Exam 1: Care Management
sum of taking in and utilizing nutrients. Basic biologic need (fluid and food)
4 reasons that nutrition is essential
normal growth and development, tissue maintenance and repair, cellular metabolism, organ function
BMR is Basal Metabolic rate. What is this?
energy needed to sustain life sustaining activities for a specific period of time. This includes breathing, circulation, heart rate, temperature
Resting Energy Expenditure (REE) or Resting Metabolic Rate (RMR) is what?
amount of energy need over 24 hours for body to maintain all internal working activities.
What 3 things affect REE or RMR?
illness, pregnancy/lactation, activity level
Main source of energy in the diet. Made of saccharides.
What are monosaccharides/disaccharides?
Polysaccharides are what?
complex carbohydrates. Insoluble in water and include fiber.
Fiber does not contribute to _
Why are proteins essential?
for synthesis of body tissue
The simplest form of protein.
There are ___ essential amino acids and they ___
10; need to be provided in the diet.
There are ___ non-essential amino acids. They're ___
12; synthesized in the body
A complete protein is ___
one that contains all essential amino acids.
An incomplete protein is __
lacking one or more essential amino acids
Fat or lipids?
major form of stored energy and most calorie dense nutrient. They're composed of triglycerides and fatty acids.
Triglycerides __ and fatty acids are ___
circulate in the blood and Fatty Acids are saturated or unsaturated.
Trans fat is a _
type of unsaturated fatty acids
All cell function depends on what?
how much of the body is water?
60-70% of total body weight
How much water does the body metabolize per day? What forms?
2.5-3 liters of water in the form of fluids and foods.
Where is the majority of water stored in the body?
What populations have the greatest body water percentage and what has the least?
infants have the greatest and elderly have the least.
Fluid intake should equal __
fluid output through elimination, sweating and respiration
What are vitamins/minerals?
Organic substances essential for normal metabolism.
Water soluble vitamins/minerals?
not stored in the body. They're a C and B complex.
Fat soluble vitamins/minerals?
stored in fatty compartments (A, D, E & K)
Inorganic substances are essential for ___. They are ___ and __.
biochemical reactions; macrominerals and micro/trace minerals.
100 mg or more daily; they promote acid/base balance.
Micro/trace minerals amt per day?
100 mg or less.
What is food security?
access to sufficient, safe and nutritious food to maintain a healthy lifestyle for all household members.
When we're screening/assessing a patient, we are concerned with the patient's
attitude, values and beliefs
objective measures when assessing a patient's nutrition status
meds, ht/wt, weight change, primary Dx, co-morbidities, labs, diet history
When assessing a patient's labs for nutrition, what 4 things do we look at?
albumin, pre-albumin, Hgb, BUN/creatinine
Normal BMI range
3 things that will lead to an "alternative" diet?
religion, culture, medically prescribed diet
What things do we examine on a physical exam to check for nutrition status?
general appearance, skin, hair/nails, eyes, oral cavity, extremities
What is malnutrition?
deficit, excess or imbalance of essential components of a health diet.
What is under nutrition
interference with normal appetite or assimilation of nutrients, caused by disease or inadequate diet.
What is over nutrition?
intake of more calories than required for bodily needs
Dysphagia is ___
warning signs of dysphagia?
coughing while eating, voice tone/quality changing after eating, abnormal gag relux, abnormal swallowing triggers
Complications from dysphagia?
aspiration pneumonia (silent aspiration), dehydration, decreased nutrition intake, wt loss
What is primary prot/cal malnutrition?
nutritional needs are not met. decreased protein intake and decreased intake of necessary vitamins and minerals.
What is secondary prot/cal malnutrition?
alteration or defect in absorption, digestion, indigestion or metabolism.
What are some things that can lead to secondary prot/cal malnutrition?
GI obstruction, CA, malabsorption issues, drugs, infectious disease
7 nursing diagnoses related to malnutrition?
risk for aspiration, diarrhea, deficient in knowledge, imbalanced nutrition, readiness for enhanced nutrition, feeding self-care deficit, impaired swallowing.
How do we plan for nutrition related interventions?
set goals/outcomes. Individualize utilizing assessment data. use "SMART" goals and outcomes
what assessment data do we use to plan for our patients?
factors influencing patient nutritional status. Short and long-term goals (medical and personal)
interventions to promote oral intake?
oral care prior to eating, provide a rest period before meal, patient input on meal planning, position the patient and provide assistive devices, placement of food and orientation to food.
What is enteral nutrition?
providing nutrition through GI tract via NG, jejunal or gastric tubes
When do we begin EN?
an order from the MD and formal type determined by RD. Feedings begin after the xray verifies placement of tube.
Polymeric EN is _
Modular EN is _
single macronutrient preparations
Elemental EN is _
"Specifically" EN is __
specific to nutrient needs
Complications with EN? What are risk factors for these complications?
aspiration which can lead to pneumonia. Laying flat, GERD, nasotracheal suctioning, artificial airway, decreased LOC
Interventions with EN to improve the efficiency of EN?
keep HOB elevated at 30-45* at all times, measure gastric residual volumes (GRV) every 4-6 hours or immediately prior to feeding.
What are 2 things that would lead us to recheck the EN order?
if GRV greater than 250 ml on 2 consecutive assessments 1 hr apart OR if greater than 500 ml on single assessment
Parenteral nutrition is _
administration of nutrients via route other than GI tract. This is specialized nutrition and nutrients are supplied in the IV.
Short term PN?
PPN (peripheral parenteral nutrition). Solutions of AA and lipids with less than 10% of dextrose.
Long term PN?
Total parenteral nutrition (TPN). delivered through a CVC (central venous catheter). These are solutions of aa, dex, elec, v&m
When we place the TPN CVC, we need to _
verify placement by xray.
When we administer PN, we need to verify what?
the order and solution label. Make sure that the nutrient content and additives are correct and also check the time that it was mixed and then the date/time of expiration.
Why do we use an infusion pump during PN?
it ensures a constant rate. Check this frequently because pumps can fail.
Two other things we need to monitor with PN?
monitor vitals every 4-8 hours and then check daily weights.
9 complications with PN
catheter site infection, phlebitis, air embolus, pneumothorax, catheter occlusion, catheter sepsis, elec imbalance, hypoglycemia and hyperglycemia
greater than 1/3 of adults, ages 40-59 has highest prevalence.
>100 lbs, second leading cause of preventable death (behind smoking)
Obesity is the 3rd leading cause of ___
Obesity is defined as ___
abnormal increase in the proportion of fat cells
excess calorie intake
congenital abnormalities, metabolic problems, chromosomal abnormalities, CNS lesions
3 classes of BMI for obesity?
Class 1: 30-34.9; Class 2: 35-39.9; Class 3: BMI > 40
Waist Circumference for obesity in men and women?
men is 40 in and higher. women is 35 in and higher.
Triglyceride levels that are associated with obesity/metabolic syndrome?
greater than 150 mg/dl or drug treatment
HDL cholesterol for metabolic syndrome?
<40 mg/dl for men and < 50 mg/dl for women (or drug treatment)
BP that's associated with metabolic syndrome?
130 mmHg or higher for systolic/ 85 mmHg or higher for diastolic. (or drug treatment)
Fasting blood glucose related to metabolic syndrome?
110 mm/dl or higher (or drug treatment)
"pear" - gluteofemoral adipose tissue accumulation
"apple" - abdominal adipose tissue accumulation
cardiovascular complications with obesity?
android obesity; HTN
respiratory complications with obesity?
Diabetic problems with obesity?
diabetes mellitus; hyperinsulinemia and insulin resistance
Musculoskeletal problems related to obesity?
GI/liver problems with obesity?
GERD and gallstones
cancer problems with obesity?
breast, endometrium, kidney, colon/rectum, pancreas, esophagus and gallbladder
psychosocial complications with obesity?
stigmatization, discrimination, self-esteem
Nursing diagnoses with over nutrition?
imbalance nutrition: more than body requirements, risk for imbalanced nutrition: more than body requirements, ineffective breathing pattern, chronic low self-esteem, readiness for enhanced knowledge
Implementation of changes with obesity
assess motivation, assess educational opportunities, nutritional therapy, exercise program and behavior modification
What is essential for positive outcomes?
What 2 things need to be stressed when assessing educational opportunities for obesity?
stressing nutrition and physical activity
Nutritional therapy for obesity?
caloric restriction and reduce caloric intake 250-1000 cal/day
how much exercise is necessary daily?
Bariatic surgery criteria?
BMI of 40 or greater or a BMI of 35 or greater with 1 or more severe obesity related issue.
What are some criteria that would restrict someone from getting bariatric surgery?
untreated depression, eating disorder, current drug or alcohol abuse, severe cardiac issues, clotting issues, inability to comply with nutritional restrictions