WEEK 8 Flashcards
plus lecture flashcards from week 9
Digestion
When the body breaks down food into simple substances that can be used as nutrients or excreted as waste
peristalsis
Involuntary muscle contractions that occur throughout the digestive system that move food along the pathway to be digested
What initiates the process of decomposing food?
saliva
how long does food remain in the stomach?
2 to 8 hours
liver functions
Removes toxins from the blood and produces bile, which breaks down carbohydrates, proteins, and fats
gallbladder functions
Stores bile and then releases it when the body needs it.
pancreas functions
Aides in the metabolism of sugar by producing insulin.
small intestine
Where food is broken down and the majority of the nutrients are absorbed
large intestine
Removes electrolytes and water from food while turning it into waste.
rectum
storage area for feces at the end of the large intestine
what does a healthy weight-loss plan consist of?
losing 1 to 2 pounds per week
what can a weight-loss of just 5% to 10% of total body weight improve?
blood pressure
blood glucose
cholesterol levels
what are the two nutrient categories
macronutrients and micronutrients
macronutrients
Building blocks of a diet, which include carbohydrates, fat, and protein.
micronutrients
vitamins and minerals; only small amounts of these nutrients are required in the diet.
optimal for growth, development, and body function
protein
the major building block of the body
provide amino acids that the body needs to build and repair muscle
carbohydrates
The digestive system turns carbohydrates into sugar to provide the body’s cells, organs, and tissues with the energy they need to function.
need the most of these in your diet
glycemic index
A carbohydrate-containing food’s ability to increase the body’s blood glucose level.
fats
Essential nutrient that help the body absorb vitamins while providing energy.
monounsaturated fats are good, trans fats are found in lots of processed foods
vitamins
Carbon-based organic micronutrients that promote health and support optimal functioning of the body.
fat-soluble vitamins
Vitamins that do not dissolve in water but instead are dissolved in fats.
water-soluble vitamins
Vitamins that are carried to the tissues of the body but are not stored in the body.
include vitamin C and B complex
minerals
Noncarbon, inorganic nutrients that promote health and support optimal functioning of the body.
include iron, zinc, and calcium
foods that have a high glycemic index
potatoes, white bread, and processed snack foods
calorie density
The number of calories a food contains related to its volume or weight.
how to calculate net carbs
In order to calculate net carbs, take the TOTAL carbs per serving and SUBTRACT the fiber and alcohol sugars
BMI
body mass index
pounds/height in inches
then, that number/height in inches
then, times that number by 703
normal BMI/healthy BMI
18.5-24.9
underweight BMI
less than 18.5
over weight BMI
25-29.9
obese BMI
30 or greater
antioxidants
Substances, commonly found in plant-based foods, that protect the cells against free radicals.
free radicals-promote the development of cancer, heart disease, and other diseases.
what does a diet with adequate protein intake help
prevent brittle hair and hair loss.
Assessing the condition of a person’s hair and skin can give an indication of their nutritional status.
omega-3 fatty acids
Found in a number of foods, mainly fish. Fish oil supplements are the most common nonvitamin/nonmineral natural product taken by adults and children.
help with brain health
A nurse is discussing dietary needs with a client. The client states, “I usually eat one or more meals per day from a drive-through restaurant. I know it’s not the best diet, but I take a vitamin every day.” Which of the following responses should the nurse make?
“A vitamin won’t replace poor eating habits. Let’s find ways to improve your overall diet.”
heart-healthy diet
Promotes cardiovascular health through controlling portion, eating a varied diet, and watching sodium intake.
a healthy adult should consume no more than how many mg of sodium a day?
2300 mg
renal diet
Diet for individuals with kidney disease that limits intake of sodium, potassium, and phosphorus.
A nurse is caring for a client who is scheduled for an upcoming procedure with sedation. Which of the following diets should the nurse expect the provider to prescribe?
NPO
warfarin
anticoagulant
dysphagia
difficulty swallowing
medical conditions that can put a client at risk for aspiration
acid reflux
mouth sores
stroke
dental issues
overt aspiration
Aspiration causing symptoms such as coughing or trouble breathing, wheezing, congestion, heartburn, etc
silent aspiration
aspiration with no obvious symptoms
Diet modifications can help prevent aspiration in the client who has dysphagia
thickening of liquids with gels and powders
are thicker or thinner liquids easier to aspirate?
thinner
stages of thickening liquids
nectar
honey
spoon-thick
manifestations of aspiration are noted
nurses should place the client on NPO status and notify the provider immediately.
tube feeding aspiration
Alterations in vital signs such as decreased oxygen saturation and increased heart rate, blood pressure, and respiratory rate, along with audible wheezing, fever
how to treat hypoglycemia
This is accomplished by providing the client with food that contains at least 15 g of carbohydrates—for example, 4 ounces of soda or juice, 1 tablespoon of honey, or 5 to 6 hard candies. The client’s blood glucose level should then be rechecked 15 minutes later, and this process repeated until the blood glucose level is above 70 mg/dL
expected range of fasting glucose for someone who does not have diabetes
less than 100 mg/dL
gaststrostomy tube (G-tube)
a tube that delivers nutrition directly into the stomach.
It is inserted through the abdomen and is indicated for clients who are unable to consume enough nutrition on their own.
NPO at least 8 hours prior to the 30-45 min procedure
nasogastric (NG) tube
a thin plastic tube that is inserted into the nostril and down the esophagus, with the end placed in the stomach
It is primarily used to provide nutrition and medication to a client, but can also be used to remove contents from the stomach in the event of a client ingesting a harmful substance, poison, or too much medication.
NG tube placement
following a prescription from a provider and are inserted by RN or PN
nasojejunal (NJ) tube
thin, soft tube that is inserted through the nostril and stomach, ending in the jejunum of the small intestine.
NJ tubes are used for clients who are unable to consume enough nutrition, cannot tolerate foods and liquids in their stomach, or have delayed gastric emptying
what does NJ tube allow
The use of an NJ tube allows food, liquids, and medications to be placed directly into the client’s intestine
placed on clients cheek to secure
enteral nutrition
Nutritional intake through the GI tract, including the mouth or a GI tube.
what pH may indicate the NG tube is not in the stomach
6.0 or above
therefore, recheck the pH of the gastric contents
what are enteral nutrition prescribed for
clients who do not have adequate oral intake or nutrition that can meet their metabolic needs. Such feedings are often used for clients who cannot eat safely due to swallowing impairments or dysphagia.
For example, a client who consumes a modified diet due to dysphagia, but is unable to meet their daily nutritional needs through their daily diet, would be prescribed enteral nutrition.
A nurse is caring for a client who has a percutaneous endoscopic gastrostomy (PEG) tube, and the enteral feeding has completed infusion. Which of the following actions should the nurse take?
flush the tubing with 30 mL of water
parenteral nutrition
Nutritional intake through the veins, given when a client’s GI system does not function.
IV
renal diet: what foods to avoid as they are quite high in potassium?
bananas
dried beans
spinach
tomatoes
clear liquid diet length?
just a few days
conventional medicine
The predominant interventions practiced by medical doctors (M.D.), doctors of osteopathy (D.O.), and other health care professionals during the typical courses of treatment.
western medicine
a conventional, or modern medical practice
complementary and integrative health (CIH)
Approaches health and wellness through a broader lens and is combined with, ideally complementing, conventional medicine.
CIH’s multiple disciplines include what?
manipulation of the body, energy, movement, traditional/indigenous/world therapies, and use of herbs, vitamins, and minerals.
example of complementary, alternative, and integrative
cooling sunburn with topical aloe vera, in addition to giving an oral anti-inflammatory medication
holistic medicine
Viewing the client as a whole person and assisting in healing not only physically, but mentally, spiritually, and emotionally.
holistic nursing
nursing practice whose goal is to heal the person and reinforce the body’s innate ability to heal itself
commonly used mind-body practices include?
massage, meditation, and mindfulness; aromatherapy; acupuncture; chiropractic; music and art therapies; hypnotherapy; relaxation therapies, such as deep breathing, guided imagery, yoga, and progressive relaxation; and energy therapies, such as Therapeutic Touch and Healing Touch.
progressive relaxation
Relies on a systematic progression of tensing and relaxing groups of muscles.
energy therapies
Hands-on techniques involving the channeling of healing energy through a practitioner to the client, for restoration of health and balance of the body’s energy.
massage precautions
For clients taking anticoagulant medications or those who have a low platelet count, bleeding or bruising may occur with energetic massage. Avoid massaging over areas of tumors, blood clots, and prostheses.
homeopathy
A system of theoretical medical practices that any substance can produce a disease state in a healthy person and that any substance can provide treatment for a person who has the disorder.
Ingredients in homeopathic remedies are often derived from plants, animals & minerals.
functional medicine
A biology-based approach whose focus is on the root cause of disease. It systemically identifies the many causes and conditions contributing to dysfunctional health.
what are common traditional Chinese medicine practices
acupuncture, herbal remedies, diet and exercise philosophies
prebiotics
A nutrient stimulating the health and growth of bacteria in the large intestine. Organisms in the colon effect digestive health.
probiotics
Substances that promote a favorable, health-promoting effect on tissues and cells. For example, Lactobacillus acidophilus inhibits the growth of damaging bacteria in the GI tract, like Salmonella or C. difficile, and can assist with digestive issues, such as lactose intolerance.
what fruit has the best source of vitamin C
1 cup strawberries
client is feeling lethargetic
request a Rx of B12 supplements
how is pain caused
stimulus causes electrical impulses to travel from the periphery to the spinal cord. If the tissue is injured, it can also release chemicals that excite or activate the nerve endings, causing pain
is what is one of the important characteristics of pain
duration
so either acute (seconds to 6 months) or chronic (more than 6 months)
perform and document a comprehensive pain assessment
Use a reliable and valid tool to determine pain intensity.
Accept the client’s report of pain.
Assist the client in establishing a comfort-function goal.
Apply the Hierarchy of Pain Measures in clients who are unable to report their pain.
what are some SUBJECTIVE indicators to assess client’s pain by asking questions about what?
Location
Duration
Quantity
Quality
Chronology
Aggravating Factors
Relieving Factors
Associated Phenomenon
objective indicators of pain
Vital signs initially showing an elevation in blood pressure, heart rate, and respiration
Muscle tension or rigidity
Pallor
When pain becomes more severe, there is a decrease in blood pressure and heart rate
Nausea and vomiting
Fainting
Withdrawal to pain
Grimacing
Restlessness
Guarding the area of pain
numeric pain scale
1-3 is slight pain
4-7 is moderate pain
8-10 is severe pain
what are some nonpharmacological pain interventions
Positioning
Cutaneous Stimulation
Heat/Cold Therapy
Touch/Healing,Touch/Therapeutic Touch
Massage
Acupuncture
Hypnosis
Acupressure
Electronic Stimulating Unit
Pharmacological interventions for pain management
opioids or narcotic analgesics
nonopioid
adjuvant analgesics
Pharmacological interventions for pain management: opioids or narcotic analgesics
considered first-line treatment for the management of moderate to severe pain/include all controlled substances; e.g., morphine, codeine, oxycodone, hydromorphone, methadone, meperidine
Pharmacological interventions for pain management: nonopioid
include acetaminophen and NSAIDs that are available over the counter
Pharmacological interventions for pain management: adjuvant analgesics
include antidepressants, anticonvulsants, corticosteroids, and bisphosphonates used to enhance the effect by opioids by reducing pain and anxiety
Patient-controlled analgesia (PCA)
used typically for clients with postoperative pain. It is a computerized intravenous pump with a syringe of a prescribed opioid medicine usually morphine, fentanyl, or hydromorphone
what happens in the brain when a situation is determined to be stressful
the hypothalamus secretes corticotropin releasing factor (CRF) which activates the sympathetic nervous system (SNS) to release norepinephrine, epinephrine, and dopamine also known as the “fight or flight” response which causes an increase in heart rate, blood pressure, cardiac output, dilation of bronchial airways, pupil dilation, and an increase in blood glucose levels.
CRF also signals the anterior and posterior pituitary glands to release adrenocorticotropic hormone (ACTH) from the adrenal cortex which is part of the autonomic nervous system (ANS).
Then, ACTH stimulates the adrenal glands to release cortisol which initiates behavioral responses such as mental alertness, focus, and reduction of pain receptors.
General Adaption Syndrome (GAS)
three srage response to stress the includes
ALARM
RESISTANCE
EXHAUSTION
goal of GAS is for the body to return to a steady state of internal, physical, and chemical balance (homeostatis) to maintain optimal functioning
sources of stress
Physiological (physical)
Generally associated with injury or illness; the body’s reaction is immediate and necessary for survival.
Psychological (emotional)
Associated with an event, situation, comment, condition, or interaction that is interpreted as negative or threatening.
types of stress
acute-most common and frequent; immediate reaction and triggers flight of fight
episodic acute-when someone experiences frequent bouts of acute streess
chronic-disabling condition that occurs when stress levels are always elevated
types of defense mechanisms
Denial: Refusal to acknowledge or accept reality to avoid the emotional impact
Rationalization: Justify or explain undesirable behaviors to avoid emotional discomfort or save face
Projection: Attribute negative or uncomfortable thoughts, feelings, or motives onto someone else
Repression: Conceal unpleasant or painful thoughts, memories, or beliefs in hopes of forgetting about them entirely
Regression: Movement back to a more comfortable developmental time in life
Compartmentalization: Categorize life experiences into segments to avoid facing the anxieties while in that mindset
types of grief
Normal: Also known as uncomplicated grief, is caused by the loss of someone very close, through death or the ending of a relationship
Anticipatory: Grief that is experienced before the expected loss of someone or something
Prolonged grief disorder (PGD): Previously known as complicated grief; lasts >6 months and can be so significant, it affects the client’s ability to function
Disenfranchised: Grief related to a relationship that does not coincide with what is considered by society to be a recognized or justified loss
Kubler-Ross five stages of grief
Denial: Client refuses to believe the truth and this helps to lessen the pain of the loss
Anger: Client is trying to adjust to the loss and is feeling severe emotional distress, often asking “why me?” and suggesting “it’s not fair”
Bargaining: Usually involves bargaining with a higher power by making a promise to do something in exchange for a different, better outcome
Depression: Reality sets in, and the loss of the loved one or thing is deeply felt
Acceptance: Client still feels the pain of the loss but realizes they will be all right
dual process model of grief
Suggests that the process of grieving oscillates (shifts back and forth) between two types of stressors: loss-oriented and restoration grief.
During loss-oriented stressors, grief is conveyed through intense thoughts and feelings.
The restoration grief process involves coping with other losses that come with the death of a loved one (secondary losses) and rebuilding one’s life without the loved one.
worden’s four tasks of mourning
Accept the reality of the loss
Experience the pain of grief
Adjust to an environment without the deceased
Create an enduring connection to the deceased loved one, while embarking on a new life
common grief reactions
Shock
Anger
Anxiety
Numbness
Denial
Guilt
Sadness
Relief (if death is expected)
Depression
NURSE technique for grief
Name: Identify what the client just stated, or the emotion expressed by the client.
Understand: Demonstrate understanding by recognizing the client’s feelings and providing an opportunity for the client to discuss their feelings.
Respect: Voice your respect for the client under these circumstances.
Support: Inform the client that you are available to him or her.
Explore: Ask open-ended questions to extend the conversation and provide a more detailed expression of the client’s feelings and beliefs
who developed the theory of culture care diversity and universality
madeleine leininger in the 1950s
but not published until the 1980s
EMIC vs ETIC
EMIC - a cultural insider’s viewpoint of a culture
ETIC - an outsider’s viewpoint of a culture
important-exam Q!
health equity vs. health equality
Health equity is defined as attaining the highest level of health for all individuals.
Health equality is the distribution of the same resources, including opportunities, to all individuals within a population.
hospice care
comfort care
The administration of medical care to support the client who has a terminal illness, so they can live the last days of their life as best as they can, as long as they can.
Provided when treatment will no longer cure or control the illness.
Originally offered only to clients diagnosed with terminal cancer but has grown to include any client with a life-limiting illness.
Interprofessional, holistic care that treats the whole person, including caregivers and family members.
criteria for hopsice
diagnosis of life expectancy of fewer than six months
palliative care
Holistic care provided throughout the lifespan for clients experiencing severe medical illness and particularly for clients approaching end of life.
Goal is to improve quality of life for the client as well as the family and caregivers.
Initially concentrated on lessening client suffering at end of life, but current best practice dictates it be implemented earlier in the course of life-threatening health events.
what is the diff between hospice and palliative care
Palliative care is different from hospice care, as palliative care is provided while the client is still engaging in curative treatment methods.
physioligical alteratios at the end of life: breathing and respirations
Breathing and Respirations
Dyspnea: shortness of breath
Retention of secretions in the respiratory tract, also known as “death rattle”
Cheyne-Stokes respirations: an irregular respiratory rate fluctuating between several quick breaths and periods of apnea
physiological alterations at the end of life: pain
Pain
Experienced by nearly 60% of older adult hospice clients who have cancer
Occurs as a result of nerve injury, organs being stretched and compressed, and/or bone pain
physiological alterations at the end of life: temperature
Temperature
Ability of the nervous system to regulate body temperature diminishes, causing clients to experience both increased and decreased temperature.
Also caused by infection, cancer, and cancer therapy.
Mottling occurs hours or days before death, with the upper and lower extremities becoming cool to the touch. Mottling occurs as result of the heart’s inability to pump blood effectively, leading to decreased blood perfusion throughout the body.
mottling
Mottling occurs hours or days before death, with the upper and lower extremities becoming cool to the touch. Mottling occurs as result of the heart’s inability to pump blood effectively, leading to decreased blood perfusion throughout the body.
physiological alterations at the end of life: vision and hearing
Vision and Hearing
Clients may experience hallucinations or report hearing and seeing those who have already died
postmortem care
Physical care performed after death to prepare a body for viewing, autopsy, or release to funeral home.
Includes washing the body, accounting for the client’s possessions, removing invasive devices such as intravenous catheters and indwelling catheters, and placing identification tags in at least two areas (toe, arm, outside of body bag, etc.).
Also includes documenting the date and time of death, the name of anyone notified, location of belongings, and where the client’s body is moved (funeral home name).
organ/tissue donation
As organ and tissue donation is voluntary, the donor must give authorization before death, or a surrogate can give permission when the client has not previously consented.
A nurse is not allowed to begin a dialogue about organ or tissue donation with the client or a family member. Only health care professionals who have completed a course provided or endorsed by an organ procurement organization (OPO) are permitted to initiate the request of the client or surrogate.
The nurse’s role is to assist families who are dealing with this challenging decision.
