Ch 36: Nutrition Flashcards
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
MACROnutrients Supply energy and build tissue
- Carbohydrate :4 kcal/Gram
- Protein :4 kcal
- 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
 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
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
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
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
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
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)
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
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
What is the percentage of lipids in diet and how does this happen
What is the recommended intake of lipids
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

 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
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
Briefly describe would each vitamins And mineral is for
Vitamin A vitamin D vitamin E vitamin K calcium iron folic acid Vitamin C
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
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
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

Give MACRO minerals
Give micro minerals
Macrominerals:
- calcium
- phosphorus
- sulfate
- sodium
- chloride
- potassium
- magnesium
Micro minerals:
- Iron
- zinc
- copper
- fluoride
- iodine
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
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
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
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
 When is BMI used
Give the BMI scale
Give the BMI formula
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

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

Physical and physiologic
Physical, social cultural, psychological
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
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
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
What are Risk factors for Poor nutrition status
Stage in life Gender State Abuse Pharm Supps
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
Regarding poor nutritional status under state of health what is anorexia nervosa
How does bulimia contribute to decreased health state
Anorexia nervosa is a sphere of being fat so patient will not eat or eat minimally
Bulimia is binge eating and purging
 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

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

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

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
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
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
Give physical assessment findings that indicate healthy nutritional status
Give physical assessment findings that indicate unhealthy nutritional status
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
What kind of guide is my plate what is the general guide when it comes to weight loss
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
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
-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
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?


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


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
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
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

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
Indications for NG tube
after when do you measure in document length
Indication for NG tube:
-cannot take nourishment orally (dysphasia)
After x-ray you measure and document length


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

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

Top three risks for short term nutritional supplement
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
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
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
What situations do you wanna alert the doctor after checking residuals
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 
What Location do you choose for TPN and why
-Central line sites
What location do you choose for PPN and why 
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

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
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
 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

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
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
ETOH Increases the need for anesthesia
Closely monitor potassium before surgery
oatmeal boost glucose tolerance for diabetics
Infection increases metabolic rate and nutritional needs

what will you see if a patient has a protein calorie malnutrition
what should newborns eat
What risk is increased for those overweight
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
