Focused Review Notes
- ATI Rationale with Additional/Supported Information
PART 1: GENERAL NOTES (Important Facts)
Vitamin B12 is for pernicious
... [Show More] anemia Ferrous sulfate for iron deficiency 18.5-24.9 bmi is healthy weight Below 18.5 BMI is underweight
25-29.9 is overweight
30 BMI or greater is obese rangea 10-20 is normal BUN level
<200 is ok for blood glucose
Celiac disease remove any gluten from diet, wheat rye and barley Pregnant woman increase iron to be able to promote RBC growth to fetus Stomatitis you want to avoid spicy, acidic foods and salty foods
• Be wary of questions regarding children drinking too much milk i.e. more than 3-4 cups of milk each day. Too much milk intake reduces intake of other essential nutrients, especially iron. Watch for anemia with milk-aholics.
• Vitamin D’s presence is required by the parathyroid gland, in order for it to function.
• If the patient is taking digoxin or K-supplements, avoid salt substitutes because many are potassium based
• Potassium Sources: bananas, potatoes, citrus fruits
• No milk (as well as fresh fruit or veggies) on neutropenic precautions.
• Nondairy sources of calcium include RHUBARB, SARDINES, COLLARD GREENS 24
• Nonfat milk reduces reflux by increasing lower esophageal sphincter pressure
• Yogurt has live cultures, so do not give to immunosuppressed patients
• No phenylalanine with a kid positive for PKU (no meat, no dairy, no aspartame).
• Acid Ash diet: cheese, corn, cranberries, plums, prunes, meat, poultry, pastry, bread
• Alk Ash diet: milk, veggies, rhubarb, salmon
PART 2: Focused Review Notes
Manifestations of Vitamin A Toxicity
• Can cause teratogenic effects on fetuses
• Blurred vision
• Bone pain or swelling
• Hypercalcemia
• ICP
• Liver damage
• Skin peeling, itching
• Nausea and vomiting
• Abnormal softening of the skull bone (children) and bulging fontanels
Planning Care for a Client Who Follows Seventh-Day Adventist Dietary Laws
• Vegetarianism
o Do not consume animal products of any type INCLUDING eggs and milk products.
o Vitamin B12 and Vitamin D supplements may be needed with a pure vegan diet.
• Vegan diets are adequate in protein due to intake of nuts and legumes (dried peas and cooked beans).
Initiating Continuous Enteral Feeding
• This is recommended for critically ill patients because it is associated with small residual volumes, and a lower risk of aspiration and diarrhea.
• Residual volumes should be measures q4-6hrs.
• Feeding tubes should be flushed with water q4hr to maintain patency and hydration.
• If patient’s gastric volume exceeds 500ml, the continuous feeding should be HELD and tolerance reassessed.
o In children, residual volumes should be measured and held if the amount is equal to or greater than ¼ the prescribed feeding amount.
• Residual should be returned and the amount rechecked in 30min to 1hr.
Recommendations for Nutritional Supplement
• Add skim milk to powder milk (double strength milk)
• Use whole milk instead of water recipes
• Add cheese, peanut butter, chopped hard-boiled eggs, yogurt.
• Dip meats in eggs or milk and coat with bread crumbs before cooking.
• Nuts and dried beans are significant sources of protein great alternatives to dairy allergy or lactose intolerance!
Assessing Caloric Intake
• Toddlers: 1 to 3 years old
o Limit 100% juice 4 to 6oz a day
o The 1 to 2-year-old requires whole cow’s milk to provide adequate fat.
o Food serving size is 1 tablespoon for each year of age.
• Preschoolers: 3 to 6 years old
o Preschoolers need 13 to 19 g/day of complete protein.
o 1 tablespoon per year of age for size of foods.
o May switch to skin or 1% low-fat milk after 2 years.
• School-Age Children: 6 to 12 years old
o Weight loss program is directed for children 40% overweight.
• Adolescence
o Energy requirements average 2,000 calorie/day for a 12 to 18-year-old female.
o Energy requirements average 2,200 to 2,800 calorie/day for a 12 to 18-year- old male.
o Average U.S. adolescent consumes a diet deficient in folate, vitamin A and E, iron, zinc, mag, calcium, and fiber.
• Adulthood and older adulthood
o Need a balanced diet that consists of 40% to 55% carbs, and 10-20% fat (with
no more than 30% fat).
o A 24 hr dietary intake is helpful in determining the need for dietary education.
- Use whole grains, select orange and dark green leafy vegetables, avoid fruits with added sugar (make half your plate vegetables and fruits), use vegetable oils, 132-362 discretionary calories are permitted per day.
MEN CALORIE INTAKE WOMEN CALORIE INTAKE
19 to 30 years old: 2,400 calories 19 to 30 years old: 2,000 calories
31 to 50 years old: 2,200 calories 31 to 50 years old: 1,800 calories
51+ years old: 2,000 calories 51+ years old: 1,600 calories
Teaching about High-Fiber Food Sources
• Beans
• Vegetables
• Oats
• Whole grains
• Cereals
• Nuts, seeds
• Raw or dried fruits
• Barley
• Flaxseed
• Avocado
• Chickpea
• Brown Rice
• Sweet Potato/Reg. Potato
• Quinoa
Priority Cholesterol Levels to Report
• HDL (good cholesterol) should have levels greater than or equal to 60mg/dl
• LDL (bad cholesterol) is less than 130mg/dl.
• Optimal cholesterol level is less than 200mg/dl.
Prioritizing Care for Intermittent Enteral Feeding
• Formula is administered q4-6hr in equal portions of 250 to 400 ml over a 30-60min time frame usually by gravity drop or pump.
• Residual volumes should be measured prior to initiating the feeding and held if the amount is greater than the amount stated in the prescription.
• Tube should be marked with ink or tape and checked to make sure it has not migrated.
• Assess bowel sounds. Dysfunction can indicate a need for alternate forms of nutrition.
• Elevate head of bed 30 degrees and for at least 30 to 60 minutes after.
Menu Choices for Preventing Aspiration
• Encourage small bites and thorough chewing.
• Pills should be taken with at least 8oz of fluid (can be thickened).
• Avoid thin liquids and sticky foods.
Interventions for Diarrhea Caused by Radiation Therapy
• Ensure adequate intake of liquids to replace losses.
• Avoid foods that exacerbate diarrhea (foods high in roughage)
• Consume foods high in pectin to increase bulk of the stool.
• Limit caffeine, hot or cold drinks, and fatty foods.
Evaluating Teaching about Complete Proteins
• Complete proteins are from animal sources and soy
• They contain sufficient amounts of all 9 amino acids.
Folate Intake During Pregnancy
• Helps prevent neural tube defects in utero (Folic acid is the synthetic form).
• Deficiency causes spina bifida, anencephaly.
• Take 400-800 mcg a day (According to the internet, does not say anywhere in ATI)
Food Choices for a Client Who Practices Orthodox Judaism
• Special food preparations (kosher kitchens) NO MEAT AND MILK TOGETHER
• Guidelines state that animal slaughter must be “humane” and do not waste meat.
• They avoid all pork and shellfish products.
Heme Sources of Iron
• Meat
• Fish
• Poultry
Appropriate Food Choices for a Toddler
• Prefer finger foods due to autonomy
• Prefer plain foods rather than mixture foods, but usually like macaroni, spaghetti, and pizza.
Teaching a Client Who Has Dumping Syndrome
• Recommend small, frequent meals.
• Eliminate simple sugars and alcohol from diet
• Recommend protein and fat at each meal.
• Avoid concentrated sugar and restrict lactose intake.
• Suggest that the client consume liquids 1 hour before or after eating instead of during meals (dry diet).
• Instruct patient to lie down for 20-30min after meals to delay gastric emptying. If reflux is an issue, suggest a recliner.
• Monitor for deficits in iron and vitaminB12.
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