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S4 2539 > M6 Nutrition > Flashcards

M6 Nutrition Flashcards

1
Q

Failure to thrive can be caused by 2 categories of illnesses

A

Physical
Psychological

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2
Q

Failure to thrive manifestations

A

Underweight
Dry skin
Prominent bony stature
Mental confusion
Drop in reflexes

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3
Q

Failure to thrive
Hx

A

Diet changes
Apathy
Food intolerance
Functional ability
Strength

Environmental (can person afford food)

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4
Q

Diagnostic labs for failure to thrive

A

Albumin/prealbumin
Liver enzymes
BUN/Creatinine
Lytes
CBC

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5
Q

Visual diagnostics for failure to thrive

A

Abdominal ultrasound
Abdominal CT
Radiology studies for swallowing

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6
Q

Nurse interventions for FTT

A

Nutrition intake assessment
Nutrition support/supplements

Daily weight
Daily I&O

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7
Q

FTT collaborative interventions

A

Psych counseling
Dietician
Enteral/parenteral nutrition

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8
Q

Meds for FTT

A

Appetite stimulants
Vitamins
Mineral supplements

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9
Q

Impaired liver function 101
results in

A

Impaired PROTEIN metabolism
Decreased ALBUMIN and CLOTTING factors
Reduced BILE production
Impaired metabolism of STEROIDS and GLUCOSE

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10
Q

Liver failure cause
CIRRHOSIS 101

A

Alcohol
Biliary problems
Nonalcoholic fatty liver

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11
Q

Posthepatic liver failure problems

A

Hepatitis B and C
Chronic viral hepatitis

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12
Q

High risk behaviors that can cause liver failure

A

Alcohol use
Injectable drugs

Exposure to toxins

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13
Q

Live failure S/S
decay

A

Malnutrition
Muscle wasting
Jaundice
Gastritis/anorexia/diarrhea
Bleeding

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14
Q

Liver failure S/S
things expanding

A

Edema
Ascites
Splenomegaly
Encephalopathy

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15
Q

Collaborative care for Cirrhosis

A

Holistic addressing
physiology
psychology
spirituality

Counseling
Job coaching
Behavior therapy
Nutrition

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16
Q

Lab exams for liver function

A

AST ALT
CBC
Coagulation studies (liver helps coagulation)

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17
Q

What serums will change with liver cirrhosis

A

Lytes
Bilirubin
Albumin
Ammonia
Glucose
Cholesterol

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18
Q

Bilirubin

A

yellow pigment
breakdown of RBCs

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19
Q

Albumin

A

liver protein

low level means malnutrition

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20
Q

Ammonia

A

15-45u

if high means liver failure

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21
Q

Visual exams for cirrhosis

A

Abdominal ultrasound
Esophagoscopy
Liver biopsy

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22
Q

Meds for cirrhosis

A

Diuretics
Beta blockers
Oxazepam
Nutrition supplements

stuff to reduce nitrogenous waste and ammonia

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23
Q

Nutrition supplements

A

Ferrous sulfate
Flic acid
Vit K
Antacids

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24
Q

Meds to reduce nitrogenous waste and lower ammonia

A

Lactulose
Neomycin

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25
Q

Oxazepam

A

benzodiazepine

helps with liver inflammation in critical citations

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26
Q

Drugs to avoid with cirrhosis

A

Barbituates
Sedatives
Hypnotics
Acetaminophen
Alcohol

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27
Q

Nutritional therapy for liver cirrhosis

A

Sodium down to 2g
Fluids down to 1500ml
Protein down to 60g
Moderate fat
Supplements

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28
Q

Cirrhosis emergency nutrition

A

Parenteral nutrition

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29
Q

Surgical/procedural therapy for cirrhosis

A

Transplant
Paracentesis
Balloon tamponade
Transjugular intrahepatic portosystemic shunt (TIPS)

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30
Q

Paracentesis

A

Perforation of a hollow cavity to remove fluid

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31
Q

Balloon temponade

A

Multiple lumen NG tube

inflates balloon on sides of tube to provide pressure on bleeding varices in GI

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32
Q

TIPS
Transjugular intrahepatic portosystemic shunt

A

Relieves portal hypertension fixing varices and ascites
Shunt is left between portal and hepatic vein allowing better perfusion

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33
Q

Nursing S/S assessment cirrhosis

A

Weight loss
Anorexia
Bleeding
Pruritus
Abdominal pain

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34
Q

Nursing Hx assessment cirrhosis

A

Liver/gallbladder disease
Alcohol and drug use
OTC meds

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35
Q

Nursing physical manifestations of cirrhosis

A

Mental status
Abdominal girth
Edema
Bruises
Jaundice

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36
Q

Cirrhosis results in what problems
aka diagnosis

A

Excess fluid volume
LOC changes
Impaired skin
Nutrition less than body requirements

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37
Q

Outcome goals for cirrhosis

A

Maintain hydration
Maintain diet
Regular elimination

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38
Q

Easiest monitoring

A

DAILY WEIGHT

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39
Q

What concepts can be impaired due to cirrhosis

A

Mobility
F/E
Perfusion
Clotting
Nutrition

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40
Q

Major functions of the liver

A

Filter blood
Detox drugs
Produce coagulants
Metabolism

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41
Q

Patho of cirrhosis

A

buildup of fibrotic tissue impairs perfusion

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42
Q

First systems to be affected by cirrhosis

A

Metabolic abnormalities
Clotting

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43
Q

Liver can regenerate it self but this results in further

A

scarring tissue that can not be perfused

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44
Q

Decompensated cirrhosis results in

A

Portal hypertension
Bleeding varices
Hepatorenal syndrome

ascites/peritonitis
encephalopathy

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45
Q

Liver pain locations

A

Dull right upper quadrant pain
Palpable liver
Epigastric pain

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46
Q

Urine with liver failure
Bowel

A

DARK
Drop in output

light colored (gray or tan) stool

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47
Q

Liver failure and lungs

A

Rapid shallow breathing

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48
Q

MOST common cirrhosis findings

A

Edema
Ascites
testicular atrophy and loss of libido

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49
Q

Cachexia

A

Liver failure symptoms

wasting of extremities

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50
Q

Due to loss of nutrition with cirrhosis, wound healing will be

A

Delayed

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51
Q

Since the liver produces clotting factors, cirrhosis can result in

A

H&H DECREASE

gum bleeding
gut bleeding in emesis or stool
easy bleeding at IV sites
etc

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52
Q

K+ and liver function

A

DECREASE

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53
Q

Areas that have edema ascites and pruritus are particularly prone to

A

SKIN BREAKDOWN

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54
Q

Portal hypertension in liver failure will result in

A

Hyperaldosteronism
Increase in fluid volume

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55
Q

Antiemetics to prevent nausea with cirrhosis

A

AVOID
liver can not process them

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56
Q

Meals frequency
Self care

A

small frequent meals
Frequent oral hygiene

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57
Q

Skin integrity care

A

trim nails short
NO alkaline soap
support areas with edema
Keep linen clean dry and wrinkle free

TURN pt q2h

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58
Q

Why does hemorrhage occur with cirrhosis

A

liver makes clotting factors
NO LIVER FUNCTIN = NO CLOTTING

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59
Q

Nutritional management for encephalopathy

A

Small frequent meals
Daily protein between 1.2-1.5 g/kg
protein is good

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60
Q

Lytes with encephalopathy
what to do

A

Hypokalemia
give lactulose

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61
Q

Why does encephalopathy occur with cirrhosis

A

Liver cant metabolize ammonia to urea for excretion
BUILD UP OF AMMONIA = Encephalopathy

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62
Q

With encephalopathy and increasing ammonia first symptom is

A

LOC - SLEEPINESS
stupor
impaired thinking

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63
Q

Second encephalopathy S/S are
neuromuscular

A

Asterixis - liver shakes
Hyperreflexia

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64
Q

MOST life threatening complications of cirrhosis

A

BLEEDING ESOPHAGEAL VARICES

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65
Q

To lower ammonia limit

A

Physical activity

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66
Q

Pancreas 101

A

behind stomach
exocrine and endocrine function

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67
Q

Exocrine function of pancrease

A

Enzymes for digesting
fat protein and carbs

most abundant enzyme trypsin

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68
Q

Trypsin

A

helps in breaking down protein

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69
Q

Endocrine pancrease function

A

Islets of Langerhans secrete

Beta (insulin)
Alpha (glucagon)
Delta (somatostatin)

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70
Q

Risk factors for pancreatitis

A

Trauma
Obstruction
Familial probs
Alcohol/drugs
Ulcers

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71
Q

Acute pancreatitis

A

Auto-digestion of the gland
Trypsin cant get out so it starts to digest the pancreas

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72
Q

Phospholipase A and pancreatitis

A

Activated by trypsin
results in fat necrosis in pancreas

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73
Q

Alcohol and pancreatitis

A

increases inflammation of pancreas
creating stenosis of ducts

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74
Q

Causes of pancreatitis
BAD HITS

A

BIlliary
Alcohol
Drugs

Hypertriglyceridemia/hypercalcemia
Idiopathic
Trauma
Scorpion sting

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75
Q

Meds that can cause pancreatitis

A

Steroids
NSAIDs
Thiazieds

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76
Q

Acute pancreatitis manifestations

A

Jaundice
Abdominal tenderness/rigidity
Guarding
Pancreatic ascites

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77
Q

Cullens sign
Turners sign

A

red/purple around umbilics

Gray on side of belly

78
Q

Pancreatitis complications

A

Hypovolemia
Hemorrhage
Acute kidney failure
Paralytic ileus

Hypovolemic/septic shock

79
Q

Lungs and pancreatitis

A

Pleural effusion
Resp distress syndrome
Penumonia

80
Q

Life threatening pancreatitis complications

A

MODs
DIC

81
Q

Nursing assessments for Pancreatitis

A

Hx
Diet
Abdominal (look listen feel)
farts are good
Pain
Weight loss

82
Q

What to monitor the most with pancreatitis

A

Respiratory
Vital signs

83
Q

Position for pancreatitis pain management

A

Fetal

84
Q

Pancreatitis pain management other interventions

A

Morphine
IV fluids
NG tube
Rest gut
Antibiotics

85
Q

Early nutrition for pancreatitis

A

NPO 2-5 days

86
Q

Diet for pancreatitis when permitted

A

High carb
moderate protein
moderate fat

87
Q

Severe pancreatitis diet

A

Jejunal feeding
Low fat formula
or standard formula

88
Q

If pt can not tolerate feedings with pancreatitis

A

TPN

89
Q

Central TPN
Peripheral TPN

how long to use

A

Max 7 days
Max 10 days

90
Q

How often to feed with pancreatitis

A

small frequent meals

91
Q

When to start diet

A

pain is subsided
lipase and amylase have decreased in concentration

92
Q

Fat consumption for pancreatitis less than

A

50g a day

93
Q

Cooking oils or pancreatitis

A

Coconut
Palm kernel
MCT

94
Q

Protein amount for pancreatitis

A

1.5 g at least

95
Q

Nursing management of diet with pancreatitis

A

no stimulant foods

give antiemetics for N/V
zofran, phenergan

96
Q

patient outcomes for pancreatitis

A

good
elimination, nutrition, perfusion

no abdominal pain

97
Q

Chronic pancreatitis 101

A

Progressive destructive disease of the pancreas
Remissions and exacerbations

98
Q

Chronic pancreatitis complications

A

Hemorrhage
Infection
Bowel obstruction
Abscess
Fistulas

99
Q

Pancreatitis manifestations

A

Left upper abdominal pain
radiating to back

Intense continued gnawing burning pain

100
Q

S/S of chronic pancreatitis same as acute +

A

steatorrhea

101
Q

Bowel rest and enteral nutrition results

A

Fewer infection sand decreased hospital stays
ON TEST

102
Q

Nursing management for Chronic Pancreatitis

A

Same as acute

103
Q

When to give Pancreatic enzymes

A

With EVERY MEAL
DO NOT crush or chew

104
Q

Calcium in pancreatitis
K+ in pacreatitis

A

WILL DECREASE

WILL INCREASE

105
Q

Labs with pancreatitis

A

Lipase
Trypsin
WBC
Glucose
Bilirubin

elevated

106
Q

Imaging for Pancreatitis

A

ABD ultrasounds
CT Scan w/contrast
ERCP
Biopsy

107
Q

Surgical measurements for pancreatitis
care

A

NG tube insertion preop

Post op monitor
drainage
skin integrity

108
Q

Primary prevention of pancreatitis
fat limits

A

20g fat daily max
no meal should be over 10g of fat

109
Q

Primary prevention of pancreatitis other

A

No alcohol
No spicy food
Healthy weight

110
Q

Cholelithiasis or biliary obstruction should be treated

A

IMMEDIATELY
prevents panreatitis

111
Q

Secondary prevention of pancreatitis

A

Total body system assessment

VS and Labs - CBC, BMP, Lytes

Assess for causative illnesses

112
Q

Causative illnesses for Pancreatitis

A

Peptic ulcers
Renal failure
Vascular disorders
Hyperparathyroidism
Hyperlipidemia

113
Q

Caloric requirement for Pancreatitis patients

A

4000-6000
Food will not absorb

hence the enzyme replacements with every meal

114
Q

Home and after care for pancreatitis

A

home health

monitoring -
diet
meds
skin
follow up appts
Labs

115
Q

Where are pancreatic enzymes supposed to activate?

A

Small intestine ONLY

116
Q

Biggest goals of pancreatitis

A

SEVERE pain management

Keep stomach EMPTY and DRY

117
Q

Why infections with pancreatitis

A

Autodigestion = release of toxic enzyme byproducts

118
Q

Pancreatitis bed rest position

A

Keep pt UP

119
Q

When you GI suction Pancreatitis pt A/B

A

Alkalosis

120
Q

Pancreatitis abdomen

Abdomen ridged and board like =

A

Bleeding

121
Q

Cullen and Turner signs are related to

A

Pancreatitis GI Bleeding

122
Q

Pancreatitis lab value INDICATOR

A

AMYLASE
Lipase

123
Q

Serum bilirubin is relate to

A

Liver

124
Q

What form of fentanyl do we treat pancreatic pain with

A

Patch

125
Q

What meds dry people up

given for

A

Anticholinergics

Pancreatitis

126
Q

If pt is on TPN should they be loosing weight

A

NO

127
Q

Treatment SPECIFIC to chronic pancreatitis

A

Digestive enzymes

128
Q

FTC and pacemakers

A

pacemaker will have a line going down on EKG
if there is no PQRS after that is

Failure to capture

129
Q

MOST IMPORTANT LIVER FUNCTIONS

A

Detoxify body
Detoxify drugs
Blood coagulation
Synthesizes albumin (metabolism)

130
Q

What to do with med doses when liver is shot

A

Half them
Liver cant metabolize drugs

131
Q

Give patients with Tylenol OD

A

Acetylcysteine
Mucomyst (carbonated drink)

132
Q

When blood backs up due to liver scaring this is called hepatic hypertension. This blood backs in to

A

Esophageal varices (Bleeding)

133
Q

BEST vasodilator for portal hypertension

A

Octreotide, ON TEST

134
Q

With balloon tamponade, pt tries to pull out device, resulting in airway obstruction. what to do

A

Deflate balloon
if not
Cut it

135
Q

With new tech, varices can now be

A

Cut or burned

136
Q

Due to all the issues with Liver and blood not being cleaned, what another complicationscould happen

A

Splenomegaly
(spleen cleans)
if liver cant, then spleen works double time

137
Q

Ammonia acts like a

A

SEDATIVE
on test

sleepiness

138
Q

Treat ammonia with

A

LACTULOSE
converts ammonia to urea in gut

139
Q

Asterixes
ON TEST

A

Liver related extremity flapping

Patient shaking due to high Ammonia

140
Q

Ascites happens due to low

A

Albumin

Protein that holds liquid in vascular space

141
Q

Prep pt for parasentisis

A

Void
High fowler

142
Q

Parasentisis can result in

A

Hypovolemic shock
removing volume that is already third spaced from body

143
Q

Ultimate diagnosis of liver cirrhosis

A

Biopsy

144
Q

Liver biopsy procedure

A

pt lay flat
raise right hand
take deep breath
hold

then we puncture

145
Q

After liver biopsy

A

lay on right side for pressure

146
Q

Why does IG blood aggrivate ammonia?

A

Blood is a form of protein
will further INCREASE ammonia

147
Q

TIPS shunts prevent parasentisis but this results in

A

More circulating ammonia

148
Q

Fetor smell

in Cirrhosis pt rooms

A

Ammonia escaping the body

Fresh cut grass/nail polish remover

149
Q

With pacemaker surgery, to prevent pt from moving affected side arm put arm in

A

SLING

150
Q

Demand pacemaker

A

Only turns on when pace drops bellow a certain rate

151
Q

Keep pacemakers away from

A

MAGNETS

152
Q

Cushings and addisons are problems related to the

A

Adrenal cortex

153
Q

Addsions disease 101

A

Not enough steroids

154
Q

S/S of addisons

A

Fatigue
N/V/D

Weight loss
Anorexia
Confusion
Shock

155
Q

Lytes with addisons

A

Hyperkalemia
Hypoglycemia
Hyponatremia

156
Q

With addisons add

A

Steroids

157
Q

Hyper or hypo tension with addisons

A

HYPOtension
Loss of sodium, loss of water

158
Q

Addisons skin

A

White hyperpigmentation (vitiligo)

159
Q

Focused treatment for addisons is based on

A

SHOCK (hypovolemia)

160
Q

When you lose sodium and water what hormone do you think of

A

Not enough ALDOSTERONE

161
Q

Should we increase Sodium and addisons

A

Increase

162
Q

Task to delegate to AP with addisons

A

Daily I&O
Daily weight
Daily BP

163
Q

Addisons clients will be in a fluid volume _

A

Deficit

164
Q

ADDisons treatment

A

Glucocorticoids (prednisone, hydrocortisone)
Mineralocorticoids (aldosterone aka fludrocortisone)

165
Q

Steroids for addisons are given in what dosage

A

2 half dose increments
1 morning, 1 evening

166
Q

For addisons do med doses stay the same

A

NO, depends on pt

167
Q

Can you stop steroids abruptly

A

NO, need to be tapered

168
Q

1 problem with addisons disease

A

Addisonian crisis - FATAL shock

169
Q

Addisonian crisis is what kind of shock

A

Hypovolemia

170
Q

Addisons low corticosteroids will lead to hypoglycemia, S/S of hypoglycemia

A

Emotional lability!
Hangry
Shaking
Sweating

171
Q

If addisons patient feels like they are going into a crisis they carry a injection pen of what?

A

Cortisol

172
Q

Cushings 101
too much

A

steroids

173
Q

Cushings appearance

A

Boonfaced
Buffalo hump
Skinny arms and legs

174
Q

Cushings S/S

A

Weight gain
Fluid volume overload
Hypertension
Hyperglycemia
Hypernatremia

175
Q

Cushings aldosterone is _
And serum potassium will be _

A

HIGH
LOW

176
Q

Urinalysis with Cushings will have

A

High level of cortisol

177
Q

Treatment of Cushings

A

Adrenalectomy (removal surgery)

178
Q

Adrenalectomy is done unilaterally or bilaterally. If bilaterally, what will happen

A

Addisons = lifelong replacement

179
Q

With too many steroids will person be calm?, need…

A

NO
Calm environment

180
Q

Diet pretreatment for Cushings

A

Sodium decrease
Glucose decrease
Calcium INCREASE
Protein INCREASE

181
Q

Why increase calcium and protein with cushings

A

High metabolism and breakdown or protein and bone

182
Q

Steroids and calcium, like prednisone, increase or decrease

A

Decrease in calcium

183
Q

Steroid 3 side effects

A

Osteoporosis
Hyperglycemia
Bad immune system

184
Q

What values may appear in urine with long term steroid use

A

Glucose
Ketones (fat byproduct)

185
Q

What is used to diagnose Cushings

A

Urinalysis

186
Q

Drug to give for afib

A

Cardizem drip

187
Q

Prolonged use of steroids can shift patient into

A

Cushings syndrome

188
Q

Due to fluid volume overload, cushings patients are put on

A

Diuretics, Fluid restriction

189
Q

What to give for high ammonia

A

Lactulose ON TEST

190
Q

Too much lactulose would be indicated by

A

Diarrhea
Hypokalemia
Dehydration

191
Q

How do you know lactulose is working

A

2-3 soft stools per day ***

192
Q

Test for cushings

A

Dexamethasone suppression test
given at night
pee cortisone in morning

S4 2539 (11 decks)

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