NCMA 215 | BSN Nutrition and Health Fitness PDF

NCMA 215 | BSN Nutrition and Health Fitness Bulimia Nervosa Nutrition in Weight Management o Have episodes of eating large amounts of food (called...

NCMA 215 | BSN Nutrition and Health Fitness Bulimia Nervosa Nutrition in Weight Management o Have episodes of eating large amounts of food (called There are huge number of factors which contribute bingeing) followed by purging (vomiting or using towards weight. However, regardless of the factors it laxatives), fasting, or exercising excessively to should ideally be within a healthy range. compensate for overeating. Being either underweight or overweight can affect 1. Binge Eating your physical and psychological wellbeing. 2. Evidence of Purging Obesity Treatment o is one of the fastest growing health concerns in the 1. Cognitive-behavioral Therapy world today and is determined by a person carrying 2. Anticonvulsant Medicines too much body fat for their height and sex. 3. Antidepressants o Growth in obesity can be partly attributed to lifestyle being less physically active than it used to be. Nutrition Exercise and Sports o Body weight is determined by the amount of energy Eating well for physical activity and sport can have obtained from food in relation to the amount of many benefits including: energy uses. Any excess energy is then taken and 1. Allowing you to perform well in your chosen stored in the body as fat. sport or activity 2. Reducing the risk of injury and illness Being obese increases the risks of certain serious diseases such as: 3. Ensuring the best recovery after exercise or a 1. Heart Disease training program 2. Diabetes 3. Cancers Foods for Fuel and Exercise 1. Carbohydrates Being Underweight also poses serious health risks: - The main role of carbohydrates is to provide 1. Irregular Periods energy. The most important form of fuel for 2. Fertility Issues exercise and sports activities. It is stored in the 3. Osteoporosis muscle and liver as glycogen and uses these 4. Anemia stores as source of fuel for the brain and muscles 5. Depleted Energy Levels during physical activity. Eating Disorders 2. Protein Describes illnesses that are characterized by irregular - is important in sports performance as it can boots eating habits and severe distress or concern about glycogen storage, reduce muscle soreness and body weight and shape promote muscle repair Eating disturbances: may include inadequate or excessive food intake which can ultimately damage 3. Fat an individual’s well-being. - provides the main fuel source for long-duration, low-to-moderate Intensity exercise. Cause of Eating Disorder: 1. Family relationships Causes of Dehydration 2. Dieting 1. Increase in sweat production 3. Depression, Anxiety, Anger 2. Inadequate fluid replacement 4. History of being teased or ridiculed based on sized or 3. Sufficient fluid intake is essential for exercise and weight optimum recovery 4. Exercising causes the body to try to cool down by Types of Eating Disorders sweating. This causes the loss of water and salts Anorexia Nervosa through the skin o This is characterized by weight loss often due to excessive dieting and exercise, sometimes to the point of Nutrition and Bone Health starvation. Steps to Prevent or Slow Bone Loss o People with anorexia feel they can never be thin enough o Pay attention to Vitamin D and continue to see themselves as fat despite extreme o Good Source of Vitamin D include oily fish, such as weight loss. salmon, trout, whitefish and tuna o Additionally, mushrooms, eggs and fortified foods, such SYMPTOMS COMMON IN PEOPLE WITH ANOREXIA as milk and cereals, are good sources of vitamin D 1. Weight loss o Sunlight also contributes to the body's production of 2. Wearing loose, bulky clothes to hide weight loss vitamin D. 3. Preoccupation with food, dieting, counting calories, etc. o If you're worried about getting enough vitamin D, ask 4. Refusal to eat certain foods, such as carbs or fats. your doctor about supplements. 5. Avoiding mealtimes or eating in front of others o Include physical activity in your daily routine 6. Exercising excessively o Weight-bearing exercises, such as walking, jogging, 7. Stopping menstruation. and climbing stairs, can help you build strong bones and slow bone loss. o Avoid substance abuse o Don't smoke. If you are a woman, avoid drinking more than one alcoholic drink each day. o If you are a man, avoid drinking more than two alcoholic drinks a day. Nutrition for Oral and Dental Health Foods for Optimum Oral Health o Daily brushing with fluoride toothpaste and flossing are essential to a healthy smile, but did you know nutrition has an effect on your dental health, too? o Eating a variety of nutrient-rich foods from all the food groups promotes healthy teeth and gums. o A balanced diet of fruits, vegetables, protein foods, calcium-rich foods and whole grains provides essential nutrients for optimum oral health as well as overall health. o Calcium-rich foods, such as low-fat or fat-free milk, yogurt and cheese, fortified soy drinks and tofu, canned salmon, almonds and dark green leafy vegetables help promote strong teeth and bones. NCMA 215 | BSN Nutrition Across Lifespan – School Age to Aging Pregnancy and Lactation o Sodium It ensures optimum nutrition before, during and after - most abundant cation in extracellular fluid pregnancy and during lactation - needed for tissue growth and development Characteristics of Pregnancy: - should not be restricted without serious - fertilized ovum implants itself to the uterus indications - human pregnancy lasted for a period of 266 to 280 days (37-40 weeks) o Iodine - consists of three trimesters - needs for fetal development and avoid cretinism - has three main phases – implantation, o Vitamins organogenesis, growth - water- and fat-soluble vitamins Nutrition in Pregnancy o Always start with diet history when it comes to giving nutritional instruction to the mother. o PICA - persistent ingestion of inedible substances of little nutritional value o Vegetarians – - lack essential protein and minerals, need Vitamin B12 supplement o Calorie Allowances CALORIE NEEDS - Non-pregnant requirements –1,800 to 2,200 Kcal/day o 2,200 women in childbearing age - Additional caloric requirement–300 Kcal/day o + 300 in pregnancy = 2,500 calories o Usual daily caloric need in pregnancy – 2,100 to o Mother – Ketoacidosis 2,500; never less than 1,800 Kcal/day o Fetus – deprivation of essential CHON- o Maternal weight gain – 25 to 35 lbs o Neurologic defects, Death o Maternal underweight causes having high risk of low o Even an OBESE pregnant should never consume birth weight, preterm and infant deaths LESS than 1,500 calories per day. o Maternal overweight causes having risk of o Weight is the most accurate indicator if the woman complications in labor and delivery, hypertension, has adequate caloric intake gestational DM, post-partum infections. o Protein allowances PROTEIN NEEDS - body-building food o 44g – 46g women in childbearing age - additional 30 g/day to ensure 74 to 76 g/day o 60g in pregnancy - rich food sources includes milk, meat, fish, poultry and eggs - provide for the storage of nitrogen - protect the mother from any complications VITAMIN NEEDS - growth for maternal uterus, mammary tissues Vitamin A and placenta - needs for fetal growth and repair - hormonal preparation for lactation o Carbohydrates - sufficient intake is necessary for added energy - Avoid “empty” calories like soft drinks o Fats - high energy foods for absorption of vitamins ADEK - Avoid too much fats to prevent vomiting and heartburn Vitamin B9 o Iron - most important mineral that must be taken in supplementary amount - supplementary in pregnancy is 30-60mg per day - needed to increase maternal RBC and for fetal liver storage in the third trimester o Calcium Discomforts - needed for maternal calcium and phosphorous o Nausea and Vomiting metabolism and fetal bone and skeletal growth - Eat dry crackers before rising in bed - 1,200 mg/day, equivalent to 1 quart of milk a day - High CHO, Low FAT diet (4 glasses) - Small frequent feedings - NEVER self-medicate esp. antacids  o It has lactalbumin – human milk protein – easy to digest and hypoallergenic and cow’s milk protein called casein causes allergy o Breast milk is higher in lactose than cow’s milk. o Heartburn (Pyrosis) - Small frequent meals Breastfeeding Misconceptions: - Don’t lie down immediately after eating o A mother sick with PTB cannot breastfeed. - Amphojel (Aluminum hydroxide) or Maalox o Breast milk is not good if the mother has stayed long may be prescribed under the sun - Maalox = Aluminum hydroxide + Magnesium o A mother cannot breastfeed during pregnancy hydroxide o A mother cannot breastfeed with only one breast if the other breast is painful Complication of Pregnancy and Dietary Modifications o A mother cannot breastfeed if she has a cold, flu or diarrhea 1. Morning Sickness o Breast milk is not good if the mother has been caught 2. Rapid weight gain or loss in a sudden shower 3. Toxemia of Pregnancy 4. Anemia Breastfeeding Contraindications: 5. Gestational DM o Breastfeeding may not be advisable when mother has 6. Constipation syphilis, AIDS, DM or any severe infections. 7. Socio-economic and cultural factors o Breastfeeding is not encouraged when the mother is 8. Alcohol, caffeine and nicotine under emotional and mental stress. o Mother who smokes. Nutritional Requirements for Lactating Mothers o Mother who takes contraceptive pills or drugs o the nutritional requirements in lactation are greater o Other contraindication includes metabolic than in pregnancy to ensure enough supply of milk abnormalities or severe prematurity of the newborn for the baby. which require the use of special therapeutic formulas. o Mother’s milk is the best food for baby (Executive Order 51) Factors affecting milk secretion - If vaginal delivery – breastfeeding may done as o Diet early as 30 minutes after birth o Nutritional State of mothers - If CS delivery – 4 hours after delivery o Emotional and Physical State o Demand feeding – best rule to observe when feeding o Suckling o Provide a relaxed, warm and supportive environment o Use of contraceptives and drugs as the letdown reflex is affected by negative emotions of the mother. Provide reinforcement for Child Health Programs positive behavior or successful actions. Infant and Young Child Feeding Newborn Screening Breastfeeding benefits to the mother EPI o Promotes maternal-infant bonding IMCI o Promotes uterine contraction and provided less incidence of thrombophlebitis Micronutrient Supplementation o Reduces rate of ovarian cancer and premenopausal Dental Health breast cancer Early Child Development o Decreases maternal morbidity and mortality Child Health Injuries o Save time, money, effort and economical o Delays fertility Infant and Young Child Feeding o Provide social and economic benefits o Initiate breastfeeding within 1 hour after birth o Exclusive Breastfeeding for the first 6 months Breastfeeding benefits for the baby o Complementary Breastfeeding for age 6 months up Promote attachment to 2 years or beyond. Provide perfect food that contains all necessary - Timely, adequate, safe, properly fed nutrients o Diet - breastfeeding / breast milk is best be given Easily digested, has the right temperature and free until 18 months to 2 years of age from harmful bacteria o bottle feeding Provides passive antibody transfer to the newborn - artificial feeding with cow’s milk, costly, It has colostrum, high protein content contains associated with infantile obesity or “protein- antibodies which help resist infection calorie malnutrition plus” Causes fewer incidences of allergies, vomiting, o mixed feeding diarrhea, constipation and aspiration. - complemented - insufficient supply of breast milk Enhances brain development because of taurine content - supplemented - mother is away from home for feeding Decreases infant morbidity and mortality Two methods of formula preparation: Advantages of Breast milk than Cow’s milk o Aseptic method o Breast milk is higher in CHO, fat and water content - equipments and ingredient are sterilized but lower in protein, vitamins and minerals. separately  o Terminal method 7. Never start two new foods at the same time - formulas are poured into clean but unsterilized 8. Allow an interval of 4-7 days between new foods bottles and are sterilized together 9. Feed baby only with freshly-cooked foods or fruits freshly peeled. Avoid giving left-over foods to Weaning: 6 months: breast to bottle babies. 12 months: bottle to cup 10. Do not bribe, plead, threaten or force the infant Feeding Time: Common Disorders o 2.5 to 2.7 kg baby feeds every 3 hours (8 feedings) o Diarrhea – most frequently caused by bacteria and viruses o 3.6 to 4 kg baby feeds every 4 hours (6 feedings) o Vomiting o 2 to 3 months old, the baby is on 4 to 5 feedings, the o Allergy – milk intolerance baby sleeps through the night after 10 pm feeding o Constipation o Colic – most common Supplementary foods: o 2 months Health Problems with Infancy: - liquids like rice water, calamansi juice may be o Galactosemia introduced depending upon infant’s tolerance o Phenylketonuria (PKU) and acceptance o Maple Syrup Urine Disease (MSUD) o 4 months - first solid foods (rice cereals) Fluid needs of the YOUNG CHILD o 5-6 months o WATER is good for thirst. - teething foods; full diet consisting of pureed o Too much FRUIT JUICE may cause diarrhea and meat, egg, strained fruits and vegetables and may reduce child’s appetite for foods chewy foods be given not only to soothe the o SODAS are not suitable sensitive gums but also to teach the baby the art o TEAS and COFFEE reduce iron absorption. of self-feeding o A SMALL DRINK will satisfy a child’s thirst during meals o 7-8 months o A non-breastfed child (6-24 mons) needs 2-3 cups of - foods are mashed or chopped finely, not strained water in a temperate day or 4-6 cups in a hot climate to teach mastication, soft cooked egg with rice porridge, boiled fish, banana and camote mash Feeding the CHILD WHO IS ILL and the like. o Encourage to eat and drink with lots of patience o 9-12 months o Feed small amounts frequently - whole tender foods or foods chopped coarsely o Give food that the child likes are given, finger foods like cottage cheese, o Give a variety of nutrient rich foods crackers, plain meats and egg yolks o Continue to breastfeed Sequence of introducing solids; cereal, fruit, vegetable, meat, fish Nutrition Program Common Nutritional Deficiencies Foods to avoid in the first year of life 1. Vitamin A o Infantile poisoning – honey (clostridium botulinum) 2. Iron 3. Iodine Choking hazards hotdogs, grapes, hard candies, raw carrots, pop corns, Micronutrient supplementation nuts, peanut butter Araw ng Sangkap Pinoy / Garantisadong Pambata / Insufficient calories - skim milk Child Health Week – twice a year distribution of Potential allergen – cow’s milk, egg whites Vitamin A capsule. Food Fortification (RA 8976) Cues to readiness to solids: mandatory fortification of staples: (flour, cooking oil, o Sucking reflexes is intact refined sugar, rice and processed foods) through o Ability to sit with support SANGKAP PINOY Seal o Avoid feeding an infant lying supine to prevent aspiration o Present salivary glands and intestinal enzymes that aids in digestion o Fetal iron reserve in the liver usually consumed by 4- 6 months Rules to follow when introducing supplemental foods: 1. Introduce one food at a time 2. Show pleasure when giving new food at the same time, make gesture. 3. Give a small amount (1 tsp) at a time 4. Offer bland foods to the baby (not too salty, not too sweets) A. Gluconeogenesis – converting protein (glucogenic 5. Do not mix with formula amino acids) to carbohydrates a release of cortisol, 6. Feed when newborn is hungry after a few sucks of the so called "stress" hormone. milk to increase his patience for a new food B. Glycogenesis – formation of glycogen to glucose  C. Glycogenolysis – breakdown of glycogen to glucose; period of food habits and preferences, selective, making The process is caused by the hormones glucagon and him more vulnerable to nutritional deficiencies epinephrine which stimulate glycogenolysis and won’t eat era - appears thinner than a toddler which are produced in response to low blood glucose decrease in weight, desire for food is erratic levels. It takes place in the muscle and liver tissue parents must be careful not to foster poor eating habits which is where glycogen is stored. by urging, forcing, or even bribing the child to eat Fear of punishment, family as significant others Total Energy Requirement Obesity is a risk o Carbohydrates (CHO) - 50 to 70 % Kcal of 85/kg/day or daily calorie of 1,700 – 1,800 o Protein (CHON) - 10 to 15 % Eating junk food is a problem o Fats (CHO with glycerol base) - 20 to 30% Imaginative thinking; imaginary playmates Mutilation, abandonment and dark, fear of Nutritional Growth and Development Associative play Infant Grow rate slows and erratic refers to a person not more than 12 months Initiative vs guilt remove small objects that the infant can choke on No new teeth develops burp the baby after each feeding to prevent colic Appetite is not large daily caloric requirements: 1200 Kcal/day Oedipus and electra complex Nutrition through breast milk Needs explanation Finger foods at 10-12 months Seen pleasures on touching of genitals Alone in playing (solitary) Note for weight 2x at 6, 3x at 12 months Good Nutrition Teething begins at 6 months o is important during pre-school years, needs adequate Sucking gives gratification food for growth and builds his body, gives plenty of Length X 50% at 1 year energy for play, helps him to fight common Only mother as significant others infections, helps keep the child healthy, happy and Estranger Anxiety around 6-8 months physically fit as well as mentally alert. Stands alone at 12 months Trust vs Mistrust Feeding Problems (Causes and Remedies): Pincer grasp at 10th month o Child is eating too little. Lower incisors erupt before upper incisors o Child is eating too much. Allow cruising at 12 months o Child is dawdling during mealtime. Yells (cries) without parents (parent preference) o Child is gagging especially when fed course foods. o Child has aversion towards some foods. Toddler o Child has allergies. a period of life from 1-3 years old daily caloric requirement: 1,300 to 1,400 kcal/day or Cystic Fibrosis 100 cal/kg/day o Mucus produced by the exocrine glands is physiologic anorexia (decrease in appetite) because abnormally THICK causing obstruction to small toddler is busy at play passageways of affected organs weight quadruple at 2 years old o Common Problems Temper tantrum - Pancreatic enzyme deficiency Offer choices - Chronic lung diseases Diet preference unpredictable, able to feed self - High Na and Cl SWEAT concentration Dental examination at 2-3 years (2y/o -16 3y/o -30) - Infant tastes SALTY when kissed Safety is priority o Dietary Management No Attitude - Administer pancreatic enzyme with meals to enhance palatability Ensures increase Ca, P and Fe - High CHON, High Calorie diet Elimination training (bowel training) - Vitamins A, D, E, K supplementation Drinks 16-24 oz milk/day - Salt supplements during hot weather or fever Separation anxiety Autonomy vs shame and doubt Cystic Fibrosis Parallel play o Intolerance to GLUTEN, the protein component of Rituals, routines and dawdling Barley, Rye, Oat, Wheat Accident – prone o Common Problems Involve parents in child care - Accumulation of amino acid GLUTAMINE is Sibling rivalry toxic to intestinal mucosal cells Explain procedures o Dietary Management - Gluten FREE Diet Preschoolers - Foods allowed: RICE, CORN, Meat, Dairy 3-6 years old products larger requirements for growth so there is a greater need for protein, vitamins and minerals  - Not Allowed: BROW (Pudding, Breads, Cookies, Cakes, Crackers, Cereals, Noodles, Beer and Ale) Phenylketonuria o Genetic disorder that results in CNS damage from toxic levels of phenylalanine in the blood o Dietary Management - LOFENALAC - Avoid high CHON – meats and dairy products - Breastmilk contains LOW phenylalanine levels Galactosemia o An inborn error of CARBOHYDRATE metabolism o Galactose 1-phosphate uridine transferase is absent - Enzyme necessary for conversion of GALACTOSE to GLUCOSE o Dietary Management - Eliminate ALL milk and lactose containing foods including BREASTMILK - Avoid PENICILLIN because it contains lactose as filler NCMA 215 | BSN Nutrition Care Process (ADIME) Process 4. Mormon - no alcohol, tobacco and caffeine Nutritional Care Process (ADIME) Process Nutritional Assessment 5. Islam Adequate Diet - no pork (Haalal diet), no alcohol, caffeine, is composed of various nutrients which body needs practices Ramadan (fasting from sunrise to for maintenance, repair, and for growth and sunset of the month) development. 6. Hinduism Essential of an Adequate Diet - all meats are prohibited o Milk Group - provide most of the calcium requirements Food Avoidance o Meat Group 1. Phenylalanine (EAA) - provides generous amounts of protein in high - low protein diet to avoid imbalance of brain quality amino acids in Phenylketonuria o Bread and Cereal Group - furnishes carbohydrates, minerals and vitamins at 2. Purine relatively low costs. - reduce uric acid producing foods in gouty o Vegetable-Fruit Group arthritis and hyperuricemia - important supplier of fiber, vitamins and minerals particularly Vitamin A and C. 3. Tyramine - high protein foods that underwent protein Assessment of Nutritional Status breakdown by aging, fermentation and smoking Nutritional Status or Nutriture o is the degree to which the individual’s psychological 4. Gluten need for nutrients is being met by food she or he eats. - a protein found in wheat, rye, barley, and other starchy o is the state of balance in the individual between the foods, except rice and corn like in Celiac Disease nutrient intake and the nutrient expenditure or needs Medications Nutritional Status Assessment 1. Monoamineoxidase Inhibitors (MAOI) A. Dietary History and Intake Date - antidepressants, AVOID tyramine containing - 24 Hour Recall – patient or individual completes foods like alcoholic beverages, dairy products, a questionnaire or maybe an interview asking to avocado, banana, meats, chocolates and recall everything that he or she ate within the last condiments causes HYPERTENSIVE CRISIS. 24 hours. 2. Warfarin Sodium (Coumadin) B. Food Frequency Questionnaire - anticoagulant, AVOID or instruct the patient to - patient answers the questionnaire for frequency decrease intake of green leafy vegetables of food use as accurately as possible 3. Methimazole (Tapazole) C. Dietary History - antithyroid, uses for Hyperthyroidism, inhibits - contains additional information about the synthesis of thyroid hormone by interfering with patient’s income, physical activity, ethnic and iodine. Teach the client to AVOID seafood and cultural background, influence s on eating habits iodine products. and religion, home life and meal patterns, factors that affect appetite, allergies, intolerances, food 4. Estrogen Replacement Therapy (HRT) avoidance, dental and oral problems in eating, - management of menopausal symptoms in gastrointestinal problems, chronic diseases, women. Estrogens increase risk of cardiovascular dietary modifications and medication. disease and cancer so instruct the patient to AVOID or reduce alcohol, caffeine and smoking. Ethnic and Religion 1. Christianity Food Diary or Record - holy week observances may restrict meat (Good o this method involves time, understanding and Friday) motivation on the part of the patient as she or he writes down everything he or she eats or drinks for a 2. Seventh Day Adventist certain period of time. - no pork and shellfish, alcohol, encourages veges diet Observation of Food Intake o most and accurate method of dietary intake 3. Judaism assessment, because it requires knowing the amount - no pork, shellfish, blood products, mixing of and kind of food presented to the patient and record milk or dairy products with meat in one meal, the amount actually eaten. Kosher diet, no cooking during Sabbath day (Saturday)  General Rules for Menu Planning o Height for age – uses statiometer, anthropometric ▪ Use the whole day as a unit rather than the individual meal. steel rods fixed accurately and vertically to the wall ▪ Use some food from each of the food groups daily o Weight for height/length – most accurate indicator (energy giving foods, body building foods and body of present state of nutrition, an expression of leanness regulating foods) or wasting ▪ Use some raw fruits or vegetables at least once a day o Skin fold thickness – uses reliable caliper ▪ Plan to have for each meal at least one food with o Body circumferences staying power or high in satiety value. o Birth weight ▪ Combine or alternate bland form with those of a more o What is the healthy waistline? pronounced flavor. - Women -