WGU C787 NUTRITION Finawl Exam Study Guide 2023/2024

Where some public strategies to reduce food deserts? • Implement urban farmers market • Supporting public policy to reduce costs of fresh foods » Main focus of the food security survey model: Financial limitations to adequate nutrition » Undernutrition • A person who consumes many calories but without adequate nutrition • Also included chronically hungry » Child food security module • Use anywhere from 4 years to adolescence • Determines if a child is experiencing hunger at home • Be able to use this over on the phone » Household food security status • An outcome measure to examine the public’s ability to secure adequate food • Outcome measures: what result did you get out of the security survey » Food Security: Means all people have access, at all times, to sufficient food for an active and healthy life » Food Security Survey Module: • It measures sufficiency of food and very low food security requires intervention • If the outcome you get at the end of the Survey is very low that’s a diagnosis which requires an intervention » Low Food Security is characterized by: Reduced quality, variety, or desirability of diet » What was one effect of the national nutrition monitoring and related research act of 1990? • Development of standardized questionnaires for measuring household food security status » Hunger: the uneasy or painful sensation caused by lack of food » A factor for a patients frequent ED visits for CHF: the patient often goes without medication because they cannot afford them until they are paid » What problems or factors can be associated with food insecurity? • Poor nutrition • Trouble obtaining food • Obesity • Lower cognitive and academic performance • Poorer health status » What does the supplemental nutrition assistance program (SNAP) do? WGU C787 nutrition Study guide 2022 Unit 2 • help low-income families who have trouble affording acquired food » Question: which is the most appropriate referral to have home meals delivered by meals on wheels? • Male, 82, limited income, BMI 17, mobility issues and cannot drive » Question: which most appropriate referral to the woman is., infants, and children program • Female, age 22, speaks limited English, 6 months pregnant, low income, difficulty obtaining pre-natal care. » Question: what is not a primary consideration when addressing nutritional needs for a homeless patient? • Is the food fair traded certified? » Considerations when addressing nutritional needs for a homeless patient • Is the food ready to eat or does it need to be prepared? • Non-perishable or will it need refrigeration • Nutritionally adequate » What is a major barrier to nutritional education, and a strategy for overcoming that barrier? • Illiteracy; screening for problems with written materials and providing picture-based instruction » When working with a patient who speaks limited English, what strategies should the nurse use? • Using pictures to teach • Using foods from the other persons culture » Elderly Nutrition Program: Program that teaches older adults how to shop, plan, and prepare nutritious meals, as well as conduction hypertension assessments. » What is one way that programs seek to provide socialization to older adults: providing meals in group settings » Programs for those at risk • Senior Farmers’ Market nutrition program: Allows older adults to acquire fruits and vegetables • Supplemental nutrition Assistance program (SNAP): Helps low income families aquire food • Special Supplementary nutrition Program (WIC): Recognizes medical and dietary risks to women and children » Meals on wheels: • It is important that the meals are appealing to the patients taste » Food Poisoning: Can be caused by either primary infection by a microbe OR production of toxins by microbes » Botulism: it is thought to be the most lethal bioterrorism agent » Commonly disseminated by ingestion (Fecal-Oral) • Cholera • Shigellosis » Food Systems Security: **DIFFERENT FROM FOOD SECURITY* • A system to focus on locating the source of a bioterrorism incident and notifying affected facilities WGU C787 nutrition Study guide 2022 Unit 2 » What foods have been common sources of food containment in recent years? • Bean Sprouts – fresh grown close to the ground; low sugar, low sodium; wet • Spinach ------------ ^ • Milk • Frozen Berries » High sugar and high sodium can be antimicrobial if high enough » Food Safety Matching • Campylobacter undercooked poultry • E. Coli Foods contaminated with fecal matter • Mycotoxins Molds • Glycoalkaloids Potatoes exposed to light • Ciguatoxin Fish such as grouper • Monosodium Glutamate Flavor enhancer which can cause chest pain, edema, facial numbness, headache » Enteritis and diarrhea are commonly caused by : E. Coli and Salmonella » Pregnant women should only eat pasteurized cheese because: Listeria in unpasteurized cheese increases the risk of spontaneous abortion and congenital infection of the newborn » Ultra-pasteurized can be stored at room temperature » Obesogen- Bisphenol A • Chemical that causes obesity » USDA organic seal indicates: • That food is 100% organic according to current standards • Food is not genetically engineered and no synthetic fungicides or insecticides were used » a snack with 240 calories, 120 calories from fat is too high in fat » A hard-boiled egg is appropriate for a patient on a low-sodium diet » Which statement is an appropriate nutritional recommendation when planning a balanced meal? spices or herbs are added to season food without adding salt » Which Dietary Reference Intake (DRI) value provides information to assist in developing recommendations for populations? Estimated average requirement (EAR) » Which foods create a nutrient-dense breakfast? Oatmeal and blueberries » A school nurse selects an activity to reinforce nutrition education given to fourth-grade students, aged 9 and 10.Which activity is appropriate for this age group? Have the students identify the food groups in a particular meal. » Which two instructional methods are effective for creating a nutritional teaching plan for a group of recent immigrants who have limited English proficiency (LEP)? Include familiar dietary habits; Show pictures of foods. WGU C787 nutrition Study guide 2022 Unit 2 » A middle school nurse is developing a program to help students control or prevent obesity Avoid using food as a reward for students’ accomplishments; Encourage students to critique media messages about food. » Which nutrient needs to be supplied in a bioavailable form for an individual on a vegetarian diet? Calcium » daily reference intakes (DRIs) for infants? The recommended dietary allowance for protein has not been established for infants younger than 7 months. C787 Study Guide: 1. Identify the differences between macronutrients and micronutrients o Macro Nutrients: Nutrients that the body needs in large amounts: Carbs, Proteins, Fat o Micro Nutrients: vitamins and minerals that organisms require in very small amounts for good health and development. 2. Differentiate the S/S for the following diseases: obesity, marasmus, kwashiorkor, anorexia nervosa, bulimia nervosa, pellagra. o Obesity: o Marasmus: means to “waste away”, an acute form of malnutrition. It is caused by a deficiency of both calories and protein in the diet and is the most severe form of childhood malnutrition. Body fat stores are used up to provide energy, and eventually muscle tissue is broken down for body fuel. Victims appear as skin and bones, gazing with large eyes from a bald head with an aged, gaunt appearance. Once severe muscle wasting occurs, death is imminent o Kwashiorkor: A form of malnutrition caused by inadequate protein intake and occurs most commonly in areas of famine, limited food supply, and low levels of education. As protein deprivation continues, symptoms include failure to gain weight and linear growth. Signs of kwashiorkor are a potbelly, dry unpigmented skin, coarse reddish hair, low muscle mass, lethargy, failure to grow, and edema in the legs o Anorexia Nervosa: Self-induced malnutrition resulting in a body weight that is 15 percent or more below normal for age and height combined with a pathological fear of becoming fat. o Bulimia Nervosa: recurrent episodes of binge eating followed by purging or other inappropriate efforts to avoid weight gain. o Pellagra: the deficiency disease of niacin (vitamin B3). It is characterized by “the Four Ds of pellagra”: dermatitis, diarrhea, dementia, and death. WGU C787 nutrition Study guide 2022 Unit 2 3. Identify diseases/illness related to specific vitamin deficiencies (vitamin A, vitamin C, vitamin D, iron, iodine, etc.). o Scurvy: Vitamin C deficiency characterized by hemorrhages in body tissue, muscular pain, tender gums, physical exhaustion, and vision disorders, especially night blindness. In advanced cases, teeth fall out, and complications with kidney or intestinal functions may lead to death o Rickets: Vitamin D deficiency, causing softening & weakening of the bone o Vitamin A deficiency: can cause blindness o Iodine Deficiency: physical and mental delays o Iron deficiency: Anemia o Beriberi: is the deficiency disease of thiamine (vitamin B1) in which the heart and nervous systems are damaged and muscle wasting occurs. 4. Identify the differences between kwashiorkor and marasmus o Kwashiorkor: Children who develop kwashiorkor are often older than children who develop marasmus. o Marasmus: occurs more often in young children and babies. 5. Identify effects and treatments for malnutrition o Treatment for PEM involves refeeding with a diet adequate in protein, calories, and other essential nutrients. Response to treatment is influenced by many factors, such as the person’s age, the stage of development in which the deprivation began, the severity of the deficiency, the duration of the deficiency, and the presence of other illnesses, particularly infections. o Prevention of PEM is the preferred therapy. In areas with unsafe water supplies and high rates of poverty, women should be encouraged to breastfeed. o Education about proper weaning foods provides further defense against PEM. o Other preventive efforts involve combining plant proteins into a mixture of high-quality protein, adding nutrients to cereal products, and using genetic engineering to produce grains with a better protein mix. The prevention of underlying causes such as famine and drought may not be feasible. 6. Briefly define HEI, NHANES, DGA, and the foods/products regulated by the FDA/USDA. o HEI: The Healthy Eating Index (HEI) is a measure of diet quality, independent of quantity, that can be used to assess compliance with the U.S. Dietary Guidelines for Americans (DGAs) and monitor changes in dietary patterns o NHANES: The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. Began in 1960s, continuous survey. o DEGA: 7. What changes were made when DRIs were established in the late 1990s? o It expanded from the RDA. It contains several different groups to provide more adequate information needed 8. What are the Physical Activity Guidelines for Americans for different age groups and what benefits are seen with these levels of physical activity? o WGU C787 nutrition Study guide 2022 Unit 2 9. The USDA recommends limits to added sugars, sodium, alcohol and saturated fats. What are these limits and why would are these limits recommended? o 10. What do the acronyms DRI, UL, EAR, RDA signify? Describe how these numbers are developed and how they are used to guide nutritional recommendations for people and populations. o Dietary reference intake (DRI): is a generic term for a set of nutrient reference values o Tolerable upper intake level (UL): is the highest level of daily nutrient intake that is likely to pose no risk of adverse health effects to almost all individuals in the general population o Estimated Average Requirement (EAR): Used to guide recommendations and meal planning for communities (NOT FAMILY) in combination with upper intake o Recommended Daily Allowances (RDA): the estimated amount of a nutrient (or calories) per day considered necessary for the maintenance of good health 11. Where would you find the %DV and how is it used? o FDA website and also on the product 12. Identify the types of dietary fats (including trans-fats) and recommendations regarding their consumption. o 13. What is the DASH diet and what level of sodium has been shown to reduce high blood pressure? o The DASH diet 14. Understand the MyPlate tips including recommended proportions of grains, fruits and vegetables and other food groups. o 15. Identify healthy “plate” options based on the “MyPlate” method o make half your plate fruits and vegetables; select nutrient dense foods to meet DRIs without exceeding calorie needs 16. Compare the recommended consumption to actual average consumption of fruits, vegetables, grains, dairy, protein for males and females across the lifespan. Are Americans eating too much/too little? o 17. What is the difference between saturated and unsaturated fat and what recommendations would you make to a patient regarding their consumption? o While full fat dairy products such as butter and cheese and fatty and processed meats (as well as many baked and processed foods like cakes and biscuits) are high in saturated fat, good sources of unsaturated fats include nuts, seeds, and vegetable oils*. 18. What recommendations would you make to a pregnant patient regarding folate and why? WGU C787 nutrition Study guide 2022 Unit 2 o All pregnant women should take at least 400 micrograms (mcg) of folic acid daily. 19. Provide examples of whole grains versus refined grains and how could a patient better meet the recommendation for consumption of whole grains? o whole grains contain the entire grain kernel ― the bran, germ, and endosperm. Examples of whole grains include whole-wheat flour, bulgur (cracked wheat), oatmeal, whole cornmeal, and brown rice. o Refined grains have been milled, a process that removes the bran and germ. This is done to give grains a finer texture and improve their shelf life, but it also removes dietary fiber, iron, and many B vitamins. Some examples of refined grain products are white flour, de-germed cornmeal, white bread, and white rice. 20. Identify at least 4 ways to modify a diet creating a healthier eating style/pattern. o Emphasizes vegetables, fruits, whole grains, and fat-free or low-fat dairy products o Includes lean meats, poultry, fish, beans, eggs, and nuts o Limits saturated and trans fats, sodium, and added sugars o Controls portion sizes 21. Compare and contrast the calcium and sodium RDA across the lifespan. What is the recommended UL for sodium? o 22. Define nutrient-dense and give examples of nutrient-dense foods. o 23. Identify foods that are typically high in sodium and strategies to reduce sodium in the diet. o 24. What are AMDRs for carbohydrates, fats and proteins? o Protein: 5-20 o Carb: 45-65 o Total Fat: 30-40 o 25. Understand recommended intakes. Ex. Calcium for adult versus older adults o 26. What recommendations would you make to an older adult patient regarding vitamin B12 and why? o 27. Identify healthy menu choices based on MyPlate o 28. Look at a food label such as those pictured here - fictional patient or family member the meaning of serving size, how DV relates to %DV, the meaning of the “footnote”, why there are upper and lower limits of WGU C787 nutrition Study guide 2022 Unit 2 some nutrients, why some nutrients are listed without a %DV and how to spot added sugars in foods. o 29. How do you calculate BMI from weight (lbs) and height (inches)? o BMI = weight (kg) / height (m)² 30. What 4 things does a healthy weight loss plan consist of? o 31. “It appears that the increasing trend of overweight and obesity will likely overtake tobacco as the leading preventable cause of mortality in the United States” What are the primary diseases associated with poor diet and lifestyle? o 32. How much of the total healthcare expenditures is spent on preventative approaches to preventable disease? o 3% 33. Define and provide examples of prevention strategies: Primary, Secondary, Tertiary. o Primary: prevention strategies, or health promotion, encourage healthenhancing behaviors by giving individuals, families, and communities ways to reduce risk factors associated with disease and injury. o Secondary: includes risk appraisal and screening to emphasize early detection and diagnosis of disease. o Tertiary: involves treatment and rehabilitation and is defined as the reduction in the amount of disability caused by a disease to achieve the highest level of function. 34. What are some factors that contribute to overweight and obesity (modifiable and non-modifiable)? o Modifiable: sedentary lifestyle, overeating, high stress levels o Non-modifiable: genetically determined traits (e.g., age, gender & raceethnicity). 35. What are the Dietary Guidelines for Americans (DGAs) key recommendations? o Follow a healthy eating pattern across the life span. o Focus on variety, nutrient density, and amount. o Limit calories from added sugars and saturated fats, and reduce sodium intake. o Shift to healthier food and beverage choices. o Support healthy eating patterns for all. 36. How much weight loss (percent of total body weight) has been shown to improve health risks associated with overweight and obesity? o 10% reduction in total weight has consistently been shown to improve health and decrease risk (move the decimal point). 37. What is the relationship between cholesterol (dyslipidemia) and cardiovascular disease and how can this be managed through diet? o Hyperlipidemia increases fatty deposits in arteries and the risk of blockages. The American Heart Association recommends limiting saturated fat to 5 to 6 percent of daily calories and minimizing the amount of trans fat you eat. WGU C787 nutrition Study guide 2022 Unit 2 o Limit your intake of red meat and dairy products made with whole milk. Limiting fried food and cooking with healthy oils, such as vegetable oil. 38. What is the relationship between hypertension and cardiovascular disease and how can this be managed through diet? o High-salt diets increase blood pressure and the risk of heart attack and stroke. 39. What is the relationship between type 2 diabetes and cardiovascular disease and how can this be managed through diet? o Studies report a positive association between hypertension and insulin resistance. o Patients with diabetes often have unhealthy cholesterol levels which can lead to blocked arteries. 40. In terms of cancer prevention, what are the benefits of a diet high in fruits and vegetables? o Fruit and vegetables are rich in fiber, vitamins, minerals, antioxidants and phytochemicals, which help to protect your body against cancer. 41. What are seven risk factors for type 2 diabetes? o Overweight/obese, older than 45yrs, family history, high cholesterol, PCOS, sedentary lifestyle. 42. Which populations are most at risk for developing osteoporosis and how can these populations protect themselves through nutritional interventions? o Women (mainly after 30), smokers, heavy drinkers, underweight patients, family history, diets low in calcium and vitamin D, anorexic patients. 43. Identify government agency sponsored dietary recommendations for management of chronic kidney disease. o “National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) o Reducing protein, sodium intake (if BP is high), potassium, Phosphorus o Depending on patient stage of kidney disease and treatment, may need to limit fluid. 44. What are anthropometric measures? o Anthropometric measurements are a series of quantitative measurements of the muscle, bone, and adipose tissue used to assess the composition of the body. o The core elements of anthropometry are height, weight, body mass index (BMI), body circumferences (waist, hip, and limbs), and skinfold thickness. 45. What are the National Cholesterol Education Program (NCEP) recommendations for cholesterol consumption and healthy cholesterol levels that reduce cardiovascular disease risk? o The National Cholesterol Education Program (NCEP) recommends that adults aged 20 years or older have their cholesterol checked every 5 years. Less than half of young adults who have these risk factors don't get cholesterol screening even though up to a quarter of them have elevated cholesterol. 46. What are the major risk factors for cardiovascular disease? WGU C787 nutrition Study guide 2022 Unit 2 o Hypertension, diabetes, high cholesterol, obesity, smoking, age (older than 65), genetics, sedentary lifestyle. 47. An underweight patient would be at risk for what conditions or diseases? o malnutrition, vitamin deficiencies, anemia, osteoporosis, depression. 48. What is a calorie? o calorie is the amount of heat needed to raise the temperature of one gram of water by one degree Celsius. Calories in food provide energy in the form of heat so that our bodies can function 49. What is the basic relationship between energy consumed and energy used by the body and how does this relate to maintenance of body weight? o Physical Activity Level (PAL)? 50. What percent of calorie intake goes to digestion, physical activity and basal metabolic rate or (basic functions)? o 51. What are the average recommended daily calorie intakes for men and women? o Generally, the recommended daily calorie intake is 2,000 calories a day for women and 2,500 for men. 52. How does fiber in food affect caloric intake? o Fiber reduces calorie absorption 53. Are obesity rates on the rise, decreasing or staying about the same? o 54. Is obesity a disease or a result of poor lifestyle choices? o Obesity is a multifactorial disease, however, influenced by both genetic and environmental factors. o some people appear to be more susceptible to weight gain, as genetic factors have an impact on appetite, endocrinology, metabolism, and activity. The environmental factors include access to palatable food and lack of exercise. While not a major contributor to the current epidemic, binge eating disorder can lead to obesity. 55. What are the benefits of eating a diet with more whole grains? o excellent sources of dietary fiber o help improve blood cholesterol levels, and lower risk of heart disease, stroke, obesity and type 2 diabetes. 56. How is body weight related to diabetes risk? o Being overweight is a risk factor for diabetes. However 57. What is insulin-resistance and how is it related to the pathology of Type 2 diabetes? o If a patient carries their weight around their abdomen opposed to their hips and thighs, the increased belly fat surrounding the abdominal organs and liver is closely linked to insulin resistance. 58. Explain what is understood about common underlying causes of eating disorders such as anorexia, bulimia and binge-eating disorder. o WGU C787 nutrition Study guide 2022 Unit 2 59. Describe key components of a successful weight management plan and how you could make recommendations to a potential patient to help them be successful in weight gain prevention and/or weight loss. o 60. What are dietary phytochemicals, specifically antioxidants, and how are they protective against disease? o Antioxidants: chemical substances found naturally in many foods. They protect the body’s cells and tissues from free radicals, which are made when our bodies use oxygen. Free radicals can damage cells, which may lead to cancer. Antioxidants are thought to help protect cells by removing free radicals before they cause damage. ▪ Examples: Vitamin A, Vitamin C, Vitamin E, Selenium o Phytochemicals: natural compounds found in plants. All vegetables and fruit and many grains contain phytochemicals. They are what give vegetables and fruit their vibrant colors. Some phytochemicals act like antioxidants. They may help reduce the risk of cancer. ▪ Examples: Carotenoids, flavonoids, indoles, isoflavones 61. Identify exercise recommendations for populations - children, adults, adults with weight loss goals. What recommendations would you give a patient who would like to increase their physical activity level? o Children: ▪ Preschool-aged children (ages 3 through 5 years) should be physically active throughout the day to enhance growth and development. ▪ Children and adolescents ages 6 through 17 years should do 60 minutes (1 hour) or ▪ more of moderate-to-vigorous physical activity daily: o Adults: ▪ 150 to 300 minutes (2 hours and 30 minutes to 5 hours) of moderate-intensity aerobic physical activity each week ▪ Adults should also do muscle-strengthening activities of moderate or greater intensity and that involve all major muscle groups on 2 or more days a week, as these activities provide additional health benefits. ▪ The first step in achieving or maintaining a healthy weight is to meet the minimum level of physical activity in the Guidelines. 62. What recommendations would you give a patient who would like to increase their physical activity level? o 63. What are health benefits of exercise for those with chronic diseases? o Aerobic exercise can help improve your heart health and endurance and aid in weight loss. Strength training can improve muscle strength and endurance, make it easier to do daily activities, slow disease-related declines in muscle strength, and provide stability to joints. Prevent pain. 64. What diseases/conditions are linked to lack of exercise? o Type 2 Diabetes, Heart disease WGU C787 nutrition Study guide 2022 Unit 2 65. How do you calculate a PAL (physical activity level)? o Total energy expenditure (cal you burn working out) / Basal metabolic rate (cal you burn being alive) 66. Identify foods recommended for a diabetic patient o healthy fats from nuts, olive oil, fish oils, flax seeds, or avocados o Fruits and vegetables—ideally fresh, the more colorful the better; whole fruit rather than juices o High-fiber cereals and breads made from whole grains o Fish and shellfish, organic chicken or turkey o High-quality protein such as eggs, beans, low-fat dairy, and unsweetened yogurt o 67. Identify foods that should be avoided by the diabetic patient. o Trans fat o Foods high in sugar o Processed meat and red meat o Low-fat products that have replaced fat with added sugar, such as fat-free yogurt 68. What are two common meal plan methods that can help diabetic patients manage their diet and how do they provide guidelines for meal planning? o 69. What is medical nutrition therapy (MNT)? o Medical nutrition therapy (MNT) is a key component of diabetes education and management. MNT is defined as a “nutrition-based treatment provided by a registered dietitian nutritionist.” It includes “a nutrition diagnosis as well as therapeutic and counseling services to help manage diabetes. 70. What are recommendations for managing blood sugar with exercise? o People taking insulin or insulin secretagogues (oral diabetes pills that cause your pancreas to make more insulin) are at risk for hypoglycemia if insulin dose or carbohydrate intake is not adjusted with exercise. Checking your blood sugar before doing any physical activity is important to prevent hypoglycemia (low blood sugar). 71. What are recommendations for diabetics to control hypoglycemia? o Check your blood sugar, If your reading is 100 mg/dL or lower, have 15-20 grams of carbohydrate to raise your blood sugar, Check your blood sugar again after 15 minutes. If it is still below 100 mg/dL, have another serving of 15 grams of carbohydrate. Repeat these steps every 15 minutes until your blood sugar is at least 100 mg/dL.