Nutrition
Vitamin E
(antioxidant) Foods Nuts, soybean, sesame oil
Dysphagia
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Kilocalorie
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Malnutrition
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how do you calculate BMI?
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Genetic Factors
/t cholesterol/ trigylceride levels Lifestyle effects - cardiovascular disease, DM,
Te risk for diabetes and cardiovascular disease increases with a waist circumference measurements of 35 inches or more for women and ____ inches or more for men
40
BMI
<19 Underweight; severe level <15 indicative of anorexia 19-24.9 Optimal body weight composition. Elderly persons should strive for BMI >21 25-29.9 Overweight; may be appropriate given health status 30-34.9 Class I obesity; slow weight loss advised to promote permanent weight loss Not appropriate for elder population to lose weight 35-39.9 Class II obesity; slow weight loss advised May be a candidate for bariatric surgery if comorbidities present and not able to achieve long-term weight loss through diet and exercise ≥40 Class III or "extreme" obesity (formerly known as morbid obesity) May be a candidate for bariatric surgery based on health status, age, and level of obesity and history of not being able to achieve long-term weight loss through diet and exercise
Paracentesis
A paracentesis is performed by inserting a needle or trocar through the abdominal wall into the peritoneal cavity. The goal is relief of abdominal ascites pressure Indications for needing: abnormal circulation of protein rich fluid in the abd. cavity cause by cirrhosis of the liver respiratory dirstress or compromised lung expansion
Fat Soluble Vitamins, requires bile for absorption in the small intestine. Absorbed with the lymphatic system with fats
A, D, E, K
Fiber
All the health benefits of fiber improve the physical functioning of the human body. The benefits are not directly nutritional but instead allow the body to function at a more efficient level. consists of substances in plant foods that, for the most part, cannot be digested by humans. We do not produce digestive juices strong enough to break down the bonds that hold the simple carbohydrates of most plant fibers, so fiber "passes through" our bodies without providing kcal or nutrients. Its texture provides bulk and eases the work of the GI muscles that regulate movement of the food mass
surgery therapeutics
Bariatric surgery Nonmalabsorptive procedures Malabsorptive procedures Common complications Surgical complications Nutrient deficiencies
Vitamins function
Blood Health Bone Health Fluid and Electrolyte Balance Organic substances essential for normal metabolism. Both vitamins and minerals are micronutrients. Present in small amounts in food. Unable to synthesize in needed amounts, they must be provided by the diet. Except Vitamin K, it is synthesized in the intestine, and vitamin D when sunlight exposure is adequate. Fresh foods are the highest in vitamins. Vitamins have antioxidant benefits. Used in cellular activities such as growth and repair. Used as coenzymes in metabolism.
Water Soluble Vitamins, passively and actively absorbed by the small intestine
C and B
Carbohydrates (CHO)
CHO we consume are primarily form plant sources. Energy is the only real nutrient function of CHO When adequate amounts of CHO ae available, both Cho and small amounts of fats are used for energy. Grains: Cereals, breads, crackers, rice, or pasta, at least half as whole grains (see following chart) Vegetables: Fiber-rich vegetables, starchy vegetables such as carrots, sweet potatoes, white potatoes, peas; legumes or dry beans such as kidney beans, chickpeas, and black-eyed peas Fruits: Fiber-rich fruits, most fruits especially bananas, grapes, pears, apples Milk: Fat-free or low fat milk, yogurt, and other milk products containing lactose (does not include most cheeses) Meats and beans: Replace animal sources with servings of legumes or dry beans
FRUIT PER DAY
Children 2-3 years old 4-8 years old 1 cup 1 to 1 1/2 cups Girls 9-13 years old 14-18 years old 1 1/2 cups 1 1/2 cups Boys 9-13 years old 14-18 years old 1 1/2 cups 2 cups Women 19-30 years old 31-50 years old 51+ years old 2 cups 1 1/2 cups 1 1/2 cups Men 19-30 years old 31-50 years old 51+ years old 2 cups 2 cups 2 cups - See more at: http://www.choosemyplate.gov/fruit#sthash.6QwvBtjX.dpuf
VEGGIES PER DAY
Children 2-3 years old 4-8 years old 1 cup 1 1/2 cups Girls 9-13 years old 14-18 years old 2 cups 2 1/2 cups Boys 9-13 years old 14-18 years old 2 1/2 cups 3 cups Women 19-30 years old 31-50 years old 51+ years old 2 1/2 cups 2 1/2 cups 2 cups Men 19-30 years old 31-50 years old 51+ years old 3 cups 3 cups 2 1/2 cups - See more at: http://www.choosemyplate.gov/vegetables#sthash.ExJNPwx0.dpuf
PROTEIN PER DAY
Children2-3 years old 4-8 years old2 ounce equivalents 4 ounce equivalents Girls9-13 years old 14-18 years old5 ounce equivalents 5 ounce equivalents Boys9-13 years old 14-18 years old5 ounce equivalents 6 1/2 ounce equivalents Women19-30 years old 31-50 years old 51+ years old5 1/2 ounce equivalents 5 ounce equivalents 5 ounce equivalentsMen 19-30 years old 31-50 years old 51+ years old 6 1/2 ounce equivalents 6 ounce equivalents 5 1/2 ounce equivalents - See more at: http://www.choosemyplate.gov/protein-foods#sthash.HG8qT2Kf.dpuf
Nasogastric Decompression
Clients who have an intestinal obstruction require NG Decomp. Goal: to relieve abd distention. The obstruction can be mechanical( tumors, adhesions, fecal impaction) Bowe sounds may be absent or hyperactive and have intermit hiccups. NA: Maintain accurate I/O assess bowel sounds and abdominal girth moniter tube for displacement
Under Nutrition
Common in hospitalized patient (30% to 55%) 23% to 85% prevalence in elderly long-term care residents
Negative Consequences of Dysphagia
Dehydration Weight loss Malnutrition Aspiration
Symptoms of Dysphagia or Possible Aspiration
Drooling, increased oral secretions Difficulty swallowing Heartburn, chest pain Coughing or choking at meals Difficulty chewing or swallowing Hoarseness or increased throat clearing Gurgling voice Increased throat clearing
gastrointestinal bleeding is common cause if anemias in older adults
Fact
vitamins Food Sources
In almost all foods, yet no one food group is a good source of all vitamins. It is always best to consume vitamins from food sources Fresh fruits and vegetables are particularly rich sources.
Erythropoitin (epoetin alfa (Epogen, Procit)
Increase production of RBC
Hypoalbuminemia
Increased concentration of albumin in the blood
The body mass _______, a reliable indicator o total body fat stores, is a ratio of weight (kg) and to height (meters)
Index
Nutrients Required for RBC Development
Iron Protein B 12 and Folate Vitamin E Vitamin C
Common Diagnostic Tests
Laboratory tests Albumin; blood glucose; hemoglobin A1C; lipid profile; electrolytes; blood urea nitrogen (BUN); tests to rule out anemia; calcium, phosphorus, and vitamin D levels Radiographic scans DXA scans (done density)
common diagnostic tests
Laboratory tests Albumin; blood glucose; hemoglobin A1C; lipid profile; electrolytes; blood urea nitrogen (BUN); tests to rule out anemia; calcium, phosphorus, and vitamin D levels Radiographic scans DXA scans (done density)
Folic Acid
Like the B vitamins folic acid is required for DNA synthesis and normal maturation of RBC's. Inadequate intake more common among people who are chronically undernourished such as: alcoholism drug addiction older adults Times of growth and development require higher levels of folic acid, such as: pregnancy infants and teenagers during times of growth
Bariatric Surgeries
Look in ATI book
Lab test for anemia
MCV (size of red bood cells) MCH (the amount of hgb per red blood cell) MCHC (amount of hgb relative to sie of cell)
Protein
Our overall physical health and well-being depend on our eating enough essential amino acids for body protein synthesis. Proteins are organic compounds formed by the linking of many smaller molecules of amino acids, amino acids contain nitrogen, which distinguish protein from other nutrients. Functions Growth and maintenance needed to make the proteins required to support muscle, tissue, bone formation, and the cells themselves Creation of communicators and catalysts vital substances produced by our bodies are formed of protein Ex. Insulin Immune system response Fluid and electrolyte regulation Acid-base balance Transportation
Diseases/ Occurrences Causing Dysphagia
Parkinson's disease Multiple Sclerosis Dementia Stroke Trauma
Vitamin E
Protects fatty acids and promotes formation of functioning RBC, muscle and other tissue
Macronutrients
Protein Carbohydrate Fatty acids
Interventions to Prevent Aspiration during Feedings
Provide rest before feedings Sit the person at 90-degrees for oral intake (including PO meds) Most important Avoid rushed feeding, adjust rate of feeding and size of bites to the individual Alternate solids and liquids Place food on non-impaired side of the mouth Have suction equipment ready at all times Avoid sedatives and hypnotics that may impair the cough reflex and swallowing.
Treatment for iron-deficiency anemia
Severe iron-deficiency anemia may require a blood transfusion, iron injections, or intravenous (IV) iron therapy. Treatment may need to be done in a hospital
Ostomies
Sugrical opening from the inside of the body to the outside. Can be permanent or temp. A stma is the artificalopening creasted during ostomy surgery. Most common: Illestomy (perforemed when the entire colon must be removed due to disease. ; opening of ileum to drain stool, colostomy; opeing inlarge intestine to drain stool
Water
The Adequate Intake (AI) recommendations for water are about 13 cups a day for men and 9 cups a day for women. This amount is in addition to fluids from foods consumed throughout the day, such as fruits and vegetables. Although the minimum amount needed by healthy adults may be about 4 cups, higher amounts are optimum considering an individual's physiologic status and energy output. We can live several weeks without food but can survive only a few days without water or fluids. Although our bodies use stored nutrients to fuel energy needs, a minimum intake of water is required for cell function and as a solution through which waste products of the body are excreted in urine.
The best source of iron
The body tends to absorb iron from meat better than iron from nonmeat foods red meat, especially beef and liver. Chicken, turkey, pork, fish, and shellfish also are good sources of iron. Peas; lentils; white, red, and baked beans; soybeans; and chickpeas Tofu Dried fruits, such as prunes, raisins, and apricots Spinach and other dark green leafy vegetables Prune juice
Obesity is defined as body weight 20% or more above ideal weight or having a body mass index (BMI) of 30 or more.
True
The health Insurance and accountability act (HIPPA), passed in 1996, established national standards to protect an individuals medical records and other personal health information.
True
Micronutrients
Vitamins Minerals Fiber* Water
Pharmacologic Agents
Weight loss medications Antilipid agents Micronutrient supplements Parenteral nutrition
Enteral Feedings
When patient can no longer take adequate nutrition oraly.
What is anemia?
abnormally low circulating RBC, hgh concentration or bth
Signs and Symptoms of Folic Acid Deficiency
anemia generally have a gradual onset as stores are depleted. Pallor Progressive weakness Fatigue Shortness of breath Heart palpatations
Screening During Pregnancy
anemia, gestational diabetes
vitamins
are organic molecules required in very small amounts for cellular metabolism. Each vitamin performs a specific metabolic function. Vitamins, except for vitamin D, are not synthesized by our bodies and thus are essential nutrients that must be provided through dietary intake
The goals of treating iron-deficiency anemia
are to treat its underlying cause and restore normal levels of red blood cells, hemoglobin, and iron.
Vitamin K
blood clotting (co-enzyme) Foods Green leafy vegetables, canola and olive oil
Screening for Adults
bmi, lipids, hgbA1c
who is most at rik for iron deficiencys anemia from inadequate intake?
children,adilsencests. and pregnant women
Assessment of Dysphagia
cognition assess follow one step commands oral motor exam
Vitamin C
collagen formation (wound healing), also protects other nutrients. Aids in absorption of iron Red pepper Orange juice Brocolli Strawberries Grapefruit juice Kiwi
the chief _____ is the issue that brings a person to the attention of the health care provider and it is recorded as the persons exact words with quotation marks
complaint
Those with a high waist circumference are at an increased risk
diabetes, dyslipidemias, hypertension, heart attack, and stroke
a nursing ____ is used to determine the appropriate plan of care for the patient and drives interventions and patient outcomes
diagnosis
Difficulyt swallowing or the inability to swallow, known as ____, is asociated with an increased risk for aspiration
dys.
a women who is 5 7" tall should have an ideal body weight of 125 pounds
false
Vitamin C and B-complex are absorbed with fat into the lymphatic ciculation and stored mostly in the liver and adipose tissue
false (absorbed not stored)
A nasogastric ir nasointestinal route is usally selected when nutritional support is neeeded for 4 to 8 weeks
false (less than 4 weeks)
Iron Supplements
ferrous sulfate (Feosol) Ferrous fumarate (Feostat) Ferrous gluconate (Fergon)
Screening at Birth
genetic linked metabolic disorders, glucose
TPN Total parenteral nutrtion
hypertonic IV blous solution. Normally through a central line. Client presentation: A weight loss of 7% body weight and NPO for 5 days or more Never stop TPN abruptly it can cause glucose to alter significantly Monitor vitals Q4-8 Change tubing bag every 24 hous Complications: Hyper/Hypoglycemia and vitamin dif.
what does vitamin C do for anemia
may increase ora iron absorption Take iron supplements between meals to increase absorption
Vitamin B
nervous system and metabolism. Vegetarian diets can lack vitamin B12 because they eat no eggs or meat. Liver, eggs, kidney Fresh shrimp and oysters Milk Cheese
one sensitive indicator of the body gain or loss of protein is its _____ balance
nitrogen
who is at risk for nutrtion anemias?
older adults
Populations at greatest risk for problems with nutrition are
older adults and infants
vital signs assessment, which is an essential part of every physical examination, includes blood pressure, pulse rate, respiratory rate, temperature measurements, and assessment of ____ if indicated
pain
subjective data of anemia
pallor, fatigue, irritability, numbness and tingling of extremeites, sensitivity to cold, dyspnea
Total _____ nutrition provides complete nutrition intravenously, bypassing the gastroinestinal ract for patients who are unable to take fluid orally
parenteral (TPN)
Tympany and resonance are sounds elicited when using assessment technique ____during a physical examination
percusion
Minerals
prime sources of minerals include both plant and animal foods. Valuable sources of plant foods include most fruits, vegetables, legumes, and whole grains. Animal sources consist of beef, chicken, eggs, fish, and milk products.
Fats
refers to the chemical group called lipids. Lipids are divided into three classifications: fats (or triglycerides), and the fat-related substances of phospholipids and sterols. Approximately 95% of the lipids in foods and in our bodies are in the triglyceride form of fat. The other two lipid classifications are the fat-related substances of phospholipids and sterols. Lecithin is the best-known phospholipid Cholesterol is the best-known sterol Function Source of Energy Palatability Fat makes food smell and taste good Satiety and Satiation helps prevent hunger between meals Food Processing Nutrient Source Stored Energy Organ Protection Insulation
Genetic influences
related to obesity include the hormones leptin and ghrelin. Leptin, produced by adipocytes, has a role in the complex system of the regulation of body weight and fat regulation. Leptin inhibits food intake and regulates long-term appetite. The size of adipose stores is regulated through messages transmitted by leptin between the brain and leptin receptors. Mutations in functions of leptin and leptin receptors may have a role in the development of obesity
objective data of anemia
shortness of breath, tachycardia, and palpations dizziness, nail bed deformities (spoon shaped nails), smooth sore bright red tongue
Vitamin D
stimulation of calcium and phosphorus, deficiency causes rickets Fatty fish, salmon, mackerel, sardines, tuna Egg Beef liver Mushrooms (the only vegan source of vitamin D)
Iron supplements can cause side effects
such as dark stools, stomach irritation, and heartburn. Iron also can cause constipation, so your doctor may suggest that you use a stool softener
Risk factors of enemia
trauma, menorrhagia, gastrointestinal bleeding, intra or post op blood loss or chemical/radiaton exposre
Ninety five percent of the lipids in the diet are in form of the ______, the predominant form of fat in food and the major storage form of fat in the body
triglcerads
A patients history of present health concern or illness is the single most important factor in helping the health care team arrive at a diagnosis or determine the patients current needs
true
Height and weight are the most commom anthropometic measurements used to determine body dimensions
true
The recommended daily intake of fiber for women is 25 grams
true
the world health organization defines obesity as a body mass index graeter than 30
true
Vitamin A
vision (night blindness), skin and bones Vitamin A Foods
who is at most risk for iron definciency anemia due to blood loss ( such as gasrointestnal ulcer)
women post menopas and men