Nutrition-Final Exam

Dysphagia; Safe practices for oral intake-look at box 19.2

1. Positioning: Ensure the person is sitting upright at a 90-degree angle during eating and for at least 30 mins afterward.

2. Food consistency: Modify the texture of the food to make them easier to swallow. Like pureeing foods or thickening liquids

3. Small bites and sips: Encourage taking small bites of food and sips of liquid to reduce the risk of choking

4. Pacing: allow plenty of time for meals to avoid rushing, which can increase the risk of aspiration

5. supervision: Supervise meals to ensure safe swallowing techniques are being used.

6. Oral care: Maintain good oral hygiene to reduce the risk of infections or complications

Levels of dysphagia diet-Table 19:2; Level 1, Level 5; Level 6

Level 1: “Pureed diet” Level seined for individuals with severe swallowing difficulties

1. texture: All foods should be pureed to a smooth, pudding-like consistency without any lumps

2. Foods: Examples include pureed meats, vegetables, fruits, and starches like mashed potatoes

3. Liquids: Thickened liquids may be required to ensure safe swallowing.

   Level 5: Minced and moist diet

   1. Texture: Foods are minced or Finley chopped to pieces no larger than 4 mm. They should be moist and require minimal chewing.

   2. Foods: Examples include minced meats, Finley chopped vegetables, and soft fruits

   3. Liquids: May still require thickened liquids depending on the individual’s needs

      Level 6: Soft and bite-sized diet:

      1. Texture: Foods are soft, tender, and easily chewed. Pieces should be no larger than 1.5 cm.

      2. Foods: Examples include soft-cooked vegetables, tender meats, and soft fruits

      3. Liquids: The need for thickened liquids will depend on the individual’s swallowing ability.

Foods that will help with nausea/recovery from GE bug

1. Clear broths

2. bananas

3. Rice

4. applesauce

5. toast

6. ginger

7. electrolyte drinks

Peptic ulcer disease: diet is individualized; avoid foods if they bother you; most common risk factor is..

Most common risk factor is H. Pylori

What role does H. Pylori play in PUD

1. Colonization: Colonizes the stomach lining, where it can survive in an acidic environment by producing an enzyme called urease, which neutralizes stomach acid.

2. Inflammation: Presence of bacteria causes inflammation (gastritis) in the stomach lining. This inflammation can weaken the stomach’s defenses against the harsh gastric acids

3. Damage: weakened stomach lining becomes more susceptible to damage from stomach acids, leading to the formation of ulcers.

Dumping syndrome-appropriate food choices (low lactose, low sugar, low fiber, low volume of intake per meal)

1. Low lactose foods: Lactose-free dairy products, hard cheeses, and lactose-free milk

2. low-sugar foods: Avoid sugary foods and drinks. Opt for complex carbohydrates like whole grains in small amounts.

3. low fiber foods: Refined grains, like white bread and pasta, avoid high-fiber foods like raw vegetables and whole grains

4. Small portions: Eat smaller, more frequent meals throughout the day to avoid overwhelming the digestive system.

Early, intermediate, and late symptoms of dumping syndrome

Early: within 30 mins

-Nausea

-vomiting

-abdominal cramps

-diarrhea

-dizziness

-increased heart rate

Intermediate: 30mins to 1 hour after eating

-bloating

-gas

-abdominal pain

Late symptoms (1-3 hours)

-weakness

-sweating

-dizziness

-rapid heart rate

-hunger

-confusion

GERD: Safe practices to improve symptoms, what is a risk of prolonged, untreated GERD?

Avoid laying down 30 minutes after meals, late night snacking, peppermint, chocolate, spicy foods, acidic foods, weight loss can help too. If left untreated, can lead to adenocarcinoma, Barret’s esophagus.

Nausea and vomiting that does not go away could be concerning for what?

Persistent nausea and vomiting that doesn’t improve could be concerning for underlying medical conditions such as gastritis, ulcers, gastrointestinal obstruction, or even more serious issues like pancreatitis or appendicitis.

Anorexia: What practices help patients experiencing loss of appetite?

-Eat small, frequent meals instead of large ones

-focus on nutrient-dense foods that offer more calories and nutrients in smaller portions.

-Keep easy-to-eat snacks handy, like yogurt, cheese, or nuts

-Stay hydrated, but avoid drinking large amounts of fluids before meals

-try to make meals more appealing by varying colors, textures, and flavors.

-sometimes, gentle exercises can help stimulate appetite.

celiac disease- what foods are OK and what foods to avoid; both gluten free foods and foods to avoid.

Food to avoid

-wheat

-barley

-rye

-triticale

-malt

-Brewer’s yeast

Gluten-Free foods:

-fruits and vegetables

-meat and poultry (not breaded or marinated)

-fish and seafood

-dairy products

-beans, legumes, and nuts

-gluten-free grains, like rice, quinoa, corn, and buckwheat

-gluten-free flours like almond, coconut, and chickpea flour

Cholecystitis-what foods are the best; diet guidelines; be able to pick out a sample meal for this patient

Best foods:

-Lean proteins like chicken, turkey, and fish

-Low-fat dairy products

-whole grains like brown rice, quinoa, and oats

-fruits and vegetables

-healthy fats in moderation, like olive oil and avocado

Diet guidelines:

-avoid fried and fatty foods

-Eat smaller, more frequent meals

-stay hydrated with plenty of water

-Limit caffeine and alcohol

Sample meal:

-Grilled chicken breast with a side of steamed broccoli

-quinoa salad with mixed greens, cherry tomatoes, and a light vinaigrette

-fresh fruit for dessert, like a bowl of berries

Colostomy-what recs would you provide to a patient about their diet?

Diet Guidelines:

-eat small, frequent meals

-chew food throughouly to aid digestion

-stay hydrated by drinking plenty of fluids

-introduce new foods one at a time to see how your body reacts.

Foods to include:

-Lean proteins like chicken, fish, and eggs

-well-cooked vegetables

-low-fiber grains like white rice and pasta

-bananas, applesauce, and other low-fiber fruits

Foods to avoid

-high fiber foods like raw vegetables and whole grains

-foods that cause gas or odor, like beans, onions, and carbonated drinks

-spicy foods and caffeine, as they can irritate the digestion system

High fiber diets- used for what diseases vs. low fiber and how to best incorporate into their diet (not too quickly)?

High-fiber diets:

-used for: constipation, diverticulosis, and to help control blood sugar levels in diabetes.

-foods to include: whole grains, fruits, vegetables, legumes, and nuts

-how to incorporate: Add fiber gradually to avoid bloating and gas Start with small amounts and increase slowly, making sure to drink plenty of water.

Low-fiber diets:

-Used for: Conditions like Crohn’s disease, ulcerative colitis during flare-ups, and after certain surgeries

-Foods to include: White bread, white rice, well-cooked vegetables without skins, and lean meats.

-How to incorporate: Stick to low-fiber foods and avoid raw fruits and vegetables, seeds, and nuts.

IBD-low fiber diet during the acute phase of the disease; which foods are included in this?

Low-fiber foods:

-white bread and refined cereals

-white rice and pasta

-lean meats like chicken, turkey, and fish

-well-cooked vegetables without skins or seeds (like carrots, potatoes, and sqaush)

-canned or cooked fruits without skins or seeds (like applesauce or canned peaches)

-eggs and tofu

Constipation-besides fluid, activity and fiber, what else can you do to include in the diet to help?

Probiotics: Yogurt with live cultures, kefir, or probiotic supplements can help balance gut bacteria

Healthy Fats: Adding healthy fats like olive oil, avocados, and nuts can help lubricate the intestines

Prunes and Prune juice: These are natural laxatives and can be really effective

Warm beverages: Drinking a warm beverage, especially in the morning, can help stimulate bowel movements

Why does Crohn’s disease cause diarrhea? Secretory vs. osmotic diarrhea.

Crohn’s disease causes diarrhea primarily due to inflammation in the intestines. This inflammation in the intestines can lead to both types of diarrhea.

osmotic diarrhea: occurs when there is high concentrations of non-absorbable substances in the intestines. These substances draw water into the bowel, leading to diarrhea.

-diarrhea usually stops once person stops consuming the offending substance

Secretory diarrhea: Results from the intestines secreting too much water and electrolytes into the bowel.

-diarrhea persists even when fasting.

low fiber diet-be able to choose an appropriate meal.

Breakfast: scrambled eggs with white toast (no seeds) and a glass of apple juice

Lunch: Grilled chicken breast with white rice and a side of cooked carrots

Dinner: Baked fish with mashed potatoes and steamed green beans

Snacks: Yogurt, cheese, and crackers, or a banana

lactose intolerance-cause; what happens to those who have lactose when intolerant

Caused by a deficiency of lactase, an enzyme produced in a small intestine. Lactase is needed to break down lactose, the sugar found in milk and dairy products. When someone with lactose intolerance consumes lactose, it isn’t properly digested and absorbed. Instead, it moves into the large intestine, where bacteria ferment it. This fermentation process produces gases and other byproducts, leading to symptoms such as:

-bloating

-gas

-diarrhea

-abdominal pain

Ileostomy s/p bowel resection: how should the RN advise the patient to advance their diet?

1. Start with clear liquids

2. Introduce low-fiber foods: like white bread, rice, pasta, and cooked vegetables.

3. Small, frequent meals

4. Stay hydrated

5. Avoid gas-producing foods

6. Chew thoroughly

7. monitor tolerance

8. consult a dietitian

Celiac disease- which food additives are you going to tell patients to avoid?

1. modified food starch

2. Malt flavoring or extract

3. hydrolyzed vegtable protein

4. dextrin

5. soy sauce

6. artificial colors and flavors

Liver transplant- pre-operative nutritional guidelines

1. High calorie diet: like nuts, seeds, avocados, and healthy fats

2. High-protein intake: Like lean meats, fish, eggs, dairy products, and legumes

3. Balanced Nutrients: Ensure a balanced intake of vitamins and minerals. This includes a variety of fruits, vegetables, whole grains, and dairy products to provide essential nutrients

4. Small, frequent meals

5. Avoid alcohol

6. Limit sodium

7. Hydration

8. Consult a dietitian

NAFLD-what recommendations should be included in the RN’s teaching

1.2-1.5 protein (more than the regular amount)

1. healthy diet

2. Weight management

3. Regular exercise

4. limit alcohol

5. monitor blood sugar

6. medications and supplements

7. regular check-ups

8. education on symptoms: Such as jaundice, swelling, and confusion

Cirrhosis- dietary teachings for this type of patient.

adequate protein and small, frequent meals, low-sodium diet, limit fat intake, avoid alcohol, vitamin and mineral supplements (especially vitamins A, D, E, and K, and hydration, and monitor for complications such as jaundice, confusion, and swelling.

Head and neck radiation-what are you concerned about nutritionally?

1. Difficulty swallowing (dysphagia): Radiation can cause inflammation and soreness in the throat, making it difficult to swallow. Soft, moist, and easy-to-swallow foods are recommended.

2. Loss of appetite: Radiation cann lead to a decreased sense of taste and appetite. It's important to encourage small, frequent meals and nutrient-dense snacks.

3. Weight loss: Unintended weight loss is common due to difficulty eating. High-calorie, high protein foods can help maintain weight and muscle mass. \

4. Dry mouth (Xerostomia): Radiation can reduce saliva production, leading to dry mouth. Sipping water frequently, using saliva substitutes, and eating moist foods can help.

5. Nutrient deficiencies: Ensure adequate intake of essential vitamins and minerals. Supplements may be necessary if the patient is unable to consume a balanced diet.

6. mucositis: Inflammation and ulceration of the mucuous membranes can make eating painful. Soft, non-acidic, and non-spicy foods are best.

7. Hydration

Chemo patients- usually feel best in the morning, so eat a large breakfast

1. High-calorie, high-protein breakfast: Eggs, yogurt, smoothies with protein powder, and whole-grain toast with nut butter

2. Nutreient dense foods

3. hydration

4. avoid nausea triggers

Metallic taste during chemo-what nutrition practices would you recommend to help?

1. Use plastic utensils

2. Flavor enhancers

3. Cold foods

4. seasonings

5. oral hygeine

6. avoid red meat

poor appetite during chemo-what would you recommend to help? Add caloric and protein dense foods

1. Small, frequent meals

2. High-calorie snacks

3. protein-rich foods

4. smoothies and shakes

5. Nutrient dense additions

6. easy to eat foods

Stomatitis-mouth sores-what nutritional interventions would you recommend?

Soft foods: Like mashed potatoes, yogurt, scrambled eggs, and smoothies

avoid irritants: like spicy, acidic, or salty foods

Cold foods: Ice cream, popsicles, and chilled smoothies can be soothing

Hydration: Keep hydrated with water, clear broths, and herbal teas

Nutrient rich: Protein shakes or meal replacement drinks if eating solid foods is too painful

oral care: maintain good oral hygiene but be gentle to avoid further irritation.

HIV/AIDS-what is the best diet? an individualized one! Patients with HIV/AIDS do not necessarily need to have more

1. balanced diet

2. Protein

3. Healthy fats

4. Hydration

5. nutrient dense foods

6. limit sugar and processed foods

Recovering from surgical resection due to cancer-what nutritional practices would you recommend-high protein!

1. High-protein foods

2. small, frequent meals

3. protein shakes

4. hydration

5. easy-to-digest foods

6. nutrient dense foods

Patients with cancer at the end of life- what nutrition recs would you provide them?

1. comfort foods

2. small portions

3. easy-to-eat foods

4. hydration

5. nutrient dense foods

6. listen to preferences

Biotherapy : What side effects can be expected?

flu-like symptoms

skin reactions: Rashes, itching, and redness at the injection site

digestive issues: nausea, vomiting, diarrhea, and loss of appetite

fatigue

allergic reactions: Swelling, difficulty breathing, and severe rashes, though those are less common

blood pressure changes: high or low BP

organ inflammation: liver, lungs, or heart, which is rare but serious

Nutritional practices that help lower the risk of cancer are:

1. Eat a variety of fruits and vegtables

2. Choose whole grain over refined grains

3. Limit red and processed meats

4. Reduce sugar and salt intake

5. Maintain a healthy weight

6. Stay hydrated

7. Limit alcohol consumptions

8. Include healthy fats

Nausea brought on by chemo-what can the nurse suggest that might help>

For nausea brought on by chemo, nurses might suggest ginger tea, peppermint candies, or small frequent meals might ease the discomfort. They also could recommend trying acupressure wristbands or prescribed anti-nausea medications to manage the symptoms effectively.

Neutropenic diet-what recs would the RN offer to help with food safety?

The RN might suggest avoiding raw or undercooked foods, including meats, eggs, and seafood. They’d also recommend washing all fruits and veggies thoroughly, avoiding unpasteurized dairy products, and steering clear of buffets or salad bars to reduce the risk of infection. Using proper food storage and handling techniques is super important too!

Diarrhea due to chemo-what recs can the RN offer to the patient?

Small, frequent meals that are low in fiber and fat. They could recommend drinking plenty of fluids to stay hydrated such as water, clear broths, and electrolyte-replenishing drinks. Avoiding dairy products, caffeine, and spicy foods can also help manage symptoms.

nephrotic syndrome-what should the nurse include in her nutrition teaching for this patient?

1. Low sodium diet

2. Adequate protein intake

3. Healthy fats

4. controlled fluid intake

5. Balanced diet

fluid allotment for a patient on dialysis

1. monitoring fluid intake

2. managing thirst

3. avoiding high-sodium foods

4. Weighing daily

when is the appetite best for a patient uremia?

Appetite is often best in the morning. Encouraging them to eat their largest meal when they feel most hungry can help ensure they get the necessary nutrients. Small, frequent meals throughout the day can also be beneficial to improve overall intake.

CKD: Necessary changes to diet and advice on how to follow this diet

1. Limit sodium

2. Control protein intake

3. monitor potassium

4. limit phosphorus

5. stay hydrated

Kidney stones-what should be decreased in the diet to avoid potential problems for more in the future?

1. Oxalate-rich foods: Cut high oxalates like spinach, beets, nuts, and chocolate

2. Sodium: Reduce salt intake to lower the amount of calcium in your urine

3. animal protein: Limit meat, eggs, and seafood, as these can increase uric acid and calcium oxalate stones.

4. Sugary foods and drinks

Nephrotic syndrome-which labs would you be worried about that would cause concern for worsening disease

You would be concerned about excess sodium and protein. Excess sodium can lead to fluid retention and worsen swelling, while too much protein can strain the kidneys. It’s also important to watch out for foods high in saturated fats and cholesterol since nephrotic syndrome can increase the risk of heart disease.

AKI: What lab value is very important to follow?

it’s very important to follow the serum creatinine levels. Creatinine is a waste product that the kidneys normally filter out of the blood, and elevated levels can indicate impaired kidney function. Monitoring blood urea nitrogen and electrolytes like potassium are also crucial.

Patient taking iron and erythropoietin for anemia due to CKD-what is the best route to give the iron?

it is best to give iron is usually IV. This method ensures that the iron is absorbed efficiently and helps to improve hemoglobin levels more effectively, especially since oral iron may not be as well absorbed in CKD patients.

Kidney transplant: what will be the difference in the diet after the transplant?

1. Increased protein

2. Limit sodium

3. balanced nutrients

4. avoid certain foods

5. Hydration

6. monitor weight

Protein needs for nephrotic syndrome

Protein needs can vary on the severity of the condition and individual health factors. Generally, it’s recommended to have a moderate protein intake to avoid overloading the kidneys while still meeting nutritional needs. This typically means about .8 to 1.0 grams of protein per kilogram of body weight per day. It’s best to get this protein from high-quality sources like lean meats, eggs, dairy, and plant-based proteins.

Patient with CKD and DMII-what is a list of reasons this patient could be malnourished?

1. Dietary restrictions

2. poor appetite: due to uremia, and in diabetes due to blood sugar fluctuations

3. nutrient loss: protein and other nutrients can be lost in urine in CKD

4. metabolic changes: Both conditions can alter metabolism and nutrient absorption.

5. Medication side effects: some medications can cause nausea or reduce appetite.

Fluid requirements post kidney transplant

1. Increased fluid intake: initially, you may need to drink more fluids to help the new kidney functions well and flush out medications

2. monitor fluid balance: the healthcare team will monitor your fluid balance closely, adjusting recommendations based on your kidney function and any signs of fluid retention or dehydration

3. avoid overhydration: to avoid the strain of the new kidney.

How would you help a patient with CKD be compliant with their diet?

1. education: make sure they understand why certain foods are restricted and how it affects their kidneys

2. meal planning: help them plan meals and snacks that fit their dietary restrictions but are still tasty and satisfying.

3. label reading: teach them how to read food labels to avoid high sodium, potassium, and phosphorus

4. cooking at home: encourage cooking at home where they can control ingredients and portion sizes

5. support groups: joining a support group can provide motivation and tips from others in the same situation

6. regular check-ins: regular appointments with a dietitian to adjust the diet as needed and keep them on track.

Medium/high K+ foods

1. Bananas

2. oranges and orange juice

3. potatoes

4. tomatoes and tomato products

5. spinach

6. avocados

7. sweet potatoes

8. beans (like kidney beans and black beans)

9. melons: Like cantaloupe and honeydew

10. dried fruits: Like raisins and apricots

Why does the Mediterranean diet help prevent CVD?

because it focuses on heart-healthy foods. It includes lots of fruits, vegetables, whole grains, nuts, and olive oil, which are rich in antioxidants and healthy fats. These foods help reduce inflammation and improve cholesterol levels. Plus, the diet encourages fish and lean protein, which are good for your heart.

What foods are sodium of the highest content in our diet?

1. processed meats: bacon, ham, sausages, and deli meats

2. canned soups and vegtables

3. snack foods

4. fast-food

5. cheese

6. condiments: soy sauce, ketchup, and salad dressings

7. frozen meals: many are loaded with sodium to enhance flavor and preservation.

What is the main type of fat to avoid to prevent CVD and what foods have this in high quantities?

1. Fried foods

2. baked goods

3. margarine: Especially the stick kind

4. snack foods

5. processed foods

For our vegan patients, what foods could be in high in sodium that you’d want them to limit in their diet?

1. Processed vegan meats: Like vegan sausages, burgers, and deli slices

2. canned beans and vegetables

3. soy sauce and tamari

4. packaged snacks

5. plant-based cheese

6. instant noodles

7. pickled and fermented foods

DASH diet guidelines-know the details of this diet

1. fruits and vegetables: Aim for 4-5 servings of each per day

2. whole grains: Include 6-8 servings daily

3. lean proteins: Focus on fish, poultry, and beans with 2 or fewer servings of meat per day.

4. Low-fat dairy: 2-3 servings per day.

5. Nuts, seeds, and legumes: About 4-5 servings per week

6. Fats and oils: 2-3 servings per day, focusing on healthy fats

7. Sweets: Limit to 5 or fewer servings per week

8. Sodium: Reduce intake to 2,300 mg per day, or even 1,500 mg for greater effect.

Be able to choose foods high in sodium

1. Processed meats

2. canned soups and vegtables

3. snack foods

4. condiments and sauces

5. cheese

6. frozen meals

7. bread and rolls

Metabolic syndrome-identify labs/body anthroprometrics that put them at risk.

1. Waist circumference

   -Men: Greater than 40 inches

   -women: Greater than 35 inches

2. Blood pressure

   -a reading of 130/85 mmHg or higher

3. Fasting blood sugar

   -100 mg/dL or higher

4. Triglycerides

   -150 mg/dL or higher

5. HDL cholesterol (Good cholesterol)

   -Men: Less than 40 mg/dL

   -Women: Less than 50 mg/dL

main difference between DASH and Mediterranean diets

1. Focus on sodium

   -DASH diet: Specifically designed to lower blood pressure, and it emphasizes reducing sodium intake.

   -mediterranean diet: Focuses more on overall heart health and doesn’t specifically emphasize low sodium.

2. Types of fats

   -DASH diet: Encourages low-fat and nonfat dairy products, and generally low-fat

   -mediterranean diet: Emphasizes healthy fats, particularly from olive oil, nuts, and fatty-fish

3. protein sources

   -DASH diet: Recommend lean meats, poultry, and fish, but more in more limited amounts

   - Mediterranean diet: Prioritizes fish as main protein source

4. alcohol consumption

   -DASH diet: Generally more restrictive with alcohol.

   -mediterranean diet: Allows for moderate consumption of red wine

What is the most “heart healthy” protein that you can eat?

Fatty fish, like salmon, mackerel, and sardines. They are packed with omega 3 fatty acids which are great your heart!

What is the DASH diet high in (the most prevalent intracellular cation+) that helps lower BP

The dash diet is high in potassium, which is the most prevalent intracellular cation. Potassium helps lower blood pressure by balancing out the negative effects of sodium.

Be able to identify “empty calories” for a patient

1. sugary drinks

2. sweets and desserts

3. fast food and fried foods

4. processed snacks

5. alcohol

When given a patient's vitals and BMI, help them make healthy choices

1. Monitor BP: If high, recommend reducing sodium intake, increasing potassium-rich foods (like bananas, spinach, and sweet potatoes), and incorporating regular physical activity

2. manage weight: if BMI is high, eat a balanced diet and encourage portion control and regular exercise. If BMI is low, recommend caloric and protein-dense foods to help gain weight healthily. Foods like nuts, seeds, avocados, and lean meats.

3. Heart health

   -Encourage the consumption of heart-healthy proteins like fatty fish

   -limit intake of saturated fats, trans fat, and cholestrol

4. blood sugar levels

   -For patients with high blood sugar, suggest foods with a low glycemic index (like legumes, non-starchy vegetables, and whole grains) and regular meals to maintain stable blood sugar levels

5. general nutrtion

   -ensure they are getting a variety of nutrients by eating a diverse range of foods

   -recommend staying hydrated and avoiding empty calories

What types of protein should be avoided to help prevent CVD?

1. red meats

2. processed meats

3. full-fat dairy products

Anorexia

Lack of appetite

Cachexia

Loss of body weight; lean muscle

Sarcopenia

muscle wasting disorder, worsens with age

BMI percentile range

Underweight: less than the 5th percentile

healthy weight: 5th to less than the 85th percentile

overweight: 85th to less than the 95th percentile

Obese: Equal to or greater than the 95th percentile

Underweight: less than 18.5

Normal: 18.5-24.9

Overweight: 25-29.9

Obese: over 30