6200: Exam 1
metabolic syndrome
A syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to increased risk of cardiovascular disease and Type 2 diabetes.
A patient has been advised to take ibuprofen (Motrin). When teaching the patient about ibuprofen, which instruction should the nurse include? (Select all that apply). A. Avoid taking aspiring with Motrin. B. Take with food to reduce GI upset. C. Monitor for bleeding gums, nosebleeds, black tarry stools. D. Take herbs, such as ginkgo and garlic, with Motrin. E. Take NSAIDs 2 days before menstruation to decrease discomfort.
A. Avoid taking aspiring with Motrin. B. Take with food to reduce GI upset. C. Monitor for bleeding gums, nosebleeds, black tarry stools.
ABCD's of nutrition assessment
Anthropometric, Biochemical, Clinical, Dietary Intake Anthropometric: simple, noninvasive techniques to measure height, weight, head circumference, and skinfold thickness Biochemical: limited; use with other methods; measure visceral protein status, immune function, and serum albumin, total lymphocyte count Clinical: medical history, social history, physical examination Dietary intake: 24-hour recall, food records, kilocalorie counts
Tube to oral feeding
Assess patient's swallowing ability. Stop tube feedings 1 hour before and after meals to promote appetite. As oral intake increases, decrease tube-feeding volume. Discontinue tube feeding when oral intake consistently exceeds two thirds of estimated energy requirements.
The client asks the nurse how the infliximab (Remicade) will be administered. The nurse should respond that this medication is administered: A. orally. B. subcutaneously. C. intramuscularly. D. intravenously
D. intravenously
During a diagnostic test for parathyroid function, a patient asks the nurse what the parathyroid gland does. The nurse correctly informs the patient that the parathyroid gland is responsible for A. regulating the body's metabolism B. maintaining blood glucose levels C. controlling the release of glucocorticoids D. regulating calcium level
D. regulating calcium level
In which type of diabetes can oral anti-diabetic agents be taken?
DM2 *do not work in DM1*
What is the subclass, indication, and adverse reaction of infliximab (Remicade)?
DMARD TNF blocker used for rheumatoid arthritis severe infections are a common adverse reaction
complications of enteral feedings
Diarrhea Tube displacement and/or obstruction Aspiration Metabolic issues Hyperosmolar dehydration/overhydration, abnormal blood levels of Na/K/P/Mg, hyperglycemia, respiratory insufficiency, rapid weight gain
A client with gout is prescribed colchicine. It is most important for the nurse to give which instruction to the client? A.Increase vitamin C intake. B.Avoid alcohol & caffeine. C.Increase foods high in purines. D.Take colchicine 2 hours before meal
B. Avoid alcohol & caffeine.
A patient is ordered to receive low-dose aspirin to prevent a heart attack. Which assessment, if found in the client, is the highest priority for the nurse? A. otitis externa B. multiple bruises C. dry mouth D. aches in the joints
B. multiple bruises
An older adult client takes tolmetin (Tolectin) for arthritis pain. Which statement made by the client is of most concern to the nurse? A."I feel like I am coming down with a cold." B."My stomach aches & burns." C."I have a bad headache." D."I feel dizzy when I get up fast.
B."My stomach aches & burns."
Blood Glucose Level Goals
Before meals: 70 to 130 mg/dL Two hours after meals: less than 180 mg/dL Bedtime: 90 to 150 mg/dL
benefits of exercise for diabetic patients
Exercise lowers blood glucose levels, assists in maintaining normal lipid levels, and increases circulation.
What is the role of histamines in inflammation?
First mediator in inflammatory process Cause dilation of arterioles Increase capillary permeability
A patient with type 1 diabetes mellitus is ordered insulin therapy once daily to be administered at bedtime. What is the type of insulin the patient is most likely receiving? A. Insulin glargine (Lantus) B. Lente insulin C. Lispro insulin D. Regular insulin
Insulin glargine (Lantus)
The patient experiences the Somogyi effect. Which statement regarding the Somogyi effect does the nurse identify as being true? A.This is a hyperglycemic condition B.The condition usually occurs immediately after dinner C.It is a response to excessive insulin D.Management usually requires increase of the bedtime insulin dos
It is a response to excessive insulin
How should insulin be stored?
Keep in refrigerator. Remove from refrigerator 30 minutes before injection. Avoid storing insulin in direct sunlight or at high temperatures.
diabetic ketoacidosis
Life-threatening problem • Occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin • Instead, fat is used for fuel & ketones build up in the body
Parenteral to oral or tube feeding
Long periods of parenteral nutrition without enteral feedings result in atrophy of the GI tract. Minimal enteral intake is encouraged to help maintain normal GI tract physiology and gut mucosal immunity. Enteral intake should be documented during weaning.
drugs with interactions with tyramine-containing foods
MAOIs
characteristics of DM2 in elderly adults
Macrovascular and microvascular complications are common. Overall risk for cardiovascular disease is higher. Target for hemoglobin A1c level in fit elderly patients who have a life expectancy of more than 10 years should be <7.0%. Hemoglobin A1c level should be somewhat higher (≤8.0%) in frail older adults with multiple medical and functional co-morbid conditions.
side effects of opioid analgesics
N/V *constipation* decrease in BP orthostatic hypotension *respiratory depression* *urinary retention*
In which class of medication is aspirin (Bayer, Ecotinin)?
NSAIDs
Types of anti-inflammatory drugs
NSAIDs corticosteroids DMARDS anti-gout
Muslim dietary restrictions
No pork, alcohol, or meat slaughtered in an inhumane way (kosher, halal)
Weight gain recommendations during pregnancy
Normal BMI (18.5 to 24.9): 25 to 35 pounds Underweight BMI (<18.5): 28 to 40 pounds Overweight BMI (25 to 29.9): 15 to 25 pounds Obese BMI (>30): 11 to 20 pounds
top 5 causes of food poisoning
Norovirus Salmonella species Clostridium perfringens Campylobacter species Staphylococcus aureus
assessments performed during TPN administration
Q8hr: vitals, temp, urine fractionals Qday: weight, I/O, serum electrolytes, BUN, creatinine, glucose) Qweek: labs, liver function, CBC, actual intake review Monitor for fluid disorders, protein status, lipid disorders, hepatic encephalopathy, GI loss, respiratory compromise, acid-base disorders
safe administration of enteral feedings
Wash hands! Medications should be liquid when possible; flush with 20mL water before and after administering meds; hyperosmolar need to be diluted; check method of absorption if feeding into duodenum or jejunum
risks for childhood DM2
acanthosis nigricans polycystic ovarian syndrome hypertension Girls more susceptible than boys.
What is the antidote for an acetaminophen overdose?
acetylcysteine (Mucomyst)
indication for octreotide acetate (Sandostatin)
acromegaly decrease GH levels
mechanism of action of opioid analgesics
act on CNS suppress pain impulses suppress respiration and coughing possess antidiarrheal effects
indication for fenamates
acute and chronic arthritic conditions
When can cow's milk be introduced to a child's diet?
after age 1
When can nonfat milk be introduced to a child's diet?
after age 2
most important lab indicators in nutritional assessment
albumin (<3 is risk for deficiency) prealbumin lymphocyte count
A 65-year-old man has been diagnosed with chronic gout. The nurse anticipates that the client will be treated with A. allopurinol (Zyloprim). B. colchicine. C. adalimumab (Humira). D. infliximab (Remicade)
allopurinol (Zyloprim)
drugs that suppress appetite
anti-depressants amphetamines
In which subclass of medication is colchicine (Colcrys, Mitigare)?
anti-inflammatory anti-gout
5 types of adjuvant therapies used along with nonopioids and opioids
anticonvulsants antidepressants corticosteroids anti-dysrhythmics local anesthetics
In which subclass of medication is methimazole (Tapazole)?
antithyroid
In which subclass of medication is propylthiouracil (PTU)?
antithyroid
In which subclass of medication is iodine?
antithyroids
examples of non-opioid analgesics
aspirin acetaminophen ibuprofen naproxen
Salicylates (examples, therapeutic effects, therapeutic level, toxic level)
aspirin, acetylsalic acid (ASA) reduce pain reduce inflammation decrease body temperature inhibit platelet aggregation inhibit prostaglandin synthesis 15-30 mg/dL >30 mg/dL
diets recommended for patients with gallbladder disease
avoid foods that cause discomfort low-fat post op: clear liquid, progress to regular
gestational diabetes
begins during pregnancy and is resolved at parturition Increased insulin in gestational diabetes causes macrosomia of fetus.
considerations of food safety
biological, chemical, and physical hazards from production, procurement, and handling of raw material to manufacturing, distribution, and consumption of the finished product
common side effect of metformin
bitter/metallic taste
adverse reactions of allopurinol
bone marrow depression aplastic anemia
2 drugs for GH excess
bromocriptine octreotide (Sandostatin)
During an initial assessment of a patient, you learn that 8 cigarettes are smoked each day, on average. Under which part of the ABCD assessment approach would this information recorded? a. Anthropometric b. Biochemical c. Clinical d. Diet evaluation
c. Clinical
most common food allergies
dairy, gluten, seafood, soy, egg, peanuts, shellfish, tree nuts
indication for selective COX-2 inhibitors
decrease inflammation and pain
indication for cosyntroping (Cortrosyn)
diagnostic testing to differentiate between pituitary and adrenal cause of adrenal insufficiency
drugs with interactions with salt substitutes
digoxin ACE inhibitors
drugs with interactions with black licorice
digoxin blood pressure meds coumadin/warfarin
cautions with salicylates
don't take with other NSAIDs don't give to children don't take during 3rd trimester
indications for non-opioid analgesics
dull, throbbing pain headaches dysmenorrhea inflammation minor abrasions muscular aches/pain mild-to-moderate arthritis
somogyi effect
early-morning hyperglycemia that occurs as a result of nighttime hypoglycemic episodes
effect and management of illness with diabetic nutrition therapy
elevated glucose decreased appetite Management: Monitor blood glucose level at least four times a day. Test urine for ketones. Do not omit medications to control blood glucose level (dose may need to be adjusted). If regular foods are not tolerated, replace carbohydrates in the meal plan with liquid, semiliquid, or soft foods. Drink 8 to 12 oz of liquid every hour. Small amounts of salty foods may be needed after vomiting and diarrhea.
calorie recommendation during pregnancy
extra 340 calories/day during second trimester extra 452 calories/day during third trimester
In which subclass of medicine is meclofenamate (Meclomen)?
fenamates NSAID
In which subclass of medicine is mefenamic acid (Ponstel)?
fenamates NSAIDs
common dietary supplements for: pregnant women children/teenagers elderly adults
folic acid, iron iron, calcium vitamin D, calcium
full liquid diet
foods that are liquid at room temperature prescribed if patients have difficulty chewing or swallowing solid foods
side effects of fenamates
gastric irritation patients with a history of peptic ulcers should avoid fenamates
In which subclass of medication is prednisone (Deltasone)?
glucocorticoid
In which subclass of medication is cortisone acetate? What is its primary use?
glucocorticoid tx for adrenocortical insufficiency
In which subclass of medication is mitotane (Lysodren)?
glucocorticoid inhibitor
In which subclass of medication is hydrocortisone (Cortef, Hydrocortone?
glucocorticoids
side effects for selective COX-2 inhibitors *in older adults*
greater incidence of GI distress *ulceration*
adverse effect of rosiglitazone (Avandia)
greater risk for heart attack
diet for a person with cirrhosis
high protein high calorie low sodium low fluid intake low potassium
infants' protein needs
highest during first 4 months 1.6 g/kg/day
Compare the analgesic effect of hydromorphone (Dilaudid) to that of morphine.
hydromorphone is 6 times more potent than morphine It has fewer hypnotic effects and less GI distress.
side effects of prednisone
hyperglycemia osteoporosis
nurse's role on the nutrition team
identify patients in need of nutrition services
In which subclass of medication is adamumab (Humira)?
immunomodulator tumor necrosis factor blocker DMARDs
In which subclass of medication is entanercept (Enbrel)?
immunomodulator tumor necrosis factor blocker DMARDs
In which subclass of medication is infliximab (Remicade)?
immunomodulator tumor necrosis factor blocker DMARDs
In which subclass of medication is rituximab (Rituxan)?
immunomodulator tumor necrosis factor blocker DMARDs
In which subclass of medication is tafactinib (Xeljanz)?
immunomodulator tumor necrosis factor blocker DMARDs
In which subclass of medication is azathiprine (Imuran)?
immunosuppressive agent DMARDs
In which subclass of medication is cyclophosphamide (Cytoxan)?
immunosuppressive agent DMARDs
In which subclass of medication is methotrexate (Mexate)?
immunosuppressive agent DMARDs
primary nutritional risk
inadequate intake of nutrients Undernutrition and chronic micronutrient deficiencies are a form of "hidden hunger"
What is the role of prostaglandins in inflammation?
increase capillary permeability increase vasodilation increase pain and fever
pregnancy's effect on BMR
increased 15-20% by the end of pregnancy
How has the prevalence of DM2 in children changed since 1994?
increased 30X
drug-drug interactions of salicylates
increased bleeding with anticoagulants hypoglycemia with oral antidiabetics
3 components of maternal weight gain
increased blood and fluid volume maternal support tissues fetus/placenta
drug-drug interactions of prednisone
increased effect with phenytoin
alcohol's effect on vitamins
increases turnover of vitamins
eating characteristics of child 4-6
independence variable hunger and appetite levels introduction of new foods
action of ketorolac (Toradol)
inhibits prostaglandin synthesis rec. for short term pain
how is Vitamin K given to an infant
injected shortly after birth
NPH insulin
intermediate acting insulin Humulin N, Novolin N
In which subclass of medication is isophane (Humulin N, Novolin N)?
intermediate-acting insulin
What was the first injectable NSAID?
ketorolac (Toradol)
In which subclass of medication is detemir?
long-acting insulin
In which subclass of medication is glargine (Lantus)?
long-acting insulin
indication for oxicam
long-term arthritic conditions
nutrition strategies with child aged 1-3
maintain consistency regulate portion sizes encourage self-feeding include snacks
Which opioid is preferred during pregnancy?
meperidine (Demerol)
When weaning off of morphine, what drug should be taken?
methadone
medical treatment for opioid addiction/dependence
methadone
nutritional risk associated with different age groups
moderate risk: 65-75 and children over 5 high risk: <5, 75+
fuel sources for mother & fetus during pregnancy
mother: fat fetus: glucose
antidote to opioid overdose
naloxone HCl (Narcan) reverse respiratory depression, sedation, analgesia, and hypotension
Jewish dietary restrictions
no pork, rabbit, shellfish, winged insects, rodents, reptiles, amphibians, or milk, eggs, fat, organs derived from these animals no portions of kosher meats that surround the sciatic nerve/vessels or fats surrounding vital organs (kosher)
Which sweeteners are safe for diabetic patients?
nonnutritive sweeteners: - saccharin - aspartame - acesulfame potassium
safety considerations of opioid agonist-antagonists
not given for cancer pain safe for use during labor safety during early pregnancy is unknown
use of NSAIDs for headaches
not recommended except aspirin and ibuprofen
antidote for hypoglycemia
octretotide (Sandostatin)
long-acting insulin: onset, duration
onset: 1 hour duration: 24 hours
intermediate-acting insulin: onset, peak, duration
onset: 2-4 hours peak: 4-12 hours duration: 18-24 hours
short-acting insulin: onset, peak, duration
onset: 30-60 minutes peak: 2-3 hours duration: 3-4 hours
rapid-acting insulin: onset, peak, duration
onset: 5-15 minutes peak: 30-60 minutes duration: 2-4 hours
risks of overweight mother during pregnancy
operative delivery postpartum weight gain gestational diabetes
In which subclass of medication is codeine sulfate?
opioid schedule II
In which subclass of medication is hydrocodone bicartrate (Hycodan)?
opioid schedule II
In which subclass of medication is meperidine (Demerol)?
opioid schedule II
In which subclass of medication is fentanyl (Duragesic, Sublimaze)?
opioid schedule II
In which subclass of medication is oxycodone HCl (OxyContin)?
opioid schedule II
In which subclass of medication is buprenorphine (Buprenex)?
opioid agonist-antagonists
In which subclass of medication is butorphanol tartrate (Stadol)?
opioid agonist-antagonists
In which subclass of medication is nalbuphine hydrochloride (Nubain)?
opioid agonist-antagonists
In which subclass of medication is pentazocine (Talwin)?
opioid agonist-antagonists
In which subclass of medication is morphine sulfate?
opioid analgesics
In which subclass of medication is naloxone HCl (Narcan)?
opioid antagonists
In which subclass of medication is rosiglitazone (Avandia)?
oral antidiabetic
In which class of medication are sulfonylureas (Glimepiride, Glipizide)?
oral antidiabetic drugs
In which subclass of medication is metformin (Glucophage)?
oral antidiabetics
Which foods contain purine, which can aggravate gout?
organ meats sardines salmon gravy herring liver meat soups alcohol (especially beer)
adverse reactions of corticotropin
osteoporosis muscle atrophy decreased wound healing
In which subclass of medicine is piroxicam (Feldene)?
oxicams NSAIDs
In which subclass of medication is indomethacin (Indocin)?
parachlorobenzoic acid NSAID
In which subclass of medication is sulindac (Clinoril)?
parachlorobenzoic acid NSAID
In which subclass of medication is tolmetin (Tolectin)?
parachlorobenzoic acid NSAID
In which subclass of medication is diclofenac sodium (Voltaren)?
phenylacetic acid NSAID
In which subclass of medication is ketorolac (Toradol)?
phenylacetic acid NSAID
fenemates (indication, side effects, examples, contraindications)
potent NSAIDs for chronic arthritic conditions s/e: edema, dizziness, tinnitus, pruritus, GI distress ex. meclofenamate, mefanamic clients with peptic ulcers should not take
Dietary supplements
products that supplement dietary intake and contain one or more of the following: - Vitamin, mineral, herb, other botanical - An amino acid - A dietary substance used to supplement the diet by increasing the total dietary intake - A concentrate, metabolite, constituent, extract, or a combination of the preceding ingredients
In which subclass of medication is fenoprofen calcium (Nalfon)?
propionic acid derivative NSAID
In which subclass of medication is flurbiprofen (ansaid)?
propionic acid derivative NSAID
In which subclass of medication is ibuprofen (Motrin, Advil)?
propionic acid derivative NSAID
In which subclass of medication is ketoprofen (Orudis)?
propionic acid derivative NSAID
In which subclass of medication is naproxen (Naprosyn)?
propionic acid derivative NSAID
In which subclass of medication is oxaprozin (Daypro)?
propionic acid derivative NSAID
diet for patient with acute pancreatitis
provides the patient's nutritional needs while minimizing secretions o IV fluids/PPN and low-fat elemental formulas o Enteral feedings to jejunum
What are 4 foods that contain salicylates?
prunes raisins licorice spices
In which subclass of medication is aspart (NovoLog)?
rapid-acting insulin
In which subclass of medication is glulisine (Apidra)?
rapid-acting insulin
In which subclass of medication is lispro (Humalog)?
rapid-acting insulin
therapeutic effects of morphine
relieve severe pain depress CNS
adverse reaction of morphine
respiratory depression
What is the primary cause of altered nutritional status in older adulthood?
retirement
indication for diclofenac sodium (Voltaren)
rheumatoid arthritis osteoarthritis
In which subclass of medication is hydromorphone HCl (Dilaudid)?
schedule II
In which subclass of medicine is celecoxib (Celebrex)?
selective COX-2 inhibitor NSAIDs
What is the action of selective COX-2 inhibitors?
selectively inhibits COX-2 without inhibition of COX-1
In which subclass of medication is regular insulin (Humulin R, Novolin R)?
short-acting insulin
indication for ketorolac (Toradol)
short-term pain management
strategies to combat N/V during pregnancy
small, frequent meals drink liquids between meals avoid fried/greasy food reduce coffee intake avoid cooking odors
side effects of parachlorobenzoic acid
sodium retention water retention increased blood pressure
2 drugs for GH deficiency
somatrem (Proptropin) somatropin (Humatrope)
soft diet
special diet containing only foods that are soft in texture low fiber, lightly seasoned transition diet
indication for corticotropin (Acthar)
stimulates ACTH
action of corticotropin (Acthar)
stimulates adrenal cortex to secrete cortisol can be used as anti-inflammatory in tx of allergic response
action of sulfonylureas
stimulates beta cells of the pancreas to release more insulin
indication for thyrotropin (Thytropar)
stimulates thyroid hormone
role of gallbladder in digestion
stores bile and releases it into the small intestine in response to fat ingestion
What is the primary cause of altered nutritional status in adulthood?
stress
indication for immunosuppressive DMARDs
suppress inflammatory process of *rheumatoid arthritis*
Action of Prednisone (Deltasone)
suppresses inflammation immunosuppression
How should corticosteroid therapy be stopped? Why?
tapered off avoid adrenal suppression
A patient received regular insulin at 7:30 AM. At 9:30 AM the patient feels slightly hungry & has a dull headache. The nurse: A. tests the patient's blood glucose level B. ensures that the patient has a meal C. provides the patient with 4 ounces of orange juice D. administers the next dose of insulin
tests the patient's blood glucose level
indication for antimalarials
treat *RA* when other methods fail method of action is *unclear*
indication for desmopressin acetate (DDAVP, Stimate)
treat ADH insufficiency treat *diabetes insipidus*, hemophilia, and von Willebrand disease
indication for vasopressin (Pitressin)
treat ADH insufficiency treat *diabetes insipidus*, relief of intestinal distention
indication for demeclocyclinc (Declomycin)
treats SIADH inhibits ADH-induced water reabsorption in renal tubes
Action of Levothyroxine sodium (Synthroid)
treats hypothyroidism increases levels of T3 and T4 increases metabolism and body growth
In which subclass of medication is calcitonin-salmon (Miacalcin, Fortical)?
tx for hyperparathyroidism and hypercalcemia tx for Pagets disease
therapeutic effects and side effects of vitamin D analogues
tx of hypoparathyroidism and hypocalcemia s/e: hypercalciuria, hypercalcemia, hyperphosphatemia
characteristics of migraines
unilateral throbbing pain disrupting ADLs N/V, photosensitivity triggered by cheese, chocolate, red win
In which subclass of medications is allopurinal (Zyloprim)?
uric acid inhibitors anti-gout
3 types of anti-gout medication
uric acid inhibitors uricosurics colchicine
In which subclass of medication is probenecid (Benemid)?
uricosurics anti-gout
side effects of morphine
urinary retention hypotension bradypnea
In which subclass of medication is calcitriol (Rocaltrol)?
vitamin D analogues tx for hypoparathyroidism and rickets
diet for non-alcoholic fatty liver
well-balanced to reverse fatty infiltration
When does the risk of lead poisoning increase in children?
when the child has iron deficiency anemia
When do nutritional screenings take place in the hospital?
within 48 hours of admission, per Joint Commission standards
effects of metabolic syndrome in diabetic patients
• Disproportionate fat deposition in the abdomen • Excessive secretion of cytokines • Chronic low-grade inflammation
drugs with interactions with grapefruit juice
calcium-channel blockers, statins, antianxiety, antidepressants
secondary nutritional risk
caused by disease states
myxedema
caused by extreme deficiency of thyroid secretion; also known as adult hypothyroidism
How does sumatriptan (Imitrex) treat migraines?
causes vasoconstriction of cranial arteries
With which populations should analgesics be used with caution?
children older adults cognitively impaired individuals oncology clients patients with a substance abuse history
Which diets contribute to gallbladder disease?
chronic intake of high-fat foods
Starvation-related malnutrition
chronic starvation without inflammation
cirrhosis
chronic, degenerative disease in which liver cells are replaced by the buildup of fibrous connective tissue and fat infiltration
mixing insulin
clear (regular) before cloudy (NPH) Long-acting cannot be combined with any other form of insulin
Which types of insulin are clear? Cloudy?
clear: rapid and short-acting cloudy: intermediate acting
dietician's role on the nutrition team
completes a comprehensive nutritional assessment and identifies the patient's needs RDNs are able to do this autonomously without needing a doctor's order
types of enteral feedings
continuous intermittent bolus
What is the mechanism of action of corticosteroids?
control inflammation by preventing inflammatory process at the injured site
steps to finding BMI when given weight in pounds and height in inches
convert to kg (divide by 2.2) convert to meters (multiply by .0254) divide kg/m^2
In which subclass of medication are prednisone, prednisolone, and dexamethasone?
corticosteroids
drugs with interactions with leafy greens
coumadin/warfarin
dietetic technician's role on the nutrition team
◦ Take diet histories ◦ Collect information for nutrition screening and assessment ◦ Work directly with patients who are having problems with their meals ◦ Provide basic nutrition education ◦ Should not be asked to counsel patients about modifications for complex disease
diet for liver transplant patient
(4-8 weeks) adequate kcal/protein for the hypercatabolic stresses from surgery and high doses of corticosteroids, TPN may be necessary (long-term) reduce kcal, 1000-1500mg calcium/day, Vitamin D supplements to prevent osteoporosis; *prevent excessive weight gain, HTN, hyperlipidemia, and DM*
A hemoglobin A1c value is indicative of blood glucose control over how long of a time period? a. Immediate b. 24 hours c. 2 weeks d. 3 months
3 months Glycosylated hemoglobin has a life span of 120 days, or approximately 3 months. Because its life span is longer than that of blood cells, it better represents overall glucose control.
What is the maximum daily dose of acetaminophen (in a healthy patient)?
4 g/day
When can solid food be introduced to a child's diet?
4-6 months
indications for enteral feeding
5+ days of inadequate oral intake severe dysphagia major burns short gut intestinal fistulas
caloric expenditure to produce breast milk
500-800 calories/day
When can self feeding be introduced to a child's diet?
9-12 months
common improper diet orders for diabetic patients
"No concentrated sweets," "no sugar added," "low sugar," and "liberal diabetic" Why unsuitable: They do not reflect diabetes nutrition recommendations. They pointlessly restrict sucrose.
types of NSAIDs
*1st generation:* - salicylates - parachlorobenzoic acid - phenylacetic acid - propionic acid derivatives - fenamates - oxicams *2nd generation:* - COX-2 inhibitors
How can migraines and cluster headaches be prevented?
*Beta-adrenergic blockers* ex. Propranolol (Inderal), Atenolol (Tenormin) *Anticonvulsants* ex. Valproic acid, gabapentin *Tricyclic antidepressants* ex. amitriptyline, imipramine
What are the differences between corticosteroids and NSAIDs? (action, side effects, treatment)
*Corticosteroids:* • Hormonal • Immunosuppressive side effects • Treat inflammatory conditions *NSAIDs:* • COX-1/2 and prostaglandin synthesis inhibitors • GI ulcers, tinnitus, kidney failure side effects • Treat pain/fever
side effects for selective COX-2 inhibitors
*GI distress* headache dizziness sinusitis *GI bleeding* with warfarin
NSAIDs Mnemonic
*N*o alcohol *S*ide effects: BIRTH* *A*spirin sensitivity *I*nhibits prostaglandins *D*o take with food *S*top 5-7 days before surgery * - BIRTH: *B*one marrow depression *I*ncreased GI distress *R*enal toxicity *T*innitus *H*epatotoxicity
What is the only insulin appropriate for mixing with short-acting insulins?
*NPH* (intermediate acting insulin; Humulin N, Novolin N)
side effects of insulin
*hypoglycemia* • Headache, dizziness, confusion, slurred speech • Nervousness, anxiety, agitation • Tremors, incoordination, sweating, tachycardia, seizures• hyperglycemia "Cold & Clammy, get some Candy" *Hyperglycemia* •Extreme thirst, dry mucous membranes •Poor skin turgor, polyuria, fruity breath •Fatigue, tachycardia "High & Dry = sugar high"
drug-drug interactions of propionic acid derivatives
*increased bleeding* with warfarin decreased effect with aspiring *gastric distress* (take with food!) *tinnitus* dizziness confusion edema
Which analgesics are most often used in PCA pumps?
*morphine* fentanyl hydromorphone
side effects of naloxone (Narcan)
*reversal of analgesia* *bleeding* tremors sweating HTN tachycardia N/V dysrhythmias *Monitor vitals and bleeding continuously.*
side effects of levothyroxine (Synthroid)
*thyroid crisis* tachycardia hypertension palpitations nervousness tremors diarrhea insomnia
side effects of salicylates
*tinnitus* *thrombocytopenia* urticaria ulceration GI bleeding
Which supplement is encouraged for breastfed infants? Which supplements are discouraged?
+: vitamin D -: fluoride, iron
nursing interventions for thyroid conditions
- encourage medical alert tag - administer thyroid replacement drug before breakfast and anti-thyroid drugs with meals - do not abruptly stop anti-thyroid drugs
components of diabetic nutrition therapy (7)
- maintain optimal BP, glucose, lipid, and lipoprotein profiles - prevent/treat chronic complications - improve health through diet and exercise - Address individual nutritional needs, personal and cultural preferences, lifestyle, and willingness to change. - Medical team member responsible for providing nutrition therapy should be the registered dietitian. - Emphasize importance of nutrition assessment and individualization. - Address use of fructose and other nutritive and nonnutritive sweeteners.
drugs that stimulate appetite
1. antihistamines 2. antianxiety drugs 3. tricyclic antidepressants 4. insulin: must be taken with food to prevent hypoglycemia 5. steroids
recommended alcohol restriction
1/day for women 2/day for men
nutrition requirements of child aged 1-3
1300 calories 16 g protein
desired BMI range
18.5-24.9
nutrition requirements of child aged 4-6
1800 calories 24 g protein
nutrition requirements of child aged 7-12
2000-2200 calories 28-46 g protein 1300 mg calcium iron/zinc increases
nutritional requirements for middle adults (40s-50s)
2300 calories for men 1920 calories for women dietary pattern: nutrient dense, low fat, high fiber
nutrition requirements of adolescent aged 13-19
2300-2900 calories; 45-59 g protein for males 2200 calories; 45 g protein for females
nutritional requirements for early adults (20s-30s)
2900 calories; 58-63 g protein for men 2200 calories; 46-50 g protein for women After age 18, calcium and phosphorus needs decrease: • Calcium: 1000 mg for adults • Phosphorus: 700 mg for adults
The nurse identifies Infliximab (Remicade) as useful in the treatment of rheumatoid arthritis as well as A. Crohn's disease. B. asthma. C. peptic ulcer disease. D.multiple sclerosis.
A. Crohn's disease.
The nurse assesses a client receiving morphine via a PCA pump. The client has a respiratory rate of 6 breaths/min. The nurse anticipates administration of which of the following drugs? A. Naloxone (Narcan) B. Sumatriptan (Imitrex) C. Nalbuphine HCl (Nubain) D. Hydromorphone (Dilaudid
A. Naloxone (Narcan)
A client is admitted to the surgical unit after undergoing an exploratory laparotomy. Morphine sulfate has been ordered for pain control. Before administering morphine, it is most important for the nurse to assess the client for A. severe renal disease. B. hypothermia. C. allergy to penicillin. D. hypertension
A. severe renal disease.
insulin shock
Acute physiological condition resulting from excess insulin in the blood low blood sugar, weakness, convulsions, & potentially coma
What is the role of cycloxygenase (COX) in inflammation?
COX is needed for the biosynthesis of prostaglandins. If COX is inhibited, inflammation is inhibited.
causes and consequences of Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)
Causes: insulin deficiency that results in severe hyperglycemia; attributable to stress (e.g., trauma, infection). Enough insulin is present to prevent ketosis and acidosis, but not enough to prevent hyperglycemia Consequences: hyperosmolar serum osmotic diuresis electrolyte depletion death rate 10% to 25%
drugs that alter taste
Chemotherapy drugs Antihistamines Antifungals Antipsychotics Asthma medications Blood pressure medications Corticosteroids Antidiabetics Diuretics Lithium
indications for glucocorticoid inhibitors
Cushing syndrome adrenal adenoma
TPN (total parenteral nutrition)
Hypertonic Solution Given via PICC line, tunneled catheter Prepared daily by pharmacy Use Sterile Asepsis for dressing change Check blood glucose every 4-6 hours Change bag every 24
effects of intrauterine growth restriction (IUGR)
HTN cardiovascular disease DM2
Describe the pathophysiology of gout.
Defect in purine metabolism leads to uric acid accumulation
management of gestational diabetes
Desired weight gain: same as in normal pregnancy; desired weight gain goals based on prepregnancy body mass index Insulin: tx of choice (does not cross the placenta) goal is <95 fasting glucose NPH/Regular Insulin 2/3 AM 1/3 PM -Glyburide: only oral hypoglycemic that does not cross the placenta but higher risk of eclampsia early delivery @ 38 weeks, c section if baby is macrosomic
indication for somatropin (Nutropin, Genotropin)
GH deficiency promotes bone growth at plates of long bones
side effects of oxicams
GI ulceration GI distress do not take with other NSAIDs
Which herb is associated with the development of bleeding if taken with NSAIDs?
Garlic
methods of blood glucose monitoring
Glycosylated hemoglobin (HbA1C): reflects blood glucose control for 100 to 120 days Self-monitoring: useful for evaluating effectiveness of meal plans in meeting goals of nutrition therapy Records: determine food, insulin, and exercise needs
When should diabetic patients exercise?
Ideal: Exercise when blood glucose level is 100 to 200 mg/dL, 30 to 60 minutes after meals. Avoid exercise when blood glucose level is greater than 250 ml/dL and ketones are in urine. when insulin level is at its peak. *People with diabetes should not exercise when insulin level is at its peak.* For DM1: ingest carbs to avoid hypoglycemia if glucose drops below 100
A 35-year-old woman diagnosed with rheumatoid arthritis has been prescribed infliximab (Remicade). The nurse identifies infliximab as which type of medication? A.Immunosuppressive B. Immunomodulator C.Antimalarial D.Steroid
Immunomodulator
How should levothyroxine be taken?
In the morning, alone, and on an empty stomach, at least 30 to 60 minutes before breakfast.
characteristics of Graves disease (thyrotoxicosis)
Increase in circulating T4 & T3 levels Caused by hyperfunction of the thyroid gland Characterized by tachycardia, palpitations, excessive perspiration, heat intolerance, nervousness, irritability, *exophthalmos* (bulging eyes), & weight loss
action of NSAIDs
Inhibit COX enzyme Inhibit prostaglandin synthesis
action and side effects of colchicine
Inhibit migration of leukocytes to inflamed site Toxicity: (early) N/V/D, abdominal pain; (late) seizures, shock, CV problems, blood dyscrasias, respiratory/renal/hepatic failure
complications of TPN
Pneumothorax(sudden sharp chest pain, dyspnea, coughing) Air embolus (can occur during indertion of catheter or when changing the tubing Infection
outcomes of malnutrition
Poor wound healing Longer lengths of stay Decline in overall health Loss of appetite, depression, or alterations in taste and smell perception
role and RDA of folate in pregnancya
Prevention of neural tube defects RDA increases to 600 μg per day
function of the liver in nutrition
Processes nutrients absorbed from the small intestine; fat digestion
action of insulin
Promote use of glucose by body cells, store glucose as glycogen in muscles Reduce blood glucose
Function of NSAIDs
Reduce inflammation, pain, and fever - inhibit biosynthesis of *prostaglandins* - analgesic effect - antipyretic effect - inhibit *platelet* aggregation - mimic effects of corticosteroids
benefits of glucose management in diabetic patients
Reduced rates of retinopathy, nephropathy, and neuropathy
action of metformin
Reduces liver production of glucose Diminishes glucose increase after eating Decreases absorption of glucose from the small intestine
mechanically altered diet
Regular diet with modifications for texture. Excludes most raw fruits and vegetables and foods with seeds, nuts, and dried fruits. Foods are chopped, ground, mashed or soft.
Reye's syndrome
Sudden onset of mental status changes, emesis, and liver dysfunction after taking *aspirin*
Which time frame would be most appropriate for administering sliding-scale lispro insulin? A. Within 30 minutes of consuming breakfast B. When the breakfast tray is served & ready to eat C. Within 1 hour of obtaining blood glucose measurement D. Within 15 minutes of obtaining blood glucose measurement
When the breakfast tray is served & ready to eat
Should long-acting insulin and short-acting insulin be taken at the same time?
Yes Short- and long-acting insulin should be taken at the same time to prevent hyperglycemia. Short-acting insulin is taken as a bolus after food intake. Long-acting insulin regulates glucose levels throughout the day.
clear liquid diet
a diet that consists of foods that are liquid at room temperature and leave little residue in the intestine should not be used more than 8-24 hours contribute to hospital malnutrition Ex: Water, Sprite, Ginger Ale, all beverages without any residue, broth, Jello
