test 5 Flashcards
When does nutrition need to be assessed?
when there is a deviation from normal growth and development
What does sodium regulate
regulates extracellular fluid volume
Sodium loss can be r/t
vomiting, diarrhea and perspiration
Adequate sodium intake for children 1-3 yrs old
1000mg/day
Adequate sodium intake for children 4-8 yrs old
1200mg/day
Adequate sodium intake for children 9-18 yrs old
1500mg/day
what does potassium do?
Helps maintain intracellular homeostasis and contributes to muscle contractility and transmission of nerve impulses
Severe hypokalemia can cause
dysrhythmias and death
Severe hyperkalemia can cause
cardiac arrest
job of chloride
Functions w/ Na to maintain fluid and electrolyte balance
Higher protein content in formula can lead to
higher BMIs/higher fat mass in infants/young children
Respond to cues of satiety
Do not force infants/children to empty their bottles or clean their plates; should eat until they are full
snack rules
Serve low calorie, low glycemic, and nutritious snacks
Increase fiber intake
Limit “screen time” to
2 hours or less a day; replace
Obesity in childhood is defined as
BMI greater than or equal to the 95th percentile for age or BMI greater than 30 (whichever is lower).
what chronic diseases are associated with hormonal imbalances and weight gain
hypothyroidism, cortisol excess, and GHD
Genetic conditions predispose children to being overweight
Prader-Willi syndrome
Children with a BMI greater than 85th percentile for age and gender should be screened for a number of conditions:
Abnormalities in glucose tolerance with a fasting glucose and /or an oral glucose tolerance test
- Nonalcoholic steatohepatitis with liver enzyme tests of aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
- Dyslipidemia with a fasting lipid panel
- Thyroid function with a thyroid panel
history of snoring, daytime somnolence
Sleep apnea
symptomatic with irregular menses, acne, or hirsutism
Polycystic ovary syndrome with a free and total testosterone level
weight management goal
not loss, in overweight child, without any other previously mentioned complications, it is expected that these children will grow into their weight and achieve a BMI less than 85th percentile
For children with an overweight-related complication,
weight loss of 1 lbs per month is an appropriate goal (more rapid weight loss in children who have not yet reached their growth potential may be associated in slowing in linear growth
When counseling an adolescent with a family history of hyperinsulinemia and type 2 diabetes, the primary care nurse practitioner will recommend avoiding what type of food.
Foods high in fructose and decreased fiber such as soda, sweetened juices, processed breads, pastries, and crackers.
High fructose consumption either as sucrose or high fructose corn syrup contributes to an increase in serum triglycerides and visceral fat that is associated with the rec
Loss occurs w/ vomiting, diarrhea and perspiration
No recommended daily value
Fundamental component of all body cells
Dietary ____ breaks down into amino acids which are required for synthesis of body cell protein and nitrogen-containing compounds
Protein
When cow’s milk is replaced with plant based milks (rice, almond) young children are vulnerable to what type of deficiency
Protein
Body’s major source of energy
45% to 65% of daily calorie intake
Two forms - simple sugar or complex
Carbohydrates
Most dietary carbs should be in what form
complex
Lipids, fats and fatty acids are used by the body to provide
energy, facilitate absorption of fat-soluble vitamins and to maintain the integrity of cell membranes and myelin
It is recommended that fat intake for children 1-3 years old be what part of their total caloric intake
30-40%
It is recommended that fat intake for children more than 3 years old be what part of their total caloric intake
25%-35%
saturated fat intake should be
minimal, less than 10%
Trans fat intake should be
excluded from the diet
what are the fat soluble vitamins
Vitamin A, D, E, K
what are the water soluble vitamins
Vitamin C and B vitamins
how often should you Monitor the child for anthropometric parameters
every 3 months
Nutritional assessment of the child with a vegetarian diet should include
regular anthropometric measurements, diet recall and analysis, and lab assessments of Vit B12, zinc, iron, and Vitamin D; supplementation as necessary
Examples of food that provide adequate protein intake include combination of
legumes, grains, nuts, seeds (peanut butter on wheat bread, beans rice, lentils, and rice, lentils and sunflower seeds, pears and rye or wheat, or tofu and almonds)
what vitamin is required for a child who is vegan.
Vit B12 (only in animal based foods)
vegans are at higher risk for
zinc deficiency and may need a supplement.
Those eating a vegetarian diet should emphasize a wide variety of
nutrient-dense foods to achieve adequate energy and nutrient intake.
Vegetarian diets, especially vegan diets, may be deficient in some nutrients, specifically
protein, vitamin B12, iron, calcium, zinc, riboflavin, and (if exposure to the sun is limited) vitamin D
If girls who are vegetarian become pregnant, the fetus is at risk for
Vit B12 deficiency with potentially severe permanent neurologic damage
Vitamin D usual sources
Animal products: egg yolk, butter, liver, salmon, sardines, tuna; sunlight
vitamin D in a vegan diet
Fortified cereals, milk, or margarine; sunlight (20-30 mins/day, 2-3 times/week)
Vitamin B12 in vegan diet
Fortified soy milk, fortified soy-based meat substitutes, nutritional yeast, fortified cereals, vitamin supplements
calcium in reg sources
Dairy products are best source; also in some fruits, nuts, dark-green leafy vegetables
calcium in vegan diet
Fortified soy milk, dried fruits, almonds, sunflower seeds, filberts, whole sesame seeds, green leafy vegetables, (at same meal, avoid eating spinach, Swiss chard, beet greens, whose oxalic acid hinders calcium absorption)
Protein in a vegan diet
Plant-based foods are considered incomplete proteins because they do not contain all 9 amino acids. To remedy this, one can eat a variety of foods such as soy, legumes, nuts seeds, grains, cereals, potatoes, pasta
Problem with gluten free foods
often highly processed and not enriched with iron or folate.
toddler and vitamin supplementation
typically not needed and increases risk of vitamin toxicity. If the child is an extremely persistent picky eater, then it might be time to consider supplementing with a multivitamin with minerals
school age and vitamins
at risk for deficiencies in iron, thiamin, vit A, and calcium. Supplementation not usually necessary except B12 in a vegan diet.
adolescence and vitamins
at risk for many vitamin deficiencies since nutritional requirements increase. As long as the adolescent eats a well-balanced diet supplements are not needed. Some girls need iron supplementation with menstruation starting, and vitamin b12 with a vegan diet.
Weight loss surgery requirements
Adolescents must meet criteria set by the NIH, should have BMI of at least 40, be at their adult height, and have serious health problems such as type 2 diabetes or sleep apnea.
supplementation may be required for premature or low-birth -weight infants who are exclusively breastfed beyond 4-6mths, and infants who are fed cow’s milk before they are 12mths as they are at risk for_____
iron; iron deficiency anemia
Long-term effects (breastfed for 6mths)
decreased incidence of atopic diseases & lower rates of asthma in young children, protection against obesity, lowering cholesterol levels in adults, & may protect against type 1 & 2 diabetes in youth.
breastfeeding frequency
After 1 day of life, feed the infant every 2-3 hours (or 8-12 times/day) with each feed duration 20-45 min.
at what age is complementary feeding of semisolid food suggested
6 mos
rules for giving juice
Only after 12mo
Given in a sippy cup
Limit to 4oz (1-3yrs)
100% natural juice, unsweetened
Offered only with meals or snacks
Not following recommendation may lead to reduced appetite for more nutritious foods – breastmilk/formula
Too much juice may cause diaper rash, diarrhea, wt gain
Never put infant to sleep with bottle or sippy cup with milk, formula, juice since it may result in early childhood caries (ECCs)
what type of water is recommended to prevent tooth decay
Recommended to provide fluoridated water
when do you introduce foods
after 6 mos
how do you introduce foods
introduce one food every 2-3 days to watch for signs of allergic reactions
- Diarrhea
- Rash
- Vomiting
how much should they eat
4oz solids each meal
Saving breast milk from an unfinished bottle for use at another feeding should be limited to
1-2 hours at room temperature
Defrosted milk that is unused within 24 hours
should be discarded
Pumped breast milk should be refrigerated ASAP and stored (refrigerated) for
8 days
Can be stored with reusable cooler packs in a cooler for
24 hours
Breast milk can be stored for___ months in a freezer with a steady temp; can be stored for ___months in a freezer at 1 F
3 months, 12 months
freezing breast milk after 3 months
Reduces calories, fat, protein, and lactoferrin
Breast budding (___) begins as a result of estradiol secretion and traditionally occurs between __ and __ yrs old,
Thelarche
8-13 years old
breast buds approx. __ months before the appearance of pubic hair.
6
Menarche occurs at ___ years on average but age of onset range is _ to_ years. Menarche occurs _ years after thelarche
12.5
9-15
2.5
Appearance of pubic hair (___or ___) commences at about ___; related to adrenal rather than gonadal development; is less valid than other secondary sex characteristics in assessing sexual maturation
adrenarche or pubarche
11.5
P1-tanner 1
preadolescent: no hair
P2, tanner 2
initial growth, scarce pigmentation, straight
P3, tanner 3
sparse, dark, curly
P4, tanner 4
coarse, curly, abundant, less than adult
P5, tanner 5
lateral spreading, type and triangle spread of adult
P6, tanner 6
further spreading laterally and upward or dispersed (occurs in 10% of women)
what is HEEADSSS:
screen adolescents for risk-taking behavior; in
what does HEEADSSS stand for
H- Home: Who lives with you? Where? Own room? Home relationships?
E- Education and employment: School performance? Changes? Struggles? Jobs?
E- Eating: Are you comfortable with your body? Want to gain/lose weight? Exercise? Daily diet?
A- Activities: on own/with peers/family? Sports? Church? Hobbies? Driving-seatbelt? How much use computer/TV/texting/listen to music?
D- Drugs: Peers/Family use? Self-use? DUI? Performance-enhancing drugs?
S- Sexuality: Date? Orientation? Experience? Pregnancy/abortion? STD? Abuse? Birth control/condoms? Sexual abuse?
S- Suicide/Depression: Feel alone or sad? Sleep? Appetite/behavior change? Withdrawal? Suicide attempt/plan? Use drugs/alcohol to feel better? Lost interest in friends or doing things previously liked?
S- Safety: ever been hurt or threatened by someone? Serious injuries? Use safety sport equipment or seat belts? Texting & driving? Feel unsafe? Bullying? Meet someone in person you met online?
