Nutrition & Elimination

• resting need for energy, just what it takes to keep body functioning
• Factors: age, gender, activity, infections, endocrine status

Body Mass: 18.5-24 is normal

• Fat: 9 kcal/g
• Protein: 4 kcal/g
• Carb: 4 kcal/g
• 1lb: 3500 kcal/g

• Carbs
• Lipids
• Proteins

• Vitamin
• Mineral
• Water

• ADEK
• absorbed into lymphatic
• not needed daily
• excessive A&D can be toxic

• (water-soluble)
• Vit C & B-complexes
• absorbed in intenstinal wall
• directly into bloodstream
• daily intake

• sugar, starch
• framework of plants
• animals-- lactose
• 90% is digested
• stored in liver as glucose
• oxidized into energy, CO2, water

• insoluble triglycerides
• bile digests it/emulsifies it
• pancreatics break down even further
• absorbed in lymphatic
• Saturated/Unsaturated/Transfats
• Cholesterol:LDL blocks arteries HDL clears arteries. Total <200 mg/dl

• pancreatic enzymes breakdown into amino acids
• absorbed into intestinal mucosa-->liver
• recombined to new
• released to bloodstream to tissues and cells

• Water Soluble: absorbed directly into bloodstream by intestinal wall, not stored
• Fat Soluble: must be attached to fat, absorbed into lymphatic, stored in livver and adipose

• Not broken down in body
• Remains in ash after digestion
• Calcium: 99 % bones and teeth
• Macrominerals
• Microminerals

• Not Stored
• Needed for everything
• 50-60% of total body weight
• Infants have more water
• 2/3 ICF, 1/3 ECF
• necessary for all chemical reactions, solvent to many solutes
• Intake 2000-3000mL/day, but 1500mL avg
• Input = Output

• mouth: enzymes begin breakdown
• stomach: acidic pH (HCl) to help food breakdown
• duodenum: sodium bicarbonate neutralizes acid from stomach [basic] gallbladder: release bile (emulsifies fats)
• pancreas: releasing enzymes (amylase) to break down proteins to amino acids
• carbohydrates broken down to glucose (enzyme sucrose)
• Small Intestine: absorption of nutrients
• Large intestine: reabsorbing water

making glycogen from glucose, then stored in liver until needed

glycogen is broken down and stored into glucose for energy

making glucose from some other form of nutrient (ex. amino acid) when glucose is not available

• breastfeed 6-12 mo
• solids at 4-6 mo (periods of 5-7 days to test allergies)
• 1 yr: table food and cows milk

• 3-5 yrs
• develops attitude toward food
• increased appetite and becomes eratic

• 6-12 yr
• body accumulates reserves
• Health Promo: intake balance w/requirements

• increased nutrient needs to support growth
• anorexia nervosa & bulimia
• eat rapidly--> overconsumption
• unhealthy meals aways from home

• Growth ceases
• BMR decreases
• If calorie change not met, weight gain occurs

• increase to support growth
• especially in 2-3 trimester
• extra 300 kcal/day
• *protein, cals, iron, folic acid, calicium, iodine

• decreased need for calories
• same need for nutrients
• BMR decrease
• Decreased peristalsis
• Decreased taste sensation
• prone to dehydration

• Animal (plus soy)
• sufficient amounts of all essential amin acids to support growth
• eggs, dairy, meat

• Plant (except soy)
• deficient in one or more essential amino acids
• grains, legumes, veggies

• combine to make up for where the other is deficient
• corn torilla + refried beans
• lentil + rice soup
• cereal + milk

they are not synthesized within the body and must be supplied through diet

• Increase vitamin, mineral, fiber
• Decrease sat fat, trans fat, cholesterol
• Increase fruit, veggie, whole grain
• *support calor intake based on energy needs to promote a healthy weight

• clear at room temp
• gelatin
• fat free broth
• bouillon
• ice pop
• clear juice
• carbonated beverage
• coffee
• tea

• Clear, Plus Others:
• milk/milk drinks
• plain frozen desserts
• pudding, custard
• eggs, cereal
• veggie juice
• milk & egg substitutes

• decreased fiber, unseasoned
• decrease GI distress
• soy, yogurt
• cooked fruit/veggies
• banana
• avacado
• melon
• lean, tender meat
• potatos, rice, pasta
• egg, cheese, peanut butter

• blenderized to liquid form
• all foods unless contraindicated

• modification for texture
• (difficulty chewing/swallowing)
• chopped, ground, mashed, pureed
• ripened fruits
• cooked veggies

• small, frequent meals
• solicit food preferences
• encouragement
• pleasant environemnt
• loos attractive
• procedured dont interfere
• control pain, nausea, depresson
• offer alternatives
• good oral hygiene
• free from odors
• easily reach food
• comfortable position
• any rituals during mealtime
• if patient is absent, order late food try
• dont interrupt meal time

• in NPO, next best method
• pass tube into GI tract to admin a formula of adequate nutrients
• stomach acts as reservoir
• regulates amt of food/liquid into small intestine

• Nasogastric: ensure tip of tube is in stomach or intestine
• Radiographic: verify initial placement
• pH of Aspirate: stomach (<5.5), intestine (7.0+), respiratory (6.0+)
• Color of Aspirate: Stomach (grass-green, tan, off-white, bloody, brown), Intestines (medium to deep golden yellow), Respiratory (off white, tinged with mucous)

• Aspiration
• Clogged Tube
• Nasal Erosion
• Diarrhea
• GI Distress
• Unplanned Extubation
• Stoma Infection

(statins) used in synthesis of cholesterol

• voiding/urination
• brain + spinal cord
• largely involuntary
• 150-250mL/day

involuntary loss of urine

• not brain-controlled
• reflex only

urine produced normally but not excreted completely from bladder

involuntary/unintentional urinary into bed or clothes

• 24 hr rine output less than 50mL
• kidney shutdown/renal failure

painful or difficult urination

presence of sugar in urine

awakening at night to urinate

• scanty or greatly diminished amount of urine voided in a given time
• 24 hr urine output less than 400 mL
• less than 30mL/hr

• excessive output of urine
• diuresis

• protein in urine
• indicates kidney disease

• pus in urine
• urine appears cloudy

• stoppage of urine production
• normally produce 60-120 mL/h

strong desire to void

• blood in urine
• pink or red color

capable of causing kidney damage

transport urine fro kidney to bladder by rhythmic peristalsis

• smooth muscle
• temporary reservoir for urin
• 3 layers
• Detrusor: inner longitudinal layer, middle circular layer, outer longitudinal layer
• Internal/Involuntary Sphincter: guards opening between urinary bladder and urethra
• SNS: retains urine
• PNS: releases urine

• bladder to exterior
• Male: 5 1/2"-6 1/4"
• Female: 1 1/2"-2 1/2"

• remove end product of metabolism from blood plasma and form urine
• maintain and regulate fluid balance through selective reasborption and secreation of water, electrolytes, and others

• Infant: no voluntary control, 6-10 wet diapers/day
• 18-24 mo: voluntary control of urethral sphincters
• 2-5 yrs: develop urinary control
• Aging: decreased ability for kidney to concentrate urine, nocturia, decr. bladder muscle tone & contractility, incr. frequency, urine retention/stasis, incr. risk UTI

• Developmental
• Food/Fluid intake
• Psychological
• Activity/Muscle Tone
• Pathologic Conditions

surgical creation of alternative routh for excretion

density of urin compared w/density of water

• urine collected and measured
• avoid contaminated
• aseptic technique
• pt name/date/time to lab soon

• 1st flush
• Catch midstream
• Discard the rest

• with needle and syringe
• directly from specimen port

• initiate
• discard first void
• all other voids are save
• last 24 hr void added to previous
• entire specimen sent to lab

• traditional catherization or portable ultrasound device to scan bladder
• supine position
• <50mL is adequate
• >150mL recommend cath= risk for UTI

• appear suddenly
• lasts for 6mo/less

• altered environment, sensory, cognitive, mobility deficits
• used to be able to, but change occur

• neurologic
• cant sense filling
• no urge to void
• no feeling of bladder fullness

• overdistension
• weakened supportive muscles
• leakage w/cough, sneeze, laugh

• neurologic/trauma
• constant/unpredictable flow
• no distention
• nocturia
• unawareness of incontinence

urine loss w/features of 2+ types of incontinence

involuntary loss of urine soon after feeling urgent need to void

overdistention/overflow of bladder

• improve voluntary control of urination
• eliminate/reduce stress incontinence by increase muscle tone
• targets inner muscles that lie under and support bladder
• contract 10 sec, relax 10 sec, 30-80x/day for 6+ wks
• (don't use abs, inner thigh, buttocks)

• Small intestine
• Ileocecal valve
• Cecum (veriform process attached)
• Ascending colon
• Hepatic Flexure
• Transverse Colone
• Splenic Flexure
• Descending Colon
• Sigmoid Colon (contains feces)
• empties into rectum
• excreted through anal sphincter

• PNS: stims movement, craniosacral inhibitory impulses
• SNS: inhibits movement, thoracolumbar motor impulses
• Act of Defactation: medulla, spinal cord, PNS stims to relax sphincter

• bearing down
• cuts of vagus nerve=hypertension
• may be contraindicated in those w/cardiovascular problems

• Developmental
• Daily Patterns vary
• Food/Fluid intake
• Activity/Muscle Tone
• Lifestyle (acceptance, preoccupation, "dirty")
• Psychological (anxiety, worry)
• Pathologoical
• Medications
• Diagnostic Studies
• Surgery/Anesthesia

• Cathartics/Laxative: promotes peristalsis
• Antidiarrheal: inhibit peristalsis
• Inhaled General Anesthetic: block impulses
• Narcotics: paralytic ileus
• Constipation: opoid, antacid (aluminum), iron sulfate, anticholinergic drugs
• Diarrhea: amoxicillin, antibiotics

• Red-Black: anticoagulant, aspirin
• Black: iron oxidation/salts
• Speckled-White: antacids
• Green-Gray: antibiotics

• Constipation: dry, hard stool
• Diarrhea: excessively liquid stool
• Incontinence: inability of anal sphincter to control discharge of fecal & gaseous matter (usually organic disease)
• Flatulence: excessive formation of gases in stomach/int; can lead to distention if not expelled

• Abdomen: inspection, auscultation, percussion, palpation
• Anus/Rectum: inspection, palpation
• Stool Characteristics: color, form, etc.

• Hyperactive: incr. motility (diarrhea, gastroenteritis, early bowel obstr)
• Hypoactive: diminished motility (abd srgry, late bowel obstr)
• Decr/Absent: absence of motility (peritonitis/parlytic ileus)

• psyllium/grain/synthetic
• stool absorbs water, swells, stimulates peristalsis

agents w/detergent activity allow water and fat to penetrate and lubricate stool

irritating intestinal mucosa or stimulates nerve endings in intestinal wall

draws water into intestine to stimulate peristalsis

• (tap, normal saline, soap solution, hypertonic solution)
• relieve constipation/fecal impaction
• prevent involuntary escape during surgical procedures
• promote visualization of int tract by radiography/intrument
• help establish regular bowl fxn during bowel training program

• Oil: lubricates
• Carminative: helps expel flatus/relief from gaseous distention
• Nutritive: admin of fluid/nutrients
• Medicated: for parasites

• expel flatus
• alternate solution in and out
• promote peristalsis

manipulate factors within pt control (intake, exercise, time for defacation) to produce the elimination of a soft, formed stool at regular intervals w/out a laxative

delivery of cholesterol to nonhepatic tissue, greatest contribution to atherosclerosis

cholesterol from peripheral back to liver to be removed

• LCL into arterial subendothelial space and oxidizes
• Attracts monocytes/macrophages
• Inhibited mobility so macrophages accumulate and increase uptake, enlarge, and become foam cells
• Foam cells can rupture
• Platelets aggregate and collagen forms a fatty streak

• inhibition of HMG-CoA Reducatse inhibits cholesterol production
• this stimulates incr. LDL receptor formation
• this allows more LDL to be drawn from blood into liver
• (thus lowering LDL level)

Atherogenesis: when LDLs penetrate wall, they cause mild injury that trigguers the inflamm. response, which can cause plaque to rupture, leading to thrombosis

• CRP: C-Reactive Protein
• compount produced when inflammation occurs
• biomaker for ongoing inflammatory process
• elevated CRP is an independent risk factor of CV events

• Adult Treatment Panel
• Executive Summary of the 3rd Report of the Natn'l Cholesterol Educ. Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults

• LDL: <100 mg/dL
• HDL: <40 mg/dL
• Total: <200 mg/dL

• Age: men >45yr, women >55yr
• Family Hx or premature CHD
• Hypertension: >140/90 mmHG or taking antihypertensives
• Current cigarette smoking (at least 1 in last month)
• Low HDL: <40 mg/dL

• Diet: incr. soluble fiber, incr. plant stanols/sterols
• Weight Control: obesity is a major risk
• Exercise: sedentary incr. risk
• Smoking Cessation: incr. LDL, decr. HDL

• Major: (1) Myopathy/Rhabdomyolysis, (2) Hepatotoxicity
• Common: (side effects uncommon) mild/transient HA, rash, GI disturbance

• evening is best time of day
• endogensou cholesterol synthesis increases during the night