Nutrition

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toddler 1to 3 years old

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needs fewer kcalories but relatively more protein and minerals for physical growth; therefore a variety of foods should be offered in appropriate portion sizes to provide key nutrients

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preschooler 3 to 6 years old

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they need calcium and iron to support growth and to build body stores. because vitamins A and C and folate are often lacking in the diets of preschool children , a variety of fruits and vegetables should be provided

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adolescents

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the calcium requirements rises to 1400mg daily to meet the demands of bone growth, increase protein to maintain nitrogen reserves, intakes of vitamin c and a may be low because of erratic food intake and low intake of vegetables and fruits

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nutritional needs

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RDA for active men 19-30 3000kcal daily women 24ookcal

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complementary protein

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when two incomplete protein sources are combined to form a protein that now has essential amino acids in adequate amounts ( mac and cheese, cereal and milk, and peanut butter sandwich)

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biological value

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a measurement of protein in terms of how usable it is by the body( or how easily it converts from being a food protein to a body protein)

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protein with high biologic value

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have essential amino acids present in adequate proportions to meet minimum body needs (eggs, fish, poultry, lean meat, and dairy products)

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incomplete proteins

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proteins with a lower amount of one or more of the indispensable amino acids as related to the reference amino acid pattern or missing an indispensable amino acid needed to form body proteins

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food insecurity

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limited or uncertain availability of food and the inability to obtain a sufficient supply of nutritionally safe, adequate, and acceptable food through socially acceptable means

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epidemiologist

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a triad of variables influences health and disease the agent , the host, the environment

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malnutrition during an admission

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hospitalized patients with hypermetabolic and physiologic stress of illness or injury can be at risk for malnutrition from increased nutritional needs

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hospital routines that may contribute to lack of nourishment

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highly restricted diets remaining on order and unsupplemenetd too long
unserved meals because of interference of medical procedures and clinical tests
unmonitored patient appetite

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nutrition screening process

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process of identifying characteristics known to be associated with nutrition problems with the purpose of identifying individuals who are malnourished or at nutritional risk

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rule of nines

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describes the percentage of the body surface represented by various anatomic areas. For example, each upper limb 9%, each lower limb 18%, anterior and posterior trunk 18% head and neck 9%, and perineum and genitalia 1%

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constitutive proteins

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albumin, prealbumin, transferrin. Plasma proteins often used to assess the response to nutrition support. Serum levels are nonspecific and nonsensitive to nutritional status requirements

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nutritional assessment for enteral nutrition

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when the GI tract is functioning should be used to restore or maintain a state of nutrition. PN should be reserved for patients with a nonfunctional GI tract that prevents the patient from meeting nutrient needs enterally

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nutrition assessment enteral nutrition

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functional GI tract, long-term gastrostomy, jejunostomy, short-term nasogastric, nasoduodeenal, nasojejunal,

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nutritional assessment parenteral nutrition

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non-functioning GI tract, diffuse peritonitis, intestinal obstruction, intractable vomiting, ileus, intractable diarrhea, gastrointestinal ischemia,

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osmolarity

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the number of millimoles of liquid or solid in a liter of solution; parenteral nutrition solutions given by central vein have an osmolarity around 1800mOsm; peripheral parenteral solutions are limited to 600-900mOsm dextrose and amino acids have the greatest effect on a solutions osmolarity

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catheter-related complications

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air embolism, catheter embolization, catheter occlusion, improper tip location, phlebitis, pneumothorax, sepsis, venous thrombosis

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gastrointestinal complications

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fatty liver, gastric hyperacidity, GI atrophy, hepatic cholestasis

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metabolic complications

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acid-base imbalance, electrolyte abnormalities, essential fatty acid deficiency, fluid imbalance, glucose intolerance, metabolic bone disease, mineral abnormalities, overfeeding, refeeding syndrome, triglyceride elevation

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anthropometric measurements

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measurements of the body, size, weight, and proportions

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VLDL very low density lipoproteins

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transports triglycerides from liver to tissue (constitute 55-65% of triglycerides); normal serum range 51-197mg/dl

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chylomicrons

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carry triglycerides in the blood stream after meals (largest and lightest, constitute 80-90% of triglycerides)

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LDL

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low-density lipoproteins are plasma proteins with triglyceride components that carry cholesterol to cells; increased levels are associated with incidence of heart disease (bad cholesterol); optimal serum range < 100mg/dl

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HDL

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high density lipoproteins are plasma proteins that carry fat in the bloodstream to tissue or to the liver to be excreted; cardioprotective in that increased levels are associated with decreased incidence of heart disease; optimal serum rance is >60mg/dl based on age

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essential fatty acids

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consist of linoleic (omega 6) , arachidonic, and linolenic acids (omega 3) that must be supplied in the diet because the body cannot manufacture them

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nonessential fatty acids

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are those that can be manufactured by the body and do not require dietary ingestion

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saturation

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refers to the maximum amount of hydrogen ions that fat can hold, the presence of double bonds differentiates lipids as to whether they are saturated or unsaturated and defines physical characteristic properties

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saturated fat

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contains no double bonds, is usually of animal origin, and is solid at room temperature

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unsaturated fats

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contains double bonds, is usually of plant origin and is liquid at room temperature

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omega 3 linolenic essential fatty acid

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has been shown to have preventive effects on heart disease( decreased blood clotting tendency, decreased blood pressure, and decreased cardiac mortality) found in fatty fish, salad, cooking oil, margarine, and fish oils

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omega 6 linoleic essential fatty acid

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has been shown to lower serum cholesterol levels, prolong clotting time, help prevent cardiovascular disease, and aid in brain development; found in vegetable oils peanuts and eggs

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trans fatty acids

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(change from cis to trans configuration in chemical structure) are associated with increased incidence of cardiovascular disease by increasing LDL levels and decreasing HDL levels

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protein nutritional demands for pregnant woman

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total amount of protein recommended for a pregnant woman is 71g/daily, and increase of 25g/daily. proteins with its essential nitrogen is the nutrient basic to tissue growth

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treatment goals; basic objectives

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maintain optimal nutrition, prevent hypo/hyperglycemia, prevent complications,

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glucose

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blood glucose cannot be oxidized properly through the main glycolytic pathway in the cell to furnish energy and a lack of insulin allows teh breakdown of hepatic glycogen and the release of glucose; therefore glucose builds up in the blood

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fat

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formation of fat (lipogenesis) is curtailed, and fat breakdown (lipolysis) increases this leads to excess formation and accumulation of ketones (ketoacidosis) appearance of the major ketone, acetone, in urine indicates development of ketoacidosis

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protein

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tissue protein is also broken down in an effort to secure energy. this causes weight loss and nitrogen excretion in the urine

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glycogenolysis

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production of blood glucose from liver glycogen

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glycogenesis

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synthesis of glycogen from blood glucose

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lipogenesis

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synthesis of fat from blood glucose

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glycolysis

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cell oxidation of glucose for energy

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somatostatin

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a hormone formed in the delta cells of the pancreatic islets of langerhans and the hypothalamus. it is a balancing factor in maintaining normal blood glucose levels by inhibiting insulin and glucagon production in the pancreas as needed

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jejunostomy

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is surgically or endoscopically placed past the ligament of treitz in the jejunum, the middle section of the small intestine, indicated for patients with neurologic impairment, a risk or history of aspiration, incompetent gag reflex or gastric dysfunction

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gastric dysfunction

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can be related to gastric atony, gastroparesis, gastric cancer, gastric outlet obstruction, or gastric ulcerative disease

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protein sources

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animal sources and eggs, soy proteins, added proteins to processed foods casein protein in cows milk provides taste and texture

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crohn's disease

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a chronic disease of unknown cause can be seen anywhere along the length of the GI tract results in abdominal pain, diarrhea, fatigue, weight loss, fever nausea and vomiting

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ulcerative colitis

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seen throughout the colon and appearance of symptoms outside the intestines that result in bloody diarrhea, dehydration, fever, weight loss, and anorexia

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dietary measures

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low residue and low roughage diets should be used in clients with crohn's disease during exacerbation's

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diet

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bowel rest along with clear liquids with alternate feeding methods such as total parenteral nutrition may be needed to provide calories during exacerbation's

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iron

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involved as a component of RBCs in hemoglobin formation and as a component of muscles in the form of myoglobin

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heme

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is the iron holding part of hemoglobin molecule and is usually found in animal sources

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non heme

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sources of iron are found in plants and animals; these are not considered to be as good an iron source as heme sources due to differences in absorption

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dietary sources of iron

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meat, poultry, and fish ban be absorbed in the body

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nutritional anemia

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iron deficiency anemia presents with fatigue, weakness, headache, pallor, temperature intolerance, and behavioral changes,

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pica

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represents the ingestion of nonfood substances that is associiated with a clinical iron deficiency and may actually be the first sign of a problem; client will eat a wide range of nonfood items

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factors that decrease iron absorption

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phytate fibers(grains and vegetables), tannic acid (found in tea and coffee), oxalic acid (spinach)calcium and phosphorus (milk)

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immunocompromised patients

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should avoid food bars, only drink bottled water

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what is a vitamin

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to be classified as a vitamin it must be an organic dietary substance that is not energy producing, as are carbs, fat, or protein. it is needed in very small quantities to perform a particular metabolic function the body cannot manufacture it

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fat soluble vitamins

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a,d,e,k, closely associated with body lipids are easily stored. their functions are usually related to structural activities with proteins

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water soluble vitamins

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vit c, thiamin, riboflavin, niacin, pantothenic acid, biotin, vitamin b6, folate, vitamin b12

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water soluble vitamins

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are easily absorbed and transported but unlike the fat soluble vitamins, they cannot be stored except in the general sense of tissue saturation