GNUR 297 EXAM 2 STUDY GUIDE
Chapter 15 – Diabetes
Understand the clinical complications of DM
o
Know what individuals are at greatest risk for diabetes (both adults and children)
o
Understand metabolic syndrome and the ATP III guidelines for defining metabolic
syndrome (you need to have three out of five of them to be dx w/metabolic syndrome)
o
Goals for pre-prandial, peak post-prandial bsl in type 1, type 2, and gestational dm
o
Know what HbA1c measures, and goals
o
Know the MNT for type 1, type 2, and gestational dm
o
Understand how carbohydrate counting is used in diabetic meal planning
o
Know how exercise affects bsl in a diabetic and appropriate pre and post workout
recommendations
o
Understand the 15-15 rule to treat hypoglycemia
Chapter 16 – Stress
Know how the body differs in its response to stress versus starvation
o Starvation = hypometabolic
Downshift
8-12hr glycogen stores last
Gluconeogenesis – protein carbs
waste
o Stress = Hypermetabolic
Upshift
Catabolism of Protein
Ketosis
Ebb – maintain blood flow to vital organs
Flow – Upregulation – more O2 and ups nitrogen production
Be able to calculate the calorie needs of a critically ill patient (25-30 kcal/kg)
o Kg x 25 – 30cal = range of cals for the day
Understand the purpose of a doing a nitrogen balance test on a patient and what it means
to be in a positive or negative nitrogen balance
o + = building
o - = breaking down
, Know the difference between marasmus and kwashiorkor
o Kwashiorkor – Protein deficit
o Marasmus – total deficit
Wasting
Be able to define refeeding syndrome, its characteristics, and who is at risk for refeeding
o Oncology pt
Chapter 12- Food Related Issues
Know the differences between enteral and parenteral nutrition, indications and
contraindications for each, risks associated along with advantages of both methods of
nutrition support
o Enteral Nutrition for those who cannot consume adequate amounts of nutrition
orally
Less expensive
Safer
Promotes gut integrity
o Parenteral Nutrition
Vein nutrition
Expensive
Higher risk for infect
Wasting of gut
Immune system complications
Sometimes only way of getting nutrients
Know the most serious complication associated with enteral feedings (aspiration) and
ways to prevent it
o HOB at 30-45
o Verify placement
o Small bowel feeding
o Continuous infusion
o Promotility
Understand other complications of enteral feeding and how best to manage them (i.e.
underfeeding, diarrhea, high gastric residuals)
o Underfeeding from hospital test schedules
o Diarrhea from antibiotics, infection, sorbitol
o GRV
How much food the pt is processing adjust based on suction
Have a general understanding of the advantages/disadvantages with each of the different
routes of enteral feeding (NG tube, NJ tube, G tube, J tube)
o Timing for each is different
Short = NG and NJ
Chapter 15 – Diabetes
Understand the clinical complications of DM
o
Know what individuals are at greatest risk for diabetes (both adults and children)
o
Understand metabolic syndrome and the ATP III guidelines for defining metabolic
syndrome (you need to have three out of five of them to be dx w/metabolic syndrome)
o
Goals for pre-prandial, peak post-prandial bsl in type 1, type 2, and gestational dm
o
Know what HbA1c measures, and goals
o
Know the MNT for type 1, type 2, and gestational dm
o
Understand how carbohydrate counting is used in diabetic meal planning
o
Know how exercise affects bsl in a diabetic and appropriate pre and post workout
recommendations
o
Understand the 15-15 rule to treat hypoglycemia
Chapter 16 – Stress
Know how the body differs in its response to stress versus starvation
o Starvation = hypometabolic
Downshift
8-12hr glycogen stores last
Gluconeogenesis – protein carbs
waste
o Stress = Hypermetabolic
Upshift
Catabolism of Protein
Ketosis
Ebb – maintain blood flow to vital organs
Flow – Upregulation – more O2 and ups nitrogen production
Be able to calculate the calorie needs of a critically ill patient (25-30 kcal/kg)
o Kg x 25 – 30cal = range of cals for the day
Understand the purpose of a doing a nitrogen balance test on a patient and what it means
to be in a positive or negative nitrogen balance
o + = building
o - = breaking down
, Know the difference between marasmus and kwashiorkor
o Kwashiorkor – Protein deficit
o Marasmus – total deficit
Wasting
Be able to define refeeding syndrome, its characteristics, and who is at risk for refeeding
o Oncology pt
Chapter 12- Food Related Issues
Know the differences between enteral and parenteral nutrition, indications and
contraindications for each, risks associated along with advantages of both methods of
nutrition support
o Enteral Nutrition for those who cannot consume adequate amounts of nutrition
orally
Less expensive
Safer
Promotes gut integrity
o Parenteral Nutrition
Vein nutrition
Expensive
Higher risk for infect
Wasting of gut
Immune system complications
Sometimes only way of getting nutrients
Know the most serious complication associated with enteral feedings (aspiration) and
ways to prevent it
o HOB at 30-45
o Verify placement
o Small bowel feeding
o Continuous infusion
o Promotility
Understand other complications of enteral feeding and how best to manage them (i.e.
underfeeding, diarrhea, high gastric residuals)
o Underfeeding from hospital test schedules
o Diarrhea from antibiotics, infection, sorbitol
o GRV
How much food the pt is processing adjust based on suction
Have a general understanding of the advantages/disadvantages with each of the different
routes of enteral feeding (NG tube, NJ tube, G tube, J tube)
o Timing for each is different
Short = NG and NJ
