Exam 4: Nutrition, Legal and Ethics, Spirituality, Elimination and Enema, Cultural Diveristy, CAM Flashcards
What factors affect bowel elimination?
age, diet, fluid intake, physical activity, psychosocial factors, personal habits, positioning, pain, pregnancy, meds
what is incontinence
inability to control defecation or urination
what are hemorrhoids
engorged, dilated blood vessels in rectal wall
what are causes of constipation? what are some interventions?
--Frequent use of laxatives Advanced age Inadequate fluid intake Inadequate fiber intake Immobilization due to injury Sedentary lifestyle Pregnancy Medication effects --Interventions: Increase fiber and water Give bulk forming products Enemas Encourage reg exercise
what are some causes of diarrhea? what are some interventions?
--Causes: Viral gastroenteritis Bacterial gastroenteritis Antibiotics Inflammatory bowel disease IBS
–Interventions:
Determine and treat cause
Admin meds to slow peristalsis
Eat yogurt once diarrhea stops
what are the different kinds of enemas? what are the details about them?
Enema types: (tap/saline; castile soap; fleet; oil)
–Tap water (hypotonic)/saline
500-1000 mL
Distends intestine, increases peristalsis, soften stool
15 min to take effect
Can lead to fluid and electrolyte imbalance, water intox, DO NOT USE IN KIDS
–Castile Soap
500-1000 mL (concentrate at 3-5 mL/1000 mL)
Distends intestine, irritates intestinal to stimulate peristalsis mucosa, soften stool
10-15 min to take effect
Must only use castile soap, others will cause rectal mucosa irritation/damage
–Fleet Enema–Hypertonic
70-130 mL
Draws fluids out of interstitial space into colon leading to distension, stimulates peristalsis
5-10 min to take effect
Avoid in dehydrated client, or where sodium retention could be a concern, can be irritating to rectum also
–Oil (mineral, olive, cottonseed)
150-200 mL
Lubricates stool and intestinal mucosa, used as retention enema
30 min to take effect (patient may need to hold solution for 30-60 min)
Adverse effects: rectal bleeding (long term)
what do you need to make sure you have before doing an enema?
physicians order
what are some complications caused by constipation? Diarrhea?
Constipation: Fecal impaction
Hemorrhoids and rectal fissures
bradycardia, hypotension, syncope
Diarrhea: Dehydration
Fluid and electrolyte disturbances
what to look for in urine and feces when observing?
color, consistency, odor, volume/amount, mucous, blood, sediment
what factors affect urinary elimination?
age, (prostate enlarges in older age, can obstruct bladder and UTIs), pregnancy, diet, immobility, psychosocial factors, pain, surgical procedures, medications
what are different ways for healthy urinary elimination?
urinal, toilet, bedpan, commode, fracture pan (supine only)
Risk factors of catheter-associated urinary tract infection? Manifestations?
Use of indwelling catheters Increased dwell time of catheter Opening the closed urinary drainage system Routine changes Irrigation of catheter
manifestations:
Urinary frequency, nocturia, flan pain, hematuria, cloudy, foul smelling urine, fever
Older adults: confusion, recent falls, new onset incontinence, anorexia, recent tachycardia, hypotension
what are the different types of urinary incontinence? what are the risk factors?
Stress Urge Overflow Reflex Functional Transient
risk factors: female, preg history, obesity, neuro disorders, decreased estrogen levels, confusion, immobility, dementia
what are the macro (essential) and micro (non-essential) nutrients? What are the purposes of each group?
–Macronutrients–energy
Carbohydrates
Proteins
Lipids
–Micronutrients–important for processes and growth
Vitamins
Minerals
(Also water)
what are carbs, proteins, and lipids for?
--Carbs Used for energy Each gram produces 4 kcal of energy Easiest to store Intake correlated to income (intake increases, income decreases)
--Proteins Tissue building Utilized for growth Protein synthesis Using protein for energy is more expensive financially and physiologically
--Lipids Storage & energy Most concentrated form of energy Insoluble in water/blood Saturated & unsaturated fatty acids--manufactured usually Trans fat Raises Cholesterol Each gram produces 9 kcalories energy Necessary for metabolic processes
what do vitamins and minerals do?
--Vitamins Catalyze metabolic processes Are organic compounds needed by the body in small amounts Do not provide energy Water soluble or fat soluble
–Minerals
Are inorganic elements found in all body fluids and tissues
Provide structure within body
Regulate body processes
Macro-minerals
Micro-minerals–trace elements (iron, zinc etc)
what is water and how does it change when aging?
- -The major body constituent present in every body cell
- -Accounts for between 50 – 60 % of adult’s total weight
- -Babies have mostly water
- -Total body water decreases with age, intracellular water increases
- -Provides the fluid medium for all chemical reactions of the body
- -The body’s most basic nutrient
- -Water is a solute
- -No calories
- -Foods include water, so monitor I&O
what factors affect nutrition?
Physical – state of health Psychological – environment Culture/ethnicity/religion One’s education (or lack of) Socioeconomic status and roles Drugs/alcohol/mediations Developmental level PERSONAL PREFERENCE & HABIT
what are the 10 different hospital diets?
- NPO
- Clear liquid
- Full liquid
- Surgical soft
- Regular
- Dysphagia diets (pureed, honey/nectar thick liquids)
- Low Residue (limit fiber, eat meat, poultry, eggs, milk)
- High fiber
- Diabetic features (low fat and low cal, low sugar)
- Sodium restricted (for heart conditions, kidney function probs)
what are the components of a nutritional assessment? (ADPIE) name details
- -history (assess needs, BMI measure)
- -physical assessment (anthropometitrics–skin fold measure, mid arm circ, BMI, weight, mid arm muscle circ; lab data; appearance)
- -dianosis (assess data–imbalanced nutrition as problem and etiology)
- -implementation (nutritional teaching, monitor nutritional status, stim appetite, assist w eating, provide sup nutrition if needed (enteral feedings etc)
- -evaluation (eval progress, monitor lab values)
In the nutritional assessment, what are you doing as part of history taking and physical assessment?
–History taking
Assessing nutritional needs
Begins with height and weight; BMI
--Physical assessment Anthropometrics -Skin fold measures -Mid-arm circumference -Mid-arm muscle circumference -Body mass index -Body weight Laboratory data Additional clinical signs of altered nutrition -General appearance -Posture -Behavior/mood -Motor/perceptual function -Hair condition -Skin -Face & neck -Lips -Tongue -Teeth -Eyes -Nails
In the nutritional assessment, what are you doing as part of diagnosis?
Assessment data may reveal actual or potential nutritional problems
Imbalanced nutrition as the problem
Imbalanced nutrition as the etiology
In the nutritional assessment, what are you doing as part of implementation?
Teaching nutritional information Monitoring nutritional status Stimulating appetite Assisting with eating Providing supplemental nutrition (Enteral feedings via feeding tube, Percutaneous endoscopic gastrostomy(PEG) tube, Total parenteral nutrition (TPN))
Approaches to stimulate appetite (Small and frequent meals, Environment, Promoting oral care, The set up)
Assisting a client with eating (Individualize, Set up as needed, Call light in reach)
what is dysphagia?
Definition: difficulty swallowing
what to do: Speech evaluation: swallow study
what is TPN? what are the risks?
Total parenteral nutrition (TPN)
–Contains three primary components necessary to maintain nutrition: Proteins, carbohydrates, & fats
Also contains electrolytes, vitamins, and trace elements, insulin, heparin
Risks
- -Risk for sepsis
- -Complications related to insertion of catheter/central IV line
- -Metabolic alterations (hyperglycemia)
- -Fluid/electrolyte, acid/base imbalances
- -Phlebitis
- -Wean slowly off of TPN, high calorie
In the nutritional assessment, what are you doing as part of evaluation? what are the lab values you check?
- -Evaluate progress toward pt. nutritional goals/outcomes
- -Evaluate pt.’s tolerance & adherence to nutritional plan
- -Assessing pt.’s understanding of nutritional plan/diet
–Lab values associated with nutrition
Hematocrit/hemoglobin – decreased in iron deficiency
Serum potassium – depleted in severe nutrition
Albumin – represents protein status
Total Protein – low may indicate malnutrition, protein deprivation
Urea Nitrogen (BUN) – inhibited protein metabolism
what are goals for nutrition?
Goals:
based on attaining specific optimum lab values
Attain or maintain “ideal body weight” (specify)
Eat a certain percentage of meals (specify)
Will attain “physical signs/sx of adequate nutrition” (specify)
what clients are at risk for altered nutrition intake?
anyone who has alterations in ability to: ingets, digest, absorb or has increased metabolic demand
what should the nurse do to stimulate appetite?
Minimize odors
Good oral hygiene
Clean, pleasant environment
Proper positioning and comfort for meal time
Allow food preferences & choices, as possible
Small frequent meals
how do you calculate BMI?
BMI = weight (kg) / height in m2
m2 = which is height x2
what is ethnicity vs race?
Ethnicity–Relates to cultural identification
Race–Physical characteristics, physical traits
what cultural factors affect nursing?
Role of family Folk and Traditional Healthcare Values & Beliefs Common Health Problems Nursing Considerations with each specific cultural group
what are spiritual needs? what are the factors that affect spirituality?
Needs:
Need for meaning and purpose
Need for love and relatedness
Need for forgiveness
Factors affecting spirituality Developmental considerations Family Ethnic background Formal religion Life events
