Exam 2 module 4 part 2 - Nutrition part 2 Flashcards

Question

Infants stage impact on nutrition

Answer 1

* 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.

Answer 2

* 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.

Answer 3

* 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.

Answer 4

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.

Answer 5

Formula feeding is safe, but cow’s milk and honey should be avoided before 1 year.

Answer 6

distinguish lean mass vs. body fat.

Answer 7

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).

Answer 8

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.

Answer 9

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.

Answer 10

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.

Answer 11

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.

Answer 12

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.

Answer 13

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).

Answer 14

* Common in institutionalized or socially isolated seniors. * Symptoms include: o Weight loss, decreased activity, social withdrawal, increased frailty. * Depression & loneliness contribute to poor nutrition.

Answer 15

o Folic acid, iron, calcium are critical. o Gestational diabetes screening is essential.

Answer 16

hydrate, fiber, mobility

Answer 17

* 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.

Answer 18

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.

Answer 19

* 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.

Answer 20

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.

Answer 21

* 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.

Answer 22

* 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.

Answer 23

* 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.

Answer 24

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.

Answer 25

* 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.

Answer 26

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

Answer 27

* 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

Answer 28

o Must ensure intake of Vitamin B12, iron, calcium, and protein. o Fortified foods and supplements are critical.

Answer 29

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

Answer 30

of vitamin B and C deficiencies.

Answer 31

ONLY anxiety and potential bone loss

Answer 32

Definition: Undernutrition occurs when nutrient intake is insufficient to meet metabolic demands, influenced by factors like activity level, sex, height, and weight.

Answer 33

* 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

Answer 34

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

Answer 35

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

Answer 36

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)

Answer 37

* 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)

Answer 38

* Physical: Weight loss, hair loss, abdominal distention, cold intolerance * Behavioral: Meal skipping, tiny portions, hiding food habits, baggy clothing

Answer 39

* 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

Answer 40

* 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

Answer 41

* 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

Answer 42

* 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

Answer 43

* 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)

Answer 44

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.

Answer 45

* Non-Hispanic Black: 49.6% * Hispanic: 44.8% * Non-Hispanic White: 42.2% * Non-Hispanic Asian: 17.4%

Answer 46

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 ## Footnote muslims avoid pork, hindus avoid beef, buddhists are veggies

Answer 47

Affect nutrient intake, digestion, absorption, utilization, and excretion.

Answer 48

* Fever or acute illness: Increases protein, water, and calorie requirements due to heightened metabolism. | so eat meat, hydrate, and increase food intake when sick

Answer 49

* Require extra protein and vitamin C for wound healing and tissue repair.

Answer 50

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.

Answer 51

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.

Answer 52

impaired mobility, fatigue, chewing swallowing, GI function

Answer 53

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.

Answer 54

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

Answer 55

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).

Answer 56

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.

Answer 57

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.

Answer 58

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).

Answer 59

* 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.

Answer 60

* Reduces vitamin C levels, increasing infection risk. * Impairs taste and appetite, reducing food intake. * Increases risk of osteoporosis due to reduced calcium absorption.

Answer 61

* 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.

Answer 62

* 1. Screening Assessments: Initial, quick evaluations for nutritional risk. * 2. Focused Nutritional Assessments: Detailed evaluations following a positive screening result.

Answer 63

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

Answer 64

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.

Answer 65

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.

Answer 66

1. Weight History: Changes over the past 6 months. 2. Dietary History: Usual intake vs. current intake. 3. GI Symptoms: Anorexia, nausea, vomiting, diarrhea. 4. Energy Level: Functional status and activity levels. 5. Existing Disease: Impact on metabolic demand. 6. Physical Examination: Loss of fat, muscle wasting, edema, or ascites.

Answer 67

1. 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 2. 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.

Answer 68

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

Answer 69

* 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.

Answer 70

Triceps (skin) * Subscapular and suprailiac regions (fat distrib)

Answer 71

* Increased WHR: Indicates central (abdominal) obesity, which is linked to: o Increased cardiovascular risk o Type 2 diabetes o Hypertension and stroke

Answer 72

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

Answer 73

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.

Answer 74

* 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.

Answer 75

* 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.

Answer 76

gen survey, vitals, bmi, skin hair nails, head & neck, cardio, ABD, MSK, Neuro

Answer 77

* Skin Turgor: Poor turgor = dehydration; Swelling = overhydration.

Answer 78

protein, vitamin C, or zinc deficiency.

Answer 79

Niacin def.

Answer 80

K or C def

Answer 81

Protein def.

Answer 82

A or C def

Answer 83

protein def

Answer 84

o Red, swollen gums: Vitamin C deficiency (scurvy). o Bright red or swollen tongue: Vitamin B deficiency (e.g., folate, niacin).

Answer 85

iodine deficiency or thyroid disorders affecting metabolism.

Answer 86

protein def electrolytes imbalanced

Answer 87

concave/scaphoid. muscle waste. round/protuberant is excess cal. enlarge is ascites from liver disease

Answer 88

GI infection, lax use, malabsorption

Answer 89

Peristalsis is slow or constipated

Answer 90

* 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.

Answer 91

Thiamine def B12 def

Answer 92

B or Mg def

Answer 93

Ca or Mg def

Answer 94

severe malnutrition

Answer 95

Could be a sign of malnutrition. Is he also small or short for his age?

Answer 96

Head circumference, ht, wt

Answer 97

sign of malnutrition, esp if he has less strength

Answer 98

cancer, HIV, COPD

Answer 99

o Low blood glucose: Triggers glucagon release, which:  Mobilizes glucose from glycogen stores.  Releases glucose into the bloodstream

Answer 100

49 ## Footnote * Symptoms: Weakness, dizziness, confusion, irritability, sweating, shakiness, anxiety. * Severe Cases: May progress to coma.

Answer 101

110 ## Footnote * 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.

Answer 102

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.

Answer 103

Risk factors for diabetes

Answer 104

* 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.

Answer 105

o Albumin - 18 d o Prealbumin - 2 d o Transferrin - 8 d

Answer 106

* 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.

Answer 107

* 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.

Answer 108

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).

Answer 109

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.

Answer 110

* 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).

Answer 111

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)

Answer 112

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)

Answer 113

* 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.

Answer 114

o Preprandial (before meals): 80–130 mg/dL o Postprandial (1–2 hours after meals): Less than 180 mg/dL

Answer 115

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. ## Footnote 70 to 100

Answer 116

o Low levels: Seen in protein depletion, inflammation, or liver dysfunction.

Answer 117

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

Answer 118

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.

Answer 119

o High BUN: Indicates renal dysfunction, dehydration, or high protein intake. o Low BUN: May indicate liver disease, overhydration, or low protein intake.

Answer 120

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.

Answer 121

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).

Answer 122

* 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 ## Footnote under 5.7 is normal between is pre. above 6.5 is diabetes

Answer 123

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

Answer 124

No, but they could be necessary if pregnant, lactating, or adolescent

Answer 125

* 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 ## Footnote 1. Supplements should complement, not replace, a nutritious diet. 2. Read supplement labels carefully (toxicity levels, dosage, side effects). 3. Encourage consulting a primary care provider before taking supplements. 4. Follow DRI or RDA dosages.

Answer 126

* 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

Answer 127

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.

Answer 128

* 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.

Answer 129

dehydration. can provide antiemetics by dr or give IV fluid

Answer 130

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.

Answer 131

. 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.

Answer 132

* 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.

Answer 133

* 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.

Answer 134

* 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.

Answer 135

* 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.

Answer 136

* 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.

Answer 137

* 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.

Answer 138

* 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.

Answer 139

* 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.

Answer 140

* 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.

Answer 141

* 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.

Answer 142

* 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.

Answer 143

* 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.

Answer 144

* 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.

Answer 145

* 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.

Answer 146

* 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.

Answer 147

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.

Answer 148

1. For Lavage (Stomach Washing): o Indicated for disease, surgery, bleeding, poisoning, or medication overdose. 2. For Diagnostic Specimen Collection: o To collect stomach contents for laboratory analysis. 3. For Gastric Decompression (Postoperative): o Prevents nausea, vomiting, and gastric distention after surgery.

Answer 149

* 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

Answer 150

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).

Answer 151

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.

Answer 152

* 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.

Answer 153

* 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).

Answer 154

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.

Answer 155

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.

Answer 156

Not reliable on its own—patients can have the tube in their lungs without obvious distress.

Exam 2 module 4 part 2 - Nutrition part 2 Flashcards

Nutrition Chapter 24