Exam 3

Babies can not have honey until age what?

1

Some pediatricians don't like to introduce peanut/nut flavor until the age of ____ or ____.

1 & 2

Solid Food Schedule for babies? *hint* usually at 6 months

1 -cereals 2- blended fruits + veggies 3- blended meats

It typically takes ____ tries before a child decides if they like a food or not.

10

It is recommended to drink _____ ______ of water per day.

12 cups

When should cow's milk be introduced into an infant's diet?

12 months

Aim to gain _____ to ______ pounds during your pregnancy. Physical activity is also recommended.

15 & 25

Up to ___ % of nations senior may be under nourished.

16

Most seniors need an average of ______ to _____ daily to meet their needs.

1600 & 2000

Iron requirements increase from ____mg/day in pre-pregnancy, to 27 mg/day during pregnancy.

18

Recommendations for salt intake is about ____ grams a day for older adults.

2

How much weight should a woman with a BMI of 23 gain during pregnancy?

20 to 35 pounds

Limit caffeine intake to _______ mg per day. *hint* it is equivalent to 12 ounces of coffee per day.

200

Bolus

200- 500 mL of formula administered over 10-20 minutes

It is also recommended to to take a ________ ________ supplement. It is an essential Omega-3 fat supplement linked to brain growth

200mg DHA

Babies can not have any peanuts until age what?

3

Because of Aaron's weight and medical history, the healthcare provider has ordered that he receive 1800 kcalories per day through formula feedings. His formula provides 1.0 kcalories per milliliter. Calculate the amount of formula that Aaron will need at each feeding if he receives intermittent feedings six times per day.

300 mL

Estimate Ruben's energy needs using the Ireton-Jones formula of: 1784 + [5 × Wt (kg)] - [11 × Age (yr)] + [244×x Sex] + [239 × Trauma] + [804 × Burn]. Weight is 168 Age: 36 Sex: Male Trauma: second- and third-degree burns Burn: over 40 percent of his body

3056 kcal

> 1st trimester no extra calories needed > 2nd trimester _____ calories a day > 3rd trimester 450 calories a day

340

An infant should not consume solid foods before:

4 months

Most of Ruben's energy intakes come through carbohydrates and fats administered with his parenteral nutrition. His carbohydrate intake provides 50 to 60 percent of his total energy requirements. To prevent hyperglycemia, Ruben's dextrose should be limited to no more than _____ mg/kg of body weight per day.

5

The economic burden of malnutrition is ___.3 billion each year!

51

How long is it recommended for a woman to breastfeed exclusively without solid foods? _____ months.

6

Limit fish w/ high mercury content to ___ ounces per week. *NEVER* eat raw fish.

6

When does a breastfed infant start solid foods? 3 months 6 months 9 months

6 months

As many as ___ % of hospitalized older adults face malnutrition.

65

Living in a nursing home or other long term care also are at risk of malnutrition. 35 to _____ % face malnutrition.

85

What age is recommeded to start eating fish?

9 months; has to be very mashed, ensure there are no bones present

Benefits of Breastfeeding for mothers? *hint* reduces risk of breast & ovarian cancer & protective against osteoporosis

> Helps uterus return to pre-pregnancy size > helps stop post-pregnancy bleeding > burns 500 calories a day

On average, as we age, our energy (caloric) needs decrease an estimated 5 percent per decade. Why ?

> as we age, we tend to reduce our physical activity, although in most cases there is no need to do so. > reduced need for calories is that basal metabolic rate declines by about 1 to 2 percent every decade as a result of decreased muscle mass and thyroid hormones.

A doctor decided which tube feeding you will receive. The decision was made based upon:

> function of GI Tract > Length of time tube feeding was likely needed

stoma *hint* a stoma in the abdominal wall and into the stomach

An opening through the skin and into an organ or other structure

> Make mealtimes fun > Introduce one new food at a time, in small amounts > Pair new foods with things they like > Avoid letting kids grocery shop with their parents > Have them choose one new food to try each week > Eat meals together as a family > Avoid television during meals > Encourage kids to eat with their friends

Are recommended strategies for feeding kids

> conserves iron stores of mother > reduces the risk of sudden infant death syndrome (SIDS)

Benefits of breast feeding

Which of the following are physiological changes that occur with age, which can increase the risk of malnutrition and disease?

Bone loss, Decreased saliva production, decrease in body water, and sarcopenia (loss of muscle)

> readily available for babies > natural process where babies immediately recognizes the smell after birth > protect against virus > increases IQ > balanced nutrition > antibodies and probiotics > promotes bonding & easily digestable

Breastfeed benefits for babies

fluid and electrolyte imbalances

Characteristic of Refeeding syndrome

> Uses stomach > Bolus feeds ideal

Characteristics of Nasogastric duration

> More difficult tube placement > Low risk of aspiration > Can't check for residuals

Characteristics of Nasojejunal

> people who are severely malnourished >someone who can't handle alot of fluids >biggest risk of infection

Characteristics of Total parenteral nutrition (TPN)

Inadequate intake of vitamin C during pregnancy will adversely affect this and may result in preterm birth.

Collagen synthesis

>Diahrrea >Hyper gastric residuals >Aspiration of formula >Tube clogged w/ formula >vomiting

Complication of enteral

>Refeeding syndrome >Hyperglycemia >Gallbladder disease >Liver abnormalities >Metabolic bone disease

Complications of Prenteral

What is the most likely behavior that leads to dental caries in children?

Consuming carbohydrate foods that stick to the teeth.

Supplements becomes very significant as people get older. Especially for Vitamin ____. Seniors don't get enough of this nutrient.

D

Inadequate intake of zinc during pregnancy will adversely affect this and may lead to fetal malformations.

DNA, RNA, and protein synthesis

This may occur in the uterus due to malnutrition during pregnancy.

Decreased vasculature

Number 1 reason why elderly don't get enough of water. Number 2 reason is because medication for hypertension, diabetes, thyroid can decrease amount of water in our body. Number 3 we lose more water when we have chronic diseases.

Difficult to access

The clinician is preparing to administer Aaron's tube feeding through an open system that transfers the formula from a container through his feeding tube. What steps should the clinician take that would best prevent formula contamination when using this system?

Discard improperly labeled containers of formula.

Why do seniors seem to eat less than they were younger?

Dull senses, chronic nausea, stomach works slower (be full longer), fat accumulation in the belly (abnormal obesity/ metabolic syndrome)

Malnutrition does not only happen to people who are in hunger or don't have access to foods. It can happen to anyone. So who is at risk?

Elderly, people w/ chronic diseases,

Which feeding route would be appropriate for a patient who has a functional GI tract but has a lack of appetite and is not able to physically eat?

Enteral nutrition by a feeding tube

Myth or Fact? Infants with a strong family history of food allergies can benefit from breastfeeding.

Fact

True or False? Is it recommended to eat solid foods before four months of age.

False!

Inadequate intake of fat during pregnancy may impair this.

Fetal brain development

Fluid imbalances that occur among patients with critical illnesses cause challenges in estimating nutrient needs in what manner?

Fluid imbalances prevent accurate weight measurements.

Which statement would be an appropriate measurable goal for Hilda's weight after surgery?

Hilda to maintain her weight between 285-295 pounds

Which of the following assessment measures in the case study identifies risk of malnutrition?

Hilda's %UBW of 91% indicates significant weight loss

Formula designed for those who can't digest or adsorb normally

Hydrolyzed

The placenta may do this during pregnancy if the pregnant woman is malnourished.

Increase in size

What are the three I's for metabolic stress?

Infection, injury, illness

The healthcare provider orders a polymeric formula for Aaron's tube feeding. What information should the dietitian give to Aaron that best describes this type of formula?

It contains proteins extracted from milk.

Which feeding tube placement would require surgical placement?

Jejunostomy

What is the best way to prevent nursing bottle syndrome?

Limit consumption of carbohydrate-containing drinks before or during sleep to prevent caries formation.

Foods not recommended to consume during pregnancy?

Lunch meat, hot dogs, and other cold foods should be heated until steaming hot and red meats & eggs should be cooked thoroughly.

What term describes this? A hidden epidemic (ex: in the U.S.) that is under recognized and under treated. It occurs when the body doesn't get the right balance of nutrients and calories that it needs to stay healthy.

Malnutrition

What is our goal of nutrition therapy in severe metabolic stress?

Minimize nutrient loss

Formula made of a single macronutrient

Modular

What is the primary reason for using alternative nutrition support?

Not able to consume adequate nutrition orally.

G-tube placed with an endoscope is called

PEG

What other measure could be obtained to strengthen the assessment for malnutrition?

Physical examination of head, hands, and upper body to identifying muscle loss

How does the slowed GI system that often accompanies severe stress affect a person?

Poor tolerance of diet or tube feeding Lowered immune response.

> Hair that falls out or plucks out easily > Redness at the corners of eyes > Dry cracked lips > Loss of subcutaneous fat stores > Pale skin > Spoon-shaped nails

Potential signs of malnutrition

Disease-related malnutrition is often associated w/ ________ _______. Could result in loss of muscle mass and strength also Sarcopenia.

Protein deficiencies

What do dietitians recommend for parents deciding on how much children can eat?

Provide children options but allow them to decide how much they eat (Let them be their own barometer)

Which metabolic complication of parenteral nutrition is related to initiating TPN at "too rapid a rate"?

Refeeding syndrome

Which labs would be most helpful to use with your physical exam to identify her fluid status?

Serum electrolytes

True or False? Children should be able to decide how much they want to eat.

True

What supplement can help slow vision loss associated with macular degeneration of the eyes in older people?

Vitamin C

Does the GI tract work? ? = Enteral Nutrition (Tube Feeding) ?= Parenteral Nutrition (IV nutrition)

Yes for enteral & No for Parenteral

If babies have a topic dermatitis, eczema, skin rashes, what type of food schedule would a pediatrician recommend?

a food schedule that delays highly allergic food to be introduced later on

Items like cheese, yogurt and milk combat the _____ in the mouth which

acids

Piggyback

administration of a 2nd solution using a separate port; often used with fatty acids.

What is the most abundant serum protein routinely monitored in hospitalized patients?

albumin

Aaron is upset about the tube feeding and says, "I feel as if I will never eat a normal meal again." The clinician can best help Aaron to cope with his tube feeding by _____.

allowing Aaron to perform some of the tube feeding tasks himself

Tight fitting shoes Abdominal distention Facial puffiness

are physical signs of fluid retention (edema)

Avoid excessive consumption of ________ ________ (diet beverages).

artificial sweeteners

Why are older adults at risk of malnutrition?

as we age our dietary needs can change, taste and smell may weaken, digestive system slows down, chewing/swallowing problems, and bodies ability to absorb nutrients declines.

When choosing a transnasal route, what is the best indicator for choosing nasogastric versus nasointestinal?

aspiration risk

Which food interacts with some types of blood pressure medication?

black licorice

Anthropometric data are measures of:

body size

A common test in that is usually use to measure private practice or any private care is _______ ______ for females to evaluate bone health. Where as in men it is less common to develop Osteoporosis.

bone health

One difference between men & women comes down to ______ ______.

bone health

What risk is likely in a child who consumes more than 3 cups of cow's milk daily?

calcium toxicity

Pregant women do have increased needs of _______, ______ and _______.

calcium, iron and folate

Bacterium plaque turns sugars into acids which dissolves tooth enamel and causes _______.

cavities

>limited osmolality of 900 milosmoles/Lit >short term >strong veins

characteristics of PPN (Parenteral nutrition)

Why is enteral considered a better choice over parenteral nutrition?

cheaper, maintains gut health and paraenteral has more serious complications

Refeeding syndrome

condition that develops when severely malnourished person is fed too aggressively

Medical nutrition therapy for COPD involves all of the following EXCEPT:

decreasing medication usage

During your assessment, you ask Hilda what dietary restrictions (if any) she has been following for her hypertension and diabetes. What type of historical information does this provide?

diet history

2-in-1 Solution

does not include fat store

What is the best indicator for clinicians to choose between transnasal or enterostomies?

duration of the feeding

Studies show that school academic performance is improved by:

eating breakfast

While the slow, natural loss of muscle mass and strength does result in lower ______ _______, nutrient needs, for the most part, remain consistent in our later years. It's also important to note that less muscle mass doesn't mean less desire or ability to participate in physical activity.

energy needs

Short term (<30 days) = transnasal (nasogastric or nasointestinal) Long term (>30 days) = ___________ (gastrostomy or jejunostomy)

enterostomy

Long term duration is called (>30 days)

enterostomy (gastrostomy or jejunostomy)

true or false? Restricting sugar intake usually helps cure hyperactivity among most kids.

false

The food that we should avoid or limit are foods that tends to store or capability of being stored in our______ and ______ tissue.

fat & adipose

Aaron needs medication to prevent gastroesophageal reflux and has an order for a prescription-strength proton pump inhibitor. The pharmacy has sent the medication in liquid form to be administered through the feeding tube. What action would most likely prevent complications when administering medication through a feeding tube?

flushing the feeding tube with warm water before and after giving the medication

People on a atkins diet most likely has a _____ deficiency which results in ______ _____ ______ which is important during the first 28 days after conception.

folate & neural tube defects

Unpasteurized juice, milk Soft cheese are ______ ______ _______ ________ ______ _______ _______.

foods not recommended to consume during pregnancy

Breast fed babies solid food schedules are a bit delayed compared to ______ fed babies.

formula

All babies are drinking breast milk or formula until ___ months. *hint* some formula infants start eating cereals at this age

four

During pregnancy is important to follow a _______ _______ ______, includes a variety of foods from each group.

general healthy diet

Obese kids are encouraged to:

get at least one hour of physical activity daily

Requesting a consultation w/ a dietitian can help make sure you are ______ _____ _______.

getting enough nutrients

Which of the following has the most interactions with common medications?

grapefruit juice

After showing progress with his blood gas measurements and demonstrating signs of independent breathing, Ruben is disconnected from the ventilator and his endotracheal tube is removed. The physician plans to discontinue the feeding tube as well, as soon as Ruben is awake and alert enough to tolerate oral feedings. What type of oral diet is most appropriate for Ruben once he is able to eat?

high-kcalorie, high-protein diet

Excessive kcalorie intake in COPD patients may:

increase respiratory distress

Bolus tube feedings are preferred over continuous enteral feedings when:

increased mobility is desired.

Medications that reduce stomach acidity, such as antacids, can impair the absorption of:

iron

What solid food is best to start feeding an infant?

iron-fortified rice cereal

The nutrition that we should focus on when we get older is increasing ______ _____ into our diets.

lean protein

A lot times seniors develop nutritional problems when they have some major _______- _______ _______. And are unaware of their change in diets.

life-changing event

Gaining too little weight during pregnancy is associated with this.

low birth weight

What would be the most important nutrition problem to address if we are concerned about her healing post open heart surgery?

malnutrition

Pressure ulcers and burns are examples of what ?

metabolic stress

Some pediatricians recommend separating, and giving the egg yolk first at __ months then a week later for the egg white and once you are sure the baby is not allergic to either then try both together.

nine

yes or no? Due to consistency of regular meals being served, elderly people living in nursing homes have lower rates of malnutrition compared to elderly persons who live on their own.

no

For the most part, people understand that older adults have decreased energy demands; however, they often overlook the fact that for the most part,______ ______ remain the same.

nutrient demands

Iron is a

nutrient not given in the parenteral nutrition bag

To avoid losing weight during hospital stay, discuss your _______ ______.

nutrition plan

People w/ disease related malnutrition may take ______ ______ _____ ______ to access needed nutrition.

oral nutrition supplement drinks

Iron absorption can be enhanced by eating iron-rich foods together with foods rich in Vitamin C such as ________.

oranges

Why are hospitalized patients at risk of malnutrition?

patients may follow restrictive diets for surgeries illnesses/procedures reduces appetite, depression and not liking their food choices.

What are the most common food allergies in children?

peanuts, shellfish, eggs and organic cows milk

Our mouths are full of bacteria, a sticky film called ______.

plaque

Iron requirements increase 50% during pregnancy due to:

poor pre-pregnancy iron stores

What are the common symptoms of iron deficiency in kids?

poor test grades & difficulty concentrating

Daily _______ _______ is recommended prior to conception, during pregnancy and while breastfeeding.

prenatal vitamins

Which physical exam finding in the case study is the most accurate indicator of fluid imbalance in her body?

presence of edema

Seniors develp less saliva and stomach acid as they get older making their bodies difficult to ________ ______ _______ and ______.

process certain vitamins & minerals

Sarcopenia *hint* significant risk factor for disability & independence

progressive loss of muscle mass and strength in aging

What is the hormonal response to meatabolic stressors?

protein breakdown

The damaging effects of the burns have elicited the stress response in Ruben's body, and his cortisol levels have been elevated since the injury. Because Ruben's recovery will be extensive, he is at increased risk of what effects of prolonged elevated cortisol?

protein degradation

Carbohydrate source is

provided as dextrose

High density formula

provides more nutrients in less volume (1.5-2.5 kcals/mL)

How will a poor diet that lacks both nutrients and calories affect a lactating mother's milk?

reduce breastmilk quantity

What is the most powerful predictor of a person's mobility in later years?

regular physical activity

Celery, apples, carrots and citrus fruits all are healthy substitutions for foods that helps the mouth to produce more ______ which washes away bacteria. *hint* think of detergent

saliva

Since high blood sugars can impair healing and increase infection risk, which lab should be requested to determine if her blood sugars are currently in range?

serum glucose

Which foods should be avoided during pregnancy?

shark, raw meat and cold deli meats

When compared with delayed feedings, early introduction of enteral feedings has been shown to provide what benefit to hospital patients?

shorter hospital stays

What diet advice woul benefit a patient with COPD who complains of abdominal discomfort and shortness of breath?

small, frequent meals

What is the leading risk factor for COPD (Chronic obstructive pulmonary disease)?

smoking

Two main symptoms of malnutrition

sudden weight loss, and or loss of appetite, and decreased food intake.

What is the primary characteristic of Acute Respiratory Distress Syndrome (ARDS)?

sudden, life-threatening inflammation of the lungs that impairs gas exchange

Protein Source

supplied as free amino acids

G (gastrostomy) tubes can be placed _________ or non surgically.

surgically

Sugar free gum and xyitol also helps stimulates saliva and helps protect ______ until kids have time to brush and floss.

teeth

> Taking multiple medications > Reduced appetite and food intake due to disease > Mental issues that may result in forgetting to eat > High rates of anxiety and depression > Decreased ability to absorb certain nutrients > Difficulty with grocery shopping and cooking > Chewing and swallowing problems

the following contribute to the high risk of malnutrition among older adults

Why it is not recommended to give fish to 6 month old babies?

there might be bones and it is a more allergic food

Why chronic patients are at risk of malnutrition?

these diseases may reduce appetite, difficulty to shop, cook, eat, remembering to eat, and changes metabolism and digestion. Treatments may require dietary restrictions and causes appetite-reducing symptoms.

How does the inflammatory response to metabolic stressors affect the body?

tissue swelling & dilated blood vessels at the point of injury

Short term duration is called (<30 days)

transnasal (nasogastric or nasointestinal)

true or false? It is best to get all of your medications from the same pharmacy.

true

Aspiration

tube feed formula that enters the lungs

gastrotomy

tube feed placement in stomach for more than 4 weeks

In some cases, _______ ______ or ______ ______ is necessary in treating malnutrition.

tube feeding & IV nutrition

Aaron's feeding tube has become clogged and the clinician is unable to administer the next tube feeding. Which strategy would most likely prevent clogging of the feeding tube?

using oral or injectable medications, when possible

Pumpkin/sunflower seeds, fresh fruits, nuts, whole grain crackers, unbuttered popcorn, sliced meats are all good for healthy ________.

variety

An estimated 10 to 20 percent of adults over the age of 50 have atrophic gastritis, a condition that results in less hydrochloric acid and intrinsic factor in the stomach. Individuals with atrophic gastritis are at risk for _________ ________ deficiency.

vitamin B12

Some parenteral solutions may exclude:

vitamin K

To meet the goal of maintaining Hilda's weight, what intervention would be appropriate for the nurse?

weigh her regularly

Two factors should be present to diagnose malnutrition.

weight (loss/low), & poor nutrition intakes

Respiratory disease usually causes:

weight loss

What determines if a clinician chooses enteral nutrition or parenteral nutrition?

whether the gut works

What questions about her social history would be important to know in your nutrition assessment?

who lives with her to help with cooking and shopping

What is vital in treating malnutrition?

whole health care team (treating underlying cause(s), changing diet, offering in-home support such as meal delivery.

Calories Protein Zinc Vitamin C

will be increased in nutrition therapy for acute metabolic stress?