Nutrition & Elimination Flashcards
define nutrition
all interactions between organism and food
nutritive value
nutrient content of specified amt of food
“macro” vitamins & minerals
K, P, Na, Ca, Mg, Cl, S
“micro” vitamins & minerals
Fe, Zn, manganise, I, Fl, Copper, Cobalt, chromium, selenium
where do most people get fluoride? who is at risk for deficiency?
city water
people who drink from a well
major enzyme for carbs
Ptyalin (salivary amylase)
how to raise a pt’s blood sugar quickly?
cake icing
dissolve in mouth
follow up with protein - PB, etc
enzyme beginning protein digestion in mouth
pepsin
trypsin, chymotrypsin, carboxypeptidase are from the…
and digest…
pancreas
proteins
aminopeptidase, dipeptidase are from the…
and digest…
intestine wall
proteins
who has to take enzymes with meals?
cystic fibrosis pts
anabolism vs catabolism
ana - building tissue
cata - breaking down
define nitrogen balance
degree of anabolism & catabolism
+ means more anabolism
- means more catabolism
“full” arms of hydrogen
saturated fats
2 types of unsaturated fats
monounsaturated
polyunsaturated
enzymes needed for lipid digestion
bile
pancreatic lipase
enteric lipase
bile
function
made and stored where?
emulsifies and increases surface area of fats
made in liver, stored in gallbladder
which pts cannot eat lipids?
gallbladder removed/nonfunctioning
lipid storage
adipocytes
why are vitamins needed in body
to catalyze metabolic processes
which vitamins are needed daily because they can’t be stored?
which can be stored?
water soluble (C, B) - needed daily
fat soluble (A, D, E, K) - storable
energy balance =
intake minus what we use
carbs - __cal/g
proteins - __cal/g
fats - __cal/g
alcohol - __cal/g
4
4
9
7
BMR
rate at which body metabolizes food to maintain energy requirement of a person awake and at rest
REE
amt of energy required to maintain basic body functions or calories required to maintain life
what is the rule of 5’s/6’s?
ideal weight
FEMALES - rule of 5s: 100 lbs for first 5 feet - then 5 lbs for every inch >5 ft
MALES - rule of 6s: 106 lbs for first 5 feet - then 6 lbs for every inch >6 ft
use BMI with caution in these pts
retain fluid, athletes, older adults
BMI
underweight =
healthy =
overweight =
obese =
extremely obese =
- Underweight - <18.5
- Healthy - 18.5-24.9
- Overweight - 25-29.9
- Obese - 30-39.9
- Extremely obese - 40+
what kind of fat distribution is unhealthy? what kind is healthier?
visceral is unhealthy
buttock is healthier
why do women need more iron than men?
loss through menstruation
nutritional complications of alcohol
wt gain
wt loss
vitamin B deficiency
nutrition — birth to 1 year
demand feeding
regurgitation
iron deficiency
bottle mouth syndrome (tooth problem)
nutrition — toddlerhood
eats most foods
adjusts to 3 meals/day
feeds self
teeth care
nutrition — preschool
eating adult foods
may require snacks
nutrition — school age
balanced diet important
start to teach healthy eating habits
poor habits lead to obesity
nutrition — adolescents
increased need for nutrients, Ca+
risk for eating disorders
nutrition - young adulthood
pay attention to protein, Ca+
limit cholesterol
nutrition — postmenopausal women
need Ca+ and vit D (reduces osteoporosis)
nutrition — older adults
need same nutritional intake, but less calories
more fluid, fiber, activity
decreases sense of smell & tooth loss
also may have issues c loneliness, transportation & access to food
keep fats < _____% of total calories
20-35%
how to prevent choking while eating
chin tuck
how long can someone be on a clear liquid diet?
24-36 hrs
exceptions to clear liquid diets
CANNOT have: red liquid
CAN have: coffee; popsicles; gelatin; honey; hard candy
exceptions to full liquid diets
CAN have: pudding; ice cream; cream; butter; eggs; yogurt
intervention that can help people with neuro, musculoskeletal, etc problems eat/drink
altered utensils
purposes of NG tube (5)
- Feedings
- Medications
- Suctioning stomach contents to prevent distension & n/v
- Remove stomach contents for analysis
- Lavage (wash) stomach in case of poisoning, OD
offer oral care q __ hr for NG tube pts
2 hr
flush NG tube with _____ mL water
10-30
how to give meds via NG tube
- dilute liquids, especially viscious
- crush and dissolve (if allowed)
- draw up fluid from capsule (if allowed)
- give each med alone with 30-60 mL warm water
- flush after each med with 15-30 mL
- change amt of water used according to how many meds there are
ways to check NG tube placement
air bolus
pH
bilirubin
x-ray
which NG tube needs more attention to flushing
Dobhoff
having pts in high Fowlers during NG tube placement, feeding, & med admin prevents…
aspiration
always do before administering tube feeding
check residual
do not give feeding if it is over amt given by the policy
give residual back
anytime you take cap off of the NG tube, you must…
kink the tubing
upper urinary tract organs
kidneys
ureters
lower urinary tract organs
bladder
urethra
pelvic floor
location of kidneys
retroperitoneal on either side of spine
kidney function
filter blood, remove metabolic wastes
regulate acid/base
regulate fluid
capacity of bladder
300-600 mL
what causes bladder spasm?
voiding too quickly
base of the bladder
trigone
length of urethra in women & men
women - 3-4 cm
men - 20 cm
why are women more prone to UTI?
anus closer to urethra
shorter urethra
what do we want UTI pts to do?
drink a lot of fluid
void every 2-3 hr
components of continence mechanism
internal sphincter involuntary
external sphincter voluntary
process of urination (6)
- Urine collects in bladder
- Pressure stimulates stretch receptors
- Stretch receptors transmit impulses to spinal cord voiding reflex center
- Internal sphincter relaxes, stimulating urge
- If appropriate, conscious portion of brain relaxes external urethral sphincter muscle
- Urine is eliminated
which exercises help voluntary control of urination?
kegel
pelvic floor
when does fetal kidney start to produce urine?
11-12 weeks
urination in infants
no voluntary control
20x/day
minimal concentration - colorless, odorless
urination in children
kidneys become more efficient
able to control urge to void around 2.5-3 years
full control (day & night) occurs at 4-5 years
urination in older adults
declining ability to concentrate urine
bladder muscle tone diminshes - nocturia
increased residual urine
incontinence - mobility problems, neuro impairments
nocturnal enuresis
bedwetting
when does bedwetting become abnormal?
>6yo
psychological factors affecting urination
privacy
natural position
being rushed
why does alcohol increase urinary output?
decreases ADH
why does caffeine increase urinary output?
irrirates urinary tract
natural diuretic
grapefruit juice
adverse effects of diuretics
loss of potassium
cramping
voiding position for men with prostate enlargement
sitting down
cytoscopy
inspection of bladder
polyuria
excessive urination
polydipsia
excessive thirst
oliguria
low urine output
<500 mL/day
<30 mL/hour
interventions for oliguria
offer fluids
assess for dehydration
anuria
no urine
sx of UTI
frequency
urgency
nocturia
dysuria
primary urinary problems (4)
enuresis, incontinence, retention, neurogenic bladder
urinary frequency > __x/day
4-6
nocturia >__x/night
2+
sudden strong desire to void - with or without large amt of urine in bladder
urgency
dysuria
painful/difficult urination
involuntary urination in children beyond age of bladder control
enuresis
bedwetting affects girls or boys more?
boys
emptying of bladder impaired - associated c overflow incontinence - prostate enlargement - having a catheter in for a long time
urinary retention
stress incontinence
weak pelvic floor
urgency incontinence
inability to stop voiding
overflow incontinence
neurogenic bladder
can’t perceive fullness
transient & functional incontinence
factors outside urinary tract - physical limitations
NORMAL URINE
amt in 24 hours
color
clarity
odor
sterility
pH
specific gravity
glucose
ketones
blood
1200-1500/24hr
straw colored
transparent
faintly aromatic odor
sterile
- 5-8 pH
- 010 to 1.025 specific gravity
no glucose, ketones, blood
who might not have non-sterile urine normally?
females - touches lots of things on its way out
how to calculate urine output with continuous bladder irrigation
measured output - irrigation put in = true output
PVR
normal
how to measure
post-void residual urine
50-100 mL
bladder scan or straight cath
preventing UTI (8)
- Drink 8 8oz glasses of water
- Frequent voiding - q2-4hr
- Avoid harsh soaps, bubble baths, powders, sprays in perineal area
- Avoid tight clothing
- Wear cotton underwear
- Wipe front to back
- Take showers rather than baths
- Urinate before/after sex
crede maneuver
pushing on bladder to void
for men, what type of catheter is preferred?
condom
catheter care
no kinks
clean away from pt multiple times per shift
check skin integrity
may be used in females who otherwise have to self-cath & have difficulty
suprapubic catheter
_____ mL chyme moves from sm intestine to lg intestine daily
1500
length of rectum
4-6 inches
length of anal canal
1-2 inches
distended veins in rectum
hemorrhoids
NORMAL FECES
color (adult, infant)
consistency
shape
amt
odor
constituents
brown in adults, yellow in infants
formed, soft, semisolid, moist
cylindrical; 2.5 cm diameter
100-400 g/day
aromatic
undigested roughage, dead bacteria & epithelium, dried constituents of digestive juices
feces are ____% water, ____% solid
75% water
25% solid
first stool of newborn
meconium
toddlers achieve some control of defecation by _____ yo
1.5-2
tx for constipation
FFA
fluid, fiber, activity
GI considerations/interventions after surgery
anesthesia stops peristalsis
assess for peristalsis, flatus
auscultate bowels
decreased frequency; hard dry formed stools; straining; painful; feeling of fullness; anorexia & nausea; h/a
constipation
high risk pts for constipation
school age children
older adults
pts on pain meds
causes of constipation (7)
IBS; pelvic floor dysfunction; slow transit; neurologic conditions; emotional disturbances; medications; habitual denial/suppression of urge
mass or collection of hardened stools in folds of rectum
fecal impaction
what is a life threatening concern with constipation?
straining can activate vasovagal response
can cause heart failure
which pts would you be especially cautious about digital removal of fecal impactions with?
heart patients
(vasovagal response)
passage of liquid feces; increased frequency; cramps & increased bowel sounds; fatigue, weakness, malaise, emaciation, dehydration
diarrhea
eructation
burping
how long should a pt be on a bedpan?
no more than 15 mins
how long should a pt hold an enema?
as long as they can
30 mins
