NUR 209 Exam II Review.
Exam II Review
Nutrition
*Need nutrition for cell growth, development, regulation, metabolism, bodily functions, etc.
*Important electrolytes include: sodium, potassium, magnesium, calcium, and phosphorus.
*Medication needs PROTEIN to bind to in order to be distributed throughout the body, or else
too much of a free drug will cause toxicity.
Assessment (Functional Health Pattern: Nutrition)
I. Subjective
A. Determine Normal Eating Pattern
⟶ 24-Hour Recall: What has the patient eaten in the last twenty-four hours? Is
that typical of what they eat on a day-to-day basis?
⟶ Food Diary: A three or seven day diary of what is eaten daily. Nutrients and
calories can then be calculated. Are they getting adequate nutrients, protein,
carbs, fiber? Based on these findings, you can determine the patient’s risk and
impacts on ADL’s.
B. Determine Risk
C. Impacts on ADL’s
II. Objective
A. Physical Assessment
1. General Observations
2. Measurements (BMI, waist circumference)
3. Intake & Output
4. Calorie Count (Tracks food intake for 3 days to measure nutrient intake)
5. Mouth Inspection (Check for thrush, stomatitis, open sores, dentures, etc.)
6. Swallowing Evaluation
a. Palpation of jaw and muscles of mastication (Cranial Nerve 5)
b. Swallowing and gag reflex (Cranial Nerves 9 & 10)
c. Cough
Factors Affecting Nutrition and Metabolism
1. Intake of Nutrients
o Physical/Mental Barriers
o Levels of Consciousness
o Knowledge Deficit
o Finances
o Dysphasia
2. Ability to Use Ingested Nutrients
o Allergies (Histamine)
o Hypersensitivity/Intolerance
o Inflammatory conditions such as colitis, gastritis, esophagitis
3. Metabolic Demand
o Sick individuals require a greater number of calories
,Significant Weight Gain/Loss
o 5% of baseline in 1 month without trying
o 10% of baseline in 6 months without trying
Signs of Malnourishment
Skin: dry, flaking, cracking,
scaly Hair: dull, dry, sparse
Eyes: dry, pale, red
Mouth: cracking lips and sides of mouth, dry, beefy red tongue, bleeding gums
Musculoskeletal: poor posture, muscle/joint pain, muscle atrophy, distended abdomen
Neurologic: irritability, disorientation, lethargy, hyporeflexia, peripheral neuropathies
Intake and Output
⟶ 2,000 mL daily is ideal
⟶ Urine output should be around 1,500 mL daily
⟶ Total values are not going to balance completely but should be < 500 mL difference
⟶ A difference greater than 500 mL must be investigated
⟶ Insensible losses include sweating (diaphoresis), vomiting, fecal matter, respirations, etc
Diagnostic Tests & Procedures
*1. Hematocrit and Hemoglobin: RBC’s and oxygen-carrying blood cells
*2. Serum Albumin and Prealbumin: Protein
*3. Serum Transferrin: Iron
*4. Creatinine Excretion: Urine test for kidney function
*5. Immunocompetence Testing: Allergies
*6. Blood Glucose:
7. Cholesterol: Low is ideal (HDL is good while LDL is bad)
8. Triglycerides: Low is ideal
*9. Hemoglobin A1C: Measure of glucose over 90 days (Ideal is below 6)
Interventions
Healthy Diet Education
Withholding Food (Ex: NPO before surgery, after surgery,
vomiting) Special Hospital Diets
Nutritional Supplements
Enteral Feedings (Non-sterile feeding tube)
Parenteral Nutrition (Sterile feeding through IV)
Diet Progression
Liquid Diets
⟶ Clear: Translucent liquids
⟶ Full: Foods that are liquid at room temperature
Soft Diets
⟶ Pureed: Blended
⟶ Mechanical Soft: Mashed with a fork
, ⟶ Low Residue/Fiber: Typically for GI patients (Monitor for constipation)
Regular Diets
⟶ High Fiber
⟶ Regular: No restrictions
Restrictive Therapeutic Diets
Bland: Spices and seasoning removed, typically for inflammatory conditions
Low-Cholesterol: Cardiac diets
Sodium-restricted: Cardiac diets (Low is 2 grams)
Gluten free: Intolerance
Lactose free: Intolerance
High fiber: Increases bowel function
Dysphagia Diet
Levels of solid textured and thickened liquids when swallowing is impaired (CVA stroke
patients)
Solid Textures/Thickened Liquids
⟶ Pureed/Spoon-thick
⟶ Mechanical Soft/Nectar-like
⟶ Advanced/Thin (Dangerous for dysphagia patients)
Lifespan Considerations for the Older Adult
o Decreased calories
o Decreased metabolism
o Decreased activity
o Calcium deficiency
o Demand for vitamins and minerals
o Fiber
*The recommended daily dietary allowances (caloric demand) decreases with age because
physical activity decreases.
Intravenous Therapy
Infusion of Fluid into a Vein
Purpose
o Maintenance of replacement of fluids
o Electrolytes
o Glucose and Nutrients
o Medication administration
o Blood product administration
o Venous access for emergencies
Solutions
1. Crystalloids (Clear)
Exam II Review
Nutrition
*Need nutrition for cell growth, development, regulation, metabolism, bodily functions, etc.
*Important electrolytes include: sodium, potassium, magnesium, calcium, and phosphorus.
*Medication needs PROTEIN to bind to in order to be distributed throughout the body, or else
too much of a free drug will cause toxicity.
Assessment (Functional Health Pattern: Nutrition)
I. Subjective
A. Determine Normal Eating Pattern
⟶ 24-Hour Recall: What has the patient eaten in the last twenty-four hours? Is
that typical of what they eat on a day-to-day basis?
⟶ Food Diary: A three or seven day diary of what is eaten daily. Nutrients and
calories can then be calculated. Are they getting adequate nutrients, protein,
carbs, fiber? Based on these findings, you can determine the patient’s risk and
impacts on ADL’s.
B. Determine Risk
C. Impacts on ADL’s
II. Objective
A. Physical Assessment
1. General Observations
2. Measurements (BMI, waist circumference)
3. Intake & Output
4. Calorie Count (Tracks food intake for 3 days to measure nutrient intake)
5. Mouth Inspection (Check for thrush, stomatitis, open sores, dentures, etc.)
6. Swallowing Evaluation
a. Palpation of jaw and muscles of mastication (Cranial Nerve 5)
b. Swallowing and gag reflex (Cranial Nerves 9 & 10)
c. Cough
Factors Affecting Nutrition and Metabolism
1. Intake of Nutrients
o Physical/Mental Barriers
o Levels of Consciousness
o Knowledge Deficit
o Finances
o Dysphasia
2. Ability to Use Ingested Nutrients
o Allergies (Histamine)
o Hypersensitivity/Intolerance
o Inflammatory conditions such as colitis, gastritis, esophagitis
3. Metabolic Demand
o Sick individuals require a greater number of calories
,Significant Weight Gain/Loss
o 5% of baseline in 1 month without trying
o 10% of baseline in 6 months without trying
Signs of Malnourishment
Skin: dry, flaking, cracking,
scaly Hair: dull, dry, sparse
Eyes: dry, pale, red
Mouth: cracking lips and sides of mouth, dry, beefy red tongue, bleeding gums
Musculoskeletal: poor posture, muscle/joint pain, muscle atrophy, distended abdomen
Neurologic: irritability, disorientation, lethargy, hyporeflexia, peripheral neuropathies
Intake and Output
⟶ 2,000 mL daily is ideal
⟶ Urine output should be around 1,500 mL daily
⟶ Total values are not going to balance completely but should be < 500 mL difference
⟶ A difference greater than 500 mL must be investigated
⟶ Insensible losses include sweating (diaphoresis), vomiting, fecal matter, respirations, etc
Diagnostic Tests & Procedures
*1. Hematocrit and Hemoglobin: RBC’s and oxygen-carrying blood cells
*2. Serum Albumin and Prealbumin: Protein
*3. Serum Transferrin: Iron
*4. Creatinine Excretion: Urine test for kidney function
*5. Immunocompetence Testing: Allergies
*6. Blood Glucose:
7. Cholesterol: Low is ideal (HDL is good while LDL is bad)
8. Triglycerides: Low is ideal
*9. Hemoglobin A1C: Measure of glucose over 90 days (Ideal is below 6)
Interventions
Healthy Diet Education
Withholding Food (Ex: NPO before surgery, after surgery,
vomiting) Special Hospital Diets
Nutritional Supplements
Enteral Feedings (Non-sterile feeding tube)
Parenteral Nutrition (Sterile feeding through IV)
Diet Progression
Liquid Diets
⟶ Clear: Translucent liquids
⟶ Full: Foods that are liquid at room temperature
Soft Diets
⟶ Pureed: Blended
⟶ Mechanical Soft: Mashed with a fork
, ⟶ Low Residue/Fiber: Typically for GI patients (Monitor for constipation)
Regular Diets
⟶ High Fiber
⟶ Regular: No restrictions
Restrictive Therapeutic Diets
Bland: Spices and seasoning removed, typically for inflammatory conditions
Low-Cholesterol: Cardiac diets
Sodium-restricted: Cardiac diets (Low is 2 grams)
Gluten free: Intolerance
Lactose free: Intolerance
High fiber: Increases bowel function
Dysphagia Diet
Levels of solid textured and thickened liquids when swallowing is impaired (CVA stroke
patients)
Solid Textures/Thickened Liquids
⟶ Pureed/Spoon-thick
⟶ Mechanical Soft/Nectar-like
⟶ Advanced/Thin (Dangerous for dysphagia patients)
Lifespan Considerations for the Older Adult
o Decreased calories
o Decreased metabolism
o Decreased activity
o Calcium deficiency
o Demand for vitamins and minerals
o Fiber
*The recommended daily dietary allowances (caloric demand) decreases with age because
physical activity decreases.
Intravenous Therapy
Infusion of Fluid into a Vein
Purpose
o Maintenance of replacement of fluids
o Electrolytes
o Glucose and Nutrients
o Medication administration
o Blood product administration
o Venous access for emergencies
Solutions
1. Crystalloids (Clear)
