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Nutrition
Lecture
| Question | Answer |
|---|---|
| Definition of Nutrition | Optimal nutrition status is achieved when there are sufficient nutrients to provide for daily body requirements and for increased metabolic demands. |
| Percentage of the American population that is Overweight | 65% of the population -34% overweight -31% obese |
| Children's Weight Classification | Underweight - less than 5th percentile Normal - 5th percentile to 85th percentile Overweight - 85-95th percentile Obese - Above 95th percentile |
| Groups at risk for Malnutrition | ~Infants / Children ~Pregnant women ~Immigrants ~Low SES ~Hospitalized patients ~Aging Adults |
| Greatest nutrition effects on elderly due to: | - Socioeconomic conditions - physical limitations - income - social isolation |
| Types of body build | Ectomorph - underweight/thin Mesomorph - normal/healthy weight Endomorph - overweight |
| What to include in the general physical assessment? | -Overall appearance -Body build -Muscle Mass -Fat Distribution |
| Purpose of Nutrition Assessment? | - Identify individuals whom are malnourished - provide data for creating a care plan which will prevent or minimize malnutrition - establish baseline data |
| Pica | - Iron deficiency in Children - Zinc deficiency - Can be a symptom of Autism and Tourette's - Sometimes seen during pregnancy |
| Characteristics of the new food pyramid | -The food groups are color coded, with the size of the sections emphasizing the proportions of foods eaten in each group. -There is also a figure, climbing some steps, on the side of the pyramid which symbolizes exercise as a part of the total plan. |
| 4 areas of focus on the new food pyramid | - At least 3oz. of grains to be whole grains - Emphasis on non-fat or low fat milk - emphasis on lean and less meat - emphasis on exercise |
| Loose rule of thumb for maintaining a certain weight | Amount of weight you want to maintain x 10 |
| Saturated fats | Found in animal tissues and are very dense |
| Unsaturated fats | Found in vegetable oils are are less dense than saturated fats |
| Transport vesicle for fats | Lipoprotein |
| Vital Signs of Obesity | - Waist Circumference - Weight - BMI |
| Waist Circumference Guidelines | -Men <40 inch waist = increased risk -Men > 40 inch waist = high risk -Women <35 inch waist = increased risk -Women > 35 inch waist = high risk |
| Faults of BMI measurements | - Muscle weighs more than fat - Inaccurate result if retaining fluid - Elderly lose muscle mass (decreasing BMI) |
| Purpose of BMI | estimate total body fat |
| Purpose of waist circumference | Determine extent of abdominal visceral fat in relation to body fat |
| Purpose of mid-arm circumference | assess skeletal muscle mass |
| purpose of triceps skin fold | Evaluate subcutaneous fat stores |
| Purpose of Mid-arm muscle circumference | Evaluate muscle reserve |
| Determining IBW (Ideal Body Weight) | -Body weight should be within 10% of ideal range -Female : 100lb for 5ft + 5lb for each inch over 5ft -Male: 106lb for 5ft + 6lb for each inch over 5 feet |
| BMI ranges | BMI below 18.5 = underweight BMI of 18.5 – 24.9 = normal (healthy weight) BMI of 25 – 29.9 = overweight BMI of 30-39.9 = obese BMI of 40+ = morbid obesity |
| Malnutrition symptoms can often be confused with these other symptoms | -Anemia -Hyper/ hypo thyroidism -Hepatic disease -Cancer -Depression |
| Common signs.symptoms of Malnutrition | -Sudden changes in body weight -Gradual changes in body weight -Change in skin, hair, or nails -Decreased energy level |
| When patients are malnourished, the body’s protein stores are affected and the patient will experience: | -A decreased immune system -Impaired/ slow healing -Higher risk for skin breakdown (pressure ulcers) |
| Indicators of good nutritional status | -Alert, energetic, good posture -Good attention span -Firm, well developed muscles -Skin has good turgor, elasticity, smooth -Eyes bright, clear -Mucous membranes pink, firm, tongue mind and moderately smooth -No skeletal changes |
| Indicators of poor nutritional status | -Withdrawn, easily fatigued, irritable -Overweight/underweight -Flaccid muscles, wasted appearance -Skin dull, pasty, scaly, dry, bruised -Eyes dull -Hair brittle/dry -Mucous membranes pale and bleed, tongue dark and swollen -Skeletal Disformity |
| Changes in nutritional status in Elderly | -Muscle tone and mass decreases -salt sensitive - fat redistributed to arms, abdomen, hips |
| Cause of height changes in Elderly | Intevertebral discs becoming thinner and spinal kyphosis |
| How to assess hydration status | -Weight -Skin turgor -Pitting edema -Skin for moisture -Venous filling -Neck veins in supine position with head elevated 45 degrees -Tongue -Eyeball palpation -Eye position -Lung sounds -Blood pressure |
| At risk for over-hydration: | -Not usually a problem in a healthy person -Renal disease -Cardiac disease -Hepatic disease -Critically ill patients |
| Symptoms of fluid overload | -Weight gains 6 – 10 pounds in a week -Pitting Edema -Visible neck veins -Cracking lung sounds -Elevated pulse rate and BP -Difficulty breathing/ SOB -Third spacing |
| Third Spacing | Fluids shift out of the vascular space, into the “third” or extracellular space |
| Dehydration signs and symptoms | -Weight loss 6 – 10lb / week -Tenting -venous filling more than 6 – 10 seconds -Flat veins in supine client -Tongue is dry, fissures -Sunken eyeballs, dark circles -BP decreased with elevated pulse rate -Decreased or absent tears -Dry mucus membra |
| Labs related to Dehydration | -Albumin -Pre-albumin -Trasferrin -Total Lymphocyte count -Cholesterol -Nutritional anemia -Nitrogen balance -Plasma proteins |
| Drugs that commonly interfere with nutrition | -Analgesics -antacids -anticonvulsants -antibiotics -diuretics -laxatives -anti-neoplastic drugs -steroids -oral contraceptives |
| Problems with herbal supplements | -Herbs beginning with the letter “g” are the most common offenders to herb/ prescription drug interactions -Most common problem is hepato-toxicity -Avoid St. John’s Wort if on other prescribed medications |
| Dietary Approaches to Stop Hypertension (DASH) Diet characteristics | - 1500mg sodium - Focuses on fruits, vegetables, whole grains, and low-fat dairy foods -Includes all protein sources - Limits sugary foods and beverages, red meat, cholesterol and added fats - increase in intake of minerals, protein, fiber to lower B |
| Effects of DASH diet on HTN | In a patient with normal blood pressure: -The diet reduced systolic BP by 6mm Hg and diastolic BP by 3mm Hg In a patient with hypertension: -The diet reduced systolic BP by 11 mm Hg and diastolic BP by 5mm Hg |
| Vitamin B6 | Assist the end products of protein digestion in the small intestine via active transport |
| Vitamin C | Strengthens capillary walls and structural tissues; prevents tissue hemorrhage; proper absorption of Iron - Sources: deep green and yellow leafy vegetables, tomatoes |
| Vitamin K | Produced by intestinal flora; assists with coagulation - Sources: leafy greens |
| Vitamin A | Assist is repair and growth of body tissues; maintain healthy vision; aids in immunity -Sources: whole milk |
| Potassium | Regulating fluid and acid- base balance; functions in nerve impulse transmission, carbohydrate metabolism, protein synthesis and skeletal muscle contractility -Sources:oranges and banannas |
| Sodium | Regulates fluid balance and cell permeability; regulates acid-base balance nurses transmission, and muscular irritability |
| Folate | Essential to metabolism and cell synthesis; prevents neural tube defects in the fetus |
| Vitamin B12 | DNA synthesis; maintains RB;, maintains the myelin sheath around nerves |
| Cooked food most likely to remain contaminated by the virus that causes hepatitis A | Steamed Lobster |
| Skin that is flaky and scaling could indicate: | deficiency or excess in vitamin A, zinc, and fatty acids |
| What causes skin to be transparent and cracked? | protein deficit |
| Skin lesions may be due to a lack of : | protein and vitamin C |
| Children who are not growing may have: | Protein deficit |
| Cause of petechiae and swollen, bleeding gums: | Vitamin C deficit |
| Sudden cardiac death linked to: | Vitamin C dfeficit |
| Purpura may be caused by: | vitamin C and vitamin K deficiencies |
| Concave shape of nails may be due to: | iron deficiencies |
| Mails with transverse ridges usually result from: | protein deficits |
| What can cause pale conjunctiva | Iron deficit |
| Papilledma, HTN, and increased intracranial pressure may result from: | Excess vitamin A |
| What may cause atrophic lingual papllae of the tongue? | Lack of riboflavin, niacin, folic acid, vitamin B12, and iron -Glossitis may be present if patient has all of the above deficits and in addition, a pyridoxine deficit |
| Cheilosis may be caused by: -If corners of mouth and ulcerates lips are inflamed, this is known as cheilitis | Riboflavin deficit |
| lack of ability to taste due to: | Zine deficit |
| MSK deformities may be due to: | Vitamin D deficit |
| This deficit in children may be seen as their teeth not erupting | Vitamin D Deficit |
| Common cause of tetany (muscle twitches, cramps) and increased DTRs | Low calcium and magnesium levels |
| This deficit may contribute to dementia | Vitamin B12 and niacin |
| Deficit that may cause cardiac dysrhythmias | Potassium deficit |
| Ascites may indicate | deficit of either protein or vitamin A |
| These deficiencies may exacerbate CHF or cause S3 heart sound | Thiamine, phosphorus, or iron |
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