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Nursing 120, chapter 34 > Chapter 36 Nutrition > Flashcards

Chapter 36 Nutrition Flashcards

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1
Q

if a patient can attempt eating regular meals during the day and is prepared to ambulate and resume activities, supplemental feedings should be provided by?

A

Cyclic feeding

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2
Q

A nutritional therapy for patients who have nonfunctional gastrointestinal tracts or who are comatose

A

TPN

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3
Q

Describe clear liquid diet and give examples

A

foods that are clear liquids at room temperature. Eg. gelatins, fat-free bouillon, ice pops, clear juices

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4
Q

what is a full liquid diet and give examples

A

All liquids that can be poured at room temperature, such as clear liquids plus milk. Eg. cereal gruels, pasteurized eggs, frozen desserts.
high-proten, high-calorie supplements are recommend if use for more than 3 days.

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5
Q

describe a soft diet

A

regular diets that have been modified to eliminate foods taht are hard to digest and chew. can be used long term

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6
Q

List the classes of nutrients

A 
Carbohydrates 
Protein
fats
vitamins
minerals and water
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7
Q

explain the significance of Carbohydrates

A

supply energy
easy to produce and store, simple sugars and starch, prevent ketosis from inefficient fat metabolism, spare protein so it can be used for other functions
low intake can cause ketosis

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8
Q

what are the functions and significance of cellulose and other water insoluble fibers

A

Absorb water to increase fecal bulk, decrease intestinal transit time, help relieve constipation.
excess intake can cause gas, distention and diarrhea

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9
Q

explain the functions and significance of water soluble fibers

A

slow gastric emptying, lower serum cholesterol level.
delay glucose absorption.
help improve glucose tolerance in diabetics

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10
Q

explain the function and significance of protein

A

tissue growth and repair, helps regulate fluid balance through oncotic pressure, transports fat and other substance through the body. provides energy when carbohydrate intake is inadequate.
deficiency increased the risk for infections and high mortality.

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11
Q

what are characteristics of protein deficiency

A

edema, retarded growth and maturation, muscle wasting, changes in the hair and skin, diarrhea, malabsorption, fatty infiltration of the liver.

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12
Q

what are the functions and significance of fat

A

Provides energy, structure, insulates the body, cushions internal organs. Necessary for the absorption of fat-soluble vitamins.
High-fat diets increase the risk for heart disease and obesity and are correlated with an increase risk for colon and breast cancers.

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13
Q

Lactose

A

The only animal source of carbohydrate in the diet (milk sugar)

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14
Q

how many grams of carbohydrate are need daily to prevent ketosis?

A

50 -100 g

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15
Q

what happens when glycogen stores are adequate?

A

The body converts excess glucose to fat and stores it as triglycerides in adipose tissue.

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16
Q

when the supply of glucose exceeds what is need for energy and for maintaining serum level, it is stored as?

A

glycogen

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17
Q

An abnormal accumulations of ketone bodies that is frequently associated with acidosis (by product of fat break down)

A

ketosis

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18
Q

What is the only plant protein that is considered as complete

A

soy

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19
Q

Essential nutrients

A

must be provided in the diet or through supplements (fats, protein, carbohydrates)

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20
Q

Type of nutrients do not have to be supplied through dietary sources because they are either not required for body functioning or are synthesized in the body in adequate amounts.

A

nonessential nutrients

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21
Q

The body converts excess carbohydrates, protein into fats and stores them as

A

triglycerides

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22
Q

catabolism

A

break down of tissues

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23
Q

build up of tissues

A

anabolism

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24
Q

positive nitrogen balance

A

occurs when nitrogen intake is greater than excretion

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25
Q

Occurs when more nitrogen is excreted than is ingested

A

Negative nitrogen balance

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26
Q

saturated fats

A

tend to raises serum cholesterol
contain more hydrogen
most animal fats
have a solid consistency at room temperature.

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27
Q

unsaturated fats

A

most vegetable fats
lower serum cholesterol levels
remain liquid at room temperature

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28
Q

Cholesterol

A

found in animal product
component of cell membranes
abundant in brain and nerve cells.
used to synthesize bile acids.
precursor of the steroid hormones and vitamin D
high serum levels are associated with an increased risk for atherosclerosis.

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29
Q

Fat digestion occurs largely in?

A

small intestine

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30
Q

which nutrients is most concentrated source of energy in the diet?

A

fat 1 g = 9kcal

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31
Q

develop a POC for a patient with hypertension and high cholesterol.

A

eating less total fat especially saturated and trans fat.
eating more unsaturated fat.
increasing fiber intake, which increase fecal excretion of cholesterol.
weight loss

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32
Q

explain the functions and significance of vitamins

A

needed for metabolism of carbohydrates, proteins and fat.

The absence or insufficient in the body causes specific deficiency syndromes.

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33
Q

what are the water-soluble vitamins and their significance

A

vitamin C - collagen formation, antioxidant, enhance iron absorption.
Vitamin B complex- coenzyme in protein, fat and carbohydrate metabolism
Not store in the body.

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34
Q

Fat soluble vitamins

A

A, D, E and K
absorbed with fat into the lymphatic circulation
must be attached to a protein to be transported through the blood.
the body stores excesses in the liver and adipose tissue.
daily intake is not imperative and deficiency may take weeks

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35
Q

SxS of excessive vitamin A intake

A

Anorexia, loss of hair, dry skin, bone pain, vomiting, birth defects.

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36
Q

SxS of vitamin A deficiency

A

night blindness, rough skin, bone growth ceases

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37
Q

SxS of vitamin D deficiency

A

retarded bone growth, bone malformation

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38
Q

what are some SxS of excess vitamin D intake

A

excessive calcification of bones, renal calculi, nausea, headache

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39
Q

SxS of vitamin C deficiency

A

scurvy, hemorrhaging, delayed wound healing

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40
Q

Excess Vitamin C intake

A

hot flashes, headache, nausea, diarrhea

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41
Q

What are signs and symptoms of Vitamin B deficiency

A

beriberi, mental confusion, fatigue

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42
Q

what are the functions and significance of minerals

A

organic elements, some function to provide structure in the body, others help regulate body processes.

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43
Q

list macrominerals needed by the body in amounts greater than 100 mg/day

A

calcium, phosphorus and magnesium

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44
Q

what are the functions of calcium

A

bone and tooth formation, blood clotting, nerve transmission and muscle contraction.

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45
Q

what are signs and symptoms of calcium deficiency

A

tetany and osteoporosis

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46
Q

signs and symptoms of excess calcium intake

A

renal calculi in susceptible people

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47
Q

what are the functions of phosphorus

A

bone and tooth formation, acid-base balance, energy metabolism

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48
Q

SxS of phosphorus deficiency

A

hypophosphatemia (anorexia, muscle weakness)

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49
Q

SxS of excessive phosphorus intake

A

hyperphosphatemia, symptoms of hypocalcemic (tetany)

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50
Q

what are the functions of magnesium

A

bone and tooth formation, protein synthesis, carbohydrate metabolism

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51
Q

what are SxS of excessive intake of magnesium

A

hypermagnesemia (CNS depression, coma, hypotension)

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52
Q

SxS of magnesium deficiency

A

hypomagnesemia (weakness, muscle pain, poor heart function)

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53
Q

Functions of Sodium

A

major ion of ECF, fluid balance, acid-base balance

54
Q

sodium deficiency

A

hyponatremia (muscle cramps, cold and clammy skin)

55
Q

excessive intake of sodium

A

edema, weight gain, high BP

56
Q

functions of potassium

A

major ion of ICF, fluid and acid-base balance

57
Q

hypokalemia

A

muscle cramps and weakness, irregular heartbeat

58
Q

hyperkalemia

A

(irritability, anxiety, cardiac arrhythmia, heart block)

59
Q

list some microminerals

A

iron, zinc, manganese and iodine

60
Q

iron deficiency

A

microcytic anemia, pallor, decreased work capacity, fatigue, weakness

61
Q

SxS of excessive iron intake

A

hemosiderosis; acute iron poisoning from accidental overdose leads to GI symptoms and possible shock

62
Q

function of iron

A

O2 transport by way of hgb

constituent of enzyme systems

63
Q

Goiter

A

Iodine deficiency

64
Q

signs and symptoms of excessive iodine intake

A

acne-like lesions

65
Q

what are some signs and symptoms of zine deficiency

A

impaired growth, sexual maturation, immune system functioning

66
Q

SxS of excessive zinc intake

A

Anorexia, N/V, diarrhea, muscle pain, lethergy

67
Q

eating disorder characterized by extreme weight loss, muscle wasting, arrested sexual development, refusal to eat and bizarre eating habits

A

Anorexia nervosa

68
Q

bulimia

A

eating disorder characterized by gorging followed by purging with self-induced vomiting, diuretics and laxative

69
Q

How does nutrition influences adulthood

A

fewer calories is required because of decrease in BMR

70
Q

factors that affects the older adults nutrition

A

decrease in BMR, physical activity, loss of lean body mass, energy expenditure, loss of teeth, periodontal disease making chewing more difficult.
decrease in peristalsis, loss of taste between salty and sweet. decrease thirst sensation, degenerative disease and medication use.

71
Q

measurements used to determine body dimensions

A

Anthropometric data

72
Q

difficulty swallowing or the inability to swallow. increase risk for aspiration

A

dysphagia

73
Q

which laboratory test is a good indicator of a patient’s nutritional status, chronic problems?

A

serum albumin levels

74
Q

which laboratory test can be used to detect daily changes in a patient’s protein status

A

prealbumin levels

75
Q

This type of lab test indicate short term nutritional status

A

prealbumin (23-24 mg/dL)

76
Q

which twenty-four-hour urine test are used to measure protein metabolism

A

creatinine and BUN

77
Q

what are implications for creatinine?

A

0.4-1.5 mg/dL
directly proportional to body’s muscle mass.
reduction is severe malnutrition

78
Q

what are nutritional implications for BUN

A

17-18 mg/dL
increase=starvation, hight protein intake, severe dehydration.
decrease=malnutrition, overhydration

79
Q

Mini nutritional assessment tool (MNA)

A

used to detect elderly person at risk for malnutrition before changes in albumin level and the BMI

80
Q

BMI

A

weight in poundsx703/ height in inches x heights in inches

81
Q

Normal BMI

A

18.5-24.9

82
Q

overweight (BMI)

A

25-29.9

83
Q

obese (BMI)

A

30-39.9

84
Q

Extreme obesity (BMI)

A

40-54

85
Q

measurement of waist circumference

A

good indicator of abdominal fat.
relative risk for heart disease, diabetes and HTN
male greater 40
females greater 35

86
Q

type of diet used after oral or facial surgery

A

pureed diet

87
Q

type of diet use for patients with limited chewing ability or who have surgery to head, neck or mouth

A

mechanical soft diet

88
Q

Factors to assess for nutritional satus

A 
usual dietary intake
food allergies or intolerances
food preparation and storage
dietary practices
eating disorder patterns
89
Q

Factors related to selection of a feeding tube

A

aspiration risk, anticipated duration, function of the GI and the patient’s overall condition and prognosis

90
Q

what is a disadvantage of using NG

A

risk for aspiration

91
Q

which patients are not candidates for NG feeding

A

dysfunctional gag reflex, high risk of aspiration, gastric stasis, gastroesophageal reflux, nasal injuries, and those who are unable to have the HOD elevated during feedings

92
Q

tube that passes through the nose and into the upper portion of the small intestine

A

Nasointestinal (IN) tube

93
Q

which tube feeding may be indicated for a patient with increased risk for aspiration due to diminished gag reflex or slow gastric motility?

A

Nasointestinal tube

94
Q

what are signs of symptoms of dumping syndrome

A

distention of the small intestine, gas, bloating, N/V, cramping, diarrhea and lightheadedness

95
Q

dumping sydrome

A

rapid administration of hypertonic feeding solution into the proximal small intestine causing the movement of ECF from the vascular system into the small intestine.

96
Q

means anabolic and catabolic metabolism of protein is in equilibrium

A

Nitrogen balance

97
Q

what are some ways to confirm feeding tube placement?

A

radiographic examination, measurement of aspirate Ph, visual assessment of aspirate, measurement of tube length and measurement of tube marking.
monitoring of carbondioxide.

98
Q

when should the nurse verify correct placement of NG tube

A

after the initial insertion.

before beginning a feeding or instilling liquids, and at regular intervals during continuos feedings

99
Q

If a tube is connected to suction what action should the nurse take?

A

keep the tube disconnected from the suction and clamped for 20 to 30 minutes after administration of the medication to allow absorption.

100
Q

how much ml of water should be mixed with crushed medications before delivery through an enteral feeding tube

A

15 to 30 ml

101
Q

how much ml of water should be flush before giving medication and immediately after?

A

15 to 30 ml

102
Q

why is giving medications separately and flushing with water between each drug important?

A

some medications may interact with each other or become less effective if mixed with other drugs.

103
Q

stomach pH

A

less than 5.5

if the patient is taking an acid-inhibiting agent the range may be 4.0-6.0

104
Q

intestine pH

A

7.0 or higher

105
Q

Respiratory tract pH

A

6.0 or higher

106
Q

what degree should the HOD be during oral feeding

A

45-90 degrees during and 60 minutes following feeding.

107
Q

Any increase in the length of expose tube may indicate?

A

dislodgment

108
Q

what is a good way to make ensure a tube has not become displaced?

A

marking the tube with an indelible marker at the nostril and assessing the marking each time the tube is used.

109
Q

confirming Nasointestinal tube placement

A

x-ray
pH of aspirate 7 or higher
bile-stained ranging in color from light to golden yellow or brownish-green

110
Q

in long-term feeding situations in which gastric problems exist what is an alternate method through which nutrition can be delivered

A

Jejunostomy

111
Q

Percutaneous endoscopic gastrostomy (PEG)

A

usually does not require general anesthesia

requires an intact function GI

112
Q

feeding are delivered at regular intervals in equal portion.
formula is introduced gradually over a set period of time via gravity or a feeding pump.
allow the patient freedom of movement between feedings.
preferred method for gastric feeding

A

intermittent feedings

113
Q

involves administering continuos feedings for a portion of the 24 hour period.
Routine is to feed the patient for 12 to 16 hours, most often overnight.
allows the patient to attempt eating regular meals during the day if possible.
ambulation and activity are easy.

A

cyclic feeding

114
Q

what is the best way to improve tolerance for patient on enteral feeding

A

starting the feeding at a slower rate

115
Q

Criteria to consider when evaluating patient feeding tolerance

A

absence of N/V, diarrhea and constipation,abdominal pain and distention.
minimal or no gastric residual.
presence of bowel sounds within normal limits

116
Q

high gastric residual volumes (200 to 250 ml or greater) can be associated with?

A

high risk for aspiration and aspiration-related pneumonia

117
Q

A residual of more than 10% to 20 % above the hourly rate for the feeding may indicate?

A

feedings should be interrupted or delayed

118
Q

feeding remaining in the stomach

A

residual

119
Q

when should the nurse check residual?

A

every 4 to 6 hours during continuous feeding (according to institution policy)

120
Q

which degree should the HOB be during tube feeding

A

30 degrees during feeding and 1 hour afterward to prevent reflux and aspiration

121
Q

how long can a closed system feeing be used

A

48 hours

122
Q

when should a disposable feeding apparatus for open system be replaced

A

24 hours

123
Q

How long should an open system be hang

A

8 hours

124
Q

nursing interventions for accidental removal or tube

A

anchor tube adequately with tape
check on patient frequently
measure external length of tubing at regular intervals
restrain patient only if necessary, with physician’s order

125
Q

nursing interventions for clogged tube

A

flush tube before and after feeding, q4h during continuos feeding and after withdrawing aspirate
instill 30 ml of warm water with 50 or 60 ml syringe to attempt to unclog tube

126
Q

preventive interventions for nasal erosion

A

keep nasal clean

check for pressure ulcer q4-8h

127
Q

less concentrated nutrient solution
for patients who have a malfunctioning GI and need short-term nutrition lasting less than 2 weeks
administered through a peripheral vein

A

peripheral parenteral nutrition (PPN)

128
Q

what actions should the nurse take when gagging and coughing persist during NG insertion

A

stop advancing the tube and check placement of tube with tongue blade and flashlight

129
Q

during insertion of an NG tube, patient shows sighs of gasping, coughing, cyanosis, and inability to speak or hum. Which action should the nurse take

A

discontinue procedure and remove the tube.

tube is in the airway (trachea)

130
Q

what to do when no gastric contents can be aspirated if patient is comatose

A

check oral cavity, if tube is in gastric area, small air boluses may need to be given until gastric contents can be aspirated.

131
Q

within 2 hours after NG tube removal, patient’s abdomen is showing signs of distention

A

notify physician. May order NG tube replacement.

132
Q

Epistaxis occurs with removal of NG tube. Interventions?

A

occlude both nares until bleeding has subsided. Ensure that patient is in upright position.
Document epistaxis in patient’s medical record.

Nursing 120, chapter 34 (10 decks)

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