Exam #2 Flashcards
A calculation with an answer resulting in a number less than 1 must have?
A leading 0, ex. 0.35 mg
A calculation with a number greater than 1 must
Not have a trailing 0
8 Aging and digestive changes
5 decreases and 3 others
Decreased taste and smell
Dry mouth (Xerostomia)
Chewing and swallowing (dysphasia) issues
Early satiety (feeling full faster)
Decreased thirst (risk of dehydration
Decreased HCl- acid secretion
Decreased absorption of nutrients
Decreased peristalsis (constipation)
Can liquid and fluid meds be drawn up to the 100ths place?
Yes
Makes food smaller by chewing, tongue movements, and mixing food with saliva to prepare food for digestion
Mechanical Digestion
Digestive juices combining with food to make an acidic “soup” called “chyme”
Mechanical digestion
Chyme travels to the__________ where localized contraction occur to mix contents and facilitate absorption
What kind of digestion is this?
Small intestine
Mechanical Digestion
This enzyme digests carbohydrates in the mouth pancreas and small intestine
Part of which kind of digestion?
Salivary amylase
Chemical digestion
This enzyme digests amino acids in the stomach but needs ____ to activate this protein
Pepsin, HCl- acid in the stomach
Chemical digestion
This enzyme digests facts into fatty acids and is found in the mouth, stomach and pancreas
Lipase
Chemical Digestion
Role of nutrition in wound healing and illness:
Maintenance of skin and mucous membranes
Vitamin A
Role of Nutrition in Wound Healing and illness:
Promotes immunity and migration of macrophages
Vitamin A
Role of Nutrition in Wound Healing and illness:
Tissue repair, granulation tissue and energy boost
Vitamin B12
Role of Nutrition in Wound Healing and illness:
Enhances tensile wound strength (builds collagen), and blood vessels formation
Vitamin C
Role of Nutrition in Wound Healing and illness:
Anti-inflammatory properties
Vitamin E
Role of Nutrition in Wound Healing and illness:
Blood clotting (2)
Vitamin K and Ca+
Role of Nutrition in Wound Healing and illness:
Builds and repairs skin and tissues, fights infection, balances fluids
Protein
What the differences between caloric, protein, carbohydrate, and fat nutritional requirements between adults and older adults
Caloric: Geriatric need less
Protein: Geriatric need more to prevent age related muscle loss
Carbohydrates: Same (45-65% of total energy intake)
Fats: same (20-35%) of total energy intake
What are the vitamin differences in adults vs geriatric patients for Vitamin D, Calcium, Iron and B12?
Vitamin D: Geriatric need more because they are not exposed to the sun as much
Calcium: Geriatric need more to prevent osteoporosis
Iron: Same, decreases after menopause for women, same all around for men
B12: same for both
Nursing Interventions to Promote Nutrition 8
- Good oral hygiene
- Small frequent meals
- Environment
- Position (HOB elevated)
- Favorite foods
- Pain control
-Collaborate with dietician *swallow assessment - Promote a balanced diet
What are the recommended servings for the 5 food groups according to my plate?
Fruits and veggies
Grains and proteins
Dairy
And how many times a day should a person consume a full food group a day
Fruits and veggies: 1/2 plate
Grains and proteins: 1/2 plate
One dairy helping
Eat at least 1 full food group per day
What are the 4 vitamins/ electrolytes included on a food label
Vitamin D
Calcium
Iron
Potassium
When calculating deliverable doses for both adult and pediatric patients results will be rounded to the
100ths place
Weight calculations:
For Adults round to:
For Pediatric round to:
10th
100th
What is the purpose of a nutritional history and screening?
What 6 things are we looking for
Purpose: collect data about eating behaviors and identifying possible nutritional risks or deficiencies
- Eating habits and appetite
- Food allergies
- Medical conditions
- Dentition/ chewing or swallowing difficulties
- Weightloss
- BMI
What are the ranges for BMI
Underweight
Normal
Overweight
Obese
Extreme Obesity
Underweight: less than or equal to 18.5
Normal: 18.5- 24.9
Overweight: 25.0- <30
Obese: >30
Extreme obesity: >40
Signs and symptoms of nutritional deficiencies
Poor skin turgor or edema
Fluids imbalance/ electrolyte imbalance
Signs and symptoms of nutritional deficiencies:
Poor skin turgor or edema
Fluids imbalance/ electrolyte imbalance
Signs and Symptoms of Nutritional deficiencies:
Pallor, spoon shaped nails
Iron
Signs and Symptoms of Nutritional deficiencies:
Bleeding abnormalities
Vitamin K
Signs and Symptoms of Nutritional deficiencies:
Brittle and fragile nails, hair loss, poor wound healing
Protein
Signs and Symptoms of Nutritional deficiencies:
Low energy, headache
Glucose
What to observe for a swallowing evaluation?
5
Orientation? Position? History? Etc…
Alertness, ability to sit upright, managing secretions, cough strength, history of aspiration pneumonia
This type of diet includes broth, clear juices (apple cranberry), water, black coffee, carbonated beverages and gelatin
Clear liquid diet
This diet includes juices with pulp, soups, milk, milkshakes, ice cream, cream soups, puddings, custards, pain yogurt, nutritional supplements and thinned hit cereal (no fruit chunks)
Full liquid
This diet is recommended for restarting oral feeding after surgery or an abdominal procedure
Also used for electrolyte replacement in people with severe diarrhea
Clear liquid diet
This diet is used as a second step to restarting oral seeing once clear liquids are tolerated.
It should be used for people who cannot tolerate a mechanical soft diet and should not be used for extended periods
Full liquid diets
This diet should be used for those with problems chewing and swallowing (for poor dental conditions, missing teeth, or a condition known as dysphasia)
Mechanically altered or soft diet
This diet should be used when a petite has a wired jaw, extremely poor definition or any other instance where chewing is inadequate (it can pass through a straw)
Puréed diet
The study or science of drugs
Pharmacology
Preparing and dispensing drugs, includes dosage form design (form determines rate of drug disruption and absorption)
Pharmaceutics
What is the order of fastest to slowest drug absorption?
Liquids, syrups
Tablets
Enteric coated
Bucal and sublingual
Capsules
Buccal and cublingual (SL)
Liquids and syrups
Capsules
Tablets
Enteric coated
The study of drug movement throughout the body?
Pharmacokinetics
What are the 4 processes of pharmacokinetics
ADME
Absorption
Distribution
Metabolism
Excretion
Medications passing through the oral and GI route
Does it bypass first effect?
Enteral
NO
Medications that include IM. IV and Subcutaneous
Bypass first effect?
Parenteral
YES
Medications that include ointments, gels, patches, drops, inhalers, creams and lotions
Bypass first pass effect?
Topical
YES
The extend of drug absorption (how much medication is actually used and absorbed by the body)
Ex. Oral drug absorption via stomach or intestine
Bioavailability
Why is knowing about 1st pass effect and bioavailability for medications
For emergent situation and. Dosing medications
Oral meds have less than 100% bioavailability meaning that not all of the dose is absorbed and used by the body
Liver changes drug into less active metabolites after being absorbed through the intestinal tract
Some medication is inactivated by the liver
First pass effect
When a medication is being distributed does it transport to the heart, liver, kidney, and brain more rapidly or the muscle skin and fat?
Heart, liver, Kidney and brain, (they are more vascular)
Bio transformation occurs in the _____ in which drug molecules are converted into _____ _____ molecules to prepare for excretion though the______
Liver, water soluble, kidney
A______ is a drug that goes to the_____ to be activated instead of inactivated like most oral drugs are
This type of drug is activated by ______ enzyme
Prodrug, liver
P450
What organ is responsible for excretion of medications
After it passes what?
Kidneys, after it passes through the liver and is metabolized into water soluble molecules
What disease affect the excretion of medications and can lead to possible toxicity?
Kidney disease
First pass effect or not?
IV?
Not
First pass effect or not?
Inhaled meds
Not
First pass effect or not?
Oral
Yes
First pass effect or not?
Sublingual
Not
First pass effect or not?
Intranasal
Not
First pass effect or not?
IM and SubQ
Not
First pass effect or not?
Transdermal
Not
First pass effect or not?
Rectal
Yes and no
It may be considered enteral or topical
Mixed first pass and non first pass absorption and metabolism
First pass effect or not?
Orally disintegrating tablets, oral soluble films
Not, oral cavity is highly vascularized and does not undergo first pass effect
The use of drugs to prevent or treat diseases
Pharmacotherapy
Food drug interactions:
Intake of leafy green veggies may decrease anticoagulant effect of this medication
Warfarin
Food drug interactions: Grapefruit juice
Which medication categories causes problems with enzymes and transporters resulting in too much or too little of the drug when combined with grapefruit juice (4 types)
Cardiac medications
Anti-seizure medication
Anti- cholesterol
Anti-anxiety
Which medication class can increase drowsiness and sedation which consumed with valerian root
CNS depressants
Therapeutic vs pharmacological classifications
Therapeutic: how a drug is used clinically to treat a specific disease or condition
Pharmacological: how a drug works at a molecular level based on its mechanism of action
What is polypharmacy and what are the risks
Many drugs, greater possibility of experiencing adverse effects and drug drug interactions
What are some dosing recommendations for medications?
Dosage? Pace?
1/2- 2/3 of standard adult dose
Start low and go slow
Look at geriatric dosing recommendations in drug guide before administering
Aging effects on pharmacokinetics:
Decreased cardiac output, and blood flow
Decreased absorption and distribution
Aging effects on pharmacokinetics
Increased alkaline gastric secretions and peristalsis
Altered absorption and delayed gastric emptying
Aging effects on pharmacokinetics:
Decreases enzyme production
Decreased metabolism
Aging effects on pharmacokinetics
Decreased blood flow, renal function and glomerular filtration rate
Decreased, metabolism and excretion 2x
