Download Nur 155 Yoost study guides and more Study notes Fundamentals of Design in PDF only on Docsity!
Exam 2 Study Guide
Nutrition
Nutrition: The body's intake and use of necessary nutrients for tissue growth and
energy production
Nutrients: Necessary substances obtained by ingesting food that supply the body with
energy and aid in normal growth and function of each body system.
Malnutrition: An imbalance in the amount of nutrient intake needed to keep boldly
processes functioning ( only have to be deficient in one nutrient to be considered
malnourished)
Metabolism
● The cyclic chemical process of changing nutrients (fats and protein) into end
products that are used to meet energy needs of the body or stored (body fat) for
future use.
Basal Metabolic Rate (BMR) - The minimal amount of energy to maintain bodily
functions in the resting and awake state (During sleep(at rest state) the body requires
a certain number of calories to support cardiac function and breathing.)
Two Major Biochemical Processes of Metabolism
Anabolism- the use of energy to change simple material into complex body
substances and tissues Example: Creation of muscle mass from amino acids.
Catabolism- the breaking down of complex material to simple, resulting in a release
of energy. Example: breakdown of protein into aminoacids
Macronutrients
● Nutrients needed in larger amounts including :carbs, fats, protein, water.
Carbs
50% daily intake
Protein
15% daily intake
Fats
20-35% daily
intake
Water
6-8 250ml glasses
daily
4 kcal/gram 4kcal/gram 9kcal/gram n/a
-Simple carbs-broken down for quick energy -Complex carbs- broken down at a slower rate and provide the body with vitamins and minerals. -Fiber- complex carb classified as soluble or insoluble. (Soluble fiber mixes with water to form a gel-like substance which results in slower digestion, insoluble fiber does not dissolve in water but adds bulk to stool, promoting regular BM.) -complete protein-has all essential amino acids -incomplete protein- lacks one or more amino acid to be a complete protein
- A combination of incomplete proteins can make a complete protein ex: rice and beans, pasta and broccoli, peanut butter and wheat bread.
- requires presents of carbs to produce energy for the body -Triglycerides are the most abundant lipids in food. -saturated fatty acid -monounsaturated fatty acid -polyunsaturated fatty acids -trans fatty acids -unsaturated “essential” fatty acid; Omega-3 and omega- -it is recommended to limit consumption of saturated fatty acids due to obesity.
- makes up 60% of adult body weight (40- 50% in elderly , risk for dehydration) -⅔ of body water is intercellular fluid -8% of body water is within blood plasma -Complex: bread,rice,legumes, starchy veggies. -Simple: processed sugar, cakes, pies,pastries -Fiber-whole grain, legumes, fruit , veggies,legumes.
- complete: milk, cheese, eggs, fish, red meat, poultry -incomplete: nuts, seeds, peas, fruits, veggies, beans.
- saturated: hard margarines,fried and processed foods, icecream.
monounsaturated:canol a, olive and peanut oils, cashews, almonds, avocados. -polyunsaturated: corn,sesame, soy beans, sunflower seed oils, fish (tuna, mackerel , salmon)
- intracellular fluid- water found within cells -extracellular fluid- fluid found outside the cell includes plasma(liquid component of blood), interstitial(fluid that surrounds cells in tissues), transcellular fluid (specialized fluids, cerebrospinal, spinal cord,lymph,fluid in eyes and joints) Micronutrients
● Nutrients needed by the body in limited amounts including: vitamins (fat and
water soluble) and minerals.
Antioxidants
● Protects the body from free radicals (smoking, environmental toxins, and
radiation), slows and prevents oxidative processes.
Antioxidant Food source
Beta carotene Dark orange, yellow and red and green fruits and veggies, kale, apricot, cantaloupe, peppers Selenium Oat meal, brown rice, chicken, dairy products,garlic , onion, whole grains, salmon,tuna. Vitamin C Red and yellow peppers , pineapples, oranges, guava , berries, darky green veggies, tomatoes Vitamin E Olive, soybean,and corn oil, nuts , seeds, legumes, whole grain, dark leafy veggies.
Alterations
Muscoskeletal: imbalance of Vitamin A and D and deficiency in minerals such
as calcium, phosphate and magnesium.
Neurological: excess dietary sodium and deficiency of folate
Folate low can lead to hypertension and cranial swelling
Metabolic:
-Diabetes type 1- insulin dependent
-Diabetes type 2- oral medication or diet changes
-Allergies and intolerances
-Obesity : BMI (body mass index) (kilograms/meters^2)
18.5-24.9 healthy
24.9-29.9 overweight
30+ obese)
Class 1 obese: 30-34.
Class 2 obese 35-39.
Class 3 obese 40 +
Physiological; anorexia nervosa and bulimia nervosa
Food Patterns and specialty diets
-Keto, Paleo,Atkins: limit carb intake
-Vegitarian: minimal animal products
-Vegan- No animal products
-Lacto-vegitarian- can have dairy
-Ovo-vegitarian- can have eggs
-Lacto-ovo vegetarian- can have eggs and dairy
-Kosher- no pork, shell fish , raremeat or blood
-NPO- nothing by mouth : most commonly used before surgical procedure
-Clear Liquid- clear fluid, juice no pulp, broth
-Full Liquid-anything liquid at room temp
-Purred - blended
-machanical soft- modified (ground meat)
-Cardiac- limit sodium and saturated fats
-Diabetic-limit simple carb intake and control cal intake
- Renal- limit potassium , sodium, protein
- hindu’s cow is considered scared (only dairy products where cow is not
harmed can be consumed)
External Feedings
NG Tube- (nasogastric tube) inserted through one of the nares into the
stomach, used for short term bowel decompression.
PEG Tube- (percutaneous endoscopic gastrostomy tube) surgically placed
upper left quadrant of abdomen, long term nutrition, X-Ray to confirm proper
placement. Used for esophageal cancer patients and for those with trauma to
mouth and nose.
*formula aversions : Nausea , diarrhea and vomiting
TPN (total parental nutrition): used for patients with no functioning GI tract
can be given through a central venous catheter (CVC) or a PICC (peripherally inserted
central catheter).
Potential complications of TPN: high risk for infection, air embolism,
gallbladder dysfunction, must slowly wean off due to risk of hypoglycemia.
*TPN patients tube must be marked so nothing else is administered through
the line, asepsis technique and change tubing every 24 hours assess skin and change
dressing every 48 hours
*labs for TPN Patient: input/ output, daily wt.,glucose check every 6 hrs, cbc,
electrolytes, bun, when administering it is always on a pump never a push.
*medication administration for tube feed: pause feeding , flush line with 15 ml
saline, crush medication and mix with saline solution place in tube and let gravity
take down the tube or use a plunger then flush 15-30 ml saline to cleanse line , then
resume feeding
*NG Tube feeding and PEG tube HOB must be raised 30 degrees and remain
raised 30 degrees 1-2 hours prior to feeding to prevent aspiration.
Fluid and electrolytes
● Hypovolemia- a decrease in fluid volume (weak thready pulse)
● Hypervolemia- excessive fluid volume (bounding pulse)
Increase in TBW:
2%- gain mild excess
5%-moderate excess
8%- severe excess
● Hypertonic= Hypovolemic (too much water not in cell so
dehydrated)
● Hypotonic=Hypervolemia (too much water within cells, fluid
over load)
● Diffusion- movement of solutes across selective permeable
membranes from low to high concentration until equilibrium is
reached.
● Facilitated diffusion- solute unable to pass through membrane
without carrier , solute is moving from high to low concentration
no energy required so this is a passive transport
● Active transport- transport solute from low to high
concentration opposite of diffusion this requires energy so its
active process
Fluid Imbalances Electrolyte Imbalances
POTASSIUM (K ) ⁺
Normal Range: 3.5 – 5.0 mEq/L
Function: Pumps the heart and muscles
↑ Hyperkalemia (K ⁺> 5.0):
● Causes: Renal failure, burns, trauma, potassium-sparing diuretics
● S/S: Muscle cramps, weakness, peaked T waves, dysrhythmias
● Causes: Vomiting, NG suction, metabolic alkalosis
● S/S: Muscle cramps, twitching, tetany
● Interventions: 0.9% NS or ½ NS IV fluids, diet with NaCl
MAGNESIUM (Mg² ) ⁺
Normal Range: 1.5 – 2.5 mEq/L
Function: Calms muscles and nerves, affects heart rhythm
↑ Hypermagnesemia (Mg² ⁺> 2.5):
● Causes: Renal failure, excessive antacids or laxatives
● S/S: Hypotension, bradycardia, low DTRs, lethargy
● Interventions: IV calcium gluconate, dialysis, avoid Mg-containing meds
↓ Hypomagnesemia (Mg² ⁺< 1.5):
● Causes: Alcoholism, diarrhea, diuretics
● S/S: Tremors, increased DTRs, seizures, tachycardia
● Interventions: Mg supplements, green leafy vegetables, nuts
CALCIUM (Ca² ) ⁺
Normal Range: 9.0 – 10.5 mg/dL
Function: Strengthens bones, blood clotting, and heartbeat
↑ Hypercalcemia (Ca² ⁺> 10.5):
● Causes: Hyperparathyroidism, bone disease, thiazides
● S/S: Muscle weakness, constipation, decreased DTRs
● Interventions: IV fluids, loop diuretics, calcitonin, mobility
↓ Hypocalcemia (Ca² ⁺< 9.0):
● Causes: Hypoparathyroidism, Vit D deficiency, renal failure
● S/S: Positive Trousseau’s & Chvostek’s signs, tingling, tetany
● Interventions: Calcium/vitamin D supplements, seizure precautions
PHOSPHATE (PO₄³ ) ⁻
Normal Range: 2.0 – 4.5 mg/dL
Function: Builds bone and teeth, works opposite of calcium
↑ Hyperphosphatemia (PO₄³ ⁻> 4.5):
● Causes: Renal failure, hypocalcemia
● S/S: Muscle cramps, tetany, numbness
● Interventions: Phosphate binders, low-phosphate diet
↓ Hypophosphatemia (PO₄³ ⁻< 2.0):
● Causes: Malnutrition, alcoholism, antacids
● S/S: Weakness, bone pain, confusion
● Interventions: Phosphate supplements, dairy, meat, eggs
Acid-based imbalances
Ph normal range: 7.35-4.
Four imbalances can occur ;
Disorder Causes Clinical Manifestations Lab Findings (ABG values) Interventions Respiratory Acidosis
Hypoventilation- COPD, pneumonia, atelectasis- Respiratory depression (drugs, head injury)- Retaining CO₂
- Confusion, drowsiness- Headache- Low RR, shallow breathing- Warm flushed skin pH ↓ (<7.35)PaCO₂ ↑ (> mmHg)HCO₃ normal (acute) or ↑ (chronic compensation) - Improve ventilation (turn, cough, deep breathe)- Oxygen, bronchodilators- Treat cause (e.g., narcotic reversal, suction) Respiratory Alkalosis
Hyperventilation (anxiety, pain,
- Lightheaded, dizzy- Numbness/tinglin pH ↑ (>7.45)PaCO₂ ↓ (< mmHg)HCO₃ - Slow breathing (paper bag)- Decrease anxiety-
Milk Carton 8 ounces 240 mL
Medication Cup 1 ounce 30 mL
Ice Cube 1 teaspoon 5 mL
Popsicle 3 ounces 90 mL
Water Pitcher 15 ounces 450 mL
Ice Cream 3 ounces 90 mL
Fluid Restrictions Fluid restrictions: 50% intake during the daytime, split between meals
- Sodium Restrictions/ per day o Mild = 3000- o Mod = 2000 o Severe = 500 IV Therapy · 6 Rights of Medication*
- Right Patient
- Rite Route
- Right Dose
- Right Time
- Right Reason
- Right Medication IV Complications:
Complication Signs & Symptoms Nursing Interventions Infection - Warm, red, swollen site- Pus or drainage- Fever, chills (systemic signs) 🛑 Stop infusionRemove IVClean siteCulture if orderedStart new IV at a different site Phlebitis - Red streak along vein- Heat, pain- Vein feels hard or cord- like 🛑 Stop IVRemove catheterApply warm compressDocument and restart IV in another extremity Infiltration - Cool, pale, swollen skin- Discomfort- Fluid leaking into tissues 🛑 Stop IV immediatelyElevate limbApply warm or cold compress (per policy)Restart IV in opposite limb Extravasation (if med is vesicant)
- Blistering, severe pain, necrosis 🛑 Stop infusionLeave catheter in place to aspirate medicationNotify provider immediately IV solutions Solution Type Examples Tonicity Effect When to Give / Key Points Isotonic 0.9% Normal Saline (NS), Lactated Ringer’s (LR), D5W* Same concentration as body fluids — stays in vessels 🛑 Used for: Burns, dehydration from vomiting/diarrhea, blood loss, surgery ⚠️ D5W is an exception: starts isotonic but becomes hypotonic after glucose is
- Urinary retention – Inability to empty bladder (obstruction, neuro) Catheters · INTERNAL) (EXTERNAL)
- Coude´(curved, prostate) - Condom Cath
- CBI ( Tripple lumen to flush bladder) - PureWick (Suction)
- Straight cath (removed immediately)
- Foley (long term)
- Suprapubic catheters- sterile tube inserted directly into the bladder through a small incision in the lower abdomen (just above the pubic bone) to drain urine.It’s placed when the urethra cannot be used for catheterization. Urinalysis and Labs Test / Term What It Measures Normal Level / Finding Key Notes / Meaning BUN (Blood Urea Nitrogen) Measures kidney’s ability to remove urea (waste from protein breakdown) 7 – 20 mg/dL ↑ = kidney dysfunction, dehydration, high protein diet↓ = liver disease, overhydration Creatinine Measures kidney filtration efficiency (best kidney indicator) 0.6 – 1.2 mg/dL ↑ = impaired kidney function↓ = muscle loss, low protein intake Urine Specific Gravity Measures urine concentration 1.005 – 1.030 ↑ = concentrated urine (dehydration)↓ = dilute urine (overhydration, renal disease) Urine pH Measures acidity or alkalinity of urine 4.5 – 8.0 ↓ Acidic = high protein diet, ketoacidosis↑ Alkaline = UTI, diet high in fruits/veggies
Glucose in Urine Checks for sugar in urine Negative Presence = diabetes or high blood sugar Ketones in Urine Checks for fat breakdown by- products Negative Presence = DKA, starvation, low-carb diet Microscopic Analysis Examines urine under microscope for cells, bacteria, or crystals Few cells, no bacteria, no casts or crystals ↑ WBCs or bacteria = infectionRBCs = trauma or stones Suspected UTI (Urinary Tract Infection) Based on symptoms and urinalysis Cloudy, foul odor, positive nitrites, positive leukocyte esterase S/S: burning, frequency, urgency, fever Culture & Sensitivity (C&S) Identifies bacteria and which antibiotic works best No growth (normal) Used when UTI suspected; takes 24– hrs for results 24-Hour Urine Collection Measures kidney function over 24 hours (creatinine clearance, protein) Amount varies (800– 2000 mL/day) Discard first urine → collect all urine for 24 hrs → keep on ice → test kidney function accuracy Quick Memory Tips ● BUN + Creatinine = Kidney function ● Specific gravity = Hydration ● pH = Acid-base balance ● Glucose + Ketones = Diabetes check ● C&S = Find the germ + the right antibiotic Diagnostic Examinations
Double Stoma (Separate Ureteral Stomas) Each ureter (right & left) is brought to the abdomen separately — two stomas. Two drainage bags needed. Used when both ureters can’t be joined together. Assess output from both stomas for equality. Left Ureter Anastomosed to Right Ureter (Single Stoma) The left ureter is connected to the right ureter, and only one stoma is made (one opening). One drainage bag. Common to simplify care and reduce infection risk. Monitor for obstruction in joined ureters. Continent Urinary Diversion (e.g., Indiana Pouch, Kock Pouch) Internal pouch made from bowel; patient catheterizes stoma to drain urine (no external bag). Must self-catheterize every 4– hours. Patient teaching essential. Orthotopic Neobladder New “bladder” made from intestine, attached to urethra; allows voiding through urethra. Patient can void normally, but may have incontinence initially. Requires bladder training. Bowel Elimination
- Normal bowel pattern - 3/week
- Encourage Fiber 20-35g daily,Fluid, movement
- Long term use of laxatives can cause dependency
- CDiff- negative before giving antidiarrheals or antibiotics
- CDiff- contact precautions
- Constipation-fewer than 3 bowel movements a week :can be caused by opioid use and some antidepressants
- Impaction- oozing may occur, hard bowel that is incapable of passing, S/S: anorexia, nasuea , vomiting, distention,cramping,rectal pain.
- Barium used in radiologic examinations can put pt at risk for impaction, after encourage fluids and give laxatives or enemas if necessary.
- Flactulence- gas in the intestine: food that cause flatulence cabbage, onion,abdominal surgey and narcotics.
- Paralytic ileus- temporary absence of intestinal movement (peristalsis) that causes intestinal obstruction without a physical blockage.(most common post op : remain NPO if no BS 72hour prior to surgery contact PCP.
Bowel Diversions
Ileostomy Small intestine (ileum) Liquid to semi-liquid, continuous drainage High risk for dehydration and skin breakdown. Must replace fluids/electrolytes. Colostomy (Ascending) Right side of colon(used for right sided tumors ) Liquid stool Strong odor, frequent output. Colostomy (Transverse)Double barrel Upper abdomen, middle(used in emergencies, 2 stomas proximal one closest to intestine drains feces and distal stoma drains muscus. Mushy or soft stool Moderate odor and output. Colostomy (Descending) Left side of abdomen(used for left sided tumors) Formed stool More predictable output, may not need appliance all the time. Colostomy (Sigmoid) Lower left side (used for rectal tumors) Normal or formed stool Closest to normal bowel function.
