Spring 2023: Exam One Notes Flashcards
(120 cards)
1
Q
What are symptoms associated with dehydration?
A
Increase in solutes (BUN), most lab values will be elevated, nausea, dizziness, sunken eyes, hyperventilation, excessive sweating, concentrated urine, dry inelastic skin, tachycardia, headache, fatigue, decreased appetite.
2
Q
What is the normal range of serum sodium?
A
135-145 mEq/L; it is the best assessment parameter for fluid status.
3
Q
What is the difference between hypernatremia and hyponatremia?
A
Hypernatremia is dehydration; Hyponatremia is over hydration.
4
Q
What are the three main causes of dehydration?
A
Decreased water intake; excessive water output: heavy solute load.
5
Q
What is the difference between acids and bases with hydrogen ions?
A
Acids releases hydrogen irons; Bases take up hydrogen ions.
6
Q
What is acid-base balance?
A
It is the regulation of hydrogen concentration.
7
Q
What is a buffer?
A
It is a mixture of acid and base components to protect against a strong acid or strong base.
A major buffer = carbonic acid and sodium bicarbonate
8
Q
What is a normal pH level? What is the level of a base and an acid?
A
A normal pH is 7
A base (alkaline) pH is >7 or 14
An acid pH is 0 or <7
9
Q
What do lungs control?
A
Lungs control supply of carbonic acid (carbon dioxide and water)
a. amount can be altered by rate and depth of breathing
10
Q
What is the difference between hypoventilation and hyperventilation with acid?
A
Hypoventilation = retention of acid; Hyperventilation = loss of acid
11
Q
What do kidneys control?
A
Kidneys control bicarbonate (base)
a. regulate hydrogen ion secretion and bicarbonate reabsorption
12
Q
What happens to the base when kidneys retain vs. excrete bicarbonate?
A
If kidneys retain bicarbonate = level of the base increases
If kidneys excrete excess bicarbonate = level of the base decreases
13
Q
A change in one side of the buffer brings about a compensatory change in the other side to maintain balance; what is the pH we want to maintain?
A
Maintaining a pH of 7.4
14
Q
What is acidosis related to respiratory failure?
A
Acidosis is the retention of carbon dioxide by lungs (decreased ventilation).
To compensate, kidneys increase absorption of the base.
15
Q
What is alkalosis related to respiratory failure?
A
Alkalosis is the loss of carbonic acid (increased ventilation)
To compensate, kidneys excrete additional base.
16
Q
What is acidosis related to metabolic failure?
A
Kidneys either produce or retain too much hydrogen leading to an increase in production of carbonic acid ; or the kidneys may excrete too much base. To compensate, respiration increases to remove carbon dioxide to decrease carbonic acid.
17
Q
What is alkalosis related to metabolic failure?
A
Loss of hydrogen due to the loss of acid; or an increased retention of base. To compensate, ventilation decreases to retain carbon dioxide to make carbonic acid.
18
Q
A patient has a pH of 7.32, a bicarbonate of 25, and a blood carbon dioxide of 56. What does this patient have?
A
Respiratory Acidosis
19
Q
A patient has a pH of 7.5, a bicarbonate of 24, and a blood carbon dioxide of 27. What does this patient have?
A
Respiratory Alkalosis
20
Q
A patient has a pH of 7.48, a bicarbonate of 30, and a blood carbon dioxide of 40. What does this patient have?
A
Metabolic Alkalosis
21
Q
A patient has a pH of 6.94, a bicarbonate of 15, and a blood carbon dioxide of 40. What does this patient have?
A
Metabolic Acidosis
22
Q
What does gravida mean?
A
Gravida refers to pregnancy
23
Q
What are the weight gain guidelines for the following pregnant women?
Normal weight female; BMI 18.5 - 24.9
Underweight female; BMI < 18.5
Overweight female; BMI 25 - 29.9
Obese female; BMI > 30
A
Normal weight female 25-35 lbs
Underweight female 28-40 lbs
Overweight female 15-25 lbs
Obese female 11-20 lbs
24
Q
What is the main target to weight gain in pregnant women?
A
To achieve the lower limit weight gain guideline.
25
What is the main target to weight gain in young and black women?
To achieve the upper end of the weight gain guideline to reduce risk
26
How many calories are increased during the second and third trimester?
Second trimester: +340 calories
Third trimester: +452 calories
27
How many calories are increase during the 6 month and 6-12 month period of lactation?
6 month: +330 calories
6-12 month: +400 calories
28
When is protein increased to 71 gm?
It is increased during the second half of the pregnancy and during lactation.
29
What are the minimum recommended levels of hemoglobin and hematocrit?
Hemoglobin: 11 g/dL
Hematocrit: 33%
30
Pregnant adolescents are at higher risk during pregnancy, what are the three extra things they need?
Iron; Calcium; Zinc
31
How much and when do pregnant women need supplementation of ferrous sulfate?
30 mgs during the second and third trimester (taken between meals, not with milk, tea, or coffee)
32
How much folic acid is needed for pregnant women?
400 mcg (added 200 mcg from food = 600 mcg)
33
What is the AI of calcium for pregnancy and lactation?
<18 yrs = 1300 mg
>18 yrs = 1000 mg
34
What is progesterone?
Progesterone is the hormone that develops placenta after implantation
35
What is the recommendation for linolenic acid for pregnant women and lactation?
1.4 g/day (300 mg DHA)
1.3 g/day for lactation
It is needed for the development of the fetal nervous system
36
What supplement do pregnant want to avoid excess intake of?
Vitamin A (supplements > 5000 IU)
37
What is the normal birth weight, lower birth weight, very low birth weight, and extremely low birth weight?
NBW = 2500-4000 g
LBW = =<5.5 lbs / <2500 g
VLBW = <3.3 lbs / <1500 g
ELBW = <1000 g
38
What are the percentiles for small for gestational age, appropriate for gestational age, and large for gestational age?
SGA = <10th percentile birth weight for gestational age
AGA = 10th to 90th percentile
LGA = > 90th percentile
39
What is the average calories/kg for a 0-6 month and a 7-12 month infant?
0-6 month = 108 cal/kg
7-12 month = 98 cal/kg
40
What is the protein RDA for a 0-6 month and a 7-12 month infant?
0-6 month = 9.1 g (1.52/kg)
7-12 month = 11 g (1.2/kg)
41
What is the water recommendations for infants?
125-155 mL/kg (based on age) or 1.5 mL/ kcal
42
What is the fat recommendations for infants?
minimum of 30 grams per day
43
What does neonate mean?
It is birth to 1 month; in which they can absorb whole, intact protein
44
What is the NCP?
The NCP is the nutrition care process that is a standardized, consistent structure ad framework used to provide nutrition care. This is different from standardized care, which infers that all patients receive the same care.
45
What are the steps of the NCP?
The steps include assess, diagnose, intervene, monitor and evaluate (ADIME)
46
Can all health care professionals provide the NCP?
Yes, but to an extent as a supportive role; only 5-10 minutes. This is not the whole 4 step process.
47
What do you review in the screening process?
Client's history; lab results; weight; physical signs
48
For screening to be effective, it relies on what two things?
Specificity (can it ID patients without a condition)
Sensitivity (can it ID those who have a condition)
49
What is cultural competence?
Cultural competence is the ability to provide care to patients with diverse values, beliefs and behaviors and tailor delivery to meet their social, cultural, and linguistic needs.
50
What do you prioritize in screening and why?
Prioritize nutrition risk.
The Joint Commission requires that risk is identified in hospitalized patients, but does not mandate a method of screening.
51
Screening Tools:
What is SGA?
Subjective Global Assessment (history, intake, GI symptoms, functional capacity, physical appearance, edema, weight change)
52
Screening Tools:
What is MNA?
Mini Nutritional Assessment (evaluates independence, medications, number of full meals consumed each day, protein intake, fruits and vegetables, fluid, mode of feeding); 65 years of age and older.
53
Screening Tools:
What is NSI?
Nutrition Screening Initiative (elderly)
54
Screening Tools:
What is GNRI?
Geriatric Nutritional Risk Index (serum albumin, weight changes)
55
Screening Tools:
What is MST?
Malnutrition Screening Tool (acute hospitalized adult population) recent weight loss, recent poor dietary intake.
56
Screening Tools:
What is NRS?
Nutrition Risk Screening (medical-surgical hospitalized) % weight loss, BMI, intake, >70 years.
57
Screening Tools:
What is MUST?
Malnutrition Universal Screening Tool (BMI, unintentional weight loss, effect of acute disease on intake for more than five days)
58
What are the two things nutrition assessment compares?
It compares data collected and reliable standards.
59
What are the five critical thinking skills needed for nutrition assessment?
a. Observe verbal/nonverbal cues that can guide effective interviewing methods
b. Determine appropriate data to collect
c. Select tools and procedures and apply in valid, reliable ways
d. Distinguish relevant from irrelevant, and important from unimportant data
e. Validate, organize and categorize the data.
60
What are the three components of nutrition assessment?
Review - review factors that affect nutritional and health status
Cluster - data is clustered for comparison with characteristics of a diagnosis; food/nutrition related history, lab/medical tests, nutrition-focused physical findings, anthropometrics, client history.
Identify - these indicators are compared to identified standards and criteria for interpretation and decision-making. Indicators are clearly defined markers that can be observed and measured. They are also used to monitor and evaluate progress towards nutrition outcomes. Nutrition care criteria are what indicators are compared against.
61
What is documentation in the nutrition assessment?
date and time, pertinent data and comparison with standards, patients' perceptions, values and motivation related to the problem, changes in patients' level of understanding, behaviors, outcomes, reason for discharge.
62
What are the four dietary intake assessment tools?
a. diet history - present patterns of eating. Do not ask leading questions
b. food record - food diary, record of everything eaten in a specific period of time
c. 24 hour recall - mental recall of everything eaten in previous 24 hours. Quick tool to estimate a sample daily intake. Clinical setting. Underreporting and overreporting are concerns
d. food frequency lists - how often an item is consumed. Community setting. Quick way to determine intakes on large numbers of groups.
63
What formula estimates the most desirable body weight?
The Hamwi Formula
64
What is important to consider with % of weight change?
It stresses the significance of weight change, and assesses nutritional risk.
65
What is considered significant weight loss?
Significant weight loss is 10% loss within 6 months
66
What is TSF and what does it do?
TSF is triceps skinfold thickness.
It measure body fat reserves and measures calorie reserves
Standards for males is 12.5 mm and females is 16.5 mm
67
What is AMA and what does it do?
AMA is arm muscle area.
It measures skeletal muscle mass (somatic protein)
To determine it using TSF and MAC (midarm circumference)
Standards for males is 25.3 cm and female is 23.2 cm
It is important to measure in growing children
68
How do you measure BMI (body mass index)?
Weight in kg is divided by height squared in meters; or weight in pounds divided by height in inches squared x 703.
69
What are the BMI ranges for healthy, overweight, and above obese individuals?
Healthy adults - 18.5 - 24.9
Overweight adults - 25-29
Over Obese - >30
70
What is the recommendations for waist circumference and why?
Males: >40
Female: >35
Waist circumference is best for assessing risk, it predicts central adiposity.
71
What is WHR and what does it do?
WHR = Waist/Hip Ratio
It differentiates between android and gynoid obesity.
WHR of >1 in men and >0.8 in women is indicative of android obesity and an increased risk for obesity-related diseases. (diabetes, hypertension)
72
BIA, or known as bioelectrical impedance analysis, used at bedside to evaluate fat free mass and total body water (usefulness may be limited) should be noted what?
The patient MUST be well-hydrated, no caffeine, alcohol or diuretics in the past 24 hours, no exercise in the past 4-6 hours.
It can be impaired by fever and electrolyte imbalance, and extreme obesity.
73
The bod pod is what and what does it do?
The bod pod or ADP; air displacement plethysmography
It measure body composition by determining body density. It measuring the amount of air displaced (as accurate as underwater weighting)
74
What is NFPE, what is the inspection, and what is the information obtained?
NFPE = nutrition-focused physical exam
Inspection: visual assessment using sight, sense of smell and hearing to observe textures, sizes, colors, shapes, and sounds.
Information obtained: obesity, cachexia, fluid status, skin integrity, wound healing, feeding devices, jaundice, ascites.
75
What is palpitation?
It is gathering data via touch using palms and fingertips
Information that is obtaining = areas of tenderness, muscle rigidity, fluid retention, pitting edema, skin integrity, skin moisture, and body temperature.
76
What is auscultation?
It is listening to bowel using stethoscope on the RLQ (right lower quadrant which is the location of the ileocecal valve)
Assessment:
1 = normal bowl sounds are gurgling high-pitched sounds every 5-15 seconds.
2= hypoactive bowel sounds, every 15-20 seconds, may indicate paralytic ileus or peritonitis
3 = hyperactive, continuous, high-pitched, tinkling sounds may indicate diarrhea or intestinal obstruction
77
What is auscultation?
It is listening to bowel using stethoscope on the RLQ (right lower quadrant which is the location of the ileocecal valve)
Assessment:
1 = normal bowl sounds are gurgling high-pitched sounds every 5-15 seconds.
2= hypoactive bowel sounds, every 15-20 seconds, may indicate paralytic ileus or peritonitis
3 = hyperactive, continuous, high-pitched, tinkling sounds may indicate diarrhea or intestinal obstruction
78
What are inputs and outputs used for?
Inputs and outputs are used to assess hydration status, measure fluid balance
79
What are the normal levels for serum albumin and what is important to note?
3.5-5.0 g/dL; visceral protein (blood and organs)
a. maintains colloidal osmotic pressure
b. hypoalbuminemia associated with edema and surgery
c. levels above normal range likely due to dehydration
d. long half-life, does not reflect current protein intake
80
What are the normal levels for serum transferrin and what is important to note?
>200 mg/dL visceral protein (transports iron to bone marrow)
a. serum level controlled by iron storage pool; rises with iron deficiency
b. can be determined by TIBC (total iron binding capacity)
c. not useful as measure of protein status
81
What are the normal levels of TTHY transthyretin and PAB prealbumin and what is important to note?
16-40 mg/dL
a. short half-life; picks up changes in protein status quickly
b. during inflammation, liver synthesizes CRP at expense of PAB
c. limited usefulness in screening or assessment
82
What are the normal levels of retinol binding protein (RBP) and what is important to note?
3-6 mg/dL
a. circulates with prealbumin; shortest half-life (12 hours)
b. binds and transports retinol
83
What is the normal ranges for hematocrit and what is important to note?
Men - 42-52%
Women - 36-48%
Pregnant Women - 33%
Newborn - 44-64%
a. volume of packed cells in the whole blood
84
What is the normal ranges for hemoglobin and what is important to note?
Men - 14-18 gm/dL
Women - 12-16 gm/dL
Pregnant Women - >11
a. iron-containing pigment of red blood cells
b. erythrocytes are produced in bone marrow
85
What is the normal ranges for serum ferritin and what important to note?
10-150 ng/mL for females and 12-300 ng/mL for males
a. indicates size of iron storage pool
86
What is the normal ranges of serum creatinine and what important to note?
0.6-1.2 mg/dL for males and 0.5 - 1.1 mg/dL for females
a. related to muscle mass; measures somatic protein
b. may indicate renal disease; muscle wastage
87
What is the normal ranges for creatinine height index (CHI) and what is important to note?
80% normal
a. ratio of creatinine excreted / 24 hours to height
b. estimates lean body mass - somatic protein
c. 60-80% mild muscle depletion
88
What is the normal ranges for blood urea nitrogen (BUN) and what is important to note?
10-20 ng/dL
a. related to protein intake
b. indicator of renal disease
c. BUN: creatinine ration; normal - 10 -15:1
89
What is the normal ranges of urinary creatinine clearance and what is important to note?
115 + 20 mL/minute
a. measures GFR - glomerular filtration, renal function
b. estimate includes body surface area (height and weight)
90
What is the normal ranges of total lymphocyte count (TLC) and what is important to note?
>2700 cells/cu mm
a. measure immunocompetency
b. moderate depletion 900-1800, severe depletion <900
c. decreased in protein-calorie malnutrition
91
What is the normal ranges for C-reactive protein (CRP) and what is important to note?
It is a marker of inflammatory stress
a. as it declines, indicates when nutritional therapy would be beneficial
b. when elevated CRP decreases, PAB increases
92
What is the normal ranges for free erythrocyte protoporphyrin (FEP) and what is important to note?
It is a direct measure of toxic effects of lead on heme synthesis. Increased in lead poisoning. Lead and calcium compete at plasma membrane for transport.
93
What are the normal ranges of prothrombin time (PT) and what is important to note?
11.0 - 12.5 seconds; 85-100% normal
a. anticoagulants prolong PT
b. evaluates clotting adequacy; change in vitamin K intake will alter rate
94
What is important about hair analysis?
It is not for nutritional assessment; useful in measuring intake of toxic metals
95
How do you assess energy requirements and what are the formulas?
It is based on activity factors and BEE
a. BEE x 1.2 sedentary
b. BEE x 1.3 active
c. BEE x 1.5 stressed
96
What is the effect of megestrol acetate?
appetite stimulant
97
What is the effect of marinol?
appetite stimulant
98
What is the effect of dextroamphetamine (adderall)?
appetite suppressant, anorexia, nausea, weight loss
99
What is the effect of orlistat?
decreased fat absorption by binding lipase; vitamin and mineral supplement
100
What is the effect of methylphenidate (Ritalin)?
anorexia, weight loss, and nausea
101
What is the effect of statins?
avoid grapefruit juice; decreased LDL, TG; increase HDL
102
What is the effect of chemotherapy?
Malabsorption
103
What is the effect of mineral oil, cholestyramine?
decrease absorption of fat, fat-soluble vitamins
104
What is the effect of glucocorticoids and antibiotics?
protein deficits
105
What is the effect of oral contraceptives?
decrease folate, vitamin B6 and vitamin C
106
What is the effect of loop diuretics?
deplete thiamin, potassium, magnesium, calcium, and sodium
107
What is the effect of thiazide diuretics?
decrease potassium and magnesium, absorb calcium
108
What is the effect of antibiotics?
decrease vitamin K
109
What is the effect of corticosteroids?
hyperglycemia, thin skin, hypertension, bone fracture
110
What is the effect of methotrexate
decrease folate
111
What is the effect of lithium carbonate (antidepressant)
increased appetite, weight gain; maintain consistent sodium and caffeine intake to stabilize levels. If sodium r caffeine are restricted, lithium exertion decreases, leading to toxicity.
112
What is the effect of anticoagulant (warfarin sodium)
antagonizes vitamin K; avoid Ginkgo biloba extract (GBE), garlic, ginger, avoid high dose of vitamin A, K, and E
113
What is the effect of Propofol?
administered in oil, consider fat calories, 1.1. cals/cc, check TGs
114
What is the effect of phenobarbital?
decreased folic acid, vitamins B12, D, K, and B6
115
What is the effect of cyclosporine?
hyperlipidemia, hyperglycemia, hyperkalemia, hypertension
116
What is the effect of isoniazid?
depletes pyridoxine, peripheral neuropathy, don't take with food, interferes with vitamin D, calcium, and phosphorus
117
What is the effect of Elavil?
sedative effect, weight gain, increased appetite
118
What is the effect of calcium?
binds tetracycline
119
What is the effect of tyramine?
hypertension if taken with MAOI (monoamine oxidase inhibitor)
120
What is the effect of curcumin (turmeric)?
may reduce inflammation, antioxidant, in curry powder
