Nursing 220: Exam 2 Study Guide

• Nursing 220: Exam 2 Study Guide

Basal Metabolic Rate (BMR)

• BMR is the rate at which a person expends energy
• At rest, 2/3 of energy consumption comes from rest, and 1/3 from activity
• BMR is affected by age, sex, lean tissue, and physical activity
• Feasting is when people consume more energy than they expend, due to excess fat, proteins, and carbs

Fasting and Starvation

• Fasting is voluntarily not eating
• Starvation is when people have no choice
• There is no metabolic distinction between the two
• Three stages of fasting:
  • Glycogen is used first, from liver storage and fatty acids from fat tissue
  • Glycogen is depleted after the first 1-2 days
  • The nervous system consumes ½ of glucose used daily
  • Protein tissues break down
  • Body protein provides 90% of glucose, and glycerol produces 10%
  • Ketone bodies are produced from the breakdown of fatty acids in fat cells
• Consequences of fasting include lean tissue waste, increased disease risk, decreased temperature, slowed metabolism, and fluid/electrolyte disturbance

Energy Balance and Weight

• The formula for energy balance is energy in - energy out
• 3500 calories is equivalent to 1 lb
• Health risks of obesity: BMI > 30, hypertension, sleep apnea, some cancers, complications in pregnancy/surgery, fatty liver, increased blood lipids
• Some causes of obesity: genetics (HIGH LPL promotes fat storage), leptin (suppresses appetite and promotes energy consumption), ghrelin (secreted by stomach cells, triggers desire to eat), excess energy stored in fat cells (increase in size AND number), environmental stimuli and built environment (discourages physical activity, not safe, no access to fresh foods)
• Weight management is affected by age, health, genetics, and extent of being overweight
• A weight loss plan should include realistic energy intake, a weight loss of 1-2 lb. per week, and reduction of portion sizes
• To gain weight, a plan should include limiting sugars/alcohol, nutrient-dense food instead of energy-dense foods, three meals, large portions with extra snacks, energy-dense foods, and juice/milk
• BMI describes weight in relation to height
• A healthy BMI is 18.5-24.9
• An apple shape is associated with strokes, diabetes, hypertension, high LDL levels, and some cancers
• Inappropriate waist circumference: F >35 in and M > 40 in
• Fad diets offer short-term weight loss success but do not offer safe/effective plans or credible research
• Weight loss surgery includes gastric bypass (section of stomach cut off) and gastric banding/sleeve (band around stomach to reduce capacity)
• Hunger is the physiological need for food
• Appetite is the psychological want for food

Eating Disorders

• Anorexia nervosa is when a person restrains eating, fears fatness, and has a distorted body image
• Bulimia nervosa is when a person binges in secret then purges by vomiting or using laxatives
• Binge eating disorder is when a person binge eats without purging

Vitamins

• Vitamins are essential, non-caloric, organic nutrients needed in tiny amounts
• Fat-soluble vitamins: A, D, E, K; stored in the liver and fatty tissues
• Water-soluble vitamins: B and C

Vitamin A

• Vitamin sources: Animal sources (liver, fish oil, eggs, fortified milk)
• Roles: vision (maintains cornea, helps with light detection), cell differentiation + protein synthesis (promotes protein synthesis, allows cells to mature/function), skin (maintains skin cells/skin integrity), immunity (body's defense against infection), and reproduction (sperm development, fetal growth/development)
• Deficiency effects: drying/hardening of cornea, dry rough skin, reduced protection against measles, dry/hardening salivary glands
• Toxicity effects: common in children; can cause teratogenic risk, contributes to osteoporosis, and hip fractures
• Beta-carotene sources: dark green and orange fruits/vegetables
• Beta-carotene function: antioxidant, compounds that protect against other compounds from reactions with oxygen

Vitamin E

• Vitamin E sources: fresh foods (vegetable oils, fruits/veggies, whole grains/nuts); destroyed by heat and oxidation
• Vitamin E functions: antioxidant, protects lungs from air pollutants, and prevents oxidation of polyunsaturated fatty acids

Vitamin D

• Vitamin D sources: non-essential (sun exposure 5-10 mins few times a week), eggs, liver, butter, some fatty fish, and fortified milk for children
• Vitamin D functions: hormone, protects against cognitive decline, signals immune function, encourages growth, and assists in absorption of calcium/phosphorus
• Vitamin D deficiency effects: increased risk for HTN, diabetes, cancers, rickets (bow legged, bones fail to calcify), osteomalacia (adult form of rickets), and osteoporosis risk

Vitamin K

• Vitamin K sources: green leafy veggies and some veggie oils
• Vitamin K functions: important for blood clotting and intestinal synthesis
• Vitamin K deficiency effects: rare, can be due to fat malabsorption/medication interactions, and can lead to hemorrhagic disease
• Infants receive vitamin K shots to prevent hemorrhagic disease
• Vitamin K toxicity effects: reduced effect of anticoagulant medications

B Vitamins

• Thiamine sources: PORK, legumes, and enriched grains
• Thiamine functions: daily intake is important for normal functioning of nerves/muscles
• Thiamine deficiency effects: Beriberi disease (seen in countries where people depend on white rice), and Wernicke Korsakoff (mostly seen in alcoholics)
• Riboflavin sources: PRIMARY sources are from MILK, and also enriched grain products; light can destroy riboflavin, but NOT cooking
• Riboflavin needs are increased in pregnant women and athletes
• Riboflavin cannot be toxic
• Niacin sources: meat, poultry, fish, legumes, and enriched whole grains
• Niacin functions: cell energy metabolism and can lower blood cholesterol
• Niacin deficiency effects: Pellagra disease
• Niacin toxicity effects: Dementia, dermatitis, diarrhea, death and niacin flush (dilates capillaries, causes painful tingling)
• Pantothenic acid and biotin sources are widespread in foods
• Pantothenic acid and biotin stimulate growth and help with metabolism
• Biotin deficiency can be caused by consuming raw egg whites
• Vitamin B6 (Pyridoxin) sources: protein meats, potatoes, some veggies and fruits, LOST during HEAT
• Vitamin B6 functions: metabolic roles, helps with conversion of NIACIN, releases glucose from glycogen
• Vitamin B6 deficiency effects: depression, seizures, poor growth, dermatitis, anemia, convulsions
• Vitamin B6 toxicity effects: nerve damage causing numbness in extremities
• Folate sources: fruits/vegetables, fortified grains, liver/legumes, oranges/cantaloupe
• Folate functions: important to fetal brain and spinal cord (prevents neural tube defects), and needed for cell division
• Folate deficiency effects: vulnerable to drug interactions, destroyed by heat and oxidation, neural tube defects, and macrocytic anemia
• Vitamin B12 sources: almost exclusively from animal foods
• Vitamin B12 functions: assists FOLATE in cell division, helps the nervous system; folate can mask vitamin B12 deficiency
• Vitamin B12 deficiency effects: can cause progressive neurological symptoms and impairs maturation of RBCS
• Intrinsic factor made by the stomach is needed for vitamin B12 absorption
• Vegans and their breastfed kids are at high risk of B12 deficiency due to B12 coming from animal products

Vitamin C

• Vitamin C sources: citrus fruits, organ meats, Brussel sprouts, broccoli, and potatoes
• Vitamin C functions: helps form collagen (wound healing), helps prevent scurvy (10 mg a day), iron absorption, and helps with common colds (reduction in severity and duration of colds)
• Vitamin C deficiency effects: bleeding problems (gums), skin changes, anemia, infection, death, and poor wound healing
• Vitamin C toxic effects: nausea, diarrhea, abdominal cramps, and stones
• Vitamin C needs are increased by burns, medications, surgeries, and toxic doses of metals

Anemia & Deficiency

• Beriberi is caused by thiamin deficiency and loss of sensation, muscular weakness, paralysis, and abnormal heart
• Pellagra is a deficiency
• Macrocytic anemia is a deficiency
• Macrocytic anemia is caused by niacin, dermatitis, dementia, diarrhea, or death
• Macrocytic anemia is caused by vitamin B12 and folate deficiency, where large blood cells don't carry Oxygen well
• Pernicious anemia is caused by vitamin B12 deficiency and causes a low number of RBCs, large and oval shaped

Water Balance

• The majority of human body weight is comprised of water
• The body regulates water balance by excreting the amount needed to maintain equilibrium; water excretion is regulated by the brain and kidneys
• 500 mL should be excreted each day as urine
• 2-3L of water is needed per day
• Caffeine is a diuretic

Acid/Base & Fluid/Electrolyte Balance

• Ions help regulate pH of fluids
• Buffers are substances that accommodate excess acids or bases; kidneys play the primary role
• Electrolytes are salts dissociated in water: N, Cl, K, P, MG
• Na + Cl exist outside the cell, K and other ions exist inside the cell
• PICA (desire to eat non-food items) is an iron deficiency sign

Calcium

• Calcium is the body's most abundant mineral; 99% stored in bones and teeth
• Calcium sources: milk, dairy products, tofu, sardines, and plant-based foods
• Calcium functions: maintains normal blood pressure, aids in blood clotting, essential for muscle contraction, and prevents osteoporosis
• Calcium affects weight: reduces body fat, protects lean tissue, and maintains healthy body weight
• Calcium deficiency effects: osteoporosis, fractures under normal actions, and increased BP
• Too much calcium causes kidney stones
• High peak bone mass protects against bone loss and fractures later
• Bones are calcium reservoirs; dietary deficiency does NOT change blood calcium
• Low blood calcium uses calcium from bones
• Risk factors for osteoporosis: female sex + older age, decreased estrogen and weight, anorexia, sedentary lifestyles, and diet low in calcium/vitamin D

Iron

• Iron sources: meats, legumes, enriched grains, and eggs
• Too much milk can cause iron deficiency
• Heme iron is from animal sources and is better absorbed
• Non-heme iron is from non-animal sources and is less absorbed
• People who need more iron: menstruating women, pregnant women, infants, children, and adolescents
• RBCs live for 3 months AKA 120 days
• Vitamin C enhances iron absorption
• Iron deficiency causes: excessive blood loss or inadequate intake
• Iron deficiency causes microcytic anemia
• Effects of excessive iron include Hemochromatosis, where iron is deposited in tissues, causing liver enlargement, joint disease, loss of hair, impotence, and amenorrhea
• Hemochromatosis is often seen in alcoholics.
• People with hemochromatosis should avoid vitamin C

Minerals

• Minerals that offer protection from hypertension: K, Mg, and C
• Sodium is the principle electrolyte in ECF
• Sodium sources: processed foods and meats
• Sodium functions: helps maintain acid-base balance, essential to muscle contraction and nerve transmission
• Sodium deficiency is unlikely; you can reduce sodium by increasing physical activity
• Upper limit is 2300 mg/day, but on average people consume 3200 mg/day
• High sodium levels can cause hypertension because it increases fluid retention, heart disease, and stroke
• Minerals important for bones/teeth: calcium, phosphorus, magnesium, and fluoride
• Iodine sources: seafood, soil, and iodized salt
• Iodine functions: important for thyroid regulation
• Iodine deficiency effects: simple goiter (enlargement of thyroid) and brain damage
• Vitamins/minerals helpful for wound healing: zinc (also decreases severity/duration of colds) and vitamin C
• Organs that support a healthy pregnancy:
  • Placenta gives nutrients/oxygen and removes waste
  • Uterus/womb
  • Umbilical cord has veins/arteries that reach the placenta
  • Amniotic sac is a bag of water where the fetus floats

Pregnancy

• Folate is important during pregnancy because it prevents neural tube defects, such as spina bifida and anencephaly
• Iron is important during pregnancy because blood volume doubles
• There is no increase in nutrient needs during the first trimester
• During the 2nd/3rd trimester, calorie needs increase by 300
• Carbs are important during pregnancy because they fuel the fetal brain
• 25 gram increase in protein is needed
• There is a need for an increase in calcium to support normal fetal bone development and the mother's bone mass

Pregnancy Complications

• Pregnancy complications: nausea, low birth weight, preeclampsia, gestational diabetes
• Nausea peaks at 9 weeks and resolves within a month or two; can be aggravated by smells
• Low birth weight is more common in women who are underweight
• Heartburn/constipation are common during pregnancy
• Gestational diabetes develops during pregnancy and usually resolves after the infant is born; The mother is more likely to develop type 2 diabetes later, and can cause fetal/infant sickness and death
• Preeclampsia involves high BP and protein in urine during pregnancies
• Preeclampsia can lead to eclampsia, which causes seizures and is the most common cause for maternal mortality
• Foods/substances to avoid during pregnancy:
  • Tobacco: restricts blood supply, harms brain growth, affects lung development, and increases risk of low birth weight/SIDS
  • Medicinal drugs: only after consulting physician, herbal supplements may not be safe
  • Abused Drugs: cross the placenta easily, cause low birth weight, CNS damage, withdrawal pain, and death
  • Environmental Contaminants: Lead and mercury impairs motor and psychomotor development
  • Listeriosis is foodborne and causes miscarriage, stillbirth, severe brain damage, and infection to the fetus/newborn
• Other things to avoid or limit are: Restrictive dieting, sugar substitutes, caffeine, alcohol, and FASD
• Ideally, pregnancy should occur at a healthy weight; excessive weight gain is more common than inadequate weight gain
• There is an increase breast size fluid volume uterus size and supporting muscles
• Recommended weight gain for an underweight woman: 28-40 lb
• Recommended weight gain for a healthy weight woman: 25-35 lb
• Recommended weight gain for an overweight woman: 15-25 lb
• Recommended weight gain for an obese woman: 11-20 lb
• Lactation needs more energy intake than pregnancy
• It is recommended to exclusively breastfeed for the first 6 months; breast feed for at least 12 months with complementary foods
• Milk production requires 500 calories; 330 should come from extra food, and the remaining 170 from fat stores
• The volume of milk produced depends on infant needs and no amount of fluid mother drinks
• Alcohol overwhelms the infant's immature alcohol-degrading system
• Caffeine makes infants jittery/wakeful
• Cigarette smoking reduces milk production/lowers fat content
• Women should NOT breastfeed if they have HIV infection or active, untreated tuberculosis
• Progestin-only oral contraceptives have no impact on breastfeeding
• Composition of human milk: