BASIC PHYSIOLOGICAL NEEDS
A.Principles of Nutrition
MEETING OXYGENATION NEEDS
A.Oxygenation- a basic human need & is required to
sustain life.
B.Cardiovascular Physiology- the function of the
cardiac system is to deliver oxygen, nutrients, &
other substances to the tissues and to remove the
waste products of cellular metabolism
C.Structure and Function- the heart pumps blood
through the pulmonary circulation by way of the right
ventricle and to the systemic circulation by way of
the left ventricle
I.Myocardial Pump- the "pumping action"
of the heart is essential to maintain oxygen
delivery
II.Myocardial Blood Flow- to maintain
adequate blood flow to the pulmonary and
systemic circulations, myocardial blood flow
must sufficiently supply oxygen and
nutrients to the myocardium itself
III.Coronary Artery Circulation -blood
flow to the atria and ventricles does not
supply oxygen and nutrients to the
myocardium itself. It is the branch of the
systemic circulation that supplies oxygen
and nutrients and removal of waste from the
myocardium
IV.Systemic Circulation- the arteries and
veins of the systemic circulation deliver
nutrients and oxygen and remove wastes
from the tissues. Oxygenated blood flows
from the left ventricle by way of the aorta
and into the large systemic arteries
V.Regulation of Blood Flow- the amount of
blood ejected from the left ventricle each
minute is the cardiac output. The circulating
volume of blood changes according to the
oxygen and metabolic needs of the body. For
example, during exercise, pregnancy and
fever, the cardiac output increases but during
sleep, the cardiac output decreases.
D.Steps in the Process of Oxygenation
I.Ventilation- process by which gases are
moved into and out of the lungs. Adequate
ventilation requires coordination of the
muscular and elastic properties of the lung
and thorax and intact innervation. The major
inspiratory muscle is the "diaphragm" which
is innervated by the "phrenic nerve".
II.Perfusion- the primary function of
pulmonary circulation is to move blood to
and from the alveolar-capillary membrane so
that gas exchange can occur
III.Exchange of Respiratory Gases-
respiratory gases are exchanged in the
alveoli of the lungs and the capillaries of the
body tissues
a.Diffusion - movement of
molecules from an area of higher
concentration to an area of lower
concentration
b.Oxygen Transport - delivery
depends on the amount of oxygen
entering the lungs (ventilation),
blood flow to the lungs & tissues
(perfusion), adequacy of diffusion
& capacity of the blood to carry
oxygen.
c.Carbon Dioxide Transport -
carbon dioxide diffuses into RBCs
and I rapidly hydrated into carbonic
acid because of the presence of
carbonic hydras
MEETING NUTRITIONAL NEEDS
I.Digestion- process by which food substances are
changed into forms that can be absorbed through cell
membranes II.Absorption- the taking in of substance
by cells or membranes
III.Metabolism- sum of all physical and chemical
processes by which a living organism is formed and
maintained and by which energy is made available
IV.Storage- some nutrients are stored when not used
to provide energy; e.g. carbohydrates are stored either
as glycogen or as fat
V.Elimination- process of discarding unnecessary
substances through evaporation, excretion
B. Nutrients
I.Carbohydrates- the primary sources are plant foods Types
of Carbohydrates
a.Simple (sugars) such as glucose, galactose, and
fructose
b.Complex such as starches (which are
polysaccharides) and fibers (supplies bulk or
roughage to the diet)
II.Proteins- organic substances made up of amino acids
III.Lipids- organic substances that are insoluble in water but
soluble in alcohol and ether.
a.Fatty acids- the basic structural units of all lipids
and are either saturated (all the carbon atoms are
filled with hydrogen) or unsaturated (could
accommodate more hydrogen than it presently
contains)
b.Food sources of lipids are animal products (milk,
egg yolks and meat) and plants and plant products
(seeds, nuts, oils) 35
IV.Vitamins- organic compounds not manufactured in the
body and needed in small quantities to catalyze metabolic
processes
a.Water-soluble vitamins include C and B-complex
vitamins
b.Fat-soluble vitamins include A, D, E, and K and
these can be stored in limited amounts in the body
V.Minerals- compounds that work with other nutrients in
maintaining structure and function of the body
a.Macronutrients - calcium, phosphate, sodium,
potassium, chloride, magnesium and sulfur
b.Micronutrients (trace elements) - iron, iodine,
copper, zinc, manganese and fluoride The best
sources are vegetables, legumes, milk and some
meats
VI.Water- the body's most basic nutrient need; it serves as a
medium for metabolic reactions within cells and a transporter
fro nutrients, waste products and other substances
MEETING URINARY ELIMINATION NEEDS
A.Normal Urinary Function
I.Normal urine output is 60mL/hr or 1500mL/day;
should remain 30 mL/hr to ensure continued normal
kidney function
II.Urine normally consists of 96% water
III.Solutes foundin urine include:
a.Organic solutes: urea, ammonia, uric acid
and creatinine
b.Inorganic solutes: sodium, potassium,
chloride, sulfate, magnesium & phosphorus
B.Common Assessment Findings
I.Urgency- strong desire to void my be caused by
inflammations or infections in the bladder or urethra
II.Dysuria- painful or difficult voiding I
II.Frequency - voiding that occurs more than usual
when compared with the person's regular pattern or
the generally accepted norm of voiding once every 3
to 6 hours
IV.Hesitancy- undue delay and difficulty in initiating
voiding
V.Polyuria- a large volume of urine or output voided
at any given time
VI.Oliguria- a small volume of urine or output
between 100 to 500 mL/24 hr
 VII.Nocturnal- excessive urination at night
interrupting sleep
VIII.Hematuria- RBCs in the urine
URINARY CATHETERIZATION
Is the introduction of a catheter through the urethra into the
bladder for the purpose of withdrawing urine?
A. Purposes
I.To relieve urinary retention
II.To obtain a sterile urine specimen from a woman
III.To measure the amount of residual urine in the
bladder 36
IV.To obtain a urine specimen when a specimen
cannot secure satisfactory by other means
V.To empty bladder before and during surgery and
before certain diagnostic examinations
C.Preparation of the Patient
I.Adequate exploration
II.Position- dorsal recumbent for the female and
supine for the male using a firm mattress or treatment
table, Sim's or lateral position can be an alternate for
the female patient
III.Provision for privacy
D.Retention or Indwelling Catheter (Foley)- A catheter to
remain in place for the following purposes:
I.The gradual decompression of an over distended
bladder
II.For intermittent bladder drainage
III.For continuous bladder drainage
An indwelling catheter has a balloon which is inflated
after the catheter is inserted into the bladder. Because
the inflated balloon is larger than the opening to the
urethra, the catheter is retained in the bladder.
F.Caring for the Patient with an Indwelling Catheter
MEETING BOWEL ELIMINATION NEEDS
A.Factors that influence Bowel Elimination
I.Age
II.Diet
III.Position
IV.Pregnancy
V.Fluid Intake
VI.Activity
VII.Psychological
VIII.Personal Habits
IX.Pain
X.Medications
XI.Surgery/Anesthesia
B.Characteristics of Normal Stool
I.Color- varies from light to dark brown foods &
medications may affect color
II.Odor- aromatic, affected by ingested food and
person's bacterial flora
III.Consistency- formed, soft, semi-solid; moist
IV.Frequency- varies with diet (about 100 to 400
g/day)
V.Constituents- small amount of undigested
roughage, sloughed dead bacteria and epithelial cells,
fat, protein, dried constituents of digestive juices (bile
pigments); inorganic matter (calcium, phosphates)
C.Common Bowel Elimination Problems
I.Constipation- abnormal frequency of defecation
and abnormal hardening of stools
II.Impaction- accumulated mass of dry feces that
cannot be expelled
III.Diarrhea- increased frequency of bowel
movements (more than 3 times a day) as well as
liquid consistency and increased amount;
accompanied by urgency, discomfort and possibly
incontinence
IV.Incontinence- involuntary elimination of feces
V.Flatulence- expulsion of gas from the rectum
VI.Hemorrhoids- dilated portions of veins in the
anal canal causing itching and pain and bright red
bleeding upon defecation.
TYPES OF ENEMAS
A.Cleansing Enemas:Stimulate peristalsis through
irrigation of colon and rectum and by distention
I.Soap Suds: Mild soap solutions stimulate
and irritate intestinal mucosa. Dilute 5 ml of
castile soap in 1000 ml of water
II.Tap water: Give caution o infants or to
adults with altered cardiac and renal reserve
III.Saline: For normal saline enemas, use
smaller volume of solution
IV.Prepackaged disposable enema (Fleet):
Approximately 125 cc, tip is pre- lubricate
and does not require further preparation
B.Oil-Retention Enemas:Lubricates the rectum and
colon; the feces absorb the oil and become softer and
easier to pass
C.Carminative Enema: Provides relief from
gaseous distention
D.Astringent Enema:Contracts tissue to control
bleeding
NASOGASTRIC and INTESTINAL TUBES
A.Nasogastric Tubes
I.Levin Tube- single lumen
a.Suctioning gastric contents
b.Administering tube feedings
II.Salem Sump Tube- double lumen (smaller blue
lumen vents the tube & prevents suction on the
gastric mucosa, maintains intermittent suction
regardless of suction source)
a.Suctioning gastric contents
b.Maintaining gastric decompression
Measure ph of aspirate
fluid 40
Characteristics of nasogastric drainage:
Normally is greenish-yellowish, with strands of
mucous
Coffee-ground drainage - old blood that has been
broken down in the stomach
Bright red blood - bleeding from the esophagus, the
stomach or swallowed from the lungs
Foul-smelling (fecal odor) - occurs with reverse
peristalsis in bowel obstruction; increase in amount
of drainage with obstruction
B.Intestinal Tubes- provide intestinal decompression
proximal to a bowel obstruction. Prevent/decrease intestinal
distention. Placement of a tube containing a mercury weight
and allowing normal peristalsis to propel tube through the
stomach into the intestine to the point of obstruction where
decompression will occur
I.Types of Intestinal Tubes
a.Cantor and Harris Tubes
i.Approximately 6-10 feet long
ii.Single lumen
iii.Mercury placed in rubber bag
prior to tube insertion
b.Miller-Abbot Tubes
i.Approximately 10 feet long
ii.Double lumen
iii.One lumen utilized for aspiration
of intestinal contents
iv.Second lumen utilized to instill
mercury into the rubber bag after
the tube has been inserted into the
stomach