CH 8

When can weight gain occur?

• caloric intake exceeds, caloric expenditure over time

• reduced body metabolism (hypothyroidism)

• abnormal accumulation of body fluids (over 2-3 days) SIGN OF CHF

In what conditions is weight loss a symptom?

• GI

•  endocrine (Diabetes mellitus)

• chronic infection

• cancer

• chronic cardiac

• pulmonary

• renal failure

• depression

• ED

• access to food

What can cause weight loss?

• endocrine disorders

• hyperthyroidism

• adrenal insufficiency

• DM

• chronic infections

• malignancy

• anorexia nervosa

what could be reasons of weight loss due to malnutrition?

• Poverty

• old age

• social isolation

• physical disability

• drug abuse

• emotional or mental impairment

• lack of teeth (need doctor order to change diet)

• ill fitting dentures

• alcoholism

What is anorexia?

loss or lack of appetite for food

• very special when eating

• exercise a lot

What is bulimia nervosa?

eating disorder by recurrent episodes of binge eating followed by compensatory behaviors to prevent weight gain like self-induced vomiting, misuse of laxatives, diuretics, fasting, excessive exercise

What is binge eating disorder

repeated episodes of eating large amounts of food in a short period while feeling loss of control overeating

NO COMPENSATORY BEHAVIOR

What are causes of poor nutrition?

• poor food choices

• inability to cook or poor cooking habits

• inability to access food stores

• lack of financial resources

Who gets a nutrition screening checklist completed?

every patient

who gets dietary intake screening taken?

ONLY outpatient

• CONSIDERED subjective bc its manipulated

IF HOSPITALIZED/@ long term facilities: use patient intake record from facility

What are causes of dehydration?

• exposure to excessive heat

• exercise in heat

• decreased mobility

• inability to drink

• certain medications

• vomiting and/or diarrhea

• burn injuries

• hemorrhage

• pt with diuretics

what are causes of overhydration?

• heart failure

• kidney failure

• liver disease

• increased sodium intake

• excess IV fluid

• pt with HF

• sodium intake

What occurs to HR and BP during dehydration?

HR increases and BP lowers

is water retention due to cardiac or peripheral vascular disease a nutritional problem?

No

What are sign and symptom of nutritional concerns?

• dry, flaky skin

• dry skin with poor turgor

• rough, scaly skin with bumps

• petechiae or ecchymoses

• sore that will no heal

• thinning, dry hair

• spoon-shaped, brittle, or ridged nails

What is the nursing intervention for a pt with ascites?

perform serial abdominal measurements to assess abdominal girth for rate of fluid accumulation

Normal range of prealbumin

15-36 mg/dl

Normal range of albumin

3.4 to 5.4 mg/dl

how should you measure the height of a children younger than 2 years who cannot stand up?

measure them supine on a length measuring board

How should patients be weighted?

at the same time in the morning, on the same scale, and in the same clothing

What are the types of body frame?

small, medium, large

What should you do when assessing for muscular atrophy?

assess extremities bilaterally side by side to compare

What do you assess for skin, hair, and nails?

• check skin for: dryness, flaking, cracking, or sores

• assess skin turgor

• check hair for: texture, thinning, or loss of color

• petechiae and ecchymosis

• check nails for shape and brittleness

what do you assess for HEENT?

• Eyes: dark circles, allergic shiners

• Mucous membranes: dryness, color, intactness; cracking at corners of mouth, enlarged thyroid

What are adventitious sounds?

NOT normal sounds

What is parenthesis?

needle like sensation

What do you inspect for musculoskeletal?

• muscle wasting or flaccidity

• bone pain

• bowing of tibia

What do assess for neurological?

• mental status

• irritability

• inability to concentrate

• paresthesia

What are the four steps to promote optimal weight and nutrition?

1. measure BMI and waist circumference: identify risk 4 overweight/obesity

2. assess dietary intake

3. assess the pt’s motivation to change

4. provide counseling about nutrition and exercise

What are health risks associated with a BMI above 25?

at risk for heart disease, hypertension, high LDL cholesterol, low HDL cholesterol, high triglycerides, high blood glucose, family history of premature heart disease, physical inactivity, smoking

What is the best technique to measuring BMI for individuals older than 75?

Measuring their waist-to-hip ratio

How do you asses dietary intake?

• obtain nutrition history and diet intake record

• analyze pt’s intake record

• use ChooseMyPlate.gov

How do you asses pt’s motivation to change?

• assess readiness to make lifestyle changes that promote weight

• use Prochaska’s model of change

How do you provide counseling about nutrition and exercise?

• USPS Task Force. Final Recommendation Statement: Obesity in Adults: Screening and Management

• U.S. DHHS and U.S. Department of Agriculture: Dietary Guidelines for Americans 2015-2020

• USDA ChooseMyPlate Weight Management

• Exercise at least 2 hours and 30 minutes each week of aerobic physical activity

What is the safe goal weight loss per week?

½ to 2 lb

What are food recommendations for a healthy diet?

• variety of veggies (a lot of color)

• fruits

• grains

• fat-free or low-fat dairy

• variety of protein foods

• oils (monosaturated or unsaturated)

What should you avoid in a healthy diet?

• limit saturated and trans fats

• limit added sugars

• limit sodium

• drink alcoholic beverages in moderation

• maintain moderate physical activity

How can you reduce the risk for developing HTN or lower BP in pt with HTN?

• regular and frequent exercise

• decrease sodium intake

• increase potassium intake

• maintenance of healthy weigh

What happens if the BP cuff is too small (narrow)?

the BP will read high

What occurs if the BP cuff is too large (wide)?

the BP will read low on a small arm and high on a large arm

What dietary changes are recommended for patients with HTN?

• increase foods high in potassium: relax blood vessel walls

• decrease foods high in sodium: retains water

What are foods high in potassium?

Baked white or sweet potatoes, cooked greens Bananas, plantains, many dried fruits, orange juice

What are foods high in sodium?

Canned foods Pretzels, potato chips, pickles, olives Many processed foods (frozen dinners, ketchup, mustard) Batter-fried foods Table salt, including for cooking

What is the range for sodium?

135-145

What is the range for chloride?

95-105

what is the range for BUN?

7-24

what is the range for glucose?

60-110

What is the range for creatinine?

0.7-1.4

What is the range for CO2?

22-28

what is the range for potassium?

3.5-5.1

what is the range for WBC?

4k-10k

What is the range for hemoglobin?

Female: 10-14 and Male:12-16

What is the range for hematocrit?

35-45

What is the range for platelets?

145k-450k