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Unit 3 Exam Part 1
Unit 3 Exam Part 1
71
Nursing
Not Applicable
03/13/2011

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Cards

Term
How many kcal/kg?
Definition
20-35 kcal/kg
Term
What happens when you don't use the gut?
Definition
It alters the normal flora of the gut. Higher risk for ulcers and risk of atrophy of the stomach
Term
What is the best route for nutrition?
Definition
Gut
Term
Oral feedings
Definition
Ensure, puddings, supplements
Term
Types of tube feedings
Definition
Nasogastric (NG or OG)
Gastrostomy (G/PEG)
Jejunostomy (J-tube)
Term
How many calories per gram of fat?
Definition
9 (20-35% of diet)
Term
How many calories per gram of carbs?
Definition
4 (primary source of energy 50% of diet)
Term
Nasogastric tube
Definition
-Thru nares or mouth to stomach
-still using gut
-continuous
-can use whole foods
-still using stomach
-administer meds (NOT extended release)
-can use almost immediately after putting in
Term
Gastrostomy tube
Definition
-Sits in stomach
-still using gut
-continuous
-can use whole foods
-still using stomach
-administer meds (NOT extended release)
-can use almost immediately after putting in
Term
How many amino acids?
Definition
22
Term
Jejunostomy tube
Definition
-Bypasses the stomach and liver (where enzymes get secreted in the bowel)
-Surgically put in
-No meds
-Foods in elemental form (amino acids)
Term
G-tube residual
Definition
should not be more than 2x the hourly
Term
Position during tube feedings
Definition
HOB greater than 30 degress due to risk for aspiration
Term
After bolus...
Definition
...patient should be sitting up for 30-60 minutes with tubes (not J-tube)
Term
How often should you change feeding tubes?
Definition
Every 24 hours with bottle change
Term
How should you check for positioning of tubes?
Definition
30 cc of air--hear swish or x-ray initially before starting to use
Term
Function of liver
Definition
Functions include metabolism, bile synthesis, glycogen storage, clotting factor
Term
Function of pancreas
Definition
Secretes amylase and lipase
Term
Function of gall bladder
Definition
Concentrates and stores biles
Term
Function of stomach
Definition
Stores and mixes food with gastric secretions
Term
Function of esophogus
Definition
Hollow, muscular tube with peristaltic waves moves food to stomach
Term
Function of small intestine
Definition
Digestion and absorption
Term
Function of colon
Definition
Absorption of water and electrolytes
Term
How many ccs should you start tube feeding?
Definition
10-20cc
Term
What temp should tube feeding be given?
Definition
Room
Term
What is risk of concentrated tube feedings?
Definition
Diarrhea (pulls fluid into bowel)
Risk for dehydration--free water flush
Term
Tube feeding complications
Definition
-Vomiting & aspiration--hear crackles--aspiration pneumonia=normally right side of lung
-Diarrhea - hyperosmolar feeding
-Constipation - will generally correct itself even after 5 days
-Dehydration-free water flushes
Term
Types of Parenteral Nutrition
Definition
TPN-given thru central line
PPN-given thru peripheral line
Term
TPN standard composition
Definition
70% glucose
40 meq potassium
1 g mag
Term
Labs are ____ for first 3 days.
Definition
daily
Term
TPN risks
Definition
-Infection due to high glucose
-Fluid overload
-Tubing change every 24 hours
-Need filter at end of tubing (filter out flat globules)
Term
If a patient is on tube feedings, they should have _____ weights.
Definition
daily
Term
Anorexia Nervosa
Definition
-Psych component (need to control)
-often abuse in history
-s/s lenugo, absent menstrual cycle, compulsive exercise, may have constipation
-Labs-Fe deficiency anemia; High BUN - dehydrated, breaking down own muscles for protein; depressed immune system
Term
Bulimia Nervosa
Definition
-self purging after binge eating
-often abuse in history
-often normal weight or slightly overweight
s/s scratches on knuckles, teeth erosion, broken blood vessels in eyes, peticchiae on cheeks
Term
Health Risks for obesity
Definition
-cardiovascular (HTN, MI, Coronary artery disease)
-Respiratory (sleep apnea risk due to increased weight)
-Diabetes Mellitis (Type II)
-Musculoskeletal (osteoarthritis)
-GI (gallstones, fatty liver)
-cancer (breast, ovarian, cervical, colon)
Term
Risk of Atkins diet
Definition
Hi protein - low carb
Ketoacidosis (stresses kidneys breakdown of protein)
Term
Well balanced low calorie diet
Definition
1000-1200 cal/day
2/3 plant sources
1/3 lean meats
1 serving fruits/veggies
30 mins exercise/day
Term
Safe weight loss
Definition
Weigh once a week
1-2 lbs per week
Term
Weight Loss drugs (4)
Definition
Adipex, Tenuate, Meridia, Xenical
Term
Surgical treatment types
Definition
restrictive-restricting volume consume
malabsorptive-decrease amount of time for food to be absorbed
Term
vertical banded gastroplasty
Definition
restrictive; small stomach pouch; not adjustable; risk for tears/rupture at staples
Term
adjustable gastric binding
Definition
slower more controlled weight loss; restrictive; can adjust pouch size
Term
biliopancreatic diversion
Definition
malabsorption; bypassing first section of small intestine; bypassing enzymes of liver and pancreas
Term
biliopancreatic diversion with duodenal switch
Definition
bypass section of small intestine
Term
Roux-en-y
Definition
gastric bypass; smaller stomach pouch
Term
Good candidate for weight loss surgery
Definition
BMI >40
HTN
Type 2 diabetes
Sleep apnea
heart failure
>18 years old
obese >5 years
psych stability
Term
Weight stabilized after ___ months after surgery.
Definition
18
Term
Nutrient deficiencies with weight loss surgeries
Definition
B12, folic acid, iron, calcium
Term
dumping syndrome
Definition
fluid seeps into bowel and they get diarrhea; within 20 minutes sweating, cramping, diarrhea; bowel not used to whole foods
Term
Pre op nursing care
Definition
address co-morbidity ; bariatric equipment at bedside=bariatric bed,large bp cuff, larger gown, wound infection (adipose tissue not a lot of blood)
Term
Post op care
Definition
If admitted, SCD's, DVT prophylaxis
Term
Discharge
Definition
wound care
Term
Diet right after surgery
Definition
initially 1 oz. water and sugar free clear liquids/hour; 2 weeks high protein liquid diet 1-2 oz/2 hrs; 2-4 weeks pureed; 4-6 weeks solid
Term
Ongoing diet after weight loss surgery
Definition
no liquid with meals; less than 1 liter/day fluids; hi protein, low carb/fat diet; 6 small meals/day
Term
Metabolic syndrome
Definition
central obesity (trunk); high BP; high triglycerides; low HDL; insulin resistance
Term
Labs for tube feedings
Definition
Prealbumin, albumin, insulin, BUN, creatinine
Term
nausea
Definition
physiological response to decreased gastric motility
Term
vomiting
Definition
neuro stimulates vomiting center in brain; smells, motion (vestibular), pain, bad food
Term
upper gi bleeding
Definition
sudden onset of insidious (unaware)occult bleeding, asymptomatic at first
Term
origins of upper gi bleeding
Definition
capillary
venous
arterial
Term
upper gi venous bleed
Definition
s/s slow bleed, nauseaus, poor apetite
Term
upper gi arterial bleed
Definition
s/s vomit profusely, stark red blood, b/p drop
Term
coffee ground emesis
Definition
venous bleed that's been sitting in belly
Term
melana
Definition
blood in stool; distinct smell; gelatinous; maroon
Term
Mallory Weiss tear
Definition
esophogeal tear; due to chronic distress=ulcer, continous vomiting, alcohol abuse, bulimia
Term
Esophageal varices
Definition
related to liver disease; portal vein pressure increases and veins surrounding esophagus also engorge; if they bleed, big problem; avoid coughing, sneezing, vomiting; massive amount of blood; not bright red blood
Term
Upper gi ulcer risk
Definition
steroid, NSAIDS, aspirin, h.pylori bacteria, stress related ulcer (surgeries, traumas)
Term
Management of upper gi bleed
Definition
2 large IVs (.9%)
labs - H&H NOW; platelets, INR/PTT (FFP to reverse high INR & clotting factors)later
Term
Diagnostic of upper gi bleed
Definition
Guiac stool (dark red blood=upper gi bleed; stark red=lower gi bleed)
Term
Endoscopy for upper gi bleed
Definition
-cauterize vessel if slow ooze
-give epinephrine into lining of stomach in area of bleed
Term
Surgery of upper gi bleed
Definition
remove that portion of stomach
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