ATI Nutrition 2023 NGN

ATI Nutrition 2023 NGN Vitamin C Function - tissue building, metabolism, iron absorption Foods- citrus fruit juices, tomato, green leafy vegetables, peppers Deficiency of vitamin c- scurvy (symptoms)- bleeding, joint pain, swollen gums, increase intake during times of stress and illness Smokers need more vitamin C Water soluble vitamins - Vitamin c, b-complex, thiamin b1 riboflavin b2, niacin b3 pyridoxine b6, pantothenic acid, biotin, folate, cobalmin b12 Fat soluble vitamins - Vitamins A, D, E, K Fat soluble vitamins have risk of toxicity since they are stored in the body for a long time Conditions that impair absorption of fat soluble vitamins - cystic fibrosis, celiac disease, crohn's disease Carbohydrates - Should make up 45-85% of calories Function in body- energy, regulate fat/protein, metabolism, and are important for cardiac and cns functioning Glycogen - Stored carbohydrates energy in the liver and muscles released in between meals to maintain blood glucose levels Carbs provide 4calories/gram of energy Recoiled fiber intake - 25g for women 38g for men Protein - Should make up 10-35% of calories Function- supports tissue building metabolism immune function maintain nitrogen balance important for wound healing Complete proteins - Contain sufficient amount of 9 essential amino acids ( animal sources, soy) Incomplete proteins - Plant sources can be combined to make a complete protein Proteins provide 4cal/gram of energy Examples of protein energy malnutrition- kwasshiorkor- little protein Marasmus- inadequacy of all nutrients Lipids/fats - Fats should make up 20-35% of calories less then 10 should come from saturated fat with a goal of less then 7% Function- stored energy for the body provides passing and insulation for hormone production and absorption of fat soluble vitamin Cholesterol should be limited to 200-300 mg a day Fats provides 9cal/g of energy Vitamin E - Antioxidant- protect cell from damage Food- fat containing food examples veg oil, nuts, dark green vegetables whole grain Deficiency- rare- muscle pain weakness poor balance Vitamin D deficiency - Helps with absorption of calcium and phosphorus bone mineralization Food/source- sunlight, fortified milk, fatty fish, eggs Deficiency- rickets bone loss B complex vitamins - metabolism, energy, nerve functioning Foods- Meat milk enriched grains whole grains legumes green leafy vegetables Deficiency of thiamin - Berberi, common in those with alcohol use disorder Deficiency of riboflavin - Cheilosis( cracking of corner of mouth) (glossitis- smooth swollen red tongue) Deficiency of folate - Result in neural tube defects in utero Deficiency of cobalmin - Pernicious anemia, affects strict vegan and those lacking intrinsic factor (need for absorption of B12 Vitamin A - Vision health , skeletal and soft tissue development and strength Foods- oranges yellow fruits and veggies carrots apricots cantaloupe fatty fish eggs liver dairy products Deficiency- vision issues xerothalemia- dry thickened conjunctiva and cornea Calcium (9-10.5) - Bone teeth formation nerve and muscle function clotting blood pressure Food- dairy product dark green veg fortified food Hypercalcemia constipation decreased deep tendon reflexes kidney stones lethargy Hypocalcemia- positive chvostek and trosseau sign muscle spasm tingling lips and fingers Chloride 98-106 - Digestion maintaining intercellular fluid and extracellular fluid Food- salt Hyperchloremia- nausea vomiting Hyopchloremia- muscle cramps gi upset Vitamin K - Blood clotting bone maintenance Food- dark green veg carrots eggs Deficiency- increase bleeding time Key point - vitamin k is antidote for warfarin Sodium 136-145 - Maintain fluid balance in body nerve and music function Foods- salt processed foods Hypernaitremia- hypervolemia hypertension Hyponaitremia- confusion common in elderly muscle cramping fatigue n/v headache Potassium 3.5-5 - Maintain intracellular fluid nerve function nerve function regulate muscle and heart contractions Food banana potato tomato orange Cantaloupe avocado dark green veg Hyperkalemia - dysrrthymia muscle weakness numbness tingling n/v confusion Hyopkalemia- dysthsrthymiax muscle cramps constipation Water - 2-3 l a day recommend Minimum is 1.5 l intake should match output Older adults and children are at higher risk for dehydration Signs of dehydration poor skin turgor confusion hypotension decrease urine output increase urine osmolality dry mucous membranes thirst Iron - Used to make hemoglobin component of rbc Food meat fish grains legumes Side effects constipation gi upset tooth discoloration Vitamin c increase absorption calcium decrease absorption Use Z track method for IM injections Magnesium 1.3-2.1 - Nerve and muscle function bone formation critical for many biochemical reaction in the body Food nuts dark green veg whole grain meat milk Hypermagnesmia n/v hypotension muscle weakness lethargy respiratory and cardiac arrest Hyponagnesmia DYSRHYTHMIAS tremors seizures confusion increase deep tendon reflexes Phosphorous 3-4.5 - Bone teeth formation Food dairy including cheese dark green veg meat fish eggs legumes Inverse relationship between calcium and phosphorus - if Calcium is high phosphorus is low Hyperphosphatemia- positive chvostek and trosseaus sign muscle spasm and tingling in lips and fingers Iodine - Used in synthesis of thyroxine which is a thyroid hormone 100-150 mcg Food a table salt and seafood Fluoride - protect against cavities Source- water Zinc- immune function Food- nuts meat fortified cereal beans BMI weight - Underweight - 18-5 Healthy 18.5-24.9 Overweight 25-29.9 Obese 30 or More Signs of malnutrition - wasted appearance, poor wound healing, dry patches on skin, hair loss, dry/brittle hair, weakness, poor coordination, low prealbumin and albumin Prealbumin- 15-36 Albumin- 3.5-5 Catabolism - Break down of substances resulting a release of energy Anabolism - Use of energy to build repair substances BMR - Energy required for involuntary activities in the body within the 24 hr period example heart function respiration temperature regulation Increase bmr- male gender increase muscle mass stress periods of growth childhood puberty pregnancy lactation exposure to cold disease or illness hyperthyroidism sepsis burns cancer fever surgery Decrease bmr- female short stature less muscle mass starvation older age 60 hypothyroidism Nitrogen balance - A component of amino acids found in protein sources Positive nitrogen- occurs during pregnancy childhood puberity lactation Negative nitrogen balance- indicates insufficiency protein intake due to illness malnutrition aging pt is using protein faster then it is being synthesized Weightloss teaching - Monitor hunger on 1- 10 scale before eating Certain foods should not be forbidden Weight loss will not be consistent weight will fluctuate do not weigh yourself daily Make lifelong vs temporary changes Eat meals free of distraction Dietary Guidelines for Americans - 1 drink for women 2 drinks for men a day Orthodox Jewish - Kosher kitchen- no meat with dairy no pork products or shellfish Muslim - No pork Mormon - no caffeine or alcohol Catholics - - No meat on Ash Wednesday and Friday during lent Acculturation - Adopting traits of the dominant culture Ethnocentrism - The belief that one's own culture is superior to all others view works from their own cultural viewpoint nurses should not demonstrate this behavior Nutrition during infancy - Birthweight doubles by 6 months Breast milk or formula only for first 4-6 months Solid foods when baby can sit up and head control ( 4 month) ok fortified cereal should be first food introduced New foods every 5-7 days to assess for allergies and tolerance Cow milk should be given after 1 year of age Weight gain during pregnancy - 25-35 pounds normal weight Dietary rec for pregnancy - 2-3 l of water No alcohol Limit caffeine 300 or less 600mcg of folic reconvened to prevent fetal neural tube defect Iron for supplement rec Fish and shellfish should be be avoided due to mercury level Osteoporosis - Bone loss begins at 35 years old white women have a higher risk Patient teaching increase intake of calcium and vitamin d Engage in weight bearing exercise Limit alcohol consumption Breast milk - Discard after feeding if unused Store in fridge 5-8 days do NOT microwave milk Can be frozen up to 6 months or 12 in deep freezer Used these milk within 24 hrs do NOT refreeze Colic infancy - Persistent crying for 3h or more per day usually resolves by 3 months if breastfeeding try eliminating cruciferous vegs cow milk onion and chocolate Lactose intolerance infancy - Gas abdominal dissection and diarrhea use soy base of casen hydrolysate formula Diarrhea in infancy - Often cause by rotavirus use oral rehydration solution Signs of dehydration sunken eyes lethargy sunken fontanels decrease tears decrease urines output dry mucus membranes childhood nutrition concerns - children gain about 5 lbs per year choking hazards: popcorn, raisins, peanuts, grapes, celery, raw carrots, hot dogs, peanut butter, candy, tough meat limit juice intake to 4-6 oz per day vitamin D is important for bone development limit milk intake to 24 oz, because overconsumption can lead to iron deficiency anemia. increase intake of iron-rich foods, vitamin C increases absorption of iron Vitamin d important for bone development Nasogastric tube - Short term use from nose to stomach Gastronomy tube - Long term use inserted in stomach or intestine Standardize formula - Contain whole protein require fully functioning gi tract Hydrolyzed formula - Contain partially digested protein use for impaired GI tract Thin liquid - All beverage no restriction Nectar thick liquid - Heavy syrup consistency can drink though straw Honey thick - Pourable can be eaten with spoon but can't drink with a straw Spoon thick - Thicken such that they maintain their shape need to be eaten with spoon clear liquid diet - Used for gi disorder post op Food- jello ginger ale tea coffee broth clear juices carbonated bev Full liquid diet - Transition from clear liquor to soft diet Food - clear liquids milk pudding soup ice cream sherbet fruit juice veg juice Soft diet - Full liquid to regular diet Food no raw fruit or veg no food that cause gas no coarse bread or cereal Puree diet - Oral facial surgery wires jaw chewing difficulty Foods turned into liquid form Mechanical soft diet - foods that require only minimal chewing before swallowing ground meat canned fruit cooked veg Dysphasia diet - Purée food- pudding like texture Level 2 mechanically altered most semi solid food with soft texture Level 3 most near normal texture food no hard sticky crusty food Parental nutrition and meds - Insulin can be added to prevent hyperglycemia from the dextrose Heparin can be added to prevent clot formation on Iv Catheter drip Do not administer any meds though PN IV line or port need a separate line TPM - Administer this central vein longer term therapy 7 days can have up to 70% dextrose PPN (peripheral parenteral nutrition) - -administered through peripheral venous catheter short term 7-10 days solution must be isotonic and cannot contain more then 10% dextrose Nursing care of enteral feeding tubes - Verify tube placement w xray before feeding Measure tube before each shift and before each feeding Verify presence of bowel sounds before feeding Measure gastric residual every 4-6hr Flush feeding with 30ml water every 4 hr Formula should be room temp Nursing care for enteral feeding - Elevated hob to 30° during feeding and for 30-60 min after feeding Flush tubing with 15-30ml water before after and in between meds Cover and label unused formula with patient Refrigerate up to 24 hrs Fill feeding bags with only 4 hr worth of formula to prevent bacterial formation PN IV lipids are contraindicated for clients who are allergic to soybean oil eggs and safflower oil - Patient with high cholesterol or hepatic disease should not get iv lipid Metabolic syndrome - Increases risk for heart disease and diabetes Diagnosis- presence of 3-5 following risk factors increased abdominal girth greater then 40in for men and 35 in for women Elevated triglycerides Decrease HDL less then 40 for men and less then 50 for women High blood pressure 135 dbp 85 Elevated fasting blood glucose Malnourished patients nausea early satiety - Offer several small meals thorough the day vs 3 bigs meals. Limit liquids at meal time Cold or room temperature foods are less likely aromatic and less likely to cause nausea Provide oral care before and after meals Increase pt intake by providing supplement drinks between meals Consume more food in morning when appetite is better Don't fill up in low calorie foods consume small amounts if High protein high calorie nutrient dense foods Nursing considerations for safe administration of PN - Use micron filter on PN IV tubing. IF THE NEXT PN BAG IS UNAVAILABLE, ADMINISTER 10-20% DEXTROSE IN WATER UNTIL IT ARRIVES. If PN solution looks oily or has a layer of fat at the top, throw it out! Verify PN prescription with second RN prior to administration. Change PN bag and tubing every 24 hours. Monitor I&Os, daily weights, electrolyte levels, blood glucose. PN can be discontinued when oral intake is at least 60% of daily caloric requirements. D/C PN gradually to prevent hypoglycemia. Dysphasia - Parkinson's disease, stroke, cerebral palsy, ms Care for pt with dysphasia- lightly stone chin throat to promote swallowing Thicken thin liquids Check for food pockets in mouth before feeding Encourage patients to tuck chin down when swallowing Monitor patients during meals have suction equipment available Education for economically disadvantaged families - -Avoid canned, boxed, processed foods, which tend high in calories, fat, and sodium. -Frozen fruits and veggies are more affordable and last longer in freezer. -Teach patients how to read food labels. -Arrange for meal delivery services. Anorexia, constipation - Anorexia- Remove unpleasant odors from environment Real small frequent meals Avoid fatty foods Drink supplemental drinks between meals Oral care before and after meals Constipation- increase fiber and fluid Increase exercise Avoid chronic use of laxatives Anemia - The body requires iron b12 and folic acid to synthesize rbc increase intake of those 3 component Iron- meat dark green veg whole grains beans tofu vitamin c increase absorption of iron B12- meat eggs milk Folic acid- leafy green veggies citrus fruits beans fortified cereal and break chicken liver Heart disease - Consume low fat low cholesterol diet less then 200 mg if cholesterol avoid saturated fat and trans fat Use liquid oils avoid frying foods Increase fiber intake Decrease red meat consumption Choose lean meat like turkey or chicken Increase omega 3 fatty acids fish nuts seeds plant oil Lower homocysteine levels Hypertension - Dash diet- low sodium high potassium high calcium Lower sodium to 1500 mg 2300mg avoid food high in sodium ( canned foods smoked meats pretzels chips processed foods Increase intake of low fat dairy fruits and vegs whole grains Limit alcohol consumption Heart failure nutrition - Limit sodium 2000mg of sodium a day or less Restrict fluid intake 2L day Increase protein intake Eat small frequent meals Myocardial infarction- avoid caffeine Eat small frequent meals Follow heart healthy diet Lactose intolerance - Limit foods with lactose such as dairy products such as milk cheese chocolate pudding suggest use of lactase enzyme Ostomies - Increase fluid and soluble fiber Avoid gas and odor causing beans carbonated drinks eggs fish garlic And foods that can cause stoma blockage nuts carrots popcorn Increase protein and calorie intake to help heal the stoma prepare means in a schedule to promote regular bowel elimination Gastritis and Peptic Ulcer Disease - Reduce stress Avoid NSAIDs, alcohol, smoking. AVOID eating frequent meals, as this increases gastric acid secretion. Avoid black pepper, spicy foods, caffeine. Dumping syndrome - When the stomach contents rapidly empty into the small intestine can lead to hypoglycemia iron deficiency anemia steatorrhea osteomalacia Symptoms- abdominal cramping, nausea, diarrhea diaphoresis tachycardia hypotension Nutrition - small frequent meals Include protein and fat at each meal avoid dairy products and concentrated sugars Do not drink liquids with meals Lie down for 20- 30 Minutes after meals GERD - Avoid tight clothes Don't lie down for 2 hours after meals Avoid large meals No citrus fruit/ juice spicy foods fatty foods caffeine chocolate alcohol carbonated beverages peppermint spearmint Lose weight don't smoke Chronic kidney disease - Limit protein intake -0.8-1g a day Limit phosphorous intake- limit dairy including cheese dark leafy veg meat fish eggs beans cola chocolate beer Limit potassium- banana potato tomato orange cantaloupe avocado dark green veg Limit sodium- to control hypertension bariatric surgery - Start each meal with protein Eat 5 small meals a day Allow 30-60 minutes to eat Chew foods thoroughly DONT CONSUME LIQUIDS WITH MEALS watch for symptoms if dumping syndrome Abdominal cramping causes diarrhea disphoresis tachycardia hypotension Diverticulitis - For acute exasterbation of diverticulitis a clear liquid diet is recommend low fiber diet AFTER INFLAMMATION IS REDUCED A HIGH FIBER LOW FAT DIET IS RECCOMENDED AVOID SEEDS HUSKS POPCORN TOMATO BERRIES IBS - A low fiber high protein high calorie diet is recommend Oral replacement fluid may be needed TPN may be needed during acute phases Avoid nicotine Cholycystitis - Consume low fat diet Pancreatitis nutrition - Consume low fat diet high protein high carb diet NPO rec during acute exasterbation TPN may be needed for chronic encourage high calorie snacks and taking enzyme prep with meals to assist is absorption Liver disease- no alcohol caffeine nicotine vitamin and mineral may be needed Celiac disease - Inability to digest gluten Cause diarrhea steatorrhea bloating anemia abdominal pain Avoid foods containing wheat rye barley Read labels on processed foods as many contain gluten ex gravy mixes deli meats cold cuts soups OK to eat dairy rice corn potato eggs fruits and veg Hyperglycemia - Over 200 Symptoms- polyuria polydipsia polyphagia kussmals respirations fruity breath headache decrease LOC dehydration Somogyi phenomenon- MORNING HYPERGLYCEMIA DUE TO UNTREATED OVERNIGHT HYPOGLYCEMIA Provide bed time snack and insulin to help somogyi phenomenon Hypoglycemia - Blood glucose less then 70 Symptoms shakiness diaphoresis confusion headache Nutrition- provide 10-20g of carbs 4oz of regular juice or spa Retest blood glucose in 15 min if it's still under 70 repeat above After blood glucose is stabilized provide a snack with carbohydrates and protein End stage renal disease - ENCOURAGE HIGH PROTEIN INTAKE due to dialysis Limit phosphorus intake take phosphate binder with meals and snacks Limit potassium intake Limit sodium, fluids Provide calcium and vitamin d supplement acute kidney injury - Limit protein intake 0.6 non dialysis 1.1.5 for dialysis pt Restrict fluids intake to daily urine output plus 500 ml during oliguric phase Potassium sodium intake dependent on phase nephrotic syndrome nutrition - Sufficient protein intake 0.7-0.8g day Emphasis on soy based protein Low sodium diet to control hypertension and edem Nephrolithiasis kidney stones - Excess protein sodium calcium and oxalate inadequate fluid intake Nutrition - increase fluid intake - 2-3L Decrease animal protein sodium alcohol caffeine For stones made of calcium oxalate limit foods such as spinach rhubarb strawberries beet chocolate tea nuts For stones made of uric acid limit food such as meat whole grains legumes Taste alteration - Eat more tart foods such as citrus fruit juices Eat small frequent meals Use plastic utensils Suck on mints candy or chew gum Gargle with mouthwash Try seasonings or sauces to improve taste of food Stomatitis - Do not use alcohol based mouthwash Use a soft toothbrush clean teeth after meals and at bedtime Avoid acidic spicy dry crunchy foods SCRAMBLED EGGS ARE A GOOD CHOICE Consume cold or room temp foods Cut foods in a smaller bite Use straw Diabetes diet - Increase intake of fiber, such as beans, veggies, whole grains Limit simple carbs Decrease intake of saturated fat less than 7% of calories less than one percent of calories and cholesterol 200 to 300 mg a day No smoking or tobacco Goal is a hemoglobin A1c of less than seven Increase exercise, encourage weight loss Monitor blood glucose levels carefully Count carbs, 45 to 75 g meal Nutrition for cancer prevention - -adequate fiber decreases colon cancer risk -no smoking to prevent lung cancer -eat 5 servings of fruits/veggies each day -whole grains instead of processed -don't eat pickled, smoked, grilled, or nitrate containing meat -choose polyunsaturated and monosaturated fats (vs. saturated) -reduce ETOH -high calcium in diet to prevent colon cancer Nutrition for cancer, HIV aids - Cancer requires increased protein in calorie with goal of maintaining weight during therapy. Add calories to recipes use whole milk versus water add milk and cheese to dishes. Use peanut butter as a spread top fruit with yogurt. HIV-consume, small frequent high protein, high calorie nutrient, dense meals, weight weight loss of 10% and one of the following for 30 days diarrhea fever chronic weakness