Basic Care and Comfort Manual PDF

BASIC CARE AND COMFORT [ Lesson 5 Basic care and Comfort General Principles  Basic needs include nutrition, care of the skin, hair, nails, mouth, teeth, eyes, ears, nostrils, and perineal and genital areas.  Assess the client’s personal hygiene habits a...

BASIC CARE AND COMFORT [ Lesson 5 Basic care and Comfort General Principles  Basic needs include nutrition, care of the skin, hair, nails, mouth, teeth, eyes, ears, nostrils, and perineal and genital areas.  Assess the client’s personal hygiene habits and determine the client’s personal routine.  Determine the client’s health status and readiness to perform hygiene procedures.  Wash hands and wear gloves and other protective items as appropriate.  Ensure privacy.  Explain procedures to the client.  Assist the client in basic hygiene and grooming or provide client care.  Promote independence as much as possible in the performance of personal hygiene and activities of daily living (ADLs) such as grooming.  Assess the client’s ability to carry out instrumental activities of daily living (IADLs) such as paying bills and shopping for groceries.  Use proper body mechanics during bathing and hygiene activities.  Assess skin integrity, particularly at pressure points.  Use the time spent with the client as an opportunity for communication and teaching.  Teach the client about adaptations that will enable him or her to perform ADLs at home (e.g., shower mats, shower bench, and handrails or grab bars in the bathtub). Nutrition Assessment  Assess the client’s ability to consume fluids and food (i.e., swallowing ability, ability to chew); be alert to the risk for aspiration.  Determine whether the client needs assistive devices (e.g., dentures, special eating utensils).  Ask the client about his or her normal eating pattern, daily fluid intake, likes and dislikes, and cultural considerations.  Determine whether the client is on a specific diet or has dietary restrictions because of a health disorder.  Assess the client’s hydration status and be alert for signs of dehydration (e.g., dry skin, dry mucous membranes, flat neck veins) or fluid overload (e.g., edema, lung congestion, distended neck veins).  Ask the client about medications being taken and identify any food/medication interactions.  Measure the client’s height and weight and calculate the body mass index (BMI) Divide the weight in kilograms by the height in meters squared. Example: A client who weighs 75 kg (165 lb) and is 1.8 m (5 feet 9 inches) tall has a BMI of 23.15 (75 ÷ 1.82 =23.15). Note: A client with a BMI of 25 to 30 is considered overweight. A BMI greater than 30 is considered to reflect obesity. ii. Nutritional assessment  weight change  appetite  food intolerance  chewing and swallowing  indigestion  elimination habits  eating behaviors  nutrient-drug interactions iii. anthropometric measurements Nutrition Interventions  Monitor the client’s nutritional status.  Record the client’s intake and output.  Initiate calorie counts for clients as needed (e.g., for the anorexic client, the client with malnutrition, the client who has been taken off tube feedings and will be fed orally).  Provide nutritional supplements such as high-protein drinks if the client’s intake is inadequate.  Base the provision of fluids and foods on the client’s disease/illness, prescribed diet (detailed on the following screens), likes and dislikes, and cultural considerations.  Promote client independence in eating as much as possible.  Teach the client about diet and the components of adequate nutrition and "The MyPlate" guidelines   A. Food guidelines a. reference dietary intake (DRI) - average daily nutrient intake for healthy people (replaces the previous recommended dietary allowance [RDA]) b. ethnic food patterns c. religious considerations in meal planning d. personal choice, e.g. vegetarian ChooseMyPlate.gov MyPlate is a reminder to find your healthy eating style and build it throughout your lifetime. Everything you eat and drink matters. The right mix can help you be healthier now and in the future. This means:  Focus on variety, amount, and nutrition.  Choose foods and beverages with less saturated fat, sodium, and added sugars.  Start with small changes to build healthier eating styles.  Support healthy eating for everyone. Eating healthy is a journey shaped by many factors, including our stage of life, situations, preferences, access to food, culture, traditions, and the personal decisions we make over time. All your food and beverage choices count. MyPlate offers ideas and tips to help you create a healthier eating style that meets your individual needs and improves your health. e. refer to the 2010 Dietary Guidelines for Americans and MyPlate for information about a. balancing calories b. foods to increase, i.e., fruits and vegetables, whole grains, reduced fat milk c. food to reduce, i.e., sodium and sugary drinks MyPlate Table  Fruits divide into BERRIES MELONS 100% Fruit Juice  Berries 1. Cranberries 1. Cantaloupe 1. Cranberry Juice  Melons 2. Currants 2. Honeydew 2. Apple juice  100% Fruit Juice 3. Goji Berries 3. Watermelon 3. Apple Juice  Other Fruits 4. Raspberries 4. Orange Juice 5. Strawberries 5. Orange Juice 6. Image of Strawberries 6. Grape Juice 7. Blackberries 7. Grapefruit Juice 8. Blueberries 8. Pineapple Juice 9. Pomegrante Juice 10. Prune Juice Other Fruits Other Fruits 1. Papaya 1. Grapefruit 2. Bananas 2. Prunes 3. Peaches 3. Grapes 4. Cherries 4. Raisins 5. In a Bowl 5. Guava 6. Pears 6. Starfruit 7. Currants 7. Kiwi Fruit 8. Persimmons 8. tangerines 9. dates 9. Lemons 10. Pineapples 10. Limes 11. Figs 11. Mangoes 12. Plums 12. Nectarines 13. Fruit Cocktail (mixed 13. Apples fruit) 14. Oranges 14. Pomegranate 15. Apricots FRUITS What foods are in the Fruit Group? Any fruit or 100% fruit juice counts as part of the Fruit Group. Fruits may be fresh, canned, frozen, or dried, and may be whole, cut-up, or pureed. How much fruit is needed daily? The amount of fruit you need to eat depends on age, sex, and level of physical activity. Recommended daily amounts are shown in the chart below. Daily Fruit Chart Daily Recommendation* 2-3 years old 1 cup Children 4-8 years old 1 to 1 1/2 cups Girls 9-13 years old 1 1/2 cups Daily Fruit Chart Daily Recommendation* 14-18 years old 1 1/2 cups Boys 9-13 years old 1 1/2 cups 14-18 years old 2 cups 19-30 years old 2 cups Women 31-50 years old 1 1/2 cups 51+ years old 1 1/2 cups 19-30 years old 2 cups Men 31-50 years old 2 cups 51+ years old 2 cups *These amounts are appropriate for individuals who get less than 30 minutes per day of moderate physical activity, beyond normal daily activities. Those who are more physically active may be able to consume more while staying within calorie needs. What counts as a cup of fruit? In general, 1 cup of fruit or 100% fruit juice, or ½ cup of dried fruit can be considered as 1 cup from the Fruit Group. This chart below shows specific amounts that count as 1 cup of fruit (in some cases equivalents for ½ cup are also shown) towards your daily recommended intake. cup of fruit chart Other amounts (count as 1/2 cup of fruit Amount that counts as 1 cup of fruit unless noted) 1/2 large (3.25" diameter) 1 small (2.5" diameter) Apple 1/2 cup sliced or chopped, raw or cooked 1 cup sliced or chopped, raw or cooked Applesauce 1 cup 1 snack container (4oz) 1 cup sliced Banana 1 small (less than 6" long) 1 large (8" to 9" long) Cantaloupe 1 cup diced or melon balls 1 medium wedge (1/8 of a med. melon) cup of fruit chart Other amounts (count as 1/2 cup of fruit Amount that counts as 1 cup of fruit unless noted) 1 cup whole or cut-up Grapes 16 seedless grapes 32 seedless grapes 1 medium (4" diameter) Grapefruit 1/2 medium (4" diameter) 1 cup sections 1 cup diced or sliced, raw or Mixed fruit (fruit cocktail) 1 snack container (4 oz) drained = 3/8 cup canned, drained 1 large (3-1/16" diameter) Orange 1 small (2-3/8" diameter) 1 cup sections Orange, mandarin 1 cup canned, drained 1 large (2 3/4" diameter) 1 small (2" diameter) 1 cup sliced or diced, raw, cooked, Peach or canned, drained 1 snack container (4 oz) drained = 3/8 cup 2 halves, canned 1 medium pear (2.5 per lb) Pear 1 snack container (4 oz) drained = 3/8 cup 1 cup sliced or diced, raw cooked, or canned, drained 1 cup chunks, sliced or crushed, Pineapple 1 snack container (4 oz) drained = 3/8 cup raw, cooked or canned, drained 1 cup sliced raw or cooked Plum 1 large plum 3 medium or 2 large plums About 8 large berries Strawberries 1/2 cup whole, halved, or sliced 1 cup whole, halved, or sliced, fresh or frozen 1 small (1" thick) Watermelon 6 melon balls 1 cup diced or balls 1/2 cup dried fruit is equivalent to 1 cup fruit: Dried fruit (raisins, prunes, 1/4 cup dried fruit is equivalent to 1/2 cup 1/2 cup raisins apricots, etc.) fruit 1 small box raisins (1.5 oz) 1/2 cup prunes 1/2 cup dried apricots 100% fruit juice (orange, apple, 1 cup 1/2 cup grape, grapefruit, etc.) - See more at: http://www.choosemyplate.gov/fruit#sthash.LpMHirg7.dpuf  Grains What foods are in the Grains Group? II. Any food made from wheat, rice, oats, cornmeal, barley or another cereal grain is a grain product. Bread, pasta, oatmeal, breakfast cereals, tortillas, and grits are examples of grain products. III. Grains are divided into 2 subgroups, Whole Grains and Refined Grains. Whole grains contain the entire grain kernel ― the bran, germ, and endosperm. Examples of whole grains include whole-wheat flour, bulgur (cracked wheat), oatmeal, whole cornmeal, and brown rice. Refined grains have been milled, a process that removes the bran and germ. This is done to give grains a finer texture and improve their shelf life, but it also removes dietary fiber, iron, and many B vitamins. Some examples of refined grain products are white flour, de-germed cornmeal, white bread, and white rice. IV. V. Most refined grains are enriched. This means certain B vitamins (thiamin, riboflavin, niacin, folic acid) and iron are added back after processing. Fiber is not added back to enriched grains. Check the ingredient list on refined grain products to make sure that the word "enriched" is included in the grain name. Some food products are made from mixtures of whole grains and refined grains. VI. How many grain foods are needed daily? The amount of grains you need to eat depends on your age, sex, and level of physical activity. Recommended daily amounts are listed in this chart below. Most Americans consume enough grains, but few are whole grains. At least half of all the grains eaten should be whole grains. Note: Click on the top row to expand the chart. If you are on a mobile device, you may need to turn your phone 90 degrees to see the full chart. VII. Daily Grain Chart Daily minimum amount of whole DAILY RECOMMENDATION* grains 2-3 years old 3 ounce equivalents 1 1/2 ounce equivalents Children 4-8 years old 5 ounce equivalents 2 1/2 ounce equivalents 9-13 years old 5 ounce equivalents 3 ounce equivalents Girls 14-18 years old 6 ounce equivalents 3 ounce equivalents 9-13 years old 6 ounce equivalents 3 ounce equivalents Boys 14-18 years old 8 ounce equivalents 4 ounce equivalents 19-30 years old 6 ounce equivalents 3 ounce equivalents Women 31-50 years old 6 ounce equivalents 3 ounce equivalents 51+ years old 5 ounce equivalents 3 ounce equivalents 19-30 years old 8 ounce equivalents 4 ounce equivalents Men 31-50 years old 7 ounce equivalents 3 1/2 ounce equivalents 51+ years old 6 ounce equivalents 3 ounce equivalents VIII. *These amounts are appropriate for individuals who get less than 30 minutes per day of moderate physical activity, beyond normal daily activities. Those who are more physically active may be able to consume more while staying within calorie needs. What counts as an ounce equivalent of grains? IX.  In general, 1 slice of bread, 1 cup of ready-to-eat cereal, or ½ cup of cooked rice, cooked pasta, or cooked cereal can be considered as 1 ounce equivalent from the Grains Group. The chart below lists specific amounts that count as 1 ounce equivalent of grains towards your daily recommended intake. In some cases the number of ounce-equivalents for common portions are also shown. Note: Click on the top row to expand the chart. If you are on a mobile device, you may need to turn your phone 90 degrees to see the full chart. X. Ounce-equivalent of grains chart Amount that counts as 1 ounce Common portions and ounce equivalents equivalent of grains Bagels WG**: whole 1" mini bagel 1 large bagel = 4 ounce equivalents wheat RG**: plain, egg Biscuits (baking powder/ 1 small (2" diameter) 1 large (3" diameter) = 2 ounce-equivalents buttermilk - RG*) Breads WG**: 100% 1 regular slice 2 regular slices = 2 ounce-equivalents Whole 1 small slice French Wheat 4 snack-size slices rye bread RG**: white, wheat, French, sourdough Bulgur cracked wheat 1/2 cup cooked (WG**) Cornbread (RG**) 1 small piece (2 ½" x 1 ¼” x 1¼") 1 medium piece (2 ½" x 2 ½” x 1 ¼") = 2ounce-equivalents Crackers WG**: 100% 5 whole wheat crackers whole 2 rye crispbreads wheat, rye 7 square or round crackers RG**: saltines, snack crackers English muffins WG**: whole ½ muffin 1 muffin = 2 ounce equivalents wheat RG**: plain, raisin Muffins WG**: whole 1 small (2 ½" diameter) 1 large (3 ½" diameter) = 3 ounce wheat equivalents RG**: bran, corn, plain Oatmeal (WG**) ½ cup cooked 1 packet instant 1 ounce (1/3 cup) dry (regular or quick) Pancakes WG**: Whole 1 pancake (4 ½" diameter) 3 pancakes (4 ½" diameter) = 3 ounce- equivalents  Ounce-equivalent of grains chart Amount that counts as 1 ounce Common portions and ounce equivalents equivalent of grains wheat, 2 small pancakes (3" diameter) buckwheat RG**: buttermilk, plain Popcorn (WG**) 3 cups, popped 1 mini microwave bag or 100-calorie bag, popped =2 ounce-equivalents Ready-to WG**: toasted 1 cup flakes or rounds eat oat, 1 ¼ cup puffed breakfast whole wheat cereal flakes RG**: corn flakes, puffed rice Rice WG*: brown, ½ cup cooked 1 cup cooked = 2 ounce-equivalents wild 1 ounce dry RG*: enriched, white, polished Pasta-- WG**: whole ½ cup cooked 1 cup cooked = 2 ounce-equivalents spaghetti, wheat 1 ounce dry macaroni, RG**: enriched, noodles durum Tortillas WG**: whole 1 small flour tortilla (6" diameter) 1 large tortilla (12" diameter) = 4 ounce wheat, 1 corn tortilla (6" diameter) equivalents whole grain corn RG**: Flour, corn XI. - See more at: http://www.choosemyplate.gov/grains#sthash.p03O4nQM.dpuf VEGETABLES What foods are in the Vegetable Group? Any vegetable or 100% vegetable juice counts as a member of the Vegetable Group. Vegetables may be raw or cooked; fresh, frozen, canned, or dried/dehydrated; and may be whole, cut-up, or mashed. Based on their nutrient content, vegetables are organized into 5 subgroups: dark-green vegetables, starchy vegetables, red and orange vegetables, beans and peas, and other vegetables. How many vegetables are needed? The amount of vegetables you need to eat depends on your age, sex, and level of physical activity. Recommended total daily amounts and recommended weekly amounts from each vegetable subgroup are shown in the the two charts below. Note: Click on the top row to expand the chart. If you are on a mobile device, you may need to turn your phone 90 degrees to see the full chart. Daily Vegetable Chart Daily Recommendation* 2-3 years old 1 cup Children 4-8 years old 1 1/2 cups 9-13 years old 2 cups Girls 14-18 years old 2 1/2 cups 9-13 years old 2 1/2 cups Boys 14-18 years old 3 cups 19-30 years old 2 1/2 cups Women 31-50 years old 2 1/2 cups 51+ years old 2 cups 19-30 years old 3 cups Men 31-50 years old 3 cups 51+ years old 2 1/2 cups *These amounts are appropriate for individuals who get less than 30 minutes per day of moderate physical activity, beyond normal daily activities. Those who are more physically active may be able to consume more while staying within calorie needs. Vegetable subgroup recommendations are given as amounts to eat WEEKLY. It is not necessary to eat vegetables from each subgroup daily. However, over a week, try to consume the amounts listed from each subgroup as a way to reach your daily intake recommendation. Note: Click on the top row to expand the chart. If you are on a mobile device, you may need to turn your phone 90 degrees to see the full chart. Weekly Vegetable Subgroup Chart Dark green Red and orange Starchy Other Beans and peas vegetables vegetables vegetables vegetables Amount per Week Children 2-3 yrs old 1/2 cup 2 1/2 cups 1/2 cup 2 cups 1 1/2 cups 4-8 yrs old 1 cup 3 cups 1/2 cup 3 1/2 cups 2 1/2 cups Girls 9-13 yrs old 1 1/2 cups 4 cups 1 cup 4 cups 3 1/2 cups 14-18 yrs old 1 1/2 cups 5 1/2 cups 1 1/2 cups 5 cups 4 cups Boys 1 1/2 cups 5 cups 4 cups 9-13 yrs old 1 1/2 cups 5 1/2 cups 2 cups 6 cups 5 cups 14-18 yrs old 2 cups 6 cups Women 19-30 yrs old 1 1/2 cups 5 1/2 cups 1 1/2 cups 5 cups 4 cups 31-50 yrs old 1 1/2 cups 5 1/2 cups 1 1/2 cups 5 cups 4 cups 51+ yrs old 1 1/2 cups 4 cups 1 cup 4 cups 3 1/2 cups Men 19-30 yrs old 2 cups 6 cups 2 cups 6 cups 5 cups 31-50 yrs old 2 cups 6 cups 2 cups 6 cups 5 cups 51+ yrs old 1 1/2 cups 5 1/2 cups 1 1/2 cups 5 cups 4 cups What counts as a cup of vegetables? In general, 1 cup of raw or cooked vegetables or vegetable juice, or 2 cups of raw leafy greens can be considered as 1 cup from the Vegetable Group. The chart below lists specific amounts that count as 1 cup of vegetables (in some cases equivalents for ½ cup are also shown) towards your recommended intake.. Cup of Vegetable Chart Amount that counts as 1 cup of Amount that counts as 1/2 cup of vegetable vegetables Dark Green Vegetables 1 cup chopped or florets Broccoli 3 spears 5" long raw or cooked Greens (collards, mustard greens, 1 cup cooked turnip greens, kale) 1 cup, cooked Spinach 2 cups raw is equivalent to 1 cup of 1 cup raw is equivalent to 1/2 cup of vegetables vegetables Raw leafy greens: Spinach, 2 cups raw is equivalent to 1 cup of 1 cup raw is equivalent to 1/2 cup of romaine, watercress, dark green vegetables vegetables leafy lettuce, endive, escarole Red and Orange Vegetables 1 cup, strips, slices, or chopped, raw or cooked 1 medium carrot Carrots 2 medium About 6 baby carrots 1 cup baby carrots (about 12) Pumpkin 1 cup mashed, cooked 1 cup chopped, raw, or cooked Red peppers 1 large pepper (3" diameter, 3 3/4" 1 small pepper long) 1 large raw whole (3") 1 small raw whole (2 1/4" diameter) Tomatoes 1 cup chopped or sliced, raw, canned, 1 medium canned or cooked Tomato juice 1 cup 1/2 cup 1 large baked (2 1/4" or more Sweet potato diameter) 1 cup sliced or mashed, cooked Winter squash (acorn, butternut, 1 cup cubed, cooked 1/2 acorn squash, baked = 3/4 cup hubbard) Beans and Peas Dry beans and peas (such as black, garbanzo, kidney, pinto, or soy beans, 1 cup whole or mashed, cooked or black eyed peas or split peas) Starchy Vegetables 1 cup Corn, yellow or white 1 large ear (8" to 9" long) 1 small ear (about 6" long)  Cup of Vegetable Chart Amount that counts as 1 cup of Amount that counts as 1/2 cup of vegetable vegetables Green peas 1 cup 1 cup diced, mashed 1 medium boiled or baked potato (2 1/2" to 3" diameter) White potatoes French fried: 20 medium to long strips (2 1/2" to 4" long) (Contains added calories from solid fats.) Amount that counts as 1 cup of Amount that counts as 1/2 cup of vegetables vegetables Other Vegetables Bean sprouts 1 cup cooked 1 cup, chopped or shredded raw or Cabbage, green cooked Cauliflower 1 cup pieces or florets raw or cooked 1 cup, diced or sliced, raw or cooked Celery 2 large stalks (11" to 12" long) 1 large stalk (11" to 12" long) Cucumbers 1 cup raw, sliced or chopped Green or wax beans 1 cup cooked 1 cup chopped, raw or cooked Green peppers 1 large pepper (3" diameter, 3 3/4" 1 small pepper long) 2 cups raw, shredded or chopped = 1 cup raw, shredded or chopped = Lettuce, iceberg or head equivalent equivalent to 1 cup of vegetables to 1/2 cup of vegetables Mushrooms 1 cup raw or cooked Onions 1 cup chopped, raw or cooked Summer squash or zucchini 1 cup cooked, sliced or diced - See more at: http://www.choosemyplate.gov/vegetables#sthash.eHUIwKxK.dpuf Protein Foods What foods are in the Protein Foods Group? All foods made from meat, poultry, seafood, beans and peas, eggs, processed soy products, nuts, and seeds are considered part of the Protein Foods Group. Beans and peas are also part of the Vegetable Group. For more information on beans and peas, see Beans and Peas Are Unique Foods. Select a variety of protein foods to improve nutrient intake and health benefits, including at least 8 ounces of cooked seafood per week. Young children need less, depending on their age and calorie needs. The advice to consume seafood does not apply to vegetarians. Vegetarian options in the Protein Foods Group include beans and peas, processed soy products, and nuts and seeds. Meat and poultry choices should be lean or low-fat. How much food from the Protein Foods Group is daily? The amount of food from the Protein Foods Group you need to eat depends on age, sex, and level of physical activity. Most Americans eat enough food from this group, but need to make leaner and more varied selections of these foods. Recommended daily amounts are shown in the chart below. Daily protein foods chart Daily recommendation* 2-3 years old 2 ounce equivalents Children 4-8 years old 4 ounce equivalents 9-13 years old 5 ounce equivalents Girls 14-18 years old 5 ounce equivalents 9-13 years old 5 ounce equivalents Boys 14-18 years old 6 1/2 ounce equivalents 19-30 years old 5 1/2 ounce equivalents Women 31-50 years old 5 ounce equivalents 51+ years old 5 ounce equivalents 19-30 years old 6 1/2 ounce equivalents Men 31-50 years old 6 ounce equivalents 51+ years old 5 1/2 ounce equivalents *These amounts are appropriate for individuals who get less than 30 minutes per day of moderate physical activity, beyond normal daily activities. Those who are more physically active may be able to consume more while staying within calorie needs. What counts as an ounce-equivalent in the Protein Foods Group? In general, 1 ounce of meat, poultry or fish, ¼ cup cooked beans, 1 egg, 1 tablespoon of peanut butter, or ½ ounce of nuts or seeds can be considered as 1 ounce-equivalent from the Protein Foods Group. This chart below lists specific amounts that count as 1 ounce-equivalent in the Protein Foods Group towards your daily recommended intake. Note: Click on the top row to expand the chart. If you are on a mobile device, you may need to turn your phone 90 degrees to see the full chart. ounce-equivalent of protein foods chart Amount that counts as 1 ounce-equivalent in the Common portions and ounce-equivalents Protein Foods Group 1 small steak (eye of round, filet) = 3 1/2 to 4 1 ounce cooked lean beef ounce-equivalents Meats 1 ounce cooked lean pork or ham 1 small lean hamburger = 2 to 3 ounce- equivalents 1 small chicken breast half = 3 ounce- 1 ounce cooked chicken or turkey, without skin equivalents Poultry 1 sandwich slice of turkey (4 1/2" x 2 1/2" x 1/8") 1/2 Cornish game hen = 4 ounce-equivalents 1 can of tuna, drained = 3 to 4 ounce- equivalents Seafood 1 ounce cooked fish or shell fish 1 salmon steak = 4 to 6 ounce-equivalents 1 small trout = 3 ounce-equivalents 3 egg whites = 2 ounce-equivalents Eggs 1 egg 3 egg yolks = 1 ounce-equivalent Nuts and 1/2 ounce of nuts (12 almonds, 24 pistachios, 7 seeds walnut halves) 1 ounce of nuts of seeds = 2 ounce- 1/2 ounce of seeds (pumpkin, sunflower, or squash equivalents seeds, hulled, roasted) 1 Tablespoon of peanut butter or almond butter Beans and 1/4 cup of cooked beans (such as black, kidney, peas pinto, or white beans) 1 cup split pea soup = 2 ounce-equivalents 1/4 cup of cooked peas (such as chickpeas, cowpeas, 1 cup lentil soup = 2 ounce-equivalents lentils, or split peas) 1 cup bean soup = 2 ounce-equivalents 1/4 cup of baked beans, refried beans 1/4 cup (about 2 ounces) of tofu 1 soy or bean burger patty = 2 ounce- 1 ox. tempeh, cooked equivalents 1/4 cup roasted soybeans 1 falafel patty (2 1/4", 4 oz) 2 Tablespoons hummus Selection Tips  Choose lean or low-fat meat and poultry. If higher fat choices are made, such as regular ground beef (75- 80% lean) or chicken with skin, the fat counts against your maximum limit for empty calories (calories from solid fats or added sugars).   If solid fat is added in cooking, such as frying chicken in shortening or frying eggs in butter or stick margarine, this also counts against your maximum limit for empty calories (calories from solid fats and added sugars).  Select some seafood that is rich in omega-3 fatty acids, such as salmon, trout, sardines, anchovies, herring, Pacific oysters, and Atlantic and Pacific mackerel.  Processed meats such as ham, sausage, frankfurters, and luncheon or deli meats have added sodium. Check the Nutrition Facts label to help limit sodium intake. Fresh chicken, turkey, and pork that have been enhanced with a salt-containing solution also have added sodium. Check the product label for statements such as “self-basting” or “contains up to __% of __”, which mean that a sodium-containing solution has been added to the product.  Choose unsalted nuts and seeds to keep sodium intake low. - See more at: http://www.choosemyplate.gov/protein-foods#sthash.zs21vOYo.dpuf  1. Nutritional needs through the life cycle a. infants - fluid needs: adequate to maintain hydration (approximately 6 wet diapers per day) b. infants - protein needs are 2.2 gm/kg/day c. breast milk or formula is adequate for the first six months of life i. whole milk is difficult for young infants to digest ii. the first food introduced is rice cereal (less likely to develop allergy to rice) d. childhood - gradual increasing of all nutrients e. adult - unchanged except for i. pregnancy - add per day: 300 calories, 15 mg iron, 30 g protein, 400 g calcium, and 200 ug folic acid ii. lactation - add 500 calories and 2 quarts extra fluid per day f. elderly: over age 65 - adequate protein to maintain immune system 2. Factors affecting dietary patterns a. health status b. ability to chew, swallow, and drink c. culture and religion d. socioeconomic status e. personal preference f. psychological factors g. alcohol and drugs 3. Energy needs a. basal metabolism: amount of energy (measured in calories) required to sustain life in a resting individual b. basal metabolic rate (BMR) i. influenced by genetic and environmental factors, e.g., gender, age, activity level, body surface area, body fat percentage, diet ii. several different formulas can be used to determine BMR B. Essential nutrients 1. Carbohydrates a. includes sugars, starches and fibers (cellulose) b. simple sugars (monosaccharides and disaccharides) are most easily metabolized c. starches are more complex in structure and metabolism d. functions of carbohydrates i. quickest source of energy (4 kcal/gram) ii. main source of fuel for brain, peripheral nerves, WBCs, RBCs, and healing wounds iii. protein sparer e. dietary sources: plant foods, except for lactose f. recommended daily intake: i. factors influencing recommended intake of carbohydrates include body structure, energy expenditure, basal metabolism and general health status ii. ideally, 50 to 60% of total calories should be complex carbohydrates g. excessive carbohydrate calories are stored as fat 2. Lipids a. basic lipids are composed of triglycerides and fatty acids b. includes saturated fatty acids (from animal sources) and unsaturated fatty acids (vegetables, nuts and seeds)  c. essential polyunsaturated fatty acids: linoleic and linolenic fatty acids are the only fatty acids that are essential to humans d. deficiencies lead to skin, blood and artery problems e. functions i. most concentrated source of energy (9 kcal/gram) ii. major form of stored energy iii. insulation iv. component of cell membranes v. carries fat-soluble vitamins A, D, E and K f. recommended dietary intake: total fat intake should not exceed 30% of daily calories with saturated fats not exceeding 10% of total daily caloric intake Take care of yourself when preparing to take the NCLEX exam. Get plenty of rest, exercise regularly, eat nutritious meals, and stay hydrated with noncaffeinated beverages. 3. Proteins a. complex organic compounds comprised of amino acids b. body breaks protein down into 22 amino acids c. all but eight amino acids are produced by the body d. "complete protein" food - contains the eight essential amino acids not produced by the body (most meat, fish, poultry and dairy products) e. "incomplete protein" food - lacks one or more of the eight amino acids (most vegetables and fruits) f. incomplete proteins can be combined to yield a complete protein: for example, beans and rice g. functions of protein i. secondary energy source (4 kcal/gram) ii. essential for cell growth iii. efficiency can affect all of body - organs, tissues, skin, muscles iv. recommended protein intake: 0.8 grams per kg of body weight per day v. the body's only source of nitrogen vi. negative nitrogen balance can occur with infection, burns, fever, starvation, and injury 4. Vitamins a. organic substances essential for body growth and metabolism b. found only in plants and animals; body cannot synthesize them; depends on dietary intake c. types (according to their solvent) i. water soluble: vitamin C and B-complex vitamins (thiamin, riboflavin, niacin, pantothenic acid, biotin, B6, folate, B12)  cannot be stored in body  require daily intake 5. 6. Vitamins 7. Vitamins are organic compounds required as a nutrient in tiny amounts. The following is a brief explanation of the importance of each vitamin and a list of foods containing these vitamins. Category Vitamin What the vitamin does Significant food sources Fat A (retinol) Supports vision, skin, bone orange fruits and vegetables (cantaloupe, soluble and tooth growth, carrots, sweet potatoes, mango); dark immunity and reproduction green leafy vegetables (kale, collards, spinach); butter, fortified milk; eggs; beef liver D (cholecalciferol) Promotes bone fortified milk; fish; egg yolks; liver; fortified mineralization cereal E (tocopherols) Antioxidant; regulation of leafy green vegetables; polyunsaturated oxidation reactions; plant oils (soybean, corn, and canola); supports cell membrane wheat germ; nuts and seeds; tofu; avocado; stabilization sweet potatoes; shrimp, cod, sardines K Synthesis of blood-clotting dairy products (milk, yogurt); broccoli, proteins; regulates blood Brussel sprouts, leafy green vegetables, calcium cabbage; liver; soybean oil; green tea Water C (ascorbic acid) Collagen synthesis; amino citrus fruits; kiwi; tomatoes; strawberries; soluble acid metabolism; helps iron broccoli; cabbage & sweet red peppers; absorption; immunity; snow peas antioxidant B1 (thiamin) Supports energy lean meat (pork chops, ham); fish; dried metabolism and nerve beans; soy milk; legumes; green peas; function watermelon; unrefined or enriched grains (like wheat germ) and cereals B2 (riboflavin) Supports energy meat; eggs; legumes (peas and lentils); metabolism; normal vision; nuts; dairy products; green leafy skin health vegetables; broccoli; asparagus; mushrooms; oysters, clams; enriched grains B3 (niacin) Supports energy peanuts; beans; lean red meat and liver; metabolism; skin health; poultry; tuna, shrimp; spinach; potatoes; nervous system and tomato juice; fortified hot and cold cereals digestive system B5 (pantothenic Supports energy widespread in foods acid) metabolism  Category Vitamin What the vitamin does Significant food sources B6 (pyridoxine) Amino acid and fatty acid beans; liver, red meats, poultry (chicken metabolism; red blood cell breast); fish; bananas; watermelon; tomato production juice; seeds & nuts; corn; wheat; eggs; white rice, fortified cereals B7 (biotin) Energy metabolism; fat widespread in foods synthesis; amino acid metabolism, glycogen synthesis B9 (folic acid or Supports DNA synthesis and tomato juice; liver; dried beans and other folate or folacin) new cell formation legumes; green leafy green vegetables; asparagus; orange juice; fortified bread, rice and cereals B12 (cobalamine) Used in new cell synthesis; fish, shellfish; lean red meats; poultry; dairy helps break down fatty products (milk & cheese); eggs; some acids and amino acids fortified cereals i. fat soluble: A, D, E, K  stored primarily in the liver and adipose tissues  absorbed by the body from the intestinal tract 8. Minerals a. inorganic substances essential as catalysts in biochemical reactions b. form most inorganic material in the body c. functions: i. catalyst for many body reactions such as regulation of acid-base balance ii. help cells metabolize, tissues absorb nutrients, and heart muscle respond iii. minerals work synergistically; a deficiency of one mineral can disturb the action of other minerals iv. types - grouped according to amount found in body  major minerals - calcium, magnesium, sodium, potassium, phosphorus, sulfur, chlorine (function is known)  trace minerals - iron, copper, iodine, manganese, cobalt, zinc and molybdenum (function unclear)  another group of trace minerals; found in even smaller amounts (function is unclear) Minerals Dietary minerals include a group of inorganic elements that are essential for normal body function.  Major dietary minerals are considered major because they are required by the body in doses of 100 mg/day or more Calcium Phosphorous Potassium Sodium Chloride Magnesium Sulfur Minor dietary minerals, or trace minerals, are required by the body in amounts of less than 100 mg/day Chromium Cobalt Flouride Zinc Selenium Silicon Boron Iron Copper Iodine Manganese Functions of dietary minerals include Constituents of bone and teeth Salts regulating body fluids Components of enzymes and hormones Major Minerals Overview Mineral Function Requirements needed each Food Sources day Calcium Constituent of bones and teeth Child (1-3 years) = 500 mg milk, cheese, yogurt, dark green leafy vegetables, Participates in nerve Child (4-8 years) = 800 mg whole sardines transmission, muscle action, permeability of cell membranes, Adolescent (9-18 years) = blood clotting 1300 mg Adult (19-50 years) = 1000 mg Older adult (51+ years) = 1200 mg Phosphorus Constituent of bones and teeth Child (1-3 years) = 460 mg milk, cheese, meat, egg yolks, whole grains, Participates in absorption of Child (4-8 years) = 500 mg legumes, nuts Mineral Function Requirements needed each Food Sources day glucose, transport of fatty acids, Adolescent (9-18 years) = energy metabolism 1250 mg Adult (19+ years) = 700 mg Magnesium Constituent of bones and teeth Adult = between 300 - 400 milk, cheese, meat, seafood, mg, depending on age and whole grains, legumes, nuts, Coenzyme in general gender avocado metabolism (energy production, protein formation and cellular replication) Smooth muscle action Neuromuscular irritability Magnesium works with calcium in muscle contraction and relaxation Sodium Major cation in extracellular Adult = 500 mg table salt, and most foods, fluid including milk, cheese, meat, eggs, carrots, beets, Water balance & acid-base spinach, celery balance Cell membrane permeability Absorption of glucose Potassium Major cation in intracellular Child (1-3 years) = 3 g fruits, raisins, vegetables fluid (baked potato with skin), Child (4-8 years) = 3.8 g legumes, nuts, meat, Water balance & acid-base salmon, whole grains balance Adolescent (9-13 years) = 4.5 g Normal muscle irritability 14+ years = 4.7 g Glycogen formation Protein synthesis Chlorine Major anion in extracellular fluid Adult = 750 mg table salt  Mineral Function Requirements needed each Food Sources day Water balance & acid-base balance Chloride bicarbonate shift Sulfur Essential constituent of protein adequate protein in diet meat, eggs, mild, cheese, structure ensures adequate sulfur nuts, legumes intake; no RDA Enzyme activity requirements Energy metabolism 9. Water a. critical body component essential for cell function b. accounts for 60 to 70% of total body weight in adults; 70 to 75% of total body weight of children c. provides normal turgor d. regulates body temperature e. dietary sources: liquids and solids, such as fresh fruits and vegetables f. deficiency: severe deficiency leads to dehydration and death g. fluid intake normally equals fluid output Learn more about nutrition from the Amercian Dietetic Association. Fluid and electrolyte balance 1. Total volume of fluid and amount of electrolytes remain relatively constant in the body 2. Fluid balance and electrolyte balance is interdependent 3. Body balances fluid and electrolytes primarily by adjusting output and secondarily by adjusting intake 4. Fluid balance is also maintained by osmosis 5. Major electrolytes a. cations i. sodium - most abundant cation in extracellular fluid  regulates cell size via osmosis  essential in maintaining water balance, transmitting nerve impulses, and contracting muscles  regulates acid-base balance by exchanging hydrogen ions for sodium ions in kidney  normal lab value for serum sodium is 135 to 145 mEq/L   sodium is regulated by salt intake, aldosterone, and urinary output  sources include table salt, processed meats, snacks and canned food ii. potassium - most abundant cation of intracellular fluid  potassium pump draws potassium into cell  essential for polarization and repolarization of nerve and muscle fibers  regulates neuromuscular excitability and muscle contraction  sources include whole grains, meat, legumes, fruits and vegetables  regulated by kidneys  normal lab value for serum potassium is 3.5 to 5.3 mEq/L iii. calcium - essential for healthy bones and teeth, cell membrane integrity, blood clotting, cardiac contraction, blood pressure, functioning of nerves and muscles and maintaining immune defenses iv. magnesium - normal constituent of bone; cofactor for enzymes in energy metabolism, neurochemical activities, muscular excitability b. anions i. chloride - most abundant anion in extracellular fluid; part of hydrochloric acid found in stomach and necessary for proper digestion; helps balance sodium; normal lab value for serum chloride is 100 to 106 mEq/L ii. bicarbonate - part of bicarbonate buffer system; limits the drop in pH by combining with an acid to form carbonic acid and a salt iii. phosphate - participates in cellular energy metabolism, combines with calcium in bone, assists in structure of genetic material Maintenance of fluid volume a. osmoreceptor system i. balances fluid intake volume by the regulation of water output volume ii. dehydration stimulates osmoreceptors which activate the thirst control center; person feels thirsty and seeks water iii. also stimulates antidiuretic hormone (ADH) secretion which decreases urinary output by causing the reabsorption of water in the tubules b. circulatory system i. increases in fluid intake increase circulatory volume ii. this increased volume stimulates the kidneys for an increased glomerular filtration rate iii. end result is an increase in urine output to decrease the initial circulatory volume c. thirst center i. located in hypothalamus ii. stimulated by  increased plasma osmolality  angiotensin II  dry pharyngeal mucous membranes  decreased plasma volume  depleted potassium  psychological factors d. Maintenance of electrolyte balance i. aldosterone - hormone (mineralocorticoid)  when extracellular fluid sodium decreases or potassium levels increase  adrenal cortex secretes aldosterone  kidneys stimulated by aldosterone to increase reabsorption of sodium and decrease reabsorption of potassium  results in water reabsorption and increased blood volume ii. renin/angiotensin - hormone affecting renal tubule reabsorption of water iii. atrial natriuretic peptide (ANP) - hormone affecting renal tubule reabsorption of water iv. parathyroid  parathyroid secretes parathyroid hormone (PTH), also called parathormone  stimulates release of calcium from bone, reabsorption in small intestine and kidney tubules  when serum calcium level is low, PTH secretion increases  when serum calcium level rises, PTH secretion falls  high levels of active vitamin D inhibit PTH and low levels or magnesium stimulate PTH secretion Normal and therapeutic diets 1. Guidelines: a. dietary reference intakes (DRIs) - average daily nutrient intake of apparently healthy people over time i. recommended dietary allowance (RDA) ii. adequate intake (AI) iii. tolerable upper intake level (UL) iv. estimated average requirement (EAR) b. ethnic food patterns c. religious considerations in meal planning d. personal choice, e.g. vegetarian Types of vegetarian diets: Vegan: refrains from eating animal products Lacto-ovo vegetarian : consumes eggs and dairy products but excludes meat, poultry, seafood Lacto vegetarian : consumes dairy products, but excludes eggs, meat, poultry, seafood Therapeutic nutrition a. modification of the nutritional needs based on disease condition b. considerations for administering therapeutic diets i. condition of client - physical, emotional, mental ability of client to tolerate diet ii. willingness of client to follow dietary guidelines c. types of therapeutic diets i.Diabetic  goals of nutritional management  providing all essential nutrients  meeting energy needs  achieving and maintaining a reasonable weight  preventing wide daily fluctuations in blood glucose levels  decreasing serum lipid levels  diet individualized according to client's age, build, weight, and activity level  recommended caloric distribution: 50-60% carbohydrates, 20-30% fat, and 10-20% protein ii. Dietary Approaches to Stop Hypertension (DASH) diet  used to help lower blood pressure, but may offer protection against osteoporosis, cancer, stroke, diabetes and heart disease   encourages sodium reduction and eating a variety of foods rich in nutrients, including potassium,  calcium and magnesium  levels of restriction  o standard DASH diet - 2,300 mg sodium/day  o lower sodium DASH diet - 1,500 mg sodium/day o ii. DASH diet is low in saturated fat, cholesterol, and total fat iii. Cardiac diet: Fat (saturated, trans-, polyunsaturated, and monounsaturated), cholesterol, and sodium are restricted. Low sodium  used in congestive heart failure, hypertension  used for correcting the retention of sodium and water  levels of restriction i. mild (2 g sodium) ii. moderate (1000 mg sodium) iii. strict (500 mg sodium)  restricts table salt, canned vegetables, smoked meats, butter, cheese  Sodium-restricted: Encourage intake of fresh rather than processed foods. Canned, frozen, instant, smoked, pickled, and boxed foods usually contain higher amounts of sodium. Lunchmeats, soy sauce, salad dressings, fast foods, soups, and snacks such as potato chips and pretzels also contain large amounts of sodium. Salt substitutes may be used to improve palatability, although most salt substitutes contain large amounts of potassium and should not be used by clients with renal disease. liquid diets  Clear liquid: Approved foods include water, bouillon, clear broth, carbonated beverages, gelatin, hard candy, lemonade, Popsicles, apple juice, and regular or decaffeinated coffee or tea. coffee without cream, tea, popsicles, fruit juices, including apple, cranberry, grape, and carbonated beverages  Full liquid: Approved foods include all clear liquids and items such as plain ice cream, sherbet, breakfast drinks, milk, pudding and custard, strained soups, refined cooked cereals, fruit juices, and strained vegetable juices, plus milk, cream, ice cream, pudding, yogurt, vegetable juice, creamy peanut butter iii.Acid ash diet  prevents kidney stone formation  restricts carbonated beverages, dried fruits, banana, figs, chocolate, nuts, olives, pickles IV. Mechanical soft  used with difficulty in chewing, such as poorly fitted dentures or endentulous clients (no teeth)   includes any foods which can be easily broken down by chewing  Mechanically altered: Foods to be avoided include nuts; dried fruits; raw fruits and vegetables; fried foods; tough, smoked, or salted meats; and foods with coarse textures.  Soft: Liquid, chopped, or puréed foods or regular foods with a soft consistency are tolerated best. Foods that contain nuts or seeds, which are easily trapped in the mouth, causing discomfort, should be avoided. Raw fruits and vegetables, fried foods, and whole grains should also be avoided. V.Low-fiber (low-residue  used for conditions such as diarrhea, diverticulitis  reduce fiber intake: canned fruit, refined carbohydrates, pasta, strained vegetables  foods high in refined carbohydrates are usually low fiber  increased use of ground meat, fish, broiled chicken without skin, white bread iv. high fiber  used to correct constipation, lower risk of colon cancer  30 to 40 gram fiber/day recommended  increased intake of fruits, vegetables, bran cereals v. Foods that are low in residue include white bread, refined cooked cereals, cooked potatoes without skins, white rice, and refined pasta. Raw fruits (except bananas), vegetables, nuts and seeds, plant fiber, and whole grains should be limited or avoided; dairy products should also be limited. iv. low protein diet  for renal disease such as pyelonephritis, uremia, kidney failure  limit protein less than 40 g/day (0.5 g/kg/day) instead of normal protein intake of 40 to 60 g/day (1g/kg/day)  restricted foods: meats and other foods high in protein such as legumes, fish, dairy  Protein-restricted: Special low-protein products such as pastas, bread, cookies, wafers, and gelatin made with wheat starch can improve energy intake and add variety to the diet. Carbohydrates in powder or liquid forms can be used to provide additional energy. Vegetables and fruits contain some protein and must be considered in the client who has been prescribed a very low protein diet. Foods from the milk, meat, bread, and starch groups are limited. v. high protein diet  for conditions such as burns, anemia, malabsorption syndromes, ulcerative colitis  include high quality proteins or protein supplements such as Sustagen®  promote high protein intake more than 60 g/day (1.5 g/kg/day) instead of normal protein intake of 40 to 60 g/day (1g/kg/day)  High-calorie, high-protein: Encourage nutrient-dense, high-calorie, high-protein foods such as whole milk and milk products, peanut butter, nuts and seeds, beef, chicken, fish, pork, and eggs. High-calorie foods include sugar, cream, gravy, oil, butter, mayonnaise, dried fruit, avocado, and honey. Encourage snacks between meals, such as milkshakes, instant breakfasts, and nutritional supplements. vi. low calcium diet  limit to 400 mg per day instead of normal 800 mg  restricts dried fruits and vegetables, shell fish, cheese, nuts Low purine diet  prevents uric acid stone; used for clients with gout  lowers levels of purine, the precursor of uric acid  restricts glandular meats, gravies, fowl, anchovies, beer and wine (see gout dietfor more details)  Low-purine: Foods to avoid or restrict include anchovies, herring, mackerel, sardines, scallops, glandular meats, gravies, meat extracts, wild game, goose, and sweetbreads GOUT AND DIET Diets high in purines and high in protein are suspected of causing an increased risk of gout Recommended diet high in complex carbohydrates (whole grain, fruit, vegetables) low in protein (15% of calories and sources should be soy, lean meats, poultry) no more than 30% of calories from fat (10% animal fat) Purine-rich foods to avoid Anchovies, sardines in oil, fish roes, herring Beer, other alcoholic beverages Yeast Organ meats (liver, kidneys, sweetbreads) Legumes (dried beans, peas) Meat extracts, including consomme, gravies Mushrooms, spinach asparagus, cauliflower Foods that may be beneficial to people with gout Dark berries (may contain chemicals that lower uric acid and reduce inflammation) Tofu Certain fatty acids found in certain fish, e.g., salmon, flax or olive oil, or nuts (may possess some anti-inflammatory benefits) vii. Gluten-restricted or gluten-free  used for people with sensitivity to glutens (proteins) in wheat, oats, rye, and barley  may eat rice, corn and millet products viii. Low cholesterol  used for cardiovascular disease, high serum cholesterol levels  normal amount of cholesterol intake - 250 to 300 mg/day  restricts eggs, beef, liver, lobster, ice cream ix. Puree diet  used with dysphagia or difficulty in chewing  used for tube feedings, small babies  food is blended to smooth consistency x. Renal diet Controlled amounts of protein, sodium, phosphorus, calcium, potassium, and fluids may be prescribed. Most clients undergoing dialysis must restrict their fluid intake. xi. Potassium-modified Foods that are low in potassium include applesauce, green beans, cabbage, lettuce, peppers, grapes, blueberries, cooked summer squash, cooked turnip greens, fresh pineapple and raspberries. Foods that are high in potassium include avocado, bananas, cantaloupe, carrots, fish, mushrooms, oranges, pork, beef, veal, potatoes, raisins, spinach, strawberries, and tomatoes. xii. High-calcium Primary dietary sources of calcium are dairy products. Lactose-intolerant clients should regularly incorporate nondairy sources of calcium into their diet.  High-iron: This diet includes organ meats, meat, egg yolks, whole-wheat products, dark-green leafy vegetables, dried fruit, and legumes. Vegetarian diets: Potential deficiencies in vegetarian diets include energy, protein, vitamin B 12, zinc, iron, calcium, omega-3 fatty acids, and (if the client’s exposure to sunlight is limited) vitamin D. Foods commonly eaten include tofu, tempeh, soy milk and other soy products, meat analogs, legumes, nuts and seeds, sprouts, and a variety of fruits and vegetables. Gluten-Free Diet: Foods that are prohibited include anything made from wheat, rye, barley, and oats; client instructions about reading the labels of all food items is critical. Tube Feedings Description  Liquefied foods are introduced into the gastrointestinal tract by way of a tube.  Tube feeding is indicated when the gastrointestinal tract is functional but oral intake is not meeting estimated nutrient needs.  This means of feeding is used for clients with swallowing problems, burns, major trauma, liver or other organ failure, or severe malnutrition. Guidelines for Administration  Check the health care providers prescription and agency policy regarding residual amounts; usually a feeding is administered if the residual volume is less than 100 mL; a large volume of aspirate indicates delayed gastric emptying and an increased risk of aspiration.  Assess the client’s bowel sounds; hold the feeding and notify the health care provider if bowel sounds are absent.  Place the client in a high Fowler’s position and on the right side if comatose.  Assess tube placement by aspirating gastric contents and measuring the pH, which should be 3.5 or lower.  Aspirate all stomach contents (known as the “residual”), measure the amount, and return the contents to the stomach to prevent electrolyte imbalances (unless the contents look abnormal).  Warm the feeding to room temperature to help prevent diarrhea and cramps.  Use an infusion feeding pump for continuous feedings.  For bolus (intermittent) feedings, maintain the client in a high Fowler position for 30 minutes after the feeding.  For continuous feeding, keep the client in a semi-Fowler position at all times. xiii. Feeding tubes  indications - inability to ingest, chew, or swallow food, but GI tract intact  tube inserted through nose into stomach or small bowel; or inserted endoscopically; gastrostomy tube or PEG tube, jejunostomy tube  types of tubes and feedings  i. small bore feeding tube: 8 to 12 Fr and 36 to 43 inches long i. difficult to aspirate stomach contents ii. may be impossible to auscultate an air bolus or air bolus may be heard even when tube is not in stomach iii. tubes may become displaced even when securely taped iv. hard to verify placement; therefore best initial method is by x-ray; thereafter routine check of stomach contents pH xiv. enteral tube feedings  keep head of bed raised at least 30 degrees, to prevent aspiration  assess placement of tube (confirm technique used, as required by agency policy)  i. obtain radiologic (x-ray) confirmation before instilling any feedings or medications or if there are concerns about other forms of assessment ii. recommended practice is to aspirate gastric contents and check if pH is acidic (pH should be below 6) iii. injecting ten mL air into nasogastric tube (NG tube) and listening with stethoscope for rush of air over stomach is no longer an accepted method to verify placement  administer enteral feeding i. may be continuous or intermittent ii. to prevent bacterial growth, change bag and tubing every 24 hours and tube feeding formula every 4 to 8 hours iii. to prevent fluid and electrolyte imbalances, administer tube feedings at a rate of no more than 300 mL/hr  assess gastric residual i. every 4 hours if continuous feeding or ii. before you begin intermittent feedings xv. tube feeding formulas: Vivonex®, Isocal, Portagen®, etc. xvi. complications  aspiration  gastrointestinal complications (diarrhea) Tube Feedings-Precautions  Change the feeding, or per agency policy.  As a means of helping prevent bacterial growth, do not hang more solution than will be required for a 4-hour period.  Check the expiration date on the formula before administering it.  Shake the formula well before pouring it into the container (feeding bag).  Always assess bowel sounds; do not administer a feeding if bowel sounds are absent.  Administer the feeding at the prescribed rate or by way of gravity flow (intermittent bolus feeding) with the use of a 50- to 60-mL syringe with the plunger removed.  Gently flush the tube with 30 to 50 mL of water or normal saline solution (depending on agency policy), using the irrigation syringe, after the feeding.  electrolyte or metabolic problems Diarrhea  Assess the client for lactose intolerance.  Use a feeding solution containing fiber.  Administer the feeding slowly after ensuring that it is at room temperature. Aspiration  Verify tube placement.  Do not administer the feeding if the residual volume is more than 100 mL (check health care providers prescription and agency policy).  Keep the head of the bed elevated.  If aspiration occurs, suction as needed, assess the respiratory rate, auscultate lung sounds, monitor the temperature for indications of aspiration pneumonia, and prepare the client for chest radiography. Clogged tube   Use liquid forms of medication, if possible.  Flush the tube with 30 to 50 mL of water or normal saline (depending on agency policy) before and after medication administration and before and after bolus feedings.  Flush the tube being used for continuous feeding with water every 4 hours. Vomiting  Administer feedings slowly and, for bolus feedings, make the feeding last at least 30 minutes.  Measure the client’s abdominal girth.  Do not allow the feeding bag to empty.  Do not allow air to enter the tubing.  Administer the feeding at room temperature.  Elevate the head of the bed.  Administer antiemetics as prescribed.  If the client vomits, stop the tube feeding and place the client in a side-lying position; suction the client as needed. xvii. Nutritional supplements and liquids for dehydration or diarrhea  infants: Infalyte, Pedialyte®, Ricelyte®  older children: sports electrolyte replacement drinks  infant formulas: standard and high-calorie  specialty formulas: i. predigested, e.g., Pregestimil, Nutramigen ii. high-calorie supplements, e.g., Scandishake, Carnation Instant Breakfast xviii. Parenteral nutrition: see Lesson 6 of this course xix. Measures to improve nutrition intake of client  frequent small feedings  feeding assistance  offering preferred foods  ethnic foods It is more productive to review materials frequently in short intervals, such as one-to-two hours at a time. Be sure to take a short break every half hour or so. NCLEX NUTRITION PRACTICE 1.A clear-liquid diet is prescribed for a client who has undergone surgery. Which items should the nurse offer to the client? Select all that apply. 1. Gelatin 2. Sherbet 3. Ginger ale 4. Tomato juice 5. Strained soup RATIONALE A,C A clear-liquid diet consists of foods that are relatively transparent to light and are clear and liquid at room and body temperature. This diet includes such items as water, bouillon, clear broth, carbonated beverages, gelatin, hard candy, lemonade, ice pops, and regular or decaffeinated coffee or tea. Strained soup, tomato juice and sherbet are items that would be included in a full liquid diet. 2.A client with hyperlipidemia has been prescribed a high-fiber diet. Which items should the nurse instruct the client to include in the diet? Select all that apply. 1. Pasta 2. Whole grain cereal 3. White rice 4. Apple juice 5. Whole-wheat bread RATIONALE A,C- Whole-grain products (e.g., whole-wheat bread, cereal) are high in fiber. Refined grain products (e.g., white bread, white rice, pasta, cereals that are not whole-grain) are low in fiber. Vegetables and fruits without skins and seeds (e.g., canned fruit and fruit juice) are also low in fiber. 3, Which of the following actions would the nurse recommend to provide a 12-month-old infant with nutrients for growth? A. Exclude milk from the infant's diet until he or she begins to like other foods. B. Offer the infant small amounts of meat and vegetables before offering milk. C. Withhold desserts until the infant has eaten his or her vegetables. D. Mix strained meat and vegetables into the milk given to the infant RationaleB- Children at this age are prone to anemia, especially when milk is offered frequently; therefore, holding liquids until after solid food is offered prevents the child from filling up on liquids 4. The nurse is discussing nutrition with a woman who is 50-years-old, perimenopausal, and has a history of hypertension. What food choices would be best to help meet the dietary needs of this client? A. Cheese and macaroni, fresh fruit, and milk shake B. Cottage cheese, glass of skim milk, and fresh spinach salad C. Roast beef with whole wheat bread, potato, and lettuce salad D. Cheeseburger, French fries, and milk shake Rationale:B-Because the woman is perimenopausal, she needs increased calcium intake (1500 mg/day). With a diagnosis of hypertension, she also needs a decreased-sodium diet. Foods high in calcium include milk products, leafy green vegetables, and dried beans. Yellow vegetables are not high in calcium. Pasta and breads are a source of sodium. 5.The nurse is serving a food tray to a client who has glomerulonephritis and azotemia. Which food selection would the nurse question? A. Bread and rice B. Dried peaches and apricots C. Bran muffin and eggs D. Apples and cucumbers Rationale: B-The increased potassium found in dried peaches and apricots is contraindicated for a client with increased potassium and blood urea nitrogen (BUN) levels. Dried fruit is high in potassium. Azotemia is an elevation of blood urea nitrogen (BUN) and serum creatinine levels. The reference range for BUN is 8-20 mg/dL, and the normal range for serum creatinine is 0.7-1.4 mg/dL. Glomerulonephritis (gloe-mer-u-low-nuh-FRY-tis) is inflammation of the tiny filters in your kidneys (glomeruli). Glomeruli remove excess fluid, electrolytes and waste from your bloodstream and pass them into your urine. Also called glomerular disease, glomerulonephritis can be acute — a sudden attack of inflammation — or chronic — coming on gradually. If glomerulonephritis occurs on its own, it's known as primary glomerulonephritis. If another disease, such as lupus or diabetes, is the cause, it's called secondary glomerulonephritis. Severe or prolonged inflammation associated with glomerulonephritis can damage your kidneys. Treatment depends on the type of glomerulonephritis you have. Signs and symptoms of glomerulonephritis depend on whether you have the acute or chronic form, and the cause. Your first indication that something is wrong may come from symptoms or from the results of a routine urinalysis. Glomerulonephritis signs and symptoms may include:  Pink or cola-colored urine from red blood cells in your urine (hematuria)  Foamy urine due to excess protein (proteinuria)  High blood pressure (hypertension)  Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen  Fatigue from anemia or kidney failure Specific signs and symptoms may suggest glomerulonephritis, but the condition often comes to light when a routine urinalysis is abnormal. Tests to assess your kidney function and make a diagnosis of glomerulonephritis include:  Urine test. A urinalysis may show red blood cells and red cell casts in your urine, an indicator of possible damage to the glomeruli. Urinalysis results may also show white blood cells, a common indicator of infection  or inflammation, and increased protein, which may indicate nephron damage. Other indicators, such as increased blood levels of creatinine or urea, are red flags.  Blood tests. These can provide information about kidney damage and impairment of the glomeruli by measuring levels of waste products, such as creatinine and blood urea nitrogen.  Imaging tests. If your doctor detects evidence of damage, he or she may recommend diagnostic studies that allow visualization of your kidneys, such as a kidney X-ray, an ultrasound examination or a computerized tomography (CT) scan.  Kidney biopsy. This procedure involves using a special needle to extract small pieces of kidney tissue for microscopic examination to help determine the cause of the inflammation. A kidney biopsy is almost always necessary to confirm a diagnosis of glomerulonephritis 6. client who is scheduled for a colonoscopy is instructed to take nothing except clear liquids for 6 hours before the procedure. What comment by the client would indicate to the nurse that the client does not understand the concept of clear liquids? A. "I can have beef or chicken broth." B. "Lemon-, orange-, or lime-flavored gelatin is okay." C. "I can have a small amount of vanilla ice cream." D. "I can have tea and coffee with sugar." Rationale: C-Ice cream is not a clear liquid. The gelatins are okay; however, red-colored gelatin is often prohibited. Coffee and tea are both acceptable with sugar, but no cream is allowed. 7. The nurse understands that the food guide (MyPlate) is a: A. Nutrient guide that categorizes foods by their fiber content B. Basic message is about healthy eating and portion control C. Food guide that emphasizes higher intakes of protein than presently consumed D. Nutrient guide aimed to promote weight loss by controlling intake of fat-soluble vitamins Rationale: B-The MyPlate is the new focus of categorizing the five major food groups according to the proportions that persons should eat daily to maintain nutritional balance and reduce the risk of diet-related diseases. MyPlate is not a therapeutic diet for any specific health condition, such as weight loss 8. An infant is 5 months old and weighs 7.5 kg. The nurse understands that the caloric requirement for this infant is 100 cal/kg per day. The infant's formula has 20 calories in 1 oz. How many milliliters of formula does the infant require in a 24-hour period? Rationale: Multiply the caloric requirement by the infant's weight: 100 cal × 7.5 kg = 750 cal/day, then 750 divided by 20 = 37.5 × 30 mL = 1125 mL. Be sure to convert ounces to milliliters: 1 ounce = 30 mL 9. The nurse is serving a bland diet to a client. Which of the following foods would the nurse question? A. Milkshake B. Orange juice C. Baked potato D. Cream of wheat Rationale: B-A bland diet is very nonirritating and usually consists of white foods. There are very few brightly colored foods on a bland diet. A milkshake, baked potato, and cream of wheat are bland in color and in taste. Orange juice is highly acidic and may cause GI irritation; therefore, it is the correct answer 10.A client is continuing his recovery from extensive surgery at home. The nurse instructs the client to increase his intake of which foods to promote healing? A. Tomatoes, rice, whole-grain cereal B. Milk, poultry, yellow vegetables C. Red meat, oranges, green beans D. Liver, corn, eggs Rationale: C-The client needs an increased intake of protein and vitamin C to promote healing. Red meat, citrus fruits, and green vegetables will give the highest amounts of these elements from the selections offered 11. A client who has had a myocardial infarction is discharged on a low-sodium, low-cholesterol diet. Which comment by the client would indicate to the nurse that he needed further diet teaching? A. "I can prepare foods with canola oil." B. "I can spice my foods with fresh herbs." C. "I will have frozen dinners for lunch." D. "I need to eat only lean beef, pork, and chicken." Rationale: C-Canned soups and frozen dinners are most often a source of significant sodium and clients are generally encouraged to avoid them. Using canola oil, fresh herbs, and lean cuts of meat would be appropriate on a low-sodium, low-cholesterol diet 12, A client complains of lactose intolerance. The nurse would recommend which foods? A. Broiled fish, fresh fruits, and vegetables B. Whole-grain breads, rice, and ice cream C. Lean red meat, dried fruits, and yogurt D. Whole-wheat pasta with cheese and milk Rationale:A-Lactose is contained in milk and milk products. Broiled fish, fresh fruits, and vegetables is the only answer that does not have a milk product (ice cream, yogurt, cheese, milk) included 13. The clinic nurse is discussing nutrition with the mother of a 10-month-old infant. The nurse determines the infant is in the 97th percentile for weight and age. The mother wants to begin giving the infant skimmed or low-fat milk. What is the best nursing response? A. She can begin rotating formula and low-fat milk at age 12 months. B. Low-fat milk can be started at this time. C. Skim or decreased-fat milk should not be given to children until they are 2 years old. D. It is important to keep children on formula until they are 36 months old. Rationale:C Skim milk or low-fat milk can be given to a child after 2 years of age. Before 2 years of age, either whole cow's milk, formula, or breast milk may be offered. Depending on family characteristics, the nurse may want to review with the mother the type and amount of food the infant is eating. 14. The nurse understands that if excessive amounts of water-soluble vitamins are ingested, which of the following happens? A. The body will store what is not used in muscle and fat tissue. B. The body will attach them to proteins and circulate. C. The excess will be stored in the liver until needed. D. The excess will be excreted in the urine. Rationale: D-Water-soluble vitamins are excreted in the urine, in contrast to fat-soluble vitamins, which can have toxic levels because they are stored in the body. The water-soluble vitamins are B and C. The fat-soluble vitamins are A, D, E, and K. 15. A nurse is discussing with a client the need to eat a high-protein diet. The nurse knows the client understands the diet when he selects which foods from the hospital menu? A. Cheeseburger, French fries, and coffee B. Grilled cheese sandwich, green salad, and tea C. Chicken and rice soup, whole wheat crackers, and milk D. Chicken breast sandwich, sliced cheese, and milk Rationale:D-Meat and dairy products are high in complete protein. The other options have a high-protein food but also contain other foods that do not contain protein (green salad, whole wheat crackers) or are not healthy foods (French fries) 16. An 8-year-old boy is hospitalized for continued intravenous treatments for his leukemia. He is on a regular diet, but he eats very little. He tells the nurse he wants a hamburger, French fries, and a milk shake. What is the best nursing action? A. Encourage him to eat his vegetables, and reward him with ice cream. B. Request these foods from the dietary department. C. Explain to him how important it is for him to eat a healthy diet. D. Find out his favorite dessert and provide that when he eats his regular diet Rationale:B-Loss of appetite is common when children are ill. The foods he likes are nutritious and the nurse should attempt to supplement his favorite foods with fruits and vegetables. Request the favorite foods and offer fruit as well 17.A client is admitted with venous insufficiency and leg ulcers that are infected and healing poorly. What would the nurse consider as an important dietary consideration for this client? Select all that apply. A. The client will need adequate and possible dietary supplements, such as vitamin A, zinc, and copper. B. Poor nutrition will decrease wound healing and increase the client's susceptibility to infection. C. Dietary history will be important so that the client can be served foods he likes.  D. Serum glucose should be carefully monitored for problems with glucose control. E. Increased age affects wound healing. F. Leg ulcers from venous insufficiency heal by primary intention. Rationale:A,B,E-The client will need an increase in protein, carbohydrates, and fats if the wound is going to heal. Dietary supplements may be necessary, and a dietary history would be important; however, these are not directly to improving the wound healing. Increased age affects wound healing. The client with diabetes has problems with peripheral artery disease, and glucose control is not related to poor wound healing, instead healing is affected by poor tissue perfusion due to poor circulation in the client with diabetes. Pressure ulcers (or a leg ulcer) from venous insufficiency heal by secondary intention (not primary), because there is loss of tissue in this type of wound. The wound edges are not approximated in a secondary intention healing wound, as they would be in a primary intention wound healing (i.e., surgical incision 18. An adult is placed on a 500-mg sodium diet. Which of the following foods should the nurse suggest when assisting this client to select a daily menu? Select all that apply. A. Cooked rice and bak