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Lecture exam 3


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what is sickle cell anemia (refering to the structure)
basically the hemaglobin molecule has one of the "wrong" protiens. it has VAL instead of GLU. the genes are expressed in the wrong way :(
how is protein digested in the stomach?
proteases from the pancreas and intesting break the polypeptides into shorter peptide chains and peptidase breaks it down the single animo acids
what makes the structure of proteins unique (from carbs and lipids)?
protiens have a nitrogen group that carbs and lipids do not have.
how are proteins digested in the stomach?
partial breakdown of protiens from the hydrochloric acid (it denatures the proteins and also converts pensinogen to pepsin). Pepsin breaks the proteins into smaller pieces
what holds one amino acid to another?
peptide bond
how many essential amino acids are there?
what strucutre of protiens gives us the 20 different amino acids?
the side group or side chain
how are protiens digested int he mouth?
they are crushed and moistened but not digested
what are the two classes of simple carbs?
monosaccharides and disaccharides.
what are the 3 monosaccharides?
glucose, fructose, galactose
what are the 3 disaccharides?
maltose, sucrose, and lactose.
what is maltose made of?
glucose and glucose
what is sucrose made of?
glucose and fructose
what is lactose made of?
glucose and galactose
What role does the mouth have in the digestion of carbs?
salavary amylase begins to digest carbs here.
what role does the stomach have in the digestion of carbs
mostly just churning, but fibers also linger here and promote fullness. Salivary amylase is deactivated here also.
what role does the small intestine have in the digestion of carbs?
most digestion occurs here. Pancreatic amylase breaks carbs down and then the enzymes for the disaccharides break them into monosaccharides.
what role does the large intesting have in the digestion of carbs?
within 1-4 hours all of the sugars and most of the starches have been digested
what role does the liver have in the digestion of carbs?
the liver converts carbs to glucose
hormone that moves glucose from the blood into the cells, thereby lowering the blood glucose levels.
hormone that moves glucose out of the cells and into the blood, thereby raising the blood glucose levels
fight or flight hormone that takes glucose stores from the livers glycogen stores and brings them into the blood.
if blood glucose regulation fails, what 2 conditions develope?
diabetes or hypoglycemia
diabetes type 1
pancreas fails to make enough insulin
diabetes type 2
cells fail to respond the insulin
condensation reactions
how stuff is put together.
hydrolysis reactions
how stuff is taken apart
how do humans and plants differ in the way they store glucose?
humans store glucose as glycogen, plants store glucose as starch.
resistant starches
escape digestion and act like fiber
what is the difference between diatary and functional fibers?
diatery is naturally occuring, and functional has been added to the foods.
how the body converts protein to glucose
what are complex carbohydrates?
polysaccharides, starches, glycogen, fiber
How does fiber differ from sugars and starches?
all have glucose units present, but fibers bonds cannot be broken down by the body and therefore contribute little energy.
what are some insoluble sources of fiber?
grains and vegetables
what is the function of insoluble fiber?
promote bowel movements and alleviate constipation
what are some sources of soluble fiber?
oats, fruit, legumes
what is the function of soluble fiber?
protects against heart disease and diabetes by lowering blood glucose and cholesterol.
where do carbohydrates come from, and what is the exception ?
primarily from plants. the exception is lactose and galactose which comes from milk. Glycogen is never found in plants, only humans and animals.
carbohydrates are broken down or converted into ______ by the ________
glucose, liver
after digestion the ____raises in the blood and stimulates teh _____ to produce ______:
glucose, pancreas, insulin
carbohydrates are stored as ________ in the _____and ______
glycogen, muscles (2/3), and liver (l/3).
after filling its glycogen stores, what does the liver do with glucose?
converts it to fat
what is the glycemic index?
foods that have a low glycemic index raise blood sugars slowly and keep glucose levels even in the blood. High glycemic index foods spike it.
how does soluble fiber lower cholesterol?
by binding with bile acids and increasing their excretion. The liver must then use its cholesterol to make new bile acids.
what 3 foods can prevent cancer?
fruits, vegetables and fiber
what is the daily value for sugars?
there is no daily value. the rule is that nutritious foods should come first and then sugars can be part of your discretionary calories.
how many grams of fiber should you get /day?
20-35 grams/day
what percentage of your total calories should come from carbs?
what is the RDA for carbs?
for a 2000 calorie diet how many grams of carbs would they be consuming?
how many grams of carbs does fruit have/serving?
how many grams of carbs do vegetables have/serving?
starchy has 15, nonstarchy has 5g
how many grams of carbs do grains have/serving?
how many grams of carbs do legumes have per serving?
20 grams, and 1/3 of it is from fiber
how many grams of carbs does milk have/serving?
12 grams/serving
where are short, medium and long chain fatty acids primarily found?
Long chain fatty acids are the most common int he diet and are found in meats, fish and vegetable oils, medium and short chain fatty acids are less common and are found in dairy products
saturated fatty acids have _____ bonds between their carbon atoms
the _____ is the point of unsaturation
double bond
describe the structure of monounsaturated and polyunsaturated fatty acids
monounsatured has one double bond, polyunsaturated has more than one
if there is not enough hydgrogen to bind with the carbon atoms of a fatty acid, what happens?
it becomes unsaturated =)
what is the structure of the omega 3 and omega 6 fatty acids?
they are polyunsaturated, and the 3 and the 6 represent how many carbons away from the methyl end the first double bond is
where are saturated fats found?
animal fats
where are monounsaturated fats found?
olive and conola oils
where are polyunsaturated fats found?
sunflower, safflower, corn and soybean oils, walnuts and flaxseed.
as a general rule, fats that are liquid at room temp are _____, and those that are solid are _____
liquid=unsaturated solid = saturated
what are the exceptions to the liquid at room temp/unsaturated rule?
cocoa butter, palm oil, and coconut oil
what is the structure of a triglyceride?
3 fatty acids and one glycerol
what does AORN stand for and what do they do?
they are the association of periOperative registered nurses, and they are one of the most highly organized and powerful specialty organizations withing the nursing profession. They basically govern perioporative practices
when does the PREoporative phase begin and end?
it begins when the client decides to have surgery and ends when they enter the oporating room
what are 4 ways surgeries can be classified?
by body system, purpose, level of urgency and degree of seriousness
what type of surgery (where on the body) would have a higher rate of infection than other surgeries?
surgery that enters the gastrointestinal, respiratory or genitourinary tracts have a high risk for infection. In addition any time there is a penetrating injury or an organ ruptures the risk is also extreemly high, no matter what body system it belongs to.
ablative surgery
removes a diseased body part. example : cholecystectomy removes the gallbladder
diagnostic surgery
confirms diagnosis
palliative surgery
is doen for the sole purpose of alleviatign pain or discomfort. It does not produce a cure. Example would be nerve root destruction for chronic pain
reconstructive surgery
restores function, rotator cuff repair and repair of a torn ligament
transplant surgery
replaces malfuntioning body part, tissue or organ. Joint replacements are included in this catagory
when an organ is harvested from someone pronounced brain dead and is transplanted into another person who needs it
urgent surgery
scheduled within 24-48 hours
a person with renal disease might have what complication with surgery?
they would be unable to excrete the medications, including the anesthesia.
what complications might someone with liver disease face during surgery?
poor wound healing, hemorhage (because you have reduced prothrombin being made, and prothrombin clots the blood), toxic reactions to anesthesia and medications
what surgical risk does someone with a neurological disorder have?
increased incidence of seizures and wide swings in blood pressure
what might someone with poor nutritional status have a problem with during or after surgery?
delayed wound healing, infection and fatigue
how might someone taking opiods be at surgical risk?
opiods increase the risk of respiratory depression
how might someone taking NSAIDs be at risk during surgery
NSAIDs inhibit platelet aggragation, increasing the risk for bleeding
which fats (saturated or unsaturated) are more resistant to oxidation?
saturated (which is probably why the food industry uses them so much :p...foods keep longer!)
what is hydrogenation?
the adding of hydrogen molecules to an unsaturated fat to make it saturated
what are cis fatty acids?
their double bonds are on the same side of the carbon chain (which is how they normally occur in nature)
what are trans fatty acids?
their double bonds are on oposite sides of the carbon chain (this is unnatural--except in milk and cheese-- and in the body they then behave as saturated fats.
fatty acids vary in : (3 things)
the length of their carbon chains, their degree of unsaturation and the location of their double bonds
what is the most common fat in the body?
what are phospholipids?
they are similar to triglycerides but they have a phosphate group instead of the 3rd fatty acid. This allows them to act as emulsifiers because the phosphate is disolvable in water and the lipid is obviously fat soluble
what is the best know phospholipid? and where is it found?
lecethin ...and its found in eggs, liver, soybeans, wheat germ and peanuts
do we need lecithin?
yes, but the body makes all of its own, so there is no need for supplementatin in food
what is cholesterol and where does it come from?
it is a lipid of the sterol group. it has a multiple ring structure and it is only found in animal derived foods
what do sterols do in your body?
they are of the fat group and they include cholesterol, bile, the sex hormones, the adrenal hormones (like cortisol) and vitamin D
vitamin D is a ______
how is fat digested in the mouth?
lingual lipase does a little bit
how is fat digested in the stomach?
peices are fround and mixed with chyme. gastric lipase helps, but little fat is digested here.
how is fat digested in the small intesting?
CCK is released and signals the gallbladder to release its stores of bile. Bile acids pair up with amino acids and act as an emulsifier. lipase enzymes from the pancreas and small intestine also play a role. Most fat digestion occurs here.
what does bile do for you?
it emulsifies fat so that it can be digested. Most of it then gets reabsorbed, but with the help of fiber, some of it can be excreted :). Since bile is made of cholesterol..this is how fiber helps lower the blood cholesterol
what are micels
tiny spherical complexes of emulsified fat that travel to the intestinal cells where they are made into triglycerides once again
what are chylomicrons
lipoproteins that transport lipids from the intestinal cells to the rest of the body.
what is the primary difference between HDL and LDL
HDL is returning to the liver and therefore poses little threat, the LDL is circulating throughout the body to all the organs and glands. The LDL is packed with cholesterol but very little triglycerides
what is the primary role of triglycerides?
provide energy
what are linoleic and linolenic fatty acids?
they are the only 2 fatty acids that the body cannot make itself. linoleic is the omega 6 and linolenic is the omega 3
what do omega three fatty acids do for you?
help protect your eyes, brain, are essential for development, and help prevent heart disease
what are ecosanoids and where are they found?
they are like hormones in a way, except that they dont travel, they only affect the nearby cells. They help to lower blood pressure, prevent blood clot formation and protect against irregular heart beats and reduce inflammation. They come from omega 3 fatty acids
how would a fatty acid deficiency manifest itself (symptom wise)
when triglycerides are metabolized , what do they yeild?
energy, carbon dioxide and water
what source of energy does your body use at rest?
mostly fat. 60%
which raises blood cholesterol more: food cholesterol or saturated fat?
saturated fat
what role does fat have on cancer?
it does not initiate it but can promote it once it has already started
what are the fat soluble vitamins?
how do proteins regulate fluid balance?
they attract water. if plasma proteins ender the interstitial spaces faster than they can be cleared, fluid accumulates and causes edema!!!
the protein related causes of edema are?
excessive protein loss from kidney disease or large wounds, inadequate protein syntheses from liver disease, and inadequate dietary intake of protien (hmmmm. :p ).
how do proteins help regulate pH,..and why is the steady pH important for the proteins?
the proteins have a (-) charge, and hydrogen has a (+) charge... so by attaching to and releaseing the hydrogen, the pH shifts. acidosis and alkalosis are important because either condition can denature protiens.
lipoproteins do what?
cary lipids around the body
in what population is nitrogen status positive? (and what does this mean?)
it means there is more nitrogen going in then is coming out. This is important for growth, so infants, children and prego women, or people recovery from a protein deficiency have excess nitrogen to meet their needs
what is negative nitrogen status, and who suffers from it?
less nitrogen coming in then going out. People who are starving or have severe infections or burns, or people with a fever . The body then has to break down its own proteins to (muscle) to obtain the missing nitrogen
if an essential amino acid is missing int he diet,.. can the body break its own proteins down to get it?
striping a protein of its nitrogen containing amino groups. It produces ammonia, which is converted to urea. This is how the nitrogen ends up in the urine!!
how does digestion of protien from plants and animals differ?
digestion of animal protiens is high (90-99%). Plant proteins are less digestible (70-90%). Soy and legumes are your best bets because they start at 90%
limiting animo acid
the body only makes whole protiens, so if there is an animo acid missing, it cannot make that protien
what is the reference protien, and where did they get the numbers from?
the reference protien is the amino acid requirements for a preschool age child. They rationalize that if it is enough for the child, it should be more than enough for an adult
what is PEM? When does it happen?
protien energy malnutrition. It happens when people are deprived of protien, energy, or both. It can be acute or chronic and most often it effects children
chronic PEM that reflects severe food deprivation over a long period of time.
it is acute PEM. It occurs frequently when a mother has 2 children and is breastfeeding both of them. The second child gets the "leftovers" and becomes malnourished. The child develops severe edema of the limbs, face and especially the stomach.
marasmus-kwashiorkor mix
conbines the severe edema of kwashiorkor with the wasting away of marasmus
an amino acid that if found in high levels in blood is an independant risk for heart disease
an amino acid that may protect against heart disease
is there any correlation between animal protiens and cancer?
yes. high levels of animal protiens have been linked to colon, breast, kidney, pancreas and prostate cancer
what happens to calcium levels when protien intake is high?
calcium excretion raises when protein levels are high, which puts you at risk for osteoperosis
someone with kidney disease may want to decrease their (choose from carbs, ,lipids or protien) :
protein consumption, because protien makes more work for the reducing it can actually slow the progression on the disease
protien should make up what percentage of your diet?
what is anthropometric data?
physical body measurements, like your height,weight, etc. The knee height may be used for someone who is bedridden, to find their height
what diagnostic tests are usually required before surgery?
complete blood count, urinalysis and an ECG if the pt is over 50
from the nurses point of view, what is your primary concern as far as getting the consent form for surgery signed?
you want to be sure the surgeon has explained everything to the pt and the pt fully understands everything. It is not your job to explain, but it is your job as teh pt advocate to make sure that they are TRUELY consenting. If they seem fuzzy or hesitant, notify the surgon and delay the surgery
what is the reason for fasting prior to surgery?
to prevent aspiration during surgery, and also because anesthesia and anxiety slow bowel movements, so it decreases the risk of vomiting or diarrhea
for a surgical procedure of the colon, what is the standard preperation before surgery
you would need to have an enema
what is the rational behind having the client void prior to surgery
so they dont fall out of bed or fall while trying to get up to go to the bathroom after surgery when they are all doped up
why might preoperative medications be given?
to relax the patient, decrease respirations or reduce the risk of vomiting and aspiration
for a pt with diabetes who is on insulin, is the medication situation handled prior to surgery?
insulin is withheld because the pt has been NPO and therefore does not need as much insulin. The anesthesiologist will monitor the blood sugar in the oporating room and give insulin if needed.
what two documentation forms must accompany the pt to the operatign room?
the completed preoperative checklist (and their informed consent)and the patients chart.
who are the members of the sterile team suring surgery?
the surgeon, surgical assistant and scrub person (both the srub nurse and the first assistant may be registered nurses)
who are members of the clean team during surgery?
the anesthesiologist, circulating nurse, biomedical technicians and radiology technicians.
what is the role of the circulating nurse during surgery?
she is a strong pt advocate and makes sure the sterile field is maintained at all times, she coordingates all activities in the operating room and communicates with personnel outside the operating room, and responds to emergencies. She also attends to thte patient during the induction of anesthesia
what are the advantages and disadvantages of general anesthesia?
advantages are that you are OUT :).... disadvantages are that you often need mechanical ventilation during surgery because the anesthesia depresses your respiratory function, you are also at risk for death, heart attack, stroke or malignant hyperthermia
what is malignant hyperthermia?
it is a rare, often fatal metabolic conditiong that causes the skeletal muscles to become rigid. Temperature rises rapidly and can be fatal
what are the benefits of conscious sedation?
pain and anxiety are adequately controlled without the risks of general anesthesia. Recovery is also rapid
what are the 4 types of regional anesthesia?
local anesthesia, nerve block, spinal and epidural anesthesia
what is a bier block?
a type of nerve block that uses a tourniquet to cut off venous return but still allows arterial flow. the nerve block is then injected and the client feels no pain as long as the tournaquate is in place. The only draw back is that there is a potentioal for systemic absorption of the anesthesia after the tourniquet is removed. Also tissue damage could occur if the tourniquet is kept on for more than 2 hours.
what is the difrference between spinal and epidural anesthesia?
spinal is injected into the CSF and is very dangerous, epidural is inserted into the epidural space and is safer. The only drawback is that epidural meds are at a much higher concentration than spinal anesthesia, so if they MISS the epidural space and go into the CSF, you are in BIG BIG BIG trouble :/.
how often does the PACU nurse assess the patient?
every 5-15 minutes
how often are the pt assessed in the post operative nursing unit?
on arrival, then every 15 minutes for the first hour, then 30 minutes for the next 2 horus, then ever hour for the next 4 hours, and finally every 4 hours.

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