Nur 242 final nutrition study guide- McCullough

benefits of breast feeding

protects from: middle ear infection, respiratory illness, GI infections, allergies, SIDS. Lower risk of overweight

appetite

psychological desire to eat

insoluble

rice, fruits, legumes, seeds, veggies, wheat grains

soluble fibers

vitamins D,E,A,K

high protein high calorie

whole milk, ½&1/2 cream, milk shakes, eggnog, cheese, ice cream, dried fruit, canned fruit in heavy syrup, avocado, potatoes, corn, peas, all meats, fish, nuts, seeds, granola, hot cereals, fruit juices, meal replacement drinks.

Clear liquid-

- products that are liquid at room temperature. Water, coffee, tea, broth, carbonated beverages, clear juices, gelatin.

Recommendations for transitioning to table food or from TPN to GI tract

Gradually shift Needs to be 2/3 of nutrient intake before discontinuing the tube

nutrition therapy for GERD:

Small meals, liquids between meals No meals close to bedtime (2-3 hrs) Elevate head of bed no Tight-fitting garments, bending over Foods that decrease LES: Chocolate, fried/greasy foods, coffee (inc. decaf), tea, spearmint, peppermint Foods that may irritate esophagus: Citrus, tomato products, garlic, onions, pepper, spicy foods, carbonated beverages, very hot or cold foods Avoid NSAIDs

iron deficiency and behavior;

Worldwide problem Affects intellectual performances before Hct, Hb. Impairs attention span and learning ability.

MAO inhibitors and tyramine sources

aged things beer, cheese, ect

AMDR

carbohydrates: 45-65% protein: 10-35% fats: 20-35%

chylomicrom

dietary lips from the intestinal cells in the body and take to it other locations in the body

nutrition recs for brain health (pg 357-359);

good for the heart good for the brain lower sodium low sat fat-animal fats (hard at room temp) green leafy vegetables

iron recommendations for pregnancy

14.7

BMI for healthy

18.5-24.9

BMI for overweight

25-29.9

BMI for obesity

>30

iron-rich food

cream of wheat cooked dried apricots fortified dry cereals dried peaches noodles, rice, barley raisins tortillas bean dip whole wheat lean roast beef/ground beef cooked snow peas liverwurst cooked mushrooms meat casseroles green peas mild chili mixed vegetable juice pb&j sandwich canned plums sloppy joes

pureed

cream of wheat, baby food meats, hummus, mashed potatoes/gravy, purreed veggies, applesauce, purreed fruits & juices, milk, smooth yogurt, custard

Mediterranean diet and olive oil

disease state helpful with: cardiovascular disease low in saturated fat. no cheese

treatment for sarcopenia

exercise, specifically resistance training or strength training. These increase muscle strength and endurance using weights or resistance bands

ketone bodies come from _____ when there is no _____

fats carbohydrates

fats bring which important nutrients with them in the diet

fats dissolved in fat. essential fatty acids. linolenic and linoliac fat soluble vitamins (deak)

edema masking weight loss

fluid retention

enternal

functioning GI tract, poor appetite, can be used alone or as a supplement, huge number and types, patients who are weak or debilitated may find it easier to consume oral supplements than consume meals.

monosaccharides

glucose fructose: soft drinks, honey galactose: milk sugar

clinical signs of nutrient deficiencies (pg 395);

hair: dull, brittle, loose, falls out, corkscrew hair (C) eyes: pale membranes (iron), spots, dryness, night blindness (A), redness at corners (B) lips: dry, cracked, sores in the corners (B) mouth/gums: bleeding gums (C), smooth or magenta tongue (B), poor taste sensation (zinc) skin: poor wound healing (PEM, C, Zinc) dry/rough, lack of fat under skin (essential fatty acids, PEM, A, B), bruising/bleeding under skin (C & K), pale (iron) Nails: ridged (PEM), spoon shaped, pale (iron) Other: dementia, peripheral neuropathy (B) swollen glands at front of neck (PEM, iodine) bowed legs (D)

health effects of insoluble fibers

increase fecal weight and feed fecal passage, and provide bulk and feeling of fullness, helps with constipation

marasmus

insufficient energy and protein intake."skin & bones" loss of body fat and muscles

kwashiorkor

insufficient protein intake. edema, bloated bellies, sometimes reddish hair

factors increasing BMR

lean, muscular build taller male>female rapid growth-infancy, puberty, pregnancy, lactation. temperature extremes involuntary tremors prolonged stress smoking caffeine

LDL's

lipoproteins derived from VLDLs as cells remove triglycerides from the liver to the body are compose primarily of cholesterol BAD!

health effects of soluble fibers

lower blood cholesterol, slow glucose absorption, slow transit of food through upper GI tract, hold moisture in stools. good for heart

nutrition recs to prevent cataracts and macular degeneration;

macular degeneration- DHA- omega 3 fatty acid in fish, vitamins- folate, B6, B12, and carotenoids lutein and deep green leafy veggies. Cataracts- antioxidant nutrients- carotenoid family- beta carotene... vitamin C vitamin E.

central obesity- waist measurements

men- 40 women- 35

recommendations from Mealtimes at Home

more fruits/veggies, grains, Ca, less soft drinks, and eat breakfast (skipping leads to higher BMI)

essential nutrients

nutrients that must come from foods b/c our bodies cannot produce it in sufficient amounts

soluble

oats, peas, beans, barley, fruit-apples, citrus)

sources of omega 3 fatty acids

oils- canola, flaxseed, soybean, walnut, wheat germ, liquid/soft margarine made from canola or soybean- nuts and seeds- flaxseeds, walnuts, soybeans vegtables human milk fish and seafood

what oils to recommend to patients for cooking

olive, canola, peanut, sunflower, corn, soybean, walnut, flaxseeds, fish oil. not coconut oil!

dysphasia diet

p 409

hunger

physiological need to eat

Nutrition therapy for: Dysphagia:

pureed—homogeneous, cohesive Ex: Cream of wheat, pureed meat, slurried pancakes mechanically altered—moist, easily form a bolus Ex: oatmeal, tender, moist meatballs, moist pancakes Advanced—moist, in bite-sized pieces Ex: cereal w milk, thin-sliced tender meats, tender veggies, canned fruit

benefits of physical activity

reduces abdominal obesity, improves blood pressure, insulin resistance. combines with energy restriction- more likely to loose more fat, retain more muscles, and regain less weight than diet alone.

factors decreasing BMR

short, overweight fasting/starvation/malnutrition increased age hypothyroidism sleep-lowest

Dumping syndrome: small, frequent meals

small, frequent meals Fluids in between meals Eat slowly, relax, chew thoroughly Protein-rich foods to help with hypoglycemia Avoid simple carbs: juices, sweetened beverages, desserts Avoid milk (simple sugars)—try cheese, dk green leafies, fish w bones, tofu Avoid carbonated beverages if bloating Soluble fibers like pectin, guar gum Lie down after eating to slow transit time

soft

soft pancakes, well-cooked noodles, ground meat w gravy, scrambled eggs, soft well cooked veggies, canned/cooked fruits without seeds/skin, milk yogurt w soft fruit, cottage cheese.

polysaccharides

starch fiber

disaccharides

sucrose maltose lactose

complementary proteins

two different plant-protein rich- foods combined to obtain all the essential amino acids in amounts sufficient to support health. ex. grains & legumes

HDL's

types of lipoproteins that transport cholesterol back to the liver from peripheral cells. composed primarily of protein. GOOD!

appropriate wt gain in pregnancy;

underweight: up to 40 lbs healthy weight: 25-35 lbs obese: 11-20 lbs

who is at risk deficiency

vit D- vegans, people with lactose intolerance/malabsorption problems, breast fed infants, not enough exposure to sunlight-elderly

standard formula

-polymeric formulas -can digest and absorb nutrients without difficulty -contain intact proteins and polysaccharides -carbohydrate sources include hydrolyzed corn starch, glucose polymers, and sugars -blenderized formulas are prepared by using food blender to mis and puree whole foods

RDA for protein for adults

0.8 grams per kilogram 10-35% men: 16% median protein intake women/children/elderly: 13-15% median protein intake

key recommendations of dietary guidelines for americans 2010

1/2 cup whole grains 1 cup fruits-especially whole fruits 1 cup fat free or low fat dairy 1 oz variety of protein foods 1 cup variety of veggies

RDAs for kcals for pregnancy/lactation

2nd trimester: 340 kcal 3rd trimester: 450 kcal lactation: 500

folate in pregnancy—RDA, what does it prevent?

600 spina bifida

parenteral

: short bowel syndrome, severe pancreatitis, malabsorption disorders, intestinal obstructions or fistulas, severe burns or trauma, critical illness or wasting disorders, bone marrow transplants, malnourished and high risk aspiration

BMI for underweight

<18.5

Table 13-8 Involuntary Wt Loss;

>2%- 1 week >5%- 1 month >7.5%- 3 months >10%- 6 months

Identifying risk of malnutrition

Age, medical diagnosis, severity of illness/injury, height/weight, BMI, unintentional weight changes, loss of muscle or subcutaneous fat, low hand grip strength, general weakness, impaired mobility, history of diabetes, renal disease, use of medications, food allergies/intolerances, depression, social isolation, dementia, anemia, problems that interfere with food intake (chewing, swallowing, nausea/vomiting), localized/general edema, presence of pressure sores.

What group of vitamins are necessary for energy metabolism?

B-vitamins (thiamine, riboflavin, niacin, pantothenic acid, pyridoxine, biotin, cobalamin)

Calcium-Magnesium-Phosphorous and bone health

Calcium- most abundant mineral in the body. Integral part of bone structure. Bone formation. Phosphorous- 2nd most abundant. Found it bones, teeth, and all body tissue. Source-animal protein, milk, and cheese. Magnesium- found in bones, muscles, heart, liver, and other soft tissues, small amounts in body fluid. Low blood calcium- muscle cramps/seizures/hallucinations. Sources: dark green leafy veggies, nuts, legumes, whole grain breads and cereals.

Iodine—thyroid, cretinism, BMR

Deficiency: goiter, most common cause of preventable mental retardation, cretinism in pregnancy, mental retardation in child. Excess: enlarges thyroid gland. Sources: iodized salt, sea food.

Actions of stress hormones in the body

Energy nutrients: mobilized from storage Heart rate and respiration increases Blood pressure rises Energy diverted from processes that are not life sustaining

COPD pts and problems with excessive kcals

Excess co2 production from food metabolism causing respiratory stress

Initial concerns for acute metabolic stress pts

Fluid and electrolytes Remove underlying stressors: treat infections, repair wounds, drain abscesses, remove dead tissue Following stabilization- provide nutrient assessment and nutrient therapy

Methotrexate and folate

Have similar structures and compete for the enzyme that converts folate to its active form. Therefore supplement with active form of folate

Vitamin D role in bones, deficiency, toxicity, sources

Helps your body absorb the minerals calcium and phosphorus from the food you eat. Help build strong bones. Block the release of parathyroid hormone. Sources: sun exposure, food (orange juice, milk, yogurt, egg yolk, fortified cereals, fish, cheese. Toxicity: buildup of calcium in your blood. Causes poor appetite, nausea, and vomiting. Weakness, frequent urination and kidney problems.

How to respond to hyperglycemia, hypertriglyceridemia for TPN pts

Hyperglycemia -for most patients receiving parenteral nutrition, blood glucose level should not exceed about 200 mg/dL -patients who are glucose intolerant or in severe metabolic stress -provide insulin with feedings or decrease dextrose (limited to less than 5 mg/kg) -may inc fat intake hypoglycemia -sometimes occurs when parenteral nutrition is interrupted or discontinued or if excessive insulin is given -young infants at risk -infusions may be tapered off over several hours before discontinuation -may infuse a dextrose solution at the same time the parenteral is interrupted or stopped

Birthwt related to pregrenancy wt;

It is the most potential single predictor of the infant's future health and survival. Normal birthweights are between 6.8 to 7.9

Recommendations to prevent childhood obesity (Table 11-5);

Limit consumption of sugar-sweetened beverages (soft drinks/fruit flavored punches) Eat the recommended amounts of fruits and vegetables Learn to eat age-appropriate portions of food Eat foods low in energy density- high in fiber Eat a nutritious breakfast everyday Eat a diet rich in calcium Eat a diet high in fiber Eat together as a family as often as possible Limit the frequency of restaurant meals Limit TV time Engage in at least 60 minutes of moderate to vigorous physical activity

Candidates for TPN

Missing the small intestines Cancer patients Pregnant with hyperemesis Severe pancreatitis Burn patients

GI organs and their functions

Mouth- oral cavity containing the tongue and teeth salivary glands- secret saliva pharynx- directs food from mouth to esophagus epiglottis- protects airways during swallowing upper esophageal sphincter- allows passage from mouth to esophagus esophagus- passes food from the mouth to the stomach lower esophageal sphincter- allows passage from esophagus to stomach stomach- churns, mixes, and grinds food to a liquid mass, adds acid, enzymes, and fluid. pyloric sphincter- allows passage from stomach to small intestine, prevents backflow from small intestine liver- manufactures bile salts, detergent like substances to help digest food gallbladder store bile when needed bile duct- conducts bile from the gallbladder to the small intestine pancreas- manufactures enzymes to digest all energy yielding nutrients and releases bicarbonate to neutralize acidic chyme that enters the small intestine pancreatic duct- conducts bile from the gallbladder to the small intestine small intestine- duodenum, jejunum, ileum. secretes enzymes that digest all energy yielding nutrients to smaller nutrient particles, cells of wall absorb nutrients into blood and lymph duodenum- top portion of the small intestine jejunum- 1st 2 5ths of the small intestine beyond the duodenum ileum- last segment of the small intestine ileocecal valve- allows passage from small intestine to the large intestine prevents backflow from large intestine appendix- houses bacteria and lymph cells

vitamin b12 absorption. deficiency symptoms, sources

Normally, vitamin B12 is readily absorbed in the last part of the small intestine (ileum), which leads to the large intestine. However, to be absorbed, the vitamin must combine with intrinsic factor, a protein produced in the stomach. Symptoms: weakness, tiredness, lightheadedness, heart palpitations and shortness of breath, pale skin, a smooth tongue, constipation, diarrhea, a loss of appetite, or gas. Nerve problems like numbness or tingling, muscle weakness and problems walking. Vision loss, mental problems like depression, memory loss, or behavior problems. Sources: beef, liver, sardines, raw cheese, cottage cheese, lamb, milk, eggs, salmon, breakfast cereals, ham, chicken

Sodium—sources, function in body

Primary regulator of the extracellular fluid volume. Cold cuts, pizza, soups, restaurant and prepared foods, breads

Protein and energy needs during acute metabolic stress

Protein: Nonobese: 1.2-2.0 grams protein per kilogram body weight per day Obeses pts given hypocaloric feeding: 2.0-2.5 grams per kilogram ideal body weight RDA healthy: 0.8 g/kg Carbohydrate: 50-60% Fat intakes: 50% of k calories

Renin-aldosterone-ADH

Regulating the sodium and water stay on board. Key for hypertension

Nutrition recs for rheumatoid and osteo arthritis;

Rheumatoid- Mediterranean-type diet, omega 3-fish oil, low saturation fats. *Osteoarthritis-

Iron—deficiency (who at risk, how to assess), sources

Sources: heme iron-meat, poultry and fish, nonheme iron meat and plant food (vit C), spinach, black/navy beans. Cause: inadequate intake, blood loss, decreased stomach acidity, partial gastrectomy. At risk: those donating blood, teen girls, blood loss, pregnant women, those going thorough growth spurt

vitamin a deficiency symptoms, sources

Symptoms: poor adaptation to darkness-night blindness, keratomalacia, dry eye, dry skin/hair. Pruritus. Broken fingernails Sources: milk, yogurt, cheese, eggs, oily fish, fortified low fat spreads, veggies like carrots, sweet potatoes, red peppers, and green leafies. Orange/yellow colored fruit- mango, papaya, and apricots.

American Academy of Pediatrics recs for breast feeding and food introduction

Vit D supplement is needed in exclusively breastfed babies. Needed earliest are Fe, then vit C. Iron fortified infant cereal to start. Rice cereal is least allergenic. Add one food at a time, check for allergies. After cereals, add vegetables and fruits, then meats. Limit juice to 4-6 oz/day. No sweets/desserts. No honey or corn syrup (risk for botulism) Wheat cereal is last cereal to be introduced (after 1 year)

nutrients likely to be deficient in teen years

Vit D- may require supplementation Iron Calcium- crucial for developing bone density, teen girls vulnerable to low intake.

Warfarin (Coumadin) and Vitamin K

Warfarin blocks enzyme that activates vit k, thus preventing several blood clotting factors from being made. Consumption of foods high in vit K (green leafy vegetables, liver) can decrease anticoagulant effects of warfarin. Need a steady level of vit K intake to keep warfarin activity stable.

blenderized

all food groups

weight management habits

believe in ability to control weight eat breakfast stay physically active monitor weight once per week maintain lower k-calorie eating patterns.

kcal/g

carbs- 4 proteins- 4 lipids- 9 alcohol- 7

VLDL's

carry by liver cells to transport lipids to various tissues in the body composed primarily of triglycerides

behavior modification

changing behavior by changing cues, the behavior itself and consequences. become aware of behaviors, make small changes, cognitive skills, personal attitude/identity issues

specialized formula

-also called disease specific -designed to meet specific nutrient needs of patients with particular illnesses -have been developed for individuals with liver, kidney, and lung diseases; glucose intolerance; severe wounds; and metabolic stress -expensive

elemental formula

-also called hydrolyzed, chemically defined, or monomeric formulas, are prescribed for patients who have compromised digestive functions -contain proteins and carbohydrates that have been partially or fully broken down -often low in fat

modular formula

-created from individual macronutrient preparations called modules -patients who require specific nutrient combinations to treat their illnesses -vitamin and mineral preparations are also included in these