NR 228 Final Exam Review
Chapter 1 Wellness Nutrition
• What is the difference between essential and non-essential nutrients?
o Non-essential
... [Show More] nutrients 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]