ati nutrition practice

How many calories do carbs provide?

4 cal/g

How many calories do fats provide?

9 cal/g

How many calories do proteins provide?

4 cal/g

Glucose

70-115

Albumin

3.5-5.0

Prealbumin

15-36

Protein

6-8

Sodium

135-145

Potassium

3.5-5.0

Calcium

9.0-10.5

Magnesium

1.3-2.1

Platelets

150,000-400,000

Hemoglobin

12-18

Hematocrit

37%-52%

Cholesterol

HDL

Male \>40; Female \>50

LDL

Triglycerides

Glycosylated Hemoglobin A1c

4.0-6.0%

Creatinine

0.6-1.3

BUN

6-20

WBC

5,000-10,000

Food sources for folic acid

Green leafy vegetables; liver, beef, and fish; legumes; grapefruit and oranges

Food sources for niacin

Meats, poultry, fish, beans, peanuts, grains, legumes, milk, whole grain, and enriched breads and cereals.

Deficiency of Niacin (B3)

results in pellagra S/S: sun-sensitive skin lesions and GI and neurological findings.

Food sources for B12 (thiamine)

pork and nuts, whole-grain cereals, legumes

Thiamin (B1) deficiency

results in beriberi (ataxia, confusion, anorexia, tachycaria), headache, wt loss, fatigue

Food sources for B2 (riboflavin)

milk, lean meats, fish, grains

Deficiency of Riboflavin (B2)

results in cheilosis (S/S: scales and cracks on lips and in corners of mouth), swollen/smooth red tongue (glossitis), and dermatitis of ears, nose, and mouth)

Food sources for B6 (pyridoxine)

yeast, corn, meat, poultry, fish

Food sources for B12 (cobalamin)

Meat, liver

Food sources for vitamin C (ascorbic acid)

Citrus fruits (oranges, lemons), tomatoes, broccoli, cabbage, peppers, green leafy vegetables, strawberries

Vitamin C deficiency

scurvy; a hemorrhagic disease w/ diffuse tissue bleeding, painful limbs/joints, weak bones, swollen gums/loose teeth

Food sources for Vitamin A

Liver, egg yolk, whole milk, green or orange vegetables, fruits

Food sources for Vitamin D

Fortified milk, fish oil, cereal

Food sources for Vitamin E

vegetable oils; green leafy vegetables; cereals; apricots, apples, and peaches

Food sources for Vitamin K

green leafy vegetables; cauliflower and cabbage.

Food sources of calcium

cheese, collard greens, milk and soy milk, rhubarb, sardines, tofu, yogurt

Food sources of chloride

salt

Food sources of iron

Bread, cereal, dark green vegetables, dried fruits, egg yolk, legumes, liver, meats

Food sources of magnesium

Avocado, canned white tuna, cauliflower, cooked rolled oats, green leafy vegetables, milk, peanut butter, peas, pork, beef, chicken, potatoes, raisins, yogurt. affects enzyme and neurochemical activities and the excitability of cardiac and skeletal muscles.

Food sources of phosphorus

Fish, nuts, organ meats, pork, beef, chicken, whole grain breads and cereals. Milk products, beef liver, chocolate, nuts, legumes, peanut butter, dried peas and beans, bran, cola, beer, some whole grains. plays a role in bone and teeth formation and energy metabolism

Food sources of potassium

Avocado, bananas, cantaloupe, carrots, fish, mushrooms, oranges, pork, beef, veal, potatoes, raisins, spinach, strawberries, tomatoes

Food sources of sodium

Bacon, butter, canned food, cheese, cured pork, hot dogs, ketchup, lunch meat, milk, mustard, processed food, snack food, soy sauce, table salt, white and whole wheat bread

Food sources of zinc

eggs, leafy vegetables, meats, protein rich foods. plays a role in tissue growth and wound healing, and supports immune function

Recommended intake of protein for adults

10%-35% of total calories

Recommended intake of fats for adults

20-35% of total calories, 10% or less of total calories should come from saturated fat souces

Full liquid diet

Used as a transition diet after clear liquids following surgery or for pts who have difficulty chewing, swallowing, or tolerating solid foods. Diet includes clear and opaque liquid foods, and those that are liquid at body temperature. Foods include all clear liquids and items such as plain ice cream, sherbet, breakfast drinks, milk, pudding, custard, soups that are strained, refined cooked cereals, fruit juices, and strained vegetable juices.

Low purine diet

used for gout, kidney stones, elevated uric acid levels. Restrict anchovies, herring, mackerel, sardines, scallops, organ meats, gravies, meat extracts, wild game, goose, and sweat breads

Renal diet

Controlled amounts of protein, sodium, phosphorus, calcium, potassium, and fluids may be prescribed; may also need modification in fiber, cholesterol, and fat based in individual requirements; restrict fluids.

Sodium restricted diet

Used for hypertension, heart failure, renal disease, cardiac disease, and liver disease. Diet plans are individualized; can include 4 g of sodium daily (no added salt diet) 2-3 g of sodium daily (moderate restriction), 1 g of sodium daily (strict restriction), or 500 mg of sodium daily (severe restriction and seldom prescribed). Encourage intake of fresh foods rather than processed foods. Canned, frozen, instant, smoked, pickled, boxed foods, lunch meat, soy sauce, salad dressing, fast foods, soups, and snacks usually have higher amounts of sodium.

Cardiac diet

Indicated for atherosclerosis, DM, hyperlipidemia, hypertension, myocardial infarction, nephrotic syndrome, and renal failure. DASH diet recommended to prevent and control hypertension, hypercholesterolemia, and obesity. Includes fruits, veggies, whole grains, low fat dairy food, meat, fish, poultry, nuts, and beans, and is limited in sugar sweetened foods and beverages, red meat, and added fats. Low sodium, high potassium, high calcium diet to lower BP and cholesterol. Decrease sodium 1,500-2,300.

High calorie high protein diet

used for severe stress, burns, wound healing, cancer, HIV, COPD, respiratory failure. Encourage whole milk, milk products, peanut butter, nuts and seeds, beef, cottage cheese, chicken, fish, pork, and eggs. Encourage snacks between meals such as milkshakes, instant breakfasts, and nutritional supplements.

Low fiber diet

canned fruit, white bread, broiled hamburger, fish, poultry

Complete proteins

eggs, meat, poultry, seafood, milk, yogurt, cheese, soybean products,

Incomplete proteins

peanut butter, cereal, pasta

Vegan

strict vegetarian diet and consume no animal foods. Eat only foods of plant origin (whole or enriched grains, legumes, nuts, seeds, fruits, vegetables.) Use of soybeans, soy milk, soybean curd (tofu) and processed soy protein products enhance nutritional value of diet

Lacto ovo vegetarian

Follow a food pattern that allows consumption of dairy products and eggs. Consume adequate plant and animal food sources, excluding meat, poultry, pork, and fish poses no nutritional risk

Lacto-vegetarian

Cosume milk, cheese, dairy foods but avoid meat, fish poultry, and eggs. Diet of whole or enriched grains, legumes, nuts, seeds, fruits, and vegetables in sufficient quantities to meet energy needs and provides a balanced diet.

Potential deficiencies in vegetarian diet

energy, protein, B12, zinc, iron, calcium, omega 3 fatty acids, and vitamin D. To enhance absorption of iron, consume a good source of iron and vitamin C with each meal. Include 2 servings per day of nuts

What should you give children under the age of two?

low fat milk. Whole milk gives necessary fat for neurological development for children up to 2 years of age

What should the nurse do to help with chemotherapy changes in taste?

Use plastic utensils, increase fluid intake to improve taste, suggest pt to eat foods served cold or at room temperature to improve taste, try tart foods and seasonings to improve taste, offer citrus fruits, suggest pickles as snack and gargle w/ mouth wash

1st day after birth, how long should the mother feed per breast?

5 minute feedings on each breast on the first day after birth

Dumping syndrome

When a portion of the stomach is removed, the contents of the stomach are rapidly emptied into the small intestine, causing dumping syndrome. Manifestations occur 15-30 minutes after eating, and include sensation of fullness, abdominal cramping, nausea, diarrhea, faintness, syncope, diaphoresis, tachycardia, hypotension, flushing. Late manifestations occur 1-3 hrs after eating and include diaphoresis, weakness, tremors, anxiety, nausea, and hunger. Manifestations resolve after intestine is emptied. There's a rapid rise in blood glucose and increase insulin levels immediately after the intestine empties, which leads to hypoglycemia. Recommend small frequent meals, consume protein and fat at each meal, avoid food w/ concentrated sugar, restricts lactose intake, consume liquids 1 hr before or after eating, Lie down for 20-30 minutes after meals to delay emptying.

Dysphagia

palpate pt's throat during swallowing, inspect for food pockets in the mouth before feeding, allow the pt to rest 30 minutes before meals, use adaptive eating devices, encourage small bites and thorough chewing, tilt head forward when swallowing, place food on unaffected side of mouth and limit disruptions during mealtime, modify texture of foods and consistency of liquids can enable pt to achieve proper nutrition, evaluate medications to see if they're causing dry mouth and dysphagia to determine if this is a potential adverse effect, place pt in upright or high Fowler's position to facilitate swallowing, provide oral care prior to eating to enhance pt's sense of taste, refer pt to speech therapist for evaluation, take pills w/ at least 8 oz of fluid (can be thickened) to prevent medication from remaining in the esophagus, avoid thin liquids and sticky foods. Nutritional supplements are beneficial if nutritional intake is deemed inadequate.

What should you teach the pt after being discharged w/ colostomy

increase foods w/ pectin

Kosher diet

combine cheese w/ non meat products at the same time; no pork; don't combine dairy products w/ meat products at same meal; no shellfish. Ritually slaughtered beef, sheep, goats and deer with no flaws or diseases; chicken, turkey, quail, geese; salmon, tuna, carp, herring, cod; beef/poultry must be eaten separately from dairy (6-hour wait time period) are acceptable. Fruits and vegetables are all Kosher as long as they are clean. Not acceptable: Pork, camel, rabbit, rodents, reptiles and any animal that died of natural causes; eagle, hawk, vulture; crab, lobster, octopus, clam, swordfish, sturgeon, shrimp; meat with dairy (eg. cheeseburger, chicken cordon bleu, burger with milkshake)

Ramadan

consume meals before dawn and after sunset. The nurse should offer the client a snack or light meal after sunset

COPD

consume foods soft in texture and easy to chew

irritable bowel disease

take peppermint oil during exacerbation of manifestations

Parkinson's disease

Critical findings: pt drools while eating, which can indicate that this client is at greatest risk for aspiration of food from dysphagia, which can lead to pulmonary complications

Intermittent enteral feedings

Place pt in fowler's position, verify tube placement, check residual, flush tubing w/ 30 mL water. If pt is experiencing diarrhea, feed the pt in small frequent volumes. increase the volume of formula over the 1st 4-6 feedings. If pt is dehydrated, provide as continuous infusion

Diabetes

three to five carbohydrate choices, or 45 g, are allowed per meal, plus one to two carbohydrate choices for each snack. Somogyi phenomenon is fasting hyperglycemia that occurs in the morning in response to hypoglycemia during the nighttime. The nurse should assess for this phenomenon by monitoring blood glucose levels during the night

Recommended weight gain during 1st trimester

1.1-4.4 lb

Normal pt wt gain (BMI (18.5-24.9) during pregnancy

1 lb/wk for 25-35 lb

Underweight pt (BMI

just more than 1 lb/wk for total of 28-40 lb

Overweight pt (BMI 25-29.9)

0.66 lb/wk for total of 15-25 lbs

Which mineral causes constipation

Calcium

Hyperlipidemia

pt should limit meat to 5 oz per day

TPN

TPN is used when a patient's GI tract isn't functioning, or when a patient cannot physically or psychologically consume sufficient nutrients orally or enterally. It's commonly used in patients who need intense nutritional support for an extended period of time, including patients undergoing treatment for cancer, bowel disorders, critically ill, and those suffering from trauma or extensive burns, as these conditions are associated w/ high caloric requirements. PPN may be used when the patient is unable to consume enough calories to meet metabolic needs or when nutritional support is needed for a short time period (7-10 days). Eval for presence of allergies to soybeans, safflower, eggs, or lipids. Monitor for "cracking" which has an oily appearance or a layer of fat ion the top of the solution. Verify RX w/ 2nd RN prior to admin. Allow solution to come to room temp for 1 hr prior to administration. Bag of tubing should be changed Q24 hrs. A micron filter on IV tubing is required when giving. Can be D/C since when oral intake exceeds at least 60% of the client's estimated daily caloric requirements

Stomatitis

provide meals at room temp, avoid salty food, rinse w/ 0.9% sodium chloride solution or baking soda mixed with water, most foods and liquids with meal to decrease discomfort and promote nutritional intake, and use soft bristled toothbrush, avoid dry coarse foods such as toast

Fluid overload

sodium level 130

Pt taking warfarin

Be mindful consuming foods high in vitamin k, such as green leafy vegetables.

Gastric bypass

instruct pt to start each meal w/ a protein. The client should consume 60 to 120 g of protein each day

Continuous enteral feedings

prevent aspiration by monitoring gastric residuals every 4 hrs

Malnutrition

Manifestations: ankle edema

Anorexia nervosa

Assign privileges based on direct weight gain. RN to stay w/ pt 1 hr after meals

Constipation

instruct the client that consuming the skin on fruits and vegetables adds fiber to the diet.-The nurse should instruct the client to add a small amount of bran to her daily diet, working up to 3 tablespoons daily, which is less than ¼ cup. Adding fiber gradually should prevent abdominal distention and excessive flatus.

Cirrhosis

decrease sodium intake to 1-2 grams per day, avoid foods high in fat, increase protein from animal or plant sources.

Macular degeneration

increase dietary intake of lutein

Hydrolyzed formula

Elemental, composed of partially digested protein peptides and free amino acids. Used for pts who have partially functioning GI tract or pts w/ impaired ability to digest and absorb food. (liver failure, IBD, pancreatic disorders, etc)

Standard formulas

Polymeric or intact, composed of whole proteins milk, meat eggs) or protein isolates. Requires a functioning GI tract.

Treatment for gout and urolithiasis

prevention of future uric acid stones: take allopurinol as prescribed, exercise several times a week, limit intake of foods high in purine

Renal calculi

drink lots of water. Avoid large amounts of vitamin c, avoid high oxalate foods like almonds or nuts, and limit sodium to 2 g/day

Foods high in cholesterol

eggs and cheese, liver and other organ meats, shrimp

Cancer prevention

Consume adequate dietary fiber (14 g per 1,00 kcal daily); eliminate tobacco; eat at least 5 servings of fruits and veggies daily including foods high in vitamin A (apricots, carrots, leafy green veggies), foods high in vitamin c, and cruciferous vegetables (broccoli, cauliflower, cabbage); consume whole grains rather than processed or refined grains and sugars; avoid meat prepared by smoking, pickling, charcoal grilling, and use of nitrate containing chemicals; consume polyunsaturated and monounsaturated fats (found in fish and olive oil) which can lower risk of cancer; limit alcohol consumption

Anorexia in cancer/immunosuppressed patients

Eat small amounts of high protein foods loaded with calories and nutrients; try to consume food in the morning when appetite is best; avoid food odors; don't fill up on low calorie foods; eat cool/room temperature foods

Nursing actions for cancer patients

encourage pt to eat more on days when feeling better; encourage nutritional supplements high in protein and/or calories as between-meal snacks. Increase protein and caloric content of foods by substituting whole milk for water in recipes, adding milk, cheese, yogurt, or ice cream to dishes, use peanut butter as a spread for fruits, use yogurt as a topping for fruit; dip meats in eggs, milk, and bread crumbs before cooking; use semisolid, thickened foods for pts w/ dysphagia and instruct them to sit upright and tilt their head forward when swallowing. Eat foods that are well tolerated and liked prior to treatments. Try adding foods that are tart (citrus juices); eat small, frequent meals; try using sauces and seasonings for added flavor; use plastic utensils for eating to decrease metallic taste; suck on mints, candy, or chew gum to remove bad taste in mouth.

Fluid volume excess

Sodium 130

Hypoglycemia

Mild shakiness, mental confusion, sweating, palpitations, headache, lack of coordination, blurred vision, seizures, and coma. take 10-20 g of a readily absorbable carb, including 2-3 glucose tablets (5 g each), 6-10 hard candies, ½ cup (4 oz( juice or regular soda, 1 tbsp honey or 4 tsp of sugar. Retest glucose in 15 minutes. If still less than 70 mg/dL, repeat the above steps. Once levels stabilize, have the pt take an additional carb and protein snack or a small meal depending on the severity of the hypoglycemic episode and whether the next meal is more than 1 hr away.