exam 4 presentaions Flashcards
WHAT DOES WATER DO FOR
OUR BODIES?
TRANSPORTS NUTRIENTS TO CELLS AND
WASTE FROM THE CELLS
TRANSPORTS HORMONES, ENZYMES, BLOOD PLATELETS, AND RED AND WHITE BLOOD CELLS
FACILITATES CELLULAR METABOLISM AND PROPER CELLULAR CHEMICAL FUNCTIONING
ACTS AS A SOLVENT FOR ELECTROLYTES AND NONELECTROLYTES
HELPS TO MAINTAIN BODY TEMPERATURE, FACILITATES DIGESTION AND PROMOTE ELIMINATION
DISTRIBUTION OF BODY FLUIDS
70% intracellular fluid
(ICF) Fluid inside cells
30% extracellular fluid
(ECF) Fluid outside cells
FLUID BALANCE
ex of intake and out
FLUID INTAKE IS REGULATED BY
THIRST MECHANISM
FLUID INTAKE
—- LIQUIDS, FOODS, METABOLIC GENERATION
- SENSIBLE AND INSENSIBLE LOSS
—URINATION, SKIN/LUNGS, SWEAT, DEFECATION
fluid volume deficiency is what
Low ECF volume
casues of hypovolemia fvd)
Dehydration, trauma, vomiting, diarrhea, third- spacing, medical conditions
s/s of hypovolemia fvd)
(weak pulse)
skin turgor decreased
Weight loss
Tachycardia (increased HR) Hypotension (low BP)
Decreased salivation (dry mouth)
Increase in hematocrit
weakness
fvd assessment/interventions
whatlooking at
vitals-decrease bp/increase hr
monitor I and o
labs-inc hit and specific grsvity
skin-check breaksdwon
weak pulse
check oral mucosa
whos at risk for fvd
Elderly,
infants (especially w/ fevers, V/D),
illness,
renal dysfunction,
gross tissue trauma,
burns,
hyponatremic,
bowel obstruction,
ileostomies,
pancreatitis,
ascites,
sepsis,
excessive N/V/D
edcaution for fvd
increase fluids
check weight
check skin
s/s electrolyte imbalace
teach dierutcs
fluid volueme excess
Excess retention of water/sodium in ECF
causes of hypervolemia
cardiac/renal disease
increase fluid
lower exercise
edema
liver cirrhosis
s/s hypervolemia
edema
ascites
sob
crackles
wet cough
wt gain
increase rr and bp
bounding pulse
fluid volume excess
assessments what to check
monitor I and o
low sodium diet
weight gain
vitals- increase bp and rr
skin-compresion
labs-lower hct
whos at risk fluid volume excess
Kidney/renal dysfunction,
excessive fluid intake (IV),
liver cirrhosis,
heart failure,
high Na diet
pt education fluid volume excess
low sodium diet
lower fluid intake
s/s electrolyte imbalance
check weight increase
increase le
sodium
labs
abundant in
LAB VALUES: 135 – 145 MEQ/L
* BELOW 135 = HYPONATREMIA
* ABOVE 145 = HYPERNATREMIA
MOST ABUNDANT IN ECF
what does sodium do to body
CONTROLS AND REGULATES WATER BALANCE = MAINTENANCE OF ECF VOLUME
TRANSMITS IMPULSES IN NERVE AND MUSCLE FIBERS
EXCRETED BY THE KIDNEYS
HYPONATREMIA
Sodium Level <135 mEq/L
HYPONATREMIA causes
Suctioning
Diarrhea/Vomiting
Low Na intake
Diuretic use
Fluid Shift
hyponatramia s/s
Lethargy
Confusion
Hypotension
Seizures
Muscle Twitching
Hemiparesis (loss of strength, unilateral)
Focal Weakness (localized, RA, L face)
hypernatremia
Sodium Level > 145 mEq/L
hypernatremia what causes
Increased Na Intake
Excess insensible water loss
Fluid Deprivation
Diarrhea
Hyperventilation/burns
Fluid shift
hypernatremia s/s
Restlessness
Weakness// Disorientation
Delusion//Hallucinations
Thirsty/Dry Mouth
Hypertension
foods hgh in sodium
BUTTER
HAM/BACON
CHEESE
CANNED FOODS
HOT DOGS
PEANUT BUTTER
SOY SAUCE
TABLE SALT
PRESERVATIVES!!! (LUNCH MEAT,ANYTHING INSTANT, ETC)
potassium
LAB VALUES: 3.5 – 5.0 MEQ/L
ICF —MOST CRITICAL ELECTROLYTE!
what does potassium do for body
TRANSMITS NERVE/ELECTRICAL IMPULSES – CARDIAC IMPULSES
check apical pulse
hypokalemia what causes
Vomiting/Diarrhea
GI Suctioning
Alkalosis
Use of diuretics
NPO
hypokalemia s/s
Muscle cramps/weakness
Fatigue//Lethargy
Anorexia
Decreased GI motility
Paresthesia (tingling/prickling)
Cardiac dysrhythmia
hyperkalema what causes
Renal Failure
Excess Intake
Medication use (ACE inhibitors, NSAIDs, Heparin, KCl, Potassium- sparing diuretics (Spironolactone!!!
hyperkalmia s/s
Muscle Weakness/twitches/cramps
Decreased Urine Output
Respiratory Failure
Decreased Cardiac Contractility
Cardiac dysrhythmias leading to cardiac arrest!!!
potassium foods
ORANGE JUICE
RAISINS
LEAN BEEF
CHICKEN
BANANAS
POTATOES
SPINACH
AVOCADOS
CANTALOUPE
calcium
LAB VALUES: 8.6 – 10.2 MEQ/99%
STORED IN THE SKELETAL SYSTEM
REGULATED BY PARATHYROID HORMONE & CALCITONIN
what does calcium do for body
FORMING BONES AND TEETH
TRANSMITTING NERVE IMPULSES
REGULATE MUSCLE contraction
hypocalcemia what causes
Nutritional Deficit
Impaired Absorption (needs Vit D)
Excess Calcium Loss
hypocalcemia s/s
Muscle cramps
Numbness / tingling of the extremities (Trousseau Sign)
Twitching of facial muscles (Chvostek Sign) and eyelids when facial nerve is touched
hypercalcemia what causes
Cancer
Hyperparathyroidism
hypsercalciemua s/s
Nausea/Vomiting
Constipation
Bone Pain
Excessive Urination
Thirst
Confusion
Lethargy
Slurred Speech
Cardiac Arrest (SEVERE ONLY!!!!)
calcium fods
MILK AND OTHER DAIRY PRODUCTS-yogurt
* BROCCOLI (7%)
* FIGS
* TOFU
* COTTAGE CHEESE
magnesium
LAB VALUES: 1.3 – 2.3 MEQ/L
FOUND PRIMARILY IN THE SKELETON AND ICF
what does magnesium do for body
OPERATING SODIUM-POTASSIUM PUMP
RELAXING MUSCLE CONTRACTIONS/ TRANSMITTING NERVE IMPULSES
VASODILATOR
hypomagnesemia is caused by
Diarrhea
NG Suctioning
Tube Feedings
Burns
Sepsis
Alcohol Withdrawal
hypomagnesemia s/s
Tremors
Seizures
Hyperreflexia (Hyperactive DTR)
Tetany (muscle spasms)
Confusion
what causes hypermagnesemia
Renal Failure
Too many Antacids
hypermagnesemia s/s
Hypotension/Bradycardia
Lethargy(tireness)//muscle weakness
Decreased Deep Tendon Reflexes
Flushing
magnesium foods
DARK GREENS
SEEDS
BEANS
FISH
AVOCADOS
chloride lab values
LAB VALUES: 97 – 107 MEQ/L
what does chloride do for body
FUNCTIONS WITH SODIUM TO REGULATE SERUM OSMOLALITY AND BLOOD VOLUME
WHEN SODIUM IS REABSORBED IN THE KIDNEY, CHLORIDE USUALLY FOLLOWS
REGULATES ACID-BASE BALANCE
BUFFER IN OXYGEN-CARBON DIOXIDE EXCHANGE IN RBC’S
phosphate lab value
LAB VALUES: 2.5 – 4.5 MG/DL
MAJOR ANION IN ICF
ALSO FOUND IN ECF, BONE, SKELETAL MUSCLE, AND NERVE TISSUE
CHILDREN HAVE A HIGHER LEVEL THAN ADULTS
what does phosphate do for body
FORMING OF BONES AND TEETH
METABOLIZING CARBOHYDRATES, PROTEIN AND FAT
CELLULAR METABOLISM; PRODUCING ATP AND DNA
MUSCLE, NERVE, AND RBC FUNCTION
phosphate foods
Foods high in protein,
Teas,
sodas,
breakfast bars
macronutrients
Carbohydrates
Protein
Fat (Lipids
micronutirnets
Vitamins
Minerals
simple carbs
Fruits
– Candy bars
– White sugars
– Milk (yes, milk has sugar!)
– Honey,
syrup
complex(starches) carbs
Breads
– Legumes
– Whole grain pasta
– Vegetables: Corn, potatoes
– Sweet potatoes
sugar
Recommended Daily Allowance (RDA) – 10%
Look on labels – try to find something without sugar, it is hard if not impossible! Even milk, tomato sauce, and bread has sugar.
Other names for sugar: high-fructose corn syrup, fruit juice concentrate, molasses, honey, and sucrose
can be addictive
too much sugar can lead to
Weight gain
– Impaired immune system
– Type 2 Diabetes (body cannot keep up)
– Multiple other chronic diseases – Cancer, Fatty liver disease, etc
protein
Recommended Daily Allowance (RDA) - 10% - 35%
Vital component of every cell
Promote tissue growth and healing (wounds, etc)
complete protein
high quality
Eggs
– Dairy products
– Meat
– Soy
incomplete protein
low quality
Grains
– Legumes
– Vegetables
– Beans
– Quinoa
– Rice
protein recomendations
Recommendation is to eat less animal proteins and more vegetable proteins
Combine 2 or more incomplete proteins to
create a complete = like 2 puzzle pieces put
together.
— Cereal w/ milk
– Peanut butter on whole grain bread
—-Rice and Bean
Fats (lipids)
Recommended Daily Allowance (RDA) - 10%
95% of lipids in the diet are in the form of triglycerides
Major store of fat in the body / predominant for of fat in food
saturated fats
Raise cholesterol levels
bad
– Butter
– Cheese
– Creams
– Blue cheese
– Fatty meats
– Oils (palm)
unsaturated fats
lower cholesterol levels
good
Mono & Poly
– Omega - 3
– Olive oil
– Avocado
– Nuts, almonds
– Beans
fats reccomendations
AVOID TRANS FAT!!
Raises LDL and lowers HDL!
Partially hydrogenating oils
Water-Soluble Vitamins
Dissolve in water
* Not stored in the body, so they need to be eaten every day!
water soluble vitamins examples
– Thiamine – B1
– Riboflavin – B2
– Niacin – B3
– Pyridoxine – B6
– Folate (Folic Acid)
– Cyanocobalamin - B12
– Vitamin C (Ascorbic Acid)
Thiamine
Water-soluble vitamin
Vitamin B1
Converts food into energy & helps the cardiac, brain, and nervous system
People affected with alcoholism are deficien
thiamine examples
Lean Pork
- Cereals
- Milk
Fat-Soluble Vitamins
Stored in fat
Can build up in the body for long periods of time because they are stored!
fat soluble vitamins examples
– Vitamin A
– Vitamin D
– Vitamin E
– Vitamin K
Vitamin K
Helps with blood clotting!
If deficient, patients could have bleeding irregularities
— Epistaxis (nose bleeds)
—- Excessive ecchymosis (bruising)
vitamin k examples
Spinach
– Kale
– Cauliflower
vitamin
K
A
D
E
what do
K-blood clotting, bone health
A-vision,reporoduction,skin,immune system, bone health
D-stregnthend bone, calcium absoroption,immune system
E-immunesystem, flush toxins
minerals-macromineralas
– Calcium
– Phosphate
– Sodium
– Potassium
– Magnesium
– Chloride
– Sulfur
minerals-microminerals
– Iron
– Zinc
– Manganese
– Iodine
– Fluoride
– Copper
– Cobalt
– Chromium
– Selenium
Iron
Micromineral
Supplement: Ferrous Sulfate
- Needed to form hemoglobin (cells that carry oxygen)
- Commonly used to treat iron-deficiency anemia
Iron should always be taken with Vitamin C to promote absorptio
iron foods
Eggs
– Meats
– Spinach
– Kale
– Nuts
– Fortified Breads
– Fortified Cereals
Antioxidants (Super Foods)
- Blueberries
- Kale
- Walnuts
- Salmon
- Sweet potatoes
- Quinoa
- Pomegranate
- Tomatoes
Body Mass Index (BMI)
Indicates change in body fat stores
Indicates whether weight is appropriate for height
Low BMI or high BMI can indicate poor nutritional status
bmi calcuation
Weight (lb) / height2 (inches) x 703 = BMI
*Normal is 18.5-24.9
percentage of weight loss
Divide the new weight by the former weight and then
change to percentage, subtract from 100%
Factors Affecting Nutrition
Development/Biological Factors
State of Health
– Pregnancy or Lactating
– Illness
– Mental Health
– Medications
– Alcohol
Religion/Culture
Social Determinants
nutritional screening tools
MNA
Food diaries
Anthropometric Data
BMI//weight circumference
biochemical data
physical assessment
Mini Nutritional Assessment (MNA)-nursing screening tool for malnourishment
Food Diaries-diary of all food-24 hrs, count calories, counts all foods taken in
Anthropometric Data–Weight, height, body mass index (BMI), body circumference (arm, waist, hip and calf), waist to hip ratio (WHR), elbow amplitude and knee-heel length.
Body Mass Index and Waist Circumference-measure BMI and test to see if waist is any different then before
Biochemical Data-labs-Hemoglobin (Hgb), Hematocrit (Hct), Prealbumin, Transferrin, BUN, Creatinine, Urine
Physical Assessment-Appearance, weight, hair, face, eyes, lips, tongue, teeth, gums, glands, skin, nails, skeleton, muscles, extremities, abdomen, nervous system, cardiovascular system, GI system
Clear liquid diet:
Chicken broth, jello, popsicle, sprite/7up, Gatorade
- Full liquid diet:
– Ice cream, prune juice, gelatin
- Puréed diet:
– Solids are blenderized to liquids
- Mechanical Soft Diet:
– Foods are chopped, ground, mashed, or soft
Psychosocial Factors
Age
Fluid and food intake
Medications
Muscle tone
Pathologic conditions
*Surgical and diagnostic procedures
Physiology of Urinary Elimination
Kidneys- Regulates fluid and acid-base balance
Ureters- Junction between the kidney and the bladder
Bladder- Hollow, muscular organ that serves as the
reservoir for urine
Urethra- Extends from bladder to urinary meatus
(opening)
Altered Urine Production and treatment
Polyuria–Excessive urination
Oliguria–the production of abnormally small amounts of urine.
Anuria–no urine
Treatment= Dialysis
Peritoneal–uses the peritoneum (in abdomen) as the membrane through which fluid and dissolved substances are exchanged with the blood
Hemodialysis– Remove extra salt, water, and waste products so they don’t build up in your body. Keep safe levels of minerals and vitamins in your body
Nocturia
-night peeing-limit nighttime fluid
Urgency
-sudden strong need-provide routine for peeing
Dysuria
-painful-assess constantly
Enuresis
-bed incontince- regular toileting schedule, providing privacy and comfort during toileting, encouraging adequate fluid intake, assisting with mobility and positioning, monitoring urinary output
Urinary Retention
–cant empty all urine in bladder-double voiding, schedule, catheter,
Neurogenic Bladder-
lack bladder control due to a brain, spinal cord or nerve problem-cath,drugs,therapy,manual help
Urinary Incontinence
t
e
Transient-Acute-urine leakage that is caused by a temporary (transient) situation-
Established-Chronic-loss of bladder control
Types of Urinary Incontinence:
Reflex-urine leaks without a warning or urge to urinate
Stress- leaking urine during physical activity that increases abdominal pressure, such as coughing, sneezing, laughing, or exercise
Total-bladder cannot store urine at all
Urge-involves sudden compelling urges to void and results in involuntary leakage of urine
NI for urinary incontince
promoting adequate fluid intake, maintaining normal voiding habits, and assisting with toileting
Urine Assessment
Diagnostics
Amount=
Color=
Clarity=
Odor=
Sterility=
pH=
Specific Gravity=
Glucose=
Ketone=
Blood=
Amount= 1200-1500ml/day
Color= yellow to light amber
Clarity= clear
Odor= faint aromatic
Sterility= no microorganisms
pH=4.5-8.0
Specific Gravity= 1.010-1.025
Glucose= none
Ketone= none
Blood= none
Nursing Interventions urine
Good Nutrition
Adequate fluid intake
Assistance with toileting and hygiene
Infection prevention education
Education
Incontinence Management
making urinary retention urinary diversions
incontince management
Bladder training
2. Kegel exercises
3. Skin care
4. External drainage
Urinary diversions
Ileal conduit
Continent urinary diversion
Supra pubic
Bowel Elimination
Stomach
Small Intestine
Large intestine
Rectum
—- Peristalsis
—- Normal
—- Abnormal
Factors Affecting Bowel Elimination
Age
Diet
Fluid intake
Activity
Psychological
Defecation Habits
Medications
Diagnostic Procedures/Surgery
Pathologic Conditions
Pain
Elimination Problems
Constipation
Fecal Impaction
Diarrhea
Incontinence
Flatulence
Nursing Interventions elimination
non pharm
Emollient
Stimulants
Lubricants
Saline-osmotic
Non-pharmacological-bladder training, movements,foods,grains, repositioning, massaging
Pharmacological
Emollient-softener
Stimulants-laxitive-moves bowels faster w/ nerve
Lubricants-keeps moisutere in stool
Saline-osmotic-reatains water
