Nutrition and Diversity Flashcards
Preventative strategies for Obesity
Education, Regulation, and modification of food supply
Obesity reduces life expectance
3-7 years with BMI over 30
At risk for obesity
low income
increasing number of women, especially black and hispanic
Genetics, Certain Meds,
Influences for nutritional status
Age
Culture
and Socioeconomic Status!!
Obesity increases risk of contracting
Type 2 diabetes, gallbladder disease, heart disease, hypertension, some cancers, sleep apnea, respiratory problem, hernia. reduces life expectance and increases medical costs
Considerations pst bariatric surgery
abdominal binder, position, 02 sat monitoring, sequential compression hose and/ or heparin, skin assessment, absorbent padding, removal of urinary catheter within 24 hours, assistant OOB, ambulate as soon as possible, monitor abdominal girth, small feedings to prevent gastric dumping (observe for sx of dumping syndrome), prevent dehydration.
Nutritional Assessments (Obesity)
Malnourished/ Well nourished Obese Physical presentation Lab studies Influences for nutritional status: age, culture and socioeconomic status
Choose myplate
US department of ag. Most grains and vegetables, then protein and fruits, and last dairy. includes guidelines for balancing calories, decreasing portion size, increasing healthy foods, increasing water consumption and decreasing fats, sodium and sugars. make half your plate fruits and vegetables, enjoy your food, but eat less, avoid oversized portions, foods to eat more often, switch to fat free or 1% milk, make half you grains whole grains, foods to eat less often, compare sodium in foods and drink water instead of sugary drinks
Clear Liquid Diet
Clear fat free broth, bouillon, coffee, tea, carbonated beverages, clear fruit juices (no pulp), gelatin, fruit ice and popsicles. Inadequate in energy and all energy besides water. should not be used for more than 24 hours
Full liquid diet
Basically anything can drink through a straw with no chunks that require chewing. All clear liquids, plus smooth textured dairy products (ice cream), strained or blended cream soups, custards, refined cooked cereals, vegetable juice, pureed vegetables, all fruit juices, shortest puddings frozen yogurt. can provide adequate energy and nutrients, unless pt is lactose intolerant. concern with high sat fat and cholesterol.
Mechanical soft diet
composition and consistency vary depending on ps needs, and can be modified for additional needs such as low sodium, kcal control or low fat. Care should be taken in evaluating pts needs for consistency and food should only be altered to degree needs to be. All of full liquid plus all cream soups, ground or finely diced meats, flaked fish, cottage cheese, cheese, rice, potatoes, pancakes, light breads, cooked legs, cooked or canned fruits, bananas, soups, peanut butter and eggs (not fried).
Mechanically altered is basically the same- but maybe a little MORE altered-ground, mashed pureed- and soft veg
soft diet
whole foods, low in fiber, easily digestible and lightly seasoned. transition diet from liquid diet to regular diet, food supplements or btwn meals snacks may be used to increase kcal, can contain hard to chew foods such as white toast, not appropriate for pts requiring mechanically soft. less about chewing swallowing/ more about easy to digest foods like pastas, casseroles, moist tender meats..
Diet as tolerated
allows for postoperative diet progression based on pts tolerance. some clinicians call this a transition or progressive diet
Macronutrients
Nutrients needed in large quantities.
Carbs- primary source of energy and fiber and chief protein spacing ingredient
Fats- a major source of energy and vitamins and give a feeling a satiety from eating. 30% or less of intake
Proteins- ideally 10-35% of daily intake, contribute to growth and repair of body tissues, provide body with essential amino acids
BMI
less than 19- underweight 19-25, optimal 25-30 overweight 30-35 class 1 obesity 35-39 class 2 obesity more than 40- extreme obesity/ morbidly
Starvation
First body selectively uses carbs rather than fat and protein for metabolic needs. (depleted in 18 hrs), skeletal protein is then converted to glucose (gluconeogenesis). may cause pt to have neg nitrogen balance. After 5-9 days the body fat is fully mobilized to supply much of needed energy. in prolonged 97% of energy from fat and protein is conserved, fat stores generally used up in 4-6 wks, - then body protein is the only source left. Visceral proteins (from internal organs and plasma) are no longer spared until organ failure occurs.
Kwashiorkor
Deficiency in protein intake superimposed by catabolic stress event (GI obstruction, Surgery, cancer, mal absorption syndrome, infectious disease) may appear well nourished- could have adequate calorie intake. SXS: Change in skin color, fatigue, diarrhea, loss of muscle mass, edema, failure to grow or gain weight, irritability
Marasmus
Concurrent deficiency in caloric and protein intake. Generalized by loss of muscle and body fat, appear emaciated but have normal serum protein levels, if condition continues, damage will occur to major organs such as heart, lungs and kidneys, children will not grow. If it happens during 6-18 months- permanent brain damage. Also, plasma oncotic pressure drops (less albumin) which shifts fluid from vascular to interstitial causing edema.
re-feeding syndrome
can be fatal, reintroduction of excess protein and calories in a starving person can overload the enzymatic and physiologic function. introduce nutrients slowly and monitor medical and metabolic status closely.
Interventions to prevent aspiration during feeding of pt with dysphagia
*sit person at 90 degrees for oral intake - including PO meds- most important!
have suction equipment ready at all times
provide rest before feedings
avoid rushed feeding, adjust rate of feeding and size of bites per individual
alternate solids and liquids
place food on non impaired side of mouth
avoid sedatives, hypnotics that may impair the cough reflex and swallowing
Anemia
A deficiency in the number of RBCs, quantity of hemoglobin and volume of packed RBCs (hematocrit) percentage of total fluid volume
not a specific disease, but a condition
manifestation of a pathologic process
Anemia sxs
Lethargy, apathy, fever, pale skin and mucous membranes, blue or pale white eyes, poor skin turgor, jaundice, pruritus, tachypnea, tachycardia, headache, beefy red tongue, confusion, night sweats, cold intolerance, spoon shaped nails, poor healing, dry brittle thinning hair, anorexia, unsteady gait, postural hypotension
causes of anemia
Medications, surgery, diet (alcohol, vegetarian), recent blood loss, chronic liver, endocrine or renal disease, GI disease, inflammatory disorders (churns), exposure to radiation or chemical toxins, infectious diseases (HIV)
Nursing goals/ planning for anemic patient
assume ADL, maintain adequate nutrition and develop no or minimize complications related to anemia. correct cause of anemia is goal, but acute interventions include drug therapy (erythropoietin, vitamin sups), blood or blood product transfusion, volume replacement and O2 therapy to stabilize pt. Dietary and lifestyle changes can usually reverse- assess pts knowledge regarding adequate nutritional intake
iron deficiency anemia
one of most common chronic hematologic disorders. from inadequate dietary intake, malabsorption(celiac, crowns, disease or gastric bypass), or chronic kidney disease, blood loss, hemolysis,
sxs of iron deficiency anemia
grumpy, weak tired, headaches and trouble concentrating. more severe- blue color to whites of eyes, brittle nails, eat ice-pica, light headedness when stand up, pale skin color, sob, sore beefy tongue
food source of vitamin b12
which aids in RBC maturation- red meats, especially liver, eggs, enriched grain products, milk/ diary, and fish
Iron deficiency collaborative care interventions
goal is to treat the underlying disease.
increase intake of iron, nutritional therapy, oral or occasional parenteral iron supplements, transfusion of packed RBCs
Diet teaching, sup iron, discus diagnostic goals, emphasize compliance, iron therapy for 2-3 months after hgb back to normal
food rich in ascorbic acid (vitamin C)
To aid in iron sup absorption- Vegetables and fruits- especially citrus. fresh and frozen usually more than canned. Vegs- broccoli, peppers, brussel sprouts, tomatoes, cabbage, potatoes, and leafy greens
Drug therapy iron def anemia
inexpensive, convenient, should be taken 1 hour prior to meals, best absorbed as ferrous sulfate in an acidic acid (take with ascorbic acid)., liquid iron should be diluted and ingested through straw to keep from staining teeth. side effects- heartburn, constipation and diarrhea. Parenteral iron can be given IM or IV, but IM may stain skin
at risk for iron def anemia
premenopausal women, pregnant women, low socioeconomic background, older adults, individuals experiencing blood loss.
Culture
culture is defined as “a pattern of shared attitudes, beliefs, self-definitions, norms, roles, and values.
Culture occurs among :
• Those who speak a particular language
• Those who live in a defined geographic region • Not restricted to race, or ethnicity
• (goth or hippie can be a culture, must belong – pack animals)
Refers to integrated patterns of behavior acquired over time.Learned within family unit, generation, and/or other social organizations
Enculturation
Process by which a person learns norms, values, and behaviors of another culture. Studying abroad and trying new ways with their culture
Acculturation
Process of acquiring new attitudes, role, customs, or behaviors. Try to be part of new culture, try to lose accent. Try to not identify with people of your original origin- different / less healthy than biculturalism.
Assimilation
Process by which a person gives up his or her original identity and develops a new cultural identify by becoming absorbed into the dominant cultural group. Want to be part of where you are, don’t always want to be an outsider.
Biculturalism
Duel pattern of identification
Ethnicity
Influenced by culture and common ancestry. Lots of different ethnicities within a country
Race
Influenced by physical or biologic characteristics. Purely what we look like.
Six Stages of Development of Intercultural Sensitivity
(Bennet• First three stages are ethnocentric (our way is best)
• 1. Denial (denying any differences, not allowing differences- may act aggressively to eliminate differences ex ISIS) broken up below
• 2. Defense
• 3. Minimization
• Second three stages are ethnorelative
• 4. Acceptance
• 5. Adaptation
• 6. Integration
Stage one: Denial
One’s own culture is the only one.
Avoidance of other cultures
Disinterest in other cultures
May active aggressively to eliminate the difference(Bennett,1986,1993)
Stage 2: Defense
Own culture or adopted culture is the only good one.
World is organized into “us” and “them”
“We” are superior. “They” are inferior.
Threatened by cultural difference
Why wouldn’t you want to do things like I do
Tend to be highly critical of other cultures (Bennett,1986,1993)
Stage 3: Minimization
Believe elements of their cultural world view as universal
Recognize you are different but make everything like your- minimizing differences by seeing similarities. This isn’t so strange bc its like my holiday of blank or food of blank
•May romanticize or trivialize other cultures
Expect similarities, but protecting own way out of self preservation
May become insistent about correcting others’ behavior to match their own
Stage 4: Acceptance
• Own culture is seen as one of a number of equally complex worldviews. Start to change your world view.
Acceptance does not mean agreement.
Cultural difference may still be judged negatively. Just because accept it doesn’t mean changing your ways.
Curious about and respectful toward cultural difference
Stage 5: Adaptation
• State in which experience of another culture yeilds understanding and behavior that is appropriate.
Adds other worldviews to own worldview. Many time mission aid workers, pick up accent of foreign. Living for a long time somewhere else.
Looks at the world through “different eyes”
May change own behavior to affectively communicate with another culture.
Stage 6:Integration
• One’s experience of self expands to include movement in and out of different cultural worldviews. Global nomads. Soak it up anywhere they are.
People in the stage deal with issues of their own “cultural marginality.”
Not necessarily better than Adaptation stage demanding intercultural competence.
Common among non-dominant minority groups, long-term expatriates and “global nomads.”
Transcultural Nursing
Focuses on care, health, and illness patterns of people with similarities and differences in cultural belief, values, and practice.
Health and illness Patterns and Cultural influence
• We can all learn about family values from our client
Culturally sensitive therapeutic communication
Colleagues and friends may be a good source of eduction
Family surveys
Cultural Competence
Expected Component of professional nursing practice
Respecting all differences; not letting one’s own biases influence others
Understanding/responding effectively to cultural and linguistic needs of patients
Requires adapting care to meet unique needs and perspectives of the individual
Joint Commission and NPSGs require cultural differences be respected
Who requires cultural difference be respected by nurses?
Joint Commission and NPSGs
Impediments to cultural sensitivity
Stereotype, prejudice, discrimination, hidden bias
Stereotype
An exaggerated belief, image or distorted truth about a person or group- a generalization that allows for little or no individual differences or social variation.”
prejudice
An opinion, prejudgment or attitude about a group or its individual members.”
discrimination
behavior that treats people unequally because of their group memberships
Hidden Bias
Your unconscious or automatic bias.” By age 2 have already learned bias, then society just reinforces it.
12 Domains for Cultural Competence
(Purnell)• Culture overview and communication • Communication • Family roles and organization • Workforce issues • Biocultural ecology • High-risk behaviors • Nutrition • Pregnancy and childbearing practices • Death rituals • Spirituality • Healthcare practices • Health care practitioner
Overview- 1st domain for cc
Country of origin- where from and where reside now? Live in higher altitude, more RBC. Mediteranean have more RBC but smaller prob to protect against malaria.
Current residence
Effects of the topography of country of origin and current residence
Reasons of emigration- refugee?
Educational status
Economics -all affect income for healthcare
Occupations
Communication- 2nd domain for cc
Dominant language and dialect
Para-language variations
• Voice volume
• Tone
• Intonations
• Willingness to share thoughts and feelings
Nonverbal communications
• Eye contact
• Facial expressions
• Touch, spatial distancing
• Acceptable greetings
Temporality Worldview Orientation
• Past
• Present
• Future
Clock versus social timeLanguage is largest barrier for non-English-speaking patients
Interpreters must be available in health care facilities
Remember that you are talking to the patient. Be looking at the patient, do they look like they are understanding. There is a blue phone that is a translator.
Determine which forms of patient communication are acceptable.
Don’t let their children be the interpreter.
Verbal and nonverbal communication demonstrates acceptance or non-acceptance of others
Interventions for communication probs
- Learn and use a few phrases of greeting in the patient’s native language
- Use an interpreter, if client is more comfortable.When speaking or listening, watch the client, not the interpreter. Stop periodically.
- Repeat important information more than onceAlways give the reason or purpose for a treatment or prescription
- Make sure the patient understands by having them explain it themselvesTeach patients their options and let them decide
Family roles and organizations- 3rd domain for cc
Family and gender roles influence plan of care
• Head of household
• Assess who makes decisions within the family
Childrearing practices
Developmental tasks of children and adolescents
Roles of the aged and extended family
Views toward alternate lifestyles
• Single parenting
• Sexual orientations
• Childless marriages
• Divorce
Workforce issues- 4th domain for cc
- Affects autonomy
- Acculturation
- Assimilation
- Gender roles
- Communication styles
- Individualism
- Health care practices from country of origin
Bicultural Ecology- 5th domain for cc
Biologic variations, health disparities • Skin coloration • Physical differences (stature) • Genetic, endemic, topographical diseases Ethnopharmacology • Absorption • Distribution • Metabolism • Excretion
High Risk Behaviors- 6th domain for cc
Tobacco
Alcohol
Recreational drugs
Sedentary life style (don’t suggest unrealistic goals, have you ever considered starting exercising? Start by walking to mailbox, then next week end of the street)
Nonuse of safety measures (seat-belts, car-seats)
High-risk sexual practices- don’t ask a teen about drugs, lifestyle with parents in the room
Nutrition- 7th domain for cc
Having adequate food know what people like to eat and what they can eat and provide alternatives for them. Everyone has a diet order, dietitian is not a chargeable item. Meaning of food Food choices Rituals Taboos How food is used • During illness • For health promotion and wellness
Pregnancy and childbearing practices- 8th domain for cc
Fertility practices Methods of birth control Views toward pregnancy • Prescriptive • Restrictive Taboo practices • Pregnancy • Birthing • Postpartum
Death rituals-9th domain for cc
• How do the individual and culture view death
Rituals to prepare
Rituals for burial or cremation
Bereavement behaviors
Spirituality- 10th domain for cc
• Involves behaviors that give purpose to life, and provides for individual strength
Joint Commission requires that all health care facilities address patients’ spiritual needs.
Chaplain is part of health care team. If they are atheist, don’t call the chaplain. They could be spiritual, but not religious, so don’t make assumption
health care practice- 11th domain for cc
- Acute or preventative
- Allopathic medicine is US traditional practice
- Traditional
- Magico religious
- Biomedical beliefs- how do they feel about medicine
- Individual responsibility for health in the family
- Self-medicating practices
- Views toward mental illness
- Organ donation and transportation beliefs
- Barriers to health care
- Personal response to pain
- Sick role- in some cultures are sicker longer- americans get back to it faster than normal.
Healthcare practitioners- 12 domain for cc
Use and perceptions health care providers
• Traditional
• Magico religious
• Allopathic
Determine what other alternative health care systems and healers a patient may use
• Healers
• Homeopathic
• Ayurvedic
Gender of health care provider may have significance
Homeless
Most homeless avoid health care.
Prone to CV disease, HTN, DM, High Cholesterol, infections
Health care providers should limit the number of visits needed.
Allopathy
Western Medicine: Allopathy
• A system of medical therapy in which a disease or an abnormal condition is treated by creating an environment that is antagonistic to the disease or condition. Kill the bacteria or cut out the bad cells
Ayruvedic
Holistic healing system developed in IndiaHomeopathy- must know what people have been using (like herbs) when they come to us for care because it can interact with what meds we give them.
Hispanic Traditions
• use of hot and cold foods, curanderismo, whole family involved in making medical decisions
Jehovah’s witnesses
- Use of blood products- cant have blood transfusions bc of religion- taking life. Can donate for themselves ahead of time sometimes, minimize blood loss,
- Also chinese don’t give blood, that is their life force-
Native Americans
• Herbs, sweat lodge, healers
nurse teaches pat who has had surgery to increase which nutrient to help with tissue repair?
protein
Appetite decreases with
illness, medications, pain, depression and unpleasant environmental stimuli. Also, disease/illness can affect the functional ability to prepare and eat food.
financial issues may prevent clients from buying foods high in
protein, vitamins and minerals
medications and nutrition
meds can alter taste and appetite and can interfere with absorption of certain nutrients.
Interventions to promote appetite
good oral hygiene, favorite foods, minimal environmental odors
tips for preventing aspiration during meals
position in fowlers position or in a chair, support upper back, neck and head, have clients tuck their chin when swallowing,observe for signs of dysphagia (coughing, choking, gagging, drooling of food) keep semi upright for at least 1 hr after meals, provide oral hygiene after meals and snacks. thin liquids and straws enhance chance of aspiration
