nutrition final

lipase

-action: breaks down emulsified fats into fatty acids and glycerol -source: pancreas

arachidonic (omega-6 PUFA)

-found in peanuts -precursor of prostaglandins

polypeptide

a chain of two or more amino acids joined together by peptide bonds

hydrolysis

a chemical reaction in which a substance is split into two smaller and simpler substances by the addition or the taking up of the elements of water -this is achieved mostly through the action of digestive enzymes, which are present in saliva, gastric juice, pancreatic juice, and intestinal juice

nutrigenetics -ex: lactose intolerance

a subfield of nutritional genetics that detects gene variants within an individual to identify nutritional factors that trigger dysfunction or celiac disease

65%

about what percentage of people throughout the world have some degree of lactose intolerance from a lack of the intestinal enzyme lactase?

metabolism

absorbed nutrients that are used by the body for energy and to form and maintain body structures and functions

b. olive oil

according to most health authorities, the average american would benefit by increasing his or her intake of which of the following fats while decreasing intake of other fats? a. corn oil b. olive oil c. safflower oil d. lard

1. whole grains, milk, or fruit 2. solid fats and added sugars

according to the USDA dietary guidelines, most people do not consume enough ___________, ___________, or ________ and ingest too many _________ and __________ in grain-based desserts and snacks

hydrochloric acid (HCl)

an electrolyte and performs many functions necessary to the digestive process

nutritional assessment

an evaluation of a client's nutritional status (nutrient stores) based on a physical examination, anthropometric measurements, laboratory data, and food intake information -many members of a health care team are involved in this -usually completed only in the cases of clients at high nutritional risk bc of it requires considerable resources

set point theory

argues that each individual has a unique, relatively stable, adult body weight based on biologic factors -obese individual may be higher -adult weight is pretty constant--body temperature, glucose, blood pressure, acid (pH) of body fluids -defending this--> regulating food intake: under-eating leads to extreme hunger/binging; changes in energy expenditure: reduced intake leads to reduced energy expenditure -controversial

sarcomas

arise from connective tissue, such as muscle or bone and are more common in young people

subjective data

as they relate to nutrition, includes the client's history from an interview, questionnaire, or food diary

sodium/solute

as water level lowers, these levels in blood rise

lymphatic fluids

assists in returning the fluid part of blood to the heart

adequate intakes (AIs)

average observed or experimentally determined intake that appears sufficient to meet individuals in the stated group

maltase

breaks down maltose to glucose and glucose

sucrase

breaks down sucrose to fructose and glucose

-cortisone -adrenaline -estrogen -testosterone

cholesterol is necessary for the production of what hormones?

trans-fatty acid

composed of partially hydrogenated fatty acids

animal-derived fats

consist of a larger content of saturated fats and tend to have a higher melting point and are solid at room temperature

mortality

death rate

-A -D -E -K

fat-soluble vitamins

A, D, E, K

fats act as a vehicle for what vitamins?

hyperglycemic gyperosmolar nonketonic syndrome (HHNS)

insulin deficiency resulting in severe hyperglycemia -enough insulin present to prevent ketosis but not hyperglycemia -causes: body's increased demand for insulin (chronic disease, infection, medications that cause increase in blood glucose (BG)) -possible symptoms (difference between symptoms of HHNS and DKAà DKA fruity smelling breath, no nausea and vomiting, no acidosis; dehydration more severe than ketoacidosis; BG levels higher)-->glucose level >600 mg/dL -->absent or slight ketosis -->3 P's: polydipsia, polyphagia, polyuria -->profound dehydration -->dry, flushed skin -->weakness -->weight loss -->seizure/tremors -treatment -->correct electrolyte imbalance, hyperglycemia, dehydration -lipolysis does not occur because insulin deficiency not as severe -->life-threatening -->usually with Type 2

physiologic equilibrium

intake is balanced by output (urine, sweat, feces, insensible perspiration)

indirect measurement

involves measuring oxygen and carbon dioxide concentrations in expired air during a prescribed period -the amount of oxygen that is used and the amount of carbon dioxide produced are entered into a scientific formula that will calculate energy expenditure

essential to metabolism -can take extra in through iodine salt -any severe maternal deficiencies can cause cretinism (congenital condition that results form lack of thyroid secretions; infants body is stunted and malformed and there can be an effect on the mental development

iodine during pregnancy

-iron from breast milk more absorbable: no supplementation -formula that is not iron fortified: supplementation -fetal iron stores are depleted by 4 months

iron during infancy

support lean body mass -you can eat more calories yet still maintain stable body weight bc it takes more energy to maintain lean body mass

it takes more energy to support what than to support body fat?

kilocaloric density

kcals contained in a given volume of a food, generally the number of kcals in a g

b. growth

kilocalories required per kilogram of body weight are highest during: a. starvation b. growth c. weight loss d. old age

incomplete proteins

lack one or more essential amino acids -plant foods--> grains, legumes, leafy green vegetables, broccoli, potatoes, green peas -gelatin -limiting amino acids-->lysine, methionine, cysteine

trichinella spiralis

larvae found in undercooked pork -when eaten, result is trichinosis -appears 2-28 days past intestine (incubation period) -symptoms: nausea, vomiting, diarrhea -migration of larvae into muscles cause fever, swelling of eyelids, sweating, weakness, muscular pain and even death

insensible water losses

loss of water from less obvious ways such as breathing -invisible -lungs/breathing: 800-1000 mL/ day (deep respirations or dry climate increases amount of water lost) -skin/evaporation: 6 mL/kg/body weight (depends on environment with greater losses: high temp, high altitude, low humidity; illnesses increase loss: burns, phototherapy, radiant warmers, fever)

sensible water losses

loss of water from obvious ways such as perspiration and urine -includes losses from the major extracellular ions, sodium, and chloride -routes: -->perspiration: 200 mL/hr in extreme cases -->urine: 400-600 mL/day (obligatory excretion) -->gastrointestinal secretions (above and below the pylorus)

major minerals -->required daily: 100 mg or higher

macrominerals

protein

makes unique contributions to body (cannot be duplicated by carbs or fats) -can be used as auxiliary source of energy (if kilocalorie intake is inadequate)

steatorrhea

malabsorption of fat; fat seen in the bowel movements (stools); often caused by inhibition of pancreatic lipase

-important predictor of morbidity and mortality -risk of malnutrition is multifactorial: -->body composition change -->physical impairment -->endocrine disorders -->metabolic changes -->malabsorption -->psychosocial issues NOTE: Malnutrition is not as frequent with the evolution of HAART

malnutrition in HIV/AIDS

-meal pattern during pregnancy -->intake of my plate recommendations -->healthy people 2020 (foods high in heme iron, iron supplements, varied diet: fruits, veggies, lean proteins, whole grains -teenagers-->nutrients needed for both themselves and fetus -individualized deal plans (for all pregnant women, based on age, size, lifestyles; vegetarians; teens with unbalanced diets) -food assistance--> SNAP program--provides supplemental foods monthly to low-income pregnant or postpartum women, infants, and children up to age 5; supplemental feeding program for women, infants, and children (WIC)

meal patterns and assistance

-three meals a day -several between-meal feedings

meal service patterns

waist-to-hip ratio

measures central distribution of fat -calculated by dividing waist circumference by hip circumference -a ratio of 1.0 or more in men and 0.85 in women indicated increased abdominal weight compared with total body fat, which is a risk factor for obesity-related medical conditions

aquaporins

membrane proteins that function as water-selective channels in the plasma membranes of many cells and help to explain the speed at which water moves across cell membranes

hormones

messengers between organs that lead to the release of enzymes and secretions during digestion

lungs, kidneys, or large intestines

metabolism waste products are excreted through which organs?

1. oral delivery 2. enteral tube feeding 3. parenteral nutrition

methods of nutrient delivery

-abdominal pain -nausea -vomiting -diarrhea -cramps

mild symptoms of foodborne illnesses?

electrolytes

minerals circulating body that carry electrical charge

electrolytes -these require a protein to move in and out of cells -sodium/potassium pump -kidneys also regulate electrolyte levels

minerals that carry electrical charges, or ions, which dissolved in water

c. on food labels

monoglycerides and diglycerides are names of lipids commonly seen: a. in clients' medical records b. on laboratory reports c. on food labels d. on clients' skin

glucose

monosaccharide that is commonly called blood sugar -also called dextrose

tetany

muscle contractions, especially of the wrists and ankles -resulting from low levels of ionized calcium in the blood -causes include parathyroid deficiency, vitamin D deficiency, and alkalosis

-immediate goal is to decrease the workload of the heart -progress diet from clears after 24 hours with goal being small frequent meals (large meals increase oxygen demand and result in increased blood flow making the heart work harder) -severe heart failure would require 2000mg sodium restriction (decrease extracellular fluid) -increased calorie needs with heart failure (protein intake is important for muscle but need to have adequate calories to support protein) -more fruits, vegetables, and whole grains are part of the plan. -should be adopted during childhood.

nutrition therapy for heart failure

-between meal feedings -diet change -feeding status-->does pt need assistance with feeding? -->enteral (nasal) or parenteral feeding (IV)

nutritional supplements

oral delivery: supplemental feedings

reason to be given: insufficient intake of nutrients or kcal due to such diseases as eating disorders, GI functioning not working properly, inability to eat, increased need for nutrients -modular supplements -->contains limited number of nutrients per patient need -->liquid or powder available -->can be added to food (doesn't change taste of food), oral supplements or tube feedings -standard or polymeric formulas (GI tract should be functional) -->oral intake: ensure, boost (commercially prepared) -->tube feedings: consistency and flavor may make less palatable orally -elemental and semi-elemental formulas (little GI function or metabolic disorders) -->easily absorbed; required little digestion (are in simplest form) -->oral or through tube feeding, however orally less palatable -disease-specific formulas -->designed for those with specific metabolic problems

chemical digestion

refers to the enzymes and the gastric juices the enzymes release during digestion

-brain -kidneys -pituitary glands -adrenal glands

regulation relies on what parts of the body?

thirst

stimulates desire to drink

limiting amino acid

undersupplied amino acid

beriberi

vitamin B1 (thiamin) deficiency causes what diseases?

jumping rope and running

what are examples of bone strengthening exercises?

pancreatic and intestinal

what type of enzymes complete carbohydrate digestion?

-young -old -pregnant -immunocompromised

who all is at risk for foodborne illnesses?

bc saturated fats are more chemically stable than unsaturated fats -the chemical bond between carbon and hydrogen is stable

why do saturated fats become rancid slower than unsaturated fats?

expanding blood volume-->it dilutes the concentration of the red blood cells

why is it expected to have lower values of hematocrit and hemoglobin?

environmental pollutants

-EPA regulation -regulates use of pesticides -chemical poisoning -->heavy metals (enzyme poisoning; mercury: can be extremely toxic to the point that the FDA has issued a consumer alert to children, pregnant women, etc for them not to eat lost of fish containing mercury (sharks, swordfish, king mackerel, tuna, marlin, orange ruvy, tilefish) -->chemical products and poisoning (found in detergents, sanitizers, pesticides, etc.; poisoning: symptoms appear a few minutes to hours-->nausea, vomiting abdominal pain, diarrhea, metallic taste; tolerance levels

growth hormone

-action: increased transport of amino acids into cells, increases rate of protein synthesis -source: anterior pituitary

insulin

-action: lowers blood glucose by increasing its uptake by cells -source: pancreas

glucagon

-action: raises blood glucose by stimulating its release from liver glycogen -source: pancreas

peptidase

-action: splits polypeptides into amino acids -source: small intestine

sucrase

-action: splits sucrose into glucose and fructose -source: small intestine

calcium

-adult rda: 1,000-2,000 mg; 3.3-4 cups 1% milk -functions: structure of bones and teeth, nerve conduction, muscle contraction, catalyst in blood clotting process -deficiency: tetany, osteoporosis, rickets (premature infants) -excess: calcification of soft tissue -good sources: milk products, salmon, sardines with bones, clams, oysters

sodium

-adult rda: 1,200-1,500 mg; 0.5-0.65 tsp salt -functions: fluid balance, transmission of electrochemical impulses along nerve and muscle membranes -deficiency: hypoatremia (caused by dehydration) -excess: hyperatremia -food sources: table salt, processed foods, milk and milk products

chloride

-adult rda: 1,800-2,300 mg; 0.5-0.67 tsp salt -functions: components of hydrochloric acid, helps maintain fluid and acid base balance -deficiency: in infants: neurological impairment -excess: none -food sources: table salt, salty snacks, process foods, eggs, meat, seafood

iodine

-adult rda: 150 mcg, 3/8 tsp iodized salt -functions: component of thyroid hormones -deficiency: goiter, cretinism, myxedema -excess: acnelike lesions, goiter -best sources: iodized salt, saltwater seafood

fluoride

-adult rda: 3-4 mg, 4.3-5.7 L fluoridated water -functions: hardens teeth -deficiency: dental caries -excess: mottled teeth, increased caries -best sources: fluoridated water, seafood, brewed tea

potassium

-adult rda: 4.7 g; 4 cups canned white beans -functions: conduction of nerve impulses, muscle contraction -deficiency: hypokalemia (not usually dietary) -excess: hyperkalemia (not usually dietary) -food sources: banana, cantaloupe, winter squash, green leafy vegetables, legumes, salt substitutes

phosphorus

-adult rda: 700 mg; 8.9 oz. sockeye salmon -functions: structure of bones and teeth, component of DNA and RNA, component of buffers and almost all enzymes, component of ADP and ATP -deficiency: increased calcium excretion, bone loss, muscle weakness -excess: tetany, convulsions, renal insufficiency -good sources: lean meat, fish, poultry, milk, nuts, legumes

zinc

-adult rda: 8-11 mg, 3.6-5 oz beef chuck roast, lean only -functions: component of 70 enzymes, involved in DNA and RNA synthesis, necessary for collagen formation, serves role in immunity -deficiency: growth failure, hypogonadism, delayed wound healing, impaired night vision, impaired taste, delayed sexual maturation -excess: copper deficiency, suppressed immune response -best sources: red meat (especially organ meat), seafood (especially oysters), poultry, pork, dairy products, whole grains

iron

-adult rda: 8-18 mg (female), 8 mg (male); 1 packet fortified, instant oatmeal -functions: component of hemoglobin -deficiency: fatigue, lightheadedness, shortness of breath, hypothermic, microcytic anemia -excess: hemosiderosis, hemochromatosis -best sources: liver, other red meats, clams, oysters, lima and navy beans, dark green leafy cooked vegetables, dried fruit

sulfur

-adult rda: none -functions: component of amino acids methionine and cysteine -deficiency: none -excess: none -food sources: complete protein foods -gives shape to: hair, skin, and nails

cancer cachexia

-anorexia resulting in severe unintentional weight loss (>5% over 6 months, low kilocaloric intake, loss of skeletal muscle mass) -->hypermetabolism--abnormal increase in rate at which fuel or kcals are burned. -->characterized by: systemic inflammation, negative protein and energy balance, involuntary loss of lean body mass -nutrition -->appetite stimulant usually used-->Megace -->nutritional supplement typically encouraged -->increase omega-3 fatty acids and protein

linolenic (omega-3 PUFA)

-anti-inflammatory role -helps to reduce cardiovascular disease (when eaten in food, not supplements)

hypoglycemia

-blood Glucose < 70 mg/dl per ADA -causes -->too much insulin -->skipping meals -->too much exercise without food replacement -->occurs most commonly during insulin peak and at night during sleep -signs & symptoms (someone with frequently high BGL (blood glucose levels) may experience symptoms when reaches WNL (within normal limits)) -->cool, clammy, pale skin -->confusion -->erratic behavior -->hunger -->trembling, shaking -treatment -->15 gm simple sugarlood -->glucose tablets -->gel tube -->2 tablespoons of raisins -->4 ounces (1/2 cup) of juice or regular soda (not diet) -->1 tablespoon sugar, honey, or corn syrup -->8 ounces of nonfat or 1% milk -->hard candies, jellybeans, or gumdrops (see package to determine how many to consume

type 1 diabetes mellitus (DM--destruction of pancreatic beta cells)

-cause: autoimmune disorder (beta cells are destroyed) -signs & symptoms: polydipsia (increased thirst), polyuria (increase urination), polyphagia (increased appetite and weight loss--typically rapid), weight loss; symptoms are typically sudden -treatment: insulin (required for type 1 DM), nutrition therapy (regulate CHO between meals and snacks with insulin), physical activity (lowers BGL so could reduce amount of insulin needed)

malnutrition

-causes longer lengths of stay in hospital -increases cost of hospitalization -increases risk for remission and mortality

cancer

-characterized by wasting and malnutrition -attributable to the disease or secondary to treatment -cells differ from normal cells -->uncontrolled cellular reproduction -->abnormal structure -->increased cell division rate

middle years (40-70)

-continuation and changes -->family demands and career development -->positive dietary patterns and exercise prevent or delay diet-related diseases -nutrition requirements -->cell loss rather than replication -->kcal needs decrease (lean body mass lost and replaced by body fat; to maintain lead body mass, this group should exercise regularly, including strength training) -->iron needs: decrease after menopause -->dietary pattern: nutrient-dense, low-fat, high-fiber (women at risk for osteoporosis and need to focus on eating habits and activity)

nutritional care services

-counseling -->educate client about nutrition; helps with personal responsibility for own care -diet manuals -->defines and describes all diets for nutritional therapy -->diet orders provided by a physician -->special diets -diets for diagnostic procedures -->needs to be accurate to avoid repetition and/or postponement of procedures -->misdiagnosis: due to following improper dietary regimen preparation

oldest years (>80)

-decreased ability to absorb or synthesize nutrients -most at risk for dehydration -increased concerns of malnutrition -->strategies for overcoming barrier to good nutrition

monitoring

-depends on pt -may need continuous monitoring (ICU), or monthly monitoring -whoever is involved in the care meets for a client care conference to make sure that appropriate care is being applied -food acceptance record-->intake of individual with regards to their weight; used to verify whether weight loss is result of poor food intake

diverticular disease

-diverticula: pouchlike herniations protruding from the muscular layer of the colon -diverticulitis: inflammation/infection of diverticula -causes -->inadequate fiber -->straining during bowel movement -nutrition therapy -->high fiber diet -->diverticulitis (nothing by mouth (NPO); progress to liquids as tolerated)

fatty liver and nonalcoholic fatty liver disease (NAFLD)

-fatty Liver -->fat build up of the liver -->early form of alcoholic liver disease -nonalcoholic Liver disease and steatohepatitis -->fat build up in the liver causing inflammation of the liver for people who do not drink alcohol (or very little) -->obesity -nutrition therapy -->calorie-controlled diet -->limit fat, fructose -->avoid alcohol -->well balanced diet

renal calculi (kidney stones)

-formation of kidney stones depends on simultaneous occurrence of the following: -->low urine volume -->high urine pH -->excessive urinary excretion of calcium, oxalate, uric acid, or combination -->decreased levels of substances in the urine that normally inhibit stone formation -nutrition therapy: -->increase fluid intake (most important for prevention) -->restrict dietary oxalate (spinach, rhubarb, beets, nuts, chocolate, tea, wheat bran, strawberries). -->dietary calcium: 800 to 1200 mg needed -->restrict animal protein (<1.7 g/kg) and salt -->decrease alcohol and caffeine intake -->increase potassium intake

metastasize

-grade of malignancy refers to the extent to which the cells under the microscope resemble normal cells, with grade 1 most like normal cells and grade 4 least like them -stage of disease refers to the physical location of the tumor, with stage I localized and stage IV involving distant metastases

diabetes

-group of disorders with persistent hyperglycemia -->signs and symptoms: excessive urine production, thirst, excessive hunger, blurred vision, sometimes weight loss -diabetes mellitus: chronic, lifelong disorder, necessitates lifestyle changes in both dietary intake and physical activity -causes: -->relative or complete lack of insulin secretion or defects of insulin receptors (results in disturbances of carbohydrate, protein, and lipid metabolism, and in elevated blood glucose levels; result: type 1 or type 2 diabetes) -7th leading cause of death in the US

mold

-grows on foods-->can be destroyed by heating food to 140˚F or higher -->aflatoxins: present in peanuts/peanut products, corn, wheat and oil seed -most commonly or widely encountered organism -spread by ear currents, insects, or rodents

chemotherapy

-how it works -->inhibits one or more steps of DNA synthesis in rapidly proliferating cells such as cancer cells -->enhancing the host's immune system -acts on all cells with rapid turnover rate: GI tract and bone marrow -->reason for many of the side effects typically heard of with cancer -nutrition -->neutropenic diet-->immunosuppressed patients (avoid undercooked meat and eggs; ensure raw fruits and vegetables are washed well or peeled) -->adequate nutrient intake helps with tolerance of chemotherapy -->individuals undergoing chemotherapy have weakened immune systems and therefore need to be especially careful to prevent foodborne illness -->the effects of chemotherapy on bone marrow cause immunosuppression because bone marrow produces many immune factors

eleiostomies and colostomies

-ileostomy: surgical opening of the ileum onto the surface of the abdomen is created after removal of entire colon and rectum -colostomy: surgical creation of an artificial anus on the abdominal wall by bringing the colon to the surface -risk -->fluid/electrolyte imbalance -nutrition therapy -->replacing fluid and electrolytes -->restrictions based on individual intolerance

obestiry

-increased among children and adolescents -etiology: multifactorial: snacking, meals away from home (large portions, high fat), decreased activity -intervention: assess for motivation/weight-associative disorders, focus on healthy lifestyle behaviors

insulin and glucose

-insulin-->lowers blood glucose -->functions/blood glucose curve -->metabolic activities -hormones that assist insulin-->they coordinate the storage and mobilization of energy nutrients) -->glycogen (increase blood glucose levels and stimulate the breakdown of body protein and fat stores -->somatostatin (act within the eyelets of langerhans (depress secretion of insulin and glycogen) -cellular sources of glucose

radiation therapy

-kills cells by altering the DNA of the malignant cells -nutrition-related side effects: -->effects depend on site of radiation (head, neck, abdomen, GI tract, central nervous system) -->anorexia: encourage eating when not hungry, exercise appropriately before meals, serve small and frequent and attractive meals, vary supplement flavors to prevent taste fatigue, offer 1 ounce of a complete supplement every hour -->nausea & vomiting: offer client dry crackers before rising, schedule meals during time when nausea is least, serve liquids 30-60 min after solid food, limit fats in the diet, teach client to eat slowly and chew thoroughly, rest after eating, minimize strong cooking odors -possible side effects related to GI tract: -->diarrhea: add pectin-containing (apple, banana) foods to client's intake, implement a low-fiber diet, test for and treat lactose intolerance, consult with a dietitian about special feedings -->steatorrhea -->malabsorption -->ulceration -->bowel damage or obstruction -->decreased saliva -radiation to the head or neck may damage salivary glands-->moist or semi liquid foods -->radiation to lower GI tract-->malabsorption and diarrhea

ovovegetarian

-meat, seafood, poultry-->no -dairy-->no -eggs-->yes

vegan

-meat, seafood, poultry-->no -dairy-->no -eggs->no

lactovegetarian

-meat, seafood, poultry-->no -dairy-->yes -eggs-->no

ovolactovegetarian

-meat, seafood, poultry-->no -dairy-->yes -eggs-->yes

pescatarian

-meat, seafood, poultry-->seafood -diary-->maybe -eggs-->maybe

atherosclerosis

-most common form of arteriosclerosis -chronic plaque formation and inflammation damaging arterial walls-begins early in life and advances throughout life -coagulation in the arteries form and block blood flow (thrombosis) -->coronary artery disease (myocardial Infarction: blood flow to the heart blocked) -->cerebrovascular accident (CVA)/stroke: blood flow blocked in the cerebral artery -->peripheral artery disease: femoral arteries are blocked Necrosis of the extremities

toxic seafood

-naturally toxic -->stable to heat -paralytic shellfish poisoning--consuming poisonous clams, oysters, and scallops -scombroid fish poisoning--caused by the presence of undesirable bacteria; can be prevented by the adequate refrigeration of freshly caught fish and the purchase of fish from reputable sources

heart failure/congestive heart failure (CHF) -also cardiac decompensation

-nutrition therapy -->initial Goal: to lessen workload of heart (will typically start with liquids then progress as tolerated, small meals vs large meals) -->restriction of dietary sodium (mild to moderate heart failure: 3000 mg/day, severe heart failure: 2000 mg/day) -->fluid Restriction 1-2 L fluid limit, sometimes needed -->increased energy (calorie) needs-->cardiac cachexia (be careful not to overfeed though)

mad cow disease

-obtained from Latin beef containing a "prion" (small protein that is resistant to most traditional methods that destroy a protein) -obtained by cattle when fed ground up carcasses of animals which contain the infected prion

type 2 diabetes

-possible Causes -->genetics (strongest risk factors) -->obesity (particularly upper body weight) -->prevalence (african americans, hispanic/latino american, native american) -signs & symptoms: -->polyuria (increased urination) -->polydipsia (increased thirst) -->frequent fatigue -->frequent infections -condition may exist for many years before complications lead to diagnosis. -treatment -->nutrition therapy (decreasing portion sizes-->decreases calories = weight loss) -->exercise -->oral glucose-lowering medications (metformin-->can actually result in weight loss) -->insulin (not always required for type 2 DM)

ESRD with hemodialysis

-procedure by which blood is removed via vascular access and cleaned then returned -->man-made membrane used to filter the blood -->fluid and waste products removed -->average treatment takes 3 to 4 hours and may be performed three times per week

chronic kidney disease (CKD)

-progressive irreversible loss of kidney function -common causes: -->diabetes (#1 cause) -->hypertension (uncontrolled) -->glomerulonephritis -->obstructive diseases (kidney stones, tumors) -->lupus erythermatosis -->illicit drug use -results -results -->accumulation of nitrogenous wastes -->fluid and electrolyte imbalances -->progression to end-stage renal disease (ESRD) -goal -->slow progression to ESRD

older years (71-80)

-quality of life depends on health status -->level of wellness reflected health behaviors of previous life span stages -risk for dehydrations -->symptoms: confusion, weakness, decreased skin turgor -risk factors for malnutrition in older adults -->ex: arthritis, alcoholism, dementia, loss of spouse, changes in smell/taste ability -->arthritis impairs ability of an older adult to prepare food. Results in decline in nutritional status. -->arthritis impairs ability of an older adult to prepare food. Results in decline in nutritional status. -->alcohol abuse: alcohol provides kcals but no nutrients; depresses appetite -->dementia: may not remember to eat -->loss of taste and smell: decreased desire for food -->loss of spouse: not wanting to eat or spouse prepared food, so do not know how to prepare their own now -nutrition requirements -->increased AI for Vitamin D (decreased ability to synthesize Vitamin D; decreased exposure to sun) -->supplement Vitamin B12 (decreased production of intrinsic factor) -->require adequate zinc (affects taste and appetite; foods taste bitter or tasteless) --->need whole grains, fruits, vegetables; decreased gastric motility so need increase in fiber / fluids -weight -->decreasing BMI is not advised -->average BMI provides weight reserves

magnesium

-rda adult: 310-420 mg; 2.1-2.8 cups spinach -functions: associated with ADP and ATP, involved in DNA and protein synthesis, influences cardiac and smooth muscle contractility -deficiency: impaired CNS function, tetany -excess: weakness, depressed respirations, cardiac arrest -food sources: green leafy vegetables, seafood, peanut butter, legumes, coffee, cocoa

ESRD with peritoneal dialysis

-removal of excess fluid and waste products from the blood using the peritoneal membrane as a filter -advantage of peritoneal dialysis (PD) over hemodialysis: -->PD can usually be performed at home -->acts more like a kidney -peritoneal Dialysis and Diabetes -->challenging due to glucose absorption from dialysate -types -->intermittent PD: infusion of 2L dialysate over 20 to 30 minutes and drained using gravity (repeated multiple times over an 8- to 10-hour period, completed four or five days per week) -->continuous ambulatory PD: infusion of specific volume of dialysate that dwells ~4 hours (4 or 5 exchanges within 24 hours, 7 days a week) -continuous cycling PD: combination of IPD and CAPD (best option for someone who wants to work) -->at night, the cycler (mechanical) preforms 3 exchanges -->in the morning, a fourth exchange is infused for the entire day

dietitican

-review data from physical exams, tests, lab work, client intake info-->will be analyzed to see if the patient is malnourished

type 2 diabetes mellitus

-risk factors: overweight and obesity, genetics and race -treatment: include the family, goal: maintain current weight while growth continues, educate on dietary patterns (myplate), goal: develop and maintain and healthy lifestyle

iron-deficiency anemia

-risk factors: poverty and lead poisoning -->lead poisoning and iron-deficiency anemia may be diagnosed at same time (e.g. child at high risk for iron deficiency anemia who lives in low-income family living in older housing) -affects ability to learn -public health issue

myocardial infarction (heart attack)

-single largest killer of men and women in the U.S. -->every 20 seconds, an American suffers myocardial infarction -->every minute, someone dies from myocardial infarction -occurs as a result of sustained ischemia that causes irreversible damage to the heart

lead poisoning

-sources of lead: old paint dust/chips (e.g. older housing) -consequences of lead poisoning: cognitive deficits -associated with iron-deficiency anemia

linoleic (omega-6 PUFA)

-strengthens cell membranes -role in transport and metabolism of cholesterol -prolong blood clotting time (takes longer for blood to clot) -hasten fibrolytic activity -involved in development of the brain

screening

-take place within 24 hrs of admittance -done by dietician -if admitted in a specific area like ICU, do screening immediately -pre-determined screening tool-->used by tech or nurse to assess what is going on with the individual

food asphyxiation

-toddlers and elderly persons at higher risk -foods associated with choking (peanut butter, peanuts, popcorn, hotdogs, etc.) -to reduce risk: make sure they are sitting down while eating and chew food well -prevention and heimlich maneuver

early years (18-39)

-transition from one stage of life span to another -->separation from family of origin; career development; reproductive decisions -->establishment of food patterns -->effects of childbearing and caring for young children on women -nutrition requirements -->growth completed in early 20s for men; late teens for women -->protein needs continue to increase until the age 24 -->after 18, calcium and phosphorous needs decrease -->for women, attention to maintaining calcium and iron intakes continues

inflammatory bowel disease

-ulcerative colitis: inflammatory process confined to the mucosa of the large intestine -crohn's disease: inflammatory disease that involves all layers of the small and/or large intestine -cause -->autoimmune disorders caused by genetic predisposition followed by environmental triggers -symptoms -->diarrhea -->abdominal pain -->protein loss -nutrition therapy -->combined with drug therapy -->high-calorie, high-protein diet -->small frequent meals -->during acute episode: bowel rest and low fiber diet (high fiber diet may be warranted during times of remission) -->adequate fluid -->keep food diary to help avoid irritating foods (limit those foods that produce gas or loose stools; may need to limit excess fat, refined sugars, fast foods) -->if lactose intolerant, eliminate dairy foods

irradiation

-used to kill parasites, insects, bacteria in food -used to delay sprouting and ripening in foods -used in foods: meat, poultry, flour, veggies, eggs -labeling: radura logo -no labeling required: foods not entirely irradiated, foods used in restaurants

bone marrow or stem cell transplantation

-used to treat certain hematologic malignancies (blood cancers) and solid tumors (breast cancer) -bone marrow transplant -->tumors-patient's own bone marrow is harvested before chemotherapy or radiation and then infused after treatment -->hematologic malignancy- bone marrow from a genetically matched donor and infused -stem Cell Transplant -->stem removed from a newborn baby's umbilical cord and stored for transplant -nutrition-related side effects: -->nausea & vomiting -->mucositis -->immunosuppression -nutrition -->typically requires parenteral nutrition (want to try small amount enteral/oral, if able, to promote gut health) -->neutropenic diet: avoid unpasteurized milk, raw fruits and vegetable, raw eggs

clostridium botulinum

-vehicles: improperly processed canned food, large masses of food with air-free center -symptoms: may lead to acute bilateral cranial nerve impairment and descending weakness or paralysis. double vision, dysphasia, and dry mouth may be present. vomiting, diarrhea, and constipation may be present initially. symptoms appear in 18-36 hours but can occur as late as 6 hours to 10 days. symptoms may last for weeks or months, and some residual problems can last for years. a small percentage of infected people die

clostridium perfringens

-vehicles: meats, poultry, gravies, and stews in large masses of food such as steam tables or left at room temperature -symptoms: abdominal cramping, diarrhea, vomiting, and fever are common. incubation time is 8-16 hours. symptoms occur within 16 hours and last for 12-24 hours (up to 1-2 weeks in elderly people)

norovirus

-vehicles: produce, raw shellfish, and any other ingredient contaminated by an infected person -symptoms: may lead to nausea, vomiting, diarrhea, abdominal pain, headache, malaise, and low-grade fever. symptoms appear 12-48 hours and usually last 1-3 days but can last 4-6

salmonella

-vehicles: raw or undercooked eggs, poultry or meat, unpasteurized milk or juice, cheese, seafood, fresh fruits and vegetables -symptoms: may lead to sudden onset of headache, fever, chills, abdominal pain, diarrhea, nausea, and vomiting. dehydration may be severe, and fever is usually present. may develop into septicemia. symptoms usually begin suddenly and last for 12-24 hours (up to two weeks in elderly people)

campylobacter jejuni

-vehicles: raw or undercooked poultry, meat, or shellfish, unpasteurized milk, water -symptoms: may lead to an cute gastroenteritis of variable severity characterized by diarrhea, abdominal pain, mails, fever, nausea, and vomiting. guillan-barre syndrome or meningitis have been seen in severe cases. symptoms usually appear 2-5 days after eating and may also 2-10 days

listeria

-vehicles: soft cheeses, deli meats, pate, burritos, ice cream, unpasteurized milk, smoked seafood, deli salads, raw veggies -symptoms: fever, chills, headache, backache, upset stomach, abdominal pain, and diarrhea. may lead to meningoencephalitis and/or septicemia in newborns and adults and miscarriages. symptoms may appear within a few hours to 3 days and it may take up to 2 months to become ill

escherichia coli

-vehicles: undercooked ground beef, other beef, unpasteurized milk and apple juice, contaminated raw fruits and veggies and water -symptoms: may lead to acute hemorrhagic colitis (cramps, blood diarrhea, nausea, vomiting, and fever). may result in hemolytic uremic failure or kidney failure. symptoms can been 1-9 days after contaminated food is eaten and last 2-9 days

protein

-visible fat on meat -meat weighed after cooking -low-fat method of cooking: baked, boiled, broiled, grilled, roasted -portion calculation (3 oz)

7 kcal

1 g of alcohol equals how many kcal?

4 kcal

1 g of carbohydrate equals how many kcal?

9 kcal

1 g of fat equals how many kcal?

4 kcal

1 g of protein equals how many kcal?

1. oliguric phase: elevated potassium and phosphorus, hypertension, edema -nutrition therapy: sodium, potassium, phosphorus, and fluid restriction (output + 500ml) 2. diuretic phase: urine output gradually increases -nutrition therapy: may need fluid, sodium, and potassium replacement 3. recovery phases: kidney function gradually improves -no nutrition therapy

3 phases of ARF

chemical digestion in the mouth

3 salivary glands -secretes saliva-->enzymes (lead to amylase), water, mucous

men--13 cups women--9 cups -minimum intake is about 4 cups

AI of water is how many cups per men and women?

gastroesophageal reflux disease (GERD)

AKA: Heartburn -increases risk: -->reclining after eating -->stress -->increased intra-abdominal pressure -complications (adults) -->esophagitis and ulcer formation -->hiatal hernia -->medications or food that reduce effectiveness of lower esophageal sphincter -->history of nasogastric intubation longer than 4 days -->surgery on pyloric sphincter -->smoking -->pregnancy and obesity - raises intra-abdominal pressure -symptoms: -->heartburn with pain across breastbone; may radiate to neck and back -prevention / treatment strategies -->avoid lying down after eating -->avoid tight clothing -->medications (tums, pepcid, reglan) -nutrition therapy (adults) -->avoid high-fat foods -->avoid irritants (fat, chocolate, alcohol, peppermint, spearment, caffeine, tobacco, high-acid foods) -->small, frequent meals -->normal amounts of protein -->upright position 30 minutes after eating

-start dietary modifications early to: -->prevent uremic toxicity -->delay progression of the disease -->prevent wasting and malnutrition -->prevent osteodystrophy (body diseases resulting in defected bone formation) -->limit foods that produce toxic waste -high-biological value proteins -->eggs, meat, poultry, game, fish -low phosphorus -->promotes bone health -->high phosphorus foods: beans, nuts, nut butters, dairy, cheese, chocolate processed foods -->may require phosphate binder (with meals; helps to eliminate the phosphorous) -appropriate sodium and potassium intake -->may decrease kidney injury and slow the progression -vitamin D supplementation -->active form of vitamin D-->calcitriol -design meal plans to meet the specific needs of the patient -->enhances compliance -->vegan diets are difficult to plan due to fact that vegetable proteins are not of high biological value.

CKD pre-ESRD: nutrition therapy

modifiable -hypertension -dyslipidemia: elevated serum cholesterol -->low-density lipoprotein (LDL) cholesterol-->high -->high-density lipoprotein (HDL) cholesterol-->low -->triglycerides-->high -LDL and Triglycerides are best predictors for cardiovascular risk. -control: therapeutic lifestyle changes (heart-healthy diet, exercise, avoiding cigarette smoke, health weight), medication (if needed) -therapeutic lifestyle is first line of defense! -primary goal for cholesterol-->reduce LDL -1000mg synthesized in body per day -300mg from diet per day - animal origin -difficulty synthesizing thought to be genetic; synthesis occurs in liver -one problem is intake of trans unsaturated fatty acids in vegetable oil -obesity -->increases triglyceride levels -->decreases HDL-C levels -->control: Exercise needed to control abdominal fat (apple shape) and lowers triglycerides, increases HDL-C levels; weight loss of 10-15 pounds is helpful -metabolic syndrome -->specific criteria: fasting blood glucose ≥100 mg/dL; triglycerides ≥150 mg/dL; HDL-C ≤40 mg/dL in men; < 50 mg/dL in women; blood pressure > 130 mmHg systolic, >85 mmHg diastolic; waist circumference >40 in. in men and >35 in. in women; insulin resistance or glucose intolerance -diabetes -->control: increase lipoprotein lipase through physical activity -physical inactivity - Just do it for heart health! -alcohol intake--small amounts causes vasodilation (heart disease lower in moderate drinkers than nondrinkers - but one is not encouraged to start drinking!) -cigarette smoking -->decreased tolerance for physical activity -->decreases HDL-C levels -->increases chance of blood clots -->control: don't smoke and stay away from second hand smoke

CVD risk factors

-energy: 30-35 Kcal/kg -protein: 1.2 gm/kg -->replace losses -fat: decrease Kcals from saturated and trans fats -sodium: 2-4gm (depending on fluid status) -fluid: 1-2 L (depending on fluid status) -potassium: dependent on output -phosphorus: 12mg/kg/day -->may have to be liberalized to meet protein needs -->may require phosphate binder -vitamin D: supplementation of active form -->calcitriol

ESRD with hemodialysis: nutrition therapy

-calories -->lower than HD due to dextrose received during PD -->weight gain is common -protein -->higher protein losses than HD (20-30gm/day) -sodium, potassium, fluid -->dependent on the patient -->due to increased frequency of PD more is removed from the body than with HD -phosphorus -->restricted -->use of phosphate binders

ESRD with peritoneal dialysis: nutrition therapy

above the pylorus

GI secretions: -1 L of saliva/day normally -vomiting or stomach suctioning -ions lost: sodium, potassium, chloride, hydrogen

below the pylorus

GI secretions: -amount of loss depends on situation -diarrhea and intestinal suctioning -ions lost: sodium, potassium, bicarbonate

-preserving lean body mass and gut function -preventing development of malnutrition -providing adequate levels of all nutrients -minimizing symptoms of malabsorption -preventing nutrition-related immunosuppression -improving quality of life -individualized care plan -determining energy and protein needs -closely monitor vitamin and mineral status. -effects of HAART on nutrition therapy -regular aerobic exercise and resistance training assist with the following: -->lipid abnormalities -->fat redistribution syndrome -maximize intake -->encouraging several small meals and snacks daily -->foods high in calories and protein (calorically dense)

HIV/AIDS nutrition therapy goals

-age -sex -growth -body size -climate -genetics

REE is affected by what things?

nephrotic syndrome

a collection of symptoms caused by damage to the glomerulus (glomerulus-->where blood flows into the nephron) -proteinuria (greater the higher the hyperlipidemia)--protein loss via urine -hypoalbuminemia--level of albumin in blood low; type of hypoproteinemia (abnormally low level of protein in the blood) -hyperlipidemia--elevated lipid levels in the blood -severe edema--accumulation of excessive amounts of fluid in interstitial spaces -causes: glomerulonephritis (inflammation of the glomerulus), nephropathy (abnormal state of the kidneys; kidneys start to incur damage), diabetes mellitus, lupus erythematosus, infectious diseases, needed monitoring:, body weight, intake (by mouth [oral], tubes [enteral], IVs [parenteral]) and output [urine, sweat]) of fluids is important to know state of fluid retention

complementation

a combination of plant foods at every meal that contain all the essential amino acids -vegetable sources of protein-->legumes (high in nitrogen content)

diet and activity

a combination of what two things have a stronger effect on energy balance?

photosynthesis

a complex process in which green plants manufacture carbohydrates -carbon dioxide and water from the soil are transformed into sugars and starches

fat and carbohydrates

a diet that has an appropriate balance of what two things is important for optimal health?

polyunsaturated

a fatty acid with more than one carbon-to-carbon bond

monounsaturated

a fatty acid with only one carbon-to-carbon double bond

low cholesterol

a food that contains less than 20 mg of cholesterol per serving

low saturated fats

a food that contains no more than 1 g of saturated fat per serving

low-fat

a food that contains no more than 3 g of fat in a serving

cardiovascular disease (CVD)

a group of diseases and conditions that affect the heart and blood vessels -->coronary Artery Disease (CAD) -->peripheral Artery Disease -->heart Failure -->congenital Heart Disease -leading cause of death for American Men and Women -prevention

c. 21-38

a healthy adult needs ____ grams of fiber each day a. 5-11 b. 12-20 c. 21-38 d. more than 50

1,000 calories

a kilocalorie is equal to how many calories?

c. the units of energy used in the body and contained in foods

a kilocalorie is used to measure both: a. weight and percentage body fat b. height and weight c. the units of energy used in the body and contained in foods d. leanness and body-fat content

calcium, riboflavin, vitamin D

a lactose-restricted diet may be low in what minerals?

alimentary canal

a long, muscular tube that extends through the body from the mouth to the anus -includes the oral cavity, pharynx, esophagus, small intestine, large intestine

malonyl-CoA

a molecule associated with all lipogenic (lipid-producing) tissue that may inhibit or stimulate food intake -elevated levels of this inhibits food intake -this is an essential intermediary in the krebs cycle

esophagus

a muscular tube through which bolus travels from mouth to stomach -peristalsis -segmentation -cardiac sphincter -necessary to swallow in this area

hepatic duct

a narrow tube that permits the movement of fluid from one organ to another

neoplasm

a new and abnormal formation of tissue (tumor) that grows at the expense of the healthy organism

hormone

a substance produced by the endocrine glands and secreted directly into the bloodstream

element

a substance that cannot be separated into simpler parts by ordinary means

carotene

a yellow pigment found mostly in fruits and veggies

acute renal failure (ARF)

abrupt loss of renal function; usually temporary (few days or weeks) -causes -->acute tubular necrosis: injury due to decreased blood supply (oxygen) to the kidneys (when body is put under stress/trauma: septic shock, major burns, major surgery OR prolonged low blood pressure) -->nephrotoxicity: anything toxic or destructive to kidneys -->symptoms that may or may not coexist with decreased urine output (oliguria: <400ml in 24 hours; anuria: <250ml in 24 hours) -other Symptoms -->acidosis (pH of blood is <7.35; may be caused by uremia-->toxic condition that is reduced by retention of nitrogenous substances) -->elevated blood potassium -->elevated blood phosphorus -->hypertension -->anorexia -->edema (rapid weight gain/kidneys not putting out fluid) -treatment -->may require short period of 'dialysis' treatments -monitoring -->daily weights -->intake and output each shift

ketoacidosis

accumulation of ketones when fatty acids are used for energy (lipolysis) -glucose is not available for energy -causes: insulin deficiency, stress on the body (infection, trauma, emotional), insufficient or interrupted insulin therapy, uncontrolled disease in a previously undiagnosed person -symptoms (check blood glucose if symptoms are apparent) -->fruity breath -->dehydration -->acidosis -->electrolyte imbalance -->dry, flushed skin -->weakness -->nausea -->3 P's: polydipsia, polyphagia, polyuria -->vomiting -->weight loss -treatment -->IV regular Insulin (sends glucose back to cells; permits use of carbs for energy (halt excessive use of fat), fluid and electrolyte replacement (potassium moves from intravascular to intracellular space so need to monitor glucose and potassium), medical monitoring -life-threatening; requires emergency treatment -usually with Type I

2015-2020 dietary guidelines for americans

acknowledges the extent of food security in the country

preformed vitamins

active form of a vitamin

-ketoacidosis -hyperglycemic hyperosmolar nonketotic syndrome -hypoglycemia

acute clinical situations

-calories: -->30 to 40 kcal/kg/day -->non-protein calories: fats, oils, simple carbohydrates, and low-protein starches -protein: -->non-dialysis: 0.6 g/kg but not less than 40 g/day -->dialysis: 1.0 to 1.4 g/kg; high biologic value -supplements: -->niacin, riboflavin, thiamine, vitamin B12, calcium, iron, and zinc if less than 60 g of protein is consumed

acute renal failure: nutrition therapy

1. length 2. width -measured along a national scale

adequate energy relented in satisfactory gains in __________ and ________

-higher than most americans consume -may lower blood pressure -decrease effect sodium chloride has on blood pressure -reduce kidney stones -reduce blood loss

adequate intakes of potassium may have what results?

-start with liquids and progress, as tolerated, to foods of regular consistency. -smaller, frequent meals are usually better tolerated. -->large meals can increase demand of oxygen, increasing blood flow -diet -->omega-3 fatty acids may decrease risk for blood clots -->controlled sodium intake -->controlled saturated fat intakes -controlled fluid intake -mediterranean-style diet

after myocardial infarction: nutritional therapy

vegetarianism

all eat plant foods, but differ with dairy, eggs, and seafood intake. no intake of meat or poultry (usually)

chemical energy

all food enters the body as what kind of energy?

culture

all the socially transmitted behavior patterns (attitudes, beliefs, and customs) shared by most members of a particular group that guide their thoughts and actions

vitamin C

all vitamins contain nitrogen except for which one?

peptide bonds

amino acids are linked by?

can cause birth defects -retinoic acid syndrome-->fetal deformities (small or nose ears, abnormal or missing ear canals, brain malformation, and heart defects)

an excess (10,000 IU per day) of vitamin A can cause what in fetuses?

bomb calorimeter

an insulated container that has a chamber in which food is burned

parasite

an organism that lives within, on, or at the expense of a living host without providing any benefit to the host

android

apple, big waste -visceral fat (abdominal fat) -most dangerous -most easily lost

insoluble

are lipids insoluble or soluble in water?

-increased physical stability -increased flexibility -decreased risk of injury

balance and stretching exercises promote:

renal transplantation

before transplantation: -identify and correct deficits before surgery. -->visceral protein stores -->low body weight -->vitamin and mineral deficiencies after transplantation: -energy Needs Increased -->30-35 Kcal -->decline 6-8 weeks after transplantation -protein Liberalized -->due to catabolism post surgery -carbohydrates -->may have to monitor intake depending on steroid use -fats -->limit if dyslipidemia occurs -steroids-->raise blood glucose-->need to monitor BGL

-decrease in surgical complications -meeting increased energy and protein requirements -repairing and rebuilding normal tissues -increased cancer therapy tolerance -improved quality of life

benefits of nutritional adequacy

interstitial fluids

between the cells and assists in transporting substances between the cells and the blood and lymph vessels--accumulation referred to as edema -water + sodium and chloride

-monitor fruit juice consumption (add water to juice -all juices must be pasteurized -baby bottle tooth decay

beverages during the first year of life

catabolism

breaking down of tissues (for reuse or elimination)

biles

breaks down dietary fats -exists the liver via the hepatic duct -emulsifies fat in the small intestine

lactase

breaks down lactose to glucose and galactose

segmentation

breaks up food and it mixes food

-healthy people 2020 goals-->increase mothers who breastfeed -nutritonal needs for other: look at myplate and plan daily food regimen, drink glass of fluid with meals and eliminate caffeinated beverages to 2-3 cups per day -calcium is obtained from the breast milk and is pulled from the mother's bones but is rapidly replaced in the skeleton when the baby is weaned -breastmilk contains 20 kcal per ounce and is obtained from mother's dietary intake and fat stores that have accumulated during pregnancy

breastfeeding mother

fluorisis

brown spotting on tooth enamel or pitting of teeth

anabolism

building up of tissues (occurs with growth or healing)

brown fat

burns kcal released as energy and not stored as body fat -individuals differ with the amount of kcal they need for normal body functions. a lean individual may actually need more kcal than an obese individual

there is an increase in the absorption during pregnancy -calcium is transferred to the fetus (most) during the third trimester -the use of supplements helps to reduce the risk of hypertension, preeclampsia, maternal death, and low birth weight in infants -if there is a deficiency, this can result in skeletal problems (skeletal growth) and neurological disorders -maternal (transient) osteoporosis-->mother gets hip pain (usually on left side) during the third trimester -->only supportive treatment

calcium during pregnancy

-contraction of the heart -maintenance of body temperature -repair of the internal organs -maintenance of cellular processes -muscle and nerve coordination -respiration (breathing)

calories necessary to support the following contribute to the REE:

malnutrition

can be cause by inadequate or unbalanced intake of food or nutrients or by ineffective processing by the body due to malfunction or disease

lean

can be used on meat, poultry, seafood, or game meat products only if the product contains less than 10 g of fat, less than 4.5 g of saturated fat, and less than 95 mg of cholesterol per 100-g serving (3.5 oz)

extra lean

can be used only if the meat product contains less than 5 g of fat, less than 2 g of saturated fat and trans fat combined, and less than 95 mg of cholesterol per serving and per 100 g

-preferred treatment for solid tumors -->prevents metastasis nutrition -increased calorie and protein needs for wound healing -when GI tract involved-->malabsorption concerns -->ay require nutrition support -->valuate for dumping syndrome if gastrectomy performed -preexisting malnutrition: increases risk for complications -different surgeries of the GI tract-->esophageal, resection of small intestine or large intestine, gastrectomy -dumping syndrome with gastrectomy (food does not get digested appropriately and goes direct to the intestines)

cancer treatment: surgery

carbon, hydrogen, and oxygen

carbohydrates are composed of what elements?

sugars and starches

carbohydrates are composed of what two things?

e. promotes tooth decay

carbohydrates have the following roles in the body except: (select all that apply) a. promotes ketosis b. spares body protein c. provides fuel d. impact learning and memory e. promotes tooth decay

-main goal-->reduce saturated fats -->fatty beef, pork, poultry with skin, lard, butter, cheese, dairy (2% or whole milk) -replace saturated fat with monounsaturated fat -->monounsaturated fats lower LDL only (almonds, walnuts, pistachios, extra-virgin olive oil, canola oil) -replace saturated fat with polyunsaturated fat -->polyunsaturated fat lowers LDL and HDL (vegetable oils, margarines low in trans fat) -replace saturated fat with complex carbohydrates -->complex carbohydrates lowers LDL (beans/peas, whole grains, vegetables) -adding soluble fiber -->oluble fiber lowers LDL (oats, barley, beans, some fruit) -mediterranean diet includes many of these recommendations (fruits, vegetables, whole grains, nuts, fish, olive oil)

cardiovascular disease nutrition therapy

lipoproteins (fat + protein) and hemoglobin

carry nutrients and oxygen in the blood -proteins help maintenance of acid-base balance

enzymes

catalysts (chemicals that influence the speed at which a chemical reaction takes place but do not actually enter into the bloodstream) -provides a place (its surface) for two substances to meet and react with each other -crucial to many body processes, such as digestion

iatrogenic malnutrition

caused by physician or institution -medications may interfere -diagnostic procedures may also effect (holding food) -food or nutrient deprivation bc of treatment -not eating related to illness (pain or unconscious, paralysis, vomiting, diarrhea, etc.)

osmotic pressure

causes a solvent (water) to move across the membrane, but the solutes (particles) outside the membrane cannot go through -develops when different concentrations are on either side of a semipermeable membrane

-genetic factors -->often triggered by lifestyle and environmental factors -->healthy Lifestyle needed for prevention in those genetically susceptible -risk factors for Type 2: -->excessive body weight, inactivity, stress -autoimmune diseases -viral infections -stress -->releases epinephrine which raises blood glucose (BG)

causes of diabetes

-trauma -infections -birth defects -medications -chronic disease (e.g., atherosclerosis, diabetes, hypertension) -toxic metal consumption -errors in genetic code -diabetic nephropathy is most common cause of renal failure, although hypertension is close behind

causes of kidney disease

transcellular fluids

cerebrospinal fluid, pericardial fluid, pleural fluid, synovial fluid, intraocular fluids, and gastrointestinal secretions are secreted into their spaces and reabsorbed into the vascular system

HIV/AIDS

challenges to nutritional status -->characterized by wasting and malnutrition -->attributable to the disease or secondary to treatment -HIV -->bloodborne and sexually transmitted (blood, semen, vaginal secretions, breast milk) -cause of AIDS -AIDS: breakdown of immune system -->replication of HIV cells results in steady depletion of CD4 cell count -->monitoring of CD4+ cell counts -highly Active Antiretroviral Therapy (HAART) -->goal-->maintain low viral load -->significant progress in treatment of HIV and AIDS -HAART Should be planned around meal times to help absorption.

hormones

chemicals secreted by various organs to regulate body processes -secreted directly into the bloodstream rather than into a duct or an organ -insulin and glucagon are two important examples that help control glucose metabolism

obesogens

chemicals thought to mimic/block action of hormones that develop fat tissue and energy homeostasis -known ex of these: diet-->monosodium glutamate, smoking-->nicotine, industrial chemicals-->bisphenol A (BPA) and perfluorootanoic acid (PFOA), organophosphate and organochlorine pesticides

-toddlerhood-->issues of autonomy -mealtimes: -->maintain consistency -->regulate portion sizes -->encourage self-feeding -->include snacks -serving size guidelines: -->fruit or veggie serving: 1 tbsp per year of age -->bread and cereal: 1/4 of adult serving -->milk: 2-3 cups per day -->meat or meat alternative: offered twice a day -begin to offer low-fat foods -introduce variety -problems with excess milk and juice intake (provides high levels of sugar) -->fill up on milk and juice do not contain iron, and not eat enough iron containing foods such as meat, poultry, eggs, or legumes

childhood stage i (ages 1-3 years)

-independent eating styles -variable hunger and appetite levels -->appetite fluctuates -->should be able to hold out for meals with snack between -food jags -->wanting one particular food -->parents educate on variety of food for nutrients -continued introduction of new foods -->don't give up after first try -->may take 9-10 times of introducing a food before the child will accept it

childhood stage ii (ages 3-6 years) eating characteristics

-growth slows, but body is preparing for growth spurt of puberty -->may be reflected in pre-puberty weight gain (chubbiness typical but not alarming) -encourage staying in touch with internal cues of hunger/satiety and being physically active -peer influences increase -->noting what others get for lunch/snack at school -health snack options -->popcorn, fruit, milk -->open faced peanut butter sandwich with fruit -->apple with peanut butter -->smoothie

childhood stage iii (ages 6-12 years)

b. only in foods of animal origin

cholesterol is found: a. only in saturated fats b. only in foods of animal origin c. mostly in eggs d. only in triglycerides

animal foods

cholesterol is present only in what foods?

celiac disease

chronic autoimmune disorder in which the mucosa of the small intestine is damaged by dietary gluten -symptoms -->diarrhea -->weight loss -->abdominal distention -risk -->malabsorption of nutrients (steatorrhea: fat malabsorption) -->vitamin and mineral deficiencies (calcium, Vit D, iron, folate, Vit B 12) -nutrition therapy -->eliminating gluten from diet

-macrovascular -->coronary artery disease (heart) -->peripheral vascular disease (extremities--wounds-->gangrene-->amputations) -->cerebrovascular disease (brain) -microvascular: -->nephropathy (kidneys) -->retinopathy (eyes) -->neuropathy (nerves) -->gastroparesis (stomach) -impaired healing ability

chronic complications (long-term complications related to prolonged hyperglycemia)

-cystic fibrosis -celiac disease -crohn's disease

chronic malabsorption diseases

-classes: -type 1-->auto-immune disease; no autoimmunity-->inherited; does not have production of insulin as they should; beta cell of pancreas are being destroyed; these individuals need daily doses of insulin -->conditions: ketoacidosis (signs are hyperglycemia and excess ketones) and hypoglycemia (low blood glucose level) -type 2-->non-insulin dependent; insulin resistance and varying degrees of insulin deficiency (may or may not need insulin injections but may need pills) -gestational diabetes-->occurs in about 7% of pregnancies; individuals may return to prediabetic state or 35-60% will have diabetes in the next 5-10 years -other and secondary diabetes (pancreatitis, cystic fibrosis, down syndrome, surgical removal of the pancreas, cushing disease, maturity-onset diabetes of the young (MODY), pharmacological doses of glucorticoids (e..g. prednisone) or other hormones or drugs)

classification of diabetes

-pernicious anemia (lack of intrinsic factor, not dietary) -vitamin B12 deficiency (avoidance of animal products)

cobalamin deficiency causes what diseases?

essential amino acids

come from either two places: -the body's own cells as they age and are broken down and replaced -the food that has just been ingested

sugar alcohols

commonly used on a one-for-one replacement basis for sugars in recipes -not only add sweetness, but also bulk recipes -have various names such as sugar replacers, polyols, nutritive sweeteners, and bulk sweeteners

highly saturated fats

completely hydrogenated fats are

-opportunistic Infections: calls for safe food handling -->thrush--thick whitish coating on the tongue or in the throat that may be accompanied by sore throat -->TB--airborne; easily obtained by individual with HIV/AIDS -->pneumocystis pneumonia (PCP)--shortness of breath, fatigue, anorexia -gastrointestinal dysfunction: difficulty eating -->pain in mouth or esophagus -->difficulty swallowing (open lesions or sores) -->affects small and large intestine enzymes for digestion and absorption -->due to medications -aids dementia complex (ADC): can't obtain and prepare own meals; slow in thinking/response, memory impairment and/or difficulty concentrating, clumsy, difficulty with fine motor skills, poor balance and coordination -->central nervous system illness -organ dysfunction: -->diseases of gallbladder, liver, pancreas, kidneys (cholecystitis, hepatomegaly, pancreatitis, end-stage renal failure) -wasting syndrome: involuntary weight loss >10% in 1 month along, both lean and fat body mass, with one of these for more than 30 days without a cause: -->chronic diarrhea, weakness, fever -high morbidity and mortality -caused by undernutrition or nutrient malabsorption -kcaloric needs increased -lipodystrophy (fat redistribution) -->adverse effect of HAART that causes: (peripheral fat wasting, fat accumulation centrally) -->causes dyslipidemia, glucose intolerance, diabetes, HTN -->diet: Mediterranean style -anorexia: frequent symptom --causes may be many; identify contributing factors. -->appetite stimulants frequently used-->Megace -foodborne Illness -->due to impaired immune function -->educate on safe food methods -->filtered water-->prevent Cryptosporidium -malabsorption -->HIV-related diarrhea, steatorrhea -->diet: restrict fat and lactose (MCT supplementation and pro/pre-biotics) -physical impairment -->nausea/vomiting -->mouth/esophageal lesions -->impaired dentition

complications of HIV infection

dietary reference intakes (DRIs)

composed of five nutrient-based reference values that can be used for assessing and planning diets according to life stage and gender -intended to apply to the healthy general population and refer to average daily intakes for 1 or more weeks

gallbladder disease

concentrate and store bile until needed for digestion -cholelithiasis: gallstones -acute cholecystitis: inflamed gallbladder -symptoms: -->midepigastric pain after eating high-fat meal due to spasms; right upper quadrant; often radiates to right shoulder -->nausea/Vomiting -causes -->long-term intake of high-fat food; gas forming foods can also cause discomfort -->very low-calorie diets/Rapid weight loss (Gallstones) -->increased sugar -->type 2 Diabetes and/or hyperinsulinemia -->dyslipidemia -nutrition therapy -->before gallbladder removal: Low-fat diet -->immediately following surgery: NPO, then clear liquid, then diet advanced as tolerated -->goal long-term following surgery is a well-balanced diet

vitamin supplement

concentrated form of vitamins

hypervitaminosis

condition caused by ingestion excess vitamins

-client has mechanical difficulties that make chewing and/or swallowing impossible or difficult-->obstruction of the esophagus, weakness or nausea, mouth sores, throat inflammation -client has an intestinal disease and cannot digest or absorb food adequately-->malabsorption syndromes -client refuses to eat or cannot eat-->esophageal cancer -client is unable to consume a sufficient amount of food bc of a clinical condition-->coma, serious infections, trauma victims, clients with large kcal requirements

conditions indicating a tube feeding

enteral tube feeding (EN)

consideration for EN vs. PN (parenteral) -safer -closely mimics normal feeding -less septic morbidity -fewer infectious complications -less expensive -->GI function important (GI utilizes intact nutrients; not hydrolyzed, required secretions and enzymes of the GI tract) -administration: continuous feeding (directly into small intestine--preferred), intermittent feeding (certain amount of formula in 3-6 equal feedings over 24 hr period; 60-75 min with or without feeding pump), bolus (syringe or gravity; aspiration, regurgitation, and side effects are common; given 4-5 times a day and last approx. 10-20 min) -potential complications: mechanical (tube irrigation, tube obstruction, aspiration and regulation, tube displacement), gastrointestinal (cramping, distention, bloating, gas pains, nausea, vomiting, diarrhea), metabolic (dehydration, over hydration, hyperglycemia, hypernatremia, hyponatremia)

large intestine

consists of cecum, colon, and rectum -passage through takes about 9-16 hours -absorption of water and some minerals

gastrointestinal muscle tone decreased -water absorbed more from intestines -uterus pressing on intestines as fetus grows -control of constipation: increase daily water intake, increase activity, moderate exercise, high-fiber diet that is low in calories

constipation during pregnancy

water intoxication

consumption of large volumes of water in a short time (dilutes electrolytes) -excessive water dispersed throughout the body, caused by various reasons -muscle cramps, decreased blood pressure, weakness

hard water

contains high amounts of minerals -mineral: calcium and magnesium -->provides the nutrients to the body -->non-nutrient-related problems-->mineral deposits may damage appliances and other -can be made soft through specific filtration processes

soft water

contains sodium -can be a problem for sodium sensitive people (those at risk for hypertension) if consumed -water softeners can only be used on the HOT tap, cold tap left unsoften for consumption

fluid volume deficit (FVD)

dehydration -causes: diarrhea, vomiting, high fever, diuretics, sweating, polyuria -polyuria-->excess urination -older adults and infants at greatest risk

light (lite)

denotes 1/3 fewer kcal or 1/2 the fat of the original or no more than 1/2 the sodium of the higher-sodium version

good source of

denotes that one serving of a food is considered to be a foo source of a vitamin, mineral, or fiber, containing 10%-19% of the daily value for that particular vitamin, mineral, or fiber

-anabolism and catabolism -nitrogen balance

describe the maintenance and growth part of proteins

-proteins provide much of the body's mass -contractile proteins, actin and myosin, are found in skeletal, smooth, and cardiac muscle -fibrous proteins (collagen), elastin, and keratin are found in the blood vessels, bone, cartilage, hair, nails, tendons, skin, and teeth

describe the provision of structure part of proteins

-one molecule of glycerol (backbone of a fat molecule) -glycerol joined to 1-3 molecules of fatty acids

describe the structure of a fat

health claim

describes the relationship between a food or food component and a disease or health-related condition

structure/function claim

describes the role of a nutrient or dietary ingredient intended to affect the structure or function in humans or characters the documented mechanism by which a nutrient or dietary ingredient acts to maintain such structure or function

-glycosylated hemoglobin (A1C)--indicates level of blood glucose control (2-3 months or 120 days) -->prediabetes: 5.7% - 6.4% -->diabetes: > 6.4% -->advantages: fasting is no required for the blood test, levels reflect an average level of blood glucose over time, greater preanalytical stability, less impact during periods of stress and illness -blood glucose levels -->fasting glucose level (no kcal intake for at least 8 hrs before the test) -->prediabetes: 100-125 mg/dL -->diabetes: over 126 mg/dl -random blood glucose -->prediabetes: 140-199 mg/dL -->diabetes: > 200 mg/dL

diagnosing diabetes

-importance of proteins (risks are infections, shock, wound dehiscence) -->dehiscence: separation of the edges of a surgical incision -clients with liver disease (bc of functions the liver has regarding to wounds-->carbs, fats, proteins, minerals; meds breakdown in liver) -preoperative nutrition -->nutritional deficiencies identified and corrected -->most at risk: -->weight loss of 5% or more in past 1-3 months -->BMI less than 18.5 -->25% - 75% oral intake reduction -->take steroids -->have cancer or immunosuppression -->preventive nutritional support -->fasting protocols -postoperative nutrition -->continued on intravenous (IV) fluids -->oral nutrition is encouraged as soon as individual is capable of taking food in through the mouth (peristalsis-->gas; shows they are ready for oral nutrition) -->early enteral nutrition therapy (most desirable for upper GI surgery) -->diet progression: clear liquids, full liquids, soft diet, regular diet

dietary considerations with surgical clients

-45% of kcal from carb -20% of kcal from fat -10% of kcal from protein or 0.8 g/kg, whichever is higher -remaining 25% of kcal open to negotiation with the client -25-35 g of fiber -all essential vitamins and minerals

diets must maintain adequate amounts of all nutrients and should provide at least...

dysphagia

difficulty swallowing food and/or liquids -intervention -->speech therapist evaluation -eight-Level dysphagia diet (Levels 0-7) -->signs and symptoms -->safe swallowing tips

liver

during absorption, gets "first choice" of nutrients and filters all the blood bc it is the powerhouse organ

nutrients, protein, and certain vitamins and minerals

during this period of rapid growth and development, the mother needs additional what?

energy intake

eating -influenced by environment -regulated by internal mechanisms (GI tract, endocrine system, brain, body fat stores)

-the mammary gland an exact most nutrients from the circulation so that breast milk ma contain adequate levels of nutrients even when the mother's intake is inadequate -levels of water-soluble vitamins in human milk depend on maternal intake, and evidence suggests that the mammary gland may tae priority in folate use over the mother's own blood-forming needs -persistent maternal vitamin deficiencies may result in inadequate concentrations in the milk

effect of maternal deficiencies

hypertension (HTN)

elevated blood pressure -leading risk factor for CAD -most important risk factor for stroke -affects 1 in 3 American adults -essential or primary hypertension: unknown cause -->secondary hypertension: specific cause (cushing's syndrome, renal insufficiency) -blood pressure -->a 'vital sign' -->goal: <120/80 mmHg -->systolic - top number (pressure when heart beats) -->diastolic - bottom number (pressure between beats) -cause: eat out more (fast foods high in sodium), intake more processed foods high in sodium -control: -->be aware of foods high in sodium -->decrease salt (sodium) intake from 3,400mg of sodium per day to recommended -->need potassium rich foods (ie: fruits, vegetables) -->need low fat dairy -->weight loss if needed, even 10-15 pounds is helpful -->DASH diet (sodium: most of our sodium intake comes from processed foods; low fat milk: high in potassium, magnesium, and calcium; weight loss: most effective treatment for HTN)

aerobic exercise

endurance type of activity, supported by increase in oxygen intake -low to moderate intensity for at least 5 minutes -ex: swimming, running, biking, walking -carbs and fats are used -once stored glycogen in the muscle is used up, the body begins to break down fat for energy

a. kcalories from food intake equal kcalories used for energy expenditure

energy homeostasis exists when: a. kcalories from food intake equal kcalories used for energy expenditure b. kcalories used for physical activity equal c. an individual is gaining weight d. kcalories from food intake equal kcalories used for resting energy expenditure

direct measurement

energy is measured by placing a person in an insulated heat-sensitive chamber and measuring the heat emitted by the body -the amount of heat (kcal) produced by the burning of the food is determined by the change in the temperature of a measured amount of water that surrounds the chamber

dietary cholesterol

evidence suggests that a lower intake of what is associated with a reduced risk of cardiovascular disease?

adaptive thermogenesis

evolved to cope with feast-or-famine conditions -being on a diet-->causes them to lose at a slower weight or stop losing weight at all -process of energy expenditure

in adults, the REE declines bc of a decline in lean body mass

example of age affecting REE

people with large bodies required more energy than small ones -a tall person uses more energy bc they have a greater skin surface -a shorter person has less muscle tissue/lean body mass

example of body size affecting REE

kcalories are needed to maintain body temperature -if someone is cold and is shivering, it causes an increase in REE

example of climate affecting REE

individual people can be the same height, weight, sex yet bc of each one's unique genetic makeup, they have a different REE

example of genetics affecting REE

kcalories are required per kg of body weight are highest during growth spurts (before birth, infancy, puberty)

example of growth affecting REE

men develop proportionality greater lean body mass than women, who deposit fat as they mature

example of sex affecting REE

adipose cells

excess triglycerides are stored in the specialized?

abdominal obesity

excess weight is between the client's chest and pelvis -is more dangerous than gluteal-femoral obesity

the neural tube is embryonic tissue that develops into the brain and spinal cord -a critical time in the development of this structure is from conception through the fourth week of pregnancy. interference with normal developmental at that time produces major congenital defects, including anencephaly, meningoencephalocele, spina bifida, and meningocele -unfortunately, the neural tube develops before many women are aware they are pregnant

explain what a neural tube defect is

elimination

expulsion of feces or body waste products called defecation -triggered by distention of rectum -residue may include: cellulose and other dietary fibers, water, bacteria, pigments, and mucus, undigested fats

-second most common cause of death in US (Heart disease #1) - 20% related to: -->obesity -->physical inactivity -->excess alcohol consumption -->poor nutrition -most common for men: -->prostate, lung/bronchus, colorectal -most common for women: -->breast, lung/bronchus, colorectal

facts about cancer

achalasia

failure of the GI muscle fibers to relax where one part joins another -cardiospasm: occurs in cardiac sphincter separating the stomach from esophagus -causes: damage to nerves of esophagus, inherited, and/or autoimmune disorder -symptoms: -->esophageal spasm caused by very hot or cold foods -->anxiety -->described as 'something sticking in my throat', and 'feeling of fullness behind my sternum' -->vomiting -->aspiration (can cause pneumonia) -nutrition therapy: -->avoid spicy foods -->minimize dietary bulky foods -->increase liquids -->small, frequent meals -medically: may need to stretch cardiac sphincter or surgically incise it to enlarge passage

liver, spleen, fatty tissues

fat-soluble vitamins are stored where in the body?

bile from the small intestine

fat-soluble vitamins require what for absorption

bile salts in the small intestine

fats are emulsified by what in which part of the body before they are digested further?

unsaturated fats

fats that are liquid at room temperate and are of plant origin -includes some fish -become rancid quickly bc their carbon bonds are unstable

saturated fats

fats that are solid at room temperature and are usually found in animal products such as meat, poultry, and whole milk -have been targeted bc they have unhealthful effects when ingested

-breastfeeding: on demand vs schedules -formula (premixed, powder, liquid-concentrate): types, preparation according to packaging, and storage -->any unused formula needs to be discarded after 2 hours

feeding from birth to 4-6 months of age

saturated fatty acid

filled with as many hydrogen atoms as the carbon atoms can bond with and has no double bonds between carbons

fetuses bones and teeth -crosses placenta to the fetus -teeth start developing around the 10-12 week during pregnancy

fluoride during pregnancy

fat-free

food contains no more than 0.5 g of fat per serving

water and fiber

foods higher in which two contents have lower kcal density?

complete protein

foods that supply all nine essential amino acids in sufficient quantity to maintain tissue and support growth -come from animal sources (90%-99% digestible) -soy beans are one plant source of these types of proteins (94% digestible)

dietary fiber

foods, mostly from plants, that the human body cannot break down to digest and is eliminated in intestinal waste -adds almost no fuel or energy value to the diet, but it does add volume -whole grains are an excellent source of this

a. energy source

for which of the following functions of protein can other nutrients be substituted? a. energy source b. immunity c. maintenance and growth d. regulation of body processes

stanols and sterols

found in membranes of plants: fruits, vegetables, nuts, seeds, cereals, legumes, vegetable oils -blocked dietary cholesterol in the body (so helps reduce cholesterol)

toxoplasma gondii

found in raw or undercooked meat, unwashed fruits/veggies, contaminated water, dust, soil, cat feces -appears 10-13 days -flulike symptoms: sweating, fever, nausea, vomiting -can cause miscarriage, birth defects (hearing loss, intellectual disability, blindness)

1. assessment 2. analysis/diagnosis 3. planning/intervention 4. monitoring/evaluation

four steps of providing nutritional care

irritable bowel syndrome (IBS)

functional GI disorder involving disturbances between the brain and gut -3 subgroups: -->alternating bowel habits -->constipation-predominant -->diarrhea-predominant -nutrition therapy -->obtain food diary (identify for intolerance to lactose, gluten, or sugar/sugar alcohols, food allergies) -->low-FODMAP (limits high sugar intake) -->avoid sugar alcohols (example: sugar free candy or gum)

maintains chemical homeostasis -filtering blood plasma (remove end products of metabolism and substances that have accumulated in the blood in undesirable amounts) -reabsorption -maintaining acid-base balance (ions being moved from blood to urine) -excretion - eliminating wastes in the urine -renal control of cardiac output and systemic blood pressure - manufactures hormone (renin) -regulates calcium/phosphorus balance (produces active form of vitamin d = regulates bone health) Stimulating red blood cell production (produces hormone that stimulates maturation of red blood cells within bone marrow) -kidneys have ~1 mil "microscopic workhorses" = nephrons

functions of the kidney

intestinal gas and flatulence

gas produced by the body in the lower intestinal tract -cause -->swallowing air -->fermentation of indigestible CHO (legumes, cabbage, broccoli, Brussels sprouts) -->lactose -nutrition therapy -->increase fluid and fiber to prevent constipation -->introduce high-fiber foods gradually

-goals -->improve quality of life! -->maintain weight and lean body mass -->adequate hydration -->adequate energy and protein -->use of appropriate and safe complementary nutrition therapy -interventions -->education of the patient on role of nutrition -->sense of control -->small, frequent meals -->high-calorie supplements -->high protein foods -->pleasant eating environment -->medications to stimulate appetite: Megace and Marinol

general nutritional goals and interventions

sucrose

glucose + fructose

lactose

glucose + galactose

maltose

glucose + glucose

aging and nutrition

gradual process that reflects influence of genetics, lifestyle, and environment over life span -some body systems more affected than others -->changes may begin to affect nutritional status

peptidases

group of enzymes secreted from the intestinal wall that act on the smaller molecules produced by the pancreatic enzymes, reducing them to single amino acids and small peptides, the final products of protein digestion

nephrosclerosis

hardening of the renal arteries -caused by arteriosclerosis and results in a decreased blood supply to the kidneys -condition is hypertensive kidney disease and can eventually destroy the kidney

cirrhosis

healthy liver tissue is replaced with scar tissue -causes -->hepatitis -->heavy alcohol use -->autoimmune disease -complications -->portal hypertension -->esophageal varices -->ascites / edema -->hepatic encephalopathy -->hepatic coma -->gallbladder and bile duct stones -->vitamins may not be absorbing, which leads to other complications -signs and symptoms: anorexia, epigastric pain, nausea that worsens as the day goes on, abdominal distention, vomiting, steatorrhea, jaundice, ascites, edema, GI bleeding -nutrition therapy -->provide adequate calories to avoid muscle catabolism, with liquid supplement (if necessary) and protein (1.0-1.5 grams/kilogram of body weight -->esophageal varices: soft, low fiber -->4 to 6 meals per day -->late evening snack helps avoid fasting associated catabolism -->ascites: sodium and fluid restriction -->encephalopathy: vegetable protein vs. animal protein -->supplemental vitamins -->sodium restriction based on ascites

relaxation of cardiac sphincter due to hormones -upward pressure on diaphragm (growing fetus) -control of heartburn: avoid spicy foods, avoid acidic foods, sit up 1 hour after meals, elevate head of bead while sleeping, do not self medicate with antacids, etc (bicarbonate produces alkalosis, antacids decrease iron absorption (so increases risk of anemia))

heartburn during pregnancy

foods and the human body

heat energy can be measured by which two thing?

thermic effect of food

heat produced by the body after a meal; -energy is needed to chew, swallow, digest, absorb, and transport nutrients -metabolism increases-->more kcal are used

motivational interviewing (MI)

helps determine what the client is feeling about identified issues -then the team can determine how best to approach issues from a client-centered perspective

tolerable upper intake levels (ULs)

highest average daily intake by an individual that is unlikely to pose risks of adverse health effects in 97% to 98% of individuals in the defined group -ordinarily refers to intake from food, fortified food, water, and supplements -designed for the general population and may be exceeded under medical supervision in clients with special needs

-both are composed of carbon, hydrogen, and oxygen -but fat's proportion of oxygen to carbon and hydrogen is lower

how are fats and carbs similar but different in their make-up?

-amounts present in the body -->major: >5 g (approx. 1 tsp) -->trace: <5 g -intake requirements -->major: 100 mg (approx. 1/50 tsp) -->trace: <100 mg per day -->ultra trace: <1 mg per day

how are major minerals and trace minerals differentiated?

340 kcal per day

how many kcal per day does a mother need in the second trimester?

452 kcal per day

how many kcal per day does a mother need in the third trimester?

85% found in bone and teeth

how much phosphorus is found in the body?

b. 8 grams

how much protein would a person receive from a glass of milk? a. 7 grams b. 8 grams c. 14 grams d. 21 grams

6 days

humans can only go how many days without water?

somatostatin

hypothalamus and pancreas hormone that inhibits functions of insulin and glucagon

b. red beans and rice

if a person has difficult purchasing meat to serve every day, which of the following foods should the nurse suggest as offering the best source of protein? a. bran muffins with raisins b. red beans and rice c. green bean, onion, and mushroom casserole d. sweet potatoes and cornbread

completely hydrogenated

if all of the double bonds are broken by the hydrogenation

they will have fluid retention and weight gain

if an individual has a low protein intake for a period of time what will happen?

adaptive response to exercise

if an individual is really muscular, they tend to perform more efficiently and therefore use fewer kcal to perform a specific amount of physical work or activity than someone who has less-developed muscles

gluconeogenesis supplies glucose to the brain by using amino acids from protein

if liver glycogen stores depleted...?

partially hydrogenated

if only some of the fat's double bonds are broken by the hydrogenation

equal

in a healthy individual, I&O should be about __________

lymphatic system

in absorption, takes larger proteins and fats

lactose intolerance

inability to breakdown lactose which then draws water into the GI tract -symptoms -->diarrhea -->abdominal cramping -->flatulence -nutrition therapy -->gradually add lactose to the diet to establish tolerance level -->encourage lactose with other foods -->lactase enzymes

provitamins

inactive for of a vitamin

malabsorption

inadequate movement of digested food from small intestine into the blood or lymphatic system -can be due to: medications, parasites, surgical procedures, disease states, medical complications -steatorrhea: malabsorption of fat; fat seen in the bowel movements (stools); often caused by inhibition of pancreatic lipase

hyperplasia

increase in amount of fat cells -occurs most in childhood

hypertrophy

increase in size of ft cells (once max size met then hyperplasia)

fluid volume excess-edema

increased fluid retention and edema -causes: sodium retention, kwashiorkor, water intoxication -may seen this after eating a lot of high sodium foods -sodium-sensitive individuals

food additives

increases: shelf life, flavor, texture, color aroma, and other characteristics/qualities -regulation: by FDA -intentional use--added directly to food -maintain or enhance nutritional value -maintain food quality -assist in processing, transporting, or holding -improve taste, look, or smell -accidental use--added to foods by accident (i.e. food touches an area that has been cleaned with a detergent, etc.)

low

indicates 3 g of fat or less per serving; also low in saturated fats, cholesterol, and/or kcal

-doubled by 4-6 months -tripled by the first year

infants' birth weight should be doubled and tripled when?

glomerulonephritis

inflammation of the glomeruli -can be acute or chronic -may be caused by infections such as strep and various autoimmune diseases such as lupus -symptoms: nausea, vomiting, fever, hypertension, hematuria, oliguria, proteinuria, edema -recovery is complete -some clients develop anuria (total lack of urine output) -without treatment, this condition is fatal

viral hepatitis

inflammation of the liver resulting from viral infections, alcohol, drugs, toxins -types to study (for this class) -->hepatitis A: fecal-oral transmission -->hepatitis B and C: transmitted via blood (predominantly) and bodily secretions -signs/symptoms: anorexia, nausea, vomiting, diarrhea, fatigue, weakness, epigastric discomfort, jaundice also occur and caused by inability of liver to convert fat-soluble bilirubin to water-soluble form -nutrition therapy -->IV fluids may be needed if nausea and vomiting present -->high calorie, high protein -->6 small meals a day, especially with fatigue and decreased appetite -->multivitamins -->abstinence from alcohol is imperative

pancreatitis

inflammatory process of the pancreas with decreased production of digestive enzymes -cause -->excessive alcohol -->gallbladder disease -->high triglycerides/high fat diet -->smoke -symptom -->severe pain left upper quadrant -->nausea/Vomiting serum lab tests: elevated levels of amylase and lipase -risk -->malabsorption of fat and protein -->diabetes mellitus -nutrition therapy -->hydration -->early introduction of enteral nutrition -->parenteral nutrition if enteral nutrition contraindicated -->restrict fat -->small frequent balanced meals -->supplemental enzymes and vitamin minerals with meals

estimated average requirements (EAR)

intake that meets the estimated nutrient needs of 50% of the individuals in the defined group -used to set the recommended dietary allowances and to assess or plan the intake of groups

d. recommended dietary allowances

intake that meets the needs of 97% to 98% of individuals in a defined group is called: a. acceptable macronutrient distribution range b. adequate intakes c. estimated average requirements d. recommended dietary allowances

recommended dietary allowances (RDAs)

intake that meets the needs of 97% to 98% of the individuals in a life stage and gender group; intended as a goal for daily intake by individuals, not for assessing adequacy of an individual's nutrient intake

-begins between ages 4-6 months -developmental readiness (sit up with no support, intentional swallowing, interest in foods others eat) -solid foods during the first year of life -satiety cues (turn head side to side, lock mouth closed, grimace as spoon comes to mouth) -self-feeding: 9-12 months -allergies: introduce solid food gradually -home-prepared foods, commercial foods, or both -variety

introduction to solid food

short bowel syndrome

large portions of the small intestine have been resected -risk -->malabsorption (vitamin and mineral deficiencies; essential fatty acid deficiency) -nutrition therapy -->immediately post resection (parenteral nutrition; IV fluids) -->progress to enteral nutrition or oral feeding as soon as possible -->limit simple sugars -->MCT oils may be warranted -->encourage fluids

dumping syndrome

large volume of particles dumped rapidly into the small intestine drawing water in and increasing bowel motility -cause -->part or all of the stomach is removed or bypassed -symptoms -->fullness -->abdominal cramps -->nausea -->diarrhea -nutrition therapy -->liquids consumed between meals -->reducing simple carbohydrates (sugars) -->small frequent meals -->encourage fluids to prevent dehydration

contamination

lead from pipes, bacterial -if lead is too high those at risk (pregnant, infants, and children) should drink bottled water -local health dept can recommend a laboratory for testing water quality

intestinal phase

leads to the release of chyme which inhibits gastric secretion

neuromuscular irritability may be the cause -control of leg cramps: stretch before going to bed, stretch before exercise, stay well hydrated, maintain intake of potassium, calcium, sodium, magnesium

leg cramps during pregnancy

mucosa

lines the alimentary canal and secretes mucus which lubricates the canal and helps facilitate the smooth passage of food -this secretes the digestive enzymes of the stomach an small intestine

enzymes in the metabolic chain

lipoprotein lipase involved in uptake of fatty acids -activity of the lipoprotein increases during weight reduction

-self-monitoring of blood glucose -->glucose meter (frequency) -physical activity -->guidelines -->exercise and type 1 diabetes -->exercise and type 2 diabetes -->exercise, S M B G, and food intake monitoring --hemoglobin A1C -->amount of exposure of sugar to RBC -->120 day look-back of blood sugar control -->Goal: <7% -self-monitoring blood glucose -->evaluating glycemic control, physical activity, and effectiveness of meal plan -->blood glucose meter -->before and after meals and at bedtime -->record keeping encouraged -->acceptable results: before meals: 70-130 mg/dL after meals: <180 mg/dL bedtime: 90-150 mg/dL physical activity -guidelines: perform at least 150 minutes per week of moderate intensive aerobic physical activity, strength training, children-->at least 60 minutes of physical activity per day -exercise and type 1 diabetes-->risk bc after exercise, there can be changes in the system of insulin requirements for more than 25 hours after exercise-->watch out for cardiovascular fitness and psychological well-being -keep alert to any complications, since these can worsen, such as retinopathy, neuropathy, renal disease -BP: may elevate -Be able to self-monitor BG -Be able to self-treat hypoglycemic episode -exercise and Type 2 diabetes -->increases # and binding capacity or insulin receptors -->helps lower BG levels -->if insulin used, decreases requirement -->weight control -->better muscle strength and flexibility -exercise, S M B G, and food intake (fruit, starch, dairy)

management

extra lean

means 5 g of fat, 2 g of sat fat, and 95 mg of cholesterol per serving

free

means less than 0.5 g of fat per serving and tiny or insignificant amounts of cholesterol, sodium, and sugar

high

means that the food must contain 20% or more of the daily value for that nutrient

cholesterol free

means the the item has less than 2 mg of cholesterol and 2 g (or less) of sat fat per serving

nitrogen balance

measurement of amount of nitrogen (N) entering the body vs. amount excreted from the body

-nutritional goals and priority: educate them about diabetes so they can make aprptiae changes depending on their needs (food and exercise)-->improves metabolic control of diabetes -->individualize -meal frequency & spacing important -->eat regular, every 4-5 hours -client readiness to change -->five stages 1. precontemplation: individuals exhibit no intention to changes behavior in the foreseeable future 2. contemplation: individuals know they ave a problem and are seriously thinking about overcoming the harmful behavior but are not ready to take action 3. preparation: individuals plan to take action in the near future, may have taken action unsuccessfully in the past, and may report small behavioral changes 4. action: individuals modify their behavior, experiences, and environment to overcome the harmful behavior. this stage requires considerable commitment of time and energy 5. maintenance: individuals continue to work to prevent relapse and to consolidate gains -meal-planning approaches -->energy nutrient distribution throughout day and to include carbohydrates, fats, and proteins -->intake of 20-35 kcal/kg per day (depends on client's level of physical activity, nutritional status, desire for weight loss or gain, and body weight) -->macronutrient distribution (individualized based on person's lifestyle, comorbidities, and what they like to eat) -->carbohydrate -->protein -->fat -carbohydrate counting (45-60 g/meal; 15 g carbs = 1 serving) -->individualized; recommended by american dietician association -mediterranean diet -->composition (plant-based, small amounts of meat and chicken; whole grains, fruits, veggies, and legumes; seafood; olive oil is main source of fat)

medical nutritional management of diabetes

trace minerals -required daily: less than 100 mg

microminerals

obligatory excretion

minimum amount of urine needed to be excreted everyday to carry away waste products resulting from metabolic processes

negative nitrogen balance

more nitrogen is excreted than is taken into the body -associated with age, illness, extreme stress, starvation, surgery

positive nitrogen balance

more nitrogen is taken into the body than excreted -ex: new cell growth and healing -can occur during pregnancy, in growing children, and during illness or injury and the recovery from these

glucose

most efficiently used source of energy, but fat and protein can be adapted as backup sources -if diet low in carbs, body uses protein for energy needs of brain and spinal cord

a. a healthy US diet

most individuals in the united states eat all of the following except: (select all that apply) a. a healthy US diet b. too much sodium and simple sugars c. too little fiber d. too few fruits and vegetables e. not enough servings of dairy

triglycerides

most of the fat formed in our diets and in the body is in the form of?

a. consider the amount of sugar he consumes especially by consuming low-fat baked goods and desserts

mr. b buys as many low-fat foods as possible. he eats fat-free muffins for breakfast, eats low-fat brownies or cookies for lunch each day, uses only fat-free ice cream, and buys fat-free salad dressings. he eats little meat and chooses fat-free dairy products. he wonders why he hasn't lost more weight. the best advice is to encourage him to: a. consider the amount of sugar he consumes especially by consuming low-fat baked goods and desserts b. eat even less meat c. consume fewer dairy products d. quit trying to lose weight

d. all of the above

mr. j claims he is trying to lose weight, and his urinalysis shows that his urine contains ketones (ketonuria). you should ask him: a. When he last ate b. how much milk, fruit, and starch he usually eats c. what else he usually eats d. all of the above

a. wheat and corn bran, nuts, fruit skins, and dried beans

mr. p complains of constipation. as his nurse, you would like to teach him to eat more insoluble fiber to help alleviate his discomfort. you should encourage the intake of: a. wheat and corn bran, nuts, fruit skins, and dried beans b. eggs, cheese, and chicken c. milk, yogurt, and ice cream d. oatmeal, barley, and broccoli

b. ChooseMyPlate

mr. p is a 65-year old man, recently widowed, whose physician is recommending weight loss. mr. p has had little experience with grocery shopping or cooking. which of the following systems for instructing mr. p would the nurse select to offer the best chance of success? a. a computerized diet analysis program b. ChooseMyPlate c. exchange lists d. the RDA/AI tables

d. dietary recall of mr. p's food and fluid intake

mr. p, a 65-year old man, widowed for 6 months, has been referred to your home health agency for assistance in managing his nutritional intake. he has lost 10 pounds over the past 6 months. a physical examination within the past month revealed no disease processes requiring treatment. in assessing mr. p, which of the following data would the nurse gather first? a. list of current medications the client takes b. blood protein levels analyzed during the recent physical examination c. a description of the procedure mr. p uses to weigh himself d. dietary recall of mr. p's food and fluid intake

d. animal fats such as butter, meats, lard, and bacon

mrs. s, 50 years old, has a cholesterol level of 233 mg/dL. she weighs 125 lb and is 5 ft, 5 in. tall. The dietitian has estimated her body fat content to be 35%. when taking a nursing history, the nurse asks mrs. s if she eats any foods that may be related to her elevated cholesterol level. which of the following groups of foods are most related to an elevated cholesterol level? a. vegetable oils such as corn, cottonseed, and soybean b. fruits and vegetables c. starches such as bread, potatoes, rice and pasta d. animal fats such as butter, meats, lard, and bacon

c. explain to her that no food is guaranteed to be 100% safe, and it is best to avoid artificial sweeteners if she is not comfortable with these products

ms. c is concerned about the dangers associated with the consumption of artificial sweeteners and was to know if they are safe. as a healthcare water, it is appropriate for you to: a. ignore ms. c's comments because you think she is overly concerned b. assure her that the government wouldn't allow a food or herbal product to be sold if it was hazardous to her health c. explain to her that no food is guaranteed to be 100% safe, and it is best to avoid artificial sweeteners if she is not comfortable with these products d. refer her to the local health food store

a. a 1-day diet recall is inadequate data on which to base supplementation

ms. e attended a community health fair where she entered her recalled intake for the previous 24 hours into a computer for analysis. on the basis of the printout she was given, she now thinks she should begin taking vitamin and mineral supplements. a friend who is a nurse correctly bases her advise on the following: a. a 1-day diet recall is inadequate data on which to base supplementation b. a hand recalculation should be done to verify the accuracy of the computer printout c. the RDAs on which computer programs are based are intended for only the 50% of the population who are obsessed with health d. undoubtedly, the operators of the computer at the fair had a product to sell: "let the buyer beware"

d. asking ms. g how she "sees" or perceives diabetes in her life

ms. g has just been diagnosed with type 2 diabetes. which of the following actions by the nurse shows respect for ms. g? a. instructing her to increase her intake of vegetables b. telling her to lose weight and avoid alcohol and fast-food restaurants c. giving ms. g an instruction sheet based on MyPlate d. asking ms. g how she "sees" or perceives diabetes in her life

-collaboration of all health care team members, including nurse and dietitian, is crucial -->nutrition assessment, counseling, and support are critical components of medical care -->early recognition and intervention for nutritional risk factors are key to effective nutrition support and related medical therapies

multidisciplinary approach

sphincters

muscles rings that separate segments of the alimentary canal -act as valves to control the passage of food -when the muscles contract, the passageway closes: when the muscles relax, the passageway opens

pharynx

muscular passage between the oral cavity and esophagus

-don't use tobacco. -limit alcohol intake. -eat 5+ servings of fruits and vegetables daily -->provide antioxidants -eat a low-fat diet. -reach and maintain a healthy weight -be physically active. -protect the skin from excessive sunlight -->may need Vitamin D supplementation *scientist estimate 50-75% of all cancer deaths can be linked to human behavior and lifestyle factors.

national cancer institute guidelines

hormonal changes which caused related GI muscle tone -less meat and more carbs are taken in during this time -control of n&v: avoid fatty foods, avoid spicy foods, small frequent meals, eat dry carbs between meals and before getting out of bed, liquids between meals rather than with meals, eat high protein snacks at bedtime, no smoking, diner, lemon oil, chamomile, vitamin b6, thiamine may help

nausea and vomiting during pregnancy

anion

negative charge

-goals -->control hypertension -->minimize edema -->decrease urinary albumin losses -->prevent protein malnutrition and muscle catabolism -->to ensure protein is used for lean body tissue-->provide adequate calories/energy -->supply adequate energy (calories) -->slow the progression of renal disease -->diet -->adequate protein (0.7-1gm/kg/day) -->adequate energy (35 Kcal/kg/day) -->reduce sodium intake (hidden sources: baking powder, drinking and cooking water, some medications, mouthwash, toothpaste

nephrotic syndrome: nutrition therapy

antibodies (proteins)

neutralizes harmful effects and fight foreign viruses and bacteria in the body

--nasogastric--the tube is passed through the nose to the stomach -nasoduodenal--the tube is passed from the nose to the duodenum -nasojejunal--the tube is passed through the nose to the jejunum

non-surgical tube placements

plant-derived fats

normally in the form of oils, having a lower melting point and comprising more unsaturated fats

norovirus

normally spread from one person to another -contaminated food, water, or environmental surfaces -kitchen workers can contaminate foods if they have the virus on their hands -to prevent: wash hands frequently, kitchen workers wear gloves, cleaning surfaces and equipment, no food preparation by ill people, wash fruits and veggies before they're prepared or consumed, cooking shellfish thoroughly washing clothes and table linens thoroughly

24 hours

normally, nutritional screenings are required within what frame of time for individuals admitted to a health care facility?

energy imbalance

number of kcal does not equal number used for energy -affected by loss of weight -lose body fat, there is also loss of body protein -LBM protected if physical activity included with weight loss -increased weight loss = more LBM lost -body's two largest components after water: fat and lean body mass (includes protein) -weight loss--dependent on body composition -starvation--if "tolerated," individual conserves body protein

parenteral nutrition

nutrients delivered through veins -normally used in acute care settings -function: for partial or total daily nutritional requirements -types: -->peripheral parenteral nutrition (PPN)--peripheral vein (hand or forearm) -->central parenteral nutrition (CPN)--central vein used -->peripherally inserted center catheter (PICC)--threaded in subclavian or jugular veins -

nonessential nutrients

nutrients that are not needed in the diet because the body can make them from other substances

conditionally essential nutrients

nutrients that, under most circumstances, a healthy body can manufacture in sufficient quantities -in certain situations, the body cannot produce optimal amounts

essential nutrients

nutrients the human body requires but cannot manufacture in sufficient amounts to meet bodily needs -must be supplied by foods in the diet

evaluate anthropometric data -compare current weight with usual body weight -->unexplained weight loss is pertinent. -->10%-->increased nutritional risk -evaluate BMI --><18-->increased mortality -identify for muscle depletion -->weight loss can be misleading -->use bioelectrical impedance analysis (see p.14) -->use calculation for upper-arm muscle area (mid-arm circumference: body proteins; right side of body used (US standard)) -dietary assessment -->24-hour recall: include all eaten within a 24 hours period to include meals and any snacks -->food frequency: usual food intake or a description of what an individual usually eats during a typical day -->food diary: logging in information via diary format throughout a day, over a period of time, to see routines and usual intake of food

nutrition assessment in cancer

-responsibility for own behavior increased, but adult guidance still required -encourage meal patterns -involve this age group in preparation of meals -physical and emotional support of adults -guidelines for dietary patterns: myplate -keep kitchen stocked with healthy snack options -adjusting to demand of college environment -influences by fast food -risk for diet-related disorders and eating disorders

nutrition during adolescence (ages 12-20 years)

-growth fluctuations -national center for health statistics growth charts-->children should grow according to these charts -dietary reference intakes (DRI) -dietary guidelines for americans: for children older than 2 years of age-->fruits, veggies, and whole grains -role of adults in nourishing children-->need to eat the proper things to show children the proper things to eat and offering them the foods

nutrition during childhood (ages 1-12 years)

-premature (born before 37 weeks) and low-birth-weight infants (full term but weigh 25 g or less at birth) -->before 34 weeks, they may require TPN (feeding that helps them acquire weight and sucking and swallowing has not developed yet) -failure to thrive--> weight loss over 2 months or longer, cannot maintain growth, and inadequate caloric intake is the usual etiology -->organic (underlying metabolic disorder-->congenital heart disease or HIV) -->nonorganic (no medical reason, could be psychological or home situation) -inborn errors of metabolism -->phenylketonuria (infant is missing the enzyme that breaks down the amino acid phenylalanine-->can result in mental retardation) -->galactosemia (missing the enzyme to metabolize galactose-->can result in diarrhea, growth retardation, and mental retardation; don't use milk or human products but use soy formulas or casein hydrolosate formulas)

nutrition-related concerns

-evaluate anthropometric data -->compare current weight with usual body weight (unexplained weight loss is pertinent, 10%-->increased nutritional risk) -evaluate BMI --><18-->increased mortality -identify for muscle depletion -->weight loss can be misleading -->use bioeletrical impedance analysis -->use calculation for upper-arm muscle area (mid-arm circumference: body proteins; right side of body used (US standard)) -dietary assessment: 24-hour recall, food frequency (usual food intake or a description of what an individual usually eats during a typical day), food diary (logging in information via diary format throughout a day, over a period of time, to see routines and usual intake of food)

nutritional assessment in HIV/AIDS

nutrition-related side effects -early satiety and anorexia -->no appetite -anxiety and depression -->due to treatment -->body image change -taste alterations -->decreased sensation of sweet, salty and sour; increased taste of 'bitterness' or metallic -->permanent changes with taste may occur with head and neck cancers -local effects in the mouth -->stomatitis: sores in the mouth -->decreased and thick saliva -->swallowing difficulty -nausea, vomiting, diarrhea -altered immune response (suppression of immune system) -food aversions--foods that make one nauseous or difficult to swallow so they stay away from then -mucositis: ulceration of the mucous membrane of the GI tract

nutritional complications

cystic fibrosis

obstruction of exocrine glands with thick mucus, affecting multiple organ systems. -obstruction by viscid material in lumen of the glands interferes with digestive secretions of pancreas. -fat malabsorption may result in passage of bulky, fatty, foul-smelling feces and protein malabsorption, leading to stunted growth -nutritional therapy: -->increased energy needs -->oral nutritional supplement or enteral tube feeding (to meet daily energy requirements) -->supplemental pancreatic enzyme therapy -->yearly monitoring of serum vitamns A, E, D levels; supplement as needed -->adequate salt intake and monitoring of electrolytes

carcinomas

occur in epithelial tissue, including cancers of the lung, breast, prostate, and colon, and are more common in older people

homeostasis

occurs when the number of kilocalories eaten equals the number of kilocalories used to produce energy -each person is different

300 kcal per day

on average, the pregnant woman will need to increase daily caloric intake by approx. how many kcal per day?

amylase

pancreatic enzyme that breaks down any remaining starch into maltose

insulin

pancreatic hormone that regulates blood glucose uptake

glucagon

pancreatic hormone that stimulates conversion of liver glucose (especially during the night)

gene

part of the DNA that carries the code to direct the synthesis of a single protein

diarrhea

passing of loose, watery bowel movements -cause -->contents of the GI tract move through too quickly to allow water to be reabsorbed into the colon -->acute -->chronic -risk -->dehydration -nutrition therapy -->depends on the cause -->may require NPO (nothing by mouth) if severe -->fluid replacement -->small, frequent meals (low fiber--bananas, rice, applesauce, dry toast, crackers; may need to avoid dairy, iincrease high potassium foods)

oral delivery

patient eats by mouth -the menu: selective (variety of foods, choosing what you want) and nonselective (same food is prepared for all patients) -pleasant eating environment -->odors (bedside toilet) -->sounds (loud tv or loud music) -->sights (clear clutter; bedside table where the food tray is going to be placed) -->was hands and face before eating -->head of bed elevated or sit in chair (if appropriate) -methods -->assisted feeding (talking, sitting, mimicking normal eating behavior) -->assisting the disabled client (partial assistance--be as independent as possible, consistency of food)

gynoid

pear, big hip, buttocks, upper thigh

-alcoholics -poor and incapacitated elderly -clients with serious diseases that affect appetite -mentally retarded -children receiving inadequate care

people prone to vitamin deficiency

accepted macronutrient distribution range (AMDR)

percentage of kilocalories from carbohydrate, fat, and protein associated with reduced risk of chronic disease while still providing sufficient intake of essential nutrients

1. oral phase (voluntary): the tongue presses food against the hard palate, forcing it toward the pharynx. 2. pharyngeal phase (involuntary) -->early: wave of peristalsis forces a bolus between the tonsillar pillars -->middle: soft palate draws upward to close posterior nares, and respirations cease momentarily -->late: vocal cords approximate, and the larynx pulls upward, covering the airway and stretching the esophagus open 3. esophageal phase (involuntary): relaxation of the upper esophageal (hypopharyngeal) sphincter allows the peristaltic wave to move the bolus down the esophagus

phases of swallowing

mechanical digestion in the mouth

physical breaking down of food into smaller pieces -teeth and tongue -formation and movement of bolus -teeth tear and the tongue guides and leads pulverizes food to the esophagus

phytochemicals

physiologically active substances from plants -stimulated the immune system, prevented damage, and reduced inflammation

intake of nonfood items -physiological causes: deficiency of zinc, iron, calcium, thiamine, vitamin C -common items: dirt, clay, laundry starch, baking soda, etc. -may cause: inadequate nutrition, iron-deficiency anemia, constipation, lead poisoning -control of pica: preventative therapy through teaching about the issue of indulging pica

pica during pregnancy

cation

positive charge

intracellular

potassium (+)

gestational diabetes

pregnant woman is diabetic but is not normally diabetic -occurs during 2nd or 3rd trimester -occurs bc of production of hormones of the placenta-->decreased insulin sensitivity and increase in insulin resistance by the mother (glucose crosses over from the placenta to the fetus, the fetus can then take its own insulin to counteract it) -these babies are usually born large (9-10 lbs) -risk factors: gestational diabetes in previous pregnancy, family history of diabetes, previous pregnancies with babies born 9 lbs or more, obesity of mother -women usually return to normal glucose levels but diet needs to be followed and exercise regimen (if not, mother may then become a type ii diabetic) -women need to also take insulin bc it helps to control blood glucose

protein

preservation of body _________ is necessary for optimal health

-blood flows into the glomerulus, and some of its fluid is absorbed into the tubule -waste products are filtered and passed through the tubule into the bladder -the fluid and dissolved substances needed by the body are resorbed in vessels alongside the tubule

process of blood flow in the nephron

glycogenesis

process of converting glucose to glycogen

glycogenolysis

process of converting stored glycogen in the liver and muscles back to glucose

gluconeogenesis

process of producing glucose from fat (non-carbohydrate)

trans-fatty acids

produced by the partial hydrogenation of unsaturated vegetable oils -are not generally recognized as safe

liver

produces bile

-needs highest during first 4 months -excess protein affects renal solute load

protein during infancy

kwashiorkor

protein is low and cellular fluid levels are imbalanced resulting in fluid accumulation in the stomach, face, and extremities

54%

protein needs are how much more for pregnant women compared to the non-pregnant women?

1. carbon 2. hydrogen 3. oxygen 4. nitrogen -these are arranged in building blocks called amino acids -nitrogen is the element that distinguishes the structure of the proteins from that of carbs and fats

proteins are composed of what four elements?

protein requires the most, then carbs, then fats require the least

put the nutrients in order from highest to lowest according to which one requires the most energy to digest

diarrhea

rapid peristalsis -can lead to dehydration

morbidity

rate of being diseased

cardiac sphincter

regulates the movement of food to the stomach -keeps the food in them gastric juices from coming back up

nucleoproteins

regulatory complexes that include proteins -located in the cell nucleus, where they direct the maintenance and reproduction of the cell -DNA and RNA are examples of these that control the protein synthesis in the cell -gene

vitamins

required by our bodies in very small amounts -two diff groups: water-soluble and fat-soluble -do not have to be digested and do not produce calories

vomiting

reverse peristalsis -can lead to dehydration

vomiting

reverse peristalsis -cause -->body protecting itself -->GI disorders -->medications -->equilibrium out of balance -->pregnancy -->bulimia -risk -->dehydration -nutrition therapy -->small, frequent meals -->cold foods -->avoid strong-smelling foods -->limit high-fat foods

-unmodifiable-->age, gender, race, hereditary, family history, prior medical history -modifiable-->hypertension, high blood cholesterol, obesity, diabetes mellitus, physical inactivity, alcohol intake, smoking

risk factors for CVD (unmodifiable vs. modifiable)

a. liquid at room temp and of vegetable origin b. more likely to become rancid than other types of fats d. comprise over 10% of the average american's diet

saturated fats are not: (select all that apply) a. liquid at room temp and of vegetable origin b. more likely to become rancid than other types of fats c. primarily of animal origin d. comprise over 10% of the average american's diet

pancreas

secretes bicarbonate -this lowers acid content of chyme

hyperemesis gravidarum

severe nausea and vomiting (goes into 14th week of pregnancy) -incidence is reported to be higher in multiple pregnancies and other conditions associated with increased pregnancy hormone levels -etiology and pathologenesis are unknown -occurs most often in western countries and in first pregnancies -hospitalization will occur to treat severe dehydration, electrolyte imbalance, weight loss greater than 5%, and ketonuria (less than 500 mL of urine in 24 hrs) -major vitamin deficiencies: hyponatremia (can cause symptoms of headache, nausea, and vomiting), deficiencies of vitamins b6 and b12 can result in peripheral neuropathy, deficiency of thiamine has caused wernicke encephalopathy in pregnant clients -most approaches include: pyridoxine, ginger, rehydration, enteral and parenteral nutritional support, antiemetics (without teratogenic effects), corticosteroid therapy

-dehydration -lood stools -neurological disorder -death

severe symptoms of foodborne illnesses?

lean

signifies less than 10 g of fat, 2 g of sat fat, and 95 mg of cholesterol per serving

-small head circumference -low nasal bridge -epicanthic folds -short palpebral tissues (obscure the cantos, or inner corner of the eye, a norma feature in certain species of the mongolian race) -short nose -small midface -indistinct philtrum (an underdeveloped groove in the center of the upper lip between the nose and the lip edge) -thin, reddish upper lip

signs of FAS

constipation

slow gastric motility -to prevent: good intake of fiber, water, and good exercise

cephalic phase (aka psychic phase)

smell and taste of food -leads to the release of gastrin which then leads to the release of gastric juices (HCl)

extracellular

sodium (+) and chloride (-)

edema and hypertension

sodium sensitive people experience what two things?

plaque

soft in the beginning and becomes fibroses (hard) and smaller, making it difficult for the vessel to constrict and dilate when blood needs to be pumped to supply oxygen to the tissues. impaired circulation is then evident distal to the obstruction

-illness (stress results in hyperglycemia and increased insulin may be needed; if a patient that is sick has no appetite, they should eat carb containing liquids and soft foods) -->blood glucose rises due to hormones released -->increased insulin needs -->diet: liquids and soft foods -gastroparesis -->delayed gastric emptying -->diet: 6 small meals, low fat, fiber -eating disorder -->T1DM typically have weight gain after insulin initiation -->insulin restriction for weight management can be very dangerous -->signs: change in eating pattern, elevation in A1c, excessive exercise, amenorrhea, DKA -metabolic Syndrome -->cause: disproportionate fat deposition in the abdomen -->results: dyslipidemia, HTN, hyperglycemia, chronic inflammation

special considerations

anaerobic exercise

speed activities of high intensity -ex: soccer, basketball, sprinting, football -only carbs from muscle glycogen can be used -results in pyruvic acid being changed to lactic acid which causes muscle soreness -does not require the use of oxygen -provides added strength and toughness

-stage 1: may experience no symptoms or develop an acute flulike illness, with symptoms appearing from 2-4 weeks to up to 3 mo. after exposure. often referred to as acute retroviral syndrome (ARS) or primary HIV infection. symptoms are not severe enough for the infected individual to seek medical attention. there are higher levels of the virus circulating in the lord, which can make the virus more easily transmittable -stage 2: referred to as asymptomatic HIV or the chronic HIV stage. may be asymptomatic for years after becoming infected with the virus. this stage can last an average of 10 years -stage 3: diagnosis is made whenever a person is HIV infected and has a CD4 count of less than 200 cells.mm3

stages of HIV/AIDS

M--mark to the tube at the exit A--anchor the tube R--reassess tube placement K--keep pressure off skin, knowledge of institution policies needed to ensure safe practice --risks: tube migration causing aspiration, regurgitation

steps for monitoring tube placement

glycogen

storage form of CHO in liver and muscles (carbohydrate energy)

body fat stores

stored in adipose fat tissue -can come from fats, carbs, or protein -if one has kcal deficit more than 1 day, fat stores pulled from adipose tissue and protein stores from organ and muscle mass. protein also stored in certain body chemicals -weight loss includes loss of lean body mass

gallbladder

stores bile

130 g -pregnant and lactating women have a higher RDA for carbohydrates

strong evidence exists that a minimum of ______ g of carbohydrates per day is necessary for adequate brain and body function

specific tubular abnormalities

structural problem in the renal tubules -results in abnormal reabsorption or abnormal reabsorption of certain substances by the tubules -the result of this is ineffective cleansing of the blood

electrolytes

substances that conduct an electric current in solution

nonnutritive sweeteners (NNS)

sugar substitutes. that provide intense sweetness -they do not add bulk or volume to a food product; they add only sweetness

-4 mo-->infant cereal mixed with formula-->bc of risk of allergies, rice offered first wheat after age 12 mo; read labels: some mixed infant cereals contain wheat -5-6 mo-->strained veggies-->less sweet than fruits; thought less likely to be rejected if offered before fruit -6-7 mo-->strained fruits-->will be well accepted; humans have strong preferences for sweets -6-8 mo-->finger foods (bananas, crackers)-->encourage self-feeding; different textures may aid speech development -7-8 mo-->strained meats-->may be introduced earlier to add iron and zinc to the diet; offer variety -10 mo-->strained or mashed egg yolk-->start with 1/2 tsp; due to possible allergy, delay egg while until 1 year old -10 mo-->bite-sized cooked foods-->select appropriate foods -12 mo-->foods from adult table-->select suitable foods, prepared according to baby's abilities

suggested introduction of foods during infancy

metabolism

sum of all chemical and physical processes -involves: catabolism (breakdown of nutrients, results in release of energy) and anabolism (building up of substances, requires energy)

-esophagostomy--the tube is surgically inserted into the neck at the esophagus and extends to the stomach -gastrostomy--the tube is surgically inserted into the stomach (called PEG when inserted with an endoscope) -jejunostomy--the tube is surgically inserted into the small intestine (PEJ when Peg cannot be used (i.e. stomach removed)

surgical tube placements

general circulatory system

takes smaller particles and helps to transport them during absorption

25%-35%

the ADMR for adults is what percentage of kilocalories from fat?

30%-40%

the ADMR for children aged 1-3 is what percentage of kilocalories from fat?

12.3%

the USDA estimates that how many american households were food insecure?

edema

the accumulation of excessive amounts of fluid between the cells (in the interstitial spaces)

nonexercise activity thermogenesis (NEAT)

the activities of daily living that burn kcalories

fortification

the addition of nutrients not normally present in a food to increase its nutritional value

calorie

the amount of energy required to raise or lower the temperature of 1 kg of water to 1˚C

d. 25-35

the average adult should consume the following percent range of fat in the diet: a. 20-30 b. 0-15 c. 35-45 d. 25-35

c. 5-18 g of fiber e. 13% added sugars ??

the average american consumes: (select all that apply) a. 46% added sugars each day b. enough whole grains c. 5-18 g of fiber d. 15 g of carbohydrate e. 13% added sugars

a. fiber c. fruits and vegetables

the average american doesn't consume enough: (select all that apply) a. fiber b. simple carbohydrate c. fruit and vegetables d. energy drinks

1. sugars 2. starches

the average american's daily intake of _______ is considered excessive, whereas the intake of ________ is considered low

ethnocentrism

the belief that one's own group's view of the world is superior to that of others

nutritional status

the body's condition related to the intake and use of nutrients

monosaccharides

the building blocks of all other carbohydrates -contains one molecule of C6H12O6

energy

the capacity to do work -exists in a variety of forms

unsaturated fatty acid

the carbon atoms are joined together by one or more of such double bonds

the degree or nature of the hydrogen atom saturation

the chemical structure of fatty acids is based on what?

health

the complete physical, mental, and social well-being and not merely the absence of disease or infirmity

c. resting energy expenditure; physical activity, and, to a lesser extent, the thermic effect of foods

the components of energy expenditure are: a. mental activity and physical activity b. thermic effects of exercise and foods c. resting energy expenditure; physical activity, and, to a lesser extent, the thermic effect of foods d. thermic effect of foods, physical activity, and thermic effect of exercise

nutrient density or foods

the concentration of nutrients in a food compared with the food's kcal content

protein and carbs

the consumption of what two nutrients results in a larger thermic effect than the consumption of fat?

bomb calorimeter

the energy content of individual foods is measured by what device?

kilocalories

the energy in both foods and in the body is measured in what?

resting energy expenditure (REE)

the energy that is used by a person at rest

thermic effect of exercise

the energy that one expends during exercise an affect the REE up to 48 hrs after the exercise

secondary prevention

the establishment of monitoring techniques to discover diseases early enough to provide the opportunity to control their effects

gluteal-femoral obesity

the excess weight is around the client's buttocks, hips, and thighs -clients with this are said to be pear-shaped and are not susceptible to chronic disease risks associated with excessive body fat

c. beef kabobs

the following foods are incomplete proteins, except? a. baked beans b. broccoli c. beef kabobs d. bread sticks

empty kcal

the food contains kcal and almost no nutrient

gastric phase

the food in the stomach -when you have food there, there is more gastrin and more gastric juices

incidence

the frequency of occurrence of any event or condition over time and in relation to the population in which it occurs (i.e. looking at female weight over a 10-yr period)

genetic code

the human body's internal instructions for manufacturing proteins

primary prevention

the implementation of practices that are likely to avert the occurrence of diseases

a. obtaining an accurate height and weight b. documenting what the client states about recent food intake c. documenting that the list states that he has had nausea and vomiting for the past 2 days d. obtaining client's cultural and/or religious food preferences

the important, supportive role nurses have in obtaining a client's accurate nutritional assessment includes: (select all that apply) a. obtaining an accurate height and weight b. documenting what the client states about recent food intake c. documenting that the list states that he has had nausea and vomiting for the past 2 days d. obtaining client's cultural and/or religious food preferences

food insecurity

the limited or uncertain availability of nutritionally adequate and safe foods or doubtful ability to acquire food, whether some of the time or always

small intestine

the longest portion of the alimentary canal -consists of duodenum, jejunum, and ileum (passage through takes about 5 hours) -major organ of digestion and most absorption (bc it contains villi--increases absorption surface area for nutrients, and microvilli--enhances absorption)

starch

the major source of carbohydrate in the diet -storage form of plant carbohydrate -found primarily in grains, starchy vegetables, legumes, and in foods made from grain -all of these yield simple sugars on digestion -mostly low in fat and high in carbohydrates -some have the advantage of containing much fiber

emulsification

the physical breaking up of fats into tiny droplets -in this way, more surface area of the fat is exposed to the chemical action of the enzyme pancreatic lipase -pancreatic lipase completes the digestion of fats by reducing triglycerides to diglycerides and monoglycerides, fatty acids, and glycerol

hydrogenation

the process of adding hydrogen to a fat of vegetable origin (unsaturated) either to extend the fat's shelf life or make the fat harder

acculturation

the process of adopting the values, attitudes, and behavior of another culture -often encourages less desirable health behaviors than were previously practiced

epigenetics

the process that regulates how and when genes are turned on and off -it may occur in response to internal factors and external/environmental factors

life expectancy

the prospect of a certain mean length of life at a specified age based on current mortality rates in the population being considered

acceptable macronutrient distribution range (AMDR)

the range of intake for a particular energy source that is associated with reduced risk of chronic disease while providing intakes of essential nutrients

enrichment

the restoration to a product of nutrients that were lost during processing

nutrition

the science of food and its relationship to health

anthropometry

the science of measuring the body -used to determine growth, body composition, and nutritional status

chyme formation

the semifluid mass of partially digested food

daily weight

the single most important indicator of fluid status -1 L = 1 kg or 2.2 lbs -changes in this caused by metabolic events and fluid shits (third space losses)

atom

the smallest particle of an element that retains its physical characteristics

molecule

the smallest quantity in which a substance may be divided without loss of its characteristics

slower -bc if you have fat in the duodenum, the hormone that is released is called the gastric inhibitory polypeptide -peristalsis of the stomach slows chyme passage

the stomach empties ______ with a high fat diet

nutrigenomics

the study of the interaction between one's diet and his or her genes -these interactions can markedly influence digestion, absorption, and elimination as well as influence their sites of action

solute

the substance that is dissolved in a solvent

metabolism

the sum of all physical and chemical changes that take place in the body

double bond

the type of chemical connection between two neighboring carbon atoms, each lacking one hydrogen atom

tertiary prevention

the use of treatment techniques after a disease has occurred to prevent complications or to promote maximum adaptation

peristalsis

the wavelike movement that propels food through the entire length of the alimentary canal -caused by the contraction and relaxation of the circular and longitudinal muscles that make up the external muscle layer of the alimentary canal -opposite direction of vomiting -fast peristalsis-->the movement too fast of food that can lead to diarrhea

conditionally (acquired) essential amino acids

these are conditionally essential or can all of a sudden become essential, depending on the biochemical needs of the body and the health of its organs due to illness or stress

starches

these are often called complex carbohydrates because they have a complex structure

sugars

these are often called simple carbohydrates because they have a simple structure

fats or foods high in fat

these foods have the highest kcal density

hypothalamus -thirst is a dryness in the mouth that stimulates desire to drink liquids-->sodium and solute levels rise in the blood as water level get low which causes water to be drawn from salivary glands to be put into the blood and the mouth becomes dry-->thirst -older individuals water needs affected by disease and medication--may not sense that they need water

thirst mechanism is controlled by which part of the brain?

kidneys

this body part has the main responsibility to remove excess sodium

liver glycogen

this helps sustain blood glucose levels during sleep

length of fatty acid chain -chain length has dietary implications

this is determined by the number of carbon atoms and determines how body transports fats

antidiuretic hormone

this is released by pituitary gland which tells kidneys to stop excretion of urine and constricts blood vessels and the retained fluid is recycled

kidneys

this part of the body regulates the amount of water excreted

liver

this regulates the amount of amino acids that are available for protein synthesis

vitamin d -no milk or milk alternatives

this vitamin supplementation is recommended in breastfed infants

nonessential amino acids

those that the body ordinarily can build in sufficient quantities to meet its needs -typically are derived from other amino acids -necessary for good health, but under normal conditions, adults do not have to obtain them from food

c. eat 2 servings of fish per week based upon a 2,000-kilocalorie diet d. consume no more than 5%-6% saturated fatty acids (AHA guidelines) e. consume less than 10% saturated fatty acids (dietary guidelines for americans)

to lower your risk of coronary heart disease, the average person should: (select all that apply) a. take 3 g of purified fish oil supplement daily b. consume no more than 11% saturated fatty acids c. eat 2 servings of fish per week based upon a 2,000-kilocalorie diet d. consume no more than 5%-6% saturated fatty acids (AHA guidelines) e. consume less than 10% saturated fatty acids (dietary guidelines for americans)

prevalence

total number of individuals in the population at a certain time

liver transplantation

treatment for end-stage liver disease -typically compromised nutritional status already -nutrition therapy -->pre-transplantation (provide enough calories and protein to decrease protein catabolism and correct nutritional deficiencies) -->initially Post-transplantation (individualized to patient needs; adequate calories and protein; TPN if nutritional needs not met orally or via tube feeding; may need nutritional supplements between meals) -->long-term post-transplantation (well-balanced diet to maintain healthy weight)

types -rapid/short acting-->lower BGL within 5 to 10 minutes after injection and has its strongest effect 30 minutes to 3 hours after injection; adjusted for meals -intermediate acting-->lower BGL within 1 to 2 hours after injection and has its strongest effect 6 to 12 after injection -long acting-->starts to lower BGL 4-6 hours after injection strongest effect 10-18 hours after injection regimens -conventional or standard -->intermediate-acting insulin combined with short/rapid acting insulin -->mixed dose of insulin -->food intake and insulin administration to be synchronized -flexible or Intensive -->multiple daily injections of short/rapid acting insulin before meals with intermediate-acting insulin 1-2 times a day -->adjusted to correspond with food intake -continuous subcutaneous insulin infusion -->insulin pump (best option, replicates our body) -->form of intensive therapy -->rapid/short acting insulin pumped continuously, and bolus given before meals

treatment: insulin

-oral hypoglycemia agents -->function: lower blood glucose and stimulate insulin release from pancreatic beta cells (reduces glucose output from liver, increases uptake in tissue) -->metaformin - popular oral med -->medications often used in combination to control BG

treatment: oral medications

lipids

true fats and oils as well as lipids and sterols

-check tube placement before feedings or meds start by aspirating gastric contents -check residual every 4 hours and return residual to stomach (greater than 100 cc or what dr ordered, hold feeding and notify dr) -tubes placed in small bowel are at a decreased risk for aspiration -head of bead elevated 30-45˚ -irrigate tube every 6-8 hours with 40-50 cc of warm water; also after each feeding, flush tubes before meds and after meds -crushed meds--dilute with water -tubing, syringe, and formula bag changed every 24 hours -feedings could not be hung more than 8 hours -give good oral and lip care -documentation (record i&o, tubing changes, type of formulas, and description of skin at the sight)

tube feeding considerations

benign

tumors that are localized but potentially dangerous if situated in vital organs

malignant (cancerous)

tumors that infiltrate surrounding tissue and spread to distant parts of the body

c. 3

twelve grams of simple carbohydrate is equal to ___ tsp of sugar a. 1 b. 2 c. 3 d. 4

trypsin and chymotrypsin

two of the major pancreatic enzymes that have inactive precursors that are activated by other enzymes -these are present during protein digestion

intensity and duration of the physical activity

two things that affect the energy expenditure?

peptic ulcer disease (PUD)

ulceration of the lining of the lower esophagus, stomach or duodenum -cause -->helicobacter pylori (H. pylori) -->non-steroidal anti-inflammatory drugs (NSAIDS) -->GERD -risk -->hemorrhage -->perforated GI wall -treatment -->antibiotics (for H. pylori) -->acid-reducing medications -nutrition therapy -->no evidence that a "bland diet" (or any specific diet) helps -->diet modifications to be individualized -->possible irritants: red and black pepper, chili pepper, caffeine, alcohol

2-6 hours

under gastric motility, it takes how many hours for the food to get through the stomach?

tapeworms

undercooked beef and pork; ingestion of raw seafood -symptoms minimal or none -person can develop b12 deficiency, anemia, infections with diarrhea, obstruction of bile duct or intestine

energy expenditure

varies from day to day -measures by # of kilocalories that body is demanding for fuel (rocking in a chair vs. riding a bike)

constipation

varies individually -in general: -->less than 3 bowel movements in 1 week -->straining to pass bowel movement -->dry, hard stool -cause -->slow movement of feces through the GI tract -nutrition therapy -->fluids (water) -->fiber -other therapies -->increased activity -->medications

high fructose corn syrup (HFCS)

very sweet because the cornstarch has been treated with an enzyme that converts some of the naturally present glucose to the sweeter fructose

-night blindness -xerophthalmia: an abnormal thickening and drying of the outer surface of the eye, is the leading cause of preventable childhood blindness

vitamin A deficiency causes what diseases?

ariboflavinosis

vitamin B2 (riboflavin) deficiency causes what diseases?

pellagra

vitamin B3 (niacin) deficiency causes what diseases?

scurvy

vitamin C deficiency causes what diseases?

13% -necessary for collagen formation and tissue building

vitamin C should be increased how much for pregnant women?

-rickets: causes soft bones and skeletal deformities -osteomalacia

vitamin D deficiency causes what diseases?

men--40 in women--35 in

waist circumferences of what measurements in men and women indicate an apple shaped body which is related to increased risks of type 2 diabetes, CVDs, and all cause mortality?

excretion of waste

wastes are those cells of no use to the body -solid and liquids removed through feces -gaseous wastes disposed of through lungs -liquid waste: most eliminated through kidneys then via urine, can be eliminated through skin (perspiration) -excess sodium, hydrogen, urea eliminated via kidneys

sodium

water follows ___________ concentration

solvent

water is a _________ for minerals, vitamins, glucose, and other small molecules

large intestine

water is the main substance absorbed -some absorbed of vitamins (vitamin k and some b complexes) and minerals

-C -B1 (thiamin) -B2 (riboflavin) -B3 (niacin) -B6 (pyridoxine) -B12 (cobalamin) -biotin -folate -pantothenic acid

water-soluble vitamins

jejunum of the small intestine

water-soluble vitamins are absorbed where?

B12-->stored in liver -makes daily intake necessary

water-soluble vitamins aren't stored in the body except for which one?

osteoporosis

weak and brittle bones

-first trimester-->2-4 lbs -after first trimester-->1 lb per week -more weight-->hypertension, gestational diabetes, cesarean delivery, preeclampsia -less weight-->fetal growth retardation, LBW, increased perinatal mortality

weight gain during pregnancy

five hundred rule

weight gain independent of diet composition -to lose 1 lb of body fat in a week must eat 500 kcal fewer per day (than expended) for 7 days. the opposite is true if i want to gain weight

insulin, glucagon, and somatostatin

what 3 hormones are used in blood glucose regulation?

balance, moderation, variety

what 3 things are highlighted as important in the MyPlate?

dietary status

what a client has been eating

-supply texture to food -trap and intensify its flavor -enhance its odor -contribute to satiety

what all do fats contribute to foods?

1. they act as a diuretic (increases urination) 2. soda contains solutes (sugar, salt, etc.) that once in the bloodstream need to be diluted so fluid/water is pulled from the cells and put into the bloodstream then the fluid is excreted as urine the increased solutes (sugar, salt, etc.) in the blood also increase thirst which means soft drinks make you thirstier verses quenching your thirst

what are 2 reasons coffee, tea, alcohol, and soft drinks are not primary sources of water?

-generally do not promote tooth decay -commonly have a cooling effect on the tongue -are slowly and incompletely absorbed from the intestine into the blood -may have a laxative effect for some if consumed in excess

what are characteristics of sugar alcohols?

-source of bacteria -food--bacteria can only grow in foods in a certain pH range (need a low pH) -temperature (40˚F-140˚F) (external and body temp) -time -moisture -ingestion

what are conditions for growth of bacteria?

vitamin A, vitamin C, and calcium

what are examples of essential nutrients?

-human milk -fatty fish -vegetable oils, such as soybean, flax, canola -wheat germ

what are examples of foods rich in omega-3 fatty acids linolenic acid?

-vegetable oils, such as safflower, corn, soybean, cottonseed -poultry fat -nuts and seeds

what are examples of foods rich in omega-6 fatty acids linoleic acid?

eating healthy, having a well-balanced diet

what are examples of primary preventions?

testing blood sugar levels if a person is at risk for diabetes, weight loss and diet modifications

what are examples of secondary preventions?

-highest-->eggnog, cream puff, cheesecake -lowest-->shrimp, liver

what are foods with the highest and lowest levels of cholesterol?

-lower blood pressure -lower elevated levels of cholesterol -lower elevated blood glucose levels

what are some advantages of losing weight?

-self-monitoring -stimulus control -slower-eating -reward yourself -cognitive strategies

what are some behavioral modification techniques?

-bacteria -viruses -parasites -mold -toxins -contaminants -allergens

what are some causes of illness?

-genetic -long-term or recent weight loss (which may be due to a medical diagnosis, psychological, or socioeconomic issues)

what are some causes of reduced body mass?

-overuse of antibiotics--antibiotics not only kill pathogens but also normal flora, which help keep the disease-producing organisms in balance -older age--more susceptible to bacteria than younger people -centralized food production -identification of foodborne illness -food imports -convenience foods -raw and lightly cooked foods

what are some complicating factors?

-risk of dehydration -risk to bones from acidity-->leeching of minerals

what are some concerns about high-protein diets?

-venous or lymphatic blockage -heart failure -severe protein deficiency -sodium retention -some kidney conditions

what are some conditions causing water retention?

-associated with increase mortality and decreased expectancy -respiratory disease is a big issue -difficulty maintaining body temperature -infections more likely -GI upsets

what are some consequences of reduced body mass?

-bare-handed food contact -raw product contaminates (from animal or environment) -food remaining at room temperature for several hours -insufficient time/temperature during cooking process

what are some contributing factors to acquiring bacterial foodborne disease?

the woody structural parts of plants, such as fruit and vegetable skins, and the outer coating (bran) of wheat kernels -promote regularity of bowel movements and reduce the risk of diverticular disease and some forms of cancer

what are some examples and characteristics of insoluble fibers?

beans, oatmeal, barley, broccoli, and citrus fruits -can dissolve in water and thicken to form gels -reduced cholesterol levels, regulated blood sugar levels, and weight loss

what are some examples and characteristics of soluble fibers?

-histidine -iscoleucine -leucine -lysine -methionine -cytesine -phenylalanine -tyrosine -threonine -tryptophan -valine

what are some examples of essential amino acids?

-meat products (visible fat and marbling in beef, pork and lamb, prime-grade ground meats, lard, suet, salt pork) -processed meats (frankfurters, lunch meats--bologna, corned beef, liverwurst, pastrami, salami, bacon, sausage) -poultry and fowl (chicken, turkey, cornish hens, duck, goose) -whole milk and whole-milk products (cheese, condensed milk, ice cream, whole-milk yogurt, all creams) -plant products (coconut oil, palm-kernel oil, cocoa butter) -full hydrogenated shortening and margarine, many cakes, pies, cookies, mixes

what are some examples of food sources of saturated fats?

-canola, olive, peanut oils -almonds, avocados, cashews, filberts, olives, peanuts

what are some examples of foods high in monounsaturated fatty acids?

-corn, cottonseed, mustard seed, safflower, sesame, soybean, and sunflower seed oils -halibut, herring, mackerel, salmon, sardines, fresh tuna, trout, whitefish

what are some examples of foods high in polyunsaturated fatty acids?

-alanine -arginine -aspartic acid -citruline -glutamic acid -glycine -hydroxyglutamic acid -hydroxyproline -norleucine -proline -serine

what are some examples of nonessential amino acids?

scar tissue, hair, blood albumin, hemoglobin

what are some examples of protein in the body?

-rate of consumption and time of day -other components in food besides carbs: fat, fiber, protein, starch -how food is prepared and processes -physiological effects, which is different from individual to individual -non-dietary factors: medications, stress, physical activity, overall health status

what are some factors that influence GI?

-variety -taste -weekend activity -skipping breakfast -eating out -speed -soda intake -dietary fat

what are some factors that influence how much food is eaten and kcal consumption?

-transport of gases, nutrients, and waste products -provides a barrier to the transfer of some substances such as maternal red blood cells and bacteria

what are some functions of placenta?

-reduce body weight 10% from current weight -current weight referred to as "baseline" -safe: 1-2#/week over 6 months

what are some goals for weight loss?

-decreased risk of cardiovascular disease -improved blood sugar control for people with diabetes -decreased risk of obesity -reversal or prevention of varicose veins -decreased risk of osteoporosis -improved quality of sleep -improved hypertension control

what are some health benefits of aerobic exercise?

-muscle toning -the building of muscular strength and endurance -building of bone mass

what are some health benefits of anaerobic exercise?

-obesity prevention -constipation -diverticular disease -colon cancer -heart disease -diabetes control

what are some health benefits of fiber?

-keep it simple -combine high GI foods with lower GI -do not worry about foods that contribute ≤5 g of carbs

what are some hints to incorporate the GI into the diet and include them in suggestions?

-less accuracy in the extremely obese -over hydration and under hydration -hormone abnormalities -need for qualified technician

what are some limitations to consider when measuring percentage body fat?

-hypertension -dyslipidemia (e.g. high total cholesterol or high levels of triglycerides) -type 2 diabetes -coronary heart disease -stroke -gallbladder and liver disease -osteoarthritis -sleep apnea and respiratory problems -distribution of faat

what are some medical consequences of obesity?

-carbohydrates-->fructose and galactose changed to glucose, excess glucose converted to glycogen -lipids-->lipoproteins formed, cholesterol synthesized, triglycerides broken down and built -amino acids-->nonessential amino acids manufactured, excess amino acids deaminated and then changed to carbohydrates or fats, ammonia removed from the blood, plasma proteins made -others-->alcohols, drugs, and poisons detoxified

what are some metabolic modifications in the liver?

-leptin -insulin -cholecystokinin -bombesin -enterostatin -lipoprotein lipase -glucose -fatty acids -ketone bodies -vagal input -GLP 1 -PYY 3-36 -ghrelin

what are some molecules and pathways that may stimulate or inhibit food intake outside the central nervous system?

-serotonin -dopamine -corticotropin-releasing hormona a MSH -cocaine-and amphetamine-regulating transcript -enterostatin

what are some nitrogen-containing compounds that inhibit food intake in the hypothalamus and other regions of the brain?

-norepinephrine -neuropeptide Y -galanin -opioids -MCH -agouti-related protein -orexin

what are some nitrogen-containing compounds that stimulate food intake in the hypothalamus and other regions of the brain?

-B12-->individuals consuming few or no animal products; infants of vegan mothers -D-->individuals consume few or no animal products, living in northern latitudes, and those with dark skin or limited sun exposure -calcium-->individuals not consuming dairy products -iron-->individuals consuming few or no animal products -omega-3 fatty acid-->adequate source of linolenic acid

what are some nutrients that vegetarians may be deficient in and why should they consider supplementation?

-maintain diets-->low in cal and fat -eat breakfast -weigh oneself weekly -watch less than 1 hr of tv per week -exercise (on ave.) 1 hr per day

what are some of national weight control registry's findings in the best ways to lose weight?

-linoleic acid (omega-6) oil sources-->corn, safflower, sunflower --alpha-linolenic acid (omega-3) oil sources-->canola, flaxseed, soybean, walnut

what are some oil sources of linolenic (omega-3) and linoleic (omega-6) fatty acids?

-usually has low LBM -women cease to ovulate and menstruate -cardiac abnormalities -more prone to infections -risk for osteoporosis

what are some overall issues with decreased body mass in reference to eating disorders?

-clean -separate -cook -chill

what are some recommendations to reduce risk?

-provide accurate information -warn against dangerous practices -teach clients to evaluate risks and benefits -refer clients to health-care professionals -help clients set realistic goals -->encourage modest amounts of weight loss, allows for maintenance, helps to prevent future weight gain, encourage 5%-10% from baseline (1#/week)

what are some roles of nutrition educators?

-cultural expectation -documented prejudice

what are some social consequences of obesity?

-use low-fat or non-dairy products (skim milk, cheese, yogurt) -brown meats by broiling or cooking in nonstick pans with little or no fat. avoid fried foods -chill soups, stews, sauces, and broths. lift off and discard hardened fat -add extra veggies to casseroles, chili, lasagna, or other hot dishes -trim all visible fat from meat before cooking -use water-packed, canned foods such as fruits and tuna -use fresh fruits and veggies often. try to eat at least 2 1/2 cups of these foods each day -use low-kcal salad dressings -don't look at the menu at a restaurant. instead, decide what you want beforehand -eat smaller portions -limit consumption of sodas and other empty kcal foods

what are some tips for decreasing kcal density of a diet?

-dietary therapy -physical activity -behavioral modification -pharmacotherapy -surgery -combined therapy

what are some ways of achieving weight loss?

-complete nutritional assessment -daily weights -regaining weight by monitoring of actual food intake and calculating the kcals -counseling regarding nutrition -psychotherapy/behavioral therapy/family therapy/group therapy -psychopharmacology -medical therapy

what are some ways that eating disorders are treated in the hospital setting?

-alcohol-->crosses placenta; inadequate enzymes in fetus so fetus can't detoxify the alcohol, so you will see fetal alcohol syndrome -soft cheese and read-to-eat meats-->listeriosis (bacterial foodborne illness; incubation period: 3-70 days) -certain species and amounts of fish-->methylmercury (environmental neurotoxin harmful to fetal brain development; fish to avoid: shark, swordfish, king mackerel, tilefish) -undercooked meat and unwashed produce (toxoplasmosis: caused by a parasite; causes the following for infants: mental retardation, blindness) -caffeine-->inconsistent harmful results of intake to pregnant women and fetus

what are substances that should be avoided during pregnancy?

1. serve as a source of energy or heat (carbs, fats, proteins) 2. support the growth and maintenance of tissue 3. aid in the regulation of basic body processes

what are the 3 functions of nutrients?

1. carbohydrates 2. fats (lipids) 3. proteins 4. minerals 5. vitamins 6. water

what are the 6 classes of nutrients?

-calcium -phosphorus -magnesium -sodium -potassium -chloride -sulfur

what are the 7 major minerals?

-iron -iodine -fluoride -zinc -copper -selenium -chromium

what are the 7 trace minerals?

-sufficient vitamin D -acidity of digestive mass -excessive intake of phosphorus or magnesium

what are the absorption factors of calcium?

-dry scaly skin -decreased growth in infants and children -increased susceptibility to infection -poor wound healing

what are the clinical signs of essential fatty acid deficiency?

women: >35 in men: >40 in

what are the diff. wast measurements that can show a risk of obesity for men and women?

-<18.5 = underweight--> 12.5-18 kg (28-40 lbs) -18.5-24.9 = normal--> 11.5-16 (25-35 lbs) -25-29.9 = overweight--> 7-11.5 kg (15-25 lbs) ->30 = obese--> 5-9 kg (11-20 lbs)

what are the different recommended weight gains for pregnancy?

-sodium pumps--moves sodium ions out of cells (and water follows) -potassium pumps--move potassium ions into cells -determination of osmotic pressure

what are the different transport mechanisms?

-monosaccharides from carb digestion -fatty acids and glycerol (and often monoglycerides) from fats -small peptides and amino acids from protein

what are the end products of digestion?

1. water 2. protein 3. fat 4. ash (mineral content as in the skeleton) 5. carbohydrate

what are the five types of substances that the human body is made of?

1. provides energy 2. helps prevent ketosis 3. naturally occurring sweeteners (sucrose and fructose) 4. brain and nerve tissues require CHO (glucose) as fuel (enhance learning and memory processes) 5. protein-sparing effects

what are the functions of carbohydrates?

1. component of bile salts 2. essential component of cell membranes 3. found in brain and nerve tissue and blood 4. precursor for production of steroid hormones 5. needed to manufacture vitamins D and sex hormones --cholesterol is a sterol

what are the functions of cholesterol?

-liver and brain function -lipid metabolism -cell membrane structure

what are the functions of choline?

-synthesis of DNA, RNA, metabolism of amino and fatty acids -synthesis and maintenance of myelin

what are the functions of cobalamin?

1. essential-->acts as a cushion, regulates body temperature, stockpiles energy 2. storage-->helps with energy reserve

what are the functions of fat?

-fuel source -vehicle for fat-soluble vitamins -satiety value -sources for essential fatty acids

what are the functions of fats in food?

1. supply fuel to most tissues 2. function as an energy reserve 3. insulate the body 4. support and protect vital organs 5. lubricate body tissues 6. form an integral part of cell membranes 7. carrier for the absorption of fat soluble vitamins

what are the functions of fats in the body?

-essential to the formation of DNA -participant in formation of heme

what are the functions of folate?

-coenzyme in fatty acid metabolism -many other metabolic and regulatory processes

what are the functions of pantothenic acid?

-provision of structure -maintenance and growth -regulation of body processes -immunity -circulation -energy source

what are the functions of proteins in the body?

-vision -maintaining epithelial tissue

what are the functions of vitamin A?

most are a result of supplements -stimulates bone production -decreases urinary excretion of calcium

what are the functions of vitamin D?

-antioxidant -protects polyunsaturated fatty acids in red blood cell membranes from oxidation in lungs

what are the functions of vitamin E?

-used in synthesis of several clotting factors, including prothrombin -assists vitamin D to synthesize a regulatory bone protein

what are the functions of vitamin K?

-co-enzymes-->causing reactions in cells, activating an enzyme in energy metabolism but not changing or participating themselves -regulate metabolic processes-->help absorb nutrients that are used by the body for energy, structures, and functioning -prevention of diseases

what are the functions of vitamins?

-structural component of cells -maintains blood volume and blood pressure -regulation of body temperature-->water conducts heat, absorbing and distributing it throughout the body, keeping the body temp stable; cools by evaporating invisibly from the lungs and surface of the skin (insensible perspiration) -lubricant -shock-absorber: cushions body tissues -solvent for transport of nutrients and waste -source of trace minerals -participates in chemical reactions

what are the functions of water?

-whole milk--> fat = 8g, % of kilocalories from fat = 48% -2% (low fat)--> fat = 5g, % of kilocalories from fat = 38% -nonfat milk--> fat = trace, % of kilocalories from fat = <1

what are the grams of fat and percentage of kilocalories from fat in whole milk, 2% milk, and nonfat milk?

men-->15%-19% women-->18%-22%

what are the health ranges for body fat for men and women?

-higher intake of monounsaturated and polyunsaturated fats -low intake of saturated fats -low total fat intake

what are the intake levels that may cause a decreased risk of coronary heat disease?

carbohydrates because they break down rapidly and are readily available for use

what are the major source of energy and why?

-men (age 20-59)--> 2,493-2,704 kcal/day -women (age 20-59)--> 1,779-1,933

what are the mean reported energy intakes for men and women?

carbohydrate, fats, proteins

what are the nutrients that supply energy? -referred to as energy nutrients

sodium, potassium, chloride

what are the three electrolytes in the body?

glucose, fructose, and galactose

what are the three important monosaccharides?

starch, glycogen, and fiber

what are the three types of complex carbohydrates of nutritional importance?

-norovirus--58% -salmonelle nontyphoida -clostridium perfringens -campylobacter -staphylococcus aureus -listeria monocytogenes -toxoplasma gondii

what are the top microbiological hazards?

-15%-20% in men -25%-30% in women

what are the total body fat recommendations for men and women?

-preformed vitamin A (retinol) -provitamin A

what are the two forms of vitamin A?

eggs and human milk

what are the two highest quality protein foods?

nutritional screening and nutritional assessment

what are the two levels of methodology that are commonly used to identify clients at nutritional risk?

-BMI -waist circumference

what are two ways of determining overweight and obesity?

can cause iron deficiency anemia -preterm delivery -low birth weight -irreversible damage to the nervous system of the infant

what can a deficiency of iron cause for fetuses?

general appearance, anthropomorphic measurements, and laboratory or other diagnostic tests

what can a physical examination include?

this can harm the fetus's skeletal formation, low bone mass, low birth weight, small for their age, and intrauterine growth retardation -can also harm mother-->gestational diabetes, bacterial vaginosis, preeclampsia

what can an insufficient amount of vitamin D do to a fetus and a mother?

an organized and systemic search for pertinent subjective (what the client reports) and objective (what the health-care provider measures) data

what does a nutritional assessment usually involve?

chlorophyll

what green pigment along with sunlight is needed for photosynthesis?

cereal grain products -it has decreased neural tube defects bc so many children eat cereal

what has folic acid been added to recently?

increased energy expenditure/decreased intake-->fat from adipocyte used for energy

what helps to reduce fat cells

body image disturbances

what is a psychological consequence of obesity?

glutamine

what is an example of a conditional and/or acquired essential amino acid?

the amino acid tyrosine

what is an example of a conditionally essential nutrient?

the amino acid alanine

what is an example of a nonessential nutrient?

someone who has type 2 diabetes managing their disease well through diet, exercise, and prescribed medications -this may prevent the development of coronary artery disease

what is an example of tertiary prevention?

100-125 mg/100 mL of serum of plasma

what is considered impaired fasting glucose (IFG)?

build fetal tissue -the mother also needs adequate protein for growth of her tissues-->her blood volume increases in anticipation of blood loss at delivery, her breasts develop in preparation for lactation, and her uterus enlarges and contains a sac filled with amniotic fluid

what is protein required for?

S: subjective data O: objective data A: analysis or diagnosis based on S and O data P: plan of action or treatment

what is the SOAP route of evaluation and documentation?

45%-65%

what is the daily intake guidelines for carbs?

20%-35%

what is the daily intake guidelines for fat?

10%-35%

what is the daily intake guidelines for protein?

-coenzyme is the synthesis of fat, glycogen, and amino acids

what is the function of biotin?

maintain phenylalanine levels within safe limits -the limit in pregnant women is 120-360 µmol/L to ensure normal growth and prevent mental retardation in the fetus

what is the goal of treatment with phenylketonuria?

albumin

what is the main protein in the blood?

calcium -99% in bones and 1% in fluids

what is the most abundant mineral in our body?

monitor both food intake and body weight over time

what is the most accurate method for determining kcal need?

iron-deficiency anemia

what is the most prevalent nutritional condition in industrialized countries?

70-100 mg/100 mL of serum of plasma

what is the normal fasting blood sugar (FBS)?

-protein -carbohydrate -fat

what is the order in macronutrient energy composition of most to lest satiating?

decrease risk of disease

what is the primary reason for weight loss?

blood glucose

what is the source of energy to all cells?

folate intakes of 15 times the UL have been associated with insomnia, irritability, and GI distress

what is the toxicity related to folate?

most are a result of supplements but some can be from food -fetal malformations (significantly higher among women who consumed more than 3,000 mcg of retinol) -carotenemia -hypervitaminosis A (clients with renal failure)

what is the toxicity related to vitamin A?

-large amounts-->abdominal pain and osmotic diarrhea from bacterial metabolism of the vitamin in the colon -cause false readings in lab tests

what is the toxicity related to vitamin C?

food toxicities are unknown but many are supplemental -can cause gastrointestinal symptoms -muscle weakness -double vision -increased bleeding tendencies

what is the toxicity related to vitamin E?

neural tube defects (NTDs) -most common preventable type of birth defect in the world, and affects approx. 300,000 children worldwide -as a multifactorial condition, the exact connection of NTD to folic acid is unclear, but folate is directly or indirectly essential for cell function, division, and differentiation

what kind of defects is folic acid important for preventing?

no low fat diets (omega-3 fatty acids needed)

what kind of diet should not be implemented for an infant?

long-chain polyunsaturated fatty acids -fatty acids accumulate in the fetal brain rapid during the third trimester of gestation and during the first postpartum month -these fatty acids can be supplied directly from the diet or synthesized from the omega-6 fatty acids and omega-3 fatty acid families -it is recommended that pregnant women consume 200 mg each day

what kind of fats have demonstrated crucial importance in fetal growth and the development of the fetal retina and brain?

50%-65%

what percentage of body weight in an average adult does water take up?

75%

what percentage of body weight in an average infant does water take up?

-minerals are inorganic substances -minerals become part of the body's composition

what two things make minerals different from vitamins?

monoglyceride

when a single fatty acid is joined to a glycerol molecule

pitting edema

when finger pressure displaces excess fluid over a bony area

first and second trimester -increase in the blood volume -in fetuses-->red blood cells, placenta, and umbilical cord

when is iron especially important during pregnancy?

c. olive

when mrs. l describes her regular intake of foods you observe that her diet is especially low in monounsaturated fats. which of the following oils would you recommend be used in place of corn oil to increase her intake of monounsaturated fats? a. sunflower seed b. soybean c. olive d. cottonseed

triglyceride

when three fatty acids are joined to a glycerol molecule

diglyceride

when two fatty acid are joined to a glycerol molecule

small intestine -substances pass through the intestinal mucosa into the blood or lymph -nutrients such as fats, carbs, and protein easily absorbed regardless of level of need -vitamin and mineral absorption based on need

where does absorption primarily occur?

in the mouth -mechanical digestion--teeth, chewing -chemical--salivary amylase

where does digestion of CHO begin?

concentrated and stored in the fetal liver during pregnancy -provides the infant with stores to sustain them for the first several months of life -can be obtained in fortified foods if the mother is a vegetarian -deficiencies have shown to result in neurological deficits of the infant

where is vitamin B12 stored in infants and why?

flavors

which additive?: -purpose: food enhancers -ingredient: hydrolyzed veggie protein, black pepper, mustard, monosodium glutamate

acidity control agents

which additive?: -purpose: influence flavor, texture, and shelf life -ingredient: sodium bicarbonate, citric acid, hydrogen chloride, sodium hydroxide, acetic acid, phosphoric acid, calcium oxide

antioxidants

which additive?: -purpose: prevent discoloration, protect fats from rancidity -ingredient: vitamin c and e, butylated hydroxytoluene (BHT) and butylated hydroxyanisole (BHA)

stabilizers and thickeners

which additive?: -purpose: to enhance texture -ingredient: gum arabic, modified starch, pectin

preservatives

which additive?: -purpose: to extend shelf life -ingredient: sulfur oxide, benzoic acid, ethylenediaminetetraacetate (EDTA), sodium casein ate, sodium nitrate and sodium nitrite

leavening agents

which additive?: -purpose: to make dough rise -ingredient: sodium acid phosphate, sodium aluminum phosphate, mono calcium phosphate, yeast

lactose

which disaccharide is the least sweet of them all and occurs naturally only in milk -commonly referred to as milk sugar

sucrose

which disaccharide is the most prevalent and is ordinary white table sugar made commercially from sugar beets and sugar cane? -brown, granulated, and powdered sugars are all forms of this -also found in molasses, maple syrup, fruits, and vegetables

maltose

which disaccharide occurs primarily during starch digestion? -produced when the body breaks starches into simpler units -smaller amounts are present in malt, malt products, beer, some infant formulas, and sprouting seeds

galactose

which monosaccharide is the least sweet of them all and comes mainly from the breaking down of the milk sugar lactose?

fructose

which monosaccharide is the sweetest of them all and is usually found in fruits and honey? -also used extensively in soft drinks, canned foods, and various other processed foods

d. 1 cup of margarine

which of the following foods is the most kilocalorie dense? a. 1 cup of sugar b. 1 cup of celery c. 1 cup of skim milk d. 1 cup of margarine

b. lactose

which of the following is a disaccharide? a. glucose b. lactose c. fructose d. galactose

b. fats e. carbohydrates

which of the following is an energy nutrient? (select all that apply) a. phytochemicals b. fats c. vitamins d. minerals e. carbohydrates

a. a gain in weight of 2 pounds in 2 weeks

which of the following outcomes would indicate achievement of the nutritional objective for mr. p? a. a gain in weight of 2 pounds in 2 weeks b. an invitation to the nurse to join him for a dinner he has learned to cook c. a report by mr. p that he is eating better d. a visual inspection of mr. p's refrigerator revealing fresh meat and milk products in abundance

d. surgical client, first day after a stomach resection

which of the following people would the nurse regard as being in a catabolic state? a. adolescent boy who is into bodybuilding b. lactating mother c. pregnant woman in the second trimester d. surgical client, first day after a stomach resection

c. recommend that mr. p supplement his meals with one of the milk-based liquid breakfast products

which of the following plans would be most appropriate to increase mr. p's protein consumption immediately? a. refer client to nutrition education program b. have mr. p apply for home-delivered meals c. recommend that mr. p supplement his meals with one of the milk-based liquid breakfast products d. suggest to mr. p that he sign up for cooking lessons at the local high school or community college

b. measuring midarm circumference

which of the following techniques is used to estimate the body's protein stores? a. weighing the person underwater b. measuring mid arm circumference c. calculating the body mass index d. determining tricep skinfolds

vitamin k -deficiency causes hemorrhaging

which vitamin is administered shortly after birth by injection or orally?

B1, B12, biotin, pantothenic acid

which vitamins are not known to have toxic or poisonous levels?

-A-->deep yellow, dark green leafy -C-->fresh fruit-citrus, vegetables

which vitamins' food sources are limited to fruit and vegetable groups?

-registered dietician -rn -ot -speech pathologist

who might be involved in the assessment?

functional foods

whole foods along with fortified, enriched, or enhanced foods that have a potentially beneficial effect on health when consumed as part of a varied diet on a regular basis at effective levels on significant standards of evidence

bc they put out beta endorphins with exercise and this has an effect similar to natural morphine (helps relax an individual) -individuals who have a severe eating disorder may exercise compulsively to relax

why does exercise decrease the appetite?

-effect on body processes such as water amount in body -travel in blood as acids, bases, and salts -role in normal functioning of nerves and muscles -each mineral serves other specific functions in the body

why is maintaining electrolyte balance important?

-formation of placenta -development of embryo and fetus's organs -rebuilding of nutrient stores

why is nutrition important during pregnancy

bc it is inorganic (does not contain carbon-->not composed of plant or animal) -quickly passes from the mouth to the small intestine where most is absorbed -what is not absorbed in the small intestine goes to the large intestine where it is absorbed or excreted in feces

why is water not digested

intravascular fluids

within the blood vessels, arteries, arterioles, capillaries, granules, and veins -plasma: liquid part of blood (91.5% is water) -serum: liquid part of blood without clotting elements

intracellular fluids

within the cell -water + potassium and phosphates

avitaminosis

without vitamins

pregnant women and those lactating need 50% more than non-pregnant women -fetus acquires this during the third trimester -deficiency can have an affect on the endocrine system

zinc during pregnancy