NUTRITION ESSENTIALS FOR NURSING PRACTICE TEST BANK ALL CHAPTERS INCLUDED ( 1 - 24) |COMPLETE TEST BANK GUIDE A+ CORRECT QUESTIONS AND ANSWERS 100% .

What role do nurses play in nutritional care? - ANSWERS-- screen hospitalized patients to identify those at nutritional risk - serve as a liaison between dietitian and physician - available as a nutrition resource when dietitians are not - reinforce nutrition counseling provided by the dietitian - basic nutrition education .Nutrition screening - ANSWERS-- a quick look at a few variables to identify individuals who are malnourished or who are at risk for malnutrition so that an in-depth analysis can follow - can be custom designed for a particular population or a specific disorder - no universally agreed upon tool that is valid and reliable at identifying risk of malnutrition in all populations at all times .Role of the Joint Commission (JCAHO) - ANSWERS-- sets health-care standards and accredits health-care facilities that meet those standards - specifies that nutrition screening be conducted within 24 hours after admission - allows facilities to determine screening criteria, how risk is defined, and who performs the screening .Malnutrition - ANSWERS-- "bad nutrition" or any nutritional imbalance including over nutrition - in practice, usually means under nutrition or inadequate intake of protein and/or calories that causes loss of fat stores and/or muscle wasting .Nutrition Screen - Acute Care - ANSWERS-Common parameters in hospital setting: - dementia? - difficulty swallowing? - advanced age? (80+ years) - abnormal BMI? - nausea/vomiting? - decreased appetite? .Nutritional Assessment - ANSWERS-- an in-depth analysis of a person's nutritional status (by dietitian) - in the clinical setting, nutritional assessments focus on *moderate- to high-risk* patients with suspected or confirmed protein-energy malnutrition - patients who are identified to be a low or no nutritional risk are re-screened within a specified period of time to determine if status has changed - referred to as the nutrition care process => 4 steps (ADIME): Assessment Diagnosis Intervention Monitoring/ Evaluating .ABCD of an Assessment - ANSWERS-*A*anthropometric data *B*iochemical data *C*linical data *D*ietary data .Anthropemetric data - ANSWERS-- physical measurements - BMI (body mass index) => formula: wt.(kg) / ht.(m)^2 ***1 kg = 2.2 lb. and 1 in. = 2.54 cm*** => healthy: 18.5 -24.9 => underweight: < 18.5 => overweight: 25 - 29.9 => obese: > 30 - IBW (ideal body weight) => Females: 100 lb. + 5 lb.(x), for every inch over 5 ft. => Males: 106 lb. + 6 lb.(x), for every inch over 5 ft - % change in wt. => unintentional => formula: ((usual body wt. - current body wt.) / (usual)) x 100 - Estimating calorie and protein needs .Anthropometric Data: What skews weight measurements? - ANSWERS-- hydration status => dehydration (lose fluid weight) - edema - anasarca - fluid resuscitation - chronic liver or renal disease - congestive heart failure (excess weight) .Anthropometric Data: Pros & Cons - ANSWERS-Pros: - easy measurements Cons: - not always properly measured - BMI does not take muscle mass into account - Can still be malnourished .Body Mass Index (BMI) - ANSWERS-- an index of a person's weight in relation to height used to estimate relative risk of health problems related to weight - quick and easy to measure ht. and wt. - requires little skill - actual measures, not estimates, should be used whenever possible to ensure accuracy and reliability => a patient's stated ht. and wt. should only be used when there are no other options .Weight Change - ANSWERS-- usually, weight changes are more reflective of chronic, not acute, changes in nutritional status - "significant" unintentional weight loss: --- 1 week: > 2% loss of body weight --- 1month: > 5% --- 3 months > 7.5% --- 6 months > 10 % .Estimating Calorie and Protein Needs - ANSWERS-- convert body weight from lb to kg - multiple weight (kg) by: => 30 cal/kg for most healthy adults => 25 cal/kg for elderly adults => 20-25 cal/kg for obese adults ***Healthy adults need 0.8 g protein/kg*** .Biochemical Data: Common Lab Values for Protein - Calorie Malnutrition: - ANSWERS-*Diagnostic Markers of Malnutrition* Albumin: - half-life of 21 days - sensitive to fluid balance - negative acute phase protein (levels decrease in response to inflammation and physiological stress) - not specific/sensitive to just malnutrition Prealbumin: - half-life of 3 days (shorter half-life => favorable marker of acute change in malnutrition; more sensitive than albumin) - visceral protein store - negative acute phase protein (levels decrease in response to inflammation and physiological stress) - much more expensive than albumin - not specific/sensitive to just malnutrition *- Albumin and prealbumin are not valid criteria for assessing protein status because they become depleted from inflammation and physiological stress.* *- Although their usefulness in diagnosing malnutrition is limited, they may help identify patients at high risk for morbidity, mortality, and malnutrition. * *- Because they are not specific for nutritional status, failure of these levels to increase with nutrition repletion does not meant that nutrition therapy is inadequate.*** .Clinical Data - ANSWERS-- physical signs and symptoms of malnutrition => nonspecific, subjective, and develop slowly => physical signs and symptoms of malnutrition develop only after other signs of malnutrition, such as laboratory values and weight changes, are observed - Pros: can see results on physical exam - Cons: considered suggested, not diagnostic, of malnutrition .Clinical Data: Physical Symptoms Suggestive of Malnutrition - ANSWERS-- hair that is dull, brittle, or dry, or falls out easily - swollen glands of neck and cheeks - dry, rough, or spotty skin that may have a sandpaper feel - poor or delayed wound healing or sores - thin appearance with lack of subcutaneous fat - muscle wasting (decreased size and strength) - edema of the lower extremities - weakened hand grasp - depressed mood - abnormal heart rate, heart rhythm, or blood pressure - enlarged liver or spleen - loss of balance and coordination .Dietary Data: Methods of Assessing Dietary History - ANSWERS-- Ask valid and reliable questions: => "Has the type or amount of food you've eaten recently changed?" rather than "How is your appetite?" => "Do you avoid any particular foods?" rather than "Are you on a diet?" (avoid the word "diet" because it tends to have negative connotation) => How many meals and snacks do you eat in a 24-hour period? => Do you have any food allergies/intolerances? If so, what are they? => Do you eat foods from all 5 food groups (grains, fruits, vegetables, dairy, protein)? => Who prepares the meals? => How much alcohol do you consume daily? => Do you have enough food to eat? => What types of vitamin, mineral, herbal, or other supplements do you use and why? .Medical and Psychosocial History - ANSWERS-May shed light on factors that influence nutrition status through: - intake - nutritional requirements - nutrition counseling needs .Psychosocial History - ANSWERS-Psychological factors: - depression - eating disorders - psychosis Social factors: - illiteracy - language barriers - limited knowledge of nutrition and food safety - altered or impaired intake related to culture or religion - lack of caregiver or social support system - social isolation - lack of or inadequate cooking arrangements - limited or low income - limited access to transportation to obtain food - advanced age (80+ years old) - lack of or extreme physical activity - use of tobacco recreational drugs - limited use or knowledge of community resources .Medication Data - ANSWERS-Risks for development of drug-induced nutrient deficiencies: - decreased appetite - increased excretion of nutrients - interference with absorption of nutrients - self-medicating - chronic illness - habitual dieting - drug user - those who require high nutrient intake (i.e. infants, the elderly) - those taking 5 or more medications ***Medications and nutritional supplements should be evaluated for their potential impact on nutrient intake, absorption, utilization, or excretion*** .Nursing Diagnosis - ANSWERS-- written documentation - serves as framework for plan of care that follows - relate directly to nutrition when the pattern of nutrition or metabolism is altered - many other nursing diagnoses, such as constipation, impaired skin integrity, knowledge deficits, and infection, may include nutrition in some aspect of the plan .Nursing Diagnoses with Nutritional Significances - ANSWERS-- Altered nutrition intake that exceeds - Altered nutrition intake that does not meet body's needs => feeding assistance => increased risk of aspiration => impaired skin integrity (ulcers) => nausea, vomiting, diarrhea => impaired physical mobility .Nursing Interventions - ANSWERS-*- Support Nutrition Therapy* => reassure clients who are apprehensive about eating => encourage a big breakfast if appetite deteriorates throughout the day => advocate discontinuation of IV therapy as soon as feasible => replace meals withheld for diagnostic tests => promote congregate dining if appropriate => question diet orders that appear inappropriate => display a positive attitude when serving food or discussing nutrition => order snacks and nutritional supplements => request assistance with feeding or meals setup => get patient out of bed to eat if possible => encourage good oral hygiene => solicit information about food preferences => theory does not always apply to practice (intake recommendations are not always appropriate for all persons) *- Client Teaching* => nurses can reinforce nutrition counseling provided by dietitian and initiate counseling for clients with low or mild risk => emphasize the things "to do" instead of the things "not to do" => listen to client's concerns and ideas => encourage family involvement if appropriate => reinforce the importance of obtaining adequate nutrition => help client to select appropriate foods => counsel about drug-nutrient interactions => avoid using the word "diet" => keep message simple .Monitoring - ANSWERS-- observe intake whenever possible to judge adequacy - document appetite and take action when client does not eat - order supplements if intake is low or needs are high - request a nutritional consult - assess tolerance (i.e., absence of side effects) - monitor weight - monitor progression or restrictive diets - monitor the client's grasp of the information and motivation to change .Evalation - ANSWERS-- assess whether client outcomes were achieved after the nursing care plan was given time to work - Has the patient gained weight? - Have the diagnosis goals been achieved? .Carbohydrates - ANSWERS-- class of energy-yielding nutrients - energy density: 4 cal/g - macromolecule required by body in large amounts - composed of carbon, hydrogen, and oxygen (CHO) arranged into basic sugar molecules - classified as either simple of complex carbohydrates - monosaccharides, disaccharides, polysaccharides .Which food groups have carbohydrates? - ANSWERS-- Grain (starch, complex) - Milk (natural sugars) - Fruit (natural sugars, simple) - Vegetables (starchy vegetables) - Protein (not carbohydrates in meat/fish; nuts = low) - Added sugars in foods with empty calories .Carbohydrates: Monosaccharides - ANSWERS-- single chain of sugar carbohydrates - absorbed "as is" without undergoing digestion - Most common types: => glucose (AKA: dextrose) --- glucose circulates through the blood to provide energy and nourishment for body cells => fructose (sweetest of all sugars --honey, high fructose corn syrup) => galactose (not found in food --combines with glucose to make lactose) .Carbohydrates: Disaccharides - ANSWERS-- two monosaccharides linked together - must be split into their component monosaccharides before they can be absorbed - Most common types => *sucrose*/table sugar (glucose and fructose molecule) => *maltose* (two glucose molecules linked together; byproduct of starch breakdown) => *lactose* (found in milk products but very little in cheese; anti-caking --found in many medications) .Carbohydrates: Polysaccharides - ANSWERS-- complex carbohydrates are known as polysaccharides (composed of hundreds to thousands of glucose molecules linked together) - Most common: => starch (starchy veggies and grains) => glycogen (stores energy in muscle when active and liver when inactive) => fiber (non-digestible --cellulose, hectin, legnin, pectin, gum) ***When eating poultry/meats, we get no glucose b/c animals convert glycogen to lactic acid when slaughtered)*** .Sources of Carbohydrates: Grains - ANSWERS-- Classified as whole or refined => Whole grains: consist of the entire kernel of a grain (cracked, ground, or milled) --- 3 parts: bran, germ, endosperm => "Refined" grains: only the endosperm; have most of the bran and germ removed; rich in starch but lack fiber, B vitamins, vitamin E, trace minerals, unsaturated fat, and most of the phytochemicals found in whole grains --- ex. white flour, white bread, white rice, refined cornmeal *Flour products will turn into sugar most easily* .Enrichment - ANSWERS-- adding back certain nutrients (to specific levels) that were lost during processing - restores some B vitamins (thiamin, riboflavin, and niacin) and iron to levels - other substances that are lost, such as other vitamins, other minerals, fiber, and phytochemicals, are not replaced by enrichment - enriched grains are also required to be fortified with folic acid .Fortification - ANSWERS-- adding nutrients that are not naturally present in the food or were present in insignificant amounts .Sources of Carbohydrates: Vegetables - ANSWERS-- 1/2 cup of starchy vegetables provides 15g: => legumes (e.g. pinto beans, black beans, garbanzo beans) => corn => lentils => peas => potatoes, sweet potatoes, yams => winter squash (e.g. acorn, butternut) - 1/2 cup of "watery" vegetables provides 5g => asparagus => bean sprouts => broccoli => carrots => green beans, wax beans => okra => tomatoes .Source of Carbohydrates: Fruits - ANSWERS-- one serving of fruit = 15g => 3/4 cup of juice => 1 piece of fresh fruit => 1/2 cup of canned fruit => 1/4 cup of dried fruit .Source of Carbohydrates: Dairy - ANSWERS-- although milk is considered a "protein," more of milk's calories come from carbohydrate than protein - one cup of milk = 12g .Source of Carbohydrates: Protein - ANSWERS-*- only legumes and nuts have CHO* - none in meat/fish ***NOT A MAIN SOURCE OF CARBOHYDRATES*** .Source of Carbohydrates: Empty Calories - ANSWERS-- come from added sugars and syrups - provide calories with few or no nutrients .Digestion of Carbohydrates (beginning => end) - ANSWERS-1) Mouth (salivary amylase; effect is small b/c food is not held in the mouth very long) 2) Stomach (chemical digestion comes to a halt) 3) Small intestine (where most of digestion takes place; pancreas secretes enzymes; absorption) 4) Large intestine (AKA: colon) ***Time span for starch digestion varies greatly (1-4 hours)*** => Rice Krispies digest more quickly than Kashi Go Lean ***Starch => Maltose => Glucose .Absorption of Carbohydrates - ANSWERS-- takes place in small intestine - glucose, fructose, galactose - undigested starch goes to large intestine - fiber and absorption of minerals: => too much fiber decreases absorption of some minerals (calcium, zinc, iron) => moderation is important .Metabolism of CHO - ANSWERS-- fructose and galactose converted to glucose in liver - rise in blood sugar causes pancreas to secrete insulin - postprandial state: => as the body uses the energy from the last meal, the blood glucose concentration begins to drop => even the slightest fall stimulates the pancreas to release glucagon .Glycemic Index - ANSWERS-- a numeric measure of the glycemic response of 50g of a food sample; the higher the number, the higher the glycemic response (effect of food/meal on blood glucose levels after consumption) - how quickly is food breaking down into glucose - determined by comparing the impact on blood glucose after 50g of a food sample is eaten to the impact of 50g of pure glucose or white bread - Pros: may help people with diabetes fine-tune optimal meal planning, and athletes can use G.I. to choose optimal fuels for before, during, and after exercise - Cons: not officially recognized by medical community; no standard and not many food have been tested; claims that a low G.I. diet promotes significant weight loss or helps control appetite are unfounded (e.g. soft drinks, candy, sugars, and high-fat foods have a low to moderate G.I, but they are not nutritious and do not promote weight loss) - Low Glycemic Index = < 50 .Glycemic Load - ANSWERS-- a food's glycemic index multiplied by the amount of carbohydrate it contains to determine the impact on blood glucose levels - Pros: more reliable indicated than glycemic index - formula: (G.I.) x (# of carbs in food intake) - Cons: not a reliable tool for choosing a healthy diet ***Low Glycemic Load = < 10*** .Functions of CHO - ANSWERS-*Glucose Metabolism* - metabolic breakdown (catabolism) and buildup of glucose (anabolism) *Glucose for Energy* - all digestible carbs provide *4 cal/g* - carbs provide energy for cells - no end product that body has to excrete *Protein Sparing* - brain is solely dependent on glucose for energy - although protein also provides 4 cal/g of energy, it has so many other functions (replenishing enzymes, hormones, antibodies, blood cells) - muscles made of protein *Ketosis Prevention* - fat normally supplies half of body's energy requirement - yet glucose fragments are needed to efficiently and completely burn fat for energy - inadequate glucose => ketone body formation (excess can lead to nausea, fatigue, loss of appetite, ketoacidosis, and eventually diabetes) => intermediate product of interrupted fat oxidation/breakdown *Glucose to Make Other Compounds* - glucose helps make glycogen for nonessential amino acids, RNA, and specific body compounds - glucose can be converted to fat and stored .Dietary Reference intakes of CHO: Total Carbohydrate Recommended Dietary Allowance - ANSWERS-- RDA for total carbohydrate (starch, natural & added sugar) = 130g for both adults and children => based on avg. minimum amount of glucose needed to fuel the brain - AMDR: *45-65%* total calories .Dietary Reference intakes of CHO: Fiber Recommendations - ANSWERS-- an adequate intake (AI) for total fiber = 14g/1000 calories OR 25g/day for females; 38g/day for males ***Whole grains = good source of fiber*** .Dietary Reference intakes of CHO: Sugar Recommendations - ANSWERS-- no more than 25% of calories from ADDED sugar .CHO in Health Promotion: The Benefits of a Whole Grain Diet - ANSWERS-- Lower Risk of: => Cardiovascular disease => Certain types of cancer (gastrointestinal, hormone-related, pancreatic) => Type II diabetes - May aid in weight management (lower risk of obesity and weight gain) - Play a role in maintaining gastrointestinal function ** - Recommended that adults and children consume at least 1/2 of their grain servings, or a minimum of 3 servings per day, in the form of whole grains** **95% of Americans do not meet their daily whole-grain intake recommendation (only consume 1 serving)** .CHO in Health Promotion: How to Increase Dietary Fiber - ANSWERS-- Read cereal labels => look for cereals with > 5g of fiber (whole grain or bran) - Replace refined grains with whole grains (whole wheat pasta, tortillas, pita, etc.) - Increase vegetable and fruit intake (5 servings of fruit/vegetables per day) - Eat a variety of fruits and vegetables => Raspberries = fruit highest in fiber - Increase fiber intake gradually - Increase fluids - Consume at least half of all grains as whole grains (replace refined grains with whole) .CHO in Health Promotion: Limit Added Sugars - ANSWERS-- Limit intake of calories from added sugars and solid fats => Added sugars: 6 tsp. per day => Alternatives to sugar: sugar alcohols (polyols); non-nutritive/artificial sweeteners => sugar alcohols are by-products of sugar (not completely absorbed in blood, cause a smaller effect on blood glucose levels, do not promote dental decay) ***But be careful because most polyols have a laxative effect (i.e. sorbitol), and low sugar does not always mean low calories*** .Ways to Limit Added Sugars - ANSWERS-- Cut back or eliminate sugar-sweetened beverages - Rely on natural sugars in fruit to satisfy "sweet tooth" - Limit sweetened grain-based and dairy-based desserts and candy - Cut sugar in home-baked products, if possible - Read labels (do not distinguish between added and natural sugar and do not include sugar alcohols) .CHO in Health Promotion: The Most Common Sources of Added Sugars in the American Diet - ANSWERS-- soft drinks - Cakes, cookies, pies - Artificial juice (fruit punch, CapriSun) - Ice cream, milkshakes - Candy .CHO in Health Promotion: Sugar Too Much of a Good Thing? - ANSWERS-Excess sugar intake could lead to: - obesity (too many calories causes weight gain, which could indirectly cause obesity) - diabetes (excess body weight) - behavioral problems - cavities - heart disease (indirectly) .Proteins - ANSWERS-- macronutrients that provide energy in the form of calories - energy density: 4 cal/g - a component of every living cell: plant, animal, and microorganism - accounts for 20% of adult weight .Amino Acids - ANSWERS-- basic building blocks of proteins and end products of protein digestion - composed of carbon, oxygen, nitrogen, and hydrogen - 20 common amino acids => all 20 must be available for the body to make proteins - types of AA: essential and nonessential .Essential Amino Acids - ANSWERS-- AKA: indispensable - 9 amino acids - body cannot make them, so must be supplied through diet - ex. phenylalanine, tryptophan .Non-essential Amino Acids - ANSWERS-- AKA: dispensable - 11 amino acids - cells can make them as needed through the process of transamination - ex. phenylketonuria, asparagine, glutamine, glycine, serine, tyrosine .Protein Structure - ANSWERS-- thousands of amino acids - shape determines function - may be straight, folded, coiled .Protein Functions - ANSWERS-1) Body structure and framework - organs, muscles (over 40%), bones, skin (15%), blood (15%), tendons, membranes 2) Enzymes