Nutrition Proctored PART 1 ,2 AND 3(BUNDLE) WITH COMPLETE GRADE A SOLUTIONS 2020

Part 1: General Notes Part 2: Focused Review Notes Part 3: ATI Rational with Additional/Supported Information PART 1: GENERAL NOTES (Important Facts) • Be wary of questions regarding children drinking too much milk i ...

Part 1: General Notes Part 2: Focused Review Notes Part 3: ATI Rational with Additional/Supported Information PART 1: GENERAL NOTES (Important Facts) • Be wary of questions regarding children drinking too much milk i.e. more than 3-4 cups of milk each day. Too much milk intake reduces intake of other essential nutrients, especially iron. Watch for anemia with milk-aholics. • Vitamin D’s presence is required by the parathyroid gland, in order for it to function. • If the patient is taking digoxin or K-supplements, avoid salt substitutes because many are potassium based • Potassium Sources: bananas, potatoes, citrus fruits • No milk (as well as fresh fruit or veggies) on neutropenic precautions. • Nondairy sources of calcium include RHUBARB, SARDINES, COLLARD GREENS 24 • Nonfat milk reduces reflux by increasing lower esophageal sphincter pressure • Yogurt has live cultures, so do not give to immunosuppressed patients • No phenylalanine with a kid positive for PKU (no meat, no dairy, no aspartame). • Acid Ash diet: cheese, corn, cranberries, plums, prunes, meat, poultry, pastry, bread • Alk Ash diet: milk, veggies, rhubarb, salmon PART 2: Focused Review Notes Manifestations of Vitamin A Toxicity  Can cause teratogenic effects on fetuses  Blurred vision  Bone pain or swelling  Hypercalcemia  ICP  Liver damage  Skin peeling, itching  Nausea and vomiting  Abnormal softening of the skull bone (children) and bulging fontanels Planning Care for a Client Who Follows Seventh-Day Adventist Dietary Laws  Vegetarianism o Do not consume animal products of any type INCLUDING eggs and milk products. o Vitamin B12 and Vitamin D supplements may be needed with a pure vegan diet.  Vegan diets are adequate in protein due to intake of nuts and legumes (dried peas and cooked beans). Initiating Continuous Enteral Feeding  This is recommended for critically ill patients because it is associated with small residual volumes, and a lower risk of aspiration and diarrhea.  Residual volumes should be measures q4-6hrs.  Feeding tubes should be flushed with water q4hr to maintain patency and hydration.  If patient’s gastric volume exceeds 500ml, the continuous feeding should be HELD and tolerance reassessed. o In children, residual volumes should be measured and held if the amount is equal to or greater than ¼ the prescribed feeding amount.  Residual should be returned and the amount rechecked in 30min to 1hr. Recommendations for Nutritional Supplement  Add skim milk to powder milk (double strength milk)  Use whole milk instead of water recipes  Add cheese, peanut butter, chopped hard-boiled eggs, yogurt.  Dip meats in eggs or milk and coat with bread crumbs before cooking.  Nuts and dried beans are significant sources of protein  great alternatives to dairy allergy or lactose intolerance! Assessing Caloric Intake  Toddlers: 1 to 3 years old o Limit 100% juice 4 to 6oz a day o The 1 to 2-year-old requires whole cow’s milk to provide adequate fat. o Food serving size is 1 tablespoon for each year of age.  Preschoolers: 3 to 6 years old o Preschoolers need 13 to 19 g/day of complete protein. o 1 tablespoon per year of age for size of foods. o May switch to skin or 1% low-fat milk after 2 years.  School-Age Children: 6 to 12 years old o Weight loss program is directed for children 40% overweight.  Adolescence o Energy requirements average 2,000 calorie/day for a 12 to 18-year-old female. o Energy requirements average 2,200 to 2,800 calorie/day for a 12 to 18-yearold male. o Average U.S. adolescent consumes a diet deficient in folate, vitamin A and E, iron, zinc, mag, calcium, and fiber.  Adulthood and older adulthood o Need a balanced diet that consists of 40% to 55% carbs, and 10-20% fat (with no more than 30% fat). o A 24 hr dietary intake is helpful in determining the need for dietary education. - Use whole grains, select orange and dark green leafy vegetables, avoid fruits with added sugar (make half your plate vegetables and fruits), use vegetable oils, 132-362 discretionary calories are permitted per day. MEN CALORIE INTAKE WOMEN CALORIE INTAKE 19 to 30 years old: 2,400 calories 19 to 30 years old: 2,000 calories 31 to 50 years old: 2,200 calories 31 to 50 years old: 1,800 calories 51+ years old: 2,000 calories 51+ years old: 1,600 calories Teaching about High-Fiber Food Sources  Beans  Vegetables  Oats  Whole grains  Cereals  Nuts, seeds  Raw or dried fruits  Barley  Flaxseed  Avocado  Chickpea  Brown Rice  Sweet Potato/Reg. Potato  Quinoa Priority Cholesterol Levels to Report  HDL (good cholesterol) should have levels greater than or equal to 60mg/dl  LDL (bad cholesterol) is less than 130mg/dl.  Optimal cholesterol level is less than 200mg/dl. Prioritizing Care for Intermittent Enteral Feeding  Formula is administered q4-6hr in equal portions of 250 to 400 ml over a 30-60min time frame usually by gravity drop or pump.  Residual volumes should be measured prior to initiating the feeding and held if the amount is greater than the amount stated in the prescription.  Tube should be marked with ink or tape and checked to make sure it has not migrated.  Assess bowel sounds. Dysfunction can indicate a need for alternate forms of nutrition.  Elevate head of bed 30 degrees and for at least 30 to 60 minutes after. Menu Choices for Preventing Aspiration  Encourage small bites and thorough chewing.  Pills should be taken with at least 8oz of fluid (can be thickened).  Avoid thin liquids and sticky foods. Interventions for Diarrhea Caused by Radiation Therapy  Ensure adequate intake of liquids to replace losses.  Avoid foods that exacerbate diarrhea (foods high in roughage)  Consume foods high in pectin to increase bulk of the stool.  Limit caffeine, hot or cold drinks, and fatty foods. Evaluating Teaching about Complete Proteins  Complete proteins are from animal sources and soy  They contain sufficient amounts of all 9 amino acids. Folate Intake During Pregnancy  Helps prevent neural tube defects in utero (Folic acid is the synthetic form).  Deficiency causes spina bifida, anencephaly.  Take 400-800 mcg a day (According to the internet, does not say anywhere in ATI) Food Choices for a Client Who Practices Orthodox Judaism  Special food preparations (kosher kitchens) NO MEAT AND MILK TOGETHER  Guidelines state that animal slaughter must be “humane” and do not waste meat.  They avoid all pork and shellfish products. Heme Sources of Iron  Meat  Fish  Poultry Appropriate Food Choices for a Toddler  Prefer finger foods due to autonomy  Prefer plain foods rather than mixture foods, but usually like macaroni, spaghetti, and pizza. Teaching a Client Who Has Dumping Syndrome  Recommend small, frequent meals.  Recommend protein and fat at each meal.  Avoid concentrated sugar and restrict lactose intake.  Suggest that the client consume liquids 1 hour before