N200 Chapter 44 Nutrition Flashcards
all household members have access to sufficient, safe, and nutritious food to maintain a healthy lifestyle; sufficient food is available on a consistent basis; and the household has resources to obtain appropriate food for a nutritious diet.
Food security
simplest form of a protein. Required from diet.
Amino acid
the energy needed to maintain life-sustaining activities (breathing, circulation, heart rate, and temperature) for a specific period of time at rest.
Basal metabolic rate (BMR)
What factors affect BMR?
age, body mass, gender, fever, starvation, menstruation, illness, injury, infection, activity level, or thyroid function affect energy requirements
serves as the main source of fuel (glucose) for the brain, skeletal muscles during exercise, erythrocyte and leukocyte production, and cell function of the renal medulla
Carbohydrates
inorganic elements essential to the body as catalysts in biochemical reactions.
Minerals
required for growth, normal pregnancy, maintenance of lean muscle mass and vital organs, and wound healing.
Positive nitrogen balance
the elements necessary for the normal function of numerous body processes.
Nutrients
resting metabolic rate, is the amount of energy that an individual needs to consume over a 24-hour period for the body to maintain all of its internal working activities while at rest.
Resting energy expenditure (REE)
Factors that affect _____ include illness, pregnancy, lactation, and activity level
metabolism
essential to normal metabolism. They are chemicals that act as catalysts in biochemical reactions.
Vitamins
the proportion of essential nutrients to the number of kilocalories
Nutrient Density
What is the function of the stomach in digestion?
- Stores and churns food
- HCl activates enzymes, breaks up food,
- kills germs.
- Mucus protects stomach wall
- limited absorption
Criteria for an acceptable range of amounts of vitamins and nutrients for each gender and age group
Dietary Reference Intakes (DRI)
What are the 4 components of DRI?
- Estimated Average Requirement (EAR)
- Recommended Dietary Requirement (RDA)
- Adequate Intake (AI)
- Upper Intake Level (UL)
Dietary Guidelines to provide ____ daily consumption guidelines of the five food groups.
These guidelines are set for person’s over __ years of age.
The _________ was developed to replace the food pyramid.
__ is missing from the myplate image!! since we already get it in our diet.
average
2
Choose My Plate
Fat
Factors influencing _____:
- Environmental
- Developmental Needs
- Gender
- Ethnicity and culture
- Beliefs about food
- Personal preferences
- Religious practices
- Lifestyle
- Economics
- Medications and therapies
- Health
- Alcohol
- Advertising
- Psychological factors
nutrition
What conditions may interfere with nutrition?
- Anything affecting the ability to absorb, ingest or digest
- Revisions to the GI tract (ex. lap band)
- Chronic illness
- Changes in metabolic requirements
What factors cause changes in metabolic requirements?
- Pregnancy & Lactation: pregnant women need more calories for baby growth and milk production
- Growth: infant up to last growth spurt.
- AGE
proteinlike substances that act as catalysts to speed up chemical reactions. They are an essential part of the chemistry of digestion
enzymes
- Most enzymes have __specific function.
- Each enzyme works best at a specific __. 3. ___ in the saliva breaks down starches into sugars. The secretions of the GI tract have very different pH levels:
- saliva is relatively ,
- gastric juice is highly ___,
- secretions of the small intestine are ___
- one
- pH
- amylase
- neutral
- acidic
- alkaline.
Nerve stimulation from the _____ (e.g., the ___ nerve) increases GI tract action.
parasympathetic nervous system
vagus
food mixes with saliva, which contains ___ (salivary amylase), an enzyme that acts on cooked starch to begin its conversion to ___ .
ptyalin
maltose
The chief cells in the stomach secrete ____; and the pyloric glands secrete __, a hormone that triggers parietal cells to secrete ______. The parietal cells also secrete HCl and ____, which is necessary for absorption of vitamin B12 in the ileum. HCl turns pepsinogen into pepsin, a protein-splitting enzyme. The body produces gastric lipase and amylase to begin _______ digestion, respectively.
pepsinogen gastrin hydrochloric acid (HCl) intrinsic factor (IF) fat and starch
Food leaves the antrum, or distal stomach, through the pyloric sphincter and enters the ____. Food is now an acidic, liquefied mass called ____.
duodenum
chyme
The small intestine is the primary ____ site for nutrients
absorption
The body absorbs nutrients by means of ____ diffusion, osmosis, active transport, and _____
passive
pinocytosis
____ refers to all of the biochemical reactions within the cells of the body. ____ is the building of more complex biochemical substances by synthesis of nutrients and occurs when an individual adds lean muscle through diet and exercise. ____ is the breakdown of biochemical substances into simpler substances and occurs during physiological states of ____ nitrogen balance.
metabolism
Anabolism
Catabolism
negative
Nutrient metabolism consists of three main processes:
- Catabolism of glycogen into glucose, carbon dioxide, and water _____
- Anabolism of glucose into glycogen for storage ____
- Catabolism of amino acids and glycerol into glucose for energy ____
glycogenolysis
glycogenesis
gluconeogenesis
present evidence-based criteria for an acceptable range of amounts of vitamins and nutrients for each gender and age-group
Dietary Reference Intakes
What are the 4 components of DRIs?
- EAR: estimated average requirement
- RDA: recommended dietary allowance
- AI: Adequate intake
- UL: upper intake level
the recommended amount of a nutrient that appears sufficient to maintain a specific body function for 50% of the population based on age and gender.
estimated average requirement
the average needs of 98% of the population, not the exact needs of the individual.
recommended dietary allowance (RDA)
the suggested intake for individuals based on observed or experimentally determined estimates of nutrient intakes and is used when there is not enough evidence to set the RDA.
adequate intake (AI)
the highest level that likely poses no risk of adverse health events. not a recommended level of intake
tolerable upper intake level (UL)
______ program includes guidelines for balancing calories; decreasing portion size; increasing healthy foods; increasing water consumption; and decreasing fats, sodium, and sugars
The ChooseMyPlate
The FDA first established two sets of reference values. The ___ are protein, vitamins, and minerals based on the RDA. The daily reference values (DRVs) make up the second set and consist of nutrients such as total fat, saturated fat, cholesterol, carbohydrates, fiber, sodium, and potassium. Daily values did not replace ___ but provided a separate, more understandable format for the public.
RDIs
RDAs
The likelihood of healthy eating and participation in exercise or other activities of healthy living is limited by________.
environmental factors
What are environmental factors that contribute to obesity?
- Lack of access to grocery stores,
- high cost of healthy food,
- widespread availability of less healthy foods in fast-food restaurants,
- widespread advertising of less healthy food
- lack of access to safe places to play and exercise
An infant usually ____ birth weight at 4 to 5 months and ____ it at 1 year.
doubles
triples
What are benefits of breastfeeding?
- fewer food allergies and intolerances;
- fewer infant infections;
- easier digestion; convenience, availability, and freshness;
- temperature always correct;
- economical (less expensive than formula);
- increased time for mother and infant interaction.
______ intake is particularly important for deoxyribonucleic acid (DNA) synthesis and the growth of red blood cells. Inadequate intake can lead to fetal neural tube defects, anencephaly, or maternal megaloblastic anemia
Folic acid
As the nurse you are in an excellent position to recognize signs of poor nutrition and take steps to initiate change. Close contact with patients and their families enables you to make observations about _____. Always ask patients about their food ____, their ____ regarding nutrition, and what they____ from nutritional therapy. In attempting to affect eating patterns, you need to understand patient’s ______ about food.
physical status, food intake, food preferences, weight changes, and response to therapy. preferences values expect values, beliefs, and attitudes
_____ a patient is a quick method of identifying malnutrition or risk of malnutrition using sample tools. Nutrition screening tools need to gather data on the current ____, ____ of the condition, assessment of whether it will worsen, and if the disease process ___.
Screening
condition
stability
accelerates
Identification of risk factors such as unintentional weight loss, presence of a modified diet, or the presence of altered nutritional symptoms (i.e., nausea, vomiting, diarrhea, and constipation) requires ______.
nutritional consultation
The Mini Nutritional Assessment (MNA) was developed to use for screening older adults in ____. The tool has 18 items that are divided into screening and ____. If a patient scores 11 or less on the screening portion, the health care provider completes the assessment portion. A total score of less than __ indicates protein-energy ____.
home care programs, nursing homes, and hospitals
assessment
17
malnutrition
Assess for nutrition risks for what 5 groups?
- Congenital anomalies
- surgical revisions of the GI tract interfere with normal function.
- Patients fed only by IV infusion of 5% or 10% dextrose.
- Chronic diseases
- increased metabolic requirements
Who is at greatest risk for nutritional deficiency?
Infants and older adults
a measurement system of the size and makeup of the body. Nurses obtain height and weight for each patient on hospital admission or entry into any health care setting
Anthropometry
Rapid weight gain or loss is important to note because it usually reflects ____. For a patient with renal failure, a weight increase of 2 lbs (0.90 kg) in 24 hours is significant because it usually indicates that the patient has retained _____. Changes in values for an individual over time are of ___ significance than isolated measurements
fluid shifts
a liter (1000 mL) of fluid
greater
A patient is ____ if his or her BMI is 25 to 30. A BMI of greater than 30 is defined as ___ and places a patient at higher medical risk of coronary heart disease, some cancers, DM, and _____.
overweight
obesity
hypertension
Common laboratory tests used to study nutritional status include measures of ____ proteins such as ____, transferrin, prealbumin, retinol binding protein, total iron-binding capacity, and ____.
plasma
albumin
hemoglobin
Factors that affect _____ levels include:
- hydration and hemorrhage
- renal or hepatic disease
- large amounts of drainage from wounds, drains, burns, or the GI tract
- steroid administration
- exogenous albumin infusions
- age
- trauma, burns, stress, or surgery.
serum albumin
Albumin level is a better indicator for___ illnesses, whereas ______ level is preferred for acute conditions
chronic
prealbumin
Nitrogen balance is important to determining _____ status
serum protein
nursing assessment of nutrition includes? (11)
- health status
- age
- cultural background
- religious food patterns
- socioeconomic status
- personal food preferences
- psychological factors
- use of alcohol or illegal drugs
- use of vitamin, mineral, or herbal supplements
- prescription or over-the-counter (OTC) drugs
- the patient’s general nutrition knowledge
What are 4 categories for causes of dysphagia?
- Myogenic
- Neurogenic
- Obstructive
- Other
What type of dysphagia (cause)? Myasthenia gravis Aging Muscular dystrophy Polymyositis
Myogenic
What type of dysphagia (cause)? - Stroke • Cerebral palsy • Guillain-Barré syndrome • Multiple sclerosis • Amyotrophic lateral sclerosis (Lou Gehrig disease) • Diabetic neuropathy • Parkinson's disease
Neurogenic
what type of dysphagia (cause)? -Benign peptic stricture • Lower esophageal ring • Candidiasis • Head and neck cancer • Inflammatory masses • Trauma/surgical resection • Anterior mediastinal masses • Cervical spondylosis
Obstructive
Name cause for dysphagia (other than myogenic, neurogenic or obstructive)
-Gastrointestinal or esophageal resection
• Rheumatological disorders
• Connective tissue disorders
• Vagotomy
Complications of _____ include aspiration pneumonia, dehydration, decreased nutritional status, and weight loss
dysphagia
Describe warning signs of dysphagia.
- cough during eating
- change in voice tone or quality after swallowing
- abnormal movements of the mouth, tongue, or lips
- slow, weak, imprecise, or uncoordinated speech.
- Abnormal gag
- delayed swallowing
- incomplete oral clearance or pocketing
- regurgitation
- pharyngeal pooling
- delayed or absent trigger of swallow
- inability to speak consistently
Early and ongoing assessment of patient with swallowing difficulties and use of a valid dysphagia screening tool increase quality of care and decrease incidence of ____
aspiration pneumonia
Nursing diagnoses for decreased nutrition are related to either the ____ (e.g., inadequate intake) or _____ for nutritional deficiencies such as oral trauma, severe burns, or infections.
actual nutrition problems
problems that place the patient at risk
Name nursing diagnoses for nutrition.
-Risk for aspiration
•Diarrhea
•Deficient knowledge
•Imbalanced nutrition: less than body requirements
•Imbalanced nutrition: more than body requirements
•Risk for imbalanced nutrition: more than body requirements
•Readiness for enhanced nutrition
•Feeding self-care deficit
•Impaired swallowing
Patients who cannot tolerate nutrition through the GI tract receive _____ nutrition, a solution consisting of glucose, amino acids, lipids, minerals, electrolytes, trace elements, and vitamins, through an indwelling peripheral or central venous catheter (CVC)
parenteral
____ tube feedings are often administered into the stomach or intestines via a tube inserted through the nose or a percutaneous access . These feedings ____a patient’s oral nutritional intake in the home, acute care, extended care, or rehabilitation setting when they cannot meet their nutritional needs by ___.
Enteral
supplement
mouth
Describe Diet Progression and Therapeutic Diets.
- Clear Liquid Clear: fat-free broth, clear fruit juices, popsicles
- Full Liquid: clear plus smooth-textured dairy products refined cooked cereals, vegetable juice
- Pureed: Same as above plus scrambled eggs; pureed meats, vegetables, and fruits; mashed potatoes
- Mechanical Soft: all cream soups, ground/ diced meats, potatoes, pancakes, light breads, cooked or canned fruits, bananas, soups, peanut butter, eggs (not fried)
- Soft/Low Residue: Addition of low-fiber, pastas, casseroles, moist tender meats, and canned cooked fruits and vegetables; desserts, cakes, and cookies without nuts or coconut
- High Fiber: plus fresh uncooked fruits, steamed vegetables, bran, oatmeal, and dried fruits
- Low Sodium: vary from no added salt to severe sodium restriction (500-mg sodium diet), which requires selective food purchases
- Low Cholesterol: 300 mg/day
- Diabetic: focus on total energy, nutrient and food distribution; balanced intake of carbs, fats, and proteins; varied caloric recommendations to accommodate patient’s metabolic demands
_____ provides nutrients into the GI tract.
- preferred method of meeting nutritional needs if a patient is unable to swallow or take in nutrients orally yet has a functioning GI tract
- provides physiological, safe, and economical nutritional support.
Enteral nutrition (EN)
Patients with a low risk of ____receive gastric feedings. if there is a risk of gastric reflux, which leads to aspiration, ____ feeding is preferred
gastric reflux
jejunal
What are the four types of enteral formula?
- Polymetric: GI tract must be able to absorb whole nutrients
- Modular: Single macronutrient. Not nutritionally complete
- Elemental: Predigested nutrients
- Specialty: Specific to nutritional needs (liver failure, pulmonary failure). formulated (lytes and minerals)
Feeding by the enteral route ___ sepsis, minimizes the hypermetabolic response to ___, ____hospital mortality, and maintains intestinal structure and ____.
reduces
trauma
decreases
function
A serious complication associated with enteral feedings is ____ of formula into the tracheobronchial tree. Aspiration of enteral formula into the lungs irritates the bronchial mucosa, resulting in decreased ____ to affected pulmonary tissue. This leads to necrotizing infection, ____, and potential abscess formation.
aspiration
blood supply
pneumonia
Some of the common conditions that increase the risk of aspiration include? (6)
- coughing,
- gastroesophageal reflux disease (GERD),
- nasotracheal suctioning,
- an artificial airway,
- decreased level of consciousness, and
- lying flat.
Gastric ileus prevents ______feedings from being given. Nasointestinal or ___ tubes allow successful postpyloric feeding because formula is placed directly into the small intestine or jejunum or beyond the ____ of the stomach
nasogastric
jejunal
pyloric sphincter
Delayed _____ is a concern if 250 mL or more remains in a patient’s stomach on two consecutive assessments (1 hour apart) or if a single GRV measurement exceeds 500 mL
gastric emptying
The North American Summit on Aspiration in the Critically Ill Patient recommends:
(1) stop feedings immediately if ____ occurs; (2) ______ and reassess patient tolerance to feedings if GRV is over 500 mL;
(3) routinely evaluate the patient for aspiration; and
(4) use nursing measures to reduce the risk of aspiration if GRV is between 250 and 500 mL
aspiration
withhold feedings
What are 6 indications for Enteral Nutrition?
- Cancer (Head and neck and Upper GI: esophageal cancer)
- Critical illness or trauma
- Neuro/muscular disorders (Brain neoplasm, CVA, Dementia, Myopathy, Parkinson’s)
- Gastrointestinal disorders
- Respiratory failure with prolonged intubation
- Inadequate oral intake
What are 3 indications for Parenteral Nutrition?
- Nonfunctional GI tract
- Extended Bowel rest
- Preoperative total Parenteral nutrition
Should enteral formulas be diluted with water?
NO, increases the risk of bacterial contamination
When patients are unable to ingest food but are still able to ______ nutrients, enteral tube feeding is indicated.
digest and absorb
Feeding tubes are inserted through the nose (____ or _____), surgically (____ or _____), or endoscopically (____ or _____).
- nasogastric or nasointestinal
- gastrostomy or jejunostomy
- percutaneous endoscopic gastrostomy or jejunostomy [PEG or PEJ]
If EN therapy is for less than 4 weeks, total,___ or ____ feeding tubes may be used. Surgical or _____ placed tubes are preferred for long-term feeding (more than 4 weeks) to reduce the discomfort of a nasal tube and provide a more secure, reliable access
nasogastric, or nasojejunal
endoscopically
When testing the pH of a patient receiving EN therapy:
- Gastric fluid from patient who has fasted for at least 4 hours usually has pH range of?
- Fluid from nasointestinal tube of fasting patient usually has pH?
- Patient with continuous tube feeding often has pH?
- pH of pleural fluid from tracheobronchial tree is generally greater than?
- 1 to 4.
- > or = 6
- > or = 5
- 6
The most reliable method for verification of placement of small-bore feeding tubes is ____ examination
x ray film
Two of the most frequent complications associated with tube feedings are?
- pulmonary aspiration, potentially leading to pneumonia, and
- accidental placement of a nasoenteric feeding tube into the lung.
True or False:
Gastric residual volume has not been found to be consistently related to aspiration
True
True or False:
The most effective nonradiological methods of verifying feeding tube placement include aspirating fluid from the feeding tube, measuring its pH, and describing its appearance
True
A pH of 0 to 4.0 is a good indication of gastric placement.
A pH of 6.0 or higher likely indicates placement in the __, intestine, or even the stomach when gastric pH is unusually high.
lung
Intestinal fluid is usually bile stained _____. Gastric fluid is usually ____, off-white to tan, or clear and colorless
(dark golden yellow)
grassy green
is a form of specialized nutrition support in which nutrients are provided intravenously.
Parenteral nutrition (PN)
____ solutions are not as calorically dense as TPN solutions and therefore are usually temporary.
Peripheral
To prevent infection, change the TPN infusion tubing every ___. Do not hang a single container of PN for more than ___ or lipids more than ____.
24 hours
24 hours
12 hours
Vitamin K is synthesized by microflora found in the ______ with normal use of the GI tract; however, because PN circumvents GI use, patients need to receive ____ vitamin K.
jejunum and ileum
exogenous
In patients with ______ Discourage:
smoking, alcohol, aspirin, and nonsteroidal antiinflammatory drugs (NSAIDs)
peptic ulcers
Inflammatory bowel disease includes Crohn’s disease and______
idiopathic ulcerative colitis
Patients manage______ by increasing fiber, reducing fat, avoiding large meals, and avoiding lactose or sorbitol-containing foods for susceptible individuals.
irritable bowel syndrome
The treatment of ____ syndromes such as celiac disease includes a gluten-free diet.
malabsorption
True or False:
The skill of assessing a patient’s risk for aspiration can be delegated to nursing assistive personnel (NAP). NAP may feed patients after receiving instructions in aspiration precautions.
False: cannot be delegated.
The nurse suspects that the patient receiving parenteral nutrition (PN) through a central venous catheter (CVC) has an air embolus. What action does the nurse need to take first?
A.Raise head of bed to 90 degrees
B.Turn patient to left lateral decubitus position
C.Notify health care provider immediately
D.Have patient perform the Valsalva maneuver
Rationale
B.Turn patient to left lateral decubitus position
An air embolus possibly occurs during insertion of the catheter or when changing the tubing or cap. Have the patient assume a left lateral decubitus position first. Then have the patient perform a Valsalva maneuver (holding the breath and “bearing down”). The increased venous pressure created by the maneuver prevents air from entering the bloodstream during catheter insertion. Maintaining integrity of the closed intravenous system also helps prevent air embolus.
