X Nutrition (Foundations Chpt 21) Flashcards
Patient weight taken mandatory how many times?
1/month
Nurse is link between patient and
dietician
RDA
Recommended Daily Allowance
DRI
Dietary Reference Intake (label at back with nutrition info)
Essential Nurtrients
nutrients the body can not make on it’s own.
6 classes of essential nutrients
Carb Fat Protein Vitamins Minerals Water
What can not make Vit C
Humans and Guinea Pigs
kcal/h
CARB
4cal
kcal/h
FAT
9cal
Vit A,D, E, K
Fat/water soluble?
Fat
Normal body pH
7.34-7.45
Normal cholesterol levels?
See pic
Total cholesterol <200mg/dL
HDL >= 60mg/dL
LDL < 100mg/dL
Triglycerides < 150mg/dL
Calories
Fat, Carb, Protein
Fat - 9 kcal/g
Carb - 4 kcal/g
Protein - 4 kcal/g
(amount of heat required to raise 1cc of H2O 1degree
Build and repair tissue
Protein, Fat, Ca, P and Fe
Anabolism
Building up
Catabolism
breaking down
Kcal, Calories, Food Calories
synonyms
Carbs main function
provide energy
Simple Carbs
Simple Sugars: monosaccharides, disaccharides
Complex Carbs
Polysaccharides
Starch, Glycogen, Dietary Fiber
(not sweet, C6H12O6)
Can we digest Dietary Fiber?
NO. it is the one carb we don’t use for energy
Carbs broken down into
Glucose to make ATP
The simplest carb is…
Glucose
Calories
Fat, Carb, Protein
Fat - 9 kcal/g Carb - 4 kcal/g Protein - 4 kcal/g ETOH - 7 kcal/fl oz (amount of heat required to raise 1cc of H2O 1degree
Can we digest Dietary Fiber?
NO. it is the ONLY carb we don’t use for energy. Helps move food through intestines
Carbs broken down into
Glucose (fuel) to make ATP (fire)
The simplest carb is…
Glucose
Merasmus
starvation
All sugars/carbs broken down into
Glucose
Fats provide
Satiety
Glucose stored where?
Liver and Muscles
Extra Glucose stored as?
Fat
Insulin allows Glucose into cells to be used for ATP
.
Glycogen stored where?
Liver, muscles
When full it is converted to fat
If energy needs met, carbs stored as?
Glycogen
If glycogen store full, excess carbs converted to ?
Fat
Fats and cholesterol are ?
Lipids
Adipose functions
Cushioning
Insulation
Cholesterol needed for
- Integrity of cells
- Vit D synthesis
Fat provides satiety and adds flavor and aroma to foods
Aka ?
Umami
Vege based sat fat (very few)
Coconut oil
Unsaturated Fatty Acids
One or more bonds of missing H
Monounsaturated (can take 1 more H)
polyunsaturated ( can take a few more H)
Plant sources
Liquid at room temp
Blood cholesterol lowering properties
Monounsaturated (can take 1 more H)
polyunsaturated ( can take a few more H)
Mono- thicker oils (avocado, olive)
Poly - thinner ( sesame, walnut, sunflower)
Fats (lipids)
Trans fatty acids
Unsaturated fats made into sat fats in lab by adding H. They become solid in room temp.
Cholesterol
Provides no energy Synthesized in liver Foods of animal origin Highest in shrimp/lobster No more than 300mg per day
Bile doesn’t break down fats, it …..
Emulsifies
Fatty stool, float or sink?
Floats
also in people without a gall bladder. bile is not deposited into duodenum to start emulsification so most fat is excreted with stool.
Lipoproteins (LDL, HDL) facilitate transport of ?what to ?where
lipids to bloodstream
Where is Lipase made and what does it do?
made in pancreas
breaks down lipids
HDL, LDL
difference? Which is good/bad?
HDL, tighter membrane
LDL, loose wall. WBS eat and die. They become so full and become foam cells, stick to wall. Atherosclerosis
Saturated fatty acids
Chem bonds completely filled w H
Generally or ANIMAL origin
Solid at room temp
Raise cholesterol levels and risk for atherosclerosis
Lard, margarine, suit
Protein made up of ….
amino acids
How many Amino acids? How many considered essential?
22, 9 essential
Essential Amino Acids
Not produced by the body. Must be obtained from diet
Complete Proteins
contains all 9 essential amino acids, of animal origin (meat, poultry, fish, milk, cheese, eggs
Incomplete Proteins
lacking one or more essential amino acids, of plant origin (grains, legumes, nuts, seeds)
Soy is the highest non-meat source of protein
contains PhytoEstrogen
Lactovegetarian
vegetarian plus dairy products
Lacto-ovo-vegetarian
vegetarian plus dairy and eggs
Create complete proteins by eating things together…
mac and cheese
peanut butter and jelly
rice and beans
Kwashiorkor malnutrition
severe protein deficiency. kids mainly. only eat rice and wheat, no protein. Causes edema. Solutes attract H2O out into intersticial. starving kids with big bellies. Change in hair color. body no longer produces melanin.
Marasmus
extreme malnutrition and emaciation. starvation.
Vitamins can be destroyed by
Heat, light. Air
Antioxidant function
Delay or prevent breakdown of cell membrane in presence of O
Pre vitamin form of Beta Carotene
Antioxidants
Vitamin E and C
Antioxidants: Oil?
Usually.
Oils prevent rust in iron
Water soluble vitamins
B, C (wound healing)
Not stored in body, excess excreted in urine
Fat soluble vitamins
A, D, E, K
Over consumption leads to toxicity
Stored in liver and fat
Bothe vitamins and minerals can be lost in food by…
Cooking in water
Minerals can be destroyed by..
Nothing.
They are single elements, not compounds
Vit C for?
Deficiency?
- wound healing, immune function
- deficiency: Scurvy
- Symptoms: petichea, gum disease, lose teeth and hair
Vit D for?
Deficiency?
Found in milk, dairy
Body can make it w exposure to sun
Deficiency: Rickets (osteopenia, osteomalaysia
Vit K for?
Deficiency?
- role in blood clotting
- Hemorage due to lack of Vit K
- found in leafy greens
- avoid when on Cumadin
- use on infants before circumcision
Rescue Drug for Cumadin
Vit K
where is Vit K made?
In gut
Folate for?
Deficiency?
- neural tube health in women of child bearing age
- Spinabifida
Congenital Disease
during gestation
B12 for?
Deficiency?
- making RBCs
- animal origin
Deficiency: Pernicious Anemia
What is made in stomach for absorption of B12?
- Intrinsic Factor
- without IF, B12 is not absorbed and can lead to pernicious anemia
Major minerals, amount needed
- needed in amounts >100mg/pday
- Ca, P, Mg, S, Na, K, Cl
Trace minerals, amount needed
- needed in smaller amounts
- Fe, Z, I, Se, Cu, Fl, Ch, Molybdenum
Pernicious Anemia symptoms
- Feeling tired and weak
- Tingling and numbness in hands and feet
- A bright red, smooth tongue
Ca for?
Deficiency?
- protection against osteoporosis, clotting, muscle contractions, and HTN
- 1000-1200mg/p day
Na for?
Deficiency?
Electrolyte
<2400mg / pday
Low residue diet
Clear liquid
Chicken no skin
High protein, not complex carbs that can break down into fiber
K for?
Deficiency?
- electrolyte
- protect against HTN
- 2000mg/day
- ESRD must be careful for HyperKalemia
Fe for?
Deficiency?
- part of hemoglobin (part of RBC that carries oxygen to cells)
- 8-15mg/pday (30mg for pregnant)
- iron rusts because of oxidation.
Water %of body
60%, adult
80%, infant
Provides form, structure, solvent for chem processes, transport, lubrication, body temp regulation
Teens usually deficient in….
Ca, Fe
Soy has
All essential amino acids. No fat. Water soluble vits
Normal pregnancy weight gain
25-35lbs
PIH (pregnancy induced hypertension)
Goes into fetus
O, antibodies, glucose, dissolved substances
Required for RBCs
Folate, B12, Fe
Deficiency Disease of
Folate, B12, Iron
Folate: microcytic anemia
B12: pernicious anemia
Fe: anemia, hemoglobin
Diabetes Melitus
Occurs during pregnancy
Mom hi blood sugar, baby hi, large and fat
If mom suffers from diabetes Melitus, what is she at risk for later?
Type II Diabetes
First milk
Colostrum
Nicotine/caffeine
Vasoconstrictor
FAS
Fetal Alcohol Syndrome
Midline, low ears, wide nose, thin upper lip, genital problems
First year food
Rice cereal
Solid food starts how old?
4-6mos
Common dietary inadequacies
Iron and Calcium
Common problem in nursing homes?
Malnutrition
Limit caffeine intake to….
Less than 300mg/day
Low residue diet
Clear liquid
chicken
over cooked watery veges
Caffeine affects
-central nervous system stimulant, diuretic
nervousness, irritability, anxiety, insomnia, heart arrhythmia’s, palpitations, BP, circulation, gastric acid secretion
-less than 300mg p/day
- People w GERD should avoid caffeine
Clear Liquids
bouillon, broth, gelatin, tea, coffee no milk, ginger ale, water, clear juice
Full liquid
strained cereals, soups no chunks, ice cream, pudding, milk, milkshakes, fruit juices
clear liquid - full liquid - solid
types of diets
mechanical soft diet
puree/chopped
High Kcal
surgery trauma, HIV AIDS, Burns
Cachectic
Cancer patients
Anorexia vs Anorexia Nervosa
lack or appetite vs self inflicted starvation
Diabetes I vs II
I: No Insulin II: Insulin resistant
Optimal Blood Glucose level
80 - 120mg/dL
Fasting BLood Sugar
blood drawn first thing in AM after fasting all night.
normal 70-80mg/dL
Exchange List
Diabetes patients. Exchange carbs for other smilar valued carbs. Every carb = glucose
(if you want a banana carb, you must remove toast)
Dumping Syndrome
occurs post sugery to stomach.
food passes throught too rapidly. body reacts by sending water into intstinal tract to wash through, reducing blood pressure.
treatment: many small meals
Bile stored and produced where?
Produced in Liver, stored in Gall Bladder
Steatorrhea
fluffy fatty stool
Protein restricted diet for
very rare
people w ESRD or Hepatic Cirrhosis (kidney, liver)
Asterixis
Liver takes Amino acid from gut to…
make protein. If diseased liver cant’ metabolize as much protein, not metabolizing N. Becomes toxic and produces NH3. crosses brain
NAS
no added salt
Potassium modified diet
ESRD patietns
3Ds: diarrhea, diuresis, diaphoresis. Losing K. HypoKalemia.
or
If not urinating, not losing K, HyperKalemia
Electrical impulse of heart
oranges, bannana
Day/Eve/Night
0700-1500/etc . 8hrs each shift
ESRD Fluid restriction to 1L/day
.
duration of Nasogastric Tube
only up to 7 days
PEG restrictions (in stomach)
- meticulous mouth care, LO salivary production. PAROTIDITIS
- continuous feed. head of bed always 30* or UP
- check residual periodically (continuous) or BA feeding (intermittent). aspirate stomach contents. >75cc
- replace residual acid from stomach
- check placement of tube. aspirate sm amount of stomach contents to check pH.
PPN
Partial Parenteral Nutrition.
can be administered into peripheral vein
TPN
Total Parenteral Nutrition (Hypertonic solution)
- Glucose + Amino Acid, vit, min, electrolytes (digested carb/protein)
1. into MAIN line (IVC or SVC venacava)
2. can’t be allergic to egggs. lipid complete
3. Sterile care of main line (bacteria would thrive in TPN mixture so avoid it)
4. Test for glucose. as UP glucose, Pancreas not getting message to release insulin on it’s own since not going through the stomach, but only intravenously.
Change TPN line how often?
every 24hr
normal: every 3 days
proteins used for?
structure
Glucagon
changes glycogen into glucose
Glycogen store where?
muscle and liver
High Protein Diet
wound healing, kids, pregnant women
IRON should be taken with?
CITRUS
Dairy (Ca) will inhibit absorbtion
*** Schillings Test
test for pernicious anemia. radioactive B12 tracer injected. If we can’t absorb B12, that indicates we LACK intrinsic factor. RBC w start dyng if no B12. ~128days
TREAT give Cyanocobalumin (B12 IM monthly)
Ca dose
1000 - 1200 mg/d
K in
banana, citrus, tomatoes, peanuts
Iron
Hemoglobin part thatl atches onto Oxygen.
Take w Citrus, straw to prevent staining. Z-track to prevent staining skin
Pre-Eclampsia
PIH, pregnancy induced HTN damage to glomeruli (spring leak i glomeruli and H20 adn protein escape. PROTEINUREA symptoms: mom has seizures treatment: Mg (risk for DOWN Resp Rate) rescue drug: Calcium Gloconate
Make vitamin D out of ?
Cholesterol
GERD
6/8 small meals
bed head elevated
don’t eat right before bed
don’t lie flat right after eating
Acidosis
1) Diabetic Ketoacidosis; symptoms Kussmaul Resp, Blow off CO2
2) Loss if bicarbonate from excessive diarrhea
Metabolic Alkalosis
loss of gastric acid (vomit, gastric suction, too many antacids)
Respiratory Acidosis
Hypoventilation (CO2 + H2O = H2CO3)
COPD, stroke, asthma, pheumonia, opiates
Respiratory Alkalosis
blow off CO2, crying baby, mom labor, anxiety
LOW CO2 +H2O = LOW H2CO3
**Kidney retains bicarbonate to neutralize acid
Gluconeogenesis
making new glucose
take glocose off of TriGlyc to leave the 3 FAs to create an acidic environment
Type 1 Diabetes
Pancrease produces NO INSULIN
Insulin
lowers blood sugar by pushing glucose into cells
Glucogon
peptide hormone, produced by alpha cells of the pancreas, that raises the concentration of glucose in the bloodstream. Its effect is opposite that of insulin, which lowers the glucose concentration. Wikipedia
HgA1C test
to monitor blood sugar compliance
should be
DRI (no RDA)
Daily recommended Intake.
No RDA
DRI
Daily recommended Intake.
No RDA
Ulcers caused from lack of ?
Protein
Protein purpose
Wound healing
Muscle building
Parenteral
IV, IM
Enteral
Through gut Ostomy NG tube (Naso gastric) PO (per os) PEG tube
TPN
Total parental nutrition
Diverticulosis diet (condition of )
High fiber diet, to move food through intestines
Diverticulitis diet
Low residue, clear fluid, high protein, non fatty
What aids in absorption of iron
Hinders?
Citrus
Ca inhibits
Hiatal Hernia diet
6-8 small meals
Don’t lie down after eating
Raise head of bed
What allergy w prevent patient from receiving TPN?
Eggs
Why monitor ? during TPN administration?
Glucose levels because pancreas doesn’t get message from stomach to release insulin.
Cholesterol , plant or animal based?
Animal
Liver and Renal patient diet
Low protein
No soy
No meat
No nuts
B12
Plant or animal
Animal
Schillings Test
Detecting Pernicious Anemia
(Using radioactive B12. If absorbed, NO pernicious anemia). If absorbed it means gut IS producing intrinsic factor to aid in absorption of B12.
If absorbed , you DO have PA
TREATMENT. IM of cyanocobalamin (B12)
BMR
Basal Metabolic Rate
how many calories burned in 24hrs at rest
Vit A Deficiency
Night Blindness
Central Line
Large Flow Vein
-jugular, subclaian, Superior vena cava, Inferior vena cava
ABG
Arterial Blood Gas
An arterial blood gas (ABG) test measures the acidity (pH) and the levels of oxygen and carbon dioxide in the blood from an artery. This test is used to check how well your lungs are able to move oxygen into the blood and remove carbon dioxide from the blood.
Allen’s Test
squeeze on Radial and Ulnar veins. Release radial to ensure there is blood flow back to hand, in case you give the Ulnar vein a clot when performing ABG test.
otomoy
temporary hole
ostomy
surgically created long lasting hole
phlebotomy
drawing blood from hole
Normal Saline
0.9% NaCl
Dextrose, 5% in normal saline
D5NS
Dextrose 5% in 1/2 normal saline
D51/2NS
half normal saline
0.45%NaCl
Macro Drip tubing
10gtt = 1ml
use if IV drip rate is 81ml or UP
Micro Drip tubing
60gtt = 1ml
use if IV drip rate is 80ml/hour or slower
Blood tubing
15 gtt/1ml