final Flashcards
fat-soluble (A,D,E,K)
Absorbed with fat into the lymph before entering the blood
*
Stored in the liver and fatty tissues
*
Rarely leave the body and thus build up in tissues
*
Can be taken
periodically
Water Soluble (B complex,C)
Absorbed directly into the blood
*
Most not stored in the body
*
Leave the body in urine
*
Needed frequently
vitamin deficiency
primary: not enough consumed to meet needs
secondary: impaired absorption/excess excretion
toxicities: rarely occurs from food consumption, mostly form supplements
minimum urine excretion
500 ml/day
AI of water
men - 3.7 L
women 2.7 L
dehydration
symptoms:
thirst
weakness, exhaustion
delirium
death
water intoxication
rare, seen in drug-induced states
symptoms:
-confusion, convulsion
-coma
-death
hypervolemia/fluid overload: excess fluid in intravascular space
symptoms:
-edema
-HTN, increased HR
-SOB
-headache, cramping, GI bloating
tx
-restrict Na
-diuretics
-maintain semifowlers
-In and outs
-VS
-auscultate lung sounds
Encouraging use of oral enteral formulas
Attractive – Offer it to them – build in “goals” - how much by when
SMALL AMTS taken often – whole serving can seem overwhelming
Cold – ice bath
Cover the container to decrease the smell
Drink through straw – deliver past the taste buds
At home – add Flavors/ put in smoothies
Practical – have it always on hand –cans in the car.
Tube Feeds
Indications:
Severe swallowing difficulties
Little or no appetite for extended periods; malnourished
GI obstructions, some types of fistulas, or impaired motility in the upper GI tract
Intestinal resections
Mentally incapacitated
Coma
Extremely high nutrient requirements
Mechanical ventilation
Parenteral Nutrition
Recommended for those who are unable to absorb or digest nutrients. Or for those conditions that require bowel rest. Conditions like;
1 Intractable vomiting or diarrhea
2 Severe GI bleeding
3 Intestinal obstructions or fistulas
4 Paralytic ileus
5 Severe malnutrition with intolerance to enteral feeds
Components;
Carbohydrates
Amino Acids
Fats
Electrolytes and Minerals
Vitamins
Trace elements
Peripheral Parenteral Nutrition
May develop phlebitis
Used in people on short term infusions (7-14 days) with normal renal function
Used in people who need to supplement an oral diet
Central Total Parenteral Nutrition
indicated whenever:
parenteral nutrition will be required for long periods of time
nutrient requirements are high
people are severely malnourished
Nursing Assessment
Check CVC site throughout shift
Check solution and monitor lab work - CHECK daily
Must be continuous pump IV
Risks: fluid overload, infection, air embolism
Catheter-related sepsis
Septic thrombosis
Metabolic (most common):
Hyperglycemia, hypoglycemia, hyperkalemia, fluid imbalance
Refeeding syndrome
Liver Disease (fatty liver)
Gallbladder Disease
Metabolic Bone Disease
Nurses have monitoring checks- chemistry and electrolyte panels, fluid intake, weight, check that what is ordered matches what came in bag
Refeeding syndrome
A shift of electrolytes from outside the cell to inside the cell
Hallmark biochemical feature: hypophosphataemia
Who is at risk: cancer cachexia, malnutrition, chronic alcoholism, really frail, NPO for more than 7 days, post op, DKA, chronic antacid user, chronic diuretic user, elderly, TB, AIDS, rapid weight loss
Sudden influx of glucose into cells + increased secretion of insulin and decreased secretion of glucagon
Results in a decrease in the serum levels of: phosphate, potassium, magnesium
Glucose
Vitamin deficiency – THIAMINE
Sodium, nitrogen, fluid
Criteria for at risk:
Unintentional weight loss of more than 15% bodyweight
Little to no food intake in 7-10 days
BMI less than 16
how can refeeding syndrome be prevented?
- plasma electrolytes and glucose should be measured at baseline
- Refeeding should be started at no more than 50% of energy requirements and slowly; increased if no refeeding problems are detected
- electrolyte levels should be measured once daily for one week, and at least three times the following week
- vitamin supplement should start immediately
pre-pregnancy
under weight = High risk of low birth weight
Overweight = Difficult labor and delivery, birth trauma, and cesarean section
Increased risk of neural tube defects and other abnormalities
placenta:
- supplies nutrients and removes waste from fetus
-is a filter for toxins
-produces hormones to prepare for lactation
-After 42 weeks, placenta is considered old and deteriorates, then labor is induced
Two hormones: estrogen, progesterone
