Nursing - Nutrition
Amino acids consist of:
- Hydrogen - Oxygen - Carbon - Nitrogen
Obesity can be a precursor of:
- Hyperlipidemia - Sleep apnea - Cholelithiasis (gallstones) - Orthopedic problems - Hypertension - Diabetes In addition, children who are obese can have psychosocial difficulties, particularly in the areas of self-esteem and body image, and are more likely to be teased by others
Factors that affect metabolism include:
- Illness - Pregnancy - Lactation - Activity level
Vitamin D supplements are important for:
- Improving strength and balance - Strengthening bone health - Preventing bone fractures and falls
One pint or 500 mL of fluid equals:
1 lb (0.45 kg) For example, for a patient with renal failure, a weight increase of 2 lbs (0.90 kg) in 24 hours is significant because it usually indicates that the patient has retained 1 L (1000 mL) of fluid
Take a dietary history and evaluate the child's eating habits and patterns. The child or parents (or both) should keep a food diary for:
1 week The diary should include the time, place, and type and amount of food eaten and the reason for eating
Food labels also state four marker nutrients:
1. Calcium 2. Iron 3. Vitamin A 4. Vitamin C Generally, if these micronutrients are included in adequate amounts from foods naturally high in them, the other needed micronutrients will also be obtained
Six Major Minerals
1. Calcium 2. Phosphorus 3. Magnesium 4. Sodium 5. Potassium 6. Chloride
Deficiency occurs when fat intake falls below:
10% of daily nutrition
The average birth weight of an American baby is:
7-7.5 lbs (3.2-3.4 kg)
Fat is stored as:
Adipose tissue
During the rehabilitation period patients experience longer:
Adjustment periods regarding new dietary restrictions
The onset of eating disorders such as anorexia nervosa or bulimia nervosa often occurs during:
Adolescence
Anorexia nervosa is most common among:
Adolescent females Is seen in both genders and can occur in childhood and adulthood
The mixture becomes increasingly:
Alkaline Inhibiting the action of the gastric enzymes and promoting the action of the duodenal secretions
Breast milk contains:
All the essential nutrients Has immunologic benefits that protect the infant from acute and chronic disease
Selenium is a trace element that also has:
Antioxidant properties
Unfortunately, many hospitalized or aging patients require:
Assistance because they have missing teeth or dentures or because their dentures no longer fit Nurses can make note of these concerns early in treatment so that altered diets may be ordered or oral health services can be provided
A thick layer of mucus protects the lining of the stomach from:
Autodigestion
Nutritional health status is also an issue of:
Balance or imbalance Poor nutritional status negatively impacts health, and poor health can negatively impact nutritional status
The quality of nutrition during pregnancy is important, and food intake in the first trimester includes:
Balanced parts of essential nutrients with emphasis on quality
The most common surgical intervention affecting nutrition is:
Bariatric surgery
With lowered vitamin D status, what is impacted?
Bone health is impacted because vitamin D is required to absorb calcium
Simple carbohydrates is the classification for:
Both monosaccharides and disaccharides
What is important for healthy bone growth?
Calcium and phosphorus
The diet of pregnant adolescents is often deficient in:
Calcium, iron, and vitamins A and C
Polysaccharides such as glycogen make up:
Carbohydrate units too (i.e., complex carbohydrates)
Fatty acids are composed of chains of:
Carbon and hydrogen atoms with an acid group on one end of the chain and a methyl group at the other
Negative nitrogen balance is present when:
Catabolic states exist
Iron
Consequences of Deficiencies: - Anemia - Fatigue - Poor growth Consequences of Toxicities: - Hemochromatosis (genetic) with liver, pancreatic, and cardiac damage
Copper
Consequences of Deficiencies: - Anemia - Skin lesions - Neurologic disease - Bone fragility Consequences of Toxicities: - Found in Wilson's disease - Neuron and liver cell damage
Starvation-Related Malnutrition
Describes conditions such as anorexia nervosa
Ideally, indirect calorimetry is used to:
Determine energy needs so overfeeding can be avoided
Chronic diseases or increased metabolic requirements are risk factors for:
Development of nutritional problems Infants and older adults are at greatest risk
Calculate BMI by:
Dividing a patient's weight in kilograms by height in meters squared: weight (kg) divided by height2 (m2) For example, a patient who weighs 165 lbs (75 kg) and is 1.8 m (5 feet 9 inches) tall has a BMI of 23.15 (75 ÷ 1.82 = 23.15)
When the *kilocalories (kcal)* of the food we eat meets our energy requirements, our weight:
Does not change
The inability to break down fiber means that it:
Does not contribute calories to the diet
Glycogen, synthesized from glucose, provides:
Energy during brief periods of fasting (e.g., during sleep)
Gather information about the patient's illness/activity level to determine:
Energy needs and compare food intake
School-age children, 6 to 12 years old, grow at a slower and steadier rate, with a gradual decline in:
Energy requirements per unit of body weight
Pinocytosis
Engulfing of large molecules of nutrients by the absorbing cell when the molecule attaches to the absorbing cell membrane
Occasionally, individuals may experience nutritional disorders because of:
Erroneous understandings or perceptions about foods
The major form of body reserve energy is:
Fat
Vitamin classifications include:
Fat soluble or water soluble
All body cells except red blood cells and neurons oxidize:
Fatty acids into *ketones* for energy when dietary carbohydrates (glucose) are not adequate
Frequently patients with dysphagia become frustrated with:
Frustrated with eating and show changes in skinfold thickness and albumin
Carbohydrates serve as the main source of:
Fuel (glucose) for the brain, skeletal muscles during exercise, erythrocyte and leukocyte production, and cell function of the renal medulla
The pyloric glands secrete:
Gastrin
Vitamin D deficiency is more frequently found among:
Hispanics and Americans of African heritage than those of European heritage
After feeding, the response time for changes in these proteins ranges from:
Hours to weeks
Individuals differ in:
How nutrients are assimilated, metabolized, stored, and excreted These differences are often significant
Lifestyle and Patterns of Eating (Individual Risk Factor)
How one chooses foods, shops, plans, and prepares meals ultimately affects his or her nutritional status
Triglyceride levels generally reflect:
Hyperinsulinemia Although an individual with newly diagnosed type 1 diabetes may have temporary elevations of triglycerides
Screening a patient is a quick method of:
Identifying malnutrition or risk of malnutrition using simple tools
Electrolytes can become imbalanced with:
Inadequate dietary intake or many other conditions such as renal disease, liver disease, and diabetes
What is typically the first semisolid food to be introduced?
Iron-fortified cereals
Water
Is critical because cell function depends on a fluid environment
Catabolism
Is the breakdown of biochemical substances into simpler substances
The *tolerable upper intake level (UL)* is the highest level that:
Likely poses no risk of adverse health events It is not a recommended level of intake
A sedentary person or one who has sarcopenia or cardiovascular disease needs:
Limited time intervals of exercise more frequently
Although unused formula must be discarded after 24 hours, the tubes can be maintained:
Longer with strict infection control procedures according to facility protocols
Poor nutrition during pregnancy causes:
Low birth weight in infants and decreases chances of survival
Ileum
Lower section of the small intestine Site of fat and fat-soluble vitamin absorption
Fatty acids are absorbed in the:
Lymphatic circulatory systems through lacteal ducts at the center of each microvilli in the small intestine
Because height and weight are the best indicators of growth, these parameters are:
Measured, plotted on growth charts, and monitored over time at each well visit
Digestion of food is the:
Mechanical breakdown that results from chewing, churning, and mixing with fluid and chemical reactions in which food reduces to its simplest form
The inclusion of the minimum number of servings in MyPlate will:
Meet the DRI micronutrient and macronutrient needs for general health needs
Girls need a continuous source of iron to replace:
Menstrual losses
A damaged liver will also be unable to:
Metabolize and excrete drugs properly Altering nutrient absorption and utilization even further
Jejunum
Middle section of the small intestine Primary site for absorbing water-soluble vitamins and proteins
Digestion begins in the:
Mouth Where chewing mechanically breaks down food
Protein is stored in:
Muscle mass
Difficulty swallowing (dysphagia) is common in:
Neurologic conditions, especially after a stroke Not all patients require altered food consistency, but patients should be seated as upright as possible to prevent aspiration
Ingestion of proteins maintains:
Nitrogen balance
Physical activity helps to prevent:
Obesity
Milk continues to be an important food for older women and men who need adequate calcium to protect against:
Osteoporosis
Parenteral Nutrition (Collaborative Intervention)
Parenteral nutrition is used to provide either total or supplemental nutrition intravenously
These intravenous feedings are generally used for:
Patients who have intestinal failure and cannot be fed orally or by enteral feeding
Use food questionnaires to establish:
Patterns over time
Extra caution should be used in:
Pediatric and neonatal units
HCl turns pepsinogen into:
Pepsin, a protein-splitting enzyme
Catabolism occurs during:
Physiological states of *negative nitrogen balance* Starvation is an example of catabolism when wasting of body tissues occur
Toddlers exhibit strong food preferences and become:
Picky eaters
Proteins
Provide a source of energy (4 kcal/g)
Pre-albumin reflects:
Recent dietary protein intake Low pre-albumin is generally associated with nutritional intake as opposed to other conditions
Dysphagia
Refers to difficulty swallowing
Low albumin levels predict:
Severity of illness and are also predictors of mortality in adults older than age 60 years
General Appearance
Signs of Good Nutrition: - Alert - Responsive Signs of Poor Nutrition: - Listless - Apathetic - Cachetic
Mouth and Oral Membranes
Signs of Good Nutrition: - Reddish-pink mucous membranes in oral cavity Signs of Poor Nutrition: - Swollen, boggy oral mucous membranes
Hair
Signs of Good Nutrition: - Shiny, lustrous - Firm - Not easily plucked - Healthy scalp Signs of Poor Nutrition: - Stringy - Dull - Brittle - Dry - Thin - Sparse - Depigmented - Easily plucked
Infants with allergies or intolerant to cow's milk should consume:
Soy protein-based formulas instead
When intake of food exceeds expenditure, the excess is:
Stored as fat
The U.S. Food and Drug Administration (FDA) created daily values for food labels in response to:
The 1990 Nutrition Labeling and Education Act (NLEA)
Resting Energy Expenditure (REE)/Resting Metabolic Rate
The amount of energy you need to consume over a 24-hour period for your body to maintain all of its internal working activities while at rest
Infant formulas contain:
The approximate nutrient composition of human milk
Negative nitrogen balance occurs when:
The body loses more nitrogen than it gains (e.g., with infection, burns, fever, starvation, head injury, and trauma)
Nutrients absorbed in the intestines, including water, transport through:
The circulatory system to the body tissues
The small intestine secretes:
The hormones *secretin* and *cholecystokinin (CCK)*
Hgb and Hct also provide information about:
The hydration status of the patient
Chyme moves by peristaltic action through:
The ileocecal valve into the large intestine Where it becomes feces
Achieving nitrogen balance means that:
The intake and output of nitrogen are equal
What happens if a vegan diet is undertaken without adequate knowledge?
The intake may be insufficient for essential amino acids, calcium, zinc, and vitamins D and B12
We meet energy needs through:
The intake of a variety of nutrients: carbohydrates, proteins, fats, water, vitamins, and minerals
Essential fatty acids maintain:
The integrity of the phospholipid-based cell membranes, found around every cell
Macronutrients
The kilocalorie (kcal) energy-containing sources of carbohydrates, proteins, and fats Alcohol also provides kilocalories, but it is not considered a macronutrient because it cannot support or maintain bodily functions
Food leaves the antrum, or distal stomach, through:
The pyloric sphincter And enters the duodenum
Feeding tubes are inserted directly into:
The stomach or small intestine for the delivery of enteral feedings
Villi increase:
The surface area available for absorption
Actual food or eating practices may not be revealed unless:
There is trust and rapport This is especially true when interviewing parents of a child whose growth and development are not within expected ranges Generally, adults respond more openly to health providers if they are aware of the rationale for the questions
Caution older adults to avoid grapefruit and grapefruit juice because:
They alter absorption of many drugs
Albumin and insulin are simple proteins because:
They contain only amino acids or their derivatives
Homebound older adults with chronic illnesses have additional nutritional risks:
They frequently live alone with little or no social or financial resources to help obtain or prepare nutritionally sound meals, contributing to the risk for food insecurity Approximately 19% of older adults experience some degree of food insecurity resulting from low income or poverty
Iodine supports increased:
Thyroid activity Use of iodized table salt ensures availability
Some of the nutrients required by the body are stored in:
Tissues
When is it important to provide iron supplements?
To meet the mother's increased blood volume, fetal blood storage, and blood loss during delivery
Infants have the greatest percentage of:
Total body water because of greater surface area
Lean people have a greater percent of:
Total body water than obese people do because muscle contains more water than any other tissue except blood
Arsenic, aluminum, and cadmium have what type of effects?
Toxic effects
Because the body has a high storage capacity for these vitamins, what is possible?
Toxicity is possible when a person takes large doses of them
Interactions occur among:
Trace elements For example, excess of one trace mineral sometimes causes deficiency of another
BMI serves as an alternative to:
Traditional height-weight relationships
Who performs growth measurements on children?
Trained individuals using reliably calibrated equipment and proper techniques
What does gastrin do?
Triggers parietal cells to secrete hydrochloric acid (HCl)
Fats are composed of:
Triglycerides and fatty acids
Disaccharides such as sucrose, lactose, and maltose are composed of:
Two monosaccharides and water
With the increase in obesity, the incidence of ___ ___ ___ in children is also increasing
Type 2 diabetes
Unsaturated Fatty Acids
Unequal number of hydrogen atoms are attached and the carbon atoms attach to one another with a double bond
What happens to an infant's birth weight at 4-5 months?
Usually doubles
What happens to an infant's birth weight at 1 year?
Usually triples
In attempting to affect eating patterns, you need to understand patients':
Values, beliefs, and attitudes about food Also assess family traditions and rituals related to food, cultural values and beliefs, and nutritional needs Determine how these factors affect food purchase, preparation, and intake
An ideal body weight (IBW) provides an estimate of:
What a person should weigh
Nursing Assessment Questions: Dietary Intake and Food Preferences
What type of food do you like? How many meals a day do you eat? What times do you normally eat meals and snacks? What portion sizes do you eat at each meal? Are you on a special diet because of a medical problem? Do you have any dietary religious or cultural food preferences? Who prepares the food at home? Who purchases the food? How do you cook your food (e.g., fried, broiled, baked, grilled)?
When are minerals classified as *microminerals* or *trace elements*?
When less than 100 mg is needed daily
When are minerals classified as *macrominerals*?
When the daily requirement is 100 mg or more
When do toddlers develop milk anemia?
When toddlers consume more than 24 ounces of milk daily in place of other foods Milk is a poor source of iron
Nursing Assessment Questions: Unpleasant Symptoms
Which foods cause indigestion, gas, or heartburn? Does this occur each time you have the food? What relieves the symptoms?
Nursing Assessment Questions: Use of Medications
Which medications do you take? Do you take any over-the-counter medications that your doctor does not prescribe? Do you take any nutritional or herbal supplements?
When could false readings of A1c occur?
With anemia or renal disease For this reason finger-stick glucose tests may be preferable in these situations
In some hospitals, the RDN may be qualified to:
Write the diet orders or even to insert the tube
Can amino acids link together?
Yes
Do older people have the least percentage of total body water?
Yes
The secretions of the GI tract have very different:
pH levels Saliva is relatively neutral, gastric juice is highly acidic, and the secretions of the small intestine are alkaline
Impact of Medical Conditions on Risk for Malnutrition: - Oral/GI problems with limited protein-calorie intake (e.g., sensory issues, allergies, dental problems, dysphagia) - Impaired intestinal absorption of proteins (diarrhea/malabsorption: e.g., celiac disease, Crohn's disease, short-bowel syndrome, bariatric surgery) - Hepatic disease with impaired protein synthesis - Chronic kidney disease with proteinuria - Nephrotic syndrome - Cancer with increased metabolic needs - Burns with loss of protein in body fluids
Impact on Nutritional Status: - Hypoalbuminemia/impaired protein nutrition
Impact of Medical Conditions on Risk for Malnutrition: - Hypoalbuminemia (lack of carrier proteins) - Hyperphosphatemia (in chronic kidney disease, end stage) - Malabsorption/diarrhea - Hypoparathyroidism - Hypomagnesemia - Vitamin D deficiency
Impact on Nutritional Status: - Hypocalcemia
Impact of Medical Conditions on Risk for Malnutrition: - GI bleed
Impact on Nutritional Status: - Iron deficiency anemia/microcytic anemia
Impact of Medical Conditions on Risk for Malnutrition: - Hemochromatosis - Hepatic disease
Impact on Nutritional Status: - Iron overload
Impact of Medical Conditions on Risk for Malnutrition: - Gastrectomy - Pernicious anemia/lack of intrinsic factor - Primary hypothyroidism - Achlorhydria
Impact on Nutritional Status: - Vitamin B12 deficiency
Impact of Medical Conditions on Risk for Malnutrition: - Chronic kidney disease with limited ability to convert to active form - Malabsorption
Impact on Nutritional Status: - Vitamin D deficiency
Impact of Medical Conditions on Risk for Malnutrition: - Hypoalbuminemia - Chronic kidney disease (end stage) and dialysis treatments - Alcoholic cirrhosis/hepatic disease - Inflammatory bowel disease - Sickle cell anemia
Impact on Nutritional Status: - Zinc deficiency
Particularly at risk are premature infants because of:
Impaired oral intake With parenteral or tube feeding, the use of breast milk may be impossible, eliminating the benefits of cost savings, immunological protection, ideal nutrient content, and microbial support
Where is glycogen stored?
In small reserves in liver and muscle tissue
Where is water primarily absorbed?
In the colon
Vitamin B Deficiency
In the early twentieth century, processed grains were becoming popular Soon, a mysterious syndrome appeared as the "4 D's": dermatitis on sun-exposed areas, diarrhea, dementia, and death. This condition (*pellagra*) was determined to be from a B vitamin deficiency The government mandated that processed white flour products had to be enriched with the nutrients that were removed during processing—vitamins B1, B2, and B3 (thiamine, riboflavin, and niacin, respectively)
History Assessment
In the interview of the patient or family members, it should be remembered that food has a strong emotional component
Gastric Enzymes
In the stomach, gastric enzymes begin to digest proteins into amino acids and carbohydrates into simple sugars
Soluble fibers include barley, cereal grains, cornmeal, and oats and dissolve:
In water
Hypoglycemia may suggest:
Inadequate caloric intake
Carbohydrate (Macronutrient) Deficiency
Inadequate carbohydrate intake can alter cellular metabolism and results in the use of dietary protein as a fuel substrate, diminishing cell growth and repair Ultimately, if inadequate carbohydrate intake continues, there is a shift to use body fat catabolism and protein for energy resulting in weight loss and accumulation of ketones, especially if insulin is also limited
Thirst sensation diminishes, leading to:
Inadequate fluid intake or dehydration Symptoms of dehydration in older adults include confusion; weakness; hot, dry skin; furrowed tongue; rapid pulse; and high urinary sodium
Cellular Metabolism
Includes the hormonal and enzymatic processes that occur within cell structures that allow proteins, carbohydrates, or fats to be used for energy or made into new products or tissues
Mechanical Breakdown
Includes: - Chewing in the mouth - As well as the mixing motions and muscular (peristaltic) action of propelling food through the stomach and intestines
Anatomy and Physiology of the Digestive System
Includes: - Digestion - Absorption - Metabolism and storage of nutrients - Elimination
Nutritional Deficiencies
Includes: - Macronutrient deficiencies - Vitamin and mineral deficiencies
Complementary proteins are pairs of:
Incomplete proteins that, when combined, supply the total amount of protein provided by complete protein sources
As CKD progresses, phosphorous levels can:
Increase and lead to hypocalcemia
Sports and regular moderate-to-intense exercise necessitate dietary modification to meet:
Increased energy needs for adolescents Carbohydrates, both simple and complex, are the main source of energy, providing 55% to 60% of total daily kilocalories Protein needs increase to 1 to 1.5 g/kg/day Fat needs do not increase Adequate hydration is very important. Adolescents need to ingest water before and after exercise to prevent dehydration, especially in hot, humid environments Vitamin and mineral supplements are not required, but intake of iron-rich foods is required to prevent anemia
The *adequate intake (AI)* is the suggested intake for:
Individuals based on observed or experimentally determined estimates of nutrient intakes and used when there is not enough evidence to set the RDA
The AAP recommends regular assessment of obesity risk beginning in:
Infancy Combined with counseling about appropriate dietary and physical activity requirements of childhood as obesity prevention measures
Brain growth can also be monitored by measuring:
Infant frontal-occipital circumference at intervals and plotting the values on growth charts
The World Health Organization growth charts are recommended for use for:
Infants and children up to 2 years of age
How much mL/kg/day of fluid do infants need?
Infants need about 100 to 120 mL/kg/day of fluid because a large part of total body weight is water
Assess patients' nutritional status by using the nursing history to gather:
Information about factors that usually influence nutrition You are in an excellent position to recognize signs of poor nutrition and take steps to initiate change
Minerals
Inorganic elements essential to the body as catalysts in biochemical reactions
PCM is one of the most common nutritional deficiency conditions associated with:
Insufficient intake, wasting disease, or a combination of both, and it has multisystem effects This can affect individuals of all ages, but it especially affects patients with extended hospitalization with acute illness or injury or the institutionalized elderly
The mechanical, chemical, and hormonal activities of digestion are:
Interdependent
Evidence shows that much immunity begins in the:
Intestine So it is important to provide nutrients through the gastrointestinal (GI) tract whenever possible
Chronic Disease-Related Malnutrition
Is exemplified by sarcopenic obesity or pancreatic cancer
When the intake of nitrogen is greater than the output, the body:
Is in positive nitrogen balance
Anorexia Nervosa
Is one of a group of psychiatric conditions associated with a fear of weight gain and distortion of body image
Anabolism
Is the building of more complex biochemical substances by synthesis of nutrients
Basal Metabolic Rate (BMR)
Is the energy needed at rest to maintain life-sustaining activities (breathing, circulation, heart rate, and temperature) for a specific amount of time
Celiac Disease
Is thought to be an autoimmune disorder whereby an inflammatory reaction occurs in the intestine when the mucosa is exposed to gluten, a protein found in wheat
Tube feedings are indicated for an individual who:
Is unable to eat or swallow but has an intact/functional GI tract
Changes in values for an individual over time are of greater significance than:
Isolated measurements
Bile acts as a detergent because:
It emulsifies fat to permit enzyme action while suspending fatty acids in solution
Malnutrition is highly devastating for infants and children because:
It limits their growth, brain development, ability to learn, and, later, their ability to participate effectively in society
Pressure from a bolus of food at the cardiac sphincter causes:
It to relax, allowing the food to enter the fundus, or uppermost part, of the stomach
What should be done if there is any suspicion of poor nutritional status?
Lab work should be ordered by the attending provider to help assess status more completely
Blood Glucose and Hemoglobin A1c
Laboratory/Diagnostic Test
Electrolytes
Laboratory/Diagnostic Test
Hemoglobin and Hematocrit
Laboratory/Diagnostic Test
Lipid Profile
Laboratory/Diagnostic Test
Serum Albumin and Pre-Albumin
Laboratory/Diagnostic Test
It is important to relate head size to weight because:
Larger babies have bigger heads
Lutein and Zeaxanthin (Vitamin A) Deficiency
Lutein and zeaxanthin are carotenoids found in yellow and orange foods (cantaloupe, corn, carrots, salmon, and egg yolks) that help to prevent macular degeneration The intact form of vitamin A is also essential for vision; deficiency begins with loss of night vision and progresses to total blindness
However, complications include:
Macro- and micronutrient deficiencies that are not easily managed, either because of lack of adherence to dietary and supplement guidelines or because of limited knowledge of actual needs
Protein
Macronutrient Facilitates growth and repair of tissues Energy source
Carbohydrates
Macronutrient Primary source of fuel and energy
Fat
Macronutrient Source of fatty acid, necessary for growth and development Energy
Carbohydrates
Main source of energy in the diet
ChooseMyPlate provides a basic guide for:
Making food choices for a healthy lifestyle It includes guidelines for balancing calories; decreasing portion size; increasing healthy foods; increasing water consumption; and decreasing fats, sodium, and sugars
Nutritional Excess
Malnutrition also occurs from excess macronutrient (energy) intake that leads to weight gain Often, obese individuals may have micronutrient insufficiency but macronutrient excesses
Difficulty chewing, missing teeth, having teeth in poor condition, and oral pain often contribute to:
Malnutrition and dehydration in older adults
Because improper nutrition affects all body systems, observe for:
Malnutrition during physical assessment
Impaired Digestion and Absorption (Underlying Medical Condition)
Many conditions interfere with digestion or absorption and place the affected individual at risk for malnutrition Examples of such conditions include lactose intolerance, gastroparesis, gastric surgery, intestinal resection, and inadequate gastric acidity Some genetic conditions lead to defects in metabolism of nutrients, such as PKU
Genetics (Individual Risk Factor)
Many conditions that impact nutrition are linked to genetics
Anthropometry
Measurement system of the size and makeup of the body
Consequences such as type 2 diabetes, heart disease, and stroke affect individuals of all ages and can lead to:
Medical complications or a shortened lifespan
Depending on the severity of the disease state, it may be difficult to:
Meet the increased nutrient needs without enteral or parenteral nutrition support
Unbalanced food intake also occurs in:
Mental health conditions such as anorexia nervosa, mood disorders, anxiety, and depression
Obese children also are at risk for developing:
Metabolic (insulin-resistance) syndrome
Linolenic acid and arachidonic acid, another type of unsaturated fatty acids, are important for:
Metabolic processes The body manufactures them when linoleic acid is available
Blood glucose reflects:
Metabolism of carbohydrates This test is generally used to screen or monitor impaired glucose metabolism
Osmosis
Movement of water through a semipermeable membrane that separates solutions of different concentrations Water moves to equalize the concentration pressures on both sides of the membrane
Lap-band procedures are:
Much less invasive, although nutritional deficits are still possible
Boys also need adequate iron for:
Muscle development
Use laboratory analysis of a 24-hour urine urea nitrogen (UUN) to determine:
Nitrogen output For patients with diarrhea or fistula drainage, estimate a further addition of 2 to 4 g of nitrogen output
Should infants have regular cow's milk during the first year of life?
No It is too concentrated for an infant's kidneys to manage, increases the risk of milk-product allergies, and is a poor source of iron and vitamins C and E
Should children under 1 year of age ingest honey or corn syrup products?
No They are potential sources of the botulism toxin, which increases the risk of infant death
Congenital anomalies and surgical revisions of the GI tract interfere with:
Normal function
Enteral Nutrition (Collaborative Intervention)
Nurses administer nutrition support via tube feedings
Diagnostic Tests
Nurses need to understand common nutrition-related tests, and they need to know when to alert the physician or dietitian if malnutrition is suspected ------ Includes: - Laboratory tests
Skipping meals or eating meals with unhealthy choices of snacks contributes to:
Nutrient deficiency and obesity
Renal disease further reduces:
Nutrient levels Specially vitamin D because the kidney metabolizes vitamin D2 into the bioactive D3 form
What do proteins transport?
Nutrients and many drugs in the blood
Interrelated Concepts
Nutrition is interrelated with nearly all of the health and illness concepts as a preventive or disease management intervention *Glucose Regulation* (closely linked to *Hormonal Regulation*) is dependent on caloric intake and is critical to adequate metabolism of nutrients - Glucose regulation is much like a subconcept of nutrition Nutrition influences other metabolic processes, such as *Immunity*, *Clotting*, *Tissue Integrity*, and *Thermoregulation* - These all depend on adequate nutrients for optimal functioning *Development*, *Culture*, and *Spirituality* are also interrelated based on the influence of these concepts on dietary patterns and preference
Identification of risk factors such as unintentional weight loss, presence of a modified diet, or the presence of altered nutritional symptoms (i.e., nausea, vomiting, diarrhea, and constipation) requires:
Nutritional consultation
Patients receiving only an IV infusion of 5% or 10% dextrose are at risk for:
Nutritional deficiencies
Ethnicity/Race (Population at Risk)
Nutritional deficits and genetic predispositions have triggered many chronic diseases of the modern world
A food diary allows you to calculate:
Nutritional intake and to compare it with DRI to see if the patient's habits are adequate
Other anthropometric measurements often obtained by RDs help identify:
Nutritional problems These include the ratio of height-to-wrist circumference, mid-upper arm circumference (MAC), triceps skinfold (TSF), and mid-upper arm muscle circumference (MAMC)
Bariatric surgery is increasingly being used to control:
Obesity and diabetes
BMI, which is a function of both height and weight, is an important measure of growth and overall nutritional status in children older than age 2 years. Because childhood overweight and obesity can contribute to health problems later in life, the American Academy of Pediatrics recommends:
Obesity prevention beginning during the prenatal period with appropriate management of maternal weight and weight gain during pregnancy
The clinical signs of nutritional status serve as guidelines for:
Observation during physical assessment
Acute Disease-Related Malnutrition
Occurs after burn injury or trauma
Insufficient Nutrition
Occurs when there is inadequate intake, impaired nutrient absorption, or ineffective nutrient utilization occur, leading to a state of malnutrition Malnutrition can be associated with insufficient calorie intake leading to unintended weight loss and/or insufficient intake of one or more nutrients leading to a number of nutritional deficiencies State of being underweight is described as a body mass index (BMI) less than 18.5
The Mini Nutritional Assessment (MNA) screens:
Older adults in home care programs, nursing homes, and hospitals The tool has 18 items divided into screening and assessment If a patient scores 11 or less on the screening part, the health care provider completes the assessment part A total score of less than 17 indicates protein-energy malnutrition
How should caregivers introduce new foods?
One at a time, approximately 4 to 7 days apart to identify allergies It is best to introduce new foods before milk or other foods to avoid satiety
Optimal Nutrition Status
One in which all nutrients are available in balanced amounts for cellular metabolism and physiological function for the individual
Incomplete proteins are missing:
One or more of the nine indispensable amino acids Include cereals, legumes (beans, peas), and vegetables
Most enzymes have:
One specific function
Adequate intake of both macro- and micronutrients is required for:
Optimal cellular metabolism
Breast-feeding is recommended for:
Optimal nutrition of infants for the 4-6 months of life
The priority of care is to provide:
Optimal preoperative nutrition support in patients with malnutrition
Patients with dysphagia often do not show:
Overt signs such as coughing when food enters the airway
One of the key elements of successful weight reduction in the child or adolescent is:
Ownership by the child of whatever plan is proposed Care should be taken to avoid a power struggle between the parent and child
The chief cells in the stomach secrete:
Pepsinogen
An RD compares values for MAC, TSF, and MAMC to standards and calculates them as a:
Percentage of the standard
Growth rate is measured in:
Percentiles
A common form of tube feeding is:
Percutaneous endoscopic gastrostomy (PEG) feeding
For short term, it may be administered:
Peripherally
Exercise and fiber stimulate:
Peristalsis
Personal Food Choices (Individual Risk Factor)
Personal choice is the major internal influence over food intake
Blood glucose screening is advised for:
Persons with evidence of insulin resistance, such as central obesity found with metabolic syndrome
Inherited metabolic defects include:
Phenylketonuria (PKU)
Growth is an excellent indicator of:
Physical well-being Meaning accurate assessments must be made at regular intervals so that patterns of growth can be determined
Age-Related Differences Older Adults
Physiologically, the effects of aging can be associated with a reduced ability to ingest, absorb, and metabolize nutrients In the mouth, reduced chewing ability, reduced saliva production, and reduced sense of taste are common The esophagus may be elongated (due to kyphosis), and atrophic changes occur, particularly in the lower esophagus Atrophic changes and intestinal microflora occur in aging, resulting in reduced efficiency in absorption In the absence of disease, the liver, gallbladder, and pancreas continue to function, although there is a decrease in metabolic efficiency
Phytochemicals
Plant compounds that have antimicrobial, antioxidant, anti-inflammatory, and immune-boosting properties Examples include: - Lutein (associated with the green color of vegetables) - Lycopene (found in high amounts in tomato products)
We obtain carbohydrates primarily from:
Plant foods, except for lactose (milk sugar)
Common laboratory tests used to study nutritional status include measures of:
Plasma proteins such as albumin, transferrin, prealbumin, retinol-binding protein, total iron-binding capacity, and hemoglobin
Starches are:
Polysaccharides
Family food offerings can:
Positively or negatively influence nutritional intake Mothers who avoid high-fat, high-sugar foods but emphasize a variety of vegetables, fruits, whole grains, lean meats, and low-fat milk can send the right message to their family
There is general agreement that an appropriate screening and counseling program throughout childhood can:
Prevent or treat obesity
The Dietary Guidelines are aimed more at:
Preventing chronic health diseases associated with excess intake of macronutrients, especially solid fats (saturated/trans fats), sugar, and salt
Healthy Eating
Primary Prevention
Physical Activity
Primary Prevention
Primary Prevention
Primary prevention measures are aimed at preventing the onset of disease through risk reduction and behavior modification The foundation of primary prevention efforts, as it relates to this concept, includes healthy eating and physical activity
Dysphagia screening quickly identifies:
Problems with swallowing and helps you initiate referrals for more in-depth assessment by an RD or a speech-language pathologist (SLP)
Bile
Produced in the liver and stored in the gallbladder Is involved in fat digestion by modifying dietary fats into emulsions for better absorption
Cream soups and meat-based vegetable soups are nutrient-dense sources of:
Protein Cheese, eggs, and peanut butter are also useful high-protein alternatives
Without adequate planning of foods containing the various amino acids, what can occur?
Protein deficiency
A toddler needs fewer kilocalories but an increased amount of:
Protein in relation to body weight Consequently, appetite often decreases at 18 months of age
Among children, protein-calorie deficiencies are:
Serious concerns because of the potential for delays in cognitive and physical development
Nitrogen balance is important in determining:
Serum protein status
Examination Findings
Several techniques are used to assess nutritional status, including: - General observation - Anthropometric measurements - Other various clinical findings from systems' assessment
Because parenteral nutrition is indicated for individuals who are unable to process nutrients via the GI tract for more than 4 or 5 days, therapy can be:
Short term or long term
The various types of fatty acids referred to in the dietary guidelines have:
Significance for health and the incidence of disease
Age-Related Differences Infants and Children
Significant changes in growth and development occur in the first year of life. Birth weight triples, and length increases by an average of 50%. Infants have very different nutrient needs (compared to adults) to support this rapid growth Due to the lack of teeth, chewing capability, and immature GI tract, the nutritional intake of infants should be limited to breast milk (or formula) and water for the first 6 months of life. Newborn infants depend on a strong suck-swallow reflex for adequate nutritional intake As the child's GI tract develops, solid foods that do not require chewing can be gradually introduced (ideally starting at 6 months of age) As teeth emerge, the older infant and young child can be offered foods with various textures The small orophyarx places young children at risk of choking; thus, the need to provide foods in small bites is particularly important Specific nutrient requirements for infants and children can be found by referring to DRIs
Age-Related Differences Pregnancy and Lactation
Significant changes in nutrition needs occur during pregnancy and lactation to account for the body composition changes during pregnancy (hormonal, metabolic, and anatomic), growing fetus (before birth), and the production of breast milk after delivery Increases in carbohydrates, proteins, fats, and most micronutrients are recommended Expected weight gain during pregnancy ranges from 15 to 40 pounds, depending on prepregnancy weight and stature Specific nutrient requirements for pregnant women and during lactation can be found by referring to DRIs
Eyes
Signs of Good Nutrition: - Bright, clear, shiny - No sores at corner of eyelids - Moist and healthy pink conjunctivae - Prominent blood vessels - No fatigue circles beneath eyes Signs of Poor Nutrition: - Eye membranes pale (pale conjunctivas) - Redness of membrane (conjunctival injection) - Dryness - Signs of infection - Bitot's spots - Redness and fissuring of eyelid corners (angular palpebritis) - Dryness of eye membrane (conjunctival xerosis) - Dull appearance of cornea (corneal xerosis) - Soft cornea (keratomalacia)
Pancreatic secretions contain six enzymes:
- *Amylase* to digest starch - *Lipase* to break down emulsified fats - *Trypsin*, *elastase*, *chymotrypsin*, and *carboxypeptidase* to break down proteins
Adequate oral intake of nutrients (and water) involves:
- Access to food sources - Informed food choices - Efficient chewing (mastication) and swallowing abilities
Elimination is enhanced with:
- Adequate fluid - Fiber intake - Physical activity
What factors affect energy requirements?
- Age - Body mass - Gender - Fever - Starvation - Menstruation - Illness - Injury - Infection - Activity level - Thyroid function
Populations at Risk
- Age or life stage - Ethnicity/race - The poor and underserved
Metabolic processes are:
- Anabolic (building) - Catabolic (breaking down)
What age-related changes affect nutrition?
- Appetite - Taste - Smell - Digestive system For example, older adults often experience a decrease in taste cells that alters food flavor and may decrease intake
The GI tract manages:
- Approximately 8.5 L of GI secretions - 1.5 L of oral intake daily
Complications of dysphagia include:
- Aspiration pneumonia - Dehydration - Decreased nutritional status - Weight loss
A lipid profile includes several tests that:
- Assess lipid metabolism - Serve as important indicators of risk for cardiovascular disease
Chyme flows into the duodenum and quickly mixes with:
- Bile - Intestinal juices - Pancreatic secretions
What requires proteins?
- Blood clotting - Fluid regulation - Acid-base balance
The tube feeding is administered either:
- By gravity - Through a feeding pump
What gets excreted through breast milk?
- Caffeine - Alcohol - Drugs
Carbohydrates are composed of:
- Carbon - Hydrogen - Oxygen
The body requires fuel to provide energy for:
- Cellular metabolism and repair - Organ function - Growth - Body movement
Feces contain:
- Cellulose and similar indigestible substances - Sloughed epithelial cells from the GI tract - Digestive secretions - Water - Microbes
Increased weight gain has been associated with:
- Central nervous system tumors - Hypothyroidism - Cushing syndrome - Turner syndrome
What is made by protein?
- Collagen - Hormones - Enzymes - Immune cells - DNA - RNA
Role of the RDN
- Complex assessments - Nutrition diagnosing - Diet therapy interventions
Many factors other than nutritional needs influence the adolescent's diet, including:
- Concern about body image and appearance - Desire for independence - Eating at fast-food restaurants - Peer pressure - Fad diets
General Vitality
Signs of Good Nutrition: - Endurance - Energy - Sleeps well - Vigorous Signs of Poor Nutrition: - Easily fatigued - No energy - Falls asleep easily - Tired and apathetic
Posture
Signs of Good Nutrition: - Erect posture - Straight arms and legs Signs of Poor Nutrition: - Sagging shoulders - Sunken chest - Humped back
Nails
Signs of Good Nutrition: - Firm, pink Signs of Poor Nutrition: - Spoon shape (koilonychia) - Brittleness - Ridges
Gastrointestinal Function
Signs of Good Nutrition: - Good appetite and nutrition - Normal regular elimination - No palpable organs or masses Signs of Poor Nutrition: - Anorexia - Indigestion - Constipation or diarrhea - Liver or spleen enlargement
Nerve Conduction and Mental Status
Signs of Good Nutrition: - Good attention span - Not irritable or restless - Normal reflexes - Psychological stability Signs of Poor Nutrition: - Inattention - Irritability - Confusion - Burning and tingling of hands and feet (paresthesia) - Loss of position and vibratory sense - Weakness and tenderness of muscles (may result in inability to walk) - Decrease or loss of ankle and knee reflexes
Gums
Signs of Good Nutrition: - Good pink color - Healthy and red - No swelling or bleeding Signs of Poor Nutrition: - Spongy gums that bleed easily - Marginal redness, inflammation - Receding
Tongue
Signs of Good Nutrition: - Good pink or deep reddish color - No swelling - Smooth, presence of surface papillae - Lack of lesions Signs of Poor Nutrition: - Swelling, scarlet and raw - Magenta, beefiness (glossitis) - Hyperemic and hypertrophic papillae - Atrophic papillae
Teeth
Signs of Good Nutrition: - No cavities - No pain - Bright, straight - No crowding - Well-shaped jaw - Clean with no discoloration Signs of Poor Nutrition: - Unfilled caries - Missing teeth - Worn surfaces - Mottled (fluorosis), malocclusion
Neck (Glands)
Signs of Good Nutrition: - No enlargement Signs of Poor Nutrition: - Thyroid or lymph node enlargement
Skeleton
Signs of Good Nutrition: - No malformations Signs of Poor Nutrition: - Bowlegs - Knock-knees - Chest deformity at diaphragm - Prominent scapulae and ribs
Legs and Feet
Signs of Good Nutrition: - No tenderness, weakness, or swelling - Good color Signs of Poor Nutrition: - Edema - Tender calf - Tingling - Weakness
Cardiovascular Function
Signs of Good Nutrition: - Normal heart rate and rhythm - Lack of murmurs - Normal blood pressure for age Signs of Poor Nutrition: - Rapid heart rate (above 100 beats/min) - Enlarged heart - Abnormal rhythm - Elevated blood pressure
Lips
Signs of Good Nutrition: - Smooth - Good color - Moist - Not chapped or swollen Signs of Poor Nutrition: - Dry, scaly, swollen - Redness and swelling (cheilosis) - Angular lesions at corners of mouth - Fissures or scars (stomatitis)
Skin (General)
Signs of Good Nutrition: - Smooth and slightly moist - Good color Signs of Poor Nutrition: - Rough - Dry - Scaly - Pale - Pigmented - Irritated - Bruises - Petachiae - Subcutaneous fat loss
Face and Neck
Signs of Good Nutrition: - Uniform color - Smooth, pink, healthy appearance - Not swollen Signs of Poor Nutrition: - Greasy, discolored, scaly, swollen - Dark skin over cheeks and under eyes - Lumpiness or flakiness of skin around nose and mouth
Weight
Signs of Good Nutrition: - Weight normal for height, age, body build Signs of Poor Nutrition: - Obesity (usually 10% above ideal body weight) - Underweight
Muscles
Signs of Good Nutrition: - Well-developed, firm - Good tone - Some fat under skin Signs of Poor Nutrition: - Flaccid, poor tone, underdeveloped tone - "Wasted" appearance - Impaired ability to walk properly
Dietary requirements for preschoolers (3 to 5 years) are:
Similar to those for toddlers They consume slightly more than toddlers, and nutrient density is more important than quantity
What will help improve nutritional intake for a toddler?
Small, frequent meals consisting of breakfast, lunch, and dinner with three interspersed high nutrient-dense snacks
When there is sufficient carbohydrate in the diet to meet the energy needs of the body, protein is:
Spared as an energy source
Lipid screening is also recommended, particularly for those with:
Specific risk factors Although not an essential nutrient, it often becomes necessary to supplement coenzyme Q10 with long-term statin use
The nutrition care process includes:
Standardized language and codes within the profession of dietetics
The longer an individual chews food, the more:
Starch digestion occurs in the mouth
The USDHHS Administration on Aging (AOA) requires:
States to provide nutritional screening services to older adults who benefit from home-delivered or congregate meal services This program requires meals to provide at least one third of the DRI for an older adult and meet the Dietary Guidelines for Americans
Standardized growth charts allow an individual child's growth (length/height, weight, head circumference, body mass index [BMI]) to be compared with:
Statistical norms
Less severe forms of gluten sensitivity have fewer symptoms, but there is:
Still an autoimmune response to the proteins found in wheat, rye, and barley that requires lifelong use of a strict gluten-free diet
What happens when the energy requirements of the body exceed the energy supplied by ingested nutrients?
Stored energy is used
Amino acids are also converted to fat and:
Stored or catabolized into energy through gluconeogenesis
Fiber, a polysaccharide, is the:
Structural part of plants that is not broken down by our digestive enzymes
Simple carbohydrates are found primarily in:
Sugars
When deprived of water, a person usually cannot:
Survive for more than a few days
Malnutrition significantly slows:
Swallowing recovery and may increase mortality
Obesity is thought to be associated with:
Systemic, chronic low-grade inflammation and conditions related to the metabolic syndrome
Another aspect of dietary interventions is ensuring:
That the food provided matches the patient's ability to eat A patient who has his or her original teeth (none missing) and good oral hygiene, or well-fitting dentures and adequate saliva, represents the best scenario for chewing all kinds of foods
Experts define childhood overweight as a BMI between:
The 85th and 95th percentile for age and gender
BMI charts are included in the most recent versions of charts available from:
The Centers for Disease Control and Prevention
Food labels with DRI values reinforce:
The Dietary Guidelines
Water-soluble vitamins absorb easily from:
The GI tract
The most commonly used growth charts for boys and girls ages 2 years to 20 years are those developed by:
The National Center for Health Statistics
The most malabsorptive bariatric surgical procedure is:
The Roux-en-Y gastric bypass In this procedure, most of the stomach and the proximal small intestine are bypassed, with food entering a Y-shaped reconnection between the upper stomach and the distal portion of the duodenum or jejunum
Warning signs of dysphagia include:
- Cough during eating - Change in voice tone or quality after swallowing - Abnormal movements of the mouth, tongue, or lips - Slow, weak, imprecise, or uncoordinated speech Other Signs: - Abnormal gag - Delayed swallowing - Incomplete oral clearance or pocketing - Regurgitation - Pharyngeal pooling - Delayed or absent trigger of swallow - Inability to speak consistently
Folic acid intake is particularly important for:
- DNA synthesis - Growth of red blood cells Inadequate intake can lead to fetal neural tube defects, anencephaly, or maternal megaloblastic anemia
Obesity becomes a problem because of:
- Decreased physical exercise - Dining out more often - Increased ability to afford more luxury foods
Interventions are classified into the following major groups:
- Dietary interventions - Pharmacologic agents - Surgical interventions
There are a variety of pharmacologic agents that address other nutrient-based problems, including:
- Dietary supplements - Statins to control lipid levels - Agents to control glucose levels
Nutritional deficiencies often occur in adolescent girls because of:
- Dieting - Use of oral contraceptives
Dysphagia leads to:
- Disability or decreased functional status - Increased length of stay and cost of care - Increased likelihood of discharge to institutionalized care - Increased mortality
Mature adults need nutrients for:
- Energy - Maintenance - Repair
Breastfeeding has multiple benefits for both infant and mother, including:
- Fewer food allergies and intolerances - Fewer infant infections - Easier digestion - Convenience, availability, and freshness - Temperature always correct - Economical because it is less expensive than formula - Increased time for mother and infant interaction
Factors that frequently alter test results include:
- Fluid balance - Liver function - Kidney function - Presence of disease
Always ask patients about their:
- Food preferences - Values regarding nutrition - Expectations from nutritional therapy
Physiological risk factors for older adults include:
- Frailty - Low BMI (BMI <21 is associated with a high risk of mortality despite nutritional intervention) - Neurologic deficits from a stroke or Alzheimer's disease
Other rare inherited metabolic defects include:
- Galactosemia - Maple syrup urine disease
Individual Risk Factors
- Genetics - Lifestyle and patterns of eating - Personal food choices - Underlying medical conditions
For infants, routine screening that occurs at birth includes the following:
- Glucose levels - At least 40 different genetically linked metabolic disorders, including phenylketonuria and maple syrup urine disease, that are related to an inability to metabolize certain amino acids or to errors in fatty acid metabolism - Carbohydrate disorders, including galactosemia - Other congenital disorders that can affect nutritional status, including cystic fibrosis - HIV The number of screenings will vary from state to state
Positive nitrogen balance is required for:
- Growth - Normal pregnancy - Maintenance of lean muscle mass and vital organs - Wound healing
Nutrition encompasses the process by which food and nutrients affect:
- Growth and development, - Cellular function and repair - Health promotion - Disease prevention
Your nursing assessment of nutrition includes:
- Health status - Age - Cultural background - Religious food patterns - Socioeconomic status - Personal food preferences - Psychological factors - Use of alcohol or illegal drugs - Use of vitamin, mineral, or herbal supplements - Prescription or over-the-counter (OTC) drugs - Patient's general nutrition knowledge
These tools typically include objective measures such as:
- Height - Weight - Weight change - Primary diagnosis - Presence of other co-morbidities
What foods present choking hazards for children?
- Hot dogs - Candy - Nuts - Grapes - Raw vegetables - Popcorn
Factors that affect serum albumin levels include:
- Hydration - Hemorrhage - Renal or hepatic disease - Large amounts of drainage from wounds, drains, burns, or the GI tract - Steroid administration - Exogenous albumin infusions - Age - Trauma, burns, stress, or surgery
Environmental influences in the development of childhood obesity are extremely strong, with:
- Increased access to fast foods - Decreased access to appropriate physical activity - Decreased sleep all having an impact
Factors that influence lifestyle and patterns of eating decisions include:
- Interpersonal relationships - Learned stress-coping mechanisms - Alterations in mood
Poor oral hygiene and periodontal disease are potential risk factors for systemic diseases such as:
- Joint infections - Ischemic stroke - Cardiovascular disease - DM - Aspiration pneumonia
Some reasons why individuals with low incomes may eat poorly and become obese:
- Lack of access to healthy foods because of insufficient funds - Distance to supermarkets - Limited options for food preparation - High prices of quality foods - Cheap prices of fast food - Limited transportation
Family influences that may negatively impact nutritional status include:
- Lack of home-prepared meals - Eating meals on the go - Restricting multiple food groups because of allergies or dislikes - Limited choices because of financial challenges
Parents have more influence on adolescents' diets than they believe. Effective strategies include:
- Limiting the amount of unhealthy food choices kept at home - Encouraging smart snacks such as fruits, vegetables, or string cheese - Enhancing the appearance and taste of healthy foods
Screening for nutritional status in the general population is limited primarily to:
- Lipid screening - Blood glucose screening - BMI
Tests included are:
- Low-density lipoprotein (LDL) - High-density lipoprotein (HDL) - Cholesterol - Triglycerides
Initial steps in assessing nutritional status:
- Measuring height and weight - Determining body mass index (BMI)
Muscle contraction involves:
- Mechanical energy - Nervous system function involves electrical energy - Mechanisms of heat production involve thermal energy
Dysphagia screening includes:
- Medical record review - Observation of a patient at a meal for change in voice quality, posture, and head control - Percentage of meal consumed - Eating time - Drooling or leakage of liquids and solids - Cough during/after a swallow - Facial or tongue weakness - Palatal movement - Difficulty with secretions - Pocketing - Choking - A spontaneous dry cough
*Hypervitaminosis* of fat-soluble vitamins results from:
- Megadoses (intentional or unintentional) of supplemental vitamins - Excessive amounts in fortified food - Large intake of fish oils
PCM is characterized by:
- Muscle wasting - Loss of subcutaneous fat - Protein deficiency
Nutrition is a basic component of health and is essential for:
- Normal growth and development - Tissue maintenance and repair - Cellular metabolism - Organ function
Adding foods to an infant's diet depends on the infant's:
- Nutrient needs - Physical readiness to handle different forms of foods - The need to detect and control allergic reactions Introducing foods that have a high incidence of causing allergic reaction such as wheat, egg white, nuts, citrus juice, and chocolate should happen later in the infant's life
A number of physiological consequences occur associated with a poor nutritional state on both ends of the spectrum:
- Nutritional deficiencies - Nutritional excess
The basic elements of a history include:
- Nutritional intake - Diet restrictions - Changes in appetite and intake - Changes in weight - Medical history - Current medical conditions - Current medications and treatments - Allergies - Family history - Social history
Features of metabolic syndrome include:
- Obesity - Elevated lipid levels - Increased blood pressure - Elevated fasting blood sugar
Fortunately, a carefully planned vegan diet offers protection against:
- Obesity - Hypertension - Type 2 diabetes - Cardiovascular disease, especially in men
Normal metabolism and anabolism are physiologically possible when:
The body is in *positive nitrogen balance*
The older adult is often:
- On a therapeutic diet - Has difficulty eating because of physical symptoms, lack of teeth, or dentures - Is at risk for drug-nutrient interactions
What can impair the ability to chew and limits diet quality?
- Pain from dental caries - Poorly fitting dentures - Loss of teeth
The approach to obesity prevention and treatment during middle childhood is multi-faceted and addresses:
- Parenting and cultural practices - Environmental modifications - Children's personal behaviors and emotional state - Changes in lifestyle
The body absorbs nutrients by means of:
- Passive diffusion - Osmosis - Active transport - Pinocytosis
Close contact with patients and their families enables you to observe:
- Physical status - Food intake - Food preferences - Weight changes - Response to therapy
Carbohydrates, protein, and fat metabolism:
- Produce chemical energy - Maintain a balance between anabolism and catabolism
Senior citizens are also at high risk for nutritional inadequacies. Factors that are common:
- Reduced organ function - Limited income - Interactions between nutrients and medications - Isolation - Decreased interest in meal preparation - Changes in appetite - Fatigue - Altered taste sensations
Those elderly who are institutionalized are at even greater risk due to:
- Severe dietary restrictions - Rigid mealtimes - Generally poor health status - Feeding dependency
A number of validated screening tools are available such as:
- The Bedside Swallowing Assessment - Burke Dysphagia Screening Test - Acute Stroke Dysphagia Screen - Standardized Swallowing Assessment
Childhood obesity contributes to medical problems related to:
- The cardiovascular system - Endocrine system - Mental health
Nutrition screening tools gather data on:
- The current condition - Stability of the condition - Assessment of whether it will worsen - If the disease process accelerates
Coordination of care often involves working with:
- The registered dietitian nutritionist - Home care services - A community agency (e.g., referral to Meals-On-Wheels for home-delivered meal services)
Digestive enzymes are responsible for:
The chemical breakdown of food matter This process is most efficient when consumed food is thoroughly chewed, thus increasing the surface of food particles for enzyme action
In addition, it is important to consider:
The chief complaint/presenting symptoms because they might relate to nutrition and may warrant a symptom analysis
Unfortunately, the long-term success rate for the elimination of childhood obesity is poor. Positive outcomes are increased when:
The child has a support system and understands the importance of diet and exercise
Electrolytes and minerals are absorbed in:
The colon
Statins (e.g., atorvastatin, fluvastatin, lovastatin, pravastatin, and rosuvastatin) are:
The drugs of choice for treatment of lipid and cholesterol reduction because of their ability to inhibit the synthesis of cholesterol, leading to reductions in LDL and HDL
Nutrients
The elements necessary for normal function of numerous body processes
Altered Organ Function (Underlying Medical Condition)
The failure of organs involved in digestion and metabolism are associated with nutritional deficiencies
The fat-soluble vitamins (A, D, E, and K) are stored in:
The fatty compartments of the body
Breast milk or formula provides sufficient nutrition for how long?
The first 4 to 6 months of life
Passive Diffusion
The force by which particles move outward from an area of greater concentration to one of lesser concentration The particles do not need a special "carrier" to move outward in all directions
Alcohol and aspirin are two substances directly absorbed through:
The lining of the stomach
Pregnancy is a very important stage because of:
The long-term effects on health of the infant and the mother
Enzyme activity depends on:
The mechanical breakdown of food to increase its surface area for chemical action
What happens once food matter has been digested?
The microscopic hairlike projections (villi) that line the intestinal tract absorb nutrients into capillaries which are then transported by the vascular system
Obesity
The most common form of excessive nutrition
For infants 4 to 11 months, cereals are:
The most important nonmilk source of protein
The energy requirements of pregnancy relate to:
The mother's body weight and activity
Macrominerals help to balance:
The pH of the body Specific amounts are necessary in the blood and cells to promote acid-base balance
The Subjective Global Assessment (SGA) uses:
The patient history, weight, and physical assessment data to assess nutritional status Is a simple, inexpensive technique that is able to predict nutrition-related complications
In addition, weight gain can still occur if:
The patient is noncompliant with calorie control
What is one of the most important aspects of a nutritional assessment?
The physical examination
A specific formula is selected by:
The physician and RDN based on patient needs
Both poverty and parental level of education affect:
The prevalence of obesity With children in poor families and children whose parents did not complete high school at higher risk
Digestion
The process of mechanical and chemical breakdown of food matter and complex forms of macronutrients
The lactating woman needs 500 kcal/day above the usual allowance because:
The production of milk increases energy requirements Protein requirements during lactation are greater than those required during pregnancy The need for calcium remains the same as during pregnancy There is an increased need for vitamins A and C
Both zinc and folic acid are critical in:
The production of proteins and cellular structures Without these micronutrients, growth and tissue repair are severely impaired
Nutrient Density
The proportion of essential nutrients to the number of kilocalories High-nutrient dense foods such as fruits and vegetables provide a large number of nutrients in relationship to kilocalories Low-nutrient dense foods such as alcohol or sugar are high in kilocalories but nutrient poor
Calcium is essential for:
The rapid bone growth of adolescence
What happens when there is enough of any specific vitamin to meet the catalytic demands of the body?
The rest of the vitamin supply acts as a free chemical and is often toxic to the body
Because the obese child develops increased numbers of fat cells, which are carried into adulthood, preventing obesity in childhood can reduce:
The risk of obesity in adulthood and plays a role in preventing disease
Nutrition
The science of optimal cellular metabolism and its impact on health and disease
Physical, chemical, and hormonal factors regulate:
The secretion of digestive juices and the motility of the GI tract
Peristalsis continues in the small intestine, mixing:
The secretions with chyme
Absorption of carbohydrates, protein, minerals, and water-soluble vitamins occurs in:
The small intestine Are then processed in the liver and released into the portal vein circulation
Primary absorption site for nutrients:
The small intestine Lined with fingerlike projections called villi
The major part of digestion occurs in:
The small intestine Producing: - Glucose, fructose, and galactose from carbohydrates - Amino acids and dipeptides from proteins - Fatty acids, glycerides, and glycerol from lipids
Nutrition therapy is a term used to describe:
The typical services of the RDN or registered dietetic technician
In CKD, protein is lost through:
The urine Can lead to impaired skin integrity, slow wound healing, suppressed immunity, sarcopenia, and altered osmotic pressure
Infants and children younger than 2 years old can be screened for overweight using:
The weight-to-length measurement Concern is generated when that percentile exceeds the 95th
Assess patients for malnutrition when they have conditions that interfere with:
Their ability to ingest, digest, or absorb adequate nutrients
Carbohydrate classification occurs according to:
Their carbohydrate units, or *saccharides*
The body does not store water-soluble vitamins; thus we need:
Them provided in our daily food intake
Collaborative Interventions
There are several interventions for nurses to manage individuals who have nutritional-related health conditions
Developmental Needs Young and Middle Adults
There is a reduction in nutrient demands as the growth period ends
What happens to large food particles and undigested fibers?
They not absorbed—they are eliminated through the colon
Cystic Fibrosis
Thick secretions block pancreatic ducts, eventually leading to impaired digestion and absorption of fats and fat-soluble vitamins
Vegetable fats have higher amounts of:
Unsaturated and polyunsaturated fatty acids
Duodenum
Upper portion of the small intestinal tract Primary site for absorbing trace minerals
Elimination of the remaining 0.1 L occurs:
Via feces
The water-soluble vitamins are:
Vitamin C and the B complex (which is eight vitamins)
Vitamin D Deficiency
Vitamin D insufficiency is known to lead to osteoporosis, hip fracture, and hyperparathyroidism Studies also suggest links with cardiovascular disease, cancer, multiple sclerosis, tuberculosis, and muscular and immune system disorders
In the colon, bacteria synthesize:
Vitamin K and some B-complex vitamins
Fortified foods (nutrients added) are important sources of:
Vitamins and minerals Snack food from the dairy, fruit, and vegetable groups are good choices
Micronutrients
Vitamins and minerals are micronutrients because they are required in minute amounts Some minerals are needed in such small amounts that they are called "ultra" trace mineral requirements
The body is unable to synthesize:
Vitamins in the required amounts
Polysaccharides are insoluble in:
Water and digested to varying degrees
The longer the material stays in the large intestine, the more:
Water is absorbed, causing the feces to become firmer
Swallowed food enters the esophagus, and:
Wavelike muscular contractions (peristalsis) move the food to the base of the esophagus, above the cardiac sphincter
The body is unable to digest some polysaccharides because:
We do not have enzymes capable of breaking them down
When the kilocalories ingested exceed our energy demands:
We gain weight
If the kilocalories ingested fail to meet our energy requirements:
We lose weight
There have been complications with previous forms of:
Weight loss medications Currently all of these medications have limitations on duration of use
Does the amount of nutrient intake needed for optimal function change across the lifespan?
Yes
Since water-soluble vitamins are not stored, can toxicity still occur?
Yes
Parents Want to Know: How to Prevent and Manage Obesity
You can help prevent and manage obesity in your child by doing the following: - Do not use food as a reward - Establish consistent times for meals and snacks and discourage in-between eating - Offer only healthy food options (ask the child to choose between an apple or popcorn, not an apple or a cookie) - Avoid keeping unhealthy food in the house and minimize trips to fast-food restaurants - Be a role model by improving your own eating habits and levels of activity - Encourage the child to do fun, physical activities with the family - Praise the child for making appropriate food choices and for increasing physical activity levels
The priority for the resumption of food intake after surgery depends on:
- The return of bowel function - The extent of the surgical procedure - The presence of any complications Ex: When patients have oral and throat surgery, they chew and swallow food in the presence of excision sites, sutures, or tissue manipulated during surgery The priority of care is to first provide comfort and pain control. Then address nutritional priorities and plan care to maintain nutrition that does not cause pain or injury to the healing tissues
Amino acids are anabolized into:
- Tissues - Hormones - Enzymes
An adolescent boy's diet is often inadequate in:
- Total kilocalories - Protein - Iron - Folic acid - B vitamins - Iodine
Diseases more common in European heritage include:
- Type 1 diabetes - Celiac disease - Neurodegenerative disorders such as Huntington's disease and multiple sclerosis
Consequences of excessive weight have been well documented and can include:
- Type 2 diabetes - Coronary heart disease - Hypertension - Stroke - Fatty liver disease - Gallbladder disorders - Sleep apnea - Asthma - Other respiratory problems, musculoskeletal disorders, as well as some cancers With more children and teens becoming obese, many of these medical conditions are seen at young ages, with similar challenges and high risks for early mortality
The most important screening problems or presenting symptoms include the following:
- Unplanned changes in weight - Changes in appetite or intake - Nausea and/or vomiting - Difficulty chewing or swallowing - Abdominal pain or discomfort - Changes in bowel habits - Recent history of constipation or diarrhea
Fat-Soluble Vitamins
- Vitamin A - Vitamin D - Vitamin E - Vitamin K
Water-Soluble Vitamins
- Vitamin C - B Vitamins (Thiamin; Riboflavin; Niacin; Pyridoxine; Pantothenic; Biotin; Folate; Cobalamin)
Supplement examples include:
- Vitamin supplements (e.g., multivitamins, niacin, B vitamins, and Vitamin C) - Mineral supplements (e.g., iron and calcium folic acid) - Protein and nutrient supplements (Ensure, nutrition bars, etc.)
The general dietary habits of the family should also be assessed. Additional strategies include:
- Watching portion size - Avoiding having unhealthy foods or snacks available in the home - Parental role modeling
Generally, bariatric surgery has demonstrated good success for:
- Weight loss - Improved glucose level - Normalized blood pressure
Protein in the formula is typically:
- Whey - Soy - Cow's milk base - Casein hydrolysate - Elemental amino acids
Three types of macronutrients:
1. Carbohydrates 2. Protein 3. Fat
Nutrient metabolism consists of three main processes:
1. Catabolism of glycogen into glucose, carbon dioxide, and water (*glycogenolysis*) 2. Anabolism of glucose into glycogen for storage (*glycogenesis*) 3. Catabolism of amino acids and glycerol into glucose for energy (*gluconeogenesis*)
Malnutrition is a comprehensive term that refers to two major categories of nutritional conditions:
1. Insufficient nutrition 2. Excess nutrition
The FDA first established two sets of reference values:
1. The referenced daily intakes (RDIs) are the first set, comprising protein, vitamins, and minerals based on the RDA 2. The daily reference values (DRVs) make up the second set and consist of nutrients such as total fat, saturated fat, cholesterol, carbohydrates, fiber, sodium, and potassium
The metabolic half-life of retinol-binding protein is:
12 hours
The metabolic half-life of prealbumin is:
2 days
These guidelines are for Americans over the age of:
2 years
Toddlers need to drink whole milk until the age of:
2 years To make sure that there is adequate intake of fatty acids necessary for brain and neurological development
Commercial formulas and human breast milk both provide approximately how many kcal/oz?
20 kcal/oz
Daily values are based on percentages of a diet consisting of:
2000 kcal/day for adults and children 4 years or older
The metabolic half-life of albumin is:
21 days
Snacks provide what percentage of a teenager's total dietary intake?
25%
The general goals include:
30 minutes of physical activity on most days of the week or 150 or more minutes weekly Weight loss may require at least twice this amount of exercise
Obesity is associated with a BMI greater than:
30, or being more than 20% over ideal body weight
Each gram of carbohydrate produces:
4 kcal/g
Protein intake throughout pregnancy needs to increase to:
60 g daily
How much water makes up total body weight?
60% to 70%
The metabolic half-life of transferrin is:
8 days
How much does the small intestine resorb?
9.5 L
The *recommended dietary allowance (RDA)* is the average needs of:
98% of the population, not the exact needs of the individual
In an outpatient setting, have a patient keep:
A 3- to 7-day food diary
Obesity is an excessive accumulation of fat in the body and is assessed in children through:
A body mass index (BMI) that exceeds the 95th percentile for age
These are usually ordered as part of:
A chemistry profile blood test
The combination of a simple protein with a nonprotein substance produces:
A complex protein such as lipoprotein, formed by a combination of a lipid and a simple protein
Phenylketonuria (PKU)
A deficiency in the enzyme responsible for the metabolism of the amino acid phenylalanine PKU allows phenylalanine to accumulate in the brain, blood, and tissues leading to cognitive dysfunction unless the affected individual follows a low-phenylalanine diet for life
Epiglottis
A flap of skin that closes over the trachea as a person swallows to prevent aspiration
Individuals are thought to have:
A genetic predisposition to hyperlipidemia But a dietary intake high in dietary fat is another contributing factor
Here, nutrition consists of:
A glucose-based intravenous solution (various dextrose concentrations) with electrolytes, minerals, and amino acids Fat emulsions (lipids) may also be included or administered as a separate solution
Obesity occurs when there is:
A greater intake of calories than energy expenditure
The area between any two percentiles is referred to as:
A growth channel
What is required for optimal elimination?
A healthy GI tract with efficient peristaltic action
A person who follows the current Dietary Guidelines for Americans and MyPlate can achieve:
A healthy diet
Saliva
A mucous-like fluid that contains the digestive enzyme amylase, which assists with the process of food breakdown and aids in the chewing and swallowing process
Screening for and treatment of dysphagia requires:
A multidisciplinary team approach of nurses, RDs, health care providers, and SLPs
Obesity is caused by:
A number of factors Can include overeating, inactivity, and genetics
The concept of nutrition is complex, involving:
A number of physiological processes
Through the chemical changes of metabolism, the body converts nutrients into:
A number of required substances
Pharmacologic Agents (Collaborative Intervention)
A number of supplements are used to enhance the nutritional status of individuals, and most are available over the counter
The *estimated average requirement (EAR)* is the recommended amount of:
A nutrient that appears sufficient to maintain a specific body function for 50% of the population on the basis of age and gender
Childhood growth normally progresses according to a pattern along:
A particular growth channel Deviations from normal growth patterns may suggest problems Any change of more than two growth channels indicates a need for more in-depth assessment
In addition to the general nursing history, use data from a more specific diet history to assess:
A patient's actual or potential nutritional needs
The diet history focuses on:
A patient's habitual intake of foods and liquids Includes information about preferences, allergies, and other relevant areas such as the patient's ability to obtain food
Complete the general physical assessment of body systems and recheck relevant areas to evaluate:
A patient's nutritional status
Researchers think that oxidative damage increases:
A person's risk for various cancers
Chewing reduces food particles to:
A size suitable for swallowing
A PEG tube requires:
A small incision into the stomach Fortunately, the procedure is relatively safe, simple, and reversible
Each enzyme works best at:
A specific pH For example, the enzyme amylase in the saliva breaks down starches into sugars
Increased Metabolic Demand (Underlying Medical Condition)
A variety of conditions increase metabolic rate and energy needs, thus increasing the risk for protein-calorie malnutrition Examples include cancer, chronic obstructive pulmonary disease, Parkinson's disease, trauma (including burns), stroke, and HIV/AIDS
In chronic kidney disease (CKD), nutritional status is adversely impacted through:
A variety of mechanisms
Underlying Medical Conditions (Individual Risk Factor)
A wide range of medical conditions place individuals at risk for various nutritional problems Include: - Impaired oral intake - Impaired digestion and absorption - Increased metabolic demand - Altered organ function
Among the most commonly reported symptoms are:
Abdominal discomfort, bloating, diarrhea, and nausea
Albumin level is a better indicator for chronic illnesses, whereas prealbumin level is preferred for:
Acute conditions
CCK inhibits further gastrin secretion and initiates release of:
Additional digestive enzymes from the pancreas and gallbladder
Individualized dietary plans are needed to:
Address unique dietary needs of patients based on their age, calorie needs, and underlying health condition For example: Not all hypertensive individuals respond to sodium (salt) restriction, not all individuals with high serum cholesterol levels respond to a low saturated fat diet, and sugar alone is not the culprit in diabetes management
Impaired Oral Intake (Underlying Medical Condition)
Adequacy of oral intake is associated with the ability to chew and swallow. Thus, the inability to chew or swallow properly can easily lead to malnutrition
Daily intake of water-soluble vitamins (B and C) is necessary to ensure:
Adequate levels in breast milk
Despite better appetites and more varied food intake, you need to assess school-age children's diets carefully for:
Adequate protein and vitamins A and C They often fail to eat a proper breakfast and have unsupervised intake at school
Combine multiple objective measures with subjective measures related to nutrition to:
Adequately screen for nutritional problems
The influence of peers is common among:
Adolescents Skipping meals, following fad diets, choosing salty and sugary snacks over healthy foods, eating super-sized portions, and drinking alcohol are examples Here, mood swings dominate. Coping mechanisms often include eating large amounts of sweets or comfort foods or reducing intake altogether during periods of depression Peer influences are especially strong among young people with lower self-esteem
Hyperlipidemia primarily affects:
Adults (an estimated 100 million in the United States) But can occur associated with childhood obesity
Factors Influencing Nutrition Older Adults
Adults 65 years and older have a decreased need for energy because their metabolic rate slows with age However, vitamin and mineral requirements remain unchanged from middle adulthood
Essential Fatty Acid (Macronutrient) Deficiency
Affects all cellular membranes and is particularly a problem with premature infants *Docosahexaenoic acid (DHA)* and *eicosapentaenoic acid (EPA)* are long-chain omega-3 fatty acids that support retinal development, neurotransmitter production, and brain function
Setting Priorities for Patients
After identifying patients' nursing diagnoses, determine priorities to plan timely and successful interventions For example, managing a patient's oral pain will be a priority over the intervention of diet education to improve nutrition if the patient is unable to swallow and maintain adequate food intake
The Poor and Underserved (Population at Risk)
As a population group, those of low socioeconomic status are at risk for malnutrition because of food insecurity and food availability
When does the growth rate start to slow for a child?
As a toddler (1-3 years)
Dietary Interventions (Collaborative Intervention)
As part of the health care team, nurses often work with other health professionals for optimal nutritional outcomes
Silent Aspiration
Aspiration that occurs in patients with neurological problems that lead to decreased sensation It often occurs without a cough, and symptoms usually do not appear for 24 hour Silent aspiration accounts for most of the 51% to 78% of aspiration in patients with dysphagia following stroke
Dietetic Technician
Assists the RDN with menu planning, nutrition education, and management of food services
Age or Life Stage (Population at Risk)
At the beginning of life and again at the later stages, nutritional deficits are a significant concern
Vitamin B3
Consequences of Deficiencies: - Pellagra with 4 D's: dermatitis, diarrhea, dementia, death Consequences of Toxicities: - Abnormal glucose metabolism - Flushing - Nausea and vomiting
Vitamin B12
Consequences of Deficiencies: - Pernicious anemia - Psychiatric disorders Consequences of Toxicities: - Toxicity unknown
Vitamin D
Consequences of Deficiencies: - Rickets - Bone disease - Muscle pain - Falls Consequences of Toxicities: - Hypercalcemia - Renal stones - Calcification of soft tissues
Vitamin B1 (Thiamine)
Consequences of Deficiencies: - Wenicke's encephalopathy with neurodegeneration Consequences of Toxicities: - Toxicity rare
Water maintains:
Consistency
To carry out the work of the body, the chemical energy produced by metabolism:
Converts to other types of energy by different tissues
To counter obesity, increasing physical activity is often more important than:
Curbing intake
Combined, both sets make up the:
Daily values used on food labels
Excessive infusion of enteral or parenteral nutrition solutions can be:
Dangerous The critically ill patient is vulnerable because metabolic shifts occur throughout each day from sepsis and various procedures
In conditions such as Parkinson's or Alzheimer's disease, the sense of smell diminishes, also leading to:
Decreased food intake
Vitamin C Deficiency
Deficiency of vitamin C was one of the first recognized nutrient deficiency diseases, with the severe form (scurvy) being a cause of death among early sea voyagers. British sailors were called "limeys" because their intake of limes while onboard sea vessels prevented this condition
Hyperglycemia may be an indication of:
Diabetes mellitus
A qualified RDN may have:
Diet order-writing privileges as determined by competency assessment, licensure laws, and facility protocols RDN can adjust a patient's meal plan so that it is appropriate for health goals, realistic, economical, and feasible for the family
The long-term consequence involves:
Dietary deficiencies due to malabsorption of nutrients (as a result of the intestinal inflammation)
Vitamin synthesis depends on:
Dietary intake
With the exception of vitamin D, people acquire vitamins through:
Dietary intake
As a nurse, consider the food preferences of patients from:
Different cultural groups, vegetarians, and others when planning diets
A full-term newborn is able to:
Digest and absorb simple carbohydrates, proteins, and a moderate amount of emulsified fat
Insoluble fibers, including cellulose, hemicellulose, and lignin, are not:
Digestible
Hormones regulate the flow of:
Digestive secretions needed for enzyme supply
Calculate nitrogen balance by:
Dividing 6.25 into the total grams of protein ingested in a day (24 hours)
We meet our fluid needs by:
Drinking liquids and eating solid foods high in water content such as fresh fruits and vegetables
Developmental Needs Adolescents
During adolescence physiological age is a better guide to nutritional needs than chronological age
Nursing Process - Assessment
During the assessment process thoroughly assess each patient and critically analyze findings to ensure that you make patient-centered clinical decisions required for safe nursing care
Saturated Fatty Acids
Each carbon in the chain has two attached hydrogen atoms
Saliva provides lubrication to:
Ease swallowing of the food
Nutritional status can be viewed as:
Either optimal or suboptimal
Epithelial cells in the small intestinal villi secrete:
Enzymes (e.g., sucrase, lactase, maltase, lipase, and peptidase) to facilitate digestion
Proteins and fats are broken down physically but remain unchanged chemically because:
Enzymes in the mouth do not react with these nutrients
Linoleic acid, an unsaturated fatty acid, is the only:
Essential fatty acid in humans
We also classify fatty acids as:
Essential or nonessential
Untreated, patients with anorexia nervosa experience:
Extreme weight loss and muscle wasting Representing a condition of insufficient nutrition
Water absorbs in the mucosa as:
Feces move toward the rectum
Calcium intake is especially critical in the third trimester, when:
Fetal bones mineralize
Pancreatic Enzymes
Finalize digestion in the small bowel, with fats being converted into fatty acids
It is diagnosed based on the presence of:
Flattened villi as well as specific antibodies in the blood
An ill person has an increased need for:
Fluid (e.g., with fever or gastrointestinal [GI] losses) By contrast, he or she also has a decreased ability to excrete fluid (e.g., with cardiopulmonary or renal disease), which often leads to the need for fluid restriction
In a healthy individual fluid intake from all sources equals:
Fluid output through elimination, respiration, and sweating
Rapid weight gain or loss is important to note because it usually reflects:
Fluid shifts
Mentioning some potential nutritional complications of a condition, or asking about the individual's personal health concerns, allows for:
Focused interviewing
Weight gain can occur when:
Food habits change to match those of the partner, such as during dating and marriage
Dysphagia often leads to an inadequate amount of:
Food intake, which results in malnutrition
Digestion produces fluid during:
Food oxidation
The patient and family must collaborate with the nurse in planning care and setting priorities. This is important because:
Food preferences, food purchases, and preparation involve the entire family The plan of care cannot succeed without their commitment to, involvement in, and understanding of the nutritional priorities
The stomach acts as a reservoir where:
Food remains for approximately 3 hours, with a range of 1 to 7 hours
Calcium and vitamin D levels tend to be low unless:
Fortified foods or supplements are used
These vitamins neutralize substances called:
Free radicals Which produce oxidative damage to body cells and tissues
Vitamin content is usually highest in:
Fresh foods that have minimal exposure to heat, air, or water before their use
Nerve stimulation from the parasympathetic nervous system (e.g., the vagus nerve) increases:
GI tract action
Children with low metabolic rates and more fat cells tend to:
Gain more weight As do children whose parents are obese
Electrolytes provide information about:
General health status Including specific information about micronutrients including sodium, potassium, calcium, magnesium, and phosphorus
Monoglycerides from the digested part of fats convert to:
Glucose by gluconeogenesis
Carbohydrates are also required to provide:
Glucose for the unique fuel needs of the brain, the neurologic system, and the red blood cells
Energy needs increase to meet:
Greater metabolic demands of growth Daily requirement of protein also increases
Proteins are essential for:
Growth, maintenance, and repair of body tissue
The parietal cells also secrete:
HCl and intrinsic factor (IF) Which is necessary for absorption of vitamin B12 in the ileum
If BMI is within normal limits and weight has been stable, it is still important to:
Have at least a brief assessment of oral intake to verify that macronutrients and micronutrients are being consumed in appropriate amounts
Monounsaturated Fatty Acids
Have one double bond
Polyunsaturated Fatty Acids
Have two or more double carbon bonds
Nursing Assessment Questions: Appetite and Weight
Have you had a change in appetite? Have you noticed a change in your weight? Was this change anticipated (e.g., were you on a weight-reduction diet)?
Nursing Assessment Questions: Taste, Chewing, and Swallowing
Have you noticed any changes in taste? Did these changes occur with medications or following an illness? Do you wear dentures? Are the dentures comfortable? Do you have any mouth pain or sores (e.g., cold sore, canker sores)? Do you have difficulty swallowing? Do you cough or gag when you swallow?
Overweight is defined as:
Having a BMI greater than 25
General physical appearance, level of orientation, and demeanor will give insight into:
Health and nutritional status ----- Skin should be smooth and elastic without cracks or bruising Hair should be shiny and not brittle Nail beds should be smooth, pink, and firm Teeth should be free of cavities, and the oral tissues should be moist, pink, and firm Mucous membranes around the eyes should be pink, moist and free of lesions; the sclera should be white Cornea should be clear and shiny
Body mass index (BMI) measures weight corrected for:
Height
B-complex vitamins are necessary to support:
Heightened metabolic activity
The very young are at risk because of:
Immature organ development and total dependence on others for feeding
Impact of Medical Conditions on Risk for Malnutrition: - Wound healing protocol with excess supplementation of zinc
Impact on Nutritional Status: - Copper deficiency anemia
Impact of Medical Conditions on Risk for Malnutrition: - Epilepsy with use of antiseizure medications - Chronic kidney disease (end stage) and dialysis treatments - Edema/hypertension with K+-depleting diuretics - Malabsorption/diarrhea - Hepatic disease - Pancreatitis
Impact on Nutritional Status: - Folic acid deficiency/megaloblastic anemia - Hypomagnesemia
Impact of Medical Conditions on Risk for Malnutrition: - Hyperparathyroidism - Hyperthyroidism - Adrenal insufficiency - Cancer - Hypervitaminosis A and D
Impact on Nutritional Status: - Hypercalcemia
Fats (Lipids)
Are the most calorie-dense nutrient, providing 9 kcal/g
Nursing Assessment Questions: Allergies
Are you allergic to any foods? Which types of problems do you have with these foods? How are these food allergies treated (e.g., EpiPen, oral antihistamines)?
When do women tend to experience cravings?
Around their menstrual periods and during pregnancy If they give in to these cravings regularly, obesity may result
Patients who are malnourished on admission are at greater risk of life-threatening complications such as:
Arrhythmia, sepsis, or hemorrhage during hospitalization
Secondary Prevention (Screening)
Secondary prevention involves screening tests to detect disease
Daily values did not replace RDAs but provided a:
Separate, more understandable format for the public
Factors Affecting Nutritional Status for Older Adults
Age-related gastrointestinal changes that affect digestion of food and maintenance of nutrition include changes in the teeth and gums, reduced saliva production, atrophy of oral mucosal epithelial cells, increased taste threshold, decreased thirst sensation, reduced gag reflex, and decreased esophageal and colonic peristalsis The presence of chronic illnesses (e.g., diabetes mellitus, end-stage renal disease, cancer) often affects nutrition intake Adequate nutrition in older adults is affected by multiple causes such as lifelong eating habits, culture, socialization, income, educational level, physical functional level to meet activities of daily living (ADLs), loss, dentition, and transportation Adverse effects of medications cause problems such as anorexia, gastrointestinal bleeding, xerostomia, early satiety, and impaired smell and taste perception Cognitive impairments such as delirium, dementia, and depression affect ability to obtain, prepare, and eat healthy foods
A complete protein, also called a *high-quality protein*, contains:
All essential amino acids in sufficient quantity to support growth and maintain nitrogen balance Examples of foods that contain complete proteins are fish, chicken, soybeans, turkey, and cheese
Assessment
All nurses should know how to perform a basic assessment of nutritional status Maintaining an awareness of the risk factors helps to focus the interview and examination
The simplest form of protein is the:
Amino acid
*Dietary reference intakes (DRIs)* present evidence-based criteria for:
An acceptable range of amounts of vitamins and nutrients for each gender and age-group
Food is now:
An acidic, liquefied mass called *chyme*
Impaired digestion and absorption can also occur as:
An adverse effect from some medications
Anorexia nervosa is characterized by:
An avoidance of food consumption often combined with excessive exercise with the intent to lose weight
The Acute Stroke Dysphagia Screen
An easily administered and reliable tool for health care professionals who are not speech-language pathologists (SLPs)
Hyperlipidemia is characterized by:
An elevation of serum lipids (cholesterol, triglycerides, and/or phospholipids)
Active Transport
An energy-dependent process whereby particles move from an area of lesser concentration to an area of greater concentration A special "carrier" moves the particle across the cell membrane
Ptyalin (Salivary Amylase)
An enzyme that acts on cooked starch to begin its conversion to maltose
Water is the final product considered to be:
An essential nutrient
Discharge planning is:
An essential team effort on behalf of the patient
Anabolism occurs when:
An individual adds lean muscle through diet and exercise
What does a cleft palate impact?
An infant's sucking ability, thereby limiting successful breast-feeding
Nutrition screening is an essential part of:
An initial assessment
Silicon, vanadium, nickel, tin, cadmium, arsenic, aluminum, and boron play what kind of role in nutrition?
An unidentified role
Calculate nitrogen balance by subtracting the nitrogen output from the nitrogen intake. A positive 2- to 3-g nitrogen balance is necessary for:
Anabolism
Pregnancy occurring within 4 years of menarche places a mother and fetus at risk because of:
Anatomical and physiological immaturity Malnutrition at the time of conception increases risk to the adolescent and her fetus. Most teenage girls do not want to gain weight
Inadequate vitamin B12 has been associated with:
Anemia and with neurologic damage, especially dangerous in children
Hyperlipidemia
Another example of excess nutrition
Certain vitamins are currently of interest in their role as:
Antioxidants
Normal intake requires:
Appropriate ingestion of necessary foods to meet macronutrient, micronutrient, and fluid needs
How much does the colon absorb?
Approximately 0.4 L
How long does peristalsis usually take to pass food through the small intestine?
Approximately 5 hours
How much water is absorbed in the small intestine?
Approximately 85% to 90%
Infants need an energy intake of:
Approximately 90 to 110 kcal/kg of body weight per day Premature infants needing 105 to 130 kcal/kg per day
Registered Dietitian Nutritionists (RDNs)
Are health professionals who have a background in biochemistry and metabolism, with knowledge about the macronutrient and micronutrient contents of foods and how the body uses them
Vitamins
Are organic substances present in small amounts in foods that are essential to normal metabolism
Excess Nutrition
At the opposite end of the spectrum is the situation in which excessive nutritional intake progresses to weight gain or nutritional toxicities Most common form of excess nutrition is associated with excessive calorie intake leading to weight gain Standardized categories, based on BMI, are used to describe overweight and obesity For adults, overweight is described as a BMI between 25.0 and 29.9. Three classes of obesity are class I (BMI of 30-34.9), class II (BMI of 35-39.9), and class III (BMI >40) Child obesity is described in terms of BMI compared to percentiles on standardized growth charts. A child who's BMI is between the 85th and 95th percentile for children of the same age and sex is classified as overweight; obesity is defined as a BMI greater than the 95th percentile Excess micronutrient intake most often occurs with high-dose fat-soluble vitamin and mineral supplements or when consuming foods that have 100% of the DRI levels of a nutrient, plus an oral supplement, and a liquid enhanced beverage all in the same day Outcomes of excessive food or supplement intake on physiological processes can be detrimental, especially if prolonged over time
Hemoglobin A1c is a test that shows:
Average blood glucose levels over time Used in the management of diabetic patients Indicates how well glucose levels are controlled
U.S. Department of Health and Human Services (USDHHS) and the U.S. Department of Agriculture (USDA) published the Dietary Guidelines for Americans 2015-2020 and provide:
Average daily consumption guidelines for the five food groups: grains, vegetables, fruits, dairy products, and meats
Indispensable Amino Acids
Because our body does not synthesize, we need these to be provided in our diet Ex: Histidine, lysine, and phenylalanine
The body produces gastric lipase and amylase to:
Begin fat and starch digestion, respectively
Chemical Breakdown
Begins in the oral cavity
Antioxidant vitamins include:
Beta-carotene and vitamins A, C, and E
Secretin activates release of:
Bicarbonate from the pancreas Which raises the pH of chyme
Dispensable Amino Acids
Body synthesizes Ex: Alanine, asparagine, and glutamic acid
The increased nitrogen loss is the result of:
Body tissue destruction or loss of nitrogen-containing body fluids Nutrition during this period needs to provide nutrients to put patients into positive balance for healing
Early recognition of malnourished or at-risk patients has a strong positive influence on:
Both short- and long-term health outcomes Studies demonstrate a link between malnutrition in adult hospitalized patients and readmission rates, higher mortality rates, and increased cost
Generally meeting the needs of a fetus is at the expense of the mother. However, if nutrient sources are not available, what happens?
Both suffer
Monosaccharides such as glucose (dextrose) or fructose do not:
Break down into a more basic carbohydrate unit
What does the American Academy of Pediatrics strongly support in regards to breastfeeding?
Breastfeeding for the first 6 months of life And breastfeeding with complementary foods from 6 to 12 months
The body uses nitrogen to:
Build, repair, and replace body tissues
Hyperlipidemia places an individual at significant risk for:
Cardiovascular disease, including acute myocardial infarction and stroke
Vitamins are chemicals that act as:
Catalysts in biochemical reactions
Proteins (in the form of essential amino acids) must be consumed for:
Cells to manufacture other proteins, such as carrier proteins, and to enable tissue growth and repair
Many metabolic enzymes assist in:
Cellular metabolism Zinc and magnesium are each part of more than 200 different metabolic enzymes
For long term, it can be administered:
Centrally Sepsis and electrolyte and metabolic imbalances can occur; thus, meticulous nursing care of the vascular access is required
Triglycerides
Circulate in the blood Are composed of three fatty acids attached to a glycerol
Serum albumin measures:
Circulating protein in the blood
It is estimated that more than 66% of the U.S. population (including adults and children) is:
Classified as overweight or obese
Manufactured in the liver, bile is then:
Concentrated and stored in the gallbladder
Vitamin C
Consequences of Deficiencies: - Bleeding tendency - Scurvy Consequences of Toxicities: - Inhibits zinc absorption - Urinary stones
Zinc
Consequences of Deficiencies: - Dermatitis - Impaired taste - Impaired growth - Low level of alkaline phosphatase enzyme Consequences of Toxicities: - Copper deficiency - Renal damage - Nausea and vomiting - Diarrhea
Biotin
Consequences of Deficiencies: - Hair loss Consequences of Toxicities: - Toxicity unknown
Magnesium
Consequences of Deficiencies: - Hypertension - Dysrhythmia - Preeclampsia Consequences of Toxicities: - Increased calcium secretion
Vitamin A
Consequences of Deficiencies: - Night blindness Consequences of Toxicities: - Loss of appetite - Bone pain - Hypercalcemia
Protein Deficiency (Macronutrient)
Protein is a component of every cell of the body Protein deficiency has diverse consequences, and the effects can be subtle or dramatic, depending on the severity, amount of inflammation, and length of time In children, an inadequate intake of protein and kilocalories (*marasmus*) impairs growth and development, stunting height and brain development most evidently The condition in which the insufficiency is protein alone, with adequate energy (*kwashiorkor*), is seen in developing countries after an infant is weaned to a diet that contains mostly grains At any age, inadequate protein intake will adversely impact the body's ability to repair or replace body tissues or produce other constituents such as immune factors In older adults, the loss of muscle mass (in sarcopenia) is difficult to replace. A spiraling decline in health may occur if not corrected through rapid and effective interventions Insufficient circulating protein in the blood (*hypoalbuminemia*) can also lead to *anasarca* (severe generalized edema)
Adequate carbohydrate intake provides the energy for:
Protein to do its many jobs
Low albumin can reflect:
Protein-calorie malnutrition However, other conditions (such as inflammation, blood loss, fluid status) can also cause low serum albumin levels
Enzymes
Protein-like substances that act as catalysts to speed up chemical reactions Are an essential part of the chemistry of digestion
Protein provides energy but, because its essential role is to promote growth, maintenance, and repair, a diet needs to:
Provide adequate kilocalories from nonprotein sources
The food mixes with saliva, which contains:
Ptyalin (salivary amylase)
Early and ongoing assessment of patients with dysphagia using a valid dysphagia-screening tool increases:
Quality of care and decreases incidence of aspiration pneumonia
Developmental Needs Infants Through School-Age
Rapid growth and high protein, vitamin, mineral, and energy requirements mark the developmental stage of infancy
Hepatic disease adversely impacts the ability to:
Reassemble amino acids into the various proteins needed for physiological function
Diagnostic Criteria for Eating Disorders Bulimia Nervosa
Recurrent episodes of binge eating (rapid consumption of a large amount of food in a discrete period of time) A feeling of lack of control over eating behavior during eating binges Recurrent inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise Binge eating and inappropriate compensatory behaviors that both occur, on average, at least once a week for 3 months • Self-evaluation unduly influenced by body shape and weight
The kidneys are involved in producing:
Red blood cells Therefore, in patients with CKD, anemia can develop that is unresponsive to iron intake due to an insufficient level of erythropoietin, a protein-based hormone
Hemoglobin (Hgb) and hematocrit (Hct) is a blood test that examines:
Red blood cells (including the number, size, shape, and color) To diagnose anemia caused by dietary deficiency such as iron, folate, and vitamin B12
National Guidelines for Recommended Intake
Referred to as Dietary Reference Intakes (DRIs) Available on the US Department of Agriculture website
Metabolism
Refers to all of the biochemical reactions within the cells of the body
Protein-Calorie Malnutrition (PCM)
Refers to an extended state of insufficient protein and calorie intake
Suboptimal State (Malnourished State)
Reflects either insufficient or excessive quantity or quality of macronutrients or micronutrients
Medical nutrition therapy is a legal term for:
Reimbursable services provided by the RDN
Nurses should understand basic modified diets to:
Reinforce messages provided by the RDN and encourage referrals as needed
The concept of personalized nutrition is:
Replacing the old paradigm that "one diet fits all" through the science of nutrigenomics In other words, how genetics influence nutritional intervention
Scope of Nutritional Status
Represented as a continuum with malnutrition on both ends (insufficient nutrition and excess nutrition) and optimal nutrition in the middle Continuum representation is important because nutritional status has the potential to change in either direction due to a number of factors and can be corrected with successful measures
In regard to pharmacologic agents for obesity management:
Research continues
Diagnostic Criteria for Eating Disorders Anorexia Nervosa
Restriction of energy intake relative to requirements, leading to a significantly low body weight in relation to age, sex, developmental trajectory, and physical health Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight Disturbance in the way in which one's body weight, size, or shape is experienced; undue influence of body weight or shape on self-evaluation; or persistent lack of recognition of the seriousness of the current low body weight (e.g., the person claims to "feel fat" even when emaciated, believes that one area of the body is "too fat" even when obviously underweight)
In the last 20 years the prevalence of overweight children has:
Risen The percent of obesity in children ages 6 to 11 years has doubled to 17%, and the percent of overweight adolescents has more than tripled to 17.6%
Folate Deficiency
Role of folate in the development of the central nervous system had been known for decades, but not until the 1990s did it become clear that most neural tube defects (NTDs) could be prevented by fortifying grains Folic acid is now added to flour processed in the United States and in many countries; an important reduction in NTDs has been shown in these countries
Most animal fats have high proportions of:
Saturated fatty acids
Fatty acids can be:
Saturated or unsaturated