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Integumentary > Lesson 2/Chapter 2 > Flashcards

Lesson 2/Chapter 2 Flashcards

1
Q

Nutrients for homeostasis, repair and regeneration:

A

water, protein, carbs, fats, vitamins, minerals

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2
Q

Dehydration:

A

1% decrease in body weight due to fluid loss

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3
Q

Patients on air-fluidized beds require:

A

40-60mL of water/kg BW daily

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4
Q

When would a patient need a dietician referral?

A

swallowing difficulties, fluid restrictions, NPO more than a few days

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5
Q

Average amount of water per kg of body weight?

A

30–35 mL

  1. 7–3.7 l/day average
  2. 5L/day minimum
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6
Q

What is protein required for?

A 
Collagen synthesis
Granulation tissue formation
Angiogenesis
Remodeling
Immune function
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7
Q

What does a protein deficiency alter?

A

osmotic pressure, causing edema

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8
Q

What percentage of protein is nitrogen?

A

16%

Positive nitrogen balance needed to enhance wound healing

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9
Q

How much of protein is need daily?

A

1.25–1.5 g protein/kg BW daily

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10
Q

Marasmus

A

protein deficiency though deprivation or impaired absorption, significant weight loss, caused by CA & COPD

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11
Q

Kwashiorkor

A

decreased albumin causes swelling, spares muscle, decreased immunity, infection, skin breakdown and pressure ulcers common

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12
Q

Marasmus Kwashiorkor-

A

combined- high risk of mortality & morbidity

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13
Q

Amount of protein needed for tissue repair?

A

½ body weight in pounds or 1.25-1.5g/kg of body weight for stage III & IV ulcers

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14
Q

Specific amino acids:

A

glutamine
arginine
hydroxy-methylbutyrate (HMB)

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15
Q

Glutamine

A

most abundant (20%) fuel source for small cells, primary fuel source for lymphocyte proliferation, precursor for nucleotide production in fibroblasts and macrophages, stimulates inflammatory response in wound healing, levels fall in plasma and muscle after trauma

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16
Q

Arginine

A

semi-essential amino acid, decreased production in times of stress and injury, primary component in wound healing, increases collagen deposition, fibroblastic activity, and immune function

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17
Q

Hydroxy-methylbutyrate (HMB)

A

helps support immune function, helps decrease muscle breakdown, need to give with arginine & glutamine

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18
Q

Carbohydrates

A

Primarily in the form of glucose
Provide energy for tissue repair and regeneration
Protein-sparing effect

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19
Q

Carbs in BW daily?

A

30-35kcal/kg

20-30% of total calories

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20
Q

What do fats do?

A

Provide a needed energy source when carbohydrates have been depleted
Carry fat-soluble vitamins
Assist with thermoregulation

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21
Q

What do free fatty acids do?

A

Vital components of cell membranes

Required for synthesis of new cells

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22
Q

What does too much fat cause?

A

immunosuppression

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23
Q

What do fat deficiencies cause?

A

decreased production of phospholipids which are part of the basement membrane and decrease prostaglandin production

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24
Q

What does omega-3 have in it?

A

anti-inflammatory effect, inhibit PDFG, IL-1 & TNF-alpha, may weaken wounds by impairing cross-links and collagen alignment

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25
Fat-soluble vitamins
A,E,K
26
Water-soluble vitamins
C | B-complex
27
Vitamin A (retinol)
Maintains healthy skin and mucous membranes Required for collagen synthesis, promotes granulation tissue formation, and facilitates epithelialization May reverse inhibitory effects of corticosteroids
28
What can Vitamin A increase?
wound tensile strength Increases inflammatory response Increases EGF-(epidermal growth factor) increases collagen synthesis
29
Vitamin C (ascorbic acid)
Builds and maintains tissues Helps body absorb iron May help control infections and limit damaging effects of free radicals May enhance wound healing in malnourished patients and patients with pressure ulcers Pretreatment of irradiated skin with Vitamin C may limit skin damage
30
What is vitamin C essential for?
collagen synthesis | deficiency delays would healing
31
RDA of vitamin C
60mg/day
32
Vitamin K
Fat-soluble vitamin Essential for blood clotting Deficiency may lengthen the inflammatory phase If on anticoagulant, do not supplement without MD clearance
33
B-Complex Vitamins
Group of eight vitamins Required for normal immune function and energy metabolism Aid in white blood cell function, antibody formation, and resistance to infection Facilitates fibroblast function, collagen synthesis Important co-enzymes
34
Vitamin B6
for protein and hemoglobin synthesis. Rec-.4mg
35
Vitamin B12:
Prevents anemia. Rec- 2mg
36
Vitamin E
Helps prevent free radical–related cellular damage Decreases inflammatory phase of wound healing Enhances immune function Decreases platelet adhesion
37
What can vitamin E adversely affect?
wound healing and decrease collagen production, may weaken wounds
38
Microminerals:
iron zinc copper magnesium
39
Macrominerals
calcium phosphorus selenium
40
How much zinc does the skin contain?
Skin contains 20% of the body’s zinc stores
41
What is zinc vital for?
Vital to collagen and protein synthesis, cell proliferation, epithelialization, and normal immune function An antioxidant
42
What does a zinc deficiency cause?
abnormal function of lymphocytes, increased susceptibility to infection and delayed wound healing
43
Iron
Component of hemoglobin Required for antibody production and normal immune functioning Cofactor in many enzyme systems Required for collagen and DNA synthesis Necessary for formation of red blood cells Transports oxygen to healing tissues
44
What can anemia lead to?
tissue hypoxia, decreased immune function, decreased cell replication, and decreased wound tensile strength
45
What is iron co-factor required for?
conversion of hydroxproline to proline in collagen maturation
46
What doe copper do?
Required for hemoglobin synthesis and iron absorption/transport Increases strength of collagen cross-links Aids in Collagen formation Helps form RBC’s
47
What does a copper deficiency lead to?
poor wound healing and decreased immune function
48
Copper and Vitamin C relationship?
Works with vitamin C to form elastin
49
Recommended dosage of copper?
Rec-1.5-3mg
50
Magnesium:
Cofactor in over 300 enzyme systems Important for bone/protein synthesis Inadequate stores lead to hypertension and vasoconstriction
51
Who is a magnesium deficit found in?
often found in patients with diabetes, alcoholism, chronic diarrhea, or dehydration
52
Calcium:
``` Bone formation, remodeling Muscle contraction Fibrin synthesis Important for blood clotting Neurotransmitter ```
53
Phosphorous
Bone formation Needed for normal metabolism Essential component of many enzyme systems
54
What does selenium do?
Assists with normal immune function | Required to make up to 30 proteins
55
What is folic acid necessary for?
RBC production
56
What is thiamin necessary for?
to obtain energy from food. Rec - 2
57
What does a nutritional screening entail?
patient characteristics recent dietary hx wound characteristics patient comorbidities
58
BMI less than 16
underweight | severe protein-energy malnutrition
59
BMI 16-16.9
underweight | moderate protein-energy malnutrition
60
BMI 17-18.4
underweight | mild protein-energy malnutrition
61
BMI 18.5-24.9
normal
62
BMI 25-29.9
overweight
63
BMI 30-34.9
Obese | Class I
64
BMI 35-39.9
Obese | Class II
65
BMI greater than 40
Obese | Class III
66
Clinical manifestation of water deficiency:
``` dry skin, hair and mucous membranes poor skin turgor increased HR and respirations orthostatic hypotension confusion sunken eyeballs ```
67
Clinical manifestation of protein deficiency:
dull, dry hair pallor peripheral edema pressure ulcers, especially multiple or repeat ulcerations
68
Clinical manifestation of carbs/energy deficiency:
decline in body weight pallor extremely poor denition
69
Clinical manifestation of fats deficiency:
emaciated epidermal flaking fissuring of the skin large flakes of dandruff
70
Clinical manifestation of Vitamin A deficiency:
``` night blindness difficulty adapting to changes in light intensity scleral changes and dry eyes gingivitis pigment changes dry skin ```
71
Clinical manifestation of Vitamin C deficiency:
swollen gums that bleed readily transparent skin quality weakness delayed wound healing
72
Clinical manifestation of Vitamin K deficiency:
petechiae | wound bleeds readily
73
Clinical manifestation of B complex vitamins deficiency:
``` pallar pale eye membranes hyperpigmentation redness or swelling of the mouth mouth sores purple discoloration tongue w/loss of villi confusion muscle cramps anemia ```
74
Clinical manifestation of zinc deficiency:
decreased sense of taste dull, dry or thinning hair seborrhea-like dryness and redness of the face
75
Clinical manifestation of iron deficiency:
``` pallor yellow discoloration of the skin soft, spoon-shaped nails easily fatigued dyspnea anemia ```
76
Clinical manifestation of copper deficiency:
thinning of hair | may have pigmentation changes
77
Clinical manifestation of magnesium deficiency:
dehydration neuromuscular hyperexcitability confusion
78
Clinical manifestation of calcium deficiency:
``` acute: neuromuscular hyperexcitability, dyrhythmias skeletal deformities bone pain dry scaling skin and hair brittle nails ```
79
Clinical manifestation of phosphorus deficiency:
skeletal deformities bone pain idiopathic fractures
80
Clinical manifestation of selenium deficiency:
muscle pain/wasting | decreased ability to fight infection
81
Creatine
Measure of kidney function and protein status Malnutrition decreases creatine levels Normal levels are 0.8–1.5 mg/dL
82
Serum Albumin
Plasma protein produced by liver | Normal levels are at least 3.5 mg/dL
83
What do low levels of serum albumin correlate with?
pressure ulcer severity Decreased levels lead to edema Dehydration will increase levels
84
How long does it take to determine effectiveness of albumin?
21 days
85
Prealbumin
Major transport protein Normal values 16–40 mg/dL Mortality risk increases as levels drop
86
How soon is a pre-albumin change observable?
observable in 42-78 hours. Not affected by hydration. Affected by renal failure. Pre-albumin < 17 mg/dL = malnutrition
87
Serum Transferrin
Sensitive indicator of protein status | Levels less than 170 mg/dL indicate malnutrition
88
C-reactive protien-CRP-
associated with systemic inflammation
89
Serum Cholesterol
< 160mg/dL with poor intake and weight loss- at risk for pressure ulcers
90
Hemoglobin
< 12mg/dL and hematocrit < 33% = anemia/pressure ulcer risk
91
Serum Osmolality
> 29 mOsm/L
92
Blood Urea Nitrogen (BUN)
Urea is a by-product of protein metabolism and is excreted by the kidney Indicator of renal function Normal levels are 5–25 mg/dL Elevated levels are associated with decreased wound healing
93
BUN/Creatinine ratio
> 10-:1-skin tugor, urine output, and weight fluctuation indicators of dehydration
94
Total Lymphocyte Count (TLC)
Indirect measure of nutritional status and immune function | TLC is a marker for HIV
95
Normal TLC count:
3000-3500 cells/ l
96
What are elevated TLC levels associated with?
infection, leukemia
97
What are decreased TLC levels associated with?
associated with delayed wound healing and increased mortality <1500- immunocompromised <1200- protein deficiency Severe- < 900
98
Increased blood glucose levels are associated with?
associated with risk of ulceration and impaired wound healing >180 neutrophils cannot chemotax to infection, >200 affects neutrophils ability to carryout oxidative bursts with phagosomes
99
Main causes of malnutrition:
Lack of knowledge, poverty, health problems
100
Proper nutritional guidelines
30–35 calories/kg BW | 1.25–1.5 g protein/kg BW
101
Changes in body weight:
1% decrease in a week 5% decrease in a month 7.5% in 3 months 10% in 6 months

Integumentary (18 decks)

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