301 test 2 Flashcards
1
Q
what can nutrition effect?
A
tissue integrity, sensory perception, and elimination
2
Q
what can effect nutrition
A
hormonal regulation, elimination, glucose regulation, and sensory perception
3
Q
people with burns are at risk for
A
hypovolemic shock
4
Q
purpose of nutritional assessment
A
identify individuals who are malnourished/dehydrated or are at risk for development of calorie and liquid malnourishment.
5
Q
what lab do we look at to assess nutrition
A
total protein= prealbumin, albumin, and globulin
6
Q
normal albumin
A
3.5-5 gdL
7
Q
what does albumin lab measure
A
circulating protein. can be impacted by fluid status and liver function
8
Q
how long will it take to see fluctuations of albumin
A
3-4 weeks
9
Q
prealbumin normal levels
A
15-36 mg/dL
10
Q
what does prealbumin reflect
A
protein and calorie intake for the previous 2-3 days
11
Q
normal levels of blood glucose
A
70-105 mg/dL
12
Q
what does blood glucose reflect
A
carbohydrate metabolism
13
Q
what can hgb/hct indicate in labs
A
can indicate anemia caused by low iron, folate and vitamin B12
14
Q
what does the lipid profile show
A
reflects lipid metabolism
15
Q
what can BUN/creatine ratio and urine specific gravity be used for?
A
to determine hydration status
16
Q
normal range of BUN/ creatine ratio
A
20:1
17
Q
Hemoglobin A1C
A
glucose levels over long period of time
18
Q
what topics are included in present health history for nutrition assessment
A
chronic illness, medications, weight changes, food intolerances, street drugs or alcohol, problems obtaining eating food, weight concerns
19
Q
what do alcohol and street drugs do to your nutrition
A
decrease nutritional absorption
20
Q
what measures can be taken to correct weight concerns
A
diet and exercise modifications and surgery
21
Q
methods of obtaining a diet history
A
24 hour recall, typical food intake, food diary, comprehensive diet history
22
Q
nutritional exam includes
A
anthropometric measurements, inspections of skin, hair, and nails, inspections of eyes, inspection and palpation of the extremities bilaterally
23
Q
BMI
A
body mass index, estimate of total body fat
24
Q
triceps skin fold
A
evaluate subcutaneous fat stores
25
mid-arm muscle circumference
evaluate muscle reserve
26
how do you calculate BMI with inches and pounds
((weight in pounds/(height in inches x height inches)) X 703
27
BMI underweight
below 18.5
28
BMI normal
18.5-24.9
29
BMI overweight
25-29.9
30
BMI obesity class 1
30-34.9
31
BMI obesity class 2
35-39.9
32
BMI morbid obesity
40 and greater
33
BMI chart does not work on individuals who are
below 5 feet
34
BMI does not differentiate between
fat and muscle tissue
35
what happens with muscle mass in elderly
they tend to lose it
36
what should you add to BMI to increase predictability for health risk
waist circumference
37
calculate percent change in weight
current body weight/usual body weight X 100
38
calculate waist to hip ratio
pear shape vs apple shape
39
DBW
desirable body weight
40
normal DBW
(desirable body weight) normal is 90-110%
41
what happens with nutrition as you get older
physical limitations, decreased taste and appetite, muscle tone and mass decrease, loss of subcutaneous fat, become more salt sensitive, fat is redistributed
42
assessing hydration status
weight, skin turgor, pitting edema, skin moisture, tongue,lung sounds, blood pressure, urine output
43
malnutrition can be confused with what other diseases
anemia, hyper or hypothyroidism, hepatic disease, alcoholism, cancer, depression
44
obesity related conditions
obesity related conditions include heart disease, CVA, DM type 2 and certain types of cancer
45
what portion of America is obese
1/3
46
estimated annual cost of medical cost towards obesity
147 billion
47
obesity risk factors
sedentary lifestyle, high fat diet, genetics, ethnicity/race, female, age
48
reasons for undernutrition
acute illness, chronic disease, extreme age, alcohol abuse, depression, limited knowledge, physical inability, eating disorder, poverty, lifestyle
49
enteral feeding
tube feeding provided through a tube inserted into the nose to stomach, small-intestine, or gastrostomy
50
parenteral nutrition
when GI tract can no longer be used for digestion. can be IV fluids with dextrose or total parenteral nutrition
51
parenteral nutrition has high risk for
infection
52
PEG
percutaneous endoscopic gastronomy tubes
53
signs of fluid overload
weight gain, pitting edema, visible neck veins, crackling lung sounds, elevated pulse rate and blood pressure, SOB
54
new food guidance system in US
choose my plate includes 5 food groups. make half your plate fruits and vegetables and half your plate grains and protein
55
peritoneum
serous membrane forming protective cover of the abdominal cavity
56
peritoneum divided into what 2 layers
parietal and visceral
57
peritoneal cavity
space between the parietal and visceral layers, contains small amount of serous fluid to reduce friction
58
alimentary tract
27 feet long. ingest, digest, absorb nutrients, electrolytes, and water, and excrete waste product
59
what parts does the alimentary tract include
esophagus, stomach, small intestine, and large intestine
60
esophagus ph
6-8
61
stomach ph
2-4
62
chyme
breakdown and conversion of carbs, proteins, and emulsified fat that is liquified
63
what does chyme consist of?
peptones, amino acids, fatty acids, and glycerol
64
small intestine
largest section of GI tract includes duodenum, jejunum, and ileum
65
large intestine
about 5 feet. includes cecum, colon, rectum, and anal canal
66
liver functions
bile production, secretion to emulsify fat, transfer bilirubin, metabolism of proteins, carbohydrates, and fats, storage of glucose in form of glycogen, production of clotting factors and fibrinogen for coagulation, synthesis of plasma proteins, detoxification of substances, and storage of minerals and vitamins
67
plasma proteins
albumin and globulin
68
gallbladder
stores bile produced by liver and ducts drain bile into duodenum
69
bile in feces cause
the brown color
70
pancreas
produces endocrine secretions and exocrine secretions
71
endocrine secretions
insulin, glucagon, somatostatin, and gastrin
72
exocrine secretions
bicarbonate, pancreatic enzymes
73
spleen
filters antigens from the blood, important in response to systemic infections, activation of B and T lymphocytes, stores erythrocytes and platelets
74
kidneys
erythropoietin secretion for erythrocyte production, regulation of fluid and electrolyte balance, RAAS, production of active vitamin D
75
kidney location
T 12-L3
76
moderate distention of bladder
300 mL
77
level of discomfort of bladder
450 mL
78
arteries in abdomen
abdominal aorta, renal artery, and iliac artery
79
Right upper quadrant
liver, gallbladder, pylorus, duodenum, head of pancreas, right kidney, right adrenal gland, hepatic flexure of colon, portions of ascending and transverse colon
80
left upper quadrant
stomach, spleen, left lobe of liver, body of pancreas, left kidney, left adrenal gland, splenic flexure of colon, and portions of transverse and descending colon
81
left lower quadrant
portion of descending colon, sigmoid colon, left ureter, left ovary, left spermatic cord, bladder if distended, and uterus if enlarged
82
right lower quadrant
cecum, appendix, right ovary, right ureter, right spermatic cord, bladder if distended, and uterus if enlarged
83
GI in older adults
slowing of GI motility, increased likelihood of regurgitation, bacterial flora less active, increased food intolerance, decrease intestinal sphincter tone, bladder decreases in size and decrease in bladder muscle tone
84
what chronic illnesses should you ask about when assessing the GI/GU
DMII, renal failure, liver failure, hepatitis, gallbladder disease, HTN, cancer, Crohn's, IBS/IBD, colitis, CVA, spinal issues, benign prostate hypertrophy
85
what family history should you ask about with GI/GU assessment
GERD, cancer of upper/lower GI, renal disease, bladder disorders and cancers, gall bladder disease
86
what could black stool indicate
bleeding internally due to ulcer or cancer
87
what could light color or white stool indicate
it could mean a bile duct obstruction
88
what could red stool mean
symptom of cancer
89
what could yellow stool mean
excess fat due to malabsorption
90
what can brown urine indicate
increased bilirubin
91
cola urine
rhabdomyolysis from muscle breakdown
92
order of assessment for GI/GU
inspect, auscultate, percuss, and palpate
93
urinary catheters should always be _____ than patient
lower
94
gastro
stomach
95
entero
intestine
96
colo
large intestine
97
procto
anus/rectum
98
hepato
liver
99
nephro
kidney
100
cysto or vesical
bladder
101
uro
relating to urine
102
itis
inflammation
103
lithiasis
formation of calculi
104
stomy
an artificial opening made into an organ through surgery
105
ectomy
surgically remove
106
scopy
to look or examine
107
fistula
an abnormal connection between an organ and another structure
108
rrhea
flow or discharge
109
uria
in the urine
110
GERD
gastroesophageal reflux disease. caused by weakened lower sphincter or increased abdominal pressure
111
findings with GERD
heartburn, regurgitation, dysphagia, often aggravated by lying down relived by sitting up antacids, eating, and mid epigastric pain with palpation
112
peptic ulcer disease risk factors
H. Pylori, NSAIDS, ASA, corticosteroids
113
peptic ulcer disease findings
burning pain in the LUQ/epigastric anywhere from 1-4 hours after eating
114
diverticulitis
inflammation of the diverticula. infectious
115
diverticulitis findings
increased temp, abdominal discomfort, bowel pattern alterations
116
hiatal hernias
stomach protrudes through esophageal hiatus in diaphragm
117
hiatal hernia findings
heartburn, regurgitation, dysphagia
118
crohn's disease
mouth to anus. looks like cobble stones (called skip lesions)
119
clinical manifestations of Crohn's disease
severe abdominal pain, cramping, diarrhea, blood or mucus in feces, constipation
120
ulcerative colitis
most common form of IBD, happens in colon. mucosa ulcerated. can progress to colon cancer.
121
what can cure ulcerative colitis
total colectomy
122
diseases of liver
hepatitis A,B,C and cirrhosis
123
hepatitis A
usually food-borne
124
hepatitis B
uncommon secondary due to immunization
125
hepatitis C
common. often undiagnosed, sometimes it doesn't effect liver enzymes profoundly, leading cause of cirrhosis and liver transplant
126
steatohepatitis
fatty liver
127
cirrhosis
associated with alcohol intake. associated with malnutrition and vitamin B deficiency, alterations in CBC, coagulopathies
128
coagulopathies
blood's ability to coagulate (form clots) is impaired
129
CBC
complete blood count
130
ascites
fluid accumulation associated with liver disease
131
cholecystitis with cholelithiasis
gallstones
132
gallstones
obstruction of the bile duct
133
cirrhosis findings
had palpable liver, ascites, jaundice, cutaneous spider angiomas, dark urine, tan stool, splenomegaly
134
risk factors for gallstones
female, fat, flatulent, forty
135
gallstones clinical finding
RUQ colicky pain that can radiate to right shoulder, indigestion, mild jaundice, nausea after eating high fat foods
136
pancreatitis
inflammation of the pancreas which causes auto digestion
137
primary cause of pancreatitis
alcohol, gallstones, pregnancy, prior pancreatitis
138
clinical findings of pancreatitis
sudden onset, LUQ can radiate to back, chronic, pain is deep, piercing, and heavy, weight loss, steatorrhea, tender abdomen, ascites, jaundice, hypotension, internal bleeding, shock, patient in fetal position
139
pyelonephritis
fever, flank, pain, dysuria, nocturia, and frequency
140
UTI clinical findings in older adults
fatigue, muscle aches, abdominal pain, shaky and weak, confusion, and delirium
141
clinical findings of UTI
frequency and urgency, dysuria, pyelonephritis
142
nephrolithiasis
kidney stones
143
risk factors for kidney stones
urinary stasis and infection
144
clinical findings of kidney stones
fever, hematuria, severe pain at costovertebral angle
145
types of bones
short, flat, irregular, long
146
compact bone
forms the shaft and outer layer
147
cancellous bone
makes up the ends and center
148
tendon
muscle to bone
149
ligament
bone to bone
150
fascia
band or sheet of connective tissue, primarily collagen, beneath the skin that attaches, stabilizes, encloses, and separates muscles and other internal organs.
151
function of cartilage
decrease friction
152
synovial
freely movable
153
nonsynovial
immovable
154
types of joints
hinge, gliding, and ball and socket
155
function of the joints
provide mobility to the skeleton
156
diathroidial
moveable joint
157
bursa
fluid filled sac that can form with friction
158
how many cervical vertebrae do we have?
7
159
how many thoracic vertebrae do we have
12
160
how many lumbar vertebrae do we have
5
161
inversion
sole of the foot towards the median plane
162
eversion
sole of foot away from the median plane
163
protraction
anterior movement
164
retraction
posterior movement
165
opposition
movement of thumb towards a finger or palm to grasp something
166
ottawa fracture rules
if you can walk the ankle its probably no broken
167
if joint is not aligned it may be
dislocated
168
what does obesity do to the joints
puts extra strain and stress on the joints, which can increase the risk of degenerative joint disease
169
if someone has a problem with there left side, what side would you look at first
right to get a feeling of what normal looks like
170
what do you asses when a patient ambulates
do their arms swing? assess their gait
171
strength scale
0/5 strength- none, 1/5 strength- trace, 2/5 strength- poor, 3/5 strength - fair, 4/5 strength - good, 5/5 - full
172
line between iliac crests crosses what spinous process
L4
173
what spinous process is at the bottom of you scapula
T7
174
which part of your spine should curve posteriorly
thoracic and sacral
175
which part of your spine should curve anteriorly
cervical and lumber
176
Scoliosis and who gets its?
side-to-side spinal curves. On an X-ray, the spine of an individual with scoliosis looks more like an "S" or a "C" than a straight line. scoliosis runs in families. it usually develops in childhood but can occur in adults and elderly.
177
radiculopathy
referred pain. pain that is causing/radiating somewhere else
178
herniated disk
Normal wear and tear over time can cause one of the disks in your spine to rupture also called a "slipped" disk. Compression or inflammation of the sciatic nerve causes sciatica — a sharp, shooting pain in the lower back, buttocks and leg.
179
what is sciatica hard to diagnose
each nerve has a sensory portion for skin sensation, pain, and muscle feedback. There is also a motor portion for muscle control and strength. This adds to the complex nature of diagnosing sciatica
180
vagus
knocked knees and usually obese
181
varus knees
bowed and usually skinny
182
Ballottement
physical exam of knee: With the patient supine and the knee extended, press on the quadriceps muscle just above the knee with one hand and keep that pressure there. Palpate the patella with the other hand feeling for fluid.
183
effusion
fluid on the joint
184
Bulge Test
physical exam of knee: Differentiates soft tissue swelling from accumulation of fluid behind the patella.
185
Drawer Sign
With patient supine flex the knee to a right angle. While standing at the at the patient’s feet, grasp the leg just below the knee and see if you can move it toward and away from self
186
some abnormal findings with MSK
TMJ dysfunction, gout, OA, RA, osteoporosis, sprains, fractures, injuries
187
TMJ
temporalmandibular joint. permits chewing and speaking, protraction and retraction, and gliding from side to side
188
gout
form of arthritis caused by excess uric acid in the bloodstream. mostly in men. strongly correlated with alcohol, obesity, HTN, diuretic use
189
osteoarthritis
hard contender nodules. can be heberden's or Bouchard's nodes
190
risk factors of osteoarthritis
inactivity, overactivity, obesity, repeated injuries, being over 45
191
Heberden’s nodes
Osteophytes of the distal interphalangeal joints
192
Bouchard’s nodes
Osteophytes of the proximal interphalangeal joints
193
osteoporosis
Decreased bone mass. old bone is not replaced as fast with new bone. Bones become weak, spongy and can break easily. osteoporotic bone looks more porous
194
risk factors for osteoporosis
woman, caucasian or asian, family history, decreased weight, smoking/drinking, steroids
195
what is the screening for osteoporosis?
the Dexa scan
196
how can osteoporosis cause back pain
If you have osteoporosis, daily lifting and other routine activities can cause low back pain by fracturing the front part of the weakened bones, these are known as compression fractures
197
rheumatoid arthritis
(RA) autoimmune, lab diagnosis, hereditary
198
kyphsis
hump back
199
lordosis
A curving inward of the lower back
200
who has the highest risk of developing problems from loss of bone density
caucasian woman
201
what do you do during the acute phase (such as fall or injury)?
assess first! do not move them! unless CPR is needed
202
left hip fracture dislocation
Affected extremity exhibits external rotation and is short compared to the unaffected leg. pain will occur when rotating the leg
203
tinel's test
physical exam of hand: Evaluates for carpel tunnel syndrome. Percuss lightly over the median nerve located on the inner aspect of the wrist.
204
phalen's test
Evaluates for carpel tunnel syndrome. Flex wrists 90 degrees and hold the backs of the hands to each other for 60 seconds.
