week six Flashcards
Anorexia
a prolonged disorder of eating due to loss of appetite
Anthropometry
measurement and study of the human body and its parts and capacities
Basal Metabolic Rate (BMR)
the rate at which the body metabolizes food to maintain the energy requirements of a person who is awake and at rest. It is the rate at which the body spends energy to keep all of the life-sustaining processes going.
Calorie
unit of heat defined as the quantity of heat required to raise the temperature of 1 gram of water by 1 degree centigrade at atmospheric pressure
Malnutrition
the results in the body of poor nutrition; undernutrition, overnutrition, or any nutrient deficiency
MyPlate
Visual representation of the relative daily portions of various food groups; replaced MyPyramid in 2011.
Nausea
A subjective, unpleasant, wavelike sensation in the back of the throat, epigastrium, or the abdomen that may lead to the urge or the need to vomit
Negative Nitrogen Balance
Occurs when more nitrogen is excreted from the body than is retained from dietary protein sources. Occurs during the aging process, starvation, and extreme stress.
Nutrient
Organic and inorganic substances found in foods that are required for body functioning
What are the nutrient categories?
Carbohydrates, proteins, fats, water, vitamins, minerals
What are essential nutrients?
Must be supplied by our diet
What are non-essential nutrients
Can be made in the body
Calories in protein
4
Calories in carbs
4
Calories in fat
9
Calories in alcohol
7
What factors influence caloric requirement?
age/growth, gender, climate, activity, fever, illness, trauma, surgery
What are the important functions of proteins?
growth, repair and maintenance of body structures and tissues. Involved in the manufacture of hormones such as insulin. Act as enzymes to help bring about some chemical reactions such as digestion.
What is a complete protein?
A complete protein contains all 9 of the essential amino acids in the correct proportions to maintain tissues and support body structures. Includes most animal proteins, cheese, and eggs
What is an incomplete protein?
An incomplete protein lacks one or more of the essential amino acids. Usually vegetables.
What is a complementary protein?
Two proteins that when combined provide adequate amounts and proportions of all essential amino acids. Black beans and rice. Peanut butter and bread.
Nitrogen
The element that distinguishes proteins from lipids and carbohydrates.
Positive Nitrogen Balance
Occurs when more nitrogen is retained in the body than is excreted. This may occur in infancy, childhood, pregnancy and during lactation.
Nitrogen Balance
Studies that are helpful in determining the protein requirement of the body throughout the life cycle. Nitrogen balance occurs when the intake of nitrogen is equal to the output of nitrogen.
Sources of protein
whole grains, oatmeal, crackers, dark green and deep yellow vegetables, cottage cheese, yogurt, hard cheese, chicken, steak, dry beans, peanut butter
Protein deficiency problems
stunted growth, muscle wasting, decreased reflexes, swollen limbs and face, abnormal weight, swollen gums, cracked lips, swollen tongue, red, eyes pale and dry, brittle pale nails, patchy scaly skin, bruises, non-healing sores, mental apathy, tired
Stages of life when protein intake needs to be increased
pregnancy, breast feeding, infancy to childhood, emotional stress, physical stress, infection, higher environmental temperature
Carbohydrates
Organic compounds of carbon, hydrogen, and oxygen that are stored in the muscles and liver. CHO are also sugar compounds made by plants when they are exposed to light.
Functions of CHO
provides a quick source of energy in the form of glucose, spares break-down of protein for energy, aids in normal functioning of intestines (as CHO in fiber form), excesses of glucose stored as fast so it can later be convered to fuel if needed
Simple carbohydrates
sugars with a simple structure. One or two sugar units.
Monosaccharides (define)
one sugar unit
Disaccharide (define)
two sugar units
Monosaccharides
Glucose, Fructose, Galactose
Glucose
simple sugars
Fructose
fruit and honey
Galactose
sugar derived from digesting lactose
Disaccharides
Sucrose, Maltose, Lactose
Sucrose
table sugar
Maltose
not found naturally in foods but occurs in starch digestion
Lactose
CHO found naturally in milk
Complex Carbohydrates (define)
Composed of long chains of carbohydrates
Polysaccharide (define)
Chain of multiple molecules, many sugar units
Polysaccharides
Starch, Glycogen, Fiber
Complex Carbohydrates
Starch, Glycogen, Fiber
Starch
Major source of CHO in our diets. Rice, pasta. Non-sweet form of CHO
Glycogen
no dietary source
Fiber
Supply roughage as it can’t be digested. Not a source of energy
Sources of Carbohydrates
pasta, bread, legumes, beans, fruits
Fats (lipids)
Organic substances that are greasy and insoluble in water but are soluble in alcohol. They are composed of carbon, hydrogen and oxygen but with a higher proportion of hydrogen
What are fats composed of?
carbon, hydrogen, oxygen. higher proportion of hydrogen
What are carbohydrates composed of?
carbon, hydrogen, and oxygen.
What are proteins composed of?
carbon, hydrogen, oxygen, nitrogen
Proteins
the building blocks of the body’s tissues and organs
Fats
Lipids that are solid at room temperature
Oils
Lipids that are liquid at room temperature
What are the functions of fats?
provides energy and fuel, supports and protects internal organs, regulates body temperature, provides palatability, provides feeling of fullness
What are the three classifications of fats?
Triglycerides, phospholipids, sterols
Triglycerides
three fatty acids, may be saturated or unsaturated
Phospholipids
lipids containing phosphorus
Sterols
cholesterol. fat-like substances produced within the body and found in animal products
What are the three types of fats?
saturated fats, unsaturated fats, trans fats
Saturated Fats
saturation occurs when all 4 potential binding sites of a carbon atom are full with hydrogen atoms. Meat, poultry, full-fat products, and tropical oils
Unsaturated Fats
A fatty acid not completely filled with all of the hydrogen ions it can hold. Olive oil, peanuts, and canola oil.
Trans Fats
Fatty acids with unusual double bond structures caused by hydrogenated unsaturated oils. Baked goods.
Hydrogenation
The process of adding hydrogen a fat. This process extends the shelf life of a product. baked good, microwave popcorn.
Sources of fat
prepared foods, doughnuts, cookies, pies, avocado, coconut, yogurt, milk, cheese, shellfish, crab, untrimmed meats
Vitamins
organic compounds not manufactured by the body and are required in small amounts
Functions of vitamins
do not provide energy but necessary for metabolism of energy, vital for life, help regulate body processes such as growth and metabolism
Two classifications of vitamins
Water soluble and fat soluble
Water soluble
dissolves or disperses in water. Easily absorbed in the small intestine, excessive amounts excreted in the urine
Fat soluble
dissolves in fat, excess not excreted, rather stored, can be toxic and cause kidney damage, hair loss, double vision
Water soluble vitamins
Vitamin C, B complex vitamins, folate, choline
Fat soluble vitamins
vitamin A, D, E, K
B Complex Vitamins
B1, B2, B3, B6, folate, B12, panthothenic acid and biotin
What do the B Complex vitamins do?
functions in energy metabolism, blood cell formation, promotes normal nervous system functioning
Sources of B Complex vitamins
meat, fish, eggs, milk
What does vitamin C do?
promotes formation of connective tissues and plays a role in immune system functioning
Sources of vitamin C
citrus fruits, vegetables
What does vitamin A do?
involved in normal growth and development of bones and teeth, enable eyes to adapt to dim light
Sources of vitamin A
liver, milk, fish, green leafy vegetables
Sources of vitamin D
sunlight on skin, liver, egg yolks, fortified milk
What does vitamin D do?
necessary for normal bones and development of teeth
What does vitamin E do?
linked to prevention of cardiovascular disease and cancers
Sources of vitamin E
leafy vegetables, whole grains, wheat germ, vegetable oils
What does vitamin K do?
plays a role in normal blood clotting
Sources of vitamin K
green leafy vegetables, yogurt
Minerals
Inorganic elements that originate from the earth’s crust, not from plants or animals
Function of minerals
play a role in structure of teeth and bones, assist in the regulation of the fluid balance of the body, involved in normal muscle relaxation and functioning
What are the two mineral categories?
macro mineral (major) and micromineral (trace)
Macromineral
needed in daily amounts of 100mg or more per mineral
Examples of macrominerals
magnesium, phosphorus, sodium, chloride, sulfur, calcium
Calcium function
provides structure to bones and teeth, stimulates muscle to contract
Sources of calcium
dairy products, shellfish, sardines
Micromineral
needed daily in amounts of less than 100mg
Examples of microminerals
Iron, zinc, iodine, selenium, copper, manganese, fluoride, and chromium
Function of iron
responsible for distribution of oxygen throughout the body
Sources of iron
red meat, organ meat, chick peas, raisins, liver
Function of iodine
regulates growth and development (r/t thyroid hormone)
Sources of iodine
Iodized salt and seafood
Water
the largest single constituent of the human body. It is the medium in which all biochemical reactions occur.
Function of water
provide shape and structure to the cells, regulates body temperature, aids in digestion
Dietican
designs therapeutic diets based upon individual needs, supervises meal preparation, educates, may hold advanced certification to teach clients about specific disease conditions
Nurse’s role in nutrition
nutritional assessments, education, may hold advanced certifications, assists client to adhere to prescribed diet
What is therapeutic nutrition?
A modified diet or special diet prescribed to promote, maintain, or restore the client to an optimal level of health
Why would a diet modification be necessary?
hypertension, cardiac, renal disease, dysphagia, edentulous, obesity, trauma
Dysphagia
difficulty swallowing
Edentulous
toothless
Nursing role in therapeutic nutrition
reinforce instructions, evaluate response, assist in planning changes, provide nursing interventions to help stimulate appetite, assist incapacitated clients, refer to various community programs
Nursing interventions for managing nausea
avoid movement, distraction, odor free setting, limit oral intake, small meals, offer fluids between meals, avoid certain foods, bland foods, lower stress, anti-emetic drug, relaxation, fresh air, crackers at the bedside
Nursing interventions for managing vomiting
change position, promote skin integrity, prevent aspiration, provide emesis basin, offer prn medications, sip cool liquids, assess urine output / I & O, provide reassurance, daily weights, frequent oral hygiene, IV fluids, assess electrolyte status, rest/safety
Emesis
vomiting
What are the types of modified diets?
low sodium, low fat, clear liquid, full liquid, soft diet
Low Sodium Diet
used for those with HTN risk or actual heart and or renal disease. Omit table salt and processed foods
Low Fat Diet
used to lower weight and cholesterol, for those with increase risk of stoke, heart disease and diabetes. eat less meat, remove fat from meat, keep total fat intake within 20-35% of total calories, decrease saturated fats to less than 10% of total daily calories
Clear Liquid Diet
used for surgical prep, post-op period, or with GI disorders. Foods that are clear at room temperature, requires minimal digestions and leaves minimal residue, inadequate in calories in nutrients, short term use only (24-36 hours), includes tea, clear juice, ginger ale, water, popsicles.
How long may a clear liquid diet be used?
Short term. 24-36 hours
What are appropriate examples of foods for a clear liquid diet?
tea, clear juice, ginger ale, water, popsicles
Full Liquid Diet
Used with GI disturbance or inability to tolerate solid/semisolid foods. liquids or foods that liquefy at room temperature. not suitable for long term use, can be supplemented with ensure. yogurt, ice cream, vegetable juice, pudding, custard
What are appropriate examples of foods for a full liquid diet?
milk, yogurt, ice cream, vegetable juice, pudding, custard
Soft Diet
those with difficulty chewing or swallowing. lower fiber, easily chewed and digested. mashed potatoes, applesauce, and bread pudding
What are appropriate examples of foods for a soft diet?
potatoes, applesauce, and bread pudding
What is important to remember about a soft diet?
Low in fiber. May cause constipation.
What are factors that influence a person’s eating patterns?
development, ethnicity/culture, personal beliefs, lifestyle, health, psychological factors, gender, food beliefs, religious beliefs, medications, alcohol, personal preferences, age, economics, advertising
What are examples of anthopometric data?
height, weight, ideal body weight, usual body weight, tricep skin-fold measurement, body mass index
What are the components of a nutritional assessment?
anthropometric data, biochemical data, dietary/health history, clinical data
Biochemical data
Lab tests used to provide objective information
Examples of biochemical data
hemoglobin, electrolytes, total lymphocyte count, urine specific gravity, serum transferrin level, serum albumin, serum pre-albumin level
If the total lymphocyte count is low, than protein is?
low
What does serum transferrin do?
binds and transfers iron
Examples of dietary/health history
gender, age, weigh changes, problems related to eating, living arrangements, difficulty with food prep, culture, education, appetite changes, activity level, medical history, 24 hour food recall, food diary
Examples of clinical data
assessment of skin, eyes, hair, nails, mucous membranes, activity level
Albumin
a blood test used to assess protein levels in the body
Normal albumin level
3.5-5.0 gm/dl
Prealbumin
a blood test to assess protein levels in the body but it is more sensitive than the albumin test because of its short half-life. It is more expensive.
Normal prealbumin level
17-40 mg/dl
Underweight
not eating enough food to take in all of the necessary essential nutrients
Underweight criteria
15-20% below weigh standards or BMI is 19 or lower
Overweight criteria
BMI between 25 and 29.9
Obese criteria
BMI over 30
Vegetarian
loosely defined as the abstinence from animal products
Ovolacto
eats dairy and eggs
Lacto
eats dairy
Ovo
eats eggs
Vegan
does not eat meat, fish, poultry, dairy, or eggs
Reasons for vegetarian diet
health, religion, ethical, ecological, financial
Fad Diets
Widespread but short-lived interest or practice of a specific diet followed with considerable zeal
Examples of fad diets
grapefruit diet, atkins diet, south beach diet, zone diet
% Daily Value
The % of nutrients that one serving contributes to a 2,000 calorie diet
Three basic messages of US dietary guidelines
aim for fitness, build a healthy base, choose sensibly
MyPlate guidelines
half of your plate fruits and vegetables, half of your grains whole, fat-free or low-fat milk, vary your protein choices, cut back on sodium and empty calories from solid fats and added sugars, enjoy food but eat less, be physically active your way
Defining characteristics of Nausea
aversion to food, gagging sensation, increased salivation, increased swallowing, report of nausea, sour taste in mouth
Define Nutrition imbalanced, less than body requirements
Intake of nutrients insufficient to meet metabolic needs
Defining characteristics of Nutrition imbalanced, less than body requirements
abdominal cramping, abdominal pain aversion to eating, body weight 20% or more under ideal, capillary fragility, diarrhea, excessive loss of hair, hyperactive bowel sounds, lack of food, lack of information, lack of interest in food, loss of weight with adequate food intake, misconceptions, misinformation, pale mucous membranes, perceived inability to ingest food, poor muscle tone, reported altered taste sensation, reported food intake less than RDA, satiety immediately after ingesting food, sore buccal cavity, steatorrhea, weakness of muscles required for swallowing or mastication
Define Nutrition imbalanced, more than body reqirements
Intake of nutrients that exceeds metabolic needs
Defining characteristics of Nutrition imbalanced, more than body requirements
concentrating food intake at the end of the day, dysfunctional eating pattern, eating in response to external cues, eating in response to internal cues other than hunger, sedentary activity level, triceps skin fold >25mm in women and >15mm in men, weight 20% over ideal for height and frame
Define Nutrition imbalanced, risk for more than body requirements
At risk for intake of nutrients that exceeds metabolic needs
Risk factors for Nutrition imbalanced, risk for more than body requirements
concentrating food at the end of the day, dysfunctional eating patterns, eating in response to external cues, higher baseline weight at the beginning of each pregnancy, observed use of food as comfort measure, observed use of food as reward, pairing foods with other activities, parental obesity, rapid transition across growth percentiles in children, reported use of solid food as major food source before 5 months of age
Gauge
Diameter of the shaft of the needle. The gauge varies from #18-#30. The larger the gauge number, the smaller the diameter of the shaft.
Vial
a small bottle that contains a drug (especially a sealed sterile container for injection by needle)
Which is a thicker needle, #18 or #30?
18
Ampule
a small glass container for individual doses of liquid medications
More than 1 ml syringe
Tenths. Never trailing 0.
Less than 1 ml syringe
Hundredths. Never trailing 0.
What factors should be considered when selecting needle length and gauge when giving an injection?
client muscle development (condition and size), client weight (thin, obese), type of injection ordered, amount of adipose tissue, age of client, viscosity of medication (thicker med - smaller gauge # needle aka bigger needle), type of medication (insulin needs insulin needle and syringe
Maximum amount of solution that can be administered into one subcutaneous site on an adult
2 mL
Needle size for subcut injection
Need gauge #25-#30, Needle Length 1/2-5/8
Subcutaneous: Pinch or Flatten?
Pinch
Appropriate locations for an I.M. injection?
deltoid, dorsogluteal, vastus lateralis, ventrogluteal
Maximum amount of a solution that can be administered into one intramuscular site on an adult
3 mL
Maximum of solution that can be administered into an adult deltoid injection site
2 mL
Needle size for an I.M. injection
Needle Gauge #21-#23, Needle Length 1-1.5 inches
Preferred Pediatric IM sites?
vastus lateralis and ventrogluteal sites. Vastus lateralis is most used.
Hub of needle
Attaches to the syringe.
Barrel of syringe
part hold medication and has markings
Tip of syringe
Provides connecting site for the needle.
Plunger of syringe
Used to pull or push medication into or out of the barrel.
Bevel of needle
The angle of the needle on the tip
Shaft of needle
Long cylindrical portion
Lumen of needle
gauge, where the medication comes out
Parts of needle that must be kept sterile
all of it
Parts of syringe that must be kept sterile
tip, inside of barrel, shaft of plunger
Deltoid Site Landmarks
Acromial process, deltoid muscle, scapula, humerus, deep brachial artery, radial nerve
Vastis lateralis Site Landmarks
Femoral artery, greater trochanter of femur, vastus lateralis
Ventrogluteal Site Landmarks
Anterior superior iliac spine, iliac crest, gluteus medius, greater trochanter
Dorsogluteal Site Landmarks
posterior superior iliac spine, gluteus maximus, greater trochanter of femur, sciatic nerve
Dorsogluteal Site
position client in the prone position with toes pointed inward or side-lying position with upper knee flexed and upper leg in front of lower leg, palpate the posterior superior iliac spine, then draw an imaginary line to the greater trochanter of the femur, the injection site is lateral and superior to this line, it is located in the upper, outer area of the buttock
Ventrogluteal Site
client can be positioned on the back, prone, or side-lying position with knee and hip flexed but the side-lying position is the most common, place your heel of hand over the greater trochanter with fingers pointing towards client’s head and thumb facing client’s groin (right hand on client’s left hip or left hand on client’s right hip), put your index finger on the anterior superior iliac spine and stretch your middle finger dorsally palpating iliac crest and pressing below it, your fingers form a V and the injection is given in it’s center
Vastis lateralis site
Thigh should be relaxed and client in side lying or sitting position, palpate the knee and greater trochanter of femur, client’s toes should be pointed inward, located site by placing 1 hand width below the great trochanter, 1 hand width above the knee, the middle area between the hands at the anterior lateral aspect of the thigh is the site
Deltoid Site
arm should be relaxed at the side of the body, palpate the lower edge of the acromion process, with the other hand find the lateral aspect of the arm which is in line with the axilla, form an upside down triangle between these points for the injection site
What are the reasons why a nurse should rotate injection sites on a client that receives multiple injections?
minimize tissue damage, aid absorption, avoid discomfort, minimize tissue irritation
What can a nurse do to minimize discomfort of injections?
Select a needle of largest gauge number that is appropriate. select needle of correct length. be sure needle is free of medication that might irritate the tissue. inject medication into relaxed muscle. do not inject areas that feel hard on palpation or tender to client. insert the needle with a dart-like motion without hesitation, remove it quickly at the same angle. do not inject more solution than is recommended for the site. inject the medication slowly. massage the area after injecting unless contraindicated. allow the fearful client to talk about their fears. rotate sites. use z track from IMs. Distract the client before giving the injection. stabilize the syringe after inserting needle, hold syringe steady. allow alcohol to dry before inserting needle
Actions to take in the event of a needlestick injury
clean: clean wound immediately, complete incident report. contaminated: follow agency policy. mcc policy
