Exam 2 - Nutrition and Aging, Diets Flashcards
Where does mechanical digestion take place?
- Mouth
- Stomach
- Intestine
Mouth mechanical digestion
chewing + saliva = bolus
Stomach mechanical digestion
stomach churning + gastric acid = chyme
sml inteastine mechanical digestion
local contractions push chyme to villi = absorption
mouth chemical digestion
lipase = fats
amylase = carb
stomach chemical digestion
HCL- + pepsin = protein (amino acids)
Lipase = fatty acids
pancreas chemical digestion
amylase = carb
lipase = fat
where does majority of digestion occur?
sml intestine
what enzyme breaks down protein?
pepsin –> amino acids
what enzyme breaks down carbs?
amylase –> glucose
what enzyme breaks down fat?
lipase –> fatty acids
Steps of carb digestion
mouth + salivary amylase
small intestine + pancreatic amylase
glucose
Steps of protein digestion
stomach (protected by buffer mucous)
HCl- + pepsin
small intestine
amino acids
Steps of fat digestion
lipase secreted by:
- mouth
- stomach
- pancreas
sml. intestine
fatty acids
steps of absorption in small intestine
- 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
three phases of wound healing
- inflammation
- proliferation
- epithelialization and remodeling
what occurs during inflammation stage?
- vasoconstriction and clotting
PACaKE
P: antibodies fight infection
A: migrate macrophages, monocytes, fibroblasts
Ca+: fibrin
K: clotting factors
E: antioxidant protects new cell membranes
What occurs during Proliferation stage?
- 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
What occurs during epithelialization and remodeling?
- scar tissue forms
PC
P: collagen and elastin = scar tissue
C:
- stim. collagen synthesis
- stim iron absorption = collagen strength
- stim angiogenesis
Symptoms of aging digestive changes
- 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
reduced taste and smell?
Caused by some meds
Reduce hunger cues
Dysphagia
- swallowing issues
- Risk of choking/aspiration
- Monitor for coughing
- Thick liquids prevent aspiration, can swallow slower
What to avoid with thickened liquids
- Do not use straws
- defeat purpose: shoot liquid too quickly down throat
What are the result of changes to the hypothalamus?
- Early satiety: fuller faster
- Decreased thirst (risk of dehydration)
- By the time you’re thirsty, you’re already dehydrated
Physiology of reduced absorption
- Decreased HCl- acid secretion
- Increased PPIs/antacids block HCL- to prevent ulcers
- stomach acid cannot perform adequate chemical digestion to liberate nutrients
What is malnourishment, what are interventions?
- 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
Nutrition requirements for adults over 70
6 points
- 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
Nutrition requirements for adults under 70
- 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
Carb and Fat recommended ratios
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
Kidney disease and protein intake
High intake taxes kidneys when breaking down
Kidney disease = reduced protein intake
Nursing Interventions to Promote Nutrition
- 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
Why should elderly be served small frequent meals?
Large meals look overwhelming
How to make a clean eating environment
Clean up urinals, spit cups, tissues, commodes
Clean = better for appetite and eating
How should back/hip surgery patients be positioned for eating?
less than 45 degree position
How to control pain to encourage eating?
- Pain eliminates appetite
- Administer meds in advance
- Reposition
- Brief change
MyPlate Recommendations
- 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
MyPlate Dairy Recommendations
- Low fat or fat-free
- Fortified soy version
MyPlate Fat Recommendations
oils recommended in small amounts
Good:
- omega 6 polyunsaturated
- monounsaturated
Limit: saturated fats
MyPlate Sugar Recommendation
less than 50g/day
MyPlate Sat Fat Recommendation
less than 22 g/day
MyPlate Sodium Recommendation
less than 2,300 mg/day
MyPlate Activity Recommendation
- Kids more than 60 min/day
- Adults more than 150 min/week
Food Label Updates
- Fonts made bigger
- Labels and servings became more realistic
- Potassium added to maintain CV health
How have portion sizes changed?
Portions increased to reflect actual serving eaten
Why was potassium added to food label?
People have been eating too little
What section of the food label indicates things to limit?
Limit fats, cholesterol, sodium
What section of the food label indicates things to get enough of?
Get enough: fiber, vitamins, minerals
What is daily value based on?
- nutrients displayed in % of daily value
- Daily value based on 2000 cals/day
What is the purpose of a Nutritional History Screening?
- collect data about eating behaviors
- identify possible nutritional risks or deficiencies
What categories are included in a nutritional Screening?
- 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
Considerations regarding dentition
- Mouth gets smaller with age –> Too large dentures are painful
- Missing teeth, loose, dentures impact chewing
- Social services can assist with getting proper devices
Considerations regarding recent weight loss
Possible causes:
- Cancer, gastrectomy, reduced muscle mass, thyroid, stress
Concerning unintentional weight loss
10% drop in 6 months
5% in 1 month
BMI Table Figures
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
What is BMI?
- 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
What can impact BMI?
- Doesn’t account for muscle mass
- Liver disease, heart failure, CKD = edema
- More weight d/t fluid vs. fat
Nutritional screening labs
- electrolytes
- glucose
- lipid panel
- liver and renal function
- complete blood count
- vitamins & minerals
How to use screening lab data?
- Use as springboard for further assessment: provides info to ask about
- Out of range labs = ask questions
- Compare against baseline, trends, meds…
how often are labs done?
LTC = yearly
Acute = daily or more
Objective and subjective cues during nutritional assessment
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…
What can disease can poor wound healing indicate?
DM: High blood sugar doesn’t feel like anything
10+ years until diagnosis
high glucose = narrowed vessels
poor circulation = poor healing
Why do a nutrition assessment for wound healing?
- Poor nutrition increase risk of complications, like infection
What nutrient has most important role in wound healing?
Proteins and amino acids
Why is it essential to assess swallowing ability?
- 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)
Causes of dysphagia
Aging
Degenerative conditions
- parkinson’s , AD, MS
non‐degenerative conditions
- Cerebral Palsy, TBI, Stroke
Nursing Process: Assessment
Swallow Screening
- alertness
- able to sit upright
- managing secretions
- coughing strength
- Hx of aspiration pneumonia? It will likely happen again
Nursing Process: Planning
Swallow Screening
Plan: nurse swallow evaluation
- obtain NPO orders PRN
- discuss meds w/MD: Liquid, IV vs. PO
Nursing Process: Intervention
Swallow Screening
arrange ST evaluation (water/food texture modifications)
Nursing Process: Evaluation
Swallow Screening
Evaluate ease/difficulty of food intake on given diet orders
When to do swallow screen?
before giving patient food, drink, or oral medications for the first time
What should you have/do before starting swallow screen?
- Oral suction immediately available
- See that mouth is moist and clean
Pre-screen checklist.
If any item is checked, stop. NPO, wait for MD/ST Eval
- 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
First Oral Trial Steps
- Sitting upright (90 degrees), awake, alert
- 15 mL of water swallowed at once
- Then ask patient to count to five out loud
Items that would result in failing oral trial?
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
Second oral trial steps
- 90mL in 2-3 sips without putting cup down
- Can assist with holding cup up, but no straws
What are therapeutic diets are modified for?
- Nutrients (ie., chronic conditions)
- Texture (swallowing concerns)
- Food allergies or food intolerances
- weight control
Nutrient modified diets
- 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
Texture modification diets
- Mechanical soft diet
- Puree diet
Food allergy diets
The most common food allergens are
- milk
- egg
- soy
- wheat/gluten
- peanuts
- tree nuts
- fish
- shellfish.
Gluten Free Diet: eliminate/replace
- elimination of wheat, rye, and barley
- Replaced with potato, corn, and rice products.
Common symptoms of food intolerance
vomiting, diarrhea, abdominal pain, and headaches.
what is included in a Clear liquid diet?
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.
Indications for a clear liquid diet
- 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.
What is a full liquid diet?
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
Indications for a full liquid diet
- 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
What is a regular diet?
- includes all foods and liquids
- may need to be modified to address chewing and swallowing difficulties
What is a Mechanically altered or soft diet?
- Changes the consistency of the regular diet to a softer texture.
- Includes chopped or ground meats
- chopped or ground raw fruits and vegetables
Indications for a Mechanically altered or soft diet
- Used when there are problems with chewing and swallowing (dysphagia)
- For people with poor dental conditions, missing teeth, no teeth
What is a puree diet?
- 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.
Indications for a puree diet
- Indicated for those with wired jaws
- extremely poor dentition –> chewing is inadequate.
Steps before advancing a diet
- 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
Impact of anaesthesia on diet
- Can increase nausea
- Digestive system goes to sleep → food can result in vomiting
‘Advance diet as tolerated’
- Start slow: crackers to see if it stays down
- Ice chips/Clear liquids
- Full liquids
- regular diet
‘Advance diet as tolerated if positive flatus’ (flatulence)
- After GI procedure
- typically want to gas before advancing diet
- Assessment will indicate which phase you start with
NPO
nothing by mouth, including meds
NPO except ice chips
- 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
NPO except meds
Small sip with meds
Ethnic and Cultural Food Preferences
- Don’t assume, just ask about food preferences
- Fam can bring food as long as it is within dietary orders.
Hispanic Food Culture
- 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
Asian Food Culture
- 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
Indian Food Culture
- Prefer home‐cooked foods; wide array of spices
- Meat selection based on religious preference
- Muslims may not eat pork
- Buddhists may be vegetarian
Body Comp Changes with Age
Over time muscle loss affects functional capacity
- potential loss of Independence
- reduction in bone mass adds to the risk of fracture
Cardiovascular Changes with Age
- 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
Renal Changes with Age
- 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
Respiratory Changes with Age
- 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
GI Changes with Age
- 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
