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Nutrition ATI
| Question | Answer |
|---|---|
| What are complete proteins sources | Animal sources and soy |
| How many amino acids are in complete protein | 9 amino acids |
| Water soluble vitamins and their sources | B & C B: meat sources (B12), shellfish, egg, dairy, legumes, C: citrus, veggies |
| Fat soluble vitamins and their sources | A: Orange and yellow fruits/vegs, fatty fish, egg yolk, cream, butter D:Dairy, fatty fish (frot cereal, milk,OJ) E: veg oil and certain nuts K: Dark leaf greens, carrots, eggs, |
| What is BMR affected by? | lean body mass and hormones. Surface area, age, sex |
| BMR increases during? | Pregnancy, lean muscles, hyperthyroid, stree, rapid growth, fever, burns |
| BMR decreases during? | Starvation, hypothyroid, opioids, barbiturates |
| What food sources contain potassium? | Oranges, dried fruit, tomatoes, avocado, dried peas, meats, broccoli, banana, dairy products meats, whole grains, potatoes. **Cantaloupe*** |
| What food sources contain folate? | liver, dark green leafy greens, orange juice, and legumes |
| What food sources contain iron? | Fish, meat, green leafy veggies, enriched bread/pasta, dried fruit, egg yolk, grains, legumes **Red meats** |
| What sources can calcium be found? | Dairy, broccoli, kale, grains **mostly in dairy** |
| Iron can cause / Liquid form | Dark stool and constipation/ discolor teeth (drink with straw and rinse mouth) |
| Normal BMI Under overweight Obese | Normal: 18.5-25 Under: Below 18.5 Overweight: over 25-29.9 Obese: over 30 |
| What qualifies as anorexia? | BMI Body fat Weight loss |
| Diet for decreased risk of cancer include: | 5 servings of Fiber rich fruits and veggies Avoid canned, processed foods |
| Food safety guidelines | Avoid raw eggs, unpasteurized milk and juices |
| Vegan | No animal products or by products |
| Lacto-Vegetarian/Lacto-ovo-Vegetarian | Lacto: milk products Lacto-ovo: milk products and eggs |
| Orthodox judaism diet | *Don't eat meat with dairy products * Fish must have scales and fins * prohibit food preparations on sabbath *********meat and fish are sad (sabbath)********* |
| Which cultures avoid caffeine and alcohol? | * 7th day advent. * Mormon * Islam |
| Which cultures avoid pork? | * 7th day advent. * orthodox jews * islam * hindu * Buddism |
| Which cultures call for kosher meats? | * Orthodox jews * Islam |
| Calorie increase during pregnancy and post | * 2nd trimester: 300 * 3rd: 452 * Post: 300-500 |
| Weight gain during pregnancy | * 1st: up to 4.5 lbs * 2nd & 3rd: 2-4lbs/ month |
| Pregnancy weight gain per BMI | * Normal: 25-35 lbs (1lbs/wk) * Under: 28-40 (^1/wk) * Over: 15-25 (0.66lbs/wk) * Obese: 11-20 (0.5lbs/wk) |
| Intake recommendations for pregnancy | * Caffeine: less than 200mg/day * Protein: 68-80g/day * folic acid: 500mcg/day (prevent neural natal tube defect) * Iron; 27-30 mg * Calcium 1000mg/daily for breast feeding |
| Nausea during pregnancy | * dried crackers and cereal before wake * mouth wash * avoid fluids with meals * sour patch kids and sour heads are the bomb *avoid coffee, alcohol, fats, spices ***dont take meds w/o doctors ok*** |
| constipation during pregnancy | * 8 cups of water * increase fiber * exercise |
| foods to avoid during pregnancy | Heavy mercury fish: Avoid tilefish, shark, swordfish, marlin, orange roughy, and king mackerel |
| Infancy development | * birth weight doubles by 4-6 months/ 3x by yr 1 * Breast/ formula for first 6 months * Iron after 4 months * Cow's milk after 1yr/ Watch their itty bitty kidneys |
| Toddlers development | * 2-3 inch in height and 5-6lbs/yr * 4-6 oz of 100% juice * Finger foods (non choking**4 yrs old**) * promote Routine and independence |
| Preschoolers development | * 13-19g protein/day |
| Teens development | Zinc, proteins, iron |
| Vitamens D, K, and calcium | DRI doesnt change over life span |
| Oral problems in older adults | * Ill-fitting dentures *.Diff. chewing/swallowing (thick liquid/mechanical soft) * Decrease salivation * Poor dental health |
| Older adults cellular function decline and reduced boy reserves leads to | * Decreased absorption * reduction in insulin/sensitivity * Reduced muscle mass (Pool aerobic/powerwalk) * Osteoporosis (Ca+ vit D+ exercise) * **Lutein makes them young again*** |
| When is swallow eval used | * Stroke * dysphagia |
| Manifestations of dysphagia | * Drooling * Pocket food * Chocking * Gagging ( Sloppy head and hold the jizz) |
| Levels of solid textures of food | 1. Puree 2. Mechanical 3. Advanced Near-Normal |
| Levels of liquid consistency | 1. Thin non-restrictive 2. Nectar-Like: thin enough to sip thru straw 3. Thick pour: honey, sauce, soup, yogurt 4. Spoon thick: maintain shape (pudding, custard, hot cereal) |
| Continuous EN | Continuously over 24 hrs |
| Intermittent EN | * every 4-6 hrs * Run for 30-60 mins * Electrical pump or gravity |
| EN care during feeds and meds | * PH 1.5-4/ Auscultate/*** xray placement*** * Flush 15-30mL every 4 hrs * before and after feed/meds * Check residuals ( more than int. 100ml /cont. 2x hr rate ok. greater waste and call dr) |
| Nasoenteral tube/ infant tube duration | 3-4 wks/ 30 days |
| Dumping syndrome Cause and S/S | Rapid emptying of formula into small intestine, resulting in fluid shift. (avoid with gastro tube) * Include proteins * Supine position S/S: dizzy, rapid pulse, diaphoresis, pallor, light headed |
| Gastrostomy PEG vs. Low profile | Low profile: more comfortable, longer‐lasting, and fully immersible in water. Checking for residual is more difficult with this device because of the close proximity of the button on the skin. |
| S/S of Not tolerating feeding | Nausea, Gas, diarrhea, abdominal distention, vomiting, high residual |
| Standard formulas | * AKA Polymeric or Intact. * composed of milk, meat, eggs, protein isolate. * Only for Functioning gastrointestinal tract * 1-2cal/mL |
| Elemental formulas | * nutrients that are part or fully hydrolyzed or broken down * For partially functioning gastrointestinal tract * impaired ability to digest and absorb foods (inflam bowel disease, liver fail, cystic fib, pancreatic , and short-gut ). * lit/no digest |
| Bolus feeding | * A large volume of formula (700 mL maximum, usual volume is 250 to 400 mL) is administered over a short period of time (5 to 30 min) four to six times daily. * Babies 5mL/ 10mins or 10mL/min ****Cause dumping syndrome**** |
| Base-line parameters for nutrient requirements | BUN: 10-20mg/dL Albumin: 3.4-5.4g/dL PreAlbumin: 15-36mg/dL Hemoglobin: F 12-16, M 14-18g Hematocrit: F 37-47%, M 42-52% Glucose: fasting below 126 normal below 200 Electrolyte levels WBC 5k-10K |
| Issues with EN | * Check residual * Flush * decrease rate or total volume * change formula * elevate bed 30 degree * Room temp formula * insulin * Monitor resp, cardiovascular, and neurologic status |
| Refeeding syndrome cause and S/S | fatal complication that occurs when a client who is in a starvation state is started on enteral nutrition S/S: shallow resp, confusion, seizure, weakness, cardiac rhythm, fluid retention, acidosis. |
| EN Food poisoning | * wash hands * Clean equipment and can food * use closed feed system * cover formula w/ sticker time and date/ 24 hrs exp * replace tube and equip every 24hrs * Only 4hrs worth of formula at a time |
| TPN used when | Parenteral nutrition (PN) is used when a client’s gastrointestinal tract is not functioning, or when a client cannot physically or psychologically consume sufficient nutrients orally or enterally. |
| TPN vs. PPN | TPN: nutritionally complete, Central vein. caloric needs are very high, long‐term therapy, or administered hypertonic D10% (sub formula out) PPN: up to 14 days into a peripheral vein. it is nutritionally incomplete, No more than D10% and 5% amino |
| TPN complications | * Infection/Sepsis * Electrolyte imbalance *Osmotic dehydration *Mechanical complications *Refeed syndrome |
| TPN important nurse requirements | * Check IV every hr * monitor glucose every 4-6hrs * |
| Why TPN | clients who need intense nutritional support for an extended period of time, treatment for cancer, bowel disorders, critically ill, and trauma or extensive burns, |
| Coronary Artertery Disease | Modifiable risk factors: High LDL, Low HDL, High sat. fats, Nicotine, HTN, DM, Metabolic syndrome, obesity, and sedentary. |
| Anemia disorder | Low iron, B12, and folic acid |
| Heart Failure | * reduce sodium. Less than 3000mg/day mild-moderate * Less than 2000mg for severe * Monitor fluid intake (restrict 2L/day) |
| Concerns when taking diuretics | Pt may require K+ if non sparing |
| Celiac disease | (Avoid brown grains: barley, oat, wheat, rye, and splet) Gluten allergy S/S: Diarrhea, abdominal pain, anemia, steatorrhea, osteomalacia |
| Nausea/Vomitting diet | NPO or clear liquids |
| Constipation diet | etra fluids, fiber, and exercise |
| GERD diet | * Small meals, sit up for 2hrs post meal * Avoid acidic, spicey, fatty, fried, chocolate, wine, unhealthy. |
| Renal disorders diet | * Low Na+, K+, Protein * Protein RDI 0.8-1g/kg/day (soy, lean meats, veggies) * Maintain low BP **Acute: restrict fluid output, plus 500 mL per day for oliguric phase. fluid increase during diuretic phase. |
| S/S of Hypoglycemia | Shaking, confusion, sweating, palpitations, headache, lack of coordination, blurred vision, seizure, and coma. ****Busted by the POPO***** |
| S/S of Hyperglycemia | * 3 POLY'S: dipsia, phagia, uria * DKA (dehydrated, headache, concentration, unconsciousness, seizure, coma) |
| Diabetes diet | * Eat grains, fruit, legumes, milk * avoid simple carbs like sugar and refined grains * Carbs 45-65% daily intake * awake 15g carbs/ 15 mins/ 15g carbs below 70 * Coma Glucagon subQ or IM |
| Cancer/Immune Anorexia diet | * Small high protein/ hi calorie meals * Morning eating * avoid food odor and low cal foods and broths * Cool and room temp foods |
| Cancer/Immune stomatitis diet | * Avoid acidic, spicey, dry or coarse foods * Cold and room temp (cryotherapy) * Use straws * Hi cal drinks/proteins * Tender/ soft foods with gravies * denture fits/ soft brush after each meal/ no alc. mouthwash |
| Cancer/immune nausea diet | * Cold or room temp * Avoid food before cancer tx * Antiemetic/ ginger ale or tea * sip fluids all day * Sit up 1hr after meals |
| Progressive diets | For GI problems. Diet as tolerated. Nurse/client decisions on progress. Clear-full-soft diet. |
| Low residue/ low fiber diet | Mild foods for inflammed small or large intestine. cheese, yogurt, eggs, lean meats, fish, fat as tolerated, poultry. |
| Sodium restricted diet | Avoid sodium and substitutes. use other herbs for season. |
| Saturated fats | eat les than 7%-10% ideally. animal products |
| Unsaturated fats | vegetables and veg oils |
| Order of EN feeding and meds | Elevate head, verify tube placement, residuals, flush, feed, flush. |
| Drooling, gagging, and left side weakness | Flex head, shin down, full fowlers, strong side , and thickened liquids. |
| Food prep guidelines | Roasts and steaks: 145° F (63° C) ● Chicken: 165° F (74° C) ● Ground beef: 160° F (71° C) ● Products that contain eggs: 160° F (71° C) |
| Food storage guidelines | meat/fish: 40° F ● Bacon: 7 days ● Sausage (reg)/Chicken/turkey: 1 to 2 days ● Smr sausage: 3 mths/3 wks ● Steak, chop, roast : 3 to 5 days ● Fish: ◯ reg: 1 to 2 d ◯ Smkd: 14 d ◯ shrimp: 1-2 d ◯ Can: 3 - 4 d/ 5 yr Egg: 4-5 wk/1 wk-boiled. |
| Obese | Leptin, ghrelin, WHR 35-40 in, 0.8-0.95 excess fat, AST, ALT |
| Positive Nitrogen | * indicates that the intake of nitrogen exceeds excretion. * during periods of growth: infancy, childhood, adolescence, pregnancy, and lactation. |
| Negative nitrogen | * indicates that the excretion of nitrogen exceeds intake. * insufficient protein * seen during periods of illness, trauma, aging, and malnutrition. |
| Increase metabolism | ● Fever ● Involuntary muscle tremors (shivering, Parkinson’s) ● Hyperthyroidism ● Cancer ● Cardiac failure ● Burns ● Surgery/wound healing ● HIV/AIDS |
| Decrease metabolism | Hypothyroidism |
| Increase BMR | ● Epinephrine ● Levothyroxine ● Ephedrine sulfate ● Lean, muscular body build ● Exposure to extreme temperatures ● Prolonged stress ● Rapid growth periods (infancy, puberty) ● Pregnancy Lactation ● Physical conditioning |
| DECREASE BMR | ● Opioids ● Muscle relaxants ● Barbiturates ● Short, overweight body build ● Starvation/malnutrition ● Age-related loss of lean body masses |
| Signs of malnutrition | pitting edema, hair loss, wasted appearance |
| Fat soluble vitamins vs kidney disease | Clients who have liver disease should be careful not to take more than the daily recommendations of fat-soluble vitamins, as excess is stored in the liver and adipose tissue |
| Xerostomia | dry mouth |
| Statin drugs can be taken with | grape. fruit |
| what organs digest fats | gallbladder and liver |
| Total cholesteral | less than 200 |
| HDL | Male less than 45 Females less than 55 |
| LDL | Less than 130 |
| Triglycerides | Male 35-135 Female 40-160 |
| Specific gravity | 1.005-1.030 dehydration less than 1.030 |
| A1C | Less than 5%: No DM 6.5%-7%: w/DM ****Goal: Less than 7% |
| Glucose | Fasting: 70-110 Norm: 70-130 |
| Creatnine | 0.6-1.3 |
Created by:
ccharles653