collaborative therapies test 1: memorization

What is the concept of "Collaborative Therapies"?

Collaborative therapies refer to strategies that manage acute and chronic health conditions using nutritional and pharmacological methods. These therapies aim to prevent and treat illnesses through diet and medication management.

What are two key areas of focus in collaborative therapies?

The two main focuses are pharmacological (safe medication practices) and nutritional (preventing and managing over/under nutrition).

How does undernutrition affect body functions from a pharmacological perspective?

Undernutrition can deplete nutritional reserves, affecting drug metabolism and increasing the risk of adverse drug reactions.

How is nutrition linked to health and wellness?

Nutrition affects physical, cognitive, and spiritual health. It enables the body to function properly, supports emotional well-being, and is often tied to religious practices.

Name the macronutrients and their primary functions.

The three macronutrients are carbohydrates (energy), fats (energy storage and protection), and proteins (tissue building and repair).

How does protein support body functions?

Protein builds, repairs, and maintains tissues, supports fluid and pH balance, and plays roles in immunity, enzyme production, and hormone development.

What role does fiber play in nutrition?

Fiber aids in weight control, glycemic control, reduces the risk of coronary artery disease (CAD), and lowers the risk of colon cancer.

Why is water referred to as the "giver of life"?

Water acts as a solvent, transporter, thermoregulator, and lubricant for the body, essential for overall function.

What are the 5+5 rights of medication administration?

They include the right patient, medication, dose, route, time, reason, assessment, patient education, the right to refuse, and documentation.

What is a common cause of medication errors?

Errors often arise from misunderstanding medication orders, such as confusion with look-alike or sound-alike drugs.

What is the importance of medication reconciliation?

It ensures that patient medications are verified and clarified at key points, like admission and discharge, to prevent errors.

How does malnutrition create risk situations from a nutritional perspective?

Malnutrition, including both under- and over-nutrition, can lead to severe conditions like CAD, type 2 diabetes, or protein-energy malnutrition.

What are the risks associated with polypharmacy in undernourished patients?

Polypharmacy can lead to adverse drug reactions, decreased drug metabolism, and drug-nutrient interactions, especially in malnourished individuals.

Why is it important to assess for nutritional supplements in patients?

Supplements may interact with medications and cause unintended side effects, so healthcare providers must inquire about their use during patient assessment.

what does pharmacokinetics include

absorption, distribution, metabolism,excretion

distribution

refers to the transport of a drug by the bloodstream to its site of action

metabolism

refers to the biochemical drug alteration into an inactive metabolite, a more soluble compound, a more potent metabolite, or a less active metabolit

excretion

elimination from the body

fastest to slowest absorption method

IV, SC, Oral

bioavaliability

the % of the unchanged drug that enters the systemic circulation, thereby accessing the site of action (unchanged amount of the med after it passed the liver

first pass effect

how much of the med is absorbed by the liver before reaching the site of action wanted ,meds that have a high first pass effect become ineffective when taken orally bc it will go through the liver and be entirely metabolized before reaching the target

what effect do IV and PR have

first pass and non first pass

what protein do meds bind to

albumin

highest % of med binding to alumin

Warfarin (99%), diltiazem (70-80%), morphine (35%)

what organ is the most important site for metabolism

liver

half life

how much time it takes for half the med in the blood to be excreted from the body, decreases by halves, (start at 100, 4h after 50, then 4h later 25

enteral

absorbed into the systemic circulation through the mucosa of the stomach or intestine ( PO or SL)

parental

• any route of administration other than the GI tract, the fastest route (IV, IM,SC)

• Topical: application of medication to various body surfaces (topical, transdermal, PR, inhalation)

what can lead to active metabolism buildup and potential toxicity

liver insufficiency due to age or disease

what meds need to be taken on an empty stomach

• Fosamax

• Synthroid

• pantoloc

meds that need to be taken with food

on-steroidal anti-inflammatory drugs (NSAIDs) ...

• antibiotics

• Metformin

• Iron

• Prednisone

• Spironolactone

• Propranolol

• Hydralazine

• Lithium

• Carbamazepine

Theophylline are often taken with food (or full glass of water) to minimize GI irritation

Route: Inhalant

Used correctly to ensure optimal effect

• Bronchodilator to open airway for delivery of corticosteroid

IM/SC

Correct sites required and recommended nursIng standard of care, (IM-22-25gauge needle, g0-degree angle) (SC 45-90-degree

with 16mm needle)

IV

Continuous IV require continuous monitoring, volume, amount, rate, therapeutlc blood levels, drug compatibilities, IV site

monitored for patency, redness, swelling, pain, flush lines with NS

oral

Liquid, solution, tablet, enteric-coated pills, empty stomach, with food, crushed, tube feeding (flush with H2O), polypharmacy, compatibility

SL

Placed under the tongue, regularly non-irritating, water soluble, ex: Nitro

PR

Absorption is erratic and unpredictable, provides safe alternative N/V, lie on Lt side, nurse is gloved

• Solution, spray, ointment or drops. Skin must be clean, nurse wears gloves, skin not intact - sterile technique

transdermal

Placed on alternating sites, clean/non-irritating area, previous patch removed, patches disposed safely.

• Onset of action(low long it takes for the med to have effect-30mins), peak effects and duration of action is related to peak level(toxicity) and trough (lowest blood level of the drug-ineffective)levels

• Tolerance: is when the pt has grew a tolerance to the drug and requires a higher dosage to get the desired effects

dependance

physiological (craving desire for feeling of the drug) or physical, physical need for the effects of the drug to function

tolerance

is when the pt has grew a tolerance to the drug and requires a higher dosage to get the desired effects

nutritional status

degree of balance between nutrients intake and nutrient requirements

• NS is influenced by level of income, level of education, nutritional literacy, access to nutritious foods and culture

• Nurse's role consist of assessment, intervention(assist to eat and teaching)

ABCD Assesment

A: anthropometric measurements

B: biochemical tests

C: clinical exam

D: dietary history

anthropometric measurments

height, weight, BMI, head circumference (over eyebrows, around the ears) waist circumference, skin fold thickness and waist-hip ratio

5-10% weight change in 1 month

significant weightloss

less than 5% weight change

severe weight loss

BMI

- morbidly obese: 40

• Obese: 30 and above

- Overweight: 25-30

- Normal weight: 18.5-25

- Underweight: under 18.5

· Category of obesity:

waist circumferences

assess abdominal fat content, storage of body fat in the abdominal region heightens the risk of CAD,

· Values that pose a risk for CAD:

males: >40inches (100cm)

Females >35 inches(>87.5cm)

biochemical tests: assesment

○ Serum proteins (albumin)

○ Blood (or urine) urea nitrogen

○ CBC: hemoglobin & lymphocyte count (WBC)

○ Serum cholesterol & triglycerides

○ Serum glucose: fasting

dietary history

○ Use of food diary/records to keep tract of the nutritional status of the pt (calorie count, protein, carbs intake)

data collected in nutritional assesment

○ Yellowing in the eyes, ○ Dry, scaly skin,○ Brittle nails, ○ Dry lips and mouth, ○ Poor oral hygiene,○ Alopecia (hair loss),○ Decreased muscle mass, ○ Weakness, ○ Confusion, irritability, ○ Ulceration of mouth, ○ Sign/symptoms of vitamin defiency (numbness at extremities, fatigue, dizziness)

populations at risk for nutritional issues

○ Age,○ Health state, ○ Health care system factors like treatments and meds that put them at higher risks

obesity

• Definition: A clinical condition characterized by excess body fat where energy intake exceeds output.

• Measurement: Classified when body weight is 20% above desired for height and weight.

• Causes: Genetic, nutritional, physiological, environmental, social, behavioral, and psychological factors.

BMI classification

• Class 1 Obesity: BMI 30–34.9

• Class 2 Obesity: BMI 35–39.9

• Morbid Obesity (Class 3): BMI ≥ 40

Body Fat distribution

• Apple Shape: Associated with visceral fat, increased risk for diabetes, CAD, breast and endometrial cancer, hypertension, and dyslipidemia.

• Pear Shape: Associated with subcutaneous fat, increased risk for varicose veins, osteoporosis, and cellulite.

contributing factors to obesity

• Genetics: Familial influence and genetic predisposition.

• Lifestyle: Sedentary behavior, lack of physical activity, and excessive caloric intake.

• Hormonal: Imbalances in hormones that regulate appetite and metabolism (e.g., leptin, insulin, peptide YY).

metabolic syndrome

• Definition: A cluster of conditions including abdominal obesity, insulin resistance, dyslipidemia (low HDL, high LDL), hypertension, and hyperglycemia.

• Risks: Increased risk of CAD, type 2 diabetes, and stroke.

• Management: Weight loss, increased physical activity, improved diet, and blood pressure/glucose control.

Set Point Theory

• Concept: The body strives to maintain a certain weight range based on internal regulation of energy intake and expenditure.

• Effect: Explains why weight loss may be difficult to maintain without lifestyle changes.

basic energy balance

• Energy In: Calories consumed through food.

• Energy Out: Calories expended through basal metabolic rate (BMR), physical activity, and body size.

• Rule of Thumb: 3500 calories = 1 lb of fat.

regulatory hormones in obesity

• Leptin: Suppresses appetite; low levels can increase hunger.

• Insulin: Regulates blood glucose and affects appetite; elevated in obese individuals.

• Peptide YY: Inhibits appetite; decreased levels in obese patients.

• Cholecystokinin: Signals fullness and inhibits gastric emptying.

nursing interventions for obesity

• Assessment: Obtain detailed history of obesity onset, associated medical conditions, and medications.

• Nursing Diagnoses: Imbalanced nutrition, ineffective breathing, impaired skin integrity, low self-esteem, and disturbed body image.

• Goals: Promote weight loss, healthier eating, physical activity, and minimize obesity-related complications.

diet and weight management strategies

• Goals: Achieve a negative energy balance by reducing caloric intake and increasing physical activity.

• Diet Tips:

o Prioritize whole foods over processed foods.

o Use smaller portions and balanced meals.

o Replace high-sugar drinks with water.

• Macronutrient Distribution:

o Carbs: 45–65%

o Protein: 10–35%

o Fat: 15–25%

surgical interventions for obesity

• Categories:

o Decrease appetite/increase satiety.

o Decrease nutrient absorption (e.g., Orlistat).

o Increase energy expenditure (not approved in Canada).

• Nursing Interventions: Educate on side effects and diet modifications.

diabetes types

• Type 1 Diabetes: Autoimmune disorder leading to no insulin production. Requires insulin for survival.

• Type 2 Diabetes: Insulin resistance or deficiency. Managed with lifestyle changes, oral medications, and sometimes insulin.

• Gestational Diabetes: Occurs during pregnancy, increasing the risk of type 2 diabetes later in life

long term complications of DM

• Retinopathy: Eye damage leading to blindness.

• Nephropathy: Kidney damage, leading to end-stage renal disease.

• Neuropathy: Nerve damage, especially in the feet, causing decreased sensation

diagnostic test for DM

• Fasting Blood Glucose: ≥7 mmol/L.

• Random Blood Glucose: >11.1 mmol/L.

• HbA1C: Reflects average blood glucose over 3 months; <7% is the goal for diabetics.

What do A cells and B cells in the pancreas produce?

A cells produce glucagon, and B cells produce insulin

Which type of insulin can be given intravenously?

Regular insulin is the only insulin that can be given IV.

What are common side effects of insulin?

Hypoglycemia, lipodystrophy, weight gain (especially in type 2 diabetes), Dawn phenomenon, Somogyi effect, and rare allergies

What is the Dawn effect in diabetes management?

An early morning rise in blood glucose levels due to counter-regulatory hormones stimulating glucose release

What is the Somogyi effect

Early morning hyperglycemia resulting from a rebound effect of late-night hypoglycemia

What is the onset, peak, and duration of rapid-acting insulin (e.g., Lispro, Aspart)?

A: Onset: 10-15 min; Peak: 1-2 hr; Duration: 3.5-4.75 hr.

What is the onset, peak, and duration of short-acting insulin (e.g., Humulin R)?

Onset: 30 min; Peak: 2-3 hr; Duration: 6.5 hr.

What is the onset, peak, and duration of intermediate-acting insulin (e.g., NPH)

Onset: 1-3 hr; Peak: 4-10 hr; Duration: up to 18 hr.

What is the onset, peak, and duration of long-acting insulin (e.g., Glargine)?

Onset: 90 min; Duration: up to 24 hr.

What is the typical dosing concentration for insulin?

A: 100 u/ml.

what is the only insulin that can be given in IV infusion?

regular insulin

when drawing two insulins and mixing them, which one needs to be drawn up first?

clear insulin (rapid acting, short acting, and long acting)

What are some drug-drug interactions that can elevate blood glucose levels?

Sympathomimetic drugs (like epinephrine), corticosteroids, and thiazide diuretics.

What are the three main mechanisms of action of biguanides (e.g., Metformin)?

Decreases glucose production in the liver, decreases intestinal glucose absorption, and increases insulin receptor sensitivity.

What are the contraindications for using Metformin?

Severe kidney disease, alcoholism, liver disease, heart failure, metabolic acidosis, and tissue hypoxia.

What are the main adverse effects of Metformin?

Lactic acidosis (rare but lethal), GI effects (nausea, cramping), and weight loss.

What are common adverse effects of Sulfonylureas?

Hypoglycemia, weight gain, hematological effects (like anemia), GI effects, and photosensitivity.

What is the mechanism of action for Thiazolidinediones (e.g., Rosiglitazone)

Enhances insulin receptor sensitivity and stimulates peripheral glucose uptake.