Ch 36: Nutrition Flashcards

1
Q

Give the three nutrients and classification that supply energy and tell what else they do + kcals they supply/ hr

Give the three nutrients that regulate body processes and classification
-what are these nutrients used for (3)

What is water used for

A

MACROnutrients Supply energy and build tissue

  1. Carbohydrate :4 kcal/Gram
  2. Protein :4 kcal
  3. Lipids (fats): 9kcal
micronutrients  regulate body processes
1. Vitamins
2. Minerals
Micro nutrients used for:
-metabolism 
-biochemical reaction 
- self functioning

water used for:
Water is critical for cell function and replaces body losses

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2
Q

 What is the most abundant and least expensive source of calories in the world

What is the only animal source of sugar

What kind of source is carbohydrates

What is the % recommendation of carbohydrates in calories

A

Most abundant in least expensive source of calories in the world are :
-carbohydrates

lactose is the only animal source of sugar

Carbohydrates are the PRIMARY source of energy

Carbohydrates are recommended 45 to 65% of total calories

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3
Q

What carbohydrates do you want to consume what carbohydrates do you want to avoid

What 2 categories do carbohydrates include

What is the name of stored carbohydrates what happens if excess

A

Consume complex carbohydrates

  • whole-grain
  • baked potato
  • brown rice
  • plant food
  • fruits

Avoid simple carbohydrates

Carbohydrates include sugars and starches

Stored carbohydrates = glycogen, if excess, stored as fat

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4
Q

What are proteins needed for what is their function

Give the difference between complete and incomplete proteins

-how did someone who does not eat complete proteins get the essential amino acids

What is a recommendation of the percentage of protein in an adult diet

A

Proteins are needed for the formation of ALL Body structures
- Function: build and repair body tissues

Complete proteins
-ANIMAL products(meat dairy poultry) and SOY!!! (Have all the essential amino acids)

Incomplete proteins:
-PLANT protein (missing essential amino acids)

A person who does not eat complete proteins can combine to incomplete proteins to get the complete amino acids

Recommendations for adults 10 to 35% of total calories (0.8 g/kg)

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5
Q

How are lipids in water and blood

Define triglycerides

Where is cholesterol found

Give the difference between saturated and unsaturated fats

What are trans fats

A

Lipids are insulble and water and blood

Triglycerides:
-Excess caloric intake certain body

Cholesterol ONLY FOUND in ANIMAL products

Saturated fats: animal source
-solid at room temp
-raise cholesterol
 
Unsaturated fats: vegetables
-lower cholesterol and fatty acids
-Liquid at room

Transfats are oils that have been hydrogenated: From a liquid to a solid and increased cholesterol

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6
Q

What is the percentage of lipids in diet and how does this happen

What is the recommended intake of lipids

A

95% of lipids in the diet are triglycerides due to a mixture of saturated (⬆️ cholesterol) and unsaturated (⬇️ cholesterol) fats

Lipids have a recommended less than 10% of calories

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7
Q

 give the water soluble vitamins give
& what does the body do to them

the fat soluble vitamins

what are nursing implications for what specific type of vitamins

What is another name for vitamins

A

What are soluble vitamins: B & C vitamins
-body does not store and will excrete if excess

Fat soluble: DEAK
-body stores

With fat-soluble vitamins we need to be cautious as nurses to give them in VERY SMALL amounts as the body stores vitamins and they will rapidly accumulate

Vitamins a.k.a. organic compounds needed in small amounts

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8
Q

Briefly describe would each vitamins And mineral is for

Vitamin A 
vitamin D 
vitamin E 
vitamin K 
calcium 
iron 
folic acid
Vitamin C
A

Vitamin A : Vision
vitamin D : Calcium and phosphorus metabolism + calcium absorption
vitamin E : protects vitamin A
vitamin K : clotting
calcium : Bone
iron : transport oxygen
folic acid: prevent brain and spinal defects
Vitamin C: immune system prepare damaged cells

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9
Q

What are minerals

What are some of the functions of minerals
-what are the two minerals that provide structure

What is the anemia that inhibits a person from observing iron and why
-what do both of these types of anemia require

A

Minerals are organic elements found in all body fluids and tissues

Mineral functions:
-structure in the body
•phosphorus + calcium)
-Regulate body processes

Pernicious anemia is an anemia that does not allow a person to have the needed enzyme to absorb iron
-what types of anemia require iron supplements



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10
Q

Give MACRO minerals

Give micro minerals

A

Macrominerals:

  • calcium
  • phosphorus
  • sulfate
  • sodium
  • chloride
  • potassium
  • magnesium

Micro minerals:

  • Iron
  • zinc
  • copper
  • fluoride
  • iodine
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11
Q

What is the most vital nutrient

What is the amount of water in adults total body weight 

How much water is in the ICF

How much water is in the ECF
-give the ECF locations
_plasma aka ?

What is water in relation to chemical reactions and what does water act as to eat in digestion absorption circulation and excretion

A

Water is the most vital nutrient

Adult bodyweight is 50 to 60% water

2/3 body water in ICF (in cells)

One third body water in ECF (body fluids)
• plasma aka intravascular and interstitial fluid

Water is the medium necessary for all chemical reactions

Water access is solvent to aid in body processes digestion, absorption, circulation excretion

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12
Q

What is The definition of  basal metabolic rate (BMR)

Give the BMR for 🚹 and why
Give the BMR for 🚺 and why

Name factors that ⬆️ metabolic rate

Name factors of ⬇️ metabolic rate

A

Basal metabolic rate:
-Energy required to sustain metabolic activities of cells and tissues

BMR 🚹: 1 cal/kg /hr due to muscle mess
BMR🚺:0.9 cal/kg/ hr due to greater fatty tissue

⬆️ metabolic rate: Burn more calories
-muscle mass
-growth
-infection fever
-stress
-temperature extremes
-certain hormones:
      •thyroid and corticosteroids
Factors that⬇️ metabolic rate:
-aging
-prolonged fasting
-sleep
-certain hormones:
      • thyroid and corticosteroids
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13
Q

 When is BMI used

Give the BMI scale

Give the BMI formula

A

BMI is used to tell the accumulation of excess fat

 underweight: ⬇️18.5
Normal: 18.5 to 24.9
Overweight: 25 to 29.9
Obese: 30+

BMI formula:
-Lb / height^2 x 703

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14
Q

Give a few factors that affect food habits (nutrition))

Physical and physiologic

Physical, social cultural, psychological

A
Factors that affect food habits (nutrition)
-physiologic and physical factors
   • stage of development 
   •stage of health 
   •medication

-physical socioccultural and psychological factors
• age: all nutrients by breastmilk and formula
• economics: Money to buy fresh V canned food
• culture
•religion : fasting, don’t eat meat
•tradition : traditional foods
•education : what you’ve learned to eat at home
•social status : more money = eating out
•food ideology

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15
Q

Developmental considerations

What populations are growing therefore need increased nutritional needs
-Specifically what do these populations need

If the pregnant mother just not taken enough proteins and carbohydrates what will the fetus do

Along with growth what else increases nutritional need

Age related changes:
What is the metabolism of an older individual and their body composition
-why do older require fewer calories

When do nutritional needs level off

A

Infants, Adolescence, PREGNANT letting need increase nutritional needs because they are growing
-specifically these populations need proteins and carbohydrates

If pregnant mother does not take an enough protein the fetus will steal from the mom

⬆️ in activity and growth = ⬆️ nutritional needs

Metabolism of an older individual is slower because they are not as active so there’s a decreased intake required
-older populations lose subcutaneous fat

Nutritional needs level off in adulthood

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16
Q

What are Risk factors for Poor nutrition status

Stage in life
Gender 
State
Abuse
Pharm
Supps
A

Risk factors for poor nutritional status:
-developmental: you get what is getting to you

-gender:

-State of health
• someone with COPD may not eat because of an increased effort to breathe
• person may not be aware they have diabetes
• anorexia nervosa 

  • Alcohol abuse
  • alcoholics drink carbohydrates and become malsheurished of vitamin B (thymine)
  • give banana bag

Medications:

  • steroids may increase Hunger
  • hunger some decrease Hunger

Mega dose of nutrients supplements
-taking too many nutrients

17
Q

Regarding poor nutritional status under state of health what is anorexia nervosa

How does bulimia contribute to decreased health state

A

Anorexia nervosa is a sphere of being fat so patient will not eat or eat minimally

Bulimia is binge eating and purging

18
Q

 How do you want to start a nutritional assessment
-What are aspects you discuss (3 items)

What do you want to discuss with your patient so they can realize

What do you want to tell the patient to keep as they eat

A

Beginning nutritional assessment for the 24 hour recall!  discuss:
-Portions, snacks, times of meals

Discuss a diet history as you can help a patient realize their own eating habits

Have patient keep food diary/ calorie count as well as the frequency of meals

19
Q

 what do the components of the nutritional assessment Give information to know

give the components of the nutritional assessment

A

The components of the nutritional assessment give information to know if the patient has a good nutritional status

History taking
-dietary, medical, sociocultural data

Physical assessment 
-anthropometric and clinical data

laboratory data
-protein Studies, body vitamins and minerals + element status

20
Q

What do the anthropometric data tell us

what is assessed during the anthropometric data

What is the significance of waist circumference (what does it indicate)
-how do you measure waist circumference

give The numerical at risk parameter for men and women

A

Anthropometric data tells us the patient’s nutritional status

Anthropometric data assesses
-height/weight/BMI

Waists circumference is an indicator of a patient at risk for obesity or diabetes
-Measure at the waist line above the hips

Men at risk if +40 inches
Women at risk if +35 inches

21
Q

When assessing laboratory data why do we assess the CBC (what does it tell)

What are vital electrolytes we want to look at

What is the vital protein we look at

  • give its normal
  • What does it mean when low and high
A

CBC tells us our hemoglobin and hematocrit as well as our iron

For electrolytes we want to look at:
-Na
-K
-Cl

When looking at proteins we look at albumin

  • albumin indicates proteins status!
  • albumin: 3.4 to 5.4 g/dL
  •  ⬇️: indicates malnutrition
  • ⬆️: indicates dehydration
22
Q

Give physical assessment findings that indicate healthy nutritional status

Give physical assessment findings that indicate unhealthy nutritional status

A

Healthy nutrition status assessment:

  • A&O +responsive
  • Energetic
  • Hair is shiny
  • eyes are clear
  • skin is smooth and moist
  • nails are pink
Unhealthy nutritional status assessment:
slow to respond 
less energetic 
apathetic
⬆️ or ⬇️ weight
poor wound healing
 dry pale skin 
dehydrated tinting 
nails are brittle
23
Q

What kind of guide is my plate what is the general guide when it comes to weight loss

A

My plate is a guide that dictates better healthier food choices

General guide for weight loss:
-A 500 cal deficit / day for 1 week will cause you to lose 1 pound/week

24
Q

What are nursing interventions you can do for a patient to help with their nutrition

Teach what
Monitor what status
Appetite
Assist with
 nutrition
Long-term what
A

-teach nutritional information
-Monitor nutritional status
- stimulate appetite : by oral nutrition
-assist with eating :If patient is not eating
-providing oral nutrition
-providing long term nutritional support
• find foods patient enjoys any plan that works for the patient

25
Q

Especially at a surgery how does the diet progress

What liquids can you give for a clear liquid diet

What can you give for a full liquid diet

Describe it the puréed diet

Describe the mechanical soft diet

  • what can you have
  • what can you not have

What is a soft diet and who is it for
-what is low?



A

Diet Progresses as:

  • NPO
  • clear liquid
  • Full liquid
  • soft diet

Clear liquid diet:
-juice, Jell-O, broth

Full liquid diet:
-yogurt, ensure, coffee with milk

Puréed diet is a blended meal

A mechanical soft diet is a finally chopped and soft diet
I.e:
-Fully cooked veggies, oatmeal
🚫 dry food, nuts

Soft diet is a regular diet that eliminates foods hard to digest and chew

  • for difficulty with digestion
  • ⬇️ fiber, fat, seasoning



26
Q

What diet do you give someone with dysphasia

What is a key component of the cardiac diet

How many calories is a diabetic diet

Give the difference between a low residue in a high residue diet and for what population

A

If dysphasia:
-give puréed diet with thick fluid

Cardiac diet
-Low sodium 500 to 3000 mg

Diabetic diet: 1800 cal

⬇️ residue:⬇️ fiber
-UC, Crohn’s

⬆️residue: ⬆️fiber
-digestive problems constipation diarrhea

27
Q

What is the route for short term nutritional support and for how long

What is the most accurate way to confirm NG tube placement

 what are other ways to ensure placement

What is not a reliable way to confirm placement

A

NG tube is the route for short term nutritional support for a maximum of 4 weeks

Most accurate NG to placement
!!! X-ray!!!

Other:
-Measure external
-PH and physical assessment of aspirate
    • 4 to 5.5 PH 
-CO2 monitoring

Do not confirm with air bolus not reliable

28
Q

Indications for NG tube

after when do you measure in document length

A

Indication for NG tube:
-cannot take nourishment orally (dysphasia)

After x-ray you measure and document length



29
Q

How do you want to position the patient for enteral feedings and for how long

When do you check residuals

  • what is considered a high residual
  • what is the risk
  • and what do you do

A

Enteral feedings position:
Semi Fowlers for 1 hour

Check residuals:

  • initially and q4-6 hours
  • 200 to 250 mL
  • ⬆️ residuals = ⬆️risk for aspiration
  • stop tube feelings and come back to double check in 1 hour

30
Q

Top three risks for short term nutritional supplement

A

1 aspiration

  • you can use warm water and gentle pressure to unclog
  • it’s not replace
#3 patient doesn’t tolerate food
signs and symptoms of intolerance 
-nausea vomiting
-abdominal distention
-diarrhea
31
Q

What are the two types of tubes used for long-term nutritional support

Implications for long-term nutrition support tube

Why is the long-term gastrostomy tube placement preferred In those with a coma

What do you wanna give the aspirate secretions back to the patient

A

Long-term nutritional support by PEG or G tube into stomach

Implications

  • issues with esophagus
  • coma
  • cannot swallow safely (CVA)

Long-term distrust me to preferred in those with coma it carries a lower risk because it cannot move into lung

Give aspirates secretions back as it contains patients electrolytes and nutrients

32
Q

What situations do you wanna alert the doctor after checking residuals

A

If patient has more than half of previous feeding still inside of the bag

Or if the rate is not infusing at an acceptable amount 

33
Q

What Location do you choose for TPN and why
-Central line sites

What location do you choose for PPN and why 

A

TPN line inserted into central line as it is highly irritating
-jugular/subclavian/ PIC Line


PPN inserted into  Peripheral line because it is less irritating



34
Q

Why is TPN started

What is inside a TPN bag

How do you give lipids when giving TPN

If your patient is NPO what do you still want to do

A

TPN started in the stomach is not digesting, not functioning, not tolerating food

TP and bag made specifically for each individual patient by pharmacist

When giving lipids with TPN they are given by separate infusion that wises with the TPN

If the patient is NPO still do oral hygiene as a patient may have skin breakdown

35
Q

 how can hyper and hypo glycemia happen with parenteral nutrition

How do fluid and electrolyte in balances happen
-What do you want to do before giving TPN

What are insertion problems with parenteral nutrition lines

  • what are your priorities if pneumothorax
  • signs and symptoms of a pneumothorax

What leads to infection in central lines



A

Hyper glycemia: the solution is 25% sugar so check glucose every 6 hours

Hypoglycemia: if you stop the nutrition for a long period of time

Fluid and electrolyte imbalances happen with miscalculation of TPN
-get daily labs

Pneumothorax may happen upon insertion
-#1 give oxygen
-#2 call Doc
 
S&s:
-shortness of breath
-CP
-Sharp inhale pain

 if there is a break in the closed system infection Will occur
36
Q

What does EtOH increase the need for

what do you wanna closely monitor before surgery

What does oatmeal boost in diabetics

what does infection increase

A

ETOH Increases the need for anesthesia

Closely monitor potassium before surgery

oatmeal boost glucose tolerance for diabetics

Infection increases metabolic rate and nutritional needs



37
Q

what will you see if a patient has a protein calorie malnutrition

what should newborns eat

What risk is increased for those overweight

A

In a patient with protein calorie malnutrition you will see

  • weakness
  • apathy
  • Poor wound healing

Newborns should eat
-breastmilk
OR
-formula with iron

 if overweight an increased risk for surgical infection and wound dehiscence