WGU Nutrition D440 Comprehensive Study Guide

Underweight

BMI under 18.5

Normal weight

18.5-24.9

Overweight

25-29.9

Obese

BMI over 30

Extremely Obese

BMI > 35

Calculate BMI

weight (kg) / height (m^2)

weight management strategies and actions

Management of the eating behavior (food diary, where why, how, and how much)

Promoting physical activity to increase energy output

Pursuit of emotional (stress), social, and psychologic health

Define problem behavior

Record and Analyze Baseline Behavior

Plan a Behavior Management Strategy

How do we assess nutritional status?

Physical appearance (health of eyes and hair)

anthropometric measurements (weight, body composition)

biochemical markers (blood lipid levels, iron status)

What is recommended for an infant diet during the first year of life?

Breastfeed for at least the first full year of life, and supplement with a vitamin K shot at birth and daily vitamin D drops

What is recommended for a child who is not breastfeeding?

Use iron-fortified formula for any infant who is not breastfeeding

What age should water and juice be avoided?

Water and juice are unnecessary for the breastfed infants during the first 6 months of life

When should you introduce cow's milk?

at the end of the first year. Provide whole milk, not reduced-fat or fat-free milk, until 2 years of age

What allergens should be avoided as first solid foods?

wheat, egg white, citrus juice, and nuts

What should you not give a child under one year of age to avoid botulism toxicity?

Honey and corn syrup

Which foods should be avoided until children are older because they are a choking hazard?

hot dogs, nuts, grapes, carrots, popcorn, cherries, peanut butter, and round candy

What are the energy needs of an infant?

80-120 calories per kg of body weight

What protein source do babies need the first 6 months of life?

breastmilk

What protein sources do babies need after 6 months of life?

Ground turkey, chicken, cheese, yogurt, and other dairy products

What percent of daily calories are recommended for carbohydrates?

45-65%

What percent of daily calories are recommended for fats?

20-35%

What percent of daily calories are recommended for proteins?

10-35%

What is needed prenatally for a client?

Folate, Vitamin D, and Choline

What are some risks with teen pregnancy?

increased rates of low birth weight, preterm delivery, and infant mortality.

How many calorie should be added to a diet of a pregnant woman in the first trimester?

none

How many calories should be added to a diet of a pregnant woman in the second trimester?

+300 kcal/day

How many calories should be added to the diet of a pregnant woman in the third trimester?

+500 kcal/day

What is the carb requirement for the diet of a pregnant woman?

Minimum carb req. increases from 130 g/day to 175 g/day. Focus on whole grains, legumes, fruits, and vegetables.

What is the fat requirement for the diet of a pregnant woman?

Minimum fat req. increases from 12 g/d to 13 g/d

What is the alpha-linolenic acid requirement for the diet of a pregnant woman?

alpha-linolenic acid increases from 1.1 g/d to 1.4 g/d –

What foods can add alpha-linolenic acid to the diet?

flax, chia, canola, walnut, soybean oil

How much protein should be consumed in the diet of a pregnant woman?

Protein – 46 g/day to 71 g/day

What protein should pregnant women consume to meet their daily requirements?

– eggs, milks, beef, poultry, fish, pork, cheese, soy products, and other animal products

What additional nutrients are needed for the diet of a pregnant woman?

Calcium, Iron, Vitamins, Folate, Vitamin D, Choline

What is the role of folic acid in pregnancy?

Folic acid – Important for DNA synthesis, cell division, and hemoglobin synthesis

When is folic acid most important for a developing fetus?

Important 2 months prior to week 6 of gestation to ensure adequate nutrient availability in the endometrial lining of the uterus for embryonic tissue development.

What does folic acid do for the developing fetus?

The neural tube forms during the critical period from 21 to 28 days gestation and it grows into the mature infant’s spinal column and its network of nerves. Full closure of the neural tube requires sufficient folate.

What is the recommended calorie increase for a breastfeeding mom during the first six months of breastfeeding?

1st 6 months: 330 kcal/day (plus 170 kcal/day from maternal stores)

What is the recommended calorie increase for a breastfeeding mom after the first 6 months of breastfeeding?

400 kcal/day

What is the recommended fluid intake for breastfeeding mothers?

3L/day

What considerations do you need to take when doing nutritional education to clients of differing religions and cultures?

Consider food restrictions on certain days, certain foods, liquids (alcohol and caffeine), how the food is prepared (certain foods mixed and how the food is cooked)

What is dysphagia and where is it typically seen?

Difficulty swallowing - chronic, common among patients with Alzheimer's, Parkinson's, and stroke complications, head and neck cancer, tooth loss, xerostomia, neurodegenerative, neuromuscular disorders, post-intubation trauma, muscular weakness of the larynx

What are some behaviors seen in patients with dysphagia?

Reluctance to eat certain food consistencies or any food at all.

-Very slow chewing or eating

-fatigue from eating

-frequent throat clearing

-complaints of food “sticking” in the throat, pockets of food held in the cheeks

-painful swallowing, regurgitation, coughing or choking ---

-silent aspirations.

Adapt the diet to individual needs in stages of thickened liquids and pureed foods

Which consults would you do with a patient with dysphagia?

Registered dietician nutritionist (RDN), Speech-lang`1uage pathologist, Occupational therapist

TPN

total parenteral nutrition (IV feeding)

Continuous PN

Infused continuously over 24 hours, most used in a hospital setting

Intermittent or cyclic PN

Nutrient solution infusion regimen varies and is commonly administered overnight. Allows clients requiring PN on a long-term basis to participate in activities of daily living during the day without the inconvenience of an IV bag and pump set. Monitor glucose levels closely to avoid hypoglycemia

Who must assess nutritional status before PN is discontinued?

Evaluation of nutritional status by a nutritionist is done before PN is discontinued

What must be done in order to prevent hypoglycemia when discontinuing PN?

If PN discontinued, gradually decrease the flow rate for 1-2 hours while increasing oral intake (helps prevent hypoglycemia)

What must you do to site of IV catheter in order to lower the risk of infection?

After removal of IV catheter, daily dressing change until insertion site heals. Being left in increases risk of infection

What must you do for a patient who had PN removed?

Encourage oral nutrition

Record oral intake, body weight, and laboratory results of serum electrolyte and glucose levels

What are some complications of PN?

Pneumothorax and air embolism associated with central line placement: air embolism also associated with tubing changes

Other complications include infection (catheter-related), hypervolemia, and metabolic alterations such as hyperglycemia and hypoglycemia (usually caused by PN solution)

PEG

percutaneous endoscopic gastrostomy (feeding tube)

Why is a feeding tube needed?

Used when the gastrointestinal tract is functional but oral intake is not meeting estimated nutrient needs

What conditions might a client have that will require a feeding tube?

Used for clients with swallowing problems, burns, major trauma, liver, or other organ failure, or severe malnutrition

When is a PEG tube used?

Placed into stomach by surgeon if patient is not at risk for aspiration

Enteral

Provides liquefied foods into the gastrointestinal tract via a tube

When is enteral used?

Used when the gastrointestinal tract is functional but oral intake is not meeting estimated nutrient needs

Used for clients with swallowing problems, burns, major trauma, liver, or other organ failure, or severe malnutrition

___________ feedings preserve gut function and are less invasive and less expensive than parenteral nutrition. Maintaining some level of gut function helps to prevent atrophy of the GI tract.

Enteral tube

Types of enteral tubes

nasogastric and nasaljejunal/nasalduodenal

When is a nasal gastric tube used?

If is required for less than 4 weeks, tube is usually inserted into the stomach through the nose

When is a nasojejunal/nasoduodenal tube used?

If at risk for aspiration, reflux, or continual vomiting.

How is a nasojejunal/nasoduedenal tube placed?

Tube passes through the nose, down the esophagus, through the stomach, and into the proper location of the small intestine by peristaltic activity, endoscopic, or fluoroscopic guidance. Use of X-ray to verify placement

What is stomatitis?

Inflammation of the oral mucous lining of the mouth

What is the treatment/diet for stomatitis?

Eat foods that are soft and east to chew and swallow

Moisten foods with gravy, broth, or sauces

Avoid alcohol and known irritants such as acidic, spicy, salty, and coarse-textured foods (crunchy foods)

Cook foods until they are soft and tender, or cut foods into small bites

Eat foods at room temperature

Supplement meals with high-calories, high-protein milkshakes or smoothies

Maintain good oral hygiene

Numb the mouth with ice chips or flavored ice pops

Radiation of the head, neck or esophagus

disturbs the oral mucosa and salivary secretions, thereby affecting taste sensations and sensitivity to food texture and temperature. Resultant anorexia and nausea may exacerbate malnutrition.

Radiation to the abdominal area

compromises the intestinal mucosa, causing a loss of villi and possibly nutrient malabsorption. Tissue breakdown may cause ulcers, inflammation, obstructions, or fistulas, and these conditions interfere with the normal function of the involved tissue.

Dietary choices and physical activity

are the most modifiable risk factors for cancer prevention

What does the American cancer society suggest about your weight in order to prevent cancer?

Be as lean as possible within normal range of body weight throughout life. Balance caloric intake with physical activity. Avoid excessive weight gain at all ages.

What does the American Cancer Society suggest about exercise for children and adolescents in order to prevent cancer?

participate in at least 60 minutes every day of moderate to vigorous physical activity, with vigorous physical activity included at least 3 days per week.

What does the American Cancer Society suggest about exercise for adults in order to prevent cancer?

engage in at least 150 minutes of moderate intensity or 75 minutes of vigorous physical activity each week. Limit sedentary behaviors.

What does the American Cancer society suggest that you eat in order to prevent cancer?

Consume a healthy diet that has an emphasis on plant-based food.

What does the American Cancer Society recommend about alcohol intake?

limit intake to two drinks per day for men

one drink per day for women

One drink is defined as 12 oz of beer, 5 oz of wine, or 1.5 oz of 80-proof distilled spirits.

What does the American Cancer Society recommend about dietary supplements?

Meet nutrient needs through diet alone; do not rely on dietary supplements

What does the American Cancer Society recommend about infant diets?

Aim to breastfeed infants exclusively for 6 months and continue to breastfeed for at least 1 year while offering complementary food after 6 months.

What factors help support glycemic management?

pharmacology (insulin injections, oral medications), healthy eating, regular physical activity, and glucose monitoring.

What should you do when assessing fatigue?

Assess tolerance for activities. Provide assistance and support as needed for maintaining bed or chair positions.

Frame size

the persons height (in centimeters) divided by their wrist circumference (in centimeters)

Conditions associated with being underweight

Wasting disease, poor food intake, malabsorption, hormonal imbalance, low energy availability, poor living situation

Who is the most at risk for malnutrition?

pregnant women, infants, children, and elderly adults.

How do we encourage adequate food intake?

Food Assistance Programs

Commodity Supplemental Food Program

Supplemental Nutrition Assistance Program

(WIC)

School Meals Program

Clear liquid

Clear juices that do not contain pulp. Examples: apple or cranberry juice, gelatin, popsicles, and clear broths. Prescribed for patients with gastrointestinal (GI) problems, before (preoperatively) and after surgery. (postoperatively), and before some diagnostic tests.

Full liquid

Foods that are or may become liquid at room or body temperature. Examples: juices (including those with pulp), milk and milk products, yogurt, strained cream soups, and liquid dietary supplements. Used to advance a patient with GI disturbances, after having dental work performed, and for those patients who cannot tolerate solid food.

Mechanical soft

As for clear and full liquid and pureed, with addition of all cream soups, ground or finely diced meats, flaked fish, cottage cheese, cheese, rice, potatoes, pancakes, light breads, cooked vegetables, cooked or canned fruits, bananas, soups, peanut butter, eggs (not fried)Food consistencies that have been modified such as ground meat or soft cooked foods. They are also used for persons who have difficulty chewing effectively.

Thickened liquids

Used for patients who have difficulty swallowing and are at risk for aspiration. Liquids are thickened by adding a commercially prepared thickening agent. Avoid nuts, seeds, and other hard or raw foods to decrease the risk of aspiration.

Regular/general

There are no dietary restrictions. The diet is intended to supply patients with a balanced diet of essential nutrients. -

Diabetes (ADA)

Prescribed to control the amount of calories by controlling the carbohydrate intake. Avoid high glycemic index foods that raise the body's blood glucose concentration rapidly. Complex carbohydrates from vegetables and fruits are preferred to simple carbohydrates, sugars, and starchy foods, such as bread or pie

Cardiac

Used to control the dietary intake of certain foods that contribute to conditions that affect the cardiovascular system. They typically consist of low cholesterol and low

sodium dietary items. Cardiac diets minimize the intake of animal products, which contain cholesterol, and soups and processed foods such as pickles and lunch meats, which are high in sodium.

DASH diet

Dietary approaches to stop hypertension. 4-6 servings of fruit, 4-6 servings of veggies, 2-3 servings of low-fat dietary foods per day, in addition to lean meats, nuts, seeds, died beans, and high fiber grains. combined with a low sodium diet. -- used for HTN

AHA dietary

a variety of foods, fresh fruits, and veggies, fiber-rich whole grains, nuts, legumes, and fat-free or low-fat dietary products. choose lean meats, eat a variety of fish, monounsaturated and polyunsaturated fats instead of topical oils or other saturated fats. Limit saturated fats to 5-6% of total cal per day. Avoid trans fats, limit sodium intake to 1500 mg, limit red meat, processed meat, and refined carbs, and consume less nutrient-poor foods. limit alcohol, and follow portion sizes. No smoking.

Heart failure diet

Fluid restriction and sodium restriction

Renal diet

Restrict potassium, sodium, protein, and phosphorus intake. Fresh fruits (except bananas) and vegetables are excellent dietary choices for individuals on a renal diet. Meats, processed foods, peanut butter, cheese, nuts, caramels, ice cream, and colas are typically allowed in limited quantities or contraindicated.

Fluid intake for renal diet

1000 ml per day

Sodium intake for renal diet

ess than 2.4 grams per day

Potassium for renal diet

2.4 grams per day

Limit for phos renal diet

800-1000 mg per day -

Limit to calcium in renal diet

2 gram per day (include calcium supplements)

Glomerulonephritis

No major changes to diet at this time. monitor I and O status.

Nephrotic syndrome -

Pro: 0.8-1.0 high biologic value. It may need to restrict with elevated BUN and decreased UOP.

nephrotic syndrome energy requirements

adequate. complex carbs combat catabolism and prevent ketosis.

nephrotic syndrome fat requirements

not to exceed 30%.