Unit 2 Flashcards
Why is the GFHP of Nutrition and Metabolism important?
Deficiencies may explain other problems fluid intake is important problems r/t being underweight or obese skin is 1st line of defense against infection treatment may interfere with metabolism
What do nutrients do?
supply the body with necessary elements for growth
List the different kinds of nutrients
Carbs
fats
proteins
alcohol (on hormones)
Essential nutrients (list)
Water electrolytes minerals vitamins and proteins for tissue building
what nutrient is used to heal wounds?
protein
Daily calorie Requirement for men? women?
2800
2000
Macro nutrients (list)
Carbs
protein
fats
Carbohydrates (why do we need them where do we get them?)
Main energy source
sources for CHO: fruits vegies grains milk
how many calories is 1g of carbs?
4cal
what percentage of calories should carbs account for?
55-60%
Protein (why do we need it?)
essential in growth and repair of tissues
20 amino acids exist
10 essential amino acids- not synthesized by body, a complete protein food has all 10 (animal product)
How many calories is 1g of protein?
4 Calories
what percentage of calories should proteins account for?
12-20%
Fats (what do we need them for? fxns?)
main source of fatty acids, essential for growth and development
fx hormones, tissue structure, nerve impulse, insulation, protection
how many calories are in 1g of fat?
9 calories
what percentage of calories should fats account for?
25-30%
Micronutrients (list)
vitamins and minerals
Vitamins
Water soluble: peed out by body if excess
Fat soluble: can be toxic if in excess because body holds onto these.
List the fat soluble vitamins
ADEK
Metabolism
process of producing and using energy within body cells fueled by nutrients -energy produced -energy used -needs to be balanced for health THYROID HORMONES PLAY A MAJOR ROLE
Ways energy is used in the body
to maintain essential life processes: breathing, circulation, nervous system function
to support non essential life activities: running, working, thinking, stress management, digestion/absorption.
Basal Metabolic Rate (BMR)
the amount of energy required for essential life processes.
breathing circulation and nervous system
when is BMR measured?
when the body is physically, metabolically, and emotionally at rest.
influenced by: activity, hormonal imbalance, temperature, stress, and illness.
anabolism
Cell building.
excess stored as fat and can be used for body needs if nutritional intake is not sufficient
fat excess=weight gain
BMI normal
18.5-24.9
Catabolism
breaking down of cells and tissues
necessary for a constant source of energy
excess= decreased weight.
muscle wasting caused by
excess catabolism.
Ingestion
nutrients taken into the GI tract, taking food into the mouth
Digestion
breakdown of ingested nutrients to be absorbed by body
begins in the mouth (chewing and saliva) peristalsis to the stomach, with other chemicals to break down nutrients.
When in the small intestines secretions from the pancreas liver, gall bladder and intestinal wall complete digestive process. nutrients are absorbed into the blood from the small intestine.
Absorption
passage of digested foods from the GI tract to blood/ lymph circulation
blood channeled to liver where metabolic processes occur
most nutrients and electrolytes are absorbed in the small intestines.
Transport
Movement of nutrients across the cell membrane.
Metabolism
Final process of nutrition, energy produced and used by body cells
Positive balance of metabolism
more consumed than excreted
increased demand during times of pregnancy, growing, kids.
Anabolic state
Negative balance of metabolism
intake less than output
loss of protein in the form of muscle and other tissue
metabolic demands are not met,
Catabolic state
Lab tests for metabolism
24 hr urine specimine
BUN blood test
24 hr food intake (cal count)
Albumin and protein blood tests
BUN normal
7-20 mg/dL
Albumin normal
3.4-5.4 g/dL
Skin
Physical barrier
protects underlying tissues, and organs
plays a role in temp. fluid/electrolyte balances, absorption, excretion, immunity, vitamin D synthesis
Skin Layers
Epidermis
dermis
subcutaneous
Epidermis
outer layer, skin color
Dermis
connective tissue and blood vessels, helps strengthen skin.
TB testing done at this layer
Subcutaneous
connective tissue.
infiltrated with fat, blood vessels and nerves, glands.
injections/immunizations done here.
pressure sores
Skin deprived of oxygen
Stage 1 pressure ulcer
blood stasis (red spot, non blanchable)
redness not relieved by massage or pressure relief
warm to touch
Stage 2 pressure ulcer
epidermal loss, possible damage to dermis
moist and depressed skin erosion, abrasion, blister or shallow crater
can heal okay r/t no blood vessel damage.
stage 3 pressure ulcer
full thickness skin loss
ulcer can extend to the subcutaneous layer
sero-sanguinous or purulent drainage is common
healing time is longer, needs regranulation
Stage 4 pressure ulcer
full thickness deep into connective tissue, muscle, bone,
may have necrosis
need adequate protein and albumin levels for healing
healing time longer
may need debridement
two types of debridement (stage 4 ulcer)
cut away necrotic tissue
wet to dry dressing changes.
healing stage 2 pressure ulcers
primary intention, epithelial migration, cell division, differentation of new epidermis
healing stage 3&4 wounds
secondary intention
tissue regeneration necessary
inflammation, granulation, matrix formation and remodeling (dark pink scar)
wound healing needs
adequate proteins, normal albumin, hemoglobin, hematocrit and transferrin levels
signs and symptoms of impaired wound healing
increased redness and swelling pus formation dehiscence (spreads apart) wound color changes decreased granulation tissue
Lymph nodes
act as filters of lymph fluid
located in the head neck breast axilla inguinal clavicle and popliteal areas
examined by palpation: roll up and down b/t fingers if palpable
not visible or palpable unless inflamed
Lymphadenitis
inflammation of the lymph nodes
painful
lymphangitis
inflammation along the course of the lymphatic vessel
lymphedema
tissue swelling
palpate by putting pressure over shin and ankle for 3-5 seconds.
most concerning lymph node finding
palpable nodes that are fixed to underlying tissue
thyroid gland
largest endocrine gland
controls metabolic rate hormone
secretes 3 hormones
hormones secreted by thyroid gland
T3
T4
calcitonin
T3
increases BMR with increased O2 consumption
increases chem. rxn rates.
increases heat prod.
promotes human growth
T4
same fxns as T3
can be converted to T3
secreted in greater amounts
longer life span than T3.
Calcitonin
Calcium metabolism
parathyroid glands
located on posterior surface of thyroid gland
regulates calcium, phosphorus metabolism
Hyperthyroidism
bulging eyes
weakness/fatigue
diaphoresis
tachy, CP, Dysrhythmias, increased BP
wt loss, increased appetite, diarrhea or constipation
restless, nervous, insomnia, irritable, hyperactivity
Hypothyroidism
swollen face
decreased CO, enlarged heart, decreased blood pressure
lethargy fatigue slow speech
atherosclerosis increased cholesterol
wt gain, decreased appetite decreased parastalsis
dry brittle hair
memory impairment
Exopthalmus
BUG EYES r/t hyperthyroidism
Myxedema
facial edema r/t hypothyroidism
Diabetes problems in skin
chronic skin infections with ulcerations
yeast infections under breasts, b/t fingers, toes, axilla etc.
Liver skin problems
jaundice, edema, ascites, impaired protein metabolism
ETOH red palms spider veins
Renal skin probs
pale (pallor), platelet dysfunction (bleeding probs), jaundice, edema
impaired O2 Skin evidence
pallor cyanosis flushing mottling (lace pattern) cold clammy
PVD skin probs
pale mottling necrosis cold ulcerations
skin assessment categories (list)
color pigment moisture temp texture thickness tugor mobility hygiene lesions
koilonychia
spooning of nail r/t malnutrition
beaus lines
lines on nails r/t recent illness
clubbing
r/t respiratory function.
Brawny (r/t edema)
warm weeping, shiny, tight, r/t heart failure
OLD CARTS
Onset Location Duration Characteristics Aggravating Related Treatment severity
GFHP cognitive perceptual definition
describes the ability to collect and use information
decision making and other cognitive processes
neurological system
major biological support system
neuro pathology affects this system
cognition
the process of knowing involves intellectual function learning motivation thinking thought processes problem solving
perception
the process of acquiring infor
involves using senses
meaning ful interpretation
goals for assessing C-P
note status of all senses
note awareness of self surroundings
ID risk factors
note ability and knowledge to manage health
Why is the C-P pattern important
perception of pain/severe discomfort signals possible tissue damage.
Perception is a protective mechanism, vision hearing and touch provide information used in higher cognitive processess
assessment for C-P
Level of consciousness orientation memory reality based thinking judgement
GLASCOW Coma Scale
used in the ICU
assessment tool for assessing LOC cerebral dysfunction
assesses eye opening, motor and verbal responses
Levels of Conciousness
fully awake- highest level
Alert- awake and oriented, responds to verbal commands
Lethargic- not fully alert, drowsy/sleepy, arousable, loses train of thought, spontaneous movements.
Obtunded- sleeps most of the time few spontaneous movements, more rigorous stimulation to arouse, decrease in appropriate responses to verbal commands
Stuporous/ Semi Comatose- Unconscious most of the time, no spontaneous motor activity, verbal responses limited or absence, rarely awake or oriented.
Comatose- unable to arouse with painful stimuli, +gag reflex, +cough reflex, if no reflexes in deep coma
fully awake
highest level if LOC
Alert
awake and oriented, responds to verbal commands
Lethargic-
not fully alert, drowsy/sleepy, arousable, loses train of thought, spontaneous movements.
Obtunded
sleeps most of the time few spontaneous movements, more rigorous stimulation to arouse, decrease in appropriate responses to verbal commands
Stuporous/ Semi Comatose
Unconscious most of the time, no spontaneous motor activity, verbal responses limited or absence, rarely awake or oriented
Comatose
unable to arouse with painful stimuli, +gag reflex, +cough reflex, if no reflexes in deep coma
decorticate
flexor posturing
abnormal flexion
may be in response to pain or spontaneous
brain damage ABOVE brainstem
Decerebrate
extension posturing
abnormal extention
to stimulus or spontaneous
damage IN brainstem
Flaccid
limp
w/o muscle tone
Increased Intracranial Pressure (IICP)
decreased LOC and reflexes headache, restless change in resp. status increased or decreased increased or decreased pulse increased BP widening pulse pressure
aphasia
inability to express oneself properly through speech
common in stroke victims
expressive aphasia
cant express words
receptive aphasia
can’t understand words
Neuro assessment
LOC:which level Orientation: X4 person place time and situation Pupils: PERRLA Strength Sensation Babinski Gait Pain
PERRLA
Pupils equal round react to light and accommodation
accommodation
pupils constrict as objects come close
convergence
eyes cross as objects come close
Pain
is whatever the client says it is and exists where ever he says it is
pain threshold
point at which pain is felt
pain tolerance
pain endurance
acute pain
significant, severe
recent onset
damage or injury has occured
chronic pain
constant or intermittent persists beyond expected healing poorly defined problematic may exist for years
Somatic pain
can be localized, originates in trunk, skin, extremities or bone. external.
Visceral
internal organs (ischemia, spasms, radiates from origin lie with CP) can’t be sharply localized (internal)
Phantom
from no body parts, nerve fibers.
i.e. amps
Neuralgia
intense burning along peripheral nerve
causalgia
intense pain after traumatic injury that involves peripheral nerves from extremity.
crushing injury, degloving.
Pain management control
medications, oral, IV, IM, Patches
therapeutic, ice, heat, massage.
