Nutrition Proctor

Pts receiving TPN are at risk for hyperglycemia so glucose blood levels should be checked every _____ hours

4 hours

*TPN contains dextrose this is why hyperglycemia can happen

When TPN is not available what should you give the pt?

D5W (dextrose 5% in water)

10% or 20% is fine too

Weight should be monitored how often for pts on TPN?

daily weights since they are at risk for fluid imbalance

How often should the tubing be changed for pts on TPN?

Q24hrs to decrease risk of infection

Which nutrient will be affected if saliva production(salivary amylase) is reduced?

starch

Which enzyme breaks down fats?

lipase

Which enzyme breaks down proteins?

pepsin

Do we digest fiber?

No

celiac disease pts should avoid

gluten which is in rye, barley, and wheat

White bread, broiled hamburger, fish, poultry, white rice, canned tomato juice, and canned peaches are all part of a low ____ diet

fiber

Coleslaw, fresh fruit, oats, peas, beans, brown rice, prune juice, and wholegrain bread are all high or low in fiber?

HIGH in fiber

(Coleslaw because it contains cabbage)

ovo-vegetarian

exclude meat and dairy but DO eat eggs

lacto-vegetarian

NO meat and eggs but DOSE include dairy products

macrobiotic diet

plant based but INCLUDES fish and seafood

flexitarian diet

mainly plant-based BUT occasionally eat meat, fish, and dairy

kosher diet have restrictions on how food is prepared, eaten, and _________

processed

Who is at risk for an iron deficiency?

-pregnant women

-vegetarian diet

-overweight toddler

-menstruating women who have excessive blood loss

Pt with hx of kidney stones how much water should they drink?

3.8L/day

Pt with hx of kidney stones what should the include/exclude from their diet?

-avoid large amounts of vit C (citrus fruit, such as oranges and orange juice · peppers · strawberries · blackcurrants · broccoli · brussels sprouts · potatoes)

-avoid high oxalate foods (almonds, leafy greens)

How much sodium /day for pt with hx of renal calculi?

2 g/day

MAOIs avoid tyramine rich foods like.....

aged cheeses, deli and processed meats, avocado, bananas, pineapple, orange, grapefruit

Potassium levels

3.5-5

Sodium levels

135-145

blood glucose levels

70-110

HbA1c levels

4-6.5%

(over 8% is poor diabetes control)

hct levels

37-52%

hgb levels

12-18

pt has end stage renal disease and has a hemoglobin (hgb) is 8 what med should we give

erythropoietin to help with RBC production

AIDS pt teaching: leftovers should be discarded after ____ hrs to prevent foodborne illness

24 hours

Use a different cutting board for ______ items to prevent cross contaminating of bacteria such as salmonella

raw poultry

thaw frozen foods in the fridge or room temp in the sink?

in the fridge to prevent bacteria growth

store foods at ____ degrees F or less to prevent bacteria growth

40 degrees F

Pt teaching with dumping syndrome

avoid fluids at meals, lie down after meals if showing s/s of dumping to slow progress of food through GI tract, avoid simple carbs like honey, sugar, and syrup, eat foods HIGH in protein and fat and low carb to delay digestion preventing dumping syndrome

Soft boiled egg, deli meat, brie cheese with unpasteurized milk should all be avoided when a pt is ?

immunocompromised

Pt is taking calcium supplements what food should they include in their diet to help w/ absorption?

fortified milk because it contains vit D

potassium rich foods?

potato, cantaloupe, spinach, broccoli, orange, banana, avocados, tuna, beets, apricots, tomatoes, peaches

broccoli is a good source of what vitamins?

vitamin C and folic acid

green leafy veggies are a good source of what vitamin?

vitamin K

collard greens are a good source of what?

calcium

(this is a great option for pts who are lactose intolerant since most calcium comes from dairy products)

iron plays a role in what?

oxygen transportation

zinc plays a role in what?

tissue growth, wound healing, and immune function

phosphorus plays a role in what?

bone and teeth formation, energy

Yogurt is low in _____ and ______ and is a good source of calcium

fat and sodium

HF pt with a limit of 2g of Na/day can he have salt?

no salt should be eliminated from the diet

baking soda is high in ?

high in sodium

pt has anorexia and nausea due to chemo what should the nurse do/recommend?

-serve cold or room temp foods

-suggest no liquids with meals to prevent bloating and early satiety

-give high calorie nutrient dense foods

-sit upright 1 hr after meals to prevent nausea

pernicious anemia pt will receive what vitamin

vitamin b12

iron deficient anemia pt will receive what vitamin

ferrous sulfate (iron)

anemia due to chemo will receive

epoetin alfa

scurvy pt is deficient in what vitamin?

deficient in vitamin C

rickets is cause by a deficiency in what vitamin?

vitamin D

vitamin A deficiency causes?

night blindness and immunodeficiency

Na intake recommendation

no more than 2.5g/day

water intake recommendation

2-3L/day

Underweight BMI

Healthy weight BMI

18.5-24.9

Overweight BMI

25-29.9

Obese BMI

over 30

s/s of poor protein-calorie malnourishment?

brittle hair, edema, poor wound healing

spoon shaped nails is a s/s of what?

iron deficiency

gingivitis is a s/s of

vit c deficiency

nursing considerations for pt with dysphagia

-thick liquids are easier to swallow

-ONLY drink fluids after clearing the mouth of food

-Use coughing or dry swallowing to remove food particles from the mouth

-rest before meals to avoid fatigue

-tell the pt to think of a food that promotes salvation to prevent dryness while eating

good protein source for vegan diet

hummus has the most but PB is a good second option

Recommendations are for infants to be breastfed for how long?

first 6-12 months

water and formula should be avoided the first 6 months unless recommended by the dr

how often to breastfeed?

awaken the infant to breastfeed Q3hrs during the day and Q4hrs at night

*15mins per breast

good choices for toddler foods?

banana, toast strips, graham crackers, noodles, cheese cubes, peeled chunks of apples, pears or peaches

full liquid diet includes?

foods that are liquid at room temp such as ice cream and strained cereal, sometimes pureed vegetables,

clear liquid diet

Water, tea, coffee, fat free broth, carbonated beverages, clear juices, ginger ale and gelatin

mechanical soft diet

foods that require minimal chewing

ex: ground meat, chicken or tuna salad, eggs, soft or canned fruit

DASH diet

sodium intake of 1,500mg or less

-AVOID canned soup, sauces, potato chips, pretzels, smoked meat, seasonings, processed foods

-low fat dairy

-fruits and veggies (apricots, tomatoes, peaches, bananas)

-limit alcohol

iron rich foods

meat, fish, poultry, tofu, dried peas and beans, whole grains, dried fruit

IBD (inflammatory bowel disease) diet (Crohn's disease)

low residue, high protein, high calorie

type 1 diabetes mellitus

diabetes in which no beta-cell production of insulin occurs and the patient is dependent on insulin for survival

type 2 diabetes

insulin resistance

Hyperglycemia S/S

3 P's (polydipsia, polyuria, polyphagia), fruity breath, headache, decreased LOC

Hypoglycemia S/S

mental confusion, sweating, palpitations, headache, lack of coordination, blurred vision, seizure, coma

(think of a drunk person)

IBS diet

avoid chocolate, fatty foods, alcohol, carbonation, coffee, high protein diet, dairy products, processed foods like chips and cookies, refined bread and cereal (not whole grain). Drink water, small meals, decrease stress and anxiety, eat slow, relaxation therapy, no distractions while eating, exercise

Folate rich foods

Dark green leafy vegetables (turnip greens, spinach, romaine lettuce, asparagus, Brussels sprouts, broccoli)

Beans.

Peanuts.

Sunflower seeds.

Fresh fruits, fruit juices.

Whole grains.

Liver.

Seafood.

What position to place dysphagia pt in for feeding?

high fowler