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55 Cards in this Set
- Front
- Back
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What helps balance out the acidosis or alkalosis in the blood?
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The lungs (respiratory) and kidneys (metabolic)
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What do the lungs control?
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Carbonic acid!
H2CO3 |
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What do the kidneys control?
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Bicarbonate
HCO3 |
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What is the normal pH range?
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7.35 to 7.45
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If the pH levels are BELOW the normal range (below 7.35), what state is the patient in?
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Acidosis
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If the pH levels are ABOVE the normal range (above 7.45), what state is the patient in?
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Alkalosis
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With pH questions- what are the two steps?
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1. Determine acidosis or alkalosis
2. Determine respiratory (lungs) vs. metabolic (kidneys) |
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pCO2 correlates with _______.
HCO3 correlates with _______. |
pCO2: Lungs
HCO3: Kidneys |
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What foods are high in K+?
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Potassium is INTRACELLULAR
*Dark leafy greens, citrus, tomatoes, potatoes, oranges, etc. |
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What is water intoxication, why can it be fatal?
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-Excessive water and intracellular fluid volume= osmolar dilution results
-Cells swell, especially brain cells -Can cause headache, nausea, vomiting, muscle twitching, convulsions, stupor -If untreated, can be fatal -If someone drinks a lot of water that doesn't have a lot of electrolytes...Then it can dilute sodium levels to a point where it is fatal to the body. |
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How is water regulated in the body?
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Osmo receptors that pick up on concentration changes- High concentration (of particles to water in cell) provokes drive to drink water.
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What is the role of the brain and water regulation? Kidneys?
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*Brain: Regulates water through ventromedial and anterior hypothalamus (near pituitary gland, which regulates ADH); high concentration of electrolytes = thirsty.
*Kidneys: Respond to antidiuretic hormone involved (ADH); Renal tubules absorb more water in response to ADH. |
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What are the different compartments in the body where water is held?
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Intracellular
Extracellular |
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Common causes of respiratory alk.
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Hyperventilation or excessive exercise
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Common causes of metabolic acidosis?
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Uncontrolled diabetes
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Common causes of metabolic alkalosis?
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COPD and emphysema
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What is significant weight change?
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//
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What is the maximum age to use growth charts?
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20 years
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What are the parameters for degrees of malnutrition?
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5% of body weight lost within 30 days.
ETC |
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Positive acute phase respondents?
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C Reactive Protein (CRP)
*It's levels go UP with trauma, stress, etc. *When trauma/stress goes away, CRP levels go down. |
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Negative acute phase respondents?
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Albumin, transferrin
*Levels go DOWN with trauma, stress, etc. *When things go back to normal, levels go back up. |
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If albumin is really low, what might you notice about the patient?
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Skin exam- Edema or pitting!
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What labs are drawn for CBC?
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Complete blood count:
-Red blood cells -Hemoglobin concentration -Hematocrit -Mean cell volume -Mean cell hemoglobin -Mean cell hemoglobin concentration -White blood cell count -Differential |
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What labs are drawn for BMP?
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Basic metabolic panel:
-Glucose -Calcium -Sodium -Potassium -CO2 (carbon dioxide, bicarbonate) -Chloride -Blood urea nitrogen (BUN) -Creatinine |
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What labs are drawn for CMP?
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Comprehensive metabolic panel:
-Glucose -Calcium -Sodium -Potassium -CO2 (carbon dioxide, bicarbonate) -Chloride -Blood urea nitrogen (BUN) -Creatinine -Albumin -Total protein -Alkaline phosphate (ALP) -Alanine aminotransferase (ALT) -Aspartate aminotransferase (AST) -Bilirubin |
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What are the differences between macrocytic and microcytic anemia?
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Macro- person is low in B12 and folate
Micro- iron related! |
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Which labs are indicative of cardiovascular inflammation or increased risk for CVD?
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Homocystine: marker of inflammation
*To improve homocystine levels, what vitamins/minerals need to be taken? |
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How is albumin used in nutrition assessment?
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//
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What is pharmacodynamics?
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The study of the physiologic and biochemical effects of a drug or combination of drugs.
*Food-drug interaction |
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What is pharmacokinetics?
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The movement of a drug through the body by absorption, distribution, metabolism, and excretion.
*Movement!!! |
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What is an excipient?
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A substance added to a drug, such as a buffer, binder, filler, diluent, disintegrant, glidant, flavoring, dye, preservation, suspending agent, or coating.
***Also called inactive ingredient. |
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What can be problematic regarding excipients?
(ppt 16?) |
Several common excipients have potential for interactions in persons with an allergy or enzyme deficiency.
*Lactose and glucose sensitivities *Ex: Fat in proprofol puts you to sleep quickly |
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How does a low albumin level affect drug action/absorption?
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If one has a low albumin there are less binding sites for the drug, more drug in the blood serum
*Most at risk are elderly, less than 3.0 |
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What is the best way to administer drugs through a feeding tube?
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Recommendations to separate phenytoin suspension from tube-feeding formulas are common. Stopping the tube feeding before and after the phenytoin dose is generally suggested, but recommendations vary from 1 to 4 hours intervals. The most common is a 2-hour feeding-free interval before and after the dose of phenytoin is administered.
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How does grapefruit juice interfere with medication metabolism?
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A substance found in grapefruit and grapefruit juice can inhibit the intestinal metabolism of drugs (such as calcium channel blockers that are dihydropyridine derivatives and/or some HMG coenzyme A reductase inhibitors such as simvastatin).
**Also inhibits the cytochrome P-450 3A4 enzyme in the intestinal wall responsible for the oxidative metabolism of many orally administered drugs. |
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What can be problematic with tetracycline?
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Reduces the amount of calcium available for absorption
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What can be problematic with methotrexate?
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Used to treat rheumatoid arthritis or cancer- CAUSES A LOWERING OF FOLATE
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What can be problematic with corticosteroids (prednisone)?
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Cause insulin resistance and inhibit glucose uptake.
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What can be problematic with MAOI's?
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Cause vasoconstriction, headache, high blood pressure, and death.
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What can be problematic with coumadin?
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*Coumadin thins the blood.
*Vitamin K interacts with coumadin. *If patients are taking coumadin, tell them to keep vitamin K levels steady and consistent. |
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What can be problematic with propofol?
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Puts you to sleep quickly (if taken with fat?)
May provide a significant amount of sodium, so may be contraindicated for patients who need to limit sodium. |
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What can be problematic with narcotics (codeine, morphine)?
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Constipation or diarrhea
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What are the steps of a physical assessment?
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//
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What are the steps of an abdominal exam?
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//
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What is a critical pathway?
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Certain elements that should occur in a patient's care and the timeframe.
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What is utilization management?
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Eliminating or reducing unnecessary tests
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What is case management?
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Assessing, evaluating, planning, implementing, coordinating, and monitoring care.
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What are DRG's?
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The hospital recieves payment based on patient diagnosis, comordibities, surgeries, age, and gender.
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What is a managed care company?
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Mechanism for financing and organizing health care delivery in which providers and payers have predetermined payments for care provided.
*Medicare is NOTTTT considered one, nor Medicaid because it's the government. *Blue Cross Blue Shield, United, etc. |
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What demographic trends are affecting healthcare?
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IMMIGRATION
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Who reimburses for MNT? What disease states will they reimburse for?
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Medicare reimburses!!!
*Only reimburses for renal (kidneys) and diabetes |
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How much do they pay for initial assessment, follow-up or group session?
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Initial assessment: $17.92 for 15 mins
Group: $7.09 per member per 30 mins |
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What are the basics of hospital diets?
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Regular diet (house diet): Usually 1600-2200 kcals, 60-80 g protein, 30-100 g fat, 180-300 g CHO
Soft diet: Transition from liquid to regular. Low in cellulose or connective tissue. Postoperative or GI problems. Liquid diet: Used for easy digestion or minimal residue- Used briefly. |
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What is palliative care?
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Encourages the alleviation of physical symptoms, anxiety, and fear while attempting to maintain the patient's ability to function independently.
*Comfort measures for terminally ill patients; Focus on quality of life and communication with family members |
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What is a SOAP note? What information is typically found under each section of a SOAP note?
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It is a charting/documentation tool.
S- subjective (info provided by patient) O- objective (factual observations; lab/clinical data) A- assessment (interpretation of sub & ob info) P- plan (studies & data needed; MNT goals) |
