Exam 2 module 4 part 2 - Nutrition part 2 Flashcards
Nutrition Chapter 24
Define lipids and their function
- Organic substances containing carbon, hydrogen, and oxygen.
- Insoluble in water.
- Includes fats (solid at room temperature) and oils (liquid at room temperature).
Function is energy when carbs unavailable, flavor, satiety, cholesterol, nutrient, thermoregulation, nerve impulse transmission, cell membrane component, insulation, protection of organs
What does cholesterol do
o Supports cell membranes.
o Helps produce bile for fat digestion.
o Precursor to steroid hormones (e.g., estrogen, testosterone).
o In excess, contributes to atherosclerosis.
Three types of lipids and their functions
Glycerides (true fat consit of 3 FA and glycerol), Sterols (no FA), Phospholipids (lipoprotein transport)
Define glycerides
- Also called true fats.
- Composed of glycerol (alcohol with three carbon atoms) and fatty acids (long chains of carbon and hydrogen).
- Triglycerides: Main dietary glycerides, consist of glycerol + 3 fatty acids.
Define Sterol
- Lipids that do not contain fatty acids.
- Cholesterol is the most important sterol in the body:
o Needed for cell membranes, vitamin D synthesis, and steroid hormones.
o Synthesized in the liver and obtained from animal products.
Define phospholipids
- Key component of lipoproteins (transport lipids in blood).
- Water-soluble, allowing transport of triglycerides.
- Types of Lipoproteins:
o LDL (Low-Density Lipoprotein): “Bad cholesterol”; deposits fat in blood vessels, increasing risk of cardiovascular disease.
o HDL (High-Density Lipoprotein): “Good cholesterol”; removes excess cholesterol from blood, returning it to the liver.
Saturated fat and what does it raise/lower
Whole milk, butter, cheese, ice cream, red meat, coconut oil, palm oil, processed foods Raises LDL and HDL
Poly unsaturated fat and what it raises/lowers
Corn, soybean, safflower, sesame, sunflower oils, fish, nuts, seeds Lowers LDL, raises HDL
Monounsat and what does it raise/lower
Monounsaturated Olives, olive oil, canola oil, peanuts, avocados, nuts Lowers LDL, raises HDL
Trans fat and what does it raise/lower
Margarines, shortening, deep-fried foods, commercial baked goods Raises LDL
Diet. cholesterol, what does it raise/lower
Animal foods (meat, dairy, eggs, organ meats, fish, poultry) Raises cholesterol
Sat vs Unsat FA
- Saturated Fats: Fully saturated with hydrogen; solid at room temperature; raises LDL cholesterol.
- Unsaturated Fats: Lighter, less dense; includes:
o Monounsaturated fats: One unsaturated bond (olive oil, nuts).
o Polyunsaturated fats: Multiple unsaturated bonds (fish, vegetable oils). - Trans-fats: Created by hydrogenation; solid at room temperature; increases LDL cholesterol.
Essential vs nonessential FA
- Essential fatty acids:
o Linoleic acid (Omega-6) and Alpha-linolenic acid (Omega-3).
o Must be obtained from diet.
o Helps protect against heart disease.
AHA rec.
- Limit intake of saturated fats, trans-fats, and cholesterol.
- Choose healthy fats:
o Olive, canola, sunflower oils (≤2g saturated fat per tablespoon). - Increase fruits, vegetables, whole grains, fish (twice a week).
- Opt for lean meats, skinless poultry, low-fat dairy.
- Use healthy cooking methods (grilling, broiling, steaming).
- Avoid tropical oils (palm, coconut oil).
What are micronutrients
vitamins and minerals
Function of vitamin and 2 types
- Organic substances required in small amounts.
- Functions:
o Support metabolism, tissue growth, immune system, and vision.
o Aid in energy conversion.
o Critical during growth, pregnancy, lactation, and healing. - Two Types:
1. Fat-Soluble (A, D, E, K)
Stored in liver and adipose tissue.
Risk of toxicity if consumed in excess.
Vitamin D needs increase in limited sun exposure or obesity.
2. Water-Soluble (C, B-complex)
Not stored; excreted in urine.
Must be consumed daily.
Essential vitamins and their functions
and where do you find it
A - vision, skin, cell growth
D- calcium reg, bone health
E- antioxidant, RBC protect
K- clot, bone strength
A- liver, dairy, greens, yellow fruit
D - fish, fortified dairy, sunlight
E- nuts, oils, greens
K- liver, greens
What are minerals and types
- Inorganic elements found in food, additives, and supplements.
- Functions:
o Regulate fluids, nerve function, energy production.
o Essential for bone health, blood health, and disease prevention.
Types of Minerals
1. Macrominerals (needed in large amounts)
2. Trace Minerals (needed in small amounts)
Essential minerals and their functions
Ca - bone and muscle, osteoporosis, muscle cramps
Fe- oxy transport, anemia
Mg - nerve/muscle, weakness
Na- fluid balance, nerve signal, dizzy
K - muscle contract, BP, heart arrhymia
How much of water is body weight overall and what is its function
- 50-65% of body weight.
- Functions:
o Solvent for chemical reactions.
o Transports oxygen, nutrients, and waste.
o Regulates temperature via sweat.
o Acts as a lubricant in joints.
o Facilitates digestion and metabolism. - Daily Requirement:
o Women: ~2.7 liters/day.
o Men: ~3.7 liters/day.
General ideal weight formula
Weight standards help correlate weight with health and longevity to determine ideal body weight (IBW).
General Ideal Weight Formula
* Men:
o 106 lb (47.7 kg) for the first 5 ft (150 cm).
o Add 6 lb per inch (2.7 kg/2.5 cm) over 5 ft.
* Women:
o 100 lb (45 kg) for the first 5 ft (150 cm).
o Add 5 lb per inch (2.25 kg/2.5 cm) over 5 ft.
* Adjustments for Body Frame:
o Large frame: Add 10% to ideal weight.
o Small frame: Subtract 10% from ideal weight.
Height and weight tables
Height and Weight Tables
* WHO child growth standards are based on age, sex, weight, height, and body frame.
* These are statistical estimates and allow for variations in growth.
Body composition
- Measures lean body mass vs. body fat percentage.
- Lean body mass: Includes muscle, bone, and connective tissue.
- Lean tissue weighs more than fat.
- A fit individual may weigh more than an unfit one of similar appearance.
- Methods for assessment include anthropometric measurements.
Factors affecting nutrition
- Developmental Stage – Nutritional needs change with growth, activity level, metabolism, and disease prevention.
- Knowledge – Awareness of healthy choices affects diet.
- Lifestyle – Activity level and habits influence nutrition.
- Culture – Cultural traditions impact food preferences.
- Disease Processes – Illness alters dietary requirements.
- Functional Limitations – Mobility and health conditions affect access to food.
* Parents & Caregivers are the most influential on children’s eating habits.
Infants stage impact on nutrition
- Rapid growth phase – Highest nutritional needs per body weight.
- Critical period for brain development:
o Protein-calorie deficiency in the last trimester or first 6 months may reduce brain cells by 20%.
Key Nutrient Needs
* Protein & Carbohydrates:
o Protein for tissue building.
o Carbohydrates to spare protein for growth.
* Vitamins & Minerals:
o Iron: Depleted by 4-6 months; must be supplemented.
o Calcium: Needed for bone and teeth development.
o Vitamin C: Aids iron absorption.
o Vitamin D: Helps calcium regulation.
* Fluids:
o Infants have higher metabolic rates and greater water loss.
o 1.5-2 oz of breast milk or formula per pound of body weight per day.
Infant Feeding how to
- Best choices: Breast milk or iron-fortified formula.
- Breastfeeding Benefits:
o Strengthens immune system (IgA coating for gut & respiratory tract).
o Reduces risk of:
Sudden Infant Death Syndrome (SIDS).
Diabetes, obesity, asthma, childhood leukemia.
o Recommended for 12 months with solid foods starting at 4-6 months.
Formula Feeding
* Types:
o Iron-fortified cow’s milk protein (most common).
o Soy-based or hydrolysate formulas (for allergies).
* Precautions:
o No fresh cow’s milk before 1 year (risk of GI bleeding & iron-deficiency anemia).
o No honey or corn syrup (risk of botulism toxin).
o Water quality considerations:
If uncertain, boil water for at least 1 minute, then cool before mixing formula.
o Fluoride supplementation if water supply lacks fluoride.
o Iron supplements start at 4-6 months, possibly continuing after 12 months.
How does toddler impact nutrition
- Growth slows compared to infancy.
- Daily needs: ~1,000 kcal and 1,250 mL of fluids.
- Maturing GI system:
o Able to eat most foods.
o Adjusts to 3 meals/day. - By age 3:
o Has full set of deciduous (baby) teeth.
o Can chew adult food.
Feeding Safety - Choking Risks:
o Cut food into small pieces.
o Watch for “chipmunking” (storing food in cheeks).
o No food in car seats or bouncy chairs – choking may go unnoticed.
Common Nutrient Deficiencies - Iron, calcium, vitamins A & C.
- Milk Recommendations:
o 1-2-year-olds: Reduced-fat (2%) or whole milk for brain development.
o Parents should offer a variety of foods for essential nutrients. - Juice Intake:
o Limit fruit juice; focus on whole fruits and vegetables.
How to deal with toddler eating battle
Toddler Eating Behavior
* Autonomy & Food Refusal:
o Refusing food is common for control.
o Taking long to eat or rejecting foods is normal.
* Parental Guidance:
o Avoid food battles – can cause long-term issues.
o Don’t use food as punishment or reward – may lead to unhealthy associations.
What about cows milk and honey
Formula feeding is safe, but cow’s milk and honey should be avoided before 1 year.
What does body composition accomplish
distinguish lean mass vs. body fat.
Toddler eating war- how to encourage healthy?
Best Practices for Parents & Caregivers
1. Model Healthy Eating
o Toddlers learn by watching behavior, not by listening to advice.
2. Provide Only Nutritious Foods
o Keep healthy options available at home.
3. Make Food Fun & Appealing
o Example: Arrange tortillas, cheese, tomatoes, and beans into a smiling face.
4. Avoid Using Dessert as a Reward
o Example: Don’t say, “You can’t have cookies until you eat your meat.”
o Instead, reward with attention, hugs, and kind words.
5. Involve Toddlers in Food Shopping & Preparation
o Allow them to pick out healthy foods and help prepare meals.
6. Commit to Family Mealtimes
o Eat together without distractions (no TV or phones).
How do preschool dev. stage affect nutrition?
Preschoolers (Ages 4-6)
Nutrient Needs
* Daily Calories: ~1,200–1,400 kcal.
* Fat Intake: 25-35% of total calories.
* Self-Regulated Appetite: Children eat based on energy needs.
Common Eating Patterns
* Food Preferences: May refuse certain foods (e.g., vegetables).
* Food Jags: Eating one food repeatedly for several days.
* Snack Requirements: Needed to support rapid growth & activity.
Long-Term Dietary Habits
* Encourage a variety of foods to meet nutritional needs.
* Check school daycare menus for balanced meals.
How does school age dev. stage affect nutrition
School-Age Children (Ages 6-12)
Growth & Development
* Gradual body changes, permanent teeth appear.
* Digestive system matures.
Caloric Needs
* Sedentary children: ~1,600–1,800 kcal/day.
* Active children: 200-400 kcal more per day.
Nutrient Requirements
* Essential vitamins & minerals needed for growth.
* Limit saturated fats, trans fats, sodium, and added sugars.
Eating Behavior Challenges
* Less parental control over food choices.
* Influence of advertising & peers on food preferences.
* Children may:
o Buy junk food with lunch money.
o Choose unhealthy school cafeteria meals.
o Skip breakfast, affecting memory, problem-solving, and physical activity.
Parental Strategies
* Encourage breakfast daily.
* Educate children about nutritious eating.
How does adolescent stage affect nutrition
Growth & Nutrient Demands
* Rapid growth & reproductive system development.
* Boys: Increased muscle tissue, bone density.
* Girls: Fat deposition increases at menstruation.
* Nutrient needs similar to infancy:
o Protein, calcium, iron, vitamins B & D are essential.
Dietary Challenges
* High intake of processed, fast foods (low nutrient value).
* Snacking is common (often unhealthy choices).
* Increased independence in food decisions.
Parental Strategies
* Keep only healthy snacks at home (cheese, fruit, raw vegetables).
* Model positive eating habits.
Eating Disorders
* Often first appear before age 20, sometimes as early as 10 years old.
* Majority of cases occur in females.
* Awareness & intervention are crucial.
Young and middle adult affects nutrition how
Young Adults (Ages 19-40)
* Balanced intake of protein, vitamins, & minerals.
* Poor eating habits may carry over from adolescence.
Middle Adults (Ages 40-65)
* Basal Metabolic Rate (BMR) decreases → weight gain risk.
* Chronic disease risks increase (diabetes, hypertension, obesity, hyperlipidemia, cancer).
* Dietary adjustments & exercise can help manage these conditions.
How does being pregnant or lactacting affect nutrition needs
Increased Nutritional Needs
* Folic Acid (400 mcg daily)
o Essential in the 1st trimester to prevent neural tube defects.
o CDC recommends supplementation.
* Protein & Calcium
o Needed for fetal muscle, brain, and bone growth.
* Iron
o Needed to support maternal & fetal blood supply.
Supplementation
* Iron supplements (needed for most pregnant women).
* Folic acid & calcium supplements are common.
Caloric Needs
* Pregnancy: +300 kcal/day in 2nd & 3rd trimester.
* Lactation: +500 kcal/day to support breast milk production.
Gestational Diabetes (GDM)
* Screening required using:
o Glucose Challenge Test (GCT) or
o Oral Glucose Tolerance Test (OGTT).
* Complications of untreated GDM:
o Congenital heart defects, fetal macrosomia, neonatal hypoglycemia.
How does older adult dev. stage affect nutrition
Changes in Nutritional Needs
* Decreased Lean Body Mass & BMR
o Fewer calories needed, but nutrient needs remain high.
* Slightly increased calcium needs.
* More fiber intake (complex carbohydrates) to prevent constipation.
* Increased hydration needs (8+ glasses of water/day).
Factors Affecting Nutrition in Aging
1. Decreased Appetite & Thirst Sensation
o Can lead to undernutrition & dehydration.
2. Chronic Diseases
o May require therapeutic diets (low sodium, low sugar, low fat).
3. Sensory Decline
o Reduced taste/smell → food becomes less appealing.
4. Chewing & Swallowing Issues
o Tooth loss, gum disease, arthritis make eating difficult.
5. Mobility Limitations
o Difficulty shopping & preparing meals.
6. Digestive Problems
o Gastroesophageal reflux, reduced gastric secretions, decreased peristalsis, glucose intolerance.
Dietary Supplements for Older Adults
* Calcium & Vitamin D (for bone health).
* Vitamin B12 (prevents cognitive decline).
What is frail elder syndrome
- Common in institutionalized or socially isolated seniors.
- Symptoms include:
o Weight loss, decreased activity, social withdrawal, increased frailty. - Depression & loneliness contribute to poor nutrition.
Critical nutrients and screening for preg and lactate
o Folic acid, iron, calcium are critical.
o Gestational diabetes screening is essential.
What is crucial about older adults nutrition
hydrate, fiber, mobility
What is more important, food quantity or quality
- Food quality is just as important as food quantity for overall health.
- IF THESE ARE NOT EQUAL = Unbalanced diets (e.g., high in processed foods, low in nutrients) can increase the risk of chronic diseases.
work environment impact on nutrition
Work Environment
* Physically demanding jobs:
o Can cause fatigue, leading to poor meal choices or skipped meals.
* Time constraints during short breaks:
o Workers may opt for fast foods or convenience meals, which are often high in fat, sugar, and sodium.
* Solution: Plan nutritious, quick meals or meal prep in advance.
Cooking and nutrition
- Cooking impacts nutrient content:
o Boiling: Destroys water-soluble vitamins (e.g., Vitamin C, folic acid, thiamin).
o Steaming, baking, or stir-frying: Preserves nutrients better. - Storage impacts vitamin longevity:
o Heat, light, moisture, air, and alkalinity degrade vitamins.
o Fresher foods are richer in vitamins.
OCP use and nutrition
Oral Contraceptive Use
* Nutrient depletion risk: Oral contraceptives reduce serum levels of:
o Vitamin C
o B vitamins (e.g., B6, B12, folic acid)
* Recommendation: Women using contraceptives, especially with poor diets, should consider a B-complex and Vitamin C supplement.
using food to cope etiology and consequences
- Stress, depression, loneliness, or boredom may cause emotional eating:
o Skipping meals or binge eating.
o Consuming comfort foods (high in sugar and fat). - Consequences:
o Poor nutrition
o Weight gain or obesity
o Low self-esteem - Healthy Coping Strategies: Exercise, hobbies, and mindful eating techniques.
tobacco and nutrition
- Smokers lose Vitamin C rapidly because:
o Vitamin C is used as an antioxidant to combat tobacco-induced oxidative stress. - Consequences of smoking:
o Increased risk of Vitamin C deficiency.
o Linked to iron deficiency, as Vitamin C aids iron absorption. - Recommendations for Smokers:
o Take a Vitamin C supplement (2,000 mg/day) for lung protection and to counteract losses.
o Best Option: Quit smoking, but if not possible, increase Vitamin C intake.
Alcohol and nutrition
- Effects of Heavy Alcohol Use on Nutrition:
o Excess calories → Obesity.
o Slows fat metabolism, increasing fat storage.
o Replaces food calories but lacks nutrients.
o Suppresses appetite, leading to malnutrition.
o Damages intestinal lining, reducing nutrient absorption.
o Impairs nutrient storage in the liver (especially B vitamins). - Nutritional Recommendations for Heavy Drinkers:
o Multivitamin supplements with B vitamins (especially B1 – Thiamin) and folic acid.
o Adequate protein intake to maintain liver function.
Caffeine and nutrition
Caffeine: Myths, Facts, and Health Effects
* Common Myths Dispelled:
o Does not cause dehydration.
o Does not increase heart disease or cancer risk.
o Has minimal effect on hypertension.
* Potential Negative Effects:
o May contribute to bone loss, but this can be offset by consuming milk or calcium.
o High doses can cause:
Anxiety
Stomach irritation
* Health Benefits of Moderate Caffeine Intake:
o Boosts mood and mental performance.
o Increases fat burning during exercise.
o Reduces risk of:
Parkinson’s disease
Type 2 diabetes
Stroke
Dementia
* Recommendation:
o Moderation is key (e.g., 2-4 cups of coffee/day).
o Pair coffee with calcium-rich foods to protect bone health.
Vegetarian and nutrition health BENEFITS ONLY
- Ethical: Concerns about animal welfare.
- Health-focused: Reduces risk of:
o Cardiovascular disease HTN or HLD
o Obesity
o Type 2 diabetes
o Cancers (e.g., colon, stomach, breast, esophageal).due to antioxidants and fiber - High fiber intake → Improves bowel motility and prevents constipation.
All 6 veggie diets and how they are different from each other
LactoOVO = EGGS, dairy but NO MEAT
Lacto VEGGIE = dairy but NO EGGS, NO MEAT
Pescatarian = Fish, NO OTHER ANIMAL PRODUCTS
Vegan = NO ANIMAL PRODUCTS
Fruitarian = NOTHING BUT fruit, nuts, honey, veg oil
all of them eat plants
Deficiencies of veggie tarians
- Common Deficiencies:
o Protein: Plant-based proteins (e.g., beans, lentils, quinoa, tofu) are essential.
o Iron: Non-heme iron from plants is less absorbable; pair with Vitamin C to enhance absorption.
o Vitamin B12: Only found in animal products; vegans need supplements or fortified foods.
o Calcium: Important for bone health; found in leafy greens, tofu, and fortified plant milk.
o Omega-3 fatty acids: Plant sources include flaxseeds, chia seeds, walnuts, and algae oil. - Zinc from meat and seafood
What should vegans keep in mind
o Must ensure intake of Vitamin B12, iron, calcium, and protein.
o Fortified foods and supplements are critical.
What should fruitarians keep in mind
o Severely restrictive diet with risk of multiple nutrient deficiencies.
o Risk of protein deficiency, vitamin deficiencies, and bone loss due to low calcium intake.
o Long-term fruitarian diets are not recommended without medical supervision
OCP and smoking increases risk of
of vitamin B and C deficiencies.
Bad of caffeine?
ONLY anxiety and potential bone loss
Alcoholics need to supplement…
vitamen B
Define undernutrition or malnourishment
Definition:
Undernutrition occurs when nutrient intake is insufficient to meet metabolic demands, influenced by factors like activity level, sex, height, and weight.
Diagnostic criteria of underweight
- Diagnostic Criteria:
o BMI < 18.5 (Underweight classification)
o Involuntary weight loss of >5% in 30 days or >10% in 180 days
o For seriously ill patients, a BMI < 21 is linked to increased mortality
What types of underweight are there according to BMI
BMI Classifications (World Health Organization, 1995, 2000, 2006)
* Severely underweight: BMI < 16
* Moderately underweight: BMI 16–16.99
* Mild underweight: BMI 17–18.49
* Underweight: BMI < 18.5
Eating disorders overview
Common Disorders Leading to Undernutrition
* Anorexia Nervosa: Psychiatric disorder characterized by self-starvation, extreme weight loss, and body image distortion
* Bulimia Nervosa: Binge eating followed by purging (self-induced vomiting, laxative abuse)
o More common in females, with onset typically before 20 years old
* Kwashiorkor: Severe protein deficiency despite adequate caloric intake
* Marasmus: Severe deficiency of both calories and protein, leading to muscle wasting and emaciation
List all the risk factors and demographics you can think of for undernutrition
Most Common Populations Affected
* Developing Nations: Limited food availability, poverty, food insecurity
* Children & Older Adults: Increased vulnerability due to higher nutritional needs or decreased intake
* People with Chronic Illnesses:
o Cancer
o HIV/AIDS
o Chronic Obstructive Pulmonary Disease (COPD)
o Gastrointestinal absorption disorders (e.g., Crohn’s disease, celiac disease)
Other Risk Factors
* Low Serum Albumin (<3.5 g/dL) → Indicates protein deficiency
* Prolonged NPO (>3 days) or Clear Liquid Diet → Increased risk of malnutrition
* Increased Nutritional Needs (Wound healing, burns, pregnancy)
* Unintentional Weight Loss >10% of Usual Weight
* Persistent Nausea/Vomiting (>3 days)
* Chewing/Swallowing Impairments (Dentition issues, stroke, dysphagia)
* Feeding Difficulty (e.g., Neuromuscular disorders, functional decline)
List complications from malnutrition
- Emotional: Self-esteem issues, depression, isolation
- Physical: Osteoporosis, infections, cardiac issues, organ failure
- Deficiency Diseases:
o Beriberi: Neurological issues (Thiamin deficiency)
o Scurvy: Poor healing (Vitamin C deficiency)
o Pellagra: Dementia, diarrhea (Niacin deficiency)
Cues of malnutrition
- Physical: Weight loss, hair loss, abdominal distention, cold intolerance
- Behavioral: Meal skipping, tiny portions, hiding food habits, baggy clothing
Label diagnosis for underweight, and NOC outcomes
- Common Labels: Body Nutrition Deficit; Risk for Body Nutrition Deficit
- Examples: Underweight r/t eating disorder or absorption disorder
- Progressive weight gain
- Maintenance of lab values within normal limits (WNL)
- Understanding of contributing factors
Interventions for underweight & how do you help to get their appetite back
- Appetite stimulants, enteral or parenteral nutrition
- High-protein, high-calorie meals and supplements
- Counseling for eating disorders
- Referrals to food resources or community programs
- Provide small, frequent, nutrient-dense meals
- Restrict liquids during meals to prevent early fullness
- Ensure oral hygiene and comfortable dining settings
- Encourage avoiding smoking before meals
Veggie patient advice
- B12: Fortified foods or supplements
- Vitamin D: Fortified soy/oat milk, sunlight
- Iron: Pair with Vitamin C (e.g., lentils + citrus fruits)
- Calcium: Fortified plant milks, kale, broccoli
- Zinc: Seeds (pumpkin, sesame), chickpeas, garlic
- Protein: Combine legumes, nuts, and soy (tofu, tempeh)
- Refer to MyVeganPlate for vegetarian food group guidelines.
- Consult a nutritionist
Describe Mediterranean, Asian, indian, hispanic diets, and religious ones
- Mediterranean: Rich in olive oil, fish, and nuts; reduces cancer and heart disease risk.
- Asian: Plant-based, high in fiber; lowers cardiovascular and diabetes risk.
- Indian: Rich in fruits, vegetables, and legumes; reduces chronic disease risk.
- Hispanic: Grain- and legume-based; benefits can decrease if prepared with unhealthy fats.
- Kosher, Halal, fasting periods like ramadan
How do you eat for athletes and health in general
- Avoid processed food, trans fats, preservatives, additivtes because they are linked to T2DM, obesity, CVD, cancer.
- Stick to organic to avoid antibiotic resistant bacteria and pesticides
- Athletes can eat Paleo (eat meat, veggies, nuts, seeds, eggs while avoiding dairy, beans, potatoes, grain)
How to lose weight if you are overweight
Fad Diets: Recognizable by these characteristics:
* Quick, dramatic weight loss: Often temporary due to fluid loss.
* Food Restrictions: Imbalanced nutrients from limited food variety.
* Product Sales: Endorsed supplements or packaged meals.
* Lack of Long-term Strategies: No behavioral change guidance.
Healthy Diet Approach (e.g., AHA Diet):
* Promotes slow, sustainable weight loss.
* Includes a variety of food choices with balanced nutrients.
* Emphasizes healthy habits: Physical activity, sleep, and stress reduction.
* Supports self-monitoring and behavioral modification.
Most to least obese
- Non-Hispanic Black: 49.6%
- Hispanic: 44.8%
- Non-Hispanic White: 42.2%
- Non-Hispanic Asian: 17.4%
Key points about medi, asian, indian, hispanic diets
Medi = heart healthy, good for cholesterol
Asian = semi heart healthy, weight loss friendly, colon cancer friendly, but TERRIBLE for T2DM
Indian = Good for diabetes, heart, and illness
Hispanic = TERRIBLE for T2DM, but has fiber, A, C, K, Fe
muslims avoid pork, hindus avoid beef, buddhists are veggies
how does DM or GI disorders affect nutrition
Affect nutrient intake, digestion, absorption, utilization, and excretion.
How does being sick / fever affect nutrition
- Fever or acute illness: Increases protein, water, and calorie requirements due to heightened metabolism.
so eat meat, hydrate, and increase food intake when sick
How does having a burn, surgery, major trauma affect nutrition
- Require extra protein and vitamin C for wound healing and tissue repair.
Cancer and alcohol how does it affect nutrition
Cancer
Long-Term Caloric Deficiency (e.g., Cancer):
* Causes protein-calorie malnutrition, leading to:
o Weight loss
o Muscle wasting
Alcohol
* Reduces appetite, leading to nutritional deficiencies.
* Interferes with the absorption and function of vitamins, notably:
o Thiamine (B1) – Leads to Wernicke’s encephalopathy.
o Vitamin C – Increases risk of scurvy.
Cognitive impairment affects nutrition how (easy)
Cognitive Impairments:
* Conditions: Dementia, mental illness, head trauma, confusion, memory loss.
* Consequences:
o Poor meal timing and planning.
o Forgetting to eat or selecting nutrient-poor foods.
What is a functional limitation
impaired mobility, fatigue, chewing swallowing, GI function
How do functional limitations of mobility, dyspnea, chewing/swallow affect nutrition
Impaired Mobility (e.g., Paralysis, Stroke):
* Affects ability to shop, cook, and feed oneself.
* Social factors (e.g., low income): Force choices between food or medication/utility bills.
Dyspnea or Fatigue (e.g., COPD, Anemia, Advanced Disease):
* Reduces energy to prepare meals, leading to reliance on processed, high-sodium foods.
* Causes: COPD, anemia, pregnancy, depression, overwork.
Chewing and Swallowing Disorders:
* Causes:
o Dental issues: Decayed or missing teeth, ill-fitting dentures
o Oral or esophageal disorders: Pharyngitis, oral cancer, esophageal strictures
* Consequence:
o Soft or liquid diets, often low in fiber and nutrients.
Bariatric surgery effects nutrition how
Bariatric Surgery Effects on Digestion:
* Types of Procedures:
o Restrictive (e.g., sleeve gastrectomy, gastric banding): Limits stomach size, reduces food capacity.
o Malabsorptive (e.g., intestinal bypass): Reduces intestinal absorption.
o Combined procedures (e.g., Roux-en-Y gastric bypass): Both restricts intake and reduces absorption.
* Common Nutrient Deficiencies Post-Surgery:
o Iron, copper, zinc, selenium
o Thiamine, folate, vitamins B12 and D
GI disorders affects nutrition how
Gastrointestinal (GI) Function:
* Common Issues: Heartburn, indigestion, and stomach disorders.
* Response: Avoidance of triggering foods (often healthy options), causing nutrient gaps.
Peristalsis Disorders:
* Causes: Bowel inflammation, infection, diverticula, tumors.
* Effect: Increased peristalsis decreases nutrient absorption; slowed peristalsis (e.g., gastroparesis) causes:
o Early satiety
o Nausea, vomiting
o Reduced intake of nutrients
Decreased Intestinal Surface Area:
* Causes: Surgery (e.g., bowel resection), Crohn’s disease.
* Effect: Reduced nutrient absorption, causing malnutrition despite normal intake.
Enzyme Deficiencies:
* Causes: Liver, gallbladder, or pancreas disorders (e.g., chronic pancreatitis, bile duct obstruction).
* Common Condition: Lactose intolerance, prevalent in:
o Native Americans, Black, and Asian populations (NIDDK, 2018).
What meds can impact nutrition
Appetite Suppressants:
* Medications: Adderall, aspirin, Benadryl, lithium carbonate.
* Effect: Reduced hunger, leading to inadequate calorie intake.
Chemotherapy and Radiation Therapy:
* Effects: Oral ulcers, intestinal bleeding, diarrhea, and taste alterations.
* Consequences: Poor nutrient absorption and reduced intake.
Nutrient Depleting Medications:
* Aspirin (Acetylsalicylic acid): Depletes folate, increases vitamin C excretion.
* Laxatives: Cause calcium and potassium depletion.
* Thiazide diuretics: Reduce absorption of vitamin B12.
Side Effects of Oral Medications:
* Common: Nausea, vomiting, metallic taste, or dry mouth.
* Consequence: Reduced appetite and aversion to food.
House regular diet vs NPO
A. Regular (House) Diet:
* Standard Diet: Balanced, providing ~2,000 kcal/day.
* Modified Options: Vegetarian, ethnic, or low-fat variations.
* Common Complaint: Perceived as bland due to limited seasoning.
B. NPO (Nil Per Os):
* Definition: No food or fluids by mouth.
* Indications: Pre-surgery, pre-procedure, or acute medical conditions.
* Risks of Prolonged NPO:
o Nutritional deficiencies if extended beyond 24-48 hours.
o Solution: Enteral (tube feeding) or parenteral (IV nutrition) support.
Clear liquid, full liquid, mechanical soft, pureed
Diets Modified by Consistency
* Clear Liquid Diet: Water, broth, gelatin, clear juices (short-term use only).
* Full Liquid Diet: Includes all clear liquids plus milk, custard, soups, and shakes.
* Mechanical Soft Diet: Softened, chopped, or pureed foods (for chewing difficulties).
* Pureed Diet: Foods blended to a smooth consistency (for severe swallowing disorders).
How do weight loss, CVD, HLD, DM, Renal, liver/kidney disease, epilepsy, allergenic, IBS and wound healing all affect nutrition? (list)
- Calorie-Restricted: For weight loss (e.g., obesity management).
- Sodium-Restricted: For hypertension, heart disease, and fluid retention.
- Fat-Restricted: For high cholesterol, triglycerides, or gallbladder disease.
- Diabetic Diet: Controls carbohydrate intake for diabetes management.
- Renal Diet: Limits potassium, sodium, protein, and fluids for kidney disease.
- Protein-Controlled: Manages liver or kidney disease.
- Ketogenic Diet: High-fat, low-carb diet for epilepsy, insulin control, and possibly cancer management.
- Antigen-Avoidance: Removes specific allergens (e.g., gluten-free for celiac disease).
- Low-FODMAP: Reduces fermentable sugars for irritable bowel syndrome (IBS).
- Calorie-Protein Push: Increases calories and protein for wound healing and weight gain.
Smoking on nutrition
- Reduces vitamin C levels, increasing infection risk.
- Impairs taste and appetite, reducing food intake.
- Increases risk of osteoporosis due to reduced calcium absorption.
All effects of alcohol
- Reduces appetite: Causes nutrient deficiencies.
- Impairs nutrient absorption: Particularly thiamine (B1), folate, and vitamin B12.
- Damages liver: Affects metabolism of fats, proteins, and vitamins.
- Increases excretion of nutrients: Especially magnesium, zinc, and potassium.
screening vs focused nutritional assessment
- Screening Assessments: Initial, quick evaluations for nutritional risk.
- Focused Nutritional Assessments: Detailed evaluations following a positive screening result.
What must all hospitalized patients be screened for
All hospitalized patients must receive a nutritional screening within 48 hours of admission (Choban et al., 2013).
* Cursory Screening Includes:
o Height and weight measurements
o Body Mass Index (BMI)
o Brief dietary history
Scenario: a hospitalized patient, after a screening assessment, shows risk factors
as part of the basic screening that is standard for everyone hospitalizd
If risk factors are identified, use validated tools:
1. Subjective Global Assessment (SGA):
o Combines medical history and physical examination to assess nutritional status.
2. Nutrition Screening Initiative (NSI) for Older Adults:
o Identifies indicators of impaired nutritional status specifically in older adults.
3. Mini Nutritional Assessment (MNA):
o A two-part screening tool for all age groups, commonly used in older adults:
Part 1: Screens for nutritional risk.
Part 2: Detailed assessment if risk is found.
o Outcome: Determines if malnutrition is present and if multidisciplinary follow-up is needed.
Describe a focused nutritional assessment
A thorough assessment includes subjective (history) and objective (physical exam) data.
A. Dietary History Collection Methods:
* 1. 24-Hour Recall: Client lists all foods eaten in the last 24 hours.
o Pros: Simple and quick.
o Cons: Relies on memory, which may be inaccurate.
* 2. Food Frequency Questionnaire: Identifies how often certain foods are consumed over time.
o Pros: Provides a broader intake pattern.
o Cons: Accuracy issues due to recall errors.
* 3. Food Record (7-Day Diary): Client records all foods and portions consumed over 7 days.
o Pros: Most accurate for intake analysis.
o Cons: Requires high commitment and effort.
SGA subjective global asses key parts
- Weight History: Changes over the past 6 months.
- Dietary History: Usual intake vs. current intake.
- GI Symptoms: Anorexia, nausea, vomiting, diarrhea.
- Energy Level: Functional status and activity levels.
- Existing Disease: Impact on metabolic demand.
- Physical Examination: Loss of fat, muscle wasting, edema, or ascites.
What are major vs minor indicators for “impaired nutritional status”
- Major Indicators:
* Significant weight loss over time
* Inappropriate weight for height
* Significant change in functional status
* Reduced mid-arm circumference or skinfold thickness
* Signs of osteoporosis or osteomalacia - Minor Indicators:
* Concurrent syndromes: Alcoholism, cognitive impairment, renal insufficiency.
* Symptoms: Anorexia, nausea, dysphagia, fatigue, memory loss.
* Physical Signs: Poor dental status, dehydration, slow-healing wounds, muscle wasting, fluid retention.
* Lab Values: Low albumin, transferrin, prealbumin, folate, iron, zinc, ascorbic acid.
What are body comp. and anthropometric measurements as part of the nutritional assessments (long list)
A. Anthropometric Measurements:
* Purpose: Evaluate body composition (proportion of fat, muscle, and bone).
* Common Uses:
o Growth rate assessment (children).
o Fat and protein stores assessment (adults).
o Identification of underweight, overweight, and obesity.
B. Skinfold Measurements:
* Purpose: Estimate subcutaneous fat and long-term nutritional status.
* Most Reliable Sites:
1. Triceps (most common)
2. Subscapular region
3. Biceps
4. Suprailiac region
C. Circumference Measurements:
1. Mid-Upper Arm Circumference (MUAC):
o Measures muscle and fat stores.
o Routinely used in screening for malnutrition.
2. Abdominal (Waist) Circumference:
o Assesses visceral fat.
o High levels of visceral fat increase risks of:
Hypertension
Type 2 diabetes
Heart disease
High cholesterol
Alzheimer’s disease
3. Waist-to-Hip Ratio (WHR):
o Indicates obesity and abdominal fat distribution.
o WHR Calculation: Waist circumference ÷ Hip circumference
Men: WHR > 0.90 = Obesity
Women: WHR > 0.85 = Obesity
D. Body Mass Index (BMI):
* Definition: BMI estimates body composition based on height and weight.
* Formula: BMI=fracWeighttext(kg)(Heighttext(meters))2BMI = \frac{Weight \text{(kg)}}{(Height \text{(meters)})^2}BMI=fracWeighttext(kg)(Heighttext(meters))2
* Example: A person weighs 75 kg and is 1.8 meters tall: BMI=frac75(1.8)2=23(HealthyWeight)BMI = \frac{75}{(1.8)^2} = 23 \ (Healthy \ Weight)BMI=frac75(1.8)2=23(HealthyWeight)
BMI Classification (WHO, 2006):
* Underweight: <18.5
o Severely Underweight: <16
o Moderately Underweight: 16–16.99
o Mildly Underweight: 17–18.49
* Healthy Weight: 18.5–24.9
* Overweight (Pre-Obese): 25–29.9
* Obesity Class I: 30–34.9
* Obesity Class II: 35–39.9
* Obesity Class III (Severe): ≥40
BMI limits for athletes, pregnant women, older adults
- Athletes: May appear overweight due to muscle mass.
- Pregnant Women: Altered body composition affects BMI accuracy.
- Older Adults: Height loss over time may distort BMI readings.
Most reliable site for adults skinfold measurement; and MC site for body fat distribution
Triceps (skin)
- Subscapular and suprailiac regions (fat distrib)
Increased waist to hip ratio is correlated with
- Increased WHR: Indicates central (abdominal) obesity, which is linked to:
o Increased cardiovascular risk
o Type 2 diabetes
o Hypertension and stroke
What is underwater weighing & its finding
Underwater Weighing (Hydrodensitometry):
* Definition: A method of determining body composition by submerging the patient in water and measuring buoyancy.
* Principle: Fat floats, so buoyancy varies with body fat percentage.
* Accuracy: Considered the gold standard for body composition measurement.
* Limitations: Impractical for:
o Children
o Older adults
o Severely ill patients
Nutritional assessment portion of the health history includes
demographics and health info
all things related to diet, stress, appetite, exercise, food prep, financial, habits, family, dental problems, drugs etc
o Usual body weight and whether it is 20% above or below desirable weight.
How to collect a diet history
- Food Intake Patterns: Use appropriate tools:
1. 24-Hour Recall: Client recalls all food consumed in the past 24 hours.
Pros: Simple and quick.
Cons: Risk of inaccurate recall, may not represent usual intake.
2. Food Frequency Questionnaire: Identifies how often certain food groups are eaten (e.g., fruits, meats).
Pros: Broad view of intake patterns.
Cons: Recall bias reduces accuracy.
3. Food Record (7-Day Diary): Client records all foods and portions over 7 days.
Pros: Most accurate for analyzing intake.
Cons: Requires high effort and commitment from the client.
Programs for nutrition
- Supplemental Nutrition Assistance Program (SNAP): Provides food-purchase coupons to low-income households.
- Commodity Supplemental Food Program (CSFP): Provides USDA foods to low-income elderly (60+ years).
- Women, Infants, and Children (WIC): Offers nutritious foods, healthy eating education, and breastfeeding support to low-income women, infants, and children under 5 years.
- National School Lunch and Breakfast Programs: Provides free or reduced-cost meals to low-income schoolchildren, meeting one-third of the child’s daily energy and nutrient needs.
o Enrollment in USDA WIC (Women, Infants, and Children) program.
o SNAP (Supplemental Nutrition Assistance Program) or other assistance.
When performing a physical exam with a focus on nutrition, what body systems does it include
gen survey, vitals, bmi, skin hair nails, head & neck, cardio, ABD, MSK, Neuro
skin turgor vs swelling
- Skin Turgor: Poor turgor = dehydration; Swelling = overhydration.
Delayed healing means
protein, vitamin C, or zinc deficiency.
Red swollen skin lesions
Niacin def.
Petechiae and ecchymosis
K or C def
Xerosis
A def
Spoon nails
Iron def.
Transverse ridges nails
Protein def.
Pale mottled nails
A or C def
Splinter hemorrhages
C def
hair that is thin or brittle, slow growing
protein def
red swollen gums vs red swollen tongue
o Red, swollen gums: Vitamin C deficiency (scurvy).
o Bright red or swollen tongue: Vitamin B deficiency (e.g., folate, niacin).
Thyroid enlargement
iodine deficiency or thyroid disorders affecting metabolism.
Pale conjunctiva
iron def
Red dry eyes
A def
peripheral edema
protein def
electrolytes imbalanced
Abd concave, round, or enlarged
concave/scaphoid. muscle waste.
round/protuberant is excess cal.
enlarge is ascites from liver disease
Hyperactive bowel sounds
GI infection, lax use, malabsorption
Hypoactive bowel sounds
Peristalsis is slow or constipated
MSK problems
- Thin extremities with loose skin: Muscle wasting from protein-calorie malnutrition.
- Joint pain and swelling: Possible gout or arthritis, which can impair mobility and cooking ability.
- Spinal curvature (kyphosis): Indicates osteoporosis due to calcium deficiency.
Confusion, memory loss, or cognitive def
Thiamine def
B12 def
Weakness or parethesia
B or Mg def
Tetany
Ca or Mg def
What if a kid has iron def. anemia, delayed sexual maturation, or large abd circumference
severe malnutrition
What if a kid is tired, doesn’t want. to play outside
Could be a sign of malnutrition. Is he also small or short for his age?
Kid with malnutrition shows up to the office. You assess him with WHAT
Head circumference, ht, wt
Old guy shows up to the office looking like he has less muscle than last year
sign of malnutrition, esp if he has less strength
Chronic ill population at risk for malnutrition
cancer, HIV, COPD
What triggers glucagon to release and what does it do
o Low blood glucose: Triggers glucagon release, which:
Mobilizes glucose from glycogen stores.
Releases glucose into the bloodstream
Blood glucose of WHAT is hypoglycemic
49
- Symptoms: Weakness, dizziness, confusion, irritability, sweating, shakiness, anxiety.
- Severe Cases: May progress to coma.
Sugar of WHAT is hyperglycemia
110
- Cause: Often a sign of diabetes mellitus, due to:
o Insufficient insulin production (Type 1 Diabetes).
o Insulin resistance (Type 2 Diabetes). - Mechanism: Glucose cannot enter cells despite excess in blood.
- Symptoms:
o Weakness or fatigue
o Weight loss despite high blood sugar
o Blurred vision
o Polyphagia (excessive hunger)
o Polydipsia (excessive thirst)
o Polyuria (frequent urination)
o Ketosis: Fat breakdown due to inability to use carbohydrates.
o Long-term complications: Renal failure, peripheral neuropathy, foot ulcers.
Fingerstick vs a CGM
Blood Glucose Monitoring Methods:
1. Fingerstick Glucose Test (Capillary Blood Glucose): Quick bedside method.
2. Continuous Glucose Monitors (CGMs):
o Disposable sensors: Placed under the skin, transmit readings to a receiver.
o Sensor watches: Pulls fluid from skin for glucose measurement without puncturing.
Slightly overweight American Indian female from Alaska is mostly sedentary, with a history of CVD and high triglycerides walks in. What does this allude to
Risk factors for diabetes
When to assess for diabetes
- Risk Factors:
o BMI > 25
o Physical inactivity
o High-risk ethnicities: American Indians, Alaska Natives
o Family history of diabetes
o History of gestational diabetes or large baby (>9 lbs)
o Hemoglobin A1c > 5.7%
o Low HDL (<35 mg/dL) or high triglycerides (>250 mg/dL)
o History of cardiovascular disease or hypertension - Physical Signs of Diabetes:
o Low Blood Sugar (Hypoglycemia): Sweating, shakiness, confusion, dizziness, difficulty speaking.
o High Blood Sugar (Hyperglycemia): Flushed skin, labored breathing, sweet-smelling breath, nausea.
How to measure proteins?
o Albumin - 18 d
o Prealbumin - 2 d
o Transferrin - 8 d
Describe Albumin
- Synthesis: Produced in the liver.
- Half-life: 18 to 21 days (slow to reflect acute changes).
- Indicator: Chronic malnutrition or chronic illness.
- Low Levels:
o Malnutrition or malabsorption (e.g., celiac disease).
o Liver disease (cirrhosis, hepatitis).
o Protein loss from burns or wounds.
o Fluid overload (edema, congestive heart failure) - causes falsely low results. - Limitation: Not reliable in fluid imbalance due to dilution effect.
Describe Prealbumin
- Synthesis: In the liver.
- Half-life: 2 to 3 days (shorter than albumin, reflects acute changes).
- Indicator: Short-term nutritional status.
- Low Levels: Protein depletion due to malnutrition, stress, infection, or surgery.
Describe Transferin
Transferrin: (Iron-Transport Protein)
* Half-life: 8 to 9 days (faster than albumin, slower than prealbumin).
* Indicator: Protein status and iron levels.
* Measured By:
o Direct transferrin level or
o Total Iron-Binding Capacity (TIBC):
High TIBC: Iron deficiency (body produces more transferrin to capture iron).
Low TIBC: Anemia or chronic disease (low transferrin production).
Describe BUN
Markers of Protein Metabolism and Kidney Function
A. Blood Urea Nitrogen (BUN): (Byproduct of Protein Metabolism)
* Synthesis: Formed in the liver from protein breakdown.
* Excretion: Through the kidneys.
* Indicator: Liver and kidney function, protein metabolism.
* High BUN:
o Kidney dysfunction (impaired excretion).
o Dehydration (concentrated blood).
o Excess protein breakdown (e.g., starvation, hyperthyroidism, or diabetes).
o High protein intake.
* Low BUN:
o Liver failure (impaired urea production).
o Fluid overload (dilution effect).
o Low protein intake or malnutrition.
Describe Creatinine
- Excretion: Through the kidneys.
- Indicator: Muscle mass and renal function.
- High Creatinine:
o Kidney impairment or renal failure.
o Muscle breakdown (rhabdomyolysis). - Low Creatinine:
o Loss of muscle mass (e.g., malnutrition or aging).
Measure immune function how
Total Lymphocyte Count (TLC): (WBC Count Related to Nutrition and Immunity)
* Normal Function: First line of defense against infection.
* Low TLC (Leukopenia):
o Protein deficiency (malnutrition)
o Alcoholism (suppresses bone marrow function)
o Bone marrow depression (chemotherapy, leukemia)
o Anemia (chronic illness or nutritional deficiency)
Measure protein and oxygen capacity how
Hemoglobin: (Oxygen-Carrying Protein in Red Blood Cells)
* Composition: Made of heme (iron) and globulin (protein).
* Low Hemoglobin Causes:
o Iron deficiency (most common cause)
o Chronic blood loss (e.g., ulcers, heavy menstruation)
o Low protein intake (inadequate globulin production)
o Vitamin B12 or folate deficiency (impaired RBC production)
* Symptoms of Low Hemoglobin: Fatigue, pallor, shortness of breath.
Globulin: (Key Protein for Hemoglobin and Antibodies)
* Functions:
o Forms the backbone of hemoglobin.
o Key component of antibodies and clotting factors.
* Low Globulin Levels:
o Protein deficiency (e.g., malnutrition or liver disease)
o Excessive protein loss (e.g., nephrotic syndrome or chronic wounds)
What is UAP good for, what is LPN good for, what is RN job
- Tasks That May Be Delegated to UAP (Unlicensed Assistive Personnel):
o Measurement of:
Weight: Using scales and recording values.
Height: Using stadiometers or measuring tapes.
Intake and Output (I&O): Tracking fluid consumption and excretion. - Tasks That May Be Delegated to Other Nursing Staff (e.g., LPN/LVN):
o Collection of Nutritional History: Interviewing patients to gather dietary patterns, preferences, and habits. - Registered Nurse (RN) Responsibilities:
o Review and Interpretation: Analyze and interpret findings from the collected data.
o Diagnosis: Identify nutritional imbalances or risks based on gathered information.
o Planning Care: Develop a care plan based on the assessment.
o Follow-up: Reassess nutritional status based on treatment outcomes.
What does ADA want diabetes patient glucose to be around meals
o Preprandial (before meals): 80–130 mg/dL
o Postprandial (1–2 hours after meals): Less than 180 mg/dL
How to measure glucose? What is a non diabetic patient fasting blood glucose
o Capillary Blood Glucose (Fingerstick): Quick bedside test using a glucometer.
o Serum Blood Glucose (Venous): Collected from a venous blood sample and analyzed in the lab.
70 to 100
What are short term reasons for protein def
o Low levels: Seen in protein depletion, inflammation, or liver dysfunction.
What are long term reasons for protein def or excess
measured by prealbumin
o High levels: Could indicate dehydration.
o Low levels: Suggest chronic malnutrition, liver disease, or protein loss (e.g., from burns or wounds).
* Limitation: Slow to respond to acute nutritional changes due to long half-life (18–21 days).
measured by albumin
Globulin high or low levels reasons
Globulin: Component of Antibodies and Important for Immunity
o High levels: Indicate chronic inflammation, infections, or immune disorders (e.g., lupus).
o Low levels: Associated with protein malnutrition, liver disease, or kidney disease.
BUN interpretation
o High BUN: Indicates renal dysfunction, dehydration, or high protein intake.
o Low BUN: May indicate liver disease, overhydration, or low protein intake.
Cr interpret
o High Creatinine: Sign of kidney dysfunction or muscle breakdown (e.g., in trauma or severe infection).
o Low Creatinine: Associated with muscle wasting, malnutrition, or aging.
Who can carry the most oxygen
How do you interpret hemoglobin
Males>Older males>Females
o Low Hemoglobin: Indicates iron deficiency anemia, blood loss, or malnutrition.
o High Hemoglobin: Suggests dehydration or polycythemia (excess red blood cells).
What are ranges for A1C?
- Normal Ranges for Patients Without Diabetes:
o Normal: 4.0%–5.6%
o Prediabetes: 5.7%–6.4%
o Diabetes: 6.5% and above
o Reflects average blood glucose levels over the past 2–3 months.
o High HgA1C: Suggests poor glucose control and increased risk of diabetes complications.
o Low HgA1C: May indicate chronic anemia or excessive blood loss.
remember 5.7 and 6.5
under 5.7 is normal
between is pre.
above 6.5 is diabetes
interventions
Specific Interventions for Common Diagnoses:
* For Frail Elderly Syndrome:
o Cognitive Stimulation
o Nutrition Therapy
* For Overweight/Obesity:
o Behavior Modification
o Nutritional Monitoring
o Exercise Promotion
o Nutritional Counseling
* For Underweight/Malnutrition:
o Eating Disorder Management
o Feeding Assistance
o Enteral Tube Feeding
o Fluid/Electrolyte Management
o Nutrition Management
o Hope Inspiration
o Self-Care Assistance
o Swallowing Therapy
o Weight Gain Assistance
Does healthy adult with balanced diet need supplements?
No, but they could be necessary if pregnant, lactating, or adolescent
What the general public (not including specific conditions) needs in supplements
And what key points to teach
- newborn vitamen K
- Breastfed inf. needs D if mom needs it
- at 4 mo. infant, need iron
- Folic acid to women trying to have kids
- Ca for elderly, anyone post menopause, and non dairy eaters
- Supplements should complement, not replace, a nutritious diet.
- Read supplement labels carefully (toxicity levels, dosage, side effects).
- Encourage consulting a primary care provider before taking supplements.
- Follow DRI or RDA dosages.
You are monitoring a patient every day for poor nutrition, what does this entail
- Documenting Daily Weights: To monitor trends and identify sudden weight loss or gain.
- Recording Intake and Output (I&O): To evaluate fluid balance.
- Tracking Food Preferences, Consumption, Tolerances, and Intolerances: For tailored nutritional care.
- Supporting Family Wishes: Be sensitive to cultural beliefs about artificial hydration and nutrition.
- manage nausea
- manage appetite, smell, taste
- watch NPO
- help sequence of eating
How to ease nausea the comfort way
Comfort Measures to Relieve Nausea:
* Cool Compress: Apply to the back of the neck to ease discomfort.
* Loose Clothing: Reduce discomfort and prevent tightness around the abdomen.
* Aromatherapy Avoidance: Eliminate strong scents, such as perfumes or scented candles.
* Frequent Oral Hygiene: Maintain a clean mouth to reduce the sensation of nausea.
* Upright Position After Eating: Have the patient sit up for 30–45 minutes to prevent reflux.
* Fresh Air: Open windows or use a fan to circulate air and reduce odors.
* Acupressure: Apply pressure on the inner wrist (about 2½ inches down) between the tendons.
* Provide Tissues and Water: For mouth rinsing to reduce discomfort.
* * Maintain a Calm Environment: Reduce stimulation.
* Use Distraction Techniques: Such as watching TV or listening to music.
* Try Relaxation Methods: Including guided imagery, biofeedback, or music therapy.
How to ease nausea the food and drink way
- Citrus Water: Add lemon to cool water to ease nausea and aid digestion.
- Cold or Bland Foods: Avoid greasy, spicy, or aromatic foods; cold foods may be better tolerated.
- Light Drinks: Offer cool (not iced) cola, ice cubes, popsicles, sorbet, or frozen fruits (e.g., pineapple, kiwi, or apple).
- Herbal Teas: Recommend chamomile (calming) or peppermint (soothing for the stomach).
- Morning Snacks: Keep crackers by the bedside to help with morning nausea.
- Bedtime Snacks: Suggest lean meat or cheese before bed to stabilize blood sugar.
- Small, Frequent Meals: Replace large meals with smaller portions to ease digestion.
- Avoid Carbonated Drinks: Especially high-sugar sodas, as they may increase bloating and reflux.
If a patient is nauseated, what do you look out for?
dehydration. can provide antiemetics by dr or give IV fluid
How to manage NPO
Nutritional Support for NPO Patients:
* IV Fluids: To supply glucose and electrolytes.
* Total Parenteral Nutrition (TPN): For patients requiring long-term NPO status.
* IV Lipid Infusion: To meet caloric and nutritional needs.
Comfort Measures for NPO Patients:
* Oral Hygiene: Assist with or provide regular mouth care.
* Mouth Moistening: Offer ice chips, hard candy, or gum (if allowed).
* Visitor Guidance: Advise family not to eat or drink in front of the patient.
* Schedule Smartly: Arrange tests early to reduce fasting duration.
* Advocate for Early Breakfast: If testing is delayed, consult the provider for early meal allowances.
Risk Management for Prolonged NPO Status:
* Malnutrition Risk: NPO for more than 3 days significantly increases this risk.
* Older Adults: Prioritize scheduling tests early for elderly patients to reduce NPO time.
Caring for Impaired Swallowing
. Provide Nutritional Support:
* Assistive Devices: Provide adaptive utensils such as special cups, spoons, or plates.
* No Drinking Straws: Straws increase aspiration risk by delivering liquids too quickly.
* Chin Tuck Position: Instruct patients to tuck their chin to their chest to prevent aspiration during swallowing.
* Food Placement: Place food at the back of the mouth on the unaffected side to ease swallowing.
* Monitor Tongue Movements: Ensure the patient can move food effectively to the back of the mouth.
* Check for Food Pocketing: Inspect for trapped food in the cheeks post-meal to prevent choking.
* Monitor Body Weight and Hydration: Assess intake/output, skin turgor, and mucous membrane moisture.
2. Prevent Aspiration:
* Assess Protective Reflexes: Check gag, cough reflex, and swallowing ability.
* Position Upright: Feed the patient in a fully upright position (90° or as tolerated).
* Keep Suction Available: Be prepared to suction if aspiration occurs.
* Small Portions: Feed in small, manageable amounts to prevent choking.
* Inspect Oral Cavity: Look for retained food or medication residues.
* Post-Meal Positioning: Keep the patient’s head elevated for 30–45 minutes after feeding to prevent reflux.
If dysphagic, what liquid consistency to avoid?
- Thin Liquids: Easy to aspirate; often restricted for dysphagic patients.
- Nectar-Thick Liquids: Slightly thickened, pourable (e.g., tomato juice).
- Honey-Thick Liquids: Similar to honey, drips slowly.
- Pudding-Thick Liquids: Spoonable, holds shape, does not pour.
Xerostomia intervention
- Avoid: Caffeine, alcohol, tobacco, and highly acidic or spicy foods.
- Stimulate Salivation: Use sugarless gum or hard candy (avoid gum for dementia patients).
- Hydration: Offer frequent sips of water and use lip moisturizers to prevent cracking.
GERD intervention
- Dietary Management:
o Avoid large meals, especially before bedtime.
o Limit trigger foods: citrus juices, fatty foods, chocolate, alcohol, and tobacco. - Lifestyle Modifications:
o Elevate the head of the bed by 30°–40°.
o Avoid bending over after meals. - Weight Management: Recommend weight loss to reduce pressure on the diaphragm.
Decreased Gastric Secretions (Hypochlorhydria): intervention
- Regular Meal Schedule: Encourage scheduled meals to support digestion.
- Thorough Chewing: Aid mechanical digestion.
- Vitamin D Intake: Promote foods high in vitamin D to enhance calcium absorption.
glucose intolerance intervention
- Avoid Simple Sugars: Limit candies, ice cream, and sugary desserts.
- Promote Complex Carbohydrates: Recommend whole-grain cereals and vegetables for better glycemic control.
- Frequent Small Meals: Maintain blood glucose levels and prevent spikes.
Constipation intervention
- Increase Fiber Intake: Recommend soluble (e.g., oats, fruits) and insoluble fiber (e.g., whole grains, vegetables) for bowel regularity.
- Ensure Hydration: Encourage at least 64 ounces (about 2 liters) of water daily.
- Promote Physical Activity: Advise regular exercise to stimulate GI motility.
When to intervene patients eating meals
- Involuntary Weight Loss: More than 5% in 30 days or 10% in 180 days.
- Low Food Intake: Leaving more than one-fourth of their food uneaten in the last 7 days.
- Low BMI: BMI of 18.5 or less.
When should we give enteral?
- Inability to Meet Nutritional Needs Orally: e.g., patients with severe dysphagia.
- Functional Intestinal Tract: Enteral feeding is preferred over parenteral nutrition.
- Adjunct or Sole Nutritional Support: Depending on the severity of oral intake issues.
4 types of enteral tubes
- Nasogastric Tube (NG): Short-term use, inserted through the nose into the stomach.
- Nasoduodenal or Nasojejunal Tubes: Bypass the stomach for patients with gastroparesis.
- Gastrostomy Tube (G-Tube): Long-term use, directly placed into the stomach.
- Jejunostomy Tube (J-Tube): Directly placed into the jejunum, for patients with high aspiration risk.
Enteral feeding downsides
- Aspiration: Can cause pneumonia or respiratory distress.
- Bacterial Growth: High glucose content in formulas can promote bacterial contamination.
- Gastrointestinal Issues: Diarrhea, nausea, or vomiting from intolerance to formula.
- Nasopharyngeal Trauma: Risk of tissue damage from prolonged NG tube use.
- Drug Interaction: Enteral formulas may interfere with medication absorption.
Safe enteral feeding precautions
- Check Tube Placement: Verify placement before each feeding to prevent aspiration.
- Elevate Head of Bed: Keep the patient in a 30°–45° upright position during and after feeding.
- Use Closed Feeding Systems: Reduce the risk of bacterial contamination.
- Flush the Tube: Maintain patency and prevent clogging by flushing with water regularly.
- Monitor for Intolerance: Watch for signs like bloating, diarrhea, or abdominal pain.
- Maintain Strict Hygiene: Use proper hand hygiene and clean equipment during feed preparation.
“When can I go back to eating food normally?”
-patient with enteral tube
- Improved Swallowing Function: When dysphagia improves.
- Adequate Oral Intake: When the patient can meet at least 75% of their nutritional needs orally.
- Gradual Weaning: Slowly reduce tube feeds while increasing oral intake.
Wt loss education
- Set Realistic Goals:
o Aim to lose 1 to 2 pounds per week, burning 500 to 1,000 calories more than consumed daily.
o Understand that rapid weight loss often results in loss of water or muscle rather than fat. - Focus on Process Goals, Not Just Outcomes:
o Example: “Exercise 30 minutes daily” instead of “Lose 10 pounds this month.”
o Habit change is more effective for long-term results. - Document Your Goals and Plans:
o Write down:
Goals
Steps to achieve them
Start date
o Review and adjust goals weekly based on progress. - Identify and Plan for Triggers:
o Recognize situations that cause overeating or missed exercise.
o Create action plans to overcome these challenges. - Get 7 to 8 Hours of Sleep Nightly:
o Sleep deprivation disrupts appetite-regulating hormones leptin (satiety) and ghrelin (hunger).
o Lack of sleep increases cravings for sugary, high-fat comfort foods.
Physical activity education
- Start Slow, Build Consistency:
o Begin with manageable routines if you are new to exercise.
o Gradually increase intensity and duration. - Work Toward 300 Minutes of Weekly Activity:
o Recommended for sustained weight loss and maintenance.
o Equivalent to about 45 minutes per day, 5–6 days a week. - Incorporate Everyday Movement:
o Use stairs instead of elevators.
o Park farther from building entrances.
o Walk or bike to work. - Plan Workouts Ahead:
o Lay out exercise clothes the night before to reduce excuses.
Parenteral nutrition ASPEN
- Adoption of ASPEN Guidelines: Followed standards from the American Society for Parenteral and Enteral Nutrition (ASPEN).
- Order Form Revision: Simplified and standardized the PN ordering process.
- Clinician Education: Provided comprehensive training for physicians and nurses on proper PN protocols.
- PN Rounds Twice Weekly: Implemented regular team reviews to monitor patients on PN.
- Appropriate Use of PN: Reduced unnecessary use of parenteral nutrition.
- Baseline Laboratory Monitoring: Ensured labs were drawn before initiating PN.
- Calorie Delivery: Maintained delivery within 10% of the patient’s estimated caloric needs.
Tubing misconnections Critical Safety Alert
A. Background on Tubing Misconnections:
* Problem: Enteral feeding tubes have been mistakenly connected to IV lines, causing severe or fatal complications.
* Risk: Enteral formulas entering the bloodstream can cause systemic infections and death.
B. FDA Recommendations to Prevent Misconnections:
1. Assess Equipment Thoroughly:
o Carefully check labels on all tubing and connectors.
2. Ensure Clear Communication:
o During patient handoffs or transfers, clearly document all infusion solutions and their sites.
3. Trace Tubing Lines:
o Follow the tubing from the patient back to the solution container, ensuring proper connections.
4. Use Non-Interchangeable Connectors:
o Use enteral feeding connectors that cannot attach to IV lines (ENFit connectors).
5. Educate Staff and Patients:
o Conduct regular training on tubing safety protocols.
C. Special Considerations for Home Care Enteral Nutrition:
* Training Caregivers: Provide detailed instructions on connecting and operating feeding tubes.
* Safety Protocols: Emphasize the importance of correct tubing identification and connection practices.
* Regular Equipment Checks: Encourage caregivers to inspect tubing for wear or damage.
Use of Enteric Tubes in detail
- For Lavage (Stomach Washing):
o Indicated for disease, surgery, bleeding, poisoning, or medication overdose. - For Diagnostic Specimen Collection:
o To collect stomach contents for laboratory analysis. - For Gastric Decompression (Postoperative):
o Prevents nausea, vomiting, and gastric distention after surgery.
Enteric Measuring Tube Size (French Scale):
- Enteric tubes are measured in French (Fr) units:
o 1 Fr = 0.33 mm diameter
o Most adult feeding tubes: 8 to 12 Fr, 90 to 108 cm (36 to 43 in.) long
o 12 Fr tube: ≈ 4 mm diameter
Enteric 1. Short-Term Tubes (Less than 6 Weeks):
o Nasogastric (NG) Tube:
Inserted through the nose into the stomach.
Preferred for patients with intact gag reflex and low aspiration risk.
Common size: 8–12 Fr, soft and flexible for comfort.
o Nasoenteric (NE) or Nasojejunal (NJ) Tube:
Longer than NG tubes (extends into the duodenum or jejunum).
Used for patients with aspiration risk, such as:
Decreased level of consciousness
Absent gag reflex
Severe gastroesophageal reflux (GERD)
o Large-Bore NG Tubes (>12 Fr):
Example: Salem Sump Tube (for decompression/lavage).
Rigid, uncomfortable, rarely used for feeding (converted to smaller tube within 48 hours).
Enteric 2. Long-Term Tubes (More than 6 Weeks):
o Gastrostomy (G-Tube):
Surgically inserted through the abdominal wall into the stomach.
Suitable for long-term feeding.
o Percutaneous Endoscopic Gastrostomy (PEG):
Inserted via endoscopy with a small abdominal incision.
Commonly used for both short- and long-term feeding.
o Jejunostomy (J-Tube or PEJ):
Inserted into the jejunum (for patients with gastric issues or high aspiration risk).
o Gastrostomy Button (G-Button):
Shorter, sits flush against the skin.
More comfortable and discreet for long-term use.
Often replaces a G-tube once the stoma heals.
Enteral Feeding at home patient education
- Hand Hygiene: Essential before handling tubes or feedings.
- Night Feeds: Patients may receive 1 to 3 liters of enteral nutrition overnight.
o Start Slowly: Gradually increase the flow rate at the beginning.
o Taper Off: Reduce the flow rate before stopping to prevent discomfort. - Parenteral Nutrition (PN) Administration:
o Requires strict sterile technique to prevent infections (e.g., sepsis).
o The caregiver must be trained to handle IV lines and use aseptic techniques. - Site Care:
o Clean around the insertion site daily with mild soap and water.
o Observe for redness, swelling, or pus (signs of infection). - Dressing Changes:
o Use sterile technique for central line dressings (for PN).
o Replace dressings as instructed by the healthcare provider. - Flushing the Tube:
o Flush the feeding tube with warm water before and after feedings to prevent clogs.
D. Proper Storage of Nutrition Solutions: - Refrigeration:
o Store all enteral and parenteral solutions in the refrigerator.
o Allow formula to reach room temperature before feeding. - Discarding Expired Solutions:
o Never use solutions past their expiration date.
Monitoring enteral patient
- Weight Tracking:
o Weigh the patient weekly, preferably on the same scale at the same time. - Regular Assessments:
o Conduct frequent assessments of nutritional status.
o Review laboratory work for signs of malnutrition or electrolyte imbalances. - Provider Communication:
o Report weight changes or complications to the primary care provider (PCP) or nutrition support team. - Ongoing Laboratory Monitoring:
o Include tests such as albumin, prealbumin, electrolyte levels, and complete blood count (CBC).
NG and NE safety
NG and NE tubes are inserted without direct visualization, which can result in the tube entering the respiratory tract instead of the stomach.
* Potential Consequences: Without verification, there is a risk of delivering feeding formula into the lungs, causing:
o Aspiration pneumonia
o Respiratory distress
o Sepsis
o Death
Key Safety Practice:
* Always verify tube placement:
o Before each feeding (for intermittent feedings).
o Once per shift (for continuous feedings).
o Before administering any medications through the tube.
Gold standard for tube placement
Radiographic Verification (X-Ray):
* Most reliable and gold standard method for confirming proper tube placement.
* Required before the first feeding is administered.
* Radiopaque markings on feeding tubes aid visibility on X-ray.
Note: If there is any doubt about placement after the initial X-ray, obtain a repeat X-ray immediately.
Problem with watching for choking, coughing, less oxygen sat after tube insert
Not reliable on its own—patients can have the tube in their lungs without obvious distress.
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