Question

exam 2 full study guid for NUR3463/rasmussen college

Answer 1

Chapter One –Nutrition and Health

1. Government Agencies: charged with reducing chronic disease and containing health care costs; giving attention to what people eat

Roles & Responsibilities:

USDA (United States Department of Agriculture): federal agency concerned w/food

Maintains the NEL (Nutrition Evidence Library)

Developed 7 messages summarizing concepts of 2010 Dietary Guidelines

Issued first food guide in 1980; Food Guide Pyramid in 2005; MyPlatein 2010

FDA (Food and Drug Administration):

Ensuring safety of food supply; food labeling

Regulation of tobacco products

Advancement of public health

CDC (Centers for Disease Control and Prevention)

            Community Health

Monitors infectious diseases/outbreaks

1. Evidence based practice (EBP) see page 14

Three Step Process:

            Identify problem: What question needs to be answered?

            Review the evidence: Search for professional studies relevant to your question/issue being addressed

      Implement findings: Develop/implement plan for clients; include evaluation component; share results  

    with other professionals

1. Review Key Terms page 8

Nutrigenomics: study of effects of nutrients/other bioactive substances found in food on genes, body proteins, and metabolites

Nutrigenetics: study of effect of individual’s particular genetic makeup on metabolic/physiologic functions, including nutrient requirements, risk of certain diseases

Homeostasis: state of dynamic equilibrium within body’s internal environment; balance achieved through control of various interrelated physiologic mechanisms

Nutrition: sum of processes involved in food intake, releasing contained nutrients, assimilating/using nutrients to provide energy, maintain body tissue

NutritionScience: body of scientific knowledge developed through controlled research, relates to all aspects of nutrition (national, international, community, clinical

Dietetics: science related to nutritional planning/preparation of foods and diets

RegisteredDietician (RD) or RegisteredDieticianNutritionist (RDN): accredited health professional w/minimum of 1200 hrs of post-baccalaureate supervised practice, passed National Registration exam

Public Health Nutritionist: health professional w/graduate degree (MPH or DrPH) in school of Public Health accredited by Council on Education for Public Health; supervises nutrition component of public health programs in country, state, national, or international community settings

Nutrients: substances in food essential for energy, growth, normal body function, maintenance of life

Essential Nutrients: substances that cannot be made by body; must be supplied in food; include essential fatty acids, essential amino acids for making protein, vitamins and minerals

Macronutrients: 3 energy-yielding nutrients = carbohydrates, fat and protein

Carbohydrate: includes starch, sugar and fiber; starch should be major source of energy in diet; sugar and starch have fuel factor of 4 kcal/g; fiber is indigestible form of carbohydrate

Fat: provides concentrated form of energy yielding 9 kcal/g; stored in body as adipose for energy reserve; supplies essential fatty acids in diet

Protein: contains nitrogen, essential amino acids; amino acids are building blocks for forming body tissues, enzymes and hormones; yields 4 kcal/g

Micronutrients: 2 classes of non-energy yielding elements and compounds = minerals and vitamins; regulate and control cell metabolism; components of specialized body structures

Metabolism: sum of all biochemical/physiologic processes so body grows/maintains itself (anabolism); breaks down/reshapes tissue (catabolism); and transforms energy to do its work; products of these reactions are called metabolites

Fuel Factors: number of kcalories that 1 g of a nutrient yields when completely oxidized; used in computing energy values of foods and diets (carbs/protein = 4; fat = 9; alcohol = 7)

1. Understand the functions of nutrients.

To provide energy

To build and repair body tissues and structures

To regulate metabolic processes that maintain homeostasis

1. Nutrition Misinformation

Improper portion sizes in both restaurants and at home

Media outlets used for nutritional/health not regulated by government regulation agencies; often contain misleading information

75% people use media outlets, not evidence-based informational websites

Chapter 6 – Vitamins

1. What is a vitamin?

It must be organic dietary substance that is not energy producing

Needed in very small quantity to perform particular metabolic function; prevent identified deficiency disease

2.Classification

Fat-Soluble: A, D, E, K

Water-Soluble: C, B6, B12, Thiamin, Riboflavin, Niacin, Pantothenic Acid, Biotin, Folate

1. Understand the following for both fat and water soluble vitamins:

FAT SOLUBLE (SEE TABLE 6-2, pg 116)

Vitamin A:

Functions:support vision, influences integrity of body coverings/linings (epithelial tissue); cell division and differentiation, growth, immunity, and reproductive function

Deficiencies: Eyes: rhodopsin can’t be formed; rods/cones increasingly sensitive; night blindness

Respiratory: nasal passages dry/cilia lost; risk for infection

GI tract: reduced salivary fluids, mouth dry/cracks, open to invading bacteria

GU tract: UTIs, vaginal infections

Skin: dry, scaly, small pustules – follicular hyperkeratosis

Tooth formation: ameloblasts don’t develop properly (in infants) required to form tooth enamel

Food Sources: Preformed: 2% milk, cheese, egg yolk, liver; Provitamin A: broccoli, carrots, squash, cantaloupe, tomato juice, apricots

Clinical Applications:Rhodopsin (made of Vitamin A) required for light sensitivity; prevents night blindness; needed to develop/maintain healthy epithelial tissue (primary infection barrier); essential for growth of bones and soft tissues (controls protein synthesis, cell division, stabilizes cell membranes); needed for normal sexual maturation/function, gene expression, role in fetal growth/CNS; direct effect on immune function

Vitamin D:

      Function: calcium & phosphorus absorption, bone formation

      Deficiencies: bone disease – rickets in children, osteomalacia/osteoporosis in adults

      FoodSources: yeast, fish liver oils; major source is fortified foods/milk

      ClinicalApplications:vit D is prohormone/functions as hormone; sterol precursor found in skin,

      converts to D3, transport to liver converts to 25OHD3, transport to kidneys for activation as calcitriol

Vitamin E:

      Function: antioxidant – 2^nd line of defense; works w/enzyme containing selenium, reducing Vit E

      requirement

      Deficiencies: hemolytic anemia in premature infants; children/adults nerves affected (1) spinal cord

      Fibers controlling movement/walking, (2) retina – disrupts myelin production, leads to degeneration of

rods/cones

Food Sources: vegetable oils, peanut butter, nuts, certain fruits/veggies, tomatoes, spinach, fortified

ready-to-eat cereals

Clinical Applications: Vit E therapy to reverse hemolytic anemia; needed for cystic fibrosis patients

and those w/malabsorption syndromes

Vitamin K:

      Function: blood clotting, bone metabolism

      Deficiencies: bleeding, easily bruising

      Food Sources: dark, leafy greens, some cheeses

      Clinical Applications: prophylactic dose to newborns; patients w/bile duct obstruction before surgery;

children w/cystic fibrosis to overcome antibiotic interference w/synthesis; Tx for OD of blood thinners,

monitor patients on blood thinners

WATER SOLUBLE:

Vitamin C (ascorbic acid) (SEE TABLE 6-3, pg 119)  

Function: powerful antioxidant, build/maintain many body tissues/bone matrix/cartilage/dentin/

collagen, support metabolism adrenal/pituitary glands, brain, eyes, WBC (SEE PAGE 117); helps

absorption of iron

      Deficiencies: easy bruising, pinpoint hemorrhages of skin (petechiae), weak bones that fracture easily,

poor wound healing, bleeding gums (gingivitis), anemia

Scurvy: hemorrhagic disease caused by lack of Vitamin C

      Food Sources: citrus fruits, tomatoes, broccoli, salad greens, strawberries, watermelon, cabbage, sweet

potatoes

      Clinical Applications: wound healing, fever/infection causes vit C depletion, needed during growth,

stress and body response uses vit C stores

B Vitamins(SEE TABLE 6-4, pg 131 to 132)

            Beriberi: paralyzing disease plagued East Asia for centuries; vitamin B deficiencies; extracts of rice

polishing used to cure by RR Williams, American chemist

Chapter 7 –Minerals and Water

1.How are minerals different from vitamins? (Review Table 7-1 pg.138)

Structure, absorption, classification, roles in body, relative amount needed, stability

2.Classification (Box 7-1, pg. 139)

1.Major (Table 7-3 pg. 153-4)

Ca, P, Mg, Na, K, Cl, S

Potassium (K) found inside the cells

Sodium (Na) main food source: sodium chloride added in food processing

Calcium (Ca) DRI: youth 9-18 1300mg/day, men/women 19-50 1000mg/day, women 51-70 1200mg/day to offset calcium losses associated with menopause

2.Trace (Table 7-5, pg. 164-5)

Fe, I, Zn, Cu, Mn, Cr, Se, F, Mo

3.Functions

1.How do vitamins and minerals work together?

Vit D helps transport/absorption of calcium; Vit C helps absorption of iron, to prevent anemia

4.Clinical Applications

Important roles in both structure and function; cofactors in enzyme systems, work w/vitamins regulating essential metabolic functions

Ca: Tx for tetany, rickets, osteomalacia, resorptivehypercalciuria/renal calculi

P: recovery from diabetic acidosis; growth; hypophosphatemia; hyperphosphatemia

Na: water balance; acid-base balance; cell permeability; muscle action

K: water balance; muscle activity; carb metabolism; protein synthesis; BP control; acid-base balance

5.Water and fluid balance

1. Functions: fluid environment for tissues; medication dissolution; regulating body temperature
2. ClinicalApplications: uncontrolled diabetes; cystic fibrosis; high fiber; high protein; intense physical activity; impaired thirst in older adults
3. WaterCompartments: (ECF) extracellular fluid – outside cells; (ICF) intracellular fluid – inside cells; interstitial fluid
4. Forces that control water distribution:

1. Solutes

Electrolytes: free in solution, carry electrical charge; Na major cation in ECF; K major cation in ICF

Plasma proteins: albumin/globulin; influence movement of water in/out of capillaries; remain in blood vessels/exert colloidal osmotic pressure (COP) to maintain vascular blood volume

1. Membranes: water/solutes move across membranes; osmosis, diffusion, active transport, pinocytosis

5. Hormones and water balance

1. Antidiuretic hormone (ADH): controls reabsorption of water by kidneys as body needs, acting as water-conserving mechanism
2. Aldosterone: Na+ conserving hormone associated w/renin-angiotensin-aldosterone system; secondary control over body water; acts on kidneys to reabsorb sodium, which also reabsorbs water, restoring normal blood volume
3. Prostaglandins: exist in virtually all body tissues; act as local hormones to direct/coordinate biologic functions; influence blood pressure, blood clotting, cardiovascular function
4. Insulin: hormone produced in pancreas, lowers blood glucose by enhancing its entry into cells

Chapter 8 – Energy Balance

Energy

1.Controlled reaction rates

Enzymes: proteins produced in cell; enzyme & substrate lock together to produce new reaction product; often act as catalysts

Coenzymes/cofactors: partners/another substrate; they are changed/reduced when material is transferred

Hormones: messengers to trigger/control enzyme action

2.Types of metabolic reactions (both release free energy, but use energy too)

Anabolic: synthesizes new, more complex substances in body growth & repair

Catabolic: breaks down complex substances into more simple ones

3.Food energy measurement

Calorimetry: bomb calorimeter used to weigh food/immerse in water/burned

Approximate Composition: kcalorie value of food (SEE TABLE 8-1, pg 177)

A.Body weight and body fat

1. Body Mass Index (BMI) = weight divided by height
2. Abdominal Fat/Waist Circumference (SEE TABLE 8-6, pg 186)

Chapter 9 – Food Selection and Food Safety

1. PersonalFoodSelection

1. Cultural Influences: determine what is eaten, how it is eaten, who prepares it; geography of land, local agriculture, religious beliefs, history/traditions influence what is eaten;
2. Components of a Cultural Food Pattern:

Core foods: usually complex carbs, eaten daily, provide bulk of energy intake

Complementary foods: added to improve palatability (veggies, meat added to rice/pasta)

Food flavors/preparation: how prepared/seasoned distinctive to group, important as food

Frequency/timing of meals: number of meals/snacks eaten daily; when eaten, foods contained, define dietary intake

1. Protecting the Food Supply

1.Government Agencies

1. FDA: enforces regulations to keep food supply safe, pure, wholesome; seize contaminated/unsafe food (SEE BOX 9-3, pg 203); food labeling
2. USDA: safeguard nation’s food; on-site inspections meatpacking/poultry plants; focuses on food/diet, responsible for Dietary Guidelines for Americans &MyPlate

2.Dietary Supplements

Dietary Supplement Health & Education Act (DSHEA) effectively deregulated dietary supplement industry; after 1994 safety standard of “no unreasonable risk;” supplements cannot claim to cure disease, but require no substantiation to claims

3.Agricultural Chemicals

1. Organic: bars the use of chemical pesticides/herbicides

1. ConsumerEducation

1. Agencies responsible: US Dept of Health & Human Services; Agency for Health Care Research and Quality (part of USDHHS) supports research to improve quality of healthcare
2. Misinformation: may be embedded in folklore, half-truths, stem from intentional deception; false claims = cure disease/condition, therapeutic effects, only ‘natural’ foods/plant remedies can meet body needs/prevent disease

1. FoodSafety

1. Foodborne Illness

1. Prevalence: refrigeration/freeze-drying brought major improvements; unwashed fruits/ veggies; transcontinental distribution; food prep/undercooking;
2. Forms: bacterial food infection occurs when individuals eat food contaminated with large colonies of bacteria; bacterial food poisoning results from toxins produced by bacteria before food was eaten

FOOD INFECTION

• E coli: unpasteurized/undercooked food, contaminated water
• Salmonella: unpasteurized/undercooked animal products; seafood
• Campylobacter: raw/undercooked beef/poultry/seafood, raw milk, untreated water
• Shigella: (causes dysentery) spread by insects, unsanitary food handling
• Listeria: (complications include pneumonia, sepsis, meningitis, endocarditis, miscarriage) unpasteurized dairy products, undercooked poultry/deli foods

FOOD POISONING

• Staphylococcal: unwashed infected hand of food worker,
• Clostridial: food held for extended times after cooking (warmers/room temp)

1. Prevention: appropriate food storage; raw poultry kept separate; thorough cooking; HAND WASHING is most important

CLEAN: wash hands/surfaces often

SEPARATE: don’t cross-contaminate

COOK: to proper temperature

CHILL: refrigerate promptly

Chapter 11–Nutrition during Pregnancy & Lactation

1. Healthy Pregnancy: 2 key factors: maternal preconception weight and weight gain during pregnancy

Complications: Anemia (iron, folate, hemorrhagic), HTN, gestational DM – glycosuria due to increased circulating blood volume and load on metabolites; GDM is intolerance of carbs such that blood glucose concentration increases during pregnancy

1.Factors determining nutritional needs

Age, Gravida, Parity

Complex Physiologic Interactions of Gestation: mother, fetus, placenta

B.Nutritional Demands of Pregnancy

1. Energy Needs

Approximately 340 kcal/day during 2^nd trimester; 452 kcal/day during 3^rd trimester; based on woman’s nonpregnant estimated requirement plus 15 – 20%; critical to ensure nutrient/energy needs, spare protein for tissue building

1. Macronutrients: protein 71g/day (increase of 25g/day), carb 175g/day, DHA/EPA 500mg/day
2. Fetal nourishment:

1. High-Risk Pregnancies

1. Special Counseling Needs: age/parity of mother; use of harmful agents (ETOH, cigarettes, drugs, pica), socioeconomic problems

Chapter 12 – Nutrition for Normal Growth & Development

1. Measuring Childhood Physical Growth: growth charts/percentile growth; weight/length
2. Nutrition for full term infant: breast milk (optimal) or formula, provides all nutrients required for first 6 months of life; breastfeeding adequate for first 12 months; newborns get dose of Vitamin K until develops on own; sometimes Vit D supplement warranted

Chapter 13 – Nutrition for Adults: Early, Middle, and Later Years

1. Older Adults

1. Nutritional Needs:

Energy: intake declines, drops from 1750 kcal at ages 50-59 to 1525 kcal at age 70 and older

Carbs: 45-65% of total energy

Fats: 20-35% of total kcalories

Protein: 1.0 g/kg body weight or more needed to support nutritional well-being, prevent age-related muscle loss

1. Fluids and dehydration (Box 13-2, pg 313)

B.Mini-Nutritional Assessment (MNA)

Tool to identify at-risk older adults and educate individuals and communities in preventive care

5 question screening, weight, LT calf circumference = screening score

Chapter 16 – Nutrition Assessment and Nutrition Therapy in Patient Care

1. Nutrition Screening: process of identifying characteristics known to be associated with nutrition problems with purpose of identifying individuals who are malnourished or at nutritional risk

B.Nutrition Assessment: systematic approach to collect, record, interpret relevant data from patients, clients, family members, caregivers, other individual/groups; ongoing dynamic process

Required w/in 24 hrs in hospital/acute setting; 7 days in ALF/nursing home

1.Measurements

1. BMI: weight divided by height; <18.5 underweight, 18.5 – 24.9 normal, 25.0-29.9 overweight, >30 obese, >40 extreme obesity
2. RMR: resting metabolic rate

Calculate: (women 0.9 kcal/kg/hr, men 1.2 kcal/kg,hr) multiply # by kg body weight x 24 (hrs in a day) = RMR

1. Weight Loss
2. Waist circumference: assesses abdominal fat content, BMI and waist circumference correlate w/obesity and cardiovascular disease risk
3. Length and Stature: most sensitive indicators of growth and development in infants/ children

2.Nutrition Care Process (NCP) (Box 16-2 pg. 361)

a.Steps

1: nutritional assessment

2: nutrition diagnosis

3: nutrition intervention

4: nutrition monitoring and evaluation

1. Developed by Academy of Nutrition and Dietetics Nutrition

C.Role of Nutrition in Clinical Care

Essential role in disease management, health care, preventive health care; should be provided by qualified nutrition professional; comprehensive nutritional assessment foundation for appropriate nutrition therapy based on individual needs; promote multiple goals: assisting patients in recovery from illness or injury, helping persons maintain follow-up care to promote health, helping control health care costs; registered dieticians (RD) use expertise/skills to make sound clinical judgments, work effectively w/clinical care team, essential component for successful management of patient’s plan of care

D.Nutrition Intervention: Food Plan and Management

1. Basic Concepts: based on normal nutritional requirements/personal needs for each patient

Disease Application: modifications to nutrients, energy, texture

1. Individual Adaptation: must be based on individual food habits within specific personal life situation; plan w/patient; valid only w/history, living conditions, food security, habits
2. Routine House Diets: based on some type of cycle menu plan, usually in hospitals for patients with no required special diet; can be liquid, soft, regular
3. Managing the Mode of Feeding

Oral diet: regular oral feeding preferred; supplements added as needed

Enteral nutrition/tube feeding: patient unable to eat, but GI tract can be used

Peripheral nutrition: patient cannot take food via GI tract, IV feeding used; solutions of dextrose, amino acids, vitamins, minerals, lipids as appropriate fed through peripheral veins

Total parenteral nutrition (TPN): great nutritional need/support therapy; feeding through a large central vein; catheter placed via special procedure; more concentrated solutions used and monitored by nutrition support team; formulas determined by dietician and physician, prepared by trained pharmacists