NURS 1015 Midterm Study Guide PDF

NURS 1015 – Winter 2025 Midterm Study Guide Know and/or define the following concepts, models, and frameworks. Be able to provide examples where appropriate: Health Promotion Health promotion: is the process of enabling people to increase control over, and to improve, their health...

NURS 1015 – Winter 2025 Midterm Study Guide Know and/or define the following concepts, models, and frameworks. Be able to provide examples where appropriate: Health Promotion Health promotion: is the process of enabling people to increase control over, and to improve, their health Health promotion: encompasses health, wellness, disease, and illness Health promotion: represents a comprehensive social and political process, it not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environmental and economic conditions so as to alleviate their impact on public and individual health. Health promotion: is the process of enabling people to increase control over the determinants of health and thereby improve their health. -​ upstream approach preventing things before they happen Population Health Population health: means health outcomes of a defined group of people along with the distribution of health outcomes within the group. Patient Education Patient education: is “anything that provides patients and families with information that enables them to make informed choices about their care, health, and wellbeing, and that helps them gain knowledge and skills to participate in care or healthy living processes.” Patient Education: is a process of helping people learn health- related behaviors so that they can incorporate these behaviors into everyday life. -​ AKA patient teaching Leadership Leadership: is “an interactive process that provides needed guidance and direction.” -​ Nurses are expected to exhibit leadership when delivering patient care and when working with others to address issues that affect the practice of nursing. -​ Three dynamic elements: leader, follower, and situation Communication Communication: is a process of interaction between people in which symbols are used to create, exchange, and interpret messages about ideas, emotions, and mind states  Collaboration Collaboration: is a development of partnerships to achieve the best possible outcomes that reflect the particular needs of the patient, family, or community, requiring an understanding of what others have to offer. Strengths-Based Nursing (SBN) -An approach to care- promotes empowerment, self-efficacy, and hope -The nurse focuses on inner and outer strengths -Fosters the capacity for health and innate mechanisms of healing -Based on 8 core values (However unlikely halloween some people still like candy) 1.​ Holism 2.​ Uniqueness 3.​ Health and Healing 4.​ Subjective reality vs created meaning 5.​ Person and environment 6.​ Self efficacy 7.​ Learning time and readiness 8.​ Collaboration Social Determinants of Health Determinants of health are the broad range of personal, social, economic and environmental factors that determine individual and population health. Health is determined by circumstances and environment. The main determinants of health include: 1.​ Income and social status 2.​ Employment and working conditions 3.​ Education and literacy 4.​ Childhood experiences 5.​ Physical environments 6.​ Social support networks 7.​ Healthy behaviors 8.​ Access to health services 9.​ Biology and genetic endowment 10.​Gender 11.​Culture 12.​Race/Racism Health Disparities Health disparities are differences in health status among different population groups that are unavoidable. “Racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention.” “Differences that occur by gender, race or ethnicity, education or income, disability, living in rural localities, or sexual orientation.” National institute of health has two separate definitions related to health care disparities: -Healthcare disparities: differences in access to or availability of facilities and services. -Health status disparities: The variation in rates of disease occurrence and disabilities between socioeconomic and/or geographically defined population groups. HRSA replaced health disparities with health equity. Health Inequities Refers to health inequities that are unfair or unjust and modifiable - often due to unfair distribution of underlying social determinants of health Health Equity  The absence of disparities or avoidable differences among socioeconomic and demographic groups or geographical areas in health status and health outcomes such as disease, disability, or mortality. Social Justice The equitable, or fair, distribution of society's benefits, responsibilities and their consequences. -Focuses on the relative position of social advantage of one individual or social group in relation to others in society as well as on the root causes of inequities and what can be done to eliminate them. *Social injustice is leading to the deaths of people on a grand scale. Canada Health Act Medicare-tommy douglas Alma Ata (WHO/UNICEF Report on Primary Health Care) Advocates!!! Expressed: “The need for urgent action by all governments, all health and development workers, and world community to protect and promote the health of all people in the world. Ottawa Charter (1986) -Influential health promotion document -Milestone document (places responsibility for health on society as a whole) Promoted health by: Enabling people to increase control, and the key concept is empowerment. -Identified prerequisites for health eg: peace shelter, income, food, etc -Viewed health as dynamic and positive, having both social and individual dimensions. -Identified 5 strategies to achieve “health for all by the year 2000” 1.​ Strengthen community action- Encourage people to get involved and take action in decisions that affect their communities health. 2.​ Build health public policy- Make public laws and rules that keep health in mind  3.​ Create supportive environments- Create safe and satisfying environments for work and play 4.​ Develop personal skills- Provide support, education, and information to help people make healthy choices. 5.​ Reorient health services- Create services which change the focus from illness to prevention. Ottawa Charter for Health Promotion 1986 -Health is created and lived by people within the settings of their everyday life; Where they learn, work, play and love. Health is created by caring for oneself and others, being able to make decisions and have control over one's life circumstances, and by ensuring that the society one lives in creates conditions that allow the attainment of health by all its members. Epp Report/Framework Achieving health for all: a framework for health promotion -Identified 3 major challenges not met by current health care practices and policies 1.​ Disadvantaged groups have lower life expectancy, poorer health, higher disability 2.​ Preventable disease continues to decrease health of canadians 3.​ Increased chronic disease/lack of community support Shifting Paradigm Conference -Challenged the healing paradigm of Western medicine and gave rise to 2 ideas 1.​ Self responsibility for health 2.​ Health and lifestyles are affected by social structures and conditions Beyond Health Care Conference - International think tank that brought health promotion into the political arena. Provided 2 ideas: 1.​ Health public policy 2.​ Health cities/communities projects  Population Health Promotion Model Cube: with who?How? And on what? Lalonde Report 1974 -Break from medical to holistic perspective -Recognised dynamic nature of health -4 Key areas: human biology, environment, lifestyle, health care organization Lalonde Report: health field concepts (1974) -Started focusing on lifestyle -Decreasing behavioral risk factors -Populations at risk (how we can support) -Entire population rather than individual (why make those choices) -Recognized value of research -Smoking, substance abuse, lack of exercise and unhealthy eating Health Belief Model (Rosenstocks) -Developed to explain individual decisions for health screening opportunities, the three primary points of his model are: 1.​ The individual's perception of his/her susceptibility to and the severity of the disease are the primary motivators to learn and change behaviour 2.​ A belief must exist that the illness can be avoided, and that taking action can reduce the risk 3.​ The individual must also believe that he/she is capable of making the necessary changes -Designed to explain health behaviour and health behaviour change -Focuses on individual -Try to understand beliefs about health -Framework for motivating people -Negative consequences are prime motivator  Health Promotion Model Developed by Pender, this model depicts a complex process associated with behavioural change for health promotion. -Focus is on optimizing wellness versus avoiding disease (big difference from first model) -Patient motivation is influenced by social support and competing priorities -Patient perceptions of benefit and the ability to succeed affect outcomes *Do not get confused with cube model* Transtheoretical Model of Change (Stages of Change Model) -Determine where person is in terms of behaviour change -Readiness for change -Respect the person’s right to choose Stages: -​ Precontemplation: Not considering behaviour change -​ Contemplation: Seriously considering a specific behaviour change in next 6 months -​ Planning: Starting to change or seriously thinking about making change in the next month -​ Action: Made behaviour change; Change persisted for 6 months -​ Maintenance: 6 months after change; Continues indefinitely Diffusion of Innovation Model -Individuals adopt innovation at different rates and are classified into one of these 5 categories: 1.​ Innovators (Quick adopters) 2.​ Early Adopters (Keeners) 3.​ Early majority 4.​ Late majority 5.​ Leggards (Resistant to adopting innovation) Diffusion of innovation theory: Clients are more likely to adopt health-related practices if the following conditions exist: 1.​ Compatibility 2.​ Flexibility 3.​ Reversibility 4.​ Simplicity 5.​ Advantageousness 6.​ Cost-efficiency SMART Goals Specifical, Measurable, Achievable, Realistic, Time-phased Specific: -Should provide who and what -Use only one action verb -Avoid verbs with vague meanings -Greater the specificity greater the measurability Measurable: -How much change is expected, the amount should be quantified -provides a reference point Achievable: -Should be attainable within given time frame and viable resources Realistic: -Accurately address scope of the problem/issue -Need to directly relate to context Time-phased: -Should provide a time frame indicating when the objective will be measured -Can be short or long term Social Cognitive Theory (Learning theory) Bandura (1997) -Emphasizes the influence of efficacy beliefs on health behaviour -Self efficacy: individuals belief in their ability to influence own health -Includes roles of reinforcement and observational learning in explaining health behaviour -Modelling *Provides opportunities for imitating behaviours *Useful to demonstrate desired behaviours Ex: Parents model behaviour for their child. Protection-Motivation Theory Social marketing. You are scared you are going to die from smoking. Installs fear Code of Ethics -Central foundation provides guidance for ethical relationships, behaviours, and decision making to be used with professional standards, best practice, research, laws, and regulations that guide practice. -A code of ethics tends to offer guidelines not only about responsibilities for ensuring good care but also about responsibilities for recognizing and addressing barriers to service. -It also services as an ethical basis for nurses to advocate for quality practice environments that support the delivery of safe, compassionate, competent, and ethical care. -As the societal context in which nurses work is constantly changing, which can significantly influence nursing practice, nurses need to anticipate future health needs and political activity when necessary to ensure health promotion. Biomedical Approach Health is defined by the absence of signs and symptoms of disease and illness is defined by the presence of signs and symptoms of disease. -The target for intervention is high-risk individuals -Examples of health promotion strategies that use a biomedical approach include such activities as immunization and screening. -Goals of the biomedical approach include decreased morbidity and prevalence of physiological risk factors, like high blood pressure. Behavioural Approach -Lalonde report (When he changed it from western to behavioral)(talked about lifestyle)  -Limited list of determinants of health -Epp report (Wanted health for all: looked at the wrong things that needed to be changed) and Ottawa Charter (Health for everyone by year 2000) expand Lalondes work -Pace responsibility for health on individuals -Social marketing and health education campaigns - Improve individuals lifestyle -Refinement of health promotion practices -Some success with anti-smoking campaigns and exercise campaigns (participACTION). Socio-environmental Approach -Social context of health -Social determinants of health -Looks beyond the individual (Holistic approach) -Recognises the complexity of health (not just making good choices) -Other factors affect health. Primary Care vs. Primary Health Care: Primary Care: Focus is on personal health services. Going to the emergency room. Primary Health Care: Includes primary care and health education, nutrition, maternal, and child health care, family planning, immunizations, and control of locally endemic disease. Primary Health Care Primary Health Care is essential health care made accessible to individuals and families in the community by means acceptable to them through their full participation and at a cost that the community and country can afford to maintain in the spirit of self-reliance and self-determination. (WHO) -Emphasis on health promotion and disease prevention Primary Care  Focus is on personal health services. 5 types of care: 1.​ Promotive 2.​ Preventative 3.​ Curative 4.​ Rehabilitation 5.​ Supportive/Palliative Social marketing Definitions of social marketing: -Social marketing may be defined as a process to influence the acceptability of a social idea or cause. -A planned process for influencing change. -The application of marketing technologies developed in the commercial sector to the solution of social programs where the bottom line is behaviour change. -These programs are designed to influence voluntary behaviour of certain people (Target population) to improve their personal welfare and societies as a whole. Use of social marketing: -It is an integrated part of health promotion strategies at health canada -It is used to deliver health promotion messages to specific Canadian populations -It is designed to help Canadians make decisions related to maintaining and improving their health and well being. Social Marketing VS Advertising: -Terms are often confused with advertising -The message is based on promotion strategies, and is so much more than just advertising. -Commercial marketing tries to change people’s behaviour for the benefit of the marketer; social marketing tries to change people’s behaviour for the benefit of the consumer, or of society as a whole. Steps in social marketing: -Identify behaviour(s) which require change  -Identify audience -Identify true barriers to change -Reduce barriers to change -Pretest idea on small group Example: Youth health campaign The 4 p’s of social marketing 1.​ Product 2.​ Price 3.​ Place 4.​ Promotion #1 Products -What is being promoted to the target audience? 1.​ The actual product: Specific behaviour being promoted (intangible object) 2.​ The augmented product: Tangible objects offered 3.​ The core products: the benefits that the target audience will experience #2 Price -Can be monetary or non-monetary -Intangibles: ​ -Time, effort ​ -Risk, embarrassment (if they fail) ​ -Disapproval #3 Place -Where will the product reach consumers? -When? #4 Promotion -Persuasive communication -The tool that ensures that the target knows the offer, believes they will experience the stated benefits, and is inspiring to act. Promotion has 2 components: 1.​ Messages  2.​ Tactics (Media advertisements, posters, public service announcements) Other P’s -Partnerships -Policy -Politics Challenges with Social Marketing: 1.​ Measuring: Measuring outcomes too early before change occurs or measuring the wrong outcomes. 2.​ Failing: Failing to measure exposure expecting too much from a limited intervention. Primordial Prevention The newest level of prevention- before risk factor The original 3 levels were developed in the 1945s-1950s -Reflects policy - level intervention -Aimed at affecting health before at risk lifestyle behaviours are adopted -Occurs at national, provincial, community levels -Examples: Healthy eating school based programs, reduction of sodium in food supply, creating bike/walking paths (sidewalks) Primary Prevention -Precedes disease/dysfunction -Interventions- health protection ​ -Health promotion (Eg. education) ​ -Vaccines are primary prevention interventions -Focus: maintain/improve general individual, family, and community health -Health protection- reducing threats to health -Health promotion- Encouraging lifestyle change to move toward health Secondary Prevention -Focus on early detection -Earlier treatment results in more favourable outcomes -Limit disabilities from disease -Screening falls under secondary prevention ​ -Individuals ​ -Populations Examples: Colon cancer screening, and pap tests Tertiary Prevention -Focus on restoration and rehabilitation -Minimize long term sequelae of disease -Restore function; Prevent further injury/disease Example: Cardiac rehab after MI, ROM to maintain mobility after CVA, and turning q 2h to prevent pressure sores Domains of Learning Cognitive: Development of new facts or concepts, and building on and applying new knowledge to situations. Affective: Expressions of feelings and acceptance of attitudes, opinions or values, spiritual beliefs, family interaction patterns and relationships that affect decisions and problem solving Psychomotor: Acquiring skills that require the integration of mental and muscular activity; developing skill from simple to complex actions (developing physical skills). Erikson Developmental Model Individuals need to develop a sense of trust and personal worth. Based on eight critical stages. Each stage requires a solution of conflict between two opposing forces. Each stage depends on preceding stages that must be successfully accomplished to proceed. Infancy: Trust vs mistrust Toddler: Autonomy vs shame and doubt Preschool: Initiative vs guilt  School-age: Industry vs inferiority (Can they do math homework) Adolescence: Identity vs role confusion Young adult: Intimacy vs isolation (meaningful relationships) Middle adult: Generativity vs. Stagnation Older adult: Ego integrity vs. despair Piaget Theory of Cognitive Development Piaget's theory of cognitive development. Uses the term “ scheme” to describe a pattern of action or thought. Schemes are used to assimilate (take in) or accommodate (modify) new experiences. Individuals strive to maintain balance between assimilation and accommodation. Piaget’s stages of cognitive development: must develop before they can learn -​ Encompases birth to 15 years old -​ Sensorimotor (0-24 months): reflexes, object permanence -​ Preoperational (2-6 years): Advancing language and movement, egocentric (Want what they want), magical thinking -​ Concrete operations (7-11): logical approaches to solving concrete problems, understanding cause and effect. -​ Formal operations (11-15): True logical thought, abstract concepts, morality. Vygotsky Theory of Cognitive Development -Proposed that learning precedes development (opposite of what piaget proposed) -Focus on cultural, social, political, and individual influences on learning/development (vs. biological universality) -Zone of proximal development: distance between actual and potential developmental level: children “pulled” toward new learning. -Guidance from others is called “scaffolding” Kohlberg Theory of Moral Development Based on Piaget's theory of cognitive development: Places emphasis on an ethic of justice.  The stages of moral developments proceed, during school age, adolescent, and young adult years. -Preconventional (children, some animals) -Conventional (Adolescents, adults) -Postconventual (individuals and society) Gilligan Theory of Moral Development (Gender Biased) -Doctoral research with Kolberg noted women scored lower than men using Kohlberg's tool. -Gilligan's theory suggests a different process of moral development exists in women. -Woman are relationship based vs cognitive development. -Women think and act based on caring and relationships (vs. Ethics/Justice of men Behavioural-Biological Development -How does environmental stress alter biological development (genetics) -Evidence suggests that environmental experiences can change gene functioning -Implications for disease development -Many regulatory changes occur in early childhood -Epigenetics: scientific investigation of capacity of cell to react to environment Slideshow 10 Development: the sequence of physical, psychological, cognitive development changes that take place over the human lifespan. Three aspects of change: physical growth, differentiation, maturation. Developmental ranks of infancy: -Psychological equilibrium: tasks go to survive the basic psychosocial function. Oral stage of development. Stimulation and environmental interaction: -Progressive connections of dendrites -Increased vascular ration of brain structures -Increased myelination of brain/nerves Concepts of infant development Eriksons: trust vs mistrust: -trust includes future relationships -Need max gratification/ minimum frustration Cognitive development Piaget: -Sensorimotor: mastering coordination activities through sense and motor activity Reflexes: response following stimulation -Rooting no sucking reflex Measuring growth and development: -Denver developmental screening test ii: -Screening tool birth to age 6 -Screen at 3-4 months, 10 months and 3 years -Areas of development: personal social, fine motor-adaptive, language, gross motor -CDC growth charts: height, weight, head circumference. Plotted on standardized grid Nutritional metabolic pattern: -Breastfeeding the perfect food: -exclusive: preferred method first 6 months -continued: breastfeeding for the first year and beyond -Nurses encourage it Introduction of solid food: 4-6 months -Recommendation wait till 6 months to lower risk of food allergy -Sequence of foods: cereal, meat, fruits, veggies -Iron fortification by 6 months Nutritional metabolic pattern: -Weaning: introducing infant to a cup -gradual process 5-6 months development milestones: -infant extrusion reflex needs to be absent -infant can sit only slightly supported -be able to turn head away to indicate refusal -Avoid propping baby bottles: aspiration -baby bottle syndrome causing tooth decay Elimination pattern: Bowel elimination: Brestfeed: softer, clean smell, several daily Bottle feed: harder, smellier, decathlon involuntary. Need vitamin D if being bottle fed -Delay toileting until 18 months Urinary elimination: -6-12 times first few months -Voiding involuntary Sleep needs to correlate growth: -80% at birth -12 hours daily at 12 months -naps 2-3 daily Sleep rest pattern sudden infant death syndrome: -10th leading cause of death for 1 month and 1 year age -Recommendation: -avoid risk factors -Supine sleep position offer pacifier -No sleep positioners device should be used Cognitive perceptual pattern: -Vision: initial eye muscles weak, vision unfocused, without meaning, eye movements coordinate at 3 months but mature at 6 months -Hearing: acutely ability sound incrimination an important developmental task -Smell: fully developed can differentiate odor of mothers milk from others at 2 months -Taste: present at birth salivation at 3 months -Touch and motion: tactile sensation well developed -Touch relieves infant tensions and speed neuromuscular development -Language development: sensory stimulation important, cooing by 2 months, babbling at 6 months, single word by 12 months. Self perception self concept pattern: -4 months age: differentiate between self in mirror image Play for infant: -non symbolic -playing alone -choice of toys -music -smiling faces -looking at them saves -reading singing -tummy time Immunizations child health clinics: 2,4,6,12 Month schedule -Toddlers 1 to 3 are a time of great growth and change, and a typical toddler will gain command of motor, cognitive and behavioural skills at a rapid rate Piaget sensorimotor: 12-24 months -no longer repeats behaviours'-object permanence, space perception and time perception -begins to solve problems Erikson: autonomy vs shame and doubt: -Increased cognition, language, motor skills and develop self concept and self esteem -Me do it Autonomy: -using negativism -displaying temper -dawdling -using rituals -exploring even when parents object Physical changes: -growth rate -advanced gross and fine motor -bone development like the fontanelle -teeth 20 of them -vision 20/40 -hearing -vital signs cognitive development: -active trial and error -begins to solve problems -attention span increases -object per menace -imaginary thinking -egocentric thought Speech and language: -understands before speaking -Words based on symbolic function and memory -Facilitated through social interaction -2 year old 2 word sentence -3 year old 3 word sentence - at 2 (50 words) at 3 (1000 words) Social: play and exercise; -explore and learn through play -solitary and parallel play -imaginary playmates -dramatic play/ imitate adults -teach parents importance of play and safety Sleep and rest: 12-14 hours -one nap -maintain schedule -rituals are common -night terrors/ nightmare Toilet training: -bowel before bladder control -Spincheter control/ brain maturation -significant affected by parental expectations and attitudes -Problem: beginning before child is ready Slide show 9 Presumptive of pregnancy: -nausea and vomiting -change in breast sensations/size -increased urinary frequency -missed menstrual period -N/V occur in up to 80% of women -FDA recently approved drug diclegis -Doxylamine (antihistamine) and pyridoxine (B12) -Side effect drowsiness -Dietary changes other non medical treatments -Thalidomide: biggest anthropogenic medical disaster ever Positive signs of pregnancy: - of fetal heart tones by auscultation, ultrasound or doppler -Palpitations of fetal body parts using Leopoldo maneuvers -Objective detection of fetal movements -radiologic or ultrasonic rhino demonstration of fetal parts Reproductive system: -uterus: increased from fist size to 3.2-4.5 kg infant and placenta. -Fundus moves higher -Breasts: enlarge early pregnancy. Late pregnancy: secrete colostrum -Vagina/ Vulva: greater blood supply, more vaginal secretions Sample recommendation for pregnant women: -vaccination and supplementations: MMR, hepatitis B, folic acid -Chronic disease management: diabetes, hypothyroidism -Screening: STIs, depression, violence -Lifestyle modifications: smoking, alcohol or/drug use, obesity Recommended weight gain: -healthy women with normal BMI 25-35 lb -underweight women 28-40lb -Overweight women 15-25lb -Obese women 11-20lb -infants with obese mothers: premature, stillbirth, neonatal deathly congenital abnormalities -Obese mothers: complications, diabetes, embolism and preeclampsia (high blood pressure in pregnant mothers) Health perception-health management pattern: -view pregnancy as illness vs natural, healthy state -healthy/ natural -Active participant in social circle/ career -choose provider with similar view -may affect when mother seeks prenatal care -Illness perspective: -withdraw from work/social obligations -May make unhealthy pregnancy choices, deny pregnancy Nutritional metabolic pattern: -good nutrition essential for proper growth/ development -Affected by pre pregnancy nutrition, finances, culture -best nurturant teaching before pregnancy -anemia of pregnancy affects half pregnancies globally -Recommendation: -weight gain 25-35 lb 300 calories more/day -well balanced diet six groups -8-10 glasses water, 70g protein -increase vitamins/ minerals Fe 30mg, folic acid 400 mcg -Fats/carbohydrates for energy needs Activity exercise pattern: Fetus: -early pregnancy:spontaneous movements reflexive -quickening: at 16 weeks, kick counts after quickening to monitor fetal activity ( report decreased activity) Pregnant women: -need physical activity, at least 30 minutes/day of aerobic (walking/swimming) exercise -Exercise improves uterine tone, lower risk diabetes -Avoid height risk sports -Usual sexual activity unless pregnancy restrictions Self perception self concept pattern: -Acceptance of pregnant body image: ambivalence vs acceptance vs yearning for pre pregnancy state -Influences in assuming maternal role: -internal (personality, maturity level) -external discussion (ideas/ feelings between women/partner) Roles relationships pattern: -pregnancy affect whole family -Without partner: isolation, dependent on family -Partner: possible resentment, financial stress, potential for abuse, concerns about role -Children: -Less attention from parents -changes relationship with mother -Extended family/ expectant grandparents: -Reminded of own aging -Feeling of resentment vs new closeness Early postnatal period: -promote skin to skin contact -breastfeeding initiation -Rooming in (keeping baby with you) -early discharge -home visiting Nutrition The science of optimal cellular metabolism and its impact on health and disease. Self-Management Ability to take care of yourself and have optimal health  Canada Food Guide Importance of Canada’s food guide: -Supports healthy eating habits to lower risk of disease -Simplifies nutrition information -Reduces confusing nutrition messages -Provides canadians with reliable healthy eating information Canada’s food guide at a glance: Online suite of resources: -Food guide snapshot -Actionable advice, videos and recipes -Mobile friendly to support Canadians to eat healthy whenever, wherever you go Key change: -Uses an online platform -Provides practical advice on how to eat rather than focusing on food groups, number of servings and serving sizes. -Encourages a pattern of eating that focuses on plant-based food -Updates specific nutrition recommendation Eat a variety of foods everyday: Eat plenty of fruits and vegetables -½ your plate should be fruits and vegetables -Fresh, frozen, and canned are healthy options -High in nutrients like fiber, vitamins and minerals -Choose different textures, colours, and shapes to fit your taste -Try a variety such as: ​ ​ *Leafy greens, cabbage, broccoli, berries, apples, and pears Eat protein foods-choose plant based more often -¼ of your plate -Plant based proteins can be beneficial for your heart health -Beans, peas, lentils, nuts, seeds, tofu, fortified soy beverage, fish, shellfish, eggs, poultry, lean red meat including mild game, lower fat dairy, and cheese lower in fat and sodium. Choose whole grain foods -¼ of your plate should be whole grains -Eat a variety of whole grain foods ​ *Whole grain bread, whole grain pasta, whole oats or oatmeal, whole grain brown rice, quinoa -Eat foods rich in fiber ​ *Fiber can help lower your risk of: Stroke, colon cancer, heart disease, and type 2 diabetes. Make water your drink of choice: Drinking water is:​ -Important for your health -A great way to quench your thirst -A way to stay hydrated without calories Other healthy drinking options include: -White milk (unsweetened and lower in fat) -Unsweetened fortified plant-beverage -Unsweetened coffees and teas Healthy eating is more than just the types of food you eat: Be mindful of your eating habits -Take your time to eat -Notice when you are hungry and when you are full -Create a healthy eating environment -Use your senses -Consider your eating habits Cook more often: -Plan ahead to eat healthier, save money, and cook more often -Share planning, preparing, and eating meals with others -Get children involved Enjoy your food -Reflect taste, culture, budget, lifestyle -Try new foods -Create a positive eating environment Eat meals with others -Enjoy quality time together at work, school, and home -Share food traditions, across generations and cultures -Explore new healthy foods that you might not normally try Use food labels Limit foods high in sodium, sugars, or saturated fat Be aware of food marketing Online based platforms: Key features:​ -Food choices -Eating habits -Recipes -Tips -Resources ​ *Videos ​ *PDF downloads ​ *Mobile friendly There was an old food guide that had the four food groups (vegetables/fruit, grain, milk/alternatives, meat/alternatives) -New food guide (2019) Dietary Reference Intakes -Replaced recommended dietary allowances (RDA’s) -Reflect a range of values (lower and upper limits) -Serve as a guide for food nutrition and health policy -Controversy: Limited data relating to genetic diversity, specific groups such as children and pregnant woman and the elderly Macronutrients Nutrients needed in larger amounts -Provide body with energy (calories) ​ *Carbohydrates ​ *Proteins ​ *Fats Proteins, fats, carbohydrates = 100% -Dietitians are the experts -For example only: *Proteins 10-35% *Fats 20-35% *Carbohydrates 45-65% Carbohydrates -Fuel during high intensity -Spares protein… protein preserves muscle mass during exercise -Fuel for CNS and brain -Food sources: -Grains: Choose mostly whole grains -Diary: Choose low fat or non fat -Fruit: Choose whole fruits more often than fruit juices Glycemic Index -Effect on blood glucose levels/insulin response ​ -????????????? Micronutrients Protein: -Tissue structure (organ tissues, muscle, hair, skin, nails, bones, tendons, ligaments, and blood plasma) -Part of plasma cell membrane -Metabolic, transport, and hormone systems -Make up enzymes that regulate metabolism -Acid/base balanced (neutral environment)  Food sources: Meat, fish, tofu, dairy, legumes, eggs, nuts, and seeds Fats: energy reserve -Protects vital organs -Insulation -Transport fat soluble vitamins -Fat soluble vitamins -Food sources: Oils, margarine, butter, nuts, seeds, meat, fish, dairy, and micronutrients Cholesterol and triglyceride, and lipids -Cholesterol and triglycerides are separate types of fats Triglycerides: store unused calories and provide your body with energy Cholesterol: Builds cells and certain hormones High density lipoprotein- good Low density lipoprotein- bad Good fat: Monounsaturated fat and polyunsaturated fat. Improves blood cholesterol, decreases risk of heart disease. Bad fat: Saturated fat and trans fat. It's harmful to the heart. Micronutrients -Nutrients needed in smaller amounts -Vitamins, minerals, trace elements, and antioxidants - Trace elements are nutrients required in very small amounts- Ex: iron, iodine, fluoride, copper, zinc, chromium, selenium, manganese and molybdenum are vital for maintaining health Vitamin B1: Thiamin (wifi network) -Makes sure you dont get berybery (if you eat not enough) -Needed to release energy in food -Prevents beriberi -Food sources: -Meat -Whole grains -Dried beans -Peas -peanuts Vitamin B2: Riboflavin Needed to build and maintain body tissues Food sources: -Organ meats -Meat -Eggs -Green and yellow vegetables -Enriched flour Vitamin B6: Pyridoxine -Helps the developer of the nervous system -Involved in the reproduction of blood -Helps break down protein and glucose to produce energy for the body -Food Sources: -Meat, fish, nuts, beans -Vegetables -Yeast -Rice Vitamin B12: Cobalamin -Promotes proper growth and development of the nervous system -Food sources: -Meats -Dairy -Eggs Vitamin C: Ascorbic Acid (first responders) -Helps form growth hormones -Needed to build strong gums, teeth, and bones -Antioxidant -Food sources: -Citrus fruits -Cabbage -Berries -Peppers Folic Acid (pregnant woman need 300mg) -Helps build DNA and protein -Helps maintain intestinal tract -Aids in bone growth -Prevents nervous system birth defects -Food sources: -Dark green leafy vegetables -Yeast -Wheat germVitamin A: Retinal (city street lights) -Vision -Healthy skin -Healthy hair -Food sources: -Milk, Butter, Margarine, Eggs, cheese, Liver The body can make vitamin A from vegetables that have carotene like carrots Vitamin D( construction workers) -Promotes strong teeth and bones -Prevents rickets -Food sources: -Milk -Cod liver oil -Tuna -Salmon -Egg yolks -Produced by the body when exposed to sunlight Vitamin E ( air filter) -Prevents damage to cell membranes -Works with vitamin A -Aids in blood productions -Food sources: -Seeds and nuts -Vegetable oil Vitamin K (traffic control) -Aids in blood clotting -Food sources: -Green leafy vegetables -Produced by bacteria in the large intestine -** baby/newborn gets vitamin K injection right away smth to do with blood clotting Calcium (Ca2+) (city construction materials) -Maintains teeth and bone -Helps blood clot -Helps nerves and muscles function -Food sources: -Cheese, milk, sardines, clams, oysters -Milk -Dark green vegetables, legumes Potassium (K) - Regulates cellular water balance - Helps nerves function - Important for heart rhythm - Food sources: - Oranges, Bananas - Meat, Poultry, fish -Cereal -Potatoes -Dried beans Sodium (Na) (water management system) -Regulates water balance -Stimulates nerves -Food sources: -Table salt -Meat -Poultry -Fish -Eggs -Milk Iron (Fe) (delivery truck) -Forms blood cells -Transports oxygen throughout the body -Food sources: -Liver -Red meats -Dark green vegetables -Whole-grain cereals-Shellfish Zinc (ZN) -Aids in transport of carbon dioxide -Aids in healing wounds -Forms enzymes -Food Sources: -Meats -Shellfish -Whole grains -Milk -Legumes Antioxidants -Substances that may prevent or delay some types of cell damage -Found in many foods, including fruits and vegetables. Examples: -Beta-carotene -Lutein -Lycopene -Selenium -Vitamins A,C, and E Water -Moistens tissues (mouth, eyes and nose) -Protects body organs and tissues -Helps prevent constipation -Helps dissolve minerals and other nutrients to make them accessible to the body -regulates body temperature -Lubricates joints -Lessens the burden on the kidneys and liver by flushing out waste products -Carries nutrients and oxygen to cells Toxicity -Vitamin and Minerals can rise to toxic levels in the body -It is important to advise patients -it is possible to consume too much of a good thing (pp. 240-241) -Of the fat-soluble vitamins (A,D,E,K), Vit A is of concern for: -Pregnant women because may be teratogenic to the fetus -Current or former smokers because it may increase the risk of lung cancer -Even herbs, dietary supplements, too much water, etc. can lead to problems -Consult a dietitian for advice, counselling, nutrition screening Evidence Qualitative Research Quantitative Research Quality Improvement Research Levels of Research Evidence Evidence-Informed Decision Making Biggest man made mistake: Thalidomide (deformed babies)