PCC-1 Exam 3 Module 10 Flashcards
Essential Nutrients
Also look on pages 5 and 6 for additional information on nutrients on Nutrition powerpoint.
Carbohydrates
Complex and simple saccharides
Main source of energy
Proteins
Amino acids
Necessary for nitrogen balance
Fats
Saturated, polyunsaturated, and monounsaturated
Calorie-dense
Water
All cell function depends on a fluid environment
Vitamins
Essential for metabolism
Water-soluble or fat-soluble
Minerals
Catalysts for enzymatic reactions
Macrominerals; trace elements
Anabolic vs. Catabolic
Anabolism
Building of more complex biochemical substances by synthesis of nutrients
Catabolism
Breakdown of biochemical substances into simpler substances; occurs during physiological states of negative nitrogen balance
Nutrient metabolism consists of three main processes:
- Catabolism of glycogen into glucose, carbon dioxide, and water (glycogenolysis).
- Anabolism of glucose into glycogen for storage (glycogenesis).
- Catabolism of amino acids and glycerol into glucose for energy (gluconeogenesis).
Nutritional Subjective Assessment
Eating patterns identify self-care ability and health vs. unhealth habits. Alternative diets are not supported.
Usual weight – excess weight carries risk of hypertension, diabetes, heart disease, and cancer
Changes – Interfere with adequate nutrient intake
Recent conditions – increased caloric and nutrient needs (2-3 X)
Chronic illness – cancer and chronic illness in crease risk for nutritional deficits
GI symptoms – interfere with nutrient intake and absorption
Allergies - peanut allergies on the rise Intolerances can cause deficiencies (intake or due to diarrhea)
Medications – can impact digestion, absorption, and metabolism. Vitamins, minerals, herbals can have harmful side effects or adverse effects
Patient centered care – poverty and lack of access to nutritious foods can lead to inadequate amount of all food groups and essential nutrients
Alcohol- “empty calories”, can block absorption, can cause birth defects
Exercise – caloric and nutrient needs increase with increased physical activity
Family history – long term nutritional impairment may present as heart disease, osteoporosis, cancer, gout, GI disorders, obesity, or diabeties
Nutritional Objective Assessment
Nutritional screening is a quick and easy way to identify individuals at nutrition risk such as those with weight loss, inadequate food intake, or recent illness. Screening includes: weight, weight history, conditions associated with risk, diet information, routine lab work.
Malnutrition is estimated to occur in one third of hospitalized patients and is associated with adverse outcomes: impaired would healing, increased infection risk, suppression of immune system, functional loss with increased fall risk, increased risk of pressure ulcers, longer hospital stay, and increased mortality.
During hospitalization documentation of nutritional intake is achieved through calorie counts of nutrients consumed and/or infused.
24- hour recall – elicit specific information about dietary intake over a specific period of time. Disadvantages = (1) client may not be able to recall, (2) last 24 hours may not be typical intake, (3) client may alter the truth, (4) snacks and gravies/sauces/condiments may be underreported
Food frequency questionnaire- record how many times per day/week/month particular foods are eaten to estimate intake. Disadvantages = (1) does not always quantify amount of intake, (2) relies on memory
Food diary – write down everything consumed over a period of time. Must teach to record immediately after eating. Disadvantages= (1) noncompliant, (2) inaccurate, (3) atypical recording, (4) conscious altering of diet
Direct observation – of the feeding and eating process. Technology- photos of meals and tracking of meals
Factors: Developmental State
Birth to 4 months is the most rapid period of growth in the life cycle. Breastfeeding is recommended for full-term infants for the first year of life. No Cows milk until 1 yr of age – poor source of iron and V-C&E Whole milk from 1yr-2yrs old (brain development)
Benefits of Breastfeeding
1. fewer food allergies and intolerances
2. reduced likelihood of overfeeding
3. less cost that infant formulas
4. increased mother-infant interaction
Adolescence - Caloric, protein, calcium, & iron requirements increase to meet the rapid physical growth and endocrine and hormonal changes than cause bone growth, increasing muscle mass, and onset of menarche in girls.
Pregnancy – national academy of sciences (NAS) recommends weight gain of 25-35 lbs for the normal weight woman. Increase of 28-40 lbs for underweight women, 15-25 lbs for overweight women, & 11-2- lbs for obese women.
Adulthood – obesity is the cardinal sign. This syndrome carries increased cardiac risk and is diagnosed when a person has 3/5 biomarkers. (1) elevated BP, (2) increased fasting plasma glucose, (3) elevated triglycerides, (4) increased waist circumference, (5) low HDL high density lipoprotein.
Aging Adult – Sarcopenia / sarcopenic obesity = age-related loss of muscle mass/ combined with increased body fat. It is attributed to a decrease in physical activity and a decreased protein intake with aging. Sarcopenic obesity results in a loss of muscle strength and function, decreased quality of life, physical frailty, and increased mortality rates. (resistance training)
Factors: Cultural/Spiritual Influence
Consider risk factors for new immigrants– unfamiliar foods, food storage, food preparation, food buying habits
Consider cultural traditions- meal frequency and food quantity, ceremonial meals, fasting
Consider religious practices – (Table 11-1, p.184)
Should you assess a culturally diverse client using a 24 hour recall
Newly arriving immigrants may be at nutritional risk because they frequently come from countries with limited food supplies resulting from poverty, poor sanitation, war, or political strife. General undernutrition, hypertension, diarrhea, lactose intolerance, osteomalacia (soft bones), scurvy, and dental caries are among the more common nutrition related problems of new immigrants from developing countries.
Buddhism – do not eat meat
Catholicism- do not eat meat on ash Wednesday, good Friday, Fridays in Lent
Hinduism – do not consume alcohol, beef, pork, fowl, red colored foods
Islam – no pork, alcohol, fasting before sunset during Ramadan
Mormon – no alcohol, caffeine, fasting the first Sunday of each month,
Orthodox Judaism – no pork, no dairy and meat in the same meal, no leavened bread during Passover, no shellfish, Kosher preparation of meat
Seventh-Day Adventists – no pork, no shellfish, meat, dairy, eggs, alcohol, coffee, tea
Types of Nutritional Assessments
Nutritional Screening:
-Malnutrition Screening Tool: Nutritional screening is a quick and easy way to identify individuals at nutrition risk such as those with weight loss, inadequate food intake, or recent illness. Screening includes: weight, weight history, conditions associated with risk, diet information, routine lab work.
Malnutrition is estimated to occur in one third of hospitalized patients and is associated with adverse outcomes: impaired would healing, increased infection risk, suppression of immune system, functional loss with increased fall risk, increased risk of pressure ulcers, longer hospital stay, and increased mortality.
Mini Nutritional Assessment: Like a 24 hour recall of what the patient had to eat
Comprehensive Nutritional Assessment
Dietary History-
24- hour recall – elicit specific information about dietary intake over a specific period of time. Disadvantages = (1) client may not be able to recall, (2) last 24 hours may not be typical intake, (3) client may alter the truth, (4) snacks and gravies/sauces/condiments may be underreported
Food frequency questionnaire- record how many times per day/week/month particular foods are eaten to estimate intake. Disadvantages = (1) does not always quantify amount of intake, (2) relies on memory
Food diary – write down everything consumed over a period of time. Must teach to record immediately after eating. Disadvantages= (1) noncompliant, (2) inaccurate, (3) atypical recording, (4) conscious altering of diet
Direct observation – of the feeding and eating process. Technology- photos of meals and tracking of meals
Also Physical exam, anthropometric measures, laboratory tests
BMI & waist-hip ratio
Calculate body mass index (BMI) by dividing the patient’s weight in kilograms by height in meters squared: weight (kg) divided by height2 (m2).
Waist-to-hip ratio >1.0 or greater in men and 0.8 or greater in women indicates android (upper body) obesity and increases the risk for obesity related disease and early mortality.
A waist circumference of >35 inches in a woman and >40 inches in a man increases the risk for heart disease, type 2 diabetes, and metabolic syndrome
Malnutrition Classifications
Obesity = 120% of standard weight with obese appearance
BMI >30 waist- to-hip >1.0 in men & >0.8 in women
BMI >40 = extreme or morbid obesity
Marasmus – weight >80% standard weight with a starved appearance
MAMC 0 mid upper arm circumference <90%
Subcutaneous fat and muscle wasting
Kwachiorkor – weight >100% standard with a well-nourishes appearance/edematous
Caused by diets high in calories but little or no protein – Serum albumin <3.5 g/dL & Serum transferrin <150 mg/dL
Mixed – weight <70% with emaciated appearance
MAMC <60% , Serum albumin <2.8 g/dL & Serum transferrin <100 mg/dL
Caused by inadequate intake of calories and protein such as severe starvation and catabolic states. Muscle, fat and visceral protein wasting. High risk for morbidity and mortality.
Medical Nutritional Therapy
Diabetes Mellitus:
Type 1 diabetes mellitus (DM) requires both insulin and dietary restrictions for optimal control, with treatment beginning at diagnosis (ADA, 2010). By contrast, patients often control type 2 DM initially with exercise and diet therapy. If these measures prove ineffective, it is common to add oral medications. Insulin injections often follow if type 2 DM worsens or fails to respond to these initial interventions.
Type 2: exercise and diet therapy initially Individualized diet Carbohydrate consistency and monitoring Saturated fat less than 7% Cholesterol intake less than 200 mg/dL Protein intake 15% to 20% of diet
Medical Nutrition Therapy Continued
Individualize the diet according to a patient’s age, build, weight, and activity level. Maintaining a prescribed carbohydrate intake is the key in diabetes management. The ADA recommends a diet that includes carbohydrates from fruits, vegetables, whole grains, legumes, and low-fat milk (American Dietetic Association, 2010b). Monitoring carbohydrate consumption is a key strategy in achieving glycemic control.
Limit saturated fat to less than 7% of the total calories and cholesterol intake to less than 200mg/day. In addition, varieties of foods containing fiber are recommended. Patients are able to substitute sucrose-containing foods for carbohydrates but need to make sure to avoid excess energy intake. Diabetics can eat sugar alcohols and nonnutritive sweeteners as long as they follow the recommended daily intake level.
Patients with diabetes and normal renal function should continue to consume usual amounts of protein (15% to 20% of energy).
The goal of MNT treatment is to have glycemic levels that are normal or as close to normal as safely possible; lipid and lipoprotein profiles that decrease the risk of microvascular (e.g., renal and eye disease), cardiovascular, neurological, and peripheral vascular complications; and blood pressure in the normal or near-normal range (ADA, 2010). Be aware of signs and symptoms of hypoglycemia and hyperglycemia.
Medical Nutrition Therapy Cardiovascular Diseases
American Heart Association (AHA) dietary guidelines
Balance caloric intake and exercise.
Maintain a healthy body weight.
Eat a diet rich in fruits, vegetables, and complex carbohydrates.
Eat fish twice per week.
Limit foods and beverages high in sugar and salt.
Limit trans-saturated fat to less than 1%.
The goal of the American Heart Association (AHA) dietary guidelines is to reduce risk factors for the development of hypertension and coronary artery disease. Diet therapy for reducing the risk of cardiovascular disease includes balancing calorie intake with exercise to maintain a healthy body weight; eating a diet high in fruits, vegetables, and whole-grain high-fiber foods; eating fish at least 2 times per week; and limiting food and beverages that are high in added sugar and salt. The AHA guidelines also recommend limiting saturated fat to less than 7%, trans-fat to less than 1%, and cholesterol to less than 300mg/day. To accomplish this goal, patients choose lean meats and vegetables, use fat-free dairy products, and limit intake of fats and sodium.
MNT HIV and AIDS
Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)
Body wasting and severe weight loss
Severe diarrhea, GI malabsorption, altered nutrient metabolism
Hyper-metabolism as a result of cytokine elevation
Maximize kilocalories and nutrients
Encourage small, frequent, nutrient-dense meals with fluid in between
Patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) typically experience body wasting and severe weight loss related to anorexia, stomatitis, oral thrush infection, nausea, or recurrent vomiting, all resulting in inadequate intake. Factors associated with weight loss and malnutrition includes severe diarrhea, GI malabsorption, and altered metabolism of nutrients. Systemic infection results in hypermetabolism from cytokine elevation. The medications that treat HIV infection often cause side effects that alter the patient’s nutritional status.
Restorative care of malnutrition resulting from AIDS focuses on maximizing kilocalories and nutrients. Diagnose and address each cause of nutritional depletion in the care plan. The progression of individually tailored nutrition support begins with administering oral, to enteral, and finally to parenteral. Good hand hygiene and food safety are essential because of a patient’s reduced resistance to infection. For example, minimization of exposure to Cryptosporidium in drinking water, lakes, or swimming pools is important. Small, frequent, nutrient-dense meals that limit fatty and overly sweet foods are easier to tolerate. Patients benefit from eating cold foods and drier or saltier foods with fluid in between.
MNT Cancer and treatment
Cancer and cancer treatment
Malignant cells compete with normal cells for nutrients.
Anorexia, nausea, vomiting, and taste distortions are common.
Malnutrition associated with cancer increases morbidity and mortality.
Radiation causes anorexia, stomatitis, severe diarrhea, intestinal strictures, and pain.
Nutrition management.
Malignant cells compete with normal cells for nutrients, increasing a patient’s metabolic needs. Most cancer treatments cause nutritional problems. Patients with cancer often experience anorexia, nausea, vomiting, and taste distortions. The goal of nutrition therapy is to meet the increased metabolic needs of a patient.
Malnutrition in cancer is associated with increased morbidity and mortality. Enhanced nutritional status often improves a patient’s quality of life.
Radiation therapy destroys rapidly dividing malignant cells; however, normal rapidly dividing cells such as the epithelial lining of the GI tract are often affected. Radiation therapy causes anorexia, stomatitis, severe diarrhea, strictures of the intestine, and pain. Radiation treatment of the head and neck region causes taste and smell disturbances, decreased salivation, and dysphagia. Nutrition management of a patient with cancer focuses on maximizing intake of nutrients and fluids. Individualize diet choices to a patient’s needs, symptoms, and situation.
Use creative approaches to manage alterations in taste and smell. For example, patients with altered taste often prefer chilled foods or foods that are spicy. Encourage patients to eat small frequent meals and snacks that are nutritious and easy to digest.
