ATI Nutrition: chp 7 Nutrition Across the Lifespan
Adolescence: diet deficiency of, exceed?
- folate, vit A and E, iron, zinc, mag, calcium, fiber -total fat, sat fat, cholesterol, sodium, and sugar
Preschoolers: 3-6 years-Nutritional Guidelines protein food jags veggies
--13-19 g/day of complete protein -preference for one food is short-lived -dislike strong tasting veggies like cabbage but like raw veggies
School-Age Children: 6-12yrs-Nutritional Guidelines growth
--2-3 inches in height and gain 5lbs annually
Preschoolers: 3-6 years-Nutritional Guidelines height and weight increase
--2-3 inches in height, gain 5lb annually
Adulthood and Older Adulthood Balanced diet includes carbs and fats:
--40% to 55% carbs -10%-20% fat
Recommended weight gain during the first and 2md/3rd trimester
-1-4 lbs -2-4 lbs per month
Head circumference increase for the first 6 months last 6 months
-1.5cm (0.6 inches) per month -0.5cm/month for months 6-12 -by 1 year, head size should increase by 33% -reflective of the growth of the nervous system
Expressed milk can be refrigerated for? frozen for?
-10 days in fridge -6 months is sterile containers (frozen)
How many newborn feedings in 24 hrs?
-12 feedings in 24 hrs
How long should a newborn nurse for? what should clients look out for if bby has completed feeding?
-15-20 min per breast -slowing of newborn suckling, softened breast, sleeping
Pregnancy: fluid intake, preferable
-2,000 to 3,000 mLs of fluids from foods and drinks -pref from water, fruit, juice or milk. carbonated drink and fruit drink provide little to no nutrients -no alcohol -less than 300 mg/day, caffeine crosses the placenta and can affect the movement and heart rate of the fetus
Toddlers: 1-3 years old-Nutritional Guidelines growth in height and weight
-2-3 inches in height and 5lbs annually
growth in height for the first 6 months and last 6 months
-2.5cm (1 in) per month in height the first 6 months 1.25 cm (0.5in) in height per month the last 6 months
Protein intake for pregnancy Protein is essential for
-20% of daily total calorie intake -1.1 g/kg.day -essential for rapid tissue growth of maternal and fetal structures, amniotic fluid, and extra blood volume
By 8 months baby should be able to eat? by 9 months baby should be able to eat?
-3 meals a day with 3 snacks -table foods that are cooked, chopped and unseasoned
Maximum amount of formula infant should drink in 24hr period
-32 oz of formula
How many calories should be increased in the second and third trimester?
-340 calories in the second trimester --452 calories in the third trimester
Toddlers: 1-3 years old-Nutritional Guidelines juice intake food serving size exposure to food
-4-6 oz a day -food serving size is 1 tbsp for each year of age -exposure to food may need to occur 8-15 times before child develops acceptance
When can an infant start weaning off bottle/breast to a cup? -which feedings are last to disappear?
-5-8 months --start cup feeding one feeding period at a time over 5 to 7 days -nighttime feedings are last to disappear -but may not be ready until 12-14 months
Toddlers: 1-3 years old-Nutritional Concerns/Risks Vit D
-5mcg/day (same for everyone) -Milk (cow, soy) and fatty fish good sources -sunlight exposure -assists in the absorption of calcium into the bones
Infant: Nutrition-related problems, lactose intolerance increased prevalence in:
-Asian, Native American, African, Latino, Mediterranean descent
Infant: Nutrition-related problems, lactose intolerance Formula
-Either soy-based (ProSobee or Isomil) or casein hydrolysate (Nutramigen or Pregestimil) formulas can be prescribed as alternative formulas for infants who are lactose intolerant
Nausea and constipation during pregnancy:
-Nausea: -eat dry crackers or toast -avoid alcohol, caffeine, fats, spices -avoid drinking fluids with meals -dont take meds to control nausea unless prescribed -Constipation: -increase fluid consumption and include extra fiber in diet -fruits, veggies, whole grains contain fiber
School-Age Children: 6-12yrs-Nutritional Concerns/Risk Overweight/obesity
-affects 20% of children -overweight children tend to be obese adults -never use food as reward or punishment
Infant: Nutrition-related problems, lactose intolerance Assess for? Provide what kind of guidance?
-assess for clinical findings of congenital defects, CNS disorders, or partial intestinal obstruction -assess for swallowing or sucking problems -ID feeding patterns, esp preparation of formulas -assess for psychological problems, esp parenting-infant bonding -nutritional guidance: high-calorie, high protein diet indicated -provide supportive parenting guidance
Cow's milk: why you don't introduce before 1 year of age
-b.c protein and mineral content stress the immature kidney -young infant cannot fully digest the protein and fat contained in cow's milk
Toddlers: 1-3 years old-Nutritional Guidelines Why do they like finger foods?
-because of increasing autonomy -like macaroni and cheese, pizza, spaghetti
During pregnancy, vitamins are essential for:
-blood formation -absorption of iron -development of fetal tissue
Source of nutrition for the first 6-12 months (milk)
-breast milk, infant formula, or combination -4-6 months solely milk -introduction of complementary foods until at least 12 mo of age
At what temp can the formula be given?
-chilled, warmed, or at room temp. stay consistent
Toddlers: 1-3 years old-Nutritional Guidelines Introducing foods that may cause allergic reactions
-cows milk, chocolate, citrus fruits, egg white, seafood, nut butters, neg fam history of allergies ----introduce gradually while monitoring for reaction
Adulthood and Older Adulthood Older adults need to reduce caloric intake, why?
-decrease in basal metabolic rate that occurs from the decrease in lean body mass that develops with aging -may predispose the older adult for development of nutrient deficiencies
Thawed milk
-do not freeze thawed milk -thaw milk in refrigerator -can be stored 24 hrs after thawing -do not defrost in microwave b.c destroys antibodies and may burn infant
Semisolid foods
-do not intro before 4 months of age coincide with development of head control, ability to sit, and back n forth motion of tongue
Why is prepregnancy nutrition significant?
-early fetal development occurs before a woman may realize she is preg -woman should be well nourished and in her normal weight range prior to conception
Infant: Nutrition-related problems, colic If breastfeeding:
-eliminate cruciferous veggies (cauliflower, broccoli, brussels sprouts), cow milk, onion, chocolate -limit caffeine and nicotine intake -burp infant in upright position
Adolescence:What are the nutritional needs that increase? When do males/females experience growth spurt?
-energy, protein, calcium, iron, zinc -females: 10-11, peaks at 12, completed by 17 -males: 12-13, peaks at 14, completed by 21
Adolescence: Nutritional Risks Increased need for iron males.females
-females: 14-18 require 15mg of iron to support expansion of blood volume and blood loss during menstruation -males: 14-18 require 11mg of iron to support expansion of muscle mass and blood volume
Adolescence: Energy requirements for females/males
-females: 2,000 cal/day for 15 y/o female, 4,000 cal/day for a 15 y/o male
Why are nutritional demands increased for?
-for development of: -placenta -enlargement of the uterus -formation of amniotic fluid -increase in blood volume -prep of the breasts for lactation
If breastfeeding, avoid which types of liquids/foods?
-freshwater fish -alcohol -limit caffeine
Iron-fortified formulas...
-give fist 6 months or until infant consumes adequate solid food -can use formula without iron after 6 months
How should the head and bottle be held when feeding?
-head slightly elevated to facilitate passage of formula into the stomach -tilt bottle to maintain formula in the nipple and prevent the swallowing of air
Infant: Nutrition-related problems, diarrhea Treatment for moderate diarrhea
-home oral rehydration solutions (Pedialyte, Infalyte, ReVital). After each loose stool, 8oz of solution should be given
Childhood: What may cause choking or aspiration?
-hot dogs, popcorn, peanuts, grapes, raw carrots, celery, peanut butter, tough meat, and candy -children are at an increased risk for choking until 4 yrs of age
Infant: Nutrition-related problems, diarrhea When to contact provider
-if clinical findings of dehydration present, vomiting, bloody stools, high fever, change in mental status, refusal to take liquids
Infant: Nutrition-related problems, failure to thrive What is it?
-inadequate gains in weight and height in comparison to established growth and development norms
Toddlers: 1-3 years old-Nutritional Concerns/Risks Iron
-iron deficiency anemia is most common deficiency disorder in children -lean red meats provide sources of readily absorbable iron -Consuming vit C (OJ/tomatoes) w/plant sources of iron (beans, raisins, peanut butter, whole grains) will maximize absorption -milk should be limited ot 24 oz b/c poor source of iron
What food should be offered first? Then?
-iron-fortified cereal, no wheat until first year -veggies or fruits started btwn 6-8 months of age, can start meat after both introduced
Infant: Nutrition-related problems, diarrhea clinical findings
-listlessness -sunken eyes -sunken fontanels -decreased tears -dry mucous membranes -decreased urine output
Maternal phenylketonuria (PKU) is: diet: interventions: foods to avoid: fetal complications:
-maternal genetic disease in which high levels of phenylalanine pose danger to the fetus -client to resume pku diet at least 3 months prior to preg and continue thru preg -diet to include foods low in phenylalanine -avoid fish, poultry, meat, eggs, nuts, dairy -monitor blood phenylalanine levels -interventions to prevent fetal complications such as mental retardation, behavior problems
Advantages of breastfeeding
-maternal-infant bonding is promoted -risk of allergies is reduced -calcium absorption is enhanced as the calcium-to-phosphorous ratio is 2:1 -iron, zinc, and mag found in breast milk are highly absorbable -breast milk is low in sodium -breast milk is high in omega 3 fatty acids -carbs, proteins, and fats in breast milk are predigested for ready absorption -reduced incidence of otitis media, type 1 & 2 diabetes, obesity, leukemia, lymphoma, gastrointestinal/resp disorders due to the transfer antibodies
Adolescence: inadequate calcium intake
-may predispose osteoporosis later in life -45% of bone mass added during this time -normal blood-calcium levels are maintained by drawing calcium from the bones if calcium intake is low -require 1300 mg of calcium a day, achieved by 3 to 4 servings of dairy food group
What foods to delay?
-milk, eggs, wheat, citrus fruits b/c of allergic reactions to susceptible infants -peanuts or peanut butter due to severe allergic reactions -no honey b.c risk of botulism
If the infant has not breastfed in 4 hrs..?
-mother should awaken infant
Trimesters 2 and 3 weight gain for clients with: normal weight underweight overweight
-normal: 1lb/week for 25-35lbs -underweight: just more than 1lb/week for a total of 28-40lbs -overweight:0.66lb/week for a total of 15-25lbs
Infant: Nutrition-related problems, constipation
-not an issue for breastfed infants -caused by formula that is too concentrated or inadequate carb intake -stress importance to dilute formula
When should solid foods be introduced
-not before 4-6 months because risk of food allergies and stress on the immature kidneys
Adulthood and Older Adulthood: Nutritional Concerns OLD AGE
-oral problems (chewing, swallowing, dentures) decrease in salivation -decreased elasticity of blood vessels can lead to hypertension -decreased cellular function and reduced body reserves, leading to decreased absorption of B12, folic acid, and calcium, and reduction of insulin production -renal function 50% decrease, reg amount of sodium and pot -decreased lean muscle mass -loss of calcium can result in decreased bone density in older adults -cell-mediated immunity decreases as an individual ages
Adulthood and Older Adulthood Potential Impact of Physical, Mental , and Social Changes diseases and treatments may interfere with nutrient and food absorption and utilization
-osteo-adequate calcium and vit D intake with regular weight-bearing exercise is important for maximizing bone density -Osteoarthritis-can limit mobility and present difficulty in obtaining and prep proper foods -alzheimer's: form of dementia causes impairments in memory and judgement that may make shopping, storing, and cooking food difficult
For how long should new foods be introduced? why?
-over a 4-5 period to observe for signs of allergy or intolerance -fussiness, rash, upper resp distress, vomiting, diarrhea, constipation
Infant: Nutrition-related problems, diarrhea Causes
-overfeeding and food intolerances are common causes of osmotic diarrhea -infectious diarrhea in the infant is commonly caused by rotavirus
Preschoolers: 3-6 years-Nutritional Concerns/Risks Concerns
-overfeeding, intake of high-calorie, high-fat, high-sodium snacks, soft drinks, juices, inadequate intake of fruits and veggies -encourage physical activity -switch to skim or 1% low fat milk after 2yrs -iron deficiency anemia
Adolescence: Pregnancy
-physiologic demands of a growing fetus compromise the adolescent's needs for her own unfinished growth and development -inconsistent eating and poor food choices place the adolescent at risk for anemia, preg induced hypertension, gestational diabetes, premature labor, spontaneous abortion, and delivery of a newborn of low birth weight
The major stages of the lifespan that have specific nutritional needs are: (5)
-pregnancy and lactation -infancy -childhood -adolescence -adulthood and older adulthood
Adolescence: Nutritional Risks Eating and snacking patterns
-promote essential nutrient deficiencies (calcium, bit, iron, fiber) + overconsumption of sugars, fat, and sodium -skip meals, eat more meals away from home -foods from vend machines, stores, fast foods high in fat, sugar, sodium -carb beverages may replace milk and fruit juices which result in deficiencies in vit c, riboflavin, phosphorous, and calcium
Open liquid formula
-require refrigeration -dont use if it has been left at room temp for more than 2 hrs
Appropriate finger foods
-ripe bananas, toast strips, graham crackers, cheese cubes, noodles, peeled chunks of apples, pears or peaches
Preschoolers: 3-6 years-Nutritional Concerns/Risks Lead poisoning
-risk for children under 6 yrs b/c they place objects in their mouths that may contain lead and have a higher rate of intestinal absorption -feed children at frequent intervals b/c more lead is absorbed on empty stomach
Hunger cues
-rooting -suckling on hands and fingers -rapid eye movement -crying is late sign of hunger
School-Age Children: 6-12yrs-Nutritional Concerns/Risk Skipping Breakfast
-skipping breakfast occurs in 10% of children -nutritious breakfast=optimum performance -have age appropriate BMI
Adolescence: Dieting
-social pressure can lead to unhealthy eating practices -males more likely to use supplements and high-protein drink to build muscle mass and improve athletic performance. Some athletes restrict calories to maintain or achieve a lower weight
Infant: Nutrition-related problems, colic comforting techniques
-swaddling, carrying infant. rocking, repetitive soft sounds
Infant: Nutrition-related problems, colic Cause? Characterized by: Resolves by:
-unknown cause, occurs late afternoon more than 3 days per week for more than 3 weeks -characterized by crying lasting 3 hrs or longer per day -accompanied by tense abdomen and legs drawn up to the belly -resolves by 3 months of age
What are indicators of readiness for intro solid food?
-voluntary control of the head and trunk -hunger less than 4 hr after vigorous nursing -intake of 8oz of formula -interest of the infant
weight gain averages for the first 5 to 6 months
0.15 to 0.21 kg (5 to 7 oz) per week
Lactating women caloric daily intake if breastfeeding: 1st 6 months 2nd 6 months
1st 6 months: 330 calories 2nd 6 months: 400 calories
Fat during pregnancy
30% of total daily intake
carbs during preg
50% of total daily caloric intake -will allow for protein to be spared and available for the synthesis of fetal tissue
Folic acid intake
600mcg/day of folic acid lactating women: 500mcg/day -necessary for the neurological development of the fetus and to prevent birth defects. -essential for maternal red blood cell formation -Food sources: leafy veggies, enriched grains, orange juice
Suggested intro of foods: birth to 4 mo: 4-6 mo: 6-8 mo: 8-10 mo: 9-12 mo: 12 mo:
birth to 4 mo: breast milk (until 6 mo) formula (at 4 mo) 4-6 mo: iron fortified cereal 6-8 mo: veggies, fruits 8-10 mo: strained meats, fish, poultry 9-12 mo: table foods (cooked, chopped, unseasoned) 12 mo: cows milk, eggs, cheese
Weight gain during infancy
birth weight doubles by 4-6 months triples by 1 year of age need for calories and nutrients is high to support the rapid rate of growth
Iron in pregnancy
can be obtained from dairy products and meats, esp red meats -consuming foods high in vit C aids in the absorption of iron
iron-fortified cereal:
first solid food intro as gestational iron stores begin to deplete around 4 months of age
DRIs of major vitamins. 19-30. nonpreg, preg, lactating protein (g) vit A (mcg) vit C (mg) vit D (mcg) vit E (mcg) vit K (mcg) Thiamin (mg) vit b6 (mg) folate (mcg) vit B12 (mcg) calcium (mg) iron (mg)
protein (g) 46, 71, 71 vit A (mcg) 700, 770, 1,300 vit C (mg) 75, 85, 120 vit D (mcg) 15, 15, 15 vit E (mcg) 15, 15, 19 vit K (mcg) 90, 90, 90 Thiamin (mg) 1.1, 1.4, 1.4 vit b6 (mg) 1.3, 1.9, 2.0 folate (mcg) 400, 600, 500 vit B12 (mcg) 2.4, 2.6, 2.8 calcium (mg) 1,000, 1,000, 1,000 iron (mg) 18, 27, 9
