Review Day 4

Obese patient – has a slow metabolic rate

Carbohydrates
Deficiency – Marasmus
Lipids
Function –
Fat soluble vitamins – A, D, E, K
 Fish, dairy products, some seeds
4 Fat: Fatty meats, Fish, Cheese (aged), butter, avocado

Saturated Fats Unsaturated Fats

 Clogs the artery - give to stroke patients
 Meats, butter - vegetables oils
 Solid in Temp - low calorie intake
 LDL (bad) - constipation
 HDL (good) - liquid
 Do not dissolve in the body - level of good cholesterol
 Causing blockage
Diet for stroke patients – low sodium, low fat
Protein – growth and repair of tissues
-After surgery
Meat, fish, dairy products, eggs, legumes, cereals

Deficiency: KWASHIORKOR
 Failure to grow in height
 Irritability
 Edema (pitting edema) – maximum 5 seconds
Pathognomic signs: Fat belly
Vitamin A – vision, skin, growth of hair
Food source: dairy products, green, yellow and orange fruits, liver
Deficiency: Night blindness, xerophthalmia
Too much: Fetal malformation
Do Not Take Vitamin A: For 1st trimester (pregnant Mother)

Vitamin D – Calcium and phosphorus absorption, bone mineralization

Good source: sunlight (30 minutes)
Food source: Dairy products, yolks, fatty fish
Deficiency: Osteomalacia, Rickets
Toxicity: Growth retardation, Ca deposits, kidney damage

Vitamin E – Blood cloth

Food source: green vegetables, interstitial
Newborn - administer
Antidote: Protamine sulfate
Deficiency:
Toxicity: Anuria, Jaundice

Vitamin C – Antioxidant, collagen formation

Food source: Citrus fruits, green peppers, cantaloupe, broccoli, cabbage
Deficiency: Scurvy, poor
Toxicity: Diarrhea (>2g), kidney stone formation, fatigue

B1- nerve function

Food source: whole grains
Deficiency: Beri beri
B6 – Metabolism of amino acids and protein
Food source: whole gains, spinach
Deficiency: Headache, convulsion, nausea
Toxicity: nerve destruction
B2 – Coenzyme for energy metabolism
Food sources: Grains, cereal, meat, fish, green leafy vegetables
Deficiency: Ariboflavinosis
B3 (niacin) – coenzyme for energy metabolism
Food source: Meat, fish, nuts, whole grains, egg
Deficiency: Ariboflavinosis, cheilosis, glossitis, pellagra
Toxicity: Liver damage
B9 – aids the metabolism of DNA and RNA
Pregnant mother – must take vitamin B9
Food source: green leafy vegetables, nuts, legumes, grains, liver
Deficiency: Megaloblastic anemia

B12 – RBC formation, nervous system

Food source:
Deficiency: Pernicious anemia, Nerve degeneration
Carb – 4kcal/gram
Protein – 4kcal
Fat – 9kcal
Alcohol – 7kcal/gram
Anthropometric measurements
Adipose tissue
Insulin – Abd (best site)
-adipose tissue
 -prevent lipodystrophy
DASH DIET – hyperkalemia, hypertension, DM, ischemic stroke
Food source: fiber, whole grain

Normal BMI 0- 18.5 – 24.9

Protein Restricted Diet – 40 to 60

Renal diet – patient on dialysis, chronic kidney disease
- iron and hemoglobin diet (liver)
- Crackers, green leafy vegetables
Dialysis patient – restrict fluids
-ice chips – to relieve thirst
-monitor weight daily as a priority
Low Purine diet – gout
 Ask patient for history of allergy
4 iron diet – anemia, IDA (Iron Deficiency Anemia)
 Inform client that concurrent intake of vit c with iron foods
Ovu – vegetarian
-only animal foods

New stoma - red, swollen, minimal bleeding, no pain, not

Old stoma - bright red, dark red, bluish, moist

Post colostomy
- Fever
- Redness in stoma
- Abd movement
- Nausea and vomiting

Renal artery
Renal vein
Normal urine characteristics
Amount in 24H- 1.2 to 1.5 L

Color: amber, straw, transparent, aromatic

Drug of Choice for UTI: Ciprofloxacin

Dribbling urine- dysuria with BPH- urinary catheterization

Urinary retention- psychological intervention through running water

Cranial Nerves - 12 pairs at the back of brain

 Makes movement, facial expression

Alterations like: Bell’s palsy, TN – CN damaged

Olfactory – sensory – sense of smell – covid 19 (affected part cranial nerve)

Optic – sensory – vision

Oculomotor – motor – pupil dilation and constriction

Trochlear – motor – eye movement – optic, oculomotor, trochlear

Trigeminal – motor and sensory – corneal reflex, photosensitivity, masticate,

                                                      - facial sensation – damaged, trigeminal neuralgia

Abducens - motor - eye movement (side to side)

Facial - Sensory and motor - facial expression, movement

Acoustic - sensory - hearing and balance 

  damaged in acoustic nerve: Tinnitus

Glossopharyngeal - sensory and motor - swallowing, taste (last ⅔ of tongue)

Vagus - sensory and motor - swallowing, peristalsis, gag reflex, bp and hr 
Spinal Accessory - motor and movement of shoulder

Hypoglossal - motor - tongue movement

Trigeminal Neuralgia - damaged CN V

                        -impulse conduction triggered by hard food

                         - hot foods not allowed, avoid facial stimulation, spitting toothbrush

Drug of Choice - Tegretol (carbamazepine) 

Diet - soft diet

Bell’s palsy - CN VII

                    -autoimmune, related to infection

                    -one side paralyze

                    -facial 

DOC - Corticosteroid and 

Lessen inflammation of face

Nursing Alert: facial massage, Alternate: warm and cold compress

GCS – highest 15, lowest 3

Clinical implication:3
 14-15 – conscious
 11-13 – lethargic/ obtunded – slight comatose
 8-10 – stupor – vegestative state, not responsive
 4-7 – coma – patient is asleep, unconscious and intubated
 3 – deep coma, poor prognosis
GCS Less than 7 – intubation Mild 13-15
Moderate 9-12
Severe 3-8
Eye movement
LOC
Alert, awake
Confused – progressive, disorientation
Lethargic – sleeps frequently but awaken to voice (GCS 7)
Obtunded – extreme drowsiness
Stupor – minimal movement, awakens briefly repeated stimuli
Comatose – does not respond to stimuli

Intracranial Pressure – pressure exerted on skull Bradycardia

Normal: 8 to 15

Factors

Factors CSF volume- 150 Cushing triad

Blood volume- 150

Main(?) volume- 1400

Pulse Pressure – systolic – diastolic/systole BP 120-90 =30

Sign and symptoms

- Nausea and vomiting

- Headache
- Seizure
- Cushing triad

Best position for pt with ICP – High fowler, head is in neutral position
Respiratory Disease
COPD – cannot tolerate too much O2 – preserve hypoxic
Medulla oblongata – center of respiration, bp , hr
Sneezing – clear upper resp track
Coughing – clear lower resp track

O2 – 1 to 2L
Venturi – mask 100% o2
Emphysema
2 disorders causing COPD
Bronchitis

Newborn pts – placed on low O2 – rationale: newborn should be placed on low O2 since they
can’t tolerate
Retrolental Fibroplasia – blind baby
Surfactant – through amniocentesis – measure lecithin and sphingomyelin (2:1)
Drug of choice for lung toxicity - betamethasone

Tidal volume – the volume of air that enter & leaves during normal expiration
Residual volume – stays in the lungs
Inspiratory – forcibly inhale 3000 – 250ml
Expiratory – forcibly exhale 1000 -120ml

OL therapy
- Do not give O2 during defibrillator/ cardioversion
- Safest: 1-2L/m
Nasal Cannula – 1-6L – patient not restricted
Simple