Fundamentals of Nursing Chapter 47

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Fundamentals of Nursing Chapter 47
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2012-10-04 13:56:43
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Nutrition
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  1. What are carbohydrates?
    • Sugars
    • Cereal & Breads
    • Vegetables
  2. What is your Resting Energy Expenditure (REE)?
    The amount of energy required to maintain basic body functions to maintain life.
  3. What is the Chinese culture for eating?
    • Foods are served at meals in a specific order
    • Traditional practices may include not having ice in ther drinks
    • Foods are chosen to balance yin and yang
  4. What is obese?
    A person is categorized as this, if their Body Mass Index (BMI) is >30 kg/m2
  5. What is a food diary?
    A detailed record of measured amounts (portion sizes) of all foods and fluids a client consumes during a specific period (usually 3-7 days).
  6. What are water soluable vitamins?
    • These include the following:
    • C
    • B1, B2, B3, B6, B9, and B12
  7. What is a calorie or caloric value?
    The amount of energy that nutrients or foods supply to the body.
  8. What is a (food) fad?
    A widespread but short-lived practice or interest followed with considerable zeal.
  9. What is lactose intolerance or a shortage of the enzyme lactase?
    • A condition in which an individual has an inability to break down the sugar in milk.
    • NOTE: Between 30 to 50 million Americans have this condition!
  10. When is a full nutritional assessment required?
    This is required to be completed on any SNF resident whose percentage of meals eaten falls below 75%
  11. What are lipids or fats?
    These organic substances are greasy and insoluble in water, but soluble in alcohol or ether.
  12. What is the ideal body weight (IBW)?
    This is the optimal weight recommended for optimal health.
  13. How do medications or drugs affect nutrition?
    These may alter the appetite, disturb taste perception, or interfere with nutrient absorption or excretion.
  14. What is the maximum range of fats that an individual should have per day?
    An individual should have less than 20% to 35% of this substance for their total calorie intake/day.
  15. What is a triceps skin-fold measurement?
    This anthropometric measurement includes skin and subutaneous tissue, but not underlying muscle.
  16. What are proteins?
    • Examples include:
    • Eggs
    • Poultry
    • Fish 
    • Meat
  17. What is the basal metabolic rate (BMR)?
    The rate at which the body metabolizes food to maintain energy requiremets while the person is awake and at rest.
  18. What effects the nutrition of the elderly?
    This group of people require fewer calories because they have a lower BMR and decrease in physical activity.
  19. What is the maximum recommended daily amount of sodium (Na+)?
    it is recommended that an individual limit their intake to less than 2,300 mg/day.
  20. What is a nutritional assessment?
    The purpose of this is to identify clients at risk for malnutrition and those with poor nutritional status.
  21. What is aspirate?
    In an intramuscular injection, after piercing the skin and inserting the needle into the muscle, this is the next step the nurse must perform.
  22. What position should a patient be placed in (at a minimum), when administering enteral meds or feedings?
    Semi-fowlers position (30-45 degrees).
  23. What effect may laxatives have on a persons nutrition?
    • This category of medications effects a patient's nutrition by possibly causing Ca+ and Na+ depletion.
    • Some also may decrease absorption of vitamins A, D, E, & K
  24. What is reconstitution?
    This is the technique of adding a diluent to a powdered drug to prepare it for administration.
  25. What is the "scoop" method to re-cap a needle?
    Place the needle cap on a flat surface and insert the needle horizontally into the cap using one hand, then use the other hand to pick up and tighten the needle hub.
  26. What size of needle do you use for a subcutaneous (SubQ) injections?
    Generally a #25 gauge, 5/8-inch needle is used for adults of normal weight for this injection.
  27. What should be the pH in the fluid from a gastric tube?
    The pH of the aspirted fluid froma  gastric tube should have a measurement of six (6) or lower.
  28. This drug is not recommended to be taken during pregnancy.
    Anti-emetic
  29. What is the Dorsogluteal site?
    This IM injection location can be found by palpating the posterior superior iliac spine, then draws an imaginary line to the greater trochanter, and the injection site is lateral and superior to this line.
  30. What should you never do after giving a client an injectable medication?
    • You should NEVER, EVER, EVER,
    • re-cap the needle!!
    • Cause I poke you and it pokes me,
    • now we both have the same disease!
  31. What is a filter needle?
    This needle is used to draw up medication from an ampule to prevent withdrawing glass particles.
  32. What is assessing for residual feeding?
    In this procedure the nurse aspirates all contents of the stomach and measures it before administering the next feeding.
  33. What effects can Antacids containing aluminum or magnesium hydroxide (tums) have on the body?
    These medications if taken in excess may decrease the absorption of phosphate and Vitamin A, inactivate thiamine, cause a deficiency of Ca+ and Vitamin D, and increase the excretion of Na+, K+, Cl-, Ca+, Mg+, zinc and riboflavin.
  34. What is the Z-track method?
    This IM injection method is less painful and decreases the leakage of medications into the SubQ tissue than traditional techniques.
  35. How do you open an ampule?
    Always use a gauze or alcohol wipe and break off the top away from you while opening this medication container.
  36. What is the maximum amount of medication that should be delivered to the deltoid site?
    It is recommended that this IM injection site have no more than 1mL of solution administered.
  37. What is the assessment step that should always be done right before administering an enteral feeding or medication?
    Check the tube placement
  38. What are anti-emetics?
    These drugs are antagonists to dopamine, histamine, serotonin, and acetylcholine which are associated with vomiting.
  39. Why is the Ventrogluteal site the preferred site for IM injections?
    • Contains no large nerves or blood vessels
    • Provides greatest thickness of gluteal muscle
    • Is sealed off by bone
    • Less fat
  40. What is a sharps container?
    This container is used to collect needles and surgical blades.
  41. What is an intradermal (ID) injection?
    This injection is given at a 5-15 degree angle, with the bevel up to form a "bleb" or "wheal".
  42. If storage of bile is not possible because the ballbladder has been removed, what effect would this have on the patient?
    The patient would have a harder time breaking down fats and oils. Thus, the patient should be put on a no/low fat/oil diet.
  43. A nurse is working in an alcoholic referral unit of a local hospital. Based on an understanding of the effects of alcohol on the GI tract, what would the nurse be alert for nutritionally?
    Vitamin B malnutrition 
  44. A nurse is teaching an older patient about nutritional needs using the older adult food pyramid. The nurse would include all of the following in teaching:
    1. Take in at least 800 mg of calcium a day to help prevent bone loss 2. Decrease calorie intake (Due to limited exercise) 3. Reduce fat intake by using leaner cuts of meat and limiting portions of these. 4. Consume fiber rich foods 5. Drink at least 8 glasses of water or fluid to decrease risk of constipation. 6. Minimize the use of laxatives.
  45. What is one recommendation that will appear on the most recent Food Guide: My Plate?
    Eat whole grain foods with meals
  46. 1 lb of body fat is approximately equal to?
    3500 calories
  47. A healthy and active 72 year old woman asks a nurse if it is safe to take dietary supplements and, if so, what should be taken?
    • Calcium
    • Vitamin D
    • Vitamin B12
  48. What are the essential nutrients we all need?
    • Water
    • Carbohydrates
    • Protein
    • Fats
    • Micronutrients (Vitamins and Minerals)
  49. How should you take iron?
    With food
  50. Are carbohydrates Micro- or Macro- nutrients?
    Macronutrients
  51. What are proteins?
    Amino acids
  52. What are major enzymes in digesting carbohydrates?
    • Ptyalin (salivary amylase)
    • Pancreatic amylase
    • Disaccharidases
  53. What are the end products of carbohydrates?
    Monosaccharides
  54. When a feeding tube is FIRST positioned, verification of placement is done by?
    An x-ray
  55. What does the body break carbohydrates into?
    Glucose, which helps maintain blood levels and is a readily available source of energy
  56. Where are carbohydrates absorbed, in a healthy person?
    In the small intestine
  57. Where does digestion of protein begin?
    In the mouth
  58. Which enzyme helps the mouth with the digestion of protein?
    Pepsin
  59. Where is most protein digested?
    In the small intestine
  60. The pancreas secretes which enzymes?
    • Trypsin
    • Chymotrypsin
    • Carboxypeptidase
  61. Glands in the pancreas secrete what type of enzymes?
    Proteolytic enzymes
  62. What do the glands of the intestinal wall secrete?
    Aminopeptidase and dipeptidase, which break protein into amino acids.
  63. What do aminopeptidase and dipeptidase do?
    Break protein into amino acids.
  64. How are amino acids absorbed through the small intestines?
    By active transport
  65. Where are lipids and fats mostly digested?
    In the small intestines
  66. Digestion of lipids/fats begins where?
    In the stomach
  67. Digestion of Lipids and Fats is done by what enzymes and alkaline fluid?
    • Pancreatic Lipase
    • Enteric Lipase
    • Bile
  68. The end products of Lipid digestion are . . . 
    • Glycerol
    • Fatty acids
    • Cholesterol
  69. The intestinal cells reassemble fats and lipids into . . . 
    • Triglycerides
    • Cholesterol esters
  70. The small intestine and the liver convert the triglycerides and cholesterol esters (formed from lipids and fats) into . . .
    Soluble compounds called lipoprotein
  71. The conversion of fat into useable energy occurs through what process?
    This conversion occurs through lipase that breaks down triglycerides in adipose cells, releasing glycerol and fatty acids into the blood.
  72. What are the calorie values for each of the following (C-PAF)?
    Carbs
    Proteins
    Alcohol
    Fats
    • Carbs = 4 cal/g
    • Proteins = 4 cal/g
    • Alcohol = 7 cal/g
    • Fats = 9 cal/g
  73. What is Energy Balance?
    The relationship between the energy derived from food and the energy used by the body.
  74. What is Caloric Value?
    The amount of energy that nutrients or foods supply to the body.
  75. A BMI of <18.5 is considered?
    Underweight
  76. A BMI of 18.5 - 24.9 is considered?
    Normal
  77. A BMI of 25.0 - 29.9 is considered?
    Overweight
  78. A BMI of 30.0 - 34.9 is considered?
    Obesity I
  79. A BMI of 35.0 - 39.9 is considered?
    Obesity II
  80. A BMI of 40.0 or > is considered?
    Extreme Obesity III
  81. If an individual is taking Warfarin (Coumadin) they must avoid which vitamin?
    Vitamin K
  82. Which antioxidants (vitamins) may be helpful in reducing the risks of heart disease in women?
    • Vitamins A, C, and E
    • (Antioxidants are substances that may protect your cells against the effects of free radicals.)
  83. Mostmenopausal women need to ingest sufficient amounts of ______ and ______ to reduce Osteoporosis?
    • Calcium
    • Vitamin D
  84. How much fluid should the average adult consume on a daily basis?
    Two (2) to three (3) liters
  85. The average adult should continue to eat a healthy diet and pay special attention to __a.__ and __b.__ and limiting __c.__ and __d.__ intake.
    • a. protein
    • b. calcium
    • c. cholesterol
    • d. caloric
  86. What is the purpose of a nutritional screening and assessment?
    Assessment performed to identify clients at risk for malnutrition
  87. If an individual is found to be at moderate or high risk for nutrition who will assess them next?
    They are followed up with a comprehensive assessment by a dietician
  88. If a nursing home resident's percent of meals eaten falls below 75%, what happens?
    As the nurse, you will perform a full nutritional assessment.
  89. What are a few risk factors for nutrition, based on the diet history?
    1. Chewing/swallowing difficulties 2. Inadequate food budget, food intake, preparation and storage facilities 3. IV fluids 4. Living and eating alone 5. No intake for > 7 days  6. Physical disabilities 7. Restricted or fad diets
  90. What are a few risk factors for nutrition, based on the medical history?
    1. Adolescent pregnancy or closely spaced pregnancies 2. Alcohol/substance abuse 3. Catabolic or hypermetabolic conditions 4. Chronic illnesses 5. Dental problems 6. Neurologic or cognitive impairments 7. Oral and GI surgeries 8. Unintentional weight loss or gain
  91. What are a few risk factors for malnutrition, based on the medication history?
    • 1. Antacid
    • 2. Antidepressants
    • 3. Antihypertensives
    • 4. Anti-inflammatory
    • 5. Antineoplastic
    • 6. Aspirin
    • 7. Aspirin
    • 8. Digitalis
    • 9. Diutetics
    • 10. Laxatives
    • 11. Potassium chloride
  92. List a few NANDA Nursing Diagnoses related to nutritional problems:
    • 1. Imbalanced Nutrition: More Than Body Requirements
    • 2. Imbalanced Nutrition: Less Than Body Requirements
    • 3. Readiness for Enhanced Nutrition
    • 4. Risk for Imbalanced Nutrition: More Than Body Requirements
  93. List a few etiologies that would be related to nutrition imbalance
    • Activity intolerance
    • Constipation
    • Low Self-Esteem
    • Risk for Infection
  94. List a few planning statements for Imbalanced Nutrition:
    • Maintain or restore optimal nutritional status
    • Promote healthy nutritional practices
    • Prevent complications associated with malnutrition
    • Decrease weight
    • Regain specified weight
    • *All of these must be individualized, realistic, measurable, and have a time frame for accomplishment!
  95. For a nutritional nursing diagnosis, what would the nurse evaluate, after the implementation process, is underway?
    The goals established in the planning phase, according to the specified desired outcomes
  96. For a nutritional nursing diagnosis, what should the nurse do if the desired outcomes are not achieved?
    Explore the reasons, adjust where necessary.
  97. What is the ADA?
    American Diabetic Association
  98. What does the ADA specialized diet recommend?
    Balanced meals based on total calories and carbohydrate counting (45-60 grams/meal).
  99. What would a specialized cardiac diet recommend?
    • Limited fat (<30% of calories)
    • Saturated fats < 7% of daily calories
    • Decreased sodium (Na+)
  100. What would a specialized renal diet recommend?
    • Low protein
    • Increased carbohydrates
    • Decreased sodium (Na+)
    • Decreased potassium (K+)
    • Controlled fluid intake
  101. What does a Vegan diet include?
    Excludes all meat and animal products
  102. What does a Lacto Vegetarian diet include?
    • Excludes all meat
    • Includes plant foods and dairy products
  103. What does a Lacto-ovo Vegetarian diet include?
    • Excludes all meat
    • Includes plant foods, dairy products, and eggs
  104. What are some nutrients that Vegans/Vegetarians may need to focus on?
    • Protein
    • Iron
    • Calcium
    • Zinc
    • Vitamin B12
  105. What are the macronutrients our bodies need?
    • Carbohydrates
    • Fats
    • Proteins
    • Minerals
    • Vitamins
    • Water
  106. Define macronutrient
    A type of food required in large amounts (hundreds of grams) in the human diet to provide energy.
  107. What are the micronutrients our bodies need?
    The vitamins and minerals that are required in small amounts (mg or mcg) to metabolize the energy-providing nutrients.
  108. What is the BMI Formula?
    BMI = weight in kg/(height in meters)2
  109. What are some of the recommendations a nurse can make to meet the nutritional needs of an older adult?
    1. Encourage regular dental visits 2. Eat more complex carbohydrates 3. Eat less sugar-rich foods (due to lowered sugar tolerance) 4. Promote social interaction (counteract loneliness) 5. Eat essential nutrient dense foods first (counteract loss of appetite) 6. Suggest generic brands and coupons (limited income) 7. Major meal at noon, rather than evening and no coffee or tea in the evening (promotes sleep)
  110. What are some of the recommendation differences between the adult and the older adult MyPyrmid?
    1. Reduce calorie intake (due to decreased activity) 2. Reduce fat consumption, leaner cuts, smaller portions 3. Reduce the consumption of empty calories 4. Reduce sodium consumption (hypertension/cardiac issues) 5. Ensure adequate calcium intake (prevent bone loss) 6. Ensure adequate vitamin D intake (maintain calcium homeostasis) 7. Ensure adequate iron 8. Consume fiber rich foods.
  111. What is Anthropometric Data?
    • Measurements that are noninvasive techniques that aim to quantify body composition. 
    • 1. Height
    • 2. Weight
    • 3. Ideal body weight
    • 4. Usual body weight
    • 5. Body mass index
    • NOTE: These can be gathered through Skinfold, MAC, and MAMA measurments.
  112. What is the skinfold measurement?
    Performed to determine fat stores (common site is the triceps skinfold) does not include the muscle layer and measured in millimeters.
  113. What is the Mid-Arm Circumference (MAC) measurement?
    A measure of fat, muscle and skeleton
  114. What is the Mid-Arm Muscle Area (MAMA) measurement?
    • Calculated from the MAC, using reference tables or the following formula:
    • MAMA (cm2) = [midarm cir (cm) - 3.14 x TSF (cm)]2 devided by 4(pie)
  115. What is biochemical data, in the nurse's nutritional assessment?
    • Lab tests provide objective data to the nutritional assessment, but because many factors can influence these tests, no single test specifically predicts nutritional risk or measures the presence or degree of a nutritional problem: 
    • Serum proteins
    • Urinary Urea Nitrogen
    • Creatinine
    • Lymphocyte Count
  116. What is chemical data, in the nurse's nutritional assessment?
    Physical examination reveals some nutritional deficiencies and accesses in addition to obvious weight changes. Assessment focuses on on rapidly proliferating tissues, such as skin, hair, nails, eyes, and mucosa, but also includes a systematic review comparable to any routine examination.
  117. What is dietary data, in the nurse's nutritional assessment?
    Includes the clients usual eating patterns and habits; food preferences, allergies, and intolerances; frequency, types, and quantities of foods consumed; and social, economic, ethnic, or religious factors influencing nutrition: 1. 24-hour food recall 2. Food frequency record 3. Food Diary and 4. Diet history
  118. What is a clear liquid diet?
    • This diet is limited to water, tea, coffee, clear boths, ginger ale, or other carbonated beverages, strained and clear juices, and plain geletin. 
    • NOTE: "Clear" does not necessarily mean "colorless".
  119. What are the drawbacks of a clear liquid diet?
    While this diet provides the client with fluid and carbohydrates (in the form of sugar), it does not supply adequate protein, fat, vitamins, minerals, or calories. 
  120. When should a patient be put on a clear liquid diet?
    • After certain surgeries
    • In the acute stages of infection, particularly of the gastrointestinal tract. 
  121. How long should a person be put on a clear liquid diet?
    This is a short term diet (24-36 hours)
  122. What are the objectives of a clear liquid diet?
    • The major objectives are:
    • 1. To relieve thrist
    • 2. To prevent dehydration
    • 3. To minimize stimulation of the gastrointestinal tract
  123. What is the full liquid diet?
    Thi diet contains only liquids or foods that turn to liquid at body temperature, such as ice cream. 
  124. Who should be put on a full liquid diet?
    This diet is often eaten by clients who have gastrointestinal disturbances or are otherwise unable to tolerate solid or semi-solid foods.
  125. What is the soft diet?
    • This diet is easily chewed and digested as it is a low residue (low-fiber) diet containing very few uncooked foods.
    • NOTE: Restrictions vary among agencies and according to the indiviual's tolerance.
  126. Who should be put on a soft diet?
    Clients who have difficulty chewing and swallowing.
  127. Define a puree diet
    This is a modification to the soft diet, where liquid is added to normal foods and they are blended.
  128. Define: Diet as tolerated.
    • Ordered when the client's appetite, ability to eat, and tolerance for certain foods may change. 
    • EXAMPLE: The first post-operative day a client may be given a clear liquid diet. If no nausea occurs, normal intestinal motility is assessed, and client feels like eating, the diet may be advanced to a full liquid, light, or regular diet. 
  129. What is dysphagia?
    Patient has inadequate solid or fluid intake because they are unable to swallow medications, or aspirates food or fluids into the lungs, causing pneumonia.
  130. Who are at risk for dysphagia?
    • 1. Older adults
    • 2. Those who have experienced a stroke
    • 3. Clients with cancer who have had radiation to the head and neck
    • 4. Those with cranial nerve dysfunction
  131. What are some nursing interventions that can be implemented to stimulate the appetite?
    • 1. Provide familiar food that the person likes (if family members bring food, educate them on special diets).
    • 2. Select small portions (helps with anorexia)
    • 3. Avoid unpleasant/uncomfortable treatments before mealtime
    • 4. Provide a tidy, clean environment free of unpleasant sights and odors
    • 5. Oral hygeine before mealtime (improves taste)
    • 6. Relieve illness symptoms/pain before meals
    • 7. Reduce psychologial stress (explain and discuss)
  132. What is the recommended way to check for a feeding tube placement?
    Ascertain correct placement of the tube by aspirating stomach contents and checking the pH, which sould be acidic. This is a reliabe way to determine the location. Gastric contents are usually a pH of 1-6. A pH of >6 indicates the contents are from the intestines or in the repiratory tract.
  133. How should the placement of a feeding tube be checked, when it is first inserted?
    By an x-ray
  134. What assessments should a nurse perform on a patient receiving tube feedings?
    1. Allergies to any food in the feeding 2. Bowel sounds BEFORE each feeding (continuous feeding every 4 to 8 hours) 3. Correct placement of the tube BEFORE feeding 4. Presence of regurgitation and feelings of fullnes after feeding 5. Dumping syndrome (nausea, vomiting, diarrhea, cramps, pallor, sweating, heart palpitations, increased heart rate, and faint after a feeding 6. Abnormal distention (measure abdominal girth at the umbilicus DAILY) 7. Diarrhea, constipation, flatulence 8. Urine for sugar/acetone 9. Hematocrit/USG 10. BUN/Na+ levels
  135. What should the nurse do if the signs indicate a feeding tube has been placed in the lungs?
    Remove the tube and begin again.
  136. What are some things a nurse should teach her patient/caregiver regarding tube feedings?
    1. Preparation of the formula 2. Proper storage of the formula 3. Administration of the feeding 4. Management of the enteral or parenteral access device 5. Daily monitoring needs 6. Signs and symptoms of complications 7. Whom to contact about questions or problems.
  137. What are the four (4) fat soluble vitamins the body needs?
    A, D, E, and K
  138. What does vitamin A do for the body?
    This vitamin is required for development and maintenance of healthy eyes, gums, teeth, skin, hair, and selected glands. It is also needed for fat metabolism.
  139. What are good sources of Vitamin A?
    • Fortified milk
    • Butter
    • Eggs
    • Leafy green and yellow vegetables
    • Fruits
  140. Where is natural vitamin A found?
    • Cod
    • Halibut
    • Shark
    • Tuna
  141. What does vitamin D do for the body?
    Promotes use of phosphorus and calcium. Important for stong teeth and bones.
  142. What are good sources of Vitamin D?
    • Fortified milk
    • Egg yolks
    • Tuna
    • Salmon
    • Liver
  143. What does vitamin E do for the body?
    Protects fatty acids and promotes teh formation and functioning of red blood cells, muscle, and other tissues.
  144. What are good sources of vitamin E?
    • Whole grain cereals
    • Wheatgerm
    • Vegetable oils
    • Lettuce
    • Sunflower seeds
    • Milk
    • Eggs
    • Meat 
    • Avacados
    • Asperagus
  145. What does vitamin K do for the body?
    This vitamin is essential for blood clotting.
  146. What are good sources of vitamin K?
    • Leafy green vegetables
    • Liver
    • Cheese
    • Egg yolks
    • Vegetable oil
    • Tomatoes
  147. What does vitamin B1 do for the body?
    Promotes use of sugars (energy). Required for good function of the nervous system and the heart.
  148. What are good sources of vitamin B1?
    • Enriched breads and cereals
    • Yeast
    • Liver
    • pork
    • Fish
    • Milk
    • Lentils
    • Black strap molasses
  149. What are good sources of vitamin B2?
    • Milk
    • Enriched breads and cereals
    • Liver
    • Lean meat
    • Eggs
    • Almonds
    • Wheat germ
    • Soy
    • Leafy green vegetables
  150. What does vitamin B2 do for the body?
    Promotes the body's use of carbohydrates, proteins, and fats by releasing energy to cells. Required for tissue integrity.
  151. What does vitamin B6 do for the body?
    Important in metabolism, synthesis of proteins, and formation of red blood cells. 
  152. What are good sources of vitamin B6?
    • Lean meat
    • Leafy green vegetables
    • Whole grain cereals
    • Yeast
    • Bananas
    • Salmon
    • Soy beans
    • Seeds
    • Nuts
    • Avacados
    • Carrots
  153. What does vitamin B12 do for the body?
    Functions as a building block of nucleic acids and to form red blood cells. Facilitates the functioning of the nervous system. 
  154. What are good sources of vitamin B12?
    • Liver
    • Kidney
    • Fish
    • Milk
    • Egggs
    • Chicken 
    • Turkey
  155. What does Folic Acid do for the body?
    Helps in the formation of genetic materials and proteins for the cell nucleus. Assists with intestinal functioning. Prevents selected anemias.
  156. What are good sources of Folic Acid?
    • Leafy green vegetables
    • Yellow fruits and vegetables
    • Yeast
    • Organ meats
    • Blackeyed peas
    • Lentils
  157. What does vitamin C do for the body?
    Helps tissue repair and growth. Required in the formation of callogen.
  158. What are good sources of vitamin C?
    • Citrus fruits
    • Cantaloupe
    • Tomatoes
    • Leafy green vegetables
    • Sweet red peppers
    • Potatoes
    • Strawberries
    • Kiwi
  159. What are some foods rich in Iron?
    • Liver
    • Lean meats
    • Egg yolks
    • Dried beans
    • Green vegetables (spinich)
    • Fruit
  160. What can effect the absorption of Iron?
    Antacids 
  161. What vitamin increases the absorption of Iron?
    Vitamin C
  162. What is an anti-emetic drug used to treat?
    • Frequently used to prevent motion sickness
    • Should be taken 30 minutes prior to travel
    • NOTE: Not effective if taken after vomiting.
  163. Under what circumstances does an anti-emetic have minimal effects?
    Severe vomiting resulting from anticancer agents (antineoplastics), radiation, and toxins.
  164. What is an antacid used to treat?
    • Promotes ulcer healing by neutralizing hydrochloric acid and reducing pepsin activity.
    • NOTE: They do not coat the ulcer
  165. What are the different types of syringes used to administer parenteral medications?
    • Hypodermic Syringe
    • Insulin Syringe
    • Tuberculin Syringe
    • Prefilled Unit Dose Syringes
  166. What are the procedures a nurse needs to follow in order to help prevent accidental needle sticks?
    • You NEVER, ever, ever, recap USED needles!!!
    • When recapping a prefilled needle (prior to use)
    • A) Use a safety mechanical device that grips the needle cap and holds it in place until you are ready to recap
    • B) Use the one handed scoop method, placing the cap on a horizontal surface and "scooping" it up with the needle, then snapping it down with the other hand.
  167. What type of needle needs to be placed on a syringe if the nurse is drawing the medication out of an ampule?
    • A filter needle or filter straw
    • **Both prevent aspiration of any glass particles
  168. What step must the nurse perform just before he/she withdraws medication from a vial?
    • The nurse must either add a solvent (serile water) tothe powder OR Rotate the vial between the palms to mix
    • DO NOT SHAKE!!!
  169. What degree angle does the nurse position the needle of an intradermal (ID) injection?
    The needle enters the skin at a 5- to 15- degree angle. The medication forms a fleb or wheat under the epidermis.
  170. What degree angle does the nurse position the needle of a subcutaneous (SQ) injection?
    Inserting a needle into the subcutaneous tissue using 90 and 45 degree angles.
  171. Why would a nurse choose a 90 degree angle for a SubQ injection?
    If the client has more than 1/2 inch of adipose tissue in the injection site it is safe to administer at this angle.
  172. Why would a nurse choose a 45 degree angle for a SubQ injection?
    If the client is thin or lean and lacks adipose tissue the shot should be given at this angle.
  173. What are the five (5) common sites for intramuscular (IM) injections?
    • 1. Ventrogluteal site
    • 2. Vastus Lateralis (good for infants)
    • 3. Dorso gluteal site
    • 4. Rectus Femoris site
    • 5. Deltoid site
  174. What is the preferred site for IM injections for adults?
    The ventrogluteal site is the preferred site, because it contains no large nerves or blood vessels, the greatest thickness is sealed off by bone, and contains less fat.
  175. What is the purpose of using the Z-track method when giving IM injections to adults?
    When the skin returns to its normal position after the needle is withdrawn, a seal is formed over the intramuscular site. This prevents seepage of the medication into the subcutaneous tissues and subsequent discomfort.
  176. What may the nurse need to consider when selecting needle length for an older adult?
    • Older clients may have a decreased muscle mass or muscle atrophy, so a shorter needle may be needed.
    • Assessment of an appropriate injection site is CRITICLE. 
    • NOTE: Absorption of medication may occur more quickly than expected.
  177. Name three types of Gastrointestinal Tubes?
    • Nasogastric Tube: Inserted from the nose to the stomach
    • Gastrostomy (PEG): Percutaneous endoscopic - placed surgically (patient can tolerate a higher concentration of fluid, since it is placed in the stomach)
    • Jejunostomy: Placed in the jejunum - placed surgically (patient cannot tolerate high concentration fluid, since this is placed in the small intestine)
  178. What are three types of solutions used in GT's?
    • Blenderized
    • Polymeric
    • Monomeric - Good for Jejunum placements
  179. What are three ways to deliver solutions via a GT?
    • Bolus - given at a slow even pace (at a rate that an individual would normally eat)
    • Intermittent Drip - Via pump - Received for a period of time  (few hours) and then it is turned off occasionally
    • Continuous - Via pump - set at a continuous drip
  180. What is a complication that can occur with a GT?
    Aspiration
  181. What are the initial steps that should be followed when setting up a feeding tube (prior to flushing the tube)?
    • Obtain a set of baseline weight, vitals, and labs
    • Raise the head of bed (HOB) at least 30 degrees (Semi-Fowler's)
    • Assess tube security and placement
    •      1. Aspiration of secretions & re-installment of secretions
    •      2. Check for a pH of 6 or <
    • Assess the tolerance for feedings
    •      1. Check for residuals for continuous feedings every 4-6 hours (or depending on agency policy)
    •      2. Residual feedings should not be more than ~100mL or agency policy
    •      3. For intermittent feeding - NO MORE THAN 50% of the previous feeding should remain
  182. After the initial steps (aspiration has just been completed), what are the steps that should be followed for a feeding tube?
    • Flush tube as indicated
    • Before administering feeding
    •      1. CHECK EXPIRATION DATE!!
    •      2. Warm feeding to room temperature
    • Hang the bag about 12 inches above insertion point, clamp tubing and add formula and then purge the tubing
    • Attach to patient tubing and regulate the drip rate
    • If syringe system, clamp tubing and add feeding to gyringe, unclamp and slowly let in feeding
    • Remain in fowlers position for at least 30 minutes
  183. What are the final and ongoing steps to be taken, once a feeding has been completed (or established, if ongoing)?
    • Monitor urine output and bowel sounds and vital signs
    • Free water (patient still needs to be hydrated so water should be given in between feedings)
    • Change feeding bag daily - Mark the date and time of initial use (can use a bag for 24 hours, but it must be changed after that)
    • Always ensure client safety and comfort
    • DON'T FORGET TO DOCUMENT!!!!
  184. What are a few points to remember when giving medications via the feeding tube (Enterally)?
    • Most drugs administered orally can be given enteral
    • Medication is diluted with water (crush pills*)
    • Placement of tube is confirmed
    • Medication delivered via gravity
    • Flushed with water
    •      1. Care is taken not to insert large amounts of air
    • *NOTE: As always - Do not crush pills that are enteric or extended release
  185. What two nutrients are both Macro and Micronutrients?
    • Vitamins
    • Minerals
  186. What three activities go into protien Metabolism?
    • Anabolism
    • Catabolism
    • Nitrogen balance
  187. What is anabolism?
    All body cels synthesize proteins from amino acid. The types of proteins formed depend on the characteristics of the cell and are controlled by its genes.
  188. What is catabolism?
    Because a cell can accumulate only a limited amount of protein, excess amino acids are degraded for energy or converted to fat. Protein degradation occurs primarily in the liver.
  189. What is Nitrogen Balance?
    • Because nitrogen is the element that distinguishes protein from lipids and carbohydrates, nitrogen balance reflects the staus of protein nutrition in the body.
    • This is a balance is a measure of the deree of protein anabolism and catabolism.
    • It is the net result of intake and loss of nitrogen. 
    • When nitrogen intake equals nitrogen output, a state of nitrogen balance exists.
  190. How do you calculate the percentage of weight loss?
    • % of weight loss = usual weight - current weight 
    •                                            usual weight
    • total x100
  191. Decribe the affect that Acetylsalicylic Acid has on nutrition.
    • Decreases serum folate and flacin nutrition.
    • Increases excretion of viatmin C, thiamine, potassium, amino acids, and glucose.
    • May cause nausea and gastritis
  192. Decribe the effect that Antacids (containing aluminum or magnesium hydroxide) have on nutrition.
    • Decrease aborption of phosphate and vitamin A
    • Inactivate thiamine
    • May cause deficiency of calcium and vitamin D
    • Increase excretion of sodium, potassium, chloride, calcium, magnesium, zinc, and riboflavin
  193. Decribe the affect that Thiazide Diuretics have on nutrition.
    • May cause anorexia, nausea, vomiting, darrhea, or constipation
    • Decrease absorption of vitamin B12
    • May cause diarrhea, nausea, or vomiting
  194. Decribe the affect that Potassium Chloride has on nutrition.
    Increaes excretion of potassium, magnesium, and calcium
  195. Decribe the affect that Laxatives have on nutrition.
    • May cause calcium and potassium depletion
    • Mineral oil and phenophthalein (Ex-ax) decrease absorption of vitamins A, D, E, and K
  196. Decribe the affect that Antihypertensives have on nutrition.
    Hydralazine may cause anorexia, vomiting, nausea, and constipation
  197. Decribe the affect that Anti-inflammatory Agents have on nutrition.
    • Colchicine decreaases absorption of vitamin B12, carotene, fat, lactose, sodium potassium, protin, and cholesterol
    • Prednisone decreases absorption of calcium and phosphorus
  198. Decribe the affect that Antidepressants have on nutrition.
    Amitriptyline increases food intake (large amounts may suppress intake)
  199. Decribe the affect that Antineoplastics have on nutrition.
    Can cause nausea, vomiting, anorexia, malabsorption, and diarrhea
  200. Decribe the affect that Grapefruit has on nutrition.
    Can cause toxicity when taken with a variety of medications including amiodarone, carbamazepine, cisapride, cyclosporine, diazepam, nifedipine, saquinavir, statins, terfenadine, verapamil.
  201. Decribe the affect that Vitamin K has on nutrition.
    Can decrease the effectiveness of warfarin (Coumadin).
  202. Decribe the affect that Tyramine (found in aged cheeses, tap beer, dried sausages, fermented soy, sauerkraut) has on nutrition.
    In  combination with monoamine oxidase inhibitor (MAOI) medication, e.g., isocarboxazid (Marplan), isoniazid, linezolid, phenelzine, tranylcypromine, creates sudden increase in epinephrine leading to headaches, increased pulse and blood pressure, and possible death.
  203. Decribe the affect that Milk has on nutrition.
    Interferes with absorption of tetracycline antibiotics.
  204. Describe the African American heritage in regard to nutrition.
    • Gifts of food are common and should never be rejected
    • Diets are often high in fat, cholesterol, and sodium
    • Being overweight may be viewed as positive
    • Many are lactose intolerant
  205. Describe the Arab heritage in regard to nutrition.
    • Many spices and herbs are used such as cinnamon, allspice, cloves, mint, ginger, and garlic
    • Meats are often skewer roasted or slow simmered (lamb and chicken are most common)
    • Bread is served at every mean
    • Muslims do not eat pork, and all meats must be cooked "well done"
    • Food is eaten (and clients fed) with the right hand
    • Beverages are drunk after the meal, not during; alcohol is prohibited
    • Muslims fast during daylight hours during the month of Ramadan (the 9th month of the year based on the lunar calendar.)
  206. Describe the Chinese heritage in regard to nutrition.
    • Foods are served at meals in a specific order
    • Each region in China has its own traditional diet
    • Traditional Chinese may not want ice in their drinks
    • Foods are chosen to balance yin and yang in order to avoid indigestion
    • Almost half are lactose intolerant
  207. Describe the Jewish heritage in regard to nutrition.
    • Dietary laws govern killing, preparation, and eating of foods
    • Meat and milk are not eaten at teh same time (diary substitutes, such as margarine, are permitted
    • Pork is one meat that is forbidden to eat
    • All blood must be drained from meats
    • Always wash hands before eating
  208. Describe the Mexican heritage in regard to nutrition.
    • Rice, beans, and tortillas are core, essential foods
    • Many are lactose intolerant. Leafy green vegetables and stews with bones provide calcium.
    • Larger body size may be viewed as a positive attribute.
    • Sweet fruit drinks, including adding sugar to juice, are popular
    • The main meal of hte day is at noontime
    • Foods are chosen according to hot and cold theory.
  209. Describe the Navajo heritage in regard to nutrition.
    • Rites of passage and ceremonies are celebrated with food
    • Herbs are used to treat many illnesses
    • Sheep are the major source of meat
    • Squash and corn are major vegetables
    • Many are lactose intolerant
  210. What are some of the problems experienced by older adults, in relation to nutrition?
    • Difficulty chewing
    • Lowered glucose tolerance
    • Decreased social interaction, loneliness
    • Loss of appetite and senses of smell and taste
    • Limited income
    • Difficulty sleeping at night
  211. Why does a client with low iron develop anemia?
    Iron is required for the formation of red blood cells. When iron stores are low, the body cannot produce enough red blood cells and anemia can develop. Symptoms of iron deficiency anema include fatigue, listlessness, anorexia, and pallor. Although iron deficiency anemia is not the only kind of anemia, it is possibly the most common and one of the easiest to treat. Immediate and timed-release forms are available.
  212. What combinations of plant proteins provide complete proteins? (Important for vegetarian diets.)
    • 1. Grains plus legumes = complete protein. 
    • EXAMPLE: Black-eyed peas and rice
    • 2. Legumes plus nuts or seeds = complete protein.
    • EXAMPLE: Lima beans and sesame seeds
    • 3. Grains, legumes, nuts, or seeds plus milk or milk products (e.g. cheese) = complete protein
    • EXAMPLES: Cereal with milk; Macaroni with cheese
  213. What are the components of a Nutritional Assessment?
    • Anthropometric data
    • Biochemical data
    • Clinical data
    • Dietary data
    • NOTE: A, B, C, D
  214. What are examples of Biochemical data?
    • 1. Hemoglobin
    • 2. Serum albumin
    • 3. Total lymphocyte count
  215. What are examples of Clinical data?
    • 1. Skin
    • 2. Hair and nails
    • 3. Mucous membranes
    • 4. Activity level
  216. What are examples of Dietary data?
    • 24-hour food recall
    • Food frequency record
  217. What tests will allow you to gather Anthropometric data?
    • Triceps skinfold (TSF)
    • Mid-arm circumference (MAC)
    • Mid-arm muscle area (MAMA)
  218. What tests will allow you to gather Biochemical data?
    • Serum transferrin level
    • Urinary urea nitrogen
    • Urinary creatinine excretion
  219. What tests will allow you to gather Clinical data?
    • Hair analysis
    • Neurologic testing
  220. What tests will allow you to gather Dietary data?
    • Selective food frequency record
    • Food diary
    • Diet history
  221. What are some of the signs/symptoms of the clinical manifestations of malnutrition?
    • General appearance and vitality: Apathetic, listless, looks tired, easily fatigued
    • Weight: Overweight or underweight
    • Skin: Dry, flaky, or scaly; pale or pigmented; presence of petechiae or bruises; lack of subcutaneous fat; edema
    • Nails: Brittle, pale, ridged, or spoon shaped (iron)
    • Hair: Dry, dull, sparse, loss of color, brittle 
    • Eyes: Pale or red conjunctive, dryness, soft cornea, dull cornea, night blindness (vitamin A deficiency)
    • Lips: Swollen, red cracks at side of mouth, vertical fissures (B vitamins)
    • Tongue: Swollen, beefy red or magenta colored (B vitamins); Smooth apprearance (B vitamins deficiency); decrease or increase in size
    • Gums: Spongy, swollen, inflamed; bleed easily (vitamin C deficiency)
    • Muscles: Underdeveloped, flaccid, wasted, soft
    • Gastrointestinal system: Anorexia, indigestion, diarrhea, constipation, enlarged liver, protruding abdomen
    • Nervous system: Decreased reflexes, sensory loss, burning and tingling of hands and feet (B vitamins), mental confusion or irritability
  222. How would you place a plate in front of an individual who is blind?
    • Use the CLOCK system to describe the location of food on the plate.
    • EXAMPLE: Potatoes are at 8 o'clock, the chicken at 12 o'clock, and the green beans at 4 o'clock.
  223. How can you help improve the client's appetite?
    • Provide familiar food that the person likes
    • Select small portions so as not to discourage the anorexic client
    • Avoid unpleasant or uncomfortable treatments immediately before or after a meal
    • Provide a tidy, clean environment that is free of unpleasant sights and odors
    • EXAMPLE: Soiled dressing, used bedban, and used dishes can negatively affect the appetite
    • Encourage or provide oral hygiene before mealtime. This improves the client's ability to taste
    • Relieve illness symptoms that depress appetite before mealtime
    • EXAMPLE: Give an analgesic for pain or an antipyretic for a fever or allow rest for fatigue
    • Reduce psychological stress.
    • EXAMPLE: A lack of understanding of therapy, the anticipation of an operation, and fear of the unknown can cause anorexia. Help by discussing feelings with the client, giving information and assistance, and allaying fears.
  224. Potassium (k+)
    For the heart
    What are all the foods that contain Potassium?
    NOTE: Do not confuse Postassium (k+) with vitamin K
    • Tomato CAMPS fix CORBS w/o chicken for Potassium
    • Fruits: Cantelope, Oranges, Raisins, Bananas, Strawberries
    • Veggies: Carrots, Avacados, Mushrooms, Potatoes, Spinish, Tomatoes
    • Protein: Fish, Pork, Beef, Veal
    • Grains: 0
  225. Vitamin A = Fats
    Assessment: Eyes, skin, teeth, gums, hair, and some glands
    Needed for fat metabolism
    What are the foods that will give you vitamin A?
    • A Yellow2 and Green BEeF SHoCs Tuna
    • Fruits: Yellow fruits
    • Vegies: Yellow and Green
    • Protein: Butter, Eggs, Fortified milk, Shark, Halibut, Cod, and Tuna 
    • Grains: 0
  226. Vitamin D = Calcium
    Dentist: Teeth and bones
    Promotes the use of Calcium and Phosphorus
    What are the foods that will give you vitamin D?
    • D' Liver FEST
    • Fruits: 0
    • Vegies: 0
    • Protein: Liver, Fortified milk, Egg yolk, Salmon, Tuna
    • Grains: 0
  227. Vitamin E
    Enteral: Protects fatty acids, promotes formation and function of RBCs, muscle, and other tissues
    What are the foods that will give you vitamin E?
    • E' yOur M2EA2LS W/Germs & Cereal
    • Fruits: 0
    • Vegies: Asparagus, Avacodos, Lettuce, Oil
    • Protein: Meat, Milk, Sunflower seeds, Eggs
    • Grains: Cereal, Wheat germs
  228. Vitamin K
    Klotting
    Essential for blood clotting
    What are the foods that will give you vitamin K?
    • K' GOT CheesEY Liver
    • Fruits: 0
    • Vegies: Green, Oil, Tomatoes
    • Protein: Cheese, Egg yolks, Liver
    • Grains: 0
  229. Vitamin B1
    #1 = Heart and Nervous system ----> Glucose
    Promotes the use of sugars 
    What are the foods that will give you vitamin B1?
    • B1 to get an LP on FM radio B/C You Love Music
    • Fruits: 0
    • Vegies: 0
    • Protein: Liver, Pork, Fish, Milk
    • Grains: Breads, Cereals, Yeast, Lentils, Molasses
  230. Vitamin B2
    2 back up Glucose
    Promotes use of Carbs, Fats, and Proteins required for tissue integrity
    What are the foods that will give you vitamin B2?
    • 2B Green = Soy MEAL2 W/Germs, Breads, & Cereals
    • Fruits: 0 
    • Vegies: Green, Soy
    • Protein: Milk, Eggs, Almonds, Liver, Lean meat
    • Grains: Wheat germ, Breads, Cereals
  231. Vitamin B6 = BP
    Metabolism/synthesis of Proteins and formation of RBC's
    What are the foods that will give you vitamin B6?
    • Y B6 S3LAC2'N Greens
    • Fruits: Bananas
    • Vegies: Carrots, Greens, Soy beans
    • Protein: Salmon, Seeds, Lean meats, Nuts
    • Grains: Cereal, Yeast
  232. Vitamin B12 = Meats
    1, 2, 3 . . . Building Blocks for Nucleic Acids, facilitates nervous system
    Forms RBC's (Like B6) 2xB6=B12
    What are the foods that will give you vitamin B12?
    • B12 LEFT My CHicKen
    • Fruits: 0
    • Vegies: 0
    • Protein: Liver, Eggs, Fish, Turkey, Milk, Chicken, Kidney
    • Grains: 0
  233. Folic Acid
    Helps in the formation of genetic material and proteins for the cell nucleus. Helps with intestinal functioning and prevents selected anemias.
    What are the foods that will give you Folic Acid?
    • For A Yellow2 & Green LOBY, eat Peas
    • Fruits: Yellow
    • Vegies: Yellow & Green
    • Protein: Lentils, Organs, Black-eyed Peas
    • Grains: Yeast
  234. Vitamin C
    C the Iron
    Tissue Repair/growth, required to form collagen
    Increases the absorption of Iron
    What are the foods that will give you vitamin C?
    • C the C2aSKeT GPS
    • Fruits: Citrus, Cantelope, Strawberries, Kiwi
    • Vegies: Tomatoes, Greens, Sweet red peppers, Potatoes
    • Protein: 0
    • Grains: 0
  235. IRON
    Hemoglobin regeneration, Vitamin C increases the absorption of iron, while food and antacids slow absorption
    What are the foods that will give you Iron?
    • Iron ALL fruits, Greens, and BELLs
    • Fruits: All
    • Vegies: Green
    • Protein: Beans (dried), Egg yolks, Lean meats, Liver
    • Grains: 0

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