ATI proctor, Nutrition
Chapter 1:
Carbohydrate, protein and fat 3 main nutrients.
Carbs: 45-65% of daily calories
function: energy, regulate fat, cardiac and cns system, protein metabolism.
Glycogen: stored carb in the liver and muscle and it release between the meals to regulate the
Blood glucose level.
Carbs 4 calories per gram per energy
*Fiber intake 25gr women, for M 38gr per day
*Protein 10-35% daily calories, 0.8 gr per kg body weight, tissue building, immune
function, neutral nitrogen balance. Wound healing is important.
Complete protein: all 9 amino acids, animal sources and soy
Incomplete: 2 different one together is complete like rice plus beans.
Protein 4 calories per gram per energy.
Fat lipids: 20-35% of daily calories. Les that 10 sutured fat, ideally 7%
Function: store energy, padding insulation. Hormone, absorption of fat-soluble vitamin
Cholesterol: 200-300 mg/day
Fat provides 9 calories/energy
If you eat 5 gr of fat how many calories: 45 calories.
Vitamins:
Fat soluble: A, D, E, K they have risk for toxicity, don’t overdose, CF, celiac and crohns disease
Water soluble: Vitamin C and B complex thiamine, niacin, pardaxin, panthocacid, folic,
cobalamin: no risk for toxicity, you will pee it out.
Vitamin c: iron absorption, tissue building Citrus fruits, tomatoes, green veggie.
Deficiency in vitamin C: bleeding, swelling gums and joint pain, during pain and illness take
more, during smoking take more
B complex: CNS functioning, meats, milk, whole grains, legumes, green leafy veggies.
Pregnancy get folic acid.
Def B12: pernicious anemia.
Vitamin A: vision health, skeletal and soft tissue: orange and yellow fruits, fatty fish, dairy
products.
Deficiency: xeropthalmia and vision issue
Vitamin D: absorption of calcium and phosphorus. Sunlight, Milk, fatty fish and eggs.
Deficiency: bone loss
Vitamin E: serve as antioxidants: fat containing food, nuts, dark green veggies.
Deficiency very rare: muscle pain.
Vitamin K: blood clotting and bone maintenance, dark green veggie, carrots deficiency: increase
bleeding time. Antidote for Warfarin
Electrolytes:
Sodium Na: 136-145 normal level.
function: fluid balance and nerve and muscle function. Food high in Na: salt and processed
food.
Hyper: hypervolemia and HTN
Hypo: confusion, muscle cramps, headache, fatigue, NV
Potassium K: 3.5-5 normal level.
Function: ICF, nerve function, muscle and heart contraction
FOOD HIGH IN K: bananas, potatoes, tomatoes, oranges, avocadoes, dark green veggies, dried
foods
Hyper: dysrhythmias, muscle weakness, NV, confusion
Hypo: dysrhythmias, muscle cramps and constipation
Chloride Cl: 98-106 is normal level
Function: Help with digestion, ICF and ECF. Find in salt
Hyper: NV
Hypo: muscle cramps, GI upset
Calcium CA: 9-10.5 is normal level
Function: bone, teeth formation, nerve and muscle function, BP
Food: dairy, dark green veggie, fruits
Hyper: constipation, decreased DTR, kidney stones, lethargy
Hypo: Positive Chvostek and Trousers’, muscle spasm and tingling
Magnesium Mg: 1.3-2.1
Function: Nerve, muscle function, bone formation, biochemical reactions
Foods: nuts, veggies, whole grain, milk
Hyper: NV/ hypotension, muscle weakness, lethargy. Respiratory and cardiac arrest
Hypo: increased DTR, dysthymias, seizure, tremors
Ph: Phosphorus 3-4.5 is normal level
Function: bone and teeth formation
Dairy and cheese, dark green veggies, fish and legumes
Inverse relationship with calcium, high Calcium low Ph
Trace Minerals:
1. Iodine: synthesis of thyroxine required level is 100-150mcg. Find in table salt and sea
food
2. Iron: make help HH. Meat, fish, legumes, Vitamin C, constipation, increase fiber intake,
tooth discoloration. Z track for IM injection. Calcium lower absorption
3. Zinc: important in immune functions, NUTS, cereal and beans
4. Fluoride: help protect cavities, in water
Water: 2-3 L/day .minimum requirement level is 1.5 L
I should = O
Sensible fluid loss: can be measured. Urine, vomit
Insensible: fluid loss from lung, water excreted in the feces. Sweat
Older adult and children greater risk for dehydration
S/S: dehydration poor skin turgor, confusion, hypotension, decrease Urine output, dry
mucous membrane, increase urine osmolarity. Sunken in babies.
Chapter 2:
Catabolism: breaking down of substance to release energy
Anabolism uses energy to repair
BMR: energy required for involuntary activities within 24hrs. heart function, respiration
INCREASE BMMR: Male gender, more muscle mass, periods of growth such as puberty,
stress, exposure to cold, disease and illness, hyperthyroidism, seizure, surgery, pregnancy
and lactation
Decrease: female gender, shorter height, less muscle mass, starvation, older age and
hypothyroidism.
Nitrogen balance: component amino acids: nitrogen intake-nitrogen excretion
For the Adults this nitrogen balance should be neutral.
Negative nitrogen: insufficient protein intake, malnutrition or aging, illness.
Positive nitrogen balance: growth, pregnancy and lactation
Chapter 3:
S/s of malnutrition: poor wound healing, hair loss, brittle hair, weakness, poor LOC and look
for pre albumin (15-36) albumin (3.5-5)
Increase protein and calories: add milk powder to milk, whole milk, high calories
food, cheese, peanut butter, use of supplement and collaborate with dietitian.
Calculations weight change: usual weight- current weight/ usual weight *100
2% weight loss in 1 wk. or 7.5% weight loss in 3 months indicate weight loss.
when to weight them? early in the morning
BMI: kg/m (WEIGHT (kg)/ Height (m))
BMI ranges include:
Under 18.5 is underweight
18.5-24.9 healthy
25-29.9 overweight
30 or more is obese
300 calories equal 1 pound.
Decrease 500 calories a week lose 1 lb. in 1 wk. 1lb =2.2 kg
Pt teaching: monitor hunger 1-10 scale before eating. Certain food should not be forbidden.
Moderation is good. Weight loss is not consistent. Don’t weight daily for fluctuations.
Eat meal free of distraction, not in front of TV
Chapter 4:
5 or more serving of veggie, fruits daily is recommended for everyone.
Monosaturated fat. Less than 7% of calories from saturated fat
Salt: 2300mg /day intake
Alcohol: women 1 drink a day and Men 2 drinks a day or less.
Exercise rec: 2.5 hrs. /wk. vigorous or 1.25/wk.
SWIMMING IS NOT HELPING TO PREVENT OSTEOPOROSIS ,NOT WEIGHT BARING
Children: 16 minutes/day of physical activities.
Vegan diet no animal products at all
Lacto-vegetarian: dairy is ok
Lacto-ovo: dairy and eggs are ok
Vegan diet not get enough vitamin D, B12, Omega 3 fatty acid.
Food labels: calories, calories from fat, sutured fat, trans fat, Na, carbs, dietary fiber, sugar,
protein, Calcium and Iron. NO Mg IN THE LIST.
Chapter 5:
Food born illness:
frequent wash hands, refrigerate perishable 2 hrs. or 1 hr if it is hot.
Prevent cross contaminations.
Cooks food to recommended temperature.
Raw and undercooked meats, sprouts, unpasteurized fruit juice, raw milk high risk
food
Salmonella, E. Choli, Listeria, Norovirus
Foods that affect med: grapefruits juice is a NO, affects statins
High in vitamin K: interfere with Warfarin
Foods high in protein affects Levodopa/ Carvedopa for Parkinson disease
Tyramine: smoked meats, chees, avocados, wine, peanuts, chocolates MAOI’s inhibitors will
cause hypertensive crisis.
Potassium rich food: hyperkalemia for pt. who are taking Ace inhibitors or potassium
sparing, Lisinopril cause hyperkalemia.
Allergy to egg for vaccination of flu.
Chapter 6:
Acculturation: adopting the trays of dominant culture
ethnocentrism :one’s culture is superior to others. Avoid it as a nurse
Orthodox, Jewish: kosher kitchen no pork, no shellfish, no dairy with meats.
Muslims: no caffeine, soda, fast during Ramadan
Mormons: no caffeinated beverages
Catholic: no meat on Ash Wednesday
African-American culture: animal fats and high in fat and sodium, type II diabetes
and hypertension. Transition to vegetable oils.
Asian: salt intake is high.
Latino: a lot of oil, replacement of corn with flour tortilla. Corn is healthier than flour.
Type II diabetes
Chapter 7:
During 2nd trimester: women consume 340 calories/day additionally
During 3rd trimester: 450 calories/day additionally.
Lactation 330/day first 6 months additional 400/day after that
Weight changes for the First trimester, all 3 months: 2-4 lbs. only
2nd, 3rd, weight gain of 2-4lbs/ each month
Weight gain for normal patients: 25-35 lbs. during pregnancy
Underweight patient: 28-40 lbs.
Overweight pt: 15-25 lbs.
Dietary rec: 2,3 L of fluid, no alcohol, limit caffeine, 600mcg of folic acid. Iron supplement and
vitamin C, NO to fish and shellfish due to mercury toxicity.
N/V is common: advised them to eat dry crackers, toast, low fat carb, no liquid with the meal,
no caffeine and spicy food, room temp and colder food, maintain good oral hygiene.
Constipation is common: increase fiber and fluid, engage physical activity for bowel
Maternal fennel ketonia: PKU: avoid high protein food, meats, fish. Blood test very frequently
Infant nutrition:
birth weight X2 by 6 months
X3 by one year
Breast milk or formula for almsot 4-6 month. Solid food once the baby can sit up and has a head
control
Iron fortified cereal first food, starting on the new food :one out of a time. New food for 5-7
days for allergic reaction. No cow’s milk until 1 year old.
Breastmilk: any unused should be discarded, in fridge 5-8 days. No microwaves ever. Can be
frozen 6-months regular freezer and 12 months in special freezer. Never re-freeze THAWED
MILK. Q4h breast feeding.
Colic: persistent crying for 3 hrs. or more a day, resolves around 3 months old. Mother should
tries eliminated eating cow’s milk, chocolate and onions.
Lactose intolerance: abdominal distention, gas, diarrhea
Try: soy-based cuisine hydrolyzed formula.
Diarrhea: cause by virus, oral rehydration solution. No sport drinks! Oral hydration only.
S of dehydration: sunken eyes, fontal head, decrease urine output, dry mucus membrane
Childhood and adolescence:
Gain 5lbs/ year.
Choking hazardous foods: POPCORN, RAISEN, GREAPES, RAW CARROTS, HOT DOGS,
PEANUTBBUTEER, TOFFME. CELERIES, PEANUTS, CANDIES
LIMIT juice intake 4-6 oz.
Limit intake of milk to 24 oz: can lead to iron deficiency anemia. Not hunger. Iron rich food.
Vitamin D for bone development for absorption of calcium
Eating disorders: anorexia begins in adolescence
Older adult: lower BMI, fewer calories bc of slower metabolism. Dehydration due to decrease
thirst sensation and med side effects. Folic acid and calcium, chewing issues is common, chop
the food, thicken liquid make it easier to swallow.
Osteoporosis: bone loss occurs at 35 years old. Caucasian highest risk
Increase intake of calcium and vitamin D, weight baring exercise. Limit alcohol consumption.
Chapter 8:
NPO: surgery
After surgery clear liquid, full liquid, soft foods and normal diet
Clear liquid diet: GI disorder, water, tea, coffer, broth, clear juices, gelatin, carbonated drinks,
gingerier.
Full liquid: all the clear + milk, pudding, ice-creams, fruit and vegetable juice, sherbet
Soft diet: no raw fruit or veggie, no gas making food, no cereal or coarse bread, sharp edges.
Only soft foods.
Pureed diet: oral and facial surgery, chewing difficulties, wire in the jaws. Through straw.
Mechanical soft diet: don’t have teeth, dysphagia and chewing difficulties, minimal chewing,
ground meats, canned fruits, cooked veggies.
Dysphagia diet 3 levels
Level 1: pureed: pudding texture
Level 2: Mechanically altered: moist soft texture
Level 3: advanced: moist, near normal food, no crusty
Liquid consistency:
Thin: water, any beverage, no restriction.
Nectar-thick liquid: heavy syrup consistency, have it through straw
Honey-thick: spoon, not a straw. Like yogurt
Spoon thick: shape and needs spoon, custards or pudding.
Chapter 9:
Enteral nutrition: used in pt. not able to eat nutrient orally, but have minimal partially
functioning digestion tract
NG tube: nose into stomach, short term use
Gastrostomy tube: directly into stomach or intestine and that’s for long term use.
1. Standard: whole protein, require fully functioning GI
2. Hydrolyzed: partially GI tract function needed
Interventions:
*Verify the tube placement by X-ray before you feed.
*Measure the tube each feeding
*Auscultate the bowel sound before each feeding
*Discard bags and tubing every 24hrs. (Bacterial contamination)
*Measure Gastric residual q4-6h, return them back to stomach.
*Whole feeding if residual exceed 500ml, return to stomach but don’t feed them.
*Flush feeding tubes q4h 30ml of water.
*Solution at room T
*Elevate HOB 30 degrees, 30-60 minutes after the feeding
*Flush the tubing 15-30 ml of water before/after/during the med.
*Cover and label any unused and fridge for 24hrs.
*Fill it for 4 hrs. only and slowly increase the volume and rate.
Chapter 10:
Nutrient in the blood stream is parenteral
GI disorder pts, cancer, trauma, burns, critical illness, increased BMR, required more nutrition.
Parenteral nutrient bag includes: dextrose, electrolyte, vitamin, trace elements, protein, lipids
! Lipids can admin separately!
Allergic to soy bean oiled, eggs, oiled no IV LIPID, hepatic disease or hyperlipoidemia NO.
2 types:
1. TPN: central vein, picc line or central line, longer term, >7 days. 70% dextrose
2. PPN: peripheral vein, short term 7-10 days. Isotonic. No more than 10% dextrose.
Whatmedcanyouadd:INSULIN(DUE TO DEXTROSEADMIN),alsoHeparintothesolutionfor
clot formation.
Other medication: never-ever through the same line. Separate line, different arm.
Nursing considerations: Micron filter for PPN
IMPORTANT: DUE FOR NEXT BAG BUT ITS DELAYED, NEVER STOP THE TPN ABRUPTLY, HANG THE
BAG OF D10 OR D20 UNTIL THE BAG ARRIVES.
Ifthebagisoily,throughitout,verifythebagwithsecondRN,checktheprescriptionand
content of the bag,
Change the bag and all the tubing q24hr.
Monitor I and O and daily weight and BS.
Can be discontinued when oral intake is 60% of patient’s requirement, Cautions for
hypoglycemia.
Chapter 11:
Dysphagia: difficulty swallowing. Parkinson, CVA, MS and palsy.
Nursing interventions:
Lightly stroke their throat while they are eating
Thin liquid is not safe, thick liquid
Check their mouth for food pocket, ulcers.
Encourage the pt. to tuck their chin IN, NEVER TILE THE HEAD BACK. RISK FOR
ASPIRATION
Monitor during meal, have suction available
Education for lack of access, financial issues:
Avoid canned box or processed food, high in calories and sodium
Choose frozen fruits and veggie, affordable and last longer.
Read food label, high fat sodium and healthy ones
Transpiration issue: delivery services
Nursing care for malnourished, anorexia:
Offer several small meals of the day verses big meals. Limit liquid at meal time.
Cold or room T food better than hot food for NV.
Provide oral care before/after meal can help
Increase intake of supplement between meals
More foods in the morning when nausea is less.
Not to fill up on calories food, high calories, high protein food should be consumed.
Visually impaired patients:
Describewhat’sonthetraywithclock,12mashedpotatoes,3vegetables.Biggerandlarger
utensils for grasp.
Chapter 12:
Metabolic syndrome: 3 of the following: (3 out 0f 5)
1. Increased abdominal girth 40 inch for M, 35 in for W
2. Elevated triglyceride equals or more than 150
3. Decreased HDL less than 40 M and 50 W
4. HTN: 130/85
5. Elevated BS: over 100 fasting blood glucose level.
Nutrition rec: low fat, low cholesterol, less than 200 mg cholesterol/day
Saturatedfatandtrans-fatavoid,increasefiber,decreaseredmeat,usedleanmeats,increase
omega 3 fatty acid (fish nuts, seeds), check on their homosystem level: higher the worst
HTN:DASHdiet,lowsodium,highpotassiumandhighcalcium.1500mcgNa,highinsodium
should be avoided such as chips. Low fat dairy and intake veggies and fruits and limit alcohol
HF:limitsodiumandwater.Lessthan200mcgandlessthan2Lperday.Increaseproteinand
frequent meals.
MI: avoid caffeine, small frequent meals, healthy diet.
Anemia: body requires Iron, B12 and folic acid for RBC, increase of intake of them
Iron can be found in green leafy dark veggies. Meats, whole grains, bean, tofu
B12: meats, egg, milk
Folic acid: veggies, beans, cereal, bread and CHICKEN LIVER.
Chapter 13:
GIdisorders:nauseaandvomiting:eatlowfat,toastcrackers,pretzels,avoidliquidwmeal,
elevated HOB, serve food at the room T, avoid high food high in fat.
Anorexia: loss of appetite
1. decrease unpleasant odor
2. frequent meals
3. avoid high fat food
4. mouth care before and after meals.
Constipation:
1. increase fiber and fluid intake and exercise.
2. Avoid chronic use of laxatives.
Anorexia Nervosa:
1. provide privileges based on calories intake and weight.
2. Weight at same time each day
3. stay with 1 hr. after meal.
4. Avoid caffeinated beverages.
Dumpingsyndrome: stomachrapidlyemptiesinto smallintestine,hypoglycemia,osteomalasia,
iron deficiency anemia.
Symptoms:
1. abdominal cramping,
2. diaphoresis,
3. hypotension,
4. diarrhea,
5. tachycardia
Nutrition rec:
1. encourage small frequent meal.
2. Protein and fat at each meal.
3. Avoid concentrated juiced sugars.
4. Avoid dairy products.
5. No liquids with meals. Consume between.
6. Lay down 20-30 minutes after food.
GERD: Avoidthighs fittingclothing,no lying down after2 hrs. ofmeal, avoid large meals, avoid:
citrus spicy, fatty, caffeine and chocolate and alcohol
Lose weight and not smoke.
GastritisandPUD:encouragetoreducestress,noNSAIDS,nosmokingandalcoholand avoid
frequent meals. Black peppers and caffeine should be avoided.
Chapter 14:
Renal disorders:
CKD:
limit protein intake to 0.8 to 1 gr per kg of body weight.
Limit phosphorus, fish, cola, chocolate, beer.
Limit potassium intake. Bananas potatoes, tomatoes, oranges, cantaloupe
Limit their intake of sodium
Endstagerenaldiseases: encourage higher protein intake. Due to protein loss. Limit K and Ph
and Na and water. Dialysis. provide Calcium and Vitamin D supplement.
AKI: Oliguric, diuretic, recovery
Limit protein for those NOT receiving dialysis 0.6 gr/day
If on dialysis 1,1.5gr/kg of protein
Oliguric: restrict fluid intake for daily urine output plus 500
K and Na intake depends on the phase of AKI
Nephrotic syndrome:
sufficient protein intake 0.7-0.8 gr/kg/day
Soy based protein.
Low sodium diet to prevent HTN and edema.
Nephrolithiasis: kidney stones, risk factors: too much protein, calcium, Na and oxalate.
Inadequate fluid intake is a risk factor
Nutrition:
1. increase fluid intake 2-3L /day,
2. decrease animal protein, alcohol, sodium, caffeine.
Pthaveproblemsmadestonefromoxalates:avoidfoodshighinspinach,rhubarb,nuts,tea,
beets and strawberries.
Uric acids kidney stones: avoid foods high in purines such as: meat, whole grain and legumes.
Chapter 15:
Hypoglycemia: BS less than 70.
s/s: shakiness, diaphoresis, confusion, headache. If they are conscious nutritional supplements.
If they are not conscious: glycogen.
10-20 grs of carbs 4oz juice or soda, wait 15 minutes less than 70, repeat it again.
After its stabilized, give them snack that contain protein and carbs.
Hyperglycemia: BS above 200.
1. s/s: polyuria, polyphagia, polydipsia
2. kusmer respiration rapid
3. fruity breath
4. decreases LOC and
5. headache,
6. dehydrations.
Give them insulin ASAP.
SOMOGYI phenomenon: morning hyperglycemia due to untreated overnight
hypoglycemia, bedtime snack before going to bed and insulin.
General rec: increase of fiber(beans, veggies), limit carbs, decrease saturated fats less than7%,
trans fat less than 1% daily calories, cholesterol 200-300 mg /day/. no smoking
HbgA1C is below 7
Encourage to exercise and lose weight and monitor BS level and counting carbohydrate,
consumption 45-75 carbs per meal.
Chapter 16:
Nutritionforcancerprevention:fiberforcoloncancer,nosmokingforlungcancer.Servingof
fruits andveggies (5serving.)Eating wholegrain, avoid eating pickles, nitratecontaining meals,
polyunsaturated fats, reduced alcohol consumption.
Who has cancer: higher metabolism, encourage intake of protein and calories, to maintain their
weight. Whole milk adds milk and cheese to their food. Add Peanut butter spread, add yogurt.
HIV and aids: consume frequent high protein, high calorie nutrient meals
HIV associated wasting: lost 10% of their body weight, diarrhea, fever or chronic weakness.
Stomatitis: ulceration in the mouth, no alcohol-based washes, soft tooth brushes, avoid crunchy
foodandacidicfood,scrambleeggs.ConsumedroomTfood,cutfoodinsmallerbite,avoid
trauma to mucosa.
Taste alterations:
Tart food citrus fruit andjuices, plastic utensil to decrease metallic taste. suckon mint, candies,
gargle with mouthwash, try seasoning and sauces to help with appetites.
How many calories do carbs provide?
4 cal/g
How many calories do fats provide?
9 cal/g
How many calories do proteins provide?
4 cal/g
Glucose
70-115
Albumin
3.5-5.0
Prealbumin
15-36
Protein
6-8
Sodium
135-145
Potassium
3.5-5.0
Calcium
9.0-10.5
Magnesium
1.3-2.1
Platelets
150,000-400,000
Hemoglobin
12-18
Hematocrit
37%-52%
Cholesterol
<200
HDL
Male >40; Female >50
LDL
<100
Triglycerides
<150
Glycosylated Hemoglobin A1c
4.0-6.0%
Creatinine
0.6-1.3
BUN
6-20
WBC
5,000-10,000
Food sources for folic acid
Green leafy vegetables; liver, beef, and fish; legumes; grapefruit and oranges
Food sources for niacin
Meats, poultry, fish, beans, peanuts, grains, legumes, milk, whole grain, and enriched breads and cereals.
Deficiency of Niacin (B3)
results in pellagra S/S: sun-sensitive skin lesions and GI and neurological findings.
Food sources for B12 (thiamine)
pork and nuts, whole-grain cereals, legumes
Thiamin (B1) deficiency
results in beriberi (ataxia, confusion, anorexia, tachycaria), headache, wt loss, fatigue
Food sources for B2 (riboflavin)
milk, lean meats, fish, grains
Deficiency of Riboflavin (B2)
results in cheilosis (S/S: scales and cracks on lips and in corners of mouth), swollen/smooth red tongue (glossitis), and dermatitis of ears, nose, and mouth)
Food sources for B6 (pyridoxine)
yeast, corn, meat, poultry, fish
Food sources for B12 (cobalamin)
Meat, liver
Food sources for vitamin C (ascorbic acid)
Citrus fruits (oranges, lemons), tomatoes, broccoli, cabbage, peppers, green leafy vegetables, strawberries
Vitamin C deficiency
scurvy; a hemorrhagic disease w/ diffuse tissue bleeding, painful limbs/joints, weak bones, swollen gums/loose teeth
Food sources for Vitamin A
Liver, egg yolk, whole milk, green or orange vegetables, fruits
Food sources for Vitamin D
Fortified milk, fish oil, cereal
Food sources for Vitamin E
vegetable oils; green leafy vegetables; cereals; apricots, apples, and peaches
Food sources for Vitamin K
green leafy vegetables; cauliflower and cabbage.
Food sources of calcium
cheese, collard greens, milk and soy milk, rhubarb, sardines, tofu, yogurt
Food sources of chloride
salt
Food sources of iron
Bread, cereal, dark green vegetables, dried fruits, egg yolk, legumes, liver, meats
Food sources of magnesium
Avocado, canned white tuna, cauliflower, cooked rolled oats, green leafy vegetables, milk, peanut butter, peas, pork, beef, chicken, potatoes, raisins, yogurt. affects enzyme and neurochemical activities and the excitability of cardiac and skeletal muscles.
Food sources of phosphorus
Fish, nuts, organ meats, pork, beef, chicken, whole grain breads and cereals. Milk products, beef liver, chocolate, nuts, legumes, peanut butter, dried peas and beans, bran, cola, beer, some whole grains. plays a role in bone and teeth formation and energy metabolism
Food sources of potassium
Avocado, bananas, cantaloupe, carrots, fish, mushrooms, oranges, pork, beef, veal, potatoes, raisins, spinach, strawberries, tomatoes
Food sources of sodium
Bacon, butter, canned food, cheese, cured pork, hot dogs, ketchup, lunch meat, milk, mustard, processed food, snack food, soy sauce, table salt, white and whole wheat bread
Food sources of zinc
eggs, leafy vegetables, meats, protein rich foods. plays a role in tissue growth and wound healing, and supports immune function
Recommended intake of protein for adults
10%-35% of total calories
Recommended intake of fats for adults
20-35% of total calories, 10% or less of total calories should come from saturated fat souces
Full liquid diet
Used as a transition diet after clear liquids following surgery or for pts who have difficulty chewing, swallowing, or tolerating solid foods. Diet includes clear and opaque liquid foods, and those that are liquid at body temperature. Foods include all clear liquids and items such as plain ice cream, sherbet, breakfast drinks, milk, pudding, custard, soups that are strained, refined cooked cereals, fruit juices, and strained vegetable juices.
Low purine diet
used for gout, kidney stones, elevated uric acid levels. Restrict anchovies, herring, mackerel, sardines, scallops, organ meats, gravies, meat extracts, wild game, goose, and sweat breads
Renal diet
Controlled amounts of protein, sodium, phosphorus, calcium, potassium, and fluids may be prescribed; may also need modification in fiber, cholesterol, and fat based in individual requirements; restrict fluids.
Sodium restricted diet
Used for hypertension, heart failure, renal disease, cardiac disease, and liver disease. Diet plans are individualized; can include 4 g of sodium daily (no added salt diet) 2-3 g of sodium daily (moderate restriction), 1 g of sodium daily (strict restriction), or 500 mg of sodium daily (severe restriction and seldom prescribed). Encourage intake of fresh foods rather than processed foods. Canned, frozen, instant, smoked, pickled, boxed foods, lunch meat, soy sauce, salad dressing, fast foods, soups, and snacks usually have higher amounts of sodium.
Cardiac diet
Indicated for atherosclerosis, DM, hyperlipidemia, hypertension, myocardial infarction, nephrotic syndrome, and renal failure. DASH diet recommended to prevent and control hypertension, hypercholesterolemia, and obesity. Includes fruits, veggies, whole grains, low fat dairy food, meat, fish, poultry, nuts, and beans, and is limited in sugar sweetened foods and beverages, red meat, and added fats. Low sodium, high potassium, high calcium diet to lower BP and cholesterol. Decrease sodium 1,500-2,300.
High calorie high protein diet
used for severe stress, burns, wound healing, cancer, HIV, COPD, respiratory failure. Encourage whole milk, milk products, peanut butter, nuts and seeds, beef, cottage cheese, chicken, fish, pork, and eggs. Encourage snacks between meals such as milkshakes, instant breakfasts, and nutritional supplements.
Low fiber diet
canned fruit, white bread, broiled hamburger, fish, poultry
Complete proteins
eggs, meat, poultry, seafood, milk, yogurt, cheese, soybean products,
Incomplete proteins
peanut butter, cereal, pasta
Vegan
strict vegetarian diet and consume no animal foods. Eat only foods of plant origin (whole or enriched grains, legumes, nuts, seeds, fruits, vegetables.) Use of soybeans, soy milk, soybean curd (tofu) and processed soy protein products enhance nutritional value of diet
Lacto ovo vegetarian
Follow a food pattern that allows consumption of dairy products and eggs. Consume adequate plant and animal food sources, excluding meat, poultry, pork, and fish poses no nutritional risk
Lacto-vegetarian
Cosume milk, cheese, dairy foods but avoid meat, fish poultry, and eggs. Diet of whole or enriched grains, legumes, nuts, seeds, fruits, and vegetables in sufficient quantities to meet energy needs and provides a balanced diet.
Potential deficiencies in vegetarian diet
energy, protein, B12, zinc, iron, calcium, omega 3 fatty acids, and vitamin D. To enhance absorption of iron, consume a good source of iron and vitamin C with each meal. Include 2 servings per day of nuts
What should you give children under the age of two?
low fat milk. Whole milk gives necessary fat for neurological development for children up to 2 years of age
What should the nurse do to help with chemotherapy changes in taste?
Use plastic utensils, increase fluid intake to improve taste, suggest pt to eat foods served cold or at room temperature to improve taste, try tart foods and seasonings to improve taste, offer citrus fruits, suggest pickles as snack and gargle w/ mouth wash
1st day after birth, how long should the mother feed per breast?
5 minute feedings on each breast on the first day after birth
Dumping syndrome
When a portion of the stomach is removed, the contents of the stomach are rapidly emptied into the small intestine, causing dumping syndrome. Manifestations occur 15-30 minutes after eating, and include sensation of fullness, abdominal cramping, nausea, diarrhea, faintness, syncope, diaphoresis, tachycardia, hypotension, flushing. Late manifestations occur 1-3 hrs after eating and include diaphoresis, weakness, tremors, anxiety, nausea, and hunger. Manifestations resolve after intestine is emptied. There’s a rapid rise in blood glucose and increase insulin levels immediately after the intestine empties, which leads to hypoglycemia. Recommend small frequent meals, consume protein and fat at each meal, avoid food w/ concentrated sugar, restricts lactose intake, consume liquids 1 hr before or after eating, Lie down for 20-30 minutes after meals to delay emptying.
Dysphagia
palpate pt’s throat during swallowing, inspect for food pockets in the mouth before feeding, allow the pt to rest 30 minutes before meals, use adaptive eating devices, encourage small bites and thorough chewing, tilt head forward when swallowing, place food on unaffected side of mouth and limit disruptions during mealtime, modify texture of foods and consistency of liquids can enable pt to achieve proper nutrition, evaluate medications to see if they’re causing dry mouth and dysphagia to determine if this is a potential adverse effect, place pt in upright or high Fowler’s position to facilitate swallowing, provide oral care prior to eating to enhance pt’s sense of taste, refer pt to speech therapist for evaluation, take pills w/ at least 8 oz of fluid (can be thickened) to prevent medication from remaining in the esophagus, avoid thin liquids and sticky foods. Nutritional supplements are beneficial if nutritional intake is deemed inadequate.
What should you teach the pt after being discharged w/ colostomy
increase foods w/ pectin
Kosher diet
combine cheese w/ non meat products at the same time; no pork; don’t combine dairy products w/ meat products at same meal; no shellfish. Ritually slaughtered beef, sheep, goats and deer with no flaws or diseases; chicken, turkey, quail, geese; salmon, tuna, carp, herring, cod; beef/poultry must be eaten separately from dairy (6-hour wait time period) are acceptable. Fruits and vegetables are all Kosher as long as they are clean. Not acceptable: Pork, camel, rabbit, rodents, reptiles and any animal that died of natural causes; eagle, hawk, vulture; crab, lobster, octopus, clam, swordfish, sturgeon, shrimp; meat with dairy (eg. cheeseburger, chicken cordon bleu, burger with milkshake)
Ramadan
consume meals before dawn and after sunset. The nurse should offer the client a snack or light meal after sunset
COPD
consume foods soft in texture and easy to chew
irritable bowel disease
take peppermint oil during exacerbation of manifestations
Parkinson’s disease
Critical findings: pt drools while eating, which can indicate that this client is at greatest risk for aspiration of food from dysphagia, which can lead to pulmonary complications
Intermittent enteral feedings
Place pt in fowler’s position, verify tube placement, check residual, flush tubing w/ 30 mL water. If pt is experiencing diarrhea, feed the pt in small frequent volumes. increase the volume of formula over the 1st 4-6 feedings. If pt is dehydrated, provide as continuous infusion
Diabetes
three to five carbohydrate choices, or 45 g, are allowed per meal, plus one to two carbohydrate choices for each snack. Somogyi phenomenon is fasting hyperglycemia that occurs in the morning in response to hypoglycemia during the nighttime. The nurse should assess for this phenomenon by monitoring blood glucose levels during the night
Recommended weight gain during 1st trimester
1.1-4.4 lb
Normal pt wt gain (BMI (18.5-24.9) during pregnancy
1 lb/wk for 25-35 lb
Underweight pt (BMI <18.5)
just more than 1 lb/wk for total of 28-40 lb
Overweight pt (BMI 25-29.9)
0.66 lb/wk for total of 15-25 lbs
Which mineral causes constipation
Calcium
Hyperlipidemia
pt should limit meat to 5 oz per day
TPN
TPN is used when a patient’s GI tract isn’t functioning, or when a patient cannot physically or psychologically consume sufficient nutrients orally or enterally. It’s commonly used in patients who need intense nutritional support for an extended period of time, including patients undergoing treatment for cancer, bowel disorders, critically ill, and those suffering from trauma or extensive burns, as these conditions are associated w/ high caloric requirements. PPN may be used when the patient is unable to consume enough calories to meet metabolic needs or when nutritional support is needed for a short time period (7-10 days). Eval for presence of allergies to soybeans, safflower, eggs, or lipids. Monitor for “cracking” which has an oily appearance or a layer of fat ion the top of the solution. Verify RX w/ 2nd RN prior to admin. Allow solution to come to room temp for 1 hr prior to administration. Bag of tubing should be changed Q24 hrs. A micron filter on IV tubing is required when giving. Can be D/C since when oral intake exceeds at least 60% of the client’s estimated daily caloric requirements
Stomatitis
provide meals at room temp, avoid salty food, rinse w/ 0.9% sodium chloride solution or baking soda mixed with water, most foods and liquids with meal to decrease discomfort and promote nutritional intake, and use soft bristled toothbrush, avoid dry coarse foods such as toast
Fluid overload
sodium level 130
Pt taking warfarin
Be mindful consuming foods high in vitamin k, such as green leafy vegetables.
Gastric bypass
instruct pt to start each meal w/ a protein. The client should consume 60 to 120 g of protein each day
Continuous enteral feedings
prevent aspiration by monitoring gastric residuals every 4 hrs
Malnutrition
Manifestations: ankle edema
Anorexia nervosa
Assign privileges based on direct weight gain. RN to stay w/ pt 1 hr after meals
Constipation
instruct the client that consuming the skin on fruits and vegetables adds fiber to the diet.-The nurse should instruct the client to add a small amount of bran to her daily diet, working up to 3 tablespoons daily, which is less than ¼ cup. Adding fiber gradually should prevent abdominal distention and excessive flatus.
Cirrhosis
decrease sodium intake to 1-2 grams per day, avoid foods high in fat, increase protein from animal or plant sources.
Macular degeneration
increase dietary intake of lutein
Hydrolyzed formula
Elemental, composed of partially digested protein peptides and free amino acids. Used for pts who have partially functioning GI tract or pts w/ impaired ability to digest and absorb food. (liver failure, IBD, pancreatic disorders, etc)
Standard formulas
Polymeric or intact, composed of whole proteins milk, meat eggs) or protein isolates. Requires a functioning GI tract.
Treatment for gout and urolithiasis
prevention of future uric acid stones: take allopurinol as prescribed, exercise several times a week, limit intake of foods high in purine
Renal calculi
drink lots of water. Avoid large amounts of vitamin c, avoid high oxalate foods like almonds or nuts, and limit sodium to 2 g/day
Foods high in cholesterol
eggs and cheese, liver and other organ meats, shrimp
Cancer prevention
Consume adequate dietary fiber (14 g per 1,00 kcal daily); eliminate tobacco; eat at least 5 servings of fruits and veggies daily including foods high in vitamin A (apricots, carrots, leafy green veggies), foods high in vitamin c, and cruciferous vegetables (broccoli, cauliflower, cabbage); consume whole grains rather than processed or refined grains and sugars; avoid meat prepared by smoking, pickling, charcoal grilling, and use of nitrate containing chemicals; consume polyunsaturated and monounsaturated fats (found in fish and olive oil) which can lower risk of cancer; limit alcohol consumption
Anorexia in cancer/immunosuppressed patients
Eat small amounts of high protein foods loaded with calories and nutrients; try to consume food in the morning when appetite is best; avoid food odors; don’t fill up on low calorie foods; eat cool/room temperature foods
Nursing actions for cancer patients
encourage pt to eat more on days when feeling better; encourage nutritional supplements high in protein and/or calories as between-meal snacks. Increase protein and caloric content of foods by substituting whole milk for water in recipes, adding milk, cheese, yogurt, or ice cream to dishes, use peanut butter as a spread for fruits, use yogurt as a topping for fruit; dip meats in eggs, milk, and bread crumbs before cooking; use semisolid, thickened foods for pts w/ dysphagia and instruct them to sit upright and tilt their head forward when swallowing. Eat foods that are well tolerated and liked prior to treatments. Try adding foods that are tart (citrus juices); eat small, frequent meals; try using sauces and seasonings for added flavor; use plastic utensils for eating to decrease metallic taste; suck on mints, candy, or chew gum to remove bad taste in mouth.
Fluid volume excess
Sodium 130
Hypoglycemia
Mild shakiness, mental confusion, sweating, palpitations, headache, lack of coordination, blurred vision, seizures, and coma. take 10-20 g of a readily absorbable carb, including 2-3 glucose tablets (5 g each), 6-10 hard candies, ½ cup (4 oz( juice or regular soda, 1 tbsp honey or 4 tsp of sugar. Retest glucose in 15 minutes. If still less than 70 mg/dL, repeat the above steps. Once levels stabilize, have the pt take an additional carb and protein snack or a small meal depending on the severity of the hypoglycemic episode and whether the next meal is more than 1 hr away.
Hyperglycemia
go to ED, take med if forgotten. Long term implications of untreated or inadequately treated hyperglycemia include blindness, kidney failure, dyslipidemia, HTTN, neuropathy, microvascular and macrovascular disease, and limb amputation. The Somogyi phenomenon is morning hyperglycemia in response to overnight hypoglycemia. Providing a bedtime snack and appropriate insulin dose prevents this phenomenon. The dawn phenomenon 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.
Chronic kidney disease
Restrict phosphorus, restrict protein, restrict sodium, restrict potassium. Recommended daily protein intake is 0.8-1.1 g/kg/day of ideal body weight. High biological value proteins are recommended for pts w/ CKD to prevent catabolism of muscle tissue, and includes eggs, meats, poultry, game, fish, soy, and dairy products. Limit meat intake to 5-6 oz/day for most men and 4oz/day for most women. Limit dairy products to ½ cup per day. Avoid high protein sports drinks, energy drinks, or meal supplements. Avoid herbal supplements that can affect bleeding time and blood pressure.
Low phosphorus food sources
Restrict animal proteins. Milk products are generally restricted because they are also sources of phosphorus.
Diet for pts w/ kidney disorders
a phosphate restricted diet, phosphate binders, vitamin D, and supplement calcium are used to treat and prevent secondary hyperparathyroidism, renal bone disease, and soft tissue calcification
Lactose intolerance
Distention , cramps, flatus, and osmotic diarrhea
Liver disease
Multivitamins (especially vitamins B, C, and K) and mineral supplements might be necessary. Protein needs are increased to promote a positive nitrogen balance and prevent breakdown of body’s protein stores. Carbs aren’t restricted, as they’re an important source of calories. Caloric requirements may need to be increased based on eval of the pt’s stage of disease, wt, and general health status. Eliminate alcohol, nicotine, and caffeine.
Diarrhea
High fiber diet is often prescribed, unless fiber is causing the diarrhea. Nutrition therapy varies w/ the severity and duration of diarrhea. A liberal fluid intake to replace losses is needed. Dudeck: Avoid clear liquids. Low fiber diet that’s also low in fat and lactose may help decrease bowel stimulation. Foods high in potassium are encouraged. Banana flakes, apple powder, or other sources of pectin may be added to foods to help thicken the consistency of stools. Probiotics may help lessen diarrhea.
Foods that stimulate the GI tract
alcohol, caffeine, foods high in simple sugars like milk, fruit (sucrose), and carbonated beverages (sucrose); high fiber and gas producing foods such as nuts, beans, corn, broccoli, and cabbage; sugar alcohols.
GERD
Avoid situations that lead to increased abdominal pressure such as wearing tight fitting clothing. Avoid eating 2 hrs or less before lying down. Elevate the body on pillows instead of lying flat and avoid large meals and bedtime snacks. Encourage wt loss for pts who are overweight. Suggest the pt avoid trigger foods (citrus fruits and juices, spicy foods, carbonated beverages. Instruct the pt to avoid items that reduce lower esophageal sphincter pressure, including fatty foods, caffeine, chocolate, alcohol, cigarette smoke, and all nicotine products, and peppermint and spearmint flavors.
Obesity
Complications: Mortality increased. Increased risk of morbidity from hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, and some cancers. Other complications include GERD, nonalcoholic fatty liver disease, and polycystic ovary syndrome. Obesity increases the risk of complications during and after surgery, and the risk of complications during pregnancy, labor, and delivery.
Central obesity
Where excess body fat is stored also influences the risk of comorbidities. as part of metabolic syndrome, increases the risk of coronary heart disease and type 2 diabetes. Central obesity also increases the risk of stroke, sleep apnea, hypertension, dyslipidemia, insulin resistance, inflammation, and some types of cancer.
What is recommended for cooking fat?
Liquid oils such as olive or canola oils.
Nursing care for gastrostomy tube
Tube placement should be verified by radiography. Tube should be measured each shift and prior to each feeding. Verify presence of bowel sounds. Flush feeding tube routinely w/ warm water. Check gastric residuals every 4-6 hours. If residual volume exceeds current residual guidelines, it can be necessary to consider reducing the rate of the feeding. Residuals should be returned to the stomach. Head of bed should be elevated at least 30 degrees during feedings and for at least 30-60 min afterward. Begin w/ small volume of full strength formula. Increase volume in interals as tolerated until the desired volume is achieved. Administer feeding solution at room temp to decrease GI discomfort. Don’t heat formulas in microwave. Discard bags and tubing every 24 hrs. Obtain gastric residuals every 4-6 hrs. Cover and label unused formula w/ pt info and can refrigerate for up to 24 hrs. Fill feeding bags for 4 hrs worth of feeding to reduce risk of bacterial contamination. Slowly increase the rate. Start low. Tubing should be flushed w/ 15-30 mL of water before and after medication is given, and between each medication if more than one is given. If pt has 500 mL + of residual in stomach, don’t feed pt.
Gavage feeding an infant
Subtract the amount of the residual from the amount of the formula to be given. Return the residual to the stomach plus the reduced amount of formula or breast milk. Burp the infant following the feeding if the infant’s condition allows. Volume of water to flush is 1.5 times the amount predetermined to flush an unused feeding tube of the same size.
Food choices for a toddler
1-2 year olds require whole cow’s milk to produce adequate fat for the still growing brain. Food servig size is 1 tbsp for each year of age. Macaroni and cheese, spaghetti, pizza. Avoid foods that are potential choking hazards including hot dogs, popcorn, peanuts, grapes, raw carrots, celery, peanut butter, tough meat, and candy. During food prep, cut small, bite sized pieces that are easy to swallow and prevent choking. Fat free or low fat dairy.
Protein recommendations for a toddler
2 year olds require 2 oz; 3 year olds require 2-4 oz, 4-5 year olds require 3-5 oz protein.
1 oz of protein: 1 oz cooked meat, poultry, or seafood; 1 egg; 1 tbsp peanut butter; ¼ cup cooked beans or peas (kidney, pinto, lentils)
Promoting nutrition for an older adult
Encourage water and natural juices. Encourage socialization and refer to a senior center or program due to social isolation can cause poor nutrition in an older adult. Fixed income can make it hard for older adults to purchase needed foods; refer to food programs, senior centers, and food banks. Meals on wheels are available for housebound older adults. All adults should exercise at a moderate or vigorous pace for at least 30 minutes a day, 3-7 days per week. Loss of lean muscle mass can be decreased w/ regular exercise. Regular exercise can improve bone density, relieve depression, and enhance cardiovascular and respiratory function. Enhance flavor of food by cooking means in new ways or adding different herbs and spices.
Expected weight for 6 month old infant
Birth weight doubles by 4-6 months of age. Appropriate weight gain averages 0.15–.21 kg (5-7 oz) per week during the 1st 5-6 months.
Dietary recommendations during lactation
Lactation requires 330 k/cals additional for 1st 6 months and additional 400 k/cal after that. The need for most vitamins and minerals increases during pregnancy and lactation.
Snacks for 9 month old infant
Iron fortified infant cereal, vegetables, fruit, strained meats, fish, poultry, table foods (cooked, chopped, and unseasoned.
Introduce new foods one at a time over 5-7 day period to observe for indications of allergy or intolerance. Delay introduction of milk, eggs, wheat, and citrus fruits that can lead to allergic reactions in susceptible infants. Don’t give peanuts or peanut butter due to risk of severe allergic reaction. No honey due to risk of botulism.
Appropriate finger foods: ripe bananas, toast strips, graham crackers, cheese cubes, noodles, and peeled chunks of apples, pears, or peaches.
Formula feeding
Can be used in place of breastfeeding, as an occasional supplement to breastfeeding, or when exclusively breastfed infants are weaned before 12 months of age. No artificial pacifier or bottles should be used until after 2 wks and when breastfeeding is well established. Iron fortified formula is recommended by AP for at least the 1st 6 months of life or until the infant consumes adequate solid food. After 6 months, formula w/o added iron might be indicated. Fluoride supplements can be required if an adequate level isn’t supplied by the water supply. Follow manufacturer’s mixing directions. Bottles of mixed formula or open cans of liquid formula require refrigeration. Don’t use if formula has been left at room temp for 2 hrs r longer. Don’t use partially emptied bottles of formula. Formula may be given chilled, warmed, or at room temp. Always give formula at approx the same temp. Hold the infant during feedings w/ head slightly elevated to facilitate the passage of formula into the stomach. Tile the bottle to maintain formula in the nipple and prevent swallowing of air. Don’t prop the bottle or put an infant to bed with a bottle; this promotes tooth decay. Infant shouldn’t drink more than 32 oz formula per 24 hrs unless directed by a provider.
Nutrition for older adults
A balanced diet for all adults consists of 40-50% carbohydrate and 10-20% fat. Increase in protein, reduce total caloric intake (due to decrease in basal metabolic rate). Dehydration is the most common fluid and electrolyte imbalance in older adults. Fluid needs increase with medication induced fluid losses, and decreased thirst sensation. Some disease processes necessitate fluid restrictions. Older adults can have oral problems (ill fitting dentures, difficulty chewing or swallowing, and a decrease in salivation or poor dental health. Older adults have decreased cellular function and reduced body reserves, leading to decreased absorption of B12, folic acid, and calcium, as well as reductions in insulin production and sensitivity. Kidneys regulate the amount of potassium and sodium in the bloodstream. Kidney function can decrease as much as 50% in older adults. Loss of calcium can result in decreased bone density in older adults. Cell mediated immunity decreases.
Myplate recommendations for older adults
Select whole grains. Select orange and dark green leafy vegetables. Select fresh, deried, canned, or juices. Avoid fruits w/ added sugar. Make half our place with vegetables and fruits. One cup of milk or plain yogurt is equal to 1 ½ oz of natural cheese or 2 oz processed cheese. Protein includes meat, fish, poultry, dry beans, eggs, soy products, seeds, and nuts. One ounce equivalent = 1 oz meat, fish, or poultry. ¼ cup cooked beans; 1 egg; 1 tbsp peanut butter; or ½ oz nuts or seeds. Use lean meats. Use vegetable oils (except palm and coconut. 1 tbsp of il equals 3 tsp equivalent; 1 tbsp mayo equals 2 ½ tsp dietary intake; and 1 oz nuts equals 3 tsp oils (except hazelnut, which equals 4 tsp) 132-362 discretionary calories are permitted per day. Calcium requirements increase for older adults. Vitamins A, D,C, E, B6, and B12 can be decreased in older adults; supplemental vitamins are required.
What do older adults have decreased absorption of?
calcium and folic acid
Chewing difficulty
Mincing or chopping food is helpful. Eat softer foods. Replace raw veggies and fresh fruits w/ cooked veggies or juices. Choose foods like applesauce and canned peaches or other fruits. Try ground or shredded meat, eggs, or dairy products like fat free or low fat milk, cheese, or yogurt. You can also replace meat w/ soft foods like cooked beans, peas, eggs, tofu, or tuna.
Seventh Day Adventists and some buddhists
practice vegetarianism
Muslims and Mormons
avoid stimulants (coffee, tea, caffinated soda)
Catholics
don’t consume meat Ash Wednesday and Fridays during Lent.
Seventh Day Adventist
Vegetarianism
Do not consume animal products of any type INCLUDING eggs and milk products.
Vitamin B12 and Vitamin D supplements may be needed with a pure vegan diet.
Vegan diets are adequate in protein due to intake of nuts and legumes (dried peas and cooked beans).
Some avoid coffee, tea, soda and other beverages that contain caffeine.
Foods to avoid while taking MAOI
including aged cheese, smoked, meats, dried fish, and overripe avocados.
(phenelzine, selegiline)
Nutritional counseling
encourage pt to set goal, wt loss of 6lbs in a month can be expected if plan was followed
BMI
Low fat diet, increase water intake, and exercise.
BMI under 24.5 is best, Healthy- 18.5 to 24.9 Overweight- 25 to 29.9 Obesity- greater than 30
BMI is calculated based on Weight in Kg/Ht (M2)
Pt with BMI of 28, refer them to weight loss group/program.
Dietary needs for wt loss
3500 calories = 1 pound
Monitor hunger on a 1-10 scale to avoid emotional eating
Never forbid foods
Loss is constant, do not weigh daily
Eat free of distractions
Do not taste foods while cooking to avoid overeating.
Control your portion sizes rather than restricting certain foods to prevent cravings.
Make a list before going shopping because it will help adhere to meal planning and prevent impulse buying.
Eat 3 to 5 meals a day to prevent hunger and overeating.
Stress
Causes protein catabolism, increase in blood glucose, and increased metabolism. Eat foods high in protein
Avoid the things that are stressing you!
Appropriate fat calories per day
Approx. 20% to 35% of total calories should come from fat
Less than 10% should come from saturated fat sources.
