nrsg 126 midterm 2 Flashcards
basal metabolic rate
the rate at which the body uses energy while at rest to keep vital functions going, such as breathing and keeping warm.
functional food
have biologically active ingredients added that have demonstrated health benefits (e.g., probiotic yogourt, or pea fibre-fortified breads and pasta).
fortified food
have additional vitamins, minerals, or both to provide added health benefits (e.g., fortified soy beverages and fruit juice with calcium
organic food
vegetables, fruit, eggs, milk, and meat produced without synthetic (human-made) pesticides, herbicides, and fertilizers; genetically modified organisms (GMOs); antibiotics or growth hormones; or irradiation or ionizing radiation (a way to preserve food with radiation energy). Organic farmers may use natural pesticides approved for organic food production
GMO
Contains the insertion of the genes of one organism into another organism, often to resist disease and develop desired characteristics, such as a hardier texture, higher nutritional value, or faster growth
carbohydrates
main source of energy. controls blood glucose and insulin metabolism. includes: sugar, starch, and fiber. can be soluble or insoluble
insoluble carbs
Don’t dissolve in water. Adds bulk to stool, good for helping with constipation, but too much can cause constipation. Ex: Whole grains, vegetables, wheat bran.
soluble carbs
Absorbs water and turns into a gel, helps with blood sugars and cholesterol. Ex: Bran, barley, nuts, seeds, beans, lentils, peas and some fruits and veggies.
what are proteins
Molecules needed for tissue growth, maintenance, and repair. Assist with BP, healing, development.
Nitrogen balance
nitrogen intake = nitrogen losses.
Negative nitrogen balance occurs from lack of protein (< intake, injury, fever, starvation)
Positive nitrogen balance increases tissue growth and repair, healing, etc.
lack of protein in the body due to decreased intake, injury, fever, starvation, infection.
negative protein balance
proteins that can not be produced in the body. There are 9 of them
essential amino acids
proteins that can be synthesized in our body.
non-essential
a protein that has all 9 amino acids. usually from animals
complete protein
what is an incomplete protein?
a protein that lacks one or more of the amino acids needed to build cells. usually from plants. can be mixed together to make a complete protein.
What makes energy, cushions organs, lubricates body tissues, and insulates/protects cell membranes.
Fat/lipids
monosaturated fats (need to redo)
Fat/lipids
polyunsaturated fats (need to redo)
good fats. need to be eaten for heart health, muscle movement, blood clotting. (omega 3, tuna, flaxseed)
saturated vs unsaturated
Saturated: usually from animals, solid, lack double bonds, less healthy.
unsaturated: usually from plants, liquid, at least one double bond, healthier
A waxy substance the body needs to build cells and make vitamins and other hormones. Too much is a problem
Cholesterol
Trans Fats
Either naturally occurring or artificial. Artificial is a process where hydrogen is added to liquid vegetable oils to make them more solid. They lower HDL and increase LDL
two sources of cholesterol
liver - regulates and produces
food - animal products
what can be a side effect from taking these meds?
Diuretics
Estrogen and progestin
Retinoids
Steroids
Beta blockers
Some immunosuppressants
Some HIV medications
High triglycerides
What are the effects of COPD exacerbation on nutrition (Metabolism, N balance, etc)
Exacerbation increased energy usage = body breaks down proteins and muscle tissue
Respiratory distress decreases appetite = limiting physical activity = decreasing nitrogen balance
A compromised respiratory system decreases fxn of absorption nutrients = contributing to malnutrition
In COPD, Cytokines are released because of chronic __________. This increases the body’s nitrogen loss as it accelerates protein breakdown.
Inflammation
What micronutrient is essential in epithelialization?
Zinc
Proteins are used in?
Tissue growth, maintenance, repair
DNA and RNA synthesis
Blood clotting, acid-base balance
Hormones
Albumin, insulin, and immunoglobulins are depleted by diseases, disorders, and ____________.
Malnutrition
Why is it important to maintain a balance between energy intake and expenditure?
To prevent malnutrition, maintain healthy body weight, and ensure proper metabolic function.
Identify factors that influence nutrition.
- Age * Socioeconomic status * Culture * Health status * Accessibility to food and genetics
What are common challenges related to nutrition in the older adult population?
- Malnutrition * Changes in appetite * Difficulty chewing or swallowing * Social isolation * Co-morbidities *
What are the components of nutritional assessment?
- Dietary history * Physical examination * Laboratory tests * Anthropometric measurements
What is the pathophysiology related to tissue integrity in older adult clients?
(Pathophysiology = ∆in body processes bc of disease/injury)
Diminished skin elasticity, reduced vascular supply, and impaired wound healing processes.
Identify assessment data pertinent to integument.
- Skin turgor * Color changes * Lesions * Integrity of skin
Discuss factors affecting skin integrity.
- Nutrition * Hydration * Age * Mobility * Chronic conditions
Describe the process of wound healing. Modify later
- Hemostasis * Inflammation * Proliferation * Remodeling
What are the risk factors that contribute to pressure injury formation?
- Immobility * Moisture * Poor nutrition * Friction and shear
What are the differences between wounds that heal by primary, secondary, and tertiary intention?
- Primary: edges are brought together * Secondary: wound heals from inside out * Tertiary: delayed closure due to infection
What does NPO stand for?
Nothing per os (nothing by mouth)
How do these macro minerals affect the body processes: Ca++, PTH (parathyroid hormone), ETOH (not sure)
Ca = muscle contractions, blood clotting, hormones
PTH = influences calcitonin (lowers Ca) and calcitriol (increases Ca), needs vitamin D to promote reabsorption
ETOH = associated with poor nutrition, decreased Ca, absorption, low Mg
Acute vs Chronic wounds
Acute = heal rapidly as long as the cause is removed, sudden onset (surgery wound, skin tears)
Chronic = plan is most oftenly to prevent wound progression, manage pain (PI, diabetic ulcers)
Aging effects on the skin.
Epidermis thinning = > risk of tears
Dehydration and poor nutrition = healing processes and overall integrity
Tape is a big risk!!!!
What is nitrogen balance?
The difference between nitrogen intake and nitrogen excretion.
The wound healing processes for secondary intention is different from primary intention by?
Repair times are longer
Greater chances of scarring
> chance of infection
If healing is further delayed, it becomes a tertiary wound (delayed primary closure)
Greater loss of tissue
What is the recommended daily water intake for adults?
Approximately 3 liters per day.
What are the two categories of vitamins?
- Fat-soluble (A, D, E, K) * Water-soluble (B & C)
What are the electrolytes the body uses?
- Calcium * Sodium * Potassium
What is the care and risks associated with Tertiary wounds?
Needs to be open
Greater risk of infection
Can require surgery to close
e.g. pressure wound with an infection needs to be kept open to drain
List some changes that occur to the body that impact eating in older adults.
- Changes in taste and smell * Decreased appetite * Difficulty chewing
What is the impact of nutrition on wound healing?
Adequate nutrition supports cellular repair, reduces infection risk, and enhances recovery.
What are the stages of wound healing?
- Hemostasis = Bleeding and clotting
- Inflammation = Redness, warmth, sometimes pain
- Proliferation = Development of granulation tissue and capillaries
- Remodelling = Same as previous
What is a pressure injury (PI)?
Localized damage to the skin and underlying tissue due to pressure.
What is incontinence associated dermatitis (IAD)?
Skin irritation caused by prolonged exposure to moisture from urine or feces.
What affects each stage of wound healing?
Bleeding/Hemostasis
Inflammation
Proliferative
Remodeling
Bleeding/hemostasis = Anticoagulants, liver/bone damage, NSAIDS
Inflammation = Steroids (anti-inflammatory), chemotherapy, immunocompromised, age, cancer
Proliferative & Remodeling = protein/nutrition, hydration, etc
What does primary intention healing involve?
Wound edges are brought together, leading to minimal scarring.
What is secondary intention healing?
Wound healing occurs from the inside out, resulting in more significant scarring.
What is tertiary intention healing?
Wound is kept open initially to reduce infection risk before being closed later.
How does the following affect the stages of inflammation:
Necrotic/dead tissue
Repeated pressure
Trauma
Foreign bodies
Infection
Poor nutrition
ETOH/Drug and cigarette use
- Dead cells/tissue needs to be removed
- No pressure relief, “tissue to breathe”
- Foreign bodies need to be removed
- Infection keeps the area damaged
- Affects healing and repair (hydration, immune function)
- Associated with poor nutrition, causes vasoconstriction relaying healing
What are the differences regarding healing between partial- and full-thickness wounds?
Partial = regeneration occurs via: hemostasis and bleeding, inflammation, epithelial proliferation, migration of cells from other areas
Full = Hemostasis and bleeding, inflammation, proliferation, remodelling that can take upwards of 2 years (stage 3-4 PI)
What can increase the risk of skin tears in older adults?
- Dehydration * Poor nutrition * Certain illnesses
Moisture, perfusion, co-morbidities, nutrition, mobility
Are all factors that can influence the chances of ________?
Pressure injuries
PI’s can be caused by these three motions of force:
Friction
Sheer
Pressure
Further risk factors for pressure injuries include:
Impaired sensory fxn
Mobility
Infection
Age
Moisture
Nutrition
What is a Pressure Injury (PI)?
A change in or break in the skin caused by an injury or trauma related to pressure, localized to skin and underlying tissue.
Also known as pressure ulcers, sores, decubitus ulcers, or bed sores.
What are factors that delay the inflammatory response?
- Necrotic tissue
- Repeated pressure
- Trauma
- Foreign bodies
- Infection
- Poor nutrition
- Substance use (ETOH, drugs, cigarettes)
These factors can significantly affect wound healing processes.
What does ‘slough’ refer to in wound healing?
Bacteria and dead tissue present in a wound.
Slough can impede the healing process and may require debridement.
What are the risk factors for Pressure Injury (PI)?
- Impaired Sensory Perception
- Impaired Mobility
- Alteration of Level of Consciousness (LOC)
- Tissue Perfusion
- Infection
- Age
- Psychosocial Impact of Wounds
Understanding these factors is crucial for prevention and management of PIs.
What are the classifications of Pressure Injuries?
- Stage 1: Intact skin, non-blanchable erythema
- Stage 2: Partial thickness skin loss
- Stage 3: Full thickness tissue loss without bone or tendon exposure
- Stage 4: Full thickness tissue loss with exposed bone, muscle, or tendon
- Unstageable: Base of ulcer covered by slough or eschar
- Suspected Deep Tissue Injury: Discolored intact skin
Each stage has specific characteristics that guide treatment.
What is Incontinence Associated Dermatitis (IAD)?
Skin inflammation due to chronic exposure to urine or feces, resulting in redness and potential blistering.
IAD can increase the risk of Pressure Injuries.
True or False: IAD can occur in the absence of any risk factors for Pressure Injuries.
True.
IAD has different etiologies compared to Pressure Injuries.
IADs can be caused or worsened by:
Immobility
Exposure to urine/feces = > pH, exposures to enzymes and bacteria
What are some systemic factors that affect wound healing?
- Age
- Anemia
- Hypo-proteinemia (low protein)
- Zinc deficiency
These factors can hinder the healing process and must be addressed.
What are some nursing assessments when concerned about a PI?
- Assessing skin integrity
- Evaluating mobility and sensory perception
- Nutritional status
- History of incontinence
These assessments help identify patients at risk for developing Pressure Injuries.
What are feeding options for a client who cannot eat?
- Tube feed (NG/NJ, PEG/PEJ)
- Total parenteral nutrition (TPN)
These options ensure proper nutrition is maintained for healing.
IADs vs PI
IADs = urinary or fecal incontinence causes, peri area, pain burning itching, poorly defined edges, with/without skin loss
PI’s = sheer friction pressure, bony prominences or medical device, pain, distinct edges, non-blanchable skin to full thickness skin loss
Both may cause infection
What is a scenario in which a patient might need total parenteral nutrition?
Patient cannot swallow or is too high risk of aspiration to safely eat.
Diagnose, Plan, and Implement strategy for a patient with PI
Diagnosis = risk for pressure injury
Plan = Skin care and nutrition maintenance, appointments with PT and OT, T&P Q2H
Implement = Assist with meals and turning and positioning
What should evaluation include for patient care?
- Weights
- Calorie counts
- Evaluation of healing
- Monitoring lab values (fluids, electrolytes, proteins)
- Evaluating vital signs
- Assessing symptoms of diagnosis
Fill in the blank: Healing can be affected by _______.
[stress, illness, injury]
True or False: Fluid restriction is not considered in patient intake assessment.
False
What does IAD stand for?
Incontinence Associated Dermatitis
How does immobility affect nutrition? (Nitrogen balance, metabolism, hunger)
Decreased mobility further decreases appetite, affecting the body by decreasing its nitrogen balance and metabolic change of increasing protein break down.
What allied heath care members can help with IADs and PIs
Nurses Specialized in Wound, Ostomy, and Incontinence Care (NSWOC)
Dietician
Speech Lanuage Pathologist
PT OT
Physician
They can increase physical strength, accelerate recovery and wound closure, decrease disk of infection
BMR impacted by?
Healing, stress, injury, illness, sex, age
What are the common effects of aging in regard to the heart and circulation?
Thickening blood vessel walls
Atherosclerosis
Arteriosclerosis
Narrowing Lumen
Less elastic vessels
Where is the Point of Maximal Impulse
5th intercostal space = mitral valve
When and where does the heart receive oxygen perfusion?
During diastole and through the coronary arteries that branch off of the aorta
Where do the coronary vessels drain blood to?
The blood vessels drain onto the coronary sinus which connects to the right atrium
Which two valves are most commonly replaced?
Aortic and Mitral (Bicuspid) valves
Starling’s Law states that increasing the _________ of the heart muscles increases its _________ force.
Stretching (preload); contraction (afterload)
When baroreceptors detect an INCREASED blood pressure…
…vasodilation is stimulated
When baroreceptors detect DECREASED blood pressure…
…vasoconstriction is stimulated to increase BP
Why is it important to understand how long blood cells live for?
It can provide an understanding of treatment side effects (e.g. chemotherapy will decrease WBC counts = < in WBCs after/within 12-20 days)
Where are plasma proteins created?
Liver
If the production of albumin is altered, the following may be affected
Fluid retention:
Ascites - fluid in belly
Edema - swelling of peripheries
RBC count (increases/decreases) during infection or disease
WBC counts (increases/decreases) during infection or injury
WBC counts (increases/decreases) during cancer or chemotherapy
Platelets (increases/decreases) from anti platelet medication
Increases
Increases
Decreases
Decreases
How does hypovolemia and heart failure affect stroke volume?
Hypovolemia causes LOW preload
Heart failure can cause HIGH preload
What is After Load
The pressure ventricles have to push against for blood to be ejected
The following contributes to an (increase/decrease) in after load
Vasoconstriction
Defective Valves
Thickness of Blood
All increases after load
What is Mean Arterial Pressure
The minimum pressure to perfume the body with O2 (usually 60)
In terms of blood flow, why is Ventricular Tachycardia so dangerous?
Ventricular tachycardia decreases cardiac output (CO) because the ventricles are not being filled up all the way. There are a number of events that occur as a result of this (e.g. the oxygen supply and demand to the heart is imbalanced. More O2 usage, less O2 perfusion).
What is the difference between dysrhythmia and arrhythmia?
Dysrhythmia refers to a broad concept of abnormal rhythm.
Arrhythmia specifically refers to “without rhythm”.
Define murmurs and state its risk factors and treatment
Murmurs are audible noises made by the blood from obstructions in flow or other factors.
Risk factors include: age, smoking, birth defects, HTN
Treatment: ∆ in lifestyle, interventions like surgery
Define: Myocardial Ischemia
Heart cell death resulting from an O2 supply and demand imbalance
Can cause angina (chest pain)
What are the two Heart Attack types and their treatments
NSTEMI = partial blockage of an artery
STEMI = full blockage of an artery
Treatment includes: ∆ in lifestyle, medication, surgery
What risk can come from using aspirin (ASA) for angina
ASA is an NSAID = bleeding risk because its an anti platelet
Arteriosclerosis and risk factors & treatment
General hardening of a vessel - loses elasticity
Risk factors include diet, lifestyle, smoking, HTN, age, family Hx
Treatment includes lifestyle changes, medication
Atherosclerosis and risk factors
Atherosclerosis is a type of arteriosclerosis. Specifically caused be a build up of plaque from cholesterol, calcium, etc.
Treatment can be medication and ∆ in lifestyle.
How does diabetes contribute to cardiovascular problems?
High sugar can damage blood vessels and can increase HTN and LDL
The hormone __________ can increase the risk of HF by contributing to T2DM, metabolic syndrome, and CAD by when levels are too high/low.
Testosterone
When the hormone ___________ is low, it increases risks for HF by causing hyperlipidemia and ventricular arrhythmias.
Thyroxine
The high levels of the hormone ____________ increases the risk of HF by causing atrial arrhythmias, HTN
Thyroxine
The acronym DOCHAP is helpful when determining the side effects for ______ - sided HF, and stands for?
Left
D - Dyspnea (difficulty breathing)
O - Orthopnea (difficulty breathing while laying down)
C - Cough
H - Hemoptysis (bloody sputum)
A - Adventitious breath sounds
P - Pulmonary congestion
Left-sided heart failure affects _________ ________ to the heart.
Venous; return
This type of HF affects venous return from the body organs, leading to edema within the legs and feet.
Right sided heart failure
The acronym AWHEAD stands for?
A - Anorexia
W - Weight gain
H - Hepatomegaly (liver enlargement)
E - Edema
A - Ascites (fluid in belly)
D - Distended neck veins
What are two ways to diagnose HF?
Lab tests - detects high levels of BNP
Chest X-ray (CXR) - observe cardiomegaly and pulmonary congestion
3 most common risk factors for HF
MI, CAD, HTN
How do the following medications help for HF?
Beta-blockers
ACE
ARBS (RAAS)
Anticoagulants
Diuretics
Beta-blockers = “lol” suffix, improves the pump of the heart
ACE = contribute to vasodilation, protects kidneys from HTN
ARBS = affects the Renin-Angiotensin-Aldosterone System
Anti-coagulants = prevent clotting, duh
Diuretic = makes you pee your pants!!
Primary S/S (risk factors) leading to HF
Age, family Hx, smoking, diet, sedentary lifestyle, idiopathic
Secondary S/S (PMHx) leading to HF
Arteriosclerosis, conventional defects, Cushing syndrome (> cortisol), adrenal gland issues, medication, pregnancy
What three ways can you detect an MI
Angiogram
Troponin levels (from cell injury)
ECG
Detects the severity of HF
Levels of BNP
Method to evaluate valves
Echocardiogram
Method to detect dysrhythmia
ECG
Detects ejection fraction
Echocardiogram
Used to insert stents
Angiogram
The SODA acronym is for risk factors that lead to _________
It stands for…
HTN.
S - sedentary, smoking, stress
O - obesity, oral contraceptives
D - diet, disease
A - African-American men, age
Why is it important to educate patients on their medication?
To ensure they adhere to the plans and to understand what they do for them.
Where and what is the fxn of the coronary sinus?
location=rt atrium
fxn= collects de02 blood from myocardium
location and fxn of coronary arteries
location = left aorta
fxn = feed myocardium during diastole
what is the Lub
S1. AV closing at and of diastole
what is the dub
S2. semilunar valves closing at end of systole
“When muscles stretch there is going to be increased strength in the contraction” is what law?
Starling’s law
BP diff of 10-15 between arms is a sign of what?
atherosclerosis or arteriol obstruction
How does body respond to low BP?
- SNS activation
- vasoconstriction
- increased CO
how does body respond to high BP?
- PSNS activation
- vasodilation
- decreased CO
List and describe fxn the layers of the heart wall from innermost to outermost.
- endocardium: regulates contractions, smooth non-adherent for blood flow
- myocardium: contracts controlled by pacemaker, where coronary arteries innervate
- epicardium: CT and fat, heart anchor, extra protection. coronary arteries are here.
what is an average MAP for an adult
> /= 60
irregular enlargement of the heart is known as
cardiomegaly
define penia
decrease
define poiesis
creation
define cytosis
increase
the blood the heart beats in L/min is known as
Cardiac output CO
HR is
the # of beats/min
amount of blood ejected from the heart during each cardiac cycle
Stroke volume
define preload
ventricular stretch at end of diastole
define afterload
resistance the heart overcomes to eject blood from ventricles
what are the 3 V’s?
factors affecting afterload
vessel diameter, viscosity, and valves
define contractility
ability of the heart to contract and the force at which it contracts
what is the issue with too much contractility?
there is not enough time for the heart to fill and CO decreases
C/C hypoxia vs hypoxemia
hypoxia = low 02 in tissues
hypoxemia = low 02 in blood
C/C tachycardia vs bradycardia
Tachy: too fast >100
* decreased CO, preload, and 02 to heart
* increased myocardial 02 demand
* can be benign from exercise, or serious (V Tach)
Brady: too slow <60
* decreased CO
* benign in athletes
treatment of arrhythmias and hear problems is based on what?
type of rhythm and s/s
common s/s of dysrrhythmias
syncope, dizzy, lightheaded, tire easily, memory problems
Examples of Tachy arhythmias
- A-Fib: chaotic signal w/ multiple pacemaker sites
- V-Fib: impulse comes from ventricles not SA node
examples of brady arhythmias
- sick sinus rhythm: SA impacted (dysfunction/disease/hypothyroidism)
- Heart block: (AKA AV block) smth blocking electrical signal
what is ACS?
unstable angina
what is NSTEMI vs STEMI
NSTEMI = partial coronary artery blockage
STEMI = complete coronary artery blockage
stemi stands for the ST segment in an ECG and means ST elevated myocardio ischemia
which is worse: NSTEMI OR STEMI?
STEMI
describe left sided heart failure
think left to the lungs
pulmonary congestion & pressure from failed venous return from lungs
THINK DOCHAP
heavy wet lung sounds
every alveoli filled with edema = impossible gas exchange
what does DOCHAP stand for?
it is a memory trick for LHF problems
D: dyspnea
O: orthopnea
C: cough
H: hematocytosis
A: adventitious breath sounds
P: pulmonary congestion
describe right sided heart failure
- think right to the rest*
venous congestion of body organs due to failed venous return.
failure of ride side bc of increased pulmonary vascular pressure.
what does AWHEAD?
memory trick for RHF
A: anorexia
W: weight gain
H: hepatomegaly
E: edema
A: ascites
D: distended neck veins
what is azotemia?
build up of waste in blood due to renal failure. symptom of rightside HF
give 5 medication classes that someone with HF would take
- Beta Blockers: improves the pump
- ACE: vasodilator, protects kidneys
- ARBS: blocks vasocontriction
- Diuretic: gets rid of fluid
- Anticoagulants: prevents sticking
common non-pharmacological treatments for someone with HF?
- restrict Na
- restrict water
- exercise
- daily weigh-ins (4lbs in 2 days or 5 lbs in 1 week is BAD)
- DASH and DRESS diets
what is metabolic syndrome?
a cluster of conditions such at T2DM, insulin resistance, abdominal obesity, high chol and triglycerides, and HTN
what is AABC?
memory trick for complications of HTN
A: atherosclerosis
A: aneurysm
B: broken kidneys, eyes, heart
C: clots in lungs, brain, heart
Primary s/s:
basically any risk factors:
age, family hx, smoking, diet, sedentary lifestyle, idiopathic
secondary s/s:
basically any meds, health HX
arteriosclerosis, congenital defect, kidney disease, cushing syndrome, adrenal gland, meds, pregnancy
What does SODA stand for?
memory trick for risk factors of HTN
S: stress, smoking, sedentary
O: obesity, oral contraceptives
D: diet (Na, chol), disease (diabetes, renal, HF, high chol)
A: African American, age
troponin labs detect…
MI, heart injury
BNP labs tell you…
detects severity of CHF. It is released from ventricles stretching.
CK labs tell you…
an inflammatory marker, detects cell damage in brain & skeletal/heart muscle
CRP labs tell you…
inflammatory marker, detects tissue injury and infection
DASH diet stands for
Dietary Approaches to Stop Hypertension
DRESS diet stands for
D: decrease Na/cal/chol
R: reduce ETOH/caffeine
E: exercise
S: stop smoking
S: stress - decrease
