Nutrition Care
What are the four key messages from MyPlate
*All food and beverage choices matter—focus on variety, amount, and nutrition. *Choose an eating style low in saturated fat, sodium, and added sugars. *Make small changes to create a healthier eating style. *Support healthy eating for everyone.
ketogenic diet
*Fat is the main source of energy * ratio of 3:1 or 4:1 grams of fat to grams of carbohydrate plus protein *Intended for epilepsy pts
What are the five key recommendations in the 2015-2020 Dietary Guidelines for Americans
*Follow a healthy eating pattern across the lifespan *Focus on variety, nutrient density, and amount *Limit calories from added sugars and saturated fats and reduce sodium intake *Shift to healthier food and beverage choices *Support healthy eating patterns for all
What are the eight domains evaluated under food and nutrition history during the nutrition assessment
*Food and nutrient intake *Food and nutrient administration *Medication and complementary/alternative medicine use *Knowledge/beliefs/attitudes *Behavior *Factors affecting access to food and food/nutrition-related supplies *Physical activity and function *Nutrition-related patient/client centered measures
nutrition interventions for acute pancreatitis
*Initiate enteral feeding/resume oral feeding *Support with IV fluids *easily digestible foods *low-fat diet and adequate protein intake once oral nutrition accepted *Increase energy
What are the eligibility requirements for SNAP
*Live in the state where applying *Have a net income at or below the poverty level *Must work more than 20 hours per week for 3 months **Allotments are based on income, household size, assets, housing costs, work requirements, and other factors. There are different rules for households with elderly or disabled individuals.
Common Nutrition Interventions for cancer patients
*Prevention of unintended weight loss, regardless of body mass index *Maintenance of lean body mass *Identification and management of treatment-related adverse effects, and nutrition impact symptoms/the symptoms of nutrition diagnoses, which could change daily *Preservation of functional status *Prevention of unintended weight gain, particularly in certain groups of cancer patients (eg, those with hormonal cancers such as prostate or breast cancer and those with prolonged use of high-dose steroids)
What does the Braden Score Measure
*Risk assessment for pressure ulcers *based on the total scores of the six criteria—sensory perception, moisture, activity, mobility, nutrition, and friction.
Which foods have a high risk for toddlers to choke
*Round and hard foods are easier to suck into the windpipe *Example: hard candies, nuts, popcorn
Marasmus
*Severe chronic calorie deficit *Population: longstanding suboptimal intake, COPD, cancer, dialysis, alcoholism, & older adults *Characteristics: <80% of UBW or IBW Significant weight loss muscle wasting mid upper arm circumference <15th percentile Preserved visceral proteins & immune function Fatigue, lethargy, & general weakness
pathophysiology of non-alcoholic fatty liver disease
*Steatosis (increased buildup of fat in the liver) *Non Alcoholic Steatohepatitis (NASH--liver inflammation and damage caused by a buildup of fat in the liver.) *Cirrhosis (liver failure)
Improving EN tolerance in moderate to severe pancreatitis
*Switching from bolus to continuous infusion *minimizing the period of ileus by initiating EN as soon as possible within the first 48 hours of ICU admission, *diverting the level of infusion of EN more distally in the GI tract *changing from standard polymeric formula to either a formula with small peptides and medium-chain triglycerides or a nearly fat‐free elemental formula
Symptoms of acute pancreatitis
*Upper abdominal pain *Abdominal pain that radiates to your back *Abdominal pain that feels worse after eating *Fever *Rapid pulse *Nausea *Vomiting *Tenderness when touching the abdomen
symptoms of chronic pancreatitis
*Upper abdominal pain *Losing weight without trying *Oily, smelly stools (steatorrhea)
What government food and nutrition assistance programs are available to the public
*WIC *SNAP *NSLP *School breakfast *Summer food service program *Team Nutrition *Commodity supplement food program *Temporary Assistance to Needy Families
nutrition-related side effects of contraceptive injection
*Weight gain *increased blood levels of LDL-cholesterol *decreased blood levels of HDL-cholesterol *decreased bone density
What are the categorical and residential eligibility requirements for the Special Supplemental Program for Women, Infants, and Children (WIC)
*Women: Pregnant (during pregnancy and up to 6 weeks after the birth of an infant or the end of the pregnancy Postpartum (up to six months after the birth of the infant or the end of the pregnancy) Breastfeeding (up to the infant's first birthday) *Infants: (to the infant's first birthday) *Children: (up to the child's fifth birthday) *At or below the poverty level set by the state they live in *Must live in the state where they apply
What is the National Health and Nutrition Exam Survey (NHANES)
*a program of studies designed to assess the health and nutritional status of adults and children in the United States. *survey is unique in that it combines interviews and physical examinations.
total energy expenditure (TEE)
*accounts for both the basal metabolic rate (BMR) and an activity factor *BMR x activity factor = TEE
osteoporosis
*bone disease that occurs when the body loses too much bone, makes too little bone, or both. *bones become weak and may break *commonly seen in elderly women *results from the imbalance between bone resorption and bone synthesis. *Calcium intake in children is important in preventing osteoporosis later in life.
identify foods that should be avoided in GERD patients
*caffeine *spicy food *citrus juices *fatty foods *mint *alcohol *chocolate *tomato products
BMI (body mass index)-for-age charts
*classify children and adolescents as underweight, overweight, or obese.
consequences of protein needs above 1.5 g/kg body weight in an elderly patient with stage III pressure ulcer and impaired renal function may cause
*dehydration *In patients who also have compromised renal function, the higher protein concentrations must be monitored to ensure that fluids are not pulled from the system
Describe Thiazide
*diuretic *pulls potassium from the blood *side effect: hypokalemia
National Academy of Medicine's framework for health care quality componenets
*effectiveness *safety *timeliness *patient/family-centeredness *access *efficiency *care coordination *health system infrastructure capabilities.
What is the priority for nutrition intervention in patients with severe burns
*first 24-48 hours, fluid and electrolyte replacement *Feeding can begin once fluid levels are stable. *high-protien diet
gestational diabetes mellitus (GDM)
*first-time diabetes diagnosis when a woman is pregnant * occurs when the body cannot produce sufficient insulin during pregnancy *typically presents in the middle or end of the second trimester.
macrocytic anemia
*folate or vitamin B12 deficiency *characterized by larger than normal red blood cells.
What triggers gastroesophageal reflux disease (GERD)
*gastric fluid is refluxed into the esophagus and causes troublesome symptoms and other complications. *Physical and lifestyle factors contribute to development of GERD
What drug-nutrient interaction exists for individuals taking statins or cyclosporine? Which food should they avoid
*grapefruit juice *Patients taking these medications need to avoid grapefruits and grapefruit juice. *Grapefruits contain naringenin, which can inhibit metabolic enzymes.
What comprises anthropometric measurements
*height *wt/wt history *BMI *weight change *frame size *Body mass *Growth pattern indexes *Body compartment estimates
Nutrition Intervention for Cystic Fibrosis
*high fat & high calorie *emphasize food choices & nutritional supplements *enteral nutrition may be indicated if weight gain is not achieved, especially if BMI <19
weight for age growth chart
*important to help explain changes in BMI-for-age in older children *not used to classify children/adolescents
Overhydration Signs and Symptoms
*increased blood pressure * very moist skin *edema present in lower extremities *puffy/swollen eyes
pancreatitis
*inflammation of the pancreas characterized by edema, cellular exudate, and fat necrosis
Microcytic Anemia
*iron deficiency anemia *characterized by the presence of small red blood cells
A 2-year-old child who drinks large quantities of milk and very little solid food is at risk for
*iron deficiency anemia *large quantity of calcium displaces iron
acceptable patient identifiers in a health care setting
*joint commission recommends using at least two patient identifiers when providing care, treatment, and services. *Patient's phone number *patient's full name *assigned identification # *other person-specific identifier such as date of birth.
Which dietary factor can cause vision problems in older adults
*low intake of antioxidants
What are objectives for treatment of polycystic ovarian syndrome (PCOS)
*maintaining a desirable body weight/weight loss *correction of dyslipidemias *maintenance of blood sugars
Up to what age should head circumference be measured?
*measure adequate head growth, to indicate brain development, up to 3 years of age (36 months)
Serum Albumin Lab Test
*measures the amount of albumin in the clear liquid portion of the blood *used to evaluate overall health status, liver function, and kidney function. *can be affected by several factors and diagnoses, therefore the serum albumin test should not be used alone in order to avoid a misdiagnosis. *not nutrition sensitive
Cachexia signs and symptoms
*muscle wasting *suboptimal intake *severe weight loss *loss of appetite (anorexia) *weakness/fatigue
metabolic syndrome
*patient must meet 3 of the following 5 criteria: 1. Elevated waist circumference 2. Elevated triglycerides: ≥150 mg/dL (1.7 mmol/L) 3. Reduced high-density lipoprotein cholesterol: <40 mg/dL (1.0 mmol/L) in men; <50 mg/dL (1.3 mmol/L) in women 4. Elevated blood pressure: Systolic ≥130 and/or diastolic ≥85 mm Hg 5. Elevated fasting glucose: ≥100 mg/dL (5.6 mmol/L) * This syndrome can lead to coronary heart disease and diabetes.
What are the three components of a client's history
*personal *patient/client/family medical history *social history
Kwashiorkor
*protein deficiency but adequate calories *Population:o healthy pts w/ severe metabolic stress/ injury w/o receiving adequate nutritional support *Characteristics: Fatty liver Puffy hands/feet Normal anthropometrics (>90% IBW) Severely depressed visceral proteins Compromised immune function Poor wound healing/skin sores changes in hair
Hyperosmolar hyperglycemic state
*rare condition that presents with extremely high blood glucose levels, elevated serum osmolality, extreme dehydration, and low amounts of ketones *often occurs when people with type 2 diabetes have an infection or forget to take their medicines
Overhydration intervention
*recalculate fluid needs *communicate w/ health care team *chart symptoms
Strategies that are used to promote weight reduction
*reduced kilocalorie diet--individualized, incorporates portion control, meal replacements or structured meal plans & maintaining a healthy nutrient composition *Increased physical activity *Use of behavioral strategies
common symptoms of hypoglycemia
*shakiness/tremor *fatigue/weakness *hunger *anxiety *sweating *tachycarida (irregular/rapid heartbeat) *dizziness *headaches *confusion
osteomalacia
*softening of the bone *most commonly develops due to impaired vitamin D absorption/vitamin D deficiency, which decreases calcium absorption *associated with cancer, kidney failure, lack of dietary phosphates, liver disease, and antiseizure medication side effects.
koilonychia
*spoon shaped nails *may indicate diet related iron deficiency *Modifications should be made to the diet by increasing iron through foods or supplementation
basal metabolic rate (BMR)
*the energy required for metabolic functions, is estimated using the Harris-Benedict equation *Men: 66.5 + (13.7 x Wt)+ (5 x H) − (6.8 × Age) Women: 655 + (9.6 x Wt) + (1.7 x H) − (4.7 × Age) *wt in kg *ht in cm *age in years
sarcopenia
*the term for loss of muscle mass *characterized by a progressive loss of muscle strength and function *often associated with aging.
What is the target hemoglobin A1c for an individual with diabetes
*under 7% *under 6.5% if individuals can maintain w/o severe & persistent hypoglycemia *A1c in this range has been shown to decrease microvascular complications from diabetes
What are possible nutrition-related etiologies for the memory loss
*vitamin B12 deficiency
Define hematocrit and identify normal values for men and women.
*volume of red blood cell in whole blood. *Men Normal Values: 39%-49% *Women Normal Values: 33%-43%
Which CDC growth charts are appropriate for children and adolecents between 2 and 20 years
*weight-for-age *stature-for-age
foods that people with celiac disease should avoid.
*wheat (breads, pasta, cereals) *oats *malt, malt flavoring and other malt products *beer, ale, porter, stout (usually contain barley) *hotdogs/processed lunch meat *candies gravies/sauces/salad dressings *breading *cookies/crackers *communion wafers *croutons *french fries *imitation meat/seafood *soups *seasoned snacks (chips) *self-basting poultry *vegetables in sauce
What percent weight change is considered significant
1 week: 1%-2% 1 month: 5% 3 months: 7.5% 6 months: 10%
what percent weight change is considered severe
1 week: >2% 1 month: >5% 3 months: >7.5 % 6 months: >10%
What are the steps in the Nutrition Care Process?
1. Assessment 2. Diagnosis 3. Intervention 4. Monitoring/Evaluation
What are the 5 stages of change
1. Precontemplation--clients have not accepted or acknowledged health risk or do not recognize they need to change 2. Contemplation--clients begin to recognize they have a problem, but are not sure how or when to begin to address it 3. Preparation--Clients are in the process of preparing to take action (creating an action plan) 4. Action--clients have taken steps to modify their behavior and intend to keep moving forward and are implementing the behavior change 5. Maintenance--clients have sustained these changes for more than 6 months but will need continual support for changes
Formula for estimated energy requirements (kcal/day) for an infant age 4-6 months
1. convert weight in pounds to kilograms 2. (89 kcal x weight in kg) - 44
Nutrition interventions for cachexia
1. increase/encourage oral intake of foods **recommend high calorie & high protein foods 2. add nutritional supplement/shake to patient's diet 3. consider initiating nutrition support
What internal temperature does fish need to meet?
145 degrees F
recommended intake for sodium
2,300 mg or less
recommended weight gain during pregnancy for a woman with a BMI between18.5 and 24.9 (normal)
25 to 35 pounds
What is the optimal level for low-density lipoprotein (LDL) cholesterol
<100 mg/dL.
Low food security vs very low food security
According to US Department of Agriculture's Economic Research Service (ERS): *low food security: formerly labeled Food insecurity without hunger, the individual reports of reduced quality, variety, or desirability of diet. Little or no indication of reduced food intake. *very low food security: formerly labeled Food insecurity with hunger, the individual reports of multiple indications of disrupted eating patterns and reduced food intake.
nutrition management for kidney stones
Achieve daily urine volume > 2 L Calcium administration based on age Avoid high-oxalate foods Reduce sodium intake from baseline Do not exceed vitamin C intake of 500 mg/day
factors that increase a person chances of developing coronary heart disease (CHD)
Age: Male > 45 years, Female > 55 years Family history of CHD Current cigarette smoking Low high-density lipoprotein cholesterol: <40 mg/dL Confirmed hypertension: > 140/90 mm Hg Diabetes mellitus Sedentary lifestyle Obesity
general rule for appropriate portion sizes for toddlers and preschool children
Approximately ½ of the adult portion based on MyPlate serving sizes
diet management of non-alcoholic fatty liver disease
Balanced low-kilocalorie diet Low-carbohydrate diet Portion-controlled diet Mediterranean diet Avoidance of sugary drinks
What are the nutrition requirements for women who are breastfeeding
Energy: *increase of 330 kcal/day for first 6 months *increase of 400 kcal/day for each month thereafter Protein: *increase 25 g/day based on 1.1 g/kg/day Carbohydrates: *About 210 g/day carbohydrates Vitamin D needs (600 IU/day) for pregnant and breastfeeding women are the same as for the general adult population.
What are the federal agencies that oversee food safety in the United States
Food and Drug Administration Centers for Disease Control and Prevention Food Safety Inspection Service
What are the five components of the Nutrition Assessment
Food and nutrition related history Anthropometric measurements Biochemical data, medical tests, and procedures Nutrition-focused physical findings Client history
biomarkers of iron-deficiency anemia
Hematocrit (packed cell volume) and hemoglobin Serum ferritin Serum iron Total iron-binding capacity
Which populations have a higher prevalence of iron deficiency
Infants--diets are primarily milk based, and milk is not high in iron adolescents--increased iron needs to support the rapid growth that occurs at this point in the lifespan.
During their peak growth spurt, adolescent males are at greatest risk for a deficiency of
Iron needs increase at a higher rate for adolescent males for development of lean body mass
What is cachexia?
Lack of appetite and rapid muscle breakdown associated with disease i
What foods need to be limited with phenylketonuria (PKU)
Meat, dairy, bread, and pasta products should be eaten in low quantities to reduce the incidence of consuming foods with phenylalanine. Phe-free products should be used to supplement amino acid intake. Diets should be centered around low-phe foods, fruits, and vegetables.
What is the HAMWI formula for calculating ideal body weight for individuals taller than 5 feet
Men: 105 lb for 5 ft + 6 lb for every inch >60 in Women: 100 lb for 5 ft + 5 lb for every inch>60 in *Add 10% if person has a large frame or subtract 10% if person has a small frame.
What equation would you use to calculate resting metabolic rate in a patient with obesity if indirect calorimetry isn't available
Mifflin-St Jeor equation to calculate RMR
Niacin (Vitamin B3) Deficiency
Pellagra "The Four D's": diarrhea, dermatitis, dementia and death
Percent weight change formula
Percent weight change = (UBW - CBW)/UBW x 100
Signs and symptoms of diabetes
Polyuria (frequent urination) Polydypsia (abnormal increased thirst) Polyphagia (excessive or extreme hunger) Weight loss fatigue
What is a PES Statement
Problem, etiology, and signs/symptoms during the nutrition diagnosis
Prevalence
The proportion of a population who have (or had) specific characteristics of a disease. It enables determination of a person's likelihood of having the specific disease.
What are potential signs of a food allergy
Tingling or itching in the mouth Hives, itching, or eczema Swelling of lips, face, tongue, throat, etc. Wheezing, nasal congestion or trouble breathing Abdominal pain, vomiting or diarrhea Dizziness, lightheadedness, or fainting In some cases, anaphylaxis
What are the BMI classifications?
Underweight - less than 18.5 Normal - 18.5 - 24.9 Overweight - 25-29.9 Obese I - 30-34.9 Obese II - 35-39.9 Obese III - 40+
morbidity
another term for illness.
What is the recommended minimum weekly and daily physical activity guidelines for adults
at least 150 minutes of physical activity per week or 30 minutes per day.
What is the purpose of a nutrition screening
identify patients, clients, or groups at nutritional risk who may have a nutrition diagnosis and benefit from nutrition assessment and intervention by an RDN
myotonia
muscle spasms
Which population is at risk for inadequate weight gain and a low-birth-weight infant
pregnant adolescents--concerned about weight gain and social stigma tend to gain less weight during pregnancy.
dystrophy
refers to defective nutrition and metabolism
autonomy
the agreement to respect another's right to determine a course of action for himself or herself, or the support of another's independent decision making.
mortality rate
the number of deaths due to a specific disease divided by the total population.
incidence
the number of newly diagnosed cases of a disease. It enables determination of a person's probability of being diagnosed with that disease during a time period.
