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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?

simple sugars

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

Amino acid?

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?

fluid environment

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 ___

difficulty swallowing

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 _

milk based

Modular EN is _

single macronutrient preparations

Elemental EN is _

predigested nutritients

"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

Obesity affects?

greater than 1/3 of adults, ages 40-59 has highest prevalence.

Morbid obesity?

>100 lbs, second leading cause of preventable death (behind smoking)

Obesity is the 3rd leading cause of ___

liver transplant

Obesity is defined as ___

abnormal increase in the proportion of fat cells

primary obesity?

excess calorie intake

Secondary obesity?

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)

gynoid obesity?

"pear" - gluteofemoral adipose tissue accumulation

Android obesity?

"apple" - abdominal adipose tissue accumulation

cardiovascular complications with obesity?

android obesity; HTN

respiratory complications with obesity?

sleep apnea

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?

30-60 min/day

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

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