Nutrition & Electrolytes

Question 1

Individual risk factors for altered nutrition

Answer 1

Gender
Alcohol
Megadoses of supplements!
Increased metabolic demand (fevers!)
Altered organ function

Question 2

Nutrition: diagnostic tests

Answer 2

Serum albumin: protein made in liver, keeps fluid in the intravascular sys.

Glucose/A1c (90days)
Lipid profile (cholesterol)

Low Hemoglobin: anemia
High Hematocrit: dehydration
High creatinine: dehydration

Question 3

What does anemia mean for nutrition?

Answer 3

Anemia indicates/can be caused by:
Low vitamin B12
Low iron
Low nutrition/absorption

Question 4

Low albumin indicates:

Answer 4

keeps fluid in the intravascular sys.
Low albumin = risk for 3rd-spacing & hypovolemia.

Malnutrition/malabsorption
Normal is 3.3-5

Question 5

Cachexia

Answer 5

Wasting syndrome: general wasting away of body tissue

Question 6

Emaciation

Answer 6

Excessive leanness

Question 7

Signs of poor nutrition

Answer 7

Apathy
Dark under-eyes
Flaky/pale skin
Dry eyes
Bad teeth
Bleeding gums
Bruises

Question 8

What objective measurements indicate obesity?

Answer 8

BMI (weight/height, must be in context)
Weight
Waist circumference

Question 9

What are 2 physiological causes of obesity?

Answer 9

Hormones/endocrine factors
Microbiota

Question 10

Effect of poor sleep on nutrition

Answer 10

Causes obesity!

Question 11

Effects of obesity

Answer 11

Depression, inflammation, CVD
Impairs ventilation & circulation
Pharmodynamics/kinetics (meds ate metabolized differently)
Skin integrity
Mobility/joint degredation

Question 12

How to assess NG tube placement

Answer 12

1. X-ray
2. Check pH of gastric fluid: stomach acid is <5.5, lung fluid is 6+

Question 13

How to give an NG tube feeding

Answer 13

IAP abdomen
HOB 30-45 degrees (& 1hr after)
Check placement
Check pH
Check gastric residue (aspirate all stomach contents w/syringe)
Flush 30-50mL water
Feed
Flush water

Question 14

What does a lot of gastric residue put you at risk for?

Answer 14

Aspiration or pneumonia

Question 15

When to confirm placement of NG tube?

Answer 15

Before use, after placement, and every 4-hrs during continuous feedings.

Question 16

Wait how long after meds or tube feeding to check pH of gastric fluid?

Answer 16

1 hr

Question 17

Gastrostomy/PEG tube

Answer 17

Stomach or small intestine.
Priority: prevent complications- always assess site & measure length of tube.
Leakage: caused by tension slack.
Irritation: gastric fluids could be leaking so apply barrier cream.
Pain: could mean cellulitis (tell MD)

Question 18

Serum/blood osmolality

Answer 18

The concentration of all particles in your blood. Osmolality increases with dehydration.

Question 19

ICF vs ECF

Answer 19

Intra, 70%, fluid within cells

Extra, 30%, fluid in intravascular sys/veins & interstitial fluids (edema)

Question 20

Hypovolemia in fluid imbalances

Answer 20

Hypov: low water + electrolytes in ECF/blood plasma in isotonic proportions

Question 21

Medical risk factors for electrolyte imbalance

Answer 21

Diuretic meds
Oxygenation
All organ failure - Kidney failure!! (Hypervolemia)
IBS/bowel
Low nutrition
Gastroenteritis
Trauma

Question 22

General consequences of f&e imbalance

Answer 22

Impaired:
oxygenation and perfusion
Cerebral function (dizzy, confusion, seizures)
Neuromuscular function (wk & cardiac)

Question 23

Potassium

Answer 23

K - regulates cell enzymes & water (Na-K pump). Heart & muscle!!!

Leg cramps/wk, fatigue, bradycardia, ECG changes, altered heart function & rythm

Hyper: diarrhea! - can worsen it
Hypo: constipation

Question 24

Relationship of K+ to diabetes

Answer 24

Hyperglycemia = Hypokalemia

Question 25

Sodium

Answer 25

Na+: regulates body fluids (Na-K pump). Water follows sodium so lots of hyper/hypovolemia symptoms.

Irritability, confusion, seizure, coma, dry mucous membranes.

Hyper: pulmonary & peripheral edema, oliguria (all h2o is in the blood)
Hypo: cerebral edema, polyuria, weight gain or loss of 2lbs/4days.

Question 26

Calcium

Answer 26

Ca2+: nerves, muscles, clots, B12, hormones

Hyper: anorexia, ECG changes
Hypo: cardiac dysrhythmias, Pos Chvostek sign (tap cheek), Pos Trousseau (hand w/BP cuff)

Question 27

What does a pos Chvostek or Trousseau sign indicate?

Answer 27

Hypocalcemia

Or hypomagnesemia

Question 28

What can cause hyper/hypocalcemia?

Answer 28

Hyper: eating calcium & high VitD, bone destruction, tumors, hyper parathyroid dysfx

Hypo: low VitD, overusing anti-acids/Tums, hypomagnesemia!

Question 29

Phosphate

Answer 29

PO4-: chem rxn, cell division, hereditary traits

Hyper: upper (tetany, nervous, vomit, tachycardia), hypocalcemia, CONSTIPATION
Hypo: downer (lethargy, wk, low BP, coma, confusion)

Question 30

Causes of hypo/hyperphosphatemia

Answer 30

Hyper: hypocalcemia, renal failure, para thyroid, chemo, high VitD, high dairy

Hypo: intestinal malabsorption, low VitD, alcoholism

Question 31

Magnesium

Answer 31

Mg2+: metabolizes carbs & protiens

Hyper: decreased DTRs
Hypo: hyperactive DTRs, pos Chv/Trou

Question 32

Causes of hyper/hypomagnesemia

Answer 32

Hyper: pre-term labor/preeclampsia due to L&D giving Mg as muscle relaxers

Hypo: malabsorption, alcohol withdrawal

Question 33

What is a major cause of electrolyte imbalances?

Answer 33

Kidney failure!

Question 34

What populations have dif fluid content?

Answer 34

Women: more water
Obese: less water
Infant: more water - high risk due to small body

Question 35

Orthopynea

Answer 35

SOB only while laying flat.
Common in HF and hypervolemia

Question 36

Moat important symptoms in hyper/hypovolemia

Answer 36

Hyper: confusion (ALOC), orthpynea, edema

Hypo: confusion, low skin turgor, dry mucous membranes, wk peripheral pulses

Question 37

What is key prevention for fluid imbalance?

Answer 37

Balance I&Os

Question 38

Main hypovolemia symptom in older adults

Answer 38

Confusion

Question 39

Usual adult oral water intake

Answer 39

2-2.5L/day

Question 40

Where is edema most evident in ambulatory & supine clients?

Answer 40

Amb: ankles
Sup: sacrum