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NURS 105 > Chapter 45: Nutrition > Flashcards

Chapter 45: Nutrition Flashcards

1
Q

Nutrition is important for

A 
normal growth and development
tissue maintenance and repair
cellular metabolism
organ function
body movement
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2
Q

Food can hold

A

symbolic meaning

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3
Q

The U.S. Department of Health and Human Services established nutritional goals and objectives for Healthy People 2020

A 
Weight and growth
Food and nutrient consumption
Iron deficiency and anemia
Schools, work sites, and nutrition counseling
Food security
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4
Q

The basal metabolic rate

A

The energy needed to maintain life-sustaining activities (breathing, circulation, HR, temperature) for a specific period of time at rest.

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5
Q

The resting energy requirements (REE)

A

The amount of energy that an individual needs to consume over a 24 hour period for the body to maintain all of its vital functions at rest

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6
Q

Kilocalories

A

when food intake equals energy requirements

no change in weight

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7
Q

Nutrients

A

Elements necessary for normal function of body processes: carbohydrates, proteins, fats, water, vitamins and minerals

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8
Q

Nutrient density

A

…

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9
Q

Carbohydrates is composed of

A

Carbon
Hydrogen
Oxygen

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10
Q

Each gram of carbohydrates produce how many kcals?

A

each gram produces 4 kcal/g

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11
Q

Carbohydrates

A

serves as a main source of fuel (glucose)

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12
Q

Carbohydrate classification

A

based on the number of carbohydrate units = saccharides.

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13
Q

Simple Carbohydrates

A

Primarily in sugars

monosaccharides and disaccharides.

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14
Q

Monosaccharides

A 
do not break down into smaller carbohydrate units
includes glucose (dextrose) and fructose
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15
Q

Disaccharides

A

composed of two monosaccharides and water

includes sucrose, maltose and lactose

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16
Q

Complex Carbohydrates include

A

polysaccharides

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17
Q

Polysaccharides

A

insoluble in water

soluble in water

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18
Q

Protein function

A
  • provide source of energy (4 kcals/g)
  • assist in transport of nutrients and certain medications
  • ingestion of proteins maintains nitrogen balance
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19
Q

Proteins are essential for

A

growth, maintenance, and repair of the body tissue

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20
Q

Proteins are the building blocks for the synthesis of

A 
DNA and RNA
Collagen
Hormones
Enzymes
Immune cells
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21
Q

Amino acids

A

the simplest form of protein

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22
Q

Amino acids consist of

A

Hydrogen, Oxygen, Carbon and Nitrogen

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23
Q

Indispensable amino acids

A

Not synthesized by the body

Needs to be provided via diet

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24
Q

Dispensable amino acids

A

synthesized by the body

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25
Q

Fats

A

also known as lipids
provides 9 kcal/g
is the most calorie dense nutrient

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26
Q

Fats are composed of

A

triglycerides and fatty acids

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27
Q

Triglycerides

A

three fatty acids attached to a glycerol

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28
Q

Fatty Acids

A

Saturated

Unsaturated - Monounsaturated and Polyunsaturated

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29
Q

Water is critical because

A

it makes up 60-70% of body weight

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30
Q

Percentage of total body weight is based on

A

muscle mass.

greater in lean people and lesser in obese people.

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31
Q

In healthy people, fluid intake equals output through

A

Elimination, respiration and sweating

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32
Q

In ill people, there might be a need for

A

Fluid intake d/t fever or GI losses

Fluid restriction d/t cardiopulmonary issues or renal insufficiency

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33
Q

Vitamins

A

neutralize free radicals

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34
Q

Free radicals

A

produce oxidative damage to body cells and tissues

increases risk for certain cancers

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35
Q

Vitamin synthesis depends on

A

dietary intake.

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36
Q

Vitamins are high in

A

fresh foods not exposed to heat, air and water

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37
Q

Vitamin Classification

A

Fat soluble: A, D, E and K

Water soluble: C and B-complex

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38
Q

Minerals

A

inorganic elements essential to the body - acts as catalyst in biochemical reactions. Acts as antioxidants.

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39
Q

Minerals are classified as

A

Microminerals and Trace elements

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40
Q

Microminerals

A

Daily requirement more than 100 mg
Help to balance the pH of the body
Promotes acid-base balance

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41
Q

Trace elements

A

Daily requirement is less than 100 mg

Excess of one trace mineral can cause deficiency of another trace mineral

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42
Q

Digestion

A

breakdown of food by chewing, mixing and churning (break down of food into absorbable nutrients)

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43
Q

Enzymes

A

protein substances that act as catalysts to speed up chemical reactions
ex. in saliva-amylase (digest carbohydrates)

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44
Q

Peristalsis

A

wavelike muscular contractions to move swallowed food through digestive tract

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45
Q

Chyme

A

acidic and liquefied food

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46
Q

What nutrients are absorbed in the small intestine?

A

carbohydrates, minerals, protein and water soluble vitamins

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47
Q

After absorption, the nutrients absorbed in the small intestine are processed in the ________ and released into the _________.

A

After absorption, the nutrients absorbed in the small intestine are processed in the LIVER and released into the PORTAL VEIN CIRCULATION.

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48
Q

About how much water is absorbed in the small intestine?

A

close to 90% of water is absorbed in the small intestine

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49
Q

Villi

A

fingerlike projections responsible for nutrient absorption

increase surface area for absorption

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50
Q

Mechanisms for Intestinal Absorption

A

Active Transport
Passive Diffusion
Osmosis
Pinocytosis

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51
Q

Metabolism

A

Biochemical reactions in the body.

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52
Q

Metabolism can be

A

anabolic or catabolic

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53
Q

anabolic

A

building of complex biochemical substances by synthesis of nutrients

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54
Q

catabolic

A

breakdown of biochemical substances into simpler forms

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55
Q

Nutrient metabolism consists of three processes

A
  1. glycogenolysis
  2. glycogenesis
  3. gluconeogenesis
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56
Q

glycogenolysis

A

breaking glycogen into glucose, carbon dioxide and water

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57
Q

glycogenesis

A

anabolism of glucose into glycogen for storage

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58
Q

gluconeogenesis

A

catabolism of amino acids and glycerol into glucose for energy

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59
Q

Chyme

A

becomes feces in the large intestine

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60
Q

During elimination, water is absorbed into the

A

mucosa while feces move toward the rectum

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61
Q

The longer the feces stay in the large intestine,

A

the firmer they become

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62
Q

What stimulates peristalsis?

A

exercise and fiber

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63
Q

Feces contain

A
  • cellulose
  • indigestible substances
  • sloughed epithelial cells from the GI tract
  • digestive secretions
  • microbes
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64
Q

Dietary reference intakes (DRI)

A

criteria for acceptable range of amounts of vitamins and nutrients for each gender and age group

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65
Q

Food guidelines

A

Dietary guidelines for Americans (2015-2020) (Box 45-2, p. 1058)
ChooseMyPlate

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66
Q

Daily Values (Food Labels)

A

Recommended daily values by the US Food and Drug Administration based on 2000 kcal/day for adults and children

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67
Q

There are two sets of reference values

A
  1. Referenced Daily Intake (RDI)

2. Daily Reference Values (DRV)

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68
Q

Factors influencing nutrition and eating

A

sociological
cultural
psychological
emotional

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69
Q

In relation to nutrition, nurse’s need to understand patient’s

A

values, beliefs, and attitudes about food and how it affects food purchase, preparation and intake.

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70
Q

Environmental factors that influences nutrition

A

sedentary lifestyle
work schedules
poor meal choices

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71
Q

Factors Influencing Nutrition

A 
Living on a fixed income
Good oral health/Periodontal disease (difficulty chewing, missing teeth, oral pain)
Medications
Type of Diet (Vegetarian, vegan)
Eating disorders
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72
Q

Nutrition in young and middle-aged adults

A

reduction in nutrient demands as the growth period ends

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73
Q

What happens to energy needs over the years?

A

energy needs decline over the years

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74
Q

Obesity becomes a problem d/t

A

decreased physical exercise
dining out more often
increased ability to afford more luxury foods

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75
Q

Poor nutrition in pregnancy causes

A

low birth weight in infants

meeting the needs of a fetus is at the expense of the mother

76
Q

What can you teach pregnant mothers about nutrition?

A 
quality food intake
protein intake (60 g/day)
calcium, iron and folic acid intake
77
Q

Lactation

A

production of milk increased energy and protein requirements

increased need for vitamins (A and C)

78
Q

Nutrition in Older Adults (65 and older)

A

Decreased need for energy d/t slower metabolic rate

Vitamin and mineral requirements remain unchanged

79
Q

Factors affecting nutritional status in older adults

A
  • Gastrointestinal changes affecting digestion of foods
  • Presence of chronic illnesses
  • Adverse effects of medications
  • Factors contributing to food insecurity (limited income, lack of transportation, limited mobility)
  • Cognitive impairments
80
Q

Nutrition: Assessment

A
  • Assess for an early recognition of malnourished and at-risk patients
  • Identify the signs and symptoms associated with altered nutrition
  • Gather data from patients regarding nutritional practices and obtain patient’s dietary history
  • Determine patient’s nutritional energy needs
  • Assess effects of chronic conditions on the ability to prepare meals
81
Q

Nutrition Screening

A

Quick method to identify malnutrition or risk for malnutrition

82
Q

Nutrition Screening includes objective measures such as

A

height
weight and weight changes
diagnosis and presence of other comorbidities

83
Q

Nutrition Screenings identify risk factors such as

A
  • unintentional weight loss
  • presence of modified diet
  • presence of altered nutritional symptoms (N/V, diarrhea, and constipation)
84
Q

Assess patients for malnutrition when their conditions interfere with

A

ability to ingest, digest or absorb nutrients

85
Q

Anthropometry

A

measurement system of the size and makeup of the body (height and weight)

86
Q

Weight

A

weight the patient at the same time each day
on the same scale
with the same type of clothing or linen

87
Q

Ideal body weight

A

provides an estimate on how much a person should weigh

88
Q

Body mass index

A

measures weight corrected for height

89
Q

BMI between 25-30

A

overweight

90
Q

BMI above 30

A

obesity

91
Q

Nutrition: Laboratory and Biochemical Tests

A

common tests used to measure nutritional status includes measures of plasma proteins, fluid balance, liver function, kidney function and presence of disease.

92
Q

Diet history and health history includes

A
  • Dietary intake and food preferences
  • Unpleasant symptoms
  • Allergies
  • Taste, chewing, and swallowing
  • Appetite and weight
  • Use of medications
93
Q

Dysphasia

A

difficulty swallowing

94
Q

Difficulty swallowing can cause complications such as

A

Aspiration pneumonia
Dehydration
Decreased nutritonal status
Weight loss

95
Q

Warning signs for dysphasia

A
  • Cough during eating
  • Change in voice tone and quality after swallowing
  • Abnormal movements of the mouth, tongue, or lips
  • Slow, weak, imprecise, or uncoordinated speech
  • Incomplete oral clearance or pocketing
  • Delayed or absent trigger of swallow
96
Q

Silent aspiration

A
  • Occurs in patients with neurological problems that lead to decreased sensation
  • Often occurs without a cough
97
Q

Silent aspiration symptoms usually don’t appear for

A

24 hours

98
Q

Silent aspiration accounts for

A

majority of aspirations in patients with dysphasia after stroke

99
Q

Valid dysphasia-screening tools

A

increase quality of care
decrease of aspiration pneumonia (bedside swallowing assessment, acute stroke dysphasia screen, standardized swallowing assessment)

100
Q

Possible nursing diagnosis RT Nutrition

A

Risk for Aspiration
Diarrhea
Imbalanced Nutrition : Less than Body Requirements
Imbalanced Nutrition: More than Body Requirements
Readiness for Enhanced Nutrition
Impaired Swallowing
Feeding Self-Care Deficit

101
Q

Planning

A
  • Select interventions to promote optimal nutrition
  • Select interventions consistent with therapeutic diets
  • Consult with other healthcare professionals to adopt interventions that reflect the patient’s needs
  • Involve family when designing interventions
102
Q

In acute care, patients

A
  • Are often refrained from drinking and eating anything by mouth (NPO)
  • Have frequent interruptions during meal times
  • Have poor appetites
  • Are too tired or uncomfortable to eat
103
Q

Advancing diets

A

-NPO patients after extended time or NPO patients who had surgical procedures require specific orders on:
Diet progression
Therapeutic diets

104
Q

Promoting Appetite

A
  • Keep environment free of odors
  • Provide oral hygiene as needed
  • Maintain patient comfort
  • Offer small frequent meals
  • Encourage use of seasoning to improve food taste
  • Encourage visitors to eat with the patient
105
Q

Mealtime is an excellent time for

A

patient education

106
Q

Teach patients about

A

therapeutic diets and adaptive devices to help with in depended feeding

107
Q

Assisting patients with oral feedings

A

Protect patient’s safety, independence, and dignity
Clear the side table of clutter
Assess for risk of aspiration

108
Q

In patients with dysphasia,

A
  • Feed the patient slowly
  • Provide small size bites
  • Allow the patient to empty the mouth after each spoonful
  • Match the speed of feeding to the patient’s readiness *
109
Q

Enteral tube feeding (enteral nutrition)

A

preferred in patients unable to swallow or take nutrients orally but have functional GI tract

110
Q

Enteral Tube feedings via

A 
Nasogastric
Jejunal (surgically inserted=jejunostomy)
Gastric (surgically inserted= gastrostomy)
111
Q

After insertion of an enteral tube, placement should be

A

verified by x-ray

112
Q

Before patient receives first enteral feeding, what is needed?

A

confirmation of placement

113
Q

When advancing the rate of tube feeding, you typically start at

A

a slow rate (advancing is institution specific, follow the order)

114
Q

When advancing the rate of tube feeding, the nurse should

A
  • Check for signs of intolerance
  • Keep the head of the bed elevated minimum 30-45 degrees
  • Measure gastric residual volumes per hospital policy
  • Evaluate for aspiration an use measures to reduce risk of aspiration
115
Q

Parenteral Nutrition or Total Parenteral Nutrition

A

Nutrition provided intravenously
Administered via central line
Adhere to principles of asepsis and infusion management
Received over a 24-hour period

116
Q

Parenteral Nutrition or Total Parenteral Nutrition is for patients

A

unable to digest or absorb enteral nutrition

117
Q

Parenteral Nutrition or Total Parenteral Nutrition requires

A

laboratory monitoring

118
Q

The goal of parenteral nutrition or total parenteral nutrition is to

A

eventually use the GI tract

119
Q

Initiating parenteral nutrition

A

Placement of central line into central vein
Placed by specially trained nurses under sterile conditions
Catheter placement placement confirmation required by radiology
Before starting TPN verify the order

120
Q

Complications of Parenteral Nutrition

A

Catheter related problems

Metabolic alternations

121
Q

Preventing complications of parenteral nutrition

A 
Change TPN tubing every 24 hours
Lipid tubing change every 12 hours
Do not hang TPN for longer than 24 hours
Use chlorhexidine to clean the catheter hub for 15 seconds before and after each time it is used 
Monitor blood glucose Q6H
122
Q

Sudden discontinuation of TPN can cause

A

hypoglycemia (recommended to infuse 10% Dextrose in the meantime, see orders)

123
Q

During central line dressing changes use

A

sterile mask and gloves and assess the site for S/S of infection

124
Q

When should central line dressings be changed?

A

Change central line dressing per hospital policy or when wet or soiled

125
Q

Medical nutritional therapy

A

specific therapies to treat illness, injury or condition

126
Q

Peptic ulcers are mainly caused by

A

(up to 85%) by Helicobacter pylori

127
Q

Peptic ulcers

A

Stress and overproduction of HCL irritate pre-existing ulcer

128
Q

Peptic ulcers can be controlled with

A

regular meals

129
Q

Patient teaching for peptic ulcers

A

-Encourage patients to avoid foods that increase stomach acidity
(caffeine, decaffeinated coffee, frequent milk intake, citric acid juices, spices)
-Discourage smoking, alcohol, aspirin, NSAIDs
-Teach patients to avoid eating large meals without snacks especially at bedtime

130
Q

Inflammatory Bowel Diseases include

A

Crohn’s Disease

Idiopathic Ulcerative Colitis

131
Q

Treatment of acute IBDs include

A

elemental diets

PN when symptoms of diarrhea and weight loss

132
Q

Treatment of chronic IBDs include

A

Regularly, highly nourishing diets

Vitamins and iron supplements

133
Q

Irritable Bowel Syndrome Treatments include

A

increasing fiber, reducing fats, avoiding large meals and avoiding lactose and sorbitol containing foods

134
Q

Treatment for Celiac disease (Malabsorption syndrome)

A

gluten-free diet

135
Q

Short-bowel syndrome (Malabsorption Syndrome)

A

results from extensive resection of bowel (lack of intestinal surface area)

136
Q

Treatments for Short-bowel syndrome (Malabsorption Syndrome)

A

lifetime feeding with either elemental formula or PN

137
Q

Diverticulitis

A

inflammation of diverticula in bowel lining (pouch-like herniations)

138
Q

Treatment for Diverticulitis

A
  • moderate or low-residue diet in acute diverticulitis

- prescription of high-fiber diet for chronic diverticula problems

139
Q

Treatment for Diabetes Mellitus

A
  • insulin/oral medications

- maintaining/monitoring a prescribed carbohydrate intake to balance glycemic levels

140
Q

Treatment for Cardiovascular Diseases

A

balanced caloric diet intake with exercise to maintain healthy weight

141
Q

Treatment for Cancer

A

maximized nutritional therapy that meets the increased metabolic needs

142
Q

Treatment for HIV/AIDS

A

restorative care of malnutrition focuses on maximizing Kcal and nutrients

143
Q

Evaluation: Reassess signs and symptoms associated with altered nutrition including

A 
Weight
Calorie intake
Protein intake
Laboratory results
Determine patient's satisfaction with nutritional therapy
144
Q

Carbohydrates are essential for normal function of the

A

Brain
Skeletal muscles during exercise
Erythrocytes and leukocyte production
Cell function of the renal medulla

145
Q

Carbohydrates are primarily obtained from

A

Plant sources (except milk)

146
Q

Complex carbohydrates

A

Made up of many carbohydrate units. Insoluble in water and digested to arming degrees. Ex) glycogen, starches (fiber: not broken down by the human digestive system)

147
Q

Additionally _____________________________________ all require proteins.

A

blood clotting, fluid regulation and acid-base balance

148
Q

Complete protein

A

Contains all essential amino acids to support growth and maintain nitrogen balance.
Ex. Fish, poultry, soybeans, cheese

149
Q

Incomplete proteins

A

Missing one or more of the nine essential amino acids.

Ex. Cereals, legumes, vegetables

150
Q

Nitrogen Balance

A

When the intake and output of nitrogen are equal.

Nitrogen Balance = Intake - Output.

151
Q

Negative Nitrogen Balance

A

When the intake is less than what the body requires

152
Q

Negative Nitrogen Balance may occur with

A

Infections, burns, fever, starvation, head injury, trauma.

153
Q

Positive Nitrogen Balance

A

When intake is greater than output.

154
Q

Positive Nitrogen Balance is essential for

A

Growth
Normal pregnancy
Maintenance of lean muscle mass and vital organs
Wound healing (to build, repair, and replace body tissues)

155
Q

Adequate amounts of _______________ for energy expenditure are essential for healing to prevent the body from using _________ as its primary energy source.

A

Carbohydrates

Protein

156
Q

Antioxidants neutralizes

A

Free radicals

157
Q

Bile

A

Manufactured in the liver and stored in the gallbladder to emulsify fats

158
Q

Pancreatic secretions

A

Contain enzymes to digest starch, emulsify fats and break down proteins

159
Q

What organ is the primary absorption site for nutrients?

A

Small intestine

160
Q

The energy produced by metabolism involves

A

Mechanical energy: muscle contraction
Electrical energy: nerve impulses
Thermal energy: Heat production

161
Q

Recommended Daily Allowances

A

The average needs of 98% of the population (not the exact needs of an individual)

162
Q

Estimated Average Requirement

A

The recommended amount of nutrients that appears sufficient to maintain a specific body function for 50% of the population based on age and gender.

163
Q

Referenced Daily Intakes

A

Protein, vitamins and minerals based on RDA

164
Q

Daily Reference Values

A

Total fat, saturated fat, cholesterol, carbohydrates, fiber, sodium and potassium

165
Q

Nutritional Requirements are dependent on

A 
Stage of development
Body composition
Activity Levels
Pregnancy and Lactation
Presence of disease
166
Q

Registered Dietitians

A

Helps develop nutrition treatment plans. I.e calorie counts

167
Q

Patients that are malnourished on admission are at greater risk of life-threatening complications including

A

Arrhythmias, sepsis and hemorrhage

168
Q

Laboratory Tests: Plasma proteins

A

Albumin
Factors affecting serum albumin include: hydration, hemorrhage, renal or hepatic disease, large amounts of drainage from wounds or the GI tract, steroid administration, exogenous albumin infusions, age and trauma.

169
Q

Dysphasia leads to

A 
Decreased functional status
Increased length of stay
Increased cost
Increased likelihood of being discharge to LTAC
Increased mortality
170
Q

Pharmacists

A

Develop PN orders/mixtures

171
Q

Physical Therapists

A

Builds strength and endurance

172
Q

Occupational Therapist

A

Identify assistive devices.

I.e utensils with large handles, plates with sides

173
Q

Speech therapists

A

Help with swallowing exercises and techniques to reduce risk of aspiration.

174
Q

Understand the effects of medications on:

A

Taste, appetite and metabolism

175
Q

Assisting a patient with dysphasia

A 
Sit patient up 90 degrees
Head position slightly chin down
Place food in stronger side of the mouth
Have sanction equipment available
Utilize speech therapy to determine viscosity of foods tolerated best.
176
Q

Four levels of liquid

A

Thin (low viscosity)
Nectar-like
Honey-like
Spoon-thick (pudding)

177
Q

Diet progression

A

Clear liquid -> regular diet

178
Q

NG tube

A

Therapy lasting < 4 weeks

179
Q

G-Tube

A

For patients with a lower risk of aspiration.

Inserted surgically or through endoscopy

180
Q

J-tube

A

(For patients with a higher risk of aspiration)

Inserted surgically or through endoscopy

181
Q

Benefits of feeding by the enteral route

A

Reduces sepsis
Minimizes the hyper metabolic response to trauma
Decreases hospital mortality
Maintains intestinal structure and function

182
Q

Signs of Intolerance for Enteral Feeding

A

High Gastric Residuals
N/V/D
Cramping

183
Q

Conditions that increase the risk of aspiration includes

A 
Coughing
GERD
Nasotracheal suction isn't
Any artificial airway
Decreased LOC
Lying flat
184
Q

Patients in highly stressed physiological states are candidates for PN

A

Sepsis, head injury and burns

185
Q

When is PN therapy usually discontinued?

A

When 75% of nutritional needs are being met by enteral feelings

186
Q

HIV precipitates

A

Weight loss and body wasting, anorexia, stomatitis, oral thrush infection, N/V/D

NURS 105 (10 decks)

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