2500: Exam 2 Nutrition + Elimination/ Hydration

Nutrition

sum of interactions between an organism and the food it consumes.

Metabolism

sum of biochemical and physiological processes by which an organism grows & maintains itself, breaks down & reforms tissues, and produces heat.

Essential nutrients

nutrients which are essential for bodily function but must be consumed as part of the dietary intake. (can't make them)

macronutrients

Carbohydrates, fats, and proteins
Make up most of our dietary intake
Too many macronutrients compared to physical activity leads to weight gain and increases risk of obesity, diabetes, cardiovascular disease, kidney disease, and other chronic illness.
Too few macronutrients compared to physical activity leads to weight loss and can contribute to malnutrition and nutritional deficits.

carbohydrates

sugars and starches that serve as an important energy source for the body, providing about 4kcal/g of energy.

Simple Carbohydrates (also called monosaccharides or disaccharides) are small molecules that are easily broken down and absorbed which can result in rapid increase in blood glucose.
Examples are sugar, honey, fruit juice.

Complex Carbohydrates (polysaccharides) are larger molecules that are broken down more slowly, causing a slower, steadier increase in blood sugar over time.
Examples are whole grains, beans, and vegetables.

proteins

peptides and amino acids that provide energy of 4kcal/g.
Proteins are necessary for growth, tissue maintenance and repair, fluid balance, blood clotting, and white blood cell production.

Complete proteins contain all the amino acids necessary for the body to maintain function.
Examples are animal proteins (meat, fish, eggs, dairy), quinoa, and soy.

Incomplete proteins contain some but not all of the amino acids necessary to maintain life. (have to mix them to get all AA)
Examples are legumes, seeds, and grains.

fats

consist of fatty acids and glycerol and provide 9 kcal/g of energy. (high energy source)
Fats are necessary for tissue growth, insulation, hormone production, energy storage, and brain function.

Saturated Fats

come from animal products and are solid at room temperature—butter, lard, the visible fat in red meat

Unsaturated Fats

ome largely from plant products (canola oil, avocado, nuts, seeds) although chicken and fish also contain some unsaturated fat.

Polyunsaturated Fats

fats that are high in omega-3 fatty acids and help lower LDL cholesterol levels.

Trans Fats

are fats that have been transformed through a hydrogenation process to keep them solid at room temperature and give a longer shelf-life.
Trans fats lower HDL cholesterol levels and raise HDL cholesterol levels, raising risk of heart disease. (BAD)

water soluble vitamins

dissolve in water are easily excreted by the body (vitamin C, the B-complex vitamins.)

Fat-soluble vitamins

dissolve in fat and are easily retained by the body (vitamin A, D, E, and K.)

Vitamin Deficiencies

caused by poor dietary intake, malabsorption issues in the GI tract, drug and alcohol use, and the use of proton-pump inhibitor medications (which are used to treat reflux and GERD.)

Vitamin Toxicity

caused by overconsumption of a vitamin. Fat-soluble vitamins are at much higher risk of this as they take longer to excrete.

Macrominerals

essential minerals we need in large amounts and include potassium, sodium, calcium, magnesium, chloride, and phosphorous.

Trace minerals

minerals we need in small amounts and include zinc, iron, chromium, copper, fluorine, iodine, manganese, molybdenum, and selenium.

Mineral deficiencies

can occur with malabsorption, malnutrition, or certain medications

Mineral Toxicity

can occur with overconsumption of a mineral or with excessive exposure to an outside source of that mineral.

Factors that Influence Nutrition/Metabolism

Age
Gender
Activity Level
Culture
Religion
Socio-Economic Status
Illness/Health/Surgery
Personal Factors/Preferences
Medications/Drugs

aspirate

At its root, aspirate means “to breathe something in.”
Can also mean to withdraw something
Medically, this may refer to withdrawing something from the body via suction--- “I aspirated 300 ml from his feeding tube.”
It can also mean---to breathe something in. If someone inhales food or fluid into their lungs, it is also referred to as aspiration and can present a significant medical risk of infection, pneumonia, and even death.

dysphagia

Difficulty swallowing

Anorexia

loss of appetite

weight change

Gain or loss of 0.5 to 1 lb per week or <5% of total body weight lost over 6 months is realistic.
Weight loss more rapid than this is considered significant.
Weight gain or loss of over 1 kg in 24 hours or >10% of total body weight over 6 months is considered a significant weight change.
Rapid changes in weight are often a result of fluid balance rather than nutrition.
Rapid or extreme weight changes should always be investigated, even more so if they are unintentional.
To calculate % of body weight change, divide weight change in lbs by original body weight and multiply the result by 100 to obtain the % change.

BMI

Weight in kg divided by height in meters squared

hyperthyroidism

LOW TSH which can lead to weight loss

hypothyroidism

HIGH TSH which can lead to weight gain.

HDL (High-Density Lipoproteins):

“Good Cholesterol”—should be 40 mg/dL or higher.

LDL (Low-Density Lipoproteins)

“Bad Cholesterol”---should be100 mg/dL or lower.

American diabetic association (ADA) diet

Diet ordered to control blood sugar. Will include a calorie count---i.e. 1500 calorie ADA diet. Used to control diabetes.

No Added Salt (NAS) diet

No salt will be added to and sprinkled on the prepared food. Hypertension, heart disease, kidney disease, edema.

Sodium Restricted diet

Nutritionist will design and dietary will provide a meal plan that does not exceed the amount of sodium ordered (i.e.-2 gram NA+).
Hypertension, heart disease, kidney disease, edema.

mechanical soft

Chopped, diced, blended, pureed foods to ease swallowing. Used in dysphagia.

Pureed Diet

All foods are pureed in a blender. Used in dysphagia.

Clear Liquid:

Only liquids that can be seen through. Often used prior to surgery and after GI surgeries.

Full Liquid

Any liquid or food that turns to liquid at room temperature (such as ice cream.) Often used prior to surgery or after GI surgeries.

Renal Diet

Restricts sodium, potassium, and phosphorous to reduce renal waste products in patients with renal disease. Avoid foods high in sodium (salt, canned foods, some frozen foods, soy sauce, etc), potassium (bananas, peanuts, orange juice), and phosphorous (meats, dairy, seeds, nuts.)

Regular/General Diet

all food allowed

Advance Diet as Tolerated

Advance the diet in stages towards a regular or general diet provided the patient tolerates the current diet without difficulty.

Enteral nutrition

tube feeding, is when a tube is passed into the patient’s GI tract to allow the transmission of nutrients without the need for chewing or swallowing.

Nasogastric (NG) Tube:

tube is passed through the patient’s nare into the esophagus, and then into the stomach. Usually used when feeding is anticipated to be a temporary intervention.

Orogastric (OG) Tube

The tube is passed through the mouth and into the stomach. Usually used with intubated/sedated patients.

Percutaneous Endoscopic Gastronomy (PEG) Tubes

Tube is passed through the abdominal wall directly into the stomach. Used when enteral nutrition is expected to be long term, or if esophagus is obstructed or absent.

Percutaneous Endoscopic Jejunostomy (PEJ) Tubes

Tube is passed through the abdominal wall and directly into the jejunum. Generally used if stomach is compromised or absent.

after feeding tube is placed then ...

correct placement is verified by X-Ray imaging.

Check tube placement each time before anything is placed through the tube (nutrition, water, or medication.)

check every 4 hours

Parenteral nutrition

nutrients are administered intravenously.
Parenteral nutrition will generally be administered through a central venous linewhich are larger, deeper intravenous catheters inserted for longer term use than peripheral IVs.
Parenteral nutrition will include all necessary nutrients (except fiber). It is sometimes referred to as Total Parenteral Nutrition (TPN) or hyperalimentation (Hyperal.)
While receiving parenteral nutrition, careful attention must be paid to lab values for signs of nutrient excess.

Mr. Jones has a diagnosis of impaired nutrition: less than body requirements due to poor dentition and report of tooth pain impairing his ability to chew. Which of the following is the most appropriate nursing intervention?

A) Provide soft foods that are easier to chew.
B) Medicate for pain 30 minutes prior to meals.
C) Contact his provider and request a dental consult.
D) Empathize with his pain but tell him that nutrition is an important part of his recovery.

C

Mr. Thompson is receiving enteral feedings via a nasogastric tube. Prior to providing the supplement via the NG tube, you would: Choose the most appropriate answer.

A) Aspirate from the NG tube to ensure you receive gastric contents.
B) Push a bolus of air through the NG tube while auscultating his abdomen to ensure you hear the air pass through.
C) Measure the external tube length compared to the placement verification X-Ray.
D) Reassure Mr. Thompson that the enteral feedings are temporary and he should be back to eating solid food soon.

C

Your patient, Terra T. has a BMI of 17.9. What weight category
does this place her in?

 A) Normal Weight
 B) Underweight
 C) Overweight
 D) Obese

B

Which of the following would verify the location of a feeding
tube?

 A) Pushing a bolus of air through the tube and auscultating the
abdomen to hear it pass.
 B) Aspirating gastric contents from the tube with a large bore
syringe.
 C) Comparing the measurement of the external tube against the
measurement documented in the confirmation x-ray.
 D) Ascertaining I&O from the previous shift to ensure it has been
balanced.

C

You are caring for Ken P., a 62 year old male admitted with an
acute exacerbation of congestive heart failure and a nursing
diagnosis of excess fluid volume. Which of the below findings
most strongly suggests a change in fluid volume?

 A) 8 hour intake and output of 1120 ml of fluid in, 970 ml of fluid
out.
 B) Weight gain of 3 kg in 24 hours.
 C) Urine outpatient of 1000 ml of cloudy yellow urine over 8 hours.
 D) Being placed on NPO status by medical order.

B

Your patient Mrs. D. Hydration III has a nursing diagnosis of fluid
volume deficit related to excessive diaphoresis with inadequate fluid
intake after being seen in the emergency room due to becoming
dizzy and light headed while working outside. Which of the following
are appropriate outcome measures? Select all that apply.

 A) Patient will have urine output of clear yellow urine of 30 ml per
hour or greater over the next 8 hours
 B) Patient will correctly verbalize importance of maintaining
hydration while working outside in hot conditions within 2 hours
 C) Patient will drink at least 1000 ml of water over the next 8 hours.
 D) IV will remain patent to infusion.

A, B, C

While assessing your patient, Dahlia D., you have diagnosed her
with stress urinary incontinence. Which of the following are
appropriate interventions? Select all that apply.

 A) Assist patient in developing voiding schedule.
 B) Educate patient in use of sanitary products to assist in
management of episodes of incontinence.
 C) Teach Kegel exercises.
 D) Insert indwelling catheter.

A, B, C

Your patient, Belinda M., has a nursing diagnosis of diarrhea
related to infection as evidenced by passing 7 watery stools in the past 24 hours. Which of the following are appropriate nursing interventions? Select all that apply.

 A)Encourage PO fluid intake.
 B) Educate regarding fluid and fiber intake to maintain bowel
regularity.
 C) Offer high fiber foods.
 D) Administer enema to remove infective agent.

ABC

Which of the following finding would be the most important to notify the medical provider about immediately?
A) BP of 134/86 in a 46 year old male.
B) Lab report showing hemoglobin of 11.7 g/dl in a 24 year old female.
C) Lab report showing NA+ of 151 mEq/l
D) Apical Pulse of 101.

c

Mr. Thomas was admitted with intractable nausea and vomiting x 3 days. He started on 0.9% normal saline at a rate of 150 ml/hour and his diet status is NPO (nothing by mouth). He has vomited twice into an emesis basin this shift. The first time the volume was 50 ml and the second time it was 30 ml. He has also voided 300 ml of dark yellow urine. What is Mr. Thompson’s I&O after 8 hours?
A) Intake is 820 ml, output is 380 ml
B) Intake is 1200 ml, output is 420 ml
C) Intake is 1200 ml, output is 380 ml
D) None of the above.

c

You are caring for Mr. Arnold who is recovering from surgery. He currently has an indwelling catheter. Which of the following would be the most important finding to communicate to is provider?
A) The catheter had a kink in it which you straightened out and is now draining freely.
B) The drainage bag is full of clear, bright yellow urine.
C) Mr. Arnold states he does not like the catheter and wishes it could be removed.
D) Over the first 8 hours of your shift, Mr. Arnold’s urine output via catheter has been 190 ml.

d

Which of the following findings during the nursing history would most raise concerns about stress incontinence?
A) The patient reports that they have unintentionally urinated on themselves in the past while intoxicated.
B) An elderly patient reports his arthritis makes it difficult for him to unzip his pants “so I sometimes end up making a mess of my clothes.” (functional)
C) A patient reports that she avoids watching comedies with others because she sometimes leaks urine while she laughs.
D) A patient reports burning on urination. (suspicions for UTI)

c

On assessment, you find that Judy G, a 36 year old female presenting to your outpatient clinic, has hyperactive bowel sounds in all 4 quadrants, reports having 4 watery stools yesterday and 2 watery stools “so far” today accompanied by abdominal cramping and bowel urgency, and takes laxatives daily due to a history of severe constipation. Which of the following is the most appropriate nursing diagnosis?
A) Laxative Abuse Disorder AEB daily laxative use.
B) Overuse of laxatives r/t history of constipation AEB 4 loose, watery stools yesterday, 2 today, and abdominal cramping with bowel urgency.
C) Diarrhea r/t laxative overuse AEB 4 loose watery stools yesterday, 2 “so far” today (0900 hours), hyperactive bowel sounds, bowel urgency, and abdominal cramping.
D) None of the above. Diarrhea is a medical diagnosis. (wrong)

c