Oral Care Study Guide PDF

Oral Care [Guidelines for Brushing Teeth (Table 31-1)] +-----------------------------------+-----------------------------------+ | 4. Apply a small amount of | Frequency: Brush after each meal | | toothpaste to the toothbrush | or at least twice daily |...

Oral Care [Guidelines for Brushing Teeth (Table 31-1)] +-----------------------------------+-----------------------------------+ | 4. Apply a small amount of | Frequency: Brush after each meal | | toothpaste to the toothbrush | or at least twice daily | +===================================+===================================+ | 1. Use gentle scrubbing motions | Duration: at least 2 minutes, | | at a 45-degree angle against | cleaning all tooth surfaces | | the gum line | systematically | +-----------------------------------+-----------------------------------+ | 2. Gently brush the upper | **AVOID**: excessive force | | surface of the tongue to | results in bristle damage, | | remove debris, plaque, and | cervical abrasion, irritation of | | bacteria | gingival tissue, or gingival | | | recession with associated | | | hypersensitivity | +-----------------------------------+-----------------------------------+ | 3. Rinse mouth and spit out all | | | of the water | | +-----------------------------------+-----------------------------------+ [Guidelines for Using Dental Floss (Table 31-2)] +-----------------------------------+-----------------------------------+ | 4. Pull out 18 in of floss and | 7. Hold the floss tightly | | wrap most of it around the | against the tooth to gently | | middle finger | scrabe the side of the tooth | | | with an up and down motion | +===================================+===================================+ | 1. Wrap the remaining floss | 5. Curve the floss around the | | around the same finger of the | adjoining tooth and repeat | | opposite hand so about an in | | | of floss is held between the | | | thumbs and forefingers | | +-----------------------------------+-----------------------------------+ | 2. Use a gentle, sawing motion | 6. Advance the length of the | | to guide the floss up and | loss to use a new segment for | | down the gum line | each tooth surface | +-----------------------------------+-----------------------------------+ | 3. Curve the floss into a C | | | shape against one tooth once | | | the gum line is reached and | | | gently slide the floss into | | | the space between the gum and | | | tooth until there is | | | resistance | | +-----------------------------------+-----------------------------------+ [Guidelines for Toothpaste Use] +-----------------------------------+-----------------------------------+ | [Adults] | [Children] | +===================================+===================================+ | - *Amount*: size of a pea of a | - Amount: | | fluoride-containing | | | toothpaste | - \< 3: size of a rice | | | grain | | - *Frequency*: BID | | | | - \> 3: size of a pea | | - *Location*: inner, outer, and | | | chewing surfaces | - Start brushing when their | | | teeth first erupt | | - Floss at least daily | | | | - Spit but no rinse | | - Use a soft toothbrush and | | | change every 3-4 mo | - Fluoride-containing | | | toothpaste | | - Hold at 45-degree angle | | | | - Supervision! parental | | | education (too much fluoride | | | causes brown spots/pits) | +-----------------------------------+-----------------------------------+   [Tooth Hypersensitivity vs. Toothache (Table 32-1)] +-----------------------+-----------------------+-----------------------+ | **Characteristic** | **Teeth | **Toothache** | | | Hypersensitivity** | | +=======================+=======================+=======================+ | Etiologic Mechanism | Exposed and open | Bacterial invasion | | | dentin tubules | extending to the pulp | +-----------------------+-----------------------+-----------------------+ | Pathophysiology | Stimuli causes fluid | Inflammatory response | | | in the dentinal | to invading bacteria | | | tubules to expand and | stimulates free nerve | | | shrink, stimulating | endings in the pulp | | | pulp nerve fibers and | | | | resulting in pain | | +-----------------------+-----------------------+-----------------------+ | Causes | - Attrition | - Cavitation/decay | | | | under existing | | | - Abrasion | restoration | | | | | | | - Erosion | - Tooth/restoration | | | | fracture | | | - Tooth/restoration | | | | fracture | - Trauma to the | | | | dentition | | | - Faulty | | | | restoration | | | | | | | | - Gingival | | | | recession | | +-----------------------+-----------------------+-----------------------+ | Symptoms | Quick, fleeting, | Pain that remains in | | | sharp, or stabbing | the absence of | | | pain on exposure to | stimulus that may | | | stimuli which stops | cause: | | | after stimuli are no | | | | longer present | - [Reversible | | | | damage]{.underlin | | | | e}: | | | | intermittent, | | | | short, sharp pain | | | | on stimulation OR | | | | | | | | - [Irreversible | | | | damage]{.underlin | | | | e}: | | | | continuous, dull, | | | | and throbbing | | | | pain without | | | | stimulation | +-----------------------+-----------------------+-----------------------+ | Assessment | Due to attrition, | Referral! (requires | | | abrasion, or erosion | dental care) | | | Not serious and | | | | self-treatable | | | | | | | | Due to fracture, | | | | faulty restoration or | | | | gingival recession | | | | **referral** to | | | | dentist | | +-----------------------+-----------------------+-----------------------+  [Teeth Whitening (Article)] Poisoning & Misuse/Abuse of OTCs +-----------------------+-----------------------+-----------------------+ | **Poisoning** | **Misuse** | **Abuse** | +=======================+=======================+=======================+ | Use of any substance | Unintentional | Intentional use of | | harmful to the body | incorrect use of a | OTC meds for | | via oral, inhalation, | medication used for | non-medical purposes | | injection, or topical | medical purposes | | | | | | | | 3 Types: | | | | | | | | 1. Taking a dose or | | | | taking | | | | differently other | | | | than as directed | | | | (EX: older | | | | adults) | | | | | | | | 2. Taking the med | | | | for an effect it | | | | can cause (EX: | | | | robotripping) | | | | | | | | 3. Mixing OTC meds | | | | together to | | | | create new | | | | products (EX: | | | | meth) | | +-----------------------+-----------------------+-----------------------+ **[National Poison Control Calls Statistics]**  OTC Abuse [Statistics] - Common substances used by students in HS - Alcohol - Vaping - Cigarettes - **Rx drugs** - **OTC drugs** - Cocaine - Meth - Heroin - DXM (1 in 31 teens) problem! **[Commonly Abused OTCs]** +-------------+-------------+-------------+-------------+-------------+ | **OTC** | **Reason** | **Other | **Doses | **Other | | | | Effects** | Needed for | Info** | | | | | Effects** | | +=============+=============+=============+=============+=============+ | 1^st^ | - Euphori | - CV: | Vary widely | Tiktok | | Generation | c | heart | and depends | "Benedryl | | Antihistami | effect | complic | on body | Challenge" | | nes | | ations | weight/drug | to take up | | | - Halluci | | tolerance | to 12 | | | nations | - CNS: | | tablets at | | | | confusi | | a time to | | | | on, | | induce | | | | irritab | | hallucinati | | | | ility, | | ons | | | | CNS | | | | | | depress | |  | | | | seizure | | | | | | s | | | | | | | | | | | | - Anticho | | | | | | linergic | | | | | | effects | | | | | | : | | | | | | urinary | | | | | | retenti | | | | | | on, | | | | | | blurred | | | | | | vision, | | | | | | dry | | | | | | mouth | | | | | | | | | | | | - Death | | | +-------------+-------------+-------------+-------------+-------------+ | Dextrometho | - Euphori | - N/V | Vary widely | Some people | | rphan | c | | and depends | inject | | (DM, DXM) | effect | - Respira | on body | | | | (robotr | tory | weight/drug | | | | ipping | depress | tolerance | | | | when | ion | | | | | mixed | | | | | | with | - Death | | | | | soda | | | | | | for | | | | | | flavor) | | | | | | | | | | | | - Halluci | | | | | | nations | | | | +-------------+-------------+-------------+-------------+-------------+ | Stimulant | - Weight | - Electro | N/A |  | | | (but | & fluid | | | | - Bisacod | only | imbalan | | | | yl | actuall | ces | | | | | y | that | | | | - Sennosi | water | may | | | | des | and | lead to | | | | | waste) | cardiac | | | | - Castor | | arrhyth | | | | oil | | mias | | | | | | (and | | | | | | eventua | | | | | | lly | | | | | | death) | | | | | | | | | | | | - Physica | | | | | | l | | | | | | and | | | | | | psychol | | | | | | ogical | | | | | | depende | | | | | | nce | | | | | | | | | | | | - Can't | | | | | | have | | | | | | bowel | | | | | | movemen | | | | | | t | | | | | | w/o | | | +-------------+-------------+-------------+-------------+-------------+ | Loperamide | - Euphori | - Cardiac | Very high |  | | heal) | | mias | | | | | - Prevent | | | | | | opioid | - Death | | | | | withdra | | | | | | wal | | | | | | symptom | | | | | | s | | | | | | | | | | | | - Lessen | | | | | | opioid | | | | | | craving | | | | | | s | | | | +-------------+-------------+-------------+-------------+-------------+ | Pseudoephed | - Halluci | - CV: | 4-5x | Historicall | | rine | nations | arrhyth | therapeutic | y | | (PSE) | or | mias, | dose | used to | | | "body | elevate | | create meth | | | high" | d | | | | | | BP | | | | | | | | | | | | - CNS: | | | | | | psychot | | | | | | ic | | | | | | symptom | | | | | | s, | | | | | | insomni | | | | | | a, | | | | | | seizure | | | | | | s, | | | | | | coma | | | +-------------+-------------+-------------+-------------+-------------+ | Propylhexed | - Stimula | - Similar | Remove of | Also known | | rine | tion | to | drug from | as | | | | pseudoe | inhaler to | parachuting | | | | phedrine | swallow or | , | | | | | inject | bombing, | | | | - Lung | myocardial | dropping | | | | damage: | infarction/ | | | | | high BP | lung | - Commonl | | | | | damage | y | | | | - Overhea | | wrapped | | | | ting/dehydr | | in | | | | ation | | tissue | | | | | | papper | | | | - Had | | to | | | | "crash" | | avoid | | | | after | | bad | | | | wearing | | taste | | | | off | | | +-------------+-------------+-------------+-------------+-------------+ **Pharmacist Role:** - **(Article) Importance**: pharmacists should remain aware of potential physical, behavioral, and psychological signs of drug abuse (physical appearance, impaired coordination, large or small pupils, irritability or anger, and anxiousness), purchasing large amounts of OTC at once or over period of time - Store browsing & purchasing vigilance - **OFFER CONSULTATIONS:** - Advice about possible abuse/addiction - Refer to medical provider - Refer to drug/alcohol abuse team - Raise awareness of online abuse support groups - Innovations for the future - Log book - Keeping implicated products out of sight/behind counter - Consult policy & pharmacist may refuse to sell - Get involved in harm reduction programs through clinics/health systems or communities - Behind-the-counter (BTC): cannot sell without having a consultation (EX: Meriter hospital outpatient pharmacy) Heartburn & Dyspepsia +-----------------------+-----------------------+-----------------------+ | Heartburn | GERD | Dyspepsia | | | | (indigestion) | +=======================+=======================+=======================+ | Burning in the | Chronic condition of | Symptoms originate | | stomach or lower | frequent reverse flow | from gastroduodenal | | chest that may extend | of stomach acid and | region and occur | | up toward the neck | contents into the | **together: early | | and occasionally to | esophagus | satiety, postprandial | | the back | | fullness (bloating), | | | - **Pharmacists | epigastric pain or | | - Also known as: | cannot recommend | burning** | | acid | therapy for | | | regurgitation, | this!** | - Associated | | acid indigestion, | | symptoms: | | sour stomach, | | anorexia, | | bitter belching | | belching, nausea, | | | - Heartburn 2 or | vomiting, upper | | - Main symptom of | more times per | abdominal | | GERD | week, usually for | bloating, | | | weeks | heartburn, | | - Onset: within 1 | | regurgitation | | hour after | - Complications: | (backflow of | | eating, usually | esophagitis, | content | | large meals | esophageal | **without** | | | stricture, | feelings of | | - Aggregating | Barrett's | nausea) | | factors: laying | esophagus | | | down or bending | (pre-cancer) | | | over | | | +-----------------------+-----------------------+-----------------------+ | Symptom |  | | | | | | | - *[Mild]{.underlin | | | | e}*: | | | | a little | | | | bothersome but | | | | doesn't affect | | | | normal activities | | | | | | | | - *[Moderate]{.unde | | | | rline}*: | | | | somewhat annoying | | | | or interferes | | | | with normal | | | | activities | | | | | | | | - *[Severe]{.underl | | | | ine}*: | | | | alarm symptoms | | | | (exclusions) | | | +-----------------------+-----------------------+-----------------------+ | Associated symptoms: | | | | | | | | - Regurgitation | | | | (bitter acid | | | | fluid in back of | | | | throat) | | | | | | | | - Water brash | | | | (sudden | | | | appearance of | | | | clear, salty | | | | fluid from | | | | salivary glands) | | | | | | | | - Burping | | | | | | | | - Hiccups | | | | | | | | - Nausea | | | | | | | | - Vomiting | | | +-----------------------+-----------------------+-----------------------+ | Risk Factors: | | | | | | | | - Exercise (abs) | | | | | | | | - Fatty, acidic, | | | | spicy foods | | | | | | | | - Alcohol | | | | | | | | - Some medications | | | | and conditions | | | +-----------------------+-----------------------+-----------------------+  **[Special Populations Considerations]** +-----------------------+-----------------------+-----------------------+ | **Pregnancy** | **Children \> 2 yr w/ | **Older Adults** | | | mild, transient, | | | | infrequent HB or sour | | | | stomach** | | +=======================+=======================+=======================+ | - Lifestyle/food | - Children's | - Triage carefully | | changes first | formulas of | as HB can be | | | calcium carbonate | indicative of | | - 1^st^ line OTC: | antacid + | more serious | | calcium or | lifestyle/food | pathology | | magnesium | changes | | | antacids | | - Consider | | | - Refer if frequent | drug-drug | | - MAX food/OTC | HB or antacid | interactions | | calcium per day: | ineffective | | | 2500 mg | | - Consider other | | | - MAX total | health conditions | | | food/OTC calcium | & kidney function | | | per day: | | | | | - Avoid H2Ras if | | | - Ages 2-3: 700 | risk for delirium | | | mg | | | | | - Short course PPI | | | - Ages 4-8: | (**14 days**) | | | 1000 mg | likely ok but | | | | long-term risk | | | - Ages 9-18: | for C. diff | | | 1300 mg | infection, | | | | fractures, | | | | long-term use | | | | only if ok with | | | | medical provider | +-----------------------+-----------------------+-----------------------+ Infant & Child Nutrition **[Infant Growth & Maturation]** +-----------------+-----------------+-----------------+-----------------+ | GI | - Stomach | Functional | | | | capacity is | Maturity: | | | | smaller at | | | | | birth and | | | | | grows | | | | | | | | | | - Human milk | | | | | empties | | | | | faster from | | | | | the stomach | | | | | more | | | | | frequent | | | | | feedings | | | | | | | | | | - Short small | | | | | intestine | | | | | length | | | | | affects | | | | | nutrient | | | | | absorption | | | +=================+=================+=================+=================+ | | - | Nutritive | Gastric: | | | | sucking: | | | | | | - Motility | | | | - Depends on | delayed in | | | | coordinatio | first few | | | | n | days of | | | | of sucking, | life | | | | swallowing, | | | | | and | | | | | breathing | | | | | | | | | | - Swallowing | | | | | develops by | | | | | end of | | | | | first | | | | | trimester | | | | | | | | | | - Sucking | | | | | develops | | | | | \~22-23 | | | | | weeks | | | | | gestation | | | | | | | | | | Effective Suc | | | | | king | | | | | | | | | | Nutr | | | | | itive Sucking | | | | | ------------- | | | | | --------------- | | | | | --------------- | | | | | ---------- ---- | | | | | --------------- | | | | | --------------- | | | | | --------------- | | | | | --------------- | | | | | ------ | | | | | Rhythmic alte | | | | | rnation between | | | | | suction and sw | | | | | allowing Deve | | | | | lops 33-34 week | | | | | s gestation; ma | | | | | ture pattern at | | | | | 37 weeks gesta | | | | | tion | | | | | | | | | | Premature | | | | | infants: | | | | | inefficient | | | | | pattern for | | | | | [\>]{.underline | | | | | } | | | | | 1 mo of life | | +-----------------+-----------------+-----------------+-----------------+ | Kidney | - Filtration | | | | | begins week | | | | | 9 in fetus | | | | | | | | | | - GFR reaches | | | | | adult | | | | | values in | | | | | 3^rd^ year | | | | | of life | | | +-----------------+-----------------+-----------------+-----------------+ **[Weight]** - Average birth weight: 3500 g (7 lbs 11 oz) - Premature infant categories: low-birth-weight, very low-birth-weight, extremely low-birth, micropreemies - Water weight loss 6-10% immediately after birth - Infants double birth weight by 4-6 mo, triple by 12 mo - Normal values for length/height, weight, and head circumference expressed in percentile for age **[Basic Requirements of Healthy Diet]** +-----------------------------------+-----------------------------------+ | Water | - Holliday-Segar Method: | | | | | | - Premature infants: 120-170 | | | mL/kg/day | | | | | | - Human milk or formula = | | | adequate daily water for | | | first 6 mo of life | | | | | | - Daily fluid losses: urine, | | | evaporation from skin/lungs, | | | feces | +===================================+===================================+ | Carbohydrates | - 40-50% of daily calorie needs | | | (kcal/day) | | | | | | - Primary source: lactose from | | | human milk or milk-based | | | formula | | | | | | - Balance with fat intake for | | | proper neurologic development | | | | | | - Fiber: whole cereals, green | | | veggies, legumes for 6-12 mo | +-----------------------------------+-----------------------------------+ | Proteins & AA | - Total body protein increases | | | from 11% 15% of body weight | | | in 1^st^ year | | | | | | - Preterm infants: early higher | | | protein needs not met by | | | human milk so fortification | | | with commercial | | | powders/liquids needed | | | | | | - Human milk protein content | | | changes with growing infant | | | needs (human body knows) | | | | | | - Essential AA that can't be | | | synthesized from other AA: | | | histidine, isoleucine, | | | leucine, lysine, methionine, | | | phenylalanine, threonine, | | | tryptophan, and valine (NOT | | | cysteine or tyrosine) | | | | | | - Taurine (non-protein AA) is | | | especially important | | | | | | - High amounts in human | | | milk, all formulas | | | supplemented | | | | | | - Building block (not a | | | source of energy) | | | | | | - Cell membrane protector | | | | | | - Deficiency problems with | | | vision, hearing, fat | | | absorption | +-----------------------------------+-----------------------------------+ | Fatty & Essential Fatty Acids | - 9 kcal/g and 50% of | | | non-protein energy in human | | | milk/formula | | | | | | - NEEDED for proper growth & | | | development | | | | | | - Do NOT restrict fat if \< | | | 2 yr unless advised by MD | | | | | | - 12 mo-2 yr & at increased | | | risk for CVD: used | | | reduced-fat milk products | | | as advised by MD | | | | | | - 2 essential polyunsaturated | | | fatty acids (PUFAs): | | | | | | Linoleic acid (omega-6 fatty | | | acid) arachidonic acid (ARA) | | | | | | Linolenic acid (omega-3 fatty | | | acid) docosahexaenoic acid | | | (DHA) most common | | | | | | - Pregnancy/lactation: | | | supplementation of DHA and | | | ARA during | | | pregnancy/lactation is | | | controversial so consult MD | +-----------------------------------+-----------------------------------+ | Micronutrients | - Formulas supplemented to meet | | | daily needs | | | | | | - Human milk needs | | | **fortification** to meet | | | needs of premature infants | +-----------------------------------+-----------------------------------+ **[Infant Food Sources]** +-----------------------+-----------------------+-----------------------+ | **Human Milk** | **Animal Milk (Cow or | **Commercial Infant | | | Goat)** | Formulas** | +=======================+=======================+=======================+ | - Recommendation of | Cow: | - Four types: | | exclusive | | | | breast/chest | - Whole, reduced | 1. Premature | | feeding for first | fat (skim 0.1%, | | | 6 mo of life + | low-fat 1%, | 2. Newborn | | recommend through | reduced-fat 2%) | | | 12 mo if | | 3. Infant/Toddler | | appropriate | - NOT for infants | | | | \< 1 yr because | 4. Specific health | | +--------+--------+ | there is too much | condition | | | Infant | Parent | | iron and protein | (requires a | | | Benefi | Benefi | | | prescription) | | | ts | ts | | - Reduced fat NOT | | | +========+========+ | for \< 2 yrs | Manufactured as... | | | - Op | - Im | | (unless MD | | | | timal | proved | | recommends for | - Base types: | | | nu | bo | | CVD) | | | | tritio | nding | | | 1. Milk-based | | | nal | | | - AVOID evaporated | | | | so | - ↓ | | milk | 2. Soy protein | | | urce | po | | | | | | | stpart | | - Source of | 3. Casein | | | - Im | um | | commercially | hydrosylate-based | | | proved | bl | | prepared, | | | | bo | eeding | | milk-based infant | - Formulations | | | nding | | | formula | | | | | - ↓ | | | 1. Concentrated | | | - ↓ | me | | | liquid, powder, | | | ri | nstrua | | | or ready-to-feed | | | sk | l | | | | | | of | bl | | | - Standard, | | | in | ood | | | fortifier, | | | fectio | lo | | | therapeutic, and | | | n | ss | | | modular (see | | | & | | | | table below) | | | di | - ↑ | | | | | | seases | sp | | | Compositions vary to | | | | acing | | | best fit infant needs | | | - *P | be | | | | | | ossibl | tween | | | | | | e* | ch | | | | | | en | ildren | | | | | | hanced | | | | | | | pe | - Ea | | | | | | rforma | rlier | | | | | | nce | re | | | | | | on | turn | | | | | | co | to | | | | | | gnitiv | pr | | | | | | e | e-preg | | | | | | de | nancy | | | | | | velopm | we | | | | | | ent | ight | | | | | | | | | | | | | | - ↓ | | | | | | | ri | | | | | | | sk | | | | | | | of | | | | | | | RA | | | | | | | or | | | | | | | po | | | | | | | stmeno | | | | | | | pausal | | | | | | | hi | | | | | | | p | | | | | | | fr | | | | | | | acture | | | | | | | , | | | | | | | os | | | | | | | teopor | | | | | | | osis | | | | | | | | | | | | | | - No | | | | | | | \$ | | | | | | | \$ | | | | | | | fo | | | | | | | r | | | | | | | fo | | | | | | | rmula | | | | | | | pu | | | | | | | rchase | | | | | | | s | | | | | +--------+--------+ | | | | | | | | Other sources: human | | | | milk donor banks! | | | +-----------------------+-----------------------+-----------------------+ | Contraindications: | Goat: | | | | | | | ☐ HIV infection (in | - Powdered, | | | US) | evaporated | | | | | | | ☐ Infant galactosemia | - Fat digested more | | | | easily than cow | | | ☐ Parental untreated | milk | | | TB | | | | | - Must be fortified | | | ☐ Parental human T | with folate, | | | cell lymphotropic | iron, % vitamin D | | | virus type I or II | | | | infection | | | | | | | | ☐ Presence of a | | | | herpes simplex lesion | | | | on the breast | | | | | | | | ☐ Parental use of | | | | contraindicated | | | | medications | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ **[Commercial Infant Considerations:]** +-----------------------------------+-----------------------------------+ | Standard Formula | - Liquid formulations must be | | | sterile | | | | | | - Premature & immunocompromised | | | infants should only receive | | | liquid or ready to feed | | | (sterile options) | | | | | | - Formulas may be fortified or | | | made to be more concentrated | | | by varying amount of water | | | added ***ONLY concentrate | | | with medical advice*** (risk | | | of dehydration) | +===================================+===================================+ | Modular Macronutrient Components | - Can add to either human milk | | | or infant formula (alt to | | | concentrated formula) | | | | | | - Protein, carbs, fat, and | | | combos | | | | | | - More expensive and time | | | consuming than concentrating | | | formula | | | | | | - Use when only a single | | | nutrient is needed for adding | | | to a formula or concentrating | | | further not appropriate | | | | | | - Use ***ONLY with medical | | | advice*** | +-----------------------------------+-----------------------------------+ | Human Milk Fortifiers: | - Parents who give birth to | | | premature infants produce | | | fortified milk | | | | | | - Even preterm milk can't | | | supply all nutritional needs | | | requires supplementation | | | | | | - Supplementation products are | | | liquid and mixed into 60-100 | | | mL of human milk | +-----------------------------------+-----------------------------------+ | Therapeutic Formulas: | - For infants with health | | | conditions requiring dietary | | | adjustment | | | | | | - ***Use with medical | | | provision*** | | | | | | - | | | | | | Indications: | | | | | | - Allergy or sensitivity to cow | | | milk or soy protein | | | | | | - Biliary atresia | | | | | | - Celiac disease | | | | | | - Cystic fibrosis | | | | | | - Various causes of diarrhea | | | | | | - Gastroesophageal reflux | | | | | | - Hepatitis | | | | | | - Lactose intolerance | | | | | | - Prematurity | | | | | | - Refractory seizure disorder | | | | | | - Renal insufficiency | +-----------------------------------+-----------------------------------+ **[General Equipment Preparation]** 1. Wash hands before handling feeding materials or preparing formula 2. Sterilize feeding equipment - Using tongs, place all equipment in a deep pan or sterilizer & cover all equipment with cold tap water a. Bring to a rolling boil and continue boiling for **5 min** OR sterilize in a dishwasher with a heated drying cycle (avoid boiling for longer) b. Remove equipment from pan using tongs & place on clean towel with their open ends facing down **[Specific Sterilization Methods for Infant Formula Preparation (Table 26-12)]** +-----------------------+-----------------------+-----------------------+ | Concentrated Liquid | Cans: | Bottles: | | Formula | | | | | - Wash top of can | - Remove protective | | | w/ hot water and | cap | | | detergent, rinse | | | | in hot running | - Shake well | | | water, and dry | | | | | | | | - Shake well | | +=======================+=======================+=======================+ | | - Mix appropriate | | | | amounts of | | | | concentrated | | | | liquid and | | | | sterilized water | | | | using a measuring | | | | cup | | | | | | | | - Tightly cover any | | | | unused formula | | | | | | | | - **Beyond Use | | | | Dating**: | | | | refrigerate up to | | | | 48 hours of | | | | preparation | | +-----------------------+-----------------------+-----------------------+ | Powdered Formula | - Wash top of can | | | | with hot water | | | | and detergent, | | | | rinse in hot | | | | running water and | | | | dry | | | | | | | | - Open can and mix | | | | appropriate | | | | amounts of powder | | | | and sterilized | | | | water using scoop | | | | | | | | - **Beyond Use | | | | Dating**: | | | | refrigerate up to | | | | 48 hours if | | | | unused, | | | | reconstituted | | | | liquid & store at | | | | room temp up to 1 | | | | mo if unused | | | | powder | | | | | | | | - **Use within**: | | | | **24 hours** of | | | | preparation | | +-----------------------+-----------------------+-----------------------+ | Ready-to-Use | - Wash top of can | | | Cans/Ready-to-Use | with hot water | | | Formula | and detergent, | | | | rinse in hot | | | | running water, | | | | and dry | | | | | | | | - Shake well and | | | | open with can | | | | opener | | | | | | | | - Add amount of | | | | formula for a | | | | single feeding to | | | | one sterilized | | | | bottle or to the | | | | number of bottles | | | | needed for a full | | | | day | | | | | | | | - Do NOT add water | | | | | | | | - **Beyond Use | | | | Dating:** | | | | refrigerate up to | | | | 48 hours tightly | | | | covered after | | | | opening | | +-----------------------+-----------------------+-----------------------+ | Ready-to-Use Bottles | - Protective cap | | | | must be removed | | | | and a sterile | | | | nipple cap must | | | | be screwed onto | | | | the bottle | | | | | | | | - Shake each bottle | | | | well | | +-----------------------+-----------------------+-----------------------+ **[Preparing Formula for Feeding:]** +-----------------------+-----------------------+-----------------------+ | 1. **Sterilization | 2. **Formulas** | 3. **Assemble | | of water** | | Equipment and | | | | Feeding** | +=======================+=======================+=======================+ | - Tap or bottled | - Wash top of can | - Shake each bottle | | | with hot water | before feeding | | - Bring to a | and detergent, | | | rolling boil for | rinse in hot | - Warm in hot water | | 1-2 min then | water, and dry | or hold under | | allow to cool to | | hot, running | | room temp for 1-2 | - Shake liquid | water (NEVER | | min | formulas (not | microwave) | | | needed for | | | - Let sit off stove | powders) | - Never boil or | | for 30 min | | overheat formula | | minimum | - Mix appropriate | | | | amounts of | - Test temperature | | | sterilized water | before feeding | | | & formula | baby with the | | | (concentrated | wrist | | | liquids or | | | | powdered) | - After feeding, | | | | discard any | | | - Do NOT dilute | formula left in | | | ready-to-use cans | bottle and rinse | | | of formula | bottle/nipple in | | | | cool water | +-----------------------+-----------------------+-----------------------+ **[Storage of Expressed Human Milk:]** - Store up to **96 hours** in glass or plastic airtight container in fridge - Okay to freeze up to **6 mo** - Thaw rapidly by holding container under lukewarm water or placing in lukewarm bath water - Use thawed milk **within 24 hours**, and NEVER refreeze +-----------------------------------+-----------------------------------+ | Eating Habits Suggestions | - Chew food thoroughly | | | | | | - Avoid: | | | | | | - Rushing through meals | | | | | | - Washing down solids with | | | a beverage | | | | | | - Gulping and sipping | | | liquids, drinking out of | | | small mouthed bottles or | | | straws, and drinking from | | | water fountains | | | | | | - Chewing gum and sucking | | | hard candy | | | | | | - Eliminate pipe, cigar, and | | | cigarette smoking | | | | | | - Check dentures for proper fit | | | | | | - Attempt to be aware of and | | | avoid deep sighing | | | | | | - Do not attempt to induce | | | belching or strain to pass | | | gas | | | | | | - Do not overload stomach in | | | any one meal | +===================================+===================================+ | Diet | - Keep a food journal for a few | | | days while tracking | | | intestinal gas symptoms | | | | | | - Avoid: | | | | | | - Foods with air whipped | | | into them | | | | | | - Carbonated beverages | | | | | | - Caffeinated beverages | | | | | | - Gas-producing foods | | | | | | - Probiotics (single and combo) | | | to introduce bacteria into | | | the gut (14 day trial) & | | | start low and go slow | | | | | | - Fermented food products with | | | live active cultures | | | (kombucha) | | | | | | - Herbal carminatives (supposed | | | to settle the stomach): | | | fennel seed, Japanese mint, | | | peppermint, spearmint) | | | | | | - Insufficient evidence | | | | | | - AVOID: GERD since | | | carminatives lower LES | | | tone/pressure and more | | | than 1 teaspoon/day of | | | fennel seed in pregnancy, | | | lactation (causes vaginal | | | bleeding) | +-----------------------------------+-----------------------------------+ | Medication Use and Lifestyle | - Avoid: | | Habits | | | | - Long-term or frequent | | | intermittent use of meds | | | intended for relief of | | | cold and allergy symptoms | | | | | | - Nonabsorbable polymers | | | | | | - Medications that contain | | | or release gas | | | | | | - Tight-fitting garments, | | | girdles, and belts | | | | | | - Avoid or minimize use of... | | | | | | - Drugs affecting | | | gastrointestinal motility | | | | | | - Drugs affecting glucose | | | metabolism | | | | | | - Drugs that affect the | | | intestinal flora | | | | | | - Avoid or gradually increase | | | intake of new foods/meds that | | | are high in fiber | | | | | | - Do not lie down or sit in a | | | slumped position immediately | | | after eating | | | | | | - Develop a regular routine of | | | exercise and rest | +-----------------------------------+-----------------------------------+ +-----------------+-----------------+-----------------+-----------------+ | Vegetables | Beans | Grains | Other | +=================+=================+=================+=================+ | - Beets, | - Black-eyed | - Barley | - Soy | | broccoli, | peas, | | products | | Brussel | buckbeans, | - Oat bran | | | sprouts | broad beans | | - Seed flour | | | | - Rice bran | | | - Cabbage, | - Chickpeas | | | | cauliflower | | - Rye | | | , | - Lentils, | | | | corn, | lima beans | - Sorghum | | | cucumbers | | grain | | | | - Mung beans | | | | - Leeks, | | - Wheat bran | | | lettuce | - Pinto beans | | | | | | - Whole wheat | | | - Onions | - Red kidney | flour | | | | beans | | | | - Parsley, | | | | | sweet | | | | | peppers | | | | +-----------------+-----------------+-----------------+-----------------+ **[Gas Producing Foods:]** +-----------------------+-----------------------+-----------------------+ | Minimal Gas | Moderate Gas | Major Gas Production | | Production | Production | | +=======================+=======================+=======================+ | - [Meats]{.underlin | - [Fruits]{.underli | - [Vegetables]{.und | | e}: | ne}: | erline}: | | fowl, fish | citrus, apples | onions, celery, | | | | carrots, Brussel | | - [Vegetables]{.und | - [Carbohydrates]{. | sprouts, | | erline}: | underline}: | cucumbers, | | lettuce, peppers, | refined white | cabbage, | | avocado, tomato, | sugar and refined | cauliflower, | | asparagus, | white flour | radishes, leeks, | | zucchini, okra, | | parsnips, peas, | | olives | | leafy greens such | | | | as kale, beans, | | - [Fruit]{.underlin | | potatoes, | | e}: | | eggplant | | cantaloupe, | | | | grapes, berries, | | - [Fruit]{.underlin | | fruit juice | | e}: | | | | raisins, bananas, | | - [Carbohydrates]{. | | apricots, prunes, | | underline}: | | dried fruit | | refined white | | | | sugar, refined | | - [Carbohydrates]{. | | white flour | | underline}: | | | | whole grains, | | - [Other]{.underlin | | wheat germ, bran, | | e}: | | brown rice | | all nuts, eggs, | | | | gelatin | | - [Dairy | | | | products]{.underl | | | | ine}: | | | | milk, ice cream, | | | | cheese (if | | | | trouble digesting | | | | lactose), check | | | | food labels of | | | | processed foods | | | | for added lactose | | | | or milk-derived | | | | ingredients | | | | | | | | - [Other]{.underlin | | | | e}: | | | | carbonated | | | | beverages | +-----------------------+-----------------------+-----------------------+ - Avoid **[Dosing for Nonprescription Antiemetic Antihistamines:]** **Agent** **Dosage (maximum daily dosage)** --------------------- ----------------------------------------------------- ------------------------------------------------------- ------------------------------------------------------- **Adults and Children [\>] 12 yr** **Children -12** **Children 2-6** **Cyclizine** 30 min before travel, then every 4-6 hr Every 6-8 hr \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- **Dimenhydrinate** Every 4-6 hr Every 6-8 hr Every 6-8 hr **Diphenhydramine** Every 6-8 hr Every 6-8 hr **Meclizine** 1 hr before travel **Doxylamine** In pregnancy, with or without pyridoxine every 8 hr \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- Gastroenteritis A white and black chart with black text Description automatically generated Essential Nutrients/Vitamins - [Essential Nutrients:] necessary for our body to function and cannot be made by the body in sufficient amounts - Two types: +-----------------------------------+-----------------------------------+ | Vitamin | Compound and more complex | | | | | | EX: Vitamin D | +===================================+===================================+ | Mineral | Elements | | | | | | EX: iron (Fe) | +-----------------------------------+-----------------------------------+ **[Sources of Essential Nutrients]** **Food** **Dietary Supplement** **Medication** --------------------------------------------------------- -------------------------------- ------------------------------------------------------- Nutritive substances that provide vitamins and minerals Products meant to improve diet Products meant to cure, prevent, or treat a condition Nutrition Facts label Supplemental Facts label Active Ingredient label or Inactive Ingredient label *Dietary Supplements:* are NOT required to prove safety or efficacy before marketing & FDA takes action if unsafe product reaches the market - Problems: actual amount stated on label is not always accurate USP offers a dietary supplement verification program (USP sticker) **[Stages of Deficiency:]** Inadequate nutrient uptake Depletion of nutrient stores Biochemical changes Physical signs of deficiency Morbidity and mortality **[Fat Soluble Vitamins: (Vitamin A, D, E, K)]** - Stored in body tissues - Deficiency caused by: - Compromised fat absorption - Bile acid sequestrant medications - Prolonged mineral oil use **[Water Soluble Vitamins:]** (Vitamin B1, B2, B3, B5, B6, B9, B12, C, - Not stored in the body - B-complex vitamins come from similar sources, so deficient in one = deficient in all - Common cause of deficiencies: malabsorptive conditions - Drug interactions are unique for each vitamin **[Minerals:]** - In every bodily tissue: incorporated in enzymes, hormones, or vitamins - Functions as free ions - Mainly used for regulation and usually charged (affects absorption of meds) - Deficiency mainly caused by inadequate diet  Dosing **[Calcium Salt Forms:]** (max absorption is 500 mg) A screenshot of a graph Description automatically generated **[Populations at Risk for Deficiencies]** +-----------------------+-----------------------+-----------------------+ | Infants and Children | - Growing, high | Vitamin A, | | | nutrient demand | multivitamin | | | | | | | - Poor eating | | | | habits | | +=======================+=======================+=======================+ | Pregnancy | - Increased | Folic acid, vitamin | | | nutritional needs | D, calcium, Iron | | | for fetus | | | | development | | +-----------------------+-----------------------+-----------------------+ | Older Adults | - Impaired | B12, vitamin D, | | | absorption | calcium | | | | | | | - Decreased | | | | appetite and | | | | sense of | | | | taste/smell | | | | | | | | - Dementia | | | | | | | | - Increased | | | | medication use | | | | | | | | - Aging skin and | | | | decreased sun | | | | exposure | | +-----------------------+-----------------------+-----------------------+ | Malabsorptive States | - IBS, UC, Crohn's | Multivitamin | | | Disease, Celiac | | | | disease | | | | | | | | - Liver dysfunction | | | | | | | | - Surgical | | | | resection of | | | | intestine | | +-----------------------+-----------------------+-----------------------+ | Alcoholism/Drug Abuse | - Poor eating | Water soluble | | | habits | vitamins (thiamine, | | | | folic acid, B6, C) | | | - Problems with | | | | absorption and | | | | liver function | | +-----------------------+-----------------------+-----------------------+ | Cystic fibrosis | - Impaired | Fat soluble vitamins | | | production of | | | | pancreatic | | | | enzymes | | | | | | | | - Limited fat | | | | absorption | | +-----------------------+-----------------------+-----------------------+ | Medications | - Appetite | Metformin -- B12 | | | suppressants | | | | | Corticosteroids -- | | | - Laxatives | Calcium, Vitamin D | | | | | | | - Drugs that affect | Methotrexate/Sulfasal | | | GI and fat | azine | | | absorption | -- Folic Acid | | | | | | | - Diuretics | Isoniazid -- B3, B6 | | | | | | | | Furosemide -- | | | | Thiamine | +-----------------------+-----------------------+-----------------------+ **[Micronutrient Interactions\ ]** +-----------------------+-----------------------+-----------------------+ | **Micronutrient** | **Drug/Micronutrient* | **Effect & | | | * | Precautionary | | | | Measures** | +=======================+=======================+=======================+ | Vitamins A, D, E, K, | - Cholestyramine | Leads to decreased | | and C | | vitamin absorption | | | - Colestipol | avoid prolonged use | | | | of these agents | | | - Orlistat | | | | | | | | - Mineral oil | | +-----------------------+-----------------------+-----------------------+ | Vitamin K | Warfarin | Leads to decreased | | | | anticoagulation keep | | | | daily intake of | | | | vitamin K consistent | +-----------------------+-----------------------+-----------------------+ | Folic Acid | Methotrexate | Leads to decreased | | | | activity/effectivenes | | | | s | | | | of folic acid monitor | | | | concomitant use | +-----------------------+-----------------------+-----------------------+ | Calcium | - Iron | **Calcium prevents | | | | nutrient absorption | | | - Zinc | separate dosing by at | | | | least 2 hours** | | | - Magnesium | | +-----------------------+-----------------------+-----------------------+ | | - H2 Blockers | **Decreased | | | | absorption of certain | | | - PPIs | salt formulations | | | | consider switch to | | | | calcium citrate** | +-----------------------+-----------------------+-----------------------+ | | - Levothyroxine | **Co-administration | | | | decreases | | | - Tetracycline | levothyroxine | | | | absorption so | | | - Fluoroquinolone | separate dosing by 4 | | | | hours** | | | - Antibiotics | | +-----------------------+-----------------------+-----------------------+ | Magnesium | - Levothyroxine | **Co-administration | | | | decreases | | | - Tetracycline | tetracycline and | | | | fluoroquinolone | | | - Fluoroquinolone | absorption so | | | | separate dosing by 2 | | | - Antibiotics | hours before or 6 | | | | hours after** | +-----------------------+-----------------------+-----------------------+ | Iron | - Antacids | **Co-administration | | | | of iron and antacids | | | - Levothyroxine | decreases antacid | | | | absorption so | | | - Tetracycline | separate by 2 hours** | | | | | | | - Fluoroquinolone | | | | antibiotics | | +-----------------------+-----------------------+-----------------------+ Sunscreen & Photoaging **[Types of UVR:]** +-----------------------+-----------------------+-----------------------+ | **UVA** | **UV[B]** | **UVC** | +=======================+=======================+=======================+ | - Suppresses immune | - Most active UVR | - Mostly screened | | system & damages | for causing | out by ozone | | DNA premature | erythema & called | layer but some is | | photoaging and | **sun[B]{.underli | emitted by | | skin cancers | ne}urn | artificial | | | radiation** | sources of UVR | | - Enhances effects |