1
Q
Factors affecting safety
A
-age and development
-lifestyle
-mobility health status
-sensory- perceptual awareness
-cognitive awareness
emotional state
-ability to communicate
-safety awareness
-environmental factors
-life span
2
Q
Age & development Safety hazards:Fetus
A
- Smoking
- Drugs
- Alcohol
- X-rays
3
Q
Age & Development Safety Hazards: Newborn & Infant
A
- Falls
- suffocation
- choking
- burns
- electric shock
- accidents (crib, auto)
4
Q
Age & Development Safety Hazards: Toddler
A
- Falling
- burns
- poisoning
- drowning
- choking
- electric shock
5
Q
Age & Development Safety Hazards: Preschooler
A
- Traffic/playground injury
- choking
- airway/ ear canal obstruction
- poisoning
- drowning
- burns/fire
6
Q
Age & Development Safety Hazards: Adolescent
A
- Accident- car/ bike
- firearms
- substance abuse
- recreational injuries
7
Q
Age & Development Safety Hazards: Older Adult
A
- falling
- burns
- auto/pedestrian accidents
8
Q
Lifestyle that increases susceptibility to injury
A
- unsafe work environment
- high crime neighborhood
- access to guns/ weapons
- insufficient income for safety equip
- access to drugs
- risk taking behaviors
9
Q
Mobility & health status that increases susceptibility to injury
A
- Muscle weakness, poor balance,& coordination
- spinal cord injury ( paralysis)- impaired mobility
- casts
- illness/surgery
10
Q
Sensory- perceptual alterations that increase susceptibility to injury
A
impaired: touch vision hearing taste smell
11
Q
Cognitive awareness that increase susceptibility to injury
A
Impaired awareness:
lack of sleep unconscious/semi-unconscious disorientation medications (narcotics, tranquilizers, sedatives) confusion (wandering in elderly)
12
Q
Impaired awareness
A
decreased ability to perceive environmental stimuli and to respond appropriately through thought and action
13
Q
Emotional state that increase susceptibility to injury
A
- Stressful situations- decrease level of concentration
- Depression- think and react more slowly to environmental stimuli
14
Q
Ability to communicate that increase susceptibility to injury
A
- Aphasia- inability to produce or understand speech
- language barriers
- inability to read
15
Q
Safety Awareness that increase susceptibility to injury
A
- unfamiliar environments
- unfamiliar equipment- O2 tanks, IV tubing, hot packs
16
Q
Environmental Factors that increase susceptibility to injury
A
- Home-flooring, bathtub surface, smoke alarms, swimming pools, lighting
- Workplace- machinery, chemical, worker fatigue, air pollutions
- Community- Street lights, safe water & sewage, food sanitation, crime, traffic,dilapidated housing, landfills
- Healthcare setting-any injury caused by medical management rather than the underlying disease or condition of the client.
17
Q
Factors that increase risk for human error
A
- limited short term memory
- being late/ in a hurry
- limited ability to multitask
- interruptions
- stress
- fatigue
- environmental factors
18
Q
Promoting Safety: Newborns & Infants
A
-accidents are leading cause of death
-teach parents:
amount of observation for safety
ID and remove common hazards in home
CPR training and intervention of airway obstruction
19
Q
Promoting Safety: Toddlers
A
- like to feel and taste everything! Lead poisoning
- todd proof home- outlets, stove tops, cabinets
- car restraints
- pools
- busy streets
20
Q
Promoting safety: Preschoolers
A
- active/clumsy
- continued control of environment: matches, medicine, poisons
- begin safety education- how to cross street, traffic signals, bike riding, avoiding pools
- developmental level not at self reliance yet- parents must watch!
21
Q
Promoting Safety: School age children
A
- Injuries are leading cause of death: MVA’s, drowning, fires, firearms
- Minor injuries include: Outdoor activity injuries, recreational equipment (swings, bikes, pools)
- Parents must monitor closely
22
Q
Promoting Safety: Adolescents
A
- parents assess level of responsibility, common sense, ability to resist peer pressure
- Age doesn’t determine readiness to drive
- sports injuries are common- coordination not fully developed
- sports are important for self esteem & overall development: exercise, personal/social needs, teamwork, competition, and conflict resolution
23
Q
two leading causes of death in adolescents
A
Suicide: firearms, drugs, auto exhaust
Homicide: firearms, cutting/stabbing, tools are used as weapons
24
Q
Promoting Safety: Young adult- mortality
A
- leading cause of death-MVA’s
- drowning, fires, burns, firearms, sun exposure, -suicide r/t inability to cope w/ pressure, responsibilities & expectations of adulthood
25
Promoting Safety: young adults- nurses role in suicide prevention
```
-identify behavior indicating potential problems: depression,
weight loss,
vague physical complaints,
sleep disturbance,
decrease interest in social,
digestive disorders, isolation
```
26
Promoting Safety: Middle aged adults
- time of changing physiologic factors: decreased reaction time, and visual acuity
- MVA's most common cause of accidental death
- other causes- falls, fires, burns, poisonings, drownings, and occupational injuries
27
Promoting Safety: Elders
-physiologic changes: limited vision - driving, climbing stairs, walking
-slowed reflexes
-brittle bones
-failing memory- fire hazards d/t cooking, cigs
-reduced sensitivity to pain and heat- burns
-organic brain syndrome- wandering.
Increase medications- analgesics, sedatives
28
Promoting Safety: elders-- suicide
- suicide rate increases
- unnoticed causes- d/t starvation, overdosing, noncompliance w/ medical care, treatments & meds
- generally more violent- hanging, gunshot
29
contributing factors r/t elder suicide
- uncontrolled pain
- loss of loved one
- major life changes
white men most often
rarely threaten they just do it
30
domestic violence
- child abuse
- intimate partner abuse
- elder abuse
- if abused as a child often show abusive behaviors as adult.
31
common hazards causing burns
- pot handles protruding over stove
- electric appliances w/ dangling cords
- excessively hot bath water
- fires d/t malfunctioning equipment, gases, cigs/ matches, grease, faulty wiring
32
Nursing interventions: Fire safety
- keep emergency #'s near phone
- check smoke alarms- batteries
- family fire drill
- extinguishers avail. ABC
- during fire- close windows/ doors, cover mouth & nose w/ damp cloth and stay close to floor
33
Nursing interventions: Falls
- encourage daily or more frequent contact w/ friends & family
- install personal emergency response systems
- maintain physical environment to prevent a fall
- "get up and go" test to assess fall risk
34
Get up and go test
1. observe posture in a straight back chair
2. ask client to stand. observe if leg muscles are used or if need to push off w/ hands
3. once comfortable standing have client close eyes. do they sway?
4. client opens eyes. walks 10 ft turns around and returns to chair. observe gait, balance, speed, stability
5. have client turn and sit in chair. observe how smoothly client preforms
35
Nursing interventions: falls r/t side rails
person's with memory loss, impairment, altered mobility, nocturia, & other sleep disorders are prone to becoming trapped in rails and more likely to fall getting OOB by going over and around rail
36
Nursing interventions: Poisoning
- teach parents childproofing and disposal of unused meds
- provide info & counseling- insects, snakes, spiders, drug use
- lock up/ keep out of reach potentially dangerous items
- #'s of poison control should be available
37
Nursing interventions: in event of poisoning
- identify poison-search open containers and empty bottles
- contact poison control
- keep person quiet, sidelying or sitting w/ head btwn knees to prevent aspiration
38
carbon monoxide poisoning
- odorless,colorless, tasteless GAS
- signs & symptoms:
* headache
* dizziness
* weakness
* N/V
* loss of muscle control
39
suffocation/ choking
- food or foreign object becomes lodged in throat- cuts off air source
- others: drowning, gas/smoke inhalation, covering of mouth w/ plastic, strangulation
- Heimlich maneuver used to dislodge object
40
Electrical Hazards
- grounded equipment (3 pronged plugs)
- check cord fraying
- don't overload outlets
- no appliance near water
- insulated wires, protective plug covers
- unplug if have tingling sensation or shock
41
Fire arms
- store in locked cabinet
- bullets in different location
- teach children to stay away/ never touch
- never point at anyone
- ensure not loaded before cleaning
- inspect Q2y by qualified person
42
Radiation
- limit exposure, use shielding devices
| - nurses need to protect themselves
43
Client restraints: physical vs. chemical
- physical- manual, physical, or mechanical device, material, or equipment attached to pt's body
- chemical- meds used to control socially disruptive behavior
- prevents pt from injuring self or others
- use everything else before resorting to restraints
44
legal implications of restraints: behavioral management standards
- client is danger to self and others
- nurse apply restraints but PCP must come within 1 hr for eval
- written restraints ordered following eval are valid for 4 hrs
- if client is restrained and secluded- continual visual & audio monitoring is needed
45
legal implications of restraints: acute medical & surgical care standards
- temporary immobilization of pt is necessary to preform procedure
- orders renewed daily
46
legal implications of restraints
- PRN orders are PROHIBITED
- used only after everything else to ensure safety was unsuccessful & DOCUMENTED
- documentation must state clearly the needs for restraint, to client and family
- not used for staff convenience, punishment of client
47
selecting restraint
- restrict pt movement as little as possible
- doesn't interfere w/ treatment or health problem
- must be readily changeable
- restraint is safe for particular pt
- least obvious to others
48
Kinds of restraints
- jacket/vest-confused or sedated pt in bed/ wheelchair
- belt- for pt being moved on stretcher or wheelchair
- mitt/hand- prevents confused pt from scratching/ injuring self
- limb- immobilize limb for therapeutic reason (IV)
- geri chair, wheelchair w/ lap tray
- bed rails
49
upper respiratory system
- mouth
- nose
- sinus
- pharynx
- larynx
50
Nose
- lined with mucus membranes
- lined w/ hair follicles- 1st defense
- air is warmed, humidified and filtered
51
sinuses
- air filled cavities within bones
- lined with ciliated epithelium
- frontal, maxillary- largest & sight of pain and inflammation
52
pharynx
- combo of oropharynx and nasopharynx
| - shared passageway for air and food consumption
53
larynx
- adam's apple- thyroid cartilage
- cricoid cartilage-contains vocal chords
- speech/voice box
- epiglottis- open during respiration, closed when swallowing
54
lower respiratory system
- trachea
- bronchi
- bronchioles
- alveoli
- pulmonary capillary network
- pleural membranes
55
trachea
- windpipe
- directly below larynx
- separated by cricoid cartilage
- leads to right and left mainstem bronchi at the carina
- aspiration occurs most in right lung
56
alveoli
- where gas exchange happens
- lined with thin walls surrounded by pulmonary capillaries
- blood supplied by right ventricle through pulmonary artery
57
respiratory membrane
divides alveoli from pulmonary capillaries
58
Smoking:mainstream smoke vs side stream smoke
- inhaled directly from cigarette
- released from the burning tip of cigarette
- side stream is more harmful
59
effects if tobacco use
-constricts bronchioles
-increases fluid secretions into airway
-causes inflammation of bronchial lining
paralyzes cilia
=reduced airflow, increase production of secretions
60
smoking leads to
- chronic bronchitis
- emphysema
- over 80% of lung cancer
61
smoking cessation
- immediate repair begins
- increased cough at first, as cilia clean up airway
- O2 levels improved within 8 hrs
- risk of heart attack decreases
- risk of lung cancer decreases
62
cough reflux
- induced by irritants in lower respiratory structures
- forceful expiration of air, after inspiration of large volume of air
- purpose- dislodge mucus & any foreign particles from lower respiratory tract
63
pleural membranes
(btwn lungs & ribcage)
- thin double layer of tissue
- parietal pleura
- visceral pleura
- potential space
64
parietal membranes
lines thorax & surface of diaphragm
65
visceral pleura
covers external surface of lungs
66
potential space
area between layers filled with pleural fluid
| 50 mL
67
ventilation
- airway-kept open by sneeze and cough reflexes, and ciliary action
- respiratory center of brain
- controls breathing
68
ventilation compromised by:
* inflammation
* edema
* excess mucus production
69
ventilation depressed by:
* head injury
| * drugs (opiates, barbituates)
70
intrapleural pressure
slightly negative, relative to atmospheric pressure, creating suction between visceral and parietal pleura
71
intrapulmonary pressure
- wants to equalize pressure with atmosphere
- inspiration
- expiration
- tidal volume
72
inspiration
-contraction of diaphragm/intercostal muscles= increase in size= neg pressure in lungs= air rushing in to equalize pressure
73
expiration
Diaphragm/intercostal muscles relax=intrapulmonary pressure increases=air expelled to equalize again
74
tidal volume
amount of air inspired/expired with each breath= about 500mL in adults at rest
-increases with exercise
75
accessory muscles
- neck, intercostal, abdominal
| - employed with: exercise, dyspnea, acute/chronic disease
76
pulmonary compliance
- elasticity of lungs
- birth--lungs stiff, loosen w/ each breath
- compliance decreases w/ age
77
atelectasis
collapse of portion of lung
78
pulmonary recoil
tendency of lungs to want to shrink down, facilitating expiration
79
surfactant
- lipoprotein produced by alveolar cells
- reduces surface tension of alveolar fluid
- facilitates lung expansion-w/o it lungs collapse
- develops 27-28 week of conception
80
gas exchange by diffusion
movement from area of greater pressure to area of lower pressure
81
gas transport: oxyhemoglobin
97% of O2 loosely combined with hemoglobin (Hgb) and carried to cells
82
oxyhemoglobin affected by:
- cardiac output: amt of blood pumped out per min
- # of erythrocytes- hematocrit
- exercise
83
Gas transport: CO2
- most(65%) carried in RBC as BICARBONATE (HCO3)
- Some(30%) combines with Hgb as carbhemoglobin for transport
- some transported in plasma and as carbonic acid
84
decreased level of O2=
increased ventilation
85
increased level of CO2=
increased rate and depth of respirations
86
CO2 narcosis
sleepy shallow breaths
87
Respiratory center of brain is more concerned about what levels
CO2
88
hypoxic drive
- A condition in which chronically high levels of C02 cause low levels of oxygen in the blood to stimulate the respiratory drive; seen in patients with chronic lung diseases
- high concentrations of O2 can knock out this drive
89
age affecting respiration
ELDERLY:
- airway more rigid
- air exchange decreased
- decrease in cough reflex/ ciliary action
- mucus membranes drier
- decrease in muscle strength and endurance
- osteoporosis
- GERD
90
environment affecting respiration
- Altitude
- heat
- cold
- air pollution
91
lifestyle affecting respiration
- exercise/activity
| - occupational hazards
92
health status affecting respiration
- nervous system compromised- Traumatic brain injury
- cardiac compromise-heart failure
- chronic pulmonary disease
- some metabolic processes- cystic fibrosis
93
medications affecting respiration
benzodiazepines- valium
- antianxiety drugs
- narcotics-morphine
94
stress affecting respiration
- psychologic- hyperventilation as response to stress
* O2 too high and CO2 too low
- physiologic- epinephrine release, bronchiole dilation, increase O2 delivery to tissue
95
hypoxia
insufficient O2 anywhere in body
96
symptoms of hypoxia
* increased pulse
* rapid shallow breaths
* increased restlessness
* flaring nostrils
* intercostal retraction
* cyanosis
97
causes of hypoxia
hypoventilation- increase CO2
- decrease gas exchange
- decreased gas transport--hypoxemia, cyanosis
98
dyspnea
difficulty breathing
99
apnea
absence of breathing
100
bradypnea
Slow breathing
101
tachypnea
rapid breathing
102
orthopnea
ability to breath only in an upright position
103
what is cyanosis
Bluish skin color resulting from inadequate tissue oxygenation.
104
kussmaul's breathing
hyperventilation with metabolic acidosis
| trying to breath off excess CO2
105
cheyne stokes
- waxing and waning of breathing- very deep to very shallow
| - short periods of apnea
106
biot's (cluster)
shallow breaths and apnea
107
partial obstructed airway
indicated by low pitched snoring during inhalation
108
complete obstructed airway
- no movement of air
| - will see retractions in attempt to breath
109
COPD
chronic obstructive pulmonary disease aka chronic airflow limitations (CAL)
110
limited reversibility COPD
emphysema
| chronic bronchitis
111
reversible COPD
asthma
112
emphysema results in
- increased air retention (CO2 retention)
- increase airflow resistance
- alveolar hyperinflation
- diaphragmatic flattening
113
emphysema characterized by
- destruction of aveoli
- loss of recoil
- narrowing of bronchioles
114
emphysema
-increase in work of breathing
-use of accessory muscles
-increase in need for O2 for increased muscle use
"air hunger"
115
dyspnea on excursion
out of breath from moving small amounts "bed to chair"
116
emphysema clinical manifestations
- dyspnea
- orthopnea
- barrel chest
- often cough- w/ minimal production
- pink tinge to skin
- inadequate nutrition
117
chronic bronchitis
- affects small/large airways rather than alveoli
| - chronic inflammation of airways--mucus gland hypertrophy and thick mucus--blockage of airways
118
chronic bronchitis clinical manifestations
- cyanosis
- sputum production
- clubbing of fingers
- cor pulmonale- right sided heart failure
119
asthma is characterized by
- reversible airflow obstruction
- airway inflammation
- airway hyperresponsiveness
- often presented before age 10
120
asthma
- overreactive airway
- exercise, fog/smog, smoke, odors/aerosols, upper respiratory tract infections
- pollen, mold spores, animal dander, dust mites, cockroaches
121
asthma clinical manifestations
- wheezes
- chest tightness
- feeling of suffocation
- symptoms disappear btwn attacks
122
complications of COPD
- hypoxemia
- respiratory acidosis
- respiratory infections
- cardiac failure
- cardiac dysrhythmias
- status asthmaticus
123
physical exam for pulmonary assessment
- respiration-rate ease quality
- use accessory muscles?
- pursed lip breathing?
- shape of thorax- barrel chest, retractions w/ inspiration?
- auscultation-lung sounds. describe sound and location
124
interventions for COPD
- stop smoking
- annual flu vaccine
- pheumococcal vaccine
- teach controlled breathing techniques
- sm frequent meals
- frequent rest periods
125
promoting good oxygen: deep breathing and coughing
- used after surgery
- promotes good pulmonary hygiene
- may promote good expectoration- (coughing up)
- prevent/reverse atelectasis
126
promoting good oxygenation: hydration
- maintains moisture to mucus membranes
- keeps secretions thin
- humidifier use
127
promoting good oxygenation: medications
- bronchodilators
- anti-inflammatory drugs
- expectorants
128
bronchodilators
- short acting beta 2 agonists- rescue med, reduces bronchospasms & dilates bronchial tubes
* albuterol (proventil)
* levalbuterol (xopenex)
- anticholinergic agents
* ipratropium atrovent
- watch for increased HR BP anxiety restlessness
129
how much meds are inhaled with spacer and without
with- 21%
| without-9%
130
anti-inflammatory drugs
- can be given orally, by IV, or inhaler
- decrease edema and inflammation
- side effects- tremors, thrush, increased blood glucose, increase HR
- long term control
* methylprednisolone (solumedrol)
* fluticasone (flovent)
* budesonide (pulmicort)
131
what do you give first anti-inflammatory or bronchodilator
bronchodilator because it will open up the lungs for an increase surface area
132
expectorants
- help break up mucus
- make it more liquid and easier to expel
- increase the water intake to increase efficacy of drug
* mucinex
133
incentive spirometry
- improve pulmonary ventilation
- counteracts effects of anesthesia
- expands collapsed alveoli
- facilitates gas exchange
- loosen secretions
134
chest physiotherapy
* percussion
* vibration
* postural drainage
- used to facilitate movement of secretions in lungs
135
chest physiotherapy percussion
forceful striking of skin with cupped hand
| avoid flat hand
136
chest physiotherapy vibration
- used after percussion
| - mechanically dislodging secretions
137
chest physiotherapy postural drainage
drainage by gravity from various lung segments
138
specifications of oxygen therapy order
- concentration
- method of delivery
- liters/minute
- desired oxygen saturation level
139
why must you be careful during oxygen therapy with a COPD patient
-need low flow of O2 delivery
-decreased O2 levels stimulate breathing so if it is too high this is knocked out (hypoxic drive)
oxygen concentrations not CO2 play a key role in regulating oxygenation
140
oxygen therapy: nasal cannula
- low concentration of O2 delivery.
- 2-6L/min, 24-45% oxygen
- dries and irritates nasal mucosa
141
oxygen therapy: face mask--simple
5-8L/min
| 40-60% oxygen delivered
142
oxygen therapy: face mask--partial rebreather
- has reservoir bag for recycling expired O2. bag must not deflate
- 6-10L/min
- 60-90% oxygen delivered
143
oxygen therapy: face mask--nonrebreather
-highest O2 level delivered
-95-100%
-10-15L/min
-one way valves attached
bag must not deflate
-doesn't allow outside air to be breathed in
144
oxygen therapy: face mask-- venturi mask
specific O2 concentrations by preset percentages (different colors determine percentages)
145
oxygen therapy: face tent
- used when face masks aren't tolerated by patient
- dampness on face & chaffing may be a problem
- can provide high humidity
146
oxygen therapy: oxygen tent
- used for children
- tent gets warm=use cooling mechanism
- keep child warm & dry
- O2 flow will be btwn 10-15L/min and 30%
147
suctioning secretions
- method of removing secretions through a catheter
- used when pt has trouble removing secretions or when O2 saturations indicates obstructions
- hyperoxygenate before beginning
- put in semifowler's position
- go through right nostril
148
artificial airways
orpharyngeal
nasopharyngeal
endotracheal
tracheostomy
149
tracheostomy
surgical creation of an opening in the trachea
150
endotracheal intubation (ET)
placing tube through mouth and into trachea to maintain open airway and facilitate artificial ventilation
used after surgery or emergency situation
151
Oropharyngeal
becomes opening of oral cavity
| used for unconscious person
152
nasopharyngeal
pertaining to the nose and pharynx
| used when obstructions of the mouth or tongue occur
153
pneumothorax
any injury that allows accumulation of atmospheric air into pleural space.
- can be opened or closed
154
pneumothorax clinical manifestations
- diminished breath sounds on affected side
- diminished chest wall movement
- deviation of trachea
- pleuritic pain, tachypnea
155
Tension pneomothorax
- complete collapsed lung on affected side
- air enters into pleural space on expiration, doesn't exit on inspiration
- increase in pressure, shift of heart and vessels, decrease in cardiac output
156
chest tube
- used to reintroduce negative pleural pressure
- sealed drainage system
- kept lower than patient's chest
157
components of chest tube
- suction control system
- water seal system
- collection chamber
158
chest tube: suction
- stays constant
| - preset by a dial or by water (centimeters)
159
chest tube: water seal
- prevents air from entering sealed system
| - allows for air in pleural space to escape
160
chest tube: collection chamber
measured every shift or more frequent
161
what if chest tube becomes disconnected
stick the tube in sterile water so no air is allowed into air space
162
nursing consideration for test tube
- check connect of tube
- assess client
- assess dressing
- assess for subcutaneous emphysema (poor seal- air in tissue)
- assess for pain
- check water seal and suction control
- assess drainage- mark with time and date
- avoid milking and clamping tube- increases risk of tension pneumothorax
163
adventitious breath sounds
abnormal breath sounds- happens when airway is filled with fluid, mucus, or when pleural linings are inflamed
164
diffusion
mixing of molecules or ions of two or more substances as a result of random motion
165
emphysema
chronic pulmonary condition in which the alveoli are dilated and distended
166
hematocrit vs hemoglobin
- proportion of RBC's to total blood volume
| - red pigment in RBC that carries oxygen
167
expectorate
spit out
168
hemothorax
accumulation of blood in pleural cavity
169
hypercapnia/hypercarbea
when CO2 accumulates in the blood
170
lung compliance vs recoil
- expansibilty of lung
| - tendency of lung to collapse away from chest wall
171
stridor
harsh, crowing sound made on inhalation caused by constriction of upper airway
172
pluerisy
inflammation of the lining of lungs and chest
| -leads to chest pain when taking deep breaths
173
bronchospasm
contraction of smooth muscle in walls of bronchioles
| -causes narrowing of lumen
174
macronutrients
- carbohydrates
- fats
- proteins
* *need in large amounts to maintain energy
175
carbohydrates
carbon, hydrogen, oxygen
simple & complex
major source of bodies energy
176
Simple vs complex carbs
- sugars
| - starches and fibers
177
simple carbs: monosaccharides vs disaccharides
- glucose, fructose, galactose
| - sucrose, lactose, maltose
178
```
glucose
fructose
galactose
sucrose
maltose
lactose
```
- blood sugar
- sweetest -- fruits
- part of lactose
- table sugar (glucose+fructose)
- beer (glucose+glucose)
- milk sugar (glucose+galactose)
179
starches
- insoluble, non-sweet
| - best source-grains, legumes
180
fiber
- supplies roughage or bulk to diet
| - indigestible to humans
181
fiber helps with:
-obesity
-constipation
-diverticular disease
-colon cancer
-heart disease
diabetes control
182
digestion of carbs
- digested by enzymes and disacchaidases
| - end product= monosacchrides absorbed by small intestine
183
glucose homeostasis
levels between 70-120 mg/dL
184
carb storage:glucose
- main source of energy, excess will circulate ready to be accessed
- insulin enhances it to transport across cell membrane
- other excess stored as glycogen (in muscle and liver) and fat
185
carb storage: glycogen
-can be converted back to glucose, but conversion of glucose to fat is irreversible
186
gluconeogensis
fat to glycogen to glucose.
| but in small amounts
187
ketone bodies
formed to compensate when not enough carbs around
| -fruity smell acid base imbalance
188
protein essential vs non essential
- must be ingested from exogenous source (9)
| - can be manufactured by body (11)
189
anabolism vs catabolism
- protein synthesis from available amino acids
| - degradation of excess amino acids into energy or conversion to fat
190
complete protein vs incomplete protein
- contains all essential amino acids and many nonessential ones-meat fish dairy
- lack one or more essential amino acids
191
complimentary proteins
combo of foods to provide all amino acids
| -corn & beans, rice & beans
192
protein digestion: pepsin
- begins in stomach
- secreted by chief cells, starts digestion of CHO
- most digestion done in small intestine with enzymes released from pancreas
193
marasmus vs kwashiorkor
- deficiency of overall energy
| - deficiency of protein
194
protein storage
- liver uses amino acids to synthesize specific proteins- albumin
- most go into muscles and cell regeneration
195
Fats
-saturated-solid at rm temp
-unsaturated- oils
-sterols-cholesterol
**no more than 30% of daily calories from fat
densest form of energy
196
fatty acids: saturated, monounsaturated, polyunsaturated
- butter, beef, palm oil
- olive oil
- vegetable oil, fish
197
Omega 3
- in walnuts, some fruits and veggies, cold water fish, flax seed
- -decreases symptoms of heart disease, depression, ADHD
198
Omega 6
- in eggs, cereal, veg oils, baked goods, margarine
| - supports skin health, lowers cholesterol, helps clotting
199
what should be the ratio of omega 3 to omega 6
4: 1 eat more omega 3
| - 6-8 g/ week
200
cholesterol
highest source: egg yolks and organ meats
| not in plants
201
lipoproteins: LDL
- contribute to plaque formation along vessels and arteries
| - plaque build up = atherosclerosis, or coronary artery disease CAD
202
lipoproteins: HDL
-bind with cholesterol and remove it from circulation
| the best kind!
203
Vitamins: B1- Thiamine
- found in brown rice and enriched rice
- important in nerve function
- see deficiency with alcohol abuse, excessive vomiting, gastrectomy, anorexia nervosa
204
beriberi
lack of thiamine
205
Vitamins: B2 riboflavin
- function similar to B1
- milk is major source
- UV rays destroy it
- enriched grains, broccoli, meats, eggs, poultry
206
cheilosis
- lack of B2
| - cracked lip corners
207
glossitis
- lack of B2
| - swollen red tongue
208
Vitamin B3: niacin
- tryptophan can be converted to niacin
| - if adequate in protein usually adequate in B3
209
pellagra
- lack of B3
| - diarrhea, dermatitis, and dementia
210
Vitamins: folate
- green leafy veggies, legumes
- necessary for formation of fetal neural tubes
- 400 mg
211
what meds affect absorption of Folate
- anticonvulsants
- oral contraceptives
- aspirin
- NSAID
212
Vitamins B12: cobalamin
- from animals
- absorptions relies on intrinsic factor
- produced in stomach mucosa
213
pernicious anemia
deficiency of B12
214
Vitamin C: ascorbic acid
- antioxidants and coenzymes
| - citrus, peppers, strawberries, broccoli, green leafy veggies
215
Scurvy
- lack of Vitamin C
| - bleeding gums
216
Vitamin A
- sources- retinoids- in animal
| - carotenoids- plants-deep green, yellow, orange
217
Night blindness
Vitamin A deficiency
218
intrinsic factor
essential for absorption on vitamin B12
| secreted by gastric mucous membrane
219
Vitamin D
-sunshine- 10-15min/3X a wk, milk, oily fish
220
rickets, osteomalacia
Vitamin D deficiency-linked to colon cancer, prostate cancer, breast cancer, autoimmune disease
221
vitamin E
- vegetable oils
| - antioxidants
222
vitamin K
- green veggies, synthesized by bacteria living in intestine
- cofactor in blood clotting
- antidote for anticoagulant coumadin (warfarin)
- newborns don't produce it
223
Mineral: calcium
- essential to bone formation
- nerve impulses
- muscle contraction and relaxation
- forms blood clots
- BP regulation
- from dairy, green leafy veggies,tofu, legumes, small fish w/ bones
224
calcium better absorption if
- sufficient vit D
- acidity of digestive mass
- weight bearing exercise
225
osteoporosis
deficiency of calcium
226
Mineral: sodium
- maintain BP and volume
- transmission of nerve impulses
- overly consumed
227
hyponatremia
low blood sodium
| -can happen with athletes, neurologic or kidney disease
228
mineral: potassium
- crucial for normal function of nerves and muscles--heart
- sweet potatoes, bananas, oranges, legumes, dairy products
3. 5-5mEq/L
229
hypokalemia
- deficiency of potassium
| - muscle weakness, confusion, EKG change, cardiac arrhythmias
230
excess hyperkalemia
-weakness cardiac arrhythmias
231
mineral: iron
- distributes oxygen throughout body
- women need more than men
- sources heme-animal. non-heme- veggies
- better absorbed with vit C
232
iron deficiency anemia
- iron deficiency
| - decreased hemoglobin and hematocrit
233
pica
- iron deficiency
| - hunger and appetite for non food items- clay dirt
234
mineral: iodine
- part of hormone thyroxine, produced by thyroid
| - seafood, iodinized salt
235
goiter
iodine deficiency
| enlarged thyroid gland
236
water
13 cups/day-men
| 9cups/day-women
237
superfoods
beans, blueberries, broccoli, oats, oranges, pumpkins, salmon, soy spinach, tea, tomatoes, turkey, walnuts, yogurt, quinoa, dark chocolate
-helps with heart disease, cancer, high cholesterol
238
energy balance growing vs dieting
- need + balance intake>output
| - need - balance intake
239
energy balance intake
-measured in Kcals
4 Kcal/gram of CHO
4Kcal/gram of protein
9Kcal/gram of fat
240
energy balance output
affected by metabolism, energy expenditure
241
BMR
basic metabolism rate
| rate at which body metabolizes food to maintain energy needs at rest
242
prebiotics
- non living indigestible polusaccharides metabolzied in intestine
- stimulate bacteria already present in gut
243
probiotics
-living organisms that have beneficial therapeutic effects on host when ingested
244
probiotic role
- antibiotic associated with diarrhea- C. Difficile
- inflammatry bowel disease (chron's ulcerative colitis)
- yeast infection, BV
- immune system booster
- cancer
245
prebiotic role
- stimulates absorption of several minerals and improves bone mineraliztion
- onion banana garlic quinoa
246
Changes through lifespan: neonate
- breast milk/ formula
- higher needs for fluid intake
- demand feeding-when infant is hungry
- be fed every 2.5-4hrs
- 80-100mL/kg body weight
247
Changes through lifespan: toddler
- adjust to regular meal times
- fluid needs decrease
- 900-1800Kcal/day
- picky eaters
248
Changes through lifespan: preschooler
- fluid needs decrease- 1500 mL/24hrs
- use utensils
- require snacks btwn meals
249
Changes through lifespan: school age child
- 2400Kcal/day
- need protein rich food at breakfast
- forming eating habits
250
Changes through lifespan:adolescent
- growth spurt-increase need for protein, calcium, vit D, iron, B vitamins
- concerns- poor self esteem, eating disorders
251
Changes through lifespan: young adult
- female- need for iron -menstration
| - need for calcium and vit D continues
252
Changes through lifespan: middle aged adult
- metabolic rate decreases
- need for higher water intake
- calcium, protein
- limit intake of high cholesterol foods
253
Changes through lifespan: elders
- decrease number of calories
- physical changes- tooth loss, decreased sense of taste
- psychosocial needs- eating alone, decreased access to food, lowered income
254
anorexia nervosa vs bulimia
-loss of at least 15% of original body weight
ammenorrhea - no menstration
-over 3 months w/ at least 2 episodes/wk
255
vegetarian diet lacto, ovo
will include eggs and milk in diet
256
vegan
omits all food from animal sources
| need to get vit B12 from other sources
257
malnutrition, protein calorie malnutrition
- overweight when BMI 25-29.9
- obese when BMI >30
- -depressed protein level( albumin, weight loss, muscle wasting)
258
nutritional assessment
- screens-at risk pt
- anthropometric data ( ht,wt,BMI)
- biochemical data (labs)
- clinical assessment (hair, nails,
- dietary data (24 hr recall)
259
BMI
- body mass index
- divide weight in kilograms by height in meters squared
- healthy range-18.5-24.9
- obese->25
- underweight<18.5
260
risk factors for nutritional problems
- diet history- difficulty swallowing, eating alone, fad diets
- medical history- alcohol abuse, teenage pregnancy, chronic illness
- medication history- antacid use, antidepressants, digoxin, laxatives
261
physical assessment for nutrition
- hair-dull brittle sparse
- nails- brittle spoon shaped
- tongue- swollen beefy red smooth
- gums- bleed easily, swollen inflamed
- skin- dry flaky petechiae bruises
262
assessment of nutrition labs
albumin- slow to change will reflect chronic deficiency- <2.8g/dL
- prealbumin- acute changes in nutrition status
- transferrin- changes r/t iron stores
263
conditions that require special diets
- surgery
- aspiration risks
- mouth conditions
- chronic diseases (renal, cardiac, hepatic)
264
special diet: clear liquid
- see through it
- maintains hydration and carbohydrates
- doesn't supply enough protein, fat vitamins, minerals, calories
- coffee tea soda gelatin popsicles
265
special diet: full liquid
- short term diet
- clear liquid plus: food that turns liquid at rm temp
- milk, high calorie drinks-ensure
266
special diet: soft
- clients that have difficulty swallowing or chewing
- low residue (low fiber) diet, mostly cooked foods
- pureed diet
267
special diets: other
- no added salt (NAS)
- ADA- american diabetic association. usually qualified with Kcal count
- cardiac-low cholesterol, low salt
- 2g protein-renal or hepatic disease
268
enteral nutrition
- through the gastrointestinal system
- nasogastric tube
- nasoenteric tube
- percutaneous endoscopic gastrostomy tube PEG
269
NG tube for nutrition
- through a nostril down nasopharynx and into stomach
| - also used for suction
270
Nasoenteric or nasointestinal tube nutrition
- longer more flexible tube
- used for clients at risk for aspiration
- sits beyond pyloric sphincter in sm intestine
- placement checked with xray
271
PEG tube nutrition
- or jejunostomy
- directly into stomach through surgical hole
- long term nutritional support
272
enteral feedings
- 300-500 mL several times a day
- administer over 30 mins
- keep in fowlers position
- check placement
273
parenteral nutritions
-PPN- partial parenteral nutrition
can be given through peripheral intravenous access
-TPN- total peripheral nutrition
must be given through central iv
274
parenteral nutrition TPN
- used when gastrointestinal tract nonfunctional
- given through superior vena cava
- highly concentrated
- dextrose 10-50%, water, fat, proteins, electrolytes, vitamins, trace elements
- high risk of infection
- gradually infused to prevent hyperglycemia
- daily labs- basic metabolic panel, complete blood count
275
TPN complications
- pheumothorax from cvc
- air embolism
- sepsis
- hyperglycemia
- fluid overload
- rebound hyperglycemia- abrupt interruption or cessation
276
when would you use antimicrobial soap
ICU, nursery
- known multiple resistant bacteria
- before invasive procedure
- immunocompromised patients
277
sepsis vs asepsis
- state of infection
| - limit growth of organism transmission
278
true pathogen vs opportunistic pathogen
- make anyone sick
| - looks for susceptible host
279
nosocomial infections
infections associated with healthcare services in a healthcare setting
most common in medical and surgical ICU's
280
most common entry site for nosocomial infections
- urinary
- respiratory
- bloodstream
- wounds
281
most common infection causing agents
- escherichia coli(intestines)
- staphylococcus aureus (nasal passage)
- streptococcus pyogenes
- lactobacillus (intestines)
282
infectious fungi
yeast- candida albicans
| molds- penicillins, and aspergillus
283
infectious parasites
- hookworm
- tapeworm
- fleas, ticks
- protozoas (malaria)
284
drug resistant organisms
drugs resistant to antimicrobial agents
- MRSA- methicillin resistant staph aureus
- VRE- vancomycin resistant enterococcus
285
MRSA
susceptible to vancomycin, linezolid--reserved for big infections
286
why resistant organisms spread
- misuse ad overuse of antibiotics
- used in livestock as growth promoters
- decreased stay in hospitals
- poor house keeping in hospitals
- lack of infection control nurse
287
prevention of spread of infection
- isolation gowns
| - many contaminations happen because of scrubs
288
majors sites for MRSA in hospitals
- surgical wounds
| - lower respiratory tract
289
community acquired MRSA
- skin infection
- susceptible to bactrim, bactroban
- common in children/ adolescents- sports, and pets
290
Multiple drug resistant TB (MDR-TB)
- multiple drug therapies used
- spread by-cough sneeze singing speaking
- not spread by kissing smoking
- need neg air pressure room
291
extended sprectum beta lactase (ESBL)
-produced by bacteria resistant to penicillin & cephalosporins
-produced by e-coli, klebsiella, pneumonia, salmonella, enterobacter
at risk- elderly, critically ill, young
-seen in UTI's
-contact precautions
292
Clostridium difficile
often with antibiotic use
- s/s watery stool, fever, loss of appetite, nausea, abdominal pain
- contact precautions
- must wash hands, sanitizer doesn't work
293
portal of exit for infection
sneezing(rhinovirus), feces (hep A), sex(gonorrhea), mosquito bite(malaria west nile)
294
portal of entry
-break in skin, iv cath, urinary cath, ingestion, respiration
295
transmission
direct- kissing
- indirect-vehicles-toys surgical tools
- vector borne-animal insect
- airborne- droplets, dust
296
3 stages of inflammatory process for defense of infection
1) vascular and cellular response- edema, pain, increase of blood flow, luekocytes
2) exudate, escaped fluid from vessel, dead phagocytic and tissue cell, area walled off with platelets, thromboplastins, fibrinogens
3) reparative stage, scar tissue forms
297
universal precautions
obstructs spread of bloodborne pathogens
| body substance isolation (BSI) for health care workers and patients
298
standard precautions
- blood
- all secretions, excretions, except sweat
- broken skin
- mucus membrane
299
contact precautions
- private room for client
- gloves, gown
- dedicated equipment- bp cuff
300
droplet precautions
private room, or shared with same infectious organism of another pt
- mask if within 3 feet
- surgical mask for pt for transport
301
airborne precautions
- private room with neg air pressure
- respiratory device to enter room
- door closed
- surgical mask for pt for transport
302
reverse precautions
- protects pt from you
- compromised pts
- leukemia, major burns
303
penicillin: considerations
- assess allergy to penicillin
- monitor renal function-most excreted through kidneys-- especially elderly
- decreases effectiveness of BC
304
penicillin: side effects
- nausea vomiting
- rash
- diarrhea
305
Penicillin G
ordered in units, given IM
typical 600,000 units
adverse reactions: rash, drug fever, anaphylaxis, neuropathy, nephopathy
306
Penicillin V
contains potassium
ordered in mg
adverse reactions: GI upset, urticaria, anaphylaxis, check K levels in renal pts
Nursing 111
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