EXAM 2 Flashcards
Define mechanical digestion
Physical breakdown of food
Define chemical digestion
Breakdown of food using enzymes
What enzyme breaks down carbohydrates in mouth?
Salivary amylase
What effect does HCL have on protein digestion?
Needed for pepsin activation - pepsin requires acidic environment to break down protein to polypeptides
What does pepsin do?
Breaks down proteins into amino acids in the stomach
What is lipase?
An enzyme that breaks down fats into fatty acids
What are the 3 parts of the inner surface of the small intestine?
Mucosal folds, villi, microvilli
What age-related change commonly happens to taste and smell?
Decreased ability to taste and smell
What is the medical term for dry mouth, a common age-related change?
xerostomia
What is the medical term for issues with chewing and swallowing?
dysphagia
What is the feeling of fullness after eating only a small amount of food?
Early satiety
Older adults often experience decreased thirst. What is the consequence of this?
They are at risk for dehydration
What happens to HCl secretion with age?
HCl secretion decreases, impairing ability to properly break down certain nutrients
What happens to the absorption of nutrients in older adults?
Decreased absorption of nutrients
What age-related change happens to the muscular contractions of the digestive system in older adults?
Peristalsis decreases
Do energy needs increase or decrease after about 70 years of age?
Decrease
Do protein needs increase or decrease after about 70 years of age?
Increase (to prevent age-related muscle loss)
What is the average daily protein requirement before 70?
0.8 g/kg of body weight per day
What is the average daily protein requirement after 70?
1 g/kg of body weight per day
What percent of total energy intake should come from carbohydrates?
45-65%
What percent of total energy intake should come from fats?
20-35%
How do vitamin D requirements change in older adults (70+)? Why?
Vitamin D requirement increases after 70 because less sun exposure and skin synthesis slows
How do calcium requirements change in older adults (70+)? Why?
Calcium requirement increases d/t increased bone resorption (break down) and decreased vitamin D levels.
(Earlier increase required for women bc estrogen promotes activity of osteoblasts and estrogen decreases post-menopause)
How do iron requirements change for older adults?
Iron requirements decrease, esp in women post-menopause
How do the vitamin B12 requirements change for adults around 70 years old?
Stays the same, but should be consumed in fortified foods and supplements as it becomes harder for older adults to absorb from natural sources
What role does Vitamin A play in healing from wounds and/or illness?
Helps maintain skin and mucous membranes
Promotes immunity (through the migration of macrophages)
What role does Vitamin B12 play in healing from wounds and/or illness?
Tissue repair, granulation tissue (new tissue that forms in healing wounds), increases energy
What role does Vitamin C play in healing from wounds and/or illness?
Enhances tensile wound strength
Helps with blood vessel formation
What role does Vitamin E play in healing from wounds and/or illness?
Anti-inflammatory properties
What role do Vitamin K and Calcium play in healing from wounds and/or illness?
Blood clotting
What roles do Proteins play in healing from wounds and/or illness?
Build and repair of skin and tissues
Fight infection
Balance fluids
Formation of hemoglobin (along with iron)
Name a few nursing interventions to promote adequate nutrition and caloric intake
Help pt maintain good oral hygiene
Offer small, frequent meals
Help create a clean environment before meal time
Elevate HOB
Ask their favorite foods
Pain control
Collaborate with dietician and/or speech therapy
Promote a balanced diet
What does “MyPlate” represent? How is it divided?
Represents recommended daily ratios of 5 food groups, 1/2 plate fruits and vegetables, 1/2 plate grains and proteins, and one dairy helping
What does “MyPlate” discourage?
“Super-sized” portions
What kind of fats should we eat?
Mono and poly unsaturated fats
Why was potassium added to food labels?
It is important for cardiovascular function and controlling blood pressure, and on average we weren’t getting enough
Why did serving sizes change on food labels?
They were increased to reflect more realistic portion sizes
What is the purpose of nutritional history and screening?
To identify possible nutritional risks or deficiencies, and eating behaviors
What are the components of a nutritional history and screening?
Eating habits and appetite
Food allergies (including intolerances)
Medical conditions
Dentition, chewing, or swallowing difficulties
Weight loss
Body Mass Index
What is Body Mass Index (BMI)?
A measurement of body fat based on weight in relation to height
What BMI value indicates someone’s underweight?
less than or equal to 18.5
What BMI values indicate normal weight?
18.5-24.9
What BMI values indicate overweight?
25.0-30
What BMI values indicate a pt is obese?
greater than 30 less than 40
What BMI values indicate extreme obesity?
greater than 40
What lab data is important for nutrition screening and assessment?
Electrolytes
Glucose
Lipid panel
Liver and renal function
Complete blood count
Vitamins & minerals
What does poor skin turgor indicate?
Dehydration
What deficiency would you expect if you noticed pallor and spoon-shaped nails?
iron
What vitamin deficiency would you expect if a pt had bleeding abnormalities?
vitamin K
What nutritional deficiency would you expect to find if you noticed a pt had brittle & fragile nails, hair loss, and poor wound healing?
A protein deficiency
What nutritional deficiency would you expect if you noticed a pt had low energy and a headache?
Glucose
Why is it important to assess swallowing ability?
In case they have difficulty swallowing food/ fluids (dysphagia)
Choking potential
Risk for aspiration, which could lead to aspiration pneumonia
What are causes of swallowing difficulties (dysphagia)?
Aging, degenerative and non-degenerative conditions
What are assessments and observations of a swallowing evaluation?
Pts alertness, ability to sit upright, manage secretions, cough strength, and history of aspiration pneumonia
What do you evaluate for after implementing swallowing interventions?
Ease/ difficulty of food intake
Therapeutic diets are modified for 3 reasons, what are they?
Nutrients (chronic conditions)
Texture (swallowing concerns)
Food allergies or food intolerances
What diet includes minimum residue fluids that can be seen through, e.g. juices without pulp, broth, and Jell-O?
Clear liquid diet
What diet is often used as the first step to restarting oral feeding after surgery or an abdominal procedure?
Clear liquid diet
What diet can also be used for fluid and electrolyte replacement in people with severe diarrhea?
Clear liquid diet
What diet should not be used for an extended period as it does not provide enough calories and nutrients?
Clear liquid diet
What diet includes fluids that are creamy, e.g. ice cream, pudding, thinned hot cereal, custard, strained cream soups, and juices with pulp, but should not be used for extended periods of time?
Full liquid diet
What therapeutic diet is used as the second step to restarting oral feeding once clear liquids are tolerated?
Full liquid diet
What diet is used for people who cannot tolerate a mechanical soft diet?
Full liquid diet
What diet changes the consistency of the regular diet to a softer texture and includes chopped or ground meats as well as chopped or ground raw fruits and vegetables?
Mechanically altered or soft diet
What diet is used for people with poor dental conditions, missing teeth, no teeth, or problems with chewing or swallowing (dysphagia)?
Mechanically altered or soft diet
What diet changes the regular diet by thinning it down (often so it can be passed through a straw) to a smooth liquid consistency?
pureed diet
What type of diet would be indicated for a patient with wired jaws, extremely poor dentition when chewing is inadequate, or with chewing and swallowing difficulties (dysphagia)?
Pureed diet
In what type of diet should foods be separated, not include nuts, seeds, raw vegetables, and raw fruits, but is adequate long-term when offering all food groups?
Pureed diet
In regards to pharmacokinetics, what is absorption?
The movement of a drug from its site of administration into the bloodstream for distribution to the tissues
Put these Oral Preparations in order from fastest absorbing to slowest:
Liquids, syrups
Enteric coated tablets
Suspension solutions
Tablets
Capsules
Powders
Buccal tablets, Sublingual
Coated tablets
Buccal tablets, sublingual
Liquids, syrups
Suspension solutions
Powders
Capsules
Tablets
Coated tablets
Enteric-coated tablets
(Table 2.1 in Lilley)
What is the term used to express the extent of drug absorption?
Bioavailability
What are the three basic routs of administration? Which is the fastest route by which a drug can be absorbed?
Enteral (GI tract), parenteral, and topical
Parenteral is the fastest
What do most oral medications undergo?
the first-pass effect
What is the first-pass effect?
When a portion of a drug is chemically changed into inactive metabolites in the liver (a smaller amount of the drug will pass into the circulation, be bioavailable)
Where are oral drugs absorbed?
the mucosa of the stomach and/ or small or large intestine
What are some factors that can alter the absorption of drugs?
Acid changes within the stomach (caused by age, medications, foods, beverages, even time of day), other factors that cause absorption changes within the small intestine
What is the term for the transport of a drug by the bloodstream to its site of action?
Distribution
Where in the body are drugs distributed the fastest? And more slowly?
First to areas with more extensive blood supply, heart, liver, kidneys, and brain
More slowly distributed to the muscle, skin, and fat
What is the difference between a “free” drug and a “bound” drug?
A “free” drug is not bound to plasma proteins, typically albumin (most common blood protein), and can freely distribute to extravascular tissue (outside the blood vessels) to reach their site of action.
A “bound” drug is bound to protein, typically albumin, and the drug-protein complex is too large to pass through the walls of blood capillaries into tissues, considered pharmacologically inactive.
What can the metabolism (aka biotransformation) of a drug turn it into?
The biochemical alteration of a drug into:
An inactive metabolite
A more water-soluble compound
A less active metabolite
A more potent active metabolite (prodrug)
What organ is primarily responsible for the excretion of drugs?
The kidney
Define half-life
The time required for one-half (50%) of a given drug to be removed from the body.
Define steady state
The physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed with each dose
Define onset of action
The time required for the drug to elicit a therapeutic response after dosing
Define “peak effect”
The time required for a drug to reach its maximum therapeutic response
Define “duration of action”
The length of time that the drug concentration is sufficient (without more doses) to elicit a therapeutic response.
What is the term for the degree to which a drug attaches to and binds with a receptor?
Affinity
What is a drug that binds to the receptor; and elicits a response?
Agonist
What is a drug that binds to the receptor; but the response is diminished compared with that elicited by an agonist?
A partial agonist (agonist-antagonist)
What is a drug called that binds to the receptor, but there is no response, and it prevents binding of agonists?
Antagonist
What drug do leafy green vegetables interact with and what is the result?
Leafy green veggies interact with warfarin, decreasing its anticoagulant effect
What fruit juice can interact with a variety of drugs and cause problems with enzymes and transporters, resulting in too much or little of the drug?
Grapefruit
What is a physiologic age-related change that affects the cardiovascular system? What effect do those changes have on pharmacokinetics?
Decreased cardiac output - decreases distribution and absorption
What are 2 physiologic age-related changes that affect the Gastrointestinal system? What effect do those changes have on pharmacokinetics?
Increased pH (alkaline gastric secretions) - altered absorption
Decreased peristalsis - delayed gastric emptyting
What are 2 physiologic age-related changes that affect the Hepatic system? What effect do those changes have on pharmacokinetics?
Decreased enzyme production - decreased metabolism
Decreased blood flow - decreased metabolism
What are 2 physiologic age-related changes that affect the Renal system? What effect do those changes have on pharmacokinetics?
Decreased blood flow - decreased excretion
Decreased Glomerular filtration rate - Decreased excretion
