Chapter 45: Nutrition Flashcards
(186 cards)
1
Q
Nutrition is important for
A
normal growth and development tissue maintenance and repair cellular metabolism organ function body movement
2
Q
Food can hold
A
symbolic meaning
3
Q
The U.S. Department of Health and Human Services established nutritional goals and objectives for Healthy People 2020
A
Weight and growth Food and nutrient consumption Iron deficiency and anemia Schools, work sites, and nutrition counseling Food security
4
Q
The basal metabolic rate
A
The energy needed to maintain life-sustaining activities (breathing, circulation, HR, temperature) for a specific period of time at rest.
5
Q
The resting energy requirements (REE)
A
The amount of energy that an individual needs to consume over a 24 hour period for the body to maintain all of its vital functions at rest
6
Q
Kilocalories
A
when food intake equals energy requirements
no change in weight
7
Q
Nutrients
A
Elements necessary for normal function of body processes: carbohydrates, proteins, fats, water, vitamins and minerals
8
Q
Nutrient density
A
…
9
Q
Carbohydrates is composed of
A
Carbon
Hydrogen
Oxygen
10
Q
Each gram of carbohydrates produce how many kcals?
A
each gram produces 4 kcal/g
11
Q
Carbohydrates
A
serves as a main source of fuel (glucose)
12
Q
Carbohydrate classification
A
based on the number of carbohydrate units = saccharides.
13
Q
Simple Carbohydrates
A
Primarily in sugars
monosaccharides and disaccharides.
14
Q
Monosaccharides
A
do not break down into smaller carbohydrate units includes glucose (dextrose) and fructose
15
Q
Disaccharides
A
composed of two monosaccharides and water
includes sucrose, maltose and lactose
16
Q
Complex Carbohydrates include
A
polysaccharides
17
Q
Polysaccharides
A
insoluble in water
soluble in water
18
Q
Protein function
A
- provide source of energy (4 kcals/g)
- assist in transport of nutrients and certain medications
- ingestion of proteins maintains nitrogen balance
19
Q
Proteins are essential for
A
growth, maintenance, and repair of the body tissue
20
Q
Proteins are the building blocks for the synthesis of
A
DNA and RNA Collagen Hormones Enzymes Immune cells
21
Q
Amino acids
A
the simplest form of protein
22
Q
Amino acids consist of
A
Hydrogen, Oxygen, Carbon and Nitrogen
23
Q
Indispensable amino acids
A
Not synthesized by the body
Needs to be provided via diet
24
Q
Dispensable amino acids
A
synthesized by the body
25
Fats
also known as lipids
provides 9 kcal/g
is the most calorie dense nutrient
26
Fats are composed of
triglycerides and fatty acids
27
Triglycerides
three fatty acids attached to a glycerol
28
Fatty Acids
Saturated
| Unsaturated - Monounsaturated and Polyunsaturated
29
Water is critical because
it makes up 60-70% of body weight
30
Percentage of total body weight is based on
muscle mass.
| greater in lean people and lesser in obese people.
31
In healthy people, fluid intake equals output through
Elimination, respiration and sweating
32
In ill people, there might be a need for
Fluid intake d/t fever or GI losses
| Fluid restriction d/t cardiopulmonary issues or renal insufficiency
33
Vitamins
neutralize free radicals
34
Free radicals
produce oxidative damage to body cells and tissues
| increases risk for certain cancers
35
Vitamin synthesis depends on
dietary intake.
36
Vitamins are high in
fresh foods not exposed to heat, air and water
37
Vitamin Classification
Fat soluble: A, D, E and K
| Water soluble: C and B-complex
38
Minerals
inorganic elements essential to the body - acts as catalyst in biochemical reactions. Acts as antioxidants.
39
Minerals are classified as
Microminerals and Trace elements
40
Microminerals
Daily requirement more than 100 mg
Help to balance the pH of the body
Promotes acid-base balance
41
Trace elements
Daily requirement is less than 100 mg
| Excess of one trace mineral can cause deficiency of another trace mineral
42
Digestion
breakdown of food by chewing, mixing and churning (break down of food into absorbable nutrients)
43
Enzymes
protein substances that act as catalysts to speed up chemical reactions
ex. in saliva-amylase (digest carbohydrates)
44
Peristalsis
wavelike muscular contractions to move swallowed food through digestive tract
45
Chyme
acidic and liquefied food
46
What nutrients are absorbed in the small intestine?
carbohydrates, minerals, protein and water soluble vitamins
47
After absorption, the nutrients absorbed in the small intestine are processed in the ________ and released into the _________.
After absorption, the nutrients absorbed in the small intestine are processed in the LIVER and released into the PORTAL VEIN CIRCULATION.
48
About how much water is absorbed in the small intestine?
close to 90% of water is absorbed in the small intestine
49
Villi
fingerlike projections responsible for nutrient absorption
| increase surface area for absorption
50
Mechanisms for Intestinal Absorption
Active Transport
Passive Diffusion
Osmosis
Pinocytosis
51
Metabolism
Biochemical reactions in the body.
52
Metabolism can be
anabolic or catabolic
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anabolic
building of complex biochemical substances by synthesis of nutrients
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catabolic
breakdown of biochemical substances into simpler forms
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Nutrient metabolism consists of three processes
1. glycogenolysis
2. glycogenesis
3. gluconeogenesis
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glycogenolysis
breaking glycogen into glucose, carbon dioxide and water
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glycogenesis
anabolism of glucose into glycogen for storage
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gluconeogenesis
catabolism of amino acids and glycerol into glucose for energy
59
Chyme
becomes feces in the large intestine
60
During elimination, water is absorbed into the
mucosa while feces move toward the rectum
61
The longer the feces stay in the large intestine,
the firmer they become
62
What stimulates peristalsis?
exercise and fiber
63
Feces contain
- cellulose
- indigestible substances
- sloughed epithelial cells from the GI tract
- digestive secretions
- microbes
64
Dietary reference intakes (DRI)
criteria for acceptable range of amounts of vitamins and nutrients for each gender and age group
65
Food guidelines
Dietary guidelines for Americans (2015-2020) (Box 45-2, p. 1058)
ChooseMyPlate
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Daily Values (Food Labels)
Recommended daily values by the US Food and Drug Administration based on 2000 kcal/day for adults and children
67
There are two sets of reference values
1. Referenced Daily Intake (RDI)
| 2. Daily Reference Values (DRV)
68
Factors influencing nutrition and eating
sociological
cultural
psychological
emotional
69
In relation to nutrition, nurse's need to understand patient's
values, beliefs, and attitudes about food and how it affects food purchase, preparation and intake.
70
Environmental factors that influences nutrition
sedentary lifestyle
work schedules
poor meal choices
71
Factors Influencing Nutrition
```
Living on a fixed income
Good oral health/Periodontal disease (difficulty chewing, missing teeth, oral pain)
Medications
Type of Diet (Vegetarian, vegan)
Eating disorders
```
72
Nutrition in young and middle-aged adults
reduction in nutrient demands as the growth period ends
73
What happens to energy needs over the years?
energy needs decline over the years
74
Obesity becomes a problem d/t
decreased physical exercise
dining out more often
increased ability to afford more luxury foods
75
Poor nutrition in pregnancy causes
low birth weight in infants
| meeting the needs of a fetus is at the expense of the mother
76
What can you teach pregnant mothers about nutrition?
```
quality food intake
protein intake (60 g/day)
calcium, iron and folic acid intake
```
77
Lactation
production of milk increased energy and protein requirements
| increased need for vitamins (A and C)
78
Nutrition in Older Adults (65 and older)
Decreased need for energy d/t slower metabolic rate
| Vitamin and mineral requirements remain unchanged
79
Factors affecting nutritional status in older adults
- Gastrointestinal changes affecting digestion of foods
- Presence of chronic illnesses
- Adverse effects of medications
- Factors contributing to food insecurity (limited income, lack of transportation, limited mobility)
- Cognitive impairments
80
Nutrition: Assessment
- Assess for an early recognition of malnourished and at-risk patients
- Identify the signs and symptoms associated with altered nutrition
- Gather data from patients regarding nutritional practices and obtain patient’s dietary history
- Determine patient’s nutritional energy needs
- Assess effects of chronic conditions on the ability to prepare meals
81
Nutrition Screening
Quick method to identify malnutrition or risk for malnutrition
82
Nutrition Screening includes objective measures such as
height
weight and weight changes
diagnosis and presence of other comorbidities
83
Nutrition Screenings identify risk factors such as
- unintentional weight loss
- presence of modified diet
- presence of altered nutritional symptoms (N/V, diarrhea, and constipation)
84
Assess patients for malnutrition when their conditions interfere with
ability to ingest, digest or absorb nutrients
85
Anthropometry
measurement system of the size and makeup of the body (height and weight)
86
Weight
weight the patient at the same time each day
on the same scale
with the same type of clothing or linen
87
Ideal body weight
provides an estimate on how much a person should weigh
88
Body mass index
measures weight corrected for height
89
BMI between 25-30
overweight
90
BMI above 30
obesity
91
Nutrition: Laboratory and Biochemical Tests
common tests used to measure nutritional status includes measures of plasma proteins, fluid balance, liver function, kidney function and presence of disease.
92
Diet history and health history includes
- Dietary intake and food preferences
- Unpleasant symptoms
- Allergies
- Taste, chewing, and swallowing
- Appetite and weight
- Use of medications
93
Dysphasia
difficulty swallowing
94
Difficulty swallowing can cause complications such as
Aspiration pneumonia
Dehydration
Decreased nutritonal status
Weight loss
95
Warning signs for dysphasia
- Cough during eating
- Change in voice tone and quality after swallowing
- Abnormal movements of the mouth, tongue, or lips
- Slow, weak, imprecise, or uncoordinated speech
- Incomplete oral clearance or pocketing
- Delayed or absent trigger of swallow
96
Silent aspiration
- Occurs in patients with neurological problems that lead to decreased sensation
- Often occurs without a cough
97
Silent aspiration symptoms usually don't appear for
24 hours
98
Silent aspiration accounts for
majority of aspirations in patients with dysphasia after stroke
99
Valid dysphasia-screening tools
increase quality of care
decrease of aspiration pneumonia (bedside swallowing assessment, acute stroke dysphasia screen, standardized swallowing assessment)
100
Possible nursing diagnosis RT Nutrition
Risk for Aspiration
Diarrhea
Imbalanced Nutrition : Less than Body Requirements
Imbalanced Nutrition: More than Body Requirements
Readiness for Enhanced Nutrition
Impaired Swallowing
Feeding Self-Care Deficit
101
Planning
- Select interventions to promote optimal nutrition
- Select interventions consistent with therapeutic diets
- Consult with other healthcare professionals to adopt interventions that reflect the patient’s needs
- Involve family when designing interventions
102
In acute care, patients
- Are often refrained from drinking and eating anything by mouth (NPO)
- Have frequent interruptions during meal times
- Have poor appetites
- Are too tired or uncomfortable to eat
103
Advancing diets
-NPO patients after extended time or NPO patients who had surgical procedures require specific orders on:
Diet progression
Therapeutic diets
104
Promoting Appetite
- Keep environment free of odors
- Provide oral hygiene as needed
- Maintain patient comfort
- Offer small frequent meals
- Encourage use of seasoning to improve food taste
- Encourage visitors to eat with the patient
105
Mealtime is an excellent time for
patient education
106
Teach patients about
therapeutic diets and adaptive devices to help with in depended feeding
107
Assisting patients with oral feedings
Protect patient's safety, independence, and dignity
Clear the side table of clutter
Assess for risk of aspiration
108
In patients with dysphasia,
- Feed the patient slowly
- Provide small size bites
- Allow the patient to empty the mouth after each spoonful
- Match the speed of feeding to the patient’s readiness *
109
Enteral tube feeding (enteral nutrition)
preferred in patients unable to swallow or take nutrients orally but have functional GI tract
110
Enteral Tube feedings via
```
Nasogastric
Jejunal (surgically inserted=jejunostomy)
Gastric (surgically inserted= gastrostomy)
```
111
After insertion of an enteral tube, placement should be
verified by x-ray
112
Before patient receives first enteral feeding, what is needed?
confirmation of placement
113
When advancing the rate of tube feeding, you typically start at
a slow rate (advancing is institution specific, follow the order)
114
When advancing the rate of tube feeding, the nurse should
- Check for signs of intolerance
- Keep the head of the bed elevated minimum 30-45 degrees
- Measure gastric residual volumes per hospital policy
- Evaluate for aspiration an use measures to reduce risk of aspiration
115
Parenteral Nutrition or Total Parenteral Nutrition
Nutrition provided intravenously
Administered via central line
Adhere to principles of asepsis and infusion management
Received over a 24-hour period
116
Parenteral Nutrition or Total Parenteral Nutrition is for patients
unable to digest or absorb enteral nutrition
117
Parenteral Nutrition or Total Parenteral Nutrition requires
laboratory monitoring
118
The goal of parenteral nutrition or total parenteral nutrition is to
eventually use the GI tract
119
Initiating parenteral nutrition
Placement of central line into central vein
Placed by specially trained nurses under sterile conditions
Catheter placement placement confirmation required by radiology
Before starting TPN verify the order
120
Complications of Parenteral Nutrition
Catheter related problems
| Metabolic alternations
121
Preventing complications of parenteral nutrition
```
Change TPN tubing every 24 hours
Lipid tubing change every 12 hours
Do not hang TPN for longer than 24 hours
Use chlorhexidine to clean the catheter hub for 15 seconds before and after each time it is used
Monitor blood glucose Q6H
```
122
Sudden discontinuation of TPN can cause
hypoglycemia (recommended to infuse 10% Dextrose in the meantime, see orders)
123
During central line dressing changes use
sterile mask and gloves and assess the site for S/S of infection
124
When should central line dressings be changed?
Change central line dressing per hospital policy or when wet or soiled
125
Medical nutritional therapy
specific therapies to treat illness, injury or condition
126
Peptic ulcers are mainly caused by
(up to 85%) by Helicobacter pylori
127
Peptic ulcers
Stress and overproduction of HCL irritate pre-existing ulcer
128
Peptic ulcers can be controlled with
regular meals
129
Patient teaching for peptic ulcers
-Encourage patients to avoid foods that increase stomach acidity
(caffeine, decaffeinated coffee, frequent milk intake, citric acid juices, spices)
-Discourage smoking, alcohol, aspirin, NSAIDs
-Teach patients to avoid eating large meals without snacks especially at bedtime
130
Inflammatory Bowel Diseases include
Crohn's Disease
| Idiopathic Ulcerative Colitis
131
Treatment of acute IBDs include
elemental diets
| PN when symptoms of diarrhea and weight loss
132
Treatment of chronic IBDs include
Regularly, highly nourishing diets
| Vitamins and iron supplements
133
Irritable Bowel Syndrome Treatments include
increasing fiber, reducing fats, avoiding large meals and avoiding lactose and sorbitol containing foods
134
Treatment for Celiac disease (Malabsorption syndrome)
gluten-free diet
135
Short-bowel syndrome (Malabsorption Syndrome)
results from extensive resection of bowel (lack of intestinal surface area)
136
Treatments for Short-bowel syndrome (Malabsorption Syndrome)
lifetime feeding with either elemental formula or PN
137
Diverticulitis
inflammation of diverticula in bowel lining (pouch-like herniations)
138
Treatment for Diverticulitis
- moderate or low-residue diet in acute diverticulitis
| - prescription of high-fiber diet for chronic diverticula problems
139
Treatment for Diabetes Mellitus
- insulin/oral medications
| - maintaining/monitoring a prescribed carbohydrate intake to balance glycemic levels
140
Treatment for Cardiovascular Diseases
balanced caloric diet intake with exercise to maintain healthy weight
141
Treatment for Cancer
maximized nutritional therapy that meets the increased metabolic needs
142
Treatment for HIV/AIDS
restorative care of malnutrition focuses on maximizing Kcal and nutrients
143
Evaluation: Reassess signs and symptoms associated with altered nutrition including
```
Weight
Calorie intake
Protein intake
Laboratory results
Determine patient's satisfaction with nutritional therapy
```
144
Carbohydrates are essential for normal function of the
Brain
Skeletal muscles during exercise
Erythrocytes and leukocyte production
Cell function of the renal medulla
145
Carbohydrates are primarily obtained from
Plant sources (except milk)
146
Complex carbohydrates
Made up of many carbohydrate units. Insoluble in water and digested to arming degrees. Ex) glycogen, starches (fiber: not broken down by the human digestive system)
147
Additionally _____________________________________ all require proteins.
blood clotting, fluid regulation and acid-base balance
148
Complete protein
Contains all essential amino acids to support growth and maintain nitrogen balance.
Ex. Fish, poultry, soybeans, cheese
149
Incomplete proteins
Missing one or more of the nine essential amino acids.
| Ex. Cereals, legumes, vegetables
150
Nitrogen Balance
When the intake and output of nitrogen are equal.
| Nitrogen Balance = Intake - Output.
151
Negative Nitrogen Balance
When the intake is less than what the body requires
152
Negative Nitrogen Balance may occur with
Infections, burns, fever, starvation, head injury, trauma.
153
Positive Nitrogen Balance
When intake is greater than output.
154
Positive Nitrogen Balance is essential for
Growth
Normal pregnancy
Maintenance of lean muscle mass and vital organs
Wound healing (to build, repair, and replace body tissues)
155
Adequate amounts of _______________ for energy expenditure are essential for healing to prevent the body from using _________ as its primary energy source.
Carbohydrates
| Protein
156
Antioxidants neutralizes
Free radicals
157
Bile
Manufactured in the liver and stored in the gallbladder to emulsify fats
158
Pancreatic secretions
Contain enzymes to digest starch, emulsify fats and break down proteins
159
What organ is the primary absorption site for nutrients?
Small intestine
160
The energy produced by metabolism involves
Mechanical energy: muscle contraction
Electrical energy: nerve impulses
Thermal energy: Heat production
161
Recommended Daily Allowances
The average needs of 98% of the population (not the exact needs of an individual)
162
Estimated Average Requirement
The recommended amount of nutrients that appears sufficient to maintain a specific body function for 50% of the population based on age and gender.
163
Referenced Daily Intakes
Protein, vitamins and minerals based on RDA
164
Daily Reference Values
Total fat, saturated fat, cholesterol, carbohydrates, fiber, sodium and potassium
165
Nutritional Requirements are dependent on
```
Stage of development
Body composition
Activity Levels
Pregnancy and Lactation
Presence of disease
```
166
Registered Dietitians
Helps develop nutrition treatment plans. I.e calorie counts
167
Patients that are malnourished on admission are at greater risk of life-threatening complications including
Arrhythmias, sepsis and hemorrhage
168
Laboratory Tests: Plasma proteins
Albumin
Factors affecting serum albumin include: hydration, hemorrhage, renal or hepatic disease, large amounts of drainage from wounds or the GI tract, steroid administration, exogenous albumin infusions, age and trauma.
169
Dysphasia leads to
```
Decreased functional status
Increased length of stay
Increased cost
Increased likelihood of being discharge to LTAC
Increased mortality
```
170
Pharmacists
Develop PN orders/mixtures
171
Physical Therapists
Builds strength and endurance
172
Occupational Therapist
Identify assistive devices.
| I.e utensils with large handles, plates with sides
173
Speech therapists
Help with swallowing exercises and techniques to reduce risk of aspiration.
174
Understand the effects of medications on:
Taste, appetite and metabolism
175
Assisting a patient with dysphasia
```
Sit patient up 90 degrees
Head position slightly chin down
Place food in stronger side of the mouth
Have sanction equipment available
Utilize speech therapy to determine viscosity of foods tolerated best.
```
176
Four levels of liquid
Thin (low viscosity)
Nectar-like
Honey-like
Spoon-thick (pudding)
177
Diet progression
Clear liquid -> regular diet
178
NG tube
Therapy lasting < 4 weeks
179
G-Tube
For patients with a lower risk of aspiration.
| Inserted surgically or through endoscopy
180
J-tube
(For patients with a higher risk of aspiration)
| Inserted surgically or through endoscopy
181
Benefits of feeding by the enteral route
Reduces sepsis
Minimizes the hyper metabolic response to trauma
Decreases hospital mortality
Maintains intestinal structure and function
182
Signs of Intolerance for Enteral Feeding
High Gastric Residuals
N/V/D
Cramping
183
Conditions that increase the risk of aspiration includes
```
Coughing
GERD
Nasotracheal suction isn't
Any artificial airway
Decreased LOC
Lying flat
```
184
Patients in highly stressed physiological states are candidates for PN
Sepsis, head injury and burns
185
When is PN therapy usually discontinued?
When 75% of nutritional needs are being met by enteral feelings
186
HIV precipitates
Weight loss and body wasting, anorexia, stomatitis, oral thrush infection, N/V/D
