M6 Nutrition Flashcards
(192 cards)
1
Q
Failure to thrive can be caused by 2 categories of illnesses
A
Physical
Psychological
2
Q
Failure to thrive manifestations
A
Underweight
Dry skin
Prominent bony stature
Mental confusion
Drop in reflexes
3
Q
Failure to thrive
Hx
A
Diet changes
Apathy
Food intolerance
Functional ability
Strength
Environmental (can person afford food)
4
Q
Diagnostic labs for failure to thrive
A
Albumin/prealbumin
Liver enzymes
BUN/Creatinine
Lytes
CBC
5
Q
Visual diagnostics for failure to thrive
A
Abdominal ultrasound
Abdominal CT
Radiology studies for swallowing
6
Q
Nurse interventions for FTT
A
Nutrition intake assessment
Nutrition support/supplements
Daily weight
Daily I&O
7
Q
FTT collaborative interventions
A
Psych counseling
Dietician
Enteral/parenteral nutrition
8
Q
Meds for FTT
A
Appetite stimulants
Vitamins
Mineral supplements
9
Q
Impaired liver function 101
results in
A
Impaired PROTEIN metabolism
Decreased ALBUMIN and CLOTTING factors
Reduced BILE production
Impaired metabolism of STEROIDS and GLUCOSE
10
Q
Liver failure cause
CIRRHOSIS 101
A
Alcohol
Biliary problems
Nonalcoholic fatty liver
11
Q
Posthepatic liver failure problems
A
Hepatitis B and C
Chronic viral hepatitis
12
Q
High risk behaviors that can cause liver failure
A
Alcohol use
Injectable drugs
Exposure to toxins
13
Q
Live failure S/S
decay
A
Malnutrition
Muscle wasting
Jaundice
Gastritis/anorexia/diarrhea
Bleeding
14
Q
Liver failure S/S
things expanding
A
Edema
Ascites
Splenomegaly
Encephalopathy
15
Q
Collaborative care for Cirrhosis
A
Holistic addressing
physiology
psychology
spirituality
Counseling
Job coaching
Behavior therapy
Nutrition
16
Q
Lab exams for liver function
A
AST ALT
CBC
Coagulation studies (liver helps coagulation)
17
Q
What serums will change with liver cirrhosis
A
Lytes
Bilirubin
Albumin
Ammonia
Glucose
Cholesterol
18
Q
Bilirubin
A
yellow pigment
breakdown of RBCs
19
Q
Albumin
A
liver protein
low level means malnutrition
20
Q
Ammonia
A
15-45u
if high means liver failure
21
Q
Visual exams for cirrhosis
A
Abdominal ultrasound
Esophagoscopy
Liver biopsy
22
Q
Meds for cirrhosis
A
Diuretics
Beta blockers
Oxazepam
Nutrition supplements
stuff to reduce nitrogenous waste and ammonia
23
Q
Nutrition supplements
A
Ferrous sulfate
Flic acid
Vit K
Antacids
24
Q
Meds to reduce nitrogenous waste and lower ammonia
A
Lactulose
Neomycin
25
Oxazepam
benzodiazepine
helps with liver inflammation in critical citations
26
Drugs to avoid with cirrhosis
Barbituates
Sedatives
Hypnotics
Acetaminophen
Alcohol
27
Nutritional therapy for liver cirrhosis
Sodium down to 2g
Fluids down to 1500ml
Protein down to 60g
Moderate fat
Supplements
28
Cirrhosis emergency nutrition
Parenteral nutrition
29
Surgical/procedural therapy for cirrhosis
Transplant
Paracentesis
Balloon tamponade
Transjugular intrahepatic portosystemic shunt (TIPS)
30
Paracentesis
Perforation of a hollow cavity to remove fluid
31
Balloon temponade
Multiple lumen NG tube
inflates balloon on sides of tube to provide pressure on bleeding varices in GI
32
TIPS
Transjugular intrahepatic portosystemic shunt
Relieves portal hypertension fixing varices and ascites
Shunt is left between portal and hepatic vein allowing better perfusion
33
Nursing S/S assessment cirrhosis
Weight loss
Anorexia
Bleeding
Pruritus
Abdominal pain
34
Nursing Hx assessment cirrhosis
Liver/gallbladder disease
Alcohol and drug use
OTC meds
35
Nursing physical manifestations of cirrhosis
Mental status
Abdominal girth
Edema
Bruises
Jaundice
36
Cirrhosis results in what problems
aka diagnosis
Excess fluid volume
LOC changes
Impaired skin
Nutrition less than body requirements
37
Outcome goals for cirrhosis
Maintain hydration
Maintain diet
Regular elimination
38
Easiest monitoring
DAILY WEIGHT
39
What concepts can be impaired due to cirrhosis
Mobility
F/E
Perfusion
Clotting
Nutrition
40
Major functions of the liver
Filter blood
Detox drugs
Produce coagulants
Metabolism
41
Patho of cirrhosis
buildup of fibrotic tissue impairs perfusion
42
First systems to be affected by cirrhosis
Metabolic abnormalities
Clotting
43
Liver can regenerate it self but this results in further
scarring tissue that can not be perfused
44
Decompensated cirrhosis results in
Portal hypertension
Bleeding varices
Hepatorenal syndrome
ascites/peritonitis
encephalopathy
45
Liver pain locations
Dull right upper quadrant pain
Palpable liver
Epigastric pain
46
Urine with liver failure
Bowel
DARK
Drop in output
light colored (gray or tan) stool
47
Liver failure and lungs
Rapid shallow breathing
48
MOST common cirrhosis findings
Edema
Ascites
testicular atrophy and loss of libido
49
Cachexia
Liver failure symptoms
wasting of extremities
50
Due to loss of nutrition with cirrhosis, wound healing will be
Delayed
51
Since the liver produces clotting factors, cirrhosis can result in
H&H DECREASE
gum bleeding
gut bleeding in emesis or stool
easy bleeding at IV sites
etc
52
K+ and liver function
DECREASE
53
Areas that have edema ascites and pruritus are particularly prone to
SKIN BREAKDOWN
54
Portal hypertension in liver failure will result in
Hyperaldosteronism
Increase in fluid volume
55
Antiemetics to prevent nausea with cirrhosis
AVOID
liver can not process them
56
Meals frequency
Self care
small frequent meals
Frequent oral hygiene
57
Skin integrity care
trim nails short
NO alkaline soap
support areas with edema
Keep linen clean dry and wrinkle free
TURN pt q2h
58
Why does hemorrhage occur with cirrhosis
liver makes clotting factors
NO LIVER FUNCTIN = NO CLOTTING
59
Nutritional management for encephalopathy
Small frequent meals
Daily protein between 1.2-1.5 g/kg
protein is good
60
Lytes with encephalopathy
what to do
Hypokalemia
give lactulose
61
Why does encephalopathy occur with cirrhosis
Liver cant metabolize ammonia to urea for excretion
BUILD UP OF AMMONIA = Encephalopathy
62
With encephalopathy and increasing ammonia first symptom is
LOC - SLEEPINESS
stupor
impaired thinking
63
Second encephalopathy S/S are
neuromuscular
Asterixis - liver shakes
Hyperreflexia
64
MOST life threatening complications of cirrhosis
BLEEDING ESOPHAGEAL VARICES
65
To lower ammonia limit
Physical activity
66
Pancreas 101
behind stomach
exocrine and endocrine function
67
Exocrine function of pancrease
Enzymes for digesting
fat protein and carbs
most abundant enzyme trypsin
68
Trypsin
helps in breaking down protein
69
Endocrine pancrease function
Islets of Langerhans secrete
Beta (insulin)
Alpha (glucagon)
Delta (somatostatin)
70
Risk factors for pancreatitis
Trauma
Obstruction
Familial probs
Alcohol/drugs
Ulcers
71
Acute pancreatitis
Auto-digestion of the gland
Trypsin cant get out so it starts to digest the pancreas
72
Phospholipase A and pancreatitis
Activated by trypsin
results in fat necrosis in pancreas
73
Alcohol and pancreatitis
increases inflammation of pancreas
creating stenosis of ducts
74
Causes of pancreatitis
BAD HITS
BIlliary
Alcohol
Drugs
Hypertriglyceridemia/hypercalcemia
Idiopathic
Trauma
Scorpion sting
75
Meds that can cause pancreatitis
Steroids
NSAIDs
Thiazieds
76
Acute pancreatitis manifestations
Jaundice
Abdominal tenderness/rigidity
Guarding
Pancreatic ascites
77
Cullens sign
Turners sign
red/purple around umbilics
Gray on side of belly
78
Pancreatitis complications
Hypovolemia
Hemorrhage
Acute kidney failure
Paralytic ileus
Hypovolemic/septic shock
79
Lungs and pancreatitis
Pleural effusion
Resp distress syndrome
Penumonia
80
Life threatening pancreatitis complications
MODs
DIC
81
Nursing assessments for Pancreatitis
Hx
Diet
Abdominal (look listen feel)
farts are good
Pain
Weight loss
82
What to monitor the most with pancreatitis
Respiratory
Vital signs
83
Position for pancreatitis pain management
Fetal
84
Pancreatitis pain management other interventions
Morphine
IV fluids
NG tube
Rest gut
Antibiotics
85
Early nutrition for pancreatitis
NPO 2-5 days
86
Diet for pancreatitis when permitted
High carb
moderate protein
moderate fat
87
Severe pancreatitis diet
Jejunal feeding
Low fat formula
or standard formula
88
If pt can not tolerate feedings with pancreatitis
TPN
89
Central TPN
Peripheral TPN
how long to use
Max 7 days
Max 10 days
90
How often to feed with pancreatitis
small frequent meals
91
When to start diet
pain is subsided
lipase and amylase have decreased in concentration
92
Fat consumption for pancreatitis less than
50g a day
93
Cooking oils or pancreatitis
Coconut
Palm kernel
MCT
94
Protein amount for pancreatitis
1.5 g at least
95
Nursing management of diet with pancreatitis
no stimulant foods
give antiemetics for N/V
zofran, phenergan
96
patient outcomes for pancreatitis
good
elimination, nutrition, perfusion
no abdominal pain
97
Chronic pancreatitis 101
Progressive destructive disease of the pancreas
Remissions and exacerbations
98
Chronic pancreatitis complications
Hemorrhage
Infection
Bowel obstruction
Abscess
Fistulas
99
Pancreatitis manifestations
Left upper abdominal pain
radiating to back
Intense continued gnawing burning pain
100
S/S of chronic pancreatitis same as acute +
steatorrhea
101
Bowel rest and enteral nutrition results
Fewer infection sand decreased hospital stays
ON TEST
102
Nursing management for Chronic Pancreatitis
Same as acute
103
When to give Pancreatic enzymes
With EVERY MEAL
DO NOT crush or chew
104
Calcium in pancreatitis
K+ in pacreatitis
WILL DECREASE
WILL INCREASE
105
Labs with pancreatitis
Lipase
Trypsin
WBC
Glucose
Bilirubin
elevated
106
Imaging for Pancreatitis
ABD ultrasounds
CT Scan w/contrast
ERCP
Biopsy
107
Surgical measurements for pancreatitis
care
NG tube insertion preop
Post op monitor
drainage
skin integrity
108
Primary prevention of pancreatitis
fat limits
20g fat daily max
no meal should be over 10g of fat
109
Primary prevention of pancreatitis other
No alcohol
No spicy food
Healthy weight
110
Cholelithiasis or biliary obstruction should be treated
IMMEDIATELY
prevents panreatitis
111
Secondary prevention of pancreatitis
Total body system assessment
VS and Labs - CBC, BMP, Lytes
Assess for causative illnesses
112
Causative illnesses for Pancreatitis
Peptic ulcers
Renal failure
Vascular disorders
Hyperparathyroidism
Hyperlipidemia
113
Caloric requirement for Pancreatitis patients
4000-6000
Food will not absorb
hence the enzyme replacements with every meal
114
Home and after care for pancreatitis
home health
monitoring -
diet
meds
skin
follow up appts
Labs
115
Where are pancreatic enzymes supposed to activate?
Small intestine ONLY
116
Biggest goals of pancreatitis
SEVERE pain management
Keep stomach EMPTY and DRY
117
Why infections with pancreatitis
Autodigestion = release of toxic enzyme byproducts
118
Pancreatitis bed rest position
Keep pt UP
119
When you GI suction Pancreatitis pt A/B
Alkalosis
120
Pancreatitis abdomen
Abdomen ridged and board like =
Bleeding
121
Cullen and Turner signs are related to
Pancreatitis GI Bleeding
122
Pancreatitis lab value INDICATOR
AMYLASE
Lipase
123
Serum bilirubin is relate to
Liver
124
What form of fentanyl do we treat pancreatic pain with
Patch
125
What meds dry people up
given for
Anticholinergics
Pancreatitis
126
If pt is on TPN should they be loosing weight
NO
127
Treatment SPECIFIC to chronic pancreatitis
Digestive enzymes
128
FTC and pacemakers
pacemaker will have a line going down on EKG
if there is no PQRS after that is
Failure to capture
129
MOST IMPORTANT LIVER FUNCTIONS
Detoxify body
Detoxify drugs
Blood coagulation
Synthesizes albumin (metabolism)
130
What to do with med doses when liver is shot
Half them
Liver cant metabolize drugs
131
Give patients with Tylenol OD
Acetylcysteine
Mucomyst (carbonated drink)
132
When blood backs up due to liver scaring this is called hepatic hypertension. This blood backs in to
Esophageal varices (Bleeding)
133
BEST vasodilator for portal hypertension
Octreotide, ON TEST
134
With balloon tamponade, pt tries to pull out device, resulting in airway obstruction. what to do
Deflate balloon
if not
Cut it
135
With new tech, varices can now be
Cut or burned
136
Due to all the issues with Liver and blood not being cleaned, what another complicationscould happen
Splenomegaly
(spleen cleans)
if liver cant, then spleen works double time
137
Ammonia acts like a
SEDATIVE
on test
sleepiness
138
Treat ammonia with
LACTULOSE
converts ammonia to urea in gut
139
Asterixes
ON TEST
Liver related extremity flapping
Patient shaking due to high Ammonia
140
Ascites happens due to low
Albumin
Protein that holds liquid in vascular space
141
Prep pt for parasentisis
Void
High fowler
142
Parasentisis can result in
Hypovolemic shock
removing volume that is already third spaced from body
143
Ultimate diagnosis of liver cirrhosis
Biopsy
144
Liver biopsy procedure
pt lay flat
raise right hand
take deep breath
hold
then we puncture
145
After liver biopsy
lay on right side for pressure
146
Why does IG blood aggrivate ammonia?
Blood is a form of protein
will further INCREASE ammonia
147
TIPS shunts prevent parasentisis but this results in
More circulating ammonia
148
Fetor smell
in Cirrhosis pt rooms
Ammonia escaping the body
Fresh cut grass/nail polish remover
149
With pacemaker surgery, to prevent pt from moving affected side arm put arm in
SLING
150
Demand pacemaker
Only turns on when pace drops bellow a certain rate
151
Keep pacemakers away from
MAGNETS
152
Cushings and addisons are problems related to the
Adrenal cortex
153
Addsions disease 101
Not enough steroids
154
S/S of addisons
Fatigue
N/V/D
Weight loss
Anorexia
Confusion
Shock
155
Lytes with addisons
Hyperkalemia
Hypoglycemia
Hyponatremia
156
With addisons add
Steroids
157
Hyper or hypo tension with addisons
HYPOtension
Loss of sodium, loss of water
158
Addisons skin
White hyperpigmentation (vitiligo)
159
Focused treatment for addisons is based on
SHOCK (hypovolemia)
160
When you lose sodium and water what hormone do you think of
Not enough ALDOSTERONE
161
Should we increase Sodium and addisons
Increase
162
Task to delegate to AP with addisons
Daily I&O
Daily weight
Daily BP
163
Addisons clients will be in a fluid volume _
Deficit
164
ADDisons treatment
Glucocorticoids (prednisone, hydrocortisone)
Mineralocorticoids (aldosterone aka fludrocortisone)
165
Steroids for addisons are given in what dosage
2 half dose increments
1 morning, 1 evening
166
For addisons do med doses stay the same
NO, depends on pt
167
Can you stop steroids abruptly
NO, need to be tapered
168
#1 problem with addisons disease
Addisonian crisis - FATAL shock
169
Addisonian crisis is what kind of shock
Hypovolemia
170
Addisons low corticosteroids will lead to hypoglycemia, S/S of hypoglycemia
Emotional lability!
Hangry
Shaking
Sweating
171
If addisons patient feels like they are going into a crisis they carry a injection pen of what?
Cortisol
172
Cushings 101
too much
steroids
173
Cushings appearance
Boonfaced
Buffalo hump
Skinny arms and legs
174
Cushings S/S
Weight gain
Fluid volume overload
Hypertension
Hyperglycemia
Hypernatremia
175
Cushings aldosterone is _
And serum potassium will be _
HIGH
LOW
176
Urinalysis with Cushings will have
High level of cortisol
177
Treatment of Cushings
Adrenalectomy (removal surgery)
178
Adrenalectomy is done unilaterally or bilaterally. If bilaterally, what will happen
Addisons = lifelong replacement
179
With too many steroids will person be calm?, need…
NO
Calm environment
180
Diet pretreatment for Cushings
Sodium decrease
Glucose decrease
Calcium INCREASE
Protein INCREASE
181
Why increase calcium and protein with cushings
High metabolism and breakdown or protein and bone
182
Steroids and calcium, like prednisone, increase or decrease
Decrease in calcium
183
Steroid 3 side effects
Osteoporosis
Hyperglycemia
Bad immune system
184
What values may appear in urine with long term steroid use
Glucose
Ketones (fat byproduct)
185
What is used to diagnose Cushings
Urinalysis
186
Drug to give for afib
Cardizem drip
187
Prolonged use of steroids can shift patient into
Cushings syndrome
188
Due to fluid volume overload, cushings patients are put on
Diuretics, Fluid restriction
189
What to give for high ammonia
Lactulose ON TEST
190
Too much lactulose would be indicated by
Diarrhea
Hypokalemia
Dehydration
191
How do you know lactulose is working
2-3 soft stools per day ***
192
Test for cushings
Dexamethasone suppression test
given at night
pee cortisone in morning
