1 / 36

NCLEX Review

NCLEX Review. Nutrition. Fat Soluble Vitamins. Vitamin A (Retinol) occuvite Needed for: Vision, skin, immune system and mucous membranes Stored in liver Foods: Vegetables: Dark green, yellow, orange Fruits: Apricots, Cantaloupe Beef liver

lilah
Download Presentation

NCLEX Review

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. NCLEX Review Nutrition

  2. Fat Soluble Vitamins • Vitamin A (Retinol) occuvite • Needed for: Vision, skin, immune system and mucous membranes • Stored in liver • Foods: • Vegetables: Dark green, yellow, orange • Fruits: Apricots, Cantaloupe • Beef liver • Deficiency causes night blindness to total blindness • Vitamin D (Cholecalciferol) • Aids in absorption of calcium • Naturally occurring: Human body and Fish liver oil • Foods: Cream, Butter, Egg Yolks, Milk • Severe deficiency causes Rickets

  3. Fat-Soluble Vitamins • Vitamin E (tocopherol) • Strong Antioxidant needed for cell wall structure • Premature infants lack this causing Hemolytic Anemia • Deficiency: Disrupts synthesis of myelin • Foods: Raw avocado and mango, Almonds, hazelnuts and peanuts and oils • Vitamin K (-quinone) • Needed for blood-clotting and bone development • ½ of our Vit K is supplied by intestinal bacteria • Foods: Leafy greens

  4. Water Soluble Vitamins • Vitamin C (ascorbic acid) • Needed for antioxidant, connective tissue, iron absorption • Deficiency: Scurvy • Foods: Citric fruits • Vitamin B1 (thiamin) • Needed for energy production and storage • Deficiency: beriberi (“I can’t I can’t”) In the US Alcoholics are at risk • Foods: Wheat germ, grains, lean pork, beef, liver, and legumes

  5. Water Soluble Vitamins • Vitamin B2 (riboflavin) • Needed for energy production and tissue health and growth. Also an antioxidant • Deficiency: cracked lips, swollen, red tongue, burning, itching, or tearing eyes and scaly greasy dermatitis • Foods: Milk (keep from light) and liver • Vitamin B3 (niacin) • Needed for energy production, high doses can reduce LDL and Triglycerides • Deficiency: Pellagra: Dermatitis, diarrhea, dementia, death • Foods: Meat, avocado, bread products

  6. Water Soluble Vitamins • Vitamin B6 (pyridoxine) • Needed for metabolism, hemoglobin synthesis, neurotransmitter synthesis • Deficiency: CNS dysfunction and certain anemias • Foods: Grains and meats • Folate (folic acid) • Needed for DNA synthesis and hemoglobin formation • Deficiency: Megaloblastic anemia during pregnancy and diet deficiencies, Neural Tube Defects: spina bifida and anencephaly • Foods: Chicken and beef liver, spinach, yeast and beans

  7. Water Soluble Vitamins • Vitamin B12 (cobalamin) • Needed for blood formation and nervous system function • Deficiency: Anemia, seen in intrinsic factor deficiency (Pernicious Anemia) and vegans • Foods: Beef and Chicken liver, clams, crab, oysters and mussels

  8. Minerals • Calcium • Needed for Bone and tooth formation, blood clotting, muscle and nerve action • Deficiency: (Common in postmenopause and chronic renal failure) Osteoporosis, Tetany (muscle spasm) and hyperreflexia, and hyperphosphatemia • Foods: Milk and milk products, dried figs, and sardines • Phosphorus • Needed for calcium regulation, energy metabolism, and acid-base balance • Deficiency: Hypercalcemia (confusion, lethargy, dysrhythmias) • Foods: High protein foods usually have high phosphorus, and carbonated drinks

  9. Minerals • Sodium • Needed for fluid balance, acid-base balance and muscle action • Deficiency: Usually caused by excessive sweating or diarrhea, can lead to: weakness, drowsiness, or seizures • Foods: Table salt, meat/animal products, and processed foods • Potassium • Needed for fluid balance, conversion of blood glucose to stored glycogen, muscle action, and release of insulin from pancreatic cells • Deficiency: Seen in vomiting/diarrhea, non-K sparing diuretics, severe malnutrition, or surgery. Leads to muscle (all) weakness • Foods: Unprocessed fruits and vegetables: Avocado, dried figs, pinto beans and soybeans

  10. Minerals • Magnesium • Deficiency seen in alcoholics, and leads to muscle weakness • Iron • Needed for hemoglobin synthesis and metabolism • Deficiency leads to anemia and primarily caused by deficient diet • Foods: Beef (esp. liver), black-eyed peas, oysters and clams, and Cream of Wheat • Iodine • Deficiency leads to hypothyroidism (goiter) • Foods: Most processed foods and table salt is iodized

  11. Protein • Complete proteins • Animal origin • Incomplete proteins • Plant origin • Vegetarians/Vegans • Teach complementary proteins • Grains and lentils or beans • Peanut butter and bread • Rice and dal • Tofu and rice • Legumes and seeds • Soybeans and pumpkin seeds • Grains and Dairy • Pasta and cheese • Cereal and milk

  12. Gastroesophageal Reflux Diseaseaka GERD • Severe reflux (heartburn) 30-60 minutes after eating • Pain may mimic cardiac chest pain (radiation to arm, neck, jaws) • Causes • Hiatal Hernia • Pregnancy • Obesity • Aggressive Vomiting • NG Tubes

  13. Acid Stimulating Agents • Food intake • Stimulates acid production • Avoid constant snacking during the day • Large meals • Distend the stomach leaving the esophageal sphincter slightly open • Milk • Stimulates more acid than it can buffer • Seasonings • Peppermint and Spearmint • Hot chili peppers, Black pepper, Chili powder

  14. Acid Stimulating Agents • Coffee, Tea, Soda, Chocolate • Individual tolerance • Regular anddecaf • Citric Acid Juices and Tomato Juice • Alcohol • Concentrated 40% (80 proof) • Beer • Smoking • Affects acid production, ulcer healing, and the effectiveness of drug therapy

  15. General Care of GERD • Increase protein and decrease fat • Decrease size of meals and increase number of meals • Drink between meals and sip liquids during meal • Sit upright for 2 hours after eating • Elevate HOB at night • Avoid constipation • Stop smoking • Avoid NSAIDs and Anticholinergics when possible • Decrease stress • Avoid tight fitting clothing

  16. Diarrhea • DEHYDRATION • Orthostatic hypotension • Decrease BP, increase HR, dizziness • Replace fluids (not just water) • Electrolyte loss • Sodium and Potassium • May cause weakness, drowsiness • Extremely low sodium levels may cause seizure • Metabolic Acidosis • Bicarbonate loss • Modified BRAT Diet • Only until regular diet tolerated

  17. Upper GI Loss • Caused by: Vomiting or NG suction • Vomiting: Aspiration Risk • Fluid Loss • Electrolyte Loss • Sodium, Chlorine (which will affect other electrolytes) • NG Flushing to be done with NS • Metabolic Alkalosis • Hydrogen loss (Gastric Acid: HCl)

  18. Absorption Disorders • Celiac Disease or Sprue • Ingestion of gluten (found in grains) causes damaging changes in the GI tract and malabsorption of vitamins, minerals, and calories • Diet • Replace Grain products with corn or rice products • Increase calories (protein) • Decrease fats • Carbs should be simple (fruits) • Supplements • Vitamins: A, B, C, D, and E • Minerals: Iron (if anemic)

  19. Absorption Disorders • Cystic Fibrosis • Genetic Disorder causing increased secretions and decreased pancreatic enzymes • Nutrition defecits • Malabsorption • Sodium loss through perspiration • Diet • Higher calorie: Protein • Vitamin Supplements: Fat soluble • Pancreatic Enzyme Replacement: Pancrease

  20. Bowel Disorders • Ulcerative Colitis and Crohn’s Disease • High protein and calorie • Vitamin and mineral supplements • Avoid gas producing foods • Bulk-forming agents • Diverticular Disease • Increase fiber as tolerated, but avoid indigestible roughage • Avoid seeds, nuts, popcorn, dried fruit (raisins) • IBS • Increase fiber, decrease fat • Smaller meals • Avoid carbonated beverages and gum chewing • Pay attention to triggering foods • Constipation • Increase activity, fiber, and maintain hydration

  21. Liver Disorders • Hepatitis • High protein, carbs, calories • Moderate fats • Cirrhosis • High protein • Low sodium, fluid restriction as ordered • Diets for PUD and varices • See GERD slides • Soft texture • B-VITAMINS!!!!! and folate • NO ALCOHOL

  22. Gallbladder/Pancreatic Diseases • Cholecystitis and Cholelithiasis • Low Fat diets (even the good fats) • Pancreatitis • Acute- IV nutrition • Chronic- • Low-fat, small meals, may need supplements • Avoid: alcohol, caffeine and nicotine • Pancreatic Enzymes • Insulin?

  23. Kidney Diseases • Acute Renal Failure • Increase carbs • Decrease sodium and potassium • End-Stage Renal Disease • As above, add low phosphorus • Moderate protein (just enough) • Nephrotic Syndrome or Nephrosis • Low sodium , Moderate protein (just enough) • Acute Glomerulonephritis • Increase carbs, high calorie • Protein, sodium and fluid restriction • Chronic Glomerulonephritis • Same as above • Polycystic Kidney Disease • Increase sodium

  24. Stones • Calcium phosphate • Decrease dietary calcium, avoid excess Vit. D • Calcium Oxalate • Avoid oxalate rich foods • Tea, almonds, cashews, chocolate, cocoa, beans, spinach, rhubarb • Struvite • Limit high phosphorus foods (dairy, red/organ meats, and whole grains) • Uric Acid • Limit purines (organ meat, gravy, red wine, sardines • Cystine • Limit methionine (meat, cheese, eggs, and milk) • Increase fluid intake to 3L/day

  25. Ash Diets • Alkaline Ash Diet (Uric Acid Stones) • Increases pH (reduces acidity of urine) • Milk, fruits (except cranberries, plums, prunes), rhubarb, vegetables, small amounts of meats: Beef, halibut, veal, trout, and salmon • Acid Ash Diet (?) • Decreases pH (increases acidity of urine) • Cheese, eggs, meat, fish, oysters, poultry, bread, cereal, whole grains, pastries, cranberries, prunes, plums, tomatoes, corn and legumes

  26. Burn/Thermal Injuries • Stage 1- Up to 48 hours • Hypovolemia • Replace fluid and electrolytes • Stage 2- 48-72 hours • Fluid overload a concern • Possible electrolyte toxicity • Stage 3- Over 72 hours • Increase in metabolism • Increase urine output

  27. Burn/Thermal Injuries • Stage 4- Healing • Increase protein (2) and calories (2-3) • 25% Protein, 50% Carbs, 25% Fat • Vitamins: A (immune), B (energy and protein metabolism), C (tissue rebuilding) • Minerals: Iron (anemia), Zinc (immune), Calcium/Phosphorus Balance • Curling’s Ulcer

  28. Endocrine • Diabetes • Carbs (low simple sugars), 1 exchange = 15 carbs 3-4 exchanges/meal 1 exchange for snacks • Protein • Thyroid • Hyper- increase calories • Hypo- decrease calories • Parathyroid • Hyper- decrease calcium • Hypo- increase calcium

  29. Cardiac • Atherosclerosis • Low fat, low cholesterol • CHF • Low sodium, fluid restriction • Watch potassium • Anemia • Iron, folic acid, B12 • Z-track Iron injections

  30. Hypertension and CHF • Sodium-Restricted Diet • Mild • 2-3 g sodium per day • Moderate • 1 g sodium per day • Strict • 500 mg sodium per day

  31. Hypertension • DASH Diet • Dietary Approaches to Stop Hypertension • 4-6 servings of fruits per day • 4-6 servings of vegetables per day • 2-3 servings of low fat dairy foods per day • Lean meats and high fiber grains

  32. Cardiovascular Disease

  33. Modifying Risk Factors • TLC Diet (Therapeutic Lifestyle Changes) • Calories taken in should equal calories used in a day • Reduce total fat intake to less than 30% of calorie intake • Reduce saturated fats to 7%, polyunsaturated fat to 10%, and monounsaturated fat to 20% of total fat intake • Reduce cholesterol to 200 mg/day • Complex carbohydrates should make up about 50% of calorie intake • Increase soluble fiber to 10-25g • Protein should account for 15% of calorie intake • Diet rich in vegetables, fruits, whole grains, low in trans fats and saturated fats

  34. Peri-operative • Pre-op • Protein • Vitamin K • Post-op • Protein • Iron (with vitamin C) • Vitamin A, B, C • Potassium • ADAT in 24-48 hours • AMBULATE

  35. Pediatrics • Food Progression (one at a time) • Iron fortified cereal, fruits/vegetables (cooked/mashed), meats (strained), toast • Non-reduced fat milk- end of first year • Hydrocephalus • Small feedings • Pyloric Stenosis • After feeding • HOB up 60 degrees • Position on Right side

  36. Miscellaneous • Anorexia • Attractive food • Neutropenic Precautions • Peeled fruits and veggies only • Rheumatoid Arthritis • Increase protein during acute attacks • Dumping Syndrome • Decrease fluids with meals • Lithium (salt) • Increase fluids • COPD • Carbs

More Related