Ch. 15 & 17 Quiz Flashcards
1
Q
According to the new US government pyramid, what are the new guidelines for grains/vegs/fruit/milk/meat and beans per day?
A
Grains-6oz, vegs-2 1/2 cups, fruits-2 cups, milk-3 cups, meat/beans-5 1/2 oz
2
Q
What are some justifications for vitamin supplements?
A
Metabolism, growth, healing, inadequate absorption (diarrhea, Crohn’s, Celiac), inability to use vitamins (renal/hepatic problems), vitamin losses (fever, hypothyroidism, cancer, diet, starvation, hemodialysis), increased requirements (child, prego, disease)
3
Q
Which vitamins are fat soluble and where are these stored?
A
Vitamins A, D, E, K. They are stored in the liver and fat.
4
Q
Which are water soluble?
A
B complex and C.
5
Q
What is the function of vitamin A?
A
Bones, skin, eyes, hair.
6
Q
What foods are good sources of vitamin A?
A
Leafy greens, yellow fruits/veggies, fortified milk/butter/dairy.
7
Q
How can vitamin A be administered?
A
PO and IM.
8
Q
What are some adverse reactions?
A
Hypervitaminosis A = Teratogenic effect (baby), Leukopenia/anemia.
9
Q
What are some s/s of hypervitaminosis A?
A
Hair loss, peeling skin, anorexia, N/V.
10
Q
What are early symptoms of vitamin A deficiency?
A
Night blindness.
11
Q
What does vitamin D do?
A
Regulates calcium and phosphorous, calcium absorption in intestines and bones.
12
Q
What are some good sources of vitamin D?
A
Salmon, liver, tuna, sunlight, fortified milk products.
13
Q
How do you administer vitamin D?
A
PO
14
Q
What are some adverse reactions to vitamin D?
A
Hypervitaminosis D = Hypercalcemia, anorexia, N/V.
15
Q
What else is vitamin A referred to as?
A
Retinol.
16
Q
What is the function of vitamin E?
A
Anti-oxidant, boosts immune, reduced CV disease.
17
Q
How can vitamin E be administered?
A
PO
18
Q
What can interfere with the absorption of vitamin E?
A
Iron.
19
Q
What are the side effects of too much vitamin E?
A
Fatigue, weakness, GI upset, HA, tender breasts
20
Q
What drugs might interact with vitamin D?
A
Prothrombin time is altered so Coumadin users should be monitored.
21
Q
What is the antidote for Coumadin (Warfarin)?
A
Vitamin K.
22
Q
What is Vitamin K’s most active form? Where do we get vitamin K from?
A
K1 is the most active form. Half from diet and half from intestinal flora.
23
Q
What does vitamin K help synthesize?
A
Prothrombin and certain clotting factors.
24
Q
How is vitamin K administered?
A
PO, parenteral (IM, not IV)
25
Who routinely gets an IM injection of vitamin K?
Newborns.
26
What does a vitamin K deficiency cause?
Spontaneous hemorrhage.
27
What can interfere with the absorption and use of Vitamin E?
Iron.
28
What is Vitamin B1 complex called?
Thiamine
29
What is Vitamin B2 complex called?
Riboflavin
30
What is Vitamin B3 complex called?
Nicotinic acid or niacin
31
What is Vitamin B6 complex called?
Pyridoxine
32
What does a Vitamin B1 complex/thiamine deficiency cause?
Polyneuritis, cardiac pathology.
33
When is thiamine/vitamin B1 complex deficiency most common?
In alcohol abuse.
34
What does an IV administration of vitamin B1 complex/thiamine treat?
Wernicke-Korsakoff syndrome (r/t alcohol abuse) usually for an emergency basis.
35
What does Vitamin B2 complex/riboflavin treat?
Dermatitis and migraine headaches
36
What does vitamin B3 complex/niacin treat?
Pellagra and hyperlipidemia
37
What doe vitamin B6 complex/pyridoxine do in the body?
Essential for RBC formation, synthesis of Hgb.
38
What does vitamin B6 complex/pyridoxine treat?
Vitamin B6 deficiency, neuritis, and anemias.
39
What vitamin is essential to prevent fetal neural tube defects?
Folic acid.
40
What is the function of folic acid (folate)?
Essential for body growth and DNA synthesis.
41
What are some causes of deficiency of folic acid?
Chronic alcoholism, malabsorption syndromes, and pregnancy.
42
What are s/s of folic acid deficiency?
Anorexia, nausea, stomatitis, diarrhea, fatigue, alopecia, blood dyscrasias, neural tube defects (in pregnancy & is typically increased before and during pregnancy)
43
What is the function of vitamin B12?
Essential for DNA synthesis, formation of RBCs in the bone marrow, and nervous system
44
What is necessary to absorb vitamin B12 in the intestines?
Intrinsic factor
45
Who is prone to vitamin B12 deficiency?
Those with pernicious anemia, malabsorption syndromes, previous gastric bypass surgery, Crohn's disease, vegetarians who don't eat/consume meat/fish/dairy (lack of intrinsic factor in parietal cells in the stomach/intestines).
46
How is vitamin B12 administered?
PO, SubQ, and IM (cyanocobalamin)
47
What is the function of vitamin C in the body?
Aids in the absorption of iron, essential for collagen formation and tissue repair
48
How is vitamin C administered?
PO
49
What does a deficiency of vitamin C cause?
Scurvy (muscle weakness, swollen and bleeding gums, loss of teeth)
50
Is taking a megadose of vitamin C good or bad?
No proof that increasing doses will ward off illness such as the common cold. May cause GI upset, diarrhea, crystalluria when taken with ASA or sulfonamides (need to increase fluids to flush it out of your system)
51
When stopping a vitamin C regimin, what must be done?
Reduce dose gradually to avoid rebound deficiency
52
What minerals are necessary for the human body to function?
Iron, copper, zinc, chromium, and selenium
53
What is the function of iron in the body?
Regenerates Hgb
54
What foods are high in iron?
Lean meats, liver, and beans
55
What slows/speeds iron absorption?
Food and antacids slow absorption (take at least 2hrs apart). Vitamin C increases absorption
56
What are the s/s of iron deficiency anemia?
SOB, pallor, weakness, fatigue
57
What are the 3 names for iron (mentioned in the book)?
Ferrous sulphate, fumarate, and gluconate.
58
When starting iron supplements, how long does it take for Hgb and Hct levels to rise?
Levels typically increase within 7 days
59
How is iron administered?
PO and IM - Z-track method also used to avoid irritation/stain.
60
What are the toxic effects of iron?
Hemorrhage, shock secondary to ulcerogenic (GI) effects
61
What is the function of copper in the body?
Formation of RBCs and connective tissues. Promotes production of norepinephrine and dopamine.
62
What foods are high in copper?
Liver, oysters, nuts, and sunflower seeds.
63
What does a copper deficiency lead to?
May lead to anemia, decrease in WBCs (decreased immune response), glucose intolerance, decrease in skin and hair pigmentation, and mental retardation.
64
What does an excess of copper lead to?
Associated with Wilson's disease (genetic disorder that prevents body from excreting excess copper)
65
What is the function of zinc in the body?
Normal growth and tissue repair, wound healing, and taste & smell
66
What foods are high in zinc?
Beef, lamb, eggs, and leafy veggies
67
What precaution must be taken when administering zinc?
Wait at least 2 hours after antibiotic administration (effects the absorption)
68
What is an unwanted side effect of intranasal zinc applications?
Loss of sense of smell
69
What does excess doses of zinc cause?
May cause copper deficiency, decrease in HDL cholesterol, and weakened immune system.
70
What is another name for vitamin B12?
Cobalamin
71
What is another name for vitamin C?
Ascorbic acid
72
What is another name for vitamin D?
Calciferol
73
How should you instruct a client to take and iron supplement?
Between meals with at least 8 oz of water or juice, sit upright for at least 30 mins, avoid milk products and antacids for 1 hour prior. Use a straw if liquid (may stain teeth).
74
Iron toxicity is a serious cause of poisoning in children. It may be fatal because of an ulcerogenic effect, resulting in which of the following? A.) Infection B.) Hemorrhage C.) Infarction D.) Kidney failure
B.) Hemorhage Rationale: Hemorrhage may occur owing to ulcerogenic effects of unbound iron leading to shock.
75
S/S of vitamin A toxicity include all of the following except... A.) euphoria B.) headaches C.) drowsiness D.) vomiting and diarrhea
A.) euphoria
76
What is a prerequisite for enteral nutrition?
Must have adequate bowel function and motility (won't work on malabsorption pts)
77
What is a nasogastric tube?
It is passed from the nose into the stomach.
78
What is a nasoduodenal/nasojejunal tube?
A weighted tube is passed through the nose into the duodenum/jejunum.
79
What is a gastrostomy tube?
It is introduced through a temporary or permanent opening on the abdominal wall (stoma) into the stomach (most common).
80
What is a jejunostomy tube?
A tube is passed through a stoma directly into the jejunum.
81
What is a blenderized enteral nutrition solution?
Blended natural foods. Compleat (commercial preparation)
82
What are Polymeric (milk-based or lactose-free) enteral nutrition solutions?
Supplements prescribed for patients who have normal or near-normal GI fxn; Usually taste good; Most commonly prescribed formula; May be used as tube feeding, meal replacement, or oral supplement; Contains protein, carbohydrates, and fat; Adequate quantities meet reference daily intakes for vitamins and minerals
83
What are some commercial preparations of polymeric/milk-based/lactose-free enteral formulas?
Meritene, Instant Breakfast, Sustacal, Boost, Ensure, Entrition, Fibersource, Isocal, Osmolite, Resource, and Ultracal
84
What is elemental (monomeric) enteral nutrition solutions?
Partially digest nutrients for feeding; Contains nitrogen (free amino acids), carbohydrates (glucose polymers), and minimal fat (long-chain triglycerides); Used for various GI diseases.
85
What are some commercial preparations of elemental (monomeric) enteral formulas?
Criticare HN, Peptamen Liquid, Vital HN, and Vivonex TEN
86
How long does it take to give a bolus of enteral nutrition?
10 minutes
87
How is an intermittent drip of enteral solutions given?
q3-4hrs over 30-60 mins
88
How fast is a continuous enteral feeding given?
5-125mL/hr continuously (typically 40-80mL/hr)
89
How are cyclic enteral infusions given?
8-16 hrs via pump (typically done by the dietician and given NOC)
90
Why is enteral nutrition feedings given warm?
If cold it may cause diarrhea.
91
What is CIB shake?
Carnation instant breakfast.
92
How high should the HOB be during and after a bolus enteral nutrition feeding?
HOB needs to be elevated at least 30-45 degrees during and for at least 30 min after feeding.
93
How often to you give a client that is on enteral feedings free water?
At least q4hrs.
94
How much free water does a client need per day?
3 liters
95
How long can an open enteral feeding hang?
4 hours max.
96
How long can a closed enteral feeding hang?
24 hours max
97
What are some complications of enteral infusions?
Aspiration (always a risk); Diarrhea from rapid infusions, GI bacteria (C. diff), drugs; Dehydration from not enough free-water between feedings
98
What does the acronym A.L.E.R.T. stand for?
A = Aseptic technique; L = Label enteral equipment; E = Elevate HOB at least 30 degrees; R = 6 rights of medication administration; T = Trace all lines and tubing back to the client
99
When DON'T you add water to an enteral medication administration?
Time-released, enteric-coated, and sublingual
100
What is done if food interferes with medication absorption?
Feeding must be stopped for 30 mins prior to giving some medications
101
What is the calculation for dilution of enteral medications?
Total volume of liquid - volume of drug = volume of water for dilution
102
Which patients usually receive parenteral feedings?
Severe burn patients; Clients with GI problems; Metastatic CA, AIDS (to help ward off infections)
103
What nutrients are in parenteral solutions?
Hyperosmolar glucose, amino acids, vitamins, electrolytes, minerals, and trace elements
104
What needs to be done before administering total parenteral nutrition?
Have the formula and bag checked by another nurse before administering
105
What IV line is most TPN administered through?
Most TPN is admistered through a central line but some can go through peripheral lines
106
What are some complications of parenteral nutrition?
Air embolism (prevention: Valsalva maneuver); Pneumothorax, hemothorax; Hyperglycemia or hypoglycemia (monitor BS, insulin may be added to TPN); Infection (monitor central line/IV site, WBCs and temperature, use aseptic technique); Fluid overload (monitor I&O, daily weights)
107
What must you always do before inserting TPN into IV tubing?
Always wipe IV tubing with alcohol before inserting into the tubing
108
What is normal gastric residual?
< 100mL
109
How often do you change the feed bag for enteral nutrition?
Daily.
110
What is used to flush an enteral feeding tube and how much is used?
Water or cola. 30mL
111
What can a sudden cessation of TPN cause?
Hypoglycemia. Give isotonic dextrose for 12-24 hours after.
112
How do you start TPN?
Slowly. 60-80 mL/hr
113
What DON'T you do with a TPN line?
Draw blood, give medications, or take central venous pressure.
114
According to the new US government pyramid, what are the new guidelines for grains/vegs/fruit/milk/meat and beans per day?
Grains-6oz, vegs-2 1/2 cups, fruits-2 cups, milk-3 cups, meat/beans-5 1/2 oz
