Ati Nutrition

Front 1

The average minimum amount of carbohydrates needed to fuel the brain

Back 1

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.

Front 2

Carbohydrates provide

Back 2

energy for cellular work, and help to regulate protein and fat
metabolism. They are essential for normal cardiac and central nervous system (CNS)
functioning.

Front 3

How many Kcals in Carbs?

Back 3

Carbohydrates provide 4 cal/g of energy.

Front 4

Proteins have many metabolic functions

Back 4

(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).

Front 5

The recommended dietary requirement of protein for adults

Back 5

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.

Front 6

How many Kcals in Protein?

Back 6

Protein provides 4 cal/g of energy.

Front 7

How much of the diet should come from fat?

Back 7

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.

Front 8

How many Kcals in Fat

Back 8

Lipids provide 9 cal/g of energy and are the densest form of stored energy.

Front 9

Vitamins

Back 9

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.

Front 10

Ascorbic Acid
Vitamin C
Major Actions

Back 10

Antioxidant,
tissue building, iron
absorption

Front 11

Ascorbic Acid
Vitamin C
Major Sources

Back 11

Citrus fruits and juices,
vegetables

Front 12

Ascorbic Acid
Vitamin C
Deficiency

Back 12

Scurvy, decreased iron
absorption, bleeding
gums

Front 13

Thiamin B1
Major Actions

Back 13

Muscle energy, GI
support, CV support

Front 14

Thiamin B1
Major Sources

Back 14

Meats, grains, legumes

Front 15

Thiamin B1
deficiency

Back 15

Beriberi, altered
digestion, CNS and CV
problems

Front 16

Riboflavin B2
Major Actions

Back 16

Growth, energy, tissue
healing

Front 17

Riboflavin B2
Major Sources

Back 17

Milk, meats, green
leafy vegetables

Front 18

Riboflavin B2
deficiency

Back 18

Skin eruptions, cracked
lips, red swollen
tongue

Front 19

Niacin B3
Major Actions

Back 19

Energy and protein
metabolism/ cellular
metabolism

Front 20

Niacin B3
Major Sources

Back 20

Liver, nuts, legumes

Front 21

Niacin B3
Deficiency

Back 21

Pellagra, skin lesions,
GI and CNS symptoms,
dementia

Front 22

Pantothenic Acid B5
Major Actions

Back 22

Fatty acid metabolism,
cell synthesis, heme
production

Front 23

Pantothenic Acid B5
Major Sources

Back 23

Organ meats, egg yolk,
avocados, broccoli

Front 24

Pantothenic Acid B5
Deficiency

Back 24

Anemia, CNS changes

Front 25

Pyridoxine B6
Major Actions

Back 25

Cellular function, heme
and neurotransmitter
synthesis

Front 26

Pyridoxine B6
Major Sources

Back 26

Organ meats, grains

Front 27

Pyridoxine B6
Deficiency

Back 27

Anemia, CNS hyperirritability,
dermatitis

Front 28

Folate
Major Actions

Back 28

Synthesis of amino
acids and hemoglobin,
lower neural tube
defect in fetus

Front 29

Folate
Major Sources

Back 29

Liver, green leafy
vegetables, grains,
legumes

Front 30

Folate
Deficiency

Back 30

Megaloblastic anemia,
CNS disturbance

Front 31

Cobalamin B12
Major Actions

Back 31

Hemoglobin
Synthesis, fatty acid
metabolism

Front 32

Cobalamin B12
Major Sources

Back 32

Organ meats, clams,
oysters, grains

Front 33

Cobalamin B12
Deficiency

Back 33

Pernicious anemia,
GI symptoms, poor
muscle coordination

Front 34

Fat soluble vitamins
Vitamin A
Major Actions

Back 34

Normal vision, tissue
strength, growth and
tissue healing

Front 35

Fat soluble vitamins
Vitamin A
Major Sources

Back 35

Orange/yellow colored
foods, liver, dairy

Front 36

Fat soluble vitamins
Vitamin A
Deficiency

Back 36

Reduced night vision,
dry/thick eyes, mucosa
changes

Front 37

Fat soluble vitamins
Vitamin D
Major Actions

Back 37

Maintain serum calcium
and phosphorus, aid in
bone development

Front 38

Fat soluble vitamins
Vitamin D
Major Sources

Back 38

Fish, fortified dairy
products, sunlight

Front 39

Fat soluble vitamins
Vitamin D
Deficiency

Back 39

Low serum calcium,
fragile bones, rickets

Front 40

Fat Soluble Vitamins
Vitamin E
Major Actions

Back 40

Protects cells from
oxidation

Front 41

Fat Soluble Vitamins
Vitamin E
Major Sources

Back 41

Vegetable oils, grains,
nuts, dark green
vegetables

Front 42

Fat Soluble Vitamins
Vitamin E
Deficiency

Back 42

Hemolytic anemia,
CNS changes

Front 43

Fat Soluble Vitamins
Vitamin K
Major Actions

Back 43

Normal blood
clotting (prothrombin
production), aids in
bone metabolism

Front 44

Fat Soluble Vitamins
Vitamin K
Major Sources

Back 44

Green leafy vegetables,
eggs, liver

Front 45

Fat Soluble Vitamins
Vitamin K
Deficiency

Back 45

Increased bleeding
times

Front 46

Sodium (Na)
Major
Actions

Back 46

Sodium (Na) Maintains
fluid volume,
allows muscle
contractions,
cardiovascular
support

Front 47

Major
Sources

Back 47

Table salt,
added salts,
processed
foods, butter

Front 48

symptoms of
Deficiency

Back 48

Muscle
cramping,
cardiac changes

Front 49

symptoms of
Excess

Back 49

Fluid retention,
hypertension,
CVA

Front 50

Sodium (Na)
Nursing Implications

Back 50

Monitor ECG, edema, and blood pressure.

Front 51

Potassium (K)
Major Actions

Back 51

Maintains
fluid volume
inside/outside
cells, muscle action, blood pressure, cardiovascular support

Front 52

Potassium (K)
Major Sources

Back 52

Oranges, dried fruits, tomatoes, avocados, dried peas, meats, broccoli, bananas

Front 53

Potassium (K)
symptoms of
Deficiency

Back 53

Dysrhythmias, muscle cramps, confusion

Front 54

Potassium (K)
symptoms of
Excess

Back 54

Dysrhythmias (caused by supplements, potassium sparing diuretics, ACE inhibitors, inadequate kidney function, diabetes)

Front 55

Potassium (K)
Nursing
Implications

Back 55

Monitor ECG and muscle
tone. PO tabs irritate the GI
system. Give with meals.

Front 56

Chloride (Cl)
Major
Actions

Back 56

Bonds to
other minerals
(esp. sodium)
to facilitate
cellular actions
and reactions,
fluid balance

Front 57

Chloride (Cl)
Major
Sources

Back 57

Table salt

Front 58

Chloride (Cl)
symptoms of
Deficiency

Back 58

Rare

Front 59

Chloride (Cl)
symptoms of
Excess

Back 59

In concert with sodium, results in high blood pressure

Front 60

Chloride (Cl)
Nursing Implications

Back 60

Monitor sodium levels.

Front 61

Calcium (Ca)
Major actions

Back 61

Bones/teeth, cardiovascular
support, blood clotting, nerve
transmission

Front 62

Calcium (Ca)
Major Sources

Back 62

Dairy, broccoli, kale, grains,
egg yolks

Front 63

Calcium (Ca)
symptoms of
Deficiency

Back 63

Osteoporosis, tetany, Chvostek’s and Trousseau’s signs, ECG changes

Front 64

Calcium (Ca)
symptoms of
Excess

Back 64

Constipation, kidney stones
.

Front 65

Calcium (Ca)
Nursing Implications

Back 65

Monitor ECG and muscle tone. Give PO tabs with
vitamin D.

Front 66

Magnesium (Mg)
Major Actions

Back 66

nourishment, catalyst for
many enzyme reactions,
nerve/muscle function, CV
support

Front 67

Magnesium (Mg)
Major Sources

Back 67

Green leafy vegetables, nuts, grains, meat, milk

Front 68

Magnesium (Mg)
symptoms of Deficiency

Back 68

Weakness, dysrhythmias,
tetany, seizure, reduced
blood clotting, eclampsia

Front 69

Magnesium (Mg)
symptoms of Excess

Back 69

Diarrhea, kidney stones,
decreased muscle control,
CV changes

Front 70

Magnesium (Mg)
Nursing Implications

Back 70

Incompatible with some
antibiotics. Give PO, 2 hr
apart.

Front 71

Phosphorus
(P)
Major
Actions

Back 71

Energy transfer of RNA/DNA,
acid-base balance, bone
and teeth formation

Front 72

Phosphorus
(P)
Major
Sources

Back 72

Dairy, peas, soft drinks,
meat, eggs, some grains

Front 73

Phosphorus
(P)
symptoms of
Deficiency

Back 73

Calcium level changes, muscle weakness

Front 74

Phosphorus
(P)
symptoms of
Excess

Back 74

Skeletal porosity, decreased
calcium levels, must stay in
balance with calcium

Front 75

Phosphorus
(P)
Nursing
Implications

Back 75

Evaluate the use of antacids (note type) and the use of alcohol.

Front 76

Sulfur (S)
Major Action

Back 76

A component
of vitamin
structure,
by-product
of protein
metabolism

Front 77

Sulfur
Major sources

Back 77

Dried fruits
(dates, raisins,
apples), meats,
red and white
wines
Only seen in
severe protein
malnourishment,
found in
all proteincontaining
foods

Front 78

Sulfur
s/s of deficiency

Back 78

Toxicity has a
very low risk

Front 79

Sulfur
s/s of excess

Back 79

Sulfur
levels are
not usually
monitored

Front 80

Iodine

Back 80

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.

Front 81

Iron

Back 81

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.

Front 82

Iron IM Injections

Back 82

Intramuscular injections are caustic to tissues and must be administered by
Z-track method.

Front 83

Iron
Major Sources

Back 83

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.

Front 84

Water
Intake/Output

Back 84

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.

Front 85

Assessing for Hydration

Back 85

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.

Front 86

Percentage weight change calculation (weight change over a specified time):

Back 86

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.

Front 87

“Ideal” body weight based on height (plus or minus 10% depending on frame
size).

Back 87

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).

Front 88

Body Mass Index (BMI)

Back 88

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)

Front 89

Fluid Intake and Output (I&O)

Back 89

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

Front 90

Albumin

Back 90

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

Front 91

Prealbumin

Back 91

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.

Front 92

Grains

Back 92

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

Front 93

Vegetables

Back 93

Recommended serving size = 2 ½ cups
From:
(raw, cooked, or juice)
Broccoli, carrots, dry beans and peas, corn,
potatoes, tomatoes

Front 94

Milk

Back 94

Recommended serving size = 3 cups
(2 cups for children ages two to eight)
2% milk, yogurt, cheese

Front 95

Meat and Beans

Back 95

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

Front 96

Oils

Back 96

Recommended serving size = 6 tsp
From: Canola oil, corn oil, olive oil, nuts, olives,
some fish

Front 97

Recommended Exercise

Back 97

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.

Front 98

Physical Fitness

Back 98

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.

Front 99

Weight loss

Back 99

To lose 1 lb of body fat per week, an adult must have an energy deficit of 3,500 calories
(500 cal/day).

Front 100

Healthy Hearts

Back 100

◯◯ 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.

Front 101

Healthy Nervous Systems

Back 101

◯◯ 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.

Front 102

Healthy Bones

Back 102

◯◯ 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.

Front 103

Good Bowel Function

Back 103

◯◯ 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.

Front 104

Cancer Prevention

Back 104

◯◯ 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.

Front 105

Proper food storage guidelines include:

Back 105

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.

Front 106

Pre-end stage renal disease (pre-ESRD)

Back 106

distinguished by an increase in serum creatinine.
Signs and symptoms include fatigue, back pain, and appetite changes.

Front 107

end stage renal disease (ESRD)

Back 107

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.

Front 108

acute renal failure (ARF)

Back 108

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.

Front 109

nephrotic syndrome

Back 109

The most pronounced manifestation of nephrotic syndrome is edema. Other
manifestations include hypoalbuminemia, hyperlipidemia, and blood hypercoagulation.

Front 110

kidney stone

Back 110

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.

Front 111

General Renal Considerations
RN

Back 111

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

Front 112

PreESRD
RN Interventions

Back 112

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.

Front 113

Dietary recommendations for pre-ESRD:

Back 113

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.

Front 114

End Stage Renal Disease (ESRD)
Therapeutic Nutrition

Back 114

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.

Front 115

End Stage Renal Disease (ESRD)
Protein Requirements

Back 115

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.

Front 116

ESRD
Vitamin D

Back 116

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.

Front 117

Acute Renal Failure (ARF)
Therapeutic Nutrition

Back 117

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.

Front 118

Nephrotic Syndrome
Therapeutic Nutrition

Back 118

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.

Front 119

Nephrolithiasis (Kidney Stones)
◯◯ Preventative Nutrition/ Therapeutic Nutrition

Back 119

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.

Front 120

Hypoglycemia

Back 120

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.

Front 121

Hyperglycemia

Back 121

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.

Front 122

Hypoglycemia
RN Interventions

Back 122

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.

Front 123

Hyperglycemia
RN Interventions

Back 123

Immediately consult a health care provider, or go to the emergency department.
■■ Take medication if forgotten.
■■ Consider modifications to insulin or oral diabetic medications.

Front 124

Long-term implications of untreated or inadequately treated hyperglycemia

Back 124

blindness, kidney failure, dyslipidemia, hypertension, neuropathy, microvascular
disease, and limb amputation.

Front 125

Somagyi’s phenomenon

Back 125

morning hyperglycemia in response to overnight
hypoglycemia. Providing a bedtime snack and appropriate insulin dose will prevent
hypoglycemia.

Front 126

Dawn phenomenon

Back 126

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.
●●

Front 127

DM General Nutritional Guidelines

Back 127

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.

Front 128

DM General Nutritional Guidelines

Back 128

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.

Front 129

DM
Other Nursing Interventions

Back 129

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.

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Cancer
Therapeutic Nutrition

Back 130

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.

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Cancer
Increase protein and caloric content of foods by:

Back 131

☐☐ 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.

Front 132

Cancer
Complications associated with nutritional management
-Early satiety

Back 132

Eat small amounts of high protein foods,
loaded with calories and nutrient

Front 133

Cancer
Complications associated with nutritional management
-Anorexia

Back 133

• 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)

Front 134

Cancer
Complications associated with nutritional management
-Mouth ulcers and stomatitis

Back 134

• 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

Front 135

Cancer
Complications associated with nutritional management
-Fatigue

Back 135

• 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

Front 136

Cancer
Complications associated with nutritional management
-Food aversions

Back 136

• Avoid eating foods that are well-tolerated
and liked prior to having treatments
(chemotherapy, radiation).

Front 137

Cancer
Complications associated with nutritional management
-Taste alterations and thick saliva

Back 137

• 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

Front 138

Cancer
Complications associated with nutritional management
-Gastrointestinal problems (nausea, vomiting,
diarrhea)

Back 138

• 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

Front 139

A client receiving immunosuppressant therapy

Back 139

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.

Front 140

clients with dysphagia

Back 140

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.

Front 141

HIV/AIDS
◯◯ Therapeutic Nutrition

Back 141

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.

Front 142

HIV/AIDS
-Wasting

Back 142

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

Back 143

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

Back 144

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

Back 145

◯◯ 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

Back 146

◯◯ 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.

Front 147

ch. 8 Modified diets
Soft (Bland, Low-Fiber) Diet

Back 147

◯◯ 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.

Front 148

ch. 8 Modified diets
Mechanical Soft Diet

Back 148

◯◯ 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.

Front 149

ch. 8 Modified diets
Regular Diet (Normal or House Diet)

Back 149

◯◯ 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.

Front 150

Chapter 9 Enteral Nutrition
Enteral nutrition (EN)

Back 150

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.

Front 151

Chapter 9 Enteral Nutrition
Enteral Feeding Routes
Transnasal tubes

Back 151

■■ 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).

Front 152

Chapter 9 Enteral Nutrition
Enteral Feeding Routes
ostomy

Back 152

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

Back 153

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.

Front 154

Chapter 9 Enteral Nutrition
Enteral Feeding Formulas

Back 154

●● Commercial products are preferred over home-blended ingredients because they provide a
known nutrient composition, controlled consistency, and bacteriological safety.

Front 155

Chapter 9 Enteral Nutrition
Enteral Feeding Formulas
Standard formulas

Back 155

◯◯ 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.

Front 156

Chapter 9 Enteral Feeding
Formulas
Hydrolyzed formulas

Back 156

, 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.

Front 157

Chapter 9 Enteral Feeding
Formulas
Tube Feedings

Back 157

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.

Front 158

Chapter 9 Enteral Feeding
Factors to consider in determining an appropriate formula

Back 158

◯◯ Caloric density.
◯◯ Water content.
◯◯ Protein density.
◯◯ Osmolality.
◯◯ Fiber and residue content.
◯◯ Presence of other nutrients.

Front 159

Tube Feeding Basics

Back 159

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.

Front 160

Enteral Feeding Delivery Methods
Continuous drip method

Back 160

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.

Front 161

Enteral Feeding Delivery Methods
Cyclic feedings

Back 161

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.

Front 162

Enteral Feeding Delivery Methods
Intermittent tube feedings

Back 162

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.

Front 163

Enteral Feeding Delivery Methods
Bolus feedings

Back 163

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.

Front 164

Chapter 9 Enteral Feeding
RN interventions

Back 164

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.

Front 165

Chapter 9 Enteral Feeding
Gastrointestinal Complications

Back 165

Gastrointestinal complications include constipation, diarrhea, cramping, pain,
abdominal distention, dumping syndrome, nausea, and vomiting.

Front 166

Chapter 9 Enteral Feeding
Mechanical Complications

Back 166

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.

Front 167

Chapter 9 Enteral Feeding
Metabolic Complications

Back 167

Metabolic complications include dehydration, hyperglycemia, electrolyte imbalances, and overhydration.

Front 168

Chapter 9 Enteral Feeding
Food Poisoning

Back 168

◯◯ 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.

Front 169

What data is important to collect before initiating feedings?

Back 169

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.

Front 170

prevention of bacterial contamination of tube
feedings

Back 170

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.

Front 171

Chapter 7
Calorie increase for Pregnant women

Back 171

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.

Front 172

Chapter 7
recommended weight gain during pregnancy

Back 172

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.

Front 173

Chapter 7
Caloric intake/Lactating Women

Back 173

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.

Front 174

Chapter 7
Dietary requirements for Protein in Pregnancy

Back 174

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

Front 175

Chapter 7
Dietary requirements for Fat in Pregnancy

Back 175

Fat should be limited to 30% of total daily calorie intake.

Front 176

Chapter 7
Dietary requirements for Carbs in Pregnancy

Back 176

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.

Front 177

Chapter 7
Vitamins

Back 177

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

Back 178

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.

Front 179

Chapter 7
Maternal Phenylketonuria (PKU)

Back 179

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).

Front 180

Chapter 7
Infant Growth
Weight/Height

Back 180

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.

Front 181

Chapter 7
Infants
Head circumference

Back 181

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.

Front 182

Chapter 7
Infants
Diet

Back 182

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.

Front 183

Chapter 7
Infants
Cow's Milk

Back 183

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.

Front 184

Chapter 7
Infants
Advantages of Breastfeeding

Back 184

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

Front 185

Chapter 7
Infants
Breastfeeding Teaching Points

Back 185

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.

Front 186

Chapter 7
Infants
Formula Feeding

Back 186

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.

Front 187

Chapter 7
Infants
Weaning

Back 187

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.

Front 188

Chapter 7
Infants
Introducing Solid Food

Back 188

> 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.

Front 189

Chapter 7
Infants
Colic

Back 189

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.

Front 190

Chapter 7
Infants
Lactose intolerance

Back 190

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.

Front 191

Chapter 7
Infants
Failure to thrive

Back 191

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.

Front 192

Chapter 7
Infants
Diarrhea

Back 192

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.

Front 193

Chapter 7
Infants
Constipation

Back 193

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.

Front 194

Chapter 7
Choking

Back 194

Foods like hot dogs, popcorn, peanuts, grapes, raw carrots, celery, peanut butter, tough
meat, and candy may cause choking or aspiration.

Front 195

Chapter 7
Children
Toddlers: 1 to 3 years old

Back 195

◯◯ 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.

Front 196

Chapter 7
Children
Toddlers: 1 to 3 years old
Allergies

Back 196

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.

Front 197

Chapter 7
Children
Toddlers: 1 to 3 years old
Nutritional Concerns

Back 197

◯◯ 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.

Front 198

Chapter 7
Children
Toddlers: 1 to 3 years old
Iron

Back 198

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.

Front 199

Chapter 7
Children
Toddlers: 1 to 3 years old
Vitamin D

Back 199

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.

Front 200

Chapter 7
Children
Preschoolers: 3 to 5 years
●● Nutrition Guidelines

Back 200

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.

Front 201

Ch. 4
Fiber

Back 201

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.

Front 202

Ch. 4
Fats

Back 202

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.

Front 203

Ch. 4
Salt

Back 203

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.

Front 204

Ch. 4
Alcohol

Back 204

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.

Front 205

Ch. 4
The Food Guide Pyramid
Grains

Back 205

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

Front 206

Ch. 4
The Food Guide Pyramid
Vegetables

Back 206

Recommended Servings
(2,000 calorie diet)
-2 ½ cups (raw, cooked, or juice)
Representative Foods
Broccoli, carrots, dry beans and peas, corn,
potatoes, tomatoes

Front 207

Ch. 4
The Food Guide Pyramid
Fruit

Back 207

Recommended Servings
(2,000 calorie diet)
-2 cups
Representative Foods
One small banana, orange,
¼ cup dried apricots

Front 208

Ch. 4
The Food Guide Pyramid
Milk

Back 208

Recommended Servings
(2,000 calorie diet)
-3 cups (2 cups for children ages two to eight)
Representative Foods
2% milk, yogurt, cheese

Front 209

Ch. 4
The Food Guide Pyramid
Meat and Beans

Back 209

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

Front 210

Ch. 4
The Food Guide Pyramid
Oils

Back 210

Recommended Servings
(2,000 calorie diet)
-6 tsp
Representative Foods
Canola oil, corn oil, olive oil, nuts, olives, some fish