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Alveoli
Terminal ends of the respiratory tree
Sites of gas exchange with the blood
Alveolar membrane is the gas-exchange surface
Carbon dioxide rich blood is pumped from the rest of the body into the alveolar blood vessels where, through diffusion, it releases its carbon dioxide and absorbs oxygen
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Apical
The adjective for apex
- The tip of a pyramidal or rounded structure,
- such as the lung or the heart
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Abnormal sounds that are heard over a patient's lungs and airways
Adventitious Breath Sounds
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Stopping of external breathing
Apnea
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Atelectasis
Collapse or closure of the lung resulting in reduced orabsent gas exchange
May affect part or all of one lung
Alveoli are deflated
NOT the same as pulmonary consolidation
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Blood Pressure
- The pressure exerted by circulating blood upon the walls of
- blood vessels
One of the principal vital signs
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Resting heart rate less than 60 beats per minute (adult)
Bradycardia
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Abnormally slow breathing rate
Bradypnea
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Tubular, hollow sounds which are heard when auscultating over the large airways
They will be louder and higher-pitched in expiration
Heard best over the trachea
Also heard on the back between the scapulae and at the lung apices
Bronchial Breath Sounds
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Breath sounds are heard across the lung surface
Lower-pitched, rustling sounds with higher intensity during inspiration
During expiration, sound intensity can quickly fade
Normally 2-3 times the length of expiration
Vesicular Breath Sounds
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Bronchovesicular Breath Sounds
Sounds intermediate between bronchial and vesicular breath sounds
- Normal when heard between the 1st and 2nd intercostals spaces anteriorly and posteriorly
- between scapulae
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Cyanosis
Appearance of a blue or purple coloration of the skin or mucous membranes
Due to the tissues near the skin surface having low oxygen saturation
Develops when arterial oxygen saturation drops to 75-85%
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The first (top) number in a blood pressure reading
Amount of pressure heart generates when pumping blood
through your arteries to the rest of your body
Systolic Pressure
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Diastolic Pressure
The second (bottom) number in a blood pressure reading
Amount of pressure in your arteries when your heart is at rest between beats
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Medical term for shortness of breath
Dyspnea
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Ecchymosis
Subcutaneous purpura
Escape of blood into the tissues from ruptured blood vessels
Looks like a bruise (not the same,bruises are considered hand in hand with trauma)
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Eupnea
Normal, good, unlabored ventilation
AKA quiet breathing or resting heart rate
Expiration employs only the elastic recoil of the lungs
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Movement of air out of the bronchial tubes, through the airways, to the external environment during breathing
Exhalation / Expiration
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Medical term for having a fever
Febrile
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Flushing
A redness of the skin, typically over the cheeks or neck
Usually temporary
Brought on by excitement, exercise, fever, or embarrassment
Involuntary response of the nervous system leading to widening of the capillaries of the involved skin
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Extremely high fever (106°F +)
Hyperpyrexia
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Hypertension
High blood pressure (hypertension) of 140/90 mmHg or above most of the time
Considered a chronic condition
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Hypotension
Definition & Causes
Low blood pressure (below 90/60)
- Can be caused by
- Reduced blood volume (hypovolemia)
- Hormonal changes or endocrine problems
- Widening of blood vessels
- Medicine side effects
- Anemia
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Hypothermia
Definition & Causes
- Dangerously low body temperature
- Below 95 °F (35 °C)
- Can be Caused By
- Cold exposure for a prolonged period (Mountain Climbing)
Elderly, infants, babies in 60 degree house after power outage
Diabetes,thyroid conditions, medications, severe trauma
Severe use of alcohol
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Hypoxia
- Reduction of oxygen supply to a tissue below physiological
- levels
- May be classified as generalized
- (affecting the whole body) or local
- (region of the body)
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Movement of air from the external environment, through the airways, and into the alveoli
Inhalation / Inspiration
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Jaundice
Jaundice is a yellow color of the skin, mucus membranes, or eyes
Yellow coloring comes from bilirubin, a byproduct of old red blood cells
Often seen in liver disease (hepatitis, liver cancer)
- Seen in infants
- Common condition, usually no treatment needed
- Because liver not mature yet to get rid of bilirubin in the bloodstream
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Korotkoff Sounds
Blood flow sounds that healthcare providers observe while taking blood pressure with a sphygmomanometer over the brachial artery
Sounds appear and disappear as the blood pressure cuff is inflated and deflated
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Orthopnea
Shortness of breath (dyspnea) which occurs when lying flat
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Orthostatic Pressure
A form of hypotension in which a person's blood pressure suddenly falls when standing up or stretching
Caused by blood pooling in the lower extremities upon a change in body position
Common and can occur briefly in anyone
Prevalent in elderly & those with low blood pressure
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Pale / Pallor
Abnormal loss of color from normal skin
- May be the result of
- Decreased blood supply to the skin
Decreased number of red blood cells (anemia)
Can be general (whole body) or affect only a region (limb)
Most easily seen on the face, lining of the eyes, inner mouth, and nails
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Using hands to examine the body
Palpation
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Tapping body parts with fingers, hands, or small instruments
as part of a physical examination
Used in clinical examinations to assess the condition of the
thorax or abdomen
Percussion
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Petchiae (Petechia)
(pronounced puh-TEE-kee-ee)
Pinpoint, round spots that appear on the skin as a result of bleeding under the skin
Red, brown or purple
Commonly appear in clusters and may look like a rash
Usually flat to the touch
Don't lose color when you press on them
- Can be caused by prolonged straining during activities such as
- Crying
- Coughing
- Vomiting
- Childbirth
- Weightlifting
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Pulse
The rhythmic dilation of an artery that results from beating of the heart
Often measured by feeling the arteries of the wrist or neck
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Pulse Deficit
Difference between heart beats and pulsations at the periphery
Determined by simultaneous palpation at radial artery & auscultation of heart apex
Subtract radial pulse from apical pulse
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Pulse Oximetry
Non-invasive method for monitoring a patient's O2 saturation
Placements of a clip on a thin part of the patient's body, usually
Fingertip, earlobe, across a foot (infant)
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Pulse Pressure
The difference between the systolic and diastolic pressure readings
Represents the force that the heart generates each time it contracts
If BP is 120/80 then pulse pressure is 40
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Medical term for fever
Pyrexia
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The transport of oxygen from the outside air to the cells
within tissues
Transport of carbon dioxide in the opposite direction
Respiration
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Spirometer
Apparatus for measuring the volume of air inspired and expired by the lungs
Identifies two different types of abnormal ventilation patterns (obstructive & restrictive)
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Stertorous
Noisy & lazy breathing characterized by heavy snoring or gasping
Caused by partial obstruction of airway above the level of the larynx
Verses stridor which is caused by turbulent air flow below or in the larynx
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Stridor
A high-pitched breath sound resulting from turbulent air flow in the larynx or lower in the bronchial tree
Caused by a narrowed or obstructed airway
Can be inspiratory, expiratory or biphasic
Usually heard during inspiration
Inspiratory stridor often occurs in children with "croup."
- Possible Causes
- Epiglottitis
- Foreign body lodged in the airway
- Laryngeal tumor
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Tachycardia
Heart rate that exceeds the normal range
More than 100 bpm in adults
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Tachypnea
Rapid breathing
More than 20 breaths per minute in adults (12-20 is normal)
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Thoracentesis
What is it?
When is it done?
Common Causes for its need?
Invasive procedure to remove fluid or air from the pleural space
A cannula (hollow needle) is introduced into the thorax after administer of local
Fluid can yield clinically useful info
- Indicated When
- Unexplained fluid accumulates in the chest cavity outside the lung
Therapeutically to improve patient comfort and lung function
- Common Causes for Need
- Cancer, CHF, pneumonia, recent surgery
- TB (in some countries)
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(Skin) Turgor
How to test for it?
Skin’s ability to change shape and return to normal (elasticity)
Sign used by health care workers to assess fluid loss or dehydration
Grasp skin on the back of the hand, lower arm, or abdomen between two fingers
Skin should tented up & is held for a few seconds then released
Normal turgor snaps rapidly back to its normal position
Decreased turgor remains elevated and returns slowly to its normal position
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Crackles (Rales)
Caused by the "popping open" of small airways and alveoli collapsed by fluid, exudate, or lack of aeration during expiration
- Found in patients with
- Pulmonary
- Edema due to Left sided CHF
- Pneumonia
- Asthma
- COPD
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Wheezes
Continuous, coarse, whistling sound
Most commonly wheezing occurs during expiration
- Narrowing of the airways can be caused by
- Inflammation from asthma
- Infection
- Allergic reaction
- Physical obstruction (tumor, inhaled foreign object)
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Gurgles (Rhonchi)
Rattling respiratory sound somewhat like snoring
Usually caused blockages to bronchial airways by mucous, lesions, or foreign bodies
Pneumonia, chronic bronchitis, cystic fibrosis
Coughing can sometimes clear this breath sound and make it change to a different sound
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Cheyne–Stokes Respiration
Abnormal pattern of breathing
Progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary apnea
Pattern repeats every few minutes
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Normal Labs for the following
RBC
WBC
Hematocrit
Hemoglobin
RBC 4.2 - 5.1 million (cells/mcL)
WBC 5000-10,000 mcL
- Hematocrit
- 42-50% (male)
- 40-48% (female)
- Hemoglobin
- 13-18 gm/dL (male)
- 12-16 gm/dL (female)
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Most accurate measure of respiratory function
Arterial Blood Gas
Uses radial artery
Needs 3 minutes of pressure once needle comes out
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Best time of the day to collect sputum?
- First thing in the morning
- First cough up is best
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The fetal circulation contains how many umbilical veins & arteries?
- 1 umbilical vein
- 2 umbilical arteries
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Foramen Ovale
An opening between the right & left atria
Allows oxygenated blood to enter the left atrium bypassing the pulmonary circulation
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The umbilical vein bifurcates at the base of the ______ with the branches going to...
Liver
First branch unites with portal vein supplying the liver
Second branch forms the ductus venosus
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Ductus Venosus
One of the two branches from the umbilical vein
Shunts oxygenated blood into the inferior vena cava
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In fetal circulation, the _________ receives both oxygenated & deoxygenated blood.
Oxygenated blood enters the heart thru the ________
Deoxygenated blood enters the heart thru the _________
Right Atrium
Inferior Vena Cava
Superior Vena Cava
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Ductus Arteriosus
Shunts blood from the pulmonary arteries to the descending aorta
Allowing blood to bypass the lung
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Core Foods
- Provide significant source calories
- Regularly included in diet on daily basis
- Typically complex carbs '
- (rice, wheat, millet, corn, potatoes, plantains)
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Secondary Foods
- Foods that are wide spread in diet but not eaten consistently
- Typically a veggie, legume, nuts, fish, eggs, or meat
Chinese consume mung beans & soybeans
Latin America consume black & pinto beans
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Peripheral / Occasional Foods
Foods eaten sporadically based on individual preferences not cultural norms
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acronym DETERMINE
What does the acronym stand for?
What is it used for?
Used to identify risk factors for warning signs of poor nutritional health
D – Disease (any illness chronic or acute)
E – Eating (poorly, too little or too much)
T – Teeth & Mouth (missing teeth, sores in mouth, dentures not fitting)
E – Economics (Hardships)
R – Reduced social contacts
- M – Medications (Multiple medications can interfere with taste, appetite. Many cause constipation, diarrhea, nausea)
I – Involuntary weight loss or gain
N – Needs (Patient needs assistance in self-care, ADLs, transportation to get food)
E – Elderly (80+ years of age)
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What groups that are at high risk for malnutrition?
Severely over or under weight
Loss of 15% of body weight
Anyone NPO longer than 5 days
Severe diarrhea, vomiting, burns
- Increased metabolic needs (trauma,
- burns, fever)
Chemotherapy
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Hematocrit definition
If a patient has an elevated hematocrit it could mean ___________
decreased hematocrit could mean ___________
What are the normal lab values?
Proportion of total blood volume that is composed of red blood cells
- 36-54% generally
- Males are higher (40-54%)
- Females are lower (36-46%)
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What is a serum albumin test?
What are the normal ranges?
What does it mean if a patient has a decreased value of serum albumin?
Albumin is a protein made by the liver. A serum albumin test measures the amount of this protein in the clear liquid portion of the blood
Normal Level is 3.5 - 5.5 g/dL
Prolonged protein depletion
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What does BUN stand for?
What does it mean?
What are the normal ranges?
If an increase or decrease is seen in patient, what does it mean in terms of nutrition?
Blood Urea Nitrogen
Liver produces ammonia — which contains nitrogen — after it breaks down proteins
Nitrogen combines carbon, hydrogen and oxygen, to form urea
Urea travels from liver to kidneys
kidneys filter urea and remove other waste products from your blood.
Filtered waste products leave body through urine
Higher than normal may mean kidneys or liver not functioning properly
Nutrition Terms
- Increased
- Starvation, high protein intake, severe dehydration
- DecreaseOver hydration, malnutrition
- Normal Ranges
- Adults: 8 - 21 mg/dL
- Children: 15-18 mg/dL
Patients on dialysis: 40-60 mg/dL
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What is Creatinine test?
What are the normal ranges?
What does it mean if a patient has an increase / decreased value of Creatinine in terms of nutrition?
- A chemical waste product produced due to muscle metabolism
- kidneys filter creatinine blood & the waste products leave body in urine
- Normal Level
- 0.4-1.5 mg/dL
- Decrease
- Reduction in total muscle mass, could be severe malnutrition
- Creatinine Test - Urine
- Serum Creatinine Test - Blood
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What is a Hemoglobin Test?
What does it mean if a patient has higher or lower levels of it?
What is the normal lab range?
Hemoglobin is a protein in RBCs that carry oxygen to organs and tissues and transports carbon dioxide back to lungs.
- Low Hemoglobin
- Patient has anemia related to vitamin deficiencies, bleeding or chronic disease(s)
- High Hemoglobin
- Polycythemia
- Live in a high altitude
- Smoking
- Dehydration
- Burns
- Excessive vomiting
- Normal Lab Range
- Adults: 12-18 mg/dL
- Females: 12-15 mg/dL (11 is not worrisome)
- Males: 13-17 mg/dL
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What are indicators of malnourishment that can be observed from just looking at a patient?
Hair & its condition
Tongue is red, purple, & smooth
Fat deposits around joints
Nails are pale, spoon shaped, brittle
- Swollen abdomen (Think: Children
- in commercials with thin limbs & swollen torso)
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Normal average house diet is ______ calories
1400-2500
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Liquid diets are ________________
What are the various forms & its purposes
Transitional diet when eating resumes after acute illness, surgery
- Each of the following diets are a progression from the previous
- (i.e. patient advances from clear to full liquid diet)
- Clear Liquid Diet
- Foods that are clear at room temperature
Gelatin, fat free broth, ice pops, clear juice, soda, tea, coffee (with no creamer)
- Inadequate in calories and most nutrients
- Progression to more nutritious alternative is needed
- Full Liquid Diet
- Anything that can be poured at room temperature
- Milk, pudding, custards, plain frozen dessert
- Pasteurized eggs, cereal gruels, veggie juices
High calorie & protein supplements are recommended if on this diet 3+ days
- Soft DietCanned fruit, avocado, potatoes (no skin)
- No raw fruits or vegetables
- White rice (not brown)
- No whole grains
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NPO means
Nothing by Mouth
Implemented before surgery to prevent aspiration due to anesthesia
After surgery until bowel sounds return
2+ days will require either nutritional support enteral or parenteral
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Enteral vs Parenteral Nutrition
- Enteral Nutrition
- Administering directly into stomach
- Parenteral Nutrition
- Administering via IV
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Vitamins are...
- Organic compounds needed by the body in small amounts
- Active in form of coenzymes (with enzymes to facilitate chemical reactions in body)
- Do not provide energy like calories Needed for metabolism of carbs, protein, & fats
- Not synthesized or insufficient amounts in body
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Water Soluble Vitamin
- Absorbed thru intestinal wall directly into bloodstream
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- Not stored in body
- Excess of need excreted in urine
- Megadoses can occur causing toxicity
Daily intake recommended as deficiency symptoms develop quickly
Niacin,Folic Acid, Vitamin C, & B complex vitamins
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Vitamin C
Water Soluble Vitamin
- Production of collagen
- Improves iron absorption
- Helps bone marrow form red blood cells
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- Broccoli, Brussel sprouts, citrus, strawberries
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Vitamin B1
Water Soluble Vitamin
- Metabolize energy from proteins
- Maintain normal nervous system
- functioning
Organ meat, green leafy veggies, whole enriched grains
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Vitamin B2
Water Soluble Vitamin
Metabolize carbs, proteins, fats (especially dairy products)
Organ meats, eggs, enriched grains
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Vitamin B6
Water Soluble Vitamin
Blood formation, maintenance of nervous tissues
Yeast, whole wheat, whole grains, pork
Amino Acid
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Vitamin B12
Water Soluble Vitamin
Synthesis of RNA & DNA
Blood formation
Meat, fish, seafood, milk, eggs
Vegans need B12 injections
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Vitamin B3 (Niacin)
- Water Soluble Vitamin
- Promote nervous system
- Supplements are popular but cause flushing
- Enriched whole grains, yeast, poultry, liver, kidney
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Vitamin B9 (Folic Acid)
Water Soluble Vitamin
DNA & RNA synthesis
Formation of mature RBCs
Very important for child bearing women
Organ meats, OJ, green leafy veggies, dried beans
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Fat Soluble Vitamins
Absorbed with fat into lymphatic circulation
Must attach to a protein to be transported thru blood
Excess stored in liver & adipose tissue
Daily intake not imperative
Excessive intake of Vitamin A & D can be toxic
Vitamins A, D, E, & K
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Vitamin A
Fat Soluble Vitamin
Vision, bone health, teeth development, skin & hair
- 2 Types of Vitamin A
- Retinol
- Milk, liver, fish
- Beta Carotene
- Green leafy veggies, deep yellow veggies
- Toxic in excess
- Slow growth, dry skin, & decreased appetite in newborns
- Enlarged spleens, livers
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Form of Vitamin A found in
Milk, liver, fish
Retinol
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Type of Vitamin A found in
Green leafy veggies, pumpkin, carrots, sweet potatoes
Beta Carotene
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Vitamin D
Fat Soluble Vitamin
- Skin & skeletal development
- Calcium & phosphorous metabolism
- Fortified milk
- 15 minute sunlight (no sunscreen)
- Deficiencies
- Rickets, knocked knees
- Toxic in Excess
- Weightless, calcification in soft tissue
- Excessive urination
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Vitamin E
Fat Soluble Vitamins
- Maintain membranes
- Calcium reabsorption from kidney
- Anti-oxidant
Veggie oil, whole wheat products
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Vitamin K
Fat Soluble Vitamins
- Blood clotting
- Regulate blood calcium
- Production prothrombin
- Production coagulation
- Eggs, liver, dark green leafy veggies
- Anything from cabbage family
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Macrominerals
Minerals needed by the body in amounts greater than 100 mg/day
Aka Bulk Minerals
- Examples
- Calcium, phosphorus, sulfur, sodium, chloride, potassium, & magnesium
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Calcium
A Macromineral
Healthy bone, teeth, blood clotting, normal heart beat, muscle contraction
Absorption of B12
Dairy products, canned fish with bones, green leafy veggies
Normal serum value in body is 8.4-10.2 mg/dL
Recommended Daily Amount 1,000 mg / day
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Phosphorus
A Macromineral
- Bone & teeth formation
- Energy metabolism
- Acid base balance
Eggs, poultry, dairy, fish
- Normal serum value in body is 2.5-4.5 mg/dL
- Recommended Daily Amount 700 mg /day
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Magnesium
A Macromineral
Bone & teeth formation
Smooth muscle relaxation
Normal serum value in body is 1.8-2.4 mg/dL
Recommended Daily Amount 310-420 mg /day
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Sodium
A Macromineral
- Has + charge
- Majorly comprised in extra cellar fluid
- Water, Acid / Base Balance
Normal serum value in body is 135-145 mEq/L
Recommended Daily Amount 1,500 mg/day
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Potassium
A Macromineral
- Major intracellular fluid
- Has + charge
- Normal serum value in body is 3.5-5 mEq/L
- Cardiac function, acid base balance
Whole grains, leafy green veggies, potatoes, fruits (bananas)
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Chlorine
A Macromineral
- Gastric acidity
- Needed for stomach to produce acid to digest food
Has negative (-) charge
Recommended Daily Amount 2,300 mg / day
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Microminerals
Needed by body in amounts lesser than 100 mg/day
Aka Trace Minerals
- Examples
- Iron, zinc, manganese, chromium, copper, selenium, fluoride, iodine
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Iron
A Micromineral
Hemoglobin formation
Liver, lean meats, enriched cereals
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Iodine
A Micromineral
Thyroid hormone (to function correctly)
- Seafood, iodized salt (not always available in other
- countries)
Deficiency causes goiters
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Zinc
A Micromineral
Tissue healing, growth, development
Beats, liver, oysters, dried peas, beans, liver, some meats
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Minerals
- Elements found in all body fluids & tissues
- in the form of salts
Can be combined with organic compounds
Provide structure within body or regulate body processes
Minerals = elements
Not broken down or rearranged in body
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Hypovolemia
Fluid volume deficit caused by loss of water & solutes in the same proportion from the ECF space
aka Isotonic Fluid Loss
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Anorexia
Medical term for "loss of appetite"
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Hypervolemia
Excessive retention of water & sodium in ECF in near equal proportions
- Caused by
- Malfunction of kidneys (inability to excrete)
Failure of heart to function as a pump (fluid accumulates in lungs)
aka Excess of Isotonic Fl
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Anthropometric
The science dealing with measurement of the size, weight, and proportion of the human body
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Basal Metabolic Rate (BMR)
- Rate of energy expenditure at rest
- Measured in kJ per hour per kg body mass
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Dysphagia vs. Dysphasia
- DysphagiaDifficulty in swallowing
- Dysphasia
- Partial or complete impairment of the ability
- to communicate
- Resulting from brain injury
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Edema
Swelling is the enlargement of organs, skin, or other body parts.
Caused by a buildup of fluid in the tissues.
The extra fluid can lead to a rapid increase in weight over a short period of time (days to weeks).
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Enternal Nutrition
Feeding into the GI tract
Peg Tube
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Prolactin
Protein best known for its role in enabling female mammals to produce milk
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Vegetarian Food Guide Pyramid
Nutrition guide that represents a traditional healthy vegetarian diet
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What is MyPlate?
The current nutrition guide published by the United States Department of Agriculture
It replaced the USDA's MyPyramid guide on June 2, 2011, ending 19 years of USDA food pyramid diagrams
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Nutrient
A substance that provides nourishment essential for growth and the maintenance of life
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Malnutrition is...
Condition that occurs when body does not get enough nutrients
- Eyes
- Dry eyes, pale conjunctiva
- Mouth
- spongy bleeding gums (vitamin C)
- Hair
- Dull, sparse, brittle hair, alopecia
- Skin
- Loose and wrinkled
- shiny and edematous
- dry, poor wound healing
- Nail
- Thin and soft nail plates, fissures or ridges
- Musculature
- Muscles wasting, particularly in the buttocks and thighs
- Skeletal
- Deformities usually a result of calcium, vitamin D, or vitamin C deficiencies
- Abdomen
- Distended - hepatomegaly with fatty liver, ascites may be present
- Neurologic
- Global development delay, loss of knee and ankle reflexes, poor memory
- Behavior
- Lethargic, apathetic
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