Exam 2 Flashcards
Salivary amylase
Breaks down carbohydrates break down into glucose
Is used in mouth, pancreas, and small intestine
Lipase
Breakdown fats into fatty acids
Produced by the mouth, pancreas, and stomach
Mechanical digestion in the stomach
Food churns with digestive enzymes to make chyme (acidic soup)
Mechanical digestion in the small intestine
Localized contractions that mix contents together (help facilitate absorption)
Energy currency for the body
Glucose (the breakdown of carbohydrate)
Storage form of quick energy
Glycogen (storage form of carbohydrate)
Fats contain and provide
Contain: Essential fatty acids
Provide: alternate storage form of energy
Which fats are healthy and which fats are unhealthy
Healthy: polyunsaturated fats (found in fish) (protect against CVD)
Unhealthy:saturated fats
Proteins function
Primary function: tissue rebuilding and maintaing body tissue
Can also: be converted to supply energy (if needed bc carb and fat is not sufficent)
What minerals help give strength to bones and teeth
Phosphorus and calcium
Vitamin C produces
The intracellular ground substance that cements tissues together and prevents tissue bleeding
Amino acids serve as the building blocks for
Body tissues
Enzymes
Hormones
Thiamin controls
The release of energy for cell work
Vitamin B12
Needed for synthesis and maturation of RBCs
(Heme formation)
What does water form/function as
Form: blood, lymph, intracelluar fluids(important for transporting nutrients and removing waste)
Functions as: regulatory agent (providing fluid environment for metabolic reactions)
Xerostomia is?
Can lead to ?
(Dry mouth)
Prolonged drastic reduction of salivary secretions
Infection and ulcers and tooth decay
Xerostomia can be caused by
Radiation therapy (damages salvilary glands)
Diabetes
Parkinson’s disease
Autoimmune defficncy disease
Medications (for managment of cardiac failure, hypertension, depression, chronic pain)
What are the three pairs of salivary glands
Parotid
Submaxillary
Sublingual
Salivary glands produce
Watery fluid containing salivary amylase (binds to starch molecules)
Mucous (to lubricate and bind food)
Lingual lipase
Second enzyme released in the saliva
Begins digestion of fats
Salivary secretions important functions (other than chemical digestion)
Moisten food so bolus can form and move down esophagus easily
Lubricate and cleanse teeth
Destroy harmful bacteria
Neutralize toxic substances entering the mouth
GERD
Gastroesophageal reflux disease (heartburn)
Regurgitation occurs when acidic stomach contents are able to move back into the esophagus
This can damage tissues in esophagus
(GERD is increased with obesity, overeating, smoking, medications)
Hydrochloric acid is important for
Breaks down proteins into amino acids
Creating acidic environment needed for pepsin activation and other enzymes
Is the reason we need mucous to protect the stomach lining
Mucous in the stomach is important for
Protecting the stomach lining from eroding effect of the acid
Also binds and mixes the food mass and helps move it along
Enzymes in the stomach
Pepsin- begins breakdown of protein (secreted from pepsinogen and activated by HCL)
Gastric lipase- acts only on butter fat (has minor role, produced in small amounts)
Rennin- aids in coagulation of milk (only found in children)
Decrease in HCL would (could occur in aging adults bc decreased secretions)
Hinders production of vitamin B12
Reduces uptake of thiamin, folate, calcium, iron
Older adults changes to GI system
Chewing and swallowing issues (dysphasia)
Constipation (decrease peristalsis bc of neural and muscular function changes )
Early satiety (limits food ingested which can lead to malnutrition)(changes in hypothalamus)
Changes in intestinal microbiota (alter immune function)
Decreased secretions (Xerostomia) (HCL)
Decreased thirst (dehydration)(caused by changes in hypothalamus)
Haw many calories does a male /female need a day if they are older then 70yrs old
Energy needs:
Male - 2100 kcal/day Female - 1600 kcal/day (more if active)
How many calories a day does a female/male need if they are under 70 yrs old
energy needs:
Male - > 2200 kcal/day Female – > 1900kcal/day (more if active)
How many calories a day does a female/male need if they are under 70 yrs old
energy needs:
Male - > 2200 kcal/day Female – > 1900kcal/day (more if active)
How much protein do you need per day (under 70 & over 70)
Under 70:
0.8 gram/kg/day body weight
Over 70:
1 gram/kg/day of body weight
-prevent age-related muscle loss
In a well balanced diet for a healthy person how many total kilocalories come from carbohydrate and what type should you have
45-65% of total kcalories come from carbohydrate, the majority should be obtained from complex carbohydrates (starch), and only a smaller amount obtained from simple carbohydrates (sugars)
In a well balanced diet for a healthy person how many total kilocalories come from carbohydrate and what type should you have
45-65% of total kcalories come from carbohydrate, the majority should be obtained from complex carbohydrates (starch), and only a smaller amount obtained from simple carbohydrates (sugars)
It is recommended that fat supply your diet at no more then
20-35% of total kcalories
Vitamin D recommendations for under and over 70
Under 70:
Vitamin D- 15 mcg/day
Over 70:
Vitamin D- 20 mcg/day (↓ sun exposure & skin synthesis)
Calcium recommendations for under/over 70 yrs old
Under 70:
Calcium-1000 mg/day
1200 mg/day (women > 50 d/t menopause)
Over 70:
Calcium- 1200mg/day
↑ d/t bone resorption and ↓ vitamin D levels
Iron recommendations for under/over 70
Under 70:
Iron- 18 mg/day
↓ 8mg/day after menopause
Over 70:
Iron- 8mg/day
Vitamin B12 recommendations under/over 70 yrs old
Under 70:
Vitamin B12: 2.4 mcg/day
Over 70:
Vitamin B12:
2.4 mcg/day (fortified foods and supplements)
Vitamin A role in wound healing
Maintenance of skin and mucous membranes
Promotes immunity (migration of macrophages)
Vitamin E role in wound healing
Anti-inflamatory properties
Vitamin K and Ca role in wound healing
Blood clotting
Protein role in wound healing
build and repair of skin and tissues, fight infection, balance fluids
Vitamin C role in wound healing
Enhances tensile wound strength
Blood vessel formation
Vitamin B12 role in wound healing
tissue repair, granulation tissue, energy boost
Nursing Interventions to Promote Nutrition
Maintain good oral hygiene
Small, frequent meals
Environment
Position
Favorite foods
Pain control
Collaborate with dietician and/or speech therapy
Promote a balanced diet
My plate recommends
5 food groups:
1⁄2 plate fruits and veggies
1⁄2 plate grains and proteins
one dairy helping
My plate recommends (cups and oz for each food group) based on 2,000 calorie plan
2 cup fruit
2 1/2 vegetables
6 oz grains
5 1/2 oz proteins
3 cups dairy
Why do older adults tend to need fewer kcal for energy
Bc of a decrease in:
Lean body mass
Physical activity
BMR
Changes that make it difficult for an older adult to achieve good nutrition
Loss of interest in eating
Decreased sensation of thirst
Decrease in taste and smell (make therapuetic diets unappealing)
Tooth loss and gum disease
Arthritic hands making preparing and eating food difficult
gatroespohageal reflux
decreased secretions of HCL
Decreased intestinal peristalsis
Glucose intolerance
No longer able to drive, harder and more expensive to get food
Frail elderly syndrome
Disorder characterized by weight loss, decreased activity and interaction, increasing frailty
Why was potassium added to the nutrition label
Bc it is a good electrolyte to maintain cardiovascular function/health and maintain blood pressure
What type of things does a Nutritional History & Screening look at
Eating habits and appetite
Food allergies
Medical conditions
Dentition, chewing, or swallowing difficulties
Weight loss
Body Mass Index
What is a nutrition screening defined as
The process of identifying characteristics known to be associated with nutrition problems, with the purpose of identifying individuals who are malnourished or at a nutritional risk
(collect data about eating behaviors and identify possible nutritional risks or deficiencies)
When should you be concerned about weight loss
Unintentional weight loss of 10% or more of the usual body weight within 6 months, or 5% of the usual body weight within 1 month
If a patient is in need of dentures who should you refer to
Social services
Should edema account for weight
No, this contributes to volume and not weight and should not be related to food intake (could occur in kidney or liver disease)
Measurements of body size, weight, and proportions
Anthropometric measurements, are used to assess nutritional status and growth
BMI
Body mass index is a ratio of weight to height and can be correlated with overall mortality and nutritional risk
(Does not estimate body composition such as lean body mass or adiposity)
Underweight BMI
≤ 18.5
Normal BMI
18.5 ‐ 24.9
Overweight BMI
25.0‐<30
Obese BMI
≥ 30.0
Extreme obesity BMI
≥ 40.0
How can laboratory data be used in a nutritional screening and assesment
electrolytes, glucose, lipid panel (shows cholesterol), liver and renal function, complete blood count, vitamins, minerals
When completing the nutritional assessment what are some observation/ signs and symptoms you should be looking for
Observations:
alertness
able to sit upright
managing secretions
coughing strength
Hx of aspiration pneumonia
Signs and symptoms:
Poor skin turgor or edema
Pallor, spoon‐shaped nails (Iron)
Bleeding abnormalities (vitaminK)
Brittle & fragile nails, hair loss, poor wound
healing (protein)
Low energy, headache (glucose)
Sclera of eye is white and not the usual pink (iron)
Why is it essential to assess swallowing ability?
Difficulty swallowing food/fluids (dysphagia)
Choking potential
Risk for aspiration into the lungs (aspiration pneumonia)
Why is it essential to assess swallowing ability?
Difficulty swallowing food/fluids (dysphagia)
Choking potential
Risk for aspiration into the lungs (aspiration pneumonia)
Therapeutic diets are modified for
Nutrients (ex. chronic conditions)
Texture (swallowing concerns)
Food allergies or food intolerances
A swallow screen for dysphagia should be given before
Giving the patient food, drink, or medication
Prior to starting a swallow screen for dysphagia you should
Have oral suction immediately avalible
See that the mouth is clean and moist
In order to advance the diet you must have
A HCP or MD order
When contemplating advancing a diet what should you be assessing/identifying
Assessing for alertness, gag reflex, GI assesment
Identify the type of surgery, procedure or anesthesia
When advancing a diet why is it important to know if a patient had anesthesia?
could make the patient nauseous resulting in them not wanting to eat
Could make the GI track “be not awake” resulting in vomiting or aspiration
NPO except meds
Nothing by mouth except meds and the water needed to swallow the meds
Postive flatus
Passing gas
Clear liquid diet
Broth, fruit juices (apple, cranberry, grape), water, black coffee, tea, popsicles, carbonated beverages, gelatin
Full liquid diet
Includes all things liquid as well as any food items that are liquid at room temperature
Juices with pulp, out, milk, milkshakes, ice cream, cream soups, uddings, custard, plain yogurt, tritional supplements
(May need oral supplementation if for longer then 3 days)
Regular diet
Includes all foods and liquids
May need to be modified to iadress chewing and swallowing issues
Such as mechanical soft, pureed, dysphasiga diets
Diet may be modified after speech therapy
What is the traditional Hispanic diet
Traditional foods prepared with lard
High prevalence of DM; sugary drinks; high Na+/fat
Belief in ‘hot‐cold’ to provide balance
Recommend boiling, grilling, or healthier oils
Traditional Asian diet
Foods are more plant‐based
Protein consists of beans, nuts; occasional poultry
Lower incidence of CVD, DM, & obesity
Prefer hot or warm water
May be lactose intolerant
Traditional Indian diet
Prefer home cooked foods; wide array of spices
Meats election based on religious preference
Muslims may not eat pork
Buddhists maybe vegetarian
Pharmacology
The study or science of drugs
How various dosage forms influence the way in which the drug effects the body
Pharmaceutics
preparing and dispensing drugs; incl. dosage form design
The form of a drug determines
the rate of drug dissolution and absorption
Out of all the oral drug preparations what is the order from fastest to slowest of drug absorption
Buccal, SL
Liquids, syrups
Capsules
Tablets
Enteric coated tablets
What is extended release
release of drug molecules over a prolonged period
What are some details about extended relase
prolongs drug absorption
• granules in capsules and dosage forms identified by capital letters (CR, SA, XL, XT, CD, TR, ER, LA)
• requires fewer doses, improved compliance
• cannot be crushed or chewed (possible toxicity)
SR
Slow release or sustained release
SA
Sustained action
CR
Controlled release
XL
Extended length
XT
Extended time
Pharmacokinetics
The study of what happens to a drug from the time it is put into the body until the parent drug and all other metabolites have left the body
(Drug absorption, distribution, metabolism, and excretion)
What is a drug
Any chemical that affects the physiologic processes of a living organism
Chemical name
Describe the drug’s chemical composition and molecular structure
Generic name
Nonproprietary name, often much shorter and simpler then the chemical name
Drug classsification
Drugs are grouped together based on their similar properties, can be classified by therapeutic use or their structure
Toxicology
The study of the adverse effect of drugs and other chemicals on living systems
Dosage form determines
The rate at which drug dissolution (dissolving of solid dosage forms and their absorption)
A drug to be ingested orally may be in what form
Solid: tablet, capsule, or powder
Liquid form: solution or suspension
Parental forms
Dosage forms that are administered via injection, need certain characteristics to be safe and effective bc arteries and veins that carry drugs throughout the body they can be easily damaged if the drug is too concentrated or corrosive (100% absorption is assumed immediately after injection)
Topically applied dosage forms
Work directly on the surface of the skin
Absorption
The movement of a drug from its site of administration into the bloodstream for distribution to the tissues
Bioavailability
Term used to express the extent of drug absorption
(Passing through the liver effects this bc drug is changed into inactive metabolites)
First pass effect
Reduces the bioavailability of the drug to less than 100%
(Happens to drugs administered by the mouth not IV)
What are the basic routes of drug administration
Enteral, parental, and topical
What factors can alter the absorption of drugs
Acid changes within the stomach
Absorption changes within the small intestine
Presence or absence of food or fluid
What factors could effect acidity of the stomach
Time of day
Age of the patient
Presence and types of medications food and beverages
Enteric coating is designed to
Protect the stomach by having drug dissolution and absorption occur in the intestines
What could happen if you take an enteric coated medication with a large amount of food
Cause it to be dissolved by acidic stomach contents and therefore reduce intestinal drug absorption
What drugs are more easily broken down in an acidic environment
Fat soluble drugs
(Presence of food may enhance absorption)
What would happen if blood flow to the GI tract is reduced? What could cause this
The stomach and small intestine are highly vascularized, when blood flow is reduced in situations like exercise or sepsis then absorption is decreased
Drugs admistered by the sublingual route and buccal route
Are absorbed rapidly by the highly vascularized tissue under the tongue and by the cheek and gum, bypass the liver, are systemically bioavailible
Parental route
The fastest route by which a drug can be absorbed
Could be IM, IV, or subcutaneous
(Bypass the first pass effect of the liver)
Subcutaneous injections
Injections into the fatty subcutaneous tissues under the dermal layer of the skin
Intradermal injections
Injections under the more superficial skin layers immediately underneath the epidermal layer of skin and into the dermal layer
Intramuscular injections
Injections given into the muscle below the subcutaneous fatty tissue
(Absorbed faster then subcutaneous bc muscle has greater blood supply then skin)
What can you do to the injection cite to increase absorption
Apply heat or massage the site
What could reduce drug activity by reducing drug delivery to the tissues
Presence of cold, hypotension, poor peripheral blood flow that compormises circulation
Topical route
Involves application of medications to various body surfaces
Onset slower, duration longer
Can be applied to skin, eyes, ears, nose, lungs, rectum, or vagina
Avoid first pass effect (unless rectum)
What are examples of topical medications
Ointments, gels, patches, drops, inhalers
Oral drugs are absorbed by
Stomach or intestine
Oral drug bioavailability is
Less then 100%
IV drug avalibility is
100%
Subcutaneous bioavalibility is
Close to 100 %
Distribution
Refers to the transport of a drug by the blood stream to its cite of action
Where are drugs distributed to first
Areas with extensive blood supply
(Heart, liver, kidneys, brain)
Where are the areas of slower distribution
Skin, muscle, and fat
When does elimination of a drug begin
As soon as the drug enters circulation (enters the blood stream) it starts to be eliminated by organs that metabolize and excrete drugs (primarily liver and kidneys)
If a drug needs to reach their site of action in extravascular tissue
(Outside the blood vessel) it must be not bound to protein otherwise drug complex would be too large to pass through the walls of the capillaries into the tissues
Albumin is
The most common blood protein and caries the majority of protein bound drug molecules
free drug
Not bound to protein
The unbound portion of a drug is limited
pharmacologically active
Bound drug
Drug molecules is bound to protien
Pharmacologically inactive
What happens if you have low albumin levels
There would be a larger amount of free drug
Could result in drug toxicity
Could be caused by being malnourished or extensive burns
What happens when a patient takes two medications that are highly protein bound?
Medications may compete for binding sites on the albumin molecule
Resulting in more free drug
Could result in drug drug interaction
When does a drug drug interaction occur
When the presence of one drug decreases or increases the actions of another drug that is administered concurrently (given at the same time)
Metabolism
(Biotransformation)
Involves the biochemical alteration of a drug into an inactive metabolite, a more soluble compound, a more potent active metabolite, or a less active metabolite
The liver is most responsible for
The metabolism of drugs
Metabolic tissues (other then the liver)
Skeletal muscle, kidneys, lungs, plasma, intestinal mucosa
Hepatic metabolism involves
The activity of a very large class of enzymes known as cytochrome P-450 enzymes (P-450 enzymes) these control a variety of reactions that aid in metabolism of drugs
Lipid soluble drugs
“Fat loving” (lipophilic)
Typically very difficult to eliminate
Targeted by P-450 enzymes
Water soluble drugs
“Water loving” (hydrophilic)
May be more easily metabolized by simpler chemical reactions such as hydrolysis
(Prepare for excretion)
Prodrug
An inactive drug dosage form that is converted to an active metabolite by various biochemical reactions once it is inside the body
*Designed to be activated by the liver
Excretion
The elimination of drugs from the body, all drugs must eventually be removed from the body
Primary organ in excretion
The kidneys
When drugs reach the kidneys
They have already gone through extensive biotransformation and only a relatively small fraction of the original drug is excreted as the original compound
What happens to drugs when they are metabolized by the liver
They become more polar and water soluble
Biliary excretion
Excretion of drugs by the intestines
Drugs will be taken up by the liver, released into the bile, and eliminated in the feces
Enteral drugs also include
(Ones that do not undergo first-pass effect)
ODTs -Orally disinegrating tablets
Oral soluble films
Sublingual
Buccal (transmucosal)
Rectal drugs
used for both local and systemic delivery
may be considered enteral or topical
mixed first-pass and non-first-pass absorption and metabolism
What does the liver want to do
Biotransformation:
Change drug from lipid soluble to water soluble
Decrease drug molecules
Inactivate drug molecules
What problems could effect excretion, why could this be problmatic
Kidney disease or kidney failure
They are at risk for toxicity
What routes are first pass effect
Oral
Rectal
What routes are non first pass effect
Inhaled
IV
Sublingual
Intranasal
IM
Subcutaneous
Transdermal
Rectal
Is Intranasal first pass or non first pass, why
Non first pass bc it goes to the lungs and moves directly into the bloodstream
Half life of a drug
The time required for on half of a given drug to be removed from the body
Drug effects
Are the physiologic reactions of the body to the drug
(Onset, peaks, duration, and trough all describe the drug effect)
A drug’s onset of action
The time required for the drug to elicit a therapeutic response
A drug’s peak effect
The time required for a drug to reach its maximum therapeutic effect
A drug’s duration of action
The length of time that the drug concentration is sufficent to elicit a therapeutic response
(Without more doses)
What is peak level & trough level
Peak is highest blood level
Trough is lowest blood level
Steady state
The physiologic state in which the amount of drug removed via elimination is equal to the amount of frug absorbed with each dose
(Determined by half life of a drug)
What could happen if peak blood level is too high
Drug toxicity may occur
What is mild drug toxicity and an example
Intensification of effects
Ex. excessive sedation
What could severe drug toxicity do
Damage vital organs bc of excessive drug exposure
What could happen if trough blood levels are to low
Drug may not be at therapeutic levels to create response
Pharmacodynamics
Relates to the mechanisms of drug action in living tissues, drug induced normal physiological functions
Therapeutic effect
A positive change in faulty physiologic system
(Goal of drug therapy)
What can a drug do once its at the cite of action?
It can modify the rate at which that cell of tissue functions (increase or decrease) or it can modify the strength of function of that cell of tissue
*can not cause a cell or tissue to perform function that is not part of its natural physiology
What are the ways drugs can exert their actions
Receptors
Enzymes
Nonselective interactions
Mechanism of action
Effect based on characteristics of cells or tissues targeted by the drug
Receptor
A reactive site on the surface or inside of a cell
Once a drug binds to a receptor a pharmacologic response is produced (if that is the mechanism of action)
Affinity
The degree to which a drug attaches to and binds with a receptor
The drug with the “best fit” will have the strongest affinity for the receptor and will elicit the greatest response
Agonist
Drug binds to the receptor, there is a response
Partial agonist
Drug binds to the receptor, the response is diminished compared with that elicited by an agonist
Antagonist
Drug binds to the receptor, there is no response. (Drug prevents binding of agonists)
Competitive antagonist
Drug competes with the agonist for binding to the receptor, if it binds there is no response
Noncompetitive antagonist
Drug combines with different parts of the receptor and inactivates it, agonist then has no effect
Pharmacotherapy
What are the classifications
Use of drugs to prevent or treat diseases
(Therapeutic and pharmacologic classifications)
Therapeutic examples of drugs
Antibiotics
Antidiabetics
Antihypertensives
Pharmacologic examples of drugs
Calcium channel blocker
ACE inhibitor
Beta-blocker
What food has a interaction with Warfrin
Leafy green veggies increase could make the anticoagulant effect decrease
Grape fruit juice has an interaction to what medications, why
Cardiac medications, antiseizure, anti cholesterol, antianxiety
Causes problems with their enzymes and transporters which leads to too much or too little drug
CNS depresents have interactions with what food, what could happen
Valerian root
Can increase drowsiness and sedation
Polypharmacy
The simultaneous use of multiple medications
As the # of meds a person takes increases so does the risk for ADRs
Prescribing cascade
When drugs are prescribed specifically to counteract the adverse effect of other drugs
Appropriate drug dosages for older adults may be
1/2 or 2/3 less than the standard adult dose
(Best to start low and go slow)
Aging effects on the cardiovascular system and pharmacokinetics
Decrease cardiac output = decrease absorption & distribution
Decrease blood flow = decrease absorption & distribution
Aging effects on the gastrointestinal system and pharmacokinetics
Increase pH (alkaline gastric secretions) = altered absorption
Decreased peristalsis = delayed gastric emptying
Aging effects on the hepatic system and pharmacokinetics
Decrease enzyme production = decrease metabolism
Decrease blood flow = decrease metabolism
Aging effects on the renal system and pharmacokinetics
Decrease blood flow = decrease excretion
Decrease function = decrease excretion
Decrease GFR= decrease excretion
Kidney function is assessed by measuring
Serum creatine, blood urea nitrogen levels (lab work)
Liver function is assessed by
Testing the blood for liver enzymes
What are the functions of proteins
Tissue building
Immune system function
Fluid balance
Acid base balance
Secondary energy source
Why does calcium recommendations increase for older adults
To reduce bone loss and bone fractures
The nurse understands that drugs exert their actions on the body by what process
Interacting with receptors
Altering metabolic chemical processes
Inhibiting the action of a specific enzyme
The nurse knows that which factors will affect the absorption of orally administered medications
Time of day
pH of the stomach
Form of drug preparation
Presence of food in the stomach
Constipation in a patient with heart failure you should assess their meds to see if they’re on what
Calcium channel blockers
