Chapter 8 Flashcards
This screening tool is used to identify older adults who are at risk of malnutrition.
The mini nutritional Assessment (MNA).
Normal BMI is between?
22-25
A score of what on the Mini nutritional assessment indicates a problem and the need to complete the assessment portion?
A score of 11 or less. After added to the assessment portion A score of 17 to 23.5 means a risk for malnutrition while a score of less than 17 indicates existing malnutrition.
True or false does declining sensory function in older adults affect appetite, desirability of food, and interest in food as well as ability to detect foods that have been spoiled increasing the risk of foodborne illness.
True
A decrease in lean body mass begins to occur in which decade of life?
Third.
Older adults who have had an involuntary weight loss of more than how many pounds over six months are at risk of malnutrition?
10 pounds
Hypoalbuminemia is also considered a risk factor for malnutrition and older adults. At what level is the cut off.
Less then 3.8 g a deciliter
Hypocholesterolemia is also a risk factor in older adults for malnutrition. At what level is this abnormal.
Less than 160 mg a deciliter
Malnutrition in a nursing home resident is defined as a weight loss of what percent in the past 30 days or what percent and 180 days? Also a dietary intake of what percentage of most meals.
5% in the past 30 days or 10% in the last 180 days. Dietary intake of 75% of most meals.
Malnutrition in a hospitalized older person is defined as dietary intake less than ?
50 percent.
Treatment of undernutrition is initially aimed at what?
Treatment of underlying causes first.
How can food be enhanced to increase its nutritional value without increasing the amount of food?
By adding protein powder, butter, corn syrup or another high carbohydrate sweetener.
This type of dehydration involves an equal loss of sodium and water and can be caused by Gastrointestinal illness.
Isotonic
This type of dehydration is the most common cause. water loss exceeds sodium loss. It can be Caused by fever and limited fluid intake.
Hypertonic
This type of dehydration is commonly caused by diuretic use. It involves sodium loss which exceeds water loss.
Hypotonic
Fluid moves through a semi permeable membrane from an area of higher hydrostatic pressure to one of lower pressure.
Filtration
Solutes (Particles) move across a semi permeable membrane from an area of higher concentration to one of lower concentration.
Diffusion
Water moves across a semipermeable membrane from an area of lower particle concentration to one of higher concentration.
Osmosis
Particles move against a pressure gradient, which requires energy.
Active transport
Is created by the particle concentrations on either side of the semipermeable membrane. Sodium is a major contributor to this.
Osmotic pressure
This is the pulling force created by the concentration of particles that cannot pass through a membrane. Proteins in the bloodstream are a major contributor to this.
Oncotic pressure
The main organs involved in regulating bodily fluids.
Kidneys.
When a person is in a state of dehydration And has extracellular fluid deficit, this is known as?
Hypovolemia
The two hormones secreted by the posterior pituitary to cause the kidneys to retain more sodium and fluid
Aldosterone and Antidiuretic hormone (ADH)
Excessive Volume or overhydration causes suppression of aldosterone and antidiuretic hormone leading to what?
Increased urine output
How much fluid intake should the nurse encourage a patient who is at risk for dehydration to take in?
1000-3000ml.
Lab values that the nurse should monitor if her patient is at risk for dehydration include?
BUN, creatinine, Serum sodium, serum osmolarity, or hematocrit.
Nursing interventions for patients at risk for dehydration include?
Monitor for constipation, diarrhea, and urine output. Weigh patient daily. Teach patient to drink despite not feeling thirsty, particularly if taking diuretics. Advise patient to avoid alcohol, carbonated, and caffeinated Beverages which can increase diuresis.
When a person is over hydrated and has extracellular fluid excess, this is known as?
Hypervolemia
Loss of oncotic pressure leads to hypovolemia.
Hypoproteinemia
Hemorrhage, over diuresis, vomiting and diarrhea, and third spacing such as ascites and burns can lead to what type of fluid imbalance?
Hypovolemia
Congestive heart failure, renal failure, liver disease, overzealous IV fluid administration, and sodium overload can lead to what type of fluid in balance?
Hypervolemia
Decreased protein intake, increased protein loss, liver and kidney disease, burns, infection, and infection can lead to what type of fluid imbalance?
Hypoproteinemia
Interventions for Hypovolemia include?
Correct underlying conditions, IV volume replacement with an isotonic fluid such as .9 normal saline or lactated ringers. Give blood products such as whole blood or plasma.
What are interventions for a patient who has hypervolemia?
Correct underlying conditions. Place patient in semi
Fowler’s position. Administer diuretics. Limit sodium intake. Assess for signs and symptoms of pulmonary edema, crackles in the Lungs, cough, and increased respiratory effort.
What are interventions for patient with hypoproteinemia?
Complete a nutritional assessment. Give a high-protein diet. IV replacement with whole blood, albumin, or plasma.
The most common precipitant of electrolyte disturbances is?
Dehydration
Sodium balance is an index of?
Body water excess or deficit
Results from an excess Ingestion or administration of sodium or, more commonly, From a water deficit due to diarrhea or decreased intake.
Hypernatremia
What electrolyte loss follows sodium loss?
Chloride
This hormone maintains sodium balance in the body by promoting renotubular reabsorption.
Aldosterone
This hormone reduces sodium concentration by stimulating water retention.
ADH, Antidiuretic hormone
May result from a loss of sodium in excess of water (primary salt depletion) or from an excess of water, which dilutes the sodium level (Dilutional).
Hyponatremia
Older adults often have hyponatremia as a result of this syndrome which causes water retention and dilutes the sodium.
Inappropriate secretion of ADH (SIADH)
Causes of hyponatremia include the following.
Vomiting, diarrhea, burns, hemorrhage, adrenal insufficiency, diuretics, increased fluid intake such as excessive D5 W, psychogenic polydipsia, hypotonic and isotonic tube feedings with excessive water. Also decreased renal function, congestive heart failure and liver failure. Certain medications such as SSRIs and tricyclic antidepressants, Tegretol, and Mellaril,
98% of the bodies potassium is located where?
In the intra- cellular fluid ICF.
Inbalances in potassium can cause life-threatening conditions such as?
Cardiac arrhythmias including ventricular tachycardia, ventricular fibrillation, and asystole.
Clinical Manifestations of hypokalemia are usually not apparent until the serum potassium falls below what level?
3.0 mEq/L
Patients taking this medication may be more susceptible to arrhythmias at only minor reductions of potassium.
Digitalis
Symptoms of hypokalemia may include the following.
Fatigue, cardiac arrhythmias, EKG changes, skeletal or respiratory muscle weakness, muscle cramps, adynamic ileus, impaired insulin release, and sensitivity.
Interventions for a patient with hypernatremia include?
Encourage fluid intake, decrease sodium intake, and administer hypertonic IV fluids.
Some common causes of hypernatremia include?
Decreased water intake, diminished functional capacity, dementia, altered thirst sensation, high sodium IV fluids, vomiting, watery diarrhea, excessive sweating, fever, excessive sodium ingestion, and diabetes insipidus.
Potassium supplementation given in combination with the following drugs can cause severe hyperkalemia.
Ace inhibitors and nonsteroidal anti-inflammatory drugs and potassium sparing diuretics.
Clinical manifestations of high potassium are?
Cardiac arrhythmias, EKG changes, muscle weakness or paralysis, nausea, diarrhea, or intestinal colic.
States of acidosis and decreased aldosterone production Can cause what to potassium levels?
Hyperkalemia
What are the causes of hypokalemia?
Potassium wasting diuretics, excess aldosterone, high Glucocorticoid levels, licorice ingestion, osmotic diuresis, hypomagnesemia, gastrointestinal losses such as vomiting diarrhea ileostomy, intracellular shifts such as in alkalosis and hyperinsulinemia, Hypothermia, anorexia nervosa, alcoholism, and sweat losses in people acclimated to heat.
Regulation of calcium is controlled primarily through the action of?
The parathyroid hormone, Calcitonin and calcitriol, which is the most active metabolite of vitamin D.
Total calcium is a reliable marker of active ionized calcium levels unless what?
Unless the pH and albumin levels are abnormal.
Is released when Calcium levels are high and decreases the calcium released from the bone.
Calcitonin
Enhances intestinal absorption of calcium and enhances bone reabsorption and stimulates renal absorption of calcium
Calcitriol
Promotes transfer of calcium from bone to plasma and increases intestinal absorption as well as renal absorption.
Parathyroid hormone or PTH.
Hypocalcemia may be seen with the following conditions.
Parathyroid or thyroidectomy, radical neck surgery for cancer, acute pancreatitis, low magnesium levels, vitamin D deficiency, malabsorption syndromes, site trait from rapid blood transfusions, renal failure, and alcoholism.
90% of hypercalcemia is attributed to?
Hyperparathyroidism
The remaining 10% of hypercalcemia results from?
Thiazide diuretics, immobilization, lithium use, vitamin D or A overdose, or renal transplantation.
Causes of hypocalcemia include?
Primary hypoparathyroidism, surgical removal of parathyroid tissue, acute pancreatitis, Malabsorption, Alkalotic states, excessive transfusion of citrates blood, sepsis, hypoalbuminemia, hypomagnesemia, and hyperphosphatemia.
interventions for patients with hypocalcemia include.
Monitor for seizures monitor airway, safety precautions for confusion educate patients about getting adequate calcium and vitamin D, performing regular weight bearing exercises, quitting smoking.
Always give calcium chloride diluted and through a central vein if possible due to risk for venous sclerosis or soft tissue damage.
Signs of hypocalcemia include?
Muscle cramps, carpopedal spasm, neuromuscular irritability, laryngeal strider, hyperactive deep tendon reflexes, peripheral numbness or tingling, prolonged QT interval, arrhythmias, decreased ventricular contractility, altered mental status, depression and psychosis.
Normal total serum calcium is?
8.9 to 10.3 mg a deciliter
Normal ionized calcium is?
4.6- 5.1 mg a deciliter
Signs of hypercalcemia include?
Muscle weakness, decreased deep tendon reflexes, muscle hypertonicity, nausea and vomiting, anorexia, constipation, confusion, lethargy, depression psychosis and stupor, and coma.
Interventions for hypercalcemia include?
Increase mobilization, encourage oral fluids, possible restriction of high calcium foods, safety precautions with confusion, monitor for digoxin intoxication if On medication, note medications that might cause hypercalcemia, administer biphosphanates as directed, administer phosphates if low.
Phosphorus has an inverse relationship with?
Calcium
Patients at risk for hypophospatemia are.
Malnourished patients, alcoholics, and patients with diabetic ketoacidosis. Monitor patients for signs of hypocalcemia while replacing phosphorus.
Causes of hypophospatemia.
Refeeding after starvation, respiratory alkalosis, alcohol withdrawal, phosphate binding antacids, glucose/insulin administration.
Signs of hypophosphatemia include.
Muscle pain and tenderness, muscle weakness, paresthesias, decreased contractility of the heart, altered mental status, seizures, and respiratory failure.
Normal serum phosphorus is?
2.5 mg deciliter - 4.5 mg deciliter
Hyperphosphatemia is caused by?
Renal failure, chemotherapy, overdose of supplementation, excessive fleets phosphorus enemas, large vitamin D intake.
Signs of hyperphosphatemia include?
Tetany, fingertip paresthesias, muscle pain and spasm.
Phosphorus and calcium Both play a role in the production and use of?
ATP
Hypomagnesia can be caused by?
Chronic alcoholism, refeeding after starvation, diarrhea or laxative abuse, NG suctioning or vomiting, and certain medications such as diuretics, cyclosporine, insulin and uncontrolled diabetes mellitus.
Signs of hypomagnesia include?
Paresthesias, muscle cramps or twitching, chvostek’s signs, trousseau’s sign, Hypertension, arrhythmias, altered mental status, seizures, psychosis, low potassium, calcium, phosphorus, and insulin resistance.
Nursing interventions for hypomagnesia include?
Safety precautions for seizures, monitor swallowing, encourage increased dietary intake of magnesium, monitor for DTRs (knee jerks) during magnesium administration and hold infusion if Absent.
Causes of hypermagnesemia Include?
Renal failure, overdose of supplementation, adrenal insufficiency, and excessive magnesium containing antacids or laxatives.
Normal serum magnesium is?
1.3 - 2.1 mEq/L
Things to assess for in hypermagnesemia include?
Peripheral vasodilation and flushing, nausea and vomiting, hypotension, bradycardia, decreased DTRs, respiratory depression,, cardiac arrest.
Interventions for patients with hypermagnesemia include?
Identify patients at risk, observe for assessment signs, avoid magnesium containing medications in patients with renal insufficiency.
Normal body pH is?
7.35-7.45
An increase in hydrogen ions reduces the pH of blood
Acidosis
A decrease in hydrogen ions in the blood increases the pH.
Alkalosis
Metabolic buffering of the pH of the blood is mainly provided by what organ?
Kidneys
The lungs work as a buffer by eliminating acid by blowing off what? Or the lungs can compensate for a metabolic alkalosis by retaining this.
CO2 (acid)
The kidneys either eliminate or retain these ions depending on the blood pH.
Bicarbonate ions (base)
In the lungs, carbonic acid dissociates into?
H2CO3 = CO2 (Exhaled)+ H2O (Water)
In the kidneys, carbonic acid associates into?
H2CO3 = HCO3 (Bicarbonate) + H+ (Hydrogen ions)
Normal PaCO2 is?
35-45 mm Hg
Low PaCO2 indicates?
Respiratory alkalosis
High PaCO2 indicates?
Respiratory acidosis
Normal HCO3 is?
21-28 mmol/L
Low HCO3 Indicates?
Metabolic acidosis
Elevated HCO3 indicates?
Metabolic alkalosis
Low PaO2 Indicates?
Impaired gas exchange
The normal range for PaO2 is?
35-45 mm Hg
When compensating for pH imbalances in the blood which is slower, the respiratory mechanism or the metabolic mechanism?
The kidneys compensate by eliminating or retaining bicarbonate ions and hydrogen ions and this Mechanism is slower than compensation by the lungs and can take hours to days.
Conditions of alkalosis are generally associated with what type of electrolyte imbalance?
Hypokalemia
Acidosis leads to what type of electrolyte in balance?
Hyperkalemia
Respiratory acidosis is caused by?
Respiratory depression or hypoventilation and chronic lung disease
Respiratory alkalosis is caused by?
Hyperventilation due to any cause
Metabolic acidosis is caused by?
Diabetic ketoacidosis, lactic acidosis, toxic ingestion, renal failure, diarrhea, excess chloride.
Metabolic alkalosis is caused by?
Vomiting, gastric suction, excessive alkali ingestion, diuretics, hypokalemia, hypoaldosteronism
If you have a pH that is lower than 7.35 with a CO2 that is normal and a bicarbonate that is less than 22 You are in what?
Metabolic acidosis
If you have an alkaline pH greater than 7.45 and a CO2 less than 35 but your bicarbonate is normal then you must be in what state?
Respiratory alkalosis
