Nutrition & Electrolytes Flashcards
Individual risk factors for altered nutrition
Gender
Alcohol
Megadoses of supplements!
Increased metabolic demand (fevers!)
Altered organ function
Nutrition: diagnostic tests
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
What does anemia mean for nutrition?
Anemia indicates/can be caused by:
Low vitamin B12
Low iron
Low nutrition/absorption
Low albumin indicates:
keeps fluid in the intravascular sys.
Low albumin = risk for 3rd-spacing & hypovolemia.
Malnutrition/malabsorption
Normal is 3.3-5
Cachexia
Wasting syndrome: general wasting away of body tissue
Emaciation
Excessive leanness
Signs of poor nutrition
Apathy
Dark under-eyes
Flaky/pale skin
Dry eyes
Bad teeth
Bleeding gums
Bruises
What objective measurements indicate obesity?
BMI (weight/height, must be in context)
Weight
Waist circumference
What are 2 physiological causes of obesity?
Hormones/endocrine factors
Microbiota
Effect of poor sleep on nutrition
Causes obesity!
Effects of obesity
Depression, inflammation, CVD
Impairs ventilation & circulation
Pharmodynamics/kinetics (meds ate metabolized differently)
Skin integrity
Mobility/joint degredation
How to assess NG tube placement
- X-ray
- Check pH of gastric fluid: stomach acid is <5.5, lung fluid is 6+
How to give an NG tube feeding
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
What does a lot of gastric residue put you at risk for?
Aspiration or pneumonia
When to confirm placement of NG tube?
Before use, after placement, and every 4-hrs during continuous feedings.
Wait how long after meds or tube feeding to check pH of gastric fluid?
1 hr
Gastrostomy/PEG tube
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)
Serum/blood osmolality
The concentration of all particles in your blood. Osmolality increases with dehydration.
ICF vs ECF
Intra, 70%, fluid within cells
Extra, 30%, fluid in intravascular sys/veins & interstitial fluids (edema)
Hypovolemia in fluid imbalances
Hypov: low water + electrolytes in ECF/blood plasma in isotonic proportions
Medical risk factors for electrolyte imbalance
Diuretic meds
Oxygenation
All organ failure - Kidney failure!! (Hypervolemia)
IBS/bowel
Low nutrition
Gastroenteritis
Trauma
General consequences of f&e imbalance
Impaired:
oxygenation and perfusion
Cerebral function (dizzy, confusion, seizures)
Neuromuscular function (wk & cardiac)
Potassium
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
Relationship of K+ to diabetes
Hyperglycemia = Hypokalemia
Sodium
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.
Calcium
Ca2+: nerves, muscles, clots, B12, hormones
Hyper: anorexia, ECG changes
Hypo: cardiac dysrhythmias, Pos Chvostek sign (tap cheek), Pos Trousseau (hand w/BP cuff)
What does a pos Chvostek or Trousseau sign indicate?
Hypocalcemia
Or hypomagnesemia
What can cause hyper/hypocalcemia?
Hyper: eating calcium & high VitD, bone destruction, tumors, hyper parathyroid dysfx
Hypo: low VitD, overusing anti-acids/Tums, hypomagnesemia!
Phosphate
PO4-: chem rxn, cell division, hereditary traits
Hyper: upper (tetany, nervous, vomit, tachycardia), hypocalcemia, CONSTIPATION
Hypo: downer (lethargy, wk, low BP, coma, confusion)
Causes of hypo/hyperphosphatemia
Hyper: hypocalcemia, renal failure, para thyroid, chemo, high VitD, high dairy
Hypo: intestinal malabsorption, low VitD, alcoholism
Magnesium
Mg2+: metabolizes carbs & protiens
Hyper: decreased DTRs
Hypo: hyperactive DTRs, pos Chv/Trou
Causes of hyper/hypomagnesemia
Hyper: pre-term labor/preeclampsia due to L&D giving Mg as muscle relaxers
Hypo: malabsorption, alcohol withdrawal
What is a major cause of electrolyte imbalances?
Kidney failure!
What populations have dif fluid content?
Women: more water
Obese: less water
Infant: more water - high risk due to small body
Orthopynea
SOB only while laying flat.
Common in HF and hypervolemia
Moat important symptoms in hyper/hypovolemia
Hyper: confusion (ALOC), orthpynea, edema
Hypo: confusion, low skin turgor, dry mucous membranes, wk peripheral pulses
What is key prevention for fluid imbalance?
Balance I&Os
Main hypovolemia symptom in older adults
Confusion
Usual adult oral water intake
2-2.5L/day
Where is edema most evident in ambulatory & supine clients?
Amb: ankles
Sup: sacrum
