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nur 112 > Preoperative Nutrition > Flashcards

Preoperative Nutrition Flashcards

1
Q

Protein labs

normal values

A

Normal = 6.4 – 8.3 g/dL

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2
Q

Albumin labs

A

Normal = 3.5-5 g/dL

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3
Q

Pre-albumin

Pre-albumin is better because:

statevules

A

Normal = 15-36 mg/dL (adult)

it reflects acute changes quicker

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4
Q

Transferrin ( females |males) * TWOOOOO*

A

Normal Values:

males 215-365 mg/dL

females 250-380 mg/dL

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5
Q

Transferrin is also a better test for ___________status than albumin because it responds to decreased protein levels more rapidly than albumin.

A

nutritional

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6
Q

Transferrin is a trace protein that

A

transports iron from the GI tract into the bloodstream.

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7
Q

Mild:

Albumin

Pre-albumin

Transferrin

A

2.8-3.4

10-15

150-200

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8
Q

Moderate

Albumin

Pre-albumin

Transferrin

A

2.1-2.7

5-9

100-149

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9
Q

Severe

Albumin

Pre-albumin

Transferrin

A

< 2.1

< 5

< 100

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10
Q

Question: Which of the following lab values suggest protein deficiency for an acutely ill patient?

a. Serum albumin 3.5 g/dL
b. Serum prealbumin 5 mg/dL
c. Serum albumin 4.5 g/dL
d. Serum protein 6.5 mg/dL

A

a. Normal albumin level is 3.5-5 g/dL
b. Normal prealbumin level is 15-36 mg/dL 🡪 5 mg/dL is too LOW!
c. Normal albumin is 3.5-5 g/dL
d.Normal protein level is 6.4-8.3 g/dL

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11
Q

_______detects rapid changes so it reflects acute changes. __________is a good measurement for long-term nutritional status since it takes longer to breakdown in the body.

A

Prealbumin

Albumin

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12
Q

Blood urea nitrogen (BUN)
Normal

A

Normal 10-20 mg

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13
Q

Creatinine
Female normal =
Male normal =

A

Creatinine
Female normal = 0.5 – 1.1 mg/dl
Male normal = 0.6 – 1.2 mg/dl

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14
Q

ZINC - (Essential for)

A

Protein synthesis
Wound healing
Normal lymphocyte and phagocyte response

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15
Q

IRON - Essential for:
State sources=

A

Replacement from blood loss
Hgb
Best Sources: Spinach, Lentils, soybeans, cashews, Duck, Goose, Wheat germ & Beef

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16
Q

Vitamin C - Essential for:
( gm/day)

A

Collagen Synthesis/wound healing
Capillary formation
Tissue synthesis
Antibody formation
Antioxidant to prevent tissue damage from inflammation
1-2 gm/day

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17
Q

Vitamin K - Essential for: (3)

A

Blood clotting
Intestinal synthesis
Prothrombin time

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18
Q

Vitamin A - Essential for:

A

Tissue synthesis
Wound healing/epithelialization
Immune Function

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19
Q

Thiamine =
Niacin =
Riboflavin =
= pyridoxine

A

Thiamine = B 1
Niacin = B 3
Riboflavin = B2
B 6 = pyridoxine

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20
Q

Thiamine, niacin and Riboflavin are members of the B vitamin family Requirements for all 3 of these increase __________.

A

as metabolic rate increases

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21
Q

________ is a disease due to niacin deficiency.

A

Pellagra

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22
Q

Pellagra you should remember the 4 D’s:

A

dermatitis, diarrhea, dementia, and death

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23
Q

K-

A

40 – 80 meq/day

Replace loss with excretion or GI suction
Prevent ileus

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24
Q

Magnesium:

A

Replace loss with GI suction

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25
Q

Na, CL, & K - Essential to:

A

Restore loss from diarrhea, vomiting, perspiration, diuresis, renal failure, drainage
Prevent electrolyte imbalance

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26
Q

Folic acid, Vitamin B12 - Essential for: ( think about DEVELOPMENT)

A

Tissue synthesis
Maturation RBC
Increased need because certain antibiotics cause malabsorption

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27
Q

Inflammatory Phase

A

3-5 days
Homeostasis and phagocytosis

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28
Q

Granulation Phase

A

5-28 days
Fibroblasts synthesize
Collagen increases
Eschar

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29
Q

Maturation Phase & Scar Contraction

A

7 days – several months or years
Fibroblasts continue
Wound is remodeled
Scar becomes stronger

30
Q

Nitrogen balance ( what should it be )

A

Protein In = Protein Out

31
Q

Anabolism -

Ex: tissue growth, recovery from surg. ( kind of nitrogen )

A

↑ protein = + nitrogen balance

32
Q

Catabolism -
Ex: surgery, burns, trauma

A

↓ protein= ‒ nitrogen balance

33
Q

hypermetabolic

A

state with stress to body

34
Q

hypermetabolic Stress includes:

A

any threat to homeostasis .
Accidents, Burns, Infection
Musculoskeletal injury
Soft tissue damage
Anesthesia, anxiety, pain
Any threat to equilibrium

35
Q

Circulating fluid volume r/t hypermetabolic stress ( think about urine)

A

ADH & aldosterone secreted, so Na is retained, K excreted to maintain plasma volume & osmolarity, urine output decreased, extracellular fluid retained

36
Q

Glucose to brain rt hypermetabolic stress ( what two things I stimulated )

A

glucocorticoids and catecholamine stimulate release of glucose from liver, glycogen from muscles and also stimulate fatty acids from fat cells that suppress the release of insulin

37
Q

Energy r/t catabolic state

A

fatty acids released used for energy, blood sugar elevated, insulin secretion decreased, breakdown of ketones, decreased appetite

38
Q

Nutrients r/t catabolic state

A

Negative nitrogen balance, erosion of muscle mass, blood proteins, enzymes, antibodies, collagen to provide nutrients for wound healing

39
Q

Nursing assessments that indicate catabolic state: ( flight or fight)

A

Decreased bowel sounds/peristalsis
Vasoconstriction- cool, pale skin, low BP
Elevated blood glucose
I>O, Urine retention, edema
Hypernatremia, hypokalemia

40
Q

Anabolic Phase

A

Begins when basic units no longer needed for energy, rebuilding phase
Loss of H2O & NA causes diuresis, I<O
Increased appetite, peristalsis, bowel sounds
K retained
Glucocorticoids & catecholamine secretion stops- Insulin & growth hormone secreted, blood glucose normal

41
Q

Fat Gain Phase

A

Final phase lasting 2-3 months
Fat lost during catabolism is regained
Immobility may lead to obesity
May need additional nutritional support

42
Q

Healthy adults are in__________nitrogen balance
Positive balance is when________
Negative balance is when _________

A

Healthy adults are in neutral nitrogen balance

Positive balance is when protein synthesis exceeds breakdown (growth, pregnancy, recovery from injury)

Negative balance is when catabolism exceeds synthesis (starvation or catabolic phase after injury)

43
Q

Osmolarity of feeding:

A

Based on the # of sugars, Amino acids, & electrolytes in formula

44
Q

________ same as blood, well tolerated

A

Isotonic, same as blood, well tolerated

45
Q

________ higher concentration, poorly tolerated, dumping syndrome run slowly

A

Hypertonic

46
Q

dumping syndrome
( s/s, state nursing interventions)

A

the stomach empties to the small intestine more quickly than it should. causing
n/v, diaphoresis /distention/cramps/weakness/dizziness

RUN SLOWY!

47
Q

NG tube ( advantages)

A

Short term: < 6 weeks
Advantages
Easy to place (and remove)
Uses stomach as a reservoir
Flexible feeding schedule
↓ risk of dumping syndrome over NI tube

48
Q

NG tube (Disadvantage)

A

↑ risk of aspiration
Irritation nose, mouth, esophagus
Easily displaced or pulled out
Not for long term use

49
Q

Nasoenteric (Advantages)

A

↓ risk of aspiration
Impaired gag, swallow reflexes/decreased consciousness

50
Q

Nasoenteric (Disadvantages)

A

↑risk of dumping syndrome ( bc right into small intestine)
Only for slow continuous feeds
Not for long term use

51
Q

GASTROSTOMY ( advantages/ disadvantages)

A

Uses stomach as a reservoir
Flexible feeding schedule
↓ risk of dumping syndrome over NI tube
More aesthetic for patient
↓ risk of misplacement in airway

Disadvantages
Risk for peritonitis
Stoma care

52
Q

Jejunostomy ( advantages vs disadvantages)

A

Advantages
↓ risk of aspiration

Disadvantages
Risk for peritonitis
Stoma care
Only for slow
continuous feeds

53
Q

A duodenostomy is used as a feeding site. T or F?

A

NOT used as a feeding site because the duodenum swings toward the back of the body and is not easily accessible.

54
Q

Intermittent feeding involves administration of EN over_______minutes every______hours via pump assist or gravity assist

A

20–60

4 to 6 hours

55
Q

PPN-

A

Isotonic solution, delivers 1020 calories/L
10% glucose, 5% AA, TE, MVI
500ml fat added (lipid solution) Total=2620cal/L

56
Q

TPN-

A

hypertonic solution, delivers 2550 calories/L

57
Q

PPN-Recommended for Pts. who:

A

Need short term use (7-10 days)
Do not need more 2000-2500 cal/day
Need oral supplements

it is given when the patient can not receive their nutrition orally and we are waiting for a central line or for enteral access.

58
Q

TPN recommended

A

Have long term need
Can not consume oral or enteral products
Need nutritional supplements D/T Cancer, AIDS, Acute Renal Failure (ARF),Acute Respiratory Failure (ARF), bone marrow transplant
Have extensive trauma, burns, GI problems
Have weigh loss of 10% or more

59
Q

TPN Complications

A

Catheter related problems; embolus, pneumothorax, sepsis etc.
Dehydration
Hyper & hypoglycemia
Electrolyte imbalance
Fat deposited in liver, elevated triglycerides ( risk for pts with severe hyperlipidemia)
Allergic reaction to lipids

60
Q

Nursing Assessments:

for tpn

A

Insulin (Rainbow) coverage q6h
Vs q4h
I/O, Weight
Electrolytes, CBC, protein, Liver enzymes, triglyceride, hepatic & renal function
S&S infection ( bc its sm sugar)
, fluid overload, breath sounds
S&S of hyperglycemia or hypoglycemia
Chest pain, back pain

61
Q

Administration of:
Fats-alone or 3:1

A

Fats-alone or 3:1
Milky white; Special tubing with filter/glass bottle/ yellowish color
Administer slowly -8-12 hours or as per policy

62
Q

Contraindications for TPN lipid

A

Severe egg allergy liver disease, atherosclerosis, pancreatitis, coagulation disorders, weak veins fluid restrictions, fat metabolism disorders

63
Q

S/S of Lipid Reaction:

A

Cyanosis,
fever
chills
back/chest pain,
dyspnea palpitations,
tachypnea,
wheezing,
nausea, blurred vision, bad taste in mouth

64
Q

PO
Clear Liquid-

Full Liquid=

Soft

House/Regular-

A

PO (ice) (Doctor may order ice chips, however, risk of aspiration)

Clear Liquid-Provides energy/fluid Min. digestion(p.243) / ;liquid at room temp/ shine light through(jello)

Full Liquid = ncludes liquid foods that are more nutritious than simple tea or broth.

Soft-A soft diet is a recommended diet for certain gastrointestinal pathologies. It is a low-fiber diet, smooth in texture, and easy to chew/ digest

House/Regular-Regular Diets, also called normal or house diets, are used to maintain or achieve the highest level of nutrition in patients who do not have special needs related to illness or injury. Regular house diet provides 70-80 gm protein, 100 gm fat, 200 gm CHO

65
Q

NPO

A

Low residue
Low fat clear liquid
Calorie reduction
Calorie enhanced
* Bowel prep

66
Q

Clear Liquid Diet

A

Short term
Clear and liquid @ room temp
400-500 cal
Deficient in calories and most nutrients
Inadequate for hypermetabolic state
Bouillon high in Na
Examples- tea, ginger ale, popsicle,
Jell-O, apple juice, broth

67
Q

Full Liquid Diet

A

Easily digested and consumed
High in cholesterol, dairy
Custard, ice cream, cream of wheat

68
Q

Soft Diet

A

Transition diet
Low residue- easily digested
Low in spice
Low cellulose and connective tissue- easier to chew
Tough foods restricted

69
Q

LIVER ENZYME TEST FUNCTIONS

A

ALP/ AST/ALT

70
Q

Medications added to parenteral nutrition

A
  • insulin = prevent hyperglycemia
  • heparin = prevtn fibrin build-up
  • prebiotic/ glutamine

nur 112 (23 decks)

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