NU 270 Exam 1

Variables affecting amount of energy used

1. Age 2. Body size 3. Rate of growth 4. State of health

Individual factor #1

1. Age 2. Growth 3. Development Effect on coping with illness Expression of illness

Cultural factors

1. Beliefs about causes of illness 2. Factors in cultural assessment (box 7.1): communication, physical distance or space, social organization, time orientation, environmental control, biological variations 3. Socioeconomic status, social class

Basal metabolic rate (BMR)

1. Chemical reactions occurring when the body is at rest 2. Provides energy for maintenance of temperature, cardiovascular, respiratory function, muscle tone, other essential activities of tissues and cells

Dietary special considerations

1. Cultural variation 2. Lactose 3. Vegetarianism 4. Pica

Risk factors for poor nutritional status

1. Developmental factors 2. Gender 3. Health state 4. Alcohol abuse 5. Medications 6. Megadoses of nutrient supplements

Components of Nutritional Assessment

1. Diet assessment 2. Health assessment 3. Anthropometric measurements 4. Laboratory studies

Treatment of obesity

1. Dietary therapy 2. Physical activity 3. Behavior therapy 4. Combined therapy 5. Pharmacotherapy 6. Weight loss surgery

PCA for feeding

1. Food is warm and attractive 2. Sit facing the patient, at the patient's eye level and encourage patient to feed self.

Individual factors #2

1. Genetics, biological factors 2. Physical health and health practices (healthier = better coping with stress or illness) 3. Response to drugs (differences in ethnic groups related to metabolism, efficacy) (Slower metabolism = need for lower doses)

Components of nutritional assessment

1. History taking: diet, medical, socioeconomic data 2. Physical: anthropometric / clinical data 3. Laboratory: protein status, body vitamin, mineral, trace elements status

Health risks associated with obesity

1. Hypertension 2. Hyperlipidemia 3. Type 2 diabetes 4. Coronary heart disease 5. Other health problems

Values clarification

1. Important for reflective practice and to strengthen the therapeutic relationship 2. Supports inclusion and acceptance of others

Cultural patterns and differences

1. Knowledge of expected cultural patterns as staring point when relating to people from different ethnic backgrounds 2. Wide variation among people from any culture

Effects of malnutrition / starvation

1. Loss of muscle mass 2. Impaired wound healing 3. Impaired immunological function 4. Decreased appetite 5. Loss of calcium / phosphate from bone 6. Anovulation and amenorrhea 7. Decreased testicular function

Metabolic factors contributing to obesity

1. Low energy expenditure rate 2. High respiratory quotient (RQ) 3. Low level of spontaneous physical activity

Metabolism definitions (nutritional state, energy, calorie, metabolism)

1. NS: condition of the body related to the availability and use of nutrients 2. Energy: measured in heat units called calories or gram calories, required by all body activities 3. Calorie: the amount of energy needed to raise the temperature of 1kg of water 1 degree C 4. Metabolism: organized process through which nutrients are broken down)

Types of malnutrition

1. Protein / calorie 2. Protein deficiency 3. Starvation 4. Malnutrition / wasting 5. Poverty 6. Ignorance 7. Acute / chronic illness 8. Self-imposed dietary restrictions

Bullimia nervosa

1. Recurrent binge eating 2. Inappropriate compensatory behaviors 3. Self-evaluation unduly influenced by body shape and weight 4. Determination that eating disorder does not occur exclusively during episodes of anorexia nervosa

Anorexia nervosa

1. Refusal to maintain normal body weight 2. Intense fear of gaining weight or becoming fat 3. Disturbance in the way body is perceived 4. Causes amenorrhea in girls

Therapeutic Relationship

1. Relationship between the caregiver and patient that is focused on promoting or restoring health and well-being of the patient 2. Central to the principle of caring in nursing 3. Trust is required; words / actions

Nurse's role in working with clients or various cultures

1. Seeking knowledge about client's cultural values, beliefs, health practices 2. Client as best sources for information 3. General cultural knowledge to guide nurse in initial meetings, decisions about what questions to ask 4. Preferences, health practices, beliefs 5. Wide variation among members of any cultural group

Individual factors #3

1. Self-efficacy: belief that personal abilities and efforts affect the events in one's life (more likely to take action, establish personal goals) 2. Hardiness (commitment, control, challenge) 3. Resilience and resourcefulness 4. Spirituality (exemplar next week)

Hunger, appetite, satiety

1. Sensation of hunger: associated with several sensory perceptions (rhythmic contractions of the stomach and that "empty feeling") stimulates a person to seek food 2. Hunger and satiety are controlled by complex group of neurohormones, many of which are produced in gastrointestinal tract

Interpersonal factors

1. Sense of belonging (value, fit) 2. Social networks and social support (perception of support system, responsiveness of support system) 3. Family support

Components of dietary reference intake (DRI)

1. Set at least four nutrient-based reference values 2. The RDA and adequate intake 3. Estimated average requirement 4. Tolerable upper intake level

Nursing Code of Ethics

1. Statement of ethical obligations and duties for all those who enter the nursing profession 2. Professions nonnegotiable ethical standard 3. Expression of nursing's own understand of its commitment to society

Resting energy equivalent (REE)

1. Used for predicting energy expenditure

Professional Values

Advocacy: protection and support of another's rights Autonomy: self-determination; being independent and self-governing Beneficence: principle of doing good Code of ethics: principles that reflect the primary goals, values, and obligations and the profession Nonmaleficence: principle of avoiding evil Values: set of beliefs that are meaningful in life and that influence relationships with others Value system: organization of values ranked along a continuum of importance Values clarification: process by which people come to understand their own values and value system Think: how can I help patients clarify their values and align with those values with known best health practices

BMI

Calculation: weight (kg)/height (m2)

Recommended Dietary Allowance (RDA)

Define the intakes that meet nutrient needs of healthy persons in a specific age and sex group

Holistic care

Encompassing the whole person 1. More than physical 2. Mental, spiritual, cultural, etc.

Is the following statement true or false? ▸ Cultural factors include hardiness and resilience.

False ▸ Rationale: Cultural factors include the client's beliefs about health and illness. ▸ Hardiness and resilience are individual factors.

Malnutrition and trama

Kwashiorkor-like secondary protein-energy malnutrition ▸ Hyper-metabolic acute illnesses ▸ Trauma, burns, and sepsis Marasmus-like secondary protein-energy malnutrition ▸ Chronic illnesses ▸Chronic obstructive pulmonary disease (COPD) ▸Congestive heart failure ▸Cancer and human immunodeficiency virus (HIV) infection

Person-Centered Care

Model of patient care based on holistic roots in which the nurse or other caregiver uses every clinical encounter to assess how the person is doing and to communicate respect, compassion, and care 1. Health care delivery system 2. In old way, focused on tasks or disease more than patient. Think: how would you respond to patients with a person-centered vision of care?

Thoughtful practice

Nursing practice that is considerate and compassionate 1. Person = center of all actions / care 2. Promoting humanity, dignity, well-being 3. Nurses are reflective / develop partnership with patients

6 classes of nutrients

Nutrients that supply energy: 1. carbs (52) 2. protein (53) 3. lipids Nutrients that regulate body processes 1. vitamins 2. minerals 3. water

Waist circumference positioning

Position a measuring tape at level of umbilicus for waist circumference

Thoughtful Person-Centered Practice

See diagram.

Eight dimensions of wellness

See image.

Elements of illness / wellness

See image.

Empathy vs. Sympathy

See image.

Maslow's Hierarchy of Needs

See image.

Mini Nutritional Assessment

See image.

Nutritional label

See image.

Professional Values table from text (6-1)

See image.

Erikson's stages of psychosocial development

Trust vs. mistrust (infant) Viewing the world as safe and reliable Viewing relationships as nurturing, stable, and dependable Autonomy vs. shame and doubt (toddler) Achieving a sense of control and free will Initiative vs. guilt (preschool) Beginning to develop a conscience Learning to manage conflict and anxiety Industry vs. inferiority (school age) Building confidence in own abilities Taking pleasure in accomplishments Identity vs. role diffusion (adolescence) Formulating a sense of self and belonging Intimacy vs. isolation (young adult) Forming adult, loving relationships and meaningful attachment to others Being creative and productive Generatively vs. stagnation (middle adult) Establishing the next generation Ego integrity vs. despair (maturity) Accepting responsibility for oneself and life

How is care delivered?

With sound clinical reasoning

Adult growth and development tasks

Young adult (25-45 years of age) Accept oneself. Stabilize self-image. Establish independence from parental home and financial independence. Establish a career or vocation. Form an intimate bond with another person. Build a congenial social and friendship group. Become an involved citizen. Establish and maintain a home. Express love through more than sexual contacts. Maintain healthy life patterns. Develop sense of unity with mate. Help growing and grown children be responsible adults. Relinquish central role in lives of grown children. Accept children's mates and friends. Middle adult (45-65 years of age) Create a comfortable home. Be proud of accomplishments of self and mate/spouse. Reverse roles with aging parents. Achieve mature civic and social responsibility. Adjust to physical changes of middle age. Use leisure time creatively. Cherish old friends and make new ones. Prepare for retirement. Recognize the aging process and its limitations. Adjust to health changes. Decide where to live out remaining years. Continue warm relationship with mate/spouse. Adjust living standards to retirement income. Older adult (65 years of age and older) Maintain maximum level of health. Care for oneself physically and emotionally. Maintain contact with children and relatives. Maintain interest in people outside the family. Find meaning in life after retirement. Adjust to the death of mate/spouse or other loved ones.

Patients with substance use disorder commonly expect discrimination and lack of empathy from others. Which intervention would the nurse use to overcome these expectations? a) Demonstrate a nonjudgmental attitude. b) Explain that an addiction is a disease. c) Offer reassurance that the client is accepted. d) Confront these attitudes when they are expressed

a) Demonstrate a nonjudgmental attitude.

A hospice nurse is caring for a patient with end-stage cancer. What action demonstrates this nurse's commitment to the principle of autonomy? a) The nurse helps the patient prepare a durable power of attorney document. b) The nurse gives the patient undivided attention when listening to concerns. c) The nurse keeps a promise to provide a counselor for the patient. d) The nurse competently administers pain medication to the patient.

a) The nurse helps the patient prepare a durable power of attorney document.

The nurse is caring for a client whose mobility is restricted to a wheelchair after a motor vehicle accident. The client has been prescribed physiotherapy as a part of rehabilitation care. Which interventions would the nurse consider when the client is discharged from the health care facility? Select all that apply. a) Focus firmly on the challenges faced by the client. b) Refrain from including children in the support system. c) Assist the family in identifying community support systems. d) Encourage the primary caregiver to set a routine time for respite. e) Consider the primary caregiver's experience in the discharge plan.

c) Assist the family in identifying community support systems. d) Encourage the primary caregiver to set a routine time for respite. e) Consider the primary caregiver's experience in the discharge plan.

An infant typically requires how many calories per kilogram per day during the first 3 months? a. 80 b. 95 c. 110 d. 150

c. 110 During the first 3 months, an infant needs 110 to 120 cal/kg/day.

A home health nurse who performs a careful safety assessment of the home of a frail elderly patient to prevent harm to the patient is acting in accordance with which of the principles of bioethics? a) Autonomy b) Beneficence c) Justice d) Fidelity e) Nonmaleficence

e) Nonmaleficence

Trust is built in the nurse-client relationship when the nurse exhibits the following behaviors:

•Caring •Openness •Objectivity •Respect •Interest •Understanding •Consistency •Treating the client as a human being •Suggesting without telling •Approachability •Listening •Keeping promises •Honesty

Water

▸ Accounts for between 50% and 60% of adult's total weight. ▸ Two-thirds of body water is contained within the cells (intracellular fluid [ICF]). ▸ The remainder of body water is extracellular fluid (ECF), body fluids (plasma, interstitial fluid). ▸ Provides fluid medium necessary for all chemical reactions in the body ▸ Acts as a solvent and aids digestion, absorption, circulation, and excretion

Nutritional cultural considerations

▸ Approximately one third of the adult population in the United States is obese, according to data from the Centers for Disease Control and Prevention (2015b). ▸ CDC (2015b) noted that the rate for childhood obesity has remained at approximately 17%, even though there has been a decrease in obesity in children from 2 to 5 years of age. ▸ Healthy People 2020 (2016) reviews studies on prevalence of obesity in the United States. ▸ The CDC (2015a) also reported that among U.S. adults, the obesity prevalence is highest for middle-aged people between 40 and 59 years of age, and non- Hispanic Blacks have the highest age-adjusted rates of obesity (47.8%) followed by Hispanics (42.5%), non-Hispanic Whites (32.6%), and non-Hispanic Asians (10.8%).

Material nutritional needs

▸ Direct effect of nutritional intake on fetal well-being and birth outcome ▸ Need for vitamin and mineral supplement daily ▸ Dietary recommendations 1. Increase in protein, iron, folate, and calories o Use of USDA's Food Guide MyPlate 2. Avoidance of some fish due to mercury content

Factors affecting hydration

▸ Exposure to excessively high environmental temperatures ▸ Inability to access adequate fluids, especially water ▸ Excess intake alcohol or other diuretic fluids ▸ Taking diuretic medications ▸ Impaired thirst mechanisms ▸ High fevers

Factors involved in nutrition

▸ Healthy diet should consist of 45% to 65% carbohydrates with 75% of those carbohydrates being complex. ▸ Certain diseases, disorders, or lifestyle behaviors can place clients at risk for undernutrition or malnutrition and can exacerbate or facilitate disease processes. ▸ Increased caloric consumption, especially of food high in fat and sugar, with decreased energy expenditure has led to near-epidemic obesity. Approximately two thirds of the adult population in the United States are overweight and nearly a third of this group is obese.

Material weight gain

▸ Healthy weight BMI: 25 to 35 lb ▸ First trimester: 3.5 to 5 lb ▸ Second and third trimesters: 1 lb/wk ▸ BMI <19.8: 28 to 40 lb ▸ First trimester: 5 lb ▸ Second and third trimesters: 1+ lb/wk ▸ BMI >25: 15 to 25 lb ▸ First trimester: 2 lb ▸ Second and third trimesters: 2/3 lb/wk

Risk Factors for Nutrition Disorders and Disease

▸ Lower socioeconomic status (SES), making nutritious foods unaffordable ▸ Lifestyle of long work hours and obtaining one or more meals from a fast-food chain or vending machine ▸ Poor food choices by children, teens, and adults, including fatty or fried meats, sugary foods, and few fruits and vegetables ▸ Chronic dieting, particularly with fad diets, to meet perceived societal norms for weight and appearance ▸ Chronic diseases (e.g., Crohn disease, cirrhosis, or cancer) that may interfere with absorption or use of nutrients ▸ Dental and other factors such as difficulty chewing, loss of taste sensation, depression ▸ Limited access to sufficient food regardless of SES such as being physically unable to shop, cook, or feed one's self ▸Disorders whereby food is self-limited or refused (e.g., anorexia nervosa, bulimia, depression, dementia, or other psychiatric disorders) ▸Illness or trauma that increases client's nutritional needs dramatically but that interferes with the ability to ingest adequate nourishment (i.e., extensive burns)

Vitamins

▸ Organic compounds needed by the body in small amounts ▸ Most are active in the form of coenzymes. ▸ Needed for metabolism of carbohydrates, protein, and fat ▸ Classified as water soluble or fat soluble ▸ Absorbed through the intestinal wall directly into bloodstream

Minerals

▸ Organic elements found in all body fluids and tissues ▸ Some function to provide structure in the body, others help regulate body processes ▸ Contained in the ash that remains after digestion ▸ Macrominerals include calcium, phosphorus (phosphates), sulfur (sulfate), sodium, chloride, potassium, and magnesium. ▸ Microminerals include iron, zinc, manganese, chromium, copper, molybdenum, selenium, fluoride, and iodine.

Nursing interventions for nutrition

▸ Teaching nutritional information ▸ Monitoring nutritional status ▸ Stimulating appetite ▸ Assisting with eating ▸ Providing oral nutrition ▸ Providing long-term nutritional support

Hydration assessment

▸ Weight ▸ Intake and output ▸ Skin turgor ▸ Pitting edema ▸ Skin for moisture ▸ Venous filling ▸ Neck veins in supine position with head elevated 45 degrees ▸ Tongue furrows ▸Eyeball palpation ▸Eye position ▸Lung sounds ▸Blood pressure

Overhydration Signs and Symptoms

▸ Weightgainsof6to10lbinaweek ▸ Pitting edema ▸ Visible neck veins ▸ Cracking lung sounds ▸ Elevated pulse rate and blood pressure

Dehydration signs and symptoms

▸ Weightlossesof6to10lbin1week ▸ Tenting ▸ Filling or emptying of venous filling more than 6 to 10 seconds ▸ Flat veins in supine client ▸ Tongue is dry ▸ Sunken eyes ▸ Blood pressure decreased with elevated pulse rate ▸ Radial pulse rate +1 and thready

Anthropometric Measurements

▸Height and weight ▸Body mass index (BMI) ▸Waist circumference ▸Mid-arm circumference ▸Triceps skin-fold thickness ▸Mid-arm muscle circumference ▸ BMI: Estimate total body fat ▸ Waist circumference: Determine extent of abdominal visceral fat in relation to body fat ▸ Mid-arm circumference: Assess skeletal muscle mass ▸ Triceps skin fold: Evaluate subcutaneous fat stores ▸ Mid-arm muscle circumference: Evaluate muscle reserve