chapter 33 nutrition Flashcards
good nutritional status can
maintain health
promote normal growth and development
protect against disease
plays a role in healing, recovery, and reducing complications
nutrition
People at an increased risk for HCA, postop complications, and increased pressure ulcer risk are
malnourished people
required for energy, cellular metabolism, and organ function
food
No single one can provide all the nutrients needed by the body
food
nutrients NOT produced in the body or not produced in enough amounts
essential nutrients
water
macronutrients: carbs, fats/lipids, protein
micronutrients: vitamins and minerals
essential nutrients
energy is measured in
kilocalories
energy producing nutrients
macronutrients: carbs, proteins, fats/lipids
most abundant essential nutrients
carbs
individuals who are poor have a diet consisting mainly of
carbs
abundant
inexpensive
body’s main source of energy
carbs
easily stored
quickly and effectively broken down by body
carbs
only has 1 or 2 sugars
no nutritional value
simple carbohydrates
gummi bears
contains many sugars
more nutrients
complex carbohydrates
apples pasta beans broccoli whole wheat bread
complex carbs
decrease serum cholesterol
decrease glucose absorption in SI
decreases constipation
decreases free radicals in GI tract
functions of fiber
dissolves in water and forms gel
soluble fiber
fruit, legumes
roughage
not digested
increased constipation and free radicals
insoluble fiber
apple peel, bran
recommended 5-10 grams/day but prefer 10-25 grams/day
fiber intake
to increase fiber to diet:
Add beans to salads
choose cereal high in fiber
eat fruit instead of drinking juice
fiber supplements
increase fiber ____________ to prevent ___________
slowly to prevent bloating and problems. have adequate intake of fluids
functions in WOUND healing, energy source when insufficient carbs or fat, regulates fluid balance, regulates acid base balance, necessary component of insulin, antibodies, and other enzymes/hormones
protein
essential for wound healing
protein
ONLY NUTRIENT THAT CONTAINS NITROGEN
PROTEIN
sufficient amount of essential amino acids
complete proteins
eggs, dairy products, meats
complete proteins
deficient in essential amino acids
incomplete proteins
plant proteins except SOY PROTEIN
incomplete proteins
mix 2 incomplete proteins to make one complete protein
complimentary proteins
black beans and rice
complimentary protein
body is taking in more protein than it is excreting
positive nitrogen balance
A pregnant woman or a child in a rapid growth spurt would have a positive/negative nitrogen balance
positive
patient taking in some protein, but excreting more than taking in
negative nitrogen balance
person on starvation diet or very malnourished
negative nitrogen balance
most common form of malnutrition in U.S.
protein energy malnutrition
treatment of protein energy malnutrition:
increase intake of protein by: supplements provide protein at each meal patient teaching consider economics, abilities, culture, etc.
insoluble in water/blood
fats/lipids
concentrated source of energy high satiety value improve palatability of diet absorption fat-soluble vitamins protect/insulate vital organs
lipid function
95% of fat in the body is
triglycerides
triglycerides are divided into three groups:
saturated fat, unsaturated fat, and transfat
types of fat in body:
triglycerides
phospholipids
sterols/cholesterol
solid at room temperature
most originate from animal sources- whole milk, beef, butter, but also coconut and palm oils
linked to CV disease and obesity
saturated fats
originates from whole milk, beef, butter, coconut oil, palm oil
Saturated fats
remain soft/liquid at room temp
unsaturated fats
olive oil, canola oil, peanut oil
monounsaturated fats
positive effect
decrease risk of CV disease and inflammatory diseases
omega 6 and omega 3
polyunsaturated fats
monounsaturated and polyunsaturated
unsaturated fats
manufactured
partially hydrogenated liquid oils
added to foods to make more solid or stable
transfat
doughnuts, French fries
transfat
contributes to CV disease
increases free radicals-cancer
transfat
component of bile salts that assist in fat digestion
cholesterol
necessary of brain and nerve cell function and steroid production
cholesterol
increased levels increase atherosclerosis
cholesterol
intake should be limited
keep intake less than 200 mg a day
desirable serum level less than 200 mg/dl
cholesterol
good cholesterol
HDL or high density lipoprotein
bad cholesterol
LDL or low density lipoprotein
circulates from liver to tissues to get caught in veins, etc.
increases CV disease, plaques in arteries
LDL
energy value of carbohydrates
4 cal/gm
energy value of protein
4 cal/gm
energy value of fat
9 cal/gm
most concentrated source of energy
fat
What are the fat soluble vitamins:
A, D, E, K
What is necessary for the absorption of fat soluble vitamins:
fats
What are some functions/common sources of Vitamin A?
carrots, sweet potatoes,
eyes, skin, hair
What are some functions/sources of Vitamin D?
calcium absorption, healthy bones
eggs, milk, yogurt
What are some functions/common sources of Vitamin E?
corn, nuts, olives
antioxidant, heart health
what are some functions/sources of vitamin K?
green leafy vegetables, broccoli, squash, tomatoes, peppers, parsley, kale, olive oil
functions in clotting
Limit which vitamin if taking Coumadin
vitamin K
water soluble vitamins
these are not stored
B & C
which type of vitamins are more likely to build up and cause toxicity
fat soluble
which vitamins are stored
fat soluble
Show signs of deficiency early with which type of vitamins:
water soluble
sources of vitamin C
limes, kiwi, tomatoes
B1
thiamine
B vitamin that is decreased in alcoholics
B1/thiamine
B2
riboflavin
B3
niacin
B vitamin often used for hypercholesteremia
B3/niacin
B6
pyridoxine
b12
cobalamin
gastrectomy patients have to take which B supplement
b12
requires intrinsic factor and HCl acid for absorption
B12
deficiency of B12 leads to
pernicious anemia
neuritis
sore mouth or tongue
nerve damage
sources of B12
animal products
liver or lean meat
A vegan would have which B deficiency
B12
Needed for RBC development, energy and oxygen transport
iron
food sources of iron
organ meats, red meat, and raisins
side effects of iron supplements
black or dark green stools
gastric upset
can discolor tooth enamel
do not crush, chew, or break oral tablets
iron
if liquid supplement, use a straw
iron
vitamin C will increase absorption of
iron
DO NOT ADMINISTER WITH DAIRY PRODUCTS, CAFFEINE, CHOCOLATE, EGGS, ANTACIDS, OR PROTON PUMP INHIBITORS; it will cause a decrease in the absorption
IRON
required for survival
infants/geriatrics most vulnerable to deprivation
50-60% total body weight in adult
2/3 in intracellular fluid
water- essential nutrient
weight at regular-daily intervals
most accurate
1 liter of fluid = 1 kg of weight
get adequate I&O
assessment of water loss
amount of nutrients needed to prevent disease
Recommended Daily Allowances (RDA)
amount of nutrient necessary to promote/optimize health
Dietary reference intake (DRI)
No meat, eggs, or dairy
vegan-total vegetarian pyramid
vegan plus eggs diet
Ovo-vegetarian
vegan plus dairy diet
Lacto-vegetarian
vegan plus dairy, eggs, and fish
presco-vegetarian
vitamins very important in vegans
B12, iron, and protein
promote awareness of nutrients found in food
comparison of nutritional values for products
product labels
foodborne disease from improperly home-canned foods, smoked and salted fish, ham, sausage, shellfish
botulism
caused by clostridium botulinum
symptoms vary from mild discomfort to death in 24 hours, initially nausea and dizziness, progressing to motor (respiratory)paralysis
botulism
disease from undercooked meat (ground beef)
E. coli
caused by Escheririchia
severe cramps, nausea, vomiting, diarrhea (may be bloody), renal failure; appears 1-8 days after eating, lasts 1-7 days
E. Coli
disease from soft cheese, meat (hot dogs, pate, lunch meats), unpasteurized milk, poultry, seafood
listeriosis
caused by Listeria
severe diarrhea, fever, headache, pneumonia, meningitis, endocarditis, appears 3-21 days after infection
listeriosis
disease from cooked meats, meat dishes held at room or warm temperature
Perfringens enteritis
caused by Clostridium
disease caused my milk, custards, egg dishes, salad dressings, sandwich fillings, polluted shellfish
salmonellosis
caused by salmonella
mild to severe diarrhea, cramps, vomiting; appear 12-24 hours after ingestion, last 1 -7 days
salmonellosis
disease caused by milk, milk products, seafood, salads
shigellosis
caused by shigella
mild diarrhea to fatal dysentery; appear 7-36 hours after ingestion; lasts 3-14 days
shigellosis
caused by custards, cream fillings, processed meats, ham, cheese, ice cream, potato salad, sauces, casseroles
staphylococcus
caused by staph aureus
severe abdominal cramps, pain, vomiting, diarrhea, perspiration, headache, fever, prostration; appear 1-6 hours after ingestion, lasts 1-2 days
Staphylococcus
who is at risk for malnutrition
burn patients, chemo patients
involuntary loss/gain of greater than 10% usual body weight within 6 months
or
greater than 5% usual body weight in 1 month
20% over/under ideal body weight
chronic disease
altered diets/diet schedules
inadequate nutrient intake for greater than 7 days
People at risk for malnutrition
disease eating poorly tooth loss/mouth pain economic hardship reduced social contact multiple medications involuntary weight loss needs assistance in self-care any disease that makes it hard to swallow or digest elder above age 80
risk factors for malnutrition
has a positive effect on appetite
socialization
difficulty chewing-dentures decreased economic status decreased ability to cook, shop decreased hand function hand/eye coordination decreased senses of taste/smell social isolation/loneliness function of the GI tract polypharmacy
problems affecting nutrition of older adult patients
The need for calories decreases/increases with aging adults.
decreases
height, weight, waist to hip ratio, skin fold measurements, mid arm muscle circumference
anthropometric measurements
measures fat stores in body
skin fold measurements
very important
measures amount of lean body mass
mid-arm muscle circumference
most widely used measure of nutritional status
weight
poor indicator of nutritional status when edema or ascites present
weight
desire waist to hip ratio for men and women
female 0.8 or less
male 1 or less
is pear or apple shaped healthier
pear shaped
ratio of height to weight
BMI formula
normal BMI is
19
BMI of 40 indicates
obesity
BMI of less than 18.5 indicates
underweight
BMI of 25-29.9 indicates
overweight
normal BMI range is
18.5-24.9
BMI of 30-39.9 indicates
obesity
BMI of greater than 40 indicates
EXTREME obesity
walking at a vigorous pace on level ground
moderate activity level
seated and standing activities
sedentary activity level
walking at a comfortable pace on level ground
light activity level
walking uphill, manual labor
heavy activity level
no coffee, tea, or alcohol in this culture’s diet
Mormons
No beef! Cows are sacred in this culture
Hindus
Pork is restricted in this culture
Islamic or Muslim
Pork is restricted in this culture also
Jewish/Kosher
long term nutritional status is indicated by this test
albumin
not a good indicator of individuals response to nutritional support
takes around 3 wks for significant changes to be reflected in lab work
albumin
3.5-5.0 g/dL normal range
albumin
this lab value increases in dehydration and decreases in malnutrition, overhydration, or trauma
albumin
Lab tests to check nutritional status:
Albumin, pre-albumin, transferrin, TLC, BUN/creatinine, UA
reflects short term nutritional status
1/2 life of 2 days
pre-albumin
20-40 mg/dL normal range
pre-albumin
expensive test
increases with nutritional intake, renal failure
decreases with poor diet intake
levels drop rapidly with sudden demands for protein synthesis
pre-albumin
loss of muscle mass related to aging and strength
sarcopenia
this is a normal finding
severe muscle wasting
involuntary
not related to aging
related usually to malnourishment
cachexia
this finding indicates iron deficiency
spoon shaped nails (koilonychia)
beefy red tongue indicates
a decrease in b12 vitamin
neurological symptoms indicate
decrease in thiamine or b12
ecchymoses indicates
decrease in Vitamin K
dry rough skin is an indicator of
decrease in Vitamin A
bone abnormalities indicate a deficiency of
vitamin D or calcium
if assisting patient in feeding him/herself
use pattern of clock
medication to stimulate appetite
Megestrol acetate or Megace
NPO should/should not be ordered for extended periods of time
should not
regular therapeutic diet is how many calories
2000
diet for dysphagia patients
mechanical soft with thickened liquids
decreased fried foods and red meat
low fat and low cholesterol diet
carbs counted, number of calories usually specified
diabetic diet
decreased fiber diet
low residue/soft diet
for patients with gastric distress
blenderized liquid-used with oral/facial surgery or chewing and swallowing disorders
pureed diet
bland diet
BRAT- bananas rice applesauce toast
high in fruits and vegs. high fiber, low sodium
DASH diet
use of certain foods to control/treat illness or disease
MNT- medical nutritional therapy
food liquid at room temp
tea, chicken broth, jello, lemon-lime soda, coffee
clear liquid diet
often for postop patients
has substance, no solids
liquid at room temp
pudding, ice cream and all included on clear
full liquid diet
patient is ready to advance diet if:
absence of nausea
no pain or abdominal distention
patient feels hungry
patient can consume 1/2 to 3/4 of meal tray
no added salt: whatever occurs naturally in food, nothing added in cooking or at table
no added salt/sodium restricted diet
sources of sodium in our diet
deli meats/processed foods
1/4 tsp of salt=500 mg
canned goods
foods high in sodium
soy sauce, Wendy’s grilled chicken Caesar salad, V-8 juice, beef salami, marinara sauce, raisin brain cereal, cottage cheese
study used to diagnose problem with aspiration
barium swallow
easiest thing to aspirate is
water/thin fluids
to prevent aspiration:
teach chin tuck method when swallowing
thicken liquids
nutrients necessary for wound healing
protein
fat
carbs/sufficient calories
vitamin C and zinc
what is the preferred method of feeding:
oral
stimulates and maintains the normal activity of the GI tract
oral feeding
feeding through a tube- NG, NJ, PEG
GI tract must be functioning
enteral feeding
intravenous route
GI system may/may not be intact
through a central IV line
Parenteral: TPN (total parenteral nutrition)
for long term nutritional support
Patient doesn’t have to have general anesthesia
PEG tube
Care for patient on enteral feeding:
Check abd distention/discomfort/nausea monitor BMs Daily weight monitor edema monitor I&O monitor residual tube feeding monitor serum electrolytes monitor for aspiration
provides calories, lipids, fluids, vitamins, electrolytes, minerals, and trace elements
highly concentrated- hypertonic
use central venous device to infuse
risk for infection is very high
risk for hypoglycemic reaction if stopped suddenly- hang concentrated glucose
TPN
High osmolality
always through a central line
bag must be changed every 24 hours
TPN
care of patient receiving TPN
use surgical aseptic technique
monitor dressing and change per policy
use infusion pump
solution should hang no longer than 24 hours
monitor blood sugar and serum electrolytes
daily weight
not as concentrated as TPN
can be infused into peripheral line
PPN (peripheral parenteral nutrtion)
