NUR 125 Nutrition & Diet Therapy Midterm 2024-2025 PDF

Tab 1  TABLE OF CONTENTS Energy Metabolism p. 2...

Tab 1  TABLE OF CONTENTS Energy Metabolism p. 2 Menu Planning p. 7 Nutrition of Pregnancy p. 8 Nutrition of Lactation p. 14 Nutrition during Infancy p. 15 Nutrition for Children p. 19 Nutrition for Adolescents p.27 Nutrition for Adulthood p.33 Nutrition for Elderly p.38 BATCH 2027 TRANXCN TEAM DEPUTY HEADS Picache, Ma. Lourine Kassandra C. Haum, Jazentha Kim G. Loyola, Tim A. TRANXCN TEAM Bondoc, Alissa S. Candelaria, Aisha Francine Brosas, Carmela Dawn C. NUR 125 De Jesus, Althaea Timothy Gonzales, Jaira Marielle M. Haum, Jazentha Kim G. Kobayashi, Samantha May B. NUTRITION & Loyola, Tim A. Macha, Elaena Katrine P. Medrano, Ma. Samantha E. Pegarido, Khristel B. DIET THERAPY Perido, Kurt Cedrick L. Pescasio, Kirsten Marianne C. Pili, Edrik Gene M. Quiaz, Vanessa Mae Rafols, Kisha Belle M. Sanchez, Rayben William L. Solon, Cahn Zyrah L. A.Y. 2024-2025 Soquila, Reinne Haizen R. Tejero, Angela P. TranxCN: MIDTERM RELEASE 2 Valdez, Mariah Richlyn E. Guidelines: The Tranx CN is NOT FOR SALE and shall only be utilized by the bona fide nursing students from De La Salle medical and Health Sciences Institute. The students are permitted to download and print the Tranx CN. However, reproducing, imitating, altering or tampering any information on the transcriptions is strictly prohibited. Failure to abide by the Tranx CN guidelines will result in immediate termination of access to the transcriptions. Disclaimer: Please use at your own discretion. Tranx CN is not intended as a substitute for resource materials such as handouts, videos, and books provided by the college. All information on these transcripts is provided in good faith and is subjected to quality control. Regardless, the Tranx CN Team makes no representation or warranties of any kind regarding the accuracy, and completeness of any information in the transcripts. The College of Nursing Faculty/Professors are not liable for any mistakes or false information that may inadvertently be included in this transcript.  NUR 125: NUTRITION & DIET THERAPY MIDTERM RELEASE 1 - NUR125 - 2728 KILOCALORIE OUTLINE Chilioi (french) means thousand & A. Energy Calor (latin) means large calorie B. Metabolism Measure of energy in the metabolism of food C. Measurement of Energy of Foods Please add the missing parts from the topic: D. Atwater or Physiologic Fuel (Calorie) Values of Food Bomb Calorimeter, examples (solvings), E. Total Energy Expenditure (TEE) a. Direct Calorimetry BOMB CALORIMETER b. Components of Total Energy Expenditure Device used for measuring calories F. Basal Metabolism The apparatus is insulated thoroughly against loss a. Basal Metabolic Rate of heat and the amount of heat produced is b. Factors Influencing BMR measured by the change in temperature of a c. Calculations of BMR G. Physical Activity measured amount of water. H. Thermic Effect of Food or Specific Dynamic Action I. Methods and Formulas in Estimating Total Energy ATWATER OR PHYSIOLOGIC FUEL (CALORIE) Requirement VALUES OF FOOD a. Krause Method b. Formulas for Infants and Children 4 cal/ gm of CHO 17J J. Energy Balance K. Methods for Computing Desirable Body Weight 9 cal/ gm of Fat 38J a. Tannhauser’s Method b. HAMWI Method 4 cal/ gm of CHON 17J L. Determining % DBW Note: 1 kcal = 4.148 Joules M. Body Mass Index (BMI) SAMPLE COMPUTATIONS N. Determination of Body Composition a. Indirect Methods A slice of cake which contains 3 gm CHON, 1 gm fat b. Direct Methods and 15gm CHO will provide the following Kcal: Energy The capacity to do work. Chemical energy locked in foodstuffs Metabolism “Metabolismos” the chemical process of transforming foods into complex tissue elements and of transforming complex body substances into simple ones All types of changes that occur in food nutrients To get the percentage of Kcal from the nutrient: after they have been absorbed from GIT and to the cellular activity involved in utilizing these nutrients. The total chemical and biological processes that takes place in the body Measurement of Energy of Foods CALORIE TOTAL ENERGY EXPENDITURE (TEE) From Latin word ‘calor’ which means heat Energy expended by an individual in 24 hours the standard unit in measuring heat. REE (Resting Energy Expenditure) or basal by-products when carbohydrates, protein and fats metabolism = largest portion 60% to 65% are oxidized in the body Thermic Effect of Food (TEF) = smallest amount of heat required to raise the temperature of component 10% 1kg of water to 1°C Physical Activity (PA) = most variable component PEGARIDO, PILI 2 of 43 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 125: NUTRITION & DIET THERAPY MIDTERM RELEASE 1 - NUR125 - 2728 2. AGE Measuring Human Energy Expenditure highest during periods of rapid growth = first and DIRECT CALORIMETRY second years of life monitors the amount of heat produced by a person BMR declines during old age placed inside a structure called whole-room ○ 5% decrease per decade (40-58 yrs) calorimeters. ○ 10% decrease per decade (60-69 & 70 and above) 3. BODY SIZE & SURFACE AREA (HEIGHT) Tall, lean man - higher metabolism 4. SEX Women have 5-10% lower BMR than men 5. ENDOCRINE GLANDS/HORMONAL STATUS Thyroid gland > Hyperthyroidism > increase basal energy needs (50- 75%) INDIRECT CALORIMETRY Hypothyroidism > decrease Thyroxine by 10% measures the amount of oxygen taken in and the carbon dioxide given off by means of a during sleep respirometer, the amount used is correlated with Stimulation of the sympathetic nervous system > body heat production release of epinephrine > glyconeolysis and increased cellular activity Components of Total Energy Expenditure Increase EE during menstruation (150 Kcal/day) Basal Metabolic Rate Physical Activity Thermic Effect of Food 6. PREGNANCY AND LACTATION BMR is increased by 20-25% BASAL METABOLISM Increase in EE Also called as Energy Expenditure for Involuntary Approx. 15-20 kcal/kg of body weight per day Activities or (REE) Resting Energy Expenditure Amount of energy required to carry on vital body 7. BODY TEMPERATURE processes when the body is at rest Increase body temp = 7% rise above 98.6°F Example: metabolic activities of cells & tissues to 13% for each degree above 37°C maintain homeostasis of body systems decreased temp = BMR increases BASAL METABOLIC RATE (BMR) 8. STATE OF NUTRITION/BODY BASAL ENERGY EXPENDITURE (BEE) Low BMR: obesity, starvation, fasting, Measurement of the basal metabolic rate hypothyroidism, undernutrition expression of the number of calories used hourly Increased BMR: hyperthyroidism, cardio-renal in relation to the surface of the body usually diseases expressed as kilocalories per 24 hours (kcal/24 hr) Acute infection in infants and young children: inc. Approximation in Adult: 1 kcal per kg of body caloric requirement by 25-40% weight per hour (1 kcal/kg DBW/hr) 9. ENVIRONMENTAL TEMPERATURE Factors Influencing the BMR People living in tropical climates usually have BMRs 1. BODY COMPOSITION that are 5% to 20% higher than those living in major single determinant: fat-free mass (FFM) or temperate areas lean body mass (LBM) Exercise in temperatures >86°F (30°C) athletes with greater muscular development = 5% = 5% increase in BMR @ sweat gland activity. higher BMR than nonathletic individuals large proportion of inactive adipose tissue lowers the BMR PEGARIDO, PILI 3 of 43 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 125: NUTRITION & DIET THERAPY MIDTERM RELEASE 1 - NUR125 - 2728 10. PHYSICAL or MUSCULAR ACTIVITY = 655.1 + 382.4 + 281.2 - 102.96 Increase in EE above basal needs = 1215.74 11. DRUGS ANSWER REE = 1215.74 or 1,200 kcal barbiturates, narcotics, and muscle relaxants NOTE: BMR, BEE, and REE are all the same, just decrease the metabolic rate worded differently. 12. SLEEP decrease BMR by 10% to 15% PHYSICAL ACTIVITY Most variable and most changeable component. FACTORS Influencing the BMR Approx. = 10% - bedridden, = 50% - athlete INCREASE DECREASE Includes voluntary exercise and involuntary Muscle mass Body fat activities. Growth, infancy, Females puberty Hypothyroidism More surface area Less surface area THERMIC EFFECT OF FOOD (TEF) OR SPECIFIC Hyperthyroidism Sleep DYNAMIC ACTION (SDA) Fever Aging The significant elevation of the metabolic rate Pregnancy, lactation Undernutrition following ingestion of a meal. Good physical When food is ingested, digested, absorbed and condition Extreme environmental metabolized, basal metabolism is increased by temp. 10%. Smoking Psychological state METHODS AND FORMULAS IN ESTIMATING TOTAL Pharmacological agents ENERGY REQUIREMENT Disease process ESTIMATING ENERGY REQUIREMENTS FOR ADULTS/ADOLESCENTS Adult Male: 2000 - 3000 kcal CALCULATION OF BMR Adult Female: 1400 - 3000 kcal HARRIS BENEDICT FORMULA KRAUSE METHOD Most frequently used method for calculating Total Energy Requirement (TER). For adolescents/adults. FORMULA: 𝑇𝐸𝑅 = 𝐷𝐵𝑊 × 𝐿𝑒𝑣𝑒𝑙 𝑜𝑓 𝐴𝑐𝑡𝑖𝑣𝑖𝑡𝑦 LEVEL OF ACTIVITY kcal/kg DBW/hr Bed Rest 27.5 EXAMPLE Sedentary 30 GIVEN 22 year-old female nurse Ht. = 5 ft. Light 35 Wt. = 88 lbs. Moderate 40 UNKNOWN Female BMR Heavy 45 FORMULA REE = 655.1 + (9.56 x wt. in kg.) + (1.85 x ht. in cm.) - (4.68 x age in yr.) SOLUTION REE = 655.1 + (9.56 x 40) + (1.85 x 152) - (4.68 x 22) PEGARIDO, PILI 4 of 43 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 125: NUTRITION & DIET THERAPY MIDTERM RELEASE 1 - NUR125 - 2728 LEVEL OF ACTIVITY OCCUPATIONS EXAMPLE Secretary GIVEN 7 year old child Typist Sedentary Administrator DBW and TER UNKNOWN Cashier Bank teller FORMULA 𝐷𝐵𝑊 (𝑘𝑔 = (𝑛𝑜. 𝑜𝑓 𝑦𝑒𝑎𝑟𝑠 𝑥 2) + 8 𝑇𝐸𝑅/𝑑𝑎𝑦 = 1000 + (100 𝑥 𝑎𝑔𝑒 𝑖𝑛 𝑦𝑟𝑠.) Teacher Nurse SOLUTION Desirable Body Weight Light Student DBW (kg) = (7yrs x 2) + 8 Lab technician = 22 kg Housewife with maids Total Energy Requirement Housewife without TER = 1000 + (100 x 7) maids = 1700 kcal Moderate Vendor Mechanic ANSWER DBW = 22 kg Jeepney and car driver TER = 1700 kcal Farmer Laborer ENERGY BALANCE Heavy Cargador Occurs when an individual’s total caloric Coal miner expenditure EQUALS the individual’s total caloric Heavy equipment intake. operator ESTIMATING ENERGY REQUIREMENTS FOR INFANTS AND CHILDREN 1. Compute for Desirable Body Weight (DBW), then 2. Compute for Total Energy Requirement (TER) INFANTS Desirable Body Weight 1st six months METHODS OF DETERMINING ENERGY BALANCE ○ 𝐷𝐵𝑊 (𝑔) = 𝐵𝑖𝑟𝑡ℎ𝑤𝑒𝑖𝑔ℎ𝑡 (𝑔) + (𝑎𝑔𝑒 𝑖𝑛 𝑚𝑜𝑠. 𝑥 60 A. Height-weight appropriations ○ If birthweight is not known, use 3000 grams B. The Body Mass Index 7-12 months C. Body Composition ○ 𝐷𝐵𝑊 (𝑔) = 𝑏𝑖𝑟𝑡ℎ𝑤𝑒𝑖𝑔ℎ𝑡 (𝑔) + (𝑎𝑔𝑒 𝑖𝑛 𝑚𝑜𝑠. 𝑥 50 ○ 𝐷𝐵𝑊 (𝑘𝑔) = ( 𝐴𝑔𝑒 𝑖𝑛 𝑚𝑜𝑛𝑡ℎ𝑠 2 ) + 3 METHODS FOR COMPUTING DESIRABLE BODY WEIGHT TANNHAUSER’S METHOD Total Energy Requirement (TER) TER/day (0-6 months) = 120 kcal/kg DBW TER/day (7-12 months) = 110 kcal/kg DBW CHILDREN DBW (kg) = (no. of years x 2) + 8 TER/day = 1000 + (100 x age in years) PEGARIDO, PILI 5 of 43 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 125: NUTRITION & DIET THERAPY MIDTERM RELEASE 1 - NUR125 - 2728 HAMWI METHOD If DBW is less than ABW (possible obesity) ○ More than 10% of DBW = client is overweight ○ More than 20% of DBW = obesity Overweight means excessive positive energy balance. BODY MASS INDEX The ratio of body fat to muscle mass as measured DETERMINING % DBW from body density. Actual Weight / DBW x 100 = % DBW Normal finding: body weight within 10% of ideal range EXAMPLE GIVEN Actual Weight: 95 lbs. DBW - 115 lbs. DETERMINATION OF BODY COMPOSITION A. INDIRECT METHODS % DBW Waist circumference UNKNOWN Waist-hip ratio or Waist-to-hip ratio (WHR) FORMULA 𝐴𝑐𝑡𝑢𝑎𝑙 𝑊𝑒𝑖𝑔ℎ𝑡 𝐷𝐵𝑊 × 100 = %𝐷𝐵𝑊 B. DIRECT METHODS 1. Underwater Weighing (hydrostatic) or SOLUTION 95 𝑙𝑏𝑠. 115 𝑙𝑏𝑠. × 100 = %𝐷𝐵𝑊 densitometry ○ A more direct measure of determining 0. 8260 × 100 = %𝐷𝐵𝑊 whole-body density. ○ The gold standard, but is not always 82. 6 = %𝐷𝐵𝑊 practical, involves significant training to perform, and requires considerable ANSWER 82.6% or 83% cooperation on the part of those being measured. If IBW is greater than ABW (possible malnutrition) 80% - 90% of DBW Mild Malnutrition 70% - 80% of DBW Moderate Malnutrition Less than 70% of IBW Severe Malnutrition 2. Bioelectrical Impedance Analysis (BIA) ○ Body composition analysis technique based Underweight is a condition where food intake or the on the principle that relative to water, lean energy value of a diet is less than the energy value tissue has a higher electrical conductivity of a diet is less than energy expenditure, thus and lower impedance than fatty tissue resulting in negative energy balance. because of its electrolyte content. PEGARIDO, PILI 6 of 43 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 125: NUTRITION & DIET THERAPY MIDTERM RELEASE 1 - NUR125 - 2728 Know the nutrient or diet distribution of the patient CHO = 60% 1g = 4 kcal CHON = 15% 1g = 4 kcal OUTLINE Fats = 25% 1g = 9 kcal A. Menu Planning ex. Diets for diabetes patients, patients with renal a. Heading 2 dse etc. B. Principles of Menu Planning STEP 4 C. Steps in Menu Planning Calculate the diet Rx in grams D. Diet/ Nutrient/ Energy Distribution STEP 5 E. Computation of Rice, Meat, and Fat Exchange Diet distribution in grams CHO = TEA/TER x 0.6/4 kcal MENU PLANNING CHON = TEA/TER x 0.15/4 kcal The process of planning and scheduling intake of Fats = TEA/TER x 0.25/9 kcal meals for a general or specific individual RULE: Round off to whole number requirements RULE: Ending must be divisible by 5, ending PRINCIPLES OF MENU PLANNING number must be 5 or 0. (1) Fulfill the nutritional needs of the family ○ Ex. 67.5g will be 70g members. ○ 88.4 = 88 (not divisible by 5) = 90 ○ Family size and composition ○ 82.5 = 83 = 85 (2) Plan meals within the family income. STEP 6 ○ Maximum use of the money available, in the Make a meal plan distribution of exchanges for a best possible way. day. ○ ex. dormers who need to budget their groceries STEP 7 (3) Aid in the proper purchase, preparation, and Convert meal plan distribution to household service of food measurement (4) Economize on time, labor, and fuel. ○ ex. going back and forth to grocery stores DIET/ NUTRIENT/ ENERGY DISTRIBUTION (5) Provide variety in diet, by making proper selection of foods from within each of the three food groups (6) Make meals appealing and palatable by proper selection of food in terms of color, texture, and flavor. (7) Provide nutrition meals to individual preferences. (8) Plan meals in advance, so that any pre-preparation required can be made and also COMPUTATION OF RICE, MEAT, AND FAT leftovers from the previous meals can be EXCHANGE economically utilized. Rice Exchange (9) Create balance and appropriate diet for various Add the value of carbo age groups and conditions. Subtract the amt. of Rx carbo ○ ex. a family member may have diabetes, heart Divide it by 23 (1exc. of rice=23) problems that require specific diet Meat exchange STEPS IN MENU PLANNING Add the value of CHON STEP 1 Subtract the amount of Rx CHON Get the DBW using Tannhauser’s method Divide it by 8 (1exc. of meat=8) RULE: Round off to whole number. STEP 2 Fat exchange TER Add the value of fats Know the caloric requirement / the total energy Subtract the Rx amt.of fats allowance (TEA) of the patient Divide it by 5 RULE: Round off to the nearest hundreds. (1exc. of fat=5) STEP 3 ENERGY/NUTRIENT DISTRIBUTION LOYOLA, HAUM, PICACHE 7 of 43 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 125: NUTRITION & DIET THERAPY MIDTERM RELEASE 1 - NUR125 - 2728 CHANGES DURING PREGNANCY WHICH HAVE NUTRITIONAL IMPLICATION An increase in BMR OUTLINE A tendency to retain water A. Factors That Influence Women’s Ability to Achieve Decreased gastric acidity and intestinal motility; Good Prenatal Nutrition impairment of digestion and absorption and A. Preconception Period constipation B. Changes During Pregnancy The production of simple glycosuria C. Nutrients and Vitamins Hormonal changes D. Calories ○ Increased activities of progesterone, E. Common Discomforts and Its Interventions gonadotropin, estrogen, adrenal steroid hormone) NUTRITION OF PREGNANCY A positive nitrogen balance FACTORS THAT INFLUENCE WOMAN’S ABILITY TO ○ For tissue building ACHIEVE GOOD PRENATAL NUTRITION An increase in plasma volume with corresponding General nutritional Eating balanced diet, decrease in hemoglobin concentration status prior to before becoming pregnant ○ Increase for about 60% - 65% and leads to pregnancy and during pregnancy can physiologic anemia (normal) help you make sure that A normal weight gain throughout the gestation the mother can receive the period right nutrients that support a healthy pregnancy WEIGHT GAIN Healthy Eating, can also The desirable weight is about 20 to 25 lbs reduce the risk of throughout the gestation period developing conditions that can affect 30.0 Obese – Weight gain 25 to 42 lbs grow a baby and give birth. Teenage pregnancy and advanced maternal age Pregnancy tends to have more complications. Maternal parity PRECONCEPTION PERIOD Maintain a healthy weight Engage in physical activity Gradually lose weight if needed (no more than 1- 2 lbs per week Cease or cut back on alcoholic beverages Quit or cut back on smoking to improve health Eat highly fortified breakfast LOYOLA, HAUM, PICACHE 8 of 43 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 125: NUTRITION & DIET THERAPY MIDTERM RELEASE 1 - NUR125 - 2728 KEY VITAMINS AND MINERAL DURING PREGNANCY Calcium (1,300mg for 14 Build strong bones and teeth Milk, cheese, yogurt, sardines, to 18 y.o; 1000mg for 19 dark leafy green vegetables. to 50y.o) Iron (27mg) Helps red blood cells to deliver oxygen to your Lean red meat, poultry, fish, fetus dried beans and peas, iron-fortified cereals, prune Iron requirements increase during pregnancy juice. because of the growth of the fetus and the placenta and the expansion of maternal blood volume. Iodine (220mg) Essential for healthy brain development Iodized table salt, dairy products, seafood, meat, some Cretinism (Neonatal Hypothyroidism) may form in breads, eggs. infants with mothers who have Iodine deficiency. Choline (450mg) Important for development of fetus’s brain and Milk, beef liver, eggs, peanuts, spinal cord soy products Vitamin A (750mg for 14 Forms healthy skin and eyesight, helps with bone Carrots, green leafy vegetables, to 18y.o; 770 mg for 19 to growth. sweet potatoes 50) Vitamin C (80mg for Promotes healthy gums, teeth, and bones Citrus fruit, broccoli, tomatoes, 14-18 y.o; 85mg for strawberries 19-50 y.o) Its major function is to aid in the formation and development of connective tissue and the vascular system. It is essential in the formation of collagen which binds cells together. Vitamin D (600 I.U) Builds your fetus’s bones and teeth, helps Sunlight, fortified milk, fatty fish promote healthy eyesight and skin for the absorption and use of calcium and phosphorus in skeletal development. Vitamin B6 (1.9mg) Helps form red blood cells, helps the body use Beef, liver, pork, ham, protein, fat, and carbohydrates. whole-grain cereals, bananas Vitamin B12 (2.6 mcg) Maintains nervous system, helps form red blood Meat, fish, poultry, milk cells Vitamin K Essential factor for synthesizing prothrombin, Its Leafy green vegetables function is thus related to normal blood clotting. Vitamin E Used for antioxidation LOYOLA, HAUM, PICACHE 9 of 43 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 125: NUTRITION & DIET THERAPY MIDTERM RELEASE 1 - NUR125 - 2728 Folic Acid (600 mcg) Helps prevent birth defects of the brain and spine, Supports the general growth and development of the fetus and placenta Carbohydrates Provide a primary source of energy as well as the fiber necessary for proper bowel function. This requirement only increases in the 2nd and 3rd trimester in pregnant women. Protein Supplies the amino acids (nitrogen) required for hyperplasia and hypertrophy of maternal tissues. Fats Are a valuable source of energy for the body and are more completely absorbed during pregnancy. Minerals They are needed for the growth of new tissue during pregnancy. Sodium Sodium was never entirely curtailed during pregnancy. Essential for metabolism and regulation of fluid balance. Avoid using extra salt. Too much sodium may induce hypertension. Zinc Involved in protein metabolism and synthesis of RNA & DNA. First Trimester: 5.1mg. Second Trimester: 6.6mg. Third Trimester: 9.6mg. Magnesium Essential for cellular metabolism and Bone mineralization. (205 mg) LOYOLA, HAUM, PICACHE 10 of 43 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 125: NUTRITION & DIET THERAPY MIDTERM RELEASE 1 - NUR125 - 2728 NUTRIENT REQUIREMENTS OF PREGNANT WOMEN CERTAIN FOODS LIMITED OR AVOIDED DURING PREGNANCY BECAUSE OF POTENTIAL TOXIC EFFECTS Consumption of some type of fish ○ Mackerel, swordfish, shark any fish with high mercury contents (teratogenic) High caffeine intake ○ Caffeine has vasoconstricting effects and leads to low blood supply to the placenta and fetus. Fetus is prone to low birth weight Unwashed fruits/vegetables Unpasteurized dairy products Undercooked meats ○ May lead to infection (ex. Listeria infection) ○ Severe infection may induce preterm labor NUTRIENTS IN PRENATAL SUPPLEMENTS LOYOLA, HAUM, PICACHE 11 of 43 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 125: NUTRITION & DIET THERAPY MIDTERM RELEASE 1 - NUR125 - 2728 CALORIES ○ If it happens during 2nd or 3rd trimester, Caloric intake is a key nutritional factor in hyperemesis gravidarum determining birth weight Commonly occurs in the morning but may occur at Pregnant women of normal weight with a singleton any time throughout the day pregnancy need to increase daily caloric intake by Etiology is unknown, probably due to rise in 340 and 450 additional kcal/day in the 2nd and estrogen or rise in HCG 3rd trimester appropriate weight gain Dietary Management: Do not need to increase energy intake in the 1st Small, frequent meals trimester Drink liquids between rather than with meals However, energy requirements vary by physical Avoid fried and greasy foods activity as well as age, weight, and height, so Reduce coffee intake recommendations should be individualized. Avoid cooking odors NUTRITIONAL CARE DURING PREGNANCY Dry toast or crackers eaten before getting out of Lower incidence of absorption and miscarriage bed Fewer stillborn and premature infants and infants Dried fruits and juice for snacks with congenital malformations HEARTBURN Fewer complications during pregnancy (e.g. Reflux of gastric contents in the lower esophagus toxemias nd anemias) and delivery (e.g. prolonged common during the final weeks of pregnancy and labor, premature separation of the placenta and disappear after delivery of infant hemorrhaging) Dietary Management: Healthier full-term babies Small, frequent meals Reduced infant mortality and morbidity rates Avoid fatty foods SPECIFIC RECOMMENDATIONS Drinking fluids between rather than with meals Energy intake must allow a weekly gain of about Limit spicy foods 0.4kg for the last 30 weeks of pregnancy Avoid lying down 1-2 hours after eating Protein intake must be increased by an additional Wear loose fitting clothing around abdomen 10g/day, preferably from food sources with high Do not take antacids without doctor’s order biological value CONSTIPATION Alcohol consumption Common during the first and third trimesters of ○ Placental barrier pregnancy Caffeine intake is limited or restricted Dietary Management: Sodium intake is at least 2000 mg/day Increase fiber intake ○ High sodium, high water may induce Increase fluid intake hypertension Moderate exercise such as daily walk Minerals, especially iron and folic acid Over the counter laxatives or enemas should not be requirements which are difficult to be provided by used unless prescribed by the physician usual diets, need supplementation under RAPID WEIGHT GAIN OR LOSS physician’s care. Excessive weight gain during pregnancy TEENAGE PREGNANCY SIGNIFICANT RISK Defines as an increase of 3 kg or more per month in FACTORS the 2nd and 3rd trimester Low pregnancy weight gain Dietary Management: Low weight for height Overweight and obese woman should consciously Excessive pre-pregnancy weight for height avoid severe caloric restriction as well as prevention Low gynecological age, i.e. age of onset of of excessive weight gain pregnancy minus age of menarche A gain of the 95th percentile 13-19 years old Rationale: to support peak bone mass, uses for bone mineralization POSSIBLE COMPLICATIONS OF OBESITY PHYSICAL EMOTIONAL/ Iron Boys (13-15) = 20 mg PSYCHOLOGICAL (16 -18) = 14 mg Girls (13-15) = 21 mg Hypertension Poor body image (16-18) = 27 mg Diabetes Mellitus Low self esteem Rationale: increase iron in female Coronary Artery Social isolation because of periodic menstrual cycle Disease Depression Pulmonary Dysfunction Rejection Iodine 150 mcg for both sexes 13-18 years old Ischemic Stroke Should be supplied in the diet in the form Orthopedic Problems of iodized salt (arthritis) BROSAS, CANDELARIA 29 of 43 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 125: NUTRITION & DIET THERAPY MIDTERM RELEASE 1 - NUR125 - 2728 THEORIES OF OBESITY foods 1. Hypothalamic Factor ○ e.g., sugary snacks, fast Tumor/lesions impact satiety signaling food pathways, structural damage leads to Regulate food portion size hyperphagia and rapid weight gain 2. Heredity 3. Exercise Helps in burning calories Genetic factors that contribute to an and improving metabolic individual's susceptibility to obesity. function Genetics can play a significant role in 4. Behavioral Therapy Focuses on changing eating determining body weight, fat distribution, and and activity habits through overall metabolic processes. psychological techniques. 3. Adipose Cell Theory Idea is that each body is programmed to have a 5. Medical Therapies Medical interventions that basic set number of fat cells may be necessary for some Creation of new fat cells is far easier than with severe obesity (e.g. losing old ones giving prescription 4. Set-Point Theory medications) There is a control system built into every 6. Prevention Promoting healthy person dictating how much fat he/she should behaviors carry ○ Utilizing “My Plate” and Some have high setting, others have low one trackers as guide ○ Increasing awareness about RISK FACTORS OF OBESITY nutrition Socio-cultural Factors Encompass societal norms and economic DIETING BEHAVIORS conditions that Common in females influence dietary habits 50% - 60% of females consider they are and physical activity levels. overweight Places adolescents at risk for eating disorders Psychological factors Includes emotional Associated with inadequate intake of essential well-being and mental nutrients health that can influence eating BODY DISSATISFACTION behaviors and weight Body image & self- esteem are closely related management. Overweight adolescents can strive toward a realistic leaner & healthier body Decreased physical activity Sedentary lifestyle contributes significantly Acne to weight gain by Healthy meals, good hygiene should be reducing energy emphasized expenditure. EATING DISORDERS ANOREXIA NERVOSA THERAPEUTIC MANAGEMENT Serious, chronic & often life-threatening disorder 1. Motivation Setting realistic goals and defined by preoccupation with weight and fostering a positive mindset. refusal to eat to maintain minimal body weight Encourage setting specific, Compulsion: measurable, achievable, ○ Exercise excessively, starvation, relevant, and time-bound frequent checks weight (SMART) goals. SIGNS AND DIAGNOSTIC 2. Diet Decrease intake of problem SYMPTOMS CRITERIA food ○ Reducing consumption of Brittle hair & nails Weight loss of at least high-calorie, low-nutrient Yellowish, dry skin 15% below normal or BROSAS, CANDELARIA 30 of 43 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 125: NUTRITION & DIET THERAPY MIDTERM RELEASE 1 - NUR125 - 2728 LACTOSE INTOLERANCE Hypothermia Ideal body weight (IBW) Depression for height or age. Not able to digest ingested lactose in small Emaciation Weight loss is intestines that may cause bloating, flatulence, self-induced by abdominal cramping & diarrhea avoiding fattening Management: foods. ○ Lessen the amount of milk intake There is self-perception ○ Eat yogurt or aged cheese as of being too fat with an substitutes and other fermented overwhelming dread of products. fatness. There is widespread hormonal disorder ALLERGIES IN FOOD which may lead to Risk: amenorrhea in women & ○ With family history loss of sexual interest in Signs and symptoms: men. ○ Dyspnea ○ Wheezing BULIMIA NERVOSA ○ Abdominal pain Eating disorder marked by weight ○ Vomiting preoccupation & destructive binge eating, ○ Skin reactions followed by purging. ○ Swelling of lips or tongue Compulsion: Management: ○ Binge eating, purging, using laxatives & ○ Total avoidance of foods causing allergy diuretics, vomiting, excessive exercise ○ Substitute other foods Desensitization ○ Therapeutic process where a person is SIGNS AND SYMPTOMS gradually exposed to an allergen in controlled doses to reduce their Erosion of dental enamel Sore at the back of hand sensitivity and decrease allergic Depression reactions over time. Weight loss ○ Typically done during childhood ADOLESCENT ATHLETE BINGE EATING DISORDERS (BED) Calorie intake of carbohydrates should be Disorder characterized by eating too much increased to fuel as energy. even if they are not hungry & feel disgusted B vitamins are increased because they are after eating necessary for energy metabolism. “Stress” / “Emotional eating” Athletes should be well hydrated before exercise and drink enough fluid during and after DIAGNOSTIC CRITERIA exercise to balance fluid levels. ○ Additional water, calories, thiamine, Recurrent episodes of overeating at least 2x a week riboflavin, niacin, sodium, potassium, over a period of 3 months. iron, and protein to prevent dehydration. ○ Large amounts of food are consumed in a short Amount of calories needed is determined by the period of time. kind, duration of activity, intensity & Persistent preoccupation with eating & a strong desire frequency of performing activities. or sense of compulsion to eat. Person attempts to counteract the fattening effects of Vulnerable to fad foods & myths that would food by self-induced vomiting, self-induced purging, enhance performance alternating periods of starvation, drugs e.g. appetite ○ eg. ergogenic aids – steroid drugs depressants or diuretics. Good diet, good health habits and practice, There is a self-perception of being too fat with an combined with innate talent, remain the excessive fear of fatness. essentials for athletic success. BROSAS, CANDELARIA 31 of 43 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 125: NUTRITION & DIET THERAPY MIDTERM RELEASE 1 - NUR125 - 2728 HELPFUL HINTS IN PREPARING MEALS FOR DAILY NUTRITION GUIDE PYRAMID FOR FILIPINO ADOLESCENTS CHILDREN (13-19 YEARS OLD) Arrange for teens to find out about nutrition for themselves. Take their suggestions regarding foods to prepare at home. Experiment with food outside your own culture. Have several nutritious snack foods readily available. If there are foods that you do not want your teens to eat, avoid bringing them into the home. BEST NUTRITION ADVICE TO KEEP ADOLESCENTS HEALTHY Eat variety of foods Balance the food you eat with physical activity Choose a diet with plenty of grain products, vegetables and fruits Choose a diet low in fat, saturated fat, and Visual representation of balanced nutrition cholesterol tailored to the dietary needs of adolescents in Choose a diet moderate in sugars and salt the Philippines Choose a diet that provides enough calcium Key components: and iron to meet their growing body's ○ Hydration (water and beverages) requirements. ○ Grains ○ Fruits and Vegetables ○ Dairy SANITATION AND SAFETY ○ Protein sources Proper washing of hands before eating. ○ Fats and oils Pack lunch or foods should be safe to eat after 2-4 hrs of preparation. Be observant of food handlers when eating in fast foods. Be sure that foods are served with the right temperature. Restaurants & fast foods are checked by sanitary surveyors for food sanitation & safety & have sanitary permits. BROSAS, CANDELARIA 32 of 43 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 125: NUTRITION & DIET THERAPY MIDTERM RELEASE 1 - NUR125 - 2728 peaks during the 20’s OUTLINE Psychosocial - begins to separate development emotionally from A. Adulthood parents a. Young Adulthood i. Young Adulthood Development and Changes Physical changes - height may begin to (YDAC) decrease slightly after B. Middle Adulthood 25 = vertebral a. Middle Adulthood Changes (MAC) disintegration i. Physical Changes ii. Physiological Changes - After age 30, lose iii. Psychosocial Development muscle tissue, amount C. Special Considerations to Specific Age Group of body fat increases D. Nutrient Requirements E. Feeding the Young and Middle Adulthood a. Smoking B. MIDDLE ADULTHOOD b. Alcohol abuse 40 - 60 years old c. Harmful working environment The aging process becomes more apparent. d. Lack of exercise, sleep, and relaxation Physical activities typically begin to decrease. Decreased caloric requirement for most individuals. ADULTHOOD A period of life when one has attained full growth & MIDDLE ADULTHOOD CHANGES (MAC) : maturity 1. Physical Changes ○ Young Adulthood → 20 - 40 years old Height ○ Middle Adulthood → 40 - 65 years old ○ One-half is lost every 10 years after age 40’s. ○ But uncommon to lose 1-3 inches. A. YOUNG ADULTHOOD 20 - 40 years old Weight The young adult years are periods of optimal ○ Men often gain weight until middle age, at age physical function, the peak years of strength and 55; agility. The 20’s are typically unmarred by the ○ Begin to lose weight later in life. presence of acute and chronic illness ○ Women gain weight until age 65, then begin to lose weight after. YOUNG ADULTHOOD DEVELOPMENT AND CHANGES (YDAC) MIDDLE ADULTHOOD CHANGES (MAC) : 2. Physiological Changes Physiological - good visual acuity and Hair development hearing up 40 years old ○ Begins to grow more slowly and become thin because the diameter of the hair follicles - good muscle strength decreases. and coordination age ○ Male pattern hair loss or balding, commonly 25 - 30 years occurs. Touch - dental maturity: ○ The sense of touch begins to decline at about eruption of molars age 45 and the tolerance of pain at about age 50. - hair thickest diameter The lens of the eyes ○ gradually becomes less elastic = loss of ability - extremely effective to focus clearly on visual images within close immune system range. Cardiovascular and pulmonary system - brain cell development ○ The contractility of the heart decreases = low cardiac index. SOLON 33 of 43 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 125: NUTRITION & DIET THERAPY MIDTERM RELEASE 1 - NUR125 - 2728 Respiratory function the infant and mother ○ may also diminish during age 30’s and 40’s ○ The lung and bronchi become less elastic = After menopause, Iron decreased maximal lung capacity. requirement for Bowel pattern women matches that ○ Less frequent bowel movements = decrease GI of men. motility and physical activity. Physiological Changes in Women FOLIC ACID - Pregnant women ○ Cessation of menses occurs at age 45 - 50. require sufficient intake ○ Decreased estrogen production “hot flushes” of folic acid and iron to occurs in the majority of women. prevent birth defects ○ Emotional reactions: anxiety, nervousness, and iron-deficiency and mood swings. anemia Physiological Changes in Men ○ Most men may experience symptoms - Food sources of folate associated with menopause. include lentils, spinach, ○ Gradual decrease of testosterone level. broccoli, and other ○ S/sx: insomnia, fatigue, and the circulatory leafy green vegetables problems. MENOPAUSAL - Avoid alcohol, spicy MIDDLE ADULTHOOD CHANGES (MAC) : ○ Cessation of foods, and caffeine. 3. Psychosocial Development menses occurs at These can make Erikson identified as GENERATIVITY vs. about age 45-50 menopausal symptoms SELF-ABSORPTION AND STAGNATION ○ Women worse. experience Cognitive Development: symptoms of - Try to maintain a The 50’s are probably the most stable decade “hot flushes”, healthy weight. Women of life. It is also when emotional maturation anxiety, who are overweight or and intellectual development peak. Most nervousness, and obese = more frequent people do not fear old age, but they also have mood swings. and severe hot flashes no strong desire to return to their youth. POST MENOPAUSAL - ↑ Calcium in diet Special Considerations Nursing considerations ○ women need to to Specific Age Group in relation to food know the - Intake of calcium, intake and behavior preventive substituting vegetable modification strategies for proteins for animal osteoporosis. protein. Rich in Reproductive Age 15- Calcium, Vitamin D, 49 years old Magnesium, and Flouride IRON Iron requirement for women throughout - weight bearing the child-bearing exercises program; 30 years remains higher mins. of exercise 3-6x than that for men /week Extra iron is - ceasing intake of necessary to caffeine, alcohol, and compensate for nicotine menstrual blood loss and build maternal RHEUMATOID - Mediterranean diet blood needed during ARTHRITIS (RA) pregnancy for both ○ affects the - Best foods: fatty fish wrists, joints of such as salmon and SOLON 34 of 43 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 125: NUTRITION & DIET THERAPY MIDTERM RELEASE 1 - NUR125 - 2728 the fingers other tuna, soy foods, extra surrounding vegetables, sweet than those virgin olive oil, cherries tissues. potatoes, carrots, closest to the and berries, green tea, pumpkin, winter fingernail, hips, citrus, whole grains, squash, tomatoes, knees, ankles, and nuts citrus fruits and brussel elbows, sprouts. It lowers the shoulders, feet, - A multiple vitamin risk of cancer of the and neck containing vitamin D larynx and esophagus. ○ an autoimmune and a calcium disease, usually supplement should be 2. Cabbage, broccoli, occurs between taken daily brussel sprouts and the ages of 30 cauliflower reduce the and 60 - Pro-inflammatory foods risk of GI and ○ Women are about such as sugar, respiratory tract cancer. two to three saturated and trans fat, times more likely and refined 3. Fruits, vegetables and to get RA than carbohydrates should whole grain cereals men. be limited such as oatmeal, bran ○ Hormones in both and wheat may help genders may play lower the risk of a role in either colorectal cancer. preventing or triggering it 4. Cabbage prevents cancer. In fact, all the HEART DISEASE - Lifestyle changes vegetables which fall ○ The leading exercise, diet, and into a group of plants cause of death in ceasing cigarette known as cruciferae middle Disease, smoking. Exercise for have an anticancer followed by 15 to 20 minutes three effect. Some malignant to four times a week. cruciferous vegetables neoplasms such are cabbage, as prostatic and - Walking (as opposed cauliflower, broccoli, colorectal cancer to jogging) has been brussel sprouts, in men and recommended; other mustard and collard breast cancer in safe exercises are greens, watercress, women. swimming, biking, or kohlrabi turnip, roller skating. rutabaga, and radish. - The possible 5. Drink moderate psychosocial benefits amounts of alcoholic includes alleviating beverages. symptoms of anxiety and physiologic DEPRESSION - Protein-Rich Foods response to stress, ○ Depression is Boost Alertness Foods which lead to midlife stressors like turkey, tuna, and improvement of or life-threatening chicken have an amino physical well-being diseases is a acid called tryptophan, potential for which may help you CANCER 1. Carotene – a form of suicidal gestures. make serotonin. Try to ○ The body’s cells vitamin A present in ○ Early eat something with begin to divide cantaloupes, peaches, midlife-crisis from protein several times without stopping broccoli, spinach, all around 25 to 35 a day, especially and spread into dark green leafy years when you need to SOLON 35 of 43 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 125: NUTRITION & DIET THERAPY MIDTERM RELEASE 1 - NUR125 - 2728 ○ A midlife crisis clear your mind and sources, or more likely might occur boost your energy add a supplement of anywhere from vitamin D. Increasing this about age 37 - Good sources of amount could prevent through the 50s healthy proteins osteoporosis include beans and peas, lean beef, low-fat OTHER VITAMINS AND cheese, fish, milk, MINERALS: poultry, soy products, and yogurt Magnesium - Magnesium contributes - A study found that rates Vitamin E to bone strength, of depression tended Vitamin A immunity, and numerous to rise in men who are Vitamin C body functions smokers who got less folate. - Potassium plays a critical role in muscle - Women who smoked or contractions, nerve didn't exercise but impulses, and when they got less maintaining fluid balance vitamin B12. in the body - Eating a variety of green NUTRIENT ADULTHOOD (20 - 50 vegetables, beans, and REQUIREMENTS: years old) dairy products → potassium. Protein - Healthy individuals Protein needs for healthy - Vitamins A, E, and C adults at 0.8 g per contain powerful kilogram of body weight antioxidant properties that offer a variety of Calcium requirement - Ca- 1000 mg. health benefits including and Vitamin D - Vit. D - 15 ug per day maintaining eye health (or 600 IUs) and vision, combating free radicals, and - Both calcium and repelling germs to vitamin D are essential for achieve a healthy strong bones, and both immune system. are found in milk (fat-free milk should be consumed Body Mass Index - After age 25, a person to limit amount of fat in (BMI)/ Resting Energy will gain weight if the total the diet. Expenditure (REE ) calories are not reduced according to actual need, - (3) glasses of milk a which will be determined day nearly fulfill the by activity, BMI (REE), requirement for calcium; and amount of lean body however, the level of mass. Those who are vitamin D in three glasses more active will require of milk still falls short of more calories than those the newer recommended who are less active. allowance. FEEDING THE YOUNG AND MIDDLE ADULTHOOD - Most people will need 1. Eat variety of food to include other vitamin D 2. Maintain ideal weight SOLON 36 of 43 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 125: NUTRITION & DIET THERAPY MIDTERM RELEASE 1 - NUR125 - 2728 3. Avoid too much fat. Saturated fat & cholesterol HARMFUL WORKING ENVIRONMENT 4. Eat foods w/ adequate starch & fiber Issues on air pollution & personal safety & security 5. Avoid too much sugar Sanitary conditions of the community & practices by the family need constant monitoring 6. Avoid too much sodium 7. If you drink alcohol, do so in moderation LACK OF EXERCISE, SLEEP, & RELAXATION Stress factors e.g. anxiety, worries, fears, anger & To stay healthy, these must be observed & followed: depression occur during adulthood 2. Maintain ideal weight - overweight can introduce They are controllable with proper nutrition, health problems (diabetes mellitus-NIDDM and coronary exercise, adequate rest & sleep artery disease, metabolic syndrome, hypertension, and Wellness programs help alleviate stress factors other diseases ) Overweight individuals are at risk for Can seek professional help with a psychologist, spiritual counselor or occupational therapist surgery. ○ A decrease of 3% daily caloric allowance is suggested by Food Agriculture and Organization (FAO) for each decade of 30 to 39 years and 40 to 49 years because the resting metabolic rate declines brought about by loss of lean body mass ○ Avoid too much fat, saturated fat & cholesterol. Foods high in fats, salt, or nitrite-cured foods like ham and fish and types of sausages smoked by traditional methods should be eaten in moderation ○ Milk, especially 2-3 cups of Vitamin D fortified skim milk a day, may help ward off colon cancer Eat foods w/ adequate starch & fiber Avoid too much sugar Avoid too much sodium If you drink alcohol, do so in moderation SMOKING Nicotine ↑ the need for Vit. C Habitual smokers often lose appetite & eat less Ability to use oxygen & exhale carbon dioxide is diminished Emphysema & COPD are respiratory disorders related to long hx of smoking Programs on how to quit smoking are given free in many medical centers ALCOHOL ABUSE Heavy drinking displaces meals resulting in nutritional deficiencies Alcohol alters metabolism Has harmful effects on vital organs like the liver, heart, brain & kidneys Affects also the social, economic, emotional & overall personality of the individual SOLON 37 of 43 The CNSC does not intend