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What is the main source of energy for the body and what percent of the RDA is it?
Carbohydrates are 60% of the RDA
How many kcals is one gram ofcarbohydrates?
1 gram = 4 kcals
What are proteins essential for and how much is their RDA?
Proteins are essential for growth and repair of body tissue. They are 30% of RDA
What is the only source of nitrogen for the body?
- *this is essential for nitrogen balance
What is positive protein balance and when does it occur?
Taking in more protein that we eliminate
dehydration, vomiting diarrhea, diabetic acidosis, chronic infection, cirrhosis, rheumatoid arthritis
needed in: pregnancy, growth, wound repair
What is a negative protein balance And when does it occur?
Excretion or protein is greater than your intake
occurs in: starvation, malnutrition, stress, trauma, illness, burns, fever
What is a dense, high caloric nutrient and what is the RDA?
Lipids are 10% of RDA
How many kcals is a gram of lipids?
1 gram = 9kcals
What is the only essential unsaturated fatty acid needed by humans and where does it come from?
Linoleic acid- plants oils
How do you calculate how many calories you need in a day?
- Current weight in lbs x 10 for women or 11 for males
- multiply by 1.2-1.5 depending on level of activity
How would you adjust your caloric intake for weight loss?
- Reduce by:
- 500 cal = 1lb/wk loss
- 750 cal = 1.5 lb/wk loss
- 1000 cal = 2 lb/ wk loss
What is BMR and how do you calculate it?
Basic metabolic rate: energy requirement at rest; energy needed to maintain life sustaining activities
- men 1cal/kg/hr
- women .9cal/kg/hr
How do you calculate ideal body weight and what range do you want to be in?
- Men 50 kg + 2.kg 3 for every inch over 5ft
- women 45.5 kg + 2.3 kg for every inch over 5ft
What are the fat soluble vitamins?
A D E K
What is the purpose of vitamin A and where is it found?
- Needed for vision, skin and organ lining
- 1 years supply stored in the body (90% in the liver)
found in: deep leafy greens, yellow/dark orange veggies
What is the purpose of vitamin D and where is it found?
- Pulls calcium and phosphorus into the blood
- targets body organs, promoters bone mineralization
found in: fortified milk, eggs, liver
What is the purpose of vitamin E and where is it found?
- Antioxidant that protects red blood cells
- destroyed in food when heating
- found in:veg oil
eddie eats oil to protect his red blood cells
What is the purpose of vitamin k and where is it found?
Blood clotting, intestinal tract synthesis
found in:green leafy veg, cabbage, liver
What vitamins are water soluble? What are their purposes?
- Vitamins B and C
- easily absorbed and excreted
- vitamin B: helps to burn energy Yielding nutrients
- vitamin C: helps form collagen
to remember: it was bc before Jesus was baptized
What are the major minerals?
Calcium, magnesium, phosphorus, sodium, chloride
What are the trace minerals?
Iron, zinc, selenium, iodine, copper, manganese, chromium
What is the purpose of calcium and where is found in the body?
Most abundant mineral, 99% found in the bone
- regulates muscle contraction, aids nerve impulses, secretion of hormones, digestive enzymes, and neurotransmitters
- *blood level is tightly controlled and bone is NOT depleted in Ca deficiency
What are some sources of calcium?
dairy, salmon, spinach, shrimp, and sardines
What is the result of calcium toxicity and calcium deficiency?
Calcium toxicity: excess dietary calcium is excreted except in hormone imbalances (watch for kidney stones)
Calcium deficiency: decreased growth in children and osteoporosis in Adults
What is the purpose of phosphorus and where is it found in the body?
Second most abundant mineral in the body with 85% in the bone
It is found in all body cells
- necessary for growth
- activates B vitamins (which burns energy)
Animal protein is the best source
What is the result of phosphorus toxicity and phosphorus deficiency?
- Phosphorus toxicity: May cause calcium excretion
- Phosphorus deficiency: unknown
What is the purpose of magnesium and where is it found in the body?
magnesium relaxes muscles after contraction, holds calcium in tooth enamel
Active in all soft tissue cells, necessary for release of energy
Mostly stored in the bone (85%), 1.75 ounces in the adult body
What are some foods rich in magnesium?
Dark green veg, nuts/legumes, whole grains, seafood, cocoa (destroyed in heating)
What is the result of magnesium toxicity and magnesium deficiency?
Magnesium toxicity: unknown, large doses are used as laxatives (epsom salts) and may cause diarrhea. Convulsions are possible
Magnesium deficiency: Weakness
What is the purpose of sodium?
- Sodium is the primary regulator of extra-cellular fluid
- -helps to maintain the acid/base balance
- essential for muscle contraction and nerve conduction
What are some foods that contain sodium?
Processed food, table salt, soy sauce, cheeses
What is the result of sodium toxicity and sodium deficiency?
- Sodium toxicity: Hypertension (dehydration possible)
- Sodium deficiency: muscle cramps, mental apathy, loss of appetitite
What is the purpose of potassium?
Primary regulator of intracellular fluid
*critical for cardiac functioning-IV push will cause cardiac arrest
assists in carb and protein metabolism
What are some foods rich in potassium?
all whole foods, meats, milk, grains, legumes
What is the result of potassium toxicity and potassium deficiency?
- Potassium toxicity: Muscle Weakness, vomiting, arhythmia
- Potassium Deficiency: muscle weakness, paralysis, confusion, dysrhythmias
What is the purpose of chloride and where is it found in the body?
- Major negative ion in the extra cellular fluid (Cl-)
- Moves freely across membranes
- Part of the hydrochloric acid chain
What is the result of chloride toxicity and chloride deficiency?
- Chloride toxicity: normally harmless, may cause vomiting
- Chloride deficiency: muscle cramps, mental apathy, loss of appetite. Decreased growth in children
What is the purpose of sulfur and where is it found in the body?
- Present in all proteins
- Helps proteins maintain their shape
What is the result of sulfur toxicity and sulfur deficiency?
- Sulfur toxicity: normally harmless, may depress growth
- Sulfur deficiency: unknown
What does the RDI contain and what does the DRV contain?
- Recommended daily intake (RDI): protein, vitamins, and minerals
- Daily Recommended Value (DRV): total fat, cholesterol, carbs, fiber, sodium, and potassium
together they make up daily values
How much sodium can one person have in a day?
Should not exceed 2,000mg/2g
What is anthropomorphic data?
- Measuring the body, assessing the nutritional status, growth and development
- diet log
What labs are common for a nutritional assessment?
- Serum Albumin
- Pre Albumin
What is the normal value for hemoglobin? What happens when it is high? What happens when it is low?
- Too High: dehydration
- Too Low: anemia, pregnancy
What is the normal value for hematocrit? What happens when it is high? What happens when it is low?
- Too high: dehydration, burns
- Too Low: Anemia, blood loss
What is the normal value for serum albumin? What happens when it is high? What happens when it is low?
- Too High: dehydration, severe v/d
- Too Low: Chronic illness, severe malnutrition
What is the normal value for prealbumin? What happens when it is high? What happens when it is low?
also called the thyroxin binding protein
prealbumin is a more sensitive measure to assess for malnutrition
What are the two lab tests used for nitrogen balance?
- BUN (blood urea nitrogen)
What is the normal value for BUN? What happens when it is high? What happens when it is low?
- Too High: dehydration, renal disease, UTI, CHF, GI bleeding, increased protein intake
- Too Low: decreased protein diet, malnutrition, over hydration
What is the normal value for creatinine? What happens when it is high? What happens when it is low?
Creatinine is a by product of muscle breakdown
- Too high: Renal disease
- Too low: muscle atrophy, aging, may indicate liver disease or low protein intake
When assessing nutrition, when historical data are you looking for?
- Dietary History
- Medical History
- Psycho-social History
- Life style factors
What are some factors influencing dietary practices?
- Cultural factors
- Religious beliefs
- Socioeconomic factors
- Personal beliefs
- Food fads (media perception included)
- Psychological factos
- Chemical dependency
- Health status
1/3 Americans are considered obese, what are some co-morbidities of obesity?
- Cardiac disease
- gallbladder disease
- sleep apnea (Pickwickian syndrome)
- increased surgical risk and post op complications
- bacterial and fungal infections
- venous edema of lower extremities
What are the keys to cross cultural communication regarding nutrition?
- Keep lines of communication open
- Be willing to listen
- Learn to follow cultural rules about personal space, touching, eye contact, hand shake
- Establish rapport for exchange of information
- Express interest
- Pay attention to body language
- Teach appropriate family members
When are NPO diets typically used?
- Prior to surgery and diagnostic procedures
- Prevention of aspiration
- Treat severe N/V
What foods constitute a clear liquid diet and when is this diet typically used?
Broth, tea, Popsicle, fruit drinks (without residue)
Usually the first diet ordered after surgery or diagnostic testing
Describe a Sodium restricted diet
- Avoid processed foods
- AMA recommends no more than 2g salt/daily
- Do not use salt at the table
- no salted foods such as chips, peanuts
- No salt preserved foods like meats
- Season with other spices like onion, garlic, and herbs instead of salt and butter
- Minimize intake of cheese and peanut butter
Describe a diabetic diet
- Reduce fat and cholesterol
- Glycemic index-foods causing less change in the blood glucose
- Carb counting!
describe a low fat diet
- Fat is an important part of a healthy diet
- Increase the good fats- monounsaturated fats found in olive, canola, and nut oils
- HDLs scour the blood vessels of excess cholesterol
- -->levels below 40 indicated increased risk of heart disease
- Eat plenty of fish, walnuts, and almonds
Describe a renal diet
- Complete proteins
- Goal of nutritional therapy is to maintain appropriate fluid status, BP, and blood chemistries
- High protein, low phosphorus, low potassium, fluid restriction
- Vitamin E deficiency because kidneys are unable to convert it to its active form
Describe Aspiration precautions
- When fluids or solids are at risk of going into the tracheobronchial passages
- Risk factors: decreased LOC, depressed cough and gag reflexes, GI tubes, tube feedings, impaired swallowing
- Monitor for choking while eating, pocketing in mouth
- Constantly assess for gag reflex and swallowing
What are some interventions for aspiration precautions?
- Always keep suction setup available
- Notify MD of decrease in cough or gag reflex
- Position client on side if choking
- Offer foods with consistency that Pt can swallow, like those thickened with honey, nectar, or pudding
- When feeding, position Pt at 90 angle (high fowlers)
- Feed slowly
- Keep sitting upright for 30-45min post feeding
- Consult with speech therapy
What are enteral tube feedings?
Nutrition given through tube, may not be nutritionally complete
Used with NG, gastrostomy, and jejunostomy tubes
Pt must be able to absorb and digest nutrients
What are some necessary assessments for enteral feedings?
- The risk for aspiration:
- Low risk-NG or Gastrostomy tube
- High Risk- jejunostomy tube
- Time factor:
- <4 weeks, use NG tube
- >4 weeks, use gastrostomy or jesunostomy tube
What is TPN?
Total Parenteral Nutrition through an IV line for patients who cannot digest the nutrients.
Blood sugar must be monitored as carb or dextrose solutions can be from 10-70%
Hypertonic solution also called Hyper-al
How is TPN different from PN?
Total parenteral nutrition is giving through a central venous catheter or PICC line while parenteral nutrition is given through a peripheral line
Totoal parenteral nutrition used if needed for over a week
Lipid emulsions may be mixed with TPN