Nutrition Board Notes PDF

1 BOARD NOTES: Nutrition Learning Objectives Basics of Nutrition Terminology  Nutrients are the necessary for the  Basic Metabolic Rate (BMR): the Identify the role of nutrients in nor...

1 BOARD NOTES: Nutrition Learning Objectives Basics of Nutrition Terminology  Nutrients are the necessary for the  Basic Metabolic Rate (BMR): the Identify the role of nutrients in normal function of numerus body energy needed at rest to maintain maintaining health throughout the processes life-sustaining activities (breathing, lifespan.  Main guidelines that are applicable circulation, heart rate, and for most patients temperature) Describe the role of nurses regarding  Every client needs to be considered  Calories: measure of energy nutrition issues and nutritional individually when assessing for derived from food assessments. nutritional needs and  Nutrient: the elements necessary recommending food/ supplement for the normal function of Summarize the process of digestion o Medical numerous body processes (ex. and absorption. o Social Carbs, proteins, fats, water, o Cultural vitamins, minerals) Identify risk factors for aspiration and o Health  Nutrient Density: the proportion of nutritional deficiencies. o Financial essential nutrients to the number of  If you recommend and unsuitable kilocalories Evaluate the potential effects of diet plan, or do not provide o High nutrient foods provide a medications, nutrition and nutritional adequate education, the client will large number of nutrients in supplements. likely NOT follow the relationship to kilocalories recommendations  Food Scarcity: shortage of food or Apply your knowledge of the digestive  Many aspects of patients’ lives will shortage of nutrient dense food system, the patient’s medical needs, affect how and what they eat  Anthropometry: a systematic and your nutritional assessment to  There is no such thing as a perfect method of measuring the size and implement diet counseling. diet if the person is not willing to makeup of the body follow it.  Ideal Body Weight (IBW): estimate  Education and listening are of what a person should weigh imperative to offer the best healthcare outcomes for your  2 patients Basic Elements of Food Vitamins Minerals Carbohydrates Vitamins Minerals  Composed of carbon, hydrogen,  Organic substances present in  Inorganic elements essential to and oxygen small amounts in foods that are the body as catalysts in  Each gram of carb produces 4 kcal essential to normal metabolism biochemical reactions  They serve as the main source of  They are chemicals that act as  Classified as microminerals when fuel for the brain, skeletal muscles catalysts in biochemical reactions the daily requirement is 100mg or during exercise, erythrocyte and  If there is enough of a vitamin to more leukocyte production, and cell meet the catalytic demands of the  Classified as microminerals or function of the renal medulla body, the rest of the vitamin trace elements when less than  Monosaccharides like glucose do supply acts as a free chemical and 100mg is needed not break down into a more basic is often toxic to the body  Macro-minerals help balance the unit  The body is unable to synthesize pH of the body and specific  Disaccharides such as sucrose, vitamins in the required amounts amounts are necessary in the lactose, and maltose are  Fat soluble Vitamins blood and cells to promote acid- composed of two o Stored in the fatty base balance monosaccharides and water compartments of the body  Calcium  Sources include grains, o Vitamin D also comes from  Potassium vegetables, fruits, sugars, starches the sun (fortified into foods) o Affects the way the heart  Breakdown into glucose or o Body has high storage functions fructose. Includes insoluble and capacity for fat soluble o Can cause dysrrhythmias soluble fiber vitamins  Iron Proteins  Vitamin A  Sodium  Vitamin D  Magnesium  Provide 4kcal per gram  Vitamin E  Essential for the growth,  Can cause  3 maintenance, and repair of body bleeding tissues  Vitamin K  Simplest form of proteins is amino  Can cause acid consisting of hydrogen, clotting oxygen, carbon, and nitrogen  Takes babies 6-  Sources include fish, meat, eggs, 7 days to poultry, dairy, soy, beans, and nuts naturally build  Only animal sources contain up complete protein  Can combine vegetarian sources  Water soluble  Protein provides energy because o The body does not store its essential role is to promote water soluble vitamins, so growth, maintenance and repair, they need to be provided in so a diet needs to include daily food intake kcalories from nonprotein sources o They are easily absorbed  If there is a sufficient from the GI tract carbohydrate intake, protein is o Although they are not spared as an energy source stored, toxicity can still Fats occur  The most calorie dense nutrient  Vitamin B providing 9kcal/g  Vitamin C  Composed of triglycerides and fatty acids  Makeup of carbon, hydrogen, acid and methyl group  Sources include animals, vegetables, and nuts  Types include saturated and unsaturated.  4  Some fats are essential for life, reproductive tract health Water  Crucial because cell function depends on a fluid environment  Makes up 60-70% of body weight  People who are lean have a greater percent of total body water than those who are obese because muscle contains more water than any other body tissue besides blood  Fluid needs are met by drinking liquids and eating solid foods high in water content  Healthy individuals will excrete water through elimination, respiration, and sweating  5 Cholesterol/Lipids Anatomy and Physiology Key Guidelines  Waxy, fat like substance in all  Mouth  Follow a healthy dietary pattern cells and necessary for o Mechanical and chemical digestion at every life stage  Essential for production of  Mechanical is chewing and the o Meet nutritional needs hormones, fetal and brain tongue moving the food primarily from nutrient development in children, around dense foods and absorption of certain vitamins/  Chemical is the initial beverages. substances breakdown of carbohydrates o Choose a variety of  Liver produces cholesterol from enzymes in the saliva options from each food  Found in animal sources  The tongue pushes the group in recommended  Low density lipoprotein (LDL): food to the back of the amounts and within sometimes called “bad” mouth and swallowing calorie limits. cholesterol, LDL transports occurs. o Pay attention to portion cholesterol throughout the  Epiglottis shuts off the size. body and can build up in the tract to the trachea  Customize and enjoy food and walls of arteries  Esophagus beverage choices to reflect  High density lipoprotein o Tube for transport personal preferences, cultural (HDL): sometimes called “good”  Moves down by peristalsis traditions, and budgetary cholesterol, HDL caries excess down the esophagus through considerations cholesterol back to the the cardiac sphincter into the o Start food planning with stomach consideration of personal  Stomach preferences o Proximal and distal sphincters o Incorporate cultural o Chemical digestion traditions by choosing o Chyme nutrient dense, culturally  Chyme passes through the relevant foods from all pyloric sphincter into the small food groups  6 intestines o Meet budgetary  Small intestine considerations by doing o Nutrient absorption advance meal planning;  Most nutrient absorption considering regional and through the cilia that line the seasonal food availability; insides and incorporating a  Large intestine variety of fresh, frozen, o Fluid absorption dried, and canned  Fluid reabsorption mostly options. occurs in the large intestine  Focus on meeting food group  Anus needs with nutrient dense foods o Elimination and beverages and stay within  The final non-usable products calorie limits are passed as fecal matter into o Eat an appropriate mix of the rectum and though the foods from the food anus and out groups and subgroups  Accessory Organs that is within the o Liver: produces bile appropriate calorie level o Gallbladder: stores bile to promote health at each o Pancreas: amylase and lipase stage o Eat a variety of nutrient dense vegetables from each of the vegetable subgroups o Eat a variety of whole fruits and 100% fruit juice o Whole grains should make up at least half of the grains eaten; limit the amount of refined grains  7  Limit foods and beverages higher in added sugars, saturated fat, and sodium, and limit alcoholic beverages o 85% of daily required calories should be met through the requirements each of the food groups in the form of nutrient dense foods o Limit saturated fats and trans fats; consume less then 10% of calories per day from saturated fats o Limit added sugar or sweeteners so that less than 10% of calories per day from sugars  8 USDA MyPlate Nutritional Needs throughout the Lifespan Medication and Supplement Interaction  This is a guideline.  Infants (0-12 months)  Dietary needs and o 100-135/kg/day restrictions need to be o Simple carbs, proteins, fat individualized. o Breastmilk or formular  The USFDA created daily o Solids at 4-6 months values in response to the o Weight usually doubles birth weight 1990 Nutrition Labeling by 6 months and triples by 1 year and Education Act  Toddlers (1-3 years) o RDI: referenced o Whole milk (need the fat for brain daily intake and neurologic development) o DRV: daily o Calorie requirement may be less per reference value kg  This was changed from o Slower growth period the old pyramid model o Toddlers can show strong food that had carbs and preferences starches at the base and  School aged (6-12 years) recommended up to 11 o Individualize to meet requirements servings per day. o Choose nutrient dense foods  People were eating tons o Calorie demand increases during of low-fat products and growth spurts gaining fat on their o Need to individualize plan based on bodies in the process. preferences, budget, and any  It is really about eating presenting medical needs “real” unprocessed foods  Adolescents as much as possible and o Needs based on physiological age focusing on moderation o Biologic females tend to need more  Low fat was not the way iron to go for most o Calorie demand increases with  9  Specific medical growth spurts and activity conditions may require  Adults lower fat diets, but we o Based on individual needs have learned to move o Pregnancy/ lactation have more away from the carb heavy demand for nutrients, vitamins, diets in the past. minerals, and calories o Supplements may be used and tailored toward individual needs  Ex. Prenatal vitamins, folic acid  Elderly o Decreased metabolism and decreased calorie need o Need to address any medical history and pick nutrient dense foods o Appetite and senses tend to decrease o At greater risk for falls, skin break down, broken bones o Vitamin D and calcium needs o Nutrition education must be aligned to medications taken  10 Diet Restrictions Per Religion Other Popular Diets Dysphagia  Paleo: Muslim  Atkins: Myogenic  Pork  Pescatarian:  Myasthenia gravis  Alcohol  Diabetic:  Aging  Ramadan fasting sunrise to sunset  Vegetarian:  Muscular dystrophy for a month  South Beach:  Polymyositis  Ritualized methods of animal  Low fat: slaughter required for meat  Vegan: Neurogenic ingestion  Low foodmap:  Stroke Christianity  Low sodium:  Cerebral palsy  Some faiths such as Baptists allow  Flexitarian:  Guillain-Barré syndrome minimal or no alcohol  DASH:  Multiple sclerosis  Some meatless days may be  Gluten free:  Amyotrophic lateral sclerosis observed during the calendar year,  Raw foods:  Diabetic neuropathy commonly during Lent  Macro counting:  Parkinson disease Hinduism  Mediterranean:  All meats  Intermittent Fasting: Obstructive  Fish, shellfish with some  Benign peptic stricture restrictions  Lower esophageal ring  alcohol  Candidiasis Judaism  Head and Neck cancer  Pork  Inflammatory masses  Predatory fish  Trauma/ surgical resection  Shellfish (only fish with scales)  Anterior mediastinal masses  Rare meets  Cervical spondylosis  Blood (ex. Blood sausage)  Mixing of milk or dairy products with meat dishes Diet Progression and Thickener  Must adhere to kosher food Clear liquid  11 preparation methods Clear fat-free broth, bouillon, coffee, tea,  24 hours of fasting on Yom Kippur, carbonated beverages, clear fruit juices, a day of atonement gelatin, fruit ices, popsicles  No leavened bread eaten during Passover Full liquid  No cooking on the Sabbath from Same as clear liquid, with addition of sundown Friday to sundown smooth-textured dairy products (e.g., ice Saturday cream), strained or blended cream soups, Mormon custards, refined cooked cereals,  Alcohol vegetable juice, pureed vegetables, all  Tobacco fruit juices, sherbets, puddings, frozen  Caffeine such as teas, coffees and yogurt sodas Seventh Day Adventists Dysphagia stages, thickened liquids,  Pork pureed  Shellfish As for clear and full liquid, with addition  Fish of scrambled eggs; pureed meats,  Alcohol vegetables, and fruits; mashed potatoes  Caffeine and gravy  Vegetarian or ovolactovegetarian diets encouraged Mechanical soft As for clear and full liquid and pureed, with addition of all cream soups, ground or finely diced meats, flaked fish, cottage cheese, cheese, rice, potatoes, pancakes, light breads, cooked vegetables, cooked or canned fruits, bananas, soups, peanut butter, eggs (not fried) Soft/low residue  12 Addition of low fiber, easily digested foods such as pastas, casseroles, moist tender meats, and canned cooked fruits and vegetables; desserts, cakes, and cookies without nuts or coconut High fiber Addition of fresh uncooked fruits, steamed vegetables, bran, oatmeal, and dried fruits Low sodium 4-g (no added salt), 2-g, 1-g, or 500-mg sodium diets; vary from no added salt to severe sodium restriction (500-mg sodium diet), which requires selective food purchases Low cholesterol 300 mg/day cholesterol, in keeping with American Heart Association guidelines for serum lipid reduction Diabetic Nutrition recommendations by the American Diabetes Association: focus on total energy, nutrient and food distribution; include a balanced intake of carbohydrates, fats, and proteins; varied  13 caloric recommendations to accommodate patient’s metabolic demands Gluten free Eliminates wheat, oats, rye, barley, and their derivatives Regular No restrictions unless specified Some Common Nursing Hypotheses Enteral and Parental Nutrition Food Safety and Foodborne Illnesses Enteral Nutrition  Essential because of a patient’s Risk for Aspiration  Provides nutrients into the GI tract reduced resistance to infection  Decreased level of alertness,  Preferred method of meeting  Small frequent nutrient dense decreased gag or cough reflexes, nutritional needs if a patient is meals that limit fatty and overly difficulty managing saliva unable to swallow or take in sweet foods are easier to tolerate  Need more help with feeding and nutrients orally yet has a  Patients benefit from eating cold swallowing functioning GI tract foods and lean, low fat protein  Usually on thickened diet  Patients with enteral feedings sources, and limiting foods with receive formula via the nasoenteral high sugar content Over or Underweight route or through gastric tubes  Sources include undercooked   The route selected to provide meats, poultry, unwashed nutrition support therapy is vegetables/ fruits Impaired or Low Nutritional Intake appropriate to the patient’s clinical  Transmitted through surface  States lack of interest in food status or condition and is contact, touching or eating/  Recent weight loss of 24 lb periodically assessed for drinking, eventually through  Body weight more than 20% under appropriateness and for its ingestion ideal weight adequacy in meeting the goals of  Incubation period varies, most  Lonely and tires easily the nutrition care plan people will be sick within 12 hours;  14  Reasons for enteral nutrition can get extremely ill, life Impaired Self Feeding o Cancer threatening o Critical illness/ trauma  Ways to prevent clean surfaces, do o Neurological and muscular not share surfaces, wear gloves, Impaired Swallowing disorders cook thoroughly, wash veggies/ o GI disorders fruits effectively o Respiratory failure with  Wash hands Risk for Dehydration prolonged intubation o Inadequate oral intake Parenteral nutrition  Specialized nutritional support provided intravenously  Patients who are unable to digest or absorb EN benefit by PN  Patients in highly stressed physiological states such as sepsis, head injury, or burns are candidates for PN therapy  Electrolyte imbalances 1. Explain the difference between intracellular and extracellular fluid compartments in terms of electrolyte composition. a. Extracellular is intravascular and interstitial spaces and comprises 1/3 of total body water content. It is in between the cells and in the blood vessels. ECF electrolytes are abundant in sodium and chloride. b. ICF is inside the cell and is approximately 2/3 of the total body water content and it is only inside the cells. More common electrolytes here are potassium and magnesium. 2. Fill in the following table Imbalance Causes S/SX - clinical Sources picture Hyponatremia Hypernatremia Hypokalemia Hyperkalemia Hypocalcemia Hypercalcemia Hypomagnesemia Hypermagnesemia 3. A patient presents with confusion, muscle weakness, and a serum sodium of 120 mEq/L. What electrolyte imbalance do they have, and what are the appropriate nursing interventions? a. They are low in sodium. Hyponatremia b. Assess them neurologically. Administer sodium and see if they need fluids along with the electrolyte supplement. Increase salt intake. May require education. 4. A patient with chronic kidney disease presents with a serum potassium of 6.2 mEq/L. What would you expect on their ECG, and how would you manage this imbalance? a. There would be conduction changes on their EKG, there may also be an abnormal rhythm because the potassium is so high. Hyperkalemia b. They may be unable to filter out this extra potassium, so dialysis may be necessary. 5. A patient in the ICU has a serum calcium of 11.5 mg/dL, constipation, and muscle weakness. What electrolyte imbalance is this, and what interventions would you initiate? a. Hypercalcemia b. Give them calcium supplement. Educate them on diet and limiting intake. Hyperparathyroidism- order labs and see if they have that. 6. A postoperative patient has a serum magnesium level of 1.0 mg/dL and is experiencing muscle cramps. What imbalance is present, and what treatment would you anticipate? a. Hypomagnesemia b. Give them supplemental magnesium IV or PO.  Fluid Imbalance and I &Os 1. A client is receiving IV fluids. Intake has been recorded as 3000ml over 24 hours and total output has been measured at 1000ml over 24 hours. This client reports shortness of breath and has visible lower extremity edema. i. What condition do you think this patient is experiencing by recognizing cues? i. Fluid excess, CHF ii. What are your priority actions? i. Alert the provider, stop the fluids, give diuretic iii. How would you evaluate the actions taken? i. Patient will have improved respiratory symptoms and edema will be drained ii. Listen to heart and lungs iii. Inspect and palpate edema in lower extremities iv. Output will increase 2. A 70 y/o client with a history of heart failure presents c/o feeling very lightheaded and confused. Vital signs are as follows: BP 98/64, HR 104 with thready pulse, RR 18, O2% = 98%, postural BP 88/52, postural HR 122. i. What condition do you think this patient may be experiencing? i. Orthostatic hypotension, fluid defecit ii. What other subjective and objective cues would you want to learn? i. Assess neuro ii. How much fluid have they had (quantify the amount) iii. Nutrition iv. Medication changes iii. Based on the information you predict, what actions would you hypothesize? i. Encourage fluids ii. Education on nutrition or medication 3. A client has the following intake and output over the previous 24 hours. Intake:  Oral fluids 1500ml IV fluids 1000ml Output: Urine 2000ml Wound drainage 300ml a. Is the client in fluid balance? i. Yes, this is typically normal b. What clinical signs would you expect to see? i. Noting abnormal, patient should appear normal. 4. A client is ordered to receive 2500ml of fluids in 24 hours. The client is receiving IV fluids at a rate of 100ml/hr. i. How much additional fluid would the client need to meet their total fluid requirements if they receive no oral intake? i. 100 mL ii. If the client consumed 400ml of oral fluids in the last 24 hours, how would that affect the IV rate? i. It would slow down. Subtract the 400 from the 2500 and you get 2100. Divide that by 24, and you get 87 mL per hour 5. Mrs. Jones drank 8oz of coffee, ½ of her 8 oz cup of water, ¼ of her 16 oz chicken broth and had a bowl of pasta. Calculate the amount of intake in ml for Mrs. Jones. 1oz = 30ml. i. 480 mL Medication Administration Copyright © 2021, Elsevier Inc. All Rights Reserved. Medication Legislation and Standards Federal regulations Pure Food and Drug Act (1906) Food and Drug Administration (FDA) (1938) Harris-Kefauver Amendment to the Federal Food, Drug, and Cosmetic Act (1962) Controlled Substance Act (1970) MedWatch program Copyright © 2021, Elsevier Inc. All Rights Reserved. 2 Medication Legislation and Standards Health care institutions and medication laws Medication regulations and nursing practice (Nurse Practice Acts) State Nurse Practice Acts define required education and skill levels of all state-licensed nurses States have the power to enforce additional regulations beyond federal mandates Copyright © 2021, Elsevier Inc. All Rights Reserved. 3  Pharmacological Concepts (1 of 2) Medication names Chemical—provides the exact description of medication’s composition. Generic—the manufacturer who first develops the drug assigns the name, and it is then listed in the U.S. Pharmacopeia. Official Name – designated by the FDA and is usually the generic name. Trade—also known as brand or proprietary name. This is the name under which a manufacturer markets the medication. Copyright © 2021, Elsevier Inc. All Rights Reserved. 4  Classification Effect of medication on body system Symptoms the medication relieves Medication’s desired effect Pharmacological Example ASA/NSAID: antipyretic, non-opioid Concepts (2 of 2) analgesic, antiplatelet, anti- inflammatory Medication forms Solid, liquid, other oral forms; topical, parenteral; forms for instillation into body cavities Copyright © 2021, Elsevier Inc. All Rights Reserved. 5  Pharmacokinetics as the Basis of Medication Actions (1 of 3) Drug Absorption Drug absorption is the transportation of the unmetabolized drug from the site of administration to the body circulation system Factors that influence absorption Route of administration Ability of a medication to dissolve Blood flow to the site of administration Body surface area Lipid solubility 6 Pharmacokinetics as the Basis of Medication Actions (2 of 3) Distribution Circulation Membrane permeability Protein binding Metabolism Medications are metabolized into a less-potent or an inactive form. Biotransformation occurs under the influence of enzymes that detoxify, break down, and remove active chemicals. 7 Pharmacokinetics as the Basis of Medication Actions Excretion Medications exit the body through the: Kidney – main organ Liver Bowel Lungs Exocrine glands Chemical makeup of medication determines the organ of excretion. Copyright © 2021, Elsevier Inc. All Rights Reserved. 8  Medication Actions Therapeutic effect: Side effect: Expected or predicted Unavoidable secondary effect physiological response Adverse effect: Toxic effect: Unintended, undesirable, often Accumulation of medication in unpredictable the bloodstream Idiosyncratic reaction: Allergic reaction: Over-reaction or under-reaction Unpredictable response to a or different reaction from medication normal  Medication Actions for Oxycodone hydrochloride-acetaminophen (Percocet)  Therapeutic Effect: relieve moderate to severe pain  Side effects: potential for addiction, constipation, dizziness, drowsiness, headache, dry mouth, nausea- vomiting, sweating, pruritis, lack-of-energy, respiratory depression  Adverse effects: severe hypotension, hepatoxicity, serious skin reactions  Allergic reactions: rare; skin redness or rash, itching, swelling (face/tongue/throat, anaphylaxis  Onset of Action: 15-30 minutes, peaks in 1 hour, and lasts up to 2-6 hours Know Your free Drug Resources: Using Micromedex Go to the QU Homepage then & Netter Library Choose School of Nursing found on right hand side under Guides by School Select School of Nursing Select Clinical Tools & Drug Resources found on left hand menus, dark blue and white text Select Drug Resources (blue text on white background) Choose Micromedex. Search Percocet (brand name) or Oxycodone hydrochloride- acetaminophen Take the quick Micromedex PRACTICE quiz found in Module 6 11 Types of Medication Action Medication interactions One medication modifies the action of another Medication tolerance More medication is required to achieve the same therapeutic effect Medication dependence Physical Psychological Copyright © 2021, Elsevier Inc. All Rights Reserved. 12 Practice using the Drug Go to the Netter Library, Micromedex, and Interactions Checker, then Drug Interaction Checker. another free resource found in the Netter Library. Then take the quiz found in Blackboard. The quiz is not graded! 13 Pharmacodynamics: achieving therapeutic effect Medication dose Route of administration Frequency of administration Function of metabolizing organs, such as the liver or kidneys  Onset of Action Peak Time it takes for a Time at which a medication to produce medication reaches its a response highest effective concentration Trough Duration Minimum blood serum Time medication takes Timing of concentration before to produce greatest the next scheduled dose result Therapeutic Effect Plateau Biological Half-Life Point at which blood Time for serum serum concentration is medication reached and concentration to be maintained halved Therapeutic Blood Levels  Half-Life You take a 100mg medication at 1 PM, and the drug has a half- life of 2 hours. If you had blood drawn and tested every 2 hrs. it Half the medication remains: 50 Half the medication remains: would look like this: mg 12.5 mg 1:00 PM 3:00 PM 7:00 PM 1:00 PM 5:00 PM Initial dose: 100 mg Half the medication remains: 25 mg Physiological Variables Affecting Therapeutic Effect Age Immature liver function limits the ability to metabolize medications Aging process can alter liver and kidney function  Gender and Body Build Physiological Difference in hormones, distribution of fat Variables Affecting and water, weight, height, and lean body mass can affect medication absorption, Therapeutic Effect metabolism, distribution & excretion Physiological Variables Affecting Therapeutic Effect Chronic disease results in body organ dysfunction Concurrent medication use Different medications used together can lead to unexpected and or unpredictable responses Physiological Variables Affecting Therapeutic Effect Nutritional status Presence or absence of food in the stomach can alter medication absorption Decreased nutritional status impairs the client’s ability to produce specific medication- metabolizing enzymes leading to impaired medication metabolism Physiological Variables Affecting Therapeutic Effect Pregnancy Circulatory changes, hormonal changes and presence of fetus may influence how medications are absorbed, distributed, metabolized, & excreted. Genetic factors Inherited traits may have a specific influence on the metabolism of certain medications Physiological Variables Affecting Therapeutic Effect Health illness beliefs Previous experience with medication Knowledge base Cultural beliefs Developmental stage Social support/ financial status Potential for medication dependence and misuse A Review from NUR 330Lab Oral Parenteral Sublingual, buccal ID, Sub-Q, IM, IV (epidural, Routes of intrathecal, Administration intraosseous, Topical intraperitoneal, Direct, body cavity intrapleural, intra- arterial) Inhalation Intraocular  A Review from SafeMedicate Systems of Medication Measurement Metric system Household system Solutions Most logically Most familiar to When a solid is organized individuals dissolved in fluid, Meter, liter, gram Disadvantage: concentration is Never use a trailing inaccuracy expressed as zero Units of mass per units of volume (g/L, mg/mL) Percentage (10% solution) Proportions (1/1000) Copyright © 2021, Elsevier Inc. All Rights Reserved. 26 Review Clinical Calculations using SafeMedicate Conversions within one system Conversions between systems Dose calculations The ratio and proportion method The formula method Dimensional analysis Pediatric doses Calculations require special caution Copyright © 2021, Elsevier Inc. All Rights Reserved. 27 Health Care Provider’s Role Prescribers Physicians, nurse practitioners, physician’s assistants Orders Written (hand or electronic) Verbal Telephone Abbreviations Can cause errors; use caution Know prohibited and error-prone abbreviations Copyright © 2021, Elsevier Inc. All Rights Reserved. 28  While telephone orders are nearly obsolete, there are a limited number of situations, Telephone such as emergencies, where you might be taking a verbal (TO) & order. Verbal See the guideline notes on this Orders slide for taking a verbal order, telephone or otherwise. (VO) And first and foremost, follow the facilities policy and protocol for taking verbal orders. Copyright © 2021, Elsevier Inc. All Rights Reserved. 29 Video clip of taking a telephone order. Reflect on the information exchange and how clarification is an essential communication skill in nursing. 30 Types of Orders in Acute Care Settings Standing orders or routine medication prn orders orders Single (one-time) STAT orders orders Now orders Prescriptions Copyright © 2021, Elsevier Inc. All Rights Reserved. 31 Example of a Medication Prescription Copyright © 2021, Elsevier Inc. All Rights Reserved. 32  Nursing Knowledge Base  Pharmacist’s role  Distribution systems  Unit dose  Automated medication dispensing systems  Special handling of controlled substances  Handling chemotherapy medications 33  Nursing Knowledge Base Nurse’s role Determines medications ordered are correct Assesses patient’s ability to self- administer Determines medication timing Administers medications correctly Closely monitors effects Provides patient teaching Medication Errors Copyright © 2021, Elsevier Inc. All Rights Reserved. 34 A Review from NUR 330 Lab Watch the Skill Video Ensuring the Six Rights of Medication Administration found in Sherpath. This is a helpful video when preparing to give medications in lab and clinical. You may also find Nurse Sarah’s video on the Rights of Medication Administration helpful. It is 17+minutes in length but offers some very good tips for administering medications. A Review from NUR 330Lab Can you name the 3 check Three Checks points when pulling a of Medication medication from the Administration shelf/automated medication dispensing system? A Review from NUR 330Lab 1. Right medication 2. Right dose 10 Rights of 3. Right patient Medication 4. Right route Administration 5. Right time 6. Right assessment/indication 7. Right documentation 8. Right evaluation 9. Right to Refuse Treatment (maintaining patients’ rights) 10. Right patient education  To be informed about a medication To refuse a medication To have a medication history To be properly advised about experimental nature of medication To receive labeled medications safely To receive appropriate supportive therapy To not receive unnecessary medications To be informed if medications are part of a research study Go to Sherpath Try your hand at administering medications to Lisa Rae. Complete the Simulation, Administering an Oral Medication Copyright © 2021, Elsevier Inc. All Rights Reserved. 39 Safety Guidelines Medication Reconciliation Comparing the past and For present medication list Admission Administering Discharge Medications Transfer to new health care provider Post-op Process Verify the list Compare the list Reconcile the list if needed Communicate the updates  Be vigilant during medication administration. Safety Guidelines For Ensure patients receive the correct medication. Know why the patient is receiving each medication. Administering Verify that medications have not expired. Use at least two identifiers before administering Medications medications and check against the medication administration record (MAR). Before administering medication, check for accuracy three times. 41 Safety Guidelines For Administering Medications Clarify unclear medication orders. Use available technology: barcoding, MAR, Pyxis, internet/intranet Use strict aseptic technique during parenteral medication preparation and administration. Educate patients about each medication. Most of the time you cannot delegate medication administration. Follow safety guidelines to prevent needlestick injuries. 42  Medical Errors More people die from medical errors than from chronic lower respiratory diseases, accidents, stroke, Alzheimer’s disease, and diabetes mellitus Nurses play an important role in patient safety Think critically to ensure safe medication administration Copyright © 2021, Elsevier Inc. All Rights Reserved. 43 Medication Medication error Any preventable event that Errors may cause inappropriate medication use or jeopardize patient safety When an error occurs First assess the patient’s condition, then notify the health care provider When patient is stable, report the incident Prepare and file an occurrence or incident report Report near misses and incidents that cause no harm During transitions in care, reconcile medications 44 Finish this module by See Blackboard for the video link watching the RaDonda Complete the 1-minute reaction Vaught story paper. 45  Now that you have completed the Sherpath readings and lessons, reviewed the Pp slides The Muddiest and completed the Point About activities, go to Blackboard to submit the Medication muddiest point about medication Administration administration before Friday October 4th, 11:59 PM. 46  Fluid, Electrolytes, and Acid- Base Imbalances NUR 300, Module 9 Slides by Jennifer Wethje, DNP, APRN, FNP-BC Learning Objectives Identify common electrolytes in the body and their functions. Recall common fluid, electrolyte imbalances. Explain acid and base concentrations in the blood and identify imbalances. Identify risks factors for fluid, electrolyte, and acid-base imbalances. Apply the clinical judgement measurement model to recognize and assess cues, prioritize hypotheses and implement actions related to fluid and electrolyte imbalances, and acid-base imbalances. Evaluate the outcome of any actions related to correcting fluid/electrolyte imbalances and acid-base imbalances.  Table of Topics 1) Introduction 2) Fluid Volume Imbalances o Fluid Volume Excess o Fluid Volume Deficit 3) Common Electrolytes in ICF, ECF 4) Electrolyte Imbalances 5) Acid Base Regulation 6) Acid Base Imbalance 11/10/2024 3  Important Definitions to Understand Osmolality Number of particles per kilogram of water. Isotonic Fluid with the same tonicity as blood. Hypotonic Solution that is more dilute than blood. (less particles per given amount). Hypertonic Solution that is more concentrated than blood (more particles per given amount). Active Transport Requires ATP to move electrolytes in and out of cells (ICF/ECF) (Na+ - K+ pump). Diffusion Passive movement of electrolytes to lower concentrated areas. Osmosis Movement of water across cell membranes 11/10/2024 4  Other Important Concepts/Terms Fluid Intake Absorbing fluid into the body. Drinking, eating foods high in water content, IVF, enemas, irrigation of body cavities. Fluid Distribution Movement of fluid through various compartments. Think osmosis Fluid Output Losing fluid from the body. Urine, vomiting, diarrhea, wound drainage, hemorrhage, sweat. Insensible (not visible) loss through the skin and respiratory tract is constant. Fluid Balance Interplay of 1) fluid intake and absorption, 2) fluid distribution, 3) fluid output. 11/10/2024 5  Questions to ponder..... Can drinking too much water be harmful? Picture yourself having run 5 miles on a day that is supper hot and humid. o How do you feel after the run? o What happened to your body during the run? o What are you craving? Picture yourself eating a full bag of your favorite potato chips. o How do you feel after eating the chips? o What are you craving? ThePhoto by PhotoAuthor is licensed under CCYYSA. 11/10/2024 6  Electrolytes Minerals (Ions) in the body that carry an electric charge (positive or negative)… think chemistry. FUNCTIONS: Balance the amount of fluid (water, blood, bodily fluids) in the body o Wherever there is bodily fluid, there are electrolytes o Help to balance pH level o Move nutrients into cells o Remove waste o Help with nerve, muscle, heart and brain function o Imperative for muscle contraction (smooth, skeletal and cardiac) o Maintain homeostasis  Key Players Kidneys o Regulators of fluids and electrolytes (balance excretion) Endocrine System o Controls fluid and electrolyte balance by actin on the kidneys  Aldosterone Secreted in adrenal cortex – acts when ECF is low in sodium o Prevents further sodium/water loss o Prevents excessive Potassium levels  Antidiuretic hormone (ADH) Produced in the brain (pituitary/hypothalamus) o Regulates water levels to control blood volume, BP 11/10/2024 8  Intake and Output Important Nursing Assessment!! Fluid is constantly filtered, excreted and replaced. I generally = O Intake o All fluids that enter the body Output o All fluids leaving the body  Sweat, urine, diarrhea, vomiting, draining, blood loss, respirations IF I > O = Hypervolemia and Hemodilution IF I < O = Hypovolemia and Hemoconcentration 11/10/2024 9  Fluid Volume Excess 1) Excessive (or too rapid) administration of IV fluids 2) Excessive intake of oral fluids 3) Heart failure o Right – peripheral edema o Left – pulmonary edema 11/10/2024 10  S/Sx of Fluid Volume Excess Cardiovascular HTN Bounding pulse JVD Blood Pressure Increased S3 heart sounds Gastrointestinal Ascites Heart Rate Increased, bounding hepatomegaly pulse Integumentary Pale, cool, taut skin Dependent pitting edema Respiratory Rate Increased Generalized edema Musculoskeletal Muscle spasms Weight Increased Neurological HA Confusion Lethargy Seizures Coma if cerebral edema Renal Oliguria or anuria Respiratory Pulmonary edema Dyspnea 11/10/2024 Crackles 11  Fluid Volume Excess – Case Study 67 y/o male with hx of diabetes and HTN 1. Subjective cues presents to the emergency department 2. Objective cues c/o dyspnea, SOB, lethargy, and rapid weight gain. 3. Prioritize hypotheses BP 150/100 What do you think is happening? HR 110 Resp 26 O2 Sat 92% 11/10/2024 12  Fluid Volume Deficit 1) Inadequate intake of water/isotonic fluid 2) Excessive intake of sodium rich fluid/foods 3) Inadequate sodium intake during rehydration ThePhoto by PhotoAuthor is licensed under CCYYSA. 4) Loss of fluid o Hemorrhage o Diarrhea o Vomiting o Suctions o Diaphoresis o Diuretic therapy o Burns 11/10/2024 13 ThePhoto by PhotoAuthor is licensed under CCYYSA.  S/Sx of Fluid Volume Deficit Cardiovascular Weak, rapid pulse Diminished peripheral veins palpitations Blood Pressure Decreased; Gastrointestinal Dry mouth orthostatic Nausea and vomiting hypotension Integumentary Pale, cool, dry skin Heart Rate Increased, weak decreased skin turgor pulse sunken eyeballs Dry mucous membranes Respiratory Rate Increased No sweating, no tears Musculoskeletal Weakness fatigue Weight Decreased Neurological Thirst Lightheaded Confusion Altered mental status Decreased consciousness Renal Depends Respiratory Increased rate 11/10/2024 14  Fluid Volume Deficit Case Study 20 y/o college student presents to health clinic 1. Subjective Cues c/o 3 days of a high fever, gastrointestinal complaints including 2 days of vomiting and 2. Objective Cues diarrhea and inability to hold in any fluids. c/o 3. Prioritize Hypothesis feeling stress due to upcoming exams. 4. Expected plans to implement BP 92/60 HR 104 5. Evaluation of Plan RR 22 Temp 101.2 O2 Sat 98% Upon standing, BP 80/50, HR 116 11/10/2024 15  ECF and ICF Extracellular Fluid and Intracellular Fluid ECF ICF INTRAVASCULAR AND INTERSTITIAL INSIDE THE CELL Approx 1/3 of total body water content Approx 2/3 of total body water content In between the cells Only inside the cells In the blood vessels ** Generally, what we are assessing in blood draws. 11/10/2024 16  Main Goals of Fluid and Electrolyte Balance Therapeutic Range Homeostasis Most effective amount with minimal risks. Balance – generally maintained by a self- regulating process. State of equilibrium (think seesaw) 11/10/2024 17  ICF and ECF https://www.pinterest.c om/pin/947163983936 10178/ 11/10/2024 18  Common Electrolytes in the body Actual range may vary amongst books and labs. These values are from your text. Electrolyte Value More Prevalent Potassium (K+) 3.5 - 5 mEq/L ICF Magnesium (Mg2+) 1.3 - 2.1 mEq/L ICF Sodium (Na+) 136 – 145 mEq/L ECF Chloride (Cl-) 98 – 106 mEg/L ECF Calcium (Ca2+) 9.0 - 10.5 mg/dL BONES Phosphate (PO4-) 3.0 - 4.5 mg/dL ICF Bicarbonate (HCO3-) 22-26 (arterial) Blood buffer 11/10/2024 19  ECF and ICF Electrolyte Composition Things to Remember Water will go in and out of ECF/ICF via osmosis. Electrolytes and water can easily flow through both areas of ECF (intravascular and interstitial). Active Transport is generally needed to move electrolytes in and out of cells. 11/10/2024 20  Lemonade example! Hemodilution - Fluid is increased; electrolytes levels low o Decrease concentration of solutes due to too much fluid o "extra gallon of water in our lemonade....pretty bland. All the right ingredients, but too much fluid." o Labs low o Overhydration o Dilutional hyponatremia – can die from too much water intake Hemoconcentration – Fluid is decreased; electrolyte levels high o Too little fluid, super thick concentration of electrolytes o Dehydration o Electrolytes can read high value o Fluid value deficit o Need extra fluid 11/10/2024 21  Potassium (K+) 3.5 - 5 mEq/L REGULATES CARDIAC IMPULSE TRANSMISSION Transmits nerve impulses Helps with skeletal and smooth muscle functioning Helps to regulate Acid-Base Balance Absorbed in Small Intestine; Eliminated Bowel Sources: Fruit, Bananas, Avocados, Green leafy vegetables, Potatoes 11/10/2024 22  Magnesium (Mg2+) 1.3 - 2.1 mEq/L Relaxation of muscle contractions Transmits nerve impulses Regulates cardiac function Helps with Calcium and Vit D absorption Absorbed in small intestine; Excreted in Kidneys Sources: Spinach, almonds, yogurt, green leafy vegetables 11/10/2024 23  Sodium (Na+) 136 – 145 mEq/L Maintains Blood Volume; BP; Takes fluid with it Helps to transmit nerve impulses Helps with contracting muscles. Absorbed in Intestines; Excreted by Kidneys Sources: Salty foods, Salty Snacks, Processed foods 11/10/2024 24  Calcium (Ca2+) 9.0 - 10.5 mEg/L Formation of Bones and Teeth Levels in blood/bone controlled by PTH and Calcitronin Most abundant Cation Helps to transmit nerve impulses Helps with regulating muscle contractions Involved in blood clotting Absorbed in Small Intestine; Excreted in Kidneys Sources: Fruits, veggies, almond, dairy, green leafy veggies 11/10/2024 25  Phosphate 3.0 - 4.5 mg/dL Necessary for production of ATP, energy needed for cellular metabolism Levels higher in ICF and bones; low in ECF Insulin/epinephrine shift phosphate into cells Indirect relationship with Calcium Sources: dairy, processed foods 11/10/2024 26  Electrolyte Elevated Levels Symptoms High Causes Low Levels Symptoms Low Causes Potassium Hyperkalemia DKA Hypokalemia Diuretics Abnormal cardiac conduction Metabolic Acidosis Dysrhythmias (life threatening) GI loss Life threatening Dysrhythmias Salt Substitutes Constipation Vomiting Kidney Failure Fatigue, muscle NGT suctioning weakness/damage/spasms Diaphoresis Cushings Metabolic alkalosis Magnesium Hypermagnesemia Kidney stones Hypomagnesemia GI loss Muscle weakness Muscle weakness Diuretics N/V Excess intake of Muscle CRAMPING Malnutrition Breathing difficulties Antacids/laxatives with Confusion/hallucinations ETOH abuse Dysrhythmias Magnesium seizures Dysrhythmias Sodium Hypernatremia Cushings Hyponatremia Diuretics Lethargy High sodium Intake Lethargy Kidney failure Swelling dehydration Swelling Heart failure BP changes BP changes Too much water Confusion, seizures N/V intake Coma Confusion, seizures Kidney stones Coma Calcium Hypercalcemia Hyperparathyroidism Hypocalcemia Diarrhea Bone issues Bone cancer Weakness Vit D Deficiency, low Kidney stones Steroid Use Muscle spasms diet intake Abdominal pain Hyperactive reflexes Depression Cardiac dysrhythmias 11/10/2024 27 Cardiac dysrhythmias Positive Chvostek  Food Sources – Intake of Electrolytes Except for calcium and magnesium – need food to get electrolyte. Eat (fruits, veggies, dairy, protein) Drink (electrolyte drinks, coconut water, juices) IV pump (NS, LR) Except sodium - o Potassium: bananas, green leafy veggies spinach (K, vit K), avocado o Sodium – canned foods, processed meat, cheeses, packaged/processed foods o Mg – spinach, almond, yogurt, green leafy veggies o Calcium – dairy, green leafy veggies, almonds, oranges o Phosphate – dairy, meat, beans o Chloride –found where Na is and in salt substitutes 11/10/2024 28  Exit doors – Excretion or Loss of Electrolytes Sweating Vomiting Feces Urination diaphoresis GI Diarrhea Urinary tract Sodium NGT Stoma Kidneys filter Insensible blood losses Heat exhaustion Fever Stress Burn patients 11/10/2024 29  Nursing Assessment for Fluid/Electrolyte Imbalances Environment Dietary intake Lifestyle Medications taken? Hot climate Quantify intake of Drinking alcohol, caffeine? Laxatives Access to food/fluids fluids/fruits/vegetables Diuretics Any constraints like Steroids chewing, mobility, cost? antihypertensives Please review boxes 11/10/2024 42.1, 42.2 and 42.3 30  Lifespan Considerations Total body water concentration decreases with age. o This increases the risk for ECV deficit and dehydration Patients with impaired mobility or bladder control issues may limit intake of fluids. Many older patients take numerous medications. Elderly have decreased sensation of thirst and taste. May drink less water and eat more sodium for flavor. Risk for dehydration, hypernatremia, ECV deficit. Dehydration can lead to postural/orthostatic hypotension. Chronic renal or cardiac medical conditions may limit the amount of fluid that can be delivered at a given time. 11/10/2024 31  Replacement of Fluids Hypotonic Isotonic Hypertonic Meaning Less solutes than ICF Same Tonicity as ICF More solutes than ICF Examples 1/4NS, ½ (0.45%)NS D5W, 0.9% NS or NaCl, LR D10W, D5NS, D5 1/2NS, (Lactated Ringers) D5LR Expected Fluid Shift Expands ECV and Expands ECV and mostly Fluid shifts OUT of cells rehydrates cells. does not enter cells. into ECF (Dextrose enters cells) ** Generally, no fluid shifts) Indications Cellular hydration Fluid and electrolyte Hypovolemia, vascular replacement expansion Risks to assess for Decreased BP? Fluid overload, edema, Hypervolemia, cellular diluted lab values. dehydration, hyperglycemia Contraindications Low BP, Burns Volume overloaded Renal or cardiac 11/10/2024 patients patients. 32  Acidosis and Alkalosis Key Terms Acid Substance that releases hydrogen ions lowering the pH Base Substances that bind to free hydrogen ions and increase pH Acidosis Blood and body tissue pH less than 7.35 Alkalosis Blood and body tissue pH greater than 7.45 Arterial Blood gas Lab test that measures the pH and levels of oxygen (PaO 2), Carbon dioxide (PaCO2) and (ABG) bicarbonate (HCO3-) in arterial blood Compensation The body's attempt to return the pH of blood and body fluids to normal, by way of the lungs and kidneys Kussmaul Abnormal respirations, rapid, deep, consistent breathing, seen in metabolic acidosis respirations Metabolic acidosis pH decreases and bicarbonate decreases Metabolic alkalosis pH increases and bicarbonate increases Respiratory acidosis pH decreases and carbon dioxide increases Respiratory pH increases and carbon dioxide decreases alkalosis 11/10/2024 33  Interpreting ABGs or Acid Base Balance 1) Ph P = Primary 2) PaCO2 2 = Second 3) HCO3 3 = Third Ph (A) 7.35 - 7.45​(B) ​ PaCO2 (B) 35 - 45​ (A) ​ HCO3 (A) 22 - 26​ (B) A = Acidosis B = Alkalosis (BASE) ​ ThePhoto by PhotoAuthor is licensed under CCYYSA. 11/10/2024 34  Condition pH Associated value Conditions Respiratory < 7.35 PaCO2 elevated Hypoventilation (medication, neurologic, trauma, MS, ALS, Acidosis sleep apnea, post-operative) Impaired gas exchange (asthma, pneumonia) Lung disease COPD CNS depressants (meds) Respiratory > 7.45 PaCO decreased 2 Hyperventilation (anxiety, stress, pain, fear, head Alkalosis injury, sepsis, pulmonary edema) Metabolic < 7.35 HCO3- decreased Chronic renal disease Acidosis Uncontrolled Diabetes Mellitus Sepsis Starvation Prolonged Diarrhea Metabolic > 7.45 HCO3- elevated Excessive antacids Alkalosis Prolonged Vomiting Prolonged gastric suctioning 11/10/2024 Cushing syndrome 35  Compensated (yes/no), if so, Partially or Fully?? Compensation – balancing pH to return to normal range o Either PaCO2 or HCO3, or both, will be out of range with a normal pH Fully compensated = pH is in normal range o Both PaCO2 and HCO3 will be out of range, but pH will be normal o If pH is closer to acid, look for that. If closer to base, look for that cause Uncompensated – pH is NOT in normal range; body isn't doing anything to correct Partial compensation – pH is not in range, but the lung or kidney is out of range and trying to get pH back. Work in progress 11/10/2024 36 11/10/2024 37  Step 2 Step 1 1) Ph P = Primary 2) PaCO2 2 = Second 3) HCO3 3 = Third Step 3 Ph (A) 7.35 - 7.45​(B) ​ PaCO2 (B) 35 - 45​ (A) ​ HCO3 (A) 22 - 26​ (B) A = Acidosis B = Alkalosis (BASE) 11/10/2024 ​ 38  Summary Table Compensation Condition pH PaCO₂ HCO₃⁻ Status Uncompensated ↓ (acidic) Normal ↓ (low) No compensation Metabolic Acidosis Uncompensated ↓ (acidic) ↑ (high) Normal No compensation Respiratory Acidosis Partially Partial respiratory Compensated ↑ (alkaline) ↑ (high) ↑ (high) compensation Metabolic Alkalosis Partially Partial metabolic Compensated ↓ (acidic) ↑ (high) ↑ (high) compensation Respiratory Acidosis Fully Compensated Full respiratory Normal ↓ (low) ↓ (low) Metabolic Acidosis compensation Fully Compensated Full metabolic Normal ↓ (low) ↓ (low) Respiratory Alkalosis 11/10/2024 compensation 39  What do we have? pH: 7.25 PaCO₂: 40 mmHg HCO₃⁻: 18 mEq PH = acidodic PaCO₂ = normal HCO₃⁻: = acidotic Diagnosis? Metabolic acidosis 11/10/2024 40  What do we have? pH: 7.30 PaCO₂: 55 mmHg HCO₃⁻: 24 mEq/L PH = acidotic PaCO₂ = acidotic HCO₃⁻: = normal Diagnosis? Respiratory acidosis (not compensated) 11/10/2024 41  What do we have? pH: 7.5 PaCO₂: 25 mmHg HCO₃⁻: 24 mEq PH = alkalotic PaCO₂ = alkalosis HCO₃⁻: = normal Diagnosis? Respiratory alkalosis uncompensated 11/10/2024 42  What do we have? pH: 7.48 PaCO₂: 47 mmHg HCO₃⁻: 34 mEq/L PH = alkalosis PaCO₂ = acidic HCO₃⁻: = alkalotic Diagnosis? Metabolic alkalosis partially compensated 11/10/2024 43  What do we have? pH: 7.43 PaCO₂: 30 mmHg HCO₃⁻: 18 mEq/L PH = normal but close to being alkalotic (acidic or alkalotic? Choose whichever the number is closest to) PaCO₂ = alkalotic HCO₃⁻: = acidotic Diagnosis? Respiratory alkalosis fully compensated 11/10/2024 44  Nursing Clinical Judgement Model – History – Subjective Cues Age Environment GI symptoms Diet Chronic diseases Trauma/Burns Lifestyle Smoking hx ETOH hx Medications taken Current ROS 11/10/2024 Recent changes in weight 45  Nursing Assessment: Objective Cues Weight Vital signs o Postural BP/pulse Skin Assessment o Turgor o Mucous membranes Respiratory Assessment Cardiac Assessment Anticipate Urinalysis o Urinalysis o Specific gravity Anticipate Labs o Serum electrolytes o ABG 11/10/2024 46  Possible Nursing Possible Nursing Hypotheses Interventions Fluid imbalance Fluid/IV management o Initiate IV Dehydration o Plan fluid and electrolyte infusion Electrolyte imbalance Oxygen Acid Base imbalance Encourage oral fluids/electrolytes Lack of knowledge of fluid if indicated regimen Relaxation Prevent falls Education 11/10/2024 47  Practice I/Os Fluid/Electrolyte Questions Acid/Base Questions 11/10/2024 48  Module 6 Nutrition Information primarily from: Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. (2022). Fundamentals of nursing (11th ed.). Elsevier. ThePhoto by PhotoAuthor is licensed under CCYYSA. Learning Objectives Identify the role of nutrients in maintaining health throughout the lifespan. Describe the role of nurses regarding nutrition issues and nutritional assessments. Summarize the process of digestion and absorption. Identify risk factors for aspiration and nutritional deficiencies. Evaluate the potential effects of medications, nutrition and nutritional supplements. Apply your knowledge of the digestive system, the patient's medical needs, and your nutritional assessment to implement diet counseling.  Basics of Nutrition There are main guidelines that are applicable for most patients. Every client needs to be considered individually when assessing for nutritional needs and recommending food/supplement. o Medical o Social o Cultural o Health o Financial If you recommend an unsustainable diet plan, or do not provide adequate education, the client will likely NOT follow your recommendations. 11/10/2024 3  Some Terminology BMR – Basic Metabolic Rate Calories Nutrient Nutrient Density Food Scarcity or Food Insecurity Antropometry IBW – Ideal Body Weight 11/10/2024 4  Basic Elements of Food Element Makeup Calories Sources Additional Information per gram (kcal/g) Carbohydrate Carbon, 4 Grains, vegetables, Breakdown into glucose or fructose. Includes Hydrogen, fruits, sugars, insoluble and soluble fiber. Good source of Oxygen starches energy Protein Amino acids 4 Fish, meat, eggs, Only animal sources contain complete poultry, dairy, soy, protein. Can combine vegetarian sources. beans, nuts Basic building block. Needed for cellular repair. Fat Carbon, 9 Animals, vegetables, Saturated and unsaturated. hydrogen, nuts. Triglycerides and fatty acids. acid and Some fat is essential for life, reproductive methyl group tract health. Water Hydrogen, 0 Water sources, Required for life (can only live a few days oxygen fruits, vegetables without). 60-70% of body mass. Lean muscle has more water than other tissues. % decreases over lifespan. 11/10/2024 5  Vitamins and Minerals Element Basics Specifics Additional Information Vitamins Organic, natural sources Fruits, vegetables, animal sources, Essential for metabolism supplements. Neutralizes free radicals Vitamins (fat -soluble) Stored in fat cells and stay A, D, E, K Can become toxic if intake in the body for a longer All from food/supplements. Vit D is also is greater than needed. time. absorbed from the sun Vitamins (water- Not stored in the body, C and B (B complex) Need a daily intake of soluble) need from nutritional these to maintain proper sources. levels Minerals Inorganic Calcium, phosphorus, potassium, Numerous functions. sodium, magnesium, zinc, iron, iodine, Essential as catalysts in copper, chloride... biochemical reactions 11/10/2024 6  Basic Anatomy and Physiology Mouth o Mechanical and chemical digestion Esophagus o Tube for transport Stomach o Proximal and distal sphincters o Chemical digestion o chyme Small intestine o Nutrient absorption Large Intestine o Fluid absorption Anus o Elimination Accessory Organs o Liver o Gall Bladder o Pancreas 11/10/2024 ThePhoto by PhotoAuthor is licensed under CCYYSA. 7  Metabolism and Storage of Nutrients Metabolism - All biochemical reactions within the cells of the body Anabolic Catabolic Building up of more complex substances Breakdown of biochemical structures into simpler structures 11/10/2024 8  Key Guidelines (Box 45.2) 1. Follow a health dietary pattern at every life stage. 2. Customize choices based on personal preferences, cultural traditions and budgetary considerations. 3. Focus on nutrient-dense foods and beverages and stay within calorie limits. 4. Limit foods and beverages high is added sugars, saturated fat, sodium and limit alcoholic beverages. 11/10/2024 9  USDA – MyPlate **This is a guideline. Dietary needs/restrictions need to be individualized.** The USFDA created daily values in response to the 1990 Nutrition Labeling and Education Act. RDI – referenced daily intake DRV – daily reference value 11/10/2024 ThePhoto by PhotoAuthor is licensed under CCYYSA. 10  Nutritional Needs through the Lifespan Age Special Requirements Additional Information Infants ~100-135 kcal/kg/day. Usually doubles birth weight by 6 months 0-12 mths Simple carbs, proteins, fat. Breastmilk or formula. Solids and triples by 1 year. about 4-6 months. Toddlers Whole milk (need the fat for brain an