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Nurs 216B > nutrition > Flashcards

nutrition Flashcards

1
Q

nutrients

A

chemicals utilized by the body for energy

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2
Q

micronutrients

A

vitamins and minerals

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3
Q

macronutrients

A

carbs, proteins, fats

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4
Q

energy measurement

A

measured in calories
- energy required to raise 1kg of water by 1 degree celsius

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5
Q

anabolism

A

synthesis of storage

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6
Q

catabolism

A

breakdown of storage with inadequate intake

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7
Q

BMR

A

energy for body maintenance
- 10 kcal/lb

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8
Q

GI absorption

A

villi in small intestine and large intestine

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9
Q

nutrition absorption

A

occurs in duodenum, jejunum, and ileum

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10
Q

water absorption

A

occurs in the large intestine

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11
Q

malnutrition

A

less than 40 nutrients required for normal function

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12
Q

organic failure to thrive

A

‘cachexia’ due to pathology

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13
Q

cachexia

A

organ disease
- accelerated BMR, high cytokines which affect normal hunger triggers causing a low appetite

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14
Q

non organic failure to thrive

A

caused by poverty or neglect

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15
Q

marasmus failure to thrive

A

lack of calories and protein
- infants
- no body fat
- no fluid buildup
- no fatty liver
- prominent ribs
- irritable
- muscle wasting
- very hungry

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16
Q

kwashiorkor failure to thrive

A

diet deficient of protein/child stops breastfeeding
- ages 6 months - 3 years
- body fat
- fluid build up causing swelling
- enlarged fatty liver
- non prominent ribs
- lethargic
- no muscle wasting
- poor appetite

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17
Q

similarities of marasmus and kwashiorkor failure to thrive

A

low immunity, dehydration, hypothermia, altered VS, hypoalbuminemia

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18
Q

enteral nutrition

A

for patients who need increased calories or cannot eat regular food
- NG, NJ, G-tubes

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19
Q

polymeric preparation for enteral nutrition

A

proteins, lipids, and carbs- high calorie intact nutrients
- eg. Ensure

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20
Q

Oligomeric preparation for enteral nutrition

A

easily digestible components- amino acids and peptides
- hydrolyzed nutrients

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21
Q

bolus feeds

A

mimics normal meals

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22
Q

intermittent feeds

A

similar to bolus but at a slower infusion such as 30-60 min

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23
Q

continuous feeds

A

easy to digest and absorb and is ideal for recovery
- avoids dumping syndrome which can cause an osmotic shift

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24
Q

parenteral nutrition

A

goes into bloodstream

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25
Q

TPN

A

IV–> ‘central line’ (subclavian vein) is ideal
- goal is to increase nutritional intake

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26
Q

side effects of TPN

A

fluid overload causing an infection
- electrolyte imbalances causing hyperglycemia

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27
Q

starvation

A

stored fat–> fatty acids –> main energy source–> increase in serum ketones –> gluconeogenesis (no glucose)
- depletion of intracellular minerals

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28
Q

refeeding syndrome

A

occurs post-nutritional starvation
- glucose surge –> insulin secretion –> low plasma levels –> water shift into cells –> non functional metabolism –> massive hemostatic change

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29
Q

signs and symptoms of refeeding syndrome

A

Thirsty
Increased HR
Exhaustion
Blurred vision
Hypothermia
Elevated liver enzymes
Electrolyte shift out of blood and into cells
Thiamine deficiency (delirium and dizziness)

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30
Q

refeeding treatment

A

before feeding give vitamins (thiamine, B)
slow feeding with slow increase (0.0418 MJ/kg/day)
slow rehydration
monitor electrolytes

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31
Q

vitamin D deficiency aka osteoporosis

A

fragile bones due to increased bone resorption
- most common cause is menopause due to low estrogen which normally drives calcium deposition
- other causes are thyroid hormone deficiency, age, genetics, high ETOH or caffeine intake

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32
Q

osteoporosis treatment

A

vitamin D and calcium
bisphosphonates- suppress osteoclast activity to decrease the rate of bone resorption

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33
Q

bisphosphonates

A

treat osteoporosis by suppressing osteoclast activity
“nate”

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34
Q

Alendronate (Fosamax), Risedronate (Actonel)

A

bisphosphonates; treat osteoporosis

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35
Q

calcium gluconate

A

vitamin medication

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36
Q

calcitriol (calcijex)

A

vitamin medication
- activates vitamin D3

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37
Q

vitamin C function, source, and deficiency

A

acts as an antioxidant, immunologic and repairs tissue
- acquired from fruits and veggies
- deficiency is called scurvy and occurs due to a restrictive diet

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38
Q

vitamin A (retinol) function, source, and deficiency

A

visual pigmentation and epithelial cell synthesis
- acquired from carotene rich foods such as green vegetables, carrots, milk, and eggs)
- deficiency is called avitaminosis and it is due to GI illness such as celiac

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39
Q

vitamin K 1 and 2 function, source, and deficiency

A

aids in bone building and blood clotting
- K2 is acquired from GI synthesis
- K1 acquired from cheese, cooked spinach, cooked broccoli, and cooked spinach
- deficiency is called VKDB and starts in newborns

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40
Q

vitamin B12 function, source, and deficiency

A

aids in CNS function, cell metabolism, and RBC maturation
- acquired from meat, seafood, and milk
- deficiency is called cobalamin and it occurs due to vegan diets

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41
Q

vitamin B complex function, source, and deficiency

A

aids in cell synthesis, repair, and function as well as DNA synthesis
- acquired from a balanced diet
- B1 deficiency is beriberi and occurs due to ETOH abuse
- B3 deficiency is pellagra and occurs due to ETOH abuse

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42
Q

vitamin D function, source, and deficiency

A

skeletal calcium deposition
- deficiency is called osteoporosis in adults and rickets in children and occurs due to a deficit in intake of vitamin D or calcium

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43
Q

prolactin

A

female lactation hormone secreted from anterior pituitary and aids in milk synthesis

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44
Q

oxytocin

A

female lactation hormone secreted from posterior pituitary and aids in milk excretion and ejection

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45
Q

colostrum

A

found in breastmilk 1-3 days after delivery and is high in IgA, EGF, and is low in lactose

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46
Q

EGF

A

found in colostrum in breast milk and helps host flora build in the GI

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47
Q

transitional milk

A

3-14 days after delivery
- lactose, protein, and fat

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48
Q

mature milk

A

high in free water and is lower calorie and fat

49
Q

breastmilk

A

56% milk fat
- 70 cal/ 100 ml
- low in vitamin D

50
Q

iron

A

essential for hgb synthesis and mitochondrial energy production
- protein bound; when unbound it is toxic
- normal is 3.5-4 in adults and less than 3 in pediatrics
- normal loss is 1-2mg/day in adults and 0.27mg/day in pediatrics

51
Q

transferrin

A

in blood and helps w/iron metabolism

52
Q

ferritin

A

iron stored in liver and small % in plasma

53
Q

source of iron for fetus

A

liver stores in 3rd trimester of gestation and is adequate until 6 months

54
Q

source of iron for adults

A

recycling from old RBC and diet

55
Q

iron in pediatrics

A

0.27mg/day
- 0.35mg/l in breastmilk
- 4-13mg/l in formula
- 10mg/day for older children

56
Q

heme iron

A

found in meat, poultry and fish

57
Q

non-heme iron

A

found in vegetables, grains, fruits, nuts, eggs, tofu

58
Q

iron bioavailability

A

heme= 20%
non-heme= 5%
induced by proteins and vitamin C
inhibited by calcium

59
Q

standard iron fortified formula contents, benefits, and issues

A

contains cow milk proteins, long chain fatty acids, nucleotides, and iron
- benefit is adequate nutrition if breastmilk not available and vitamin D fortified
- issue is long chain fatty acids are difficult to digest and it lacks immune boosters
- eg. Enfamil A

60
Q

lactose free formula contents, benefits, and issues

A

glucose instead of lactose
- benefit is that its good for confirmed lactate deficiency
- issue is it may contain galactose/galactosemia and it contains intact proteins
- eg. Enfamil lactose free and Similac sensitive

61
Q

hypoallergenic formula contents, benefits, and issues

A

hydrolyzed proteins and free amino acids
- benefit is that its good for milk protein allergy
- issue is that its expensive
eg. Alimentum and Enfamil nutramigen

62
Q

soy formula contents, benefits, and issues

A

soy protein instead of milk protein
-benefit is galactosemia
- issue is low amino acids, fatty acids, and calcium
eg. Isomil, Enfamil soy

63
Q

drugs not to use while breastfeeding

A

high Vd drugs, and highly lipophilic drugs

64
Q

drugs best to use while breastfeeding

A

short half life drugs because it allows for clearance prior to breastmilk synthesis

65
Q

infant contraindications for breastfeeding

A

galactosemia and lactose intolerance

66
Q

galactose

A

monosaccharide that is metabolized lactose and is present in dairy
- milk, cheese, butter, yogurt, whey

67
Q

galactosemia

A

hepatic GALT enzyme is deficient causing alternate metabolism and leading to active toxic metabolites such as galactitol
- tested for if suspected

68
Q

S&S of galactosemia

A

vomiting, poor weight gain, fatigue, hypoglycemia

69
Q

complications of galactosemia

A

failure to thrive- no weight gain (later sign)
hypoglycemia- causes brain damage
cataracts, low albumin (jaundice and bleeding disorders)
e-coli sepsis (opportunistic due to high galactose)

70
Q

treatment of galactosemia

A

soy protein formula with calcium supplements

71
Q

treatment of liver damage due to galactosemia

A

phototherapy for bilirubin
vitamin K and FFP for bleeding

72
Q

lactose intolerance

A

lactase enzyme deficiency in the brush border of duodenum causing an inability to hydrolyze lactose
- high incidence especially in asian and south american ethnicities

73
Q

congenital lactose intolerance

A

inherited trait

74
Q

primary lactose intolerance

A

decreasing levels of lactase with age which is most common to occur after 2yrs of age

75
Q

secondary lactose intolerance

A

associated with other illnesses

76
Q

S&S of lactose intolerance

A

fluid shift into intestine causing watery stool
fermentation by bacteria causing gas and bloating
low appetite

77
Q

lactose intolerance treatment

A

lactose free formula is first choice and soy formula is second choice

78
Q

tests hydrogen gas concentration high post lactose ingestion

A

lactose intolerance breath test

79
Q

if serum glucose level of milk lower than 500ml then it is indicative of lactose malabsorption

A

lactose intolerance lab test

80
Q

feeding at 2 week visit wellness check

A

feeding every 2-3 hours for 20-30 min at a time
- 90 calories/kg/day
- void every 1-3 hours
- stool every 6-24 hours
- iron stores utilized

81
Q

feeding at 6 month visit wellness check

A

can start solid foods at 6 months, but no cow milk until 12 months
- 100 calories/kg/day
- void every 6-24 hours
- iron supplementation required after 6 months

82
Q

child expected growth and development by 1 year of age

A

-brain should be 2/3 of adult size
-head circumference 47cm
-myelination of nervous system nearly complete
- birth weight tripled
- single words, babbling, imitation of sounds

83
Q

cow milk

A

not recommended until 12 months and 2 cups/day post 2 years of age helps meet vitamin D requirements

84
Q

too much cow milk

A

will interfere with iron absorption due to calcium and will cause secondary anemia and can displace other foods from diet

85
Q

RBC production

A

flat bone marrow in adults (pelvis, ribs, sternum)
endothelial cells, liver, and spleen in utero
- production elements are iron, vit B12, folate

86
Q

RBC stimulus

A

cytokine hormone erythropoietin (EPO) which is produced in the kidneys

87
Q

RBC elimination

A

spleen, liver, bone marrow
- iron and amino acids are recycled
- heme which is converted to bilirubin is through biliary excretion

88
Q

RBC lifespan

A

120 days

89
Q

anemia

A

impaired oxygen carrying capacity
- causes hypoxemia leading to hypoxia
- can be low hemoglobin or low RBC’s

90
Q

anemia due to low production

A

low EPO, low RBC, low Iron

91
Q

anemia due to losses

A

haemorrhage causing loss of RBCs or hemolysis which is destruction of RBC’s

92
Q

‘iron deficiency’ anemia

A

nutritional deficiency due to inadequate supply or GI malabsorption

93
Q

iron intake target for pediatrics

A

10mg/day

94
Q

iron intake target for adults

A

20mg/day
- greater than 45 will yield GI symptoms of OD

95
Q

‘iron deficiency’ anemia

A

ferrous sulfate (supplement)

96
Q

S&S of anemia

A

fatigue, weak, pale, diaphoretic, tachycardic, increased CO, decreased immunity

97
Q

serum iron

A

transferrin which is bound to plasma protein

98
Q

serum ferritin

A

iron stores

99
Q

serum hematocrit

A

RBC volume

100
Q

cause of low serum iron and ferritin

A

iron deficiency and consequence will be low hemoglobin and low RBC’s

101
Q

high serum iron and high ferritin

A

cause is hemolytic anemia (destruction of RBC) and consequence will be hypoxemia and hypoxia

102
Q

low serum iron and normal ferritin

A

cause will be hemorrhage and consequence will be decompensation

103
Q

high serum iron and normal ferritin

A

cause will be iron poisoning and consequence will be mitochondrial damage

104
Q

Ferrous salts (PO)

A

90% bioavailable so it will reach bloodstream and should not take with calcium
- side effects include constipation and GI pain

105
Q

Iron dextran (IV)

A

calculate based on lean body weight and hemoglobin

106
Q

Monoferic (Monofer, Venofer) (IV)

A

iron by injection; “fer”
- better absorption

107
Q

vomiting and GI pain as a S&S of iron poisoning

A

due to intestinal hemorrhage which causes mucosa damage and osmotic fluid shift leading to hemorrhage and hypovolemia

108
Q

cardiac and CNS S&S of iron poisoning

A

due to no ATP production which causes altered Ca cellular transport leading to arrhythmias, cardiogenic shock, and altered LOC

109
Q

iron poisoning treatment

A

deferoxamine (desferal)

110
Q

deferoxamine (desferal)

A

treats iron poisoning
- binds iron to form non reactive complexes

111
Q

hemorrhagic anemia

A

due to severe blood loss

112
Q

acute hemorrhagic anemia

A

sudden loss due to injury, surgical bleed, childbirth
- once 10-30% of blood volume has been lost symptoms will present and there will be compensatory mechanisms, hypotension, and hypovolemic shock

113
Q

hemorrhagic anemia treatment

A

crystalloid fluids, PRBC (if hemoglobin less than 7), injection iron medications

114
Q

PRBC

A

administer if hemoglobin less than 7
- O is universal donor and can be given to everyone

115
Q

allergic transfusion reaction

A

due to antigen recognition by immune system; antigens A, B, O, Rh

116
Q

S&S of allergic transfusion reaction

A

IV vein redness/pain
flushed face due to vasodilation
VS changes (considered anaphylaxis)
- tachycardia, hypotension, dyspnea
Urticaria (hives)
N&V

117
Q

allergic transfusion reaction treatment

A

NS and diuretics to enhance renal perfusion and function, antihistamines, glucocorticoids, epinephrine

118
Q

lung function monitoring post allergic transfusion reaction

A

monitor due to hemolysis infarction and monitor VS and chest xray

119
Q

renal function monitoring post allergic transfusion reaction

A

monitor due to hemolysis filtration and monitor I/O as well as nephrologist consult

Nurs 216B (19 decks)

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