Nursing - Nutrition

Amino acids consist of:

- Hydrogen - Oxygen - Carbon - Nitrogen

Obesity can be a precursor of:

- Hyperlipidemia - Sleep apnea - Cholelithiasis (gallstones) - Orthopedic problems - Hypertension - Diabetes In addition, children who are obese can have psychosocial difficulties, particularly in the areas of self-esteem and body image, and are more likely to be teased by others

Factors that affect metabolism include:

- Illness - Pregnancy - Lactation - Activity level

Vitamin D supplements are important for:

- Improving strength and balance - Strengthening bone health - Preventing bone fractures and falls

One pint or 500 mL of fluid equals:

1 lb (0.45 kg) For example, for a patient with renal failure, a weight increase of 2 lbs (0.90 kg) in 24 hours is significant because it usually indicates that the patient has retained 1 L (1000 mL) of fluid

Take a dietary history and evaluate the child's eating habits and patterns. The child or parents (or both) should keep a food diary for:

1 week The diary should include the time, place, and type and amount of food eaten and the reason for eating

Food labels also state four marker nutrients:

1. Calcium 2. Iron 3. Vitamin A 4. Vitamin C Generally, if these micronutrients are included in adequate amounts from foods naturally high in them, the other needed micronutrients will also be obtained

Six Major Minerals

1. Calcium 2. Phosphorus 3. Magnesium 4. Sodium 5. Potassium 6. Chloride

Deficiency occurs when fat intake falls below:

10% of daily nutrition

The average birth weight of an American baby is:

7-7.5 lbs (3.2-3.4 kg)

Fat is stored as:

Adipose tissue

During the rehabilitation period patients experience longer:

Adjustment periods regarding new dietary restrictions

The onset of eating disorders such as anorexia nervosa or bulimia nervosa often occurs during:

Adolescence

Anorexia nervosa is most common among:

Adolescent females Is seen in both genders and can occur in childhood and adulthood

The mixture becomes increasingly:

Alkaline Inhibiting the action of the gastric enzymes and promoting the action of the duodenal secretions

Breast milk contains:

All the essential nutrients Has immunologic benefits that protect the infant from acute and chronic disease

Selenium is a trace element that also has:

Antioxidant properties

Unfortunately, many hospitalized or aging patients require:

Assistance because they have missing teeth or dentures or because their dentures no longer fit Nurses can make note of these concerns early in treatment so that altered diets may be ordered or oral health services can be provided

A thick layer of mucus protects the lining of the stomach from:

Autodigestion

Nutritional health status is also an issue of:

Balance or imbalance Poor nutritional status negatively impacts health, and poor health can negatively impact nutritional status

The quality of nutrition during pregnancy is important, and food intake in the first trimester includes:

Balanced parts of essential nutrients with emphasis on quality

The most common surgical intervention affecting nutrition is:

Bariatric surgery

With lowered vitamin D status, what is impacted?

Bone health is impacted because vitamin D is required to absorb calcium

Simple carbohydrates is the classification for:

Both monosaccharides and disaccharides

What is important for healthy bone growth?

Calcium and phosphorus

The diet of pregnant adolescents is often deficient in:

Calcium, iron, and vitamins A and C

Polysaccharides such as glycogen make up:

Carbohydrate units too (i.e., complex carbohydrates)

Fatty acids are composed of chains of:

Carbon and hydrogen atoms with an acid group on one end of the chain and a methyl group at the other

Negative nitrogen balance is present when:

Catabolic states exist

Iron

Consequences of Deficiencies: - Anemia - Fatigue - Poor growth Consequences of Toxicities: - Hemochromatosis (genetic) with liver, pancreatic, and cardiac damage

Copper

Consequences of Deficiencies: - Anemia - Skin lesions - Neurologic disease - Bone fragility Consequences of Toxicities: - Found in Wilson's disease - Neuron and liver cell damage

Starvation-Related Malnutrition

Describes conditions such as anorexia nervosa

Ideally, indirect calorimetry is used to:

Determine energy needs so overfeeding can be avoided

Chronic diseases or increased metabolic requirements are risk factors for:

Development of nutritional problems Infants and older adults are at greatest risk

Calculate BMI by:

Dividing a patient's weight in kilograms by height in meters squared: weight (kg) divided by height2 (m2) For example, a patient who weighs 165 lbs (75 kg) and is 1.8 m (5 feet 9 inches) tall has a BMI of 23.15 (75 ÷ 1.82 = 23.15)

When the *kilocalories (kcal)* of the food we eat meets our energy requirements, our weight:

Does not change

The inability to break down fiber means that it:

Does not contribute calories to the diet

Glycogen, synthesized from glucose, provides:

Energy during brief periods of fasting (e.g., during sleep)

Gather information about the patient's illness/activity level to determine:

Energy needs and compare food intake

School-age children, 6 to 12 years old, grow at a slower and steadier rate, with a gradual decline in:

Energy requirements per unit of body weight

Pinocytosis

Engulfing of large molecules of nutrients by the absorbing cell when the molecule attaches to the absorbing cell membrane

Occasionally, individuals may experience nutritional disorders because of:

Erroneous understandings or perceptions about foods

The major form of body reserve energy is:

Fat

Vitamin classifications include:

Fat soluble or water soluble

All body cells except red blood cells and neurons oxidize:

Fatty acids into *ketones* for energy when dietary carbohydrates (glucose) are not adequate

Frequently patients with dysphagia become frustrated with:

Frustrated with eating and show changes in skinfold thickness and albumin

Carbohydrates serve as the main source of:

Fuel (glucose) for the brain, skeletal muscles during exercise, erythrocyte and leukocyte production, and cell function of the renal medulla

The pyloric glands secrete:

Gastrin

Vitamin D deficiency is more frequently found among:

Hispanics and Americans of African heritage than those of European heritage

After feeding, the response time for changes in these proteins ranges from:

Hours to weeks

Individuals differ in:

How nutrients are assimilated, metabolized, stored, and excreted These differences are often significant

Lifestyle and Patterns of Eating (Individual Risk Factor)

How one chooses foods, shops, plans, and prepares meals ultimately affects his or her nutritional status

Triglyceride levels generally reflect:

Hyperinsulinemia Although an individual with newly diagnosed type 1 diabetes may have temporary elevations of triglycerides

Screening a patient is a quick method of:

Identifying malnutrition or risk of malnutrition using simple tools

Electrolytes can become imbalanced with:

Inadequate dietary intake or many other conditions such as renal disease, liver disease, and diabetes

What is typically the first semisolid food to be introduced?

Iron-fortified cereals

Water

Is critical because cell function depends on a fluid environment

Catabolism

Is the breakdown of biochemical substances into simpler substances

The *tolerable upper intake level (UL)* is the highest level that:

Likely poses no risk of adverse health events It is not a recommended level of intake

A sedentary person or one who has sarcopenia or cardiovascular disease needs:

Limited time intervals of exercise more frequently

Although unused formula must be discarded after 24 hours, the tubes can be maintained:

Longer with strict infection control procedures according to facility protocols

Poor nutrition during pregnancy causes:

Low birth weight in infants and decreases chances of survival

Ileum

Lower section of the small intestine Site of fat and fat-soluble vitamin absorption

Fatty acids are absorbed in the:

Lymphatic circulatory systems through lacteal ducts at the center of each microvilli in the small intestine

Because height and weight are the best indicators of growth, these parameters are:

Measured, plotted on growth charts, and monitored over time at each well visit

Digestion of food is the:

Mechanical breakdown that results from chewing, churning, and mixing with fluid and chemical reactions in which food reduces to its simplest form

The inclusion of the minimum number of servings in MyPlate will:

Meet the DRI micronutrient and macronutrient needs for general health needs

Girls need a continuous source of iron to replace:

Menstrual losses

A damaged liver will also be unable to:

Metabolize and excrete drugs properly Altering nutrient absorption and utilization even further

Jejunum

Middle section of the small intestine Primary site for absorbing water-soluble vitamins and proteins

Digestion begins in the:

Mouth Where chewing mechanically breaks down food

Protein is stored in:

Muscle mass

Difficulty swallowing (dysphagia) is common in:

Neurologic conditions, especially after a stroke Not all patients require altered food consistency, but patients should be seated as upright as possible to prevent aspiration

Ingestion of proteins maintains:

Nitrogen balance

Physical activity helps to prevent:

Obesity

Milk continues to be an important food for older women and men who need adequate calcium to protect against:

Osteoporosis

Parenteral Nutrition (Collaborative Intervention)

Parenteral nutrition is used to provide either total or supplemental nutrition intravenously

These intravenous feedings are generally used for:

Patients who have intestinal failure and cannot be fed orally or by enteral feeding

Use food questionnaires to establish:

Patterns over time

Extra caution should be used in:

Pediatric and neonatal units

HCl turns pepsinogen into:

Pepsin, a protein-splitting enzyme

Catabolism occurs during:

Physiological states of *negative nitrogen balance* Starvation is an example of catabolism when wasting of body tissues occur

Toddlers exhibit strong food preferences and become:

Picky eaters

Proteins

Provide a source of energy (4 kcal/g)

Pre-albumin reflects:

Recent dietary protein intake Low pre-albumin is generally associated with nutritional intake as opposed to other conditions

Dysphagia

Refers to difficulty swallowing

Low albumin levels predict:

Severity of illness and are also predictors of mortality in adults older than age 60 years

General Appearance

Signs of Good Nutrition: - Alert - Responsive Signs of Poor Nutrition: - Listless - Apathetic - Cachetic

Mouth and Oral Membranes

Signs of Good Nutrition: - Reddish-pink mucous membranes in oral cavity Signs of Poor Nutrition: - Swollen, boggy oral mucous membranes

Hair

Signs of Good Nutrition: - Shiny, lustrous - Firm - Not easily plucked - Healthy scalp Signs of Poor Nutrition: - Stringy - Dull - Brittle - Dry - Thin - Sparse - Depigmented - Easily plucked

Infants with allergies or intolerant to cow's milk should consume:

Soy protein-based formulas instead

When intake of food exceeds expenditure, the excess is:

Stored as fat

The U.S. Food and Drug Administration (FDA) created daily values for food labels in response to:

The 1990 Nutrition Labeling and Education Act (NLEA)

Resting Energy Expenditure (REE)/Resting Metabolic Rate

The amount of energy you need to consume over a 24-hour period for your body to maintain all of its internal working activities while at rest

Infant formulas contain:

The approximate nutrient composition of human milk

Negative nitrogen balance occurs when:

The body loses more nitrogen than it gains (e.g., with infection, burns, fever, starvation, head injury, and trauma)

Nutrients absorbed in the intestines, including water, transport through:

The circulatory system to the body tissues

The small intestine secretes:

The hormones *secretin* and *cholecystokinin (CCK)*

Hgb and Hct also provide information about:

The hydration status of the patient

Chyme moves by peristaltic action through:

The ileocecal valve into the large intestine Where it becomes feces

Achieving nitrogen balance means that:

The intake and output of nitrogen are equal

What happens if a vegan diet is undertaken without adequate knowledge?

The intake may be insufficient for essential amino acids, calcium, zinc, and vitamins D and B12

We meet energy needs through:

The intake of a variety of nutrients: carbohydrates, proteins, fats, water, vitamins, and minerals

Essential fatty acids maintain:

The integrity of the phospholipid-based cell membranes, found around every cell

Macronutrients

The kilocalorie (kcal) energy-containing sources of carbohydrates, proteins, and fats Alcohol also provides kilocalories, but it is not considered a macronutrient because it cannot support or maintain bodily functions

Food leaves the antrum, or distal stomach, through:

The pyloric sphincter And enters the duodenum

Feeding tubes are inserted directly into:

The stomach or small intestine for the delivery of enteral feedings

Villi increase:

The surface area available for absorption

Actual food or eating practices may not be revealed unless:

There is trust and rapport This is especially true when interviewing parents of a child whose growth and development are not within expected ranges Generally, adults respond more openly to health providers if they are aware of the rationale for the questions

Caution older adults to avoid grapefruit and grapefruit juice because:

They alter absorption of many drugs

Albumin and insulin are simple proteins because:

They contain only amino acids or their derivatives

Homebound older adults with chronic illnesses have additional nutritional risks:

They frequently live alone with little or no social or financial resources to help obtain or prepare nutritionally sound meals, contributing to the risk for food insecurity Approximately 19% of older adults experience some degree of food insecurity resulting from low income or poverty

Iodine supports increased:

Thyroid activity Use of iodized table salt ensures availability

Some of the nutrients required by the body are stored in:

Tissues

When is it important to provide iron supplements?

To meet the mother's increased blood volume, fetal blood storage, and blood loss during delivery

Infants have the greatest percentage of:

Total body water because of greater surface area

Lean people have a greater percent of:

Total body water than obese people do because muscle contains more water than any other tissue except blood

Arsenic, aluminum, and cadmium have what type of effects?

Toxic effects

Because the body has a high storage capacity for these vitamins, what is possible?

Toxicity is possible when a person takes large doses of them

Interactions occur among:

Trace elements For example, excess of one trace mineral sometimes causes deficiency of another

BMI serves as an alternative to:

Traditional height-weight relationships

Who performs growth measurements on children?

Trained individuals using reliably calibrated equipment and proper techniques

What does gastrin do?

Triggers parietal cells to secrete hydrochloric acid (HCl)

Fats are composed of:

Triglycerides and fatty acids

Disaccharides such as sucrose, lactose, and maltose are composed of:

Two monosaccharides and water

With the increase in obesity, the incidence of ___ ___ ___ in children is also increasing

Type 2 diabetes

Unsaturated Fatty Acids

Unequal number of hydrogen atoms are attached and the carbon atoms attach to one another with a double bond

What happens to an infant's birth weight at 4-5 months?

Usually doubles

What happens to an infant's birth weight at 1 year?

Usually triples

In attempting to affect eating patterns, you need to understand patients':

Values, beliefs, and attitudes about food Also assess family traditions and rituals related to food, cultural values and beliefs, and nutritional needs Determine how these factors affect food purchase, preparation, and intake

An ideal body weight (IBW) provides an estimate of:

What a person should weigh

Nursing Assessment Questions: Dietary Intake and Food Preferences

What type of food do you like? How many meals a day do you eat? What times do you normally eat meals and snacks? What portion sizes do you eat at each meal? Are you on a special diet because of a medical problem? Do you have any dietary religious or cultural food preferences? Who prepares the food at home? Who purchases the food? How do you cook your food (e.g., fried, broiled, baked, grilled)?

When are minerals classified as *microminerals* or *trace elements*?

When less than 100 mg is needed daily

When are minerals classified as *macrominerals*?

When the daily requirement is 100 mg or more

When do toddlers develop milk anemia?

When toddlers consume more than 24 ounces of milk daily in place of other foods Milk is a poor source of iron

Nursing Assessment Questions: Unpleasant Symptoms

Which foods cause indigestion, gas, or heartburn? Does this occur each time you have the food? What relieves the symptoms?

Nursing Assessment Questions: Use of Medications

Which medications do you take? Do you take any over-the-counter medications that your doctor does not prescribe? Do you take any nutritional or herbal supplements?

When could false readings of A1c occur?

With anemia or renal disease For this reason finger-stick glucose tests may be preferable in these situations

In some hospitals, the RDN may be qualified to:

Write the diet orders or even to insert the tube

Can amino acids link together?

Yes

Do older people have the least percentage of total body water?

Yes

The secretions of the GI tract have very different:

pH levels Saliva is relatively neutral, gastric juice is highly acidic, and the secretions of the small intestine are alkaline

Impact of Medical Conditions on Risk for Malnutrition: - Oral/GI problems with limited protein-calorie intake (e.g., sensory issues, allergies, dental problems, dysphagia) - Impaired intestinal absorption of proteins (diarrhea/malabsorption: e.g., celiac disease, Crohn's disease, short-bowel syndrome, bariatric surgery) - Hepatic disease with impaired protein synthesis - Chronic kidney disease with proteinuria - Nephrotic syndrome - Cancer with increased metabolic needs - Burns with loss of protein in body fluids

Impact on Nutritional Status: - Hypoalbuminemia/impaired protein nutrition

Impact of Medical Conditions on Risk for Malnutrition: - Hypoalbuminemia (lack of carrier proteins) - Hyperphosphatemia (in chronic kidney disease, end stage) - Malabsorption/diarrhea - Hypoparathyroidism - Hypomagnesemia - Vitamin D deficiency

Impact on Nutritional Status: - Hypocalcemia

Impact of Medical Conditions on Risk for Malnutrition: - GI bleed

Impact on Nutritional Status: - Iron deficiency anemia/microcytic anemia

Impact of Medical Conditions on Risk for Malnutrition: - Hemochromatosis - Hepatic disease

Impact on Nutritional Status: - Iron overload

Impact of Medical Conditions on Risk for Malnutrition: - Gastrectomy - Pernicious anemia/lack of intrinsic factor - Primary hypothyroidism - Achlorhydria

Impact on Nutritional Status: - Vitamin B12 deficiency

Impact of Medical Conditions on Risk for Malnutrition: - Chronic kidney disease with limited ability to convert to active form - Malabsorption

Impact on Nutritional Status: - Vitamin D deficiency

Impact of Medical Conditions on Risk for Malnutrition: - Hypoalbuminemia - Chronic kidney disease (end stage) and dialysis treatments - Alcoholic cirrhosis/hepatic disease - Inflammatory bowel disease - Sickle cell anemia

Impact on Nutritional Status: - Zinc deficiency

Particularly at risk are premature infants because of:

Impaired oral intake With parenteral or tube feeding, the use of breast milk may be impossible, eliminating the benefits of cost savings, immunological protection, ideal nutrient content, and microbial support

Where is glycogen stored?

In small reserves in liver and muscle tissue

Where is water primarily absorbed?

In the colon

Vitamin B Deficiency

In the early twentieth century, processed grains were becoming popular Soon, a mysterious syndrome appeared as the "4 D's": dermatitis on sun-exposed areas, diarrhea, dementia, and death. This condition (*pellagra*) was determined to be from a B vitamin deficiency The government mandated that processed white flour products had to be enriched with the nutrients that were removed during processing—vitamins B1, B2, and B3 (thiamine, riboflavin, and niacin, respectively)

History Assessment

In the interview of the patient or family members, it should be remembered that food has a strong emotional component

Gastric Enzymes

In the stomach, gastric enzymes begin to digest proteins into amino acids and carbohydrates into simple sugars

Soluble fibers include barley, cereal grains, cornmeal, and oats and dissolve:

In water

Hypoglycemia may suggest:

Inadequate caloric intake

Carbohydrate (Macronutrient) Deficiency

Inadequate carbohydrate intake can alter cellular metabolism and results in the use of dietary protein as a fuel substrate, diminishing cell growth and repair Ultimately, if inadequate carbohydrate intake continues, there is a shift to use body fat catabolism and protein for energy resulting in weight loss and accumulation of ketones, especially if insulin is also limited

Thirst sensation diminishes, leading to:

Inadequate fluid intake or dehydration Symptoms of dehydration in older adults include confusion; weakness; hot, dry skin; furrowed tongue; rapid pulse; and high urinary sodium

Cellular Metabolism

Includes the hormonal and enzymatic processes that occur within cell structures that allow proteins, carbohydrates, or fats to be used for energy or made into new products or tissues

Mechanical Breakdown

Includes: - Chewing in the mouth - As well as the mixing motions and muscular (peristaltic) action of propelling food through the stomach and intestines

Anatomy and Physiology of the Digestive System

Includes: - Digestion - Absorption - Metabolism and storage of nutrients - Elimination

Nutritional Deficiencies

Includes: - Macronutrient deficiencies - Vitamin and mineral deficiencies

Complementary proteins are pairs of:

Incomplete proteins that, when combined, supply the total amount of protein provided by complete protein sources

As CKD progresses, phosphorous levels can:

Increase and lead to hypocalcemia

Sports and regular moderate-to-intense exercise necessitate dietary modification to meet:

Increased energy needs for adolescents Carbohydrates, both simple and complex, are the main source of energy, providing 55% to 60% of total daily kilocalories Protein needs increase to 1 to 1.5 g/kg/day Fat needs do not increase Adequate hydration is very important. Adolescents need to ingest water before and after exercise to prevent dehydration, especially in hot, humid environments Vitamin and mineral supplements are not required, but intake of iron-rich foods is required to prevent anemia

The *adequate intake (AI)* is the suggested intake for:

Individuals based on observed or experimentally determined estimates of nutrient intakes and used when there is not enough evidence to set the RDA

The AAP recommends regular assessment of obesity risk beginning in:

Infancy Combined with counseling about appropriate dietary and physical activity requirements of childhood as obesity prevention measures

Brain growth can also be monitored by measuring:

Infant frontal-occipital circumference at intervals and plotting the values on growth charts

The World Health Organization growth charts are recommended for use for:

Infants and children up to 2 years of age

How much mL/kg/day of fluid do infants need?

Infants need about 100 to 120 mL/kg/day of fluid because a large part of total body weight is water

Assess patients' nutritional status by using the nursing history to gather:

Information about factors that usually influence nutrition You are in an excellent position to recognize signs of poor nutrition and take steps to initiate change

Minerals

Inorganic elements essential to the body as catalysts in biochemical reactions

PCM is one of the most common nutritional deficiency conditions associated with:

Insufficient intake, wasting disease, or a combination of both, and it has multisystem effects This can affect individuals of all ages, but it especially affects patients with extended hospitalization with acute illness or injury or the institutionalized elderly

The mechanical, chemical, and hormonal activities of digestion are:

Interdependent

Evidence shows that much immunity begins in the:

Intestine So it is important to provide nutrients through the gastrointestinal (GI) tract whenever possible

Chronic Disease-Related Malnutrition

Is exemplified by sarcopenic obesity or pancreatic cancer

When the intake of nitrogen is greater than the output, the body:

Is in positive nitrogen balance

Anorexia Nervosa

Is one of a group of psychiatric conditions associated with a fear of weight gain and distortion of body image

Anabolism

Is the building of more complex biochemical substances by synthesis of nutrients

Basal Metabolic Rate (BMR)

Is the energy needed at rest to maintain life-sustaining activities (breathing, circulation, heart rate, and temperature) for a specific amount of time

Celiac Disease

Is thought to be an autoimmune disorder whereby an inflammatory reaction occurs in the intestine when the mucosa is exposed to gluten, a protein found in wheat

Tube feedings are indicated for an individual who:

Is unable to eat or swallow but has an intact/functional GI tract

Changes in values for an individual over time are of greater significance than:

Isolated measurements

Bile acts as a detergent because:

It emulsifies fat to permit enzyme action while suspending fatty acids in solution

Malnutrition is highly devastating for infants and children because:

It limits their growth, brain development, ability to learn, and, later, their ability to participate effectively in society

Pressure from a bolus of food at the cardiac sphincter causes:

It to relax, allowing the food to enter the fundus, or uppermost part, of the stomach

What should be done if there is any suspicion of poor nutritional status?

Lab work should be ordered by the attending provider to help assess status more completely

Blood Glucose and Hemoglobin A1c

Laboratory/Diagnostic Test

Electrolytes

Laboratory/Diagnostic Test

Hemoglobin and Hematocrit

Laboratory/Diagnostic Test

Lipid Profile

Laboratory/Diagnostic Test

Serum Albumin and Pre-Albumin

Laboratory/Diagnostic Test

It is important to relate head size to weight because:

Larger babies have bigger heads

Lutein and Zeaxanthin (Vitamin A) Deficiency

Lutein and zeaxanthin are carotenoids found in yellow and orange foods (cantaloupe, corn, carrots, salmon, and egg yolks) that help to prevent macular degeneration The intact form of vitamin A is also essential for vision; deficiency begins with loss of night vision and progresses to total blindness

However, complications include:

Macro- and micronutrient deficiencies that are not easily managed, either because of lack of adherence to dietary and supplement guidelines or because of limited knowledge of actual needs

Protein

Macronutrient Facilitates growth and repair of tissues Energy source

Carbohydrates

Macronutrient Primary source of fuel and energy

Fat

Macronutrient Source of fatty acid, necessary for growth and development Energy

Carbohydrates

Main source of energy in the diet

ChooseMyPlate provides a basic guide for:

Making food choices for a healthy lifestyle It includes guidelines for balancing calories; decreasing portion size; increasing healthy foods; increasing water consumption; and decreasing fats, sodium, and sugars

Nutritional Excess

Malnutrition also occurs from excess macronutrient (energy) intake that leads to weight gain Often, obese individuals may have micronutrient insufficiency but macronutrient excesses

Difficulty chewing, missing teeth, having teeth in poor condition, and oral pain often contribute to:

Malnutrition and dehydration in older adults

Because improper nutrition affects all body systems, observe for:

Malnutrition during physical assessment

Impaired Digestion and Absorption (Underlying Medical Condition)

Many conditions interfere with digestion or absorption and place the affected individual at risk for malnutrition Examples of such conditions include lactose intolerance, gastroparesis, gastric surgery, intestinal resection, and inadequate gastric acidity Some genetic conditions lead to defects in metabolism of nutrients, such as PKU

Genetics (Individual Risk Factor)

Many conditions that impact nutrition are linked to genetics

Anthropometry

Measurement system of the size and makeup of the body

Consequences such as type 2 diabetes, heart disease, and stroke affect individuals of all ages and can lead to:

Medical complications or a shortened lifespan

Depending on the severity of the disease state, it may be difficult to:

Meet the increased nutrient needs without enteral or parenteral nutrition support

Unbalanced food intake also occurs in:

Mental health conditions such as anorexia nervosa, mood disorders, anxiety, and depression

Obese children also are at risk for developing:

Metabolic (insulin-resistance) syndrome

Linolenic acid and arachidonic acid, another type of unsaturated fatty acids, are important for:

Metabolic processes The body manufactures them when linoleic acid is available

Blood glucose reflects:

Metabolism of carbohydrates This test is generally used to screen or monitor impaired glucose metabolism

Osmosis

Movement of water through a semipermeable membrane that separates solutions of different concentrations Water moves to equalize the concentration pressures on both sides of the membrane

Lap-band procedures are:

Much less invasive, although nutritional deficits are still possible

Boys also need adequate iron for:

Muscle development

Use laboratory analysis of a 24-hour urine urea nitrogen (UUN) to determine:

Nitrogen output For patients with diarrhea or fistula drainage, estimate a further addition of 2 to 4 g of nitrogen output

Should infants have regular cow's milk during the first year of life?

No It is too concentrated for an infant's kidneys to manage, increases the risk of milk-product allergies, and is a poor source of iron and vitamins C and E

Should children under 1 year of age ingest honey or corn syrup products?

No They are potential sources of the botulism toxin, which increases the risk of infant death

Congenital anomalies and surgical revisions of the GI tract interfere with:

Normal function

Enteral Nutrition (Collaborative Intervention)

Nurses administer nutrition support via tube feedings

Diagnostic Tests

Nurses need to understand common nutrition-related tests, and they need to know when to alert the physician or dietitian if malnutrition is suspected ------ Includes: - Laboratory tests

Skipping meals or eating meals with unhealthy choices of snacks contributes to:

Nutrient deficiency and obesity

Renal disease further reduces:

Nutrient levels Specially vitamin D because the kidney metabolizes vitamin D2 into the bioactive D3 form

What do proteins transport?

Nutrients and many drugs in the blood

Interrelated Concepts

Nutrition is interrelated with nearly all of the health and illness concepts as a preventive or disease management intervention *Glucose Regulation* (closely linked to *Hormonal Regulation*) is dependent on caloric intake and is critical to adequate metabolism of nutrients - Glucose regulation is much like a subconcept of nutrition Nutrition influences other metabolic processes, such as *Immunity*, *Clotting*, *Tissue Integrity*, and *Thermoregulation* - These all depend on adequate nutrients for optimal functioning *Development*, *Culture*, and *Spirituality* are also interrelated based on the influence of these concepts on dietary patterns and preference

Identification of risk factors such as unintentional weight loss, presence of a modified diet, or the presence of altered nutritional symptoms (i.e., nausea, vomiting, diarrhea, and constipation) requires:

Nutritional consultation

Patients receiving only an IV infusion of 5% or 10% dextrose are at risk for:

Nutritional deficiencies

Ethnicity/Race (Population at Risk)

Nutritional deficits and genetic predispositions have triggered many chronic diseases of the modern world

A food diary allows you to calculate:

Nutritional intake and to compare it with DRI to see if the patient's habits are adequate

Other anthropometric measurements often obtained by RDs help identify:

Nutritional problems These include the ratio of height-to-wrist circumference, mid-upper arm circumference (MAC), triceps skinfold (TSF), and mid-upper arm muscle circumference (MAMC)

Bariatric surgery is increasingly being used to control:

Obesity and diabetes

BMI, which is a function of both height and weight, is an important measure of growth and overall nutritional status in children older than age 2 years. Because childhood overweight and obesity can contribute to health problems later in life, the American Academy of Pediatrics recommends:

Obesity prevention beginning during the prenatal period with appropriate management of maternal weight and weight gain during pregnancy

The clinical signs of nutritional status serve as guidelines for:

Observation during physical assessment

Acute Disease-Related Malnutrition

Occurs after burn injury or trauma

Insufficient Nutrition

Occurs when there is inadequate intake, impaired nutrient absorption, or ineffective nutrient utilization occur, leading to a state of malnutrition Malnutrition can be associated with insufficient calorie intake leading to unintended weight loss and/or insufficient intake of one or more nutrients leading to a number of nutritional deficiencies State of being underweight is described as a body mass index (BMI) less than 18.5

The Mini Nutritional Assessment (MNA) screens:

Older adults in home care programs, nursing homes, and hospitals The tool has 18 items divided into screening and assessment If a patient scores 11 or less on the screening part, the health care provider completes the assessment part A total score of less than 17 indicates protein-energy malnutrition

How should caregivers introduce new foods?

One at a time, approximately 4 to 7 days apart to identify allergies It is best to introduce new foods before milk or other foods to avoid satiety

Optimal Nutrition Status

One in which all nutrients are available in balanced amounts for cellular metabolism and physiological function for the individual

Incomplete proteins are missing:

One or more of the nine indispensable amino acids Include cereals, legumes (beans, peas), and vegetables

Most enzymes have:

One specific function

Adequate intake of both macro- and micronutrients is required for:

Optimal cellular metabolism

Breast-feeding is recommended for:

Optimal nutrition of infants for the 4-6 months of life

The priority of care is to provide:

Optimal preoperative nutrition support in patients with malnutrition

Patients with dysphagia often do not show:

Overt signs such as coughing when food enters the airway

One of the key elements of successful weight reduction in the child or adolescent is:

Ownership by the child of whatever plan is proposed Care should be taken to avoid a power struggle between the parent and child

The chief cells in the stomach secrete:

Pepsinogen

An RD compares values for MAC, TSF, and MAMC to standards and calculates them as a:

Percentage of the standard

Growth rate is measured in:

Percentiles

A common form of tube feeding is:

Percutaneous endoscopic gastrostomy (PEG) feeding

For short term, it may be administered:

Peripherally

Exercise and fiber stimulate:

Peristalsis

Personal Food Choices (Individual Risk Factor)

Personal choice is the major internal influence over food intake

Blood glucose screening is advised for:

Persons with evidence of insulin resistance, such as central obesity found with metabolic syndrome

Inherited metabolic defects include:

Phenylketonuria (PKU)

Growth is an excellent indicator of:

Physical well-being Meaning accurate assessments must be made at regular intervals so that patterns of growth can be determined

Age-Related Differences Older Adults

Physiologically, the effects of aging can be associated with a reduced ability to ingest, absorb, and metabolize nutrients In the mouth, reduced chewing ability, reduced saliva production, and reduced sense of taste are common The esophagus may be elongated (due to kyphosis), and atrophic changes occur, particularly in the lower esophagus Atrophic changes and intestinal microflora occur in aging, resulting in reduced efficiency in absorption In the absence of disease, the liver, gallbladder, and pancreas continue to function, although there is a decrease in metabolic efficiency

Phytochemicals

Plant compounds that have antimicrobial, antioxidant, anti-inflammatory, and immune-boosting properties Examples include: - Lutein (associated with the green color of vegetables) - Lycopene (found in high amounts in tomato products)

We obtain carbohydrates primarily from:

Plant foods, except for lactose (milk sugar)

Common laboratory tests used to study nutritional status include measures of:

Plasma proteins such as albumin, transferrin, prealbumin, retinol-binding protein, total iron-binding capacity, and hemoglobin

Starches are:

Polysaccharides

Family food offerings can:

Positively or negatively influence nutritional intake Mothers who avoid high-fat, high-sugar foods but emphasize a variety of vegetables, fruits, whole grains, lean meats, and low-fat milk can send the right message to their family

There is general agreement that an appropriate screening and counseling program throughout childhood can:

Prevent or treat obesity

The Dietary Guidelines are aimed more at:

Preventing chronic health diseases associated with excess intake of macronutrients, especially solid fats (saturated/trans fats), sugar, and salt

Healthy Eating

Primary Prevention

Physical Activity

Primary Prevention

Primary Prevention

Primary prevention measures are aimed at preventing the onset of disease through risk reduction and behavior modification The foundation of primary prevention efforts, as it relates to this concept, includes healthy eating and physical activity

Dysphagia screening quickly identifies:

Problems with swallowing and helps you initiate referrals for more in-depth assessment by an RD or a speech-language pathologist (SLP)

Bile

Produced in the liver and stored in the gallbladder Is involved in fat digestion by modifying dietary fats into emulsions for better absorption

Cream soups and meat-based vegetable soups are nutrient-dense sources of:

Protein Cheese, eggs, and peanut butter are also useful high-protein alternatives

Without adequate planning of foods containing the various amino acids, what can occur?

Protein deficiency

A toddler needs fewer kilocalories but an increased amount of:

Protein in relation to body weight Consequently, appetite often decreases at 18 months of age

Among children, protein-calorie deficiencies are:

Serious concerns because of the potential for delays in cognitive and physical development

Nitrogen balance is important in determining:

Serum protein status

Examination Findings

Several techniques are used to assess nutritional status, including: - General observation - Anthropometric measurements - Other various clinical findings from systems' assessment

Because parenteral nutrition is indicated for individuals who are unable to process nutrients via the GI tract for more than 4 or 5 days, therapy can be:

Short term or long term

The various types of fatty acids referred to in the dietary guidelines have:

Significance for health and the incidence of disease

Age-Related Differences Infants and Children

Significant changes in growth and development occur in the first year of life. Birth weight triples, and length increases by an average of 50%. Infants have very different nutrient needs (compared to adults) to support this rapid growth Due to the lack of teeth, chewing capability, and immature GI tract, the nutritional intake of infants should be limited to breast milk (or formula) and water for the first 6 months of life. Newborn infants depend on a strong suck-swallow reflex for adequate nutritional intake As the child's GI tract develops, solid foods that do not require chewing can be gradually introduced (ideally starting at 6 months of age) As teeth emerge, the older infant and young child can be offered foods with various textures The small orophyarx places young children at risk of choking; thus, the need to provide foods in small bites is particularly important Specific nutrient requirements for infants and children can be found by referring to DRIs

Age-Related Differences Pregnancy and Lactation

Significant changes in nutrition needs occur during pregnancy and lactation to account for the body composition changes during pregnancy (hormonal, metabolic, and anatomic), growing fetus (before birth), and the production of breast milk after delivery Increases in carbohydrates, proteins, fats, and most micronutrients are recommended Expected weight gain during pregnancy ranges from 15 to 40 pounds, depending on prepregnancy weight and stature Specific nutrient requirements for pregnant women and during lactation can be found by referring to DRIs

Eyes

Signs of Good Nutrition: - Bright, clear, shiny - No sores at corner of eyelids - Moist and healthy pink conjunctivae - Prominent blood vessels - No fatigue circles beneath eyes Signs of Poor Nutrition: - Eye membranes pale (pale conjunctivas) - Redness of membrane (conjunctival injection) - Dryness - Signs of infection - Bitot's spots - Redness and fissuring of eyelid corners (angular palpebritis) - Dryness of eye membrane (conjunctival xerosis) - Dull appearance of cornea (corneal xerosis) - Soft cornea (keratomalacia)

Pancreatic secretions contain six enzymes:

- *Amylase* to digest starch - *Lipase* to break down emulsified fats - *Trypsin*, *elastase*, *chymotrypsin*, and *carboxypeptidase* to break down proteins

Adequate oral intake of nutrients (and water) involves:

- Access to food sources - Informed food choices - Efficient chewing (mastication) and swallowing abilities

Elimination is enhanced with:

- Adequate fluid - Fiber intake - Physical activity

What factors affect energy requirements?

- Age - Body mass - Gender - Fever - Starvation - Menstruation - Illness - Injury - Infection - Activity level - Thyroid function

Populations at Risk

- Age or life stage - Ethnicity/race - The poor and underserved

Metabolic processes are:

- Anabolic (building) - Catabolic (breaking down)

What age-related changes affect nutrition?

- Appetite - Taste - Smell - Digestive system For example, older adults often experience a decrease in taste cells that alters food flavor and may decrease intake

The GI tract manages:

- Approximately 8.5 L of GI secretions - 1.5 L of oral intake daily

Complications of dysphagia include:

- Aspiration pneumonia - Dehydration - Decreased nutritional status - Weight loss

A lipid profile includes several tests that:

- Assess lipid metabolism - Serve as important indicators of risk for cardiovascular disease

Chyme flows into the duodenum and quickly mixes with:

- Bile - Intestinal juices - Pancreatic secretions

What requires proteins?

- Blood clotting - Fluid regulation - Acid-base balance

The tube feeding is administered either:

- By gravity - Through a feeding pump

What gets excreted through breast milk?

- Caffeine - Alcohol - Drugs

Carbohydrates are composed of:

- Carbon - Hydrogen - Oxygen

The body requires fuel to provide energy for:

- Cellular metabolism and repair - Organ function - Growth - Body movement

Feces contain:

- Cellulose and similar indigestible substances - Sloughed epithelial cells from the GI tract - Digestive secretions - Water - Microbes

Increased weight gain has been associated with:

- Central nervous system tumors - Hypothyroidism - Cushing syndrome - Turner syndrome

What is made by protein?

- Collagen - Hormones - Enzymes - Immune cells - DNA - RNA

Role of the RDN

- Complex assessments - Nutrition diagnosing - Diet therapy interventions

Many factors other than nutritional needs influence the adolescent's diet, including:

- Concern about body image and appearance - Desire for independence - Eating at fast-food restaurants - Peer pressure - Fad diets

General Vitality

Signs of Good Nutrition: - Endurance - Energy - Sleeps well - Vigorous Signs of Poor Nutrition: - Easily fatigued - No energy - Falls asleep easily - Tired and apathetic

Posture

Signs of Good Nutrition: - Erect posture - Straight arms and legs Signs of Poor Nutrition: - Sagging shoulders - Sunken chest - Humped back

Nails

Signs of Good Nutrition: - Firm, pink Signs of Poor Nutrition: - Spoon shape (koilonychia) - Brittleness - Ridges

Gastrointestinal Function

Signs of Good Nutrition: - Good appetite and nutrition - Normal regular elimination - No palpable organs or masses Signs of Poor Nutrition: - Anorexia - Indigestion - Constipation or diarrhea - Liver or spleen enlargement

Nerve Conduction and Mental Status

Signs of Good Nutrition: - Good attention span - Not irritable or restless - Normal reflexes - Psychological stability Signs of Poor Nutrition: - Inattention - Irritability - Confusion - Burning and tingling of hands and feet (paresthesia) - Loss of position and vibratory sense - Weakness and tenderness of muscles (may result in inability to walk) - Decrease or loss of ankle and knee reflexes

Gums

Signs of Good Nutrition: - Good pink color - Healthy and red - No swelling or bleeding Signs of Poor Nutrition: - Spongy gums that bleed easily - Marginal redness, inflammation - Receding

Tongue

Signs of Good Nutrition: - Good pink or deep reddish color - No swelling - Smooth, presence of surface papillae - Lack of lesions Signs of Poor Nutrition: - Swelling, scarlet and raw - Magenta, beefiness (glossitis) - Hyperemic and hypertrophic papillae - Atrophic papillae

Teeth

Signs of Good Nutrition: - No cavities - No pain - Bright, straight - No crowding - Well-shaped jaw - Clean with no discoloration Signs of Poor Nutrition: - Unfilled caries - Missing teeth - Worn surfaces - Mottled (fluorosis), malocclusion

Neck (Glands)

Signs of Good Nutrition: - No enlargement Signs of Poor Nutrition: - Thyroid or lymph node enlargement

Skeleton

Signs of Good Nutrition: - No malformations Signs of Poor Nutrition: - Bowlegs - Knock-knees - Chest deformity at diaphragm - Prominent scapulae and ribs

Legs and Feet

Signs of Good Nutrition: - No tenderness, weakness, or swelling - Good color Signs of Poor Nutrition: - Edema - Tender calf - Tingling - Weakness

Cardiovascular Function

Signs of Good Nutrition: - Normal heart rate and rhythm - Lack of murmurs - Normal blood pressure for age Signs of Poor Nutrition: - Rapid heart rate (above 100 beats/min) - Enlarged heart - Abnormal rhythm - Elevated blood pressure

Lips

Signs of Good Nutrition: - Smooth - Good color - Moist - Not chapped or swollen Signs of Poor Nutrition: - Dry, scaly, swollen - Redness and swelling (cheilosis) - Angular lesions at corners of mouth - Fissures or scars (stomatitis)

Skin (General)

Signs of Good Nutrition: - Smooth and slightly moist - Good color Signs of Poor Nutrition: - Rough - Dry - Scaly - Pale - Pigmented - Irritated - Bruises - Petachiae - Subcutaneous fat loss

Face and Neck

Signs of Good Nutrition: - Uniform color - Smooth, pink, healthy appearance - Not swollen Signs of Poor Nutrition: - Greasy, discolored, scaly, swollen - Dark skin over cheeks and under eyes - Lumpiness or flakiness of skin around nose and mouth

Weight

Signs of Good Nutrition: - Weight normal for height, age, body build Signs of Poor Nutrition: - Obesity (usually 10% above ideal body weight) - Underweight

Muscles

Signs of Good Nutrition: - Well-developed, firm - Good tone - Some fat under skin Signs of Poor Nutrition: - Flaccid, poor tone, underdeveloped tone - "Wasted" appearance - Impaired ability to walk properly

Dietary requirements for preschoolers (3 to 5 years) are:

Similar to those for toddlers They consume slightly more than toddlers, and nutrient density is more important than quantity

What will help improve nutritional intake for a toddler?

Small, frequent meals consisting of breakfast, lunch, and dinner with three interspersed high nutrient-dense snacks

When there is sufficient carbohydrate in the diet to meet the energy needs of the body, protein is:

Spared as an energy source

Lipid screening is also recommended, particularly for those with:

Specific risk factors Although not an essential nutrient, it often becomes necessary to supplement coenzyme Q10 with long-term statin use

The nutrition care process includes:

Standardized language and codes within the profession of dietetics

The longer an individual chews food, the more:

Starch digestion occurs in the mouth

The USDHHS Administration on Aging (AOA) requires:

States to provide nutritional screening services to older adults who benefit from home-delivered or congregate meal services This program requires meals to provide at least one third of the DRI for an older adult and meet the Dietary Guidelines for Americans

Standardized growth charts allow an individual child's growth (length/height, weight, head circumference, body mass index [BMI]) to be compared with:

Statistical norms

Less severe forms of gluten sensitivity have fewer symptoms, but there is:

Still an autoimmune response to the proteins found in wheat, rye, and barley that requires lifelong use of a strict gluten-free diet

What happens when the energy requirements of the body exceed the energy supplied by ingested nutrients?

Stored energy is used

Amino acids are also converted to fat and:

Stored or catabolized into energy through gluconeogenesis

Fiber, a polysaccharide, is the:

Structural part of plants that is not broken down by our digestive enzymes

Simple carbohydrates are found primarily in:

Sugars

When deprived of water, a person usually cannot:

Survive for more than a few days

Malnutrition significantly slows:

Swallowing recovery and may increase mortality

Obesity is thought to be associated with:

Systemic, chronic low-grade inflammation and conditions related to the metabolic syndrome

Another aspect of dietary interventions is ensuring:

That the food provided matches the patient's ability to eat A patient who has his or her original teeth (none missing) and good oral hygiene, or well-fitting dentures and adequate saliva, represents the best scenario for chewing all kinds of foods

Experts define childhood overweight as a BMI between:

The 85th and 95th percentile for age and gender

BMI charts are included in the most recent versions of charts available from:

The Centers for Disease Control and Prevention

Food labels with DRI values reinforce:

The Dietary Guidelines

Water-soluble vitamins absorb easily from:

The GI tract

The most commonly used growth charts for boys and girls ages 2 years to 20 years are those developed by:

The National Center for Health Statistics

The most malabsorptive bariatric surgical procedure is:

The Roux-en-Y gastric bypass In this procedure, most of the stomach and the proximal small intestine are bypassed, with food entering a Y-shaped reconnection between the upper stomach and the distal portion of the duodenum or jejunum

Warning signs of dysphagia include:

- Cough during eating - Change in voice tone or quality after swallowing - Abnormal movements of the mouth, tongue, or lips - Slow, weak, imprecise, or uncoordinated speech Other Signs: - Abnormal gag - Delayed swallowing - Incomplete oral clearance or pocketing - Regurgitation - Pharyngeal pooling - Delayed or absent trigger of swallow - Inability to speak consistently

Folic acid intake is particularly important for:

- DNA synthesis - Growth of red blood cells Inadequate intake can lead to fetal neural tube defects, anencephaly, or maternal megaloblastic anemia

Obesity becomes a problem because of:

- Decreased physical exercise - Dining out more often - Increased ability to afford more luxury foods

Interventions are classified into the following major groups:

- Dietary interventions - Pharmacologic agents - Surgical interventions

There are a variety of pharmacologic agents that address other nutrient-based problems, including:

- Dietary supplements - Statins to control lipid levels - Agents to control glucose levels

Nutritional deficiencies often occur in adolescent girls because of:

- Dieting - Use of oral contraceptives

Dysphagia leads to:

- Disability or decreased functional status - Increased length of stay and cost of care - Increased likelihood of discharge to institutionalized care - Increased mortality

Mature adults need nutrients for:

- Energy - Maintenance - Repair

Breastfeeding has multiple benefits for both infant and mother, including:

- Fewer food allergies and intolerances - Fewer infant infections - Easier digestion - Convenience, availability, and freshness - Temperature always correct - Economical because it is less expensive than formula - Increased time for mother and infant interaction

Factors that frequently alter test results include:

- Fluid balance - Liver function - Kidney function - Presence of disease

Always ask patients about their:

- Food preferences - Values regarding nutrition - Expectations from nutritional therapy

Physiological risk factors for older adults include:

- Frailty - Low BMI (BMI <21 is associated with a high risk of mortality despite nutritional intervention) - Neurologic deficits from a stroke or Alzheimer's disease

Other rare inherited metabolic defects include:

- Galactosemia - Maple syrup urine disease

Individual Risk Factors

- Genetics - Lifestyle and patterns of eating - Personal food choices - Underlying medical conditions

For infants, routine screening that occurs at birth includes the following:

- Glucose levels - At least 40 different genetically linked metabolic disorders, including phenylketonuria and maple syrup urine disease, that are related to an inability to metabolize certain amino acids or to errors in fatty acid metabolism - Carbohydrate disorders, including galactosemia - Other congenital disorders that can affect nutritional status, including cystic fibrosis - HIV The number of screenings will vary from state to state

Positive nitrogen balance is required for:

- Growth - Normal pregnancy - Maintenance of lean muscle mass and vital organs - Wound healing

Nutrition encompasses the process by which food and nutrients affect:

- Growth and development, - Cellular function and repair - Health promotion - Disease prevention

Your nursing assessment of nutrition includes:

- Health status - Age - Cultural background - Religious food patterns - Socioeconomic status - Personal food preferences - Psychological factors - Use of alcohol or illegal drugs - Use of vitamin, mineral, or herbal supplements - Prescription or over-the-counter (OTC) drugs - Patient's general nutrition knowledge

These tools typically include objective measures such as:

- Height - Weight - Weight change - Primary diagnosis - Presence of other co-morbidities

What foods present choking hazards for children?

- Hot dogs - Candy - Nuts - Grapes - Raw vegetables - Popcorn

Factors that affect serum albumin levels include:

- Hydration - Hemorrhage - Renal or hepatic disease - Large amounts of drainage from wounds, drains, burns, or the GI tract - Steroid administration - Exogenous albumin infusions - Age - Trauma, burns, stress, or surgery

Environmental influences in the development of childhood obesity are extremely strong, with:

- Increased access to fast foods - Decreased access to appropriate physical activity - Decreased sleep all having an impact

Factors that influence lifestyle and patterns of eating decisions include:

- Interpersonal relationships - Learned stress-coping mechanisms - Alterations in mood

Poor oral hygiene and periodontal disease are potential risk factors for systemic diseases such as:

- Joint infections - Ischemic stroke - Cardiovascular disease - DM - Aspiration pneumonia

Some reasons why individuals with low incomes may eat poorly and become obese:

- Lack of access to healthy foods because of insufficient funds - Distance to supermarkets - Limited options for food preparation - High prices of quality foods - Cheap prices of fast food - Limited transportation

Family influences that may negatively impact nutritional status include:

- Lack of home-prepared meals - Eating meals on the go - Restricting multiple food groups because of allergies or dislikes - Limited choices because of financial challenges

Parents have more influence on adolescents' diets than they believe. Effective strategies include:

- Limiting the amount of unhealthy food choices kept at home - Encouraging smart snacks such as fruits, vegetables, or string cheese - Enhancing the appearance and taste of healthy foods

Screening for nutritional status in the general population is limited primarily to:

- Lipid screening - Blood glucose screening - BMI

Tests included are:

- Low-density lipoprotein (LDL) - High-density lipoprotein (HDL) - Cholesterol - Triglycerides

Initial steps in assessing nutritional status:

- Measuring height and weight - Determining body mass index (BMI)

Muscle contraction involves:

- Mechanical energy - Nervous system function involves electrical energy - Mechanisms of heat production involve thermal energy

Dysphagia screening includes:

- Medical record review - Observation of a patient at a meal for change in voice quality, posture, and head control - Percentage of meal consumed - Eating time - Drooling or leakage of liquids and solids - Cough during/after a swallow - Facial or tongue weakness - Palatal movement - Difficulty with secretions - Pocketing - Choking - A spontaneous dry cough

*Hypervitaminosis* of fat-soluble vitamins results from:

- Megadoses (intentional or unintentional) of supplemental vitamins - Excessive amounts in fortified food - Large intake of fish oils

PCM is characterized by:

- Muscle wasting - Loss of subcutaneous fat - Protein deficiency

Nutrition is a basic component of health and is essential for:

- Normal growth and development - Tissue maintenance and repair - Cellular metabolism - Organ function

Adding foods to an infant's diet depends on the infant's:

- Nutrient needs - Physical readiness to handle different forms of foods - The need to detect and control allergic reactions Introducing foods that have a high incidence of causing allergic reaction such as wheat, egg white, nuts, citrus juice, and chocolate should happen later in the infant's life

A number of physiological consequences occur associated with a poor nutritional state on both ends of the spectrum:

- Nutritional deficiencies - Nutritional excess

The basic elements of a history include:

- Nutritional intake - Diet restrictions - Changes in appetite and intake - Changes in weight - Medical history - Current medical conditions - Current medications and treatments - Allergies - Family history - Social history

Features of metabolic syndrome include:

- Obesity - Elevated lipid levels - Increased blood pressure - Elevated fasting blood sugar

Fortunately, a carefully planned vegan diet offers protection against:

- Obesity - Hypertension - Type 2 diabetes - Cardiovascular disease, especially in men

Normal metabolism and anabolism are physiologically possible when:

The body is in *positive nitrogen balance*

The older adult is often:

- On a therapeutic diet - Has difficulty eating because of physical symptoms, lack of teeth, or dentures - Is at risk for drug-nutrient interactions

What can impair the ability to chew and limits diet quality?

- Pain from dental caries - Poorly fitting dentures - Loss of teeth

The approach to obesity prevention and treatment during middle childhood is multi-faceted and addresses:

- Parenting and cultural practices - Environmental modifications - Children's personal behaviors and emotional state - Changes in lifestyle

The body absorbs nutrients by means of:

- Passive diffusion - Osmosis - Active transport - Pinocytosis

Close contact with patients and their families enables you to observe:

- Physical status - Food intake - Food preferences - Weight changes - Response to therapy

Carbohydrates, protein, and fat metabolism:

- Produce chemical energy - Maintain a balance between anabolism and catabolism

Senior citizens are also at high risk for nutritional inadequacies. Factors that are common:

- Reduced organ function - Limited income - Interactions between nutrients and medications - Isolation - Decreased interest in meal preparation - Changes in appetite - Fatigue - Altered taste sensations

Those elderly who are institutionalized are at even greater risk due to:

- Severe dietary restrictions - Rigid mealtimes - Generally poor health status - Feeding dependency

A number of validated screening tools are available such as:

- The Bedside Swallowing Assessment - Burke Dysphagia Screening Test - Acute Stroke Dysphagia Screen - Standardized Swallowing Assessment

Childhood obesity contributes to medical problems related to:

- The cardiovascular system - Endocrine system - Mental health

Nutrition screening tools gather data on:

- The current condition - Stability of the condition - Assessment of whether it will worsen - If the disease process accelerates

Coordination of care often involves working with:

- The registered dietitian nutritionist - Home care services - A community agency (e.g., referral to Meals-On-Wheels for home-delivered meal services)

Digestive enzymes are responsible for:

The chemical breakdown of food matter This process is most efficient when consumed food is thoroughly chewed, thus increasing the surface of food particles for enzyme action

In addition, it is important to consider:

The chief complaint/presenting symptoms because they might relate to nutrition and may warrant a symptom analysis

Unfortunately, the long-term success rate for the elimination of childhood obesity is poor. Positive outcomes are increased when:

The child has a support system and understands the importance of diet and exercise

Electrolytes and minerals are absorbed in:

The colon

Statins (e.g., atorvastatin, fluvastatin, lovastatin, pravastatin, and rosuvastatin) are:

The drugs of choice for treatment of lipid and cholesterol reduction because of their ability to inhibit the synthesis of cholesterol, leading to reductions in LDL and HDL

Nutrients

The elements necessary for normal function of numerous body processes

Altered Organ Function (Underlying Medical Condition)

The failure of organs involved in digestion and metabolism are associated with nutritional deficiencies

The fat-soluble vitamins (A, D, E, and K) are stored in:

The fatty compartments of the body

Breast milk or formula provides sufficient nutrition for how long?

The first 4 to 6 months of life

Passive Diffusion

The force by which particles move outward from an area of greater concentration to one of lesser concentration The particles do not need a special "carrier" to move outward in all directions

Alcohol and aspirin are two substances directly absorbed through:

The lining of the stomach

Pregnancy is a very important stage because of:

The long-term effects on health of the infant and the mother

Enzyme activity depends on:

The mechanical breakdown of food to increase its surface area for chemical action

What happens once food matter has been digested?

The microscopic hairlike projections (villi) that line the intestinal tract absorb nutrients into capillaries which are then transported by the vascular system

Obesity

The most common form of excessive nutrition

For infants 4 to 11 months, cereals are:

The most important nonmilk source of protein

The energy requirements of pregnancy relate to:

The mother's body weight and activity

Macrominerals help to balance:

The pH of the body Specific amounts are necessary in the blood and cells to promote acid-base balance

The Subjective Global Assessment (SGA) uses:

The patient history, weight, and physical assessment data to assess nutritional status Is a simple, inexpensive technique that is able to predict nutrition-related complications

In addition, weight gain can still occur if:

The patient is noncompliant with calorie control

What is one of the most important aspects of a nutritional assessment?

The physical examination

A specific formula is selected by:

The physician and RDN based on patient needs

Both poverty and parental level of education affect:

The prevalence of obesity With children in poor families and children whose parents did not complete high school at higher risk

Digestion

The process of mechanical and chemical breakdown of food matter and complex forms of macronutrients

The lactating woman needs 500 kcal/day above the usual allowance because:

The production of milk increases energy requirements Protein requirements during lactation are greater than those required during pregnancy The need for calcium remains the same as during pregnancy There is an increased need for vitamins A and C

Both zinc and folic acid are critical in:

The production of proteins and cellular structures Without these micronutrients, growth and tissue repair are severely impaired

Nutrient Density

The proportion of essential nutrients to the number of kilocalories High-nutrient dense foods such as fruits and vegetables provide a large number of nutrients in relationship to kilocalories Low-nutrient dense foods such as alcohol or sugar are high in kilocalories but nutrient poor

Calcium is essential for:

The rapid bone growth of adolescence

What happens when there is enough of any specific vitamin to meet the catalytic demands of the body?

The rest of the vitamin supply acts as a free chemical and is often toxic to the body

Because the obese child develops increased numbers of fat cells, which are carried into adulthood, preventing obesity in childhood can reduce:

The risk of obesity in adulthood and plays a role in preventing disease

Nutrition

The science of optimal cellular metabolism and its impact on health and disease

Physical, chemical, and hormonal factors regulate:

The secretion of digestive juices and the motility of the GI tract

Peristalsis continues in the small intestine, mixing:

The secretions with chyme

Absorption of carbohydrates, protein, minerals, and water-soluble vitamins occurs in:

The small intestine Are then processed in the liver and released into the portal vein circulation

Primary absorption site for nutrients:

The small intestine Lined with fingerlike projections called villi

The major part of digestion occurs in:

The small intestine Producing: - Glucose, fructose, and galactose from carbohydrates - Amino acids and dipeptides from proteins - Fatty acids, glycerides, and glycerol from lipids

Nutrition therapy is a term used to describe:

The typical services of the RDN or registered dietetic technician

In CKD, protein is lost through:

The urine Can lead to impaired skin integrity, slow wound healing, suppressed immunity, sarcopenia, and altered osmotic pressure

Infants and children younger than 2 years old can be screened for overweight using:

The weight-to-length measurement Concern is generated when that percentile exceeds the 95th

Assess patients for malnutrition when they have conditions that interfere with:

Their ability to ingest, digest, or absorb adequate nutrients

Carbohydrate classification occurs according to:

Their carbohydrate units, or *saccharides*

The body does not store water-soluble vitamins; thus we need:

Them provided in our daily food intake

Collaborative Interventions

There are several interventions for nurses to manage individuals who have nutritional-related health conditions

Developmental Needs Young and Middle Adults

There is a reduction in nutrient demands as the growth period ends

What happens to large food particles and undigested fibers?

They not absorbed—they are eliminated through the colon

Cystic Fibrosis

Thick secretions block pancreatic ducts, eventually leading to impaired digestion and absorption of fats and fat-soluble vitamins

Vegetable fats have higher amounts of:

Unsaturated and polyunsaturated fatty acids

Duodenum

Upper portion of the small intestinal tract Primary site for absorbing trace minerals

Elimination of the remaining 0.1 L occurs:

Via feces

The water-soluble vitamins are:

Vitamin C and the B complex (which is eight vitamins)

Vitamin D Deficiency

Vitamin D insufficiency is known to lead to osteoporosis, hip fracture, and hyperparathyroidism Studies also suggest links with cardiovascular disease, cancer, multiple sclerosis, tuberculosis, and muscular and immune system disorders

In the colon, bacteria synthesize:

Vitamin K and some B-complex vitamins

Fortified foods (nutrients added) are important sources of:

Vitamins and minerals Snack food from the dairy, fruit, and vegetable groups are good choices

Micronutrients

Vitamins and minerals are micronutrients because they are required in minute amounts Some minerals are needed in such small amounts that they are called "ultra" trace mineral requirements

The body is unable to synthesize:

Vitamins in the required amounts

Polysaccharides are insoluble in:

Water and digested to varying degrees

The longer the material stays in the large intestine, the more:

Water is absorbed, causing the feces to become firmer

Swallowed food enters the esophagus, and:

Wavelike muscular contractions (peristalsis) move the food to the base of the esophagus, above the cardiac sphincter

The body is unable to digest some polysaccharides because:

We do not have enzymes capable of breaking them down

When the kilocalories ingested exceed our energy demands:

We gain weight

If the kilocalories ingested fail to meet our energy requirements:

We lose weight

There have been complications with previous forms of:

Weight loss medications Currently all of these medications have limitations on duration of use

Does the amount of nutrient intake needed for optimal function change across the lifespan?

Yes

Since water-soluble vitamins are not stored, can toxicity still occur?

Yes

Parents Want to Know: How to Prevent and Manage Obesity

You can help prevent and manage obesity in your child by doing the following: - Do not use food as a reward - Establish consistent times for meals and snacks and discourage in-between eating - Offer only healthy food options (ask the child to choose between an apple or popcorn, not an apple or a cookie) - Avoid keeping unhealthy food in the house and minimize trips to fast-food restaurants - Be a role model by improving your own eating habits and levels of activity - Encourage the child to do fun, physical activities with the family - Praise the child for making appropriate food choices and for increasing physical activity levels

The priority for the resumption of food intake after surgery depends on:

- The return of bowel function - The extent of the surgical procedure - The presence of any complications Ex: When patients have oral and throat surgery, they chew and swallow food in the presence of excision sites, sutures, or tissue manipulated during surgery The priority of care is to first provide comfort and pain control. Then address nutritional priorities and plan care to maintain nutrition that does not cause pain or injury to the healing tissues

Amino acids are anabolized into:

- Tissues - Hormones - Enzymes

An adolescent boy's diet is often inadequate in:

- Total kilocalories - Protein - Iron - Folic acid - B vitamins - Iodine

Diseases more common in European heritage include:

- Type 1 diabetes - Celiac disease - Neurodegenerative disorders such as Huntington's disease and multiple sclerosis

Consequences of excessive weight have been well documented and can include:

- Type 2 diabetes - Coronary heart disease - Hypertension - Stroke - Fatty liver disease - Gallbladder disorders - Sleep apnea - Asthma - Other respiratory problems, musculoskeletal disorders, as well as some cancers With more children and teens becoming obese, many of these medical conditions are seen at young ages, with similar challenges and high risks for early mortality

The most important screening problems or presenting symptoms include the following:

- Unplanned changes in weight - Changes in appetite or intake - Nausea and/or vomiting - Difficulty chewing or swallowing - Abdominal pain or discomfort - Changes in bowel habits - Recent history of constipation or diarrhea

Fat-Soluble Vitamins

- Vitamin A - Vitamin D - Vitamin E - Vitamin K

Water-Soluble Vitamins

- Vitamin C - B Vitamins (Thiamin; Riboflavin; Niacin; Pyridoxine; Pantothenic; Biotin; Folate; Cobalamin)

Supplement examples include:

- Vitamin supplements (e.g., multivitamins, niacin, B vitamins, and Vitamin C) - Mineral supplements (e.g., iron and calcium folic acid) - Protein and nutrient supplements (Ensure, nutrition bars, etc.)

The general dietary habits of the family should also be assessed. Additional strategies include:

- Watching portion size - Avoiding having unhealthy foods or snacks available in the home - Parental role modeling

Generally, bariatric surgery has demonstrated good success for:

- Weight loss - Improved glucose level - Normalized blood pressure

Protein in the formula is typically:

- Whey - Soy - Cow's milk base - Casein hydrolysate - Elemental amino acids

Three types of macronutrients:

1. Carbohydrates 2. Protein 3. Fat

Nutrient metabolism consists of three main processes:

1. Catabolism of glycogen into glucose, carbon dioxide, and water (*glycogenolysis*) 2. Anabolism of glucose into glycogen for storage (*glycogenesis*) 3. Catabolism of amino acids and glycerol into glucose for energy (*gluconeogenesis*)

Malnutrition is a comprehensive term that refers to two major categories of nutritional conditions:

1. Insufficient nutrition 2. Excess nutrition

The FDA first established two sets of reference values:

1. The referenced daily intakes (RDIs) are the first set, comprising protein, vitamins, and minerals based on the RDA 2. The daily reference values (DRVs) make up the second set and consist of nutrients such as total fat, saturated fat, cholesterol, carbohydrates, fiber, sodium, and potassium

The metabolic half-life of retinol-binding protein is:

12 hours

The metabolic half-life of prealbumin is:

2 days

These guidelines are for Americans over the age of:

2 years

Toddlers need to drink whole milk until the age of:

2 years To make sure that there is adequate intake of fatty acids necessary for brain and neurological development

Commercial formulas and human breast milk both provide approximately how many kcal/oz?

20 kcal/oz

Daily values are based on percentages of a diet consisting of:

2000 kcal/day for adults and children 4 years or older

The metabolic half-life of albumin is:

21 days

Snacks provide what percentage of a teenager's total dietary intake?

25%

The general goals include:

30 minutes of physical activity on most days of the week or 150 or more minutes weekly Weight loss may require at least twice this amount of exercise

Obesity is associated with a BMI greater than:

30, or being more than 20% over ideal body weight

Each gram of carbohydrate produces:

4 kcal/g

Protein intake throughout pregnancy needs to increase to:

60 g daily

How much water makes up total body weight?

60% to 70%

The metabolic half-life of transferrin is:

8 days

How much does the small intestine resorb?

9.5 L

The *recommended dietary allowance (RDA)* is the average needs of:

98% of the population, not the exact needs of the individual

In an outpatient setting, have a patient keep:

A 3- to 7-day food diary

Obesity is an excessive accumulation of fat in the body and is assessed in children through:

A body mass index (BMI) that exceeds the 95th percentile for age

These are usually ordered as part of:

A chemistry profile blood test

The combination of a simple protein with a nonprotein substance produces:

A complex protein such as lipoprotein, formed by a combination of a lipid and a simple protein

Phenylketonuria (PKU)

A deficiency in the enzyme responsible for the metabolism of the amino acid phenylalanine PKU allows phenylalanine to accumulate in the brain, blood, and tissues leading to cognitive dysfunction unless the affected individual follows a low-phenylalanine diet for life

Epiglottis

A flap of skin that closes over the trachea as a person swallows to prevent aspiration

Individuals are thought to have:

A genetic predisposition to hyperlipidemia But a dietary intake high in dietary fat is another contributing factor

Here, nutrition consists of:

A glucose-based intravenous solution (various dextrose concentrations) with electrolytes, minerals, and amino acids Fat emulsions (lipids) may also be included or administered as a separate solution

Obesity occurs when there is:

A greater intake of calories than energy expenditure

The area between any two percentiles is referred to as:

A growth channel

What is required for optimal elimination?

A healthy GI tract with efficient peristaltic action

A person who follows the current Dietary Guidelines for Americans and MyPlate can achieve:

A healthy diet

Saliva

A mucous-like fluid that contains the digestive enzyme amylase, which assists with the process of food breakdown and aids in the chewing and swallowing process

Screening for and treatment of dysphagia requires:

A multidisciplinary team approach of nurses, RDs, health care providers, and SLPs

Obesity is caused by:

A number of factors Can include overeating, inactivity, and genetics

The concept of nutrition is complex, involving:

A number of physiological processes

Through the chemical changes of metabolism, the body converts nutrients into:

A number of required substances

Pharmacologic Agents (Collaborative Intervention)

A number of supplements are used to enhance the nutritional status of individuals, and most are available over the counter

The *estimated average requirement (EAR)* is the recommended amount of:

A nutrient that appears sufficient to maintain a specific body function for 50% of the population on the basis of age and gender

Childhood growth normally progresses according to a pattern along:

A particular growth channel Deviations from normal growth patterns may suggest problems Any change of more than two growth channels indicates a need for more in-depth assessment

In addition to the general nursing history, use data from a more specific diet history to assess:

A patient's actual or potential nutritional needs

The diet history focuses on:

A patient's habitual intake of foods and liquids Includes information about preferences, allergies, and other relevant areas such as the patient's ability to obtain food

Complete the general physical assessment of body systems and recheck relevant areas to evaluate:

A patient's nutritional status

Researchers think that oxidative damage increases:

A person's risk for various cancers

Chewing reduces food particles to:

A size suitable for swallowing

A PEG tube requires:

A small incision into the stomach Fortunately, the procedure is relatively safe, simple, and reversible

Each enzyme works best at:

A specific pH For example, the enzyme amylase in the saliva breaks down starches into sugars

Increased Metabolic Demand (Underlying Medical Condition)

A variety of conditions increase metabolic rate and energy needs, thus increasing the risk for protein-calorie malnutrition Examples include cancer, chronic obstructive pulmonary disease, Parkinson's disease, trauma (including burns), stroke, and HIV/AIDS

In chronic kidney disease (CKD), nutritional status is adversely impacted through:

A variety of mechanisms

Underlying Medical Conditions (Individual Risk Factor)

A wide range of medical conditions place individuals at risk for various nutritional problems Include: - Impaired oral intake - Impaired digestion and absorption - Increased metabolic demand - Altered organ function

Among the most commonly reported symptoms are:

Abdominal discomfort, bloating, diarrhea, and nausea

Albumin level is a better indicator for chronic illnesses, whereas prealbumin level is preferred for:

Acute conditions

CCK inhibits further gastrin secretion and initiates release of:

Additional digestive enzymes from the pancreas and gallbladder

Individualized dietary plans are needed to:

Address unique dietary needs of patients based on their age, calorie needs, and underlying health condition For example: Not all hypertensive individuals respond to sodium (salt) restriction, not all individuals with high serum cholesterol levels respond to a low saturated fat diet, and sugar alone is not the culprit in diabetes management

Impaired Oral Intake (Underlying Medical Condition)

Adequacy of oral intake is associated with the ability to chew and swallow. Thus, the inability to chew or swallow properly can easily lead to malnutrition

Daily intake of water-soluble vitamins (B and C) is necessary to ensure:

Adequate levels in breast milk

Despite better appetites and more varied food intake, you need to assess school-age children's diets carefully for:

Adequate protein and vitamins A and C They often fail to eat a proper breakfast and have unsupervised intake at school

Combine multiple objective measures with subjective measures related to nutrition to:

Adequately screen for nutritional problems

The influence of peers is common among:

Adolescents Skipping meals, following fad diets, choosing salty and sugary snacks over healthy foods, eating super-sized portions, and drinking alcohol are examples Here, mood swings dominate. Coping mechanisms often include eating large amounts of sweets or comfort foods or reducing intake altogether during periods of depression Peer influences are especially strong among young people with lower self-esteem

Hyperlipidemia primarily affects:

Adults (an estimated 100 million in the United States) But can occur associated with childhood obesity

Factors Influencing Nutrition Older Adults

Adults 65 years and older have a decreased need for energy because their metabolic rate slows with age However, vitamin and mineral requirements remain unchanged from middle adulthood

Essential Fatty Acid (Macronutrient) Deficiency

Affects all cellular membranes and is particularly a problem with premature infants *Docosahexaenoic acid (DHA)* and *eicosapentaenoic acid (EPA)* are long-chain omega-3 fatty acids that support retinal development, neurotransmitter production, and brain function

Setting Priorities for Patients

After identifying patients' nursing diagnoses, determine priorities to plan timely and successful interventions For example, managing a patient's oral pain will be a priority over the intervention of diet education to improve nutrition if the patient is unable to swallow and maintain adequate food intake

The Poor and Underserved (Population at Risk)

As a population group, those of low socioeconomic status are at risk for malnutrition because of food insecurity and food availability

When does the growth rate start to slow for a child?

As a toddler (1-3 years)

Dietary Interventions (Collaborative Intervention)

As part of the health care team, nurses often work with other health professionals for optimal nutritional outcomes

Silent Aspiration

Aspiration that occurs in patients with neurological problems that lead to decreased sensation It often occurs without a cough, and symptoms usually do not appear for 24 hour Silent aspiration accounts for most of the 51% to 78% of aspiration in patients with dysphagia following stroke

Dietetic Technician

Assists the RDN with menu planning, nutrition education, and management of food services

Age or Life Stage (Population at Risk)

At the beginning of life and again at the later stages, nutritional deficits are a significant concern

Vitamin B3

Consequences of Deficiencies: - Pellagra with 4 D's: dermatitis, diarrhea, dementia, death Consequences of Toxicities: - Abnormal glucose metabolism - Flushing - Nausea and vomiting

Vitamin B12

Consequences of Deficiencies: - Pernicious anemia - Psychiatric disorders Consequences of Toxicities: - Toxicity unknown

Vitamin D

Consequences of Deficiencies: - Rickets - Bone disease - Muscle pain - Falls Consequences of Toxicities: - Hypercalcemia - Renal stones - Calcification of soft tissues

Vitamin B1 (Thiamine)

Consequences of Deficiencies: - Wenicke's encephalopathy with neurodegeneration Consequences of Toxicities: - Toxicity rare

Water maintains:

Consistency

To carry out the work of the body, the chemical energy produced by metabolism:

Converts to other types of energy by different tissues

To counter obesity, increasing physical activity is often more important than:

Curbing intake

Combined, both sets make up the:

Daily values used on food labels

Excessive infusion of enteral or parenteral nutrition solutions can be:

Dangerous The critically ill patient is vulnerable because metabolic shifts occur throughout each day from sepsis and various procedures

In conditions such as Parkinson's or Alzheimer's disease, the sense of smell diminishes, also leading to:

Decreased food intake

Vitamin C Deficiency

Deficiency of vitamin C was one of the first recognized nutrient deficiency diseases, with the severe form (scurvy) being a cause of death among early sea voyagers. British sailors were called "limeys" because their intake of limes while onboard sea vessels prevented this condition

Hyperglycemia may be an indication of:

Diabetes mellitus

A qualified RDN may have:

Diet order-writing privileges as determined by competency assessment, licensure laws, and facility protocols RDN can adjust a patient's meal plan so that it is appropriate for health goals, realistic, economical, and feasible for the family

The long-term consequence involves:

Dietary deficiencies due to malabsorption of nutrients (as a result of the intestinal inflammation)

Vitamin synthesis depends on:

Dietary intake

With the exception of vitamin D, people acquire vitamins through:

Dietary intake

As a nurse, consider the food preferences of patients from:

Different cultural groups, vegetarians, and others when planning diets

A full-term newborn is able to:

Digest and absorb simple carbohydrates, proteins, and a moderate amount of emulsified fat

Insoluble fibers, including cellulose, hemicellulose, and lignin, are not:

Digestible

Hormones regulate the flow of:

Digestive secretions needed for enzyme supply

Calculate nitrogen balance by:

Dividing 6.25 into the total grams of protein ingested in a day (24 hours)

We meet our fluid needs by:

Drinking liquids and eating solid foods high in water content such as fresh fruits and vegetables

Developmental Needs Adolescents

During adolescence physiological age is a better guide to nutritional needs than chronological age

Nursing Process - Assessment

During the assessment process thoroughly assess each patient and critically analyze findings to ensure that you make patient-centered clinical decisions required for safe nursing care

Saturated Fatty Acids

Each carbon in the chain has two attached hydrogen atoms

Saliva provides lubrication to:

Ease swallowing of the food

Nutritional status can be viewed as:

Either optimal or suboptimal

Epithelial cells in the small intestinal villi secrete:

Enzymes (e.g., sucrase, lactase, maltase, lipase, and peptidase) to facilitate digestion

Proteins and fats are broken down physically but remain unchanged chemically because:

Enzymes in the mouth do not react with these nutrients

Linoleic acid, an unsaturated fatty acid, is the only:

Essential fatty acid in humans

We also classify fatty acids as:

Essential or nonessential

Untreated, patients with anorexia nervosa experience:

Extreme weight loss and muscle wasting Representing a condition of insufficient nutrition

Water absorbs in the mucosa as:

Feces move toward the rectum

Calcium intake is especially critical in the third trimester, when:

Fetal bones mineralize

Pancreatic Enzymes

Finalize digestion in the small bowel, with fats being converted into fatty acids

It is diagnosed based on the presence of:

Flattened villi as well as specific antibodies in the blood

An ill person has an increased need for:

Fluid (e.g., with fever or gastrointestinal [GI] losses) By contrast, he or she also has a decreased ability to excrete fluid (e.g., with cardiopulmonary or renal disease), which often leads to the need for fluid restriction

In a healthy individual fluid intake from all sources equals:

Fluid output through elimination, respiration, and sweating

Rapid weight gain or loss is important to note because it usually reflects:

Fluid shifts

Mentioning some potential nutritional complications of a condition, or asking about the individual's personal health concerns, allows for:

Focused interviewing

Weight gain can occur when:

Food habits change to match those of the partner, such as during dating and marriage

Dysphagia often leads to an inadequate amount of:

Food intake, which results in malnutrition

Digestion produces fluid during:

Food oxidation

The patient and family must collaborate with the nurse in planning care and setting priorities. This is important because:

Food preferences, food purchases, and preparation involve the entire family The plan of care cannot succeed without their commitment to, involvement in, and understanding of the nutritional priorities

The stomach acts as a reservoir where:

Food remains for approximately 3 hours, with a range of 1 to 7 hours

Calcium and vitamin D levels tend to be low unless:

Fortified foods or supplements are used

These vitamins neutralize substances called:

Free radicals Which produce oxidative damage to body cells and tissues

Vitamin content is usually highest in:

Fresh foods that have minimal exposure to heat, air, or water before their use

Nerve stimulation from the parasympathetic nervous system (e.g., the vagus nerve) increases:

GI tract action

Children with low metabolic rates and more fat cells tend to:

Gain more weight As do children whose parents are obese

Electrolytes provide information about:

General health status Including specific information about micronutrients including sodium, potassium, calcium, magnesium, and phosphorus

Monoglycerides from the digested part of fats convert to:

Glucose by gluconeogenesis

Carbohydrates are also required to provide:

Glucose for the unique fuel needs of the brain, the neurologic system, and the red blood cells

Energy needs increase to meet:

Greater metabolic demands of growth Daily requirement of protein also increases

Proteins are essential for:

Growth, maintenance, and repair of body tissue

The parietal cells also secrete:

HCl and intrinsic factor (IF) Which is necessary for absorption of vitamin B12 in the ileum

If BMI is within normal limits and weight has been stable, it is still important to:

Have at least a brief assessment of oral intake to verify that macronutrients and micronutrients are being consumed in appropriate amounts

Monounsaturated Fatty Acids

Have one double bond

Polyunsaturated Fatty Acids

Have two or more double carbon bonds

Nursing Assessment Questions: Appetite and Weight

Have you had a change in appetite? Have you noticed a change in your weight? Was this change anticipated (e.g., were you on a weight-reduction diet)?

Nursing Assessment Questions: Taste, Chewing, and Swallowing

Have you noticed any changes in taste? Did these changes occur with medications or following an illness? Do you wear dentures? Are the dentures comfortable? Do you have any mouth pain or sores (e.g., cold sore, canker sores)? Do you have difficulty swallowing? Do you cough or gag when you swallow?

Overweight is defined as:

Having a BMI greater than 25

General physical appearance, level of orientation, and demeanor will give insight into:

Health and nutritional status ----- Skin should be smooth and elastic without cracks or bruising Hair should be shiny and not brittle Nail beds should be smooth, pink, and firm Teeth should be free of cavities, and the oral tissues should be moist, pink, and firm Mucous membranes around the eyes should be pink, moist and free of lesions; the sclera should be white Cornea should be clear and shiny

Body mass index (BMI) measures weight corrected for:

Height

B-complex vitamins are necessary to support:

Heightened metabolic activity

The very young are at risk because of:

Immature organ development and total dependence on others for feeding

Impact of Medical Conditions on Risk for Malnutrition: - Wound healing protocol with excess supplementation of zinc

Impact on Nutritional Status: - Copper deficiency anemia

Impact of Medical Conditions on Risk for Malnutrition: - Epilepsy with use of antiseizure medications - Chronic kidney disease (end stage) and dialysis treatments - Edema/hypertension with K+-depleting diuretics - Malabsorption/diarrhea - Hepatic disease - Pancreatitis

Impact on Nutritional Status: - Folic acid deficiency/megaloblastic anemia - Hypomagnesemia

Impact of Medical Conditions on Risk for Malnutrition: - Hyperparathyroidism - Hyperthyroidism - Adrenal insufficiency - Cancer - Hypervitaminosis A and D

Impact on Nutritional Status: - Hypercalcemia

Fats (Lipids)

Are the most calorie-dense nutrient, providing 9 kcal/g

Nursing Assessment Questions: Allergies

Are you allergic to any foods? Which types of problems do you have with these foods? How are these food allergies treated (e.g., EpiPen, oral antihistamines)?

When do women tend to experience cravings?

Around their menstrual periods and during pregnancy If they give in to these cravings regularly, obesity may result

Patients who are malnourished on admission are at greater risk of life-threatening complications such as:

Arrhythmia, sepsis, or hemorrhage during hospitalization

Secondary Prevention (Screening)

Secondary prevention involves screening tests to detect disease

Daily values did not replace RDAs but provided a:

Separate, more understandable format for the public

Factors Affecting Nutritional Status for Older Adults

Age-related gastrointestinal changes that affect digestion of food and maintenance of nutrition include changes in the teeth and gums, reduced saliva production, atrophy of oral mucosal epithelial cells, increased taste threshold, decreased thirst sensation, reduced gag reflex, and decreased esophageal and colonic peristalsis The presence of chronic illnesses (e.g., diabetes mellitus, end-stage renal disease, cancer) often affects nutrition intake Adequate nutrition in older adults is affected by multiple causes such as lifelong eating habits, culture, socialization, income, educational level, physical functional level to meet activities of daily living (ADLs), loss, dentition, and transportation Adverse effects of medications cause problems such as anorexia, gastrointestinal bleeding, xerostomia, early satiety, and impaired smell and taste perception Cognitive impairments such as delirium, dementia, and depression affect ability to obtain, prepare, and eat healthy foods

A complete protein, also called a *high-quality protein*, contains:

All essential amino acids in sufficient quantity to support growth and maintain nitrogen balance Examples of foods that contain complete proteins are fish, chicken, soybeans, turkey, and cheese

Assessment

All nurses should know how to perform a basic assessment of nutritional status Maintaining an awareness of the risk factors helps to focus the interview and examination

The simplest form of protein is the:

Amino acid

*Dietary reference intakes (DRIs)* present evidence-based criteria for:

An acceptable range of amounts of vitamins and nutrients for each gender and age-group

Food is now:

An acidic, liquefied mass called *chyme*

Impaired digestion and absorption can also occur as:

An adverse effect from some medications

Anorexia nervosa is characterized by:

An avoidance of food consumption often combined with excessive exercise with the intent to lose weight

The Acute Stroke Dysphagia Screen

An easily administered and reliable tool for health care professionals who are not speech-language pathologists (SLPs)

Hyperlipidemia is characterized by:

An elevation of serum lipids (cholesterol, triglycerides, and/or phospholipids)

Active Transport

An energy-dependent process whereby particles move from an area of lesser concentration to an area of greater concentration A special "carrier" moves the particle across the cell membrane

Ptyalin (Salivary Amylase)

An enzyme that acts on cooked starch to begin its conversion to maltose

Water is the final product considered to be:

An essential nutrient

Discharge planning is:

An essential team effort on behalf of the patient

Anabolism occurs when:

An individual adds lean muscle through diet and exercise

What does a cleft palate impact?

An infant's sucking ability, thereby limiting successful breast-feeding

Nutrition screening is an essential part of:

An initial assessment

Silicon, vanadium, nickel, tin, cadmium, arsenic, aluminum, and boron play what kind of role in nutrition?

An unidentified role

Calculate nitrogen balance by subtracting the nitrogen output from the nitrogen intake. A positive 2- to 3-g nitrogen balance is necessary for:

Anabolism

Pregnancy occurring within 4 years of menarche places a mother and fetus at risk because of:

Anatomical and physiological immaturity Malnutrition at the time of conception increases risk to the adolescent and her fetus. Most teenage girls do not want to gain weight

Inadequate vitamin B12 has been associated with:

Anemia and with neurologic damage, especially dangerous in children

Hyperlipidemia

Another example of excess nutrition

Certain vitamins are currently of interest in their role as:

Antioxidants

Normal intake requires:

Appropriate ingestion of necessary foods to meet macronutrient, micronutrient, and fluid needs

How much does the colon absorb?

Approximately 0.4 L

How long does peristalsis usually take to pass food through the small intestine?

Approximately 5 hours

How much water is absorbed in the small intestine?

Approximately 85% to 90%

Infants need an energy intake of:

Approximately 90 to 110 kcal/kg of body weight per day Premature infants needing 105 to 130 kcal/kg per day

Registered Dietitian Nutritionists (RDNs)

Are health professionals who have a background in biochemistry and metabolism, with knowledge about the macronutrient and micronutrient contents of foods and how the body uses them

Vitamins

Are organic substances present in small amounts in foods that are essential to normal metabolism

Excess Nutrition

At the opposite end of the spectrum is the situation in which excessive nutritional intake progresses to weight gain or nutritional toxicities Most common form of excess nutrition is associated with excessive calorie intake leading to weight gain Standardized categories, based on BMI, are used to describe overweight and obesity For adults, overweight is described as a BMI between 25.0 and 29.9. Three classes of obesity are class I (BMI of 30-34.9), class II (BMI of 35-39.9), and class III (BMI >40) Child obesity is described in terms of BMI compared to percentiles on standardized growth charts. A child who's BMI is between the 85th and 95th percentile for children of the same age and sex is classified as overweight; obesity is defined as a BMI greater than the 95th percentile Excess micronutrient intake most often occurs with high-dose fat-soluble vitamin and mineral supplements or when consuming foods that have 100% of the DRI levels of a nutrient, plus an oral supplement, and a liquid enhanced beverage all in the same day Outcomes of excessive food or supplement intake on physiological processes can be detrimental, especially if prolonged over time

Hemoglobin A1c is a test that shows:

Average blood glucose levels over time Used in the management of diabetic patients Indicates how well glucose levels are controlled

U.S. Department of Health and Human Services (USDHHS) and the U.S. Department of Agriculture (USDA) published the Dietary Guidelines for Americans 2015-2020 and provide:

Average daily consumption guidelines for the five food groups: grains, vegetables, fruits, dairy products, and meats

Indispensable Amino Acids

Because our body does not synthesize, we need these to be provided in our diet Ex: Histidine, lysine, and phenylalanine

The body produces gastric lipase and amylase to:

Begin fat and starch digestion, respectively

Chemical Breakdown

Begins in the oral cavity

Antioxidant vitamins include:

Beta-carotene and vitamins A, C, and E

Secretin activates release of:

Bicarbonate from the pancreas Which raises the pH of chyme

Dispensable Amino Acids

Body synthesizes Ex: Alanine, asparagine, and glutamic acid

The increased nitrogen loss is the result of:

Body tissue destruction or loss of nitrogen-containing body fluids Nutrition during this period needs to provide nutrients to put patients into positive balance for healing

Early recognition of malnourished or at-risk patients has a strong positive influence on:

Both short- and long-term health outcomes Studies demonstrate a link between malnutrition in adult hospitalized patients and readmission rates, higher mortality rates, and increased cost

Generally meeting the needs of a fetus is at the expense of the mother. However, if nutrient sources are not available, what happens?

Both suffer

Monosaccharides such as glucose (dextrose) or fructose do not:

Break down into a more basic carbohydrate unit

What does the American Academy of Pediatrics strongly support in regards to breastfeeding?

Breastfeeding for the first 6 months of life And breastfeeding with complementary foods from 6 to 12 months

The body uses nitrogen to:

Build, repair, and replace body tissues

Hyperlipidemia places an individual at significant risk for:

Cardiovascular disease, including acute myocardial infarction and stroke

Vitamins are chemicals that act as:

Catalysts in biochemical reactions

Proteins (in the form of essential amino acids) must be consumed for:

Cells to manufacture other proteins, such as carrier proteins, and to enable tissue growth and repair

Many metabolic enzymes assist in:

Cellular metabolism Zinc and magnesium are each part of more than 200 different metabolic enzymes

For long term, it can be administered:

Centrally Sepsis and electrolyte and metabolic imbalances can occur; thus, meticulous nursing care of the vascular access is required

Triglycerides

Circulate in the blood Are composed of three fatty acids attached to a glycerol

Serum albumin measures:

Circulating protein in the blood

It is estimated that more than 66% of the U.S. population (including adults and children) is:

Classified as overweight or obese

Manufactured in the liver, bile is then:

Concentrated and stored in the gallbladder

Vitamin C

Consequences of Deficiencies: - Bleeding tendency - Scurvy Consequences of Toxicities: - Inhibits zinc absorption - Urinary stones

Zinc

Consequences of Deficiencies: - Dermatitis - Impaired taste - Impaired growth - Low level of alkaline phosphatase enzyme Consequences of Toxicities: - Copper deficiency - Renal damage - Nausea and vomiting - Diarrhea

Biotin

Consequences of Deficiencies: - Hair loss Consequences of Toxicities: - Toxicity unknown

Magnesium

Consequences of Deficiencies: - Hypertension - Dysrhythmia - Preeclampsia Consequences of Toxicities: - Increased calcium secretion

Vitamin A

Consequences of Deficiencies: - Night blindness Consequences of Toxicities: - Loss of appetite - Bone pain - Hypercalcemia

Protein Deficiency (Macronutrient)

Protein is a component of every cell of the body Protein deficiency has diverse consequences, and the effects can be subtle or dramatic, depending on the severity, amount of inflammation, and length of time In children, an inadequate intake of protein and kilocalories (*marasmus*) impairs growth and development, stunting height and brain development most evidently The condition in which the insufficiency is protein alone, with adequate energy (*kwashiorkor*), is seen in developing countries after an infant is weaned to a diet that contains mostly grains At any age, inadequate protein intake will adversely impact the body's ability to repair or replace body tissues or produce other constituents such as immune factors In older adults, the loss of muscle mass (in sarcopenia) is difficult to replace. A spiraling decline in health may occur if not corrected through rapid and effective interventions Insufficient circulating protein in the blood (*hypoalbuminemia*) can also lead to *anasarca* (severe generalized edema)

Adequate carbohydrate intake provides the energy for:

Protein to do its many jobs

Low albumin can reflect:

Protein-calorie malnutrition However, other conditions (such as inflammation, blood loss, fluid status) can also cause low serum albumin levels

Enzymes

Protein-like substances that act as catalysts to speed up chemical reactions Are an essential part of the chemistry of digestion

Protein provides energy but, because its essential role is to promote growth, maintenance, and repair, a diet needs to:

Provide adequate kilocalories from nonprotein sources

The food mixes with saliva, which contains:

Ptyalin (salivary amylase)

Early and ongoing assessment of patients with dysphagia using a valid dysphagia-screening tool increases:

Quality of care and decreases incidence of aspiration pneumonia

Developmental Needs Infants Through School-Age

Rapid growth and high protein, vitamin, mineral, and energy requirements mark the developmental stage of infancy

Hepatic disease adversely impacts the ability to:

Reassemble amino acids into the various proteins needed for physiological function

Diagnostic Criteria for Eating Disorders Bulimia Nervosa

Recurrent episodes of binge eating (rapid consumption of a large amount of food in a discrete period of time) A feeling of lack of control over eating behavior during eating binges Recurrent inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise Binge eating and inappropriate compensatory behaviors that both occur, on average, at least once a week for 3 months • Self-evaluation unduly influenced by body shape and weight

The kidneys are involved in producing:

Red blood cells Therefore, in patients with CKD, anemia can develop that is unresponsive to iron intake due to an insufficient level of erythropoietin, a protein-based hormone

Hemoglobin (Hgb) and hematocrit (Hct) is a blood test that examines:

Red blood cells (including the number, size, shape, and color) To diagnose anemia caused by dietary deficiency such as iron, folate, and vitamin B12

National Guidelines for Recommended Intake

Referred to as Dietary Reference Intakes (DRIs) Available on the US Department of Agriculture website

Metabolism

Refers to all of the biochemical reactions within the cells of the body

Protein-Calorie Malnutrition (PCM)

Refers to an extended state of insufficient protein and calorie intake

Suboptimal State (Malnourished State)

Reflects either insufficient or excessive quantity or quality of macronutrients or micronutrients

Medical nutrition therapy is a legal term for:

Reimbursable services provided by the RDN

Nurses should understand basic modified diets to:

Reinforce messages provided by the RDN and encourage referrals as needed

The concept of personalized nutrition is:

Replacing the old paradigm that "one diet fits all" through the science of nutrigenomics In other words, how genetics influence nutritional intervention

Scope of Nutritional Status

Represented as a continuum with malnutrition on both ends (insufficient nutrition and excess nutrition) and optimal nutrition in the middle Continuum representation is important because nutritional status has the potential to change in either direction due to a number of factors and can be corrected with successful measures

In regard to pharmacologic agents for obesity management:

Research continues

Diagnostic Criteria for Eating Disorders Anorexia Nervosa

Restriction of energy intake relative to requirements, leading to a significantly low body weight in relation to age, sex, developmental trajectory, and physical health Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight Disturbance in the way in which one's body weight, size, or shape is experienced; undue influence of body weight or shape on self-evaluation; or persistent lack of recognition of the seriousness of the current low body weight (e.g., the person claims to "feel fat" even when emaciated, believes that one area of the body is "too fat" even when obviously underweight)

In the last 20 years the prevalence of overweight children has:

Risen The percent of obesity in children ages 6 to 11 years has doubled to 17%, and the percent of overweight adolescents has more than tripled to 17.6%

Folate Deficiency

Role of folate in the development of the central nervous system had been known for decades, but not until the 1990s did it become clear that most neural tube defects (NTDs) could be prevented by fortifying grains Folic acid is now added to flour processed in the United States and in many countries; an important reduction in NTDs has been shown in these countries

Most animal fats have high proportions of:

Saturated fatty acids

Fatty acids can be:

Saturated or unsaturated