nutrition exam 1

Iron Rich Foods

Responsible for oxygen distribution to hemoglobin and myoglobin. Body Recycles unused iron from dying RBC and stores for later use heme iron found in meat, fish, and poultry. Non heme found in grains, legumes, and veggies.

Iron Supplements cause

constipation, nausea, vomiting, diarrhea, teeth discoloration. Encourage fresh fruits, veggies, high fiber diet.

Iron info

supplements that are unneeded and become toxic. Vitamin C Increases absorption of iron

Foods high in Iron

Spinach, Red Meat, Broccoli, Dark Chocolate, Dried or canned peas and beans, lentils, peas, tofu, enriched white breads, enriched pasta, wheat product, bran cereals, cornmeal, oat cereals-cream of wheat, egg yolks, legumes

Calcium

Bone/Teeth formation, BP, blood clotting, nerve transmission

Calcium foods

Dairy, Broccoli, Kale, Fortified Grains

Deficiency in calcium

Tetany, Positive Chvostek's sign Trousseau's signs, ECG Changes, Osteoporosis in Adults, Poor growth in children

Finding of excess calcium

constipation, renal stones, lethargy, depressed deep tendon reflexes.

Nursing Actions for excess calcium

Monitor ECG and Respiratory Status, give PO tabs with vitamin D

Vitamin D

Assists in the absorption of calcium and phosphorus, and aids in bone mineralization. Sunlight enables the body to synthesize vitamin D in the skin

Vitamin D Deficiency results in

bone mineralization and extreme deficiency can cause rickets and osteomalacia.

Excess consumption of Vitamin D can cause

hypercalcemia.

Vitamin D Food sources include

fatty fish, eggs, and fortified products (ready to act cereals, milk, and orange juice)

Protein Rich Foods Metabolic Functions

Tissue Building and Maitenance: balance of nitrogen and water, backup energy, support of metabolic processes (nitrogen balance), transportation of nutrients, other vital substances. Facilitates acid base, fluid, and electrolyte Imbalances, formation of neurotransmitters, enzymes, antibodies, hormones, breast milk, histamine, and sperm

Influence protein need

Tissue growth needs, quality of dietary protein, added needs due to illness

Protein high foods

Grains, Nuts, Seeds, Or Dairy, legumes, Meat, Beans/Rice, Hummus Crackers and bread, Mac N cheese, Peanut Butter Sandwich

Sodium functions

Maintains Fluid Volume, allows muscle contractions, contributes to nerve impulses

Sodium Major Sources

Table salts, added salts, processed foods

Sodium Deficiency s/s

muscle cramping, memory loss, anorexia

Excess sodium s/s

Fluid Retention, HTN, disorientation

Nursing Actions for sodium imbalance

Monitor LOC, edema, and BP

foods with high sodium

packaged shrimp, ham, canned soup, veggie juice, breakfast cereal, butter, cottage cheese, processed cheese, buttermilk

Sodium RDA

less than 2300 milligrams daily

Potassium Major Actions

Maintains fluid volume inside cells, muscle action

Major Sources Potassium

Oranges, dried fruits, tomatoes, avocados, dried peas, meats, broccoli, bananas, dairy products, meats, whole grains, potato

Findings of potassium Deficiency

Dysrhythmias, muscle cramps, confusion

Findings of Excess potassium

Dysrhythmia, muscle weakness, irritability, confusion, numbness in extremities

Nursing Actions potassium imbalance

monitor cardiac status and ECG. Give oral preparations (tabs, elixirs) with meals to minimize GI irritation.

Fiber

categorized as a carbohydrate

Dietary fibers is

the substance in plant foods that is indigestible. Types are pectin, gum, cellulose, and oligosaccharides.

Fiber is important for

proper bowel elimination. It adds bulk to the feces and stimulates peristalsis to ease elimination.

Fiber helps to

lower cholesterol and lessen the incidence of intestinal cancers. It has also been shown to help to keep glucose levels stable by slowing the rate of glucose absorption.

Total Fiber AI

25 g/day for females and 38 g/day for males

The fermentation and metabolism of fiber in the colon provide

1.5 to 2.5 Cal/g of energy, depending on the type

Fats

AKA Lipids, and they are available from many sources

lipid food sources

Dark Meat, Poultry Skin, Dairy Foods, added oils such as margarine, butter, shortening, oils, lard)

Fat is an essential nutrient

serves as a concentrated form of stored energy for the body and supplies important tissue needs

Lipid function

Hormone production, structural material for cell walls, protective padding for vital organs, insulation to maintain body temp, covering for nerve fibers, aid in the absorption of fat soluable vitamins

Lipids 3 Types

triglycerides, Phospholipids and Sterols

Triglyceride

95 percent of fat in the food. They combine with glycerol to supply energy to the body, allow fat soluable vitamin transport, and form adipose tissue that protects internal organs.

Saturated fatty acid

solid at room temperature, animal sources

Unsaturated fatty acid

monounsaturated and polyunsaturated fatty acids, plant sources and reduce health risks.

Mono fatty acid examples

olives, canola oil, avocado, peanuts, and other nuts

Poly fatty acid examples

corn, wheat germ, soybean, safflower, sunflower, and fish

Essential fatty acids

made from broken-down fats, must be supplied in diet-omega 3 and 6, used to support blood clotting, BP, inflammatory responses, and other metabolic processes.

Phospholipids

important to cell membrane structure, as well as the transport of fat soluble substances across the cell membrane

Sterols

found in tissue of animals, and are not an essential nutrient because the liver is able to produce enough to meet needs

cholesterol is built up in excess

it can build up in the tissues, causing congestion and increasing the risk of CVA

ADMR of Fats

20-35 percent

Low intake of dietary cholesterol is associated with

reduced risk of CVA and obesity. High fat increases CVD, obesity HTN, and DM

Those under 2 need more

fat to form brain tissue. Less than 10 percent of fat cannot supply adequate amounts of essential fatty acids and results in cathectic (wasting) state.

Majority of Lipid Metabolism

occurs after fat reaches the small intestine, where the gallbladder secretes concentrated bile, which acts as an emulsifier and enables the breakdown of fat down into smaller particles for digestion.

Pancreas secretes

amylase lipase, which breaks down fat.

Intestinal Cells

absorb most of the end products of digestion, with some being secreted in the feces.

VLDL

Very Low-Density Lipoproteins. Carry Triglycerides to the cell.

LDL

Low Density Lipoproteins: Carry cholesterol to the tissue cells.

HDL

Remove excess cholesterol from the cells, and transport to liver for disposal.

9cal/gram, dense

metabolism

the sum of all chemical processes that occur on a cellular level to maintain homeostasis.

catabolism

breaking down of substances with the resultant release of energy

anabolism

the use of energy to build or repair substances

energy nutrients

are metabolized to provide CO2, water, and ATP. Excess energy nutrients are stored, glucose is converted to glycogen and stored in the liver and muscle tissue, surplus glucose is converted to fat, glycerol and fatty acids are reassembled into triglycerides and stored in adipose tissue, and amino acids make body proteins. The liver removes nitrogen from amino acids that make body proteins.

Metabolic rate

the speed at which food energy is burned

Basal Metabolic Rate (BMR)

refers to the amount of energy used in 24 hrs for involuntary activities of the body (body temperature, heartbeat, circulation, and respirations). This rate is determined while at rest and following a 12 hr fast.

BMR is affected by

lean body mass and hormones. Body surface area, age, and sex are also factors contributing to BMR

Resting Metabolic Rate (RMR)

refers to the calories needed for involuntary activities of the body at rest. This rate does not consider the 12 hr fast criteria.

Males have a higher metabolic rate than female due to

their higher amount of body muscle and decreased amount of fat.

thyroid function tests

can be used as an indirect measure of BMR

Vegan

excludes all meat and animal products

Lactose Vegetarian

diet includes dairy products.

Lactose-Ovo Vegetarian

diet includes dairy product and eggs.

vegetarian diet considerations

ensure vitamin D, B12, calcium, and omega 3 fatty acids

Vegetarian diet focuses on

plants for food, including fruits, veggies, dried beans, and peas, grains, seeds, and nuts

Manifestations of Malnutrition

hair that is dry/brittle, skin with dry patches, poor wound healing or sores, lack of subcutaneous fat or muscle wasting, irregular cardiovascular measurement (HR, BP) enlarged spleen or liver, general weakness or impaired coordination.

Pre albumin

a sensitive measure used to assess critically ill clients who are at risk for malnutrition (prealbumin levels can decrease with an inflammatory process-inaccurate)

Nitrogen balance

the relationship between protein breakdown and protein synthesis.

Record nitrogen balance by

record protein intake over 24 hr and divide by 6.25, record nitrogen excretion in urine in over 24 hr and add 4 g

Nitrogen intake - outtake

total nitrogen balance

Neural balance

adequate nutritional intake

Positive nitrogen balance

indicates protein synthesis is greater than protein breakdown during growth, pregnancy, or during recovery.

Negative nitrogen balance

indicates protein is used at a greater rate than it is synthesized as in starvation or a catabolic rate following injury of disease.

Tyramine

a naturally occurring amine found in many foods that have a HTN crisis (norepinephrine) Tyramine is metabolized by MAO, and clients taking MAOIs (phenelzine, selgeline) who consume foods high in tyramine can suffer a hypertensive crisis-aged cheese, smoked meats, dried fish, and overripe avocados.

Coumadin diet considerations

Foods high in Vitamin K (dark green veggies, eggs, carrots) decrease the anticoagulant effects of warfarin Vitamin K: makes various proteins needed for blood clotting and building of bones

Infant and Toddler Diets

Growth rate slows. follow myplate, smaller serving sizes. energy needs and appetites vary with child's activity level and growth rate

nutrition needs increase with

age

Toddler habits

attitudes around food habits are established by 5years of age

increasing the variety and texture of foods help

child develop good eating habits

Safety concern toddlers

hot dog, popcorn, peanuts, grapes, carrots, celery, peanut butter, meat, candy can cause aspiration

Meal considerations children

inclusion in family mealtime important. group eating is significant

Toddlers

2-3 inches in height and gain 5-6 pound per year. 100 percent fruit juice 4-6 oz a day. 1-2-year-olds require whole cow's milk. food serving size 1 tsp per year. takes 15-20 times for toddler to accept food. monitor child for reactions. like finger foods. regular mealtime and nutritious snacks best meet nutritious needs. snacks or desert that are high in sugar, fat or sodium should be avoided

Safety toddlers

increased choking risk until 4 years of age

Iron deficiency anemia

common in children. lean red meats should be consumed. vitamin C with plain sources of iron will maximize absorption. limit milk, displace iron rich foods

Vitamin D function

Essential for bone development

Vitamin D daily

5mcg a day from birth to age 50

Vitamin D foods

milk and fatty fish are good sources

sun exposure leads to vitamin D synthesis

children who spend large amounts of time inside are at an increased risk for vitamin D deficiency

Sensory impairments

decreased vision needs assistance shopping and with food prep. May need help with setup of tray-work it like a clock.