N202 Exam #2

Nerves, sensory receptors, blood vessels, lymphatics

• - It secretes sweat (saline)
• - Matures at 2 months of age

• - Secrete fluid in response to heat and emotional stimuli
• - Open in hair follicles
• - axilla, nipples, areolae, anogenital area, eyelids, and external ears
• - They activate during puberty
• - They decrease with aging, so the elderly are prone to over heating

• Skin and nails- which leads to soft and supple skin
• w/o have dry and wrinkling skin

• 1. Cradle cap
• 2. Seborrheic dermatitis
• 3. Acne

• 1) Soft
• 2) Non pigmented
• 3) Fine
• 4) Covers most of the body

• 1) Coarse
• 2) Pigmented
• 4) Thick
• Eye brows, scalp, axilla

No

• It is made up of adipose tissue.
• 1) Temperature regulation
• 2) Insulation

• 1) Thermoregulation (sweat and fat insulation)
• 2) Protection
• 3) Vitamin D production
• 4) Absorption and secretion (metabolic waste)
• 5) Replace cells in surface wounds (from bottom to top)
• 6) Sensory perception (pain, touch, temperature, and pressure)

Uremic frost occurs when a patient has renal failure and is not on dialysis. Then the metabolic waste seeps through the skin making a white powder.

Excessive dryness that is commonly seen in the elderly

• - It is itching
• Commonly seen in the elderly due to xerosis
• Also commonly seen in patients with liver or kidney disease because of inability to metabolize and remove waste from their system.

• 1) Rash
• 2) Pruritis
• 3) Photosensitivity
• 4) Skin eruptions

It is pulling out of one's hair due to stress/anxiety.

It is excessive terminal hair growth that is caused by androgen productions by the adrenal glands.

• Fungal infections and lesions
• groin, under the breast, and between the toes

• 1) Previous history of skin disease
• 2) Changes in pigmentation
• 3) Changes in mole size, shape, and color
• 4) Xerosis
• 6) Seborrhea
• 7) Pruritis
• 8) Excessive bruising
• 9) Rash or lesions
• 10) Medication effects
• 11) Alopecia
• 12) Hirsutism
• 13) Nail change
• 14) Skin fold assessment
• 15) Self-care/ sun exposure

It is an absence of melanin pigment in patchy areas that is progressive and commonly seen in people with darker skin.

It is another word for freckles and they are not documented because they are so common.

They are moles. Changes could be an indication of malignant melanoma.

• Pallor is a white coloring to the skin that indication blood profusion problems.
• 1) Anxiety/ fear- activation of SNS causes vasoconstriction
• 2) Shock (shunting blood from periphery to major organs)
• 3) Anemia/ arterial insufficiency (decreased blood supply to PVS)
• 4) Cold/cigarrete smoking (decreased blood supply to PVS)

• Pallor
• Smoking causes vasoconstriction

Because all of the blood is going to major organs instead of the PVS and it is called pallor

Becaue during fear or anxiety the vessels vasoconstrict, so less blood goes to the PVS. It is called pallor.

The patient would appear red and flushed because of the collection of blood in one area.

Hyperemia is excessive blood that causes erythema. It is caused by infection (cellulitis), fever, and increased emotion.

• 1) Hyperemia
• 2) Carbon monoxide poisoning
• 3) Venous stasis
• 4) Polycythemia

Increased RBC

Cyanosis is a bluish coloring of the skin due to hypoxia

• Central cyanosis is when parts of the trunk are blue (i.e. tongue, lips, oral mucosa)
• The cause is less than 5 gm of unoxygenated hemoglobin secondary to pulmonary problems.

• Peripheral cyanosis is when the extremities are blue (i.e. fingers)
• It is caused by vasoconstriction.

• Jaundice is a yellow coloring to the skin.
• It is caused by rising levels of bilirubin in the blood with reabsorption into the skin. Bilirubin is a byproduct of RBC break down due to Biliary obstruction or ineffective bilirubin breakdown due to liver disease or immature livers (infants)

• Clay colored feces
• Dark yellow urine

The intake, use, and storage of nutrients. This includes the macronutrients and micronutrients

• 1) Carbohydrates
• 2) Proteins
• 3) Fats

• Energy and the unused ones are stored as fat
• - Growth
• - Normal body system function
• - Resistance to infection
• - Growth and repair

Nosocomial infections

• -Vitamins
• - Minerals
• - Electrolytes

• - Require for use of major nutrients
• - Provide structure for bones, teeth, cells membranes and connective tissue
• - Regulate cellular metabolism, maintain acid-base balance, and maintain oncotic pressure
• - maintain nerve & muscle irritability for transmission of impulses & contraction of muscles

1 lb

3,500 calories

4 cal/gm

9 cal/gm

4 cal/gm

carbohydrates

protein

Malnurished

Mortality and morbidity

Stored in the liver and muscle as glycogen

250 grams or 1,000 calories. This storage is depleted after 15-20 hours of not eating.

• Proteins are stored as plasma proteins, hemoglobin, hormones, antibodies, clotting factors, and skeletal and smooth muscle
• approximately 6,000 gm/ 2,400 cal of protein are stored in the body

They play a major role in proper functioning of the body, and so there can be big problems if they are depleted/ broken down, such as hemorrhaging from depletion of clotting factors.

• 1500 gm/ 135,000 cal are stored in the body depending on the person's intake
• They provide energy
• No major malfunction occurs with breakdown

Triglycerides

• First the the glycogen (carbohydrates) are broken down from the muscle and liver in the 1st 15-20 hours
• Second the fat storage is depleted
• Then the body metabolism decreases to try to conserve the body's proteins
• Last of all the proteins are broken down

In patients with chronic illness, such as cancer patients

the starvation process

• 1) impaired wound repair
• 2) decreased resistance to infection
• 3) impaired work of breathing
• 4) multi-system organ failure and death

• Similar to the starvation process the carbohydrate stores (glycogen) is depleted in the first 15-20 hours.
• Next is protein loss
• Contrary to the stravation process: The metabolisms increases because of the release of stress hormones
• this causes increased metabolism of proteins and fat.

• Decrease in insulin release
• Hyperglycemia
• This is why stressed patient have high BG

• - catecholamines [adrenal medulla]
• - growth hormones [anterior pituitary]
• - glucocorticoids [adrenal cortex]
• - glucagon [alpha cells of pancreas]

They are in a highly catabolic state. This leads to an increased break down of proteins and fat. Some patient can lose 20 lbs a week in this state

It means breakdown and it is the opposite of anabolic state, which is a building process

8 years old

2 years old

CNS development

More (common sense)

200-300 calories

1 lb a year

• 1) Loss of teeth
• 2) Decreased income
• 3) Decreased senses
• 4) Decreased GI motility
• 5) Loss of spouse
• 6) Social isolation
• 7) Medications side effect that affect GI function
• 8) Chronic disease

• Nausea decreased amount of food taken in
• Diarrhea affects the amount of food absorbed.

Less activity and slower metabolism

• Those who have lost 10 or more lbs unintentionally
• The overweight (IBW of greater than 120%)
• The underweight (IBW of less than 80%)
• and those who have a history of illness that causes malabsorption and impaired nutrient intake

• It is collected by direct observation.
• This can be difficult because visitors may eat some food and patients may save food for later

A person's height is not accounted for

The report is ATP (adult treatment panel) give recommendations on fat intake

• Total fat: 25-35% of total calories- same for children and adults
• Saturated fat: < 7% of total calories-Solid at room temperature (e.g., meat fat, palm oil, coconut oil)
• Polyunsaturated fat: < 10% of total calories- e.g., corn oil, safflower oil
• Monounsaturated fat: < 20% of total calories- e.g. olive oil, avocado
• Cholesterol: <200 mg/day- a type of saturated fat that comes from an animal source.

Sometimes but not always

No

because they are highly athrogenic

40-45%

50-60%

14-20%

25-30 gm/ day

• 1- 5 oz glass of wine
• 1- 12 oz bottle/ can of beer
• 1 oz hard liquor

greater than or equal to 5 drinks on one occasion

• 1) Take 2,000 multiply by 0.35 for (35%) = 700
• 2) Take 700 and divide by 9 (calories per gram in fat) = 77
• 3) patient can consume 77 grams of fat a day

1% or Skin, no less calcium in skim

Adults that had traumatic events in childhood are at a greater risk of addictive behavior that can cause health problems, such as smoking and over eating

It could effect the absorption and metabolism of nutrients

Healthier food costs more, so this causes people with less money to eat foods that are higher in fat.

Well Developed, Well Nourished

A patient with decreased intravascular protein, fluid moves out of blood vessels into interstitial spaces (d/t decreased oncotic pressure)

• In women: 100 lbs for 5 ft plus an extra 5 lbs for each inch more
• In men: 106 lbs for 5ft plus an extra 6 lbs for each inch more

10%

• < 18.5% Underweight
• 18.6-24.9% Normal
• 25-29.9% Overweight
• > 29.9 Obese

• 1) HTN
• 2) DM
• 3) Cardiovascular diseas
• 4) Osteoarthritis

• 1) Take the patients body weight divided by IBW: Mild malnutrition 80-90% of IBW
• Moderate malnutrition 70-79% of IBW
• Severe malnutrition < 70% of IBW
• 2) ((Usual weight- current weight) / usual weight) * 100
• > 5% in 1 month
• >7.5% in 3 month
• >10% in 6 month

• Apple
• Women: greater than 35 inches
• Men: greater than 40 inches

• 1) DM
• 2) Cardiovascular disease
• 3) HTN
• 4) Metabolic syndrome

• It is an anthropometric measurement. <10% fat= undernutrition
• >10% = over nutrition

• the minimal rate of energy expenditure needed to sustain life at rest
• expressed as calories
• regulated by thyroxin (thyroid hormone)

• Children and pregnant women
• Lean body
• Fever
• Stress
• Hot or cold environmental temps
• Increased thyroxin

• Fasting or starvation (hormone effects)
• Obesity
• Malnutrition
• Decreased thyroxin levels

1,000 calories for the first year plus another 100 calories per a year.

• Kyphosis
• Vertebral space
• Bent knees

• Women: 2 inches
• Men: 1.25 inches

• Dyslipidemia
• Hyperlipidemia

Muscle breakdown

• Protein catabolism
• Malnutrition

• Women: 12-16 g/dL
• Men: 14-18 g/dL

It is three times the hemoglobin

• 1) Polycythemia
• 2) Dehydration

Chronic hypoxia causes increased erythropoietin from the kidneys which stimulates the bone marrow to produce more RBCs which causes polycythemia.

Results in hemoconcentration of blood.

• Females 36-46%
• Males 37-49%

• Cholesterol- < 200 mg/dL
• HDL- > 50 mg/dL
• LDL- < 160 mg/dl (0-1 CAD risk factors) *
• < 130 mg/dl (≥ 2 CAD risk factors)
• < 100 (CAD, DM)
• < 70 in some cases
• Triglycerides- <150 mg/dL (fast for 12 hours)

• - Gender
• - Female > 45
• - Male > 55
• - Smoker
• - HTN or HTN treatment
• - HDL < 40
• - FHX of premature CAD
• - father/brother <55
• - mother/sister < 65

• - Hight saturated fat diet
• - Low saturated fat diet &/or malnutrition
• - Exercise
• - Genetics

• It measures the visceral protein stores.
• 17-20 days.
• Indicates thes state of nutrition from three weeks previous.
• 3.5 to 5.5 gm/dL

• It measures protein that carries iron.
• Half life is 8-10 days
• Earlier indicator of malnutrition

• Half life of 2-3 days
• More reflective on current nutrional state.

• Normal level: 8-25 mg/dL
• Muscle trauma/destruction, decreased excretion as seen in Renal failure, or high protein intake

• Primary (dietary deficit)
• Marasum- Protein and calorie malnutrition (cancer)
• Kwashiorkor- Protein deficit and high in carbohydrates

• Malabsorbtion
• Medication side effects