Chapter 27: Nutrition
What Are the Main Points in This Chapter?
-Reliable guidelines for designing a nutritious diet include the Dietary Reference Intakes (DRIs), the USDA Dietary Guidelines, and the nutrition facts panel found on packaged foods in the United States. -ChooseMyPlate is a food guide that illustrates healthful dietary choices. It stresses six concepts for healthy eating: activity, moderation, personalization, proportionality, variety, and gradual improvement. -Energy nutrients are carbohydrates, proteins, and fats (lipids). Other important nutrients are water and the micronutrients: fat-soluble vitamins, water-soluble vitamins, and minerals. -Carbohydrates include simple sugars called monosaccharides and disaccharides and complex carbohydrates called polysaccharides. -Glucose, a monosaccharide, is the primary source of energy for the brain, as well as for the body during moderate-to-intense physical activity. -Proteins are made up of amino acids and are required for cell and tissue growth, maintenance, and repair. They also act as buffers in acid-base balance. Proteins are an energy source. -Lipids, including fats and oils, are classified as glycerides, sterols, and phospholipids. They are essential components of cells, fuel the body at rest and during light activity, aid in absorption of fat-soluble vitamins, and promote a sense of satiety when eaten. Low-density lipoproteins (LDLs) are the "bad" cholesterol. High-density lipoproteins (HDLs) are the "good" cholesterol. -Saturated fats and trans-fats are less healthful lipid choices than mono- and polyunsaturated fats. -Saturated fats and trans-fats raise LDL cholesterol levels in the blood. -The essential fatty acids omega-6 and omega-3 help protect against heart disease when they replace trans-fats in the diet. They are found mainly in vegetable oils, nuts, seeds, and fatty fish. -Nutrients must be consumed at least at a minimal level in order to meet the body's physiological needs. This level is called Dietary Reference Intake (DRI). -The fat-soluble vitamins are A, D, E, and K. Water-soluble vitamins are C and the B-complex vitamins. -Minerals (e.g., calcium, iron, magnesium) are important for transmitting nerve impulses, regulating fluid balance, strengthening bones, and producing energy. -The basal metabolic rate (BMR) is a measure of the energy required by resting tissue to maintain basic function. -Factors influencing a client's nutritional status include developmental stage, pregnancy and lactation, education, lifestyle choices, vegetarianism, dieting for weight loss, culture, religion, disease processes, functional limitations, economic factors, and modified or special diets. -Many people must follow a modified diet to assist in managing their illness. In addition, all inpatients must have a diet prescribed by their primary care provider. -When examining an individual's nutritional balance, it is important to screen for nutritional problems. When risk factors are present, thoroughly assess nutritional history, physical findings, anthropometric measurements, imaging techniques, and biochemical values. -A food record is the most accurate method of obtaining data about a client's actual food intake. -The body mass index (BMI), skinfold measurements, and body part circumferences are estimates of body composition. -Laboratory or biochemical indicators of nutritional status include blood glucose and serum protein levels or indices such as albumin, urea, and hemoglobin. -Vitamin and mineral supplementation may be appropriate for some people, but they do not replace the need for a balanced diet. -Government programs provide some assistance for clients who cannot afford to buy food. -Nutritional requirements of older adults are similar to those for all adults, with a slight reduction in the need for calories, and the more likely need for nutrient supplementation. Nutritional problems are also similar, but the incidence is higher among older adults. -Nurses can help support nutrition for patients who have Self-Care Deficits or Impaired Swallowing by assisting patients with meals and providing swallowing therapy. -Nutritional imbalance can range from either inadequate or excessive amounts of a single nutrient relative to overall caloric intake. -Obesity is a major problem in the United States, both in children and adults. -Interventions for underweight/undernutrition include measures to improve the patient's appetite, assisting with meals, and providing enteral and parenteral nutrition. -Nasogastric tubes are inserted to lavage the stomach; collect a specimen of the stomach contents, or prevent nausea, vomiting, and gastric distention. They are also placed to facilitate enteral feeding. -The most accurate way to check enteral tube placement is by radiographic (x-ray) verification. To check enteral tube placement at the bedside, you could also use a combination of techniques: aspirate stomach contents to observe color and measure the pH (normally 1 to 5.5 for stomach contents); the "whoosh test"; serial observations for respiratory distress, residual volume, length of tube extending outside the body; and capnometry. Do not rely on a single technique. -Potential complications associated with enteral feedings include aspiration, infection, diarrhea, and electrolyte imbalance. -Meticulous sterile technique when administering parenteral nutrition is critical because the solution is delivered into a large central vein; if infection occurs, sepsis is almost immediate.
Identify and describe the types of enteral nutrition tubes.
Answer: -A nasogastric (NG) tube terminates in the stomach. -A nasoenteric (NE) tube terminates in the small intestine. -A gastrostomy tube (G-tube), percutaneous gastrostomy tube (PEG) tube, jejunostomy tube, or G-button is inserted into the stomach or jejunum, respectively, through the skin and abdominal wall. -A percutaneous jejunostomy (PEJ) tube is inserted into the stomach through the abdominal wall and advanced into the jejunum.
The head of the bed of a patient who is receiving enteral feedings is elevated to 45 degrees. Which complication associated with enteral feedings does this intervention help prevent? 1) Aspiration 2) Diarrhea 3) Infection 4) Electrolyte imbalance
Answer: 1) Aspiration Rationale: The head of the bed (HOB) should be elevated to at least 30 to 45 degrees during enteral feeding administration to prevent regurgitation and aspiration. Maintaining an elevated HOB aids in digestion by helping the transit of feeding through the GI tract. Diarrhea, infection, and electrolyte imbalance are all complications associated with enteral feeding, but cannot be prevented by elevating the head of the bed.
Match the following terms and definitions: Terms 1. Failure to thrive 2. Carbohydrates 3. BMR 4. Micronutrient 5. Bulimia 6. Low-density lipoproteins 7. Vegan 8. Full liquid diet food Definitions A. Increase the risk for cardiovascular disease B. Cycle of binging and purging C. Provide nearly all the energy for the brain D. Affects institutionalized elders E. Tomato soup F. Only foods of plant origin G. Energy required by resting tissue H. Fat-soluble vitamins
Answer: 1, D 2, C 3, G 4, H 5, B 6, A 7, F 8, E
Patients may be deficient in which vitamin during the winter months? 1) A 2) D 3) E 4) K
Answer: 2) D Rationale: The body can synthesize vitamin D from a cholesterol compound in the skin when exposed to adequate sunlight. People at risk for vitamin D deficiency are those who spend little time outdoors; older people; and people who live in an institution (e.g., a nursing home). The deficiency can also occur in the winter at northern and southern latitudes, in people who keep their bodies covered (e.g., traditional Muslim women), and in those who use sunscreen. Also, because breast milk contains only small amounts of vitamin D, breastfed infants who are not exposed to enough sunlight are at risk of the deficiency and rickets. There is no seasonal tie to deficiencies in the other fat-soluble vitamins, A, E, and K.
Which action should the nurse take after administering a dose of medication through a percutaneous endoscopic gastrostomy (PEG) tube? 1) Continue the enteral feeding. 2) Flush the tube with 30 mL of water. 3) Wait 2 hours before resuming the feeding. 4) Check residual volume.
Answer: 2) Flush the tube with 30 mL of water. Rationale: The nurse should flush the PEG tube with 30 mL of water before and after administering a medication through the tube. The tube feeding should be held for 1 hour before and 1 hour after administering some medications, such as phenytoin (Dilantin). It is not necessary to hold the feeding for 2 hours. Residual volume should not be checked immediately after administering medications.
During parenteral nutrition administration, a nurse breaks sterile technique. For which complication does this place the patient at risk? 1) Air embolism 2) Sepsis 3) Thrombosis 4) Pneumothorax
Answer: 2) Sepsis Rationale: A break in sterile technique places the patient at risk for sepsis. Air embolism can occur when the intravenous tubing is disconnected from the catheter hub. Thrombosis occurs as a result of irritation of the vein from the central venous catheter. Pneumothorax is a complication of central venous catheter insertion.
During an admission assessment, the patient reports that he takes vitamin E supplements twice a day. The nurse should explain that taking vitamin E supplements twice a day 1) ensures healthy vision. 2) can lead to toxicity. 3) strengthens the immune system. 4) helps maintain body tissues.
Answer: 2) can lead to toxicity. Rationale: Vitamins are critical in building and maintaining body tissues, supporting the immune system to fight infection, and ensuring healthy vision. However when fat-soluble vitamins, such as vitamins A, D, E, and K, are supplemented in large doses, toxicity may occur.
Identify three nutritional risk factors.
Answer: Answers may include any of the following nutritional risk factors: -Inappropriate food intake -Poverty -Social isolation -Dependency or disability -Acute or chronic health conditions -Chronic medication use, including recreational drugs -Aging -Chronic alcohol abuse
An adult patient who is receiving a continuous enteral feeding at 80 ml/hr has a residual volume of 120 ml 6 hours after the last check. How should the nurse proceed? 1) Continue administering the enteral feeding. 2) Hold the enteral feeding and notify the provider immediately. 3) Hold the feeding for 1 hour, and recheck. 4) Hold the feeding for 2 hours, then resume the feeding.
Answer: 3) Hold the feeding for 1 hour, and recheck Rationale: The nurse should check enteral feeding residual every 4 to 6 hours. If residual is 10% greater than the formula flow rate for 1 hour (or alternatively, a total of 150 mL), the nurse should hold the feeding for 1 hour and recheck. If residual is still not within normal limits, she should notify the provider.
Which food provides the only animal source of carbohydrate? 1) Beef 2) Eggs 3) Milk 4) Chicken
Answer: 3) Milk Rationale: The only animal source of carbohydrate is lactose, the sugar contained in milk. Beef, eggs, and chicken do not provide a source of carbohydrate.
The nurse is caring for a patient who has multiple fractures from a skiing accident. To best promote bone growth, the nurse should encourage the patient to eat foods high in calcium and vitamin D. Which food selection by the client indicates an understanding of foods that are high in calcium? 1) Orange juice from concentrate 2) Cottage cheese 3) Tofu 4) Brie cheese
Answer: 3) Tofu Rationale: Firm tofu (½ cup serving) contains approximately 227 mg of calcium. This is an excellent dietary source of calcium. A ½ cup serving of orange juice from concentrate contains 27 mg of calcium. Brie cheese (1 oz) contains only 50 mg of calcium. A ½ cup serving of cottage cheese contains only 65 mg of calcium.
Which organ relies almost exclusively on glucose for energy? 1) Liver 2) Heart 3) Pancreas 4) Brain
Answer: 4) Brain Rationale: The brain relies almost exclusively on glucose for energy. The heart and liver do not. The pancreas produces insulin for glucose utilization but does not use glucose.
A patient has anemia. An appropriate goal for that the patient would be for him to increase his intake of which nutrient? 1) Calcium 2) Magnesium 3) Potassium 4) Iron
Answer: 4) Iron Rationale: Iron deficiency causes anemia; therefore, the nurse should encourage the patient with anemia to increase his intake of iron. Increasing calcium intake helps prevent osteoporosis. Magnesium supplementation may decrease the risk of hypertension and coronary artery disease in women. Potassium is essential for muscle contraction, acid-base balance, and blood pressure control.
The nurse is preparing an enteral feeding for a patient who will be receiving intermittent feedings via nasogastric tube for the first time. The patient is conscious. Which of the following is the priority intervention before administering this feeding? 1) Observe whether the patient can speak. 2) Inject air into the feeding tube while auscultating the stomach. 3) Aspirate stomach contents and measure residual volume. 4) Obtain an x-ray of the chest and abdomen.
Answer: 4) Obtain an x-ray of the chest and abdomen. Rationale: It is essential to verify that the NG tube is in the stomach and not the airway. The only reliable method among these four is to obtain an x-ray of the chest and abdomen. For subsequent feedings, however, it is not practical to obtain an x-ray each time, and presence of formula in the stomach complicates the pH readings. Therefore, the nurse should use a combination of bedside techniques, including observing appearance and measuring the amount of gastric residual volume, asking the patient to speak, and injecting air ("whoosh" test) while auscultating the stomach.
Imagine that you have just eaten a food consisting of 4 grams of protein, 18 grams of carbohydrate, and 1 gram of fat. What would your total kcal intake be?
Answer: 97 kcal total 4 g protein × 4 kcal/g = 16 kcal 18 g carbohydrate × 4 kcal/g = 72 kcal 1 g fat × 9 kcal/g = 9 kcal 16 + 72 + 9 = 97 kcal
What are the implications of an increased WHR?
Answer: A waist-to-hip ratio (WHR) evaluates obesity by looking at the amount of abdominal fat present. A high level of abdominal fat is associated with increased risk for hypertension, diabetes, hyperlipidemia, and cardiovascular disease. A WHR greater than 1.0 in men and greater than 0.8 in women indicates obesity.
According to the text calculations, which of the following patients is taking in the correct number of kcal to meet their total energy needs? Choose all that apply. A. Mr. Jones, who weighs 180 lb, is active, has a normal weight, and is taking in 3,240 kcal per day. B. Mrs. Sanchez, who weighs 220 lb, is sedentary, overweight, and taking in 1,000 kcal per day. C. Susan, who weighs 100 lb, is slightly underweight, plays soccer three times a week, and is taking in 1,500 kcal per day. D. Mr. Clark, who works a desk job, weighs 190 lb (a normal weight for his height), and is currently taking in 2,800 kcal per day.
Answer: A. Mr. Jones, who weighs 180 lb, is active, has a normal weight, and is taking in 3,240 kcal per day. Rationale: Although Mrs. Sanchez is overweight, her caloric intake may not enable her to meet her daily metabolic needs in terms of maintaining health. Susan's caloric intake is not enough to meet her active lifestyle, and Mr. Clark's caloric intake is too large given his sedentary job.
Which age group experiences a growth spurt second only to that of infants?
Answer: Adolescents
Identify at least 10 physical examination findings that would lead you to suspect nutritional problems.
Answer: Answers may include any of the following examination findings: -An increase in temperature -An elevated BP may be related to fluid volume excess; a low BP may be a sign of dehydration. Heart rate usually responds in an inverse fashion. -A BMI less than 18 or greater than 25 -An appearance of illness -Poor skin turgor -Poor wound healing -Constipation -Any areas of warmth or erythema require investigation -Red, swollen skin lesions, excessive bleeding and xerosis -Abnormal nail findings -Hair that grows slowly, is thin, or easily breaks -Irritation of the mouth, teeth, and gums -Facial paralysis or drooping of one side of the face -An enlarged thyroid gland -Bounding pulses or a weak, thready pulse -Edema -An abdomen that is scaphoid or concave, round to protuberant, or generally enlarged -Hyperactive or hypoactive bowel sounds -Thin extremities with excess skinfolds -Enlarged skinfold measurements -Joint swelling, deformities, or limitation in range of motion -Joint pain on palpation or with movement -Cognitive deficits or severe psychiatric disorders -Motor or sensory deficits -Confusion, weakness, or diminished reflexes
Identify five functions of adipose tissue (body fat).
Answer: Answers may include any of the following functions of body fat: Energy supply Thermal insulation Vital organ protection Nerve impulse transmission Tissue membrane structure Cell metabolism Essential precursor substances
Compare and contrast four nutritional screening approaches: cursory screening, subjective global assessment, Mini Nutritional Assessment, and Nutrition Screening Initiative.
Answer: Answers should include the following aspects of the nutritional screening approaches: -Cursory screening consists of evaluating height, weight, and BMI, coupled with a brief dietary history. More detailed screening is required when nutritional problems are suspected. -The subjective global assessment (SGA) method is completed by an experienced clinician who examines subjective and objective parts of a medical history and physical examination to evaluate a client's nutritional status. It may be used with any type of client. Success with this tool has been mixed because it is largely dependent on the experience of the clinician. -The Mini Nutritional Assessment (MNA) and Nutrition Screening Initiative (NSI) were developed primarily for use with elderly clients. -The MNA is a simple and quick method of identifying individuals with nutritional risk or with malnutrition. See ESG Figure 27-6 on DavisPlus. -The NSI addresses nutritional concerns associated with chronic diseases that are frequently seen in older adults. The NSI requires collection and evaluation of data in four areas: clinical, dietary, body composition, and biochemical.
Why is it sometimes a challenge to meet the nutritional needs of toddlers?
Answer: Answers will vary, but may include the following reasons: -Toddlers may assert their autonomy and attempt to control parents by refusing the foods offered. -Toddlers may take a long time to eat or refuse to eat at all. -Toddlers are beginning to form attitudes about food. -They are mobile and might be distracted during meal times.
Identify the patient with the greatest risk for developing protein-calorie malnutrition. A patient: A. who is HIV positive B. with a fractured leg and pelvis from trauma who is running a fever of 101.5°F (38.6°C) C. weighing 300 lb who has entered the hospital for cardiac bypass surgery D. who is of Hispanic heritage
Answer: B. A patient with a fractured leg and pelvis from trauma who is running a fever of 101.5°F (38.6°C). Rationale: The trauma patient with a fever could be developing a wound infection, which demands additional energy for healing. There is no information to indicate that the person with HIV is not eating well. An obese patient may malnourished after surgery, with the diet that is high in calories but low in nutrients, especially protein. Race alone (Hispanic) is not a risk factor for protein-calorie malnutrition.
Why is breast milk an ideal food source for infants?
Answer: Breast milk is the ideal nutrition for infants because it is species-specific and matched to basic nutritional requirements. It enhances the maturation of the infant's immune system and provides passive immunity against a number of infections. Breastfed infants also have a reduced exposure to foreign dietary antigens and are believed to have a reduced risk of subsequent allergies.
The nurse would suspect an alteration in a patient's nutritional status if she notes which of the following? A. Fasting serum blood glucose of 87 mg/dL B. BUN of 16 mg/dL C. Serum albumin level of 1.8 g/dL D. Total white blood cell count of 6,000/mm3
Answer: C. Serum albumin level of 1.8 g/dL Rationale: All of the other results are within normal limits.
The nurse is caring for a patient who has multiple fractures from a skiing accident. To best facilitate bone growth, the nurse should encourage the patient to eat foods high in calcium and vitamin D. Which food selection by the client indicates an understanding of foods that are high in calcium? A. Orange juice B. Peanut butter C. Tofu D. Baked flounder
Answer: C. Tofu Rationale: One cup of orange juice contains 27 mg calcium. One tablespoon of peanut butter contains only 5 mg of calcium. One-half cup of firm tofu contains approximately 227 mg of calcium. Three ounces of baked flounder contains only 13 mg of calcium.
What is the body's most usable energy source?
Answer: Carbohydrates, especially glucose, provide the most usable energy.
List the current USDA dietary guidelines for Americans.
Answer: Current dietary guidelines are as follows: Consume a variety of nutrient-rich foods daily. Adopt a balanced eating pattern (e.g., the USDA Food Guide) to meet recommended intakes. Limit the intake of saturated fats, trans fats, and cholesterol. Keep fat intake below 20% to 35% of total calories. Most fats should come from foods such as fish, nuts, and vegetable oils. Limit your intake of added sugars, salt, and alcohol. Achieve and maintain a healthy weight. Be physically active each day. Balance energy (kcal) intake with an increase or decrease in activity. Choose a variety of fruits and vegetables each day. Choose fiber-rich fruit, vegetables, and whole grains often. At least half the grains should come from whole grains. Cook, chill, and store foods to keep them safe from microorganisms. Clean hands, food contact surfaces, and fruits and vegetables. Do not wash or rinse meat and poultry. (Also see Chapter 24 in the textbook for food safety.)
Which of the following is/are not an anthropometric measurement of body composition? A. Using calipers to measure the skinfold on the triceps B. Obtaining the waist-to-hip ratio C. Hydrodensitometry D. 24-hour food recall
Answer: D. 24-hour food recall Rationale: Asking the client to recall his food intake for the past 24 hours is an example of obtaining subjective data.
What are the DRIs?
Answer: DRIs are "dietary reference intakes" established by the National Academy of Sciences in a collaborative effort of the United States and Canada to promote the consumption of healthful nutrient levels by all Americans. These guidelines include DRIs for vitamins and minerals, protein, and total energy that are thought to meet the needs of 98% of individuals in a group. For carbohydrates and lipids, the acceptable macronutrient distribution range (AMDR) is used. The DRIs are actually a revision of the older recommended dietary allowances (RDAs). Because the revision is not yet complete for all nutrients, the tables in Chapter 27 include both RDAs and DRIs.
What are the likely causes of hyperglycemia?
Answer: Elevated glucose levels may develop from excessive carbohydrate intake or emotional or physical stressors. High dose glucocorticoid therapy (steroids) can cause hyperglycermia. Although it may not have been stated in the chapter, elevated glucose levels can also occur because of insufficient physical activity or insufficient diabetes medication.
When is enteral nutrition the preferred alternative feeding?
Answer: Enteral nutrition is the preferred method of feeding for a patient with a functioning intestinal tract who is unable to meet his nutritional needs through oral intake.
What factors would lead to poor wound healing?
Answer: Factors contributing to diminished healing are insufficient intake of protein, vitamin C, and zinc.
The most important assessment for the nurse to complete when evaluating a patient's nutritional status is lab results.
Answer: False Rationale: Lab results reflective of nutritional status may be skewed by many factors, including hydration status, medications, organ function, and so on.
The RN may delegate the collection of nutritional history information to the NAP.
Answer: False Rationale: The nurse aide may obtain height, weight, and document intake and output. The nurse must collect information related to the nutrition history.
Why are energy (kcal) requirements less for older adults?
Answer: For older adults, lean body mass is lost and appetite, physical activity, and BMR decrease, resulting in slightly reduced energy requirements.
What is the challenge in meeting the nutritional needs of school-age children?
Answer: For school-age children, parental control over food intake declines as the child eats lunch at school and advertising influences his food choices. The child may buy junk food with his lunch money. Even if the child brings lunch from home, he may trade his food or not eat lunch at all.
Why are an infant's nutritional needs per unit of body weight greater than at any other period of development?
Answer: Infants' nutritional needs are greatest because the most rapid growth occurs during the first year of life. Birth weight triples during the first year and length increases 50%.
What distinguishes a major mineral from a trace mineral?
Answer: Major minerals are those needed in amounts of 100 mg or greater per day. Trace minerals are essential, but needed in lower amounts.
After interviewing Mr. Schwartz, you estimate his average caloric intake to be approximately 3,000 kcal per day. Determine whether his kcal intake is sufficient or insufficient to maintain his present activity level.
Answer: Mr. Schwartz is 69 inches tall and weighs 245 lb, so he is overweight. A general evaluation of the data shows that the BMR for Mr. Schwartz is 2,674 kcal per day—this is the energy required to maintain his weight. Because his activity level is light, he will need a limited number of additional kcal to maintain this weight. If he consumes 3,000 kcal per day, he should have more than enough kcal to maintain his activity level and weight; he may even gain weight on this level of energy (kcal) intake. To use the more specific energy requirements presented in Table 27-7 in the textbook, a sedentary person who is overweight requires 9 to 11 kcal per pound of body weight per day. Using the midrange, 10, Mr. Schwartz could maintain his present weight with a daily intake of 10 kcal/lb × 245 lb—2,450 kcal per day. Go to Chapter 26, Table 27-7, Energy Needs Based on Weight and Activity, in Volume 1 of the textbook.
You have already calculated the expected BMR for Mr. Schwartz (Meet Your Patients, in Volume 1 of your textbook) for a 24-hour period: If Mr. Schwartz describes himself as working at a desk 8 to 10 hours per day, lawn mowing manually every other week during the summer, and playing an occasional game of golf, how would you classify his general activity level?
Answer: Mr. Schwartz spends a considerable amount of time in sedentary activity. His work at the desk would be considered light activity. His outside activities are limited and extend only to the light-to-moderate activity level.
List at least three nutrients that may be more difficult to supply through a vegetarian diet.
Answer: Nutrients more difficult to supply with a vegetarian diet are vitamin B12, protein, calcium, iron, zinc, and vitamin D. Vegans must supplement these nutrients and calcium or consume foods fortified with them.
When selecting a program for weight loss, what factors should a person consider?
Answer: One should consider whether a diet is nutritionally and scientifically sound. For example, is it recommended by a respected organization, or is it a trendy diet without sound nutrition? Moderate calorie-restriction diets such as the American Heart Association diet describe food selection and preparation tips and other behavior modifications that can lead to slow, sustained weight loss, promote a diet that includes a variety of food choices and a balance of nutrients, and encourage physical activity as a cornerstone of weight loss. In contrast, fad diets often promise quick and dramatic weight loss, limit the range of foods from which the dieter can select, often recommend consuming supplements and/or specialized packaged meals, or include no practical strategies that help dieters permanently change eating and activity patterns.
Why is it important to identify the serum albumin level?
Answer: Serum albumin levels are useful in identifying chronic nutritional deficiency and malnutrition.
Describe the effects on nutrition of (1) smoking and (2) heavy alcohol use.
Answer: The effects on nutrition are as follows: -Smoking. Smokers use vitamin C faster than do nonsmokers. Even children exposed to secondhand smoke tend to have lower plasma levels of ascorbic acid than those who are unexposed. If the person cannot quit smoking, a vitamin C supplement may help compensate. -Alcohol. A 12-oz beer contains 150 kcal; a juice-based cocktail contains about 160 kcal. Such drinks can add many unnecessary calories to the regular diet. In addition, alcohol significantly decreases the rate of fat metabolism, contributing to obesity. Excessive alcohol use interferes with adequate nutrition by (a) replacing the food in the person's diet, (b) depressing the appetite, (c) decreasing the absorption of nutrients by its toxic effects on intestinal mucosa, and (d) impairing the storage of nutrients. People who use alcohol heavily will need multivitamin supplements, especially rich in B vitamins and folic acid.
What is the most accurate type of food diary?
Answer: The food record is the most accurate food diary. From the detailed information collected, you can analyze the total energy (kcal) and nutrient content for the recorded period.
What are the most reliable locations for skinfold measurement?
Answer: The most reliable locations for skinfold measurement are as follows: -Triceps for children and women -Subscapular area in men
Which nutrient's primary function is growth and repair of tissue?
Answer: The primary function of dietary protein is the growth and repair of body tissues. Secondarily, proteins attract water in the bloodstream and contribute to regulating fluid balance in the body. They function as buffers for regulating acid-base balance. Proteins are a secondary energy source. They are also involved in immune defense.
What percentage of your kcal is from carbohydrates? Protein? Fat?
Answer: To calculate these percentages, divide the kcal for each nutrient by the total kcal in the food (97). Carbohydrates. 72 divided by 97 = 0.74 = 74% Protein. 16 divided by 97 = 0.16 = 16% Fat. 9 divided by 97 = 0.09 = 9%
Why should you encourage clients from various cultures to follow their traditional diets?
Answer: Traditional diets of many cultures are healthy and respect family or cultural traditions. Adaptations made to these diets may have compromised nutritional quality.
Sending the patient for an x-ray of the chest and abdomen is the most reliable way to ensure that a nasogastric feeding tube has been placed correctly.
Answer: True
List four tube placement verification techniques.
Answer: Tube placement can be verified by the following techniques: -Radiography, which is the most reliable method -Aspiration of contents and inspection for color -Measuring the pH of the aspirate -Injecting air into the tube while auscultating the stomach ("whoosh test") -Serial observations and assessments. These include observing for respiratory distress, inspecting aspirate for color and consistency, measuring the residual volume of the aspirate, and measuring the tube that extends outside of the body. -When observing for respiratory distress you might note difficulty breathing, coughing, choking, or cyanosis. Absence of these symptoms is not a reliable indicator of correct placement, but the presence of these symptoms is a strong indicator that the tube is in the respiratory tract. -Inspecting the aspirate may help distinguish placement through observation of a brown, white, or greenish color and curdled consistency for gastric contents and a more yellow (bile) color with no curdling for intestinal contents. -When evaluating residual volumes, note that gastric volumes will generally be larger than intestinal or esophageal volumes. -If the tube is not well secured, it may migrate either up or down, and so a consistent measurement of the external tube may also help verify tube placement (Peter & Gill, 2009). -Other bedside verification methods. *Capnometry and additional tests of gastric juices may also serve as measures to ensure that the tube is correctly placed. ***Capnometry tests for carbon dioxide (CO2). The presence of CO2 with the placement of an NG or NE tube would indicate that the tube has been placed in the respiratory tract. This method is best used at the time of tube placement. For a photo of a CO2 detector Go to Chapter 27, Clinical Insight.27-5, Checking Feeding Tube Placement. Measuring bilirubin, trypsin, and pepsin in the aspirate provides a positive determination that the tube is placed in the stomach. Test devices for these three gastric components may not be commercially available (Elpern, Killeen, Talla, Perez, & Gurka, 2007; Peter & Gill, 2009). Copy
Identify at least four functions of water.
Answer: Water has the following functions: -Solvent. Water is the basic solvent for the body's chemical processes, assisting in the regulation of nerve impulses and muscle contractions. -Transport. Circulating as blood, water serves as a medium for transporting oxygen, nutrients, and metabolic wastes. -Body structure and form. Water "fills in the spaces" in body tissues (e.g., in muscle) providing structure and form to the body. -Temperature. Water helps maintain body temperature and creates the necessary environment and temperature for cellular metabolism to occur. When body temperature rises, evaporation of sweat helps cool the body.
Which type of vitamin requires daily consumption to maintain appropriate levels?
Answer: Water-soluble vitamins require daily intake because they are eliminated in the urine with little storage in the body.
