NUR212B: Nutrition:

A person with a BMI below ____ is underweight, a BMI of _____ to _____ is a healthy weight, a BMI of ______ to _____ indicates an overweight person, a BMI of _____ or greater indicates obesity, and a BMI of _____ or greater indicates extreme obesity.

A person with a BMI below 18.5 is underweight, a BMI of 18.5 to 24.9 is a healthy weight, a BMI of 25 to 29.9 indicates an overweight person, a BMI of 30 or greater indicates obesity, and a BMI of 40 or greater indicates extreme obesity. (Practice drawing it out as a scale)

People with a larger WAIST CIRCUMFERENCE are

At a greater risk for disease

_________ is the energy required to carry on the involuntary activities of the body at rest—the energy needed to sustain the metabolic activities of cells and tissues. These activities include actions such as maintaining body temperature and muscle tone, producing and releasing secretions, propelling food through the gastrointestinal (GI) tract, inflating the lungs, and contracting the heart muscle.

BASAL METABOLISM is the energy required to carry on the involuntary activities of the body at rest—the energy needed to sustain the metabolic activities of cells and tissues. These activities include actions such as maintaining body temperature and muscle tone, producing and releasing secretions, propelling food through the gastrointestinal (GI) tract, inflating the lungs, and contracting the heart muscle.

BMI also provides an estimation of relative risk for diseases such as ______, ______, and ______.

BMI also provides an estimation of relative risk for diseases such as heart disease, diabetes, and hypertension.

BMI for age percentile: 1. Less than the ______ percentile is UNDERWEIGHT 2. From the _____ to the ______ percentile is a HEALTHY WEIGHT 3. ______ to the ______ percentile is OVERWEIGHT 4. ______ percentile or greater is OBESE

BMI for age percentile: 1. Less than the 5th percentile is UNDERWEIGHT 2. From the 5th to the 85th percentile is a HEALTHY WEIGHT 3. 85th to the 95th percentile is OVERWEIGHT 4. 95 percentile or greater is OBESE

______, ______, and _______ provide ENERGY, which is measured in _______

Carbohydrates, proteins, and fats provide ENERGY, which is measured in CALORIES

Essential nutrients that supply energy and build tissue (such as carbohydrates, fats, protein) are referred to as _______. _______, such as vitamins and minerals, are required in much smaller amounts to regulate and control body processes.

Essential nutrients that supply energy and build tissue (such as carbohydrates, fats, protein) are referred to as MACRONUTRIENTS. MICRONUTRIENTS, such as vitamins and minerals, are required in much smaller amounts to regulate and control body processes.

However, it is important to note that BMI may not be accurate for certain groups of people, such as ________, with a large muscle mass, people with _____ or ______, and _______ and others who have lost muscle mass.

However, it is important to note that BMI may not be accurate for certain groups of people, such as ATHLETES, with a large muscle mass, people with EDEMA or DEHYDRATION, and OLDER PEOPLE and others who have lost muscle mass.

______ are specific biochemical substances used by the body for growth, development, activity, reproduction, lactation, health maintenance, and recovery from illness or injury.

NUTRIENTS are specific biochemical substances used by the body for growth, development, activity, reproduction, lactation, health maintenance, and recovery from illness or injury.

The ________ is the study of how food nourishes the body.

The SCIENCE of NUTRITION is the study of how food nourishes the body.

The more preferred methods to establish ideal body weight include ______ for adults and children and measurement of ______ for adults only

The more preferred methods to establish ideal body weight include BODY MASS INDEX (BMI) for adults and children and measurement of WAIST CIRCUMFERENCE for adults only

How do you calculate BMI?

Using pounds and inches: Weight/Height x 703

Vitamins and minerals, needed for the _______ of energy, do not provide calories.

Vitamins and minerals, needed for the METABOLISM of energy, do not provide calories.

FIGURE 35-4. Levin tube. FIGURE 35-5. Dobbhoff tube. (Taylor 1226) Go over the photos and process it in your head

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ADMINISTRATION OF ENTERAL FEEDING Feeding Schedule. Based on the patient's physical, medical, and nutritional condition, the nutritionist usually makes recommendations concerning the feeding pattern or schedule. Continuous feedings allow gradual introduction of the formula into the GI tract, promoting maximal absorption. They require use of an enteral feeding pump, which limits the patient's mobility and increases cost. Continuous feeding into the stomach, however, is controversial because of the risk for reflux and aspiration. Feedings into the intestine are always continuous to avoid triggering dumping syndrome, as the natural reservoir of the stomach is bypassed. Dumping syndrome is caused by overdistention of the small intestine. The use of intermittent or bolus feedings would provide larger-than-normal amounts of food and liquid in the proximal small intestine, causing overdistention, leading to nausea, diarrhea, cramping, and lightheadedness (Taylor 1229)

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ASSESSING DIETARY INTAKE Many different methods can be used to assess actual dietary intake. 24-Hour Recall Method. The easiest way to collect dietary data is to obtain a 24-hour recall of all food and beverages the patient normally consumes during an average day. Ask the patient to recall details related to nutritional intake from the prior 24 hours. This method includes the patient's portion sizes, meal and snack patterns, meal timing, and location where food is eaten. Because this method relies on memory and accurate interpretation of portion sizes, the information may not be reliable. Food Diaries/Calorie Counts. Food diaries and calorie counts require documentation of actual intake for a specified period of time. In an outpatient setting, ask the patient to record everything the patient has had to eat or drink, including portion size, over a set period of time. In the hospital setting, documentation is usually completed by the nursing staff. These tools may provide a better overall picture of nutrient intake because all food and beverages consumed in a specified period, usually 3 to 7 days, are recorded. Food Frequency Record. Food frequency records give a general picture of nutritional consumption. Ask patients questions to elicit an average number of times certain foods or food groups are consumed in a given period of time: per day, per week, or per month. For example, ask, "How many times in the last week have you eaten fresh fruit or fish?" or "How many times in the last week have you had a glass of milk?" Diet History. A more comprehensive approach to diet assessment is a full diet history. In addition to a 24-hour food recall, calorie counts/food diaries, and food-frequency record, interview questions are geared to provide information on past and present food intake and habits. Sample questions are included in the accompanying Focused Assessment Guide 35-1 . (Taylor 1215)

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For the skills, either keep rereading and make sure you make flashcards on the parts in red or if you have time write down the title and the most important parts while digesting the info then make flashcards on the red parts

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Intermittent feedings are the preferred method for gastric feeding. Intermittent feedings are delivered at regular intervals in equal portions, introducing the formula gradually over a set period of time via gravity or a feeding pump. Alternately, bolus intermittent feedings, for which a syringe is used to deliver the formula quickly into the stomach, may place the patient at risk for aspiration or cause distention. They are usually not recommended but may be used in long-term situations if tolerated by the patient. Intermittent feedings resemble a more normal pattern of intake and allow the patient freedom of movement between feedings (Dudek, 2014). Another option is cyclic feeding. This involves administering continuous feeding for a portion of the 24-hour period. The usual routine is to feed the patient for 12 to 16 hours, most often overnight. Cyclic feeding allows the patient to attempt eating regular meals during the day, if this is possible, making ambulation and activity easier. Skill 35-2 describes administration of a tube feeding. (Taylor 1229)

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MEDICAL AND SOCIOECONOMIC DATA Medical, social, and economic factors, as well as cultural and psychological influences, require evaluation for their impact on nutritional requirements and food choices. A nutritional assessment should include the following medical, social, and economic information. Medical data include: Current illness as well as medical and surgical history Past and current drug history History of drug dependence or abuse (Taylor 1215) Ability to chew and swallow, including condition of mouth, missing teeth, or dentures Appetite, food intolerance and allergies, and bowel habits Social data include: Age, gender, family history, lifestyle (e.g., those at extremes in age are most at risk) Educational background Information about occupation, exercise, and sleep patterns Religious affiliation, cultural and ethnic background Use of alcohol and tobacco Economic Data include: Source of income Food budget (Taylor 1216)

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Reread all the info then go over GUIDELINES FOR NURSING CARE 35-1 VISUAL ASSESSMENT AND pH MEASUREMENT OF GASTRIC CONTENTS (Taylor 1227)

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Reread and process FIGURE 35-6. Percutaneous endoscopic gastrostomy tube in place in the stomach. (Taylor 1228)

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Short-Term Nutritional Support (Taylor 1225) Watch the Video on a Nasogastric Tube

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(BOX 35-6) Biochemical Data with Nutritional Implications Hemoglobin (normal = 12-18 g/dL) decreased → anemia Hematocrit (normal = 40%-50%) decreased → anemia increased → dehydration Serum albumin (normal = 3.5-5.5 g/dL) decreased → malnutrition (prolonged protein depletion), malabsorption Prealbumin (normal = 23-43 mg/dL) decreased → protein depletion, malnutrition Transferrin (normal = 240-480 mg/dL) decreased → anemia, protein deficiency Blood urea nitrogen (normal = 17-18 mg/dL) increased → starvation, high protein intake, severe dehydration decreased → malnutrition, overhydration Creatinine (normal = 0.4-1.5 mg/dL) increased → dehydration decreased → reduction in total muscle mass, severe malnutrition (Taylor 1218)

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ANTHROPOMETRIC DATA Anthropometric measurements are used to determine body dimensions. In children, anthropometric measurements are used to assess growth rate; in adults, they can give indirect measurements of body protein and fat stores. For the data to be accurate and reliable, use standardized equipment and procedures, and compare the data with the appropriate reference standards for the patient's age and gender. Obtain height and weight, the most common anthropometric measurements, when the patient is admitted to the health care facility and periodically thereafter or assess height and weight in a home care environment. Weigh a patient on the same scale each time and at the same time of day, preferably before breakfast. Height and weight are used to calculate the patient's BMI. Because actual weight may be increased if the patient has edema, consider hydration status. Although self-reported weight may be recorded when actual weight is unobtainable, it is highly inaccurate and must be noted. Record an actual weight as soon as feasibly possible. Self-reported height in the older adult can be inaccurate related to shortening of the spine (DiMaria-Ghalili & Amella, 2005). Record an actual height as soon as possible. Additional anthropometric measurements include triceps skin-fold measurements, a measure of subcutaneous fat stores; midarm circumference, a measure of skeletal muscle mass; and midarm muscle circumference, a measure of both skeletal muscle mass and fat stores. (Taylor 1216)

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Assess for barriers to eating. Dysphagia (difficulty swallowing or the inability to swallow) can be the result of poor dental health, cancer, or a neurologic disease, such as stroke, Parkinson's disease, or dementia, and may reduce the patient's nutritional intake. Dysphagia also is associated with an increased risk for aspiration, the misdirection of oropharyngeal secretions or gastric contents into the larynx and lower respiratory tract (Eisenstadt, 2010). Dental problems are associated with impaired chewing and avoidance of foods that may be difficult to chew, such as meat, fruit, and vegetables. Patients who experience weakness and fatigue may find eating to be a chore to avoid. Diminished sensor abilities, such as sight, taste, smell, and hearing, may also impact a patient's nutritional intake. (Taylor 1217)

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FOCUSED ASSESSMENT GUIDE 35-1 NUTRITION (Taylor 1216)

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Go over Figure 35-7 and 35-8

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If it runs out of time, reread the first 2 sections on the the Principles of Nutritions and the Factors that Affect Nutrition**Try to make flashcards

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Make flashcards on FOCUS ON THE OLDER ADULT NURSING STRATEGIES TO ADDRESS AGE-RELATED CHANGES AFFECTING NUTRITION Age-Related Changes Nursing Strategies (Taylor 1221)

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Providing Enteral Nutrition (Taylor 1225) Providing Enteral Nutrition (Taylor 1225) Oral feeding is the preferred and most effective method of feeding patients. However, at times, a patient will be unable to meet nutritional needs through oral intake of an adequate diet. In this circumstance, an alternate feeding method may be necessary. Selection of a feeding tube may be appropriate, because the next best method of feeding is via the enteral route. Enteral nutrition involves passing a tube into the GI tract to administer a formula containing adequate nutrients. Gastric feedings have the advantage of allowing the stomach to be used as a natural reservoir, regulating the amount of foods and liquids released into the small intestine. This alternate feeding method may deliver total or supplemental nutrition over a short-term period or for longer intervals. Consider factors related to selection of a feeding tube, including aspiration risk, the anticipated duration of the feeding tube, the function of the gastrointestinal (GI) tract, and the patient's overall condition and prognosis. Also, it is important to consider the ethical implications surrounding initiation of tube feedings, which entail knowledge of the patient's wishes concerning this intervention. The decision to place, maintain, and/or discontinue feeding tubes can be a source of much turmoil in the lives of patients and their families. There are many emotional, physical, psychological, and cultural aspects to the institution, maintenance, and withdrawal of nutrition. Nurses can be a source of great support and information to aid patients and their families in making nutrition-related health care decisions. (Taylor 1225)

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Reread and process PROMOTING HEALTH 35-1 NUTRITION (Taylor 1215)

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TABLE 35-5 Clinical Observations for Nutritional Assessment (Taylor 1217)***

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