Test 3

What are the four steps in the Nutrition Care Process?

(1) Nutrition assessment, (2) Nutrition diagnosis, (3) Nutrition intervention (4) Nutrition monitoring and evaluation

List the three components of maternal weight gain.

(1) maternal body composition changes, including increased blood and extracellular fluid volume (2) the maternal support tissues, such as the greater size of the uterus and breasts (3) the products of conception, including the fetus and the placenta. Blood volume increases, support tissues, fetus & placenta.

Contrast the three methods used to assess dietary intake.

24-hour diet recall - In 24-hour diet recall, the patient is asked by a trained interviewer to report all foods and beverages consumed during the past 24 hours. Food Records - All foods, beverages, snacks, and supplements are recorded by the patient, usually over 1 to 7 days using household measures. These are more realistic, the patient must be literate, numerate, and well-motivated. Calorie Counts - Information gathered in this manner is used to determine the adequacy of patients' daily oral intake or to document need for nutrition support. Most accurate.

What are the recommended total weight gain ranges for pregnant women?

25-30 pounds is the normal total weight gain.

Define gestational diabetes mellitus (GDM). What are the risk factors for GDM?

A diabetes that occurs during pregnancy. Risk factors include Obesity, Advanced maternal age, African or Hispanic heritage, Recurrent infections, Gestational diabetes in previous pregnancy, in a previous pregnancy, child having a congenital malformation or birth defect and/or unexplained death of fetus or newborn, and Previous newborn weighing more than 9 pounds.

When should a recumbent height be taken?

A recumbent measure can be taken while the subject is lying down or reclining. When the patient comatose, critically ill, or unable to be moved for other reasons.

What is the difference between a food allergy and food intolerance?

A true food allergy is caused by the release of histamine and serotonin, which can be reproduced in a double-blind food challenge. Food intolerance is a nonallergic reaction; it may be caused by toxins, drugs, or conditions such as lactose and gluten intolerances.

List the risk factors associated with drug-nutrient interactions.

Age, physiologic status, multiple-drug intake, hepatic and renal function, and typical dietary intake.

List the normal ranges in the blood for albumin, hemoglobin, fasting blood glucose, total cholesterol, and triglycerides.

Albumin - 3.5-5.0 g/dL Hemoglobin - Males: 13.8-17.2 g/dL Females: 12.1-15.1 g/dL Fasting blood glucose - 70-99 mg/dL [fasting] Total cholesterol - <200 mg/dL Triglycerides - 40-160 mg/dL

What is the main difference between albumin and prealbumin?

Albumin reflects long-term changes in nutritional intake because the half-life is 14 to 20 days. Indicate compromised protein status; May precede pressure ulcer development. Long term nutrition changes. May indicate infections, burns, trauma, CHF, chronically low protein intake, hepatic insufficiency. Prealbumin (transthyretin) is ordered for monitoring short-term changes in visceral protein status because of its short half-life of 2 days. Visceral Protein status; can indicate chronic kidney disease, surgical trauma, stress, inflammation, infection, and liver disfunction.

List at least four risk factors for malnutrition of the older adult

Alcoholism, Anorexia, Chewing and swallowing problems (dysphagia), Consuming only one meal a day, Dental difficulties, Depression or dementia, Diabetes, diminished physical functioning, feeding problems, Food purchasing/preparation difficulties, Impaired acuity of taste and smell, Living in long-term care institution, Loss of spouse, Taking multiple medications, Nerve disorders, Poverty, Pulmonary disease, Surgery.

Describe the ABCD approach to comprehensive nutritional assessment.

An "ABCD" approach includes four key areas of data: Anthropometrics, Biochemical tests, Clinical observations, and Dietary evaluation. Anthropometrics: Simple, noninvasive techniques to measure height, weight, head circumference, and skinfold thickness. Measuring infant length: an example of an anthropometric measure with a stadiometer. Biochemical tests: Limitations: no single test is available for nutrition, Testing is inappropriate for some patients, Serial measurements are best, Use with other measurements clinical observation, diet evaluation. Blood, hemoglobin, & urine Clinical Assessment: Sources of data: medical history, social history, physical examination, Features associated with nutritional deficiencies. Dietary intake: 24-hour recall, Food records, Kilocalorie counts

At what age should low-fat milk be introduced?

At the age of 2 years old.

Describe strategies to minimize drug side effects related to nutrition and dietary intake.

Dry, sore mouth: Eat softer foods, Modified taste sensation: visit dentist regularly. Diminished appetite: eat several small meals a day

How does grapefruit juice alter the bioavailability of certain medications?

Blocks the CYP3A4 enzyme in the wall of the small intestine.

What are the major causes of duodenal ulcers? Describe the treatment goals of nutrition therapy.

Causes: Infection with Helicobacter pylori and use of nonsteroidal anti-inflammatory drugs (NSAIDs) are major causes of duodenal ulcers. Treatment Goals: reducing stomach acidity, relieving symptoms, healing the ulcer, preventing reoccurrence, and avoiding complications. triple therapy, a combination of two antibiotics and acid-reducing medications taken for at least 10 to 14 days. avoid red and black pepper, chili pepper, coffee (caffeinated and decaffeinated), other caffeinated beverages, and alcohol

Explain the nutritional implications of celiac disease and gluten sensitivity.

Celiac disease is a chronic auto-immune disorder. If a person with this disease eats anything containing gluten, the immune system damages the lining of the small intestine. Stay away from greens, gluten foods, wheat, rye & barley.

Discuss four physiologic changes in the mother's body during pregnancy.

Changes in the blood occur, plasma doubles, slower motility, weight gain, hormonal changes, craving of clay, cardboard, etc. (Pica)

Contrast the three methods of administering a tube feeding.

Continuous infusion is a common method of feeding. It provides controlled delivery of a prescribed volume of formula at a constant rate over a continuous period using an infusion pump. Intermittent infusion involves delivering the total quantity of formulas needed for a 24-hour period in three to six equal feedings. Bolus feedings involve infusing volumes of formula (250-500 mL) by gravity or syringe over short periods.

When might the following diets be appropriately used: clear liquid diet, full liquid diet, pureed diet, mechanical soft diet, and soft diet?

Clear liquid diet: Provide oral fluids; before/after surgery; prepare bowel for diagnostic tests (colonoscopy examination, barium enema, and other procedures); acute gastrointestinal (GI) disturbances. EX) anything you can see through Full liquid diet: Provide oral fluids; after surgery; transition between clear liquids and solid food; oral or plastic surgery to the face and neck; mandibular fractures; patients who have chewing or swallowing difficulties; esophageal or GI strictures; diarrhea Pureed diet: Neurologic changes; inflammation or ulcerations of the oral cavity and/or esophagus; edentulous patients; fractured jaw; head and neck abnormalities; cerebrovascular accident Mechanical soft diet: Poorly fitting dentures; edentulous patients; limited chewing or swallowing ability; dysphagia; strictures of intestinal tract; radiation treatment to oral cavity; progression from enteral tube feedings or parenteral nutrition to solid foods Soft diet: Debilitated patients unable to consume a regular diet; mild GI problems

Characterize gastroesophageal reflux disease (GERD), and briefly describe the appropriate nutrition therapy.

Commonly known as heartburn, Usually occurs within 1 to 4 hours after meals, Caused by factors that decrease pressure of lower esophageal sphincter (LES). Therapy: avoid large or high-fat meals, lying down after eating, eating on the run. chocolate, alcohol, peppermint, spearmint, liqueurs, and caffeine and high-acid foods (tomatoes, vinegar-based foods, citrus fruits, and juices).

Compare and contrast the following terms: complementary medicine, alternative medicine, and integrative medicine.

Complementary medicine: refers to non-Western healing approaches used at the same time as conventional medicine. EX) Like prescription and yoga. Alternative medicine: used instead of conventional medicine, example - use of herbal supplements or shark cartilage to treat cancer instead of chemotherapy or surgery. Integrative medicine: an approach to medical care that combines conventional medicine with CAM practices that have shown through science to be safe and effective.

List four signs of dehydration in older adults.

Confusion, Weakness, A hot, dry body, Furrowed tongue, decreased skin turgor (may not be valid finding in older adults), Rapid pulse, Elevated urinary sodium, urine color, & constipation.

What is the name of the legislation that regulates dietary supplements?

Dietary Supplement Health and Education Act of 1994 (DSHEA).

List several types of dietary supplements.

Dietary supplements are consumed orally as tablets, liquids, capsules, extracts, powders, concentrates, gel caps, liquids, or powders. A vitamin or a mineral, An herb or other botanical, An amino acid, A dietary substance for use to supplement the diet by increasing the total dietary intake, A concentrate, metabolite, constituent, extract, or a combination of the preceding ingredients.

For the early years, middle years, older years, and oldest years of adulthood: (1) discuss an influence that affects nutritional lifestyles and (2) describe changes in nutrition requirements.

Early years: (1) more time restricted, women bear children (2) Protein need increases, vitamin & mineral stay the same, Calcium and phosphorus needs decrease, Middle years: (1) increased stress & responsibility (2) kcal need decline, protein remains the same, & iron intake can be decreased for women. Older years: (1) continued professional or career advancement and recreational enjoyment, retirement and settling into new patterns of activities. health status; nutritional well-being; spirituality; living arrangements; physical activity; social interactions; physical, mental, and emotional functioning; disease management; and level of financial and physical independence. (2) ability of the body to either process or synthesize certain nutrients, vitamin D for individuals older than age 70 increase, dental health may affect getting nutrients. Oldest years: (1) ability of the body to absorb and synthesize nutrients, Optimum nutrition continues to be critical. (2) Malnutrition and being underweight become a concern during this stage & kcal intake may diminish.

In which instances might weight not be a good indicator of nutritional status?

Edema, dehydration, or ascites.

Define elemental formulas and describe when they should be used.

Elemental formulas are also called predigested or hydrolyzed formulas (11.3 kcal/mL). They are composed of partially or fully hydrolyzed nutrients that can be used for the patient with a partially functioning GI tract, impaired capacity to digest foods or absorb nutrients, pancreatic insufficiency, or bile salt deficiency.

How do these nutritional needs differ from those of children?

Energy needs increase. micronutrients, calcium, vitamin D, iron are important in children. Calorie intake increases as puberty comes on. The carve for these extra calories also increases.

If the gut is functioning but oral intake is poor, then which method of feeding should be started—enteral or parenteral?

Enteral nutrition (EN) - tube feeding.

Discuss the potential harmful effects on the fetus of alcohol consumption during pregnancy.

Fetal alcohol syndrome (FAS) or fetal alcohol spectrum disorder (FASD) in the infant. Symptoms include central nervous system defects and specific anatomic defects such as a low nasal bridge, short nose, flat midface, and short palpebral fissures (separation between the upper and lower eyelids.)

How many additional kilocalories (kcal) are needed daily for expectant mothers during the first, second, and third trimesters?

First - 0kcal Second - 340kcal Third - 452kcal

List the foods that pose a food safety risk during pregnancy.

Fish (tuna, catfish, mudfish, bottom of water fish), uncooked meats, sandwich meats, refrigerated smoke seafood Rare, raw, or undercooked meats and poultry (rare hamburgers, carpaccio, and beef or steak tartare), Raw fish (including sushi, sashimi, ceviche, and carpaccio), Undercooked and raw shellfish (clams, oysters, mussels, and scallops), Fish containing high levels of mercury (swordfish, tilefish, king mackerel, and shark), Refrigerated smoked seafood, Unpasteurized dairy products ("raw" milk and cheeses), Some fresh soft cheeses (Brie, Camembert, blue-veined varieties, and Mexican-style queso fresco) unless made with pasteurized milk, Raw or undercooked eggs, Food items that contain undercooked eggs (unpasteurized eggnog, Monte Cristo sandwiches, French toast, homemade Caesar salad dressing, Hollandaise sauce, mayonnaise, some puddings and custards, chocolate mousse, tiramisu, and raw cookie dough or cake batter), Raw sprouts (alfalfa, clover, and radish), Deli salads, Unpasteurized fruit and vegetable juices, Refrigerated pâté or meat spreads.

List recommendations for managing constipation.

Fluid intake should be approximately 8 to 10 glasses a day, fiber-rich products such psyllium (Metamucil), whole-grain breads and cereals, fruits, and vegetables. Following a schedule, exercise, relaxation.

Which vitamins and minerals are of great importance during pregnancy?

Folate, Iron, Calcium, Vitamin C, prenatal vitamins.

Explain the difference between the nutrition therapy regimens used for diverticulosis and diverticulitis.

For diverticulosis (holes in bowel), a high fiber diet is recommended. Diverticulitis (inflammatory of the bowel) calls for only liquids, bed rest.

What are three types of tube-feeding complications?

GI distress, Diarrhea, Nausea/vomiting, Cramps/bloating, Regurgitation/aspiration, Constipation. Rapid weight gain.

List at least four contraindications to breastfeeding.

HIV/AIDS, Herpes simplex lesions on the maternal breast, Maternal alcoholism, Maternal drug addiction, Malaria, Maternal chickenpox (first 3 weeks postpartum only), Maternal breast cancer requiring treatment, and Maternal hepatitis C.

Why should cow's milk (regardless of the form—evaporated, liquid, or dried) not be fed to infants?

Infants are not able to digest fats and metabolize cow's milk. It could also cause obesity, diarrhea, and iron deficiency anemia.

What are the most important factors in preventing foodborne illness?

Is food poisoning. Personal hygiene and hand washing are most important. Food temps.

What is baby bottle tooth decay (BBTD)? How can it be prevented?

It is when a baby is put to bed with a bottle and just enough milk is left sitting on the teeth. Ways to prevent include: don't put baby to bed with a bottle or substitute milk for water.

What do the two biochemical parameters for nutrition status measure?

Many routine blood and urine laboratory test. Visceral protein stores & immune function.

What are some complications of parenteral nutrition?

Mechanical/Technical Complications Subclavian artery puncture, carotid artery puncture, or catheter obstruction. Improper initial placement of a central venous catheter can lead to pneumothorax, vascular injury with hemothorax, brachial plexus injury or cardiac arrhythmia. Venous thrombosis can occur after central venous access is established. Signs include distended neck veins and swelling of the face and ipsilateral arm. The risk of venous thrombosis is greater with dehydration, certain malignancies, prolonged bed rest, venous stasis, sepsis, hypercoagulation, morbid obesity, history of smoking or ongoing estrogen therapy. Septic Complications Catheter-related sepsis or septic thrombosis Metabolic complications Volume overload, Essential fatty acid deficiency, Hyperglycemia, Trace mineral deficiency, Refeeding syndrome, Vitamin deficiency, Hypokalemia, Metabolic bone disease, Hypophosphatemia, Hepatic steatosis, Hypomagnesemia, Hepatic cholestasis, Hyperchloremic acidosis, Lung puncture

Compare the six tube-feeding routes.

Nasoduodenal: Tube is passed from the nose to the duodenum (small intestine). Nasojejunal: Tube is passed through the nose to the jejunum (small intestine). Esophagostomy: Tube is surgically inserted into the neck and extends to the stomach. Gastrostomy: Tube is surgically inserted into the stomach. Jejunostomy: Tube is surgically inserted into the small intestine. Nasogastric: Tube is passed through the nose to the stomach.

List two community supports for children.

National School Lunch Program (NSLP), Supplemental Nutrition Assistance Program (SNAP), EBT, Temporary Assistance for Needy Families (TANF), Food District Program on Indian Reservations (FDPIR), WIC, and Classroom nutrition education.

What are the five nutrition-related health concerns of childhood and adolescence? What is the role of the school nurse as related to these?

Obesity, iron deficiency anemia, lead poisoning, T2D mellitus, type 2 diabetes, GED, malnutrition, Food Asphyxiation, choking. Roles of the nurse: to educate, know awareness, provide emotional, social & physical support.

Define preeclampsia, and list two risk factors for developing this disease.

Preeclampsia, pregnancy-induced hypertension, is considered hypertension with proteinuria (excess protein in urine) after 20 weeks' gestation. Risk factors include First pregnancies, Diabetes mellitus (type 1, type 2), Hypertension (for at least 4 years), Advanced maternal age, African American heritage, Multiple pregnancies, renal disease, and age at conception.

Describe the special nutrition needs of a premature infant.

Premature infants have increased needs for protein, kcal, calcium, phosphorus, sodium, iron, zinc, vitamin E, and fluids.

What is the role of progesterone during pregnancy? What is the role of estrogen?

Progesterone promotes the development endometrium and relaxes the smooth muscle cells of the uterus. Estrogen helps the uterus grow, maintains uterine lining, regulates hormones, and triggers the development of the babies' organs.

What is the difference between prolactin and oxytocin?

Prolactin promotes milk synthesis. Oxytocin stimulates milk ejection.

List three community supports for older Americans.

SNAP, The Emergency Food Assistance Program (TEFAP), and community food banks and Meals, churches, & meals on wheels.

Why are snacks an important part of a child's diet during the toddler years?

Snacks are an important part of the child's energy and is very convenient. They boost nutrient intake.

Briefly describe the primary development factors for each of the three stages of childhood. For each stage, list two factors that influence nutrient requirements.

Stage I (1-3yrs): growth and endless activity means increase protein and provide low fat foods. high fat content is more filling and will displace other nutrient rich foods. They imitate adults, so provide and eat a variety of foods. Stage II (4-6): independent eating styles, understand time frame and can safe their appetite for meals. Still need snacks though. Stage III (7-12): physical growth slows, but body is preparing for puberty growth spurt. Possible increased chubbiness. Remind them to stop eating when full to rule out overeating

List at least three types of drugs that may act as appetite stimulants and at least three types that may act as appetite depressants.

Stimulants - Antidepressants, Antihistamines, Bronchodilator, Steroids, Tranquilizers - all increasing appetite Suppressants - Amphetamines, Antidysrhythmic, Antibiotics, Antidepressant, Antihistamine, Antihypertensive, Muscle Relaxant, Stimulant/Anti attention Deficit Disorder Agent

What is the difference between total parenteral nutrition (TPN) and peripheral parenteral nutrition (PPN)?

TPN - provision of energy and nutrients intravenously. LARGE VEIN PPN - When a smaller, peripheral vein is used (usually in the forearm) SMALL VEIN

List four effects of aging on status

Taste & smell, sense of thirst, swallowing, absorption of vitamin B12 & folate, constipation, metabolism slows, & gain weight.

1. How much does the basal metabolic rate (BMR) increase during pregnancy?

The BMR increases about 15-20%. This increase is caused by the greater oxygen needs of the fetus and the maternal support tissues.

List the nutrition therapy goals for the treatment of IBD.

The goals of nutrition therapy are to replace lost nutrients, correct deficits, and achieve energy, nitrogen, fluid, and electrolyte balance.

Identify two factors that may affect the nutritional status of adolescents.

Trying to be like others, poverty, resources available, physical & emotional support, & puberty.

Name the two conditions collectively termed as inflammatory bowel disease (IBD)

Ulcerative colitis (UC) and Crohn's disease (regional enteritis). UC is an inflammatory process confined to the mucosa of the large intestine. Crohn's disease is an inflammatory disorder that involves all layers of the intestinal wall and may affect the small intestine, large intestine, or both.

Immune function can be nutritionally evaluated through the measurement of what vitamin?

Vitamin D levels.

Name two vitamins and two minerals of special concern to infants.

Vitamins K is used for clotting. Vitamin D. Iron and fluoride (helps build teeth and bones.)

Identify four warning signs of dysphagia. Describe the factors that affect the ability of patients with dysphagia to consume a nutritionally adequate diet.

Warning signs: Pain while swallowing (odynophagia), Inability to swallow, Sensation of food getting stuck in the throat or chest, Drooling, Hoarseness, bringing food back up (regurgitation), Frequent heartburn, Food or stomach acid backing up into the throat, Unplanned weight loss, Coughing or gagging when swallowing, Avoidance of certain foods because of trouble swallowing Dense foods, thicken liquids.

Name four grains that contain gluten.

Wheat, oats, rye, and barley.

What are the possible nutrient deficiencies for the following physical signs?

a. Dull brittle hair - Protein b. Epistaxis - Vitamin K c. Thyroid enlargement - Iodine d. Pale conjunctiva - Iron (Fe) e. Glossitis - Niacin, folate, vitamin B12, and other B vitamins f. Poor wound healing - Protein, Zinc, vitamin C g. Spoon-shaped nails - Iron (Fe) h. Tremor - Magnesium (Mg)

What are the associated adverse effects for the following herbs and nutraceuticals?

a. Kava - Prolonged use causes a temporary yellow coloring of skin, hair, and nails; may cause liver damage; not recommended for use with other central nervous system depressants, including alcohol b. Ginseng - Typically, mild and dose related; most observed are nervousness, sleeplessness, nausea, and occasionally headache c. St. John's wort - Fatigue, pruritus, weight gain, emotional vulnerability; photosensitivity; decreased effectiveness of oral contraceptive therapy possible d. Chaparral - Hepatoxic, liver toxicity; unproven and dangerous e. Fish oil - Triglyceride-lowering effect may diminish with continued use; variable effects (decreases and increases) on blood cholesterol levels; may increase bleeding risk f. Aloe - A harsh purgative; less toxic laxatives are available. Contraindicated in patients with hemorrhoids, kidney disease, intestinal obstruction, abdominal pain, nausea, or vomiting

List at least four symptoms of the dumping syndrome.

epigastric fullness, abdominal cramps, nausea, or diarrhea. Vasomotor symptoms may also occur: tachycardia, postural hypotension, profuse sweating, weakness, flushing, and syncope.

What are the main components of a TPN solution?

lipid emulsions, dextrose, amino acids, vitamins, electrolytes, minerals, and trace elements.