Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
72 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
Calculate Basic Metabolism Rate
|
Women: 655 + (4.3 x weight in pounds) + (4.7 x height in inches) - (4.7 x age in years)
Men: 66 + (6.3 x weight in pounds) + (12.9 x height in inches) - (6.8 x age in years) *Please note that this formula applies only to adults. |
|
|
|
Calculate Activity
|
If you are sedentary : BMR x 20 percent
If you are lightly active: BMR x 30 percent If you are moderately active (You exercise most days a week.): BMR x 40 percent If you are very active (You exercise intensely on a daily basis or for prolonged periods.): BMR x 50 percent If you are extra active (You do hard labor or are in athletic training.): BMR x 60 percent |
|
|
|
How many calories?
|
Add BMR to Calculated Activity
The result of this formula will be the number of calories you can eat every day and maintain your current weight. In order to lose weight, you'll need to take in fewer calories than this result. |
|
|
|
1 pound
|
3500 calories
|
|
|
|
Safe weight loss
|
2 - 3 pounds per week
|
|
|
|
Carbohydrates
|
Are primary source of energy
- 4 kcal per gram Chief protein-sparing ingredient Compose 47% of daily caloric needs |
|
|
|
Monosaccharides
|
simple carbohydrate
- Glucose - Fructose - Found in fruits and honey |
|
|
|
Disaccharides
|
simple carbohydrate
- Sucrose - Maltose - Lactose - Glucose - Fructose - Found in table sugar, malted cereal, milk |
|
|
|
Polysaccharides
|
complex carbohydrate
Starches: - cereal grains - Potatoes - Legumes |
|
|
|
Fats
|
Major source of energy
Source of insulation Carriers of essential fatty acids and fat-soluble vitamins 20% to 35% of total daily caloric intake 9 kcal per gram |
|
|
|
Proteins
|
Essential for tissue growth, repair, and maintenance
Body regulatory functions Energy production Complex nitrogenous organic compounds consisting of amino acids Obtained from animal and plant sources 4 kcal per g 15% to 20% of daily caloric needs Complete proteins vs. incomplete proteins Indispensable vs. dispensable amino acids |
|
|
|
Complete proteins
|
contain all essential amino acids in order to support growth & maintain nitrogen balance:
- Milk, eggs, soybeans, cheese & meat |
|
|
|
Incomplete proteins
|
lack one or more essential amino acids:
- Grains, nuts, seeds, & legumes |
|
|
|
essential amino acids
|
human body cannot synthesize them from other compounds at the level needed for normal growth, so they must be obtained from food.
|
|
|
|
Non-essential amino acids
|
can be synthesized by the body if protein is available
|
|
|
|
semi-essesential amino acids
|
Cysteine, tyrosine, histidine & arginine
*In children, because the metabolic pathways that synthesize these amino acids are not fully developed. * The amounts required also depend on the age and health of the individual, so it is hard to make general statements about the dietary requirement for some amino acids. |
|
|
|
Essential (Indispensable)
|
Isoleucine
Leucine Lysine Methionine Phenylalanine Threonine Tryptophan Valine Histidine |
|
|
|
Nonessential (dispensable)
|
Alanine
Asparagine Aspartate Cysteine Glutamate Glutamine Glycine Proline Serine Tyrosine Arginine |
|
|
|
Vitamins
|
Organic compounds required in small amounts for normal metabolism
Function primarily in enzyme reactions Water soluble versus fat soluble - Water soluble (vitamin C and B-complex) - Fat soluble (vitamins A, D, E, K) |
|
|
|
Mineral salts
|
Magnesium, iron, calcium make up 4% of total body weight
Necessary for building tissues Regulation of body fluids Assist in various body functions Can be toxic in excessive amounts Major and trace |
|
|
|
Major minerals
|
Calcium
Chloride Magnesium Phosphorus Potassium Sodium Sulfur |
|
|
|
SPECIAL DIETS
|
Vegetarian
Vegans Lacto-ovo vegetarians |
|
|
|
Vegetarian
|
Common element is exclusion of red meat from diet
Need well-planned diets to avoid deficiencies Various reasons for following - Religious - Cultural |
|
|
|
Vegans
|
Eat only plant foods
Lack of vitamin B12 common Can develop megaloblastic anemia and neurological symptoms of deficiency Other possible deficiencies - Calcium, zinc, vitamins A and D, protein, iron |
|
|
|
Lacto-ovo vegetarians
|
Eat plant foods and sometimes dairy products and eggs
Watch for vitamin and mineral deficiencies |
|
|
|
In cultural care the nurse should:
|
Include cultural/ethnic considerations
- Dietary choices (traditional foods) - Weight maintenance Avoid cultural stereotyping Teach dietary restrictions/changes with entire family |
|
|
|
Nutritional problems include:
|
Malnutrition
Under-nutrition Over-nutrition Overweight Obesity |
|
|
|
Obesity
|
defined as a weight of 20% or more above recommended body weight
|
|
|
|
Severe obesity
|
signifies an excess of 100% or 100lbs above recommended body weight.
|
|
|
|
What significant health problems is obesity linked to?
|
GI problems (i.e., cancers of the gallbladder & colon)
HTN CVD Diabetes Orthopedic dysfunction |
|
|
|
Overweight
|
defined as a weight of 10 to 20% in excess of recommended body weight.
|
|
|
|
Malnutrition
|
an imbalance, whether a deficit or excess, of the required nutrients of a balanced diet
|
|
|
|
Under-nutrition
|
inadequate intake of the nutrients needed to maintain optimal body functioning (can be dietary or disease related)
|
|
|
|
Over-nutrition
|
an excessive intake of nutrients, either food or food supplements
|
|
|
|
Body mass index (BMI)
|
a measure of body fat based on height and weight that applies to both adult men and women
|
|
|
|
How would the nurse best respond to a client’s statement, “I am always dieting, but I never seem to be losing weight:?
|
A. “Weight loss is only maintained if you really want to lose the weight.”
B. “Dieting is a way of life, & compliance is required to maintain weight loss.” C. “By saying you are always dieting, it sounds like you need some assistance in attaining your weight loss goals.” D. “I need to know which type of diet you are on because it may not be effective.” |
Answer C
The perception of being in a state of “always dieting” can be problematic in terms of compliance & goal attainment because it can be viewed either as a restriction or as a form of punishment. “A” is not true: wanting to lose weight is not the only factor to consider; many other variables affect weight loss. While it is important to find out the type of diet the client is on (or has been on), this knowledge doesn’t address the main concern of the client regarding “always dieting” and yo-yo effect (weight cycling). The core issue of the question is identification of a client’s need for assistance with weight control. Use nutrition knowledge & the process of elimination to make a selection. |
|
|
When the nurse assesses the intake of a vegetarian client’s health & dietary patterns, which finding does the nurse conclude is most likely to negatively affect health status?
|
A. Use of vitamin B-12 supplements
B. Intake of milk & dairy products C. Genetic tendency toward lactose intolerance D. Reports of problems with vision |
Answer D
Problems with vision may be attributed to vitamin deficiency, especially vitamin A. This finding could adversely affect the client’s health status & requires follow-up by the nurse. Options “A” & “B” will not adversely affect health status. Option “C” has a lesser chance of adversely affecting health status since it is a familial risk & not a personally identified problem. Use knowledge of components of a balanced diet to eliminate options “A” & “B”. Choose option “D” over “C” because actual problems take priority over potential problems. |
|
|
The nurse is checking the dietary trays that have been delivered to the nursing unit. A client of Orthodox Jewish faith has received a tray containing a chicken dinner with vegetables, tea, & a carton of 2% milk. What action by the nurse is the best?
|
A. Instruct the nursing assistant to deliver the meal tray after removing the tea.
B. Call the dietary department to send a tray without chicken. C. Have the dietary department replace the entire meal tray. D. Ask the client if lactose-free milk would be preferred. |
Answer C
The Jewish religion prohibits the ingestion of meat & dairy products during the same meal. The nurse should ask that the entire tray be replaced by the dietary department. It is unnecessary to remove the tea (option “A”) or the chicken alone (option “B”). Option “D” will not resolve the dietary issue. The core issue of this question is the that milk & meat products cannot be consumed during the same meal for clients of the Jewish faith. Use the process of elimination & this knowledge to make a selection. |
|
|
The nurse determines that a hypertensive client understands the DASH diet (Dietary Approaches to Stop Hypertension) when the client choose which items from a sample menu used in dietary teaching?
|
A. Caesar salad, bread sticks, frozen yogurt.
B. Grilled chicken sandwich, strawberries, & lettuce salad C. Grilled cheese sandwich, canned pineapple, brownie D. Chicken and vegetable stir-fry, rice, egg roll |
Answer B
The DASH diet increases daily servings of vegetables & fruits & recommends low-fat dairy foods & reduced intake of saturated fats & cholesterol. Option “A” reflects increased fats; option “D” reflects increased sodium content. The core issue of the question is knowledge that hypertensive clients should loose weight if necessary & restrict dietary intake of sodium. Use nutrition knowledge & the process of elimination to make a selection. |
|
|
A 40-year-old male client reports that he is “out of shape,” overweight, and has a strong family history of Type 2 diabetes mellitus and heart disease. He would like to make lifestyle changes to improve his health. Develop a comprehensive plan for this client.
What additional assessment information do you need? |
Minimum information required would include weight, height, BMI, activity level at work and home, vital signs, complete physical exam looking for signs of chronic illness (hypertension, diabetes, etc.), usual dietary patterns, and personal health goals. A more comprehensive assessment would include past history, family history, and laboratory studies (CBC, renal panel, serum protein, and urinalysis).
|
|
|
|
A 40-year-old male client reports that he is “out of shape,” overweight, and has a strong family history of Type 2 diabetes mellitus and heart disease. He would like to make lifestyle changes to improve his health. Develop a comprehensive plan for this client.
How would you calculate his daily caloric needs? |
Follow these 3 steps to calculate the client’s caloric needs:
Step one: Calculate BMR: 66 + (6.3 x weight in pounds) + (12.9 x height in inches) – (6.8 x age in years) Step two: Calculate energy for physical activity (CPA) Sedentary : BMR x 20 percent Lightly active: BMR x 30 percent Moderately active (You exercise most days a week.): BMR x 40 percent Very active (You exercise intensely on a daily basis or for prolonged periods.): BMR x 50 percent Extra active (You do hard labor or are in athletic training.): BMR x 60 percent Add this number to your BMR. Step three: Add answers from first two steps (BMR + CPA = total caloric needs to maintain current weight). The result of this formula will be the number of calories that the client can eat every day and maintain his current weight. In order to lose weight, he'll need to take in fewer calories than this result. Remember the following: 1 pound = 3500 calories Less calories in + More calories out + weight loss. Safe weight loss = 2 to 3 pounds a week |
|
|
|
A 40-year-old male client reports that he is “out of shape,” overweight, and has a strong family history of Type 2 diabetes mellitus and heart disease. He would like to make lifestyle changes to improve his health. Develop a comprehensive plan for this client.
What ethnic, cultural, and religious considerations must be included in the planning? |
It is important to ascertain the type of eating patterns, food preferences (likes and dislikes), preferred preparation methods, restricted food items, and what value the client places on food and eating behaviors. Ethnic, cultural, and religious factors can have considerable impact on choice, preparation, and importance of food in the diet. Many foods can have symbolic meanings and affect dietary selections.
|
|
|
|
A 40-year-old male client reports that he is “out of shape,” overweight, and has a strong family history of Type 2 diabetes mellitus and heart disease. He would like to make lifestyle changes to improve his health. Develop a comprehensive plan for this client.
What type of exercise would be appropriate? What information is needed to determine a safe level of exercise? |
The client needs to engage in aerobic exercise, strength training, and stretching. Aerobic exercise should be a minimum of 30 minutes of low to moderate physical activity most days. Examples of moderate activity include walking at 3 to 4 mph, swimming, canoeing, and ice skating. The activity duration, intensity, and frequency should increase over time; more vigorous activities include brisker walking, cycling, and running. Strength training exercises should be performed two times per week and stretching exercises a minimum of three times per week. Perform 8 to 10 strength training exercises that work the major muscle groups, 8 to 12 repetitions of each exercise. Increase the weight over time; maintain proper form and breathing throughout weight lifts. Select stretching exercises that maintain posture; hold stretch for 30 seconds and repeat 3 to 5 times. To ensure safe exercising, obtain the resting heart rate, the target heart rate zone, and the maximum heart rate. Most beginning exercises should exercise at 50 to 75% of maximum heart rate.
|
|
|
|
What physiologic changes put older adults at risk for inbalanced nutrition?
|
- Oral cavity
- Digestion/motility - Endocrine system - Musculoskeletal system - Vision and hearing |
|
|
|
Name two nutrition risk assessment forms.
|
- Mini Nutrition Assessment - MNA
- Nutrition Risk Assessment |
|
|
|
Sick persons have increased nutrional requirements
True or False |
T
|
|
|
|
Malnutrition is not an uncommon consequence of:
|
- Illness
- Surgery - Injury - Hospitilization |
|
|
|
Fever increases basal metabolic rate leading to what?
|
Protein depletion
|
|
|
|
What is?
- Most prevalent in countries lacking adequate food sources and education - Does exist in United States * Usually found in lower socioeconomic class or those with chronic or acute illness - Common in hospitalized patient (30% to 55%) - 23% to 85% prevalence in elderly long term care residents |
Under-Nutrition
|
|
|
|
What is the most common form of under-nutrition?
|
Protein-Calorie Malnutrition (PCM)
|
|
|
|
Regarding Protein-Calorie Malnutrition (PCM), what is a primary cause?
|
- poor eating habits
* Ingesting food deficient in protein, vitamins, minerals |
|
|
|
Regarding Protein-Calorie Malnutrition (PCM), what is a secondary cause?
|
- alteration or defect in ingestion, digestion, absorption, or metabolism
* Due to GI obstruction, surgical procedures, cancer, malabsorption syndromes, drugs, infectious diseases |
|
|
|
Marasmus
|
Results from a combination (concomitant) deficiency in caloric and protein intake
- Generalized loss of muscle and body fat - Appear emaciated but have normal serum protein levels |
|
|
|
Kwashiorkor
|
Deficiency of protein intake superimposed by catabolic stress event such as
- GI obstruction - Surgery - Cancer - Malabsorption syndrome - Infectious disease May appear well nourished, have low protein levels |
|
|
|
Etiology and Pathophysiology
Starvation process |
- Initially body uses carbohydrate stores from liver and muscle to meet metabolic needs
- Stores are minimal and may be depleted in 18 hours - Once stores depleted, protein is converted to glucose for energy - Gluconeogenesis occurs * Formation of glucose by liver - Allows metabolic processes to continue - Negative nitrogen balance In 5 to 9 days, fat is mobilized to supply energy - Prolonged starvation: 97% of calories from fat and protein are conserved - Fat stores used in 4 to 6 weeks, depends on amount available - Once fat stores are used, body proteins (from internal organs and plasma) are no longer spared - Liver function impaired - Protein synthesis diminished - Plasma oncotic pressure ↓ - Shift from vascular space into interstitial - Albumin leaks into interstitial space - Edema presents - Skin is dry and wrinkled - Na+/K+ pump fails—deficiency in calories and proteins - Liver loses mass, becomes infiltrated with fat - Diet of protein and other constituents must be initiated or death will occur |
|
|
|
What are causes of starvation?
|
- Socioeconomic status
- Cultural influences - Psychologic disorders - Medical conditions - Medical treatments |
|
|
|
Malabsorption Syndrome
|
Impaired absorption of nutrients from the GI tract
- May result from ↓ Enzymes Drug side effects ↓ Bowel surface area |
|
|
|
Incomplete Diets
|
Vitamin deficiencies rare in developed countries
- Usually found in - Alcoholics - Drug abusers - Fad diet followers - Poorly planned vegetarian diets |
|
|
|
Obvious clinical signs of inadequate protein/calorie intake apparent in
|
- Skin
- Eyes - Mouth - Muscles - CNS - Muscles wasted and flabby - Delayed wound healing - More susceptible to infection * Humoral and cell mediated immunity deficient * ↓ in leukocytes in peripheral blood * Phagocytosis altered - Anemia |
|
|
|
What information do you need to gather for the history/physical examination for adequate nutrition?
|
- Food history for past week
- Height - Weight - VS - Physical examination |
|
|
|
What laboratory studies would be run to assess nutritional status?
|
- Serum albumin
- Prealbumin - Serum transferrin - Electrolyte levels - Complete blood count * RBC, Hb, lymphocyte count - Liver enzymes - Serum levels of vitamins |
|
|
|
What anthropometric measurements would be taken to assess nutritional status?
|
- Skinfold thickness—various sites
- Midarm circumference - Compared with standard for healthy persons |
|
|
|
What data needs to be gathered to complete Nursing Assessment?
|
- Changes in weight
- Diet history - Minimum data set - Medications - Laboratory test results - Physical examination - Anthropometric measurements |
|
|
|
What are the Nursing Diagnosis r/t nutrition?
|
- Imbalanced nutrition: Less than body requirements
- Self-care deficit (feeding) - Constipation or diarrhea - Deficient fluid volume - Risk for impaired skin integrity - Noncompliance - Activity intolerance |
|
|
|
What are plans r/t nutrition?
|
- Achieve weight gain
- Consume specified number of calories per day - Have no adverse consequences related to malnutrition or nutrition therapies |
|
|
|
What Nursing Implementation r/t nutrition?
|
- Teach/reinforce good eating habits
- Assess nutritional state and other health problems - Daily weights and I&O - Daily calorie count - High-protein, high-calorie foods - Multiple, small feedings - Supplements - Appetite stimulants - Diet diary - Dietitian consult - Discharge instructions |
|
|
|
What are Gerontologic Considerations for nutrition?
|
- Oral cavity
- Digestion/motility - Endocrine system - Musculoskeletal system - Vision and hearing |
|
|
|
How much grains should be included in a standard 2000 calorie diet?
|
6 oz.
Half of all grains should be whole grains |
|
|
|
How much fruit should be included in a standard 2000 calorie diet?
|
2 cups
Eat a variety of fruits, go easy on the juices |
|
|
|
How much vegetables should be included in a standard 2000 calorie diet?
|
2.5 cups
Eat a variety of vegetables |
|
|
|
How much dairy products should be included in a standard 2000 calorie diet?
|
3 cups
Eat low-fat or fat-free dairy products |
|
|
|
How much meat and beans should be included in a standard 2000 calorie diet?
|
5.5 oz.
Eat lean cuts, seafood, and beans. Avoid frying. |
|
