Nutrition Flashcards

Question

Fat metabolism process?

Answer 1

Occurs in the small intestine Bile secreted by the gallbladder emulsifies fat for pancreatic lipase to break down fat more efficiently Most fats are absorbed in the lymphatic system and transported to the liver Only 3% of fats eaten are excreted in the stool the body has to burn off excess fat

Answer 2

Cholesterol sources: produced by the liver and consumption of animal foods Essential for cell membrane, the precursor of steroid hormones and Vitamin D, synthesizes bile acids

Answer 3

The “bad” cholesterol High levels lead to plaque buildup → atherosclerosis

Answer 4

The “good” cholesterol Carries LDL away from body to liver for processing

Answer 5

Most common type of fat Liver converts excess CHO as glycogen or converted to triglycerides and stored in adipose tissue

Answer 6

Organic compounds are required for normal metabolism and prevention of diseases related to deficiency - Not made by the body; must be consumed

Answer 7

absorbed directly by the small intestine and into the bloodstream Not stored; excess excreted in the urine

Answer 8

Inadequate amounts lead to deficiency syndromes Vit C deficiency →Scurvy Vit D deficiency →Rickets in children; osteomalacia in adults Folate (Folate is the natural form of vitamin B9) and Iron → Anemias Absorbed with fat and carried in the lymphatic circulation; must be attached to a protein to be transported in the blood Excess stored in the liver and adipose tissue

Answer 9

- Inorganic elements found in nature (food and supplements) - For tissue building, nerve impulse, fluid regulation, bone and blood health - Not broken down by body - Major minerals (macrominerals) Required in amounts of > 100 mg/day e.g. Calcium, phosphate, sodium, potassium, magnesium - Trace minerals (microminerals) Essential but in low amounts < 100 mg/day e.g. Iron, Zinc, Iodine, fluoride

Answer 10

- Major minerals (macrominerals) Required in amounts of > 100 mg/day e.g. Calcium, phosphate, sodium, potassium, magnesium - Trace minerals (microminerals) Essential but in low amounts < 100 mg/day e.g. Iron, Zinc, Iodine, fluoride

Answer 11

Water is more vital to life than any other nutrient - Major body constituent in every body cell - Accounts for 50-60% of an adult’s body weight * ⅔ in intracellular space * ⅓ in extracellular space - Average adult requirement: 2.2 -3L/day - Water balance and levels in the body are affected by : * renal function * fever, perspiration, tachypnea, severe burns * diarrhea, vomiting * Draining fistulas and drainage tubes * Hemorrhage * Prolonged open abdominal surgery Water source: fluid and food intake and produced during the metabolism of CHO, protein, fat - Water depletion through urine, stool, insensible loss (breathing and perspiration)

Answer 12

Vegetarian Lacto-Ovo vegetarians Vegans

Answer 13

Exclusion of meat from the diet Need a well-planned diet to avoid vitamin, protein, and iron, deficiencies

Answer 14

Plant food diet and occasional dairy products and eggs Risk for vitamin and mineral deficiencies Iron deficiency

Answer 15

Exclusive plant foods Can develop megaloblastic anemia and neurologic signs of deficiency Require fortified foods with Cobalamin (vitamin B12)

Answer 16

2g of Na a day only (Cardiac diet)

Answer 17

low K and Na

Answer 18

Npo a secas you can take some medicine and ice chips.

Answer 19

low carbohydrate and sugar-free

Answer 20

- For patients with difficulty swallowing or increased risk of aspiration - Need to thicken thin liquids or puree. Thicker consistency like pudding is recommended

Answer 21

common for patients with heart failure or SIADH) The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a disorder of impaired water excretion caused by the inability to suppress the secretion of antidiuretic hormone (ADH) [1]. If water intake exceeds the reduced urine output, the ensuing water retention leads to the development of hyponatremia (low sodium)

Answer 22

Important also to assess for adequate fluid intake for patients having diarrhea No longer recommended for it is unnecessarily restrictive

Answer 23

- Cultural preferences * Integrate culture foods into meals if not contraindicated * Be mindful about including foods with herbal supplements because they have chemicals that actually act like medicine. - Religious practices * Dietary restrictions during sacred holidays * Hindus do not eat beef * Kosher diet in the Jewish religion - Developmental age * Periods of growth, pregnancy, and lactation require high caloric intake and vitamins - Fad diets - Food insecurity/Food Access - Medication effects - Alcohol consumption - Eating disorders - Health disorders * anemia * short gut syndrome * Trauma, surgery, burns * Chronic disorders: DM, CAD, cancer - Elderly

Answer 24

- Hypertension - Cardiomyopathy (a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body) - Dyslipidemia (s the imbalance of lipids such as cholesterol, low-density lipoprotein cholesterol, (LDL-C), triglycerides, and high-density lipoprotein (HDL). ) - Pancreatitis - Obesity - Hepatic dysfunction (ASH) - Fetal alcohol syndrome - Addiction

Answer 25

Hypertension Myocardial infarction Dyslipidemia Pancreatitis Obesity Hepatic dysfunction (NASH: Nonalcoholic fatty liver disease) Fetal insulin resistance Habituation, if not addiction

Answer 26

Altered ability to chew (edentulus or poor dentition) Loss of sense of taste or smell Decrease peristalsis GERD (Gastroesophageal reflux disease: A digestive disease in which stomach acid or bile irritates the food pipe lining) Lower glucose tolerance Reduction in appetite and thirst sensation Physical disability * arthritis pain, gout Social isolation and depression Food access Osteoporosis → ↑ risk of osteoporosis and fractures

Answer 27

Interview -Recent weight loss or gain -Appetite and special diets -Chronic conditions -Exercise pattern -Nutrition/food access Assessment -Measure height and weight person for BMI -Assess dysphagia → indication of high aspiration risk -Nutritional lab studies: albumin, prealbumin, transferrin, Hg, Fe, blood glucose, lipid panel

Answer 28

A protein synthesized by the liver half-life of 2-3 days Better indicator of recent or current nutritional status Most accurate in identifying early protein or calorie malnutrition

Answer 29

Albumin value lags behind actual protein changes by > 2 weeks (20-22 days) Not a good indicator of acute changes in nutritional status

Answer 30

Diagnosis Imbalanced nutrition less than body requirement r/t... food security, chronic illness, poor appetite, etc. Readiness for enhanced nutrition as e/b desire to lose weight, reduce alcohol consumption, etc. Planning Collaborate with dietician Consult social worker for etoh cessation programs Monitor daily nutritional labs and blood gluocose Implementation Social worker and dietician ordered for consult Daily nutritional labs drawn and blood sugar checks before meals Assisted patient with menu selection Evaluation Evaluate results of planned interventions

Answer 31

Enteral Oral Gastrointestinal Parenteral Intravenous (peripheral or central)

Answer 32

- When patient has normal swallowing reflexes (+ cough and gag) * Completely awake, alert, follows commands * Sit up at 90 degree; preferably in chair * Follow ordered diet * Sit up for at least 30 min after meals - For patients with nutritional deficit: * High-calorie supplements -Milkshakes - Ensure, Glucerna for DM patients, -Nepro for renal failure patients * Consult dietician

Answer 33

Often referred to as tube feeding Administration of nutritionally balanced liquified food or formula through a tube inserted into: Stomach Duodenum Jejunum - Also inserted for medication administration in a sedated/comatosed patient - Provides nutrients alone or is a supplement to oral or parenteral nutrition

Answer 34

Maintains gut function Easily administered Infection risk: Enteral < Parenteral route Physiologically more efficient than parenteral Less expensive than parenteral

Answer 35

- Indications include those with: 1- Anorexia 2- Frequent aspirations 3- Orofacial fractures 4- Head/neck cancer 5- Burn victims 6- Nutritional deficiencies 7- Neurologic conditions 8- Psychiatric conditions 9- Chemotherapy

Answer 36

When longer-term enteral feeding is anticipated: More comfortable Tube replaced every few months Laparoscopically (a type of surgical procedure that allows a surgeon to access the inside of the abdomen ) placed in interventional radiology

Answer 37

A J-tube is considered in the following circumstances: -Gastroparesis (a condition that affects the normal spontaneous movement of the muscles (motility) in your stomach) -GERD -High-risk aspiration -If surgery is needed on stomach/esophagus at a later point

Answer 38

Nasogastric and nasointestinal tubes: - Inserted through the nasal cavity directly to the GI tract - Confirmed by x-ray prior to use - Tube can be inadvertently placed in lungs or sinuses - Observe for cough, change in voice, respiratory distress - ↓ the likelihood of regurgitation and aspiration when placed post-pyloric - Nasogastric feeding tube is the best choice to use if the tube feeding plan is < 6 weeks

Answer 39

Insertion: - Measure from nose to earlobe to tip of xiphoid process (approximates position of stomach) - Most tubes have cm markings so note approximately how far the tube should go - Ask the patient to flex chin to chest - Ask patient to swallow once the tube passes the nasopharynx to the epiglottis - Insert gently and never force if obstruction is met - Advance the tube as the patient swallows - May be necessary to change the angle and rotate the tip as it is inserted - Observe the patient closely *******Prior to feeding, X-ray confirmation must be done and nursing order ”ok to use” Do not rely on auscultation of abdomen or pH strips Record and documented insertion length; use sharpie to mark if tube has no measurement marking **Follow individual hospital policy and procedures for feeding tube placement and maintenance

Answer 40

- Aspiration pneumonia (most serious) *Insert post pyloric * HOB (head of bed)>30-45°, maintain upright for at least 30 min- 1° after bolus feed * Check tube placement and residual - Tube migration: by vigorous vomiting or coughing - Clogged tube *Flush tube with sterile water per policy *Crush meds finely - Nasal or gastrointestinal erosion (Erosive gastritis causes both inflammation and erosion (wearing away) of the stomach lining.) * Check skin under securement - Diarrhea * Do not hang more than 4° worth of modular formula and 8° vol of pre-packaged formula; change system Q 12-24° - Stoma infection -assess skin and cleanse around the stoma

Answer 41

- Assess for residual per hospital policy (generally every 4-8hrs) - Insertion length verified and documented every shift - Securement tape should also be changed every day to assess skin - Eyeball for same marking before administration of feeding/meds - Check for protocols such as hanging D10 when tube feed nutrition interrupted to prevent hypoglycemia - Will need MD order to restart tube feeding

Answer 42

- Patient position: * Patient should be sitting or with HOB at 30 to 45° if in bed * HOB remains elevated for 30 to 60 minutes for intermittent delivery * Continuous feedings administered on the feeding pump * Aspiration precautions - Tube patency * Flush with sterile water before/after each feeding, drug administration, and after residual checks * Flush with 5mL of sterile water between meds * Depending on order: usual residual withhold order is >250- 400mL * If residual is less than hold order, simply document feeding and refeed residual

Answer 43

- Continuous infusion by pump - Intermittent by gravity or syringe - NEW PRACTICE per JCAHO

Answer 44

Usually gradual increase in rate every 8-12hrs until patient reaches ordered goal rate

Answer 45

Vol usually 200 to 500 mL per feeding Remember to flush with 30mL water before after feeding so tube does not clog Cyclic feedings by an infusion pump (feeding by electric enteral feeding pump over a period of )

Answer 46

Flush 30 ml of sterile water before and after med administration / Feeding Flush 5 ml of sterile water in between meds 10 ml sterile water to dissolve meds Meds are never combined; not a Nursing scope of practice – considered compounding meds

Answer 47

- Daily weights - Assess bowel sounds and abdominal distention - Monitor bowel movements - Accurate intake/output - Check the order for free water boluses (for patients with hypernatremia) coz if there is very low levels of water sodium levels can increase dangerously - Refeeding syndrome (the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding) - Dehydration * More calorically dense, less water contained in formula * High protein content - Initial glucose checks -Label enteral bag with patient name, formula type, date and time started - Enteral bags changed every 12-24h - Wear gloves when hanging feeding

Answer 48

Starvation of nutrients for many consecutive days or metabolically stressed d/t critical illness leads to: -Depletion of intracellular minerals, especially phosphate - Using fatty acids and amino acids for fuel - Insulin (decreases blood sugar levels) secretion is suppressed; glucagon (a hormone)release increase (Glucagon increases your blood sugar level ) When “refeeding”: - Insulin secretion resumes in response to sugar sources - Glycogen, fat and protein synthesis require phosphate, mag, and potassium which are already depleted leads to further decrease - Hallmark of refeeding syndrome leading to Hypophosphatemia - Fluid retention and electrolyte imbalances ensues

Answer 49

Identify individuals at risk Correct depleted electrolytes before refeeding Initiate nutrition support at approximately 25% of the estimated goal. 3-5 days before reaching the goal rate. Serum electrolytes and vital signs monitored carefully after initiation

Answer 50

Identify individuals at risk Correct depleted electrolytes before refeeding Initiate nutrition support at approximately 25% of the estimated goal and advance over 3-5 days to the goal rate Serum electrolytes and vital signs monitored carefully after initiation

Answer 51

Gastrostomy or jejunostomy tubes: -Skin irritation around the tube *Skin assessment and care *Tube dislodgement *Teach patient/family about feeding administration, tube care, and complications -Fistulas -entero-cutaneous (is an abnormal connection that develops between the intestinal tract or stomach and the skin) -Infections: skin, fasciitis (inflammation of the fascia), peritonitis ( peritoneum: the serous membrane lining the cavity of the abdomen and covering the abdominal organs) -Abdominal wall or intraperitoneal bleeding and bowel perforation -Obstruction or erosion of the gastric wall -Gastric mucosa hypertrophy (overgrowth of the cells that make up the mucosa.)

Answer 52

- More vulnerable to complications *Fluid and electrolyte imbalances *Glucose intolerance *Decreased ability to handle large volumes *Increased risk of aspiration

Answer 53

-Administration of nutrients by route other than GI tract (i.e. Intravenously) -Used when * GI tract cannot be used for ingestion, digestion, and absorption of essential nutrients

Answer 54

Indications: Chronic or intractable diarrhea and vomiting Complicated surgery or trauma Post GI surgery GI obstruction GI tract anomalies and fistulae Sepsis (the body's extreme response to an infection) Severe malnutrition Malabsorption Pancreatitis Composition: Base solutions contain dextrose and protein in the form of amino acids Prescribed electrolytes, vitamins, and trace elements are added to customize the patient need IV fat emulsion is added to complete the nutrients *Different from crystalloid solutions in that crystalloids do not contain amino acids or vitamins

Answer 55

Base Solution 20-25% dextrose - May only be infused via central access due to the risk of thrombophlebitis (blood clot) caused by hypertonic (too much glucose ) solution of TPN (total parenteral nutrition ) - Tip of catheter lies in superior vena cava where vesicant and irritant solutions are safe to be administered *Central catheter to internal jugular vein to superior vena cava *Peripherally inserted central catheters (PICCs) - For longer term nutrition support

Answer 56

The base solution must be < 20% dextrose -Through the peripherally inserted catheter -Short-term -When lower protein and calorie content is required

Answer 57

Hyperglycemia and hypoglycemia Fluid, electrolyte, and acid base imbalances Hyperlipidemia when lipids used Phlebitis (inflammation of a vein) Infection and bacteremia Gallbladder and liver disease Thrombosis (occurs when blood clots block veins or arteries)

Answer 58

- Vital signs every 4 to 8 hours - Daily weights - Regular blood glucose monitoring ****Check initially every 4 to 6 hours - Check labs: Electrolytes, BUN, Creatinine, CBC, liver function enzymes - Assess the central access site *Site assessment for phlebitis *Dressing change every 7 days or as needed *Use sterile technique with dressing changes *Assess for refeeding syndrome *Infusion pump must be used

Answer 59

Before administering, check label and ingredients against order Examine bag for signs of contamination, leaks, color, particulate matter, clarity, cracking - MUST replace solution and tubing every 24 hours even if the bag hanging is not empty - If the solution is not available, hang D10W to prevent hypoglycemia Tubing with filter is required for TPN Do not abruptly discontinue TPN - Decrease rate by half for one hr then stop. Check blood sugar in an hr. - Monitor for infection and bacteremia: *Local infection *Erythema *Tenderness *Exudate at catheter insertion site - Systemic Infection – High risk associated with TPN *Fever, chills *Nausea/vomiting *Malaise

Answer 60

Before administering, check label and ingredients against order Examine bag for signs of contamination, leaks, color, particulate matter, clarity, cracking - MUST replace solution and tubing every 24 hours even if the bag hanging is not empty - If the solution is not available, hang D10W to prevent hypoglycemia Tubing with filter is required for TPN Do not abruptly discontinue TPN - Decrease rate by half for one hr then stop. Check blood sugar in an hr. - Monitor for infection and bacteremia: *Local infection Erythema Tenderness Exudate at catheter insertion site *Systemic Infection – High risk associated with TPN Fever, chills Nausea/vomiting Malaise

Answer 61

- Perform DTTP (differential time to positivity) blood cultures when systemic infection is suspected Differential time to positivity Differentiates infection likely source from catheter or blood Samples must be drawn no more than 15 min apart and collect same amount of blood for each sample If the sample from catheter grows bacteria < 2hrs before peripheral sample, the likely source of infection is from catheter - Chest X-ray: To check changes in pulmonary status - Urinalysis and Urine culture When 60% of caloric needs met orally, then can discontinue PN or EN nutrition

Answer 62

Deficit, excess, or imbalance in essential components needed for a balanced diet Under-nutrition: Poor nourishment due to inadequate consumption or disease process Over-nutrition: Ingestion of more food than body requires

Answer 63

- Starvation-related malnutrition Primary protein-caloric malnutrition (PCM) Nutritional needs not being met Chronic starvation without inflammation Anorexia nervosa - Disease or injury-related malnutrition Secondary Protein Calorie Malnutrition (SCM) Sustained mild to moderate inflammation Conditions including organ failure, cancer, rheumatoid arthritis, and other autoimmune disorders, obesity, and metabolic syndrome Ex: Major infections, burns, trauma, closed head injury

Answer 64

-Contributing factors *Socioeconomic factors – food insecurity *Physical illnesses Illness, surgery, injury, hospitalization Malabsorption syndrome Fever Incomplete diets, vitamin deficiencies -Impaired absorption of nutrients from the GI tract as a result of: *pancreatitis: ↓ digestive enzymes *Drug side effects * short gut syndrome: ↓ bowel absorption

Answer 65

- Initially during the starvation process, there is a decreased BMR, sparing of skeletal muscle, and decreased protein breakdown - In inflammatory states, alterations in expression of proinflammatory (interleukin-6) and antiinflammatory cytokines (interleukin-10). - Cytokine changes result in: Increased protein and skeletal muscle breakdown Increased BMR Decreased protein (albumin, prealbumin) production Increased C-reactive protein production

Answer 66

- Starvation process *Prolonged starvation: 97% of calories from fat and protein *Fat stores depleted in 4 to 6 weeks, depending on amount available - Once fat stores used, body protein no longer spared - Liver function impaired - Protein synthesis diminished - Low albumin leads to ↓ plasma oncotic pressure *Fluid shifts from vascular space into interstitial space - Na+/K+ pump fails due to deficiency in calories and proteins

Answer 67

Mild to emaciation: *Skin dry and scaly, brittle nails, hair loss *Mouth and tongue: crusting and ulceration, *Muscles-wasting, decreased mass and weakness *CNS -mental status changes such as confusion and irritability *Fatigue *Increased susceptibility to infection *Anemia related to deficiencies in iron and folic acid, chronic dx

Answer 68

-Daily calorie count -High-protein, high-calorie foods or feedings -Multiple, small feedings -Supplements -Appetite stimulants such as Megace and Marinol -Regular weight schedule -Diet diary -Dietitian consult -Social work consult for help with purchasing food/meal preparation -Discharge instructions

Answer 69

-A chronic multisystem disease related to abnormal insulin production, impaired insulin utilization, or both -Affects 25.8 million people; incidence Type II DM on the rise and affecting children -7th leading cause of death -Leading cause of *Adult blindness *End-stage kidney disease *Nontraumatic lower limb amputations -Major contributing factor *Heart disease *Stroke *Hypertension

Answer 70

Elevated BG (>180mg/dl) Increase in urination Increased in Thirst Increase appetite Glycosuria Weakness Fatigue, Headache Nausea Abdominal cramps Blurred vision Progression to DKA or HHS DKA- Daibetic Ketoacidosis HHS- Hyperosmolar Hyperglycemic Syndrome

Answer 71

Intake > expenditure Illness, Infection Corticosteroids Improper diabetic management Inactivity Emotional or physical stress

Answer 72

Insulin Oral Antidiabetic Agents Frequent blood glucose checks Check blood/ urine for ketones Fluid replacement

Answer 73

BG <70mg/dl Cool Clammy Skin Hunger Numbness of fingers, toes mouth Rapid Heartbeat Irritability Headache Faintness, shakiness Dizziness, unsteady gait slurred speech, Changes in vision Seizure, coma

Answer 74

Inadequate food consumption Alcohol abuse Overmedication of diabetic medication Strenuous exercise without adequate food intake Loss of weight without change in dose of medication Use of Beta Adrenergic Blockers – interfering with recognition of symptoms

Answer 75

Conscious patient: Eat or drink 15 grams of quick acting carbohydrate Orange Juice or Regular soda 4-6 oz Hard candy/Glucose tabs Wait 15 min then recheck blood glucose level Once stable, give longer acting carbs Worsening symptoms, or unconscious pt: SQ or IM of 1mg Glucagon IV administration (IVP) of 25-50 ml of 50% Glucose / Dextrose (also for pts unable to eat or drink)

Answer 76

- Goals of diabetes management *Decrease symptoms *Promote well-being *Prevent acute complications *Delay onset and progression of long-term complications -Need to maintain blood glucose levels as near to normal as possible -Patient teaching *Nutritional therapy *Drug therapy *Exercise *Self-monitoring of blood glucose -Diet, exercise, and weight loss may be sufficient for patients with type 2 diabetes -All patients with type 1 require insulin

Answer 77

-Metformin (Glucophage) most commonly used -Reduces glucose production by liver -Enhance insulin sensitivity -Improve glucose transport -May cause weight loss -Also used in prevention of type 2 diabetes -Least likely to cause hypoglycemia -Hold med if patient is undergoing surgery or radiologic procedure with contrast medium *24-48 before procedure and at least 48 hours after *Monitor serum creatinine -Contraindications *Renal, liver, cardiac disease *Excessive alcohol intake

Answer 78

ADA healthy food choices for improved metabolic control *Maintain blood glucose levels to as near normal as safely possible *Normal lipid profiles and blood pressure *Prevent or slow complications *Maintain pleasure of eating *Consistent carbohydrate diet -Meal plan is based on individual’s usual food intake and is balanced with insulin and exercise patterns -Day-to-day consistency important for patients using conventional, fixed insulin regimens -More flexibility with rapid-acting insulin, multiple daily injections, or insulin pump

Answer 79

- Ambulatory and home care *Assess patient’s ability to perform BG injection and insulin injection *Assess patient/caregiver knowledge and ability to manage diet, medication, and exercise therapy *Teach manifestations/treatment of hypoglycemia and hyperglycemia

Answer 80

Glycogenesis: excess glucose stored in form of glycogen in the liver Carbohydrates and proteins are converted to fat in excess and stored as triglycerides in the liver or fat cells (adipose tissue)

Answer 81

Glycogenolysis: When glycogen is broken down into glucose for energy Blood glucose is regulated by the hormones insulin and glucagon The body completely metabolizes glucose (unlike fats and proteins which leaves behind ketones - toxic byproduct)