NEP-2380 Unit 3 Exam

What are functions of water in the body?

- Carries nutrients and waste products

-Maintains structure of large molecules

-Participate in metabolic reactions

-Serves as a solvent (things dissolve in water)

-Acts as a lubricant and cushion

-Aids in the temperature regulation of body temperature

-Maintains blood volume

What is thirst and does it relate to the body's need for fluids?

-Conscious desire to drink

-Lags behind the body's need to drink

-Blood becomes more concentrated than Na

-Normally through thirst, kidney adjustment can alleviate fluid imbalance

dehydration

-From water deprivation or excessive water losses

intoxication

-From excessive ingestion with kidney disease that reduce urine output

-Can occur with endurance exercise with excessive sweating and water only ingestion

-Hyponatremia: low Na in blood

What are the three sources of fluid input? How do they contribute?

- Liquids = 550-1500 - Foods = 700-1000

- Metabolic water = 200-300

-Breakdown of CHO, fat, pro, resulting in ATP, CO2, and H2O

sources of fluid output

a. Kidney = 500-1400 (sensible)

-Urine

-Variable based on fluid intake

-Minimum needed to get rid of waste (obligatory loss)

b. Skin = 450-900 (insensible)

-Sweat

-Variable based on climate and activity, fitness level

c. Lungs = 350 (insensible)

-Water vapor loss during breathing

d. Feces = 150 (sensible)

-Increased losses with diarrhea

dilute/concentrated urine output and obligatory loss

-normal excretion = 500mL/day (obligatory loss)

-diluted urine excretion = more than 500 mL (clear pee)

-concentrated urine excretion = less that 500 mL (yellow pee)

Why is the AI for total water so much greater than drinking 8 glasses of water?

AI includes all the fluid needs for both fluid you drink and what you get in food

What are good sources for fluid intake?

-Water

-coffee/tea

-Milk

-fruit/veggie juices

-unsweetened/artificially sweetened beverages

-NOT ALCOHOL

-Sugar sweetened beverages

Can caffeinated beverages be counted toward your total fluid intake?

yes

Metric volumes for fluid measurement

1cc = 1mL

1 fluid oz = 30 cc = 30 ml

What is a critical period in pregnancy?

time of intense development and rapid cell division

fetal programming

Mother's nutrition alters gene expression in fetus

May lead to chronic disease in adulthood

-Maternal malnutrition associated with type 2 diabetes

What is the recommended weight gain in pregnancy for a normal weight adult?

25-35 pounds

Why would an underweight or overweight pregnant women have different recommendations for weight gain?

recommendations depend on the fat mass the woman has prior to pregnancy

Why are we concerned about infant birthweight?

infants birth weight is a predictor of health and development

general pattern of weight gain through pregnancy and increased energy needed

i. First trimester: no increased energy needed

-Total weight gain is 3-5 pounds

ii. Second trimester: 340 kcals extra

-Weight gain = 1 pound per week

iii. Third trimester: 450 extra kcals

-Weight gain = 1 pound per week

why are CHO needs increased during pregnancy

fetal brain needs glucose for an energy source

why are protein needs increased during pregnancy

anabolism

-gaining tissue

-fetus is growing

why are essential fatty acids needs increased during pregnancy

for brain development

What vitamins and minerals are needed in increased quantity for RBC and cell growth?

Folate, Vitamin B12, and Iron - increased synthesis for new cells

What vitamins and minerals are needed in increased quantity for bone development?

Vitamin D and calcium

Which vitamins and minerals may need to be supplemented to meet a pregnant woman's needs?

i. iron

ii. vitamin D

iii. Calcium

What is considered a LBW infant?

less than 5.5 lb

gestational diabetes

-a type of diabetes that can develop during pregnancy in women who don't already have diabetes

-Fetal consequence: macrosomia (large birth weight baby)

-Tx: consistent CHO intake (first) and insulin if needed

gestational hypertension

-Elevated BP in 2nd trimester

-Returns to normal after delivery

Pre-eclampsia

-Symptoms: high BP; protein in urine; sudden weight gain

-Risks to mom: miscarriage; decreased blood flow to different organs

-Risks to fetus: decreased fetal growth

-Will completely go away as soon as the baby is born

eclampsia

Symptoms: sudden seizures and coma

How does maternal age affect pregnancy risk?

i. Adolescent

-Decrease risk with prenatal care and adequate weight gain

ii. Older adults

-Older than 35

-Chronic conditions

-Maternal death rate

-Increased preterm birth

-Genetic abnormalities

What are the two hormones that affect lactation and what do they do?

-Prolactin: milk production

-Oxytocin: milk ejection

How does the mother's need for energy change with breastfeeding?

an extra 500 kcals is needed to be eaten a day

What happens to breastmilk when vitamins and minerals are inadequate?

Inadequate intake affects QUANTITY not QUALITY of breastmilk

How does weight and length change in the first year for an infant?

weight doubles by 6 months and triples by one year, length is increased by 50% by year one

Why is plotting the infant's growth chart important in assessing an infant?

you can determine whether the child is following an expected growth pattern

How does the relative energy requirement (kcal/kg) of an infant compare to an adult's?

twice the adult need per body weight

Why do the proportions of CHO, fat and protein for infants differ from adult recommendations?

CHO: greater need due to relative brain size

FAT: primary source of energy

PRO: want adequate but not excessive amount

-protein and fat have a different ratio than CHO would for babies compared to adults

Why is dehydration more of a concern for infants?

-greater percent body is water with most extracellular

-immature kidneys

What factors in breastmilk make it superior to infant formula?

1. Immunological protection

2. Sterile

3. Colostrum

-Pre-milk

-not many nutrients but provides immunological protection

4. oligosaccharides/Bifidus factors: increase the growth of lactobacilli's bifidus

5. Decreased allergies

6. Weight loss (advantage for mom)

7. Decreased expense

What causes baby bottle tooth decay?

when a child goes to bed with a bottle filled with milk or juice — anything except water.

When are complementary food introduced? Why?

6 months

a. Developmental Readiness

b. Purpose: provide nutrients not adequately provided by breastmilk alone

What foods should never be given to an infant?

a. Choking hazards

b. NO concentrated sweets (for two years)

c. NO honey or corn syrup

d. Milk until 1 year of age

After one year, how does appetite and food intake change in a child?

a. Appetite: declines after 1 year of age

b. Food Intake corresponds to growth pattern!

Should healthy children be given vitamin and mineral supplement?

only needed if children don't eat nutrient dense foods

(except for vitamin D)

How do we assure that children meet their micronutrient needs?

offer a diet full of healthy, colorful foods rich in plants

What affect does skipping meals have on behavior?

decreased attention, irritable, apathetic

What affect does iron deficiency have on behavior?

-Can affect attention

-Intellectual performance

Does sugar cause hyperactivity?

no

food allergy vs. food intolerance

food allergy:

-immune response

-anaphylaxis

food intolerance

-NO immune response

-often GI symptoms

-no anaphylaxis

What are factors contributing to childhood/adolescent obesity?

-Parental obesity

-Diet

-Inactivity and screen time

What is the effect of childhood obesity on growth

-Early puberty

-Early cessation of growth

What is the effect of childhood obesity on physical health

-Dyslipidemia (high TG, total Cholesterol, LDL)

-HTN

-Type 2 diabetes

-Increased risk of adult obesity

What is the effect of childhood obesity on psychological development

-Prejudice

-Poor self-image

-Passive approach to life

What is the goal for weight management for obese children?

to improve BMI by reducing weight gain

What are strategies to combat obesity in children?

-Parents: role model

-Physical activity

-Psychological support

-Behavior change

-Extreme conditions

Why is it so important that adolescents meet their vitamin D and Ca requirements

to build strong bones and fight bone loss later in life

food consumption habits that are common to adolescents

1. Family meals lead to increased F, V, Ca rich foods

2. Skip breakfast

-Increased BMI

3. Fast food

-Adolescence are the greatest consumers

4. Snacks

-¼ of food intake

5. Beverages

-Sugar sweetened beverages replace milk

How does body composition change with age (older adults)?

-LBM decreases

-Sarcopenia: decreased muscle mass and strength

-Osteoporosis: weakening of bones (porous)

-Increased risk with obese

How can you prevent these age-related changes?

-Physical activity

-Adequate nutrition, especially protein

affect of Decline in GI function in older adults

a. Slowed GI motility

-Constipation

b. Decreased appetite

c. Atrophic gastritis

d. Dysphagia

affect of tooth loss in older adults

a. Inadequate dental care over a lifetime

b. Effect on food intake

-Limits food selection

affect of Psychological changes in older adults

a. Depression common

b. Affects appetite and motivation for health habits

affect of economical changes in older adults

a. fixed income

affect of social changes in older adults

example:

-spouse dying

-nursing home

How does energy need change in the older adult?

energy needs decline

Why does energy density become more important in older adults?

restore nutritional health

how is water affected by age change?

thirst response lessened

-dehydration associated with UTI, confusion, pneumonia

how is vitamin B12 affected by age change?

Atrophic gastritis

-inflammation in stomach that causes decreased stomach function

-hydrochloric acid and intrinsic factors in the stomach absorbs vitamin b12

-damage to the stomach could cause vitamin b12 to be absorbed less

how is vitamin D affected by age change?

-Changes in synthesis of D in skin

-Changes in kidney's ability to activate vitamin D

-Supplements often necessary

how is iron affected by age change?

iron levels increase with age

What are programs or policies discussed in class that are designed to help to improve the nutritional health of older Americans?

1. Congregate meals

-Columbia senior center

2. Meal delivery

-Meals on wheels

What is the purpose of nutrition assessment?

1. Identify by assessing those at risk for malnutrition

2. Determine diagnosis and intervention

What types of data might be used in a nutrition assessment?

1) historical information

2) food data

-24 hour recall, food frequency, food record, observation

3) anthropometric data

-height, weight, head circumference, muscle/fat measure

4) Biochemical data

-urine and blood

5) physical exam

24 hour recall

ask individual what they ate in the last 24 hours

food frequency

-what is typical for the individual to eat

-patient needs to be able to read

food record

-journal everything you eat, how it was consumed, how much, etc

-can change your behavior when you have to write down what you eat

observation

-health care setting

-calorie count

Why is it important to not just look at a person's body weight when assessing someone's risk for malnutrition?

there are other ways to measure malnutrition

malnutrition

any condition caused by excess or deficient food energy or nutrient intake or an imbalance of nutrients

-excess, deficiency, or imbalance

What are some causes of adult malnutrition?

-Decreased dietary intake

-Increased requirements

-Impaired absorption

-Altered nutrient utilization

what are the clinical characteristics used to diagnose malnutrition? (ADA/ASPEN)

a. Insufficient energy intake

b. Interpretation of weight loss

c. Loss of body fat

d. Loss of muscle mass

e. Localized or generalized fluid accumulation (edema)

f. Reduced grip strength

enteral feeding

-Provides nutrients using the GI tract

-Tube feedings directly into the stomach or small intestine

-Placement of the tube feeding is specific to the needs of the patient

When might a tube feeding be warranted?

people with

-Swallowing D/O

-Upper GI motility issues

-GI obstruction and fistula-bypassed with TF (Fistula: abnormal connection between organs)

-Mechanical ventilator

-Very high nutrient requirements

-Poor appetite over extended time especially if malnourished

-Altered mental status

When is a tube feeding not appropriate choice for nutrition support?

-Severe GI bleeding

-High-output fistulas

-Intractable vomiting or diarrhea

-Complete intestinal obstruction

-Severe malabsorption

When are oral supplements used?

When someone is unable to absorb nutrients needed for life

What are some common oral supplements?

-usually liquid

-high in calories and protein

Describe tube feeding placements—points of insertion and termination. What are some considerations for tube feeding placement?

Short term (less than 4 weeks)

-Nasogastric

-Nasojejunal or nasoduodenal

-Try to use as much of the GI tract as possible

Long term or can't use nasal passage

-Use stoma (opening)

-Gastrostomy

-Jejunostomy

Describe types of tube feeding formulas from a nutrition standpoint

(energy needs, fluid requirements, fiber, osmolality, allergy).

Standard

-commercial or blenderized foods

Elemental

-CHO and PRO that are partially/fully hydrolyzed

-predigested for damaged stomachs

Specialized formulas

-Specific disease state

Modula

-Contain single macronutrient

Discuss methods of feeding delivery—bolus, intermittent and continuous. Which delivery method is tolerated into the small intestine?

Bolus

-Large volume given by syringe every 3-4 hours

-Tolerated into stomach

-No equipment

-Mimics normal eating times

Intermittent

-Infused over 30-45 minutes

-Tolerated into stomach

Continuous

-Slow and constant (8-24 hours)

-Hooked up to tube feeding formula

-Tolerated into small intestine

What is the purpose of water flushes?

-Clogging

-Water needs

open vs. closed enteral feeding system

Closed

-Packaged where you can directly take the bottle with the formula in it and put the tube in it and transfer it to the patient

-Never leaves the bottle

-Sterile

Open

-Transfer it from original container into something that can be used to get the nutrition into the individual

-Examples: Powder, Canned, Etc

does an open or closed enteral feeding system have a higher risk of contamination

open

What is parenteral nutrition?

nutritional feeding through the vein

Who is a candidate for parenteral nutrition?

1. Severe GI bleeding

2. High output fistula

3. Intractable vomiting or diarrhea

4. Complete intestinal obstruction

5. Severe malabsorption

6. paralytic ileus (intestinal paralysis)

*not used if patient is well nourished and not able to eat for 7 days

PPN vs. TPN

PPN

-peripheral vein

-short term use

-limited quantities of nutrients supplied

-fewer complications

TPN

-central vein

-longer term support

-greater nutrient concentration

-best for those on fluid restriction

What are the ingredients in parenteral nutrition?

-protein: amino acids

-CHO: glucose (dextrose) - supply energy

-lipid emulsions: supply EFA + energy

-fluids and electrolytes: adjusted to patient needs for fluid/electrolytes and acid/base balance

-vitamins and trace minerals

parenteral nutrition formulas

Two in one

-dextrose, AA, fluids, electrolytes, vitamins, trace, minerals

-lipids separate

Three in one

-everything else

formula delivery

1) Continuous

-critically ill

2) Cyclic

-Long term use

-Allow more freedom

-8-14 hours

What are common complications with TPN?

-hyperglycemia

-hypoglycemia

-hypertriglyceridemia

-refeeding syndrome

-liver disease (fatty liver)

-gall bladder disease

-metabolic bone disease

-infection

What is refeeding syndrome?

-rapid refeeding after a period of under-nutrition

-results from hormonal and metabolic changes associated with starvation

-with feeding, blood glucose increases which leads to increased insulin and anabolism (fluid and electrolyte imbalance)

-start slowly

Why is enteral preferred to parenteral nutrition if at all possible?

it is more physiological, simpler, cheaper and less complicated