ATI Nutrition Proctor Study Guide Review Latest 2023 Graded A

ATI Nutrition Proctor Study Guide Review Latest 2023 Graded A How many calories do carbs provide? ✔✔4 cal/g How many calories do fats provide? ✔✔9 cal/g How many calories do proteins provide? ✔✔4 cal/g Glucose ✔✔70- ...

ATI Nutrition Proctor Study Guide Review Latest 2023 Graded A How many calories do carbs provide? ✔✔4 cal/g How many calories do fats provide? ✔✔9 cal/g How many calories do proteins provide? ✔✔4 cal/g Glucose ✔✔70-115 Albumin ✔✔3.5-5.0 Prealbumin ✔✔15-36 Protein ✔✔6-8 Sodium ✔✔135-145 Potassium ✔✔3.5-5.0 Calcium ✔✔9.0-10.5 Magnesium ✔✔1.3-2.1 Platelets ✔✔150,000-400,000 Hemoglobin ✔✔12-18 Hematocrit ✔✔37%-52% Cholesterol ✔✔<200 HDL ✔✔Male >40; Female >50 LDL ✔✔<100 Triglycerides ✔✔<150 Glycosylated Hemoglobin A1c ✔✔4.0-6.0% Creatinine ✔✔0.6-1.3 BUN ✔✔6-20 WBC ✔✔5,000-10,000 Food sources for folic acid ✔✔Green leafy vegetables; liver, beef, and fish; legumes; grapefruit and oranges Food sources for niacin ✔✔Meats, poultry, fish, beans, peanuts, grains, legumes, milk, whole grain, and enriched breads and cereals. Deficiency of Niacin (B3) ✔✔results in pellagra S/S: sun-sensitive skin lesions and GI and neurological findings. Food sources for B12 (thiamine) ✔✔pork and nuts, whole-grain cereals, legumes Thiamin (B1) deficiency ✔✔results in beriberi (ataxia, confusion, anorexia, tachycaria), headache, wt loss, fatigue Food sources for B2 (riboflavin) ✔✔milk, lean meats, fish, grains Deficiency of Riboflavin (B2) ✔✔results in cheilosis (S/S: scales and cracks on lips and in corners of mouth), swollen/smooth red tongue (glossitis), and dermatitis of ears, nose, and mouth) Food sources for B6 (pyridoxine) ✔✔yeast, corn, meat, poultry, fish Food sources for B12 (cobalamin) ✔✔Meat, liver Food sources for vitamin C (ascorbic acid) ✔✔Citrus fruits (oranges, lemons), tomatoes, broccoli, cabbage, peppers, green leafy vegetables, strawberries Vitamin C deficiency ✔✔scurvy; a hemorrhagic disease w/ diffuse tissue bleeding, painful limbs/joints, weak bones, swollen gums/loose teeth Food sources for Vitamin A ✔✔Liver, egg yolk, whole milk, green or orange vegetables, fruits Food sources for Vitamin D ✔✔Fortified milk, fish oil, cereal Food sources for Vitamin E ✔✔vegetable oils; green leafy vegetables; cereals; apricots, apples, and peaches Food sources for Vitamin K ✔✔green leafy vegetables; cauliflower and cabbage. Food sources of calcium ✔✔cheese, collard greens, milk and soy milk, rhubarb, sardines, tofu, yogurt Food sources of chloride ✔✔salt Food sources of iron ✔✔Bread, cereal, dark green vegetables, dried fruits, egg yolk, legumes, liver, meats Food sources of magnesium ✔✔Avocado, canned white tuna, cauliflower, cooked rolled oats, green leafy vegetables, milk, peanut butter, peas, pork, beef, chicken, potatoes, raisins, yogurt. affects enzyme and neurochemical activities and the excitability of cardiac and skeletal muscles. Food sources of phosphorus ✔✔Fish, nuts, organ meats, pork, beef, chicken, whole grain breads and cereals. Milk products, beef liver, chocolate, nuts, legumes, peanut butter, dried peas and beans, bran, cola, beer, some whole grains. plays a role in bone and teeth formation and energy metabolism Food sources of potassium ✔✔Avocado, bananas, cantaloupe, carrots, fish, mushrooms, oranges, pork, beef, veal, potatoes, raisins, spinach, strawberries, tomatoes Food sources of sodium ✔✔Bacon, butter, canned food, cheese, cured pork, hot dogs, ketchup, lunch meat, milk, mustard, processed food, snack food, soy sauce, table salt, white and whole wheat bread Food sources of zinc ✔✔eggs, leafy vegetables, meats, protein rich foods. plays a role in tissue growth and wound healing, and supports immune function Recommended intake of protein for adults ✔✔10%-35% of total calories Recommended intake of fats for adults ✔✔20-35% of total calories, 10% or less of total calories should come from saturated fat souces Full liquid diet ✔✔Used as a transition diet after clear liquids following surgery or for pts who have difficulty chewing, swallowing, or tolerating solid foods. Diet includes clear and opaque liquid foods, and those that are liquid at body temperature. Foods include all clear liquids and items such as plain ice cream, sherbet, breakfast drinks, milk, pudding, custard, soups that are strained, refined cooked cereals, fruit juices, and strained vegetable juices. Low purine diet ✔✔used for gout, kidney stones, elevated uric acid levels. Restrict anchovies, herring, mackerel, sardines, scallops, organ meats, gravies, meat extracts, wild game, goose, and sweat breads Renal diet ✔✔Controlled amounts of protein, sodium, phosphorus, calcium, potassium, and fluids may be prescribed; may also need modification in fiber, cholesterol, and fat based in individual requirements; restrict fluids. Sodium restricted diet ✔✔Used for hypertension, heart failure, renal disease, cardiac disease, and liver disease. Diet plans are individualized; can include 4 g of sodium daily (no added salt diet) 2-3 g of sodium daily (moderate restriction), 1 g of sodium daily (strict restriction), or 500 mg of sodium daily (severe restriction and seldom prescribed). Encourage intake of fresh foods rather than processed foods. Canned, frozen, instant, smoked, pickled, boxed foods, lunch meat, soy sauce, salad dressing, fast foods, soups, and snacks usually have higher amounts of sodium. Cardiac diet ✔✔Indicated for atherosclerosis, DM, hyperlipidemia, hypertension, myocardial infarction, nephrotic syndrome, and renal failure. DASH diet recommended to prevent and control hypertension, hypercholesterolemia, and obesity. Includes fruits, veggies, whole grains, low fat dairy food, meat, fish, poultry, nuts, and beans, and is limited in sugar sweetened foods and beverages, red meat, and added fats. Low sodium, high potassium, high calcium diet to lower BP and cholesterol. Decrease sodium 1,500-2,300. High calorie high protein diet ✔✔used for severe stress, burns, wound healing, cancer, HIV, COPD, respiratory failure. Encourage whole milk, milk products, peanut butter, nuts and seeds, beef, cottage cheese, chicken, fish, pork, and eggs. Encourage snacks between meals such as milkshakes, instant breakfasts, and nutritional supplements. Low fiber diet ✔✔canned fruit, white bread, broiled hamburger, fish, poultry Complete proteins ✔✔eggs, meat, poultry, seafood, milk, yogurt, cheese, soybean products, Incomplete proteins ✔✔peanut butter, cereal, pasta Vegan ✔✔strict vegetarian diet and consume no animal foods. Eat only foods of plant origin (whole or enriched grains, legumes, nuts, seeds, fruits, vegetables.) Use of soybeans, soy milk, soybean curd (tofu) and processed soy protein products enhance nutritional value of diet Lacto ovo vegetarian ✔✔Follow a food pattern that allows consumption of dairy products and eggs. Consume adequate plant and animal food sources, excluding meat, poultry, pork, and fish poses no nutritional risk Lacto-vegetarian ✔✔Cosume milk, cheese, dairy foods but avoid meat, fish poultry, and eggs. Diet of whole or enriched grains, legumes, nuts, seeds, fruits, and vegetables in sufficient quantities to meet energy needs and provides a balanced diet. Potential deficiencies in vegetarian diet ✔✔energy, protein, B12, zinc, iron, calcium, omega 3 fatty acids, and vitamin D. To enhance absorption of iron, consume a good source of iron and vitamin C with each meal. Include 2 servings per day of nuts What should you give children under the age of two? ✔✔low fat milk. Whole milk gives necessary fat for neurological development for children up to 2 years of age What should the nurse do to help with chemotherapy changes in taste? ✔✔Use plastic utensils, increase fluid intake to improve taste, suggest pt to eat foods served cold or at room temperature to improve taste, try tart foods and seasonings to improve taste, offer citrus fruits, suggest pickles as snack and gargle w/ mouth wash 1st day after birth, how long should the mother feed per breast? ✔✔5 minute feedings on each breast on the first day after birth Dumping syndrome ✔✔When a portion of the stomach is removed, the contents of the stomach are rapidly emptied into the small intestine, causing dumping syndrome. Manifestations occur 15-30 minutes after eating, and include sensation of fullness, abdominal cramping, nausea, diarrhea, faintness, syncope, diaphoresis, tachycardia, hypotension, flushing. Late manifestations occur 1-3 hrs after eating and include diaphoresis, weakness, tremors, anxiety, nausea, and hunger. Manifestations resolve after intestine is emptied. There's a rapid rise in blood glucose and increase insulin levels immediately after the intestine empties, which leads to hypoglycemia. Recommend small frequent meals, consume protein and fat at each meal, avoid food w/ concentrated sugar, restricts lactose intake, consume liquids 1 hr before or after eating, Lie down for 20-30 minutes after meals to delay emptying. Dysphagia ✔✔palpate pt's throat during swallowing, inspect for food pockets in the mouth before feeding, allow the pt to rest 30 minutes before meals, use adaptive eating devices, encourage small bites and thorough chewing, tilt head forward when swallowing, place food on unaffected side of mouth and limit disruptions during mealtime, modify texture of foods and consistency of liquids can enable pt to achieve proper nutrition, evaluate medications to see if they're causing dry mouth and dysphagia to determine if this is a potential adverse effect, place pt in upright or high Fowler's position to facilitate swallowing, provide oral care prior to eating to enhance pt's sense of taste, refer pt to speech therapist for evaluation, take pills w/ at least 8 oz of fluid (can be thickened) to prevent medication from remaining in the esophagus, avoid thin liquids and sticky foods. Nutritional supplements are beneficial if nutritional intake is deemed inadequate. What should you teach the pt after being discharged w/ colostomy ✔✔increase foods w/ pectin Kosher diet ✔✔combine cheese w/ non meat products at the same time; no pork; don't combine dairy products w/ meat products at same meal; no shellfish. Ritually slaughtered beef, sheep, goats and deer with no flaws or diseases; chicken, turkey, quail, geese; salmon, tuna, carp, herring, cod; beef/poultry must be eaten separately from dairy (6-hour wait time period) are acceptable. Fruits and vegetables are all Kosher as long as they are clean. Not acceptable: Pork, camel, rabbit, rodents, reptiles and any animal that died of natural causes; eagle, hawk, vulture; crab, lobster, octopus, clam, swordfish, sturgeon, shrimp; meat with dairy (eg. cheeseburger, chicken cordon bleu, burger with milkshake) Ramadan ✔✔consume meals before dawn and after sunset. The nurse should offer the client a snack or light meal after sunset COPD ✔✔consume foods soft in texture and easy to chew irritable bowel disease ✔✔take peppermint oil during exacerbation of manifestations Parkinson's disease ✔✔Critical findings: pt drools while eating, which can indicate that this client is at greatest risk for aspiration of food from dysphagia, which can lead to pulmonary complications Intermittent enteral feedings ✔✔Place pt in fowler's position, verify tube placement, check residual, flush tubing w/ 30 mL water. If pt is experiencing diarrhea, feed the pt in small frequent volumes. increase the volume of formula over the 1st 4-6 feedings. If pt is dehydrated, provide as continuous infusion Diabetes ✔✔three to five carbohydrate choices, or 45 g, are allowed per meal, plus one to two carbohydrate choices for each snack. Somogyi phenomenon is fasting hyperglycemia that occurs in the morning in response to hypoglycemia during the nighttime. The nurse should assess for this phenomenon by monitoring blood glucose levels during the night Recommended weight gain during 1st trimester ✔✔1.1-4.4 lb Normal pt wt gain (BMI (18.5-24.9) during pregnancy ✔✔1 lb/wk for 25-35 lb Underweight pt (BMI <18.5) ✔✔just more than 1 lb/wk for total of 28-40 lb Overweight pt (BMI 25-29.9) ✔✔0.66 lb/wk for total of 15-25 lbs Which mineral causes constipation ✔✔Calcium Hyperlipidemia ✔✔pt should limit meat to 5 oz per day TPN ✔✔TPN is used when a patient's GI tract isn't functioning, or when a patient cannot physically or psychologically consume sufficient nutrients orally or enterally. It's commonly used in patients who need intense nutritional support for an extended period of time, including patients undergoing treatment for cancer, bowel disorders, critically ill, and those suffering from trauma or extensive burns, as these conditions are associated w/ high caloric requirements. PPN may be used when the patient is unable to consume enough calories to meet metabolic needs or when nutritional support is needed for a short time period (7-10 days). Eval for presence of allergies to soybeans, safflower, eggs, or lipids. Monitor for "cracking" which has an oily appearance or a layer of fat ion the top of the solution. Verify RX w/ 2nd RN prior to admin. Allow solution to come to room temp for 1 hr prior to administration. Bag of tubing should be changed Q24 hrs. A micron filter on IV tubing is required when giving. Can be D/C since when oral intake exceeds at least 60% of the client's estimated daily caloric requirements Stomatitis ✔✔provide meals at room temp, avoid salty food, rinse w/ 0.9% sodium chloride solution or baking soda mixed with water, most foods and liquids with meal to decrease discomfort and promote nutritional intake, and use soft bristled toothbrush, avoid dry coarse foods such as toast Fluid overload ✔✔sodium level 130 Pt taking warfarin ✔✔Be mindful consuming foods high in vitamin k, such as green leafy vegetables. Gastric bypass ✔✔instruct pt to start each meal w/ a protein. The client should consume 60 to 120 g of protein each day Continuous enteral feedings ✔✔prevent aspiration by monitoring gastric residuals every 4 hrs Malnutrition ✔✔Manifestations: ankle edema Anorexia nervosa ✔✔Assign privileges based on direct weight gain. RN to stay w/ pt 1 hr after meals Constipation ✔✔instruct the client that consuming the skin on fruits and vegetables adds fiber to the diet.-The nurse should instruct the client to add a small amount of bran to her daily diet, working up to 3 tablespoons daily, which is less than ¼ cup. Adding fiber gradually should prevent abdominal distention and excessive flatus. Cirrhosis ✔✔decrease sodium intake to 1-2 grams per day, avoid foods high in fat, increase protein from animal or plant sources. Macular degeneration ✔✔increase dietary intake of lutein Hydrolyzed formula ✔✔Elemental, composed of partially digested protein peptides and free amino acids. Used for pts who have partially functioning GI tract or pts w/ impaired ability to digest and absorb food. (liver failure, IBD, pancreatic disorders, etc) Standard formulas ✔✔Polymeric or intact, composed of whole proteins milk, meat eggs) or protein isolates. Requires a functioning GI tract. Treatment for gout and urolithiasis ✔✔prevention of future uric acid stones: take allopurinol as prescribed, exercise several times a week, limit intake of foods high in purine Renal calculi ✔✔drink lots of water. Avoid large amounts of vitamin c, avoid high oxalate foods like almonds or nuts, and limit sodium to 2 g/day Foods high in cholesterol ✔✔eggs and cheese, liver and other organ meats, shrimp Cancer prevention ✔✔Consume adequate dietary fiber (14 g per 1,00 kcal daily); eliminate tobacco; eat at least 5 servings of fruits and veggies daily including foods high in vitamin A (apricots, carrots, leafy green veggies), foods high in vitamin c, and cruciferous vegetables (broccoli, cauliflower, cabbage); consume whole grains rather than processed or refined grains and sugars; avoid meat prepared by smoking, pickling, charcoal grilling, and use of nitrate containing chemicals; consume polyunsaturated and monounsaturated fats (found in fish and olive oil) which can lower risk of cancer; limit alcohol consumption Anorexia in cancer/immunosuppressed patients ✔✔Eat small amounts of high protein foods loaded with calories and nutrients; try to consume food in the morning when appetite is best; avoid food odors; don't fill up on low calorie foods; eat cool/room temperature foods Nursing actions for cancer patients ✔✔encourage pt to eat more on days when feeling better; encourage nutritional supplements high in protein and/or calories as between-meal snacks. Increase protein and caloric content of foods by substituting whole milk for water in recipes, adding milk, cheese, yogurt, or ice cream to dishes, use peanut butter as a spread for fruits, use yogurt as a topping for fruit; dip meats in eggs, milk, and bread crumbs before cooking; use semisolid, thickened foods for pts w/ dysphagia and instruct them to sit upright and tilt their head forward when swallowing. Eat foods that are well tolerated and liked prior to treatments. Try adding foods that are tart (citrus juices); eat small, frequent meals; try using sauces and seasonings for added flavor; use plastic utensils for eating to decrease metallic taste; suck on mints, candy, or chew gum to remove bad taste in mouth. Fluid volume excess ✔✔Sodium 130 Hypoglycemia ✔✔Mild shakiness, mental confusion, sweating, palpitations, headache, lack of coordination, blurred vision, seizures, and coma. take 10-20 g of a readily absorbable carb, including 2-3 glucose tablets (5 g each), 6-10 hard candies, ½ cup (4 oz( juice or regular soda, 1 tbsp honey or 4 tsp of sugar. Retest glucose in 15 minutes. If still less than 70 mg/dL, repeat the above steps. Once levels stabilize, have the pt take an additional carb and protein snack or a small meal depending on the severity of the hypoglycemic episode and whether the next meal is more than 1 hr away. Hyperglycemia ✔✔go to ED, take med if forgotten. Long term implications of untreated or inadequately treated hyperglycemia include blindness, kidney failure, dyslipidemia, HTTN, neuropathy, microvascular and macrovascular disease, and limb amputation. The Somogyi phenomenon is morning hyperglycemia in response to overnight hypoglycemia. Providing a bedtime snack and appropriate insulin dose prevents this phenomenon. The dawn phenomenon is an elevation of blood glucose around 0500 to 0600. It results from an overnight release of growth hormone and is treated by increasing the amount of insulin provided during the overnight hours. Chronic kidney disease ✔✔Restrict phosphorus, restrict protein, restrict sodium, restrict potassium. Recommended daily protein intake is 0.8-1.1 g/kg/day of ideal body weight. High biological value proteins are recommended for pts w/ CKD to prevent catabolism of muscle tissue, and includes eggs, meats, poultry, game, fish, soy, and dairy products. Limit meat intake to 5-6 oz/day for most men and 4oz/day for most women. Limit dairy products to ½ cup per day. Avoid high protein sports drinks, energy drinks, or meal supplements. Avoid herbal supplements that can affect bleeding time and blood pressure. Low phosphorus food sources ✔✔Restrict animal proteins. Milk products are generally restricted because they are also sources of phosphorus. Diet for pts w/ kidney disorders ✔✔a phosphate restricted diet, phosphate binders, vitamin D, and supplement calcium are used to treat and prevent secondary hyperparathyroidism, renal bone disease, and soft tissue calcification Lactose intolerance ✔✔Distention , cramps, flatus, and osmotic diarrhea Liver disease ✔✔Multivitamins (especially vitamins B, C, and K) and mineral supplements might be necessary. Protein needs are increased to promote a positive nitrogen balance and prevent breakdown of body's protein stores. Carbs aren't restricted, as they're an important source of calories. Caloric requirements may need to be increased based on eval of the pt's stage of disease, wt, and general health status. Eliminate alcohol, nicotine, and caffeine. Diarrhea ✔✔High fiber diet is often prescribed, unless fiber is causing the diarrhea. Nutrition therapy varies w/ the severity and duration of diarrhea. A liberal fluid intake to replace losses is needed. Dudeck: Avoid clear liquids. Low fiber diet that's also low in fat and lactose may help decrease bowel stimulation. Foods high in potassium are encouraged. Banana flakes, apple powder, or other sources of pectin may be added to foods to help thicken the consistency of stools. Probiotics may help lessen diarrhea. Foods that stimulate the GI tract ✔✔alcohol, caffeine, foods high in simple sugars like milk, fruit (sucrose), and carbonated beverages (sucrose); high fiber and gas producing foods such as nuts, beans, corn, broccoli, and cabbage; sugar alcohols. GERD ✔✔Avoid situations that lead to increased abdominal pressure such as wearing tight fitting clothing. Avoid eating 2 hrs or less before lying down. Elevate the body on pillows instead of lying flat and avoid large meals and bedtime snacks. Encourage wt loss for pts who are overweight. Suggest the pt avoid trigger foods (citrus fruits and juices, spicy foods, carbonated beverages. Instruct the pt to avoid items that reduce lower esophageal sphincter pressure, including fatty foods, caffeine, chocolate, alcohol, cigarette smoke, and all nicotine products, and peppermint and spearmint flavors. Obesity ✔✔Complications: Mortality increased. Increased risk of morbidity from hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, and some cancers. Other complications include GERD, nonalcoholic fatty liver disease, and polycystic ovary syndrome. Obesity increases the risk of complications during and after surgery, and the risk of complications during pregnancy, labor, and delivery. Central obesity ✔✔Where excess body fat is stored also influences the risk of comorbidities. as part of metabolic syndrome, increases the risk of coronary heart disease and type 2 diabetes. Central obesity also increases the risk of stroke, sleep apnea, hypertension, dyslipidemia, insulin resistance, inflammation, and some types of cancer. What is recommended for cooking fat? ✔✔Liquid oils such as olive or canola oils. Nursing care for gastrostomy tube ✔✔Tube placement should be verified by radiography. Tube should be measured each shift and prior to each feeding. Verify presence of bowel sounds. Flush feeding tube routinely w/ warm water. Check gastric residuals every 4-6 hours. If residual volume exceeds current residual guidelines, it can be necessary to consider reducing the rate of the feeding. Residuals should be returned to the stomach. Head of bed should be elevated at least 30 degrees during feedings and for at least 30-60 min afterward. Begin w/ small volume of full strength formula. Increase volume in interals as tolerated until the desired volume is achieved. Administer feeding solution at room temp to decrease GI discomfort. Don't heat formulas in microwave. Discard bags and tubing every 24 hrs. Obtain gastric residuals every 4-6 hrs. Cover and label unused formula w/ pt info and can refrigerate for up to 24 hrs. Fill feeding bags for 4 hrs worth of feeding to reduce risk of bacterial contamination. Slowly increase the rate. Start low. Tubing should be flushed w/ 15-30 mL of water before and after medication is given, and between each medication if more than one is given. If pt has 500 mL + of residual in stomach, don't feed pt. Gavage feeding an infant ✔✔Subtract the amount of the residual from the amount of the formula to be given. Return the residual to the stomach plus the reduced amount of formula or breast milk. Burp the infant following the feeding if the infant's condition allows. Volume of water to flush is 1.5 times the amount predetermined to flush an unused feeding tube of the same size. Food choices for a toddler ✔✔1-2 year olds require whole cow's milk to produce adequate fat for the still growing brain. Food servig size is 1 tbsp for each year of age. Macaroni and cheese, spaghetti, pizza. Avoid foods that are potential choking hazards including hot dogs, popcorn, peanuts, grapes, raw carrots, celery, peanut butter, tough meat, and candy. During food prep, cut small, bite sized pieces that are easy to swallow and prevent choking. Fat free or low fat dairy. Protein recommendations for a toddler ✔✔2 year olds require 2 oz; 3 year olds require 2-4 oz, 4- 5 year olds require 3-5 oz protein. 1 oz of protein: 1 oz cooked meat, poultry, or seafood; 1 egg; 1 tbsp peanut butter; ¼ cup cooked beans or peas (kidney, pinto, lentils) Promoting nutrition for an older adult ✔✔Encourage water and natural juices. Encourage socialization and refer to a senior center or program due to social isolation can cause poor nutrition in an older adult. Fixed income can make it hard for older adults to purchase needed foods; refer to food programs, senior centers, and food banks. Meals on wheels are available for housebound older adults. All adults should exercise at a moderate or vigorous pace for at least 30 minutes a day, 3-7 days per week. Loss of lean muscle mass can be decreased w/ regular exercise. Regular exercise can improve bone density, relieve depression, and enhance cardiovascular and respiratory function. Enhance flavor of food by cooking means in new ways or adding different herbs and spices. Expected weight for 6 month old infant ✔✔Birth weight doubles by 4-6 months of age. Appropriate weight gain averages 0.15--.21 kg (5-7 oz) per week during the 1st 5-6 months. Dietary recommendations during lactation ✔✔Lactation requires 330 k/cals additional for 1st 6 months and additional 400 k/cal after that. The need for most vitamins and minerals increases during pregnancy and lactation. Snacks for 9 month old infant ✔✔Iron fortified infant cereal, vegetables, fruit, strained meats, fish, poultry, table foods (cooked, chopped, and unseasoned. Introduce new foods one at a time over 5-7 day period to observe for indications of allergy or intolerance. Delay introduction of milk, eggs, wheat, and citrus fruits that can lead to allergic reactions in susceptible infants. Don't give peanuts or peanut butter due to risk of severe allergic reaction. No honey due to risk of botulism. Appropriate finger foods: ripe bananas, toast strips, graham crackers, cheese cubes, noodles, and peeled chunks of apples, pears, or peaches. Formula feeding ✔✔Can be used in place of breastfeeding, as an occasional supplement to breastfeeding, or when exclusively breastfed infants are weaned before 12 months of age. No artificial pacifier or bottles should be used until after 2 wks and when breastfeeding is well established. Iron fortified formula is recommended by AP for at least the 1st 6 months of life or until the infant consumes adequate solid food. After 6 months, formula w/o added iron might be indicated. Fluoride supplements can be required if an adequate level isn't supplied by the water supply. Follow manufacturer's mixing directions. Bottles of mixed formula or open cans of liquid formula require refrigeration. Don't use if formula has been left at room temp for 2 hrs r longer. Don't use partially emptied bottles of formula. Formula may be given chilled, warmed, or at room temp. Always give formula at approx the same temp. Hold the infant during feedings w/ head slightly elevated to facilitate the passage of formula into the stomach. Tile the bottle to maintain formula in the nipple and prevent swallowing of air. Don't prop the bottle or put an infant to bed with a bottle; this promotes tooth decay. Infant shouldn't drink more than 32 oz formula per 24 hrs unless directed by a provider. Nutrition for older adults ✔✔A balanced diet for all adults consists of 40-50% carbohydrate and 10-20% fat. Increase in protein, reduce total caloric intake (due to decrease in basal metabolic rate). Dehydration is the most common fluid and electrolyte imbalance in older adults. Fluid needs increase with medication induced fluid losses, and decreased thirst sensation. Some disease processes necessitate fluid restrictions. Older adults can have oral problems (ill fitting dentures, difficulty chewing or swallowing, and a decrease in salivation or poor dental health. Older adults have decreased cellular function and reduced body reserves, leading to decreased absorption of B12, folic acid, and calcium, as well as reductions in insulin production and sensitivity. Kidneys regulate the amount of potassium and sodium in the bloodstream. Kidney function can decrease as much as 50% in older adults. Loss of calcium can result in decreased bone density in older adults. Cell mediated immunity decreases. Myplate recommendations for older adults ✔✔Select whole grains. Select orange and dark green leafy vegetables. Select fresh, deried, canned, or juices. Avoid fruits w/ added sugar. Make half our place with vegetables and fruits. One cup of milk or plain yogurt is equal to 1 ½ oz of natural cheese or 2 oz processed cheese. Protein includes meat, fish, poultry, dry beans, eggs, soy products, seeds, and nuts. One ounce equivalent = 1 oz meat, fish, or poultry. ¼ cup cooked beans; 1 egg; 1 tbsp peanut butter; or ½ oz nuts or seeds. Use lean meats. Use vegetable oils (except palm and coconut. 1 tbsp of il equals 3 tsp equivalent; 1 tbsp mayo equals 2 ½ tsp dietary intake; and 1 oz nuts equals 3 tsp oils (except hazelnut, which equals 4 tsp) 132-362 discretionary calories are permitted per day. Calcium requirements increase for older adults. Vitamins A, D,C, E, B6, and B12 can be decreased in older adults; supplemental vitamins are required. What do older adults have decreased absorption of? ✔✔calcium and folic acid Chewing difficulty ✔✔Mincing or chopping food is helpful. Eat softer foods. Replace raw veggies and fresh fruits w/ cooked veggies or juices. Choose foods like applesauce and canned peaches or other fruits. Try ground or shredded meat, eggs, or dairy products like fat free or low fat milk, cheese, or yogurt. You can also replace meat w/ soft foods like cooked beans, peas, eggs, tofu, or tuna. Seventh Day Adventists and some buddhists ✔✔practice vegetarianism Muslims and Mormons ✔✔avoid stimulants (coffee, tea, caffinated soda) Catholics ✔✔don't consume meat Ash Wednesday and Fridays during Lent. Seventh Day Adventist ✔✔Vegetarianism Do not consume animal products of any type INCLUDING eggs and milk products. 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). Some avoid coffee, tea, soda and other beverages that contain caffeine. Foods to avoid while taking MAOI ✔✔including aged cheese, smoked, meats, dried fish, and overripe avocados. (phenelzine, selegiline) Nutritional counseling ✔✔encourage pt to set goal, wt loss of 6lbs in a month can be expected if plan was followed BMI ✔✔Low fat diet, increase water intake, and exercise. BMI under 24.5 is best, Healthy- 18.5 to 24.9 Overweight- 25 to 29.9 Obesity- greater than 30 BMI is calculated based on Weight in Kg/Ht (M2) Pt with BMI of 28, refer them to weight loss group/program. Dietary needs for wt loss ✔✔3500 calories = 1 pound Monitor hunger on a 1-10 scale to avoid emotional eating Never forbid foods Loss is constant, do not weigh daily Eat free of distractions Do not taste foods while cooking to avoid overeating. Control your portion sizes rather than restricting certain foods to prevent cravings. Make a list before going shopping because it will help adhere to meal planning and prevent impulse buying. Eat 3 to 5 meals a day to prevent hunger and overeating. Stress ✔✔Causes protein catabolism, increase in blood glucose, and increased metabolism. Eat foods high in protein Avoid the things that are stressing you! Appropriate fat calories per day ✔✔Approx. 20% to 35% of total calories should come from fat Less than 10% should come from saturated fat sources.