Nursing 200 Foundations > Quiz 8 > Flashcards
Quiz 8 Flashcards
P
Pulse
p
After
pc
After meals
PAC/PVC
Premature atrial contraction. Normal if we have nicotine, caffeine, stress. Tend to feel feelings of heart beat or feel something. Patient can have this feelings bc more commonly they have hypoxia, atrial flutter, atrial fibrillation
PACU
Post anesthesia care unit
PCA
Patient controlled analgesia or patient care assistance. Needs to have a continuous infusion. Around 8-10 minutes for patient to call to get the medications. It is patient who needs it and what patient wants. If patient is not allowed for PCA, need to talk. If patient continues to push for pain meds, review and might give more.
PE
Pulmonary embolus or pulmonary edema
PERRLA
Pupils equal, round and reactive to light and accommodation
PEG
Percutaneous endoscopic gastrostomy
pH
Used to express acidity and alkalinity
PICC
Peripherally inserted central catheter
PID
Pelvic inflammatory disease
PIV
Peripheral intravenous
PLT
Platelet
PMH
Past medical history
PMI
Point of maximal impulse
PND
Paroxysmal nocturnal dyspnea
PO
By mouth (per os)
POC
Point of care
POD
Post-op day
Post.
Posterior
ppd
Packs per day
PPD
Purified protein derivative (TB skin test) or percussion and postural drainage
PPN (lower concentration)/ TPN (PEG line, more concentration)- high amount of amino acids, high amount of dextrose, electrolytes, vitamins, insulin (TPN is a mixture of separate components which contain lipid emulsions, dextrose, amino acids, vitamins, electrolytes, minerals, and trace elements. [8][9] Clinicians should adjust TPN composition to fulfill individual patients’ needs.)
Peripheral parenteral nutrition
Hyper emesis= 2nd and 3rd trimester, nausea, vomit: use PPN
PPV
Pneumococcal polysaccharide vaccine
PR
Per rectum
prn
When necessary
PROM
Passive range of motion
PSA
Prostate-specific agent
pos/+
positive
PT
Prothrombin time or physical therapy
PTA
Prior to admission
Pt
Patient
PTT= heparin
Partial thromboplastin time. Only do heparin IV for patient has pulmonary emboli and blood clot. Do subcut heparin when to prevent blood clots. Disease: liver disease, cirrhosis
PUD
Peptic ulcer disease
PVR
Peripheral vascular resistance
PWB
Partial weight bearing
Activity tolerance
Person’s ability to perform an activity or occupational without a disproportionate amount of physical, emotional, or psychological fatigue
Atrophy
Decrease in size of a body part, cell, organ or other tissue. Ex: muscle atrophy due to immobilize. Atrophy can happen because starvation, aging and certain disease
Contracture
A permanent tightening of the muscles, tendons, skin, and nearby tissues that causes the joints to shorten and become very stiff. This prevents normal movement of a joint or other body part. Contractures may be caused by injury, scarring, and nerve damage, or by not using the muscles. It may also occur at some point in time after a stem cell transplant that caused chronic graft-versus-host disease.
Crepitation
Crepitus, sometimes called crepitation (krep-i-tay-shen), describes any grinding, creaking, cracking, grating, crunching, or popping that occurs when moving a joint. People can experience crepitus at any age, but it becomes more common as people get older.
The sound associated with crepitus may be muffled or it may be loud enough for other people to hear.
The term crepitus is sometimes also used to describe other conditions, such as lungs crackling from respiratory illnesses and bones grating after fractures.
Embolus
An embolus is anything that moves through the blood vessels until it reaches a vessel that is too small to let it pass. An embolus is anything that moves through the blood vessels until it reaches a vessel that is too small to let it pass. When this happens, the blood flow is stopped by the embolus. An embolus is often a small piece of a blood clot that breaks off (thromboembolus). It may also be fat, air, amniotic fluid, a tumour, or a foreign substance such as talc, iodine, cotton, or a tiny piece of catheter tube.
Flaccid
soft and hanging loosely or limply, especially so as to look or feel unpleasant.
Flaccid paralysis
Ex: Have confusion, agitation, hallucinations, or seizures
Are injured
Develop a fever or other illness
Experience progressive weakness in any part of body
Fowler’s position
In the standard Fowler position, the head of the bed is elevated between 45-60 degrees, and this position is commonly used for head, shoulder, and chest surgeries as well as for respiratory distress syndrome because it facilitates breathing
Gait
person’s manner of walking.
High Fowler’s position
In High Fowler’s position, the patient is usually seated upright with their spine straight. The upper body is between 60 degrees and 90 degrees. The legs of the patient may be straight or bent. This Position is commonly used when the patient is defecating, eating, swallowing, taking X-Rays, or to help with breathing
Lateral position
The lateral position is described as side‐lying with pillows strategically placed along the patient’s back, and possibly buttocks, and a pillow placed between the patient’s flexed legs to prevent adduction and internal rotation of the hip.
Nurses change the body position of critically ill patients as frequently as every two hours to prevent bed sores and other complications associated with immobility. Turning from side to side may also help loosen and drain secretions accumulated within the lungs. Routine lateral repositioning is a relatively safe standard practice. However, if a patient’s blood pressure or oxygen level drops to a dangerously low reading during the position change, urgent medical attention is required. Most events resolve quickly, but for some patients these events may be slow to resolve and are potentially life‐threatening. We wanted to discover whether routine lateral repositioning is better than other positioning strategies including less frequent turns, and whether a lateral position may cause more adverse events.
Log rolling
Logrolling is a common patient care procedure performed by many health care workers. The purpose of logrolling is to maintain alignment of the spine while turning and moving the patient who has had spinal surgery or suspected or documented spinal injury.
The log roll technique can also be used in other settings to help move an unconscious patient to assess or clean their backside.
Logrolling turn is used when changing linens for an occupied bed.
▪It can be done either with or without a lift sheet.
▪If a lift sheet is used, two or three people are needed to accomplish the move, depending on the patient size.
Lordosis
A curving inward of the lower back.
Some lordosis is normal. Too much is referred to as swayback. It may be inherited or caused by conditions such as arthritis, muscular dystrophy, and dwarfism.
Lordosis causes an unusually large, inward arch on the lower back, just above the buttocks. The condition may cause lower back pain.
In children, lordosis often fixes itself. Some adults with lordosis may need physical therapy.
Osteoporosis
a bone disease that develops when bone mineral density and bone mass decreases, or when the structure and strength of bone changes. This can lead to a decrease in bone strength that can increase the risk of fractures (broken bones).
A condition in which bones become weak and brittle.
Osteoporosis causes bones to become weak and brittle. The body constantly absorbs and replaces bone tissue. With osteoporosis, new bone creation doesn’t keep up with old bone removal.
There typically are no symptoms in the early stages of bone loss. Once bones are weakened by osteoporosis, symptoms may include back pain, stooped posture, loss of height over time and bones that break easily.
Medications, healthy diet, and weight-bearing exercise can help prevent bone loss or strengthen already weak bones.
Ex: Bisphosphonates slow bone resorption by reducing osteoclast function.
Paresis
Paresis is characterized by muscle weakness. A person with paresis can still move the affected muscle or muscles. However, these movements are weaker than normal.
Paresis is different from paralysis. An individual who has paralysis isn’t able to move a specific muscle or muscle group at all.
You may also see paresis used as a suffix to distinguish what part of the body is affected. For example, a person with monoparesis has muscle weakness affecting one limb.
The corresponding suffix for paralysis is “-plegia.” Using the same example, a person with monoplegia has paralysis that affects one limb.
Several examples of causes include:
head injury
spinal cord injury
pressure on the spinal cord or nerves due to things like inflammation, bone spurs, or a tumor
stroke
seizures
multiple sclerosis (MS)
cerebral palsy
diabetes
Prone position
Prone position is the medical term for lying flat on your stomach. The prone position produces an increase in functional residual capacity and alterations in the distribution of both ventilation and perfusion throughout the lungs. The prone position is often used for spine and neck surgeries, neurosurgery, colorectal surgeries, vascular surgeries, and tendon repairs.
Renal calculi
Kidney stones (also called renal calculi, nephrolithiasis or urolithiasis) are hard deposits made of minerals and salts that form inside your kidneys.
Diet, excess body weight, some medical conditions, and certain supplements and medications are among the many causes of kidney stones. Kidney stones can affect any part of your urinary tract — from your kidneys to your bladder. Often, stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together.
Passing kidney stones can be quite painful, but the stones usually cause no permanent damage if they’re recognized in a timely fashion. Depending on your situation, you may need nothing more than to take pain medication and drink lots of water to pass a kidney stone. In other instances — for example, if stones become lodged in the urinary tract, are associated with a urinary infection or cause complications — surgery may be needed.
A kidney stone usually will not cause symptoms until it moves around within the kidney or passes into one of the ureters. The ureters are the tubes that connect the kidneys and bladder.
If a kidney stone becomes lodged in the ureters, it may block the flow of urine and cause the kidney to swell and the ureter to spasm, which can be very painful. At that point, you may experience these symptoms:
Severe, sharp pain in the side and back, below the ribs
Pain that radiates to the lower abdomen and groin
Pain that comes in waves and fluctuates in intensity
Pain or burning sensation while urinating
Risk factors
Factors that increase your risk of developing kidney stones include:
Family or personal history. If someone in your family has had kidney stones, you’re more likely to develop stones, too. If you’ve already had one or more kidney stones, you’re at increased risk of developing another.
Dehydration. Not drinking enough water each day can increase your risk of kidney stones. People who live in warm, dry climates and those who sweat a lot may be at higher risk than others.
Certain diets. Eating a diet that’s high in protein, sodium (salt) and sugar may increase your risk of some types of kidney stones. This is especially true with a high-sodium diet. Too much salt in your diet increases the amount of calcium your kidneys must filter and significantly increases your risk of kidney stones.
Obesity. High body mass index (BMI), large waist size and weight gain have been linked to an increased risk of kidney stones.
Digestive diseases and surgery. Gastric bypass surgery, inflammatory bowel disease or chronic diarrhea can cause changes in the digestive process that affect your absorption of calcium and water, increasing the amounts of stone-forming substances in your urine.
Other medical conditions such as renal tubular acidosis, cystinuria, hyperparathyroidism and repeated urinary tract infections also can increase your risk of kidney stones.
Certain supplements and medications, such as vitamin C, dietary supplements, laxatives (when used excessively), calcium-based antacids, and certain medications used to treat migraines or depression, can increase your risk of kidney stones.
Types of kidney stones include:
Calcium stones. Most kidney stones are calcium stones, usually in the form of calcium oxalate. Oxalate is a substance made daily by your liver or absorbed from your diet. Certain fruits and vegetables, as well as nuts and chocolate, have high oxalate content.
Dietary factors, high doses of vitamin D, intestinal bypass surgery and several metabolic disorders can increase the concentration of calcium or oxalate in urine.
Calcium stones may also occur in the form of calcium phosphate. This type of stone is more common in metabolic conditions, such as renal tubular acidosis. It may also be associated with certain medications used to treat migraines or seizures, such as topiramate (Topamax, Trokendi XR, Qudexy XR).
Struvite stones. Struvite stones form in response to a urinary tract infection. These stones can grow quickly and become quite large, sometimes with few symptoms or little warning.
Uric acid stones. Uric acid stones can form in people who lose too much fluid because of chronic diarrhea or malabsorption, those who eat a high-protein diet, and those with diabetes or metabolic syndrome. Certain genetic factors also may increase your risk of uric acid stones.
Cystine stones. These stones form in people with a hereditary disorder called cystinuria that causes the kidneys to excrete too much of a specific amino acid.
Range of motion- active and passive
Active exercise is any exercise in which a person must exert force to complete a move (independent move). The opposite of active exercise is a passive exercise, in which another person moves the client’s extremities to keep muscles from atrophying or better the client’s range of motion.
It is used to measure how much you can move a joint on your own (active ROM) or with the assistance of someone else (passive ROM).
Semi-Fowler’s position
Semi-Fowler, or low Fowler, position is a supine position in which an individual lies on their back on a bed, with the head of the bed elevated between 30-45 degrees, and the legs of the patient can be either straight or bent at the knees. A pillow can also be placed under the calves for support and comfort. This position is commonly used when a patient has difficulty breathing, has a feeding tube, is experiencing gastroesophageal reflux disease (GERD), or is going through childbirth.
Spastic
is abnormal muscle tightness due to prolonged muscle contraction. It is a symptom associated with damage to the brain, spinal cord or motor nerves, and is seen in individuals with neurological conditions, such as: Cerebral palsy (CP) Multiple sclerosis (MS)
Supine position
The supine position, also known as the dorsal decubitus position, refers to one of the ways an individual can lie on a table during a surgical procedure or a physical exam. In the supine position, the individual is lying on their back, with their face and abdomen facing upwards. During a procedure, the back of their head typically rests on a pad or pillow, and their neck is in a neutral position, as if in a sleeping position. The individual’s arms are usually positioned with the palms facing up and abducted out to less than 90 degrees from the side of their body or tucked next to the body. If the arms are abducted, arm boards are used to secure and support the arms.
Use: surgery, abdomen assessment
Tripod position
Physical stance often assumed by people experiencing respiratory distress or who are simply out of breath. In this position, a person sits or stands leaning forward and supports the upper body with hands on knees or other surface.
The tripod position helps the diaphragm move downward to increase the volume in the chest cavity, known as the thoracic cavity. This increased volume might force the lungs to expand.
The Tripod Sitting Position refers to the state whereby a patient assumes a forward-leaning posture while seated. Typically found in individuals with respiratory distress, it is a use of gravity to facilitate the usage of accessory muscles and expansion of the chest cavity.
Thrombus
A blood clot that forms inside one of your veins or arteries is called a thrombus. A thrombus may also form in your heart.
Situations in which a blood clot is more likely to form in veins include:
Being on long-term bed rest
Sitting for long periods, such as in a plane or car
During and after pregnancy
Taking birth control pills or estrogen hormones (especially in women who smoke)
Long-term use of an intravenous catheter
After surgery
Blood clots are also more likely to form after an injury. People with cancer, obesity, and liver or kidney disease are also prone to blood clots.
Smoking also increases the risk of forming blood clots.
Conditions that are passed down through families (inherited) may make you more likely to form abnormal blood clots. Inherited conditions that affect clotting are:
Factor V Leiden mutation
Prothrombin G20210A mutation
Other rare conditions, such as protein C, protein S, and antithrombin III deficiencies.
A blood clot may block an artery or vein in an organ, affecting the:
Heart (angina or a heart attack)
Intestines (mesenteric ischemia or mesenteric venous thrombosis)
Kidneys (renal vein thrombosis)
Leg or arm arteries
Legs (deep vein thrombosis)
Lungs (pulmonary embolism)
Neck or brain (stroke)
Urinary retention
Urinary retention is when your bladder doesn’t empty completely or at all. Feel severe discomfort or pain in your lower belly and urinary tract. Can do KUB, bladder scan
The most common cause of urinary retention is benign prostatic hyperplasia. Other common causes include prostatitis, cystitis, urethritis, and vulvovaginitis; receiving medications in the anticholinergic and alpha-adrenergic agonist classes; and cortical, spinal, or peripheral nerve lesions.
Valsalva maneuver
The Valsalva maneuver is a quick, noninvasive method for a fast heart rhythm called supraventricular tachycardia (SVT). It’s sometimes the first choice of treatment before trying medicine or another procedure to get your heart rhythm back to normal. To do the Valsalva maneuver, you push air out, but with your nose and mouth closed (like having a bowel movement).
You should do the Valsalva maneuver after your provider gives you instructions. They’ll also know if you have the type of abnormal heart rhythm that responds to this maneuver.
The Valsalva maneuver can:
Slow down your heart rate and stop supraventricular tachycardia (SVT), an abnormal heart rhythm.
Help your provider decide which kind of heart murmur you have.
Tell your provider if you have heart failure.
Help diagnose other problems, such as venous (vein) disease or a varicocele (a swollen vein in your scrotum).
Help diagnose an issue with your autonomic nervous system (which controls your heartbeat, breathing and other functions without you thinking about it).
Get something out of your middle ear that shouldn’t be there.
Because the Valsalva maneuver increases pressure in your eyes and belly, you shouldn’t do this maneuver if you have retinopathy (a problem with blood vessels in the retina of your eye) and intraocular lens implants in your eyes, such as after cataract surgery.
You need to be careful with the Valsalva maneuver if you have:
Heart valve disease.
Coronary artery disease.
Congenital (since birth) heart disease.
Circadian rhythm
are the physical, mental, and behavioral changes an organism experiences over a 24-hour cycle. Light and dark have the biggest influence on circadian rhythms, but food intake, stress, physical activity, social environment, and temperature also affect them.
Circadian rhythm is the 24-hour internal clock in our brain that regulates cycles of alertness and sleepiness by responding to light changes in our environment. Our physiology and behavior are shaped by the Earth’s rotation around its axis. This biological circadian system has evolved to help humans adapt to changes in our environment and anticipate changes in radiation, temperature, and food availability. Without this endogenous circadian clock, Homo sapiens would not be able to optimize energy expenditure and the internal physiology of the body.
Hypersomnia
Hypersomnia is excessive sleepiness. There are many causes of excessive sleepiness, including insufficient or inadequate sleep, sleep disorders, medications and medical or psychiatric illnesses. The characteristics of hypersomnia vary from one person to the next depending on age, lifestyle and underlying causes.
Treatments include medications, non-drug options and education and support groups.
Hypersomnia is a condition in which you feel extreme daytime sleepiness despite getting sleep that should be adequate (or more than adequate)
The cause of most cases of hypersomnia remains unknown. Researchers have looked at the potential roles of neurotransmitters in the brain and cerebrospinal fluid including hypocretin/orexin, dopamine, histamine, serotonin and gamma-aminobutyric acid (GABA). A genetic link may be possible since a family history is present in up to 39% of people with idiopathic hypersomnia. Researchers are also exploring the role of certain genes in circadian rhythm that may be different in people with idiopathic hypersomnia.
Other tests your sleep specialist may order include:
Polysomnography. This overnight sleep study test measures your brain waves, breathing pattern, heart rhythms and muscle movements during stages of sleep. The test is performed in a hospital, sleep study center or other designated site and under the direct supervision of a trained sleep specialist. This test helps diagnose disorders believed to cause sleepiness.
Multiple sleep latency test. This daytime sleep test measures a person’s tendency to fall asleep during five, 20-minute nap trials scheduled two hours apart. The test records brain activity, including the number of naps containing REM sleep.
Sleep questionnaires. You may be asked to complete one or more sleep questionnaires that ask you to rate your sleepiness. Popular sleep questionnaires are the Epworth Sleepiness Scale and the Stanford Sleepiness Scale.
Insomnia
Insomnia is a common sleep disorder. With insomnia, you may have trouble falling asleep, staying asleep, or getting good quality sleep. This happens even if you have the time and the right environment to sleep well. Insomnia can get in the way of your daily activities and may make you feel sleepy during the day.
Short-term insomnia may be caused by stress or changes in your schedule or environment. It can last for a few days or weeks. Chronic (long-term) insomnia occurs 3 or more nights a week, lasts more than 3 months, and cannot be fully explained by another health problem.
To diagnose insomnia, your healthcare provider may ask about your sleep habits and ask you to keep a sleep diary. Your provider may also recommend healthy lifestyle habits such as a regular sleep schedule, cognitive behavioral therapy for insomnia, and medicines to help you manage your insomnia.
Insomnia can affect your memory and concentration. Chronic insomnia raises your risk of high blood pressure, coronary heart disease, diabetes, and cancer.
Narcolepsy
Narcolepsy is a chronic neurological disorder that affects the brain’s ability to control sleep-wake cycles. People with narcolepsy may feel rested after waking, but then feel very sleepy throughout much of the day. Many individuals with narcolepsy also experience uneven and interrupted sleep that can involve waking up frequently during the night.
Narcolepsy can greatly affect daily activities. People may unwillingly fall asleep even if they are in the middle of an activity like driving, eating, or talking. Other symptoms may include sudden muscle weakness while awake that makes a person go limp or unable to move (cataplexy), vivid dream-like images or hallucinations, and total paralysis just before falling asleep or just after waking up (sleep paralysis).
In a normal sleep cycle, a person enters rapid eye movement (REM) sleep after about 60 to 90 minutes. Dreams occur during REM sleep, and the brain keeps muscles limp during this sleep stage, which prevents people from acting out their dreams. People with narcolepsy frequently enter REM sleep rapidly, within 15 minutes of falling asleep. Also, the muscle weakness or dream activity of REM sleep can occur during wakefulness or be absent during sleep. This helps explain some symptoms of narcolepsy.
If left undiagnosed or untreated, narcolepsy can interfere with psychological, social, and cognitive function and development and can inhibit academic, work, and social activities.
NREM
Sleep architecture refers to the basic structural organization of normal sleep. There are two types of sleep, non-rapid eye-movement (NREM) sleep and rapid eye-movement (REM) sleep. NREM sleep is divided into stages 1, 2, 3, and 4, representing a continuum of relative depth. Each has unique characteristics including variations in brain wave patterns, eye movements, and muscle tone. Sleep cycles and stages were uncovered with the use of electroencephalographic (EEG) recordings that trace the electrical patterns of brain activity
REM
Throughout your time asleep, your brain will cycle repeatedly through two different types of sleep: REM (rapid-eye movement) sleep and non-REM sleep.
The first part of the cycle is non-REM sleep, which is composed of four stages. The first stage comes between being awake and falling asleep. The second is light sleep, when heart rate and breathing regulate and body temperature drops. The third and fourth stages are deep sleep. Though REM sleep was previously believed to be the most important sleep phase for learning and memory, newer data suggests that non-REM sleep is more important for these tasks, as well as being the more restful and restorative phase of sleep.
As you cycle into REM sleep, the eyes move rapidly behind closed lids, and brain waves are similar to those during wakefulness. Breath rate increases and the body becomes temporarily paralyzed as we dream.
The cycle then repeats itself, but with each cycle you spend less time in the deeper stages three and four of sleep and more time in REM sleep. On a typical night, you’ll cycle through four or five times.
Parasomnia
Parasomnias occur in a state that lies between sleep and wakefulness.
A person with parasomnias may seem to be alert, walking or talking or eating or doing other such activities but without awareness because the brain is only partially awake. Or a person with a different type of parasomnias may experience sleep terrors or sleep paralysis. These are also a result of the brain being slightly more conscious than usual during sleep.
Although more common in children, parasomnias can occur at any age. Parasomnias are not in and of themselves worrisome; the main danger is when a person with the condition unknowingly causes injury to themselves or to others.
“Parasomnias can sometimes be more frightening for the observer than for the person having it,” says Lynelle Schneeberg, PsyD, a Yale Medicine sleep specialist at the Sleep Medicine program. “For example, a child having a sleep terror looks very frightened and this can be very difficult for a parent, but the child will have no memory of this event if awakened or in the morning.”
Sleep apnea
Sleep apnea is a breathing disorder that causes repeated lapses in breathing during sleep. Symptoms of sleep apnea can include snoring, headaches, and excessive sleepiness. Obstructive sleep apnea occurs when throat muscles reduce space for air to pass through.
There are two types of sleep apnea.
Obstructive sleep apnea happens when your upper airway becomes blocked many times while you sleep, reducing or completely stopping airflow. This is the most common type of sleep apnea. Anything that could narrow your airway such as obesity, large tonsils, or changes in your hormone levels can increase your risk for obstructive sleep apnea.
Central sleep apnea happens when your brain does not send the signals needed to breathe. Health conditions that affect how your brain controls your airway and chest muscles can cause central sleep apnea.
Possible treatments include:
Conservative (nonmedical) treatments.
Positive airway pressure and adaptive ventilation devices.
Oral appliances (mouthpieces).
Nerve stimulators.
Surgery.
Medications (central sleep apnea only).
Sundown syndrome
“Sundowning” in demented individuals, as distinct clinical phenomena, is still open to debate in terms of clear definition, etiology, operationalized parameters, validity of clinical construct, and interventions. In general, sundown syndrome is characterized by the emergence or increment of neuropsychiatric symptoms such as agitation, confusion, anxiety, and aggressiveness in late afternoon, in the evening, or at night. Sundowning is highly prevalent among individuals with dementia. It is thought to be associated with impaired circadian rhythmicity, environmental and social factors, and impaired cognition. Neurophysiologically, it appears to be mediated by degeneration of the suprachiasmatic nucleus of the hypothalamus and decreased production of melatonin. A variety of treatment options have been found to be helpful to ameliorate the neuropsychiatric symptoms associated with this phenomenon: bright light therapy, melatonin, acetylcholinesterase inhibitors, N-methyl-d-aspartate receptor antagonists, antipsychotics, and behavioral modifications. To decrease the morbidity from this specific condition, improve patient’s well being, lessen caregiver burden, and delay institutionalization, further attention needs to be given to development of clinically operational definition of sundown syndrome and investigations on etiology, risk factors, and effective treatment options.
Anemia
is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Different types of anemia include: Anemia due to vitamin B12 deficiency. Anemia due to folate (folic acid) deficiency.
Ex: kidney problems: not making enough EPO to trigger bone marrow to produce and release RBCs
Anorexia nervosa
an eating disorder that causes a severe and strong fear of gaining weight. You may have an altered view of being fat even when you are dangerously thin. You may use extreme exercise, calorie and food limitations, or binging and purging to control your weight.
Symptoms include trying to maintain a below-normal weight through starvation or too much exercise.
Medical treatment may be needed to restore normal weight. Talk therapy can help with self-esteem and behavior changes
Body mass index
Body mass index (BMI) is a measure of body fat based on height and weight that applies to adult men and women.
Standard Measurements View Metric Measurements
Your Height:
(feet) (inches)
Your Weight:
(pounds)
Your BMI:
BMI Categories:
Underweight = <18.5
Normal weight = 18.5–24.9
Overweight = 25–29.9
Obesity = BMI of 30 or greater
Bulimia
A serious eating disorder marked by binging, followed by methods to avoid weight gain.
Bulimia is a potentially life-threatening eating disorder.
People with this condition binge eat. They then take steps to avoid weight gain. Most commonly, this means vomiting (purging). But it can also mean excessive exercising or fasting.
Treatments include counseling, medications, and nutrition education.
an eating disorder characterized by regular, often secretive bouts of overeating followed by self-induced vomiting or purging, strict dieting, or extreme exercise, associated with persistent and excessive concern with body weight.
an eating disorder in which a large quantity of food is consumed in a short period of time, often followed by feelings of guilt or shame
Cholesterol
Cholesterol is a waxy substance found in your blood. Your body needs cholesterol to build healthy cells, but high levels of cholesterol can increase your risk of heart disease.
With high cholesterol, you can develop fatty deposits in your blood vessels. Eventually, these deposits grow, making it difficult for enough blood to flow through your arteries. Sometimes, those deposits can break suddenly and form a clot that causes a heart attack or stroke.
High cholesterol can be inherited, but it’s often the result of unhealthy lifestyle choices, which make it preventable and treatable. A healthy diet, regular exercise and sometimes medication can help reduce high cholesterol.
High cholesterol has no symptoms. A blood test is the only way to detect if you have it.
Cholesterol is carried through your blood, attached to proteins. This combination of proteins and cholesterol is called a lipoprotein. There are different types of cholesterol, based on what the lipoprotein carries. They are:
Low-density lipoprotein (LDL). LDL, the “bad” cholesterol, transports cholesterol particles throughout your body. LDL cholesterol builds up in the walls of your arteries, making them hard and narrow.
High-density lipoprotein (HDL). HDL, the “good” cholesterol, picks up excess cholesterol and takes it back to your liver.
A lipid profile also typically measures triglycerides, a type of fat in the blood. Having a high triglyceride level also can increase your risk of heart disease.
Complete protein
A protein is formed out of 20 different types of amino acids (organic compounds) all connected to each other. Our body makes 11 types of amino acids on its own. But we need to get the remaining nine types of amino acids, called “essential amino acids” through other sources, such as the food we eat. The nine essential amino acids are histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine.
Complete proteins. If the protein you eat has all the 9 types of amino acids you need to get from food, it is called a “complete protein.” Great sources of complete proteins are:
Fish
Poultry (chicken, duck, or turkey)
Eggs
Dairy products (milk, yogurt, or cheese, for example)
Beef or pork
Soy products, such as tofu and edamame
Also, remember to space out your proteins throughout the day. Our bodies can only take in 25 to 40 grams of protein at one time.
Dysphagia
Dysphagia is the medical term for difficulty swallowing. When you swallow, many muscles and nerves work together to move food or drink from your mouth to your stomach. When there’s an issue with how these parts work, swallowing may feel uncomfortable or slow. You may cough or choke when you try to swallow water, food or even your own saliva (spit).
Most people know what dysphagia feels like. If you’ve ever eaten too fast and felt like food went down the wrong pipe, or if you’ve cleared your throat because something felt stuck — you’re already familiar with dysphagia. The feeling’s unpleasant, and it’s usually not anything to worry about.
But dysphagia can be a sign of something serious. It’s a common symptom following a stroke. Untreated dysphagia can pose risks like food or liquid getting into your airway (aspiration). This can lead to a lung infection or pneumonia.
A specialist in swallowing disorders called a speech-language pathologist (SLP) can assess your ability to swallow and provide treatment if there’s a risk.
Enteral nutrition
Enteral nutrition, also known as tube feeding, is a way of sending nutrition right to the stomach or small intestine. Your healthcare professional might suggest tube feeding if you can’t eat or drink enough to get the nutrients you need.
Tube feeding outside a hospital is called home enteral nutrition (HEN). A HEN care team can teach you how to feed yourself through a tube. The team can give you support when you have problems.
HEN might be for you if you have trouble eating, but your digestive system works as usual. Reasons you might have trouble eating include:
Cancer, such as head and neck cancers, or cancer treatment that makes it hard or painful to swallow.
Problems of the brain or spinal cord, also called neurological. Examples include stroke and amyotrophic lateral sclerosis (ALS).
Problems of the stomach and intestines. Examples are delayed gastric emptying, also called gastroparesis, or something blocking your bowel, called an obstruction.
Trauma, such as an injury to your digestive tract.
Fat soluble vitamins
A vitamin that can dissolve in fats and oils. Vitamins are nutrients that the body needs in small amounts to stay healthy and work the way it should. Fat-soluble vitamins are absorbed along with fats in the diet and are stored in the body’s fatty tissue and in the liver. They are found in many plant and animal foods and in dietary supplements. Vitamins A, D, E, and K are fat-soluble.
-Vitamin A: Many breakfast cereals, juices, dairy products, and other foods are fortified with retinol (preformed vitamin A). Many fruits and vegetables and some supplements contain beta-carotene, lycopene, lutein, or zeaxanthin.
Leafy green vegetables (kale, spinach, broccoli), orange and yellow vegetables (carrots, sweet potatoes, pumpkin and other winter squash, summer squash)
Tomatoes
Red bell pepper
Cantaloupe, mango
Beef liver
Fish oils
Milk
Eggs
Fortified foods
-Vitamin D:
oily fish, including salmon, mackerel, and sardines. Other sources include egg yolks, red meat, and liver. Vitamin D is added to some foods too, including breakfast cereals, plant milks and fat spreads.
Vitamin E: Green leafy vegetables including collard and turnip greens, kale, spinach, broccoli, Brussels sprouts, cabbage, lettuces
Soybean and canola oil
Salad dressings made with soybean or canola oil
Fortified meal replacement shakes
Menaquinones
Natto (fermented soybeans)
Smaller amounts in meat, cheese, eggs
-Vitamin K:
Phylloquinone
Green leafy vegetables including collard and turnip greens, kale, spinach, broccoli, Brussels sprouts, cabbage, lettuces
Soybean and canola oil
Salad dressings made with soybean or canola oil
Fortified meal replacement shakes
Menaquinones
Natto (fermented soybeans)
Smaller amounts in meat, cheese, eggs
Fiber
Fiber is a type of carbohydrate that the body can’t digest. Though most carbohydrates are broken down into sugar molecules called glucose, fiber cannot be broken down into sugar molecules, and instead it passes through the body undigested. Fiber helps regulate the body’s use of sugars, helping to keep hunger and blood sugar in check.
Children and adults need at least 25 to 35 grams of fiber per day for good health, but most Americans get only about 15 grams a day. Great sources are whole grains, whole fruits and vegetables, legumes, and nuts.
Soluble fiber, which dissolves in water, can help lower glucose levels as well as help lower blood cholesterol. Foods with soluble fiber include oatmeal, chia seeds, nuts, beans, lentils, apples, and blueberries.
Insoluble fiber, which does not dissolve in water, can help food move through your digestive system, promoting regularity and helping prevent constipation. Foods with insoluble fibers include whole wheat products (especially wheat bran), quinoa, brown rice, legumes, leafy greens like kale, almonds, walnuts, seeds, and fruits with edible skins like pears and apples.
Gastrostomy tube
A tube inserted through the wall of the abdomen directly into the stomach. It allows air and fluid to leave the stomach and can be used to give drugs and liquids, including liquid food, to the patient. Giving food through a gastrostomy tube is a type of enteral nutrition. Also called PEG tube and percutaneous endoscopic tube.
Ideal body weight
Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet. Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet. The IBW and ABW are used to calculate medication dosages when the patient is obese. This formula only applies to persons 60 inches (152 cm) or taller.
Jejunostomy tube
A jejunostomy tube (J-tube) is a soft, plastic tube placed through the skin of the abdomen into the midsection of the small intestine. The tube delivers food and medicine until the person is healthy enough to eat by mouth.
Minerals
Mineral-rich foods include nuts, seeds, shellfish, cruciferous vegetables, eggs, beans, and cocoa.
Minerals are elements that are found in the earth and food and essential to life. For example, minerals are needed for heart and brain function, as well as the production of hormones and enzymes (1).
Minerals are divided into two categories based on how much the human body needs. Macrominerals are needed in larger amounts and include calcium, potassium, sodium, chloride, phosphorus, and magnesium (2Trusted Source).
Although equally important, trace minerals, including iron, copper, fluoride, selenium, zinc, chromium, molybdenum, iodine, and manganese, are needed in smaller amounts (2Trusted Source).
Minerals can be found in a variety of foods, but some foods are especially abundant in these important nutrients.
Nasogastric tube
nasogastric tube (NG tube) is a special tube that carries food and medicine to the stomach through the nose. It can be used for all feedings or for giving a person extra calories. Nasogastric tubes are used both to deliver substances to your stomach and to draw substances out. They’re often used for short-term tube feeding and to deliver oral medications to hospitalized people. They can also suction out stomach contents to relieve pressure or remove poisons.
The two primary purposes of the nasogastric tube are short-term tube feeding (and medication administration) and gastric suctioning (stomach pumping).
Obese
A disorder that involves having too much body fat, which increases the risk of health problems.
Obesity is a disorder that involves having too much body fat, usually a body mass index — also known as BMI — of 30 or greater. It increases the risk of serious health problems. Obesity often results from taking in more calories than are burned by exercise and typical daily activities.
Body mass index, also known as BMI, is often used to diagnose obesity. Many health care professionals also measure around a person’s waist to help guide treatment decisions. This measurement is called a waist circumference.
Treatments include lifestyle changes, medicines and weight-loss surgery.
Use of BMI to determine, greater than 30
Overweight
Overweight is defined as a body mass index (BMI) of 25 or higher. Obesity is defined as a BMI of 30 or higher.
Parenteral nutrition
Parenteral nutrition, often called total parenteral nutrition, is the medical term for infusing a specialized form of food through a vein (intravenously). The goal of the treatment is to correct or prevent malnutrition.
Parenteral nutrition provides liquid nutrients, including carbohydrates, proteins, fats, vitamins, minerals and electrolytes. Some people use parenteral nutrition to supplement feeding through a tube placed into the stomach or small bowel (enteral nutrition), and others use it by itself.
People whose digestive systems either can’t absorb or can’t tolerate adequate food eaten by mouth use parenteral nutrition. When used outside the hospital, intravenous feeding is called home parenteral nutrition. Using home parenteral nutrition may be necessary for weeks or months, or in some cases for life.
You may need parenteral nutrition for one of the following reasons:
Cancer. Cancer of the digestive tract may cause an obstruction of the bowels, preventing adequate food intake. Cancer treatment, such as chemotherapy, may cause your body to poorly absorb nutrients.
Crohn’s disease. Crohn’s disease is an inflammatory disease of the bowel that may cause pain, bowel narrowing and other symptoms that affect food intake and its digestion and absorption.
Short bowel syndrome. In this condition, which can be present at birth or occur as the result of surgery that has removed a significant amount of small intestine, you don’t have enough bowel to absorb enough of the nutrients you eat.
Ischemic bowel disease. This may cause difficulties resulting from reduced blood flow to the bowel.
Abnormal bowel function. This causes food you eat to have trouble moving through your intestines, resulting in a variety of symptoms that prevent enough food intake. Abnormal bowel function can occur due to surgical adhesions or abnormalities in bowel motility. These may be caused by radiation enteritis, neurological disorders and many other conditions.
Catheter infection is a common and serious complication of parenteral nutrition. Other potential short-term complications of parenteral nutrition include blood clots, fluid and mineral imbalances, and problems with blood sugar metabolism.
Long-term complications may include too much or too little of trace elements, such as iron or zinc, and the development of liver disease. Careful monitoring of your parenteral nutrition formula can help prevent or treat these complications.
Refeeding syndrome
Refeeding syndrome can happen when somebody who is malnourished begins feeding again. Malnourished means your body is deprived of nutrients. When your body tries to metabolize nutrients again, severe shifts — related to electrolyte deficiencies — can occur in your body’s chemistry. They can cause dangerous complications, affecting your muscles, lungs, heart and brain.
Refeeding syndrome can affect anyone who has begun refeeding after they have been malnourished. If you haven’t been eating enough, you could be malnourished. Certain medical conditions can also cause malnutrition. They can affect your appetite or your ability to absorb nutrients from your food. Some risk factors for malnutrition and refeeding syndrome include:
Recent loss of more than 10% of your body weight.
Food deprivation for more than seven days with evidence of stress and depletion.
Eating disorders like anorexia nervosa and bulimia nervosa.
Malabsorption disorders such as chronic pancreatitis and inflammatory bowel disease.
Long-term parenteral nutrition (feeding through an IV).
Cancer and chemotherapy.
Uncontrolled diabetes.
Chronic alcohol use.
Chronic overuse of antacids or diuretics.
Symptoms: phosphate, magnesium, thiamine B12, potassium, body fluid disturbances, blood sugar
Before beginning refeeding, your healthcare providers will give you a blood test. They’ll measure your electrolyte levels to identify any deficiencies. Then they’ll build the missing micronutrients into your nutritional formula. The idea is to replace your missing micronutrients first. Then, your body will be better prepared to metabolize carbohydrates.
But, electrolyte deficiencies won’t always show up in the initial blood test. Because refeeding hasn’t begin yet, your body doesn’t know yet that it will need those electrolytes. The great shift of electrolytes from your blood into your cells hasn’t happened yet. For this reason, sometimes deficiencies don’t show up until after refeeding has begun.
Your healthcare team will continue to watch you for symptoms. They’ll also measure your electrolyte levels daily. Refeeding syndrome usually occurs within the first five days of refeeding. If symptoms appear, your healthcare team will slow down your refeeding. They’ll reduce the carbohydrates in your formula. They may replace your missing nutrients through an IV into your bloodstream.
When your body is starved for nutrients, it makes certain changes to adapt. It changes its metabolism — the way it converts food into energy. Instead of carbohydrates from food, your body metabolizes its own fat and muscle. Metabolism also slows down. Your resting metabolic rate — how much energy you spend while at rest — reduces by as much as 20%.
This type of metabolism takes fewer resources. It doesn’t use micronutrients — vitamins, minerals and electrolytes — the way normal metabolism does. But when refeeding begins, so does normal carbohydrate metabolism. Your body reaches deep into its pockets for the micronutrients it needs to get the job done. If your stores are too low, now is when you will feel the effects.
Sugars
Sugars are carbohydrates. Like all carbohydrates, they provide a source of energy in our diet.
Sugar is a term that includes all sweet carbohydrates, although the term is most often used to describe sucrose or table sugar, a ‘double sugar’. The body breaks down carbohydrates into simple sugars such as glucose, that can be readily used in the body.
There are several different sugars. Sugars occur naturally in some foods, such as fruit and dairy products, and are also added to a wide variety of foods. Sugar can take many different forms, including white, raw or brown sugar, honey or corn syrup.
Too much sugar in your diet can make your diet high in kilojoules or ‘energy dense’ and can contribute to health problems like obesity, diabetes and tooth decay.
Refined (or processed) sugar provides a quick, simple source of energy, but it doesn’t contain other nutrients such as vitamins and minerals.
Sugars are popular in the processed food industry because they add taste, colour, bulk and thickness to food products. They also prevent mould forming and act as a preservative.
Starches
Starch is a carbohydrate and a natural component of most plants, including fruits, vegetables, and grains. Starchy foods are an essential part of a balanced diet, as they provide energy, fiber, and a sense of fullness.
The body breaks down starch molecules into glucose, which is the body’s primary fuel source. The brain, in particular, requires a considerable amount of glucose each day.
Starchy foods are safe for most individuals and present no risks or side effects. However, it is important that people with diabetes or CSID carefully consider their starch intake.
Carbohydrates, or carbs, provide the body with energy, but not all carbohydrates are the same. Carbs are an important part of a balanced diet. Unprocessed carbs contain fiber, vitamins, and minerals.
However, processing them removes nutrients and results in refined carbs, which people sometimes refer to as empty carbs or empty calories.
Refined carbs provide very few vitamins and minerals. The body processes refined carbs quickly, so they do not provide lasting energy, and they can cause a person’s blood sugar to spike.
Carbs consist of:
Sugars: Fruits, milk products, and ultra processed foods, such as sodas and flavored candy bars, contain sugars.
Starches: Grains, legumes, and vegetables contain starches.
Fiber: The digestive system cannot break down dietary fiber, which is in fruits, vegetables, and other foods.
The body digests refined carbohydrates quickly, and they provide a source of energy. However, they can cause a quick rise in blood sugar and trigger the pancreas to release insulin.
The body uses refined carbs much more quickly than it uses unrefined carbs.
As a result, refined carbs create a short burst of energy, whereas unrefined carbs release energy more slowly throughout the day.
Once the short burst of energy is over, a person may need to eat more food to gain more energy.
As a result, they can consume a high number of calories, contributing to weight gain.
Having overweight or obesity can increase the risk of health problems, such as:
heart disease
type 2 diabetes
stroke
hypertension
asthma
chronic back pain
osteoarthritis
Refined carbs also do not have as much nutritional value as unrefined carbs. They lack fiber, which is important for both digestive health and keeping blood sugar stable.
Water soluble vitamins
Vitamins play a vital role in many biochemical functions in the human body and are essential components for maintaining optimal health. There are two main groups of vitamins – fat-soluble (easily stored in fat upon absorption) and water-soluble (washed out and not easily stored). Although adequate intake of all vitamins is important, regular intake is required to avoid deficiency due to the transient nature of water-soluble vitamins. The water-soluble vitamins include Vitamin C and Vitamin B complex (thiamine, riboflavin, niacin, pantothenic acid, pyridoxine, biotin, folate, and cobalamin).
Vitamin B complex and vitamin C are found in many foods, especially vegetables and fruits, as well as dairy, meat, legumes, peas, liver, eggs, and fortified grains and cereals. In addition to serving as cofactors in biochemical reactions, the vitamin B complex is vital for normal body growth and development, healthy skin, the proper function of nerves and the heart, and red blood cell formation. The overall lack of water-soluble vitamins is rare in North America, though it can present in alcohol use disorder, malabsorption syndromes, strict veganism, and malnourished states.
The amount of thiamin adults (aged 19 to 64) need is:
1mg a day for men
0.8mg a day for women
You should be able to get all the thiamin you need from your daily diet.
Thiamin cannot be stored in the body, so you need it in your diet every day.
Food: whole grains, citrus food, liver, fish
