Bundle
NR 228
10 Items
NR 228 Final Exam Review
NR 228 Final Exam Review Chapter 1 Wellness Nutrition • What is the difference between essential and non-essential nutrients? o Non-essential nutri... [Show More] ents are made by the body o Essential nutrients are not made by the body in an amount adequate to meet needs • How do you calculate kilocalories? o Protein and carbohydrates = 4 kcal/gram o Fats = 9 kcal/gram o Alcohol = 7 kcal/gram Chapter 2: Personal and Community Nutrition • Review terms associated with food selection o Food preferences for salt and sweet flavors is a genetic thing • Know what information is required on the Nutrition Facts panel o Serving per container o Servings size o Calories per serving o Calories from fat o Total fat Saturated fat Trans fat o Cholesterol o Sodium o Total Carbohydrates Dietary fiber Sugar • Added sugar o Protein o Vitamin D o Calcium o Iron o Potassium Chapter 4: Carbohydrate • Multiply body weight in kg by 5 grams to determine the number of carbohydrate needed daily o 70 kg x 5 g = 350 grams of carbohydrate daily • Identify food high in carbohydrates o Rice, potatoes, oranges • Identify simple carbohydrates o Milk, sugar, fruits, corn syrup • Identify complex carbohydrates = fiber and starch o Oatmeal, pasta, sweet potatoes, potatoes, rice, vegetables and legumes o Keep you fuller longer and have more even glucose levels • High fiber foods o Substances in plant foods that can’t be digested by humans o Soluble fiber Dissolves in fluids Thickens substances Decreases cholesterol levels and risk of coronary heart disease Pectin, mucilage, psyllium seed husk, guar gum and other related gums Kidney beans, split peas, lentils, chickpeas/garbanzo beans, navy beans, soybeans, apples, pears, bananas, grapes, citrus fruits, oat bran, oatmeal, barley, corn, carrots and white potatoes o Insoluble fiber Does not dissolve in fluids Provides structure and protection for plants Decreases risk for colon cancer Cellulose, hemicellulose and lignin Whole grains, brown rice, buckwheat groats, whole wheat flour, whole wheat pasta, unrefined cereals, vegetables, wheat bran, seeds, popcorn, nuts, peanut butter, leafy green vegetables such as kale and broccoli Chapter 5: Fats • Identify sources of fats o Essential fatty acids deficiency symptoms include skin lesions and scaliness/eczema o Saturated fatty acids Primarily animal sources • Beef, pork, poultry, lamb, luncheon meats, egg yolks and dairy products Plant sources • Palm oil, coconut oil and cocoa butter o Monounsaturated fatty acids Olive oil, peanut oil, canola oil o Polyunsaturated fatty acids Corn, safflower, sesame, canola and sunflower oils, margarine, o Omega 3 fatty acids Appears to lower risk of heart disease Tuna, salmon, bluefish, halibut, sardines, rainbow trout, mackerel & herring Canola oil, walnuts, soybeans, flaxseed, wheat germ and green leafy vegetables Chapter 6: Protein • Protein requirements = 0.8 grams/kg/day • Combine complementary proteins (peanut butter and jelly sandwich) • Complete proteins are the best source of protein for wound healing • There are 9 essential amino acids and foods are complete/incomplete based on this • Soybeans are the main non-animal source of complete protein • Cereals, legumes and grains are sources of incomplete proteins • Legumes = black eyed peas, lentils, beans, chickpeas, split peas and peanuts Chapter 7: Vitamins • Eat a variety of colorful fruits and vegetables to get adequate intake of vitamins and minerals • Know the sources, function, toxicity and deficiency • Vulnerable groups are the youngest and oldest folks • Vitamin B 1 / Thiamin o Coenzyme energy metabolism and muscle nerve action o Deficiency: beriberi, headaches, tiredness o Lean pork, whole or enriched grains, legumes, seeds and nuts • Vitamin B 2 / Riboflavin o Coenzyme energy metabolism o Deficiency: Ariboflavinosis with cheilosis, glossitis, seborrheic dermatitis o Milk, dairy products, meat, fish, poultry, eggs, dark green leafy vegetables, whole breads • Vitamin B 3 / Niacin / Nicotinic acid / niacinamide o Cofactor to enzymes involved in energy metabolism; glycolysis and TCA cycle o Amino acid tryptophan is precursor o Deficiency: Pellagra o Toxicity: vasodilation, liver damage gout, and arthritic reactions o Meats, poultry, fish, legumes, whole and enriched cereals and milk • Vitamin B 6 / Pyridoxine o Forms coenzyme pyridoxal phosphate for energy metabolism; CNS; hemoglobin synthesis o Deficiency: dermatitis, altered nerve function, weakness, anemia o Oral contraceptive agents decrease B 6 levels o Toxicity: ataxia, sensory neuropathy o Whole grains/cereals, legumes, poultry, fish, pork and eggs • Folate / folic acid o Coenzyme metabolism, fetal neural tube formation o Deficiency: megaloblastic anemia o Many drugs affect folate use o Toxicity: megadoses may mask pernicious anemia o Green leafy vegetables, legumes, ascorbic acid containing foods • Vitamin B 12 / Cobalamin o Transport and storage of folate; metabolism of fatty acids and amino acids o Deficiency: pernicious anemia, CNS damage o Need intrinsic factor for absorption o Animal sources (meat, fish, poultry, eggs and dairy products) so problem for vegans • Biotin o Metabolism of carbohydrate, fat and protein o Deficiency: produced by avidin in egg whites and long term antibiotic use o Liver, kidney, peanut butter, egg yolks, intestinal synthesis • Pantothenic acid o Part of coenzyme A o No deficiency o Widespread in foods • Choline o Synthesis of acetylcholine and lecithin o Deficiency is rare o Toxicity: body odor, liver damage, hypotension o Milk, eggs, peanuts and a variety of foods • Vitamin C o Antioxidant, coenzyme, collagen formation, wound healing, iron absorption, hormone synthesis o Deficiency: scurvy o Toxicity: cramps, nausea, kidney stone formation, gout, rebound scurvy o Citrus fruits, tomatoes, peppers, strawberries, broccoli, cantaloupe • Vitamin A o Maintains epithelial tissues, rhodopsin formation for vision, bone growth, reproduction o Deficiency: xerophthalmia, night blindness, keratomalacia, degeneration of epithelial tissue, inhibited growth (respiratory and gastrointestinal disturbances) o Toxicity: hypervitaminosis A if taking supplements with blistered skin, weakness, anorexia, vomiting, enlarged liver and spleen o Deep green, yellow and orange fruits and vegetables, animal fat sources, whole milk, butter, liver, egg yolks and fatty fish • Vitamin D o Calcium and phosphorus absorption; bone mineralization o Deficiency: bone malformation, rickets in children, osteomalacia in adults o Toxicity: hypercalcemia and hypercalciuria o Butter, egg yolks, fatty fish, liver, fortified milk and body synthesis • Vitamin E o Antioxidant for polyunsaturated fatty acid and vitamin A; antioxidant with selenium and ascorbic acid o Deficiency: primary deficiency is rare but secondary deficiency caused by fat absorption leads to neurologic disorders o Toxicity: none but supplements contraindicated with anticoagulation drugs o Vegetable oil, whole grains, seeds, nuts, green leafy vegetables • Vitamin K o Cofactor in synthesis of blood clotting factors; protein formation o Deficiency: blood coagulation inhibited; hemorrhagic disease in infants o Toxicity: therapeutic vitamin K reactions in neonates causing hemolytic anemia and hyperbilirubinemia o Green leafy vegetables and intestinal synthesis Chapter 8: Water and Minerals • Iron o Best absorbed with foods high in vitamin C o Meats, fish, green leafy vegetables, whole grain cereals and iron fortified cereals • Calcium o Older adults need more to reduce risk of osteoporosis Chapter 9: Energy, Weight and Fitness • Underweight is BMI < 18.5 kg/m2 • Normal is BMI 18.5 – 24.9 kg/m2 • Overweight is BMI > 25.0 – 29.9 kg/m2 • Obesity is BMI > 30 Chapter 10: Nutrition Across the Lifespan • Pregnancy o Foods high in iron o Folic acid intake 400 mcg for women of childbearing age o Folic acid intake 600 mcg for pregnant women o Weight gain determined by prepregnancy BMI • Children o This is when eating habits-good or bad-are developed • Older adult o Increased risk for vitamin deficiencies Chapter 11: Nutrition, Assessment & Patient Care • Nutritional intake can be effected by nausea and vomiting • Nutrition risk assessment focuses on potential to become malnourished o Primary = inadequate intake of nutrients o Secondary = caused by disease or iatrogenic affects • Body Mass Index = (Weight in lbs. x 703) divided by Height in inches squared • Nutrition assessment o Anthropometric measurements o Biochemical tests Serum albumin 3.5 – 5 g/dL and reflects long term changes in nutritional intake due to its half-life of 14-20 days Prealbumin 16 – 40 mg/dL and reflects short term changes in visceral protein status due to its short half-life of 2 days o Clinical observations o Dietary evaluation Chapter 12: Food Related Issues • Clear liquid diet o Indications: mild nausea/vomiting, post op, prior to certain procedures o Limit caffeine due to increased acid production o Apple juice, grape juice, broth, tea, coffee, gelatin, water and no pulp juices • Full liquid diet o Used to provide oral nourishment for folks with wired jaws or difficulty chewing or swallowing solid foods o Offers more variety and commercial supplements and milk supply calories and nutrients o Milk, ice cream, sherbet, cooked eggs, eggnog, milkshakes and oral supplements • Mechanical soft diet o Consists of foods that don’t require a lot of chewing o Poached eggs, scrambled eggs, ground meats • Enteral feedings: check residual and pH; using the gut • Parenteral feedings: using IV access Chapter 13: Nutrition for Disorders of the Gastrointestinal Tract • GERD o Avoid spicy foods, high fat foods, caffeine, mint and chocolate o No smoking • Lactose intolerance o Avoid dairy products o Can have soy or almond milk • Low residue diet o Inflammatory bowel disorders need low fiber/low residue diet Chapter 14: Nutrition for Disorders of the Liver, Gallbladder, and Pancreas • Avoid fatty foods with gallbladder and pancreas issues • Avoid alcohol with liver issues • Cirrhosis o Sodium is restricted to 1-2 grams if edema/ascites is present o Emphasis on folate, B12 and thiamine • Cholecystitis o Avoid fats • Pancreatitis o Avoid fats Chapter 15: Nutrition for Diabetes Mellitus • Diet therapy must be individualized for all types of diabetes • Focus on counting carbohydrates • Elimination of regular soft drinks has a big impact Chapter 16: Nutrition in Metabolic Stress: Burns, Trauma and Surgery • Burns o Micronutrients needed include vitamins A and C o Protein needs increase for wound healing so watch vegan patient Chapter 17: Nutrition for Cardiopulmonary Diseases • Reduce effects of coronary heart disease by increasing • DASH diet = Low cholesterol, low sodium diet, low saturated fats and high fiber • Snacks on DASH diet = fruits, vegetables, unsalted nuts and plain popcorn • Weight loss of 10-15 pounds will help hypertension • COPD o Often underweight and malnourished o Small frequent meals to use less energy o Avoid gassy foods to decrease distention which makes it hard to take a breath o Foods should be easy to chew • Heart failure o DASH diet especially watching sodium and fluid intake o Fluid restriction of 1 – 2 liters per 24 hours o Sodium restriction of 2 grams/day is usual with severe heart failure Chapter 18: Nutrition for Diseases of the Kidneys • Pre-dialysis o Decrease potassium in diet to decrease ventricular dysrhythmias and cardiac arrest • Chronic kidney disease/dialysis o Decrease protein, phosphorus, potassium and sodium o High potassium foods: tomatoes, potatoes, dairy products, raisins, apricots, meats, dried fruits, bananas o High phosphorus foods: soda, chocolate, milk and dairy products • Kidney stones o Calcium oxalate accounts for 80% of kidney stones o Increase fluids o Do not restrict calcium o Avoid increased vitamin C o Avoid foods high in oxalates Beets, tea, tree nuts (walnuts and almonds) Chapter 20: Nutrition in Cancer and HIV/AIDS • Cancer prevention guidelines o Do not drink too much alcohol o Do not smoke o Eat 5 or more servings daily of fruits and vegetables o Eat a low fat diet o Achieve and/or maintain a healthy weight o Be physically active o Protect skin from sunlight while ensuring adequate vitamin D intake from foods • Prevent protein energy malnutrition (PEM) o Not getting enough protein or calories o Need to increase protein intake and caloric intake o Use nutrient dense foods like cottage cheese, tuna, egg and ham omelet • Avoid uncooked fruits and vegetables and sushi if immunocompromised • Avoid unpasteurized products if immunocompromised • For nausea/vomiting, eat foods cold or at room temperature r/t less odor and take antiemetic prior to eating • Changes in taste: use plastic utensils to decrease metallic taste and use hard candy • Malnutrition documented in all stages of HIV/AIDS infection and diet is one area where the person can have control over their treatment • Anorexia is the most frequent symptom associated with HIV/AIDS that affects their nutritional status [Show Less]
- Exam
- $8.45
- 1
- 762
NR 228 Week 2 Discussion Question: Carbs, Culture, and Diabetes
NR 228 Week 2 Discussion Question: Carbs, Culture, and Diabetes. In this discussion, you will consider the following information prior to responding with ... [Show More] your post. In order to fully understand Hannah's situation, please first answer the following: • When are carbohydrates good for us? • What are "good" versus "bad" carbohydrates? • When are they not good for us or our bodies? • What chemistry is involved in their breakdown, usage, and storage? After you have discussed this, consider Hannah and Rose's situations and think like a nurse! Hannah is a 12-year-old who has had Type I diabetes for a few years. Her mother, Rose, is a strict vegetarian and believes this is also the best diet plan for her daughter. Hannah says, "I just want to eat like all my friends do!" As a result, she often cheats, and lately, there has been a steady increase in Hannah's blood sugar. What are the first steps you would take, as Hannah's nurse, to assess her eating habits and understanding of diabetes mellitus? What did Hannah and Rose tell you (subjective) and what did you see (objective)? Answer Hi class, According to Grodner (2016), “Carbohydrates provide energy, fiber, and naturally occurring sweeteners. Carbohydrates supply energy in the most efficient form for use by our bodies.” Whole carbs are unprocessed and contain the fiber found naturally in the food, while refined carbs have been processed and had the natural fiber stripped out.Examples of whole carbs include vegetables, whole fruit, legumes, potatoes and whole grains. These foods are generally healthy.On the other hand, refined carbs include sugar-sweetened beverages, fruit juices, pastries, white bread, white pasta, white rice and others.Numerous studies show that refined carbohydrate consumption is associated with health problems like obesity and type 2 diabetes. These would be considered bad carbohydrates. (https://www.healthline.com/nutrition/good-carbs-bad-carbs#section2) Carbohydrates are not good for us when they are processed, have added sugars to them or consumed in large amounts. According to Grodner (2016), “the gastrointestinal tract has the role of digesting carbohydrates into monosaccharides for easy absorption. The digestive process begins in the mouth. Mechanical digestion breaks food into smaller pieces and mixes the carbohydrate-containing food with saliva, which contains an amylase called ptyalin. This begins the hydrolysis of starch into the simpler carbohydrate intermediary forms of dextrin and maltose. In the small intestine, intestinal enzymes and specific pancreatic amylase work on starch intermediary products to continue the breakdown to monosaccharides. Carbohydrates supply energy in the most efficient form for use by our bodies. If enough carbohydrate is provided to meet the energy needs of the body, protein can be spared or saved to use for specific protein functions.” The first steps I would take as Hannah's nurse is to get her blood sugar level, vital signs, ask her what types of foods does she eats, and teach her what her body is doing when she eats the wrong types of foods. Subjective: The types of food she eats. Objective: Blood sugar levels References https://www.healthline.com/nutrition/good-carbs-bad-carbs#section2 Grodner, Michele, Sylvia Escott-Stump, Suzie Dorner. Nutritional Foundations and Clinical Applications: A Nursing Approach, 6th Edition. Mosby, 01/2015. VitalBook file. [Show Less]
- Exam
- $5.45
- 0
- 514
NR 228 Week 1 Discussion Question: Digestive System
NR 228 Week 1 Discussion Question: Digestive System Let’s follow the path of a delicious ham and cheese sandwich with lettuce and pickles as it is eaten... [Show More] and digested! Start at the beginning and discuss the anatomical parts as well as the biochemical roles that contribute to this sandwich being turned into chemical energy. Be sure to include mechanical and chemical mechanisms, along with how they are metabolized in the body! What happens if one part does not function? For example, what happens to digestion if the person is missing many teeth but can't afford dentures or perhaps has a digestive disorder? 1. What stress factors may cause issues in the digestive tract for some people? 2. How can a regular exercise program aid in the development of a healthy digestive tract? 3. How might digestion and metabolism be different over the life span? Answer Hi class, The digestion of the ham and cheese sandwich, starts in the mouth. The mouth breaks up the food into particles along with the salivary glands that produces saliva to help moisten the food which then becomes a bolus. According to Grodner (2016), “Chemical digestion occurs through the action of saliva that not only moistens the foods we chew but also contains amylase, an enzyme that begins the digestive process of starches. Another digestive process that occurs in the mouth is mechanical digestion, which depends on teeth.” The teeth help with mastication and the tongue help with the formation and movement of the bolus. The bolus travels down the esophagus to the stomach. In the stomach the bolus mixes with gastric secretions. The contents of the stomach (chyme) are then emptied into the small intestine. The small intestines absorb nutrients but mostly water. All contents are then moved to the large intestine where some water, ions, and vitamins are reabsorbed. The liquid is then formed and stored into feces where it is then ready for elimination. If a person is missing many teeth it would be difficult for the patient to break down their food. According to Xu (2016),” increasing chewing difficulty due to the impaired dental functions is an major problem affecting the ability of food intake for many older people.” They would have to eat foods that are softer and easier to break down such as mashed potatoes and oatmeal. Stress such as work, substance abuse, and anxiety which alters the fight or flight response can lead to problems in the digestive tract. Stress can lead to inflammation, peptic ulcers, and irritable bowel syndrome. A regular exercise program can help aid in moving the food down the digestive tract. Exercise will help with peristalsis which is the movement of food in the stomach. It will also help with elimination and decrease the chances of being constipated. According to Grodner (2016), “Metabolic changes are most noticeable later in life as the amount of food energy required decreases in relation to lowered metabolic rates. Nutrient needs, however, remain constant. As we enter the middle years and beyond, our challenge is to meet nutrient needs while maintaining or reducing our kcal needs to equal actual metabolic use. Recognition of this change can forestall the unexpected weight gain that appears to accompany aging in the United States.” Grodner, M., Escott-Stump, S., Dorner, S. (2016) Nutritional Foundations and Clinical Applications: A Nursing Approach. [VitalSource]. Retrieved from https://online.vitalsource.com/#/books/9780323242103/ Xu, X. (2016). On the Oral Health and Chewing Enjoyment of the Elderly: A Review from the Point of Mechanics. Journal of Texture Studies, 47(4), 323–341. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1111/jtxs.12206 [Show Less]
- Exam
- $5.45
- 0
- 585
NR 228 FINAL EXAM STUDY GUIDE Chapters 1-11
NR 228 FINAL EXAM STUDY GUIDE Chapters 1-11 CHAPTER 1 (2 left to answer) How many calories are provided by protein, carbohydrates, fat and alcohol? ... [Show More] Protein/Carbs: 4 kcal/gram Fat: 9 kcal/gram Alcohol: 7 kcal/gram What does “nutrient density” mean? Nutrient density assigns the value to a food on the basis of a comparison of its nutrient content with the kcal the food contains. The more nutrients and the fewer kcal a food provides, the higher its nutrient density. Know the basics of the six categories of nutrients. The six categories of Nutrients; Carbohydrates, Proteins, Lipids (fats), Vitamins, Minerals, Water. (**Pages 9-10 on the book goes into a lot of detail about each one***) CHAPTER 2 (1 left to answer) What are the five food groups of MyPlate? Veggies: 2 ½ cups Fruits: 2 cups Grains: 6 oz. Protein: 5 ½ oz. Dairy: 3 cups What is “fortification”? Enrichment of nutrients What nutrients are required on a food label? Calories, calories from fat, total fat, saturated fat, trans fat, cholesterol, sodium, total carbohydrates, dietary fiber, sugars, protein, Vitamin A, Vitamin C, Calcium & Iron Know how to read a food label (Page 30-32, page 32 shows an actual label**) The Daily Values is a system for food labeling composed of two sets of reference values: daily intakes (RDIs) and daily reference values. The percent of Daily Values information (%DV), based on a 2000 kcal diet, is intended to show consumers how much of a day’s ideal intake of a particular nutrient they are eating. DVs for selected nutrients and food components based on a 2500-calorie diet are also given at the bottom of the label. CHAPTER 3 In what order does food pass through the G.I. tract? The mouth the esophagus the stomach small intestine large intestine Know chemical versus mechanical digestion. Mechanical Digestion: Chewing, peristalsis, segmentation, action of sphincter muscles Chemical Digestion: Actual breakdown of substances from the production and/or storage of gastric and digestive secretions. Know the physiological function of the stomach, small intestine, pancreas, liver, gallbladder, and large intestine as it relates to digestion. Stomach: Holding food for partial digestion, producing gastric juice, providing muscular action, secreting the intrinsic factor for Vitamin b12, releasing gastrin, and assisting in the destruction. Small Intestine: Absorption of nutrients. Duodenum jejunum ileum Pancreas: Releases digestive enzymes. Liver: Releases glycogen. Breaks down RBCs. Breaks down fats and produces energy/bile. Gallbladder: Stores bile Large Intestine: Absorption of water. Consists of cecum, colon and rectum. CHAPTER 4 (1 left to answer) What are the three sizes of carbohydrates? Name examples of each size. Carbohydrates are classified according to the number of saccharide units making up their structure. • Monosaccharides: simple carbohydrates (glucose-corn syrup, fructose-fruits, galactose-found in milk) • Disacchardies: simple carbohydrates (sucrose-table sugar, lactose-milk sugar, maltose-malt sugar) • Polysaccharides: complex carbohydrates(starches-grains, legumes, and root vegetables, Fiber-whole grains, fruits, and veggies!) What is the normal blood glucose range? 70-100 What is the function of insulin? Bring down blood sugar. What are the health benefits of a high fiber diet? Prevents obesity, formation of diverticula, prevents cancer, prevents heart disease CHAPTER 5 (2 left to answer) What foods contain cholesterol? The only food sources of cholesterol are animal and include beef, pork (bacon), chicken, luncheon meats, eggs, fish, and dairy products (milk, butter, and cheese); plant foods do NOT contain cholesterol! What are good sources of omega-3 fatty acids? Linolenic Acid. Omega 3s may reduce risk by reducing clotting process. Fish sources for Omega 3: Salmon, mackeral, herring, tuna, trout, sardines. Plant Sources: Canola oil, walnuts/walnut oil, Soybean/soybean oil, flaxseed ground and oil, wheat germ and oat germ, green leafy veggies Which lipoprotein in high levels correlates with low cardiovascular risk? HDL Which lipoprotein in high levels correlates with a high risk of heart disease? LDL Be able to interpret serum cholesterol lab tests (Page 366) HDL Levels: Normal is 35-65 mg/dL for men and 35 to 80 for women. (40 or higher is good!) LDL Levels: less than 100, a reading of 130-159 is borderline high and 160 189 is high What is the difference between a monounsaturated fat, a polyunsaturated fat, and a saturated fat? What are sources of each? Monounsaturated Fatty Acid: Only one unsaturated double bond. Ex Oleic Acid, Olive oil, peanuts, canola oil, peanut butter, peanut oil and avocado. Saturated Fatty Acid: single bonded carbon chain. Ex: Palmitic Acid found in animal-derived foods Food Sources: beef, poultry, pork, lamb, luncheon meats, egg yolks, and dairy products. Palm and coconut oils. Polyunsaturated Fat: Two or more unsaturated double bond. Ex: veggie oils, fish, margarine. CHAPTER 6 What are the major functions of proteins? Provide energy and structure to body. What kinds of food are quality sources of protein? Found in animal and plant sources meat, fish, poultry, and some dairy products, such as milk and cheese. Grains, legumes, peas and beans, seeds, nuts and many veggies. CHAPTER 7 Name the water-soluble vitamins. Vitamin C & B Name the fat-soluble vitamins. A,D,E,K. What are good sources of Vitamin C? Green leafy veggies, bacteria in GI tract, eggs, and carrots What is a sign of Vitamin C deficiency? Scurvy w/ bleeding What is the main function of the B vitamins? Metabolism What are good sources of Vitamin B-12? Animal Products What is the main function of Vitamin D? Necessary for absorption of calcium & phosphorus; affects bone mineralization What is the main function of Vitamin K? Blood clotting CHAPTER 8 What minerals are lost through sweating and bleeding? Zinc, Magnesium, sodium, potassium, and calcium What are the two categories of minerals? Trace & Major Which minerals are in each category? TRACE: Chromium, Copper, Fluoride, Iodine, Iron, Manganese. MAJOR: Caclium, Phosphorus, Magnesium, Sulfur What is the definition of each category? Trace: RDA < 20 mg Major: RDA at least 100 mg a day Name the differences between intracellular, interstitial, and extracellular fluids. Intracellular fluids- in cells Interstitial fluids- in between cells Extracellular fluids- outside of cells What enhances iron absorption? Vitamin C What reduces iron absorption? Milk, phylates, oxylates, teas and coffee CHAPTER 9 (4 left to answer) What is basal metabolic rate? Rate at which the body spends energy to keep all life-sustaining processes going. What percent of daily expenditure is used for basal metabolism? The basal metabolic rate accounts for about 60-75% (Honestly found this one on google ) What factors affect basal metabolic rate? What are the BMI categories? Underweight: Less than 18.5 Normal Weight: 18.5-24.9 Overweight: 25-29.9 Obese: Higher than 30 How do you calculate BMI? Divide your weight in kilograms (kg) by your height in metres (m) then divide the answer by your height again to get your BMI What nutrients yield energy when metabolized? Carbs, protein, and fat CHAPTER 10 (3 left to answer) Ideally, how much weight should a normal woman gain during pregnancy? 25- 35 lbs What nutrients need to be increased during pregnancy? All EXCEPT D,E,K, Phosphorus, fluoride, calcium. What advantages does breastfeeding have over bottle-feeding? Antibodies from mom What nutrient may need to be supplemented in breast-fed infants? Iron, Vitamin D, Fluoride At what age should you introduce solid foods to an infant? 4-6 months What are the recommendations for fruit juice in infancy? Around 6 months 4-6 oz a day until 12 months Main nutrition concerns of childhood? Obesity, Type 2 Diabetes pages 213-215 in book), Lead poisoning because they naturally absorb greater amounts of minerals than adults, iron deficiency Main nutrition concerns of infancy? Food asphyxiation for toddlers, avoid peanuts, popcorn, hard candies, grapes, and foods containing bones. Main nutrition concerns of adolescence? Obesity CHAPTER 11 Types of malnutrition? Starvation-Related Malnutrition: Chronic starvation without inflammation Chronic Disease-Related Malnutrition: Chronic Inflammation of mild to moderate degree. Acute Disease-Or injury-Related Malnutrition: Acute inflammation of severe degree Requirement for hospital nutrition screening? Must be done within 48 hours. What are anthropometric measurements? ABCD Anthropometric, biochemical, clinical and dietary assessment Anthropometric: Simple, noninvasive techniques to measure height, weight, head circumference, and skinfold thickness. Biochemical: No single test for nutrition. Important indicators visceral protein status and immune function. Serum albumin; prealbumin; lymphocyte count. BMI. Clinical Assessment: Medical history, physical exam, features associated with deficiencies. Dietary Assessment: 24 hour recall, food diary [Show Less]
- Study guide
- $8.45
- 0
- 796
NR 228 Week 6 Discussion Question: Case Studies
NR 228 Week 6 Discussion Question: Case Studies. Jordan is a 14 year old middle school student, weighing 275 pounds and is 5’6” tall. Over the past 2... [Show More] years, he has gained 60 pounds, as he has begun to withdraw from social activities, and avoid other students, due to bullying from others his age about his weight/appearance. Lately, Jordan has been missing a great deal of school too, particularly on the days he has gym. Jordan’s parents are both average in height and weight, and Jordan’s mother says that he just takes after his grandfather William, who “was a husky man, and died of a sudden heart attack at the age of 44”. She says “We just have fat genes in the family; you can’t do anything about that”! Answer He has been told he had “no willpower, or is weak, or that he needed to change his lifestyle, eat less and exercise more.” Jordan says “I go for a couple days without eating, but then I get so hungry that I could eat the couch” and Jordan says “I go for a couple days without eating, but then I get so hungry that I could eat the couch”! Jason has recently been diagnosed with gallbladder disease and has symptoms that typically occur after eating that include mild pain in the mid-epigastric region, radiating to the right upper quadrant of the abdomen and right subscapular area of the body. You are the nurse assigned to Jason. In my initial assessment data, I would like to do nursing assessment and find out his health conditions, including his vital signs, pain level, his daily eating habits, and physical activity. I would also like to do thorough assessment to confirm his present diagnosis or any disease associated with his present signs and symptoms. Based on the scenario provided, he might be progressing to stroke, hypertension, diabetes, and cholelithiasis, and so on. Symptoms of cholelithiasis typically occur after eating and include mild pain in the mid epigastrium region (Grodner, Escott-Stump, & Dorner, 2016). Finally, I would like to check his blood glucose and other lab panels to find out his lipids profiles and other disease progression. As a nurse, the first thing I would like to do is to change his daily eating habits. I would like to include his family members in the teaching sessions and show them how healthy foods are important to shape individuals health and wellness. Secondly, I would show them how much calories Jordan needs to consume from proteins, fruits, vegetables, grains, and dairy products as per his health condition, age, gender, height, weight, physical activities, and so on. He needs to be active, so I would teach and recommend him to join after physical exercise program. I would also like to request Jordan to make daily food journal so that I would be easier to make food adjustment in the next visit. It seems that both mother and son have deficient knowledge how foods play important role in individuals life. The first diagnosis would be: Deficient knowledge related to information misinterpretation as evidenced by the statements, “We just have fat genes in the family; you can’t do anything about that” and “I go for a couple days without eating, but then I get so hungry that I could eat the couch”! Both parents and the child do not have enough knowledge about healthy lifestyle behaviors. Jordan and his family need to understand that how obesity and other health issues need to be controlled properly for the severe progression of other diseases. Even though he might be risk for family history diseases, but he can control those through proper diet and regular exercises. Also, Jordan is missing school. He will have anxiety related to separation from friends and school. So, he shouldn’t miss school to avoid gym. He needs to have positive behavior so that he can cope with health and school simultaneously. Finally for Jordan, I would recommend to see nutritionists and his primary care provider as often and as needed. References Grodner, M., Escott-Stump, S., & Dorner, S. (2016). Nutritional foundations and clinical applications: A nursing approach (6th ed.). St. Louis, MO: Elsevier Mosby. Response: If Jordan is not serious about changing his lifestyle modifications, he is at greater risk of progressing to many diseases and illnesses. He is already obese and he has a problem of gallbladder. He has a family history of heart disease, so he is at a greater risk of getting this illness. He and his family need to think and adopt positive lifestyle modifications from their day to day life. Many diseases are cured through proper diet and nutrition (Grodner, Escott-Stump, & Dorner, 2016).He needs proper plan and interventions to eat variety of diets and nutrition with portion control according to myplate.gov. Besides proper diet and nutrition, he needs to do regular physical exercise so that he will remain healthy. He might be getting bullied at the school and that might be the reason he is missing school, or he might be shy to show his body image, so he is withdrawing from his social group. So, it is in the hands of nurse to do thorough assessment and take necessary steps to change his overall health and behaviors by reporting to the school authorities and so on. School is also important because he needs positive behavior to be connected with his peers and other groups. He also needs to visit his doctor regularly to test his lipid profiles and other disease risk factors. The highest priority would be changing his diet to improve gallbladder function and decrease his chances of developing cholelithiasis. References Grodner, M., Escott-Stump, S., & Dorner, S. (2016). Nutritional foundations and clinical applications: A nursing approach (6th ed.). St. Louis, MO: Elsevier Mosby. 1. Assess whether nutritional intake provides basic nutrients for optimal health and wellness. It depends on the diet, but, if one eats varied diet with portion control according to myplate.gov, they should have adequate nutrition. One thing that can be helpful is to make sure that you get a full physical with blood work yearly. They can tell many of your vitamin levels and tell you if you are deficient. 2. Describe nutritional needs for optimal health and wellness throughout the lifespan. 3. Discuss the psychological, sociological, economical, and cultural implications of food on nutritional status. 4. Describe evidence based practice interventions and modifications in nutrition therapy that can positively influence the outcome of disease and illness. During childhood is a good time for parents to establish good eating habits. Girls during this time need about 1200 to 1800 calories. Boys may need up to 2000 calories to maintain their energy level. During adolescence, many girls become anemic. Teen-aged girls should increase their iron intake. Children and teenagers can benefit from extra protein so that they have adequate amounts for muscle growth and development. Fatty acids are also important, as is fiber. Teenagers are also experiencing more autonomy. Parents should encourage good choices and discourage empty calories. Girls need about 1400 to 2200 calories during this time and boys need about 1600 to 2600 calories in early adolescence. This increases to 1800 to 2400 for girls and 2000 to 3200 for boys by late adolescence. This is also the time when good exercise habits for life must be developed because active play has usually stopped by this time. Vitamins A, D, K, and B12 are very important during this time, as is calcium so that strong bones are developed early to prevent osteoporosis late in life. Fiber is especially important during adolescence. Teens are also at a high risk for dehydration so adequate fluid intake must be encouraged. During this age, caretakers must monitor for eating disorders. Because of body image issues, eating disorders often develop during this time. During young adulthood, the body has stopped growing, but it is important to maintain balanced nutrition and activity to prevent conditions like obesity and diabetes, which may be decided by lifestyle. Vitamins C and K are very important along with thiamine, riboflavin and niacin. Women still require additional iron during this time. People should start paying attention to their sodium intake to make sure that it is within healthy limits to prevent hypertension and heart failure later. The choices that a person makes during this time in their life can grossly affect their health later, so good choices are very important. During middle age, women may experience pregnancy, which comes with special nutritional guidelines. People need to pay attention to their diet to make sure that it is varied and nutritious. This is also especially important because many people experience a natural slow-down in metabolism during this time. The required caloric intake is 1800 to 2200 for women, and 2200 to 3000 for men. This is also a very busy time for both men and women. During this time, people need to learn to schedule health maintenance activities and nutritious meals into their lives to prevent obesity and chronic illness or, between jobs, children, and relationships, it will fall to the wayside. During later middle age, many people have chronic illnesses that require special diets or maintenance, like diabetes or heart failure. They may be encouraged to eat a DASH diet. Exercise is still important as it can reverse some of the damage caused by disease process and, many times, may eliminate the disease. Important nutrients during this time are folate and vitamin B6 and B12 to prevent homocysteine elevation, which can cause atherosclerosis. Many during this age need to take a daily multivitamin to meet their nutritious needs. Fruits and vegetables, which contain antioxidants and phytochemicals, should be increased during this time to reduce cancer risk. Omega 3 fatty acids are also important for preventing coronary artery disease. Vitamin D and calcium remain important. As women experience menopause, their iron needs decrease. Beginning in their 50s, hormone production, muscle mass, and strength declines. Kidneys do not function as well, so acid base balance and dehydration are major concerns. Immune function decreases so vaccines are very important. The absorption of vitamins and minerals decreases so it is very important that older adults eat nutrient-dense foods to ensure their nutritional needs are met. Caloric needs during this time range from 1600 to 2800 calories depending on the activity level of the person. Lean protein and healthy fats should be included in the diet. Vitamin D is difficult to get for many older people. They may need supplementation. Vitamin B6 and B12 requirements increase. Many become lactose intolerant during this time. Some also need help with nutrition due to sensory issues, such as dementia, or physical barriers to food preparation, such as Parkinson’s. Also, many people lose friends and life partners during this time. It is especially important to monitor people at this age for depression, which may lead to malnutrition. References Zimmerman, M., & Snow, B. (2012). An Introduction to Nutrition. Mountain View, CA: Creative Commons. [Show Less]
- Exam
- $7.45
- 0
- 947
NR 228 Week 1 Class Notes/Study Guide (Chapters 1 and 2)
NR 228 Week 1 Class Notes/Study Guide (Chapters 1 and 2) General Notes - Use learning objectives to study for exams RUA’s - Nutritional Assessment: ... [Show More] • Evaluating menus at hospitals, community centers, schools, nursing homes, etc • Determine whether the menu is healthy or not (govt MyPlate guidelines) • Create a new menu that follows the guidelines • Regions- east vs west, north vs south, etc. • Due December 1st • Make a ppt with a slide for each section on rubric Chapter 1: Wellness Promotion - Health- merging and balancing of five physical and psych dimensions of health: physical, emotional, social, spiritual, intellectual - Nutrition- study of essential nutrients and processes by which they are used by the body - Wellness- lifestyle that enhances your level of health - Health promotion- strategies used to increase health of indiv, families, groups and communities (knowledge, techniques, comm supports) - Healthy People 2020: • Educate people to change outcomes • Attain high quality, longer lives, free of preventable disease, disability, injury, premature death • Achieve health equity, elim disparities, improve health of all groups • Create social and physical env that promote good health for all • Promote quality of life, healthy dev, healthy behaviors - Disease prevention- recognition of a danger to health that could be reduces or alleviated through specific actins or changes in behaviors - Primary- initial development, disease prevention - Secondary- screening, early detection, maintenance - Tertiary- rehabilitation, prevent further complications - Health literacy- ability to understand basic health concepts and apply them to one’s own health decisions • Formal education- take a class w/ a certified professor or teacher; gaining credit for a class • Nonformal education- documented and correct; do not receive credit for; brochures, pamphlets; no person directly provides info; clinics; organized learning events • Informal education- friend told you, commercials, advertisements; daily activities - Health literacy- indiv factors, cultural factors, social factors, supportive health system - Six nutrient categories: carbs, proteins, lipids, vitamins, minerals, water - Fxn of nutrients: provide energy, regulate body processes, aid in growth and repair of tissues - Essential- not made in the body; must be consumed • Carbohydrates- glucose • Lipids- linoleic acid • Protein- amino acids, histidine, isoleucine, lysine, methionine, tryptophan • Vitamins- fat-soluble and water soluble • Minerals- calcium, phosphorus, sodium, potassium, sulfur, chlorine, magnesium, cobalt, chromium, copper, iodine, iron, zinc • Water - Nonessential- nutrients the body can make - Energy yielding- organic; carbs, proteins, fat - Measures in kilocalories - Kilocalorie Values: • Carbohydrates- 4 kcal/gram • Proteins- 4 kcal/gram • Lipids- 9 kcal/gram • Alcohol- 7 kcal/gram - Carbs: • Major source of energy and dietary fiber • Simple- fruits, milk, sweetener • Complex- cereal, grains, pasta, fruits, veggies • All except dietary fibers can be broken down to units of glucose • Glucose- most efficient form of energy for the body - Proteins- • Provide energy and perform extensive fxns in the body • 20 amino acids- 9 essentials found in animal and plant sources • Consumption of excess protein in USA • Excess protein can cause body to overwork/strain; also, can be stored as fat - Fats: • Provide densest form of energy • Essential fatty acids and ADEK found in food lipids • Triglycerides- adipose tissue to protect body structure a. Saturated b. Monounsaturated c. Polyunsaturated • Phospholipids- cell membrane structure • Sterols- cholesterol • Relationship b/w consumption of lipids and risk for diet-related diseases • HDL- excess sterol from tissue; WANT TO BE HIGH • LDL- carry sterol to the tissue; WANT TO BE LOW - Vitamins: • Indirectly assist other nutrients though processes of digestion, absorption, metabolism, excretion • 13 vitamins • Fat soluble and water soluble • Esp found in fruits and veggies - Minerals: • 16 essentials • Structural purposes in the body • Fruits, veggies, dairy, meats, legumes - Water: • Major part of every tissue • Transportation for nutrients • 9-13 cups of water per day from foods and beverages** - Dietary standards- guide to adequate nutrient intake levels against which to compare nutrient values of foods consumed - DRIs: • Estimated Average Requirement- amt of a nutrient needed to meet the basic requirements of ½ the indiv in a specific group that rep the needs of a population • Recommended Dietary Allowance- level of nutrient intake sufficient to meet the needs of almost all healthy indiv of a life-stage and gender group • Adequate Intake- approx. level of an avg nutrient intake determined by observation of or experimentation w/ a particular group or population that appears to maintain good health • Acceptable Macronutrient Distribution Range- daily percentage energy intake values for the macronutrient’s fat, carbs, and protein a. Carbohydrates- 45-65% b. Fats- 20-35% c. Protein- 10-35% - Assortment- various options from every food group - Balance- provide foods from all food groups in quantities so essential nutrients are consumed in proportion to one another - Nutrient density- assigns value to a food on the basis of a comparison of its nutrient content w/ the kcal the food contains - Imbalanced dietary intake: • Undernutrition- not consuming enough energy or nutrients compared to DRI • Overnutrition- too much energy and nutrient consumption compared to DRI • Malnutrition- imbalances nutrient/energy intake; both under and overnutrition - Positive self-efficacy- believing that personal behaviors can be changed and one ahs control over their own life Chapter 2: Personal and Community Nutrition - Food selection- what you select to eat - Food preference- foods we choose to eat when all foods are available at the same time and in the same quantity • Food preferences: a. Genetic factors b. Environmental effects c. The media • Food choice- specific foods that are convenient to choose when ready to eat • Food liking- foods we like to eat - Nutritional status of communities- reflection on indiv nutritional health • Nutrient deficiency • Nutrient excess - Guidelines for Americans older than 2 y/o; updated every 5 years - MyPlate: • Purpose- implement dietary guidelines and DRI’s • Based on age, sex, activity level • Four themes- variety, proportion, moderation, activity • ½ plate fruits and veggies • ½ plate grains and proteins • Cup of dairy - By increasing fruit/veggies intake prevent cancers, diabetes, stroke, HTN - Grains- 6 oz; at least 3 oz of whole grains - Veggies- 2.5 cups; vary your veggies and the colors - Fruits- 2 cups; eat a variety - Dairy- 3 cups; fat free or low fat - Proteins- 5.5 oz - Physical activity 150 mins each week or 30 mins per day - Reduce sodium intake to less than 2300 mg per day - Limit calories from solid fats and added sugars to 260 calories/day - Food buying styles: • Food budget- having a budget helps to eliminate extra foods • Consumer diversity • Dietary preferences • Shopping frequency- how many times per week, less frequent = more additives • Location and types of food stores- regular grocery stores vs organic foods - Nutrition facts label: • Energy (kcal) • Fat • Total food energy • Food energy from fat • Total fat • Sat fat • Sodium • Carbs • Fiber • Sugar • Protein • Vit A • Vit C • Calcium • Iron - Facts label guide: 1. Be aware of serving size and amt per serving 2. Check calories and calories from fat 3. Limit total fat, cholesterol, sodium 4. Get enough of: Vit A, vit C, calcium, iron 5. Footnote 6. % Daily value- 5% or less is low; 20% or more is high - Food descriptors- “light” and “low-fat” titles can trick you, look at the facts label - Food Descriptors: • Free- contains a tiny/insignificant amt of fat, cholesterol, sodium, sugar, and calories • Low- no more than 3g of fat per serving; can be eaten fairly often w/out exceeding dietary guidelines • Lean- less than 10g of fat/4g of saturated fat, and 95 mg of cholesterol per serving • Reduced, Less, Fewer- 25% less of a nutrient/calories • Light- 1/3 fewer calories or ½ fat of original • More- 10% more of the daily value of a vitamin, mineral, or fiber in a serving • Good Source Of- 10-19% of the daily value for a particular vitamin, mineral, or fiber - Organic food standards and labels- definition, labeling requirements - 100% organic- USDA organic seal optional - Organic- 95% or more organic; USDA organic seal optional - Made w/ organic ingredients- at least 70% organic - Less than 70% organic- organic ingredients denoted in ingredient list only - Potassium reduced risk of HTN - Whole grains reduced risk of heart disease and certain cancers - Calcium lower risk of osteoporosis - Dietary supplements- covered by regulations; Dietary Supplement Health and Education Act of 1994; make sure it has federal regulated symbol - Internal locus of control- - External locus of control- [Show Less]
- Exam
- $10.45
- 0
- 940
NR 228 Week 7 Discussion Question: Supplementing Your Diet.
NR 228 Week 7 Discussion Question: Supplementing Your Diet. It has become common practice for people to supplement their diets with pills, smoothies, teas... [Show More] , herbals, and other complementary practices. Select 2 from the list below and locate an evidence-based article for each. Summarize the intended use, recommended dosage, and side effects and known interactions with over the counter and prescription medications. What if any contraindications are identified for a patient with liver and/or kidney disease? Answer I am interested to summarize probiotics and garlic because they are mostly used in my day to day life. Probiotics People talk all the time about probiotics and its uses. The FDA has not approved probiotics for medical uses so far, but if we visit doctors’ offices with digestive issues, they recommend us to use it as a complimentary treatment. It is not approved by the FDA, but it helps for treatment and prevention of diarrhea and irritable bowel syndrome. It may play a role in aiding digestion for patients suffering from some digestive diseases, including irritable bowel syndrome, inflammatory bowel disease, antibiotic-associated diarrhea, and Clostridium difficile-associated diarrhea (Stevens, 2016). The recommended dosage is 250 mg – 500 mg two to four times a day. The properties of probiotics may help strengthen homeostasis and thus reduce side effects associated with cancer and other disease treatments (Mego, Holec, Drgona, & Hainova, 2013). Probiotics alters the properties of gut microorganisms, which range from their growth to their metabolism and use of nutrients. These alterations appear to influence glucose and fat metabolism in the host (Arora, Singh, & Sharma, 2013). Side effects are bloating, constipation, and flatulence. Antifungal medications may decrease effectiveness of probiotics, but there is limited data to support contraindications of this supplement. Since, this is not approved by the FDA, we as nurses should advise our patients and other groups to read package labels carefully to ensure safe and efficacious use. Garlic Garlic is also considered as complimentary or alternative medicines as a lipid lowering agents, but medical use of this product has not been approved by FDA. Garlic has so many health benefits for treatment and prevention of various diseases; keeps away unwanted and harmful viruses, bacteria, fungi, reduces heart disease, prevent infection of wounds, and may improve individual’s blood sugar levels by reducing insulin resistance (Tweed, 2017). There are multipurpose benefits from garlic supplements. Garlic contains numerous sulfide compounds, which have anticarcinogenic properties (Kodali & Eslick, 2015). The dosage of garlic supplement is 200 to 400 mg three times a day, which is available over the counter (OTC) as well as in the grocery markets in raw forms. It is contraindicated for the people who have bleeding disorders. Use of garlic with anticoagulants, thrombolytics, antiplatelet agents may increase risk of bleeding (Tweed, 2017). We as educators need to educate our patients not to take herbal remedies without consulting with their providers because of drug interactions and other side effects. References: Arora, T., Singh, S., & Sharma, R. K. (2013). Probiotics: Interaction with gut microbiome and antiobesity potential. Nutrition, 29(4), 591-596. doi:10.1016/j.nut.2012.07.017 Kodali, R. T., & Eslick, G. D. (2015). Meta-Analysis: Does Garlic Intake Reduce Risk of Gastric Cancer?. Nutrition & Cancer, 67(1), 1-11. doi:10.1080/01635581.2015.967873 Mego, M., Holec, V., Drgona, L., & Hainova, K. (2013). Probiotic bacteria in cancer patients undergoing chemotherapy and radiation therapy. Complementary Therapies In Medicine, 21(6), 712-723. doi:10.1016/j.ctim.2013.08.018 Stevens, G. A. (2016). Probiotics for Digestive Health: A Review of Information Resources. Journal Of Consumer Health On The Internet, 20(4), 167-172. doi:10.1080/15398285.2016.1202019 TWEED, V. (2017). Put More Garlic in Your Life. Better Nutrition, 79(1), 24-25. Response: I really enjoyed reading your summary. I also summarized garlic and probiotics in the discussion because these supplements are considered as vitals in our cultural diets. Garlic is one of the important supplements that has been used everywhere in the world. Studies has shown that in people with high blood pressure, garlic intake help decrease the blood pressure, and works as an anticoagulants, thrombolytics, and antiplatelet (Tweed, 2017). Just like prescribed medicines, many people use it by adding during meals preparations. Garlic supplements can interact with different drugs, including warfarin (Rahman, 2007). In our culture, we believe that garlic with green tea helps our immune system to fight from disease processes. Without garlic, we never cook vegetables or meat, so it is considered as one of the main ingredients/supplements in cooking. In our culture, both probiotics and garlic are used for immune system enhancement, lowering the risk of different allergies, and reducing high cholesterol. Since, this is not approved by the FDA, we as nurses should advise our patients and other groups to read package labels carefully to ensure safe and efficacious use. Anything in moderation is good, but consuming excess than that of body’s requirement causes serious effects in our health. Reference Rahman, M. S. (2007). Allicin and Other Functional Active Components in Garlic: Health Benefits and Bioavailability. International Journal Of Food Properties, 10(2), 245-268. doi:10.1080/10942910601113327 TWEED, V. (2017). Put More Garlic in Your Life. Better Nutrition, 79(1), 24-25. Melatonin, in its oral form, has many uses, the most common being insomnia and jet lag. It is also used for heart disease, symptoms of menopause, benzodiazepine withdrawal in the elderly, breast and prostate cancer prevention and treatment, fibromyalgia, IBS, epilepsy, pulmonary sarcoidosis, and to increase chances of pregnancy in women with polycystic ovarian syndrome. Topical melatonin is used to prevent and treat sunburn. In a study done by the National Natural Science Foundation of China, melatonin was given to severely burnt rats with less than 60% kidney function. After administration, glomerular filtration rate was drastically improved and creatinine and BUN levels dropped. It also reduced inflammatory response by inhibiting inflammatory cytokines and increasing the action of inflammation reducing cytokines. In their study they concluded that melatonin activates sirtuin 1, a nicotinamide adenosine dinucleotide dependent deacetylase that regulates hepatic lipid homeostasis, which has a protective and therapeutic effect on the kidneys. They believe this serves as evidence that melatonin has the potential to improve renal function and prevent acute kidney injury in burn victims (Bai et al., 2016). For insomnia and jet lag, 0.5-5 mg 1 hour prior to bedtime is the recommended dose. For other indications, there are no widespread recommended dosage amounts for melatonin. The doctor decides on the dosage based on the individual needs of the patient, usually as a part of multimodal treatment. Side effects of melatonin may include vivid dreams or nightmares and a hangover effect. A lower dose can prevent this. Melatonin is contraindicated in pregnant women. It should be used only under physician supervision in those with hormonal issues, a history of depression, and those over the age of 65. Melatonin can interact with many medications. It decreases the effects of desipramine, fluoxetine, clonidine, methoxamine, steroids, and immunosuppressants so they are less effective. Calcium channel blockers, beta blockers, NSAIDs, caffeine, tobacco, and alcohol lower melatonin levels, making melatonin less effective. Birth control pills may increase the amount of melatonin that your body naturally makes, so taking a melatonin supplement may cause unhealthy levels in the system. Melanin increases the bleeding risk in people who are on anticoagulant therapy. Melatonin may also improve patient response to tamoxifen, interleukin-2, and triazolam. Probiotics have not been approved by the FDA for any medical use; however, their usage is common. People usually use it for vaginal infections and bowel issues like diarrhea, constipation, IBS, Crohn’s disease, and ulcerative colitis. It can also be used immune system enhancement, lowering the risk of pollen allergies, reducing the risk of childhood eczema, and high cholesterol. A recent study done in China has shown that probiotics can reverse Langerhans cell histiocytosis and alcoholic hepatic stenosis and injury in rats. Previous studies have shown that alcoholic liver disease is closely related to the alterations that alcohol induce in the microbial flora of the gut. Using this knowledge, the researchers investigated the use of probiotics to provide a more favorable environment is the gut and they were successful in find a link. The improvement seems to be related to a reduction in circulating lipopolysaccharide and improvement of the intestinal barrier function. This study also showed that probiotics had a beneficial role in regulating hypoxia-inducible-factor, a gene that, when overexpressed and dysregulated, is strongly linked to cancer of the colon, breast, pancreas, prostate, kidneys, stomach, brain, and bladder. This seems to point to the use of probiotics for cancer prevention; however, this study was done on rats and human trials have not been done. On the other hand, the cancer prevention potential is exciting(Li, Duan, Wang, McClain, & Feng, 2016). It is generally recommended that probiotics are ingested through natural means like yogurt with live cultures, but it can be taken as a supplement or vaginal suppository. Some supplements require refrigeration; others do not. Probiotics feed on the prebiotics, carbohydrates that the body cannot break down, which provides them with the nutrients that the bacteria need to establish a firm colony in the body; therefore, t is recommended that prebiotics are ingested concurrently. Sources of prebiotics include breast milk, onions, tomatoes, honey, garlic, wheat, and barley. Under the age of one, babies get probiotics from breast milk. For formula fed infants of this age, it is recommended that a pediatrician be consulted concerning route and dose. In adult, doses are different depending on the health goal. Additionally, dose ranges drastically depending on the source. Anywhere from 1-15 billion colony forming units (CFUs) per day is appropriate. The accepted supplement dose is 250-500 mg orally 2-4 times daily. Each person’s flora is different, hence the ideal dose can vary drastically from person to person. Diarrhea or bloating are the only established side effect in those with normally functioning immune systems. If this occurs, you do not need to stop taking them and this is not a sign of intolerance, but the dose is too high. Contraindications may exist for people with immune deficiencies so, for them, probiotics should only be taken under physician supervision. Probiotics interact with sulfasalazine by increasing its metabolism. Probiotics also interfere with antibiotics, which kill probiotics. Antibiotics should be taken at least 2 hours from probiotics, before or after. Melatonin, in its oral form, has many uses, the most common being insomnia and jet lag. It is also used for heart disease, symptoms of menopause, benzodiazepine withdrawal in the elderly, breast and prostate cancer prevention and treatment, fibromyalgia, IBS, epilepsy, pulmonary sarcoidosis, and to increase chances of pregnancy in women with polycystic ovarian syndrome. Topical melatonin is used to prevent and treat sunburn. In a study done by the National Natural Science Foundation of China, melatonin was given to severely burnt rats with less than 60% kidney function. After administration, glomerular filtration rate was drastically improved and creatinine and BUN levels dropped. It also reduced inflammatory response by inhibiting inflammatory cytokines and increasing the action of inflammation reducing cytokines. In their study they concluded that melatonin activates sirtuin 1, a nicotinamide adenosine dinucleotide dependent deacetylase that regulates hepatic lipid homeostasis, which has a protective and therapeutic effect on the kidneys. They believe this serves as evidence that melatonin has the potential to improve renal function and prevent acute kidney injury in burn victims (Bai et al., 2016). For insomnia and jet lag, 0.5-5 mg 1 hour prior to bedtime is the recommended dose. For other indications, there are no widespread recommended dosage amounts for melatonin. The doctor decides on the dosage based on the individual needs of the patient, usually as a part of multimodal treatment. Side effects of melatonin may include vivid dreams or nightmares and a hangover effect. A lower dose can prevent this. Melatonin is contraindicated in pregnant women. It should be used only under physician supervision in those with hormonal issues, a history of depression, and those over the age of 65. Melatonin can interact with many medications. It decreases the effects of desipramine, fluoxetine, clonidine, methoxamine, steroids, and immunosuppressants so they are less effective. Calcium channel blockers, beta blockers, NSAIDs, caffeine, tobacco, and alcohol lower melatonin levels, making melatonin less effective. Birth control pills may increase the amount of melatonin that your body naturally makes, so taking a melatonin supplement may cause unhealthy levels in the system. Melanin increases the bleeding risk in people who are on anticoagulant therapy. Melatonin may also improve patient response to tamoxifen, interleukin-2, and triazolam. References Bai, X., He, T., Gao, J., Liu, Y., Liu, J., Han, S., … Hu, D. (2016). Melatonin prevents acute kidney injury in severely burned rats via the activation of SIRT1. Scientific Reports, 6, 32199. doi:10.1038/srep32199 Ehrlich, S. (2015, August 6). Lactobacillus acidophilus | University of Maryland Medical Center. Retrieved from http://umm.edu/health/medical/altmed/supplement/lactobacillus-acidophilus Ehrlich, S. (2016, February 3). Melatonin | University of Maryland Medical Center. Retrieved from http://umm.edu/health/medical/altmed/supplement/melatonin Grodner, M., Roth, S. L., Walkingshaw, B. C., &Grodner, M. (2012). Nutritional foundations and clinical applications: A nursing approach (2nd ed.). St. Louis, MO: Mosby/Elsevier. Li, F., Duan, K., Wang, C., McClain, C., & Feng, W. (2016). Probiotics and alcoholic liver disease: Treatment and potential mechanisms. Gastroenterology Research and Practice, 2016(5491465), 11. doi:10.1155/2016/5491465 Vallerand, A. H., Sanoski, C. A., &Deglin, J. H. (2014). Davis's drug guide for nurses (14th ed.). Salt Lake City, UT: F.A. Davis Company. Discuss the psychological, sociological, economical, and cultural implications of food on nutritional status. I decided to look at the countries with the highest rates of fish consumption, since that is a major source of Omega-3 fatty acids, and compare it to heart disease rates. It is true that the countries with the highest fish intake in the world also have the lowest rates of heart disease in the world. This means that the cultural implications of being raised in a culture with high fish consumption can be nutritionally beneficial for those people. For instance, South Korea is the 6th highest consumer of fish in the world, and they have the lowest rate of heart disease in the world. Other countries, like Spain, Italy, and Japan, also rank in the 10 highest consumers of fish and the 10 lowest rates of heart disease. This would serve as evidence that Omega-3 fatty acids are very beneficial for the heart. However, there are also countries, like France and Luxembourg,that do not have extremely high levels of fish intake that are also among the lowest rates of heart disease in the world. In fact, France is the lowest, second to South Korea. Dr. Peter Attia believes that this is because having very low intake of Omega-6 (mostly from plant oils), low amounts of artificial sugar, and lower consumption of carbohydrates can be just as beneficial as Omega-3 fatty acids. But if you do consume high levels of Omega-6, high amounts of Omega-3 will combat the negative effects. References Attia, P. (2016, April 18). How do some cultures stay lean while still consuming high amounts of carbohydrates? - The Eating Academy | Peter Attia, M.D. The Eating Academy | Peter Attia, M.D. Retrieved from http://eatingacademy.com/nutrition/how-do-some-cultures-stay-lean-while-still-consuming-high-amounts-of-carbohydrates Grodner, M., Roth, S. L., Walkingshaw, B. C., &Grodner, M. (2012). Nutritional foundations and clinical applications: A nursing approach (2nd ed.). St. Louis, MO: Mosby/Elsevier. Kvrgic, D. (2015, May 29). 11 Countries That Consume the Most Fish. Retrieved from http://www.insidermonkey.com/blog/11-countries-that-consume-the-most-fish-350130/ World Health Organization. (2014). CORONARY HEART DISEASE DEATH RATE BY COUNTRY. Retrieved from http://www.worldlifeexpectancy.com/cause-of-death/coronary-heart-disease/by-country/ [Show Less]
- Exam
- $8.45
- 0
- 561
NR 228 Week 4 Discussion Question: Bone Health.
NR 228 Week 4 Discussion Question: Bone Health. Mrs. Law, a 77-year-old female, is at home recovering from surgery that she had after falling and breaking... [Show More] her hip 5 days ago. She lives with her husband, Dean, who helps to care for her. Mrs. Law is a former smoker and has a past medical history of hypertension and hyperlipidemia. You are the visiting nurse, assigned to check on her postoperative progress. You ask the client how she is feeling, do an assessment, and inquire as to what she has eaten over the past 24 hours. Mrs. Law states that she has “No pep, no appetite, has been taking her pain medication as prescribed (every 4 hours—but not real helpful!), cannot sleep well, doesn’t feel much like walking, except for to the bathroom, and has been unable to move her bowels for several days.” Breakfast: Two glazed doughnuts, coffee (black) Lunch: Tossed salad with oil and vinegar, diet soda Dinner: Tomato soup, 1 cup; four soda crackers; and red homemade wine Snack: Pretzels, diet soda What nutrients that contribute to bone health are missing in Mrs. Law’s diet? What other dietary concerns do you have? Is Mrs. Law getting the appropriate amount of vitamins and minerals for her age and current condition? Why or why not? Answer Vitamins and minerals are very important for bone health. Vitamin D, K, and A are the vitamins that need to be in the diet for proper bone health and growth. Vitamin D helps with bone mineralization, Vitamin K helps with protein formation and bone mineralization, and Vitamin A helps with bone growth. Minerals that are important to bone health are calcium, phosphorus, magnesium, and fluoride. They all play a role in bone and tooth formation, as well as the stability and structure of bones (Dorner, Escott-Stump, & Grodner, 2016). I think that Mrs. Law needs be educated on the importance of a healthy, well rounded diet- because the foods she consumes can affect her bones. She needs to be eating plenty of fish, dairy, fruits, and vegetables, and if she isn’t - she needs to try supplementing with a multivitamin. She also needs to understand that if she eats high sodium meals, the sodium can actually cause her body to lose calcium, which further leads to bone loss. Also, Mrs. Law seems to enjoy coffee and soda, these drinks can also decrease calcium absorption and lead to bone loss (Food and your bones, 2016). She doesn’t need to cut these completely out of her diet, but she definitely needs to limit them. According to ChooseMyPlate (2016), older adults need to be consuming at least 3 cups of fat-free milk throughout the day. Mrs. Law is not drinking any milk. If she doesn’t like milk, she can try to consume small amounts of yogurt or cheese throughout the day. Adding fruits and veggies as snacks throughout the day will also be beneficial for her bone health. Once Mrs. Law is recovered from her broken hip, she needs to start some sort of physical therapy or excrete to strengthen the muscles around her bones. Just walking 10 minutes a day can help improve her strength and balance, to hopefully above any future falls (MyPlate, 2016). Dorner, S., Escott-Stump, S., & Grodner, M. (2016). Nutritional foundations and clinical applications: a nursing approach (6th ed.). St. Louis, MO: Elsevier. Food and your bones. (2016). Retrieved from National Osteoporosis Foundation website: https://www.nof.org/patients/treatment/nutrition/ Grodner, M., Roth, S. L.,& Walkingshaw, B. C. (2012). Nutritional foundations and clinical applications: A nursing approach (5th ed.). St. Louis, MO: Elsevier Mosby. My plate. (2016). Retrieved from United States Department of Agriculture Choose My Plate website: https://www.choosemyplate.gov/MyPlate Phillips, F. (2004). Diet and bone health. Nutrition Bulletin, 29(2), 99-110. Response: I agree with you. In order to protect bones from osteoporosis, a healthy balanced diet needs to consume along with exercise throughout life. We need sufficient calcium and vitamin D for strengthening bones and to help our body absorb calcium (Grodner, Roth, & Walkingshaw, 2012). By looking at the daily dietary intake pattern, Mrs. Law is missing many healthy nutrients including vitamins, minerals, and antioxidants to recover from her illness and to maintain her daily optimal health. The good sources of calcium include milk, cheese, yogurt, green leafy vegetables, fruits, nuts, fish (Wallace, Boxall, & Riddick, 2004). The good sources of vitamin D are sun, fish, fortified breakfast cereals, eggs, and so on. Mrs. Law needs to consider taking daily vitamins supplements along with healthier diet choices. Lifestyle changes in diet and exercise are important for her health because if continues to consume same food regularly, she might end-up getting more diseases and illnesses. Grodner, M., Roth, S. L.,& Walkingshaw, B. C. (2012). Nutritional foundations and clinical applications: A nursing approach (5th ed.). St. Louis, MO: Elsevier Mosby. Wallace, L., Boxall, M., & Riddick, N. (2004). Influencing exercise and diet to prevent osteoporosis: lessons from three studies. British Journal Of Community Nursing, 9(3), 102-109. [Show Less]
- Exam
- $5.45
- 0
- 568
NR 228 Week 5 Discussion Question: Case Study Discussion
NR 228 Week 5 Discussion Question: Case Study Discussion You are asked to see Mr. Basset, who is 80 years old, currently living alone, and has recently lo... [Show More] st his wife. His children do not live nearby, but Mr. Basset sees them on holidays. Mr. Basset was recently diagnosed with lung cancer and has had an unexplained weight loss of 20 pounds in 3 months. He is getting chemotherapy as well as taking oral medication for hypertension and arthritis, and is showing signs of dehydration. Mr. Basset reports that his wife did most of the cooking and he has limited cooking skills. He usually has cereal with milk and coffee for breakfast and soup for a second meal later in the day. He eats crackers throughout the day if he is hungry, but admits that he doesn’t have much of an appetite. In addition, Mr. Basset has ill-fitting dentures and claims that food just does not taste the same. He is also on a limited budget. Answer As people age, their body systems, including immune systems are going to function less as compared to other population groups. Since Mr. Basset is 80 years old and his body system is declining. Besides his age, he has lung cancer, arthritis, and hypertension. He has not consumed enough nutritious foods to maintain his weight and diseases. Weight loss in older adults is often associated with a loss of muscle mass, which will eventually influence their mobility or functional status (Grodner, Roth, & Walkingshaw, 2012). Also, he is getting chemotherapy. The side effects of chemotherapy include loss of appetite, accelerate weight loss, and loss of muscle mass (McGinley, 2016). Proper nutrition is one of the important factors that need to be taken care for cancer patients. He is also not able to eat well because he has ill-fitted dentures. Mr. Basset may not have enough budgets to cover his expenses. Other factors might be depression because he recently lost his wife and living alone. It seems there is not enough social support for him. He is also not able to enjoy his life because of cancer and other diseases. All of the above factors might have contributed to his psychosocial and weight loss. Mr. Basset’s dentures do not fit because they might have been made before his weight loss and now they’re not fitting correctly. He also may not be cleaning well and there might be plaque and tarter build-up. Also, aging and weight fluctuations can significantly change the shape of the mouth and dentures don’t fit well. At first, Mr. Basset needs to be assessed thoroughly about his weight loss besides his current diseases and illnesses. The plan of care to improve his nutritional status would be supplemental nutrition to meet his daily calories requirements. All group of healthcare team members needs to be involved, including dietitian, social worker, dentists, psychiatrists, and other professionals for his proper treatment and necessary referrals. Dietary modification that incorporates what he likes the most, what he is capable of chewing, and what is good for his current health status. He needs proper dentures so that he would be able to eat properly. He also needs his social group to eat and go through the disease process. He might need medications to improve his appetite. If he is not able to effort food, it is also useful for him to refer to the community organizations that provide free healthy meals. Also, he should be referred to counseling group for proper psychotherapy treatment. References Grodner, M., Roth, S. L.,& Walkingshaw, B. C. (2012). Nutritional foundations and clinical applications: A nursing approach (5th ed.). St. Louis, MO: Elsevier Mosby. McGinley, E. (2016). The provision of nutritional advice in patients with cancer. Journal Of Community Nursing, 30(5), 60-66. DISCUSSION RESPONSE: I think you have done an excellent job on explaining Mr. Basset situation. I missed some of the information to explain the side effects of the chemotherapy medications that may have contributed to weight loss. Chemotherapy medications cause nausea and vomiting, and contribute to client’s weight loss (McGinley, 2016). His dehydration could be the cause of insufficient fluid intake and loss of fluid and electrolytes due to nausea and vomiting. As a nurse, it is important to incorporate side effects and benefits of medications, supplements, fluids, electrolytes, diets, etc. If he is not able to consume enough foods, he should be encouraged to eat small amounts of nutritious foods throughout the day to meet his daily food requirements. Some of the other risk factors of not eating well might be because of his present diseases and his age. From my own experiences, I came to know that during the time of illness, the desire for food disappears. In the case of Mr. Basset, he might even decide to forgo some crucial meals of the day. It is very important for him to visit his age group, support group, and church for moral and other necessary psychosocial needs. Older adults may struggle with the family and friends death and may not have desire to eat (Grodner, Escott-Stump, & Dorner, 2016). His treatment needs to focus on the underlying cause and his food preferences. He might benefit from nutritional supplements along with modified diet and medications. His plan of care needs to be developed by integrating his case worker, nurse, physician, pharmacist, dietitian, and other healthcare team members. References McGinley, E. (2016). The provision of nutritional advice in patients with cancer. Journal Of Community Nursing, 30(5), 60-66. Grodner, M., Escott-Stump, S., & Dorner, S. (2016). Nutritional foundations and clinical applications: A nursing approach (6th ed.). St. Louis, MO: Elsevier Mosby. [Show Less]
- Exam
- $5.45
- 0
- 274
NR 228 Week 3 Discussion Question: Diet and Lab Values.
NR 228 Week 3 Discussion Question: Diet and Lab Values. Mark, a single father of a 2-year-old son, Jacob, stops every morning at a local fast food restaur... [Show More] ant to pick up breakfast for himself and his son on their way to daycare. Mark says, “I don’t have time to cook in the mornings, and I can’t feed Jacob anything I would ever make at home any cheaper than this! Besides, he really loves these sausage and egg sandwiches, and at least I can get him to eat them!” Mark has a family history of diabetes, as well as hyperlipidemia, and has the following risk factors for cardiovascular disease: primary hypertension (treated with medication), cigarette smoking, inactive lifestyle, and occasionally eating foods high in sodium. Both of his parents died at young ages due to what Mark calls “heart troubles,” and his brother has high cholesterol. During his physical, Mark learns that his lipid panel is as follows: total cholesterol 245 mg/dl, LDL 180 mg/dl, and HDL 35 mg/dl. Answer 1. As his nurse, you know that risk factors for cardiovascular disease are fixed or modifiable. Give at least two examples of each. For modifiable risk factors, what can be done to reduce risk? The examples of fixed and modifiable risk factors for cardiovascular diseases are as follows: Modifiable: hypertension, dyslipidemia, diabetes, cigarette smoking, obesity, and sedentary lifestyle. The non-modifiable or fixed risk factors are: race, advanced age, and family history (Huether & McCance, 2016). In order to reduce risk from modifiable factors, Mark needs to quit smoking, start exercising regularly, and eat healthy food. 2. What is the significance of Mark’s blood work? What a normal lipid profile look like? By looking at Mark’s blood work, his total cholesterol is high, LDL is high, and HDL is low. The desirable total cholesterol is less than 200 mg/dl, borderline is 200 – 239 mg/dl, and high risk is 240 mg/dl and above. The desirable LDL is 60-130 mg/dl, borderline is 130-159 mg/dl, and high risk is 160-189 mg/dl. The desirable HDL is 60 mg/dl, borderline is 35-45 mg/dl, and high risk is less than 35 mg/dl (Huether & McCance, 2016). 3. Based on the information provided in the scenario how would you educate him? Be sure to include physical fitness and nutrition based on the USDA 2015 Dietary Guidelines, and choosemyplate.gov link covered in unit 1 Based on the above scenario, I would educate him about risk factors and complications of diabetes, hypertension, dislipidemia, and smoking. Since he has a family history of diabetes and dislipidemia, I would educate and recommend him to adopt a DASH diet, USDA 2015 Dietary Guidelines, and show and teach him regarding nutrition guide from MyPlate. A decreasing caloric intake, making more well-informed food choices, increasing one’s physical activity to reach and maintain a healthy weight, chronic disease risk reduction, and promotion of overall health (Grodner, Roth, & Walkingshaw, 2012). I would also advise him to think and eat about what goes into his plate, cup, and bowl. Since Mark has a son, he is also risk for genetic and environmental risk factor diseases. I would teach Mark how to maintain good health of his son from the childhood. The first and foremost thing that Mark needs to consider is to do regular exercise, quit smoking, and eat healthy food. I would show him the lipid profile and advise him regarding the risk factors associated with it. I would sit with him to make plans for daily interventions. Mark needs to decrease sodium intake, choose food items that are low in saturated fats, eat more fruits and vegetables, exercise regularly, and quit smoking. References Grodner, M., Roth, S. L., & Walkingshaw, B. C. (2012). Nutritional foundations and clinical applications: A nursing approach (5th ed.). St. Louis, MO: Elsevier Mosby. Huether, S., & McCance, K. (2016). Understanding Pathophysiology (6th ed.). St. Louis, MO: Elsevier. RESPONSE: I agree with you. The two types of risk factors for cardiovascular disease (CVD) are modifiable and non-modifiable. As nurses, it is important to focus health-promoting behaviors to reduce or to prevent CVD from modifiable risk factors. In the above scenario, we should encourage and focus Mark to do regular exercise, smoking cessation, and proper nutritional diet to decrease his risk for developing CVD and other illnesses. Since Mark has a family history of CVD, it is highly potential that he could and his child end-up getting CVD. Regular physical exercise or activity has been associated with reduced CVD risk factors; however, a decrease in the amount of time spent during the remainder of the day in sedentary behavior may be equally important (Saleh, Lennie, & Moser, 2015). A decreasing caloric intake, making more well-informed food choices, increasing one’s physical activity to reach and maintain a healthy weight, chronic disease risk reduction, and promotion of overall health are important considerations to maintain one’s health (Grodner, Roth, & Walkingshaw, 2012). As a nurse, I would properly give him knowledge about heart disease and behavioral intention to engage in reducing CVD. By looking at Mark’s blood work, his total cholesterol is high, LDL is high, and HDL is low. Educations decreasing sodium intake, choosing food items that are low in saturated fats, eating more fruits and vegetables, exercising regularly, and quitting smoking are some of the important topic I would consider him to teach. Grodner, M., Roth, S. L., & Walkingshaw, B. C. (2012). Nutritional foundations and clinical applications: A nursing approach (5th ed.). St. Louis, MO: Elsevier Mosby. Saleh, Z. T., Lennie, T. A., Moser, D. K. (2015). Decreasing sedentary behavior by 30 minutes per day reduces cardiovascular disease risk factors in rural Americans. Heart & Lung, 44(5), 382-386. doi:10.1016/j.hrtlng.2015.06.008 [Show Less]
- Exam
- $5.45
- 0
- 808
Purchase the bundle to get the full access instantly
- 3 Million+ Study Documents
- 100% Money Back Guarantee
- Immediate Download Access
Add To Cart
Reviews 0
Bundle Details
$18.45
- Trusted by 800,000+ Students
- 24/7 Money Back Guarantee
- Download is directly available
371
0
Seller Details
