NR 228 NUTRITION DISCUSSION

Week 1: Digestive System (graded, 25 points) Let’s follow the path of a delicious ham and cheese sandwich with lettuce and pickles as it is eaten and digested! Start at the beginning and discuss the anatomical parts as well as the biochemical roles that contribute to this sand- wich being turned into chemical energy. Be sure to include mechanical and chemical mechanisms, along with how they are metabolized in the body! What happens if one part does not function? For example, what happens to digestion if the person is missing many teeth but can't afford dentures or perhaps has a digestive disorder? 1 What stress factors may cause issues in the digestive tract for some people? 2 How can a regular exercise program aid in the development of a healthy digestive tract? 3 How might digestion and metabolism be different over the life span? Digestion is the chemical breakdown of food molecules into smaller molecules that can be used by various cells within the body. The breakdown is initiated when food is ingested in the mouth and specific enzymes are exposed to components within the food molecules. Digestion begins in the mouth with mastication, or chewing, performed by the teeth. The purpose of chewing is to grant the food more exposure to enzymes, therefore allowing chemical diges- tion to occur faster. The presence of the food in the mouth stimulates exocrine glands. This causes the mouth to se- crete digestive enzymes, namely salivary amylase. These secreted enzymes aid in the breakdown of foods, officially starting the digestion process. What happens if that part does not function? For example, what happens to digestion if the person is missing many teeth but can't afford dentures, or perhaps has a digestive disorder? There are several dilemmas involving digestion that the human body may encounter with progressed age, disease, or improper mechanics, such as lack of teeth. A major threat involving a decrease in digestion ability is malnutrition. Malnutrition does not simply refer to not eating, but also encompasses insufficient absorbance of nutrients once food has been eaten. There is a wide array of factors that may lead to malnutrition in an individual. Mechanically, the lack of teeth is a simple but yet common reason of decreased nutrition intake. Though salivary glands are stimulated upon the introduction of food to the mouth, a person with no teeth tends to avoid the more strenuous foods to chew, such as meats, carrots, lettuce, and nuts, and become partial to a lot of soft foods like potatoes and eggs, which may not necessarily be the most nutritious or balanced. Individuals with gum disease may have all their teeth, but it can become sore for them to chew their meals and, as a result, the eating dwindles. Jaw injuries or surgeries can cause discomfort and may temporarily hinder proper ingestion. This makes the digestion process more strenuous and time consuming on other organs. What stress factors may cause issues in the digestive tract for some people? The enteric nervous system, composed of millions of nerves, controls digestion. It communicated with the central nervous system. Stress has the ability to activate our ‘fight or flight’ response. In this mode, digestion can be slowed or shut down completely as blood flow is cut off by the central nervous system to focus energy on the perceived threat. In more nervous situations that are not threats, the body slows down digestion, which may cause abdominal cramps, grumbling, and gas. Stress factors include substance abuse, such as drugs and alcohol, work, school, and simply puberty. Also, the constant intake of pesticides and growth hormones from processed foods take a big toll on the digestive tract; the body does not receive the proper balanced nutrition. Constant stress can cause inflammation in the GI tract, and vice versa, constant GI tract problems cause increased levels of hormonal stress. How can a regular exercise program aid in the development of a healthy digestive tract? Exercise improves blood circulation throughout the entire body, including in our digestive systems. This motion aids in peristalsis and keeps food moving easily moving through the entire tract. This repels constipation, which also de- ters the possible chance of hemorrhoids, gas, bloating and cramps, even those sometimes associated with the men- strual cycle. How might digestion and metabolism be different over the lifespan? Aging is a factor in many digestive disorders; older adults are more prone to get digestive tract disorders because of medicines, antibiotics, and sometimes simply genetics. In the esophagus, the elderly tend to have impaired esophageal contractions. The movement of food is not impaired by this though, and the bolus can still easily reach the stomach. In the stomach, damage to the lining increases from the constant acidic environment, especially in adults who take aspirin. The risk for peptic ulcers increases. Also the stomach loses its elasticity over time and is not able to accommodate as much food. This is one of the reasons elderly people do not eat nearly as much, but still feel satisfied after meals. Not many changes occur regarding absorption in the small intestine. The commonly noted change is that lactase levels decrease, leading to lactose intolerance. Lastly, the rectum does somewhat enlarge in circumference, but the large intestine does not change much. Constipation can occur more frequently, mainly be- cause prescription drugs and antibiotics are used more frequently in older adults and elders. Grodner, Michele, Escott-Stump, S., Dorner, S. (2016). Nutritional Foundations and Clinical Applications: A Nurs- ing Approach, 6th Edition. Week 2: Carbs, Culture, and Diabetes (graded, 25 points) In this discussion, you will consider the following information prior to responding with your post. In order to fully understand Hannah's situation, please answer the following first: When are carbohydrates good for us? What are "good" versus "bad" carbohydrates? When are they not good for us or our bodies? What chemistry is involved in their breakdown, usage, and storage? Once you have discussed this, then consider Hannah and Rose's situation, and think like a nurse! Hannah is a 12-year-old who has had Type I diabetes for a few years. Her mother, Rose, is a strict vegetarian and be- lieves this is also the best diet plan for her daughter. Hannah says, "I just want to eat like all my friends do!" As a re- sult, she often cheats, and lately, there has been a steady increase in Hannah's blood sugars. What are the first steps you would take, as Hannah's nurse, to assess her eating habits and understanding of diabetes mellitus? What did Hannah and Rose tell you (subjective) and what did you see (objective)? 1. When are carbohydrates good for us? -Carbohydrates, often referred to as “carbs,” are your body's primary energy source, and they're a crucial part of any healthy diet. Carbs should never be avoided, but it is important to understand that not all carbs are alike. 2. What are "GOOD" versus "BAD" carbohydrates? -Good carbs are considered as high in naturally occurring fiber. It is also high in nutrients. Good carbs has low sodium and low saturated fat. Good carbs also help lower blood sugars and insulins. -Bad carbs is the opposite of good carbs. It is high in sugar, high in calorie density. It has low fiber and are high in sodium and saturated fat. 3. When are they not good for our bodies? -High sodium can have an effect on our bodies. I know when I have too much sodium, I end up getting migraines. I believe we have to balance the good and the bad carbs. This way, it can help us balance the nutrients we need. 4. What chemistry is involved in their breakdown, usage, and storage? - Once entered, salivary amylase in the mouth when food is chewed to break down starches to the small intestine where intestinal juice and pancreatic amylase further break down the starch to simple sugars where they are ab- sorbed and converted into energy, the necessity for proper carbohydrate consumption can be realized. The proper form of carbohydrates, when ingested, trickle down through the digestive system where each step in the process can have a positive effect. The "bad" form of carbohydrates, when eaten, provides the negative effect. Hannah is a 12-year-old who has had Type I diabetes for a few years. Her mother, Rose, is a strict vegetarian and be- lieves this is also the best diet plan for her daughter. Hannah says, "I just want to eat like all my friends do!" As a re- sult, she often cheats, and lately, there has been a steady increase in Hannah's blood sugars. What are the first steps you would take, as Hannah's nurse, to assess her eating habits and understanding of diabetes mellitus? What did Hannah and Rose tell you (subjective) and what did you see (objective)? Hannah, as said, has a type I diabetes. I totally disagree with her mother saying that being a vegetarian is the best diet plan for her daughter. We have different bodies. Back in high school, I saw a video that made me want to be a vegetarian, after 1 day of trying, my whole body was hurting me. I needed Meat! We can't just expect to say "okay, this is good for my child because it is good for me". We also have to keep in mind that Hannah is only 12 and is dia- betic so she needs the stuff that can help her with her diabetes. As Hannah's nurse, I would tell her that being dia- betic is serious even if it is just type I. She has to develop solid meal plans. When it comes to medication, she needs to: 1. Monitor her glucose level. 2. Must administer her insulin. 3. And always work closely with her healthcare team to determine which insulin is best for her body Exercising is also a key component of proper diabetes care. Being active can help with having a stable blood glucose level. Grodner, Michele, Escott-Stump,S., Dorner, S. (2016). Nutritional Foundations and Clinical Applications: A Nursing Approach, 6th Edition. Retrieved from Bookshelf Online Weel 3: Diet and Lab Values (graded, 25 points) Proteins have many functions within our bodies. List the functions, and explain why proteins are crucial to growth and maintenance. Why are the protein diets of children different from adults? Mark, a single father of a 2-year-old son, Jacob, stops every morning at a local fast food restaurant to pick up break- fast for himself and his son on their way to daycare. Mark says, “I don’t have time to cook in the mornings, and I can’t feed Jacob anything I would ever make at home any cheaper than this! Besides, he really loves these sausage and egg sandwiches, and at least I can get him to eat them!” Mark has a family history of diabetes, as well as hyper- lipidemia. At his next physical, Mark learns that his lipid panel is as follows: total cholesterol 245 mg/dl, LDL 180 mg/dl, and HDL 35 mg/dl. What is the significance of this blood work? What should his lipid profile look like, and as the nurse in Mark’s physician’s office, how would you educate him? Proteins are composed of amino acids as the building units linked together in peptide bonds. Proteins have the unique and vital function of building and repairing cells and tissues in our body and no other nutrient can take its place for that important biological role. FUNCTIONS OF PROTEIN: 1. Body-building and Structural Role 2. Essential for Growth 3. Source of Energy 4. Regulator of Body Process 5. Source of Essential Amino Acids Children have different nutritional needs than adults. Nutrition is the single most important environmental factor af- fecting health, growth and development of the child. The period between 2-6 years old is a crucial age among chil- dren because it is chiefly characterized by fluctuations of growth by the fast rate of intellectual social and emotional development. They are also prone to certain infections and acute illnesses. Because of this, children need a higher intake of protein diet . A child’s body is still growing and developing so they need all the essential proteins and amino acids to help them build certain structures of their bodies esp their antibodies. As a nurse, we have to make Mark realize that the food he is serving his kid is not healthy for both of them. We have to carefully explain to him that sausages and egg sandwiches bought in a fast food restaurant are bad food choices for him and his son, especially since he has a diabetic and hyperlipidemic history in his family. When it comes to sausages, it has a lot of saturated fats which can contribute to high bad cholesterol levels and heart disease. Diabetic people or people at risk should limit intake of this fat. It also has Trans fat which can also increase the LDL level in the body causing certain cardiovascular diseases and lastly, sausages have refined sugar that can quickly be con- verted into glucose. Make him understand that high glucose level in the blood is toxic to his/his son’s liver, and may cause diabetes-related hyperglycemic symptoms such as fatigue, dizziness, poor mental function and fainting. An al- ternative would be to make turkey sausages from fresh lean turkey which he can prepare during the weekends and Jacob will pretty much like it because it’s still a sausage but without the bad fats. Grodner, Michele, Escott-Stump, S., Dorner, S. (2016). Nutritional Foundations and Clinical Applications: A Nurs- ing Approach, 6th Edition. Week 4: Bone Health (graded, 25 points) Mrs. Law, a 77-year-old female, is at home recovering from surgery that she had after falling and breaking her hip 5 days ago. She lives with her husband, Dean, who helps to care for her. Mrs. Law is a former smoker and has a past medical history of hypertension and hyperlipidemia. You are the visiting nurse, assigned to check on her postopera- tive progress. You ask the client how she is feeling, do an assessment, and inquire as to what she has eaten over the past 24 hours. Mrs. Law states that she has “No pep, no appetite, has been taking her pain medication as prescribed (every 4 hours—but not real helpful!), cannot sleep well, doesn’t feel much like walking, except for to the bathroom, and has been unable to move her bowels for several days.” Breakfast: Two glazed doughnuts, coffee (black) Lunch: Tossed salad with oil and vinegar, diet soda Dinner: Tomato soup, 1 cup; four soda crackers; and red homemade wine Snack: Pretzels, diet soda What nutrients that contribute to bone health are missing in Mrs. Law’s diet? What other dietary concerns do you have? Is Mrs. Law getting the appropriate amount of vitamins and minerals for her age and current condition? Why or why not? We all know that Mrs. Law just had her surgery after breaking her hip 5 days ago. As the visiting nurse, I would as- sess and have an interview to see what is going on. She states that she has “No pep, no appetite, has been taking her pain medication as prescribed (every 4 hours—but not real helpful!), cannot sleep well, doesn’t feel much like walk- ing, except for to the bathroom, and has been unable to move her bowels for several days" tells me that she is not doing or eating the stuff she needs to help her. With the list of the food she eats everyday, it tells me that she is not really taking care of her body. She is missing Calcium and all the vitamins an elderly women need. Elderly people are prone to more injuries or harm on their bod- ies and taking vitamins can help reduce this. I would recommend to change her dietary plan to help improve her. Since she is taking red wine it causes to interact with the pain medicatio