NURS 299: Nutrition Exam 5

What helps with self-esteem for young adults?

Work is more than a source of income; it provides self-esteem and social interaction

Erikson’s Developmental stage for young adults

Intimacy vs. isolation. This stage emphasizes forming meaningful relationships and finding a sense of connection with others.

Erikson’s Developmental Stages for all adult stages

a. Intimacy vs. Isolation (Young Adults) 80% 18-35yrs

b. Generativity vs. Stagnation (Middle Age) 35-65yrs

c. Ego integrity vs. Despair (Older Age) 65+yrs

Metabolic syndrome

High Lipid Levels

Hypertension

Obesity

Precursor to diabetes, heart disease, and stroke

metabolic syndrome

Most common causes of death for young adults.

• Motor Vehicle Accidents/Unintentional Injury/Accidents #1

• Suicide #2

• Homicide #3

Safety recommendations to prevent death in young adults

• wear seatbelts

• If riding bicycle or motorcycle, wear a helmet

Piaget’s theory Formal Operations only

Analysis of all combinations of possibilities and constructs hypotheses; more perceptive/insightful

• Stepping back

• Abstract thinking

• Introspective Thinking

• Analyze

Most prevalent sexually transmitted infections in young adults

gonorrhea, chlamydia, syphilis

Suicide screening questions

• Assess for stress-related complaints

• Assess for signs of achievement stress

• Assess for depression and suicidal ideation

Kohlberg’s theory Postconventional Level

• Define rights and morality in terms of self-chosen principles

• Interests of individuals can be weighed against the needs of society and the state (e.g., doing something that benefits society versus self)

Normal total cholesterol, LDL, and HDL levels.

• LDL = less than 100

• HDL = greater than 60

• Cholesterol = less than 200

Identify lab values that would indicate a need for education for cardiac disease risk factors.

• Elevated lipids

• High cholesterol

• hypertension (130/80 mmHg)

• obesity

• diabetes

Hormone-containing (estrogen or estrogen/progestin) contraceptive methods and potential negative side effects

increase the risk of thromboembolic disorders (blood clots)

Obesity: what BMI makes a client a candidate for surgery?

BMI is greater than or equal to 40

Is BMI the best predictor for health risks?

No

• (assess cardiovascular and obesity-related risks)

Which two minority groups have the highest rates of obesity?

Hispanics and Blacks

How has online networking impacted young adult relationships?

• Can lead to compulsive or addictive use

• Can negatively impact relationships

Women in the workforce. What percentage of women are in the workforce?

Nearly half

Is there support for working mothers in the US?

Less support for working mothers compared to other Western countries

Are women paid equally to men?

They earn 81% of what men earn

Erikson’s Developmental Stage for Middle-Aged Adults

Generativity vs. Stagnation.

• During this stage, adults strive to create or nurture things that will outlast them, often by parenting or engaging in productive work, while the opposite involves feeling unproductive and disconnected.

How does the glomerular filtration rate change with aging?

Decreases by nearly half

Benefits of aspirin on cardiovascular health

• Helps maintain cardiovascular health only for those who need it. Lowers the risk of clot formation

Identify the signs and symptoms of iron-deficiency anemia

• Tired, pale, Spoon-shaped nails

Ask about history, before providing/recommending medication

Sleep recommendations for adults. How do you assess sleep quality?

7-9 hours

• Avoid exercise within 2 hr bedtime, avoid excess caffeine

• Need regular sleep-wake cycle in 24 hr period

• Cognitive-behavioral therapy is useful

Interventions for weight management for a group

Obtain a history of diet and physical activity

• Fewer calories

• Exercise 30 min/day; 3-5 days a week

• Social support groups (ask for a list of topics that interest the group)

Contrast the accident rates in the workplace between non-smokers and smokers

• Accidents are twice as high among smokers than nonsmokers

• Implementing a smoke-free work environment would have the largest effect on the reduction of work-related injuries

What may be included in a work-related injury-prevention educational session?

• Employees may need to be educated concerning the use of protective clothing or devices when needed

• Environmental hazards; Workplace safety

• Baseline health (employment physicals)

What would be the most important topic to provide a community-based education series?

• Screening for disease, health risks, behaviors

• Target group health trends

• Increase Physical activity

• Well-balanced diet

What is Bloom’s taxonomy?

• Knowledge (Remembering)

• Comprehension (Understanding)

• Application (Applying your knowledge)

• Analysis (Draw conclusions among ideas)

• Evaluation (Justify a decision)

• Synthesis (Creating a plan)

Explain the risks associated with postmenopausal women who took estrogen and progesterone with cardiac events

increased risk of cardiac events

Risk factors for developing osteoporosis (in Grodner 10 too)

• Postmenopausal women who have fair complexions and who are small, sedentary individuals

• White and Asian persons

• Persons of either gender on long-term steroids 

• Increases with age

 List the signs and symptoms of a client with peptic ulcer disease

• Iron deficiency anemia due to blood loss

• Tarry stools due to intestinal bleeding

• Epigastric pain is described as a gnawing or burning sensation

Erikson’s developmental stage for Older Adults

Ego Integrity vs. despair

• In this stage, older adults reflect on their lives, assessing their achievements and failures, potentially leading to feelings of fulfillment or regret.

Heat regulation in older adults

• Impaired heat/cold perception

Sex education for older adults

STIs and AIDS: issue for older adults

• Teach safe sexual practices

• Survey: 5.1% of men over 61 had used a condom in recent sex

What is the Grandparents Raising Grandchildren support group?

It's a support system that helps to connect caregivers to get resources in the community due to stress

Obesity paradox

• obesity is not associated with a shorter life span

  • Studies suggest that the “ideal” protective weight might be higher in the older population

Hospice

End-of-life care, focusing on comfort

Home

Assistance with daily living

Hospital

conditions that require intensive care, the patient might not be comfortable

Home Health

• medical support at home

• Allow older adults to return to their home environment, which is better to recover from an illness

• Home health nurses help with connecting with community resources

Ways to promote cognitive health in long-term care facilities

• Always continue learning

• Annually assess for dementia

• Encourage class enrollment, reading, promote entertainment to keep mind active

Healthy coping patterns for loss

• Talks about the “good times”

• Does NOT blame him/herself

Suicide risk factors for older adults.

serious illnesses, social isolation, alcohol abuse, bereavement

Describe pain management to suicide risk.

• promote value in life & alleviate suffering to manage pain; euthanasia

Dementia in adults

• Umbrella term for cognitive disorders

• Causes:

  • Multi-infarct dementia: death of brain tissue

  • Alzheimer’s disease

• Can be chronic or progressive

• NOT a normal change of aging

• Assessment for dementia should be part of routine physical exams

• Treatment:

  • Medications, vaccine research, encourage stimulation, routines

  • Older adults can continue to learn

Urinary incontinence and management in adults

• Voiding schedules, prompted voiding, incontinence devices, avoid caffeine

• Increasing fiber/fluid, weight loss, exercise, diet, kegel exercises

Food assistance programs available to older adults.

• Food stamps (SNAP), senior nutrition program, meals-on-wheels

• The Senior Nutrition Program provides inexpensive meals, education, and socialization for all adults aged 60 and older. Does not specifically target disabled, low-income, or socially isolated adults

Are older adults more likely to be malnourished living in their own homes or in a nursing home? (In Grodner 10 too)

Nursing Home

Identify the risks for malnourishment for older adults

• Access to food and ability to prepare food (If a client has arthritis, it may be hard to prepare food)

• Decline in GI absorption, metabolism, elimination

• Deterioration of senses

• High frequency of dentition (teeth) problems

• Cultural food preferences

• Living environment (e.g., institutions, living alone)

• Anorexia resulting from disease

• Medications

Factors that motivate older adults to be more receptive to health-promotion interventions

• granchildren

• sense of spirtuality

Taste buds as adults age

• Diminished sense of taste

• Loss of taste buds

• Zinc: marginal deficiency alters taste receptors

Protein requirements for women

46-50 g

Protein requirements for men

58-63 g

How can adults maintain lean body mass?

Aerobic exercises and strength training

Iron needs for younger women compared to older women

• Pregnancy needs 30 mg/day

• Menstruation needs 18 mg/day

• Older women: after menopause, decreases to 8 mg

Signs and symptoms of dehydration in older adults

• Confusion 

• Thirst

• Dry mouth

• Less frequent urination

• Dry skin

• Headache 

• Rapid heartbeat

Why may nutritional status decline in patients with arthritis?

Malnutrition caused by inability to prepare food

Vitamin D requirements for older adults

• Need for vitamin D increases (synthesis reduced)

• May need vit. D supplements

• Low serum vitamin D levels are related to poor immune function 

• Climate: Ability to feel changes in heat and cold may be impaired

Risk factors for malnutrition in the elderly population. Greatest dietary concern for older adults.

• High risk for adults age 75 years or older

• Greatest Dietary concern: Protein

Explain hunger cues and the relationship to body weight

• As we get older, the hormone leptin (which allows you to

feel full) is reduced, causing overeating habits and weight

gain

• Stick to healthier, lean food choices low in fat and carbs and

pay attention to caloric intake

SNAP program

Food assistance for low-income individuals

Iatrogenic malnutrition

inadvertently caused by treatment or diagnostic procedure

• Scheduling frequent daily tests that prevent the patient from eating meals

• 40% of patients demonstrate malnutrition during hospitalization

• Nutrition screening or monitoring helps identify patients at nutrition risk

• Monitoring: for diet orders, nothing-by-mouth (NPO), or clear and full liquid diets

Purpose of a growth chart for children. What does it mean if a child's weight is below the 5th percentile for height?

Great risk for malnutrition

 identify the client who need to have their albumin checked

• Serum albumin levels of 3 g/dL or lower indicate high nutritional risk 

• Clients with Congestive Heart Failure (CHF), hepatic insufficiency, and trauma may cause abnormally low values

Serum albumin level is a good index of

• visceral protein status for patients who are otherwise healthy

Signs and symptoms of iron-deficiency anemia

• Fatigue, spoon-shaped nails, need blood hemoglobin

• Cracked lips, drowsiness, heartache, fragility of hair, dry skin, pallor

Calorie count

•  the percentage of each food served that was actually eaten 

• Determines if nutritional interventions are needed

Describe the process in the hospital setting with a calorie count.

• Nutrition assessment and/or physician’s order is obtained which is conducted for 72 hours 

• Nursing staff will do the recording of everything the client consumes (food and beverages) 

• The nutrition professional analyzes and makes recommendation 

The roles of a registered dietitian

• Nutrition care process

• Detailed nutrition assessments

• Nutrition diagnosis

• Intervention: provision of specific nutrition therapies

• Monitoring and evaluation of outcomes

Relate the use of alcohol to depression medication, antihypertensive medication, or hypoglycemic medications.

It reduces drug efficacy and absorption of medications, interferes with disease control, causes nutritional deficiencies, influences food intake, food absorption, and metabolism

Causes of rapid weight gain

• More intake than energy requirement = weight gain

• Rapid weight gain (> 1 lb/day) may be an accumulation of fluid

How to manage an elderly person in the hospital who was found on the floor in her home? What are your first steps?

• Check for pulse, call for help, assess for injury, and further investigate reason for fall

Vitamin D and role with immune function

Low serum vitamin D levels are related to poor immune function

What nutrients promote wound healing?

Protein, zinc, vitamin C

What foods contain protein?

meats, beans, dairy products

What foods contain zinc?

roast beef, whole grain bread, pine nuts, cashews

What foods contain vitamin C?

citrus fruits, strawberries, tomatoes, kale, snow peas, broccoli, spinach

Steroid use and appetite

• Appetite stimulus 

• Counsel patients to limit food intake to avoid weight gain

What foods are high in vitamin K?

Green leafy vegetables such as kale, collard greens, broccoli, spinach, cabbage, and lettuce

What is vitamin K effect on warfarin (Coumadin)

• Conflicts with warfarin (Coumadin): reduce the efficacy of warfarin 

  • Warfarin blocks the liver from using vitamin K to make clotting factors

  • This thins your blood, so it takes longer to clot

  • Vitamin K: makes various proteins that are needed for blood clotting and the building of bones