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NRAD 201D > Exam 2 - Nutrition and Aging, Diets > Flashcards

Exam 2 - Nutrition and Aging, Diets Flashcards

1
Q

Where does mechanical digestion take place?

A
  • Mouth
  • Stomach
  • Intestine
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2
Q

Mouth mechanical digestion

A

chewing + saliva = bolus

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3
Q

Stomach mechanical digestion

A

stomach churning + gastric acid = chyme

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4
Q

sml inteastine mechanical digestion

A

local contractions push chyme to villi = absorption

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5
Q

mouth chemical digestion

A

lipase = fats
amylase = carb

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6
Q

stomach chemical digestion

A

HCL- + pepsin = protein (amino acids)
Lipase = fatty acids

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7
Q

pancreas chemical digestion

A

amylase = carb
lipase = fat

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8
Q

where does majority of digestion occur?

A

sml intestine

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9
Q

what enzyme breaks down protein?

A

pepsin –> amino acids

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10
Q

what enzyme breaks down carbs?

A

amylase –> glucose

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11
Q

what enzyme breaks down fat?

A

lipase –> fatty acids

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12
Q

Steps of carb digestion

A

mouth + salivary amylase
small intestine + pancreatic amylase
glucose

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13
Q

Steps of protein digestion

A

stomach (protected by buffer mucous)
HCl- + pepsin
small intestine
amino acids

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14
Q

Steps of fat digestion

A

lipase secreted by:
- mouth
- stomach
- pancreas
sml. intestine
fatty acids

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15
Q

steps of absorption in small intestine

A
  • sml intestine
  • villi
  • microvilli (with brush border enzymes ex: lactase)
  • capillary bed
  • hepatic portal vein
  • liver (first pass effect)
  • hepatic vein
  • inferior vena cava
  • heart
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16
Q

three phases of wound healing

A
  1. inflammation
  2. proliferation
  3. epithelialization and remodeling
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17
Q

what occurs during inflammation stage?

A
  • vasoconstriction and clotting

PACaKE
P: antibodies fight infection
A: migrate macrophages, monocytes, fibroblasts
Ca+: fibrin
K: clotting factors
E: antioxidant protects new cell membranes

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18
Q

What occurs during Proliferation stage?

A
  • angiogenesis and new tissue
  • less monocytes = less inflammation
  • increased macrophages and fibroblasts = bacteria fighting and contractility

PIB12
- P: angiogenesis, contraction, collagen deposition
- I: collagen strength and cell perfusion
- B12: energy to cells, proliferation of granulation tissue

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19
Q

What occurs during epithelialization and remodeling?

A
  • scar tissue forms

PC
P: collagen and elastin = scar tissue
C:
- stim. collagen synthesis
- stim iron absorption = collagen strength
- stim angiogenesis

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20
Q

Symptoms of aging digestive changes

A
  • Decreased taste and smell
  • Dry mouth (xerostomia)
  • chewing issues
  • Dysphagia
  • Early satiety: fuller faster
  • Decreased thirst (risk of dehydration)
  • Reduced absorption
  • Decreased peristalsis
  • Constipation
  • Malnourishment
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21
Q

reduced taste and smell?

A

Caused by some meds
Reduce hunger cues

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22
Q

Dysphagia

A
  • swallowing issues
  • Risk of choking/aspiration
  • Monitor for coughing
  • Thick liquids prevent aspiration, can swallow slower
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23
Q

What to avoid with thickened liquids

A
  • Do not use straws
  • defeat purpose: shoot liquid too quickly down throat
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24
Q

What are the result of changes to the hypothalamus?

A
  • Early satiety: fuller faster
  • Decreased thirst (risk of dehydration)
  • By the time you’re thirsty, you’re already dehydrated
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25
Q

Physiology of reduced absorption

A
  • Decreased HCl- acid secretion
  • Increased PPIs/antacids block HCL- to prevent ulcers
  • stomach acid cannot perform adequate chemical digestion to liberate nutrients
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26
Q

What is malnourishment, what are interventions?

A
  • Imbalance between nutritional requirements and intake causing measurable adverse effects
  • Misconception that only underweight individuals can be malnourished
  • albumin below 35 g/dL Indicates inflammation or infection
  • Need to supplement with ensure drinks and vitamins
  • When food is refused, ask what they would prefer
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27
Q

Nutrition requirements for adults over 70
6 points

A
  • lower cals: less mobile
  • 1g protein/kg weight to prevent age related muscles loss
  • more D: less sun exposure
  • more Ca+: d/t bone resorption and low D
  • less iron (after menopause)
  • B12 same across lifespan 2.4 mcg/day
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28
Q

Nutrition requirements for adults under 70

A
  • more cals: more mobile
  • 0.8g protein/kg weight mobility prevents muscle loss
  • less D: more sun exposure
  • less Ca+: d/t bone resorption and low D
  • more Ca+ for women over 50 d/t menopause
  • more iron (pre menopause)
  • B12 same across lifespan 2.4 mcg/day
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29
Q

Carb and Fat recommended ratios

A

CHO: 45-65% of total energy intake → complex CHOs (not simple sugars)

Fats: 20-35% of total energy intake → healthy fats avoid weight loss
High age = low body comp.
Fats keep weight up

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30
Q

Kidney disease and protein intake

A

High intake taxes kidneys when breaking down
Kidney disease = reduced protein intake

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31
Q

Nursing Interventions to Promote Nutrition

A
  • Maintain good oral hygiene
  • Small, frequent meals
  • Clean Environment / dining room
  • Position: Upright, HOB elevated
  • offer Favorite foods
  • Pain control
  • Collaborate with dietician and/or speech therapy
  • Swallow assessment
  • Follow trend of intake
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32
Q

Why should elderly be served small frequent meals?

A

Large meals look overwhelming

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33
Q

How to make a clean eating environment

A

Clean up urinals, spit cups, tissues, commodes
Clean = better for appetite and eating

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34
Q

How should back/hip surgery patients be positioned for eating?

A

less than 45 degree position

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35
Q

How to control pain to encourage eating?

A
  • Pain eliminates appetite
  • Administer meds in advance
  • Reposition
  • Brief change
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36
Q

MyPlate Recommendations

A
  • represents 5 food groups
  • ½ plate fruits and veggies
  • ½ plate grains and proteins
  • one dairy helping
  • oils recommended in small amounts
  • eat a full food group per day
  • Small plate discourages “super-sized” portions

Limit
- added sugars
- sat fat
- sodium

Be active to prevent disease and manage weight

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37
Q

MyPlate Dairy Recommendations

A
  • Low fat or fat-free
  • Fortified soy version
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38
Q

MyPlate Fat Recommendations

A

oils recommended in small amounts

Good:
- omega 6 polyunsaturated
- monounsaturated

Limit: saturated fats

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39
Q

MyPlate Sugar Recommendation

A

less than 50g/day

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40
Q

MyPlate Sat Fat Recommendation

A

less than 22 g/day

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41
Q

MyPlate Sodium Recommendation

A

less than 2,300 mg/day

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42
Q

MyPlate Activity Recommendation

A
  • Kids more than 60 min/day
  • Adults more than 150 min/week
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43
Q

Food Label Updates

A
  • Fonts made bigger
  • Labels and servings became more realistic
  • Potassium added to maintain CV health
44
Q

How have portion sizes changed?

A

Portions increased to reflect actual serving eaten

45
Q

Why was potassium added to food label?

A

People have been eating too little

46
Q

What section of the food label indicates things to limit?

A

Limit fats, cholesterol, sodium

47
Q

What section of the food label indicates things to get enough of?

A

Get enough: fiber, vitamins, minerals

48
Q

What is daily value based on?

A
  • nutrients displayed in % of daily value
  • Daily value based on 2000 cals/day
49
Q

What is the purpose of a Nutritional History Screening?

A
  • collect data about eating behaviors
  • identify possible nutritional risks or deficiencies
50
Q

What categories are included in a nutritional Screening?

A
  • food allergies (intolerances = allergies)
  • medical conditions (acute Dx & chronic)
  • dentition, chewing, or swallowing difficulties
  • recent weight loss
  • BMI
  • lab work: deficiencies…
  • eating behaviors: food preferences, appetite…
  • digestive behaviors: constipation, GI symptoms…
  • Risk factors: Age, conditions…
  • nutritional therapies
51
Q

Considerations regarding dentition

A
  • Mouth gets smaller with age –> Too large dentures are painful
  • Missing teeth, loose, dentures impact chewing
  • Social services can assist with getting proper devices
52
Q

Considerations regarding recent weight loss

A

Possible causes:
- Cancer, gastrectomy, reduced muscle mass, thyroid, stress

Concerning unintentional weight loss
10% drop in 6 months
5% in 1 month

53
Q

BMI Table Figures

A

Underweight less than 18.5
Normal 18.5 ‐ 24.9
Overweight 25.0 - less than 30
Obese 30.0-40.0
Extreme Obesity greater than 40.0

54
Q

What is BMI?

A
  • Body Mass Index (BMI) – measure of body fat based on weight in relation to height
  • screening tool
  • Monitored in LTC to note trends, not as much in acute
55
Q

What can impact BMI?

A
  • Doesn’t account for muscle mass
  • Liver disease, heart failure, CKD = edema
  • More weight d/t fluid vs. fat
56
Q

Nutritional screening labs

A
  • electrolytes
  • glucose
  • lipid panel
  • liver and renal function
  • complete blood count
  • vitamins & minerals
57
Q

How to use screening lab data?

A
  • Use as springboard for further assessment: provides info to ask about
  • Out of range labs = ask questions
  • Compare against baseline, trends, meds…
58
Q

how often are labs done?

A

LTC = yearly
Acute = daily or more

59
Q

Objective and subjective cues during nutritional assessment

A

Observe for any nutritional deficiencies
- objective data: edema, turgor, nail shape
- subjective data: fatigue, headache, etc…

  • clarify data: how long, how much hair loss, etc…
60
Q

What can disease can poor wound healing indicate?

A

DM: High blood sugar doesn’t feel like anything
10+ years until diagnosis

high glucose = narrowed vessels
poor circulation = poor healing

61
Q

Why do a nutrition assessment for wound healing?

A
  • Poor nutrition increase risk of complications, like infection
62
Q

What nutrient has most important role in wound healing?

A

Proteins and amino acids

63
Q

Why is it essential to assess swallowing ability?

A
  • Can’t assume that patient’s can swallow meds, foods, liquids
  • Choking potential
  • Do they need to crush meds?
  • Risk for aspiration into the lungs (aspiration pneumonia)
64
Q

Causes of dysphagia

A

Aging

Degenerative conditions
- parkinson’s , AD, MS

non‐degenerative conditions
- Cerebral Palsy, TBI, Stroke

65
Q

Nursing Process: Assessment
Swallow Screening

A
  • alertness
  • able to sit upright
  • managing secretions
  • coughing strength
  • Hx of aspiration pneumonia? It will likely happen again
66
Q

Nursing Process: Planning
Swallow Screening

A

Plan: nurse swallow evaluation
- obtain NPO orders PRN
- discuss meds w/MD: Liquid, IV vs. PO

67
Q

Nursing Process: Intervention
Swallow Screening

A

arrange ST evaluation (water/food texture modifications)

68
Q

Nursing Process: Evaluation
Swallow Screening

A

Evaluate ease/difficulty of food intake on given diet orders

69
Q

When to do swallow screen?

A

before giving patient food, drink, or oral medications for the first time

70
Q

What should you have/do before starting swallow screen?

A
  • Oral suction immediately available
  • See that mouth is moist and clean
71
Q

Pre-screen checklist.
If any item is checked, stop. NPO, wait for MD/ST Eval

A
  • Patient is not alert or unable to follow simple commands
  • patient is unable to sit in 90° upright position
  • recent history of pneumonia
  • currently on aspiration precautions
  • difficulty managing secretions
  • absent or weak cough
  • no voice
  • weak voice, wet sounding vocal quality, coughing
  • Patient has feeding to present
  • unable to screen patient
72
Q

First Oral Trial Steps

A
  • Sitting upright (90 degrees), awake, alert
  • 15 mL of water swallowed at once
  • Then ask patient to count to five out loud
73
Q

Items that would result in failing oral trial?

A

If any box is checked, fail and NPO
- 4+ seconds elapsed before swallow
- Multiple swallows
- Coughed immediately or within 1 min of swallowing
- Vocal quality wet, gargly/gurgly
- Dribble or drool from mouth

74
Q

Second oral trial steps

A
  • 90mL in 2-3 sips without putting cup down
  • Can assist with holding cup up, but no straws
75
Q

What are therapeutic diets are modified for?

A
  1. Nutrients (ie., chronic conditions)
  2. Texture (swallowing concerns)
  3. Food allergies or food intolerances
  4. weight control
76
Q

Nutrient modified diets

A
  • No concentrated sweets diet
  • Diabetic diets
  • No added salt diet
  • Low sodium diet
  • Low fat diet and/or low cholesterol diet
  • High fiber diet
  • Renal diet
77
Q

Texture modification diets

A
  • Mechanical soft diet
  • Puree diet
78
Q

Food allergy diets

A

The most common food allergens are
- milk
- egg
- soy
- wheat/gluten
- peanuts
- tree nuts
- fish
- shellfish.

79
Q

Gluten Free Diet: eliminate/replace

A
  • elimination of wheat, rye, and barley
  • Replaced with potato, corn, and rice products.
80
Q

Common symptoms of food intolerance

A

vomiting, diarrhea, abdominal pain, and headaches.

81
Q

what is included in a Clear liquid diet?

A

Includes minimum residue fluids that can be seen through.
- Broth
- clear juices (apple, grape, cranberry)
- NO OJ. could have pulp
- water
- black coffee (sugar, no creamer)
- tea
- popsicles
- carbonated beverages
- gelatin.

82
Q

Indications for a clear liquid diet

A
  • prescribed when it is necessary to limit undigested food in the GI tract
  • first step in oral alimentation
  • Often used as the first step to restarting oral feeding after surgery or an abdominal procedure.
  • Can also be used for fluid and electrolyte replacement in people with severe diarrhea.
  • Should not be used for an extended period as it does not provide enough calories and nutrients.
83
Q

What is a full liquid diet?

A

includes clear liquid as well as any food items that are liquid at room temperature
Includes fluids that are creamy.
- juices with pulp (OJ okay now)
- soups (tomato)
- milk
- milkshakes, ice cream
- puddings, custards, plain yogurt (no fruit added)
- nutritional supplements
- thin hot cereal

84
Q

Indications for a full liquid diet

A
  • Used as the second step to restarting oral feeding once clear liquids are tolerated.
  • Used for people who cannot tolerate a mechanical soft diet.
  • Should not be used for extended periods
  • may need oral supplementation of longer than 3 days
85
Q

What is a regular diet?

A
  • includes all foods and liquids
  • may need to be modified to address chewing and swallowing difficulties
86
Q

What is a Mechanically altered or soft diet?

A
  • Changes the consistency of the regular diet to a softer texture.
  • Includes chopped or ground meats
  • chopped or ground raw fruits and vegetables
87
Q

Indications for a Mechanically altered or soft diet

A
  • Used when there are problems with chewing and swallowing (dysphagia)
  • For people with poor dental conditions, missing teeth, no teeth
88
Q

What is a puree diet?

A
  • Changes the regular diet by pureeing it to a smooth liquid consistency.
  • Often thinned down so it can pass through a straw.
  • Foods should be pureed separately.
  • Avoid nuts, seeds, raw vegetables, and raw fruits.

Nutritionally adequate when offering all food groups.

89
Q

Indications for a puree diet

A
  • Indicated for those with wired jaws
  • extremely poor dentition –> chewing is inadequate.
90
Q

Steps before advancing a diet

A
  • Must have an MD or HCP order
  • Identify the type of surgery, procedure, anesthesia
  • Assess for alertness, gag reflex, GI assessment
  • Awake, swallow secretions, bowel sounds
91
Q

Impact of anaesthesia on diet

A
  • Can increase nausea
  • Digestive system goes to sleep → food can result in vomiting
92
Q

‘Advance diet as tolerated’

A
  • Start slow: crackers to see if it stays down
  • Ice chips/Clear liquids
  • Full liquids
  • regular diet
93
Q

‘Advance diet as tolerated if positive flatus’ (flatulence)

A
  • After GI procedure
  • typically want to gas before advancing diet
  • Assessment will indicate which phase you start with
94
Q

NPO

A

nothing by mouth, including meds

95
Q

NPO except ice chips

A
  • Ice in 8 oz cup
  • Ice melts in a large container and becomes water.
  • Report to MD if they keep finishing ice, may be time to advance
96
Q

NPO except meds

A

Small sip with meds

97
Q

Ethnic and Cultural Food Preferences

A
  • Don’t assume, just ask about food preferences
  • Fam can bring food as long as it is within dietary orders.
98
Q

Hispanic Food Culture

A
  • prepared with lard
  • High prevalence of DM; sugary drinks
  • high Na+/fat
  • Belief in ‘hot‐cold’ to provide balance: Fever eat cold, cold eat hot

Recommend boiling, grilling, or healthier oils

99
Q

Asian Food Culture

A
  • Foods are more plant‐based
  • Protein consists of beans, nuts; occasional poultry
  • Lower incidence of CVD, DM, & obesity
  • Prefer hot or warm water
  • May be lactose intolerant
100
Q

Indian Food Culture

A
  • Prefer home‐cooked foods; wide array of spices
  • Meat selection based on religious preference
  • Muslims may not eat pork
  • Buddhists may be vegetarian
101
Q

Body Comp Changes with Age

A

Over time muscle loss affects functional capacity
- potential loss of Independence
- reduction in bone mass adds to the risk of fracture

102
Q

Cardiovascular Changes with Age

A
  • The heart weakens as a pump
  • less able to respond to increased demands for oxygen during strenuous physical exercise emotional stress or acute illness
  • a drop in the amount of blood pumped with each stroke reduces the blood supply to major organs such as the kidney and lungs
103
Q

Renal Changes with Age

A
  • aging kidneys are less efficient and require more time to clear waste products from the blood
  • Urine cannot be concentrated to the same extent
  • increased fluid is required to excrete a given amount of waste
104
Q

Respiratory Changes with Age

A
  • Reduction in the available surface area for exchange of oxygen and carbon dioxide
  • dead space is susceptible to the growth of pathogens
  • more vulnerable to upper respiratory conditions and pneumonia
105
Q

GI Changes with Age

A
  • Loss of gastric acid interferes with the absorption of vitamin B12
  • reduces uptake of thiamine folate calcium and iron
  • Changes in neural and muscle function contribute to constipation
  • increasing the time needed for food to pass through the lower digestive tract
  • changes in gastric Control Systems sometimes result in early satiety

NRAD 201D (3 decks)

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