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210 Cards in this Set
- Front
- Back
The average minimum amount of carbohydrates needed to fuel the brain
|
130 g/day
Median carbohydrate intake is 200 to 330 g/day among men and 180 to 230 g/day among women, and the acceptable macronutrient distribution range for carbohydrates is 45% to 65% of calories. |
|
Carbohydrates provide
|
energy for cellular work, and help to regulate protein and fat
metabolism. They are essential for normal cardiac and central nervous system (CNS) functioning. |
|
How many Kcals in Carbs?
|
Carbohydrates provide 4 cal/g of energy.
|
|
Proteins have many metabolic functions
|
(tissue building and maintenance, balance of
nitrogen and water, backup energy, support of metabolic processes [nitrogen balance, transportation of nutrients, other vital substances], support of the immune system). |
|
The recommended dietary requirement of protein for adults
|
is 10% of intake, or 46 g/
day for women and 56 g/day for men. ◯◯ Undernutrition may lead to protein malnourishment, which can lead to kwashiorkor or marasmus. These serious disorders are caused by a lack of protein ingestion, or the metabolism resulting in a cachectic (wasting) state. |
|
How many Kcals in Protein?
|
Protein provides 4 cal/g of energy.
|
|
How much of the diet should come from fat?
|
Generally, no more than 20% to 35% of total calories should come from fat (10% or
less from saturated fat sources). Conversely, a diet with less than 10% fat cannot supply adequate amounts of essential fatty acids and results in a cachectic (wasting) state. |
|
How many Kcals in Fat
|
Lipids provide 9 cal/g of energy and are the densest form of stored energy.
|
|
Vitamins
|
Vitamins are organic substances required for many enzymatic reactions. The main function
of vitamins is to be a catalyst for metabolic functions and chemical reactions. ◯◯ There are 13 essential vitamins, each having a specialized function. ◯◯ The two classes of vitamins are: ■■ Water-soluble – Vitamins C and B-complex ■■ Fat-soluble – Vitamins A, D, E, and K ◯◯ Vitamins yield no usable energy for the body. |
|
Ascorbic Acid
Vitamin C Major Actions |
Antioxidant,
tissue building, iron absorption |
|
Ascorbic Acid
Vitamin C Major Sources |
Citrus fruits and juices,
vegetables |
|
Ascorbic Acid
Vitamin C Deficiency |
Scurvy, decreased iron
absorption, bleeding gums |
|
Thiamin B1
Major Actions |
Muscle energy, GI
support, CV support |
|
Thiamin B1
Major Sources |
Meats, grains, legumes
|
|
Thiamin B1
deficiency |
Beriberi, altered
digestion, CNS and CV problems |
|
Riboflavin B2
Major Actions |
Growth, energy, tissue
healing |
|
Riboflavin B2
Major Sources |
Milk, meats, green
leafy vegetables |
|
Riboflavin B2
deficiency |
Skin eruptions, cracked
lips, red swollen tongue |
|
Niacin B3
Major Actions |
Energy and protein
metabolism/ cellular metabolism |
|
Niacin B3
Major Sources |
Liver, nuts, legumes
|
|
Niacin B3
Deficiency |
Pellagra, skin lesions,
GI and CNS symptoms, dementia |
|
Pantothenic Acid B5
Major Actions |
Fatty acid metabolism,
cell synthesis, heme production |
|
Pantothenic Acid B5
Major Sources |
Organ meats, egg yolk,
avocados, broccoli |
|
Pantothenic Acid B5
Deficiency |
Anemia, CNS changes
|
|
Pyridoxine B6
Major Actions |
Cellular function, heme
and neurotransmitter synthesis |
|
Pyridoxine B6
Major Sources |
Organ meats, grains
|
|
Pyridoxine B6
Deficiency |
Anemia, CNS hyperirritability,
dermatitis |
|
Folate
Major Actions |
Synthesis of amino
acids and hemoglobin, lower neural tube defect in fetus |
|
Folate
Major Sources |
Liver, green leafy
vegetables, grains, legumes |
|
Folate
Deficiency |
Megaloblastic anemia,
CNS disturbance |
|
Cobalamin B12
Major Actions |
Hemoglobin
Synthesis, fatty acid metabolism |
|
Cobalamin B12
Major Sources |
Organ meats, clams,
oysters, grains |
|
Cobalamin B12
Deficiency |
Pernicious anemia,
GI symptoms, poor muscle coordination |
|
Fat soluble vitamins
Vitamin A Major Actions |
Normal vision, tissue
strength, growth and tissue healing |
|
Fat soluble vitamins
Vitamin A Major Sources |
Orange/yellow colored
foods, liver, dairy |
|
Fat soluble vitamins
Vitamin A Deficiency |
Reduced night vision,
dry/thick eyes, mucosa changes |
|
Fat soluble vitamins
Vitamin D Major Actions |
Maintain serum calcium
and phosphorus, aid in bone development |
|
Fat soluble vitamins
Vitamin D Major Sources |
Fish, fortified dairy
products, sunlight |
|
Fat soluble vitamins
Vitamin D Deficiency |
Low serum calcium,
fragile bones, rickets |
|
Fat Soluble Vitamins
Vitamin E Major Actions |
Protects cells from
oxidation |
|
Fat Soluble Vitamins
Vitamin E Major Sources |
Vegetable oils, grains,
nuts, dark green vegetables |
|
Fat Soluble Vitamins
Vitamin E Deficiency |
Hemolytic anemia,
CNS changes |
|
Fat Soluble Vitamins
Vitamin K Major Actions |
Normal blood
clotting (prothrombin production), aids in bone metabolism |
|
Fat Soluble Vitamins
Vitamin K Major Sources |
Green leafy vegetables,
eggs, liver |
|
Fat Soluble Vitamins
Vitamin K Deficiency |
Increased bleeding
times |
|
Sodium (Na)
Major Actions |
Sodium (Na) Maintains
fluid volume, allows muscle contractions, cardiovascular support |
|
Major
Sources |
Table salt,
added salts, processed foods, butter |
|
symptoms of
Deficiency |
Muscle
cramping, cardiac changes |
|
symptoms of
Excess |
Fluid retention,
hypertension, CVA |
|
Sodium (Na)
Nursing Implications |
Monitor ECG, edema, and blood pressure.
|
|
Potassium (K)
Major Actions |
Maintains
fluid volume inside/outside cells, muscle action, blood pressure, cardiovascular support |
|
Potassium (K)
Major Sources |
Oranges, dried fruits, tomatoes, avocados, dried peas, meats, broccoli, bananas
|
|
Potassium (K)
symptoms of Deficiency |
Dysrhythmias, muscle cramps, confusion
|
|
Potassium (K)
symptoms of Excess |
Dysrhythmias (caused by supplements, potassium sparing diuretics, ACE inhibitors, inadequate kidney function, diabetes)
|
|
Potassium (K)
Nursing Implications |
Monitor ECG and muscle
tone. PO tabs irritate the GI system. Give with meals. |
|
Chloride (Cl)
Major Actions |
Bonds to
other minerals (esp. sodium) to facilitate cellular actions and reactions, fluid balance |
|
Chloride (Cl)
Major Sources |
Table salt
|
|
Chloride (Cl)
symptoms of Deficiency |
Rare
|
|
Chloride (Cl)
symptoms of Excess |
In concert with sodium, results in high blood pressure
|
|
Chloride (Cl)
Nursing Implications |
Monitor sodium levels.
|
|
Calcium (Ca)
Major actions |
Bones/teeth, cardiovascular
support, blood clotting, nerve transmission |
|
Calcium (Ca)
Major Sources |
Dairy, broccoli, kale, grains,
egg yolks |
|
Calcium (Ca)
symptoms of Deficiency |
Osteoporosis, tetany, Chvostek’s and Trousseau’s signs, ECG changes
|
|
Calcium (Ca)
symptoms of Excess |
Constipation, kidney stones
. |
|
Calcium (Ca)
Nursing Implications |
Monitor ECG and muscle tone. Give PO tabs with
vitamin D. |
|
Magnesium (Mg)
Major Actions |
nourishment, catalyst for
many enzyme reactions, nerve/muscle function, CV support |
|
Magnesium (Mg)
Major Sources |
Green leafy vegetables, nuts, grains, meat, milk
|
|
Magnesium (Mg)
symptoms of Deficiency |
Weakness, dysrhythmias,
tetany, seizure, reduced blood clotting, eclampsia |
|
Magnesium (Mg)
symptoms of Excess |
Diarrhea, kidney stones,
decreased muscle control, CV changes |
|
Magnesium (Mg)
Nursing Implications |
Incompatible with some
antibiotics. Give PO, 2 hr apart. |
|
Phosphorus
(P) Major Actions |
Energy transfer of RNA/DNA,
acid-base balance, bone and teeth formation |
|
Phosphorus
(P) Major Sources |
Dairy, peas, soft drinks,
meat, eggs, some grains |
|
Phosphorus
(P) symptoms of Deficiency |
Calcium level changes, muscle weakness
|
|
Phosphorus
(P) symptoms of Excess |
Skeletal porosity, decreased
calcium levels, must stay in balance with calcium |
|
Phosphorus
(P) Nursing Implications |
Evaluate the use of antacids (note type) and the use of alcohol.
|
|
Sulfur (S)
Major Action |
A component
of vitamin structure, by-product of protein metabolism |
|
Sulfur
Major sources |
Dried fruits
(dates, raisins, apples), meats, red and white wines Only seen in severe protein malnourishment, found in all proteincontaining foods |
|
Sulfur
s/s of deficiency |
Toxicity has a
very low risk |
|
Sulfur
s/s of excess |
Sulfur
levels are not usually monitored |
|
Iodine
|
used for synthesis of thyroxine, the thyroid hormone that helps regulate
metabolism. Iodine is taken up by the thyroid. When iodine is lacking, the thyroid gland enlarges creating a goiter. ☐☐ Grown food sources vary widely and are dependent on the iodine content of the soil in which they were grown. ☐☐ Seafood provides a good amount of iodine. Table salt in the United States is fortified with iodine, so deficiencies are not as prevalent. ☐☐ The RDA is 100 to 150 mcg for adults. |
|
Iron
|
for hemoglobin formation/function, cellular oxidation of
glucose, antibody production, and collagen synthesis. ☐☐ The body “scavenges” unused iron from dying red blood cells and stores it for later use. ☐☐ Iron supplements may cause constipation, nausea, vomiting, diarrhea, and teeth discoloration (liquid form). They should be taken with food to avert gastrointestinal symptoms, and nurses should encourage fresh fruits, vegetables, and a high-fiber diet. ☐☐ Supplements that are unneeded can become toxic. |
|
Iron IM Injections
|
Intramuscular injections are caustic to tissues and must be administered by
Z-track method. |
|
Iron
Major Sources |
Food sources include organ meats, egg yolks, whole grains, and green leafy
vegetables. ☐☐ Vitamin C increases the absorption of iron. ☐☐ The greatest need for iron is the newborn who is not breastfed, and for females during the menstruating years. |
|
Water
Intake/Output |
To maintain a balance between intake and output, intake should approximate output.
The minimum daily total fluid output in healthy adults is 1,500 mL. Therefore, the minimum daily amount of water needed is 1,500 mL. Under normal conditions, recommended adult fluid intake is 3 to 4 L/day for men and 2 to 3 L/day for women. It is recommended that half be from water. |
|
Assessing for Hydration
|
Assessment for proper hydration should include skin turgor, mental status, orthostatic
blood pressures, urine output and concentration, and moistness of mucous membranes. ◯◯ Thirst is a late sign of the need for hydration, especially in older adults. |
|
Percentage weight change calculation (weight change over a specified time):
|
usual weight – present weight
divided by usual weight x 100 ☐☐ 1% to 2% in 1 week indicates a significant weight loss. ☐☐ 7.5% in 3 months indicates a significant weight loss. |
|
“Ideal” body weight based on height (plus or minus 10% depending on frame
size). |
For males, 48 kg (106 lb) for the first 152 cm (5 ft) of height, and 2.7 kg (6
lb) for each additional 2.5 cm (1 inch). ☐☐ For females, 45 kg (100 lb) for the first 152 cm (5 ft) of height, and 2.3 kg (5 lb) for each additional 2.5 cm (1 inch). |
|
Body Mass Index (BMI)
|
Normal/healthy weight is indicated by a BMI of 18.5 to 24.9.
■■ Overweight is defined as an increased body weight in relation to height. It is indicated by a BMI of 25 to 29.9. ■■ Obesity is an excess amount of body fat. It indicated by a BMI greater than or equal to 30. ■■ BMI = weight (kg) ÷ height (m2) |
|
Fluid Intake and Output (I&O)
|
Normal daily range
◯◯ Adults 2,000 to 3,000 milliliters (2 to 3 liters) per day ◯◯ Total average output 2,300 to 2,600 milliliters per day |
|
Albumin
|
Protein levels are commonly measured by serum albumin levels. Many non-nutritional
factors (injury or renal disease), interfere with this measure for protein malnutrition. Albumin: Normal = 3.5 to 5.0 g/dL Moderate depletion = 2.1 to 2.7 g/dL |
|
Prealbumin
|
NOrmal = 23 to 43 mg/dL Moderate depletion = 5 to 9 mg/dL.
Prealbumin (thyroxin-binding protein) is a more susceptible measure used to assess critically ill clients who are at a higher risk for malnutrition. This test reflects more acute changes as opposed to gradual changes. |
|
Grains
|
Recommended serving size =6 oz
From: Whole grain breads, cereals, rice, pasta One slice bread = 1 oz 1 cup cereal = 1 oz ½ cup cooked pasta = 1 oz |
|
Vegetables
|
Recommended serving size = 2 ½ cups
From: (raw, cooked, or juice) Broccoli, carrots, dry beans and peas, corn, potatoes, tomatoes |
|
Milk
|
Recommended serving size = 3 cups
(2 cups for children ages two to eight) 2% milk, yogurt, cheese |
|
Meat and Beans
|
Recomended serving size = 5 ½ oz
From: Beef, poultry, eggs, kidney beans, soy beans, fish, nuts and seeds, peanut butter One small chicken breast = 3 oz One egg = 1 oz ¼ cup dried cooked beans = 1 oz |
|
Oils
|
Recommended serving size = 6 tsp
From: Canola oil, corn oil, olive oil, nuts, olives, some fish |
|
Recommended Exercise
|
Engage in physical activity for 30 min most days of the week.
◯◯ In order to prevent weight gain, 60 min of moderate intensity physical activity per day may be necessary. ◯◯ Children and teenagers should be physically active for 60 min/day. |
|
Physical Fitness
|
A physically fit person has strength, flexibility, cardiopulmonary endurance, and muscular
endurance. ●● Encourage increased physical activity as the first step to becoming physically fit, and for the maintenance of energy balance. Although aerobic exercise burns more calories, 20 min of low and moderate intensity exercise burns more fat. |
|
Weight loss
|
To lose 1 lb of body fat per week, an adult must have an energy deficit of 3,500 calories
(500 cal/day). |
|
Healthy Hearts
|
◯◯ Limit saturated fat to 10% of calories and cholesterol to 300 mg/day.
◯◯ For individuals with elevated low density lipoproteins (LDL), the American Heart Association (AHA) recommends increasing monounsaturated fats and soluble fiber. |
|
Healthy Nervous Systems
|
◯◯ Normal functioning of the nervous system depends on adequate levels of the
B-complex vitamins, especially thiamin, niacin, and vitamins B6 and B12. ◯◯ Calcium and sodium are important regulators of nerve responses. Consuming the recommended servings from the grain and dairy food groups provides these nutrients. |
|
Healthy Bones
|
◯◯ Consuming the recommended servings from the Food Pyramid’s dairy group supplies the
calcium, magnesium, and phosphorus necessary for bone formation, and vitamin D that aids in the absorption of calcium and phosphorus. ◯◯ Weight-bearing physical activity is essential to decrease the risk of osteoporosis. |
|
Good Bowel Function
|
◯◯ Normal bowel functioning depends on adequate fluid intake and 25 g/day of fiber for
women, and 38 g/day for men. ◯◯ The minimum number of servings from the Food Pyramid’s fruit, vegetable, and grain food groups (specifically whole grains) provides the essential nutrients. |
|
Cancer Prevention
|
◯◯ A well-balanced diet using the Food Pyramid and a healthy weight are guidelines to prevent
cancer. ◯◯ Increase high-fiber plant-based foods. ◯◯ Limit saturated and polyunsaturated fat, while emphasizing foods with monounsaturated fat or omega-3 fatty acids (nuts and fish). ◯◯ Limit sodium intake. ◯◯ Avoid excess alcohol intake. ◯◯ Include regular physical activity. |
|
Proper food storage guidelines include:
|
Fresh meat: 1 to 2 days at 40° F or cooler.
◯◯ Fish: 1 to 2 days at 40° F or cooler. ◯◯ Dairy products: Store in the refrigerator for 5 days for milk, and 3 to 4 weeks for cheese. ◯◯ Eggs: Store in the refrigerator for 3 weeks in shell, and 1 week for hard-boiled. ◯◯ Fruits and vegetables: Keep for 3 to 5 days; citrus fruits and apples, 1 week or longer. ◯◯ Pantry items: Store in a dry, dark place at room temperature. ◯◯ Canned goods: Store 1 year or longer at room temperature. |
|
Pre-end stage renal disease (pre-ESRD)
|
distinguished by an increase in serum creatinine.
Signs and symptoms include fatigue, back pain, and appetite changes. |
|
end stage renal disease (ESRD)
|
occurs when the glomerular filtration rate (GFR)
is less than 25 mL/min, the serum creatinine level steadily rises, or dialysis or transplantation is necessary. Signs and symptoms of end stage renal disease (ESRD) include fatigue, decreased alertness, anemia, decreased urination, headache, and weight loss. |
|
acute renal failure (ARF)
|
Signs and symptoms of acute renal failure (ARF) include a decrease in urination, decreased
sensation in the extremities, swelling of the lower extremities, and flank pain. It is characterized by rising blood levels of urea and other nitrogenous wastes. |
|
nephrotic syndrome
|
The most pronounced manifestation of nephrotic syndrome is edema. Other
manifestations include hypoalbuminemia, hyperlipidemia, and blood hypercoagulation. |
|
kidney stone
|
The passing of a kidney stone is characterized by sudden, intense pain that is typically
located in the flank and is unrelieved by position changes Diaphoresis and nausea and vomiting are common, and there may be blood in the urine. Approximately 80% of stones contain calcium. |
|
General Renal Considerations
RN |
Monitor daily weights (unless prescribed more frequently
Monitor I&O Monitor for s/s of constipation Explain to clients why dietary changes are necessary. Ultimately, alterations in the intake of protein, calories, sodium, potassium, phosphorus, and other vitamins will be necessary. Family/pt support |
|
PreESRD
RN Interventions |
Goals of nutritional therapy:
Control blood glucose levels and hypertension Help preserve remaining renal function by limiting the intake of protein and phosphorus. (High levels of phosphorus contribute to calcium and phosphorus deposits in the kidneys.)(peanut butter, dried peas and beans, bran, cola, chocolate, beer, some whole grains) Protein restriction is essential for clients with pre-ESRD. ☐☐ Slows the progression of renal disease. ☐☐ Too little protein results in the breakdown of body protein. Protein intake must be carefully determined. |
|
Dietary recommendations for pre-ESRD:
|
Restrict sodium intake to maintain blood pressure.
☐☐ The recommended daily protein intake is 0.6 to 1.0 g/kg of ideal body weight. ☐☐ Limit meat intake to <5 to 6 oz/day for most men and < 4 oz/day for most women. ☐☐ Limit dairy products to ½ cup per day. ☐☐ Limit high-phosphorus foods (peanut butter, dried peas and beans, bran, cola, chocolate, beer, some whole grains) to one serving or less per day. ☐☐ Caution clients to use vitamin and mineral supplements only when recommended by a health care provider. |
|
End Stage Renal Disease (ESRD)
Therapeutic Nutrition |
Low Potassium intake is dependent upon the client’s laboratory values, which should be closely monitored.
Low Sodium (2-4 g/day) and fluid allowances are determined by blood pressure, weight, serum electrolyte levels, and urine output. |
|
End Stage Renal Disease (ESRD)
Protein Requirements |
High protein
Protein needs increase once dialysis has begun as protein and amino acids are lost in the dialysate. ☐☐ Fifty percent of protein intake should come from biologic sources (eggs, milk, meat, fish, poultry, soy). ☐☐ Adequate calories (35 kcal/kg of body weight) should be consumed to maintain body protein stores. ■■ Phosphorus must be restricted. ☐☐ A high protein requirement leads to an increase in phosphorus intake. ☐☐ Phosphate binders must be taken with all meals and snacks. |
|
ESRD
Vitamin D |
Vitamin D deficiency occurs as the kidneys are unable to convert vitamin D to its
active form. ☐☐ This alters the metabolism of calcium, phosphorus, and magnesium, leading to hyperphosphatemia, hypocalcemia, and hypermagnesemia. ☐☐ Calcium supplements will likely be required since foods high in phosphorus (which are restricted) are also high in calcium. |
|
Acute Renal Failure (ARF)
Therapeutic Nutrition |
Diet therapy for ARF is dependent upon the phase of ARF and its underlying
cause (trauma, sepsis, poor perfusion, or medications). Protein, calories, fluids, potassium, and sodium need to be individualized according to the phase of ARF, and adjusted as improvement develops. |
|
Nephrotic Syndrome
Therapeutic Nutrition |
Nephrotic syndrome results in the leakage of serum proteins into the urine.
Nutritional therapy goals include minimizing edema, replacing lost nutrients, and minimizing renal damage. ■■ Dietary recommendations indicate sufficient protein and low-sodium intake. |
|
Nephrolithiasis (Kidney Stones)
◯◯ Preventative Nutrition/ Therapeutic Nutrition |
Preventative Nutrition
■■ Excessive intake of protein, sodium, calcium, and oxalates (rhubarb, spinach, beets) may increase the risk of stone formation. ◯◯ Therapeutic Nutrition ■■ Increasing fluid consumption is the primary intervention for the treatment and prevention of renal calculi. At least 8 to 12 oz (240 to 360 mL) of fluid, preferably water should be consumed before bedtime as urine becomes more concentrated at night. |
|
Hypoglycemia
|
an abnormally low blood glucose level.
◯◯ It results from taking too much insulin, inadequate food intake, delayed or skipped meals, extra physical activity, or consumption of alcohol without food. ◯◯ Blood glucose levels of 70 mg/dL or less require immediate action. ◯◯ Symptoms include mild shakiness, mental confusion, sweating, palpitations, headache, lack of coordination, blurred vision, seizures, and coma. |
|
Hyperglycemia
|
Hyperglycemia is an abnormally high blood glucose level.
◯◯ It results from an imbalance among food, medication, and activity. ◯◯ Symptoms include blood glucose greater than 250 mg/dL, ketones in urine, polydipsia (excessive thirst), polyuria (excessive urination), hyperventilation, dehydration, fruity odor to breath, and coma. |
|
Hypoglycemia
RN Interventions |
Clients with hypoglycemia should be instructed to take 15 to 20 g of a readily
absorbable carbohydrate, including: ■■ Two or three glucose tablets (5 g each). ■■ Five LifesaversTM/hard candies. ■■ ½ cup (4 oz) juice or regular soda. ■■ 1 tbsp of honey or brown sugar. ◯◯ Retest the blood glucose in 15 min. If it is 70 to 75 mg/dL, repeat the above steps. Once levels normalize, give an additional 15 g if the next meal is more than 1 hr away. |
|
Hyperglycemia
RN Interventions |
Immediately consult a health care provider, or go to the emergency department.
■■ Take medication if forgotten. ■■ Consider modifications to insulin or oral diabetic medications. |
|
Long-term implications of untreated or inadequately treated hyperglycemia
|
blindness, kidney failure, dyslipidemia, hypertension, neuropathy, microvascular
disease, and limb amputation. |
|
Somagyi’s phenomenon
|
morning hyperglycemia in response to overnight
hypoglycemia. Providing a bedtime snack and appropriate insulin dose will prevent hypoglycemia. |
|
Dawn phenomenon
|
is an elevation of blood glucose around 0500 to 0600. It results
from an overnight release of growth hormone, and is treated by increasing the amount of insulin provided during the overnight hours. ●● |
|
DM General Nutritional Guidelines
|
Coronary heart disease (CHD) is the leading cause of death among clients with
diabetes. Therefore, clients with diabetes are encouraged to follow a diet that is high in fiber and low in saturated fat, trans fat, and cholesterol. ■■ Encourage the client to consume complex carbohydrates found in grains, fruits, and vegetables. ■■ Carbohydrates and monounsaturated fats combined should account for 60% to 70% of total calories. ■■ Saturated fat should account for less than 10% of total calories. If LDL is greater than 100 mg/dL, the saturated fat should be limited to less than 7% of intake. ■■ Promote fiber intake (beans, vegetables, oats, whole grains). ■■ Protein should comprise 15% to 20% of total caloric intake. Protein intake may need to be reduced in clients with diabetes and renal failure. |
|
DM General Nutritional Guidelines
|
Encourage clients with diabetes mellitus to eliminate all tobacco use.
◯◯ Limit alcohol intake and consuming food with alcohol consumption. ◯◯ Vitamin and mineral requirements are unchanged for clients who have diabetes. Supplements are recommended for identified deficiencies. Deficiencies in magnesium and potassium can aggravate glucose intolerance. ◯◯ Artificial sweeteners are acceptable. Saccharin crosses the placenta and should be avoided during pregnancy. |
|
DM
Other Nursing Interventions |
Encourage exercise. Blood glucose levels and medication dosages should be closely
monitored. ◯◯ Encourage weight loss. ■■ Weight loss is especially encouraged in clients with type 2 diabetes mellitus as it can decrease insulin resistance, improve glucose and lipid levels, and lower blood pressure. ◯◯ Clients should be encouraged to perform self-monitoring of blood glucose levels. ■■ Strict control of glucose levels can reduce or postpone complications (retinopathy, nephropathy, neuropathy). ◯◯ Clients should be encouraged to receive regular evaluations from the provider. ◯◯ Client education and support should be provided for: ■■ Self-monitoring of blood glucose. ■■ Dietary and activity recommendations. ■■ Signs, symptoms, and treatment of hypoglycemia and hyperglycemia. ■■ Long-term complications of diabetes. ■■ Psychological implications. ◯◯ Children with diabetes will require parental support, guidance, and participation. Dietary intake must provide for proper growth and development. |
|
Cancer
Therapeutic Nutrition |
Increased caloric intake ranging from 25 to 35 cal/kg to maintain weight
and 40 to 50 cal/kg to rebuild body stores. ☐☐ Protein needs are increased to 1.5 to 2.0 g/kg. ☐☐ Vitamin and mineral supplementation is based upon the client’s needs. ■■ Encourage clients to eat more on days when feeling better (on “good” days). ■■ Encourage intake of foods that have been modified to contain additional protein and calories. Foods choices include: ☐☐ Milk, cheese, milkshakes, and pudding. ☐☐ Fish. ☐☐ Eggs. ☐☐ Nuts. ■■ Nutritional supplements that are high in protein and/or calories should be encouraged. ☐☐ These supplements should be offered between meals and can be used as meal replacements if necessary. |
|
Cancer
Increase protein and caloric content of foods by: |
☐☐ Substituting whole milk for water in recipes.
☐☐ Adding cheese to dishes. ☐☐ Using peanut butter as a spread for fruits. ☐☐ Using yogurt as a topping for fruit. ☐☐ Dipping meats in milk and bread crumbs before cooking. |
|
Cancer
Complications associated with nutritional management -Early satiety |
Eat small amounts of high protein foods,
loaded with calories and nutrient |
|
Cancer
Complications associated with nutritional management -Anorexia |
• Eat small amounts of high protein foods,
loaded with calories and nutrient • Try to consume food in the morning when appetite is best • Avoid food odors • Do not fill up on low calorie foods (broth, high roughage foods containing water) |
|
Cancer
Complications associated with nutritional management -Mouth ulcers and stomatitis |
• Use a soft toothbrush to clean teeth after
eating and at bedtime • Avoid mouth washes that contain alcohol • Omit spicy, dry, or coarse foods • Include cold or room temperature foods in the diet • Cut food into small bites • Try using straws • Be sure dentures fit well |
|
Cancer
Complications associated with nutritional management -Fatigue |
• Eat a large, calorie-dense breakfast when
energy level is the highest • Conserve energy by eating foods that are easy to prepare • Utilize a meal delivery service |
|
Cancer
Complications associated with nutritional management -Food aversions |
• Avoid eating foods that are well-tolerated
and liked prior to having treatments (chemotherapy, radiation). |
|
Cancer
Complications associated with nutritional management -Taste alterations and thick saliva |
• Try adding foods that are tart (citrus juices), pickles to stimulate saliva
• Include cold or room temperature foods in the diet • Try using sauces for added flavor • Use plastic utensils when cooking • Suck on mints, candy, or chew gum to remove bad taste in mouth. -gargle with mouthwash to get rid of metallic taste |
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Cancer
Complications associated with nutritional management -Gastrointestinal problems (nausea, vomiting, diarrhea) |
• Nausea, vomiting
◯◯ Eat cold or room temperature foods ◯◯ Try high carbohydrate, low fat foods ◯◯ Avoid fried foods ◯◯ Do not eat prior to chemotherapy or radiation ◯◯ Take prescribed antiemetic medication at the direction of the provider • Diarrhea ◯◯ Ensure adequate intake of liquids throughout the day to replace losses ◯◯ Avoid foods that may exacerbate diarrhea (foods high in roughage) ◯◯ Consume foods high in pectin to increase the bulk of the stool and to lengthen transition time in the colon |
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A client receiving immunosuppressant therapy
|
may need to minimize exposure to microorganisms found on the outer layers of fresh fruits and vegetables.
Peeling and thorough washing or cooking may be necessary. In some cases, fresh foods may increase the risk of infection. |
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clients with dysphagia
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Nurses should teach clients with dysphagia to inhale, swallow, and then exhale
and tilt. Tilting of the head may help with swallowing. Avoid sticky or lumpy food. |
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HIV/AIDS
◯◯ Therapeutic Nutrition |
HIV infection, secondary infection, malignancies, and medication therapies can
cause symptoms and side effects that impair intake and alter metabolism. ■■ Overall, caloric needs are increased, generally ranging from 35 to 45 cal/kg. ■■ A high-protein diet is recommended with amounts varying from 1.2 to 2.0 g/kg. ■■ The intake of a multivitamin that meets 100% of the recommended daily servings is sufficient, unless a specific deficiency is identified. |
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HIV/AIDS
-Wasting |
Poor nutritional status leads to wasting and fever, further aggravating the
susceptibility to secondary infections. ■■ Wasting is distinguished by an unintended weight loss of 10% and concurrent problems that include diarrhea or chronic weakness and fever for at least 30 days. ■■ Decreased nutrient intake occurs because of physical symptoms (anorexia, nausea, vomiting, diarrhea). Psychological symptoms may include depression and dementia. |
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Nutritional warning signs in clients with HIV/AIDS
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include rapid weight loss,
gastrointestinal problems, inadequate intake, increased nutrient needs, food aversions, fad diets, and supplements. ■■ If the client with AIDS is unable to consume sufficient nutrients, calories, and fluid, enteral feedings may be needed. ■■ Encourage the client to consume small, frequent meals that are composed of high-protein, high-calorie, and nutrient-dense foods. |
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Ch. 8 Modified Diets
Clear Liquid Diet |
This diet consists of foods that are clear and liquid at room temperature.
◯◯ The clear liquid diet primarily consists of water and carbohydrates. This diet requires minimal digestion, leaves minimal residue, and is non-gas forming. It is nutritionally inadequate and should not be used long term. ◯◯ Indications for a clear liquid diet include acute illness, reduction of colon fecal material prior to certain diagnostic tests and procedures, acute agstrointestinal disorders, and some postoperative recovery. ◯◯ Acceptable foods are water, tea, coffee, fat-free broth, carbonated beverages, clear juices, ginger ale, and gelatin. ◯◯ Caffeine consumption should be limited as it can lead to increased hydrochloric acid and upset stomach. |
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Ch. 8 Modified Diets
Full Liquid Diet |
◯◯ Consists of foods that are liquid at room temperature.
◯◯ Full liquid diets offer more variety and nutritional support than a clear liquid diet and can supply adequate amounts of energy and nutrients. ◯◯ Acceptable foods include: all liquids on a clear liquid diet, all forms of milk, soups, strained fruits and vegetables, vegetable and fruit juices, eggnog, plain ice cream and sherbet, refined or strained cereals, and puddings. ◯◯ If this diet is used more than 2 to 3 days, high-protein and high-calorie supplements may be indicated. ◯◯ Indications include a transition from liquid to soft diets, postoperative recovery, acute gastritis, febrile conditions, and intolerance of solid foods. ◯◯ This diet provides oral nourishment for clients having difficulty chewing or swallowing solid foods. Clients with dysphagia (difficulty swallowing) should be cautious with liquids unless they are thickened appropriately. ◯◯ This diet is contraindicated for clients who have lactose intolerance or hypercholesterolemia. Lactose reduced milk and dairy products should be used when possible. |
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ch. 8 Modified diets
Blenderized Liquid (Pureed) Diet |
◯◯ Consists of liquids and foods that have been pureed to liquid form.
◯◯ The composition and consistency of a pureed diet varies, depending on the client’s needs. ◯◯ Pureed diets can be modified with regard to calories, protein, fat, or other nutrients based on the dietary needs of the client. ◯◯ Adding broth, milk, gravy, cream, soup, tomato sauce, or fruit juice to foods in place of water provides additional calories and nutritional value. ◯◯ Each food is pureed separately to preserve individual flavor. ◯◯ Indications for use include clients with chewing or swallowing difficulties, oral or facial surgery, and wired jaws. |
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ch. 8 Modified diets
Soft (Bland, Low-Fiber) Diet |
◯◯ A soft diet contains whole foods that are low in fiber, lightly seasoned, and easily digested.
◯◯ Food supplements or snacks in between meals are used to add calories. ◯◯ Food textures may be smooth, creamy, or crisp. Fruits, vegetables, coarse breads and cereals, beans, and other potentially gas-forming foods are excluded. ◯◯ Indications for this diet include clients transitioning between full liquid and regular diets, or those with acute infections, chewing difficulties, or gastrointestinal disorders. |
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ch. 8 Modified diets
Mechanical Soft Diet |
◯◯ A mechanical soft diet is a regular diet that has been modified in texture. The diet composition may be altered for specific nutrient needs.
◯◯ This diet includes foods that require minimal chewing before swallowing (ground meats, canned fruits, softly cooked vegetables). ◯◯ A mechanical soft diet excludes harder foods (dried fruits, most raw fruits and vegetables, foods containing seeds and nuts). ◯◯ Indications for this diet include clients who have limited chewing or swallowing ability; clients with dysphagia, poorly fitting dentures, and who are edentulous (without teeth); clients who have had surgery to the head, neck, or mouth; and clients with strictures of the intestinal tract. |
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ch. 8 Modified diets
Regular Diet (Normal or House Diet) |
◯◯ A regular diet is indicated for clients who do not need dietary restrictions. The diet is adjusted to meet age specific needs throughout the life cycle.
◯◯ Many health care facilities offer self select menus for regular diets. ◯◯ Dietary modifications to accommodate individual preferences, food habits, and ethnic values can be done without difficulty for the client receiving a regular diet. |
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Chapter 9 Enteral Nutrition
Enteral nutrition (EN) |
used when a client cannot consume adequate nutrients and calories orally, but maintains a partially functional gastrointestinal system.
●● EN consists of blenderized foods or a commercial formula administered by a tube into the stomach or small intestine. Enteral feedings most closely utilize the body’s own digestive and metabolic routes. EN may augment an oral diet or may be the sole source of nutrition. |
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Chapter 9 Enteral Nutrition
Enteral Feeding Routes Transnasal tubes |
■■ Nasogastric (NG) tubes are passed from the nose to the stomach.
■■ Nasointestinal tubes are passed from the nose to the intestine. ■■ These tubes are used short term (less than 3 to 4 weeks). |
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Chapter 9 Enteral Nutrition
Enteral Feeding Routes ostomy |
into the stomach or intestines.
■■ Gastrostomy tubes are endoscopically or surgically inserted into the stomach. A percutaneous endoscopic gastrostomy (PEG) tube is placed with the aid of an endoscope. ☐☐ Gastrostomy tube feedings are generally well tolerated because the stomach chamber holds and releases feedings in a physiologic manner that promotes effective digestion. As a result, dumping syndrome is usually avoided. ■■ Jejunostomy tubes are surgically inserted into the jejunal portion of the small intestine (jejunum). |
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Chapter 9 Enteral Nutrition
Enteral Feeding Routes long-term use |
Endoscopic or surgical placement is preferred when long-term use is anticipated, or when a
nasal obstruction makes insertion through the nose impossible. ●● Placement into the stomach stimulates normal gastrointestinal function. |
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Chapter 9 Enteral Nutrition
Enteral Feeding Formulas |
●● Commercial products are preferred over home-blended ingredients because they provide a
known nutrient composition, controlled consistency, and bacteriological safety. |
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Chapter 9 Enteral Nutrition
Enteral Feeding Formulas Standard formulas |
◯◯ Standard formulas, also called polymeric or intact, are composed of whole proteins or
protein isolates. ■■ These formulas require a functioning gastrointestinal tract. ■■ Most provide 1.0 to 1.2 cal/mL, but are available in high-protein, high-calorie, and disease-specific formulas. |
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Chapter 9 Enteral Feeding
Formulas Hydrolyzed formulas |
, or elemental, are composed of partially digested protein
peptides and are referred to as free amino acids. ■■ These formulas are used for clients with a partially functioning gastrointestinal tract, or those who have an impaired ability to digest and absorb foods (people with inflammatory bowel disease, short-gut syndrome, cystic fibrosis, pancreatic disorders). ■■ Most routine formulas provide 1.0 to 1.2 cal/mL. High calorie formulas provide 1.5 to 2.0 cal/mL. Partially hydrolyzed formulas provide other nutrients in simpler forms that require little or no digestion. |
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Chapter 9 Enteral Feeding
Formulas Tube Feedings |
Tube feedings may be packaged in cans or in pre-filled bags.
◯◯ Pre-filled bags should be discarded every 24 hr or according to facility policy, even if they are not empty. ◯◯ Cans may be used to add formula to a generic bag to infuse via a pump, or for feedings directly from a syringe. |
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Chapter 9 Enteral Feeding
Factors to consider in determining an appropriate formula |
◯◯ Caloric density.
◯◯ Water content. ◯◯ Protein density. ◯◯ Osmolality. ◯◯ Fiber and residue content. ◯◯ Presence of other nutrients. |
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Tube Feeding Basics
|
Prior to instilling enteral feeding, tube placement should be verified by radiography.
Aspirating gastric contents and measuring pH levels are less reliable methods of verifying placement. HOB 30 degrees minimum. pH of Gastric contents 0-4. Aspirate for residual - < 10 mL intestinal residual. < 100 ml gastric residual. |
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Enteral Feeding Delivery Methods
Continuous drip method |
Formula is administered at a continuous rate over a 16 to 24 hr period.
■■ Infusion pumps help ensure consistent flow rates. ■■ This method is recommended for critically ill clients because of its association with smaller residual volumes, and a lower risk of aspiration and diarrhea. ■■ Residual volumes should be measured every 4 to 6 hr. ■■ Feeding tubes should be flushed with water every 4 hr to maintain patency. ■■ If the volume of gastric residual exceeds the volume of formula given over the previous 2 hr, it may be necessary to reduce the rate of feeding. |
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Enteral Feeding Delivery Methods
Cyclic feedings |
Formula is administered at a continuous rate over an 8 to 16 hr time period, often during sleeping hours.
■■ Often used for transition from total EN to oral intake. -flush tube w/30-60 mL tap water q 4-6h and check tube placement. |
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Enteral Feeding Delivery Methods
Intermittent tube feedings |
Formula is administered every 4 to 6 hr in equal portions of 200 to 300 mL over a 30 to 60 min time frame, usually by gravity drip.
■■ Often used for noncritical clients, home-tube feedings, and clients in rehabilitation. - follow with 60-100 mL of tap water (or amount prescribed) to flush/prevent clogging. |
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Enteral Feeding Delivery Methods
Bolus feedings |
A large volume of formula (500 mL maximum, usual volume is 250 to
400 mL) is administered over a short period of time, usually less than 15 min, four to six times daily. ■■ Bolus feedings are delivered directly into the stomach. They may be poorly tolerated and may cause dumping syndrome. |
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Chapter 9 Enteral Feeding
RN interventions |
Weaning occurs as oral consumption increases. Enteral feedings may be discontinued when the client consumes two-thirds of protein and calorie needs orally for 3 to 5
days. ◯◯ A client who is NPO will require meticulous oral care. ◯◯ A client may require nutritional support service at home for long-term EN. A multidisciplinary team comprised of a nurse, dietician, pharmacist, and the provider, will monitor the weight, electrolyte balance, and overall physical condition of the client. |
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Chapter 9 Enteral Feeding
Gastrointestinal Complications |
Gastrointestinal complications include constipation, diarrhea, cramping, pain,
abdominal distention, dumping syndrome, nausea, and vomiting. |
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Chapter 9 Enteral Feeding
Mechanical Complications |
Mechanical complications include tube misplacement or dislodgement, aspiration,
tube obstruction or rupture, irritation and leakage at the insertion site, and irritation of the nose, esophagus, and mucosa. ◯◯ Nursing Actions ■■ Feeding tube obstruction can be prevented by flushing the tube with 20 to 60 mL of warm water after use and every 4 hr, and by avoiding dry products and administering crushed medications. Be sure to include water used to flush the tube in daily intake. |
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Chapter 9 Enteral Feeding
Metabolic Complications |
Metabolic complications include dehydration, hyperglycemia, electrolyte imbalances, and overhydration.
|
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Chapter 9 Enteral Feeding
Food Poisoning |
◯◯ Bacterial contamination of formula can result in food poisoning.
◯◯ Nursing Actions ■■ To avoid bacterial contamination: ☐☐ Wash hands before handling formula or enteral products. ☐☐ Clean equipment and tops of formula cans. ☐☐ Cover and label unused cans with the client’s name, room number, date, and time of opening. ☐☐ Refrigerate unused portions promptly for up to 24 hr. ☐☐ Replace the feeding bag and tubing every 24 hr. ☐☐ Fill generic bags with less than 6 hr worth of formula. |
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What data is important to collect before initiating feedings?
|
The nurse should first verify the presence of bowel sounds in the client. Then, the placement of the tube should be verified by radiography. Measuring pH levels and aspirating gastric
contents are less reliable methods of verifying placement. The nurse should elevate the head of the bed at least 30° during the feeding, and for 30 to 45 min following the feeding. This is done to reduce the risk of aspiration. Lastly, the nurse should obtain baseline assessment data including height, weight, and BMI. Preliminary laboratory values include albumin, hemoglobin, hematocrit, glucose, and electrolyte levels. |
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prevention of bacterial contamination of tube
feedings |
Feeding bags should be filled with no more than 6 hr worth of formula. Irrigation sets
should be changed every 24 hr. Pre-filled bags usually contain enough formula for a 24 hr period. Any unused portion should be covered, properly labeled, and refrigerated. Tubing and feeding should be replaced every 24 hr unless otherwise specified by facility policy. |
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Chapter 7
Calorie increase for Pregnant women |
A daily increase of 340 calories is recommended during the second trimester of pregnancy,
and an increase of 452 calories is recommended during the third trimester of pregnancy. |
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Chapter 7
recommended weight gain during pregnancy |
The recommended weight gain during pregnancy varies for each woman depending on her
body mass index (BMI) and weight prior to pregnancy. ◯◯ Recommended weight gain during the first trimester is 2 to 4 lb. ◯◯ Trimesters 2 and 3: ■■ Normal weight client – 1 lb/week for a total of 25 to 35 lb. ■■ Underweight client – just more than 1 lb/week for a total of 28 to 40 lb. ■■ Overweight client – 0.66 lb/week for a total of 15 to 25 lb. |
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Chapter 7
Caloric intake/Lactating Women |
Lactating women require an increase in daily caloric intake. If the client is breastfeeding
during the postpartum period, an additional daily intake of 330 calories is recommended during the first 6 months, and an additional daily intake of 400 calories is recommended during the second 6 months. |
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Chapter 7
Dietary requirements for Protein in Pregnancy |
Protein should comprise 20% of the daily total calorie intake. The recommended daily
allowance (RDA) for protein during pregnancy is 1.1 g/kg/day. Protein is essential for rapid tissue growth of maternal and fetal structures, amniotic fluid, and extra blood volume. Women who are pregnant should be aware that animal sources of protein might contain large amounts of fats. RDA= NPG=46 PG=71 Lact=71 |
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Chapter 7
Dietary requirements for Fat in Pregnancy |
Fat should be limited to 30% of total daily calorie intake.
|
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Chapter 7
Dietary requirements for Carbs in Pregnancy |
Carbohydrates should comprise 50% of the total daily calorie intake. Ensuring
adequate carbohydrate intake allows for protein to be spared and available for the synthesis of fetal tissue. |
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Chapter 7
Vitamins |
Vitamins content of breastmilk depends on maternal intake, especially A, B, C & D.
Vitamin A (mcg) NPG=700 PG=770 Lact=1300 Vitamin C (mg) NPG=75 PG=85 Lact=120 Vitamin D (mcg)* NPG=5 PG=5 Lact=5 Vitamin E (mcg)NPG=15 PG=15 Lact=19 Vitamin K (mcg)* NPG=90 PG=90 Lact=90 Thiamin (mg)NPG=1.1 PG=1.4 Lact=1.4 Vitamin B6 (mg) NPG=1.3 PG=1.9 Lact=2.0 Folate (mcg) NPG=400 PG=600 Lact=500 Vitamin B12 (mcg) NPG=2.4 PG=2.6 Lact=2.8 Calcium (mg)* NPG=1000 PG=1000 Lact=1000 Iron (mg) NPG=18 PG=27 Lact=9 |
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Chapter 7
N/V and Diarrhea during PG |
Nausea and constipation are common during pregnancy.
◯◯ For nausea, eat dry crackers or toast. Avoid alcohol, caffeine, fats, and spices. Avoid drinking fluids with meals, and do not take medications to control nausea without checking with the provider. ◯◯ For constipation, increase fluid consumption and include extra fiber in the diet. Fruits, vegetables, and whole grains contain fiber. |
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Chapter 7
Maternal Phenylketonuria (PKU) |
This is a maternal genetic disease in which high levels of phenylalanine poses danger to the fetus.
◯◯ It is important for a client to resume the PKU diet at least 3 months prior to pregnancy, and continue the diet throughout pregnancy. ◯◯ The diet should include foods low in phenylalanine. Foods high in protein (fish, poultry, meat, eggs, nuts, dairy products) must be avoided due to high phenylalanine levels. ◯◯ The client’s blood phenylalanine levels should be monitored during pregnancy. ◯◯ These interventions will prevent fetal complications (mental retardation, behavioral problems). |
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Chapter 7
Infant Growth Weight/Height |
Birth weight doubles by 4 to 6 months and triples by 1 year of age. The need for calories and nutrients is high to support the rapid rate of growth.
●● Appropriate weight gain averages 150 to 210 g (5 to 7 oz) per week during the first 5 to 6 months. ●● An infant grows approximately 2.5 cm (1 in) per month in height the first 6 months, and approximately 1.25 cm (0.5 in) in height per month the last 6 months. |
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Chapter 7
Infants Head circumference |
increases rapidly during the first 6 months at a rate of 1.5 cm (0.6 in) per month. The rate slows to 0.5 cm per month for months 6 to 12. By 1 year, head size should have increased by 33%. This is reflective of the growth of the nervous system.
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Chapter 7
Infants Diet |
Breast milk, infant formula, or a combination of the two is the sole source of nutrition for the first 4 to 6 months of life.
●● Semi-solid foods should not be introduced before 4 months of age to coincide with the development of head control, the ability to sit, and the back-and-forth motion of the tongue. Iron-fortified infant cereal is the first solid food introduced as gestational iron stores begin to deplete around 4 months of age. |
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Chapter 7
Infants Cow's Milk |
Cow’s milk should not be introduced into the diet until after 1 year of age as protein and mineral content stress the immature kidney. A young infant cannot fully digest the protein and fat contained in cow’s milk.
|
|
Chapter 7
Infants Advantages of Breastfeeding |
Recommended first 6-12 months.
Incidence of otitis media (ear infections), and gastrointestinal and respiratory disorders are reduced. This is due to the transfer of antibodies from mother to infant. ■■ Carbohydrates, proteins, and fats in breast milk are predigested for ready absorption. ■■ Breast milk is high in omega-3 fatty acids. ■■ Breast milk is low in sodium. ■■ Iron, zinc, and magnesium found in breast milk are highly absorbable. ■■ Calcium absorption is enhanced as the calcium-to-phosphorous ratio is 2 to 1. ■■ The risk of allergies is reduced. ■■ Maternal-infant bonding is promote |
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Chapter 7
Infants Breastfeeding Teaching Points |
There should be eight to 12 feedings in a 24 hr period.
Expressed milk may be refrigerated in sterile bottles for use within 3 to 5 days, or frozen in sterile containers for 3 to 6 months. Thaw milk in the refrigerator, it can be stored for 24 hr after thawing. No microwave. Don't refreeze thawed milk. Avoid consuming freshwater fish or alcohol, and limit caffeine. ■■ Do not take medications unless prescribed by a provider. |
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Chapter 7
Infants Formula Feeding |
They are modified
from cow’s milk to provide comparable nutrients. ◯◯ An iron-fortified formula is recommended by the American Academy of Pediatrics for at least the first 6 months of life or until the infant consumes adequate solid food. The infant should not drink more than 32 oz of formula per 24 hr period unless directed by a provider. |
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Chapter 7
Infants Weaning |
Developmentally, the infant is ready for weaning from the breast or bottle to a cup
between 5 to 8 months of age. ◯◯ If breastfeeding is eliminated before 5 to 6 months, a bottle should be provided for the infant’s sucking needs. ◯◯ It is best to substitute the cup for one feeding period at a time over a 5 to 7 day period. ◯◯ Nighttime feedings are often the last to disappear. The infant may not be ready to wean from the bottle or breast until 12 to 14 months of age. |
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Chapter 7
Infants Introducing Solid Food |
> 4-6 mos.
due to the risk of food allergies and stress on the immature kidneys. ◯◯ Indicators for readiness include: voluntary control of the head and trunk, hunger less than 4 hr after vigorous nursing or intake of 8 oz of formula, and interest of the infant. ◯◯ Iron-fortified rice cereal should be offered first. Wheat cereals should not be introduced until after the first year. ◯◯ New foods should be introduced one at a time over a 5 to 7 day period to observe for signs of allergy or intolerance, which may include fussiness, rash, vomiting, diarrhea, or constipation. Vegetables or fruits are first started between 6 and 8 months of age, and after both have been introduced meats may be added to the diet. ◯◯ Delay the introduction of milk, eggs, wheat, and citrus fruits that may lead to allergic reactions in susceptible infants. ◯◯ Do not give peanuts or peanut butter due to the risk of a severe allergic reaction. ◯◯ The infant may be ready for three meals a day with three snacks by 8 months of age. |
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Chapter 7
Infants Colic |
persistent crying lasting 3 hr or longer per day.
◯◯ The cause of colic is unknown, but usually occurs in the late afternoon, more than 3 days per week for more than 3 weeks. The crying is accompanied by a tense abdomen and legs drawn up to the belly. ◯◯ Colic usually resolves by 3 months of age. ◯◯ Breastfeeding mothers should continue nursing, but limit caffeine and nicotine intake. ◯◯ If breastfeeding, eliminating cruciferous vegetables (cauliflower, broccoli, and Brussels sprouts), cow’s milk, onion, and chocolate may be helpful. ◯◯ Burping the infant in an upright position or giving warm water may help. ◯◯ Other comforting techniques (swaddling, carrying the infant, rocking, repetitive soft sound) may soothe the infant. ◯◯ Most infants grow and gain weight despite colic. ◯◯ Reassure the parent that colic is transient and does not indicate more serious problems or a lack of parental ability. |
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Chapter 7
Infants Lactose intolerance |
increased prevalence in individuals of Asian, Native
American, African, Latino, and Mediterranean descent. ◯◯ Signs and symptoms include: abdominal distention, flatus, and occasional diarrhea. ◯◯ Either soy-based (ProSobee® or Isomil®) or casein hydrolysate (Nutramigen® or Pregestimil®) formulas can be prescribed as alternative formulas for infants who are lactose intolerant. |
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Chapter 7
Infants Failure to thrive |
inadequate gains in weight and height in comparison to established
growth and development norms. ◯◯ Assess for signs and symptoms of congenital defects, central nervous system disorders, or partial intestinal obstruction. ◯◯ Assess for swallowing or sucking problems. ◯◯ Identify feeding patterns, especially concerning preparation of formulas. ◯◯ Assess for psychosocial problems, especially parent-infant bonding. ◯◯ Provide supportive nutritional guidance. Usually a high-calorie, high-protein diet is indicated. ◯◯ Provide supportive parenting guidance. |
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Chapter 7
Infants Diarrhea |
characterized by the passage of more than three loose, watery stools over a 24
hr period. ◯◯ Overfeeding and food intolerances are common causes of osmotic diarrhea. ◯◯ Infectious diarrhea in the infant is commonly caused by rotavirus. ◯◯ Mild diarrhea may require no special interventions. Check with the provider for any diet modifications. Treatment for moderate diarrhea should begin at home with oral rehydration solutions (Pedialyte®, Infalyte®, ReVital®) or generic equivalents. After each loose stool, 8 oz of solution should be given. Sports drinks are contraindicated. ◯◯ Educate parents about the signs and symptoms of dehydration: listlessness, sunken eyes, decreased tears, dry mucous membranes, and decreased urine output. ◯◯ Breastfed infants should continue nursing. ◯◯ Formula-fed infants usually do not require diluted formulas or special formulas. ◯◯ Contact the provider if signs and symptoms of dehydration are present, or if vomiting, bloody stools, high fever, change in mental status, or refusal to take liquids occurs. |
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Chapter 7
Infants Constipation |
Constipation is not a common problem for breastfed infants.
◯◯ Constipation may be caused by formula that is too concentrated or by inadequate carbohydrate intake. ◯◯ Stress the importance of accurate dilution of formula. ◯◯ Advise adherence to the recommended amount of formula intake for age. |
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Chapter 7
Choking |
Foods like hot dogs, popcorn, peanuts, grapes, raw carrots, celery, peanut butter, tough
meat, and candy may cause choking or aspiration. |
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Chapter 7
Children Toddlers: 1 to 3 years old |
◯◯ Toddlers generally grow 2 to 3 inches in height and gain approximately 5 lb annually.
◯◯ Limit juice to 4 to 6 oz a day. ◯◯ The 1 to 2-year-old child requires whole cow’s milk to provide adequate fat for the still growing brain. ◯◯ Food serving size is 1 tbsp for each year of age. ◯◯ Exposure to a new food may need to occur 8 to 15 times before the child develops an acceptance of it. |
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Chapter 7
Children Toddlers: 1 to 3 years old Allergies |
If there is a negative family history for allergies, cow’s milk, chocolate, citrus fruits,
egg white, seafood, and nut butters may be gradually introduced while monitoring the child for reactions. |
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Chapter 7
Children Toddlers: 1 to 3 years old Nutritional Concerns |
◯◯ Toddlers prefer finger foods because of their increasing autonomy. They prefer plain
foods to mixtures, but usually like macaroni and cheese, spaghetti, and pizza. ◯◯ Regular meal times and nutritious snacks best meet nutrient needs. ◯◯ Snacks or desserts that are high in sugar, fat, or sodium should be avoided. ◯◯ Children are at an increased risk for choking until 4 years of age. ◯◯ Avoid foods that are potential choking hazards (nuts, grapes, hot dogs, peanut butter, raw carrots, tough meats, popcorn). Always provide adult supervision during snack and mealtimes. During food preparation, cut small bite-sized pieces for easier swallow, and to prevent choking. Do not allow the child to engage in drinking or eating during play activities or while lying down. |
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Chapter 7
Children Toddlers: 1 to 3 years old Iron |
Iron deficiency anemia is the most common nutritional deficiency disorder in
children. ■■ Lean red meats provide sources of readily absorbable iron. Consuming vitamin C (orange juice, tomatoes) with plant sources of iron (beans, raisins, peanut butter, whole grains) will maximize absorption. ■■ Milk should be limited to the recommended quantities (24 oz) as it is a poor source of iron and may displace the intake of iron-rich foods. |
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Chapter 7
Children Toddlers: 1 to 3 years old Vitamin D |
Vitamin D is essential for bone development.
■■ Recommended vitamin D intake is the same (5 mcg/day) from birth through age 50. Children require more vitamin D because their bones are growing. ■■ Milk (cow, soy) and fatty fish are good sources of vitamin D. ■■ Sunlight exposure leads to vitamin D synthesis. Children who spend large amounts of time inside (watching TV, playing video games) are at an increased risk for vitamin D deficiency. ■■ Vitamin D assists in the absorption of calcium into the bones. |
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Chapter 7
Children Preschoolers: 3 to 5 years ●● Nutrition Guidelines |
Preschoolers generally grow 2 to 3 inches in height and gain approximately 5 lb
annually. ◯◯ Preschoolers need 13 to 19 g/day of complete protein in addition to adequate calcium, iron, folate, and vitamins A and C. ◯◯ Preschoolers tend to dislike strong-tasting vegetables (cabbage, onions), but like many raw vegetables that are eaten as finger foods. ◯◯ Food jags (ritualistic preference for one food) are common and usually short-lived. ◯◯ Food Pyramid guidelines are appropriate, requiring the lowest number of servings per food group. ◯◯ Food patterns and preferences are first learned from the family, and peers begin influencing preferences and habits at around 5 years of age. |
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Ch. 4
Fiber |
Increase consumption of fiber-rich fruits and vegetables to a minimum of five servings per day in order to decrease risk factors for certain cancers. The vitamin and mineral content of these foods may decrease the risk of DNA damage and cancer.
|
|
Ch. 4
Fats |
Choose monounsaturated and polyunsaturated fats from fish, lean meats, nuts, and
vegetable oils. Fat intake may average 30% of total caloric intake with less than 10% from saturated fats. |
|
Ch. 4
Salt |
Consume less than 2,300 mg of salt per day (about 1 tsp) by limiting most canned and processed foods. Prepare foods without adding salt.
|
|
Ch. 4
Alcohol |
Drink alcohol in moderation: up to one drink per day for women and two per day for
men, as appropriate. Certain medical conditions, medication therapies, and physical activities preclude the use of alcohol. |
|
Ch. 4
The Food Guide Pyramid Grains |
Recommended Servings
(2,000 calorie diet) -6 oz Representative Foods Whole grain breads, cereals, rice, pasta One slice bread = 1 oz 1 cup cereal = 1 oz ½ cup cooked pasta = 1 oz |
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Ch. 4
The Food Guide Pyramid Vegetables |
Recommended Servings
(2,000 calorie diet) -2 ½ cups (raw, cooked, or juice) Representative Foods Broccoli, carrots, dry beans and peas, corn, potatoes, tomatoes |
|
Ch. 4
The Food Guide Pyramid Fruit |
Recommended Servings
(2,000 calorie diet) -2 cups Representative Foods One small banana, orange, ¼ cup dried apricots |
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Ch. 4
The Food Guide Pyramid Milk |
Recommended Servings
(2,000 calorie diet) -3 cups (2 cups for children ages two to eight) Representative Foods 2% milk, yogurt, cheese |
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Ch. 4
The Food Guide Pyramid Meat and Beans |
Recommended Servings
(2,000 calorie diet) -5 ½ oz Representative Foods Beef, poultry, eggs, kidney beans, soy beans, fish, nuts and seeds, peanut butter One small chicken breast = 3 oz One egg = 1 oz ¼ cup dried cooked beans = 1 oz |
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Ch. 4
The Food Guide Pyramid Oils |
Recommended Servings
(2,000 calorie diet) -6 tsp Representative Foods Canola oil, corn oil, olive oil, nuts, olives, some fish |