition

Back 142

- high calorie, high protein foods
- Six small meals
- Pureed or soft diet if difficulty chewing
- Quiet environment conducive to eating
- Allow a long time to eat

Front 143

Nursing Diagnosis

Back 143

- Fluid Volume Deficit
- Fluid Volume Excess
- Impaired Swallowing
- Altered Nutrition: More than body requirements

Front 144

The nurse is preparing a diet plan for the client who is taking Warfarin (Coumadin) daily. Which of the following foods will the nurse instruct the client to exclude from his diet?

Back 144

1. Pasta
2.Broccoli
3. Oranges
4. Potatoes

2

Front 145

The nurse is caring for a postoperative patient. The physician has prescribed a clear liquid diet. In planning to initiate this diet, which of the following would the nurse place at his bedside?

Back 145

1. Code cart
2. A straw
3. Cardiac monitor
4. Suction equipment

4

Front 146

A burned client is transferred to the nursing unit, and a regular diet has been ordered. Which dietary items should the nurse encourage the client to eat in order to promote wound healing?

Back 146

1.Veal, potatoes, Jell-o, orange juice
2. Peanut butter and jelly sandwich, cantaloupe, tea
3. Chicken breast, broccoli, strawberries, milk
4. Spaghetti with tomato sauce, garlic bread, ginger ale.

3

Front 147

The nurse is preparing to administer a feeding to the client receiving enteral nutrition through a nasaogastric tube. What is the priority action?

Back 147

A. Measuring intake and output
B. Weighing the client
C. Adding blue food coloring to the formula to aid in diagnosing aspiration
D. Determining tube placement

A

Front 148

The nurse has completed discharge teaching with a family of a client who is to have enteral feedings at home. Which method of evaluation should the nurse use to best determine the family’s competence in performing the feeding procedure?

Back 148

1. Return demonstration of the feeding procedure.
2. Selection of appropriate equipment for the feeding procedure.
3. Written testing of the steps of the feeding procedure
4. Verbal description of the feeding procedure by each member of the family.

1

Front 149

The nurse is reviewing a patient’s lipid profile. The nurse concludes that the patient has the desired pattern of results if the laboratory values show:

Back 149

A. High HDL, low LDL, low VLDL
B. Low HDL, high LDL, high VLDL
C. Low HDL, low LDL, low VLDL
D. High HDL, high LDL, high VLDL

A

Front 150

A patient with a low basal metabolic rate (BMR) would be most likely to experience which of the following nutritional problems?

Back 150

A. Undernutrition
B. Obesity
C. Low serum albumin
D. Low hemoglobin

B

Front 151

food sits in the stomach for

Back 151

1-7 hours

Front 152

The nurse is measuring the pH of fluid from a jejunostomy tube and suspects that the tube has migrated into the stomach when the pH reading is:

Back 152

A. 3.0
B. 4.0
C. 5.0
D. 6.0
pH of gastric contents is low and acidic (3 or less), while pH of small intestine is higher because of the bicarbonate released

Front 153

Which of the following statements about water-soluble vitamins is true? (Select all that apply.)

Back 153

A. They must be consumed daily.
B. They often cause toxicity.
C. They cannot be stored.
D. They require the use of supplements to reach RDA.
a and c. Water-soluble vitamins are eliminated daily; thus they must be consumed daily

Front 154

When evaluating the history of a client who has gastrointestinal (GI) upset, the nurse is sure to assess the client for routine ingestion of the following (select all that apply):

Back 154

A. High-fiber foods
B. Beer
C. Acetaminophen
D. Aspirin
b and d. Alcohol and aspirin are two substances directly absorbed through the lining of the stomach. This can contribute to GI upset.

Front 155

A woman is considering becoming pregnant. The nurse practitioner recommends that the client begin to consume __________ before attempting pregnancy to prevent neural tube defects in the fetus.

Back 155

A. Vitamin C
B. Calcium
C. Folic acid
D. Riboflavin
The importance of consuming folic acid to prevent neural tube deficits has been proven.

Front 156

The nurse wants to begin feeding a client through a small-bore feeding tube that was recently placed. Before initiating tube feedings through this tube, the nurse confirms tube placement by:

Back 156

A. Injecting air through the feeding tube while auscultating for air in the stomach
B. Measuring pH of fluid aspirated through the small-bore tube
C. Requesting placement via x-ray examination
D. Aspirating fluid contents from the stomach
The most reliable method for verification of placement of small-bore feeling tubes is via x-ray examination. Thus all the other methods are not as reliable

Front 157

A client has gained 2 pounds of weight in the past day. The nurse calculates this weight gain to be __________ ml of fluid.
1000. One pound of weight gain is equal to 500 ml; thus a 2-pound weight gain in 1 day is equivalent to 1000 ml.
Calculate the number of carbohydrate, protein, and fat calories in the following food, and determine the total number of calories in this serving

Back 157

One serving of food has 12 g of carbohydrate, 6 g of protein, and 8 g of fat.
12 × 4 (each gram of carbohydrate has 4 kcal) = 48 cal
6 × 4 (each gram of protein has 4 kcal) = 24 cal
8 × 9 (each gram of fat has 9 kcal) = 72 cal
Total number of calories = 144 cal

Front 158

A woman who has decided not to breast-feed asks the nurse if it is okay to feed her newborn infant regular cow’s milk. The nurse responds by saying

Back 158

No, cow’s milk should not be used during the first year of life because it may cause intestinal bleeding and is too concentrated for the infant’s kidneys to manage

Front 159

A mother is considering buying skim milk for her children, ages 1½ and 5. What recommendation does the nurse make?

Back 159

The 1½-year-old will still need whole milk to ensure adequate intake of fatty acids necessary for brain and neurological development. The 5-year-old can be slowly introduced to skim milk so that it is gradually accepted.

Front 160

A client was admitted to the hospital 5 days ago for a GI bleed. The client has received 4 units of blood over the past 5 days along with a maintenance fluid of normal saline at 125 ml/hour. What is of concern to the nurse with regard to this patient’s nutrition?

Back 160

Normal saline has no calories in it. Hydration is being maintained, but nutrition is not. Although the client received blood to replace blood loss (most likely based on H and H findings), there are minimal calories in the blood. Five days is a long time to go without sufficient calories. The nurse needs to discuss alternate methods of providing sufficient calories to meet basic metabolic needs to the client

Front 161

Describe the action, indication, and nursing implications of the following medication:

Back 161

Classification: Phenothiazine
Prototype: promethazine HCI (generic)
Phenergran (Trade)