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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
Created by: ckaplan3291