Nutrition exam 4

Explain general nutrition recommendations for nephrotic syndrom

Primary objective: reduce proteinuria (protein in urine) • Recommended protein intake for adults with nephrotic syndrome is similar as the protein intake for healthy adults • Do not use high-protein diet • Restrict sodium intake • Low fat, low-cholesterol diet • Have adequate calories • Take vitamin D supplements when having vitamin D deficiency

How can someone with chronic disorders be able to get their daily nutrients, if their bodies have trouble filtering out their urine?

Wasting (low weigh for height) is prevalent in patients with chronic kidney disease Nutrition supplements Nutrition treatment

Describe the nutrition recommendations about alcohol for patients with diabetes

Women no more than 1 drink/day, men no more than 2 drinks/day Increase the risk of hypoglycemia (low blood sugar)

Discuss ways to increase a client's calorie intake

Add butter to hot foods • Bread, pancake, waffles, soups, vegetables, potatoes, cooked cereal, rice, pasta Add dried fruit, nuts, or granola to desserts and cereal Substitute mayo for salad dressing in salad, eggs, casseroles, sandwiches Use honey on toast, cereal, fruit, coffee, or tea

Understand nutrition recommendations about sodium for patients with CKD

Choose foods with less sodium • Avoid salting food during cooking or at the table • Buy fresh food more often • Use spices, herbs, and sodium-free seasonings instead of salt • Check the Nutrition Facts Label • A daily value of ≥20%: the food is high in sodium Look for foods that are labeled sodium free, salt free, very low sodium, low sodium, reduced or less sodium Rinse canned vegetables, beans, and meat before eating Avoid processed meats, salted snacks and crackers Avoid high-sodium condiments (soy sauce, teriyaki sauce, bottled salad dressings)

Give examples of ways to modify the diet to alleviate side effects of fatigue

Eat a hearty breakfast, fatigue may worsen as day progresses Consume easy-to-eat foods that can be prepared with a minimal amount of effort If weight loss is not a problem, avoid overeating. Excess weight worsens fatigue Friends and families help to provide meals

Give examples of ways to modify the diet to alleviate side effects of nausea

Eat food served cold Eat high-carb, low fat, easy to digest food Avoid fatty, greasy, fried, spicy, or food with strong order Avoid eating 1-2 hours before chemotherapy or radiotherapy

Teach a person living with HIV/AIDS guidelines using a healthy eating pattern including fats

Eat healthy fats in moderate • Olive oil, canola oil, seeds, nuts, nut butters, avocados Limit saturated and trans fats • Butter, margarine, shortenings, foods make with solid fat

Describe the nutrition recommendations about fat for patients with diabetes

Eat more unsaturated fat Eat less saturated fat

List three meal-planning approaches

Achieve glycemic control > Manage carb intake > Meal planning approaches Meal planning approaches • Carbohydrate counting • The plate method • Food list Choose specific meal planning approach based on client's pharmacological

Optimal intake

(p 325, Box15.4) Promote congregate dining, if appropriate Display a positive attitude when serving food or discussing nutrition Remove unpleasant orders from the room

Discuss nutrition and lifestyle interventions (such as heart healthy eating pattern) that may help prevent chronic kidney disease (CKD)

Avoid excessive intake of protein and sodium Additional restriction for phosphorus and potassium are added as necessary Mediterranean diet Heart-healthy options • Grill, broil, bake, roast, or stir-fry instead of deep-fat frying • Use nonstick cooking spray or olive oil instead of butter • Trim fat from meat and remove poultry skin before eating • Choose lean protein: loin or round cuts of meat, skinless white-meat poultry, fish, legumes, low-fat milk, yogurt, cheese • Limit alcohol intake: women ≤1drink/day, women ≤1drink/day, men ≤2drinks/day,

Give examples of foods to eat or avoid when phosphorus is restricted

Box 23.5 pg. 516

Give examples of foods to eat or avoid when potassium is restricted

Box 23.5 pg. 516

Give examples of foods to eat or avoid when protein is restricted

Box 23.5 pg. 516

Give examples of foods to eat or avoid when sodium is restricted

Box 23.5 pg. 516

Teach a person living with HIV/AIDS guidelines using a healthy eating pattern including overall recommendations

Calorie-appropriate, balanced eating pattern, rich in a variety of fruit, vegetables, and whole grains Drink adequate fluid Practice food safety guidelines Manage symptoms: anorexia, nausea, vomiting, diarrhea

Describe carbohydrate counting

Carbohydrate choice: 15 grams of carbs/choice Total calorie intake is individualized (Two tables) The number of carbohydrate choices may differ between meals, but should be consistent from day to day Consume a variety of carb sources

Describe food lists

Carbohydrate: starch, fruit, milk, nonstarchy vegetables, sweets/desserts/other carbohydrates Protein: lean protein, medium-fat protein, high fat protein, plant-based protein Fats: monounsaturated fats, polyunsaturated fats, saturated fats Individualized meal plan specify the number of servings allowed from each list for each meal and snack Any food (in the serving size specified) can be exchanged for any other within each list

Teach a person living with HIV/AIDS guidelines using a healthy eating pattern including protein

Choose lean sources: skinless poultry, lean cut of beef and pork, fish and seafood, legumes

Teach a person living with HIV/AIDS guidelines using a healthy eating pattern including dairy

Choose low-fat or nonfat milk or yogurt

High fiber diet

Constipation Diabetes Obesity

Describe the nutrition recommendations about carbs for patient with diabetes

Eat some: whole, minimally processed carbohydrate foods • Fruits: apples, blueberries, strawberries and cantaloupe • Whole intact grains: brown rice, whole wheat bread, whole grain pasta and oatmeal • Starchy vegetables: corn, green peas, sweet potatoes, pumpkin; and beans and lentils (black beans, kidney beans, chickpeas and green lentils) Eat less: refined, highly processed carbohydrate foods and those with added sugar • Sugary drinks: Soda, sweet tea and juice • Refined grains: White bread, white rice and sugary cereal • Sweets and snack foods: cake, cookies, candy and chips Overall:Lower overall carb intake improves glycemic control Carb choices • Eat the most: whole, unprocessed, non-starchy vegetables

How long should a person follow nutrition treatment after a kidney transplant?

Eating at least five servings of fruits and vegetables each day Avoiding grapefruit and grapefruit juice due to its effect on a group of immunosuppression medications Having enough fiber in daily diet Drinking low-fat milk or eating other low-fat dairy products, which is important to maintain optimal calcium and phosphorous levels Eating lean meats, poultry and fish Maintaining a low-salt and low-fat diet Staying hydrated by drinking adequate water and other fluids each day

Understand nutrition recommendations about calories for patients with CKD

Ensure adequate calorie intake Fat and simple sugar are considered as "free" foods • Add honey or sugar to cereal or beverages • Add oils or trans fat-free margarine to cooked rice, pasta, cereals, or vegetables • Use jam or jelly on toast or crackers • Snack on hard candy, gummies, lollipops, jelly beans, mashmallows

What specific diets must HIV/AIDS patients have to be healthy

Healthy eating patter: similar to healthy people • Do not eat or drink • Raw eggs or foods that contain raw eggs • Raw or undercooked poultry, meat, and seafood • Unpasteurized milk or dairy products and fruit juices • Wash hands, cooking utensils, and countertops • Separate foods to prevent the spread of germs • Use a food thermometer to make sure that foods are cooked to safe temperatures • Refrigerate or freeze meat, poultry, eggs, seafood, or other foods

Are there specific foods that you can eat that would increase your chances of getting cancer?

Heavy or regular alcohol consumption: risk increase • Antioxidant supplements: uncertain about lowering the risk • Artificial sweeteners: no evidence about increasing the risk • Charred meat: unclear about increasing the risk • Tea: uncertain about lowering the risk

List six characteristics that may be used to diagnose malnutrition

Inadequate calorie intake • Unintentional weight loss • Loss of muscle mass • Loss of subcutaneous fat • Localized or generalized fluid accumulation that may mask weight loss • Diminished functional status as measured by handgrip strength

Understand nutrition recommendations about potassium for patients with CKD

Limit potassium intake without compromising fruit, vegetable, and high-fiber intake

Teach a person living with HIV/AIDS guidelines using a healthy eating pattern including added sugar

Limit sugar sweetened beverages and foods with added sugar • Candy, cookies, cakes, ice cream

Heart healthy diet

Limited in saturated fats, trans fats, and sodium Encourage whole grains, fruits, vegetables, unsaturated fats, and appropriate calories to attain/maintain healthy weight

Understand nutrition recommendations about protein for patients with CKD

Low protein diet • Slow the progression of CKD • Contribute to malnutrition • Difficult to comply with Control the type and amount of protein chosen • Eat small portions of protein • Use a mix of animal protein (chicken, fish, meat, eggs, dairy) and plant protein (legumes, nuts)

Understand nutrition recommendations about phosphorus for patients with CKD

Low protein diet has lower phosphorous than the typical American diet Minimize processed food intake

Summarize nutrition and lifestyle strategies that may help prevent kidney stones from forming

Maintain normal BMI Drink adequate amount of fluid: ≥2L/day DASH diet Consume adequate calcium Avoid frequent intake of sugar-sweetened beverages

Discuss ways to increase a client's protein intake

Make double-strength milk: add skim power milk to milk, chill well before serving Add grated cheese to soups, casseroles, vegetable dishes, rice, and noodles Use peanut butter as spread on slices of fruits, crackers Use yogurt, especially Greek yogurt, as a topping for fruit, plain cakes

Name eating patterns that are associated with a decrease in A1C level

Mediterranean diet, vegetarian and vegan diet, DASH diet, low-carb and very low-carb diets Regardless of which eating pattern • Total calorie intake: important • Nutrient-dense food: emphasized • Added sugars, refined grains: minimized • Choose whole foods over highly processed foods

Describe the nutrition recommendations about nonnutritive sweetener for patients with diabetes

Moderation use of nonnutritive sweeteners is the key for patients with diabetes Use nonnutritive sweeteners does not guarantee weight loss

How would a patient track their carbohydrate count when they're eating at a restaurant that may not provide that information?

Monitor by blood glucose before and or 2 hours after the start of your meal • Know your meal plan, • 3 carb choices (1 starch choice, 1 lean protein choice, 1 nonstarchy veg choice) • Food lists: identify the food you can eat Use hands to estimate portion size

Describe the nutrition recommendations about supplements for patients with diabetes

No clear evidence that taking supplements (vitamins, minerals, herbs) will benefit people with diabetes

Why not give every patient enteral nutrition (if possible) to make sure they adhere to nutritional guidelines?

Oral diet is preferred when ever possible • Oral diet > enteral nutrition > parenteral nutrition

Describe the characteristics of different categories of oral nutrition supplements

Oral nutrition supplements should be provided to treat malnutrition

Give examples of ways to modify the diet to alleviate side effects of anorexia

Overeat during 'good' days Eat a high-protein, high-calorie, nutrient-dense breakfast if appetite is best in the morning Add extra protein and calories to food Eat high protein food first

clear liquid diet

P327, Table 15.2 Clear broth or bouillon Coffee, tea, carb beverages Fruit juice (clear or strained) Popsicles

Soft diet

P327, Table 15.2 Soft-cooked vegetables Eggs Mashed potatoes Well-cooked cereal without dried fruits or nuts

Understand nutrition-related guidelines that may reduce the risk of cancer

Picture on slides or figure 24.1

Describe the nutrition recommendations about protein for patients with diabetes

Plant-based protein foods provide quality protein, healthy fats and fiber • Read labels for carbs and fat • Beans, hummus, falafel, peas, nuts (including spread such as peanut butter) Fish and sea food: at least 2 times/week Poultry without the skin Cheese and eggs Limit red meat and processed meats

Are plant sources the only way the kidney can work to excrete nitrogenous waste?

Protein metabolism generates nitrogenous wastes that the kidney must excrete People with kidney disease are recommended to increase the plant sources of protein

Give examples of ways to modify the diet to alleviate side effects of diarrhea

Replace fluid and electrolytes with broth, soups, sports drinks, and canned fruit Drink at least one cup of liquid after each loose bowel movement Limit caffeine, hot or cold liquids, and high-fat foods (may aggravate diarrhea) Avoid gassy foods and liquids • Dried peas and beans, carb beverages

Describe the plate method

Simple, people who have difficulty understanding math and health concepts 1 non-starchy vegetable 2 protein foods 3 carbohydrate foods 4 water or 0 cal drink

Give examples of ways to modify the diet to alleviate side effects of mouth sores

Soft, nonirritating foods that are easy to chew and swallow • Banana, yogurt, cottage cheese, scrambled eggs, milk Cook food until soft and tender Cut food into small pieces or puree in a blender Add gravy, broth, or sauces to increase the fluid content of foods Avoid spices, acid foods, coarse foods, salty foods, alcohol and smoking

Give examples of ways to modify the diet to alleviate side effects of taste change

Use sugar-free lemon drops gum, or mints to counter a metallic or bitter taste Drink tart juice before eating to mask a metallic taste • Orange juice, cranberry juice Experiment with tart foods to mask a metallic taste • Pickles, vinegar Eat meat with something sweet • Pork with apple sauce, turkey with cranberry sauce