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.
