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
during preg
1-12,
13-26,
27-40
a week after fertilization, implantation happens and the placenta begins nourishing embryo
critical periods: of rapid cell growth
Malnutrition/substance use effects are irreversible because growth of organs and tissues have a small window of growth
high risk preg:
-geriatric mother 15-35
-obese
-chronic disease
-high blood pressure
-small fetus
-diabetes
-hx of perinatal problems
Nutrient needs during pregnancy
First trimester: _no extra cal needed 1-12 weeks
Second trimester: extra _340 cal
Third trimester: extra ___450 cal
macronutrients:
-carb- at least 175 g
-increase fiber dt decreased peristalsis
-protein - 25 g more than what is required
-Essential fatty acids - increase omega 3 and 6 because fat is important to develop fetal brain
Micronutrients:
-Folate and vitamin B12 -To prevent neural defects
Flour is fortified with folic acid
40-50% more blood volume in preg
-Vitamin D and calcium - for bones and teeth
for calcium absorption and utilization
Calcium absorption _doubles__ in pregnancy
Supplements- take prenatal vit before conceiveing and during preg.
Also phosphorus, magnesium, and fluoride
-Iron
Fetus’s iron supply regulated by the placenta. take supplements
Preeclampsia
medical emergency
Preeclampsia
Signs: hypertension and protein in the urine
pharmokinetics
absorption; slower
distrubution: increased fluid volume, faster
excretion: increased blood flow to kidenys= reduced half life
Adolescent pregnancy
Deficiencies of folate, B12, vit D, calcium, iron
Breastfeeding
Infants should have only breast milk for 6 months, if not then use formula. Do not need water, juice, food
Breastfeeding with complementary foods for at least 12 months
Energy Needs during lactation:
First 6 months: extra __330 kcal/day
Second 6 months: extra ___400 kcal/day
Moderate, gradual weight loss does not interfere with breastfeeding. 1lb/week
Nutrition during lactation
Water: about __13___ cups/day
Smoking reduces milk volume
Drugs pass into milk
Colds do not pass into milk, but HIV and TB is contraindicated
Nutrition of the Infant
-Birthweight doubles by 5-6 months, triples by 1 year
-High basal metabolic rate; high energy requirements
-Vitamins and minerals critical to growth (e.g., vitamins A, D, calcium
Lipids are the main source of energy
Vitamins and minerals -Generous amounts of vitamin C
Supplemental vit D - at birth
supplemental iron 0- at 4 mon
supplemental fluoride - at 6 mon
Immunological protection - Colostrum is the first milk. Preg women start to produce milk near end of pregnancy. First milk that comes out is thick and yellow, full of antibodies, vit, nutrients. Newborn stomach is size of a teaspoon. Takes a few days to transition to regular breast milk in the body.
Introducing First Foods
Factors governing addition of foods at 4-6 mon:
Infant’s nutrient needs
Infant’s physical readiness
Need to detect and control allergic reactions
Goal is to transition to table food by age 2
Try 1-2 new foods for a few days and watch for allergy- rash, GI upset
No honey- botulism spores which GI tract cannot get rid of until after 1 year old
Avoid choking risk foods- grapes, carrots
Nutrition during Childhood
Growth slows at 1 year of age
Appetite diminishes at age 1, then fluctuates
Energy intake controlled by internal appetite regulation in normal-weight children
1-year-old: 800 kcal/day
6-year-old (active): 1600 kcal/day
10-year-old (active): 2000 kcal/day
Carbohydrate:
same as for adults after 1 year
Fat and fatty acids:
1 to 3 years old: 30% to 40% of energy
4 to 18 years old: 25% to 35% of energy
Protein
Needs increase slightly with age
Vitamins and minerals:
Needs increase with age; Typically met through balanced nutrition
Iron: Foods should provide 7 to 10 mg iron/day
Vitamin D: Fortified milk or cereals, supplements
Iron deficiency
Weight, height, and head circumference to indicate health and nutrition of a child
monitor lab for Iron deficiency
A child’s brain is sensitive to low-iron. Lowers motivation and impairs overall intellectual performance
Iron supplementation improves learning and memory – regulates the ability to pay attention.
protein deficiency
With too little protein, the body slows its synthesis of proteins while increasing its breakdown of body tissue protein to free the amino acids it needs
signs:
-Slow growth in children
-Impaired brain and kidney functions
-Weakened immune defenses
-Impaired nutrient absorption from the digestive tract
Malnutrition
3 types:
Protein-energy malnutrition (PEM)
-Too little protein, too little energy
Severe acute malnutrition (SAM): kwashiorkor and marasmus
-when food suddenly becomes unavailable
Chronic malnutrition
Failure To Thrive (FTT)
-Weight for length: below 5th percentile
Refeeding
Start with electrolytes, caloric intake at 50%
Childhood obesity
Overweight above 85th
Obese above 95th percentile
High blood lipids
High blood pressure
Increased risks of type 2 diabetes and respiratory diseases
Main goal: improve long-term physical health through permanent healthy lifestyle habits
Initial goal: maintain weight during growth so BMI falls as height increases
Nutrition during Adolescence
Energy and nutrient needs vary due to growth rate, gender, body composition, and physical activity
Vitamin D - Deficiency risk: Those with darker skin tones, females, overweight
Iron
Increased needs during adolescents due to growth, greater lean body mass (in males), and menstruation (in females)
Deficiency most prevalent among teen girls
Calcium
Crucial for developing dense bones
Teen girls are most vulnerable to low intakes
-Importance of breakfast
-snacks should be nutrient dense rather than energy dense
Adult
Cataracts and macular degeneration
-Supplements of vitamins C and E reduce risk of progression
Folate, vitamins B6 and B12, lutein, and zeaxanthin may help prevent or slow progression
Rheumatoid arthritis
-suggest high intakes of omega-3s from fish
The aging brain - Blood supply decreases
Number of neurons diminishes
-Folate, vitamins B6 & B12 slow brain atrophy
Energy and Nutrient Needs during Late Adulthood
Energy needs decline with advancing age
-Reduced activity
-Basal metabolic rate declines
-Sarcopenia: age-related loss of skeletal muscle
Protein
-RDA: 0.8 g/kg; but may need 1.0 to 1.2 g/kg
- With lower total kcal, may need a greater
percentage of kcal from protein
Carbohydrate
-Ample amounts of carbohydrate to prevent protein use for energy
-Fiber for constipation
Fat
-Provides essential fatty acids
Water
Women: 9 cups fluids per day
Men: 13 cups fluids per da
Vitamins and Minerals
Vitamin B12
Deficiency associated with poor cognition, anemia, and other devastating neurological effects
-Symptom of low B12 low energy
Malabsorption due to atrophic gastritis – pernicious anemia?
So have to inject it.
Iron
Deficiency may occur with low food energy intakes and other factors such as blood loss
-meat is hard to chew
Vit D -skin doesn’t absorb enough
Zinc
Deficiency can depress appetite and blunt sense of taste
Many medications impair absorption or enhance excretion
Calcium
Intakes low, especially among women
folate
ON EXAM
Q: Have you been eating less than normal for 2 weeks? Q: Have you lost weight unintentionally in the last 6 mon
random
Gluteal IM site is usually contraindicated in infants
in children, because the liver and kidneys are immature, drugs will have a greater impact due to their prolonged duration of activity
Calculating Pediatric Drug Dosages
Body weight method
-mg/kg
Altered Pharmacokinetics: Older Adulthood
Increased gastric pH, delayed gastric emptying, decreased peristaltic rate may affect absorption
Pregnancy: same three but decreased pH
