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PROMOTING REST AND SLEEP

2. Non-Rapid Eye Movement Sleep (NonCircadian Rhythm
 A biological rhythm
 A biological clock
 Regulated from outside the person’s
body

Types of Sleep
1. Rapid Eye Movement Sleep (REM
sleep)
 Increased brain metabolism and
activity
 Also
called
PARADOXICAL
SLEEP
 Characterized by:
o Vivid dreams
o Easily
recalled
upon
awakening

Concepts!
 REM sleep is NOT AS RESTFUL as
NON-REM sleep
 However, REM sleep is NEEDED
 Dreaming is a psychological outlet
of pent up emotions

Nursing Alert!
 Deprivation of REM sleep results to:
o Irritability
o Restlessness
o Poor concentration

REM Sleep)
 Deep restful sleep
 Benefit is that it restores the body
physically
and
psychologically
(especially
for
post-operative
patients)

Concept!
 Deprivation of Non-REM sleep
causes:
o Physical exhaustion
o Decreased resistance against
infection

Wellness Teachings to Enhance or
Promote Sleep
 Establish a regular routine
 Have adequate exercise at daytime
o Avoid stimulating activity by
bedtime
 Avoid all types of stimulants
o Caffeine-containing foods
 Coffee
 Cocoa
 Chocolate
 Tea
 Cola
o Nicotine
o Alcohol
 Prolongs the REM
stage of sleep
 It excites the patient
like an anesthetic
 Not a stimulant

The R.A Gapuz Review Center Inc. makes no representations about the accuracy, authenticity, and reliability of this compilation. It declaims any and all
responsibility or liability for plagiarism, copyright infringement and violation of related laws in connection with the contents of the materials. It had no
participation and compilation thereof such being sole responsibility of the reviewer concerned. This disclaimer serves as a notice to the public that R. A.
Gapuz Review Center Inc. shall not be liable for any complaints, actions or suits in connection with the contents of the materials of this compilation.

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get up and pursue satisfying activity  Drink something warm or hot (except stimulants) o Milk contains L-tryptophan o L-tryptophan is an amino acid with a natural sedative effect that induces one to sleep  Do something HOT! o Twice-a-week masturbation is ideal o Facilitates release of tension of the day  Side-to-side turning every two hours with back tapping  Support bedtime rituals  Remove all music in order to sleep PROMOTING NUTRITION Proteins  Macromolecules composed of o Carbon o Hydrogen o Oxygen o Nitrogen Basic Body Needs:  Carbohydrates  Proteins  Fats Concepts:  Glucose is a ready source of energy for metabolic processes Carbohydrates  When eaten are metabolized to glucose for energy  Excess carbohydrates are converted to glycogen and stored in the liver  Other excess carbohydrates go to the fat cells Key Concept!  During starvation. and reliability of this compilation. . makes no representations about the accuracy. A. It declaims any and all responsibility or liability for plagiarism. Avoid shabu  Use the bed mainly for sleep  If unable to sleep. stored glycogen is converted to glucose via a process called glycogenolysis  If glycogen is used up. fat resources are converted to glucose via a process called gluconeogenesis Nursing Alert!  Fat conversion to glucose produces waste products called KETONE BODIES  These give rise to metabolic acidosis as in Diabetic Ketoacidosis Additional concepts!  During starvation protein reserves are converted to glucose via process called gluconeogenesis Gluconeogenesis 2 The R. authenticity.A Gapuz Review Center Inc. shall not be liable for any complaints. This disclaimer serves as a notice to the public that R. Gapuz Review Center Inc. copyright infringement and violation of related laws in connection with the contents of the materials. actions or suits in connection with the contents of the materials of this compilation. It had no participation and compilation thereof such being sole responsibility of the reviewer concerned.

Gapuz Review Center Inc. It declaims any and all responsibility or liability for plagiarism. shall not be liable for any complaints.A Gapuz Review Center Inc. authenticity. Very Low Density Lipoproteins (VLDL)  Very bad cholesterol Functions of Fats  Proteins that cannot be produced by the body itself  To be sourced out from food eaten  Animal protein is complete protein  Plant protein is considered as incomplete protein 2. Essential Proteins Types of Lipoproteins 1. High Density Lipoproteins (HDL)     High-grade lipoprotein Good grade lipoprotein Good cholesterol Function of HDLs o Transports the bad cholesterol from systemic circulation to the liver for metabolism and eventual elimination 2. Non-essential Proteins  Proteins that can be produced by the body Functions of Protein  Main element of our cells. It had no participation and compilation thereof such being sole responsibility of the reviewer concerned. and reliability of this compilation. o Building blocks of the cells are proteins  Resistance against infection o Formation of Immunoglobulins (globular proteins)  Maintenance of normal intravascular fluid volume o Works with glucose and sodium o Albumin  Main protein of blood  Acts as a colloid  Attracts water around it  Insulation The R. Production of glucose out of noncarbohydrate products Lipoproteins  Substances composed of fats and proteins  Heat Conservation  Source of Energy Proteins Two (2) types in terms of needs of the body: 1. A. Low Density Lipoproteins (LDL)     Low-grade lipoprotein Bad cholesterol Function of LDLs They clog the blood vessels 3. actions or suits in connection with the contents of the materials of this compilation. copyright infringement and violation of related laws in connection with the contents of the materials. This disclaimer serves as a notice to the public that R. 3 . makes no representations about the accuracy.

Gapuz Review Center Inc. . A. sodium and glucose will not be enough to hold plasma inside blood vessel resulting into edema  In liver cirrhosis. It had no participation and compilation thereof such being sole responsibility of the reviewer concerned. there would be decreased calcium levels  Increased levels of Vitamin D leads to increased calcium levels Vitamin E VITAMINS Two (2) types of Vitamins  Fat Soluble Vitamins  Water Soluble Vitamins  Anti-oxidant  Promotes cell membrane integrity (like Vitamin C)  Vitamin for the heart and skin  Sources are meats and in vegetables  Deficiency results to Vitamin E deficiency hemolytic anemia Vitamin K Fat Soluble Vitamins 1. actions or suits in connection with the contents of the materials of this compilation. Vitamin D  Source is food  Precursor is in the skin  Sunlight is needed for Vitamin D to be converted to its active form  Function: o Influences calcium metabolism o To metabolize calcium  Deficiency in prothrombin leads to bleeding MICRONUTRIENTS Ferrous sulfate (FeSO4)  Forms: 4 The R. shall not be liable for any complaints.Concepts!!!  If protein levels are decreased. makes no representations about the accuracy. and reliability of this compilation. It declaims any and all responsibility or liability for plagiarism. Vitamin A  Essential for normal vision  For transmission of light stimulus via the optic nerve  Synthesis of clotting factors  Synthesis of prothrombin Concept!  Decreased levels of Vitamin K leads to prothrombin deficiency 2. authenticity. This disclaimer serves as a notice to the public that R. hypoalbuminemia results to edema Concept!  Without Vitamin D. copyright infringement and violation of related laws in connection with the contents of the materials.A Gapuz Review Center Inc.

This disclaimer serves as a notice to the public that R.5” to 2. shall not be liable for any complaints. It declaims any and all responsibility or liability for plagiarism. actions or suits in connection with the contents of the materials of this compilation.A Gapuz Review Center Inc. and reliability of this compilation. advice taking orange juice o Vitamin C in orange juice enhances iron absorption o Do not take milk o Milk inhibits absorption of iron o Too much fiber prevents absorption of iron o Thus. Light Diet      Given for post-operative patients Plainly cooked No spices Large amounts of FAT omitted Avoid bran and high fiber 2.o Tablet o Liquid o Injectable  Oral (tablet and liquid forms) o Take on an empty stomach o If there is GI distress (i. berry)  Raw fruits and vegetables  Fried Foods  Whole grains and cereals 5 The R.M. diarrhea). makes no representations about the accuracy. guava. take with food o If GI distress subsides. Gapuz Review Center Inc. do not take oats when taking iron.5 ml of air in syringe so that medication would not leak into the subcutaneous tissues  Nursing Alert! o Apply firm pressure for at least five (5) minutes after injection  Do NOT massage SPECIAL DIETS o Rationale:  To avoid staining the teeth  Health Teaching!!! o To enhance iron absorption.  Injectable Iron o Route is deep I. o Use Z-track technique o Gauge of Needle is at least 18 o Length of Needle is 1.e. Soft Diet  For people with difficulty with swallowing and chewing  Generally low residue diet  Nursing Alert! o Avoid the following:  Nuts  Seeds (tomato.0” o Site of administration is the GLUTEAL MUSCLE ONLY!!! o Rationale: 1. copyright infringement and violation of related laws in connection with the contents of the materials. take on an empty stomach  Toxic effects: o Constipation (first option)  Oral Liquid Iron o Use dropper and apply at the back of the tongue or use a straw  To avoid staining the skin  Concept: o Use an airlock o Place 0. It had no participation and compilation thereof such being sole responsibility of the reviewer concerned. . authenticity. A.

shall not be liable for any complaints.3. . Full Liquid Diet  Foods that melt or liquefy at body temperature 5. Pureed Diet  Osteorized diet 4.A Gapuz Review Center Inc. copyright infringement and violation of related laws in connection with the contents of the materials. authenticity. Clear Liquid Diet  Given to surgical patients  Limited to: o Water o Coffee o Tea o Cola o Clear stained broth o Gelatin o Hard candies  Nursing Alert! o Dairy products are avoided 6. makes no representations about the accuracy. A. actions or suits in connection with the contents of the materials of this compilation. Candidiasis Diet ASSESSMENT OF NUTRITIONAL  Free of the following: o Fruits o Sugar o Yeast o Fermented foods STATUS Anthropometric Measurements 8. This disclaimer serves as a notice to the public that R. High Fiber Diet  For patients at risk for constipation  Reduced fiber  To decrease GI irritation  For patients with inflammatory diseases: o Chron’s disease o Ulcerative colitis bowel Acid-Ash Diet  To alkalinize urine  To soothe an irritated bladder and urethra  Give citrus fruits  Give vegetables  Exceptions are: o Prune Juice o Cranberry Juice o Both produce ACIDIC URINE Ash-Acid Diet  Given to acidify urine  To minimize or help control Urinary Tract Infections  Give the following: o Protein o Meat o Poultry 7. Low Residue Diet 6 The R. and reliability of this compilation. Gapuz Review Center Inc. It had no participation and compilation thereof such being sole responsibility of the reviewer concerned. It declaims any and all responsibility or liability for plagiarism.

NASOGASTRIC TUBE FEEDING (NGT)  Purpose of NGT insertion o For gastric gavage and lavage o For administration of food and medication o To keep the stomach empty o To prevent aspiration from regurgitation of gastric contents o For gastric decompression  How to Insert NGT o Depth of Insertion Measure length from the tip of the nose to the ears to the tip of the xiphoid process  Insertion: o Position the patient in semiFowler’s or Fowler’s position o While inserting to NASOPHARYNX  Position the head in a hyperextended manner o When glottis. Let patient hum  If positive for humming. actions or suits in connection with the contents of the materials of this compilation. Skin Fold Test  Derived from reserved fat of the body Mid-upper arm Circumference Measurement  Obtains the muscle mass of the body  This reflects the protein reserves of the body  Laboratory diagnostic procedure for albumin SUPPORTING NUTRITION OF PATIENT: ENTERAL AND PARENTERAL FEEDING ENTERAL FEEDING 1. makes no representations about the accuracy. Gapuz Review Center Inc. observe for coughing or difficulty of breathing  After inserting. authenticity. 7 . epiglottis are approached  Flex the head o Rationale:  To prevent entry of the tube into the trachea  Nursing Alert! o Watch for signs and symptoms of RESPIRATORY DIFFICULTY o If there are signs. A. tube is in the esophagus and stomach  If negative for humming. WITHDRAW TUBE o While inserting tube. and reliability of this compilation. tube is in the trachea  Nursing Alert! o Small-bore tube allows patient to hum The R. It had no participation and compilation thereof such being sole responsibility of the reviewer concerned. ascertain proper placement on the stomach  Concept! o Most accurate method to test for proper placement of the NGT is via X-RAY  Other ways to test proper placement: o 1. This disclaimer serves as a notice to the public that R. shall not be liable for any complaints. It declaims any and all responsibility or liability for plagiarism.A Gapuz Review Center Inc. copyright infringement and violation of related laws in connection with the contents of the materials.

o Therefore. CHECK THE FOLLOWING:  Placement of the tube  For patient safety  To prevent LUNG aspiration of food  Patency of the tube  To insure successful introduction or administration of food o 3. this method is NOT RELIABLE o 2. therefore. Gapuz Review Center Inc. it will suck        the water and lead to pulmonary aspiration Position during feeding: o Fowler’s Position Measure gastric residual volume o Subtract this from total feeding to introduce o If aspirate is greater than 50 ml for adult or 10 ml for infant. actions or suits in connection with the contents of the materials of this compilation. shall not be liable for any complaints. By auscultating the epigastric region while insufflating 50 ml of air  Hear gurgling sound TUBE FEEDING  Never try to submerge the free end of the NGT to water o This is potentially dangerous o If in trachea and submerging of free end to water coincides with inspiration. Determine the pH of the aspirate  Use litmus paper  Change of color from BLUE to RED indicates that the aspirate is acidic and. from lung contents  IMPORTANT CONCEPTS!!! o To insure safety of the patient prior to feeding. copyright infringement and violation of related laws in connection with the contents of the materials. from stomach contents  Change of color from RED to BLUE indicates that the aspirate is basic and. makes no representations about the accuracy. It declaims any and all responsibility or liability for plagiarism. then WITHHOLD FEEDING for 2 – 3 hours. This disclaimer serves as a notice to the public that R. A. . o If same occurs after 2 – 3 hours. therefore. It had no participation and compilation thereof such being sole responsibility of the reviewer concerned.  There is a problem with gastric emptying Watch out for COUGHING o Leakage to trachea If with DIFFICULTY OF BREATHING o Stop the procedure Flush with water after feeding to avoid clogging of the tube After the procedure o Do not place the patient on bed before 30 minutes have lapsed o Rationale:  To prevent aspiration and regurgitation Average volume of feeding: o 300 ml to 400 ml TOTAL PARENTERAL NUTRITION  Introduced directly to the bloodstream  Tube is inserted via the: o Subclavian vein o Internal jugular vein of the neck 8 The R. authenticity. and reliability of this compilation.A Gapuz Review Center Inc. o Rationale:  Patient is not yet ready for next feeding. NOTIFY DOCTOR.

shall not be liable for any complaints. This disclaimer serves as a notice to the public that R. copyright infringement and violation of related laws in connection with the contents of the materials. and reliability of this compilation. makes no representations about the accuracy. A. Gapuz Review Center Inc. actions or suits in connection with the contents of the materials of this compilation. It had no participation and compilation thereof such being sole responsibility of the reviewer concerned.o External jugular vein of the neck  Important Concept!!! o Tube must reach two (2) centimeters before or above the RIGHT ATRIUM  Nursing Responsibilities: o Watch out for signs and symptoms of embolism  Care of Insertion Site o Application of sterile dressing with anti-bacterial ointment as ordered by doctor (prn) GASTROSTOMY TUBE FEEDING (Enteral)  No auscultation needed  Assess for the patency of the tube  Use water to do this 9 The R.A Gapuz Review Center Inc. . authenticity. It declaims any and all responsibility or liability for plagiarism.