question

Increases BMR

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Growth Infection Fever Stress Environmental Extremes

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Decreases BMR

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Aging Fasting Sleep

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BMI Below 18.5

answer

Underweight

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BMI 25-29.9

answer

Overweight

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BMI 30+

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Obesity

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BMI 40+

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Extreme Obesity

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BMI Calculation

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(Weight in pounds x 703)/ (Height in inches)^2

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Ideal Body Weight (IBW) Rule of Thumb

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Women: 100+ 5lb. for every inch over 5 feet Men: 106+ 6 lb. for every inch over 5 feet

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Carbohydrates

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Sugars and Starches Most abundant and least expensive Simple or complex sugars 50-100 g of carbs a day needed to prevent ketosis

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Carbohydrate Functions

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Provide energy Prevent ketosis Absorb water Slow gastric emptying Lower cholesterol Delay glucose absorption

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Protein

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Required for growth and repair of tissues Complete: animal proteins, soy, and quinoa Incomplete: Plants. Don't have all 9 essential amino acids

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Protein Functions

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Tissue and growth repair Help regulate fluid balance Help regulate acid-base balance Forms antibodies Detoxifies harmful substances

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Fats

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Insoluble in water and blood 95% of lipids are triglycerides Saturated raises cholesterol levels (animal fats) Unsaturated lowers cholesterol levels (vegetable fats) RDA between 20%-35%

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Fat Functions

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Provide energy Provide structure Insulate body Cushion organs Necessary for absorption of fat soluble vitamins

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Fat Soluble Vitamins

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A D E K Help with visual acuity, calcium & phosphorus metabolism and absorption, blood clotting

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Water Soluble Vitamins

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Collagen formation Carbohydrate, protein, and fat metabolism

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Ways to Assess Nutritional Status

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24 hour recall Food diaries/ frequency Count calories Diet history

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Nursing Considerations for Aspiration

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Fowlers Tuck chin when swallowing Observe for aspiration and pocketing Position in semi-fowlers for 1 hour after eating Provide oral hygiene

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Albumin

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Indication of patients nutritional status over a few weeks Detects chronic nutritional problems

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Pre-Albumin

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Indicates short term nutritional status Can detect daily changes in patient's protein status Excellent marker for malnutrition

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Ways to Stimulate Appetite

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Small, frequent meals Encourage favorite foods Make sure food looks attractive Control pain/nausea Encourage and provide oral hygiene Arrange so foods are easily reached

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NPO

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Nothing by mouth Provide ice chips as allowed

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Clear Liquids

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Little residue and clear at room temperature Broth Clear fruit juice Gelatin

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Full Liquids

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Can be poured at room temperature Clear liquid plus: Milk Puddings Plain frozen dessert Eggs Vegetable juice

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Soft Diet

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Sometimes called bland or low fiber diet Full liquid plus foods that are low fiber No foods that are hard to chew, hard to digest, or spicy

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Regular Diet

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No restrictions

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TPN

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Highly concentrated Can only be given through central line Used when GI can't absorb nutrients

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Complications of TPN

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Insertion problems Infection and sepsis Metabolic alterations Fluid, electrolyte, and acid-base imbalances Phlebitis Hyperlipidemia Liver and gall bladder disease

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Preoperative Phase

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Begins with the decision to have surgery Ends when the patient is transferred to the OR procedural bed

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Intraoperative Phase

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Begins when the patient is transferred to the OR bed Ends when the patient is transferred to recovery

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Postoperative Phase

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Lasts from admission to recovery room to complete recovery from surgery and last follow up appointment

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Diagnostic Surgery

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Make or confirm a diagnosis

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Ablative Surgery

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Remove diseased parts Ex: appendectomy

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Palliative Surgery

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Relieve intensity of illness Ex: Removing part of cancer to help patient feel better- mastectomy *Doesn't remove all of disease

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Reconstructive Surgery

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Restore functioning to traumatized or malfunctioning tissue

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Transplantation Surgery

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Replace organs Ex: heart transplant

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Constructive Surgery

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Restore congenital anomalies

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General Anesthesia

answer

Administered by inhalation or IV Risks: circulatory/respiratory depression, alteration in thermoregulation, bronchospasm

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Regional Anesthesia

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Injected near a nerve or nerve pathway Ex: Nerve blocks, epidural

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Topical/ Local Anesthesia

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Used on mucous membranes, open skin, wounds, and burns

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Moderate Sedation Anesthesia

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Used for short term, minimally invasive procedures

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Phases of General Anesthesia

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Induction: from administration of anesthesia to ready for incision Maintenance: from incision to near completion of procedure Emergence: starts when the patient emerges from anesthesia and is ready to leave operating room

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Nurses Responsibility with Consent Form

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Secure the informed consent from patient NOT responsible for explaining everything

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Hemorrhage Nursing Responsibilities

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Monitor vital signs, surgical wounds, and IV fluids If bleeding, apply pressure to site Notify surgeon Prepare to administer blood products

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Shock

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Typically hypovolemic shock due to hemorrhaging Improve tissue perfusion by: lying flat, increasing fluids, administer O2, check HCT and blood gases, start second IV line

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Thrombophlebitis Nursing Responsibilities

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Assess calf or thigh for redness, swelling, and pain If DVT present: administer anticoagulants, bedrest, apply heat, antiembolism stockings, measure circumference every shift

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Upper Airway

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Consists of: nose, pharynx, larynx, and epiglottis Warms, filters, and humidifies inspired air

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Lower Airway

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Consists of: trachea, mainstream bronchi, segmental bronchi, terminal bronchioles Conduction of aid, mucocilliary clearance, production of surfactant

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3 Processes of Breathing

answer

1: Ventilation 2: Diffusion (respiration) 3: Perfusion

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Factors that Influence Diffusion of Gases in Lungs

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Change of surface area available Thickening of alveolar capillary membrane Partial pressure Solubility and molecular weight of gas

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Perfusion

answer

Oxygenated blood passing through the tissue of the body Dependent on cardiovascular system Vital for exchange of gases

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Respiratory Activity in Infant

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Airways are short Aspiration is a potential problem Rate is rapid and activity is primarily abnormal Can be given synthetic surfactant to reopen alveoli Crackles at the end of deep respiration are normal

question

Respiratory Activity in Children

answer

Subcutaneous fate makes landmarks less prominent Eustachian tubes, bronchi, and bronchioles are elongated and less angular End of late childhood, immune system protects from most infections

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Respiratory Functioning in Older Adult

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Bony landmarks are prominent Kyphosis may be present Tissues and airways become more rigid; diaphragm moves less efficiently Increased risk for disease- especially pneumonia

question

Resonance

answer

loud, hollow low-pitched sound heard over normal lungs

question

Hyperresonance

answer

Loud, low booming sound heard over lungs that have emphysema

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Flatness

answer

detected over bone or heavy muscle

question

Dullness

answer

Medium pitch and intensity heard over the liver

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Tympany

answer

high pitched, loud, drum like sound produced over the stomach

question

Vesicular

answer

low pitched soft sound during expiration heard over most the lungs

question

Bronchial

answer

high pitched and longer heard primarily over trachea

question

Bronchovesicular

answer

medium pitch and sound during expiration heard over anterior chest and intercostal area

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Coarse Crackles

answer

Ronchi Heard in chronic bronchitis and cystic fibrosis Treat with mucolytics, expectorants, corticosteroids, and chest physiotherapy

question

Fine Crackles

answer

Rales Heard in pneumonia, CHF, pulmonary edema, bronchitis, and COPD Treat with diuretics, turn, cough, and deep breaths

question

Wheezes

answer

Continuous sound heard on expiration and sometimes inspiration as air passes through constricted airways Heard in asthma, allergies, and obstructions (tumors) Treat with nebulizer, bronchodilators, and steroids

question

Stridor

answer

Upper airway obstruction Heard in croup

question

Pulse Oximetry

answer

Measures arterial oxyhemoglobin saturation

question

Early Signs of Hypoxemia

answer

Restlessness Tachypnea Tachycardia Pale Skin Use of accessory muscles Adventitious lung sounds

question

Late Signs of Hypoxemia

answer

Confusion Stupor Cyanotic skin and mucous membranes Bradypnea Bradycardia Dysrhythmias Hypotension

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Thoracentesis

answer

Puncture the chest wall and aspirate plural fluid Maximum fluid removed is 1000ml Instruct patient not to cough or deep breath and remain still

question

Nasal Cannula

answer

1-6 L/min 22-44%

question

Simple Mask

answer

5-8 L/min 35-60%

question

Nonrebreather Mask

answer

10-15 L/min 60-100%

question

Tent

answer

10-15 L/min 60-100%

question

Type of Artificial Airways

answer

Oropharyngeal and nasopharyngeal airway Endotracheal tube Tracheostomy tube

question

Vital Capacity

answer

Maximum amount of air exhaled after maximum inspiration

question

Total Lung Capacity

answer

The amount of air contained within the lungs at maximal expiration

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Peak Expiratory Flow Rate

answer

The maximum flow attained during the forced vital capacity

question

Infants

answer

Breast milk preferred or formula No cow milk or honey for first year Solids start at 6 months

question

Toddlers

answer

Need to increase protein and clacium

question

Adolescents

answer

Need calories, protein, calcium, and iron to support increased growth

question

Young Adults

answer

Decreased need for most nutrients Women still need essential nutrients, calcium, and iron

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Adulthood

answer

Nutritional needs level off Fewer calories needed

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Older Adults

answer

May need to supplement calcium, Vit. D, and Vit. B12 May need to increase fiber and bulk to enhance GI function

question

Pregnant and Lactating Women

answer

Need to increase calories by 340-400/day Key nutrients: protein, iron, folic acid, calcium, and iodine

question

Men

answer

Need B vitamins Muscle is more active than adipose tissue

question

Women

answer

Need higher iron requirements because of menstruation

question

Wounds

answer

Need more protein, Vitamin C, Vitamin A, and Zinc

question

Alcohol Abuse

answer

Alters body's absorption of nutrients Need B vitamins

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