N105: Essentials of Nursing Care - Health Differences

Achieve WAY!

DOING IT THE

NURSING 105 Essentials of Nursing Care – Health Differences

www.AchieveTestPrep.com

ACHIEVE TEST PREP Essentials of Nursing Study Guide

1st Edition 9/12/2017

This study guide is subject to copyright.

Acknowledgements We would like to thank the authors for their patience, support, and expertise in contributing to this study guide; and Christina Wulff for her invaluable efforts in reading and editing the text. We would also like to thank those at Achieve Test Prep whose hard work and dedication to fulfilling this project did not go unnoticed. Lastly, we would like to thank the Achieve Test prep students who have contributed to the growth of these materials over the years. Copyright © 2017 by Achieve Test Prep All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the publisher except for the use of brief quotations in a book review. Printed in the United States of America First Printing, 2014 Achieve Test Prep PO Box 10188 #29831 Newark, NJ 07101-3188 Tel: 888.900.8380 Visit the Achieve Test Prep website at http://www.achievetestprep.com/student

Essentials of Nursing Study Guide

©2017 Achieve Test Prep Page 3 of 160 Table of Contents Chapter One: Nutrition ...................................................................................................................... 7 1.1 Physiology of Nutrition ......................................................................................................................... 7 Ingestion .............................................................................................................................................................. 7 Digestion .............................................................................................................................................................. 7 Absorption ........................................................................................................................................................... 8 Metabolism .......................................................................................................................................................... 8 Elimination .......................................................................................................................................................... 9 1.2 Nutrients ................................................................................................................................................ 9 Micronutrients ..................................................................................................................................................... 9 Macronutrients .................................................................................................................................................... 9 Deficiencies and Toxicity .................................................................................................................................. 10 Essential and Non-Essential Nutrients ............................................................................................................ 10 The Six Essential Nutrients ............................................................................................................................... 11 1.3 Nutritional Needs .................................................................................................................................17 Nutritional information throughout the life cycle .......................................................................................... 18 Nutritional diseases .......................................................................................................................................... 19 Feeding Difficulties in Children ........................................................................................................................ 21 Weight Management ......................................................................................................................................... 22 1.4 Medications ...........................................................................................................................................23 Food/Drug Interactions .................................................................................................................................... 23 Drug/nutrient interactions .............................................................................................................................. 23 Groups of medicines .......................................................................................................................................... 24 1.5 Nutritional Assessment .......................................................................................................................26 Patient History and Physical Examination ...................................................................................................... 26 1.6 Nutritional Support ..............................................................................................................................27 Nasogastric Tube Insertion .............................................................................................................................. 27 Nursing Interventions Prior to Tube Feeding ................................................................................................. 28 Principles for Administering a Tube Feeding ................................................................................................. 29 Principles for Administering a Gastrostomy or Jejunostomy Feeding: ........................................................29 Parenteral Nutrition (PN) ................................................................................................................................. 30 The mouth and pharynx ................................................................................................................................... 31 Chapter One Practice Questions ...............................................................................................................33 Chapter Two: Elimination ............................................................................................................... 37 2.1 The Large Intestine ..............................................................................................................................37 Functions of the Large Intestine ...................................................................................................................... 37 Types of Movement in the Large Intestine ...................................................................................................... 38 Nursing Procedures .......................................................................................................................................... 38 2.2 Fecal Elimination ..................................................................................................................................39

Essentials of Nursing Study Guide

©2017 Achieve Test Prep Page 4 of 160 Fecal Impaction ................................................................................................................................................. 41 Diarrhea ............................................................................................................................................................. 41 Flatulence ........................................................................................................................................................... 42 Bowel Incontinence ........................................................................................................................................... 42 Consequences of Fecal Incontinence ............................................................................................................... 43 2.4 Bowel Diversion Ostomies ..................................................................................................................43 Anatomic Location of the Ostomy .................................................................................................................... 43 Nursing Procedures .......................................................................................................................................... 45 2.5 Enemas ..................................................................................................................................................45 Types of Enemas ................................................................................................................................................ 45 Administering an Enema .................................................................................................................................. 46 2.6 Laxatives ...............................................................................................................................................46 Types of Laxatives ............................................................................................................................................. 46 Nursing Procedures .......................................................................................................................................... 47 2.7 Urinary Elimination .............................................................................................................................48 Factors Influencing Urinary Elimination ......................................................................................................... 49 Altered Urine Production ................................................................................................................................. 49 Nursing Procedures .......................................................................................................................................... 50 Urinary Incontinence Management ................................................................................................................. 51 Managing Urinary Retention ............................................................................................................................ 51 Principles of Urinary Catheters ........................................................................................................................ 52 Nursing Procedures .......................................................................................................................................... 54 Chapter Two Practice Questions ...............................................................................................................55 Chapter Three: Oxygenation ........................................................................................................... 65 3.1 Physiology of the Respiratory System ................................................................................................65 Respiratory regulation ...................................................................................................................................... 66 Landmarks ......................................................................................................................................................... 66 Lung Sounds ...................................................................................................................................................... 67 Nursing Procedures .......................................................................................................................................... 67 3.2 Oxygenation ..........................................................................................................................................67 Factors Influencing Patient’s Oxygenation ...................................................................................................... 67 Common Oxygen Disturbances ........................................................................................................................ 68 Interventions to Promote Oxygenation ........................................................................................................... 69 3.3 Pulmonary Physiology .........................................................................................................................70 Transport ........................................................................................................................................................... 71 3.4 Physiology of the Cardiovascular System ..........................................................................................72 Nursing Procedures .......................................................................................................................................... 72 Elimination throughout Life Stages ................................................................................................................. 39 Additional Factors that Affect Elimination ...................................................................................................... 39 2.3 Common Disturbances of the Intestines ............................................................................................40 Constipation ...................................................................................................................................................... 40

Essentials of Nursing Study Guide

©2017 Achieve Test Prep Page 5 of 160 3.5 Blood .....................................................................................................................................................73 Blood Products and Blood Groups ................................................................................................................... 73 Products for Transfusion .................................................................................................................................. 73 Transfusion Reactions ...................................................................................................................................... 74 3.6 Pediatric Variations .............................................................................................................................75 3.7 Complications of Oxygen Therapy ......................................................................................................75 3.8 Pulmonary Volumes and Capacities ...................................................................................................76 3.9 Arterial Blood Gases ............................................................................................................................76 Components of the Arterial Blood Gas ............................................................................................................ 77 Steps to an Arterial Blood Gas Interpretation ................................................................................................. 77 Buffer Responses ............................................................................................................................................... 78 Acid-Base Disorders .......................................................................................................................................... 79 Nursing Procedures .......................................................................................................................................... 80 Chapter Three Practice Questions ............................................................................................................82 Chapter Four: Fluid and Electrolyte Imbalance ............................................................................ 85 4.1 Principles Related to Normal Fluid and Electrolyte Balance ...........................................................85 4.2 Regulation of Body Fluid Compartments ...........................................................................................85 Fluid Output ....................................................................................................................................................... 86 Physiology .......................................................................................................................................................... 87 Osmolality .......................................................................................................................................................... 87 4.3 Common IV Fluids ................................................................................................................................88 4.4 Regulating Electrolytes ........................................................................................................................88 Factors Influencing the Patient’s Fluid and Electrolyte Balance ...................................................................90 Disturbances in Fluid Volume, Electrolyte, and Acid-Base Balances ............................................................91 4.5 Common Diseases ................................................................................................................................91 4.6 Common Risk Factors for Fluid, Electrolyte, and Acid–Base Disorders ..........................................96 4.7 Nursing Procedures .............................................................................................................................97 Diuretics ............................................................................................................................................................. 99 Anti-Diarrheals .................................................................................................................................................. 99 Anti-Emetics .................................................................................................................................................... 100 Chapter Four Practice Questions ............................................................................................................102 Chapter Five: Activity and Mobility .............................................................................................. 105 5.1 Normal Movement ..............................................................................................................................105 5.2 Exercise ...............................................................................................................................................105 Types of Exercise ............................................................................................................................................. 106 Benefits of Exercise ......................................................................................................................................... 106 5.3 Factors Influencing Activity and Mobility ........................................................................................107 5.4 Effects of Immobility ..........................................................................................................................108 5.5 Nursing Procedures ...........................................................................................................................110 5.6 Body Mechanics ..................................................................................................................................111

Essentials of Nursing Study Guide

5.7 Positioning Clients .............................................................................................................................111 Transfer Techniques ....................................................................................................................................... 113 Assistive Devices ............................................................................................................................................. 113 5.8 Interventions ......................................................................................................................................114 5.9 Joints ....................................................................................................................................................114 Range of Motions (ROM) ................................................................................................................................. 114 Types of Joints ................................................................................................................................................. 115 Types of Joint Movements .............................................................................................................................. 115 5.10 Nursing Procedures .........................................................................................................................117 Chapter Five Practice Questions .............................................................................................................118 Chapter Six: Rest and Sleep ........................................................................................................... 121 6.1 Stages of Sleep ....................................................................................................................................121 6.2 Circadian Rhythm ...............................................................................................................................123 Common Circadian Rhythm Disorders .......................................................................................................... 123 6.3 Factors Influencing the Patient’s Rest and Sleep ............................................................................124 Age and Developmental Level ........................................................................................................................ 124 Individual Preferences and Patterns ............................................................................................................. 124 Physical Condition ........................................................................................................................................... 125 Environmental Factors ................................................................................................................................... 125 Medications ...................................................................................................................................................... 125 6.4 Common Disturbances in Sleep ........................................................................................................125 Interventions to promote rest and sleep ....................................................................................................... 126 6.5 Nursing Procedures ...........................................................................................................................127 Chapter Six Practice Questions ...............................................................................................................129 Appendix A: Practice Examination ............................................................................................... 133 Appendix B: Answer Keys ............................................................................................................. 156 Index ................................................................................................................................................. 158

©2017 Achieve Test Prep Page 6 of 160

Essentials of Nursing Study Guide

©2017 Achieve Test Prep Page 7 of 160 Gastric juice in the stomach starts proteindigestion. Gastric juice mainly contains hydrochloric acid and pepsin. As these two chemicals may damage the stomach wall, mucus is secreted by the stomach, providing a slimy layer that acts as a shield against the damaging effects of the chemicals. At the same time protein digestion is occurring, mechanical mixing occurs by peristalses, which are waves of muscular contractions that move along the stomach wall. This allows the mass of food to further mix with the digestive enzymes. After some time, typically an hour or two in humans, the resulting thick liquid is called chyme . When the pyloric sphincter opens, chyme enters the duodenum where it mixes with digestive enzymes from the pancreas, and then passes through the small intestine, in which digestion continues. When the chyme is fully digested, it is absorbed into the blood. Chapter One: Nutrition Nutrition is all the processes involved in consuming and utilizing food for energy, maintenance, and growth. 1.1 Physiology of Nutrition There are five processes involved in the body’s use of nutrients: Ingestion, Digestion, Absorption, Metabolism and Elimination. Process #1 Ingestion is the taking of food into the digestive tract, generally through the mouth. In other words, it is the consumption of a substance by an organism. In animals, it normally is accomplished by taking in a substance through the mouth into the gastrointestinal tract, usually through eating or drinking. Besides nutritional items, other substances which may be ingested are medications (where ingestion is termed oral administration). Process #2 Digestion is the mechanical and chemical processes that convert nutrients into a physically absorbable state. Digestion includes mastication (chewing), deglutition (swallowing), and peristalsis (coordinated, rhythmic, serial contractions of the smooth muscles of the GI tract). In other words, it is the mechanical and chemical breakdown of food into smaller components that are more easily absorbed into a blood stream. Digestion is a form of catabolism , which is a breakdown of large food molecules to smaller ones. When food enters the mouth, digestion starts by the action of mastication (chewing), which is a form of mechanical digestion, and the contact of saliva. Saliva, which is secreted by the salivary glands, contains saliva y amylase , an enzyme which starts the digestion of starch in the food. After undergoing mastication and starch digestion, the food will be in the form of a small, round slurry mass called a bolus . It will then travel down the esophagus and into the stomach by the action of peristalsis .

Essentials of Nursing Study Guide

©2017 Achieve Test Prep Page 8 of 160 is the body’s conversion of nutrients into energy. Basal metabolism is the amount of energy needed to maintain essential physiologic functions when a person is at complete rest, both physically and mentally. Metabolism is a set of chemical reactions that happen in the cells of living organisms to sustain life. These processes allow organisms to grow and reproduce, maintain their structures, and respond to their environments. The word metabolism can also refer to all chemical reactions that occur in living organisms, including digestion and the transport of substances into and between different cells, in which case the set of reactions within the cells is called intermediary metabolism or intermediate metabolism . Metabolism is usually divided into two categories: Catabolism breaks down organic matter, for example to harvest energy in cellular respiration, and anabolism uses energy to construct components of cells such as proteins and nucleic acids. Process #3 Absorption is the process by which the end products of digestion pass through the small and large intestines into the blood or lymph systems. Digested food is now able to pass into the blood vessels in the wall of the intestine through the process of diffusion . The small intestine is the site where most of the nutrients from ingested food are absorbed. The inner wall, or mucosa , of the small intestine is lined with simple columnar epithelial tissue. Structurally, the mucosa is covered in wrinkles or folds called plicae circulares , which are considered permanent features in the wall of the organ. They are distinct from rugae , which are considered non-permanent or temporary, allowing for distention and contraction. From the plicae circulares project microscopic finger-like pieces of tissue called villi . The individual epithelial cells also have finger-like projections known as microvilli . The function of the plicae circulares, the villi and the microvilli is to increase the amount of surface area available for the absorption of nutrients. Each villus has a network of capillaries and fine lymphatic vessels called laterals close to its surface. The epithelial cells of the villi transport nutrients from the lumen of the intestine into these capillaries (amino acids and carbohydrates) and lacteals (lipids). The absorbed substances are transported via the blood vessels to different organs of the body where they are used to build complex substances such as the proteins required by our body. The food that remains undigested and unabsorbed passes into the large intestine. Absorption of most nutrients takes place in the jejunum , with the following notable exceptions: • Iron is absorbed in the duodenum. • Vitamin B12 and bile salts are absorbed in the terminal ileum. • Water and lipids are absorbed by passive diffusion throughout the small intestine. • Sodium bicarbonate is absorbed by active transport and glucose and amino acid cotransport. • Fructose is absorbed by facilitated diffusion. Process #4 Metabolism

Essentials of Nursing Study Guide

©2017 Achieve Test Prep Page 9 of 160 is a chemical that an organism needs to live and grow. Nutrients are used to build and repair tissues, regulate body processes, and are converted to and used as energy. Organic nutrients include carbohydrates, fats, proteins (or their building blocks, amino acids) and vitamins. Inorganic chemical compounds , such as dietary minerals, water, and oxygen, may also be considered nutrients. A nutrient is said to be "essential" if it must be obtained from an external source, either because the organism cannot synthesize it or produces insufficient quantities. Nutrients needed in very small amounts are micronutrients and those that are needed in larger quantities are called macronutrients . The effects of nutrients are dose-dependent and shortages are called deficiencies . Micronutrients Micronutrients are essential for good health and deficiencies can cause serious health problems. Micronutrients like zinc and iodine are necessary for promoting healthy functioning of major body systems. They also help with brain growth and bone development. Micronutrients are generally referred to as vitamins and minerals. The body also uses micronutrients to support metabolism. The vitamins, compounds, and minerals that support metabolism include: • Dietary minerals like salts or ions such as copper and iron • Vitamins which act as coenzymes or cofactors for various proteins in the body • Water which allows chemical reactions of life to take place Macronutrients People need a variety of macronutrients. The largest quantities of chemical elements consumed are carbon, hydrogen, nitrogen, oxygen, phosphorous, and sulphur. Chemical compounds like water and atmospheric oxygen must also be consumed in large quantities, but are not always considered food or nutrients. Sometimes calcium, salt, magnesium, and potassium (along with phosphorus and sulfur) are considered macronutrients because they are required in large quantities compared to other vitamins and minerals. They are sometimes referred to as the macro minerals. Process #5 Elimination is composed of two processes, excretion and egestion. Excretion is the process of eliminating or removing waste products from the body. This is most commonly done through urination and sweating. It can also be done via exhaling, when carbon dioxide is let out through the nasal cavity. Elimination can also occur via egestion. Egestion is the discharge of undigested food from the body. During egestion, any undigested material exits the digestive track via the anus. 1.2 Nutrients A nutrient

Essentials of Nursing Study Guide

©2017 Achieve Test Prep Page 10 of 160 are unable to be synthesized internally (either at all, or in sufficient quantities), and so they must be consumed by an organism from its environment. Nonessential nutrients are those nutrients that can be made by the body; they may often also be absorbed from consumed food. Most animals ultimately get their essential nutrients from plants, though some animals may consume mineral-based soils to supplement their diet. For humans, these include essential fatty acids, essential amino acids, vitamins, and certain dietary minerals. Oxygen and water are also essential for human survival, but are generally not considered "food" when consumed in isolation. Non-essential substances within foods can still have a significant impact on health, whether beneficial or toxic. For example, most dietary fiber is not absorbed by the digestive tract, but is important in digestion and absorption of harmful substances. Interest has recently increased in phytochemicals, which include many non-essential substances which may have health benefits. The largest quantities of chemical compounds humans consume are carbohydrates, proteins, and fats. These macronutrients provide energy. • Carbohydrates are compounds made up of types of sugars. Carbohydrates are classified by their number of sugar units: monosaccharides (such as glucose and fructose), disaccharides (such as sucrose and lactose), oligosaccharides, and polysaccharides (such as starch, glycogen, and cellulose). • Proteins are organic compounds that consist of the amino acids joined by peptide bonds. The body cannot manufacture some of the amino acids (termed essential amino acids), so the diet must supply these. In nutrition, proteins are broken down through digestion by proteases back into free amino acids. • Fats consist of a glycerin molecule with three fatty acids attached. Fatty acids are unbranched hydrocarbon chains, connected by single bonds alone (saturated fatty acids) or by both double and single bonds (unsaturated fatty acids). Fats are needed to keep cell membranes functioning properly, to insulate body organs against shock, to keep body temperature stable, and to maintain healthy skin and hair. The body does not manufacture certain fatty acids (termed essential fatty acids) and the diet must supply these. Fat has an energy content of 9 kcal/g (~37.7 kJ/g) and proteins and carbohydrates 4 kcal/g (~16.7 kJ/g). Ethanol (grain alcohol) has an energy content of 7 kcal/g (~29.3 kJ/g). Deficiencies and Toxicity An inadequate amount of a nutrient is a deficiency. Deficiencies can be due to several causes including inadequacy in nutrient intake called dietary deficiency , or conditions that interfere with the utilization of a nutrient within an organism. Some of the conditions that can interfere with nutrient utilization include problems with nutrient absorption, substances that cause a greater than normal need for a nutrient, conditions that cause nutrient destruction, and conditions that cause greater nutrient excretion. Nutrient toxicity occurs when an excess of a nutrient does harm. Essential and Non-Essential Nutrients Nutrients are frequently categorized as essential or nonessential. Essential nutrients

Essentials of Nursing Study Guide

©2017 Achieve Test Prep Page 11 of 160 (single molecules) and glucose. Fructose and galactose, which require no digestion and are used readily by the body for energy, are also a source as well as disaccharides (double molecules) and lactose which is a combination of glucose and galactose which is found in milk. Carbohydrates may be simple or complex. Simple carbohydrates are single or double sugars. Complex carbohydrates are composed of many single sugars joined together (starch, dietary fiber, glycogen). Starches are polysaccharides which are branched chains of glucose molecules. Fiber is a complex carbohydrate derived from plants, not digestible but supplies bulk to the body. • Functions: Carbohydrates are the primary source of energy for the body. They spare proteins from being used for energy, allowing them to build and repair body tissues. Carbohydrates are stored in the body as glycogen or fat. Carbohydrates are needed to oxidize fats completely and for the synthesis of fatty acids and amino acids. The Six Essential Nutrients Water Water is the most important nutrient. The daily requirements are 1,000mL of water to process 1,000 kcal eaten. The human body is composed of 46-60% water. Age, gender, and body fat influence the amount of water in the body. Infants have the highest percentage (70-80%) of body weight; whereas, the water percentage in a 60-year-old is about 50% of body weight. Fat tissue contains no water and lean muscle does, so an obese patient has a reduced percentage of water. The average adult needs 2500ml of water daily. About 1500ml is drunk, an additional 750ml comes from food, and 200ml from the metabolism of food. • Classification and Sources: Liquids consumed (water, coffee, juice, tea, milk, soft drinks); foods consumed (especially fruits and vegetables) • Functions: The functions of water are to act as a solvent (dissolves substances to form solutions) and a transporter (carries nutrients,wastes, etc. throughout the body). Water is a regulator of body temperature. It is also a lubricant as it aids in providing smooth movement for joints and is a componentof all cells. Hydrolysis is the process where water is used to break apart substances, especially during metabolism. • Digestion, Absorption and Storage : Water is not digested. It is absorbed and used by cells. The body loses water in four ways: urine, feces, perspiration and respiration. • Signs of Deficiency : Signs of abnormal water loss include profuse sweating, vomiting, diarrhea, hemorrhage, wound drainage (burns), fever, and edema. A deficiency of water is called dehydration. Prolonged dehydration results in death. Carbohydrates Carbohydrates are made up of carbon, hydrogen, and oxygen. They are the major source of food for all bodies. The daily requirements are 50% to 60% of an individual’s kcal intake per day. • Classification and Sources: Sources are sugars, including monosaccharides

Essentials of Nursing Study Guide

• Digestion, Absorption and Storage: Digestion of cooked starches begins in the mouth. There is only a little digestion that occurs in the stomach. Ptyalin (salivary amylase) and pancreatic amylase are digestive enzymes that break down carbohydrates. Carbohydrate digestion is completed in the small intestine. Glucose is transported through the cell membrane and is augmented by insulin. Metabolism is controlled by the rate which insulin is available. Carbohydrates are used completely, leaving no waste for the kidneys to excrete. Carbohydrates are stored either as Glycogen or Fat. Most are stored in the liver and skeletal muscles, but all body cells are capable of storing glycogen. Glucose that cannot be stored as glycogen is converted to fat. • Signs of Deficiency: Mild deficiency can result in weight loss and fatigue. Serious deficiency can result in ketosis. Fats The daily requirements of fats should not exceed 25% to 30% of an individual’s caloric intake per day. Lipids are greasy and insoluble in water; they are soluble in alcohol or ether. Chemical digestion of fats begins in the stomach, mainly in the small intestines by bile, pancreatic lipase and enteric lipase. The end products are glycerol, fatty acids, and cholesterol. Fatty acids are carbon chains and hydrogen; they are the basic structural units of most lipids. Fatty acids are either saturated fatty acids, unsaturated fatty acids, monounsaturated fatty acids or polyunsaturated fatty acids. • Classification and Sources: Fats are found in animals (lard, butter, milk, cream, egg yolks, and fat in meat, poultry, and fish) and plants (oils from corn, safflower, peanut, palm, as well as nuts and avocado). Glycerides are simple lipids. Triglycerides account for 90% of lipids in food and in the body. Cholesterol is a fatlike substance produced by the body and found in foods of animal origin. Cholesterol is a precursor of bile acids and is necessary for synthesis of steroid hormones. Lipoproteins are made up of various lipids and a protein. Phospholipids are lipoids, composed of glycerol, fatty acids, and phosphorus. • Functions: Fats provide a concentrated source of energy. They assist in the absorption of fat soluble vitamins like A, D, E and K. They are a major component of cell membranes and myelin sheaths. Fats improve flavor of foods and delay the stomach’s emptying time. Fats protect and hold organs in place. They also insulate the body, thus assisting in temperaturemaintenance. • Digestion, Absorption and Storage: There is no chemical breakdown of fats that occurs in the mouth and very little in the stomach. Digestion occurs in small intestine. Fats not immediately needed by the body are stored in adiposetissue. • Signs of Deficiency and Excess: Deficiency occurs when fats provide less than 10% of daily kcal requirement. Gross deficiency may result in eczema, retarded growth and weight loss. Excess fat consumption can lead to obesity and heart disease.

©2017 Achieve Test Prep Page 12 of 160

Essentials of Nursing Study Guide

©2017 Achieve Test Prep Page 13 of 160 Deficiency signs include muscle wasting, edema (swelling), lethargy and depression. Excess can result in heart disease, colon cancer, and osteoporosis. Vitamins Vitamins are organic compounds that cannot be manufactured by the body and are needed to catalyze the metabolic process. Vitamins regulate body processes and are required for metabolism of fats, proteins, and carbohydrates. Vitamins are needed in very small amounts, and can be obtained in adequate supply with a balanced diet. • Classification and Sources: The fat-soluble vitamins are A, D, E and K. The water-soluble vitamins are C, B1, B2, B3, B6, B9, B12, Pantothenic acid and biotin. Sources of vitamins are foods and vitamin supplements. • Digestion, Absorption and Storage: Vitamins do not require digestion. Fat-soluble vitamins are absorbed into the lymphatic system; water-soluble vitamins are absorbed into the circulatory system. An excess of fat-soluble vitamins is stored in the liver and adipose tissue. Excess water-soluble vitamins are excreted through urine. • Signs of Deficiency and Excess: Vitamin deficiencies commonly afflict alcoholics, the poor, incapacitated elders, clients with serious diseases that affect appetite, mentally retarded persons, and neglected children. Vitamins consumed in excess can be toxic. Vitamin Overdose Guide Protein Proteins are made up of carbon, hydrogen, oxygen and nitrogen. They are the only nutrient that can build, repair, and maintain body tissues. Daily requirements are determined by size, age, gender, physical and emotional conditions. Daily protein requirement for average adults is 0.8g for each kilogram of weight. Organic substances are composed of amino acids. Essential amino acids are those that cannot be made by the body. Amino acids are essential for tissue growth and maintenance. The amino acids are threonine, leucine, isoleucine, valine, lysine, methionine, phenylalanine, tryptophan and histidine. Nonessential amino acids are those that the body makes. These are glycine, alanine, aspartic acid, glutamic acid, praline, hydroxyproline, cysteine, tyrosine, and serine. • Classification and Sources: Complete proteins contain all nine essential amino acids. All animal fats, except for gelatin, are complete. The only plant fat that is complete is soybean. Partially complete proteins are some fish and milk. Incomplete proteins have one or more essential amino acids missing. Complementary proteins are combinations of incomplete proteins that can achieve a balanced ratio of amino acids. • Functions: Proteins provide amino acids necessary for synthesis of body proteins used to build, repair, and maintain body tissues. They assist in regulating fluid balance and are used to build antibodies. Plasma proteins help control water balance between the circulatory system and the surrounding tissues. In the event of insufficient stores of carbohydrates and fats, proteins can be converted into glucose and used for energy. • Digestion, Absorption and Storage: Digestion of protein begins in the mouth, where the enzyme pepsin breaks protein down into smaller units. Most protein is digested in the small intestine, broken down into amino acids for use in the body. • Signs of Deficiency and Excess:

Essentials of Nursing Study Guide

Vitamin

Recommended Daily Allowance

Effects of Overdose

©2017 Achieve Test Prep Page 14 of 160 Fat Soluble A 5000 IU (International Units) headache; vomiting; hair loss; anemia; enlarged liver; birth defects; miscarriage D 400 IU nausea; vomiting; join pain; calcification of heart, lungs, and kidneys; birth defects E 30 IU blood-clotting defects; acne; nausea; vomiting K 80 mcg hemolytic anemia; liver damage Fat Soluble Vitamins Vitamin RDA/AI Best Sources Functions Men Women Vitamin A (carotene) 900ug 700ug Yellow or orange fruits and vegetables, green leafy vegetables, fortified oatmeal, liver, dairy products Formation and maintenance of skin, hair, and mucous membranes; helps people see in dim light; bone and tooth growth Vitamin D 5ug 5ug Fortified milk, sunlight, fish, eggs, butter, fortified margarine Aids in bone and tooth formation; helps maintain heart action and nervous system function Vitamin E 15mg 15mg Fortified and multigrain cereals, nuts, wheat germ, vegetable oils, green leafy vegetables Protects blood cells, body tissue, and essential fatty acids from harmful destruction in the body Vitamin K 120ug 90ug Green leafy vegetables, fruit, dairy, grain products Essential for blood-clotting functions Water Soluble 1.5 mg (milligrams) gastric upset and severe allergic reactions none reported in humans dizziness; nausea; staggering gait 6 mcg (micrograms) iron absorption affected nausea; diarrhea; kidney stones B1 B2 B3 B12 C 1.7 mg 20 mg 60 mg

Essentials of Nursing Study Guide

Water Soluble Vitamins

Vitamin

RDA/AI

Best Sources

Functions

©2017 Achieve Test Prep Page 15 of 160 Women Thiamin (B1) 1.2mg 1.1mg Fortified cereals and oatmeal, meats, rice and pasta, whole grains, liver Helps the body release energy from carbohydrates during metabolism; growth and muscle tone Riboflavin 1.3mg 1.1mg Whole grains, green leafy vegetables, organ meats, milk, eggs Helps the body release energy from protein, fat, and carbohydrates during metabolism Niacin 16mg 14mg Meat, poultry, fish, enriched cereals, peanuts, potatoes, dairy products, eggs Involved in carbohydrate, protein, and fat metabolism Pantothenic Acid 5mg 5mg Lean meats, whole grains, legumes Helps release energy from fats and vegetables Folate 400ug 400ug Green leafy vegetables, organ meats, dried peas, beans, lentils Aids in genetic material development; involved in red blood cell production B6 1.3mg 1.3mg Fish, poultry, lean meats, bananas, prunes, dried beans, whole grains, avocados Helps build body tissue and aids in metabolism of protein B12 2.4ug 2.4ug Meats, milk products, seafood Aids cell development, functioning of the nervous system, and the metabolism of protein and fat Biotin 30ug 30ug Cereal/grain products, yeast, legumes, liver Involved in metabolism of protein, fats, and carbohydrates Vitamin C 90mg 75mg Citrus fruits, berries, and vegetables, especially peppers Essential for structure of bones, cartilage, muscles, and blood vessels; helps maintain capillaries and gums and aids in absorption of iron Men

Essentials of Nursing Study Guide

©2017 Achieve Test Prep Page 16 of 160 Minerals Minerals are inorganic compounds that help regulate body processes and serve as structural components of the body. The daily requirements are amounts greater than 100 mg/day. Trace mi r ls are less than 100mg/day. Functions of Minerals are unique to each individual mineral. • Classification and Sources: Minerals are classified as major minerals or trace minerals. They are found in water, natural foods, and supplements. • Digestions, Absorption and Storage: Minerals are influenced by three factors: the type of food (minerals from animal foods are more readily absorbed than those from plant foods), the needs of the body (a deficiency will result in more absorption) and the health of absorbing tissue. • Signs of Deficiency and Excess: Too much mineral intake can be toxic. Excessive amounts of minerals can result in hair loss and changes in the blood, muscles, bones, hormones, blood vessels, and nearly all tissues. Common Minerals Mineral Best Sources Functions Deficiencies Excesses Calcium milk, cheese, dark green leafy vegetables, and legumes bone and tooth formation; blood clotting; nerve transmission stunted growth; and bone loss depressed absorption of some other minerals; kidney damage Phosphorous milk, cheese, meat, poultry, and whole grains bone and tooth formation; acid- base balance weakness and demineralization of bone depressed absorption of some minerals Magnesium whole grains and green leafy vegetables maintains nerve and muscle functions neurologic disturbances neurologic disturbances Sulfur sulfur amino acids in dietary proteins component of cartilage, tendon, and proteins; acid- base balance protein deficiency increased sulfur amino acid intake; poor growth; liver damage Sodium salt, soy sauce, cured meats, pickles, canned soups, and processed cheese body water balance; nerve function muscle cramps; reduced appetite elevated blood pressure Potassium meats, milk, many fruits and vegetables and whole grains maintain body water balance; nerve function muscular weakness; paralysis muscular weakness; cardiac arrest