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Chapter Review for Test 5

1. What are 9 typical points assessed on a nutrition assessment? Weight, height, weight changes Diet Albumin, hematocrit Appetite Nausea, vomiting Bowel movements Chewing & swallowing problems Medical diagnosis Food allergies 2. Define carbohydrates, proteins, fats. a. What are the sources of each? b. Where is each one metabolized? c. Give examples of saturated and unsaturated fats. Carbohydrates- composed of C, H and O >Simple sugars water soluble, produced by plants and animals Monosaccharadises glucose, fructose, galactose Disaccharides lactose (fructose + galactose), molasses, table sugar, corn syrup >Complex starch (non-soluble, nonsweet) - polysaccharides grains, legumes, veggies Fiber cannot be digested, outer layer of grains, bran, pulp, veggie skin, seeds, a. Ptyalin salivary amylase, pancreatic amylase, disaccharidases maltase, sucrose, lactase metabolized in mouth and absorbed in small intestine Proteins amino acids, organic molecules made up of carbon, hydrogen, oxygen & nitrogen - Essential- cannot be produced by body, used for tissue growth and maintenance - Non-essential-can be produced by body - Complete (meats, eggs), partially complete (gelatin, casein)& incomplete (corn+beans) Digestion in stomach, absorbed in small intestine, metabolized by liver, excreted by kidneys (BUN). Lipids- organic substances insoluble in water, but soluble in alcohol and ether, C, H & O. Fats solid at room temperature; Oils liquid at room temperature Digestion duodenum, jejunum with bile, absorbed in small intestine, metabolized by bile salts, excreted in stool Saturated butter, animal products, cheese, whole milk, ice cream, cream, coconut and palm oil, fatty meats Unsaturated olive oil, lowers LDL, raises HDL 3. Know the function of vitamins. Organic compounds, facilitate cell reactions, coenzymes, help energy metabolism, catalyze metabolic processes, protect against free radicals, subject to oxidation. a. What are examples of water soluble vitamins? B1 thiamine, B2 riboflavin, B3 niacin (nicotinic acid), B6 pyridoxine, B9 folic acid, B12 cobalamine, pantothenic acid, and biotin; C b. What are examples of fat soluble vitamins? A,D, E & K

Vitamin A essential for bones, teeth, vision, immune function, mucosal epithelium growth Vitamin D GI absorption of calcium, release and absorption from bones Vitamin E antioxidant, protects cell membranes Vitamin K synthesizes clotting proteins. Helps regulate blood calcium. Vitamins B coenzymes in energy metabolism, DNA synthesis, nerve cell function Vitamin C collagen synthesis, promotes Fe absorption, healthy immune system 4. Teach a client about Vitamin K and the role it plays in Coumadin therapy. Vitamin K synthesizes clotting proteins. Deficiency of vitamin K causes bleeding. Its antidote for Coumadin therapy. 5. Describe 7 major problems associated with nutrition and older people. Oral & GI changes Dentition problems Decreased HCl secretion Malabsorption Altered glucose tolerance Altered renal function Polypharmacy 6. Know which therapeutic diets would be used for renal disease, cardiac disease and diabetes. Diabetic consistent carbohydrate diet Renal disease - potassium modified diet Cardiac disease low sodium diet & low-fat diet 7. Apply the nursing process to a client receiving enteric feedings. Nursing Diagnoses Fluid volume deficit Fluid volume overload Electrolyte imbalance Acid base imbalance Infection, Risk for Nutrition, Imbalanced: Less than Body Requirements Fluid Volume, Imbalanced, Risk for Knowledge, Deficient, related to drug therapy Injury, Risk for 8. What are the main concerns of the nurse when caring for a client on parenteral nutrition therapy? Inserted through the central vein catheter into superior vena cava or subclavian vein Use strict aseptic technique with IV tubing, dressing changes, and TPN solution, and refrigerate solution until 30 min before using. (Infusion site is at high risk for development of infection.) Maintain accurate infusion rate with infusion pump, make rate changes gradually, and never discontinue TPN abruptly. (Abrupt discontinuation may cause hypoglycemia, and a sudden change in flow rate can cause fluctuations in blood glucose levels.)

Monitor for signs of fluid overload. (TPN is a hypertonic solution and can create intravascular shifting of extracellular fluid.) i.e. shortness of breath, heart palpitations, swelling, or decreased urine output. Monitor blood glucose levels. Observe for signs of hyperglycemia or hypoglycemia and administer insulin as directed. Hyperglycemia (excessive thirst, copious urination, and insatiable hunger). Hypoglycemia (nervousness, irritability, and dizziness).

Death and Spirituality

1. What is spiritual well-being and spiritual distress? Well-being: generally alive, purposeful, and fulfilled - Meaning (having purpose, sense of life) - Value (cherished beliefs and standards) - Transcendence (appreciating dimension beyond self) - Connecting (relating to others, nature, Ultimate other) - Becoming (reflection of who one is) Distress: Hopelessness, anger, feeling abandoned. Its challenge to spiritual well-being or to the belief system that provides strength, hope, and meaning to life - Lack of hope, purpose in life, forgiveness to oneself - Feeling abandoned - Refuses interaction with family & friends - Sudden changes in spiritual practices - Request to see religious leader - No interest in nature, or literature 2. What are nursing goals for addressing spiritual distress? Understand the actual or potential problem. Mobilize spiritual resources. Remain objective. Learn role of culture in belief system. Know personal limitations. Document the spiritual care plan. 3. Recognize appropriate nursing diagnoses for spirituality. Spiritual Distress Readiness for enhanced spiritual well-being Risk for spiritual distress Impaired religiosity Risk for impaired religiosity Readiness for enhanced religiosity Health Promotion, Health and Illness 1. What is the difference between acute and chronic illness? Acute Illness severe, short, sudden, resolves quickly, with or without medical care

Chronic illness 6 months or longer, slow onset, remission, exacerbation

2. What are the four main homeostatic mechanisms? Self-regulating Compensatory Regulated by negative feedback inhibits change Several feedback mechanisms- positive feedback stimulates change 3. What is the purpose of Healthy People 2010 and how does it apply to nursing? First presented in 2000 later revised. US Dept. of Health and Human Services recommendations for improving health and preventing disease. Aligns personal health with community health. Emphasizes health promotion. Healthy People 2010 presents a comprehensive 10-year strategy for promoting health and preventing illness of individuals and communities. 2 major goals: - increase the quality and year of healthy life: population aging - Eliminate health disparities: diversity of population 4. Describe the differences between health promotion and illness prevention. Health promotion any activity undertaken for the purpose of achieving a higher level of health and wellbeing, behavior towards developing well-being (exercise, healthy diet, Illness prevention behavior towards preventing illness, detecting it early, maintaining function (regular doctors checkups, immunization) 5. Identify the stages of health behavior change. Precontemplation Stage person denies the problem Contemplation Stage want to change but have a resistance to change Preparation Stage planning to make final plans to accomplish the change Action Stage actively implements desired behavior Maintenance Stage person made the change and behavioral changes Termination Stage ultimate confidence that there is longer temptation to previous behavior

6. Know the five dimensions of wellness. Internal Variables Biologic genetics, gender, age, developmental level Psychologic mind body interactions, self-concept Cognitive lifestyle, spiritual and religious beliefs External Variables Environment geographic location, pollution Standards of Living occupation, income, education Family and Culture family patterns, cultural perceptions Social Support family, friends a. Physical ability to do things, achieve fitness, maintain adequate nutrition, proper body fat, avoid drugs, alcohol, smoking b. Social ability to interact successfully with people c. Emotional ability to manage stress and express emotions appropriately

d. e. f. g.

Intellectual ability to learn and use information for personal and career development Spiritual belief in force nature, power, god that serves to unite human beings Occupational balance between work and leisure Environmental ability to promote health measures to improve quality of life in community