Nutrition & Elimination

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kathleenagrace
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53650
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Nutrition & Elimination
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2010-12-06 00:31:01
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nursing nutrition elimination
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Test 3
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  1. Basal Metabolic Rate + Factors
    • resting need for energy, just what it takes to keep body functioning
    • Factors: age, gender, activity, infections, endocrine status
  2. What is the normal range for BMI?
    Body Mass: 18.5-24 is normal
  3. Calorie Content of:
    Fat, Protein, Carb, One lb body fat
    • Fat: 9 kcal/g
    • Protein: 4 kcal/g
    • Carb: 4 kcal/g
    • 1lb: 3500 kcal/g
  4. Which 3 supply energy and build tissue?
    • Carbs
    • Lipids
    • Proteins
  5. Which 3 regulate/control body processes?
    • Vitamin
    • Mineral
    • Water
  6. Fat Soluble Vitamins
    • ADEK
    • absorbed into lymphatic
    • not needed daily
    • excessive A&D can be toxic
  7. Non-fat Soluble Vitamins
    • (water-soluble)
    • Vit C & B-complexes
    • absorbed in intenstinal wall
    • directly into bloodstream
    • daily intake
  8. Carbohydrate
    • sugar, starch
    • framework of plants
    • animals-- lactose
    • 90% is digested
    • stored in liver as glucose
    • oxidized into energy, CO2, water
  9. Fat
    • insoluble triglycerides
    • bile digests it/emulsifies it
    • pancreatics break down even further
    • absorbed in lymphatic
    • Saturated/Unsaturated/Transfats
    • Cholesterol:LDL blocks arteries HDL clears arteries. Total <200 mg/dl
  10. Protein
    • pancreatic enzymes breakdown into amino acids
    • absorbed into intestinal mucosa-->liver
    • recombined to new
    • released to bloodstream to tissues and cells
  11. Vitamin
    • Water Soluble: absorbed directly into bloodstream by intestinal wall, not stored
    • Fat Soluble: must be attached to fat, absorbed into lymphatic, stored in livver and adipose
  12. Mineral
    • Not broken down in body
    • Remains in ash after digestion
    • Calcium: 99 % bones and teeth
    • Macrominerals
    • Microminerals
  13. Water
    • Not Stored
    • Needed for everything
    • 50-60% of total body weight
    • Infants have more water
    • 2/3 ICF, 1/3 ECF
    • necessary for all chemical reactions, solvent to many solutes
    • Intake 2000-3000mL/day, but 1500mL avg
    • Input = Output
  14. Digestive Process
    • mouth: enzymes begin breakdown
    • stomach: acidic pH (HCl) to help food breakdown
    • duodenum: sodium bicarbonate neutralizes acid from stomach [basic] gallbladder: release bile (emulsifies fats)
    • pancreas: releasing enzymes (amylase) to break down proteins to amino acids
    • carbohydrates broken down to glucose (enzyme sucrose)
    • Small Intestine: absorption of nutrients
    • Large intestine: reabsorbing water
  15. Glycogenesis
    making glycogen from glucose, then stored in liver until needed
  16. Glycogenolysis
    glycogen is broken down and stored into glucose for energy
  17. Gluoneogenesis
    making glucose from some other form of nutrient (ex. amino acid) when glucose is not available
  18. Infant Needs
    • breastfeed 6-12 mo
    • solids at 4-6 mo (periods of 5-7 days to test allergies)
    • 1 yr: table food and cows milk
  19. Toddler Needs
    • 3-5 yrs
    • develops attitude toward food
    • increased appetite and becomes eratic
  20. School Age Needs
    • 6-12 yr
    • body accumulates reserves
    • Health Promo: intake balance w/requirements
  21. Adolescent Considerations
    • increased nutrient needs to support growth
    • anorexia nervosa & bulimia
    • eat rapidly--> overconsumption
    • unhealthy meals aways from home
  22. Adult Considerations
    • Growth ceases
    • BMR decreases
    • If calorie change not met, weight gain occurs
  23. Pregnancy Considerations
    • increase to support growth
    • especially in 2-3 trimester
    • extra 300 kcal/day
    • *protein, cals, iron, folic acid, calicium, iodine
  24. Older Adult Considerations
    • decreased need for calories
    • same need for nutrients
    • BMR decrease
    • Decreased peristalsis
    • Decreased taste sensation
    • prone to dehydration
  25. Complete Diet
    • Animal (plus soy)
    • sufficient amounts of all essential amin acids to support growth
    • eggs, dairy, meat
  26. Incomplete Diet
    • Plant (except soy)
    • deficient in one or more essential amino acids
    • grains, legumes, veggies
  27. Complementary Proteins
    • combine to make up for where the other is deficient
    • corn torilla + refried beans
    • lentil + rice soup
    • cereal + milk
  28. Essential Fats/Amino Acids
    they are not synthesized within the body and must be supplied through diet
  29. Goals of Food Pyramid
    • Increase vitamin, mineral, fiber
    • Decrease sat fat, trans fat, cholesterol
    • Increase fruit, veggie, whole grain
    • *support calor intake based on energy needs to promote a healthy weight
  30. Clear Liquid Diet
    • clear at room temp
    • gelatin
    • fat free broth
    • bouillon
    • ice pop
    • clear juice
    • carbonated beverage
    • coffee
    • tea
  31. Full Fluid Diet
    • Clear, Plus Others:
    • milk/milk drinks
    • plain frozen desserts
    • pudding, custard
    • eggs, cereal
    • veggie juice
    • milk & egg substitutes
  32. Soft Diet
    • decreased fiber, unseasoned
    • decrease GI distress
    • soy, yogurt
    • cooked fruit/veggies
    • banana
    • avacado
    • melon
    • lean, tender meat
    • potatos, rice, pasta
    • egg, cheese, peanut butter
  33. Pureed Diet
    • blenderized to liquid form
    • all foods unless contraindicated
  34. Mechanical Soft Diet
    • modification for texture
    • (difficulty chewing/swallowing)
    • chopped, ground, mashed, pureed
    • ripened fruits
    • cooked veggies
  35. Methods for Improving Appetite/Nutritional Status:
    • small, frequent meals
    • solicit food preferences
    • encouragement
    • pleasant environemnt
    • loos attractive
    • procedured dont interfere
    • control pain, nausea, depresson
    • offer alternatives
    • good oral hygiene
    • free from odors
    • easily reach food
    • comfortable position
    • any rituals during mealtime
    • if patient is absent, order late food try
    • dont interrupt meal time
  36. Purpose of Enteral Feeding Tubes
    • in NPO, next best method
    • pass tube into GI tract to admin a formula of adequate nutrients
    • stomach acts as reservoir
    • regulates amt of food/liquid into small intestine
  37. Methods to Check Placement of Feeding Tube
    • Nasogastric: ensure tip of tube is in stomach or intestine
    • Radiographic: verify initial placement
    • pH of Aspirate: stomach (<5.5), intestine (7.0+), respiratory (6.0+)
    • Color of Aspirate: Stomach (grass-green, tan, off-white, bloody, brown), Intestines (medium to deep golden yellow), Respiratory (off white, tinged with mucous)
  38. Safety Considerations w/Feeding Tube
    • Aspiration
    • Clogged Tube
    • Nasal Erosion
    • Diarrhea
    • GI Distress
    • Unplanned Extubation
    • Stoma Infection
  39. HMG COA Enzyme Reducers
    (statins) used in synthesis of cholesterol
  40. Micturation
    • voiding/urination
    • brain + spinal cord
    • largely involuntary
    • 150-250mL/day
  41. Urinary Incontinence
    involuntary loss of urine
  42. Autonomic Bladder
    • not brain-controlled
    • reflex only
  43. Urinary Retention
    urine produced normally but not excreted completely from bladder
  44. Enuresis
    involuntary/unintentional urinary into bed or clothes
  45. Anuria
    • 24 hr rine output less than 50mL
    • kidney shutdown/renal failure
  46. Dysuria
    painful or difficult urination
  47. Glycosuria
    presence of sugar in urine
  48. Nocturia
    awakening at night to urinate
  49. Oliguria
    • scanty or greatly diminished amount of urine voided in a given time
    • 24 hr urine output less than 400 mL
    • less than 30mL/hr
  50. Polyuria
    • excessive output of urine
    • diuresis
  51. Proteinuria
    • protein in urine
    • indicates kidney disease
  52. Pyuria
    • pus in urine
    • urine appears cloudy
  53. Suppression
    • stoppage of urine production
    • normally produce 60-120 mL/h
  54. Urgency
    strong desire to void
  55. Hematuria
    • blood in urine
    • pink or red color
  56. Nephrotoxic drugs
    capable of causing kidney damage
  57. Ureters
    transport urine fro kidney to bladder by rhythmic peristalsis
  58. Bladder
    • smooth muscle
    • temporary reservoir for urin
    • 3 layers
    • Detrusor: inner longitudinal layer, middle circular layer, outer longitudinal layer
    • Internal/Involuntary Sphincter: guards opening between urinary bladder and urethra
    • SNS: retains urine
    • PNS: releases urine
  59. Urethra
    • bladder to exterior
    • Male: 5 1/2"-6 1/4"
    • Female: 1 1/2"-2 1/2"
  60. Nephrons
    • remove end product of metabolism from blood plasma and form urine
    • maintain and regulate fluid balance through selective reasborption and secreation of water, electrolytes, and others
  61. Elimination Changes in LifeSpan
    • Infant: no voluntary control, 6-10 wet diapers/day
    • 18-24 mo: voluntary control of urethral sphincters
    • 2-5 yrs: develop urinary control
    • Aging: decreased ability for kidney to concentrate urine, nocturia, decr. bladder muscle tone & contractility, incr. frequency, urine retention/stasis, incr. risk UTI
  62. Factors for Urinary Output
    • Developmental
    • Food/Fluid intake
    • Psychological
    • Activity/Muscle Tone
    • Pathologic Conditions
  63. Urinary Diversion
    surgical creation of alternative routh for excretion
  64. Specific Gravity
    density of urin compared w/density of water
  65. Routine Urinalysis
    • urine collected and measured
    • avoid contaminated
    • aseptic technique
    • pt name/date/time to lab soon
  66. Clean Catch Specimen
    • 1st flush
    • Catch midstream
    • Discard the rest
  67. Specimen from Indwelling Catheter
    • with needle and syringe
    • directly from specimen port
  68. 24 hr Urine Specimen
    • initiate
    • discard first void
    • all other voids are save
    • last 24 hr void added to previous
    • entire specimen sent to lab
  69. Post Void Residual
    • traditional catherization or portable ultrasound device to scan bladder
    • supine position
    • <50mL is adequate
    • >150mL recommend cath= risk for UTI
  70. Transient Incontinence
    • appear suddenly
    • lasts for 6mo/less
  71. Functional Incontinence
    • altered environment, sensory, cognitive, mobility deficits
    • used to be able to, but change occur
  72. Reflex Incontinence
    • neurologic
    • cant sense filling
    • no urge to void
    • no feeling of bladder fullness
  73. Stress Incontinence
    • overdistension
    • weakened supportive muscles
    • leakage w/cough, sneeze, laugh
  74. Total Incontinence
    • neurologic/trauma
    • constant/unpredictable flow
    • no distention
    • nocturia
    • unawareness of incontinence
  75. Mixed Incontinence
    urine loss w/features of 2+ types of incontinence
  76. Urge Incontinence
    involuntary loss of urine soon after feeling urgent need to void
  77. Overflow Incontinence
    overdistention/overflow of bladder
  78. Kegal Exercises
    • improve voluntary control of urination
    • eliminate/reduce stress incontinence by increase muscle tone
    • targets inner muscles that lie under and support bladder
    • contract 10 sec, relax 10 sec, 30-80x/day for 6+ wks
    • (don't use abs, inner thigh, buttocks)
  79. Course of Bowel Elimination
    • Small intestine
    • Ileocecal valve
    • Cecum (veriform process attached)
    • Ascending colon
    • Hepatic Flexure
    • Transverse Colone
    • Splenic Flexure
    • Descending Colon
    • Sigmoid Colon (contains feces)
    • empties into rectum
    • excreted through anal sphincter
  80. Nervous Regulation of Bowel Elimination
    • PNS: stims movement, craniosacral inhibitory impulses
    • SNS: inhibits movement, thoracolumbar motor impulses
    • Act of Defactation: medulla, spinal cord, PNS stims to relax sphincter
  81. Valsalva Maneuver
    • bearing down
    • cuts of vagus nerve=hypertension
    • may be contraindicated in those w/cardiovascular problems
  82. Factors of Bowel Eliminiation
    • Developmental
    • Daily Patterns vary
    • Food/Fluid intake
    • Activity/Muscle Tone
    • Lifestyle (acceptance, preoccupation, "dirty")
    • Psychological (anxiety, worry)
    • Pathologoical
    • Medications
    • Diagnostic Studies
    • Surgery/Anesthesia
  83. Medications affecting Bowel Elim
    • Cathartics/Laxative: promotes peristalsis
    • Antidiarrheal: inhibit peristalsis
    • Inhaled General Anesthetic: block impulses
    • Narcotics: paralytic ileus
    • Constipation: opoid, antacid (aluminum), iron sulfate, anticholinergic drugs
    • Diarrhea: amoxicillin, antibiotics
  84. Medications and Appearance of Stool:
    Red/Black, Black, Speckled/White, Green/Gray
    • Red-Black: anticoagulant, aspirin
    • Black: iron oxidation/salts
    • Speckled-White: antacids
    • Green-Gray: antibiotics
  85. Fecal Elimination Problems:
    Constipation, Diarrhea, Incontinence, Flatulence
    • Constipation: dry, hard stool
    • Diarrhea: excessively liquid stool
    • Incontinence: inability of anal sphincter to control discharge of fecal & gaseous matter (usually organic disease)
    • Flatulence: excessive formation of gases in stomach/int; can lead to distention if not expelled
  86. Areas of Bowel Assessment
    • Abdomen: inspection, auscultation, percussion, palpation
    • Anus/Rectum: inspection, palpation
    • Stool Characteristics: color, form, etc.
  87. Bowel Tones:
    Hyperactive, Hypoactive, Decreased/Absent
    • Hyperactive: incr. motility (diarrhea, gastroenteritis, early bowel obstr)
    • Hypoactive: diminished motility (abd srgry, late bowel obstr)
    • Decr/Absent: absence of motility (peritonitis/parlytic ileus)
  88. Bulk-Forming Laxatives
    • psyllium/grain/synthetic
    • stool absorbs water, swells, stimulates peristalsis
  89. Emollient/Stool Softener
    agents w/detergent activity allow water and fat to penetrate and lubricate stool
  90. Stimulant Laxative
    irritating intestinal mucosa or stimulates nerve endings in intestinal wall
  91. Saline Osmotic Laxative
    draws water into intestine to stimulate peristalsis
  92. Cleansing Enema
    • (tap, normal saline, soap solution, hypertonic solution)
    • relieve constipation/fecal impaction
    • prevent involuntary escape during surgical procedures
    • promote visualization of int tract by radiography/intrument
    • help establish regular bowl fxn during bowel training program
  93. Retention Enema:
    Oil, Carminative, Nutritive, Medicated
    • Oil: lubricates
    • Carminative: helps expel flatus/relief from gaseous distention
    • Nutritive: admin of fluid/nutrients
    • Medicated: for parasites
  94. Return Flow Enema
    • expel flatus
    • alternate solution in and out
    • promote peristalsis
  95. Bowl Training Program
    manipulate factors within pt control (intake, exercise, time for defacation) to produce the elimination of a soft, formed stool at regular intervals w/out a laxative
  96. LDL: Bad Cholesterol
    delivery of cholesterol to nonhepatic tissue, greatest contribution to atherosclerosis
  97. HDL: Good Cholesterol
    cholesterol from peripheral back to liver to be removed
  98. Atherosclerosis:
    process of plaque formation
    • LCL into arterial subendothelial space and oxidizes
    • Attracts monocytes/macrophages
    • Inhibited mobility so macrophages accumulate and increase uptake, enlarge, and become foam cells
    • Foam cells can rupture
    • Platelets aggregate and collagen forms a fatty streak
  99. How do HMG-CoA enzyme lowering meds (statins) lower lipids? How are they effective for treatment?
    • inhibition of HMG-CoA Reducatse inhibits cholesterol production
    • this stimulates incr. LDL receptor formation
    • this allows more LDL to be drawn from blood into liver
    • (thus lowering LDL level)
  100. How is atherosclerotic plaque r/t the inflammatory response?
    Atherogenesis: when LDLs penetrate wall, they cause mild injury that trigguers the inflamm. response, which can cause plaque to rupture, leading to thrombosis
  101. What is a CRP level?
    • CRP: C-Reactive Protein
    • compount produced when inflammation occurs
    • biomaker for ongoing inflammatory process
    • elevated CRP is an independent risk factor of CV events
  102. What does ARP III stand for?
    • Adult Treatment Panel
    • Executive Summary of the 3rd Report of the Natn'l Cholesterol Educ. Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
  103. Normal Levels:
    LDL, HDL, Total
    • LDL: <100 mg/dL
    • HDL: <40 mg/dL
    • Total: <200 mg/dL
  104. Risk Factors for CV disease?
    • Age: men >45yr, women >55yr
    • Family Hx or premature CHD
    • Hypertension: >140/90 mmHG or taking antihypertensives
    • Current cigarette smoking (at least 1 in last month)
    • Low HDL: <40 mg/dL
  105. Lifestyle Changes to Lower Cholesterol
    • Diet: incr. soluble fiber, incr. plant stanols/sterols
    • Weight Control: obesity is a major risk
    • Exercise: sedentary incr. risk
    • Smoking Cessation: incr. LDL, decr. HDL
  106. Statins:
    Major Adver Effects & Common Side Effects
    • Major: (1) Myopathy/Rhabdomyolysis, (2) Hepatotoxicity
    • Common: (side effects uncommon) mild/transient HA, rash, GI disturbance
  107. When is the best time of day to administer statins?
    • evening is best time of day
    • endogensou cholesterol synthesis increases during the night

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