Running head: CHAPTER 44: NUTRITION

Chapter 44: Nutrition Jilian McGugan ITT Technical Institute

NU110 Slomiany July 16, 2012

CHAPTER 44: NUTRITION

Chapter 44: Nutrition 1. C 2. H 3. I 4. N 5. O 6. J 7. K 8. V 9. D 10. S 11. P 12. F 13. M 14. E 15. R 16. Q 17. W 18. G 19. L 20. U 21. T 22. A 23. B 24. F 25. H 26. B 27. G 28. L 29. K 30. J 31. M 32. D 33. E 34. C 35. A 36. I 37. Explain the four components of the dietary reference intake (DRI): a. (EAR) the recommended amount of nutrition that appears sufficient to maintain a specific body function for 50% of the population based on age and gender. b. (RDA) the average needs of 98% of the population, not the individual. c. (AL) suggested intake for individuals based on observed or experimental determined estimates of nutrient intakes.

CHAPTER 44: NUTRITION d. (UL) the highest level that likely poses no risk of adverse health events. 38. a. Adopt a balanced eating pattern with a variety of nutrient-dense food and beverages among the basic food groups. b. Maintain body weight in a healthy range. c. Encourage physical activity, and decrease sedentary activities. d. Encourage fruits, vegetables, whole-grain products, and fat-free or low-fat milk while staying within energy needs. e. Keep total fat intake between 20-35 % of total calories, with most fats coming from polyunsaturated or monosaturated fatty acids. f. Choose and prepare foods and beverages with little added sugars or sweeteners. g. Choose and prepare foods with little salt while at the same time eating potassium-rich foods. h. Limit intake of alcohol. i. Practice food safety to prevent microbial food-borne illness. 39. a. Reduced food allergies and intolerances b. Fewer infant infections c. Easier digestion d. Convenient, correct temperature, available and fresh e. Economical f. Increases time for mother and infant interaction 40. Causes GI bleeding, is too concentrated for infants kidneys to manage, increases the risk of mild product allergies, poor source of iron and vitamin C and E 41. Are potential sources of botulism toxin and should not be used in the infants diet 42. a. The infants needs b. Physical readiness to handle different forms of foods c. Detect and control allergic reactions 43. a. Diet rich in high-calorie foods b. Inactivity

CHAPTER 44: NUTRITION c. Genetic predisposition c. Use of food for coping mechanism for stress or boredom d. Family and social factors 44. a. Body image and appearance b. Desire for independence c. Eating at fast-food restaurants d. Peer pressure e. Fad diets 45.

a. Anorexia nervosa: Refusal to maintain body weight over a minimal normal weight for age and height, e.g., weight loss leading to maintenance of body weight less than 85% of IBW; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected; Intense fear of gaining weight or becoming fat, although underweight; Disturbance in the way in which ones body weight, size, or shape is experienced, e.g., the person claims to feel fat even when emaciated, believes that one area of the body is too fat even when obviously underweight; In females, absence of at least 3 consecutive menstrual cycles when otherwise expected to occur (primary or secondary amenorrhea). (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.) b. Bulimia nervosa: Recurrent episodes of binge eating (rapid consumption of a large amount of food in a discrete period of time); A feeling of lack of control over eating behavior during the eating binges; The person regularly engages in either self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise in order to prevent weight gain; A minimum average of 2 binge eating episodes a week for at least 3 months. 46. Is important for DNA synthesis and the growth of RBCs, inadequate intake will lead to possible neural tube defects, anencephaly or maternal; megaloblastic anemia 47. a. Age-related gastrointestinal changes that affect digestion of food and maintenance of nutrition include changes in the teeth and gums, reduced saliva production, atrophy of oral mucosal epithelial cells, increased taste threshold, decreased thirst sensation, reduced gag reflex, and decreased esophageal and colonic peristalsis

CHAPTER 44: NUTRITION

b. The presence of chronic illnesses (e.g., diabetes mellitus, end-stage renal disease, cancer) often affect nutrition intake. c. Malnutrition in older adults has multiple causes, such as income, educational level, physical functional level to meet activities of daily living (ADLs), loss, dependency, loneliness, and transportation. d. Adverse effects of medications cause problems such as anorexia, xerostomia, early satiety, and impaired smell and taste perception. e. Factors affecting nutrient needs: Calcium, vitamin D, or phosphorus for basic metabolic demand (BMD). B12 may not be synthesized because of lack of intrinsic factor in terminal ileum, decreased lean muscle mass, lower basic energy expenditure (BEE) f. Cognitive impairments such as delirium, dementia, and depression affect ability to obtain, prepare, and eat healthy foods. 48. Avoid meat, fish, and poultry but eat eggs and milk. 49. Drink milk but avoid eggs. 50. Eat primarily brown rice, other grains, and herb teas. 51. Eat only fruits, nuts, honey, and olive oil. 52. a. Screening for malnutrition for risk factors (unintentional weight loss, presence of a modified diet, presence of nutrition impact symptoms. b. Anthropometry (size and make- up of the body) c. BMI d. Lab and biochemical tests (albumin, transferring, prealbumin, retinal binding protein, total iron-binding capacity, and hemoglobin) e. Dietary history 53. Difficulty swallowing (neurogenic, myogenic, and obstructive causes) 54. a. General appearance: Listless, apathetic, and cachectic. b. Weight: Obesity (usually 10% above IBW) or underweight (special concern for underweight) c. Posture: Sagging shoulders; sunken chest; humped back. d. Muscles: Flaccid, poor tone, underdeveloped tone; wasted appearance; impaired ability to walk properly.

CHAPTER 44: NUTRITION e. Nervous system: Inattention; irritability; confusion; burning and tingling of hands and feet (paresthesia); loss of position and vibratory sense; weakness and tenderness of muscles (may result in inability to walk); decrease or loss of ankle and knee reflexes; absent vibratory sense. f. Gastrointestinal: Anorexia; indigestion; constipation or diarrhea; liver or spleen enlargement. g. Cardiovascular: Rapid heart rate (above 100 beats/min), enlarged heart; abnormal rhythm; elevated blood pressure. h. General vitality: Easily fatigued; no energy; falls asleep easily, tired and apathetic. i. Hair: Stringy, dull, brittle, dry, thin, and sparse, depigmented; easily plucked. j. Skin: Rough, dry, scaly, pale, pigmented, irritated; bruises; petechiae; subcutaneous fat loss

k. Face and neck: Greasy, discolored, scaly, swollen; dark skin over cheeks and under eyes; lumpiness or flakiness of skin around nose and mouth l. Lips: Dry, scaly, swollen; redness and swelling (cheilosis); angular lesions at corners of mouth; fissures or scars (stomatitis) m. Mouth, oral membranes: Swollen, boggy oral mucous membranes n. Gums: Spongy gums that bleed easily; marginal redness, inflammation; receding o. Tongue: Swelling, scarlet and raw; magenta, beefiness (glossitis); hyperemic and hypertrophic papillae; atrophic papillae p. Teeth: Unfilled caries; missing teeth; worn surfaces; mottled (fluorosis), malpositioned q. Eyes: Eye membranes pale (pale conjunctivas); redness of membrane (conjunctival injection); dryness; signs of infection; Bitots spots, redness and fissuring of eyelid corners (angular palpebritis); dryness of eye membrane (conjunctival xerosis); dull appearance of cornea (corneal xerosis); soft cornea (keratomalacia) r. Neck (glands): Thyroid or lymph node enlargement

s. Nail: Spoon shape (koilonychia); brittleness; ridges t. Legs, feet: Edema; tender calf; tingling; weakness u. Skeleton: Bowlegs; knock-knees; chest deformity at diaphragm; prominent scapulae and ribs

CHAPTER 44: NUTRITION 55. Risk for aspiration 56. Constipation 57. Diarrhea 58. Health-seeking behaviors 59. Deficient knowledge 60. Imbalanced nutrition: less than body requirements 61. Imbalanced nutrition: more than body requirements 62. Risk for imbalanced nutrition: more than body requirements 63. Readiness for enhanced nutrition 64. Feeding self-care deficit 65. a. Nutritional intake meets the minimal DRIs b. Fat nutritional intake is less than 30% c. Removes sugared beverages from the diet d. Refrains from eating unhealthy foods between meals and after dinner e. Loses at least to 1 pound per week 66. a. Botulism: Improperly home-canned foods, smoked and salted fish, ham, sausage, shellfish b. Escherichia: Undercooked meat (ground beef) c. Listeriosis: Soft cheese, meat (hot dogs, pate, lunch meats), unpasteurized milk, poultry, and seafood. d. Perfringens enteritis: Cooked meats, meat dishes held at room or warm temperature. e. Salmonellosis: Milk, custards, egg dishes, salad dressings, sandwich fillings, polluted shellfish. f. Shigellosis: Milk, milk products, seafood, and salads. g. Staphylococcus: Severe abdominal cramps, pain, vomiting, diarrhea, perspiration, headache, fever, and prostration. Appears 1-6 hours after ingestion and lasts 1-2 days. 67. Decreased level of alertness, decreased gag and/or cough reflexes, and clients who have difficulty managing saliva. 68. a. Dysphagia puree b. Dysphagia mechanically altered c. Dysphagia advanced

CHAPTER 44: NUTRITION d. Regular 69. a. Thin liquids (low viscosity) b. Nectar-like liquids (medium viscosity) c. Honey-like liquids d. Spoon-thick liquids (pudding) 70. a. (1.0-2.0 kcal/mL) milk-based blenderized foods b. (3.8 4.0 kcal/mL) single macronutrient preparations, not nutritionally complete c. (1.0-3.0 kcal/mL) predigested nutrients that are easier for a partially dysfunctional GI tract to absorb d. (1.0-2.0 kcal/mL) designed to meet specific nutritional needs in certain illnesses 71. a. Reduces sepsis b. Minimizes the hypermetabolic response to trauma c. Maintains intestinal structure and function 72. a. Appropriate assessment of nutrition needs b. Meticulous management of the CVC line c. Careful monitoring to prevent or treat metabolic complications 73. Provide supplemental kcal and prevent fatty acid deficiencies 74. a. Pulmonary aspiration: Regurgitation of formula, feeding tube displaced, Deficient gag reflex, Delayed gastric emptying b. Diarrhea: Hyperosmolar formula or medications, Antibiotic therapy, Bacterial contamination, Malabsorption c. Constipation: Lack of fiber, Lack of free water, Inactivity d. Tube occlusion: Pulverized medications given per tube, Sedimentation of formula, Reaction of incompatible medications or formula

CHAPTER 44: NUTRITION e. Tube displacement: Coughing, vomiting, Not taped securely f. Abdominal cramping, nausea/vomiting: High osmolality of formula, Rapid increase in rate/volume, Lactose intolerance, Intestinal obstruction, High-fat formula used, Cold formula used g. Delayed gastric emptying: Diabetic gastroparesis, serious illnesses, Inactivity. h. Serum electrolyte imbalance: Excess GI losses, Dehydration, Presence of disease states such as cirrhosis, renal insufficiency, heart failure, or diabetes mellitus. i. Fluid overload: Refeeding syndrome in malnutrition, Excess free water or diluted (hypotonic) formula. j. Hyperosmolar dehydration: Hypertonic formula with insufficient free water 75. a. Electrolyte imbalance: Monitor Na, Ca, K, Cl, PO4, Mg, and CO2 levels. b. Hypercapnia: Increased oxygen consumption, increased CO2, respiratory quotient >1.0, minute ventilation. c. Hypoglycemia: Diaphoresis, shakiness, confusion, and loss of consciousness. d. Hyperglycemia: Thirst, headache, lethargy, increased urination. e. Hyperglycemic hyperosmolar non-ketotic dehydration/coma (HHNC): Hyperglycemia (>500 mg/dl), glycosuria, serum osmolarity >350 mOsm/L, confusion, azotemia, headache, severe signs of dehydration (see Chapter 41), hypernatremia, metabolic acidosis, convulsions, coma.

76. Once the client meets 1/3 to of their kcal needs per day, PN is usually decreased to the original volume; increase the EN to meet needs (75%) 77. is the use of nutritional therapies to treat an illness, injury, or condition 78. is a bacteria that causes peptic ulcers and is confirmed by lab tests, treated with antibiotics 79. Crohns disease and ulcerative colitis: treat with elemental diets or PN, supplemental vitamins, and iron. Manage by increasing fiber, reducing fat, avoiding large meals, and avoiding lactose, 80. Celiac disease, gluten-free diet 81. Treat with moderate-to-low residue and high-fiber diet 82. Carbohydrates 45-75%, limit fat to less than 7%, cholesterol less than 200 mg/day 83. Balancing caloric intake with exercise; diet high in fruits, vegetables, and whole-grain fiber; fish at least twice per week; limit food high in added sugar and salt 84. Goal is to meet the increased metabolic needs of the client by maximizing intake of nutrients and fluids 85. Small, frequent, nutrient-dense meals that limit fatty foods and overly sweet foods

CHAPTER 44: NUTRITION

10

86. Ongoing comparisons need to be made with baseline measures of weight, serum albumin, and protein and kcal intake, changes in condition 87. 4. Each gram of CHO produces 4 kcal and serves as the main source of fuel (glucose) for the brain, skeletal muscles during exercise, erythrocyte and leukocyte production, and cell function of the renal medulla 88. 3. Is when the intake of nitrogen is greater than the output, which is used for building, repairing, and replacing body tissues. 89. 4. The growth rate slows during the toddler years (1-3) and therefore needs fewer kcal but an increased amount of protein in relation to body weight; appetite often decreases at 18 months of age. 90. 1. All of the other clients are at risk for a nutritional imbalance. 91. 2. The measurement of pH of secretions withdrawn from the feeding tubes helps to differentiate the location of the tube. 92. 2. The recommended diet from the AHA to reduce risk factors for the development of hypertension and coronary heart disease. 93.Mrs. Cooper, who is 68 years old and has a history of congestive heart failure. Recently Mrs. Cooper noticed a weight loss (15%). Three months have passed since Mrs. Cooper started taking sertraline for depression related to the loss of her husband 6 months ago. Mrs. Cooper was also referred for counseling 3 months ago for help with grief and depression through a local senior service agency. When Maria inquired as to her financial situation, Mrs. Cooper responded that it was tight living on a small pension and Social Security, but she was able to manage. Mrs. Cooper states that she drinks some juice in the morning and two or three cups of coffee. In addition, she often has a sandwich in the late afternoon. Mrs. Cooper states, Im just not interested in food. It has no taste. Mrs. Cooper complains of loneliness and said she does not get out much, although her psychologist recommended more socializing. Her friends at church call her to come back to meetings, but she is just not ready. She says she tires easily. She has lost 24 pounds over the past 6 months. Her weight is 20% below her IBW and her BMI is 17. Mrs. Cooper has stooped posture; dull, thinning hair; dry, scaling skin; pale conjunctivae and mucous membranes; 2+ bilateral pitting ankle edema; and generalized poor muscle tone. Goals for this patient include gaining 1 to 2 pounds per month until goal of 130 pounds is reached by consuming 1900 kcal/day, including 50 g of protein per day. Her physical assessment and laboratory values will be within normal limits. In order to accomplish these goals, the nurse practitioner will coordinate plan of care with healthcare provider, psychologist, and registered dietitian. She will individualize her menu plans and teach Mrs. Cooper about the food pyramid. Mrs. Cooper will be monitored monthly for weight gain, anemia, serum albumin level, and total lymphocyte count (TLC). She will encourage client to eat small meals and to increase dietary intake, including fluids and fiber, to help offset anorexia secondary to sertraline. The nurse practitioner will encourage Mrs. Cooper to eat lunch at the senior center 5 times per week.

CHAPTER 44: NUTRITION

11

Reference Potter, P., & Perry, A. G. Fundamentals of Nursing. Saint Louis, Missouri: Mosby.

CHAPTER 44: NUTRITION

12