Nutrition Week 8
Consumption of foods high in vitamin K
(green leafy vegetables, eggs, liver) can decrease the anticoagulant effects of warfarin (Coumadin).
Avoid foods that are potential choking hazards
(nuts, grapes, hot dogs, peanut butter, raw carrots, tough meats, popcorn). Always provide adult supervision during snack and mealtimes. During food preparation, cut small bite-sized pieces that are easier swallow, and to prevent choking. Do not allow the child to engage in drinking or eating during play activities or while lying down
appropriate weight gain averages
0.15 to 0.21 kg (5 to 7 oz) per week during the first 5 to 6 months.
the highest amount of calcium
1 cup of low fat yogurt
protein intake should be
10% per day or 46 g/per day on women and 56 g/day on men
Males 14 to 18 years of age require
11 mg of iron to support expansion of muscle mass and blood volume.
Females 14 to 18 years of age require
15 mg of iron to support expansion of blood volume and blood loss during menstruation.
vegetables
2 1/2 cups
fruits
2 cups
Energy requirements average
2,000 cal/day for a 15-year-old female, and 4,000 cal/day for a 15-year-old male.
Fluid for pregnant women
2,000 to 3,000 mL of fluids daily from food and drinks. Preferable fluids include water, fruit juice, or milk. Carbonated beverages and fruit drinks provide little or no nutrients.
total fat intake should be
20-35 % intake per day
milk
3 cups
protein provides
4 cal/g of energy
birth weight doubles by
4 to 6 months and triples by 1 year of age. The n
Children are at an increased risk for choking until
4 yr of age
solid food should not be introduced until
4-6 months of age iron cereal should be offered first, wheat cereals not until the first yr new food should be introduced 4-5 day period to observe for signs of allergy vegetables are introduced between 6-8 months do not give peanuts or peanut butter, or honey give 3 meals with 8snacks y 8 months by 9 months the infant should be ready to eat table foods
from bottle to cup
5-8 months of age the infant may not be ready to wean the bottle until about 12-14 months of age
grains
6oz
lipids provide
9 cal/g of energy
sULfUR (s)
A component of vitamin structure, by-product of protein metabolism Dried fruits (dates, raisins, apples), meats, r ed and white wines Only seen in severe protein malnourishment, found in all protein-containing foods Toxicity has a very low risk Sulfur levels are not usually monitored
End Stage kidney disease
A high-protein, low-phosphorus, low-potassium, low-sodium (2 to 4 g/day), fluid-restricted diet is recommended. Vitamin D and calcium are nutrients of concern Potassium intake is dependent upon the client's laboratory findings, which should be closely monitored. ■■ Sodium and fluid allowances are determined by blood pressure, weight, serum electrolyte findings, and urine output. ■■ Achieving a well-balanced diet based on the above guidelines is difficult. The National Renal Diet provides clients with a list of appropriate food choices. ■■ Protein needs increase once dialysis has begun as protein and amino acids are lost in the dialysate. ☐☐ Fifty percent of protein intake should come from biologic sources (eggs, milk, meat, fish, poultry, soy). ☐☐ Adequate calories (35 kcal/kg of body weight) should be consumed to maintain body protein stores. ■■ Phosphorus must be restricted. ☐☐ A high protein requirement leads to an increase in phosphorus intake. ☐☐ Foods high in phosphorus are milk products, beef liver, chocolate, nuts, and legumes. ☐☐ Phosphate binders (e.g., calcium carbonate, calcium acetate) must be taken with all meals and snacks. ■■ Vitamin D deficiency occurs as the kidneys are unable to convert vitamin D to its active form. ☐☐ This alters the metabolism of calcium, phosphorus, and magnesium, leading to hyperphosphatemia, hypocalcemia, and hypermagnesemia. ☐☐ Calcium supplements will likely be required because foods high in phosphorus (which are restricted) are also high in calcium.
Myocardial Infarction (MI)
A liquid diet is best for the first 24 hr after the infarction. ■■ Caffeine should be avoided because it stimulates the heart and increases heart rate. ■■ Small, frequent meals are indicated. ■■ Counsel the client about recommendations for a heart-healthy diet.
Bolus feeding -
A variation of intermittent feeding using a large syringe attached to the feeding tube. A large volume of formula (500 mL maximum, usual volume is 250 to 400 mL) is administered over a short period of time, usually less than 15 min, four to six times daily. ■■ Bolus feedings are delivered directly into the stomach. They may be poorly tolerated and may cause dumping syndrome.
fat soluble
A, D, E and K
Acute kidney injury (AKI)
AKI is an abrupt, rapid decline in kidney function caused by trauma, sepsis, poor perfusion, or medications, and usually is reversible. AKI can cause hyponatremia, hyperkalemia, hypocalcemia, and hyperphosphatemia. Infection is a complication of AKI and is the leading cause of death in these clients. ◯◯ Therapeutic Nutrition ■■ Diet therapy for AKI is dependent upon the phase of AKI and its underlying cause. Protein, calories, fluids, potassium, and sodium need to be individualized according to the three phases of AKI (oliguric phase, diuretic phase, and recovery phase), and adjusted as improvement develops if the client is receiving dialysis. ■■ Recommendation is to consume 30 to 50 kcal/kg of body weight to maintain energy and demands of stress. ■■ Simple carbohydrates, fats, oils, and low-protein starches provide nonprotein calories. ■■ Protein intake may increase if the client is receiving dialysis, from 0.6 to 2 g/kg compared to 0.6 g/kg (40 g/day) for nondialysis clients. ■■ Potassium and sodium are dependent on urine output, serum values, and if the client is receiving dialysis. ☐☐ Potassium is restricted to 60 to 70 mEq/day when on dialysis. ☐☐ Sodium is restricted to 1 to 3 g/day if not receiving dialysis, and 1 to 4 g/day if receiving dialysis, which also depends on the phase. ☐☐ Calcium requirements are of less than 2,000 mg daily if on hemodialysis or peritoneal dialysis. ■■ Fluids are restricted to the client's daily urine output plus 500 mL during the oliguric phase. Fluid needs are increased during the diuretic phase
Clear Liquid Diet
Acceptable foods are water, tea, coffee, fat-free broth, carbonated beverages, clear juices, ginger ale,and gelatin. ◯◯ Limit caffeine consumption, which can lead to increased hydrochloric acid and upset stomach.
illeostomies/colostomies
An ostomy is a surgically created opening on the surface of the abdomen from either the end of the small intestine (ileostomy) or from the colon (colostomy). ◯◯ Fluid and electrolyte maintenance is the primary concern for clients who have ileostomies and colostomies. ◯◯ The colon absorbs large amounts of fluid, sodium, and potassium. ◯◯ Nutrition therapy begins with liquids only and is slowly advanced based upon client tolerance. ◯◯ Nursing Interventions ■■ Advise the client to consume a diet that is high in fluids and soluble fiber. ■■ Encourage the client to avoid foods that cause gas (beans, eggs, carbonated beverages), stomal blockage (nuts, raw carrots, popcorn), and foods that produce odor (eggs, fish, garlic). ■■ Encourage the client to increase his intake of calories and protein to promote healing of the stoma site. ■■ Provide emotional support to clients due to their altered body image.
ChLoRidE (Cl)
Bonds to other minerals (especially sodium) to facilitate cellular actions and reactions, fluid balance Table saltfindings of deficiency high blood pressure Monitor sodium levels
MAGNEsiUM (Mg)
Bone nourishment, catalyst for many enzyme r eactions, nerve/muscle function, CV support Green leafy vegetables, nuts, grains, meat, milk Weakness, dysrhythmias, tetany, seizure, reduced blood clotting, eclampsia Diarrhea, kidney stones, decreased muscle control, CV changes Incompatible with some antibiotic
CALCiUM (Ca)
Bones/teeth, cardiovascular support, blood clotting, nerve transmission Dairy, broccoli, kale, grains, egg yolks Osteopor osis, tetany, Chvostek's and Trousseau's signs, ECG changes Constipation, kidney stones Monitor ECG and muscle tone. Give PO tabs with vitamin D.
water soluble
C and B
Caffeine:
Caffeine crosses the placenta and can affect the movement and heart rate of the fetus. However, moderate use (less than 300 mg/day) does not appear to be harmful.
osteoporosis is most seen on ?
Caucasian women
cholecystitis
Cholecystitis is characterized by inflammation of the gallbladder. ◯◯ The gallbladder stores and releases bile that aids in the digestion of fats. ◯◯ Clinical manifestations include pain, tenderness, and rigidity in upper right abdomen. Pain can radiate to the right shoulder or midsternal area. Nausea, vomiting, and anorexia also can occur. If the gallbladder becomes filled with pus or becomes gangrenous, perforation can result. ◯◯ In clients who have large stones or inability to control the condition with diet modifications, surgery is required. ◯◯ Pancreatitis and liver involvement can result from uncontrolled cholecystitis. ◯◯ Fat intake should be limited to reduce stimulation of the gallbladder. ◯◯ Other foods that may cause problems include coffee, broccoli, cauliflower, Brussels sprouts, cabbage, onions, legumes, and highly seasoned foods. ◯◯ The diet is individualized to the client's needs and tolerance. ◯◯ Diet modifications are not necessary for healthy people with asymptomatic gallstones
altered sensory perception
Clients who have an altered sense of smell will have an altered sense of taste. ■■ Clients who smoke can have a diminished sense of smell. ■■ Clients on chemotherapy and other types of medications can have an unusual taste in their mouth (metallic taste), masking the real taste of food. ■■ Clients on chemotherapy can experience nausea and anorexia, resulting in an aversion to food.
constipation
Clients who have constipation have difficult or infrequent passage of stools, which may be hard and dry. ◯◯ Causes include irregular bowel habits, psychogenic factors, inactivity, chronic laxative use or abuse, obstruction, medications, GI disorders such as IBS, pregnancy, or secondary to genital/rectal trauma such sexual abuse or child birth, and inadequate consumption of fiber and fluid. ◯◯ Encourage exercise and a diet high in fiber (25 g/day for women and 38 g/day for men), and promote adequate fluid intake to help alleviate symptoms. ◯◯ If caused from medication, a change in the medication may be required. ◯◯ Nursing Interventions ■■ Assess onset and duration of past and present elimination patterns, what is normal for the client, activity levels, occupation, dietary intake, and stress levels. ■■ Assess past medical and surgical history, medication use (OTC, herbal supplements, laxatives, enemas, and prescriptions), presence of rectal pressure or fullness, and abdominal pain. ■■ Encourage client to gradually increase daily intake of fiber. ■■ Advise the client that an increase in fiber intake is the preferred treatment for constipation. Chronic use of laxatives should be avoided.
hyperglycemia
Clients with hyperglycemia should: ■■ Immediately consult a provider, or go to the emergency department. ■■ Take medication if forgotten. ■■ Consider modifications to insulin or oral diabetic medications. ◯◯ Long-term implications of untreated or inadequately treated hyperglycemia include blindness, kidney failure, dyslipidemia, hypertension, neuropathy, microvascular disease, and limb amputation. ◯◯ Somogyi's phenomenon is morning hyperglycemia in response to overnight hypoglycemia. Providing a bedtime snack and appropriate insulin dose prevents this phenomenon. ◯◯ Dawn phenomenon is an elevation of blood glucose around 0500 to 0600. It results from an overnight release of growth hormone, and is treated by increasing the amount of insulin provided during the overnight hours.
Hypoglycemia
Clients with hypoglycemia should be instructed to take 15 to 20 g of a readily absorbable carbohydrate, such as: ■■ Two or three glucose tablets (5 g each). ■■ Eight Lifesavers™/hard candies. ■■ ½ cup (4 oz) juice or regular soda. ■■ 1 tbsp of honey or brown sugar. ◯◯ Retest the blood glucose in 15 min. If it is less than 70 mg/dL, repeat the above steps. Once levels normalize, have the client take an additional carbohydrate and protein snack or small meal, depending on the severity of the hypoglycemic episode and whether the next meal is more than 1 hr away
cancer nutrition
Consume adequate dietary fiber (14 grams per 1,000 kcal daily requirement) to lessen the risk of colon cancer. ■■ Eliminate tobacco to reduce the risk of lung cancer. ■■ Eat at least five servings of fruits and vegetables daily (linked to a lowered incidence of many types of cancer). ■■ Consume whole grains rather than processed or refined grains and sugars. Gluten-free grains reduce the risk in some clients who have gastrointestinal disease. ■■ Avoid meat prepared by smoking, pickling, charcoal grilling, and use of nitrate-containing chemicals (may be carcinogenic). ■■ Consume polyunsaturated and monounsaturated fats (found in fish and olive oil) presumed to be beneficial in lowering the risk of many types of cancer. ■■ Limit alcohol consumption (associated with many types of cancers). ■■ A calcium-rich diet is associated with a lower incidence of colon cancer as it binds free fatty acids and bile salts in the lower gastrointestinal tract protein needs to be increased to - g/kg
impaired swallowing
Continually monitor clients who are at risk for aspiration during meals, and have suction available
inflammatory bowel disease
Crohn's disease (regional enteritis) and ulcerative colitis are chronic, inflammatory bowel diseases characterized by periods of exacerbation and remission. ◯◯ Clinical manifestations include nausea, vomiting, abdominal cramps, fever, fatigue, anorexia, weight loss, steatorrhea, and low-grade fever. ◯◯ Nutrition therapy is focused on providing nutrients in forms that the client can tolerate. ◯◯ Generally, diets are low in fiber to minimize bowel stimulation. ◯◯ A low-residue, high-protein, high-calorie diet with vitamin and mineral supplementation is prescribed. Fluid and electrolyte imbalances are corrected with IV fluids or oral replacement fluids. ◯◯ Teach clients to avoid intake of substances that cause or exacerbate diarrhea, and to avoid nicotine. ◯◯ Total parenteral nutrition (TPN) is indicated for clients who are severely ill during the acute phase of the illness. ◯◯ Additional therapy ■■ Sedatives ■■ Antidiarrheal and antiperistaltic agents ■■ Aminosalicylate medications and corticosteroids to reduce inflammation ■■ Immunomodulators to alter the immune response and prevent relapse ■■ Surgery when other treatments are not effectiv
Anorexia
Decrease stress at meal times. ■■ Administer medications to stimulate appetite. ■■ Assess and modify environment for unpleasant odors. ■■ Remove items that cause a decrease in appetite (soiled linens, garbage, emesis basins, bedpans, used tissues, clutter). ■■ Assess and manage anxiety and depression. ■■ Provide small, frequent meals and avoid high-fat foods to help maximize the intake of clients who are anorexic. ■■ Provide liquid supplements between meals to improve protein and calorie intake. ■■ Ensure that meals appear appealing. Serve larger meals early in the day. ■■ Assess for changes in bowel status (increased gastric emptying, constipation, diarrhea). ■■ Position to increase gastric motility. ■■ Provide mouth care before and after meals.
Mechanical Fixation of the Jaw
Disorders of the jaw requiring surgery include facial trauma and reconstruction. ■■ After fractured bones are realigned, the client's upper and lower jaw may be wired together. ■■ The jaw may be immobilized for several weeks. ■■ The client may be placed on a liquid diet during this period. ◯◯ Nursing Care ■■ Encourage the intake of fluids ■■ Help the client determine where to insert a straw through the space between the jaws ■■ Work with the dietician to develop a liquid meal plan that includes the necessary nutrients
diverticulitis/diverticulosis
Diverticula are pouches protruding through the muscle of the intestinal wall, usually from increased intraluminal pressure. They occur anywhere in the colon, but usually in the sigmoid colon. Unless infection occurs, diverticula cause no problems. ◯◯ Diverticulosis is a condition characterized by the presence of diverticula. ◯◯ Diverticulitis is inflammation that occurs when fecal matter becomes trapped in the diverticula. ◯◯ Clinical manifestations of diverticulitis include abdominal pain, nausea, vomiting, constipation or diarrhea, and fever, accompanied by chills and tachycardia. ◯◯ The client is administered antibiotics, anticholinergics, and analgesics. Clients who have severe manifestations are admitted to the hospital and dehydration is treated with IV therapy. Opioid analgesics are administered for pain. Complications (peritonitis, bowel obstruction, abscess) may warrant surgical intervention. ◯◯ A high-fiber diet may prevent diverticulosis and diverticulitis by producing stools that are easily passed, thus decreasing pressure within the colon. ◯◯ During acute diverticulitis, a clear liquid diet is prescribed until inflammation decreases, then a high‑fiber, low-fat diet is indicated. ◯◯ Instruct the client to avoid foods with seeds or husks (corn, popcorn, berries, tomatoes). ◯◯ Clients require instruction regarding diet adjustment based on the need for an acute intervention
Fatigue
Eat a large, calorie-dense breakfast when energy level is the highest. ›› Conserve energy by eating foods that are easy to prepare. ›› Use a meal delivery service
Carbohydrate (DM)
Encourage the client to consume carbohydrates found in grains, fruits, legumes, and milk. Limit simple carbohydrates, which include refined grains and sugars. XX Carbohydrates should include a minimum of 130 g/day for healthy brain function. XX Carbohydrates should be 45% to 60% of total daily caloric intake
Anemia
Fatigue Lethargy Pallor of nail beds Intolerance to cold
Nausea and constipation are common during pregnancy.
For nausea, eat dry crackers or toast. Avoid alcohol, caffeine, fats, and spices. Avoid drinking fluids with meals, and do not take medications to control nausea without checking with the provider. For constipation, increase fluid consumption and include extra fiber in the diet. Fruits, vegetables, and whole grains contain fiber.
Continuous drip method -
Formula is administered at a continuous rate over a 16- to 24-hr period.
Cyclic feeding -
Formula is administered at a continuous rate over an 8- to 16-hr time period, often during sleeping hours
Intermittent tube feeding -
Formula is administered every 4 to 6 hr in equal portions of 200 to 300 mL over a 30- to 60-min time frame, usually by gravity drip.
GERD
GERD occurs as the result of the abnormal reflux of gastric secretions up the esophagus. This leads to indigestion and heartburn. ◯◯ Long-term GERD can cause serious complications including adenocarcinoma of the esophagus and Barrett's esophagus. ◯◯ Clinical manifestations include heartburn, retrosternal burning, painful swallowing, dyspepsia, regurgitation, coughing, hoarseness, and epigastric pain. Pain may be mistaken for a myocardial infarction. ◯◯ Nursing Interventions ■■ Instruct the client to avoid situations that lead to increased abdominal pressure, such as wearing tight-fitting clothing. ■■ Advise the client to avoid eating 2 hr or less before lying down. ■■ Advise the client to elevate the body on pillows instead of lying flat and to avoid large meals and bedtime snacks. ■■ Encourage weight loss for overweight clients. Suggest that the client avoid trigger foods (citrus fruits and juices, spicy foods, carbonated beverages). ■■ Instruct the client to avoid items that reduce lower esophageal sphincter (LES) pressure, including fatty foods, caffeine, chocolate, alcohol, cigarette smoke and all nicotine products, and peppermint and spearmint flavors
acute and chronic gastritis
Gastritis is characterized by inflammation of the gastric mucosa. The gastric mucosa is congested with blood and fluid, becoming inflamed. There is a decrease in acid produced and an overabundance of mucus. Superficial ulcers occur, sometimes leading to hemorrhages. ◯◯ Acute gastritis occurs with excessive use of NSAIDs, bile reflux, ingestion of a strong acid or alkali substance, as a complication of radiation therapy, or as a complication of trauma (burns; food poisoning; severe infection; liver, kidney, or respiratory failure; major surgery). ◯◯ Chronic gastritis occurs in the presence of ulcers (benign or malignant), Helicobacter pylori, autoimmune disorders (pernicious anemia), poor diet (excessive caffeine, excessive alcohol intake), medications (alendronate [Fosamax], perindopril [Aceon]), and reflux of pancreatic secretions and bile into stomach. ◯◯ Clinical manifestations include abdominal pain or discomfort (may be relieved by eating), headache, lassitude, nausea, anorexia, hiccupping (lasting a few hours to days), heartburn after eating, belching, sour taste in mouth, vomiting, bleeding, and hematemesis (vomiting of blood). ◯◯ Nursing Interventions ■■ Suggest that the client avoid eating frequent meals and snacks, as they promote increased gastric acid secretion. ■■ Tell the client to avoid alcohol, cigarette smoking, aspirin and other nonsteroidal anti‑inflammatory drugs (NSAIDs), coffee, black pepper, spicy foods, and caffeine. ■■ Monitor the client for vitamin deficiency, especially of vitamin B12. ◯◯ Acute recovery typically occurs in 1 day, but may take 2 to 3 days. The client should eat bland diet when able to tolerate food. IV fluid replacement therapy may be required if the condition persists. ◯◯ When the condition occurs due to ingestion of strong acids or alkalis, dilution and neutralization of the causal agent is needed. Avoid lavage and emetics due to potential perforation and esophageal damage. ◯◯ Chronic management: modify diet, reduce and manage stress, avoid alcohol and NSAIDS. If condition is persistent, the provider will prescribe an H2 receptor antagonist such as ranitidine (Zantac
Vitamin B12 Deficiency Anemia
Gastrointestinal Findings Glossitis (inflamed tongue) Anorexia Indigestion Weight loss Frequent diarrhea and/or constipation Neurological Findings Paresthesia (numbness) of hands and feet Decreased proprioception (sense of body position) Poor muscle coordination Increasing irritability Delirium
Lactating women require an increase in daily caloric intake
If the client is breastfeeding during the postpartum period, an additional daily intake of 330 calories is recommended during the first 6 months, and an additional daily intake of 400 calories is recommended during the second 6 months
HIV/AIDS
Increased caloric needs, ranging from 35 to 55 cal/kg. ☐☐ A high-protein diet is recommended with amounts varying from 1.2 to 2.0 g/kg. ☐☐ The intake of a multivitamin that meets 100% of the recommended daily servings is sufficient, unless a specific deficiency is identified. ■■ Decreased nutrient intake occurs because of physical manifestations (anorexia, nausea, vomiting, diarrhea). Psychological manifestations can include depression and dementia. ■■ Nutritional warning findings in clients who have HIV/AIDS include rapid weight loss, gastrointestinal problems, inadequate intake, increased nutrient needs, food aversions, fad diets, and supplements. ■■ If the client who has AIDS is unable to consume sufficient nutrients, calories, and fluid, enteral feedings may be needed. ■■ Encourage the client to consume small, frequent meals that are composed of high-protein, high-calorie, and nutrient-dense foods. ■■ Poor nutritional status leads to wasting and fever, further increasing susceptibility to secondary infections. ■■ HIV associated wasting is characterized by unintended weight loss of 10% and at least one concurrent problem (diarrhea, chronic weakness, or fever) for at least 30 days. ■■ Diarrhea and malabsorption are prominent clinical problems in clients who have AIDS. ■■ Liberal fluid intake is extremely important to prevent dehydration
coronary artery disease
Increasing fiber and carbohydrate intake, avoiding saturated fat, and decreasing red meatIncreased intake of omega-3 fatty acids found in fish, flaxseed, soy beans, canola, and walnuts reduces the risk of coronary artery disease. Deficiencies in folate and vitamins B6 and B12 increase homocysteine levels
TPN complications
Infection and sepsis are evidenced by a fever or elevated WBC count. Infection can result from contamination of the catheter during insertion, contaminated solution, or a long-term indwelling catheter. ●● Metabolic complications include hyperglycemia, hypoglycemia, hyperkalemia, hypophosphatemia, hypocalcemia, hypoalbuminemia, dehydration, and fluid overload (as evidenced by weight gain greater than 1 kg/day and edema). ●● Mechanical complications include catheter misplacement, pneumothorax (evidenced by shortness of breath, diminished or absent breath sounds), subclavian artery puncture, catheter embolus, air embolus, thrombosis, obstruction, and bolus infusion.
interventions for enteral feeding
Interventions◯◯ Weaning occurs as oral consumption increases. Enteral feedings may be discontinued when the client consumes two-thirds of protein and calorie needs orally for 3 to 5 days. ◯◯ A client who is NPO will require meticulous oral care. ◯◯ A client may require nutritional support service at home for long-term EN. A multidisciplinary team comprised of a nurse, dietician, pharmacist, and the provider, monitors the weight, electrolyte balance, and overall physical condition of the client. ◯◯ Transitioning from EN to an oral diet requires the client to receive adequate nutrition as food items are reintroduced. ■■ Begin the transition process by stopping the EN for 1 hr before a meal. ■■ Slowly increase the frequency of the meals until the client is eating six small meals daily. ■■ When oral intake equals 500 to 750 cal/day, the continuous tube feeding is administered only during night
Folic acid intake:
It is recommended that 600 mcg/day of folic acid be taken during pregnancy. Current recommendations for lactating clients include 500 mcg/day of folic acid. It is necessary for the neurological development of the fetus and to prevent birth defects. It is essential for maternal red blood cell formation. Food sources include green leafy vegetables, enriched grains, and orange juice.
lactose intolerance
Lactose intolerance results from an inadequate supply of lactase in the intestine, the enzyme that digests lactose. ◯◯ The enzyme that converts lactose into glucose, and galactose is absent or insufficient. Clinical manifestations include distention, cramps, flatus, and osmotic diarrhea. ◯◯ Nursing Interventions ■■ Encourage clients to avoid or limit their intake of foods high in lactose (milk, cheese, ice cream, cream soups, sour cream, puddings, chocolate, coffee creamer). ■■ Suggest that the client ask the provider about the use of a lactase enzyme. ■■ Monitor the client for vitamin D deficiency and calcium
potassiUM (K)
Maintains fluid volume inside/outside cells, muscle action, blood pressure, cardiovascular support Oranges, dried fruits, tomatoes, avocados, dried peas, meats, broccoli, bananas Dysrhythmias, muscle cramps, confusion ACE inhibitors, inadequate kidney function, diabetes) Monitor ECG and muscle tone. PO tabs irritate the GI system. Give with meals.
sodiUM (Na)
Maintains fluid volume, allows muscle contractions, car diovascular support Table salt, added salts, processed foods, butter findings of deficiency Muscle cramping, cardiac changes, Fluid retention, hypertension, CVA, Monitor ECG, edema, and blood pr essure
diahrrea
May cause significant losses of potassium, sodium, and fluid, as well as nutritional complications. ◯◯ Common causes of diarrhea include emotional and physical stress, gastrointestinal disorders, malabsorption disorders, infections, and certain drug therapies. ◯◯ A high-fiber diet may be prescribed, unless it is the fiber that is causing the diarrhea. ◯◯ Nutrition therapy varies with the severity and duration of diarrhea. A liberal fluid intake to replace losses is needed.
Nutritional assessments include identification of food allergies.
Milk, peanuts, fish, eggs, and wheat are the most commonly reported food allergies. Common reactions and manifestations may include nausea, vomiting, dyspnea, itching, dizziness, and headache or even anaphylaxis
renal considerations
Monitor kidney parameters for clients who have renal disorders. ■■ Nurses should monitor weight daily or as prescribed. Weight is an indicator of fluid status, which is a primary concern. ■■ Monitor fluid intake and encourage compliance with fluid restrictions. ■■ Nurses should monitor urine output. Placement of an indwelling urinary catheter may be necessary for accurate measurement. ■■ Monitor for manifestations of constipation. Fluid restrictions predispose clients to constipation. ◯◯ Explain why dietary changes are necessary. Ultimately, alterations in the intake of protein, calories, sodium, potassium, phosphorus, and other vitamins will be needed.
Nephrolithiasis (kidney stones)
Most common type of kidney stone is made of calcium oxalate. ◯◯ Contributing factors include inadequate fluid intake, elevated urine pH, and excess excretion through the kidneys of oxalate, calcium, and uric acid. ◯◯ Kidney stone formation is more influenced by the amount of oxalate in the client's system than calcium. A client who has an ileostomy has a higher incidence of kidney stones. ◯◯ Preventative Nutrition ■■ Excessive intake of protein, sodium, calcium, and oxalates (rhubarb, spinach, beets) may increase the risk of stone formation. ◯◯ Therapeutic Nutrition ■■ Increasing fluid consumption is the primary intervention for the treatment and prevention of kidney stones. Daily fluid intake should be at least 1,500 mL to 3,000 mL. At least 8 to 12 oz (240 to 360 mL) of fluid, preferably water, should be consumed before bedtime because urine becomes more concentrated at night. ■■ Recommendation for calcium oxalate stone formation is to limit animal protein, excess sodium, alcohol, and caffeine use. Low potassium also may be a contributing factor in calcium stone formation. ■■ Foods high in oxalates include spinach, rhubarb, beets, nuts, chocolate, tea, wheat bran, and strawberries and should be limited in the diet. Avoid megadoses of vitamin C, which increases the amount of oxalate excreted. ■■ Recommendation for prevention of uric acid stones is to limit foods high in purines, which include lean meats, organ meats, whole grains, and legumes
Gastrointestinal problems (nausea, vomiting, diarrhea)
Nausea, vomiting »»Eat cold or room temperature foods. »»Try high-carbohydrate, low-fat foods. »»Avoid fried foods. »»Do not eat prior to chemotherapy or radiation. »»Take prescribed antiemetic medication at the direction of the provider. ›› Diarrhea »»Ensure adequate intake of liquids throughout the day to replace losses. »»Avoid foods that may exacerbate diarrhea (foods high in roughage). »»Consume foods high in pectin to increase the bulk of the stool and to lengthen transition time in the colon.
Nephrotic syndrome
Nephrotic syndrome results in the increased excretion of serum proteins into the urine, resulting in hypoalbuminemia, edema, hyperlipidemia, and blood hypercoagulation. Prolonged protein loss leads to protein malnutrition, anemia, and vitamin D deficiency. ◯◯ Diabetes mellitus, kidney damage due to medications or chemicals, autoimmune disorders, and infections can cause nephrotic syndrome. ◯◯ Therapeutic Nutrition ■■ Nutritional therapy goals include minimizing edema, replacing lost nutrients, minimizing renal damage, controlling hypertension, and preventing protein malnutrition that can lead to muscle catabolism. ■■ Dietary recommendations indicate sufficient protein and low sodium intake. ☐☐ Adequate amount of protein intake is 0.7 to 1.0 g/kg/day. ☐☐ Soy-based proteins may decrease protein losses and lower serum lipid levels. ☐☐ Low-sodium diet of 1,000 to 2,000 mg can help control edema and hypertension. ☐☐ Carbohydrates should provide the majority of the client's daily calories. ☐☐ Foods high in trans fats and cholesterol are limited, and total fat should be less than 30% of the daily diet. ☐☐ Provide a multiple vitamin supplement to replace loss of vitamins with protein excretion
dumping syndrome
Normally, the stomach controls the rate in which nutrients enter the small intestine. When a portion of the stomach is surgically removed, the contents of the stomach are rapidly emptied into the small intestine, causing dumping syndrome. ■■ Early manifestations typically occur 15 to 30 min after eating. Late manifestations occur 1 to 3 hr after eating. ◯◯ Early manifestations include a sensation of fullness, faintness, diaphoresis, tachycardia, palpitations, hypotension, nausea, abdominal distention, cramping pain, diarrhea, weakness, and syncope. ◯◯ Manifestations resolve after intestine is emptied. However, there is a rapid rise in blood glucose and increase in insulin levels immediately after the intestine empties. This leads to hypoglycemia. ◯◯ The client experiences vasomotor symptoms, such as dizziness, sweating, palpitations, shakiness, and confusion. ◯◯ Nursing Interventions ■■ Recommend small, frequent meals. ■■ Recommend consumption of protein and fat at each meal. ■■ Tell the client to avoid food that contains concentrated sugars and to restrict lactose intake. ■■ Suggest that the client consume liquids 1 hr before or after eating instead of during meals (dry diet). ■■ Instruct client to lie down for 20 to 30 min to after meals to delay gastric emptying. If reflux is a problem, assume a reclining position. ■■ Monitor clients receiving enteral tube feedings and report clinical manifestations of dumping syndrome to the provider. ■■ Monitor the client for vitamin and mineral deficits, such as iron and vitamin B12. ●●
Salmonella -
Occurs due to eating undercooked or raw meat, poultry, eggs, fish, fruit, and dairy products. Common manifestations include headache, fever, abdominal cramping, diarrhea, nausea, and vomiting. This condition can be fatal.
PUD peptic ulcer disease
PUD is characterized by an erosion of the mucosal layer of the stomach or duodenum. ◯◯ This may be caused by a bacterial infection with H. pylori or the chronic use of NSAIDs (aspirin, ibuprofen). ◯◯ Some clients who have PUD are asymptomatic. Others report dull, gnawing pain, burning sensation in the back or low midepigastric area, heartburn, constipation or diarrhea, sour taste in mouth, burping, nausea, vomiting, bloating, urea present in breath, and tarry stools. Eating may temporarily relieve pain. Anemia can occur due to blood loss. CHAPTER 13 Gastrointestinal Disorders 122 Nutrition for Nursing ◯◯ For PUD caused by H. pylori, the provider prescribes triple therapy (a combination of antibiotics and acid reducing medications) to be taken for 14 days. ◯◯ Nursing Interventions ■■ Advise the client to avoid eating frequent meals and snacks as they promote increased gastric acid secretion. ■■ Suggest that the client avoid coffee, alcohol, caffeine, aspirin and other NSAIDs, cigarette smoking, black pepper, and spicy foods
Shigella -
Poor personal hygiene and improper hand hygiene commonly cause Shigella. Food sources include dairy products and salads. Findings include diarrhea.
nausea vomiting
Potential causes of nausea and vomiting include decreased gastric acid secretion; decreased gastrointestinal motility; allergy to food(s); bacterial or viral infection; increased intracranial pressure; liver, pancreatic, and gall bladder disorders; or adverse effects of some medications. ◯◯ The underlying cause of nausea and vomiting should be investigated. Assessing the appearance of the emesis will aid in diagnosis and treatment (i.e., coffee-ground emesis indicates the presence of blood; pale green indicates bile). ◯◯ Once manifestations subside, begin with clear liquids followed by full liquids, and advance the diet as tolerated. ◯◯ Easy-to-digest, low-fat carbohydrate foods (crackers, toast, oatmeal, pretzels, plain bread, bland fruit) are usually well-tolerated. ◯◯ Other interventions include: ■■ Clients should avoid liquids with meals as they promote a feeling of fullness. ■■ Promote good oral hygiene with toothbrushing, mouth swabs, mouthwash, and ice chips. ■■ Elevate the head of the bed. ■■ Discourage hot and spicy foods. ■■ Serve foods at room temperature or chilled. ■■ Avoid high-fat foods if they contribute to nausea because they are difficult to digest.
fiber (DM)
Promote fiber intake (beans, vegetables, oats, whole grains) to improve carbohydrate metabolism and lower cholesterol. ☐☐ Recommendation for fiber intake includes at least 14 g per 1,000 calories.
Protein (DM)
Protein from meats, eggs, fish, nuts, beans, and soy products should comprise 15% to 20% of total caloric intake. Protein intake may need to be reduced in clients who have diabetes and kidney failure
Escherichia coli 0157:H7 -
Raw or undercooked meat, especially hamburger, can cause this foodborne pathogen. Findings include severe abdominal pain and diarrhea.
Recommended weight gain during pregnancy varies for each woman depending on her body mass index (BMI) and weight prior to pregnancy.
Recommended weight gain during the first trimester is 1 to 4 lb. Recommended weight gain is 2 to 4 lb per month during the second and third trimesters. Trimesters two and three: Normal weight client - 1 lb/week for a total of 25 to 35 lb. Underweight client - just more than 1 lb/week for a total of 28 to 40 lb. Overweight client - 0.66 lb/week for a total of 15 to 25 lb.
Heart failure
Reduce sodium intake to 2,000 mg/day or less.
fats (DM)
Saturated fat should account for less than 7% of total calories. ☐☐ Trans fatty acid recommendation is less than 1% of total daily caloric intake. Limit fried foods and bakery products, which contain high quantities of trans fatty acid from preparation with hydrogenated oils. ☐☐ Cholesterol is restricted to 200 to 300 mg/day. ☐☐ Polyunsaturated fatty acids are found in fish. Two or more servings per week are recommended
Protein restriction is essential for clients who have pre-stage CKD.
Slows the progression of kidney disease. ☐☐ Too little protein results in the breakdown of body protein. Protein intake must be carefully determined. Restrict sodium intake to maintain blood pressure. hese proteins include eggs, meats, poultry, game, fish, soy, and dairy products. ☐☐ Limit meat intake to 5 to 6 oz/day for most men and 4 oz/day for most women. ☐☐ Limit dairy products to ½ cup per day. CHAPTER 14 Renal Disorders 132 Nutrition for Nursing ☐☐ Limit high-phosphorus foods (peanut butter, dried peas and beans, bran, cola, chocolate, beer, some whole grains) to one serving or less per day. ☐☐ Caution clients to use vitamin and mineral supplements only when recommended by a health care provider. Avoid sports drinks, energy drinks, or meal supplement systems, which can be high-protein. Avoid herbal supplements that may affect bleeding time and blood pressure
Listeria monocytogenes -
Soft cheese, raw milk products, undercooked poultry, meat, seafood, and vegetables can cause the illness. Listeria monocytogenes causes significant problems for newborns, pregnant clients, and immunocompromised clients. Onset occurs with the development of a sudden fever, diarrhea, headache, back pains, and abdominal discomfort. It can lead to stillbir
increase protein and caloric on cancer patients by?
Substituting whole milk for water in recipes. XX Adding milk, cheese, yogurt, or ice cream to dishes. XX Using peanut butter as a spread for fruits. XX Using yogurt as a topping for fruit. XX Dipping meats in milk and bread crumbs before cooking
dysphagia
Teach client who has dysphagia how to promote swallowing: inhale, swallow, and then exhale and tilt the head.
HTN
The Dietary Approaches to Stopping Hypertension (DASH) diet is a low-sodium, high‑potassium, high-calcium diet that has proven to lower blood pressure (systolic and diastolic) and cholesterol. ☐☐ Decrease sodium intake (a daily intake of less than 2,400 mg is recommended). ☐☐ Foods high in sodium include canned soups and sauces, potato chips, pretzels, smoked meats, seasonings, and processed foods. ☐☐ Include low-fat dairy products to promote calcium intake. ☐☐ Include fruits and vegetables rich in potassium (apricots, bananas, tomatoes, potatoes). ■■ Limit alcohol intake. ■■ Encourage the client to read labels and educate the client about appropriate food choices. ■■ Other lifestyle changes include exercising, weight loss, and smoking cessation.
mothers breastfeeding
The rate of the bolus feeding should be no more than 5 mL of breast milk or formula over 5 to 10 min for a premature infant, and 10 mL for an older infant or child, to prevent nausea and regurgitation.
DIabetes diet
To avoid hypoglycemia, the client should consume alcohol with a meal or immediately after a meal. ■■ Alcohol is not recommended for a client who has hyperlipidemia. ■■ Alcoholic beverages should replace two fat exchanges in the diabetic diet. Deficiencies in magnesium and potassium can aggravate glucose intolerance. ◯◯ Artificial sweeteners are acceptable. Saccharin crosses the placenta and should be avoided during pregnancy. ■■ Sucrose (table sugar) can be included in a diabetic diet as long as adequate insulin or other agents are provided to cover the sugar intake. ◯◯ Carbohydrate counting focuses on counting total grams of carbohydrates in each food item. emains accurate. decrease insulin resistance, improve glucose and lipid levels, and lower blood pressure. ns.
Mouth ulcers and stomatitis
Use a soft toothbrush to clean teeth after eating and at bedtime. ›› Avoid mouth washes that contain alcohol. ››Omit acidic, spicy, dry, or coarse foods. ›› Include cold or room temperature foods in the diet. ›› Cut food into small bites. ›› Try using straws. ›› Be sure dentures fit well.
for TPN
Use sterile technique when changing central line dressing and tubing. The bag and tubing should be changed every 24 hr or per facility protocol
nuts/ spinach
a good source of zinc
semisolid foods should not be introduced until
a months of age because protein mineral content stress the immature kidney and a young infant cannot fully digest the protein and cow's milk
cancer and immunosupression disorders
affect chewing, swallowing, satiety, digestion, nutrient absorption, use of glucose, and stool formation (dependent on type).
Cow's milk should not be introduced into the diet until
after 1 year of age because protein and mineral content stress the immature kidney. A young infant cannot fully digest the protein and fat contained in cow's milk.
Niacin (B 3)
aids in the metabolism of fats, glucose, and alcohol. Deficiency causes pellagra (manifestations include sun-sensitive skin lesions, and gastrointestinal and neurological findings). Sources include beef liver, nuts, legumes, whole grain and enriched breads and cereals.
celiac disease
also known as gluten-sensitive enteropathy (GSE), celiac sprue, and gluten intolerance. ◯◯ It is a chronic, inherited, genetic disorder with autoimmune characteristics. Clients who have celiac disease are unable to digest the protein gluten. They lack the digestive enzyme DPP-IV, which is required to break down the gluten into molecules small enough to be used by the body. In celiac disease, gluten is broken down into peptide strands instead molecules. The body is not able to metabolize the peptides. If untreated, the client will suffer destruction of the villa and the walls of the small intestine. Celiac disease may go undiagnosed in both children and adults. ◯◯ Clinical manifestations vary widely. Children who have celiac disease have diarrhea, steatorrhea, anemia, abdominal distention, impaired growth, lack of appetite, and fatigue. Typical manifestations in adults include diarrhea, abdominal pain, bloating, anemia, steatorrhea, and osteomalacia. CHAPTER 13 Gastrointestinal Disorders Nutrition for Nursing 125 ◯◯ Treatment for celiac disease is limited to avoiding gluten. However, eliminating gluten, which is found in wheat, rye and barley, is difficult because it is found in many prepared foods. Clients must read food labels carefully in order to adhere to a gluten-free diet. Some gluten-free products are unappealing to clients, and many are more expensive that other products. Prognosis is good for clients who adhere to a gluten-free diet. ◯◯ Nursing Interventions ■■ Encourage clients to eat foods that are gluten-free: milk, cheese, rice, corn, eggs, potatoes, fruits, vegetables, fresh poultry, meats and fish, dried beans. ■■ Remind clients to read labels on processed products. Gravy mixes, sauces, cold cuts, soups, and many other products have gluten as an ingredient. Advise clients to read labels on nonfood products, which also may have gluten as an ingredient
Vitamin K (menaquinone, phylloquinone)
assists in blood clotting and bone maintenance. Deficiency results in increased bleeding time. Used as an antidote for excess anticoagulants (warfarin [Coumadin]). Vitamin K is found in some oils, liver, and green leafy vegetables (spinach, broccoli, cabbage.
Vitamin D (calciferol)
assists in the utilization of calcium and phosphorus, and aids in skin repair. It can be used preventively for immune function. Sunlight enables the body to synthesize vitamin D. Deficiency results in bone demineralization, and extreme deficiency results in rickets. Clients on glucocorticoid therapy may require additional amounts. Excess consumption may cause hypercalcemia. Food sources include fortified milk, cod liver oil, and eggs. Low vitamin D levels may increase the risk for chronic diseases, such as multiple sclerosis, type 1 DM, HTN and certain cancers
phosphoRUs (p)
bone and teeth formation Dairy, peas, soft drinks, meat, eggs, some grains Calcium level changes, muscle weakness Skeletal porosity, decreased calcium levels, must stay in balance with calcium Evaluate the use of antacids (note type) and the use of alcohol.
Iron
can be obtained from dairy products and meats, especially red meats. Consuming foods high in vitamin C aids in the absorption of iron.
expressed milk
can be stored frozen for 6 months and in refrigerator for 10days thaw milk in refrigerator it can be stored for 24hr after thawing do not defrost in micro do not freeze thawed milk
Foods high in protein, amino acids, and vitamin B6
can increase the metabolism of the anti-Parkinson's medication levodopa (L-dopa, Sinemet), which decreases the duration of its therapeutic effects.
PPN
can provide a nutritionally complete solution. However, it is administered into a peripheral vein, resulting in a limited nutritional value. It is indicated for clients who require short-term nutritional support with fewer calories per day. The solution must be isotonic and contain no more than 10% dextrose and 5% amino acids.
pregnant with nausea
can take dry cereal before getting up
Gastrointestinal complications include
constipation, diarrhea, cramping, pain, abdominal distention, dumping syndrome, nausea, and vomiting. ◯◯ Nursing Actions ■■ Consider a change in formula. ■■ Decrease the flow rate for the infusion. ■■ Increase the volume of free water if constipated. ■■ Administer the EN at room temperature. ■■ Take measures to prevent bacterial contamination
IV lipids are
contraindicated for clients who have hyperlipidemia, severe hepatic disease, or an allergy to soybean oil, eggs, or safflower oil.
Vitamin A (retinol, beta-carotene)
contributes to vision health, tissue strength and growth, and embryonic development. Care should be taken when administered to pregnant clients as some forms have teratogenic effects on the fetus. Deficiency results in vision changes, xerophthalmia (dryness and thickening of the conjunctiva), and changes in epithelial cells (especially in the mouth and vaginal mucosa). Food sources include fish liver oils, egg yolks, butter, cream, and dark yellow/orange fruits and vegetables (carrots, yams, apricots, squash, cantaloupe).
for macular degeneration use?
dietary intake of lutein (because lutein slows the progress of MDG.
kosher diet
eat macaroni and cheese, they do not eat shrimp, pork or chicken
Residual volumes should be measured
every 4 to 6 hr.
Feeding tubes should be
flushed with water every 4 hr to maintain patency.
High-fiber diets focus on
foods containing more than 5 g of fiber per serving. A diet high in fiber helps: ■■ Increase stool bulk. ■■ Stimulate peristalsis. ■■ Prevent constipation. ■■ Protect against colon cancer.
Euro American
have lactose intolerance
vitamin A
helps improve vision at night
fiber
helps minimize cholesterol and intestinal cancer as well as peristalsis and bowel elimination
breast milk is
high in omega 3 low in sodium iron, zinc, magnesium, calcium is enhanced risk of allergies is reduced there should be 12-24 feedings in a 24he period the newborn should breast feed 15-20min per breast frequent feedings is every 2hr if its 4hr and the baby is not awake, the mother should awake the baby to feed
Licorice can cause
hyperkalemia (elevated serum potassium). Excess ingestion can be dangerous for clients taking digoxin (Lanoxin), stimulant laxatives, some beta-blockers, ACE inhibitors, some calcium channel blockers, monoamine oxidase (MAO) inhibitors, and spironolactone.
Tyramine is a naturally occurring amine found in many foods that has
hypertensive effects similar to other amines (norepinephrine). Tyramine is metabolized by MAO, and clients taking MAO inhibitors who consume foods high in tyramine may suffer a hypertensive crisis. Foods high in tyramine include aged cheese, smoked meats, red wines, and pickled meats.
Gavage feeding is
implemented to conserve energy when an infant is attempting to breast feed or bottle feed, but becomes fatigued, weak, or cyanotic
for enteral feeding
increase the amount of formula over the 4-6 times feeding (until order is achieved)
Two medications added to TPN
insulin and heparin, may be added to the PN solution by pharmacy services. Insulin may be added to reduce the potential for hyperglycemia, and heparin may be added to prevent fibrin buildup on the catheter tip. Administering any IV medication through a PN IV line or port is contraindicated
Maternal phenylketonuria (PKU)
is a maternal genetic disease in which high levels of phenylalanine pose danger to the fetus. It is important for a client to resume the PKU diet at least 3 months prior to pregnancy, and continue the diet throughout pregnancy. The diet should include foods low in phenylalanine. Foods high in protein (fish, poultry, meat, eggs, nuts, dairy products) must be avoided due to high phenylalanine levels. The client's blood phenylalanine levels should be monitored during pregnancy. These interventions will prevent fetal complications (mental retardation, behavioral problems
Vitamin E (tocopherol)
is an antioxidant that helps to preserve muscles and red blood cells, and maintains the myelin sheath that insulates nerve cells. Deficiency results in hemolytic anemia and affects the nerve fibers that influence walking and vision. Food sources include vegetable oils and certain nuts.
vitamin C - ascorbic acid
is for wound healing, fracture healing, collagen formation, adrenaline production, iron absorption found in oranges, lemons, tomatoes, peppers, green leafy vegetables and strawberries. stress and illness increase the need of vitamin C severe deficiency creates- scurvy, hemorrhagic disease, painful limb joints, weak bones and swollen gums, loose teeth.
Pantothenic acid (B 5)
is involved in biological reactions (energy production, catabolism, and synthesis of fatty acids, phospholipids, cholesterol, steroid hormones, the neurotransmitter acetylcholine). Deficiency results in anemia and CNS changes. However, a deficiency is unlikely due to the diverse availability in foods. Rich sources include organ meats (liver, kidney), egg yolk, avocados, cashew, nuts
obalamin (B 12)
is necessary for the production of red blood cells. Deficiency causes pernicious anemia and is seen mostly in strict vegetarians (B12 is found solely in foods of animal origin), and those with the absence of intrinsic factor needed for the absorption of B 12 Sources include beef liver, shellfish, and fortified grains
(folic acid is the synthetic form)
is required for hemoglobin Deficiency causes megaloblastic anemia, CNS disturbances, and fetal neural tube defects (spina bifida and anencephaly). Folate occurs naturally in a variety of foods including liver, dark-green leafy vegetables, citrus fruits, whole-grain products, and legumes.
for diverticulitis
limit fiber on diverticulitis when experiencing manifestations
Carbonated beverages may replace
milk and fruit juices in the diet with resulting deficiencies in vitamin C, riboflavin, phosphorous, and calcium.
thiamin (B1)
necessary for digestion, peristalsis, energy to the muscles, glands, the CNS and blood vessels deficiency results in beriberi, GI findings, cardio problems found in all plants and animals tissues, especially meats, grains and legumes
dumping syndrome
occurs due to rapid emptying of the formula into the small intestine, resulting in a fluid shift. Manifestations include dizziness, rapid pulse, diaphoresis, pallor, and light-headedness.
NG tubes
on adults 3-4 weeks infants up to 30 days
formula feeding
pacifier or bottles should be used until after 2 weeks iron fortified should be used until 6 months refrigerate formula do not use formula that has been left out for 2hr or longer always give formula at about same temp do not feed more than 32oz per 24hr period
Colic is characterized by
persistent crying lasting 3 hr or longer per day. occurs in the late afternoon, more than 3 days per week for more than 3 weeks. The crying is accompanied by a tense abdomen and legs drawn up to the belly. Colic usually resolves by 3 months of age. If breastfeeding, eliminating cruciferous vegetables (cauliflower, broccoli, and Brussels sprouts), cow's milk, onion, and chocolate may be helpful. Burp the infant in an upright position.
TPN
provides a nutritionally complete solution. It can be used when caloric needs are very high, when the anticipated duration of therapy is greater than 7 days, or when the solution to be administered is hypertonic (composed of greater than 10% dextrose). It can only be administered in a central vein.
roboflavin B2
required for growth and tissue healing Deficiency results in cheilosis (manifestations include scales and cracks on lips and mouth), smooth/swollen red tongue, and dermatitis particularly in skin folds. Dietary sources include milk, meats, and green leafy vegetables
Iron
responsible for hemoglobin formation/function, cellular oxidation of glucose, antibody production, and collagen synthesis. The body "scavenges" unused iron from dying red blood cells and stores it for later use. Iron supplements may cause constipation, nausea, vomiting, diarrhea, and teeth discoloration (liquid form). They should be taken with food to avert gastrointestinal symptoms, and nurses should encourage fresh fruits, vegetables, and a high-fiber diet. Supplements that are unneeded can become toxic. Intramuscular injections are caustic to tissues and must be administered by Z-track method. Food sources include organ meats, egg yolks, whole grains, and green leafy vegetables. Vitamin C increases the absorption of iron. The greatest need for iron is the newborn who is not breastfed, and for females during the menstruating years. Iron deficiency anemia can result from poor intestinal absorption, blood loss, and inadequate consumption. ■■ Sources of iron ☐☐ Meat ☐☐ Fish ☐☐ Poultry ☐☐ Tofu ☐☐ Dried peas and beans ☐☐ Whole grains ☐☐ Dried fruit ■■ Iron-fortified foods ☐☐ Infant formula (acceptable alternative or supplement to breastfeeding) ☐☐ Infant cereal (usually the first food introduced to infants) ☐☐ Ready-to-eat cereals ■■ Vitamin C facilitates the absorption of iron (promote consumption). ■■ Caution: Medicinal iron overdose is the leading cause of accidental poisoning in small children and can lead to acute iron toxicity. ◯◯ Vitamin B12 deficiency anemia results from a failure to absorb vitamin B12 (pernicious anemia) or inadequate intake. ■■ Natural sources of vitamin B12 ☐☐ Fish ☐☐ Meat ☐☐ Poultry ☐☐ Eggs ☐☐ Milk ■■ People over the age of 50 are urged to consume most of their vitamin B12 requirement from supplements or fortified food. ■■ Vegans need supplemental B12. ◯◯ Folic acid deficiency anemia is caused by poor nutrition, malabsorption (Crohn's disease), and drug use. ■■ Folic acid sources ☐☐ Green leafy vegetables ☐☐ Dried peas and beans ☐☐ Seeds ☐☐ Orange juice ☐☐ Cereals and breads fortified with folic acid ■■ If the client is unable to obtain an adequate supply of folic acid, supplementation may be necessary
prefilled tube feedings
should be discarded every 24hrs
Failure to provide optimal nutritional intake is the result of
solutions administered too slowly.
gastric bypass diet
start each meal with a protein
the infant should be breast fed for
the first 6-12 months
Iron-fortified infant cereal is
the first solid food introduced as gestational iron stores begin to deplete around 4 months of age.
Lactose intolerance is
the inability to digest significant amounts of lactose (the predominant sugar of milk) and is due to inadequate lactase (the enzyme that digests lactose into glucose and galactose). Lactose intolerance has an increased prevalence in individuals of Asian, Native American, African, Latino, and Mediterranean descent. Clinical findings include abdominal distention, flatus, and occasional diarrhea. 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.
Graperuit juice interferes with
the metabolism of many medications, resulting in an increased serum level of the medication.
Pernicious anemia is
the most common form of vitamin B12 deficiency. It is caused by lack of intrinsic factor, a protein that helps the body absorb vitamin B12. Risk factors include gastric surgery, gastric cancer, Helicobacter pylori, and age greater than 50. Clients who have pernicious anemia require vitamin B12 injections.
for pancreatitis
the pt should have increased glucose due to decreased insulin
cancer patients instruct?
to avoid food sources of bacteria (raw fruits and vegetables, undercooked meat, poultry, or eggs). Wash, peel, and cook fruits and vegetables. Cook all foods thoroughly
person with hypernatremia can have?
tomato slices because they are low in sodium, orange slices and brown rice
Hyperosmolar diuresis can result from an infusion that is
too rapid, and can lead todehydration, hypovolemic shock, seizures, coma, and death. To avoid hypoglycemia, an IV of dextrose 10% to 20% in water is administered if the PN solution is unavailable.
Mechanical complications include
tube misplacement or dislodgement; aspiration; tube obstruction or rupture; irritation and leakage at the insertion site; irritation of the nose, esophagus, and mucosa; and clogging of the feeding tube. ◯◯ Nursing Actions ■■ Flush the tubing with 20 to 30 mL of warm water every 4 hr for continuous infusion, after returning residual formula into the stomach, and before and after bolus feedings and each medication administration. ■■ Unclog tubing using gentle pressure with 50 mL of water in a piston syringe. Use carbonated beverage only when water does not open the tubing. ■■ Do not mix medications with the formula. ●● Metabolic complications include dehydration, hyperglycemia, electrolyte imbalances, and overhydration. ●● Food poisoning can result due to bacterial contamination of formula.
Iron
■■ Iron deficiency anemia is the most common nutritional deficiency disorder in children. ■■ Lean red meats provide sources of readily absorbable iron. ■■ Consuming vitamin C (orange juice, tomatoes) with plant sources of iron (beans, raisins, peanut butter, whole grains) will maximize absorption. ■■ Milk should be limited to the recommended quantities (24 oz) because it is a poor source of iron and may displace the intake of iron-rich foods.
Folic Acid Deficiency Anemia
■■ Manifestations include mental confusion, fainting, fatigue, and gastrointestinal distress. ■■ Findings of folic acid deficiency anemia mimic those for vitamin B12 deficiency anemia except for the neurological manifestations.
Vitamin D
■■ Vitamin D is essential for bone development. ■■ Recommended vitamin D intake is the same (5 mcg/day) from birth through age 50. Children require more vitamin D because their bones are growing. ■■ Milk (cow, soy) and fatty fish are good sources of vitamin D. ■■ Sunlight exposure leads to vitamin D synthesis. Children who spend large amounts of time inside (watching TV, playing video games) are at an increased risk for vitamin D deficiency. ■■ Vitamin D assists in the absorption of calcium into the bones.
Mechanical Soft Diet
◯◯ A regular diet that is modified in texture. The diet composition is altered for specific nutrient needs. ◯◯ Includes foods that require minimal chewing before swallowing (ground meats, canned fruits, softly cooked vegetables). ◯◯ Excludes harder foods (dried fruits, most raw fruits and vegetables, foods containing seeds and nuts). ◯◯ Indications include limited chewing ability; dysphagia, poorly fitting dentures, and clients who are edentulous (without teeth); surgery to the head, neck, or mouth; and strictures of the intestinal tract
Full Liquid Diet
◯◯ Consists of foods that are liquid at room temperature. ◯◯ Offer more variety and nutritional support than a clear liquid diet and can supply adequate amounts of energy and nutrients. ◯◯ Acceptable foods include all liquids on a clear liquid diet, all forms of milk, soups, pureed vegetables and fruits, vegetable and fruit juices, eggnog, plain ice cream and sherbet, refined or strained cereals, and puddings. ◯◯ Evaluate the need for high-protein and high-calorie supplements if this diet is used more than 2 to 3 days. ◯◯ Indications include a transition from liquid to soft diets, postoperative recovery, acute gastritis, febrile conditions, and intolerance of solid foods. ◯◯ Provides oral nourishment for clients having difficulty chewing or swallowing solid foods. Use cautiously with clients who have dysphagia (difficulty swallowing) unless liquids are thickened appropriately. ◯◯ Contraindicated for clients who have lactose intolerance or hypercholesterolemia. Use lactose‑reduced
Blenderized Liquid
◯◯ Consists of liquids and foods that are pureed to liquid form. ◯◯ The composition and consistency of a pureed diet varies, depending on the client's needs. CHAPTER 8 Modified Diets 74 Nutrition for Nursing ◯◯ Modify with regard to calories, protein, fat, or other nutrients based on the dietary needs of the client. ◯◯ Adding broth, milk, gravy, cream, soup, tomato sauce, or fruit juice to foods in place of water provides additional calories and nutritional value. ◯◯ Each food is pureed separately to preserve individual flavor. ◯◯ Indications include clients who have chewing or swallowing difficulties, oral or facial surgery, and wired jaws. ●● Soft (Bland, Low-Fiber) Diet ◯◯ Contains whole foods that are low in
Soft (Bland, Low-Fiber) Diet
◯◯ Contains whole foods that are low in fiber, lightly seasoned, and easily digested. ◯◯ Food supplements or snacks in between meals add calories. ◯◯ Food selections vary and can include smooth, creamy, or crisp textures. Fruits, vegetables, coarse breads and cereals, beans, and other potentially gas-forming foods are excluded. ◯◯ Indications include clients transitioning between full liquid and regular diets, or those who have acute infections, chewing difficulties, or gastrointestinal disorders.
Evidence supporting the effectiveness of PN includes:
◯◯ Daily weight gain of up to 1 kg/day. ◯◯ Increases in albumin level (expected reference range of 3.5 to 5.0 g/dL) and in prealbumin level (expected reference range of 23 to 43 mg/dL).
Ongoing care for enteral feeding
◯◯ Monitor daily weights and I&O. ◯◯ Obtain gastric residuals (every 4 to 6 hr). ◯◯ Monitor electrolytes, BUN, creatinine, serum minerals, and CBC as prescribed. ◯◯ Monitor the tube site for manifestations of infection or intolerance (pain, redness, swelling, drainage). ◯◯ Monitor the character and frequency of bowel movements. ◯◯ When appropriate, administer medications through a feeding tube. ■■ Feeding should be stopped prior to administering medications. ■■ The tubing should be flushed with water (15 to 30 mL) before and after the medication is administered, and between each medication if more than one is administered. ■■ Liquid medications should be used when possible. ☐☐ For an infant or child, the volume of water to flush is 1.5 times the amount predetermined to flush an unused feeding tube of the same size. ☐☐ More water may be required to flush the tubing following certain medications (suspensions
pancreatitis
◯◯ Pancreatitis is an inflammation of the pancreas. ◯◯ The pancreas is responsible for secreting enzymes needed to digest fats, carbohydrates, and proteins. ◯◯ Nutritional therapy for acute pancreatitis involves reducing pancreatic stimulation. The client is prescribed nothing by mouth (NPO), and a nasogastric tube is inserted to suction gastric contents. ◯◯ TPN may be used until oral intake is resumed. ◯◯ Nutritional therapy for chronic pancreatitis usually includes a low-fat, high-protein, and high‑carbohydrate diet. It may include providing supplements of vitamin C and B-complex vitamins
liver disease
◯◯ The liver is involved in the metabolism of almost all nutrients. ◯◯ Disorders affecting the liver include cirrhosis, hepatitis, and cancer. ◯◯ Malnutrition is common with liver disease. ◯◯ Protein needs are increased to promote a positive nitrogen balance and to prevent a breakdown of the body's protein stores. ◯◯ Carbohydrates are generally not restricted, as they are an important source of calories. ◯◯ Caloric requirements may need to be increased based upon an evaluation of the client's stage of disease, weight, and general health status. ◯◯ Multivitamins (especially vitamins B, C, and K) and mineral supplements may be necessary. ◯◯ Alcohol, nicotine, and caffeine should be eliminated.
