Ch 42. Nutrition

Question 1

Factors of Nutrition

Answer 1

Aging population – people staying at home longer where cooking may not be as complete as living in a care home

Social isolation – food is social

Preschool or daycare – children are going there and they don’t necessarily get homecooked food there

Poverty – child poverty is 1/5 Canadian children. 60% of first nation children on reserves are below the poverty line.

Overweight and obesity – more cases of type 2 diabeties

Rising cost of living – many people with tight budgets are seeing what they can cut back on. Nutrient rich foods may be to expensive to buy

Question 2

Digestion Phases

Answer 2

Digestion
Begins in the mouth and ends in the small and large intestines

Absorption
Primary site: small intestine
Metabolism and storage of nutrients
Anabolic and catabolic reactions

Elimination
Chyme moved by peristalsis into the large intestines and turned into feces

Question 3

Nutrition Developmental Considerations:

Infants, Adolescents, Middle Age, Older

Answer 3

Infants through school-aged children
Breastfeeding
Formula
Introduction to solid food
Childhood obesity

Adolescents
Nutritional deficiencies (need calcium and iron for female period and iodine needed for thyroid)
Eating disorders – obesity, anorexia, bulemia
Physical activity - increases dietary need for protein and water

Young and middle-aged adults
Obesity
Pregnancy – avoid foods with listeria. Need folic acid, iron/iodine
Lactation

Older persons
difficulty chewing, loss of taste/smell, access to food, lack of teeth, isolation
Nutritional deficiencies – calcium, Vit D, phosphorous
Women more likely to get osteoporosis
Health status- decrease need in NRG due to decreased metabolism
Dehydration

Question 4

Food with religion, cultural background, ethics, health beliefs, preference

Answer 4

Meaning of food to patient

Lactose intolerance

“Hot” and “cold” foods (ie cancer is a “cold” illness neededing “hot” food)

Vegetarian diet – ranges from eggs/dairy to entirely plant based
Iron and calcium must be supplemented

Question 5

Nutritional assessment

Answer 5

• Anthropometry - study of the measurements and proportions of the human body.
• Laboratory and biochemical tests
• Dietary history and health history
• Clinical observation and physical examination
• Patient expectations

Question 6

Risk of Aspiration

Answer 6

Can have decreased level of alertness, decreased cough/gag reflex, wet gurgling voice hard time managing saliva. Warning signs: coughing during eating, change in voice tone, abnormal movement of mouth, unquardinated of speech, pocketing of food

Question 7

Diet planning

Cardiac, renal, lactose, gluten, diabetes

Answer 7

Cardiac – reduce hypertension and overweight to prevent risk of stroke and heart attack

Renal – meet nutritional needs, reduce kidney workload, preserve kidney function, control buildup of food waste like urea

Lactose-intolerant – avoid sugar found in milk and milk products

Gluten-free – avoid foods with gluten

Diabetes – regular eating to control glucose levels. Replace high sugar foods with high fiber foods

Question 8

Types of Diets:
Clear liquid
Thickened Liquid
Full Liquid
Pureed
Mechanical Soft
Low/Soft Residue
High Fiber
Low Sodium

Answer 8

Clear Liquid: diet is limited to broth bouillon coffee tea
stick

Thickened Liquid: all liquid must be thickened to the appropriate consistency such as nectar huting honey or pudding since thin liquid may be aspirated

Full liquid: to a clear or thickened liquid diet can be added smooth texture dairy products custards refined cooked cereals vegetable juice

Pureed: this diet includes all of the above with the addition of scrambled eggs pureed meats vegetables fruits mashed potatoes and gravy

Mechanical Soft: diet includes all of the above with addition of ground or finely diced meats flaked fish cottage cheese rice potatoes pancake light bread

Low or Soft Residue: low fiber easily digested foods such as pastas casseroles moist tender meat canned cooked fruits

High Fiber: diet includes fresh uncooked fruit steamed vegetables brand and oatmeal

Low Sodium: limited to 4 grams, two, one or 500 milligrams of sodium

Low Cholesterol: diet is restricted to less than 200 milligrams per day

Question 9

Assisting patients with feeding

Answer 9

• Assess for risk of aspiration
• Head tilted back at high risk for aspiration
• Sit upright for 30 min to reduce risk of food travelling back up

Question 10

Enteral Tube Feeding

Answer 10

• Nutrients given via the gastrointestinal tract
• Nasogastric, jejunal, gastric tubes
• Enteral nutrition is anything that can’t be taken through the mouth
• If NG tube needed for more than 4 weeks then have it surgicaly put in
• All nutition is coming through the tube so you need to be giving ‘free water’ too
• Ensure head to bed elevated at least 45º before starting feed to prevent aspiration

Question 11

Parenteral Nutrition

Answer 11

• Provide nutrients through an IV. Requires special monitoring
• Administered to patients who are unable to digest or absorb enteral nutrition
• Peripheral or through a central line
• Initiating parenteral nutrition
• Preventing complications