NR 228 Final Study Guide

1. Nutritive content of sugar sub vs. sugar sweeteners (honey) ● Multiply the number of grams of sugars by 4 kcal. By dividing this number by the total kcal per serving and multiplying the decimal by 100, you can determine the percentage of sugar content. ● Sugar substitute is a food additive that provides a sweet taste like that of a sugar while containing significantly less food energy. One packet of sugar substitute is equal to 1 dessertspoon (2 teaspoons). ● Sugar sweeteners are found in ice cream, chewing gum, candy, honey. It’s loosely considered any sweetener that you use instead of regular table sugar (sucrose). Content for sugar sweeteners is 0g which is 1 tsp. 2. Feeding patients with dysphagia (NG vs TPN vs soft/mechanical) ● Dysphagia Diets begin with the most restrictive diet (pureed, often with thinned or thickened liquids) and progress back to a general diet if dysphagia improves (Heiss, et al, 2010). Level 1 is the Dysphagia Pureed diet; no coarse textures are allowed and foods are totally blended without lumps. Liquids are ordered separately, usually at pudding consistency. Level 2 is Dysphagia Mechanically Altered; foods are to be moist, softened, and easily chewed. Meats are ground and served with a gravy or sauce, or soft salads may be used (tuna or chicken salad, for example). Level 3 is Dysphagia Advanced; hard, dry, sticky and crunchy foods are omitted. Level 4 is a return to the general diet. Nurses should check with their institution's diet manual for the list of specific foods that may be served for each level of the dysphagia progression. ● Soft diets are often used during transition from liquid diets to regular or general diets. Whole foods, low in fiber and only lightly seasoned, are used. Food supplements or between-meals snacks may be used if needed to add kcal. Soft diets can contain “hard to chew” foods such as white toast. This diet is not appropriate for patients requiring mechanically altered diets. ● Total parenteral nutrition (TPN) may be necessary if nutritional needs cannot be met enterally (feeding by mouth and/or with tube feeding). When oral intake is initiated, early satiety and altered tastes may prevent adequate intake. In such cases, between-meal feedings or supplements should be used to meet calorie and protein goals. Fluid losses from drains, nasogastric tubes, stool output, and urine should be considered in the determination of postoperative fluid needs. 3. Pg.235, BMI BMI (kg/m 2 ) Underweight 18.5 Normal 18.5-24.9 Overweight 25.0-29.9 Obesity ≥30 4. What kinds of foods do you want on a low cholesterol diet? ● Soluble fiber from certain foods, such as whole oats and psyllium seed husk, as part of a diet low in saturated fat and cholesterol and a reduced risk of heart disease (Whole wheat pasta/oatmeal/Quinoa) ● Examples she threw in class: Beef (77 mg), milk (24 mg), eggs (187 mg), raw beans (0 mg)? 5. Low sodium diet: (fruits, veggies and smoked meats) → What are good things and bad things about these diets? ● A diet rich in fruits and vegetables reduced the risk of cancer. ● Constipation is alleviated by slowly increasing consumption of whole wheat products, fruits, vegetables, fluids and exercise. ● DASH diet ● A high dietary sodium intake is detrimental to the nephron, often contributing to high blood pressure and a more rapid decline in renal status ● Use fresh poultry, fish, and lean meat, rather than canned, smoked, or processed types. • Choose unsalted nuts and low-sodium canned foods. Cook dried peas and beans. ● low-salt diet increases the risk of heart attack or stroke 26 percent for people without high blood pressure 6. Vegans and burn patients: (What is the best kinds of proteins for these patients?) ● Consists of only plant foods, including grains, legumes, fruits, vegetables, seeds, and nuts; no animal-derived products are eaten. ● Burn patients: the first 24 to 48 hours of treatment for such patients are dedicated to replacement of fluid and electrolytes. ● Vitamin C and protein: Enteral nutrition support with high protein (chicken breast, almonds, salmon, black beans, low-fat milk) 7. Coronary artery patients (What should their diet consist less or more of) ● More fruits and vegetables (frozen or canned without added fat or salt), breads like whole grain/ pasta/rice/potatoes/dry beans/ low fat crackers/cookies. 1% or fat free milk, lean meats, unsaturated oils/ salad dressing. ● Less: many baked products like doughnuts, biscuit, muffin, croissant, vegetables that are fried/prepared with butter, cheese, or cream cheese, fruits served with butter or cream, diary products like whole or 2%, whole eggs, high fat meats like ribs, steak, hamburger, sausages and for fats and oils should be no margarine, chocolate, coconut. 8. CHF – what do we want them have, to cut down on and why? ● Sodium restriction, choose fruits and vegetables instead because it prevents the heart from swelling and in return causing a high blood pressure from occurring, allows breathing to become easier as well. 9. Atherosclerosis – What are the best oils/nuts/fats to lower cholesterol ● Almonds/Walnuts/ Pine nuts and extra virgin olive oil. ● High intake of fruits and vegetables, whole grains, nuts, soy products. 10. Fats: which are saturated and unsaturated ● Saturated fats: primarily animal, including beef, poultry, pork, lamb, luncheon meats, egg yolks, and dairy products (milk, butter, and cheeses); the only major plant sources are palm and coconut oils (often called tropical oils) and cocoa butter. ● Unsaturated fats: plants foods like nuts, seeds and oils. 11. Mediterranean Diet and DASH diet ● Mediterranean diet consists of: Fresh fruits and vegetables, whole grains, nuts, garlic, fish, and wine in moderation ● Meat and animal products in very small amounts ● Dairy products used sparingly; if cheese is consumed, Feta cheese is the choice ● Up to 4%0 of calories coming from fat, especially olive oil ● DASH diet consists of: Consume dietary pattern of fruits, vegetables, and low-fat dairy products and reduce intake of saturated fat and total fat. 12. Wound healing diet ● Protein: chicken, eggs, beans ● Vitamin A, C and zinc 13. B est form of energy for the brain ● Glucose 14. Foods for patients with pancreatitis, what should they avoid? ● High fat foods such as fatty beef, pork, lamb, dark chicken meat with skin, high fat dairy foods like whole milk, butter. 15. NPO, full liquid, etc. – what is in each (pg 266) ● Liquid diet: Broths, bouillon