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MEDSURGE
nutrition - EX#2
| Question | Answer |
|---|---|
| At what BMI range is a person considered overweight? | 25.0-->29.9 |
| At what BMI range is a person considered obesity (Class 1)? | 30-->34.9 |
| At what BMI range is a person considered obesity (Class 2)? | 35-->39.9 |
| At what BMI range is a person considered obesity (Class 3)? | Greater than 40 - These patients may be candidates for more aggressive measures such as surgery like bariatrics |
| Formula for BMI? | Weight (kg) / Height (meters)^2 |
| Name the three types of bariatric surgeries? | Restrictive, malabsorptive(not used much anymore), and combination techniques. |
| What is a restrictive bariatric surgery? | Adjustable gastric banding, sleeve gastrectomy and gastric plication |
| What is combination bariatric surgery? | Roux-EN-Y gastric bypass |
| What is an early complication of bariatric surgery? | Anastomosis leak Anastomosis = a cross connection between adjacent channels or tubes. |
| What is a late complication of bariatric surgery? | Band slippage, anemia, vitamin deficiency, acid reflux, dumping syndrome |
| What is a general complication of bariatric surgery? | Infection, DVT, PE |
| Pre-albumin lab data tests for what? | A low value reflects recent and adequate protein intake. This is a better predictor of nutritional status. |
| Albumin lab data tests for what? | Similar to pre-albumin, albumin also reflects nutritional status over time but can be low due to other conditions as well |
| You are doing an assessment on a patient who you suspect has an adequate nutrition. What are some things you would assess to determine this? | Assess for skin breakdown, poor wound healing, weight loss |
| What are some benefits of enteral feeding? | Benefits of the enteral route are that nutrients are metabolized and utilized by the body via the G.I. route better than other rap. It is less expensive. |
| What is a normal BMI | 18.5-24.9 |
| what is an underweight BMI | less than 18.5 |
| what is the definition of bariatrics | the medical specialty that focuses on the causes, prevention and treatment of obesity |
| what are effects of long term obesity | increase of mortality and morbidity, increase hospital length of stay, overall health care cost, |
| what are other health conditions related to obesity | type 2 diabetes, heart disease, high triglycerides, low HDL, Increase cholesterol,HTN, high glucose, airway obstruction, CKD,liver disease, infertility, GERD, cancer |
| what are things that obesity increases the risk of | stoke, sleep apnea, GERD,liver disease, osteoarthritis, CKD, cancer |
| what is energy expenditure | the amount of energy required to maintain vital organ function also known as basal metabolic rate |
| what is satiety | the feeling of being satisfied |
| what is leptin | the hormone produced by fat cells that plays a major role in body weight |
| what are obesogenic environments | environments that cause obesity/ or promote obesity |
| what is the goal of laboratory testing | aimed at the identification of secondary causes and comorbid risk factors --- screening for DM, dyslipidemia, thyroid dysfunction, fatty liver disease, --- fasting blood glucose, A1C, liver function test, TSH, 24 hour urine collection |
| what are diagnostic test | overnight sleep study, RU, transvaginalultrasonography, ECG, --- CT is the prefered imaging |
| what is diet therapy | diet modification, increased physical activity, and behavior therapy |
| when should a medication regimen be implemented | with a BMI greater than 30 |
| what is orlistat | medication- reduces dietary fat absorption- lowers BP less likely of having 2DM SE- gi symptoms liver injury, dark urine, itching, light colored stool jaundice |
| what is lorcaserin | medication- helps to regulate appetite and increase feeling of fullness, SE- HE, dizziness, nausea, fatigue, constipation and dry mouth contraindication in depression, cardiac disease |
| what is phentermine/topiramate | medication- suppresses appetite, SE- altered taste, numbness, tingling, insomnia, dizziness, anxiety |
| what is bupropion | medication- adjunct to diet and exercise with BMI above 30 approved for 12 week use, SE- HA insomnia vomiting dizziness dry mouth- can increase BP |
| what is Liraglutide | medication- the only injectable SE- n/v and increase resting HR- slows gastric emptying |
| what is phendimetrazine | medication- decreases appetite- caution in pts. with hypertension, contraindicated for cardio disease hyperthyroidism arrhythmias insomnia and glaucoma |
| what is the action of an adjustable gastric banding | the placement of a silicone band around the fundus of the stomach causing a restriction in the amount of food intake |
| what is the action of a sleeve gastrectomy | the greater curvature of the stomach is removed creating a smaller like tube |
| what is the action of a gastric plication | involves the infolding of the greater curvature of the stomach |
| what are malabsorptive procedures | jejunoileal bypass, biliopancreatic diversion |
| what is the action of a jejunoileal bypass | surgical connection of the jejunum and the ileum bypassing a large portion of the small intestine |
| what is the action of a biliopancreatic diversion | bypassing of the majority of the small intestine and the removal of a large portion of the stomach |
| what is the action of a Roux-en-y | involves the creation of a restrictive 30 ml gastric pouch and bypass of a portion of the small intestine cause mild malabsorption |
| who should receive a low sodium diet | pt with heart failure |
| what types of foods are appropriate for a low sodium diet | fruits, vegies, grain, healthy fat, fresh beef |
| what types of food are restricted in a low sodium diet | smoked, salted and canned meats/ fish/poultry. salt marinades/condiments, processed or canned foods |
| who should be on a low protein diet | people with kidney disease |
| what types of foods are allowed with a low protein diet | bread, rice, fresh fruits/veggies |
| what foods are not allowed in a low protein diet | meant/fish dairy cheeses eggs, beans soy and tofu hummus nuts and seeds |
| who should be on a diabetic diet | diabetics |
| what is not allowed in a diabetic diet | highly processed cars/ foods with added sugar white bread/rice |
| what foods are allowed in a diabetic diet | fruits and veggies, low fat milk whole wheat and flour |
| who should be on a clear of full liquid diet | post medical procedures, digestive problems, difficulty swallowing |
| what is allowed on a clear liquid diet | black coffee, apple juice anything you can see through |
| what is allowed on a full liquid diet | clear liquid diet plus dairy, fruits, popsicles |
| what should a person on a clear/full liquid diet not have | red, orange, and purple - this may discolor secretions |
| who are people on pureed/ soft diets | head/neck/ stomach surgeries, recent oral surgery, dysphagia |
| what types of foods are allowed on a pureed/soft diet | most anything soft/ cooked veggies/ cooked and softened meats |
| what is not allowed in a pureed/ soft diet | raw fruits/ veggies, hard cheese, tough meats, nuts, crusty bread, spicy foods, caffeine |
| who is on a low fiber diet | crohns disease, diverticulitis, IBS, ulcerative colitis, recent bowel surgery |
| what is allowed in a low fiber diet | little/ no pulp, juices, refined cereal, tofu, fish, stew, plain pasta tender veggies |
| what is not allowed in a low fiber diet | raw vegs/fruits, whole grain, dried fruits, deli meats, spicy foods brown rice/oats |
| Enteral Feedings- route? who? | tube feedings- {routes} nasogastric,nasoduodenal,nasojejunal,percutaneous, {who} pts who cant eat/swallow but have a functional Gi tract |
| risk and benefits to Enteral feedings | Risk- diarrhea/constipation/ aspiration/tube clogging/refeeding syndrome/ electrolyte shift benefit- nutrients are metabolized better- less expensive |
| nursing considerations with Enteral feedings | continuous,cyclic,bolus --keep feedings at room temp chang tubing Q24H- check blood sugar Q6H |
| Parenteral feedings- who? | total or supplemental nutrition IV- pts who cannot get nutrition via oral/enteral route for 4-5 days/ intestinal failure |
| risk/benefits for parenteral feedings | risk- phlebitis thrombosis, pain if infused to fast, contamination, infection sepsis, electrolyte imbalance/ overfeeding benefit- major macronutrients and electrolytes |
| nursing considerations for parenteral feedings | short term therapy- central vein/PICC line, portacath/ more complete nutrition- patient education |
| what are risk for malnutrition | NPO for 72 hours, clear/full liquid diet, problems with chewing/swallowing, drug/alcohol use, low serum albumin |
| function of vit a | fat soluble, healthy teeth, skeletal soft tissue, mucus membranes, skin vision{retinol} breast feeding |
| deficiency in vit a | night blindness |
| source of vit a | animal liver, whole milk, fortified food, egg,cold liver,oil orange and yellow fruits/vegy, broccoli, spinach and leafy greens |
| function of b1-thiamine | carb metabolism and neurotransmitters, helps to protect brain cells |
| deficiency in b1 | poor memory, irritability,sleep probs, lower extremity paresthesia, muscle cramps/atropy,fatigue, n/v, most common w/ alcohol abuse and bariatric surgery |
| source of b1 | whole grain,bread,cereal, fasta,flour, wheat germ beef steak, pork, egg, legumes, peas, nuts seeds- can be given in a banana bag |
| function of b12 | nerve/blood cells used to make DNA |
| deficiency of b12 | weakness, fatigue, SOB, common w/ poor absorption acid reducing meds, alcoholics and vegans |
| source b12 | animal protein, meat, milk, cheese, egg |
| function of vit c | healthy skin, scar tissue, blood vessel, bones, cartilage |
| deficiency of vit c | fatigue, depression, anemia, gingivitis, petechiae, rash, bleeding,edema, impaired wound, spoon shaped nail, bruising, low immune system weight gain, scurvy, alcohol/drug abuse anorexia |
| source of vit c | oranges lemons strawberries blackberries guava kiwi papayas tomatoes bell peppers carrots potatoes cabbage spinach paprika liver oysters |
| function of vit d | strong bones |
| deficiency of vit d | bone/ muscle pain, rickets, poor intake lack of sun exposure |
| source of vit d | sun, fish, liver egg, dairy, grain |
| function of k+ | helps blood clot |
| deficiency in k+ | muscle cramping, abnormal heart rhythms |
| source of k+ | your Os and watermelon, spinach, beets, squash, mushrooms and white beans |
| function of iron | blood production |
| deficiency of iron | extreme fatigue, weakness, chest pain, fast HR SOB pale skin |
| source of iron | clams, organ meets, enriched bread/cereal, egg yolk, broccoli, raisin |
| function of protein | manufacturing other proteins, tissue growth and repair, component of blood and muscle |
| deficiency of protein | kwashiorkor, marasmus, stunted growth,cognition decreased healing, excess intake, obesity, chronic illness |
| source of protein | meat poultry fish eggs dairy |
| function of carbs | calories for energy, protein building, glucose |
| deficiency in carbs | alters cell metabolism, uses protein as fuel which gives less energy, shift to using ketones |
| source of carb | bread, bean, sweet pot. rice, past oatmeal banana sugars and starch |
| function of fats | integrity of phospholipid membranes |
| deficiency in fats | impaired neuro function |
| source of fats | fish nuts seeds and oil |
Created by:
bolenrocks
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