Unit 4: Malnutrition, Macronutrients, Micronutrients, Assissting with feeding, Therapeutic diets, Mobilizing patients and Bed positions Flashcards
(100 cards)
1
Q
Mouth
A
Chews food and mixes it with saliva
2
Q
Salivary glands
A
Produce saliva, which contains a starch-digesting enzyme called a salivary amylase.
3
Q
Pharynx
A
Swallows the chewed food mixed with saliva called bolus.
4
Q
Esophagus
A
Moves bolus to stomach
5
Q
Stomach
A
Mixes and churns food with gastric juice that contain acid and a protein-digesting enzyme called pepsin creating chyme.
6
Q
Liver
A
Makes bile which aids in digestion and absorption of fat.
7
Q
Pancreas
A
Releases bicarbonate to neutralize intestinal contents; produces enzymes that digest carbs, proteins, and fats.
8
Q
Gallbladder
A
Stores bile and releases it into the small intestine when needed.
9
Q
Small intestine
A
Digests food and absorbs water and some vitamins and minerals; home to intestinal bacteria; passes waste material.
10
Q
Large intestine
A
Absorbs water and some vitamins and minerals; home to intestinal bacteria; passes waste material.
11
Q
Anus
A
Opens to allow waste to leave the body.
12
Q
Nutrients
A
components of food that are indispensable to the body’s functioning.
13
Q
Diet
A
the foods (including beverages) a person usually eats and drinks.
14
Q
Malnutrition
A
any condition caused by deficient or excess food energy or nutrient intake or by an imbalance of nutrients; can be caused by several factors.
15
Q
Energy
A
Capacity to do work
16
Q
Calorie
A
Unit of energy used to measure the energy in foods.
17
Q
Balance
A
food choices do not overemphasize one nutrient or food type at the expense of another.
18
Q
Adequacy
A
foods provide enough of each essential nutrient, fibre, and energy. Ex/ Iron
19
Q
Calorie Control
A
foods provide the amount of energy needed to maintain appropriate weight.
20
Q
Moderation
A
foods do not provide excess fat, salt, sugar, or other unwanted constituents.
21
Q
Variety
A
Foods chosen differ from one day to the next.
22
Q
Variety
A
Foods chosen differ from one day to the next.
23
Q
Meals
A
Should occur with regular timing throughout the day to maintain a steady supply of nutrients.
24
Q
Macro-nutrients
A
Carbs, fats, proteins, and water
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Micro-nutrients
Vitamins and minerals
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Fx of Carbs
- Provide energy for body (particularly brain and nervous system)
- Maintain healthy digestive system
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Minimum intake of carbs
* Minimum 130g needed daily for healthy brain function
* 55%-75% of total daily calories
* 4 cal/g
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Sources of Carbs
• From plant-based and milk-based foods
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Simple carbs
• Simple sugars
• Monosaccharides (glucose, fructose, galactose)
• Disaccharides (lactose, maltose, sucrose)
- Need something to divide them (lactase, maltase, sucrase)
• Glucose is the most-used monosaccharide in the body
30
Complex carbs
• Composed of polysaccharides
• Starch: wheat, rice, corn, potatoes
• Fibre: soluble and insoluble, 25g – 35g per day
- Helps bulk up stool and pass easily
- Glucose stability
- Prevent heart disease
- Reduce colorectal cancer
- Soluble – dissolve in water, forms gel, flows through GI slowly, broken by bacteria in colon
- Barley , oats, fruits, veggies
- Insoluble – less fermented, help with fecal elimination
- Outer layer of whole grains, strings of celery, skins of apples
31
Fx of fats
* Energy storage
* Part of cell membranes
* Deposits insulate body and cushion vital organs
* Required for absorption of fat-soluble vitamins (A, D, E, K)
* Slows stomach emptying = feeling of satiation
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Minimum intake of fats
* 15%-30%of total daily calories
| * 9 cal/g (concentrated source of calories)
33
Lipoproteins, the types, and the fx of each type
Fx: transport fat in bloodstream
• Low-density lipoproteins (LDL): transports cholesterol and other lipids to the tissues; “bad cholesterol”
- Cause risk for heart disease
• High-density lipoproteins (HDL): transports cholesterol away from body cells to the liver for disposal; “good cholesterol”
- Lowers risk for heart disease
34
Sterols
ie/cholesterol, vitamin D, sex hormones; raw material for making bile; part of cell membrane structure; forms plaque in arteries
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Phospholipids
help keep fat dispersed in water by emulsification; important in cell membranes
- Soluable in water
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Triglycerides
consist of 3 fatty acids and 1 molecule of glycerol
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Types of triglycerides
Saturated and unsaturated
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Saturated fats and examples
• Saturated fats: triglycerides in which most of the fatty acids are saturated; firm at room temperature; increase LDL
- examples/ butter, coconut oil, animal fat,
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Unsaturated fats
fatty acid chain with one or more points of unsaturation; liquid at room temperature
40
Types of unsaturated fats and examples of each and function
• Monounsaturated fats: triglycerides in which most of the fatty acids are have one point of unsaturation; lowers LDL; olive oil, peanut oil, canola oil
• Polyunsaturated fats: triglycerides in which most of the fatty acids have two or more points of unsaturation; lowers LDL; includes essential fatty acids:
• Omega-6 (linoleic acid): nuts, seeds, vegetable oils
• Omega-3 (alphalinolenic acid): cold water fatty fish (salmon), flax or flaxseed oil
Functions: Muscle relaxation and immune response
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Trans fat
fatty acids with unusual shapes that can arise when polyunsaturated oils are hydrogenated
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Fx of proteins
• Part of body structure
• Growth and repair of tissue
• Transportation of materials throughout the body
- Hemoglobin – carries o2
• Building enzymes, hormones, and other compounds
• Building antibodies, aids in immunity
• Blood clotting
• Maintaining fluid-electrolyte and acid-base balance
• Providing energy
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Minimum intake of protein
* 10%-15% of total daily calories
| * 4 cal/g
44
Examples of foods with proteins
• Complete protein – eggs, some meats
45
Fx of water
* Most important nutrient in the body!
* Part of every cell, tissue, and organ – 60-70% of body weight
* Helps maintain body temperature
* Actively participates in chemical reactions
* Carries nutrients throughout the body
* Cleanses the tissues and blood of wastes
* Serves as the solvent for minerals, vitamins, amino acids, glucose, and other small molecules
* Lubricates and cushions
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Recommended intake for each sex
- men = 15.6c (3.7L) per day
| - women = 11.4c (2.7L) per day of fluid from beverages and drinking water
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Dehydration
loss of water; symptoms progress from thirst, weakness, and constipation to exhaustion, renal problems, delirium, and death
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Water intoxication
dilution of body fluids resulting from excessive ingestion of plain water; symptoms include headache, muscle weakness, lack of concentration, poor memory, loss of appetite, death
49
Vitamins
* Organic compounds vital to life but needed in small amounts; non-caloric
* Classified as fat-soluble or water-soluble
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Fat-soluble vitamins: A, D, E, K
* Dissolve in lipids
* Require bile for absorption
* Stored in body tissues
* May be toxic in excess
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Fx vitamin A
roles in gene expression, cell development, vision, growth and repair of epithelial tissue, reproduction, immunity, hormone synthesis, bone and tooth formation
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Fx vitamin D
roles in calcium and phosphorus metabolism and absorption (maintenance of bone integrity), protection against certain diseases (cancers, multiple sclerosis), liver, fish, eggs, fortified milk
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Fx vitamin E
antioxidant (defend from free radicals – damage that cause heart disease or cancers); roles in red blood cell protection, immunity, normal nerve development
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Vitamin K
roles in blood clotting, calcium metabolism, green leafy veggies
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Water-soluble vitamins
```
• Dissolve in water
• Easily absorbed and excreted
• Not stored extensively in body tissues
• Seldom reach toxic levels
- B and C
```
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Vitamin B
coenzymes (combine with other enzymes to do job); roles in metabolism of macronutrients, whole grains, legumes, milk products, veggies
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Vitamin B: Fx Thiamin, riboflavin, niacin
roles in cell metabolism, nerve processes, thiamin – nerve cell membranes
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Vitamin B: Fx Folate
roles in DNA synthesis, amino acid metabolism, works with B12, red blood cell production, prevention of neural tube defects
Deficiency: anemia
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Vitamin B: Fx Vitamin B12
roles in red blood cell production, maintenance of nerve cell sheaths.
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Vitamin B: Fx Vitamin B6
: roles in hemoglobin and neurotransmitter synthesis, regulation of blood glucose, immune function, fetal brain and nervous system development
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Vitamin C
antioxidant; roles in synthesis of collagen and carnitine, promotion of iron absorption, formation of certain neurotransmitters and hormones
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Minerals
Inorganic substances, not broken down during digestion and absorption; chemical elements
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Minerals: Calcium
main mineral in bones and teeth; roles in muscle contraction, nerve functioning, regulation of cell activities, blood clotting, blood pressure, immune response
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Minerals: Sodium
Main extracellular anion; major role in fluid and electrolyte balance and acid-based balance; roles in muscle contraction, nerve transmission; intake directly affects blood pressure
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Potassium
main intracellular cation; roles in fluid and electrolyte balance and keeping cell integrity; crucial for cardiac function
66
Phosphorus
roles in mineralization of bones and teeth, DNA & RNA, ATP, part of cell membrane
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Magnesium
roles in bone mineralization, protein building, enzyme action, normal muscle function, transmission of nerve impulses, proper immune function
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Iron
part of hemoglobin & myoglobin, roles in immune function and cognitive performance
69
Iodine
Crucial for proper thyroid function
70
Zinc
roles in hormones, enzymes, immune function, signaling in brain cells, wound healing, sperm synthesis, normal fetal development, taste perception
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Factors that drive food choices
1. Convenience
2. Advertising
3. Availability
4. Economy
5. Emotional comfort
6. Habit
7. Personal preference and genetics
8. Positive associations
9. Region
10. Social pressure
11. Values or beliefs
12. Weight
13. Nutritional value
72
Purpose of therapeutic diets:
to treat an illness or disease state
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Quantitative diets
number/size of meals, amount of nutrients, number of calories are modified
74
Qualitative diets
consistency, texture, or nutrients are modified
75
Restricted fluids
required in severe heart failure or renal failure (ie/ 1000mL per day)
76
Sodium-restricted
may be ordered for patients with heart failure, renal failure, cirrhosis, or hypertension
77
Fat-modified
low total & saturated fat, low cholesterol; for patients with hypercholesteremia, malabsorption disorders, diarrhea
78
Diabetic
limited sugars, sweets, refined carbohydrates; high fibre; low fat
79
Assessment for feeding adults
* Review orders for type of diet
* Assess presence and condition of teeth/dentures and mouth pain
* Assess speech, swallowing and gag reflex
* Determine level of assistance needed (motor skills, LOC, vision)
* Assess appetite, recent intake, and cultural/religious/social preferences
* Assess for fatigue, pain, SOB
* GI assessment: nausea, recent bowel patterns, bowel sounds, flatus
* Assess need for toileting, handwashing, and oral care before feeding
80
Guidelines for feeding adults
• Patient should be in sitting position
• If appropriate, glasses/contact lenses should be worn
• Use assistive devices as necessary
• If patient is at risk for aspiration, stay with the patient
• Feeding techniques for patients with special needs:
- Older adult: small amounts at a time; observe biting, chewing, tongue function, swallowing, fatigue; be sure patient swallows food between bites; offer variety of foods and frequent rest periods
- Neurologically impaired: small amounts at a time; observe biting, chewing, tongue function, swallowing; check for pocketing; give thin liquids between bites
- Patients with cancer: check for food aversions; monitor fatigue
• Assist patient with hand hygiene and oral care after meals
• HOB should be at minimum 45 degrees for 30-60 minutes after meals
81
Complications of immobility
* Respiratory: pneumonia
* Cardiovascular: orthostatic hypotension, venous thromboembolism (VTE)
* Musculoskeletal: loss of muscle mass (atrophy), muscle tone, strength, stability, bone density; joint contracture
* Elimination: urinary stasis (leading to UTIs), constipation
* Integumentary: decubitus ulcers
* Psychosocial: diminished self-concept, self-esteem, depression
82
Proprioception
* Awareness of posture, movement, changes in equilibrium
| * Knowledge of position, weight, resistance of objects in relation to body
83
Types of exercise
- Isometric (Static)
- Isotonic (dynamic)
- Isokinetic (resistive): Aerobic and anaerobic
84
Isometric
* Muscle contraction without moving the joint (muscle length does not change)
* Involves exerting pressure against a solid object or force
* Produces a mild increase in HR and CO (Cardiac output)
* No apparent increase in blood flow to other parts of the body
* Do not significantly build strength, but help maintain strength
* Ex/ Plank exercise
85
Isotonic
* Muscle shortens and lengthens to produce muscle contraction and active movement
* Increase muscle tone, mass, and strength
* Maintain joint flexibility and circulation
* HR and CO increase
* Ex/ Sit up or bicep crunch
86
Isokinetic
* Muscle contraction or tension against continuous resistance
* Can either be isotonic or isometric
* Person moves (isotonic) or tenses (isometric) against continuous resistance
* Often used as part of injury recovery programs
* An increase in blood pressure and blood flow to muscles occurs
* Ex/ pilaties
87
Isokinetic: Aerobic
* Muscle contraction or tension against continuous resistance
* Can either be isotonic or isometric
* Person moves (isotonic) or tenses (isometric) against continuous resistance
* Often used as part of injury recovery programs
* An increase in blood pressure and blood flow to muscles occurs
* Ex/ pilaties
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Isokinetic: Anaerobic
* Short-lasting, high-intensity activity; promotes strength, speed, and power
* Body’s demand for oxygen exceeds oxygen supply
* Relies on energy sources stored in muscles
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Prepare patient:
* Assess patient’s LOC, muscle strength, dizziness, side effects of medication, activity tolerance
* Ensure patient is rested and not fatigued
* Put on flat shoes with gripping soles
* Make sure obstacles are out of the way
* Address patient’s fear of falling, if applicable
90
Fowlers/High Fowlers
* HOB at 45-90 degrees
* Semi-sitting or sitting position
* Foot of bed may also be raised at knee
* Used during eating, nasogastric tube insertion, nasotracheal suction
* Promotes lung expansion
91
Semi Fowlers
* HOB at 30-45 degrees
* Foot of bed may also be raised at knee
* Used during gastric feedings to reduce r/f aspiration
* Promotes lung expansion
* Relieves strain on abdominal muscles
92
Trendel-enburgs
* Entire bed frame tilted with HOB down
* Used for postural drainage
* Facilitates venous return in patients with poor peripheral perfusion
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Reverse trendel-enburgs
* Entire bed frame tilted with foot of bed down
* Used infrequently
* Promotes gastric emptying and prevents esophageal reflux
94
Supine
* Patient lies flat on back
* Bed frame is horizontally parallel with floor
* For patients with vertebral injuries and in cervical traction
* Used for hypotensive patients
* Preferred sleeping position for some
* Most normally relaxed position
95
Prone
* Patient lies on anterior with pillows supporting lower legs, arms, and head
* Good position for assessing posterior areas and certain joint ROM
* Patients with respiratory difficulties do not tolerate well
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Dorsal recumbent
* Patient lies on back with knees flexed and soles of feet flat on bed
* Patients with painful disorders are often more comfortable with knees flexed
* Good for assessment of anterior areas
* Helps relax abdominal muscles
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Lithotomy
* Patient supine with legs separated, flexed, and supported in raised stirrups
* Common for surgery or examination of the pelvis and lower abdomen
* Common in childbirth
* Uncomfortable; patients may not be able to tolerate this position
98
Right Lateral Recumbent
* Side-lying position
* Bottom leg can be straight or bent
* Pillows used for support
* Good position for assessing heart murmurs
* Patients with respiratory difficulties do not tolerate well
* Used for lumbar puncture
99
Sims' position
* Part prone and part lateral recumbent
* Flexion of the hip and knee improves exposure to rectal and genitourinary areas for assessments or procedures
* Assess patient’s ability to bend hips and knees before positioning
100
Blood glucose monitoring
* BGM is essential to diabetes management
* Monitored up to QID (as per orders, often pre-prandial and at HS)
* Involves skin puncture on fingertip, blood wicked onto test strip, reading by point-of-care machine, reporting and documentation
* Results often determine amount of insulin to administer
