NR 228 Nutrition Exam

NR 228 Nutrition Exam 2 NR 228 Nutrition Exam 2 Pregnancy weight gain for normal weight - ANS 25-35 lbs *due to breast feeding and amniotic fluid Dietary Guidelines for pregnant women - ANS -Avoid foods such as raw eggs, raw meats, excessive amounts of coffee (only one cup per day) Vitamins that should not increase during pregnancy are - ANS -Vitamin C (hypercalcemia) -Vitamin E (fetal heart defect) -Vitamin K (prolong jaundice) Preeclampsia nutrition related concerns - ANS -Patient will be put on the DASH diet (hypertension diet) to help lower BP -Limit and avoid trans fats, sat. fats, sugar, salt, no fast food, no coffee -Increase foods rich in potassium, magnesium, and vitamins, fruits and vegetables, whole grain, protein Gestational Diabetes Mellitus - ANS Recommended foods to prevent GDM include carbohydrates, iron, calcium, protein, and fat sources. (simple carbs, fruits and veggies) Maternal PKU - ANS Lack of proper dietary therapy during pregnancy. Findings in infant: microcephaly, mental retardation, growth retardation, congenital heart defects. -Pregnant women should not eat foods high in phenylalanine (should only consume 1-4 mg per day) -Avoid fish, meat, diet soda, eggs, wheat -Fruit, vegetables, and low protein foods are okay to eat Lactation - ANS 750-1000mL of breast milk daily -500 kcal for producing breast milk daily *avoid foods such as garlic, citrus (lemon/limes), broccoli, spices, and cauliflower because it may alter taste of breast milk Infancy birth weight and breast feeding - ANS -first 6 months of life infant should consume breast milk. -second 6 months of life infant should consume a combination of breast milk and baby food Infant Dietary Guidelines - ANS -Solid foods at 4-5 months -if exclusively breastfeeding, baby should be taking in an iron supplement at 4 months old to avoid iron deficiency anemia. Infancy and Fat Consumption - ANS -Fat and cholesterol consumption is important in brain growth and development and nerve tissue -If infant is overweight, do not restrict fats Baby Bottle Tooth Decay - ANS occurs when baby goes to bed with a bottle -bottle before bed should only contain water Nutrition-Related Concerns: Infancy - ANS -Premature/low-weight = failure to thrive -if child has PKU, phenyl-free formula should be used -If baby has galactosemia (lactose intolerant) baby should consume soy formula Toddlers: 1-3 years old diet - ANS -limit 100% juice: 4-6oz per day -consume snack foods such as graham crackers, apple slices, and cheese cubes -Limit milk intake to 24oz per day due to lack of iron -child should try food product 7-10 times before deciding not to like something Preschoolers: 4-6 years old diet - ANS -environmental influencer eaters -avoid eating sugary foods while watching tv -healthy plate contains: veggies, fruits, whole grain, healthy protein, water, healthy oils School age children: 7-12 years old diet - ANS -Concerns are: 10% skipping breakfast and type of diet they are consuming -Risk for diabetes and obesity Adolescence: 13-19 years old diet - ANS - iron, fiber, calcium, protein, and vitamins are important nutrients to consume -Calcium intake = 1300 mg daily (3 to 4 servings of dairy products) -Adolescents reach maximum bone density levels during this time -Foods high in CA: milk, sardines, cheese, yogurt Adulthood diet - ANS -important to exercise and eat a balanced diet to avoid cardiovascular diseases -calcium is an important vitamin to consume due to bone health Older adult diet concerns - ANS -arthritis is the most common factor of prevention of eating well -decrease in calorie needs -decrease in nutrient absorption(vitamin B12, B9 (folic acid), and calcium) -decrease in mass and tone -oral problems caused by dentures -medical conditions Nutritional Guidelines for balanced diet (eldery) - ANS -40-55% carbohydrates -10-20% fat -consume whole grains such as brown rice, oat meal, and whole wheat bread -avoid added sugars especially in fruits -avoid coconut oil due to high in sat. fat Elderly Population prevention - ANS -exercise and strength training -increase water intake for hydration -weight bearing exercises, increase sun exposure, and consumption of vitamin D reduces risk for osteoporosis Primary nutritional deficiency - ANS inadequate intake of nutrients secondary nutritional deficiency - ANS caused by illness, disease, and iatrogenic (ex: patient is NPO for procedure and it's causing nutritional deficiency) Malnutrition side effects - ANS - weight loss -dry skin -brittle, thin hair -loss of muscle mass -brittle nails -weakness -bone and joint pain -fatigue Nutrition Assessment Tools - ANS -ht/wt -bi/triceps skin fold measurements Calculate % of wt change overtime: Usual wt - present wt / usual wt X 100 - ANS - 1-2% in 1 week = moderate wt loss - 2% in 1 week = severe wt loss - 5 in 1 month = moderate wt loss - 5 in 1 month = severe wt loss Normal BMI - ANS 18.5-24.9 Overweight BMI - ANS 25-29.9 Obese BMI - ANS 30-39.9 Severely Obese BMI - ANS 35-39.9 Morbidly Obese BMI - ANS greater than 40 Males that are high risk for cardiovascular disease and diabetes have a waist circumference of - ANS greater than 102 cm Females that are high risk for cardiovascular disease and diabetes have a waist circumference of - ANS greater than 88 cm Clinical values that measure adequate nutrition intake are - ANS - fluid intake and output -calorie count = most accurate measure -hemoglobin levels: low levels = patient is not eating enough nutrients such as protein Albumin Levels - ANS 3.5-5 g/dL monitors long term protein consumption -good for patients who are going in for a scheduled surgery Prealbumin Levels - ANS 16-40 mg/dL -short term indicator of protein consumption from the last two days -Drawn for patients with traumas, infection, and stress -low levels require supplementation Food-Drug interactions - ANS may cause: increase absorption, decrease absorption, irritation of digestive tract, or no effect Who is at risk for drug interactions - ANS Elderly, due to: -polypharmacy -chronic conditions -metabolism decrease Common foods that can cause drug interactions are - ANS dairy products, coffee, grapefruit juice, coke or sodas, alcohols, tea, green leafy vegetables, licorice, ginseng, and charcoal boiled foods grapefruit juice interaction - ANS can cause Lipitor or atorvastatin to increase effect and cause toxicity leading to liver injury or liver failure Vitamin K rich food interactions - ANS increase in vitamin k and warfarin cause clot formation effect. decrease in vitamin k and warfarin cause prolong bleeding. Foods high in vitamin k include: broccoli, squash, peppers, parsley, tomatoes, olive oil, kale, swiss chard Consuming foods high in protein, amino acids, and vitamin B6 can cause effect on - ANS Levodopa (Parkinson's Disease Med) - interaction with protein and vitamin B6 -energy drinks and supplements that contain B6 may decrease levodopa effects and cause exacerbation in Parkinson's causing tremors and balance problems Tyramine rich foods interact with - ANS MAOI's: hypertensive crisis - age cheese, bleu cheese, smoked meats, wine, and dark chocolate contain tyramine. clear liquid diet - ANS provides rest for GI, see through liquids -water, coffee, tea, broth full liquid diet - ANS careful planning provides adequate nutrition -yogurt, ice cream, pudding, Blenderized (pureed) diet - ANS blending food into liquid form for patients who cannot chew. Good for patients with fractured/wired jaws mechanical soft diet - ANS is recommended for people with difficulty in chewing or swallowing. -soft and easy to eat: ground meats, smashed carrots, and soft cheese. -good for mouth sores from radiation therapy on head/neck cancer patients soft diet - ANS low in fiber (easy to chew & digest), used for GI tract getting back to normal because unable to digest. no raw vegetables, no beef diet as tolerated - ANS Ordered when the client's appetite, ability to eat, and tolerance for certain foods may change -gradual progression to normal eating or dietary pattern Nursing Measurements to take before determining correct diet plan are: - ANS -assess bowel function before advancing diet -ongoing assessment parameters -document nutritional intake (I's and O's) -education and support for diet therapy Enteral nutrition (EN) - ANS Provision of nutrients through the gastrointestinal tract when the client cannot ingest, chew, or swallow food but can digest and absorb nutrients. -feeding pump and feeding tube is used - initial placement is checked by chest xray -if pH levels are greater than 7 it is in the lungs EN: Polymeric/Intact/Standard formulas - ANS contains whole proteins and complete nutrition -normal GI function is required EN: Elemental formula - ANS used when there is partial function of GI tract due to illness or short bowel syndrome EN: modular formula - ANS used for an add in supplement EN: specialty formula - ANS used for patients with disorders EN administration methods - ANS -head of bed is raised to 30-45 degrees to help reduce aspiration -placement of feeding tube should be check before feeds by checking apirating gastric contents in a syringe and testing pH levels. Contents should be between levels of 1-4. gastric residual volume - ANS the volume of formula and GI secretions remaining in the stomach after a previous feeding -checked Q4H - first 48 hrs for all patients and critical -routinely Q6-8hr for noncritical patients -250-500mL notify physician Phenytoin and Theophylline - ANS medication interactions with tube feedings. May decrease or increase effects. *stop feeding 2 hours before administration and for 2 hours after medication is recieved Most common complication of EN is - ANS diarrhea -decrease infusion rate if this occurs Prevention of food poisoning for EN patients - ANS -frequently washing hands before, during, and after handling tube -refrigerate unused portion for up to 24 hr -change ET tube/equipment Q24H Transition to tube feeding to regular feeding - ANS -stop feeding 1 hour before and after meals -full liquid diet initially follow by purred to soft diet Weaning occurs as oral intake increases: -decrease tube feeding vol. until 6 meals/day are eaten -oral intake is 500-750kcal/day -cyclic feeding at nighttime Discontinue tube feeding: -consumes 2/3 of protein and calorie needs for 3-5 days Home Enteral Nutrition - ANS -Homemade blenderized formulas is strongly discourage because it can clog the tube -recommended to stay on a feeding schedule Parenteral Nutrition (PN) - ANS method of supplying nutrients to the body by an intravenous route. -kcal/day -Protein = 150g/day -postivie nitrogen balance PN Therapeutic Outcomes - ANS -daily wt gain: up to 1kg/day -increase in albumin levels (3.5-5.0) -increase in prealnumin levels (15-36) PN Solution Components - ANS -Commerically prepared PN based solution -carbs: 5-70% dextrose -protein: amino acids: 3.5-15% PN Fat/Lipid Emulsion - ANS -additional calories and essential fatty acid -"three-in-one" solution -soy bean oil allergy, unless they have an allergy to soil Peripheral PN (PPN) - ANS -no need for high protein and caloric requirements -solution is isotonic: 5-10% dextrose and 3-5% amino acids -used for short term Central PN (TPN) - ANS -high protein and caloric requirement -HYPERtonice soluction -used for long term care of supplment support TPN care/nursing management - ANS -keep solution in the fridge until 1 hr before use -DONT interrupt existing TPN infusion: it will cause hypoglycemia -Glycosuria: first few days of TPN -infuse 10-20% dextrose if need to -catheter site dressing change with strict aseptic technique Complications of TPN are - ANS hyperglycemia hypoglycemia septicemia fluid overload clogged tubing infection r/t catheter Q6 accu checks home parenteral nutrition - ANS cyclic infusion Transition: oral/tube feeding - ANS -reduce infusion rate 50% for 1-2 hours before stopping -provide sips of diluted fruit juice to maintain GI function -stop TPN if oral intake is 60% of total energy and protein requirements signs and symptoms of dysphagia - ANS choking, drooling, decrease food intake, coughing, watery eyes, clearly throat, excessive tongue movement -elderly = at risk - complications: aspiration pneumonia, dehydrations, malnutrition nutrition therapy to decrease aspiration - ANS -using thicken agencies (foods such as apple sauce, mash potatoes, chocolate pudding) -minimize distractions -encourage dry swallows and coughing -sit upright with chin to chest -dont rush -use spoons when dealing with fluids to decrease liquid amount -encourage small bites GERD (gastroesophageal reflux disease) - ANS Risk factor: obesity -most common cause is a hiatal hernia (found on chest xray) -chocolate, coffee, doxycycline, spicy foods, alcohol, smoking can increase risk for GERD common symptoms of GERD are - ANS chest pains belching tooth erosion excessively swallowing painful chest/heart burn (pyrosis) developing a sour taste **dietary modifications can help treat these symptoms Dietary and lifestyle modifications of GERD - ANS watch your weight limit caffeine, peppermint, fatty foods, and alcohol quit smoking don't eat 2-3 hours before bed raise HOB 4-6 inches(30 degrees) don't lay down after meals small frequent meals are encouraged avoid tight clothing and belts Peptic Ulcer Disease (PUD) - ANS -Risk factor: increase use in NSAIDS and ibuprofen common in elderly -i is 80% of cases and treated with antibiotic and antacids -main concern is bleeding, pain causes: stress, alcohol, family hx, excessive use of meds Nutrition Therapy for PUD - ANS -individualize diet plan: consume foods as tolerated avoid foods: coffee, soda, spicy food, high sugar foods, fried foods consume: raw honey. avocados, spinach, kale, cabbage, celery, and Brussel sprouts Dumping syndrome - ANS common in gastric bypass patients cause: consuming contents too fast Dumping syndrome S/S - ANS -Can occur 15-30 mins after consumption of food: Fullness, faintness, diaphoresis, tachycardia, palpitations, hypotension, nausea, abdominal distinction, cramping, diarrhea, weakness, and syncope. **Concern = hypoglycemia Nutrition therapy for dumping syndrome is - ANS -avoid drinking fluids during meals -lie down for 30 min after meal intake more complex carbs(peas, beans, whole grains, vegetables) and avoid simple carbs celiac disease symptoms - ANS gas diarrhea stomach pain fatigue joint pain weight loss itchy skin celiac disease diet - ANS Consume: fruits vegetables eggs quinoa rice unprocessed meats **reduces digestive issues, increases energy, and decreases inflammation Do not consume: wheat, rye, barley, milk, cheese, yogurt, butter lactose intolerance - ANS The inability to completely digest the milk sugar lactose -add lactase enzyme to milk 24 hours before consumption -milk and dairy are important for bone health which is a big concern for lactose intolerant patients. inflammatory bowel disease (IBD) - ANS Inflammation of the colon and small intestine. - Crohn disease and ulcerative colitis. -exacerbation due to stress: can be painful, can damage or destroy intestines Nutrition Therapy for IBD - ANS -adjunct to drug therapy and surgery (immunosuppressants and colostomy) -TPN -Elemental formula =high calorie, high vitamin, low residue foods ACUTE STAGE = high protein and low fiber (can cause diarrhea) REMISSION STAGE = high fiber intake Short Bowel Syndrome (SBS) - ANS decreased digestion and absorption that result from a large resection of the small intestine Nutrition Therapy = MCT oil containing formula Should consume complex carbs and avoid simple carbs (soda, fried food, sugary foods) - worried about malabsorption and diarrhea (fatty stools) Ostomy - ANS Biggest concern is fluid and electrolyte imbalances of NA and K - supplement fat-soluble vitamins -avoid high fiber and hard to digest food and foods that can cause gas and diarrhea -consume strained fruits and veggies Colostomy - ANS Create an eating pattern of eating the largest meal in the middle of the day and the smallest meal in the evening to avoid a bag blow out during the night -consume low fiber foods -consume 8-10 cups of water -avoid eggs, garlic, onions, fish, asparagus, cabbage, broccoli, and alcohol-- these foods are odor producing Diverticulosis/diverticulitis Risk Factors are - ANS age low fiber diet high refined CHOs sedentary lifestyle Treatment= diverticulitis is antibiotics diverticulosis is increasing fiber intake Nutrition therapy for diverticulosis and diverticulitis is - ANS -high fiber diet of 25-38 g/day 5 cups/servings of fruits and vegetables 6 ounces/servings of whole grain breads and cereals -fluid intake of 8-12 cups daily