1
Q
What type of digestion involves making food smaller?
A
Mechanical digestion
2
Q
What type of digestion includes chewing, tongue movements and mixing food with saliva?
A
Mechanical
3
Q
What type of digestion includes stomach churning and digestive juices creating chyme?
A
Mechanical
4
Q
What is chyme?
A
The acidic soup that results from stomach churning and digestive juices
5
Q
Food moving to the small intestine from the stomach for absorption is what kind of digestion?
A
Mechanical
6
Q
The breakdown of macronutrients into their building blocks needed for energy is what type of digestion?
A
Chemical
7
Q
In chemical digestion, carbohydrates are broken down into what?
A
glucose
8
Q
What enzyme breaks down CHO into glucose in the mouth, pancreas and small intestine?
A
(salivary/pancreatic) amylase
9
Q
Where are proteins broken down into amino acids?
A
Stomach
10
Q
What two things are needed to break down proteins into amino acids?
A
HCl which activates pepsin
11
Q
Fats are broken down into fatty acids by what enzyme?
A
Lipase
12
Q
Where is lipase produced?
A
Mouth, stomach and pancreas
13
Q
What are some of the digestive changes that occur as we age (8 total)?
A
- Decreased taste and smell
- Dry mouth
- Chewing and swallowing issues
- Early satiety
- Decreased thirst (risk of dehydration)
- Decreased HCl acid secretion
- Decreased absorption of nutrients
- Decreased peristalsis
14
Q
Dry mouth
A
xerostomia
15
Q
Trouble swallowing
A
dysphagia
16
Q
What is a calorie?
A
A unit of energy required to raise one gram of water one degree celsius
17
Q
Do calorie needs increase or decrease as we age?
A
decrease
18
Q
Do protein needs increase or decrease as we age?
A
Increase
19
Q
Do carb requirements increase or decrease as we age?
A
Neither - they stay the same
20
Q
Do fat requirements increase or decrease as we age?
A
Neither - they stay the same
21
Q
Do vitamin D needs increase/decrease with aging?
A
Increase due to less sun exposure and skin synthesis
22
Q
Do calcium needs increase or decrease as we age?
A
Increase
23
Q
Do iron needs increase or decrease as we age?
A
Decrease after menopause for women; stay the same after that (8mg)
24
Q
Does Vitamin B12 increase or decrease as we age?
A
Neither - stays the same
25
What is the role of vitamin A in wound healing and illness?
maintenance of skin and mucous membranes
promotion of immunity through migration of macrophages
26
What is the role of vitamin B12 in wound healing and illness?
tissue repair, granulation tissue, energy boost
27
what is the role of vitamin C in wound healing and illness?
enhances tensile wound strength, blood vessel formation
28
What is the role of Vitamin E in wound healing and illness?
anti-inflammation
29
Which nutrients support blood clotting as part of wound healing?
Vitamin K and calcium
30
What is the role of protein in wound healing and illness?
build and repair skin tissues
fight infection
balance fluids
supports iron containing heme group in hemoglobin
31
What are the nursing interventions that promote nutrition?
Maintaining good oral hygiene
Offering small, frequent meals
Promoting a positive and clean environment
Supporting appropriate body position for eating
Offering patient's favorite foods
Helping with pain control
Collaborating with dietitian and/or SLP
Promoting a balanced diets
32
According to MyPlate, what should your plate look like?
1/2 plate of fruit and veggies
1/2 plate of grains and protein
one dairy helping
33
Daily fruit serving
2 cups
34
Daily vegetable serving
2.5 cups
35
daily serving of grains
6 oz
36
daily protein serving
5.5 oz
37
daily dairy serving
3 cups
38
Max amount of added sugar/day
50 grams
39
Max sat. fat for one day
22 grams
40
Max sodium intake in one day
2300mg
41
What are some data points collected via nutrition assessments
Eating habits and appetite
Food allergies
Medical conditions
Dentition, chewing or swallowing difficulties
Weight loss
BMI
42
Underweight BMI
18.5 and below
43
Normal BMI
18.5-24.9
44
Overweight
25 - <30
45
BMI - Obese
30 - 39.9
46
Extreme Obesity
40 and above
47
Poor skin turgor indicates the patient could be...
dehydrated
48
Swelling due to an accumulation of fluid in the body's tissues
Edema
49
Pallor and spoon shaped nails indicate a deficiency of...
iron
50
Bleeding abnormalities could indicate a deficiency in
Vitamin K
51
Brittle/fragile nails, hair loss and poor wound healing could indicate a deficiency in...
protein
52
Low energy and headaches are symptoms of low...
glucose
53
Muscle wasting, especially in the temporal area is an indication of ____ deficiency
energy
54
Nutritional deficiencies that cause edema include
protein and vitamin B1
55
Calf tenderness can result from deficiencies in
Bitamin B1, C or biotin, Se
56
Beading of ribs or "rachitic rosary" in a child is caused by a deficiency in
Vitamins C and D
57
Bone and joint tenderness can be caused by a deficiency in
Vitamins C, D, Ca and P
58
Knock knee, bowed legs and fragile bones are caused by deficiencies in:
Vitamin D, Ca, P, and Cu
59
pain and tingling or altered sensation in the extremeties
paresthesias
60
Paresthesias is caused by
deficiencies in Vitamins B1, 6, 12 and biotin
61
Weakness is caused by deficiencies in vitamins
C, B1, B6, B12, energy
62
neurological condition characterized by lack of coordination and control of movements
Ataxia
63
Deficiencies in these cause ataxia and decreased position and vibratory senses
Vitamins B1 and 12
64
A deficiency of Magnesium can cause
tremors
65
Decreased tendon reflexes are due to a deficiency in Vitamin ___
B1
66
Confabulation and disorientation are signs of deficiencies in
Vitamins B1 and 12
67
Drowsiness and lethargy are signs of deficiencies in ___ and excess of ___ and ___
B1; A and D
68
Depression can be due to deficiencies in ___
Vitamins B1 and 12 as well as biotin
69
A swallow evaluation may be needed after observing these:
1. Not alert
2. Unable to sit up right
3. Cannot manage secretions well
4. Poor coughing strength
5. a history of aspiration/ aspiration pneurmonia
70
What plan would you implement if you were concerned about a patient's ability to swallow safely?
1. Nurse swallow eval
2. NPO orders PRN
3. Review meds and discuss with doctor
71
Dysphagia occurs in what percentage of stroke patients?
37-78%
72
According to the Yale Swallow Protocol the following would exclude someone from participating in a nursing swallow study
1. Unable to remain alert
2. Baseline modified diet/thickened liquid
3. Tube feeding in place
4. Head of bed restrictions < 30 degrees
Tracheostomy tube
5. NPO by physician order
73
Step 1 in the Yale Swallow Protocol
Brief cognitive screening name, where are you, year
74
True or False: Failure of the brief cognitive screen in a swallow test may warrant an SLP consult and indicates failure of the YSP
False - may warrant an SLP consult, but does not prevent YSP
75
What is step 2 in the Yale Swallow Protocol?
An oral mechanical exam
76
What are the parts of an oral mechanical exam?
1. Check tongue ROM - ask pt. to stick out tongue, move it side to side
2. Check for facial symmetry through smiling and puckering
3. Check for lip closure - ask pt. to puff up cheeks with air and hold
77
If a pt. cannot successfully complete all parts of the oral mechanical exam during a swallow study, what are next steps?
Possible modification of food textures and need for SLP consult
78
What is step 3 of the Yale Swallow Protocol?
3 oz water swallow challenge
79
What is involved in the 3 oz Water Swallow Challenge?
1. Sit pt. up at 90 degrees (at least 30 degrees) if not tolerated
2. Ask the pt. to drink 3 oz of water from a cup or straw with sequential swallows - slow and steady but without stopping
80
A failure of the YSP is indicated by what?
Stopping while drinking , coughing or throat clearing
81
True or False: You do not need a doctor's order to conduct a Nursing Swallow Test
True
82
What is your plan if a pt. fails a swallow screening?
Obtain orders for NPO diet
Get Swallow Eval and Treatment Order
Notify MD to review current med orders
83
Diet category that includes: no concentrated sweets, diabetic, no salt added, low sodium, low fat/cholesterol, high fiber and renal diets
Nutrient modifications
84
Therapeutic diet that includes a mechanical soft diet or puree diet
Texture modification
85
Texture modifications are primarily made due to problems with:
chewing and swallowing
86
What are the most common food allergies?
Milk, egg, soy, wheat, peanuts, tree nuts, fish and shell fish
87
A gluten free diet replaces wheat, rye and barley with:
potato, corn and rice products
88
Most common food intolerances
1. lactose
2. products added to enhance taste, color or protect against bacterial growth
89
Common symptoms of a food intolerance
Vomiting, diarrhea, abdominal pain and headaches
90
Which diet is used for electrolyte replacement in people with severe diarrhea?
Clear liquid diet
91
Which diet is is used for people who cannot tolerate a mechanical soft diet?
Full liquid diet
92
Which diets are used when there are issues with chewing and swallowing?
Mechanically altered/soft diet or pureed diet
93
Which diet includes chopped or ground meats, fruits and vegetables?
Mechanically altered or soft diets
94
Which diet is used for people with poor dental conditions, missing teeth, no teeth or dysphagia?
mechanically altered/soft
95
Which diet is sued for people with wired jaws or extremely poor dentition in which chewing is inadequate
Pureed diet
96
True or False: You must have an MD or HCP order to advance a diet
True
97
What do you need to identify/check for when advancing a diet?
The type of surgery, procedure anesthesia and assess for alertness, gag reflex and GI assessment
98
Juices with pulp are part of which therapeutic diet
Full liquid
99
Pudding, custard and yogurt are part of which therapeutic diet
full liquid
100
Popsicles and gelatin are part of what therapeutic diet
Clear liquid
101
Nutritional supplements are part of which type of diet?
Full liquid
102
Full liquid diets may need to be supplemented if not able to advance after how long?
3 days
103
large folds of the small intestine that appear like hills and valleys in a mountain range - can be seen with the naked eye
mucosal folds
104
Fingerlike projections on mucosal folds of the SI through simple compound microscope
villi
105
Extremely small projections on each villus of the small intestine that can only be seen with an electron microscope
microvilli
106
array of microvilli on the small intestine villi
brush border
107
central lymph vessel in villi in SI that absorbs fatty acids
lacteal
108
part of villi that absorbs monosaccharides and amino acids
network of blood capillaries
109
Pharynx refers to
the throat
110
pH when pepsin is active (converted from pepsinogen by HCl in stomach)
1.8 to 3.5
111
the study or science of drugs
pharmacology
112
preparing and dispensing drugs; including dosage form design
pharmaceutics
113
What does dosage form design determine in pharmaceutics?
rate of drug dissolution and absorption
114
Order the following drug types from fastest absorption to slowest
capsules
tablets
liquids/syrups
buccal, SL
enteric coated tablets
buccal, SL
liquids/syrups
capsules
tablets
enteric coated tablets
115
drugs that are absorbed over a prolonged period of time
Extended release
116
Pro vs con of extended release drugs
Pro: requires fewer doses so may improve compliance; Con: May be perceived as less effective by pt.
117
True or False: ER tablets cannot be crushed or chewed due to possible toxicity
True
118
study of drug movement throughout the body
pharmacokinetics
119
4 processes involved in pharmacokinetics
ADME
Absorption
Distribution
Metabolism
Excretion
120
What are three things that affect absorption of drugs?
Acidity, food, age
121
Drugs taken orally that travel through the GI tract. Also includes sublingual and buccal drugs. May undergo first-pass effect
enteral
122
First-pass effect
concentration of oral medication is significantly reduced before reaching systemic circulation because they hepatic portal vein carries it to the liver where it is metabolized after being absorbed from the SI.
123
Parenteral drugs
Administered outside of the digestive system
124
Types of parenteral drugs
IM, IV and subq
125
Ointments, gels, patches, drops and inhalers are all types of what kind of drugs?
Topical
126
bioavailability
extent of drug absorption
127
True or False: topical drugs and parenteral drugs avoid the first-pass effect
False - some topical drugs are impacted and some are not
128
less active form of a drug that results from metabolism in the liver
drug metabolite
129
Which receives the drug more quickly from the bloodstream? Muscle, skin and fat OR heart, liver, kidneys and brain
heart, liver, kidneys and brain
130
True or False: plasma proteins increase the rate of drug distribution to its intended site
False - drug-protein complexes are too large to cross membranes and these drugs are pharmacologically inactive
131
Which part of pharmacokinetics is also known as biotransformation?
Metabolism
132
True or False: suppositories undergo a partial first pass effect
True
133
Most drug metabolism occurs where?
Liver
134
Which is more likely to lead to drug toxicity - high or low concentration of plasma proteins?
Low concentration
135
Aspirin is an example of this type of drug that exceptionally becomes more active after metabolism in liver
prodrug
136
In the liver, drugs can be metabolized in to any of the following
water-soluble molecules
inactive metabolite
less active metabolite
prodrug
137
Which organ is primarily involved with drug excretion?
kidneys (also occurs in large intestine)
138
Drugs administered where may be used for both local and systemic delivery and have mixed first-pass/non-first pass absorption and metabolism
Rectal drugs
139
What is the most common sublingual medication?
nitroglycerin
140
time for drug to start a physiologic response
onset of effect
141
time required for drug to reach max therapeutic response
peak effect
142
length of time drug concentration is sufficient to elicit a therapeutic response
Duration of action
143
Time required for 50 of a drug to be removed by the body and reach a steady state
Half-Life
144
How many half lives does it take for drug to be eliminated?
5
145
pharmacodynamics refers to
drug induced physiological changes
146
effect based on characteristics of cells/tissue targeted by the drug
Mechanism of action
147
how well a drug firsts within its receptor
affinity
148
substance that binds to a receptor and causes a response
agonist
149
drug that binds to a receptor a blocks a response
antagonist
150
drug that binds to a receptor and causes a lesser response
partial agonist (agonist-antagonist)
151
therapeutic and pharmacologic classifications of drugs reference what?
Drug pharmacotherapy
152
use of drugs to prevent or treat diseases
pharmacotherapy
153
Leafy green veggies may interact with warfarin in what way
increasing intake of leafy green veggies may decrease anticoagulant effect
154
Grapefruit juice interacts with which type of medications
cardiac, anti-seizure, anti-cholesterol, anti-anxiety
155
What food interacts with CNS depressants to increase drowsiness and sedation?
Valerian Root
156
top drugs of people age 40-59 years
1. antidepressants
2. lipid lowering drugs (high cholesterol)
3. ACE inhibitors (high blood pressure)
4. Analgesics (pain relief)
5. Antidiabetic agents
157
top drugs of people 60-79 years
1. Lipid lowering drugs (high cholesterol)
2. Antidiabetic agents
3. Beta blockers (high blood pressure and heart disease)
4. ACE inhibitors (high blood pressure)
5. Lipid lowering drugs (high cholesterol)
158
how aging affects cardiovascular medications
decreased cardiac output and blood flow decreases absorption and distribution
159
how aging affects GI medications
Increased pH alters absorption and decreased peristalsis delays gastric emptying
160
How aging affects drugs in the liver
decreased enzyme production and blood flow = decreased metabolism
161
how aging affects drugs in the kidneys
decreased blood flow, function and GFR = decreased excretion
162
Dosing variations for the elderly include
starting with 1/2 to 2/3 of standard adult dose and increasing as tolerated based on response
NRAD 201D
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