Nutrition Exam 2 (NR 228)

Nutrition Exam 2 (NR 228) VNutrition Exam 2 (NR 228) what are the water soluble vitaminsANS B-complex vitamins, choline, and vit. C what are the fat soluble vitaminsANS A, D, E, K which type of vitamins do you develop toxicity withANS fat soluble Deficiency of any of these nutrients will affect overall blood healthANS vit. B12, iron, folate, zinc, vit. B6, copper, vit. K active Transport/storage of folate needed for heme and cell formation and other functionsANS vit. B12 (cobalamin) Distributes oxygen in hemoglobin and myoglobinANS iron Coenzyme metabolism (synthesis of amino acid, heme, deoxyribonucleic acid [DNA], ribonucleic acid [RNA]) and other functionsANS folate (folic acid) Cofactor for more than 200 enzymes, including enzymes to make heme in hemoglobin, genetic material, and proteinsANS zinc Hemoglobin synthesis and other functionsANS vit. B6 (pyridoxine) helps with iron useANS copper Cofactor in synthesis of blood clotting factors; protein formationANS vit. K (active form) what nutrients are required by the bone to maintain cellular structureANS vit. D, K, A, calcium, phosphorous, magnesium, and fluoride bone mineralizationANS vit. D Protein formation for bone mineralization; cofactor for blood clotting factorsANS vit. K active Bone growth; maintains epithelial cells; regulation of gene expressionANS vit. A Bone and tooth formation (component of hydroxyapatite) Bone structure increases stability of boneANS calcium, phosphorous, magnesium, and fluoride what vit. and minerals are needed to metabolize carbohydrates, lipids, and protein into energyANS thiamin (B1), riboflavin (B2), niacin (B3), pyridoxine (B6), folate, cobalamin (B12), biotin, pantothenic acid, iodine, chromium, phosphorous, sulfur, iron, and zinc Coenzyme energy metabolism; muscle nerve actionANS thiamin (B1) Coenzyme energy metabolismANS riboflavin (B2) Cofactor to enzymes involved in energy metabolism; glycolysis and tricarboxylic acid (TCA) cycle synthesisANS niacin (B3) Forms coenzyme pyridoxal phosphate (PLP) for energy metabolismANS pyridoxine (B6) Coenzyme metabolism (synthesis of amino acid, heme, deoxyribonucleic acid [DNA], ribonucleic acid [RNA])ANS folate Metabolism of fatty acids/amino acidsANS cobalamin (B12) Part of coenzyme AANS Pantothenic acid (B5) Metabolism of carbohydrate, fat, and proteinANS biotin Thyroxine synthesis (thyroid hormone) regulates growth and development; basal metabolic rate (BMR) regulationANS iodine fluid and electrolyte balance (acid-base balance) of body fluids is buffered by other mineralsANS sodium, potassium, chloride, and phosphorus Major extracellular electrolyte for fluid regulation; body fluid levels; acid-base balance; nerve impulse and contraction; blood pressure/volumeANS sodium With sodium and chloride, major intracellular electrolyte for fluid regulation; muscle functionANS potassium acid-base balanceANS chloride and phosphorus no animal products of any type (no eggs or milk products) requires variety of plant materials including nuts, legumes (dried peas and cooked beans); while consuming enough iron, zinc, calcium, vit. D, omega-3 fatty acids, and vit. B12ANS vegan use milk and milk products but not eggs, meat, poultry, or fishANS lactovegetarian exclude meat, poultry, and fish consume eggs, milk, and other dairy products since they are not obtained by killing the animalANS ovo-lacto-vegetarian include fish or chicken minimally exclude red meatANS pescatarian prefer vegetarian diets, but are willing to eat meat, fish, or chicken on occasionANS flexitarian Energy metabolism (enzymes) Component of protein structures Distributes oxygen in hemoglobin and myoglobin Carbohydrate metabolism (insulin function); cofactor to more than 200 enzymesANS phosphorus, sulfur, zinc, and iron Carbohydrate metabolism, part of glucose tolerance factorANS chromium rec. daily increase of calories in second trimester pregnancyANS increase of 340 calories rec. daily increase of calories in third trimester pregnancyANS increase of 452 calories rec. daily increase of calories in postpartum breastfeeding mothers during first 6 monthsANS increase of 330 calories rec. daily increase of calories in postpartum breastfeeding mothers during second 6 monthsANS increase of 400 calories rec. daily caloric intake of protein during pregnancyANS 20% of total intake or 71 g/day rec. daily caloric intake of carbohydrates during pregnancyANS 50% of total intake rec. daily caloric intake of fats during pregnancyANS 30% of total intake rec. weight gain during pregnancy for 1st trimesterANS 1.1-4.4 lbs rec. weight gain for 2nd and 3rd trimester for underweight client (BMI: 18.5)ANS a little more than 1 lb/week for total of 28-40 lbs rec. weight gain for 2nd and 3rd trimester for normal weight client (BMI: 18.5 - 24.9)ANS 1 lb/week for total of 25-35 lbs rec. weight gain for 2nd and 3rd trimester for overweight client (BMI: 25-29.9)ANS 0.66 lb/week for total of 15-25 lbs rec. weight gain for 2nd and 3rd trimester for obese client (BMI: 30)ANS 0.5 lb/week for total of 11-20 lbs rec. fluid intake for pregnant/lactatingANS 2,000-3,000 mL/day rec. alcohol intake for pregnant/lactatingANS none, these pt's should abstain rec. caffeine intake for pregnant/lactatingANS less than 200 mg/day, bc it crosses the placenta and can affect fetal HR and movement rec. folic acid intake for pregnant/lactatingANS pregnancy: 600mcg/day lactating: 500 mcg/day * synthetic folic acid (folate) is absorbed better folic acid food sourcesANS green leafy veggies, enriched grains, and orange juice rec. intake of iron for pregnant/lactatingANS increase by 50% to increase maternal BV and provide iron for fetal liver storage rec. intake of nonnutritive sweeteners for pregnant/lactatingANS several have been approved for occasional use rec. intake of fish for pregnant/lactatingANS advisories have been issued due to risk of mercury levels, mercury can be toxic to fetus and cause development of fatal brain tissue limit consumption of seafood to 12 oz birth weight of infant doubles byANS 4-6 months birth weight of infant triples byANS 1 year appropriate weight gain for first 5-6 monthsANS 0.15-0.21 kg per week (5-7 oz) in the first 6 months an infant growsANS about 2.5 cm (1 in) in the second 6 months an infant growsANS 1.25 cm (0.5 in) head circumference increases to what in the first 6 monthsANS 1.5 cm (0.6 in) per month when should semisolid foods be introduced to an infantANS around 6 months for the development of the GI system when do gestational iron stores begin to deplete in an infantANS around 4 months, so start iron supplements for breastfed babies when do you introduce cows milk to an infantANS after 1 year of age who requires whole cows milk for adequate fat for still-growing brainANS 1-2 year olds children are at an increased risk for choking untilANS 4 years of age how many grams of protein should a preschooler consumeANS 13-19 g/day energy requirements for 12-18 year old femalesANS 2,000 cal/day energy requirements for 12-18 year old maleANS 2,200-2,800 cal/day indications for a liquid dietANS before/after surgery, prep bowel for diagnostic tests, acute GI disturbances, and provide oral fluids contraindications for liquid dietANS no longer than 24 hours, inadequate Gi function, nutrients required in parenteral nutrition foods allowed on liquid dietANS broths, bouillon, apple juice, grape juice, gelatin w/out fruit, sprite, ginger ale, coffee, and tea w/out cream indications for full liquid dietANS after surgery, transition from clear liquids to soft food, oral/plastic surgery on face or neck, mandibular fx, chew/swallowing difficulty, esophageal/GI strictures, diarrhea contraindications for full liquid dietANS dysphagia and wired jaw foods allowed on full liquid dietANS clear liquids and all other juices, milk, ice cream, cooked eggs, eggnog, oral supplements, and milkshakes indications for pureed dietANS neurologic changes, inflammation/ulceration of oral cavity or esophagus, edentulous patients, fx jaw, abnormalities, CVA contraindications for pureed dietANS situations which ground and chopped foods are appropriate foods allowed on pureed dietANS any food that can be blended and serves particles that can cause choking indications for mechanical soft dietANS poorly fitting dentures, edentulous patients, limited chew/swalloing ability, dysphagia, intestinal strictures, radiation to oral cavity, progression from enteral tube feeds or parenteral nutrition to solid foods contraindications for mechanical soft dietANS situations which regular foods are appropriate foods allowed in a mechanical soft dietANS all foods cut easily with fork, chopped, or blended; hard, stringy foods like broccoli, celery, nuts, popcorn, and meat are not allowed indications for soft dietANS debilitated patients unable to consume a regular diet; mild GI problems contraindications for soft dietANS situations which regular foods are allowed foods allowed on a soft dietANS all foods served on the general diet except highly fibrous fruits and veggies used when a client cannot consume adequate nutrients and calories orally, but Gi system is intact and functioningANS enteral nutrition enteral feedings can be administered through which tubesANS nasogastric (NG), nasoduodenal, nasojejunal, gastrostomy (G-tube, PEG tube), and jejunostomy (PEJ or J-tube) advantages of NG tubeANS Easy to place/easy to remove No surgery necessary Less expensive Medications can be administered disadvantages of NG tubeANS Greater risk of aspiration (compared with nasointestinal feeding) Gastric emptying must be monitored advantages of nasoduodenal/nasojejunalANS Less aspiration (compared with nasogastric feedings) Helpful in patients with gastroparesis disadvantages of nasoduodenal/nasojejunalANS Requires placement via endoscopy Gastric motility cannot be monitored advantages of gastrostomy or PEG tubeANS Intermediate/bolus feedings possible Patient comfort Size of tube allows medication administration and/or gastric decompression disadvantages of gastrostomy or PEG tubeANS Increased risk of aspiration in some individuals Stoma care required Potential for dislodgment of tube advantages of jejunostomy or PEJ tubeANS Early postoperative feeding possible Decreased aspiration risk disadvantages of jejunostomy or PEJ tubeANS Smaller tube used, so tube may clog easily Stoma care required Intraperitoneal leakage possible Volvulus possible standard formulas - composed of whole proteins (milk, meat, and eggs) provide what cal/mLANS 1-2 cal/mL elemental formulas - made up of nutrients partially/fully hydrolyzed or broken down provide what cal/mLANS 1-1.5 cal/mL 1.5-2 cal/mL (high-calorie formula) how much water should a 1 cal/mL formula be mixed inANS 850 mL of water continuous enteral tube feedsANS Patients who have not eaten for a significant period; debilitated patients; patients with impaired gastrointestinal (GI) function; patients with uncontrolled type 1 diabetes mellitus; intestinal feedings advantages of continuous enteral tube feedsANS Feedings can be administered at constant rate over 24-hour period; feedings can be cycled (allows formula to be delivered over shorter period, allowing patients freedom of movement, and to promote oral intake if appropriate); gastric pooling minimized and fewer GI side effects experienced; continuous feeding into jejunum is similar to normal gastric emptying disadvantages of continuous enteral tube feedsANS Requires feeding pump if accuracy of volume delivered is required; continuous drip by gravity is possible, but less accurate intermittent enteral tube feedsANS Feedings that are infused at specific intervals throughout the day (total volume of feeding divided and given four to six times per day) advantages of intermittent enteral tube feedsANS Requires only simple equipment; can be used in home settings; may be more physiologic than continuous infusion; feedings can be administered by gravity over 30-90 minutes disadvantages of intermittent enteral tube feedsANS In absence of pumps, feedings must be monitored vigilantly; may become time consuming depending on number of scheduled feedings per day; rate of intermittent infusion (rather than volume) seems to be a major reason for intolerance of tube feedings bolus of enteral tube feedsANS Appropriate only for feeding into the stomach; involves feeding large volumes of formula intermittently over short periods, usually by syringe advantages of bolus of enteral tube feedsANS More manageable for the patient; rate of 30 mL/min or volume of 500-700 mL per feeding seems to be cutoff of physical tolerance disadvantages of bolus of enteral tube feedsANS Associated with increased risk of aspiration, regurgitation, and GI side effects; not appropriate for post-pyloric feedings