Module 2.3 nutrition

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Augusta University *

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Dec 6, 2023

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Module 2.3 – Protein and Vitamins Distinguish between complete proteins and incomplete proteins. - Complete protein: contains all 9 Essential amino acids. - Incomplete: does not contain all 9. • What types of food would represent complete and incomplete proteins? Complete protein foods are animal products like meat, dairy, fish, eggs, soybeans (only plant source to be a complete protein). Incomplete: Many plant foods are incomplete proteins. Only a problem for deficiency if you restrict the foods you eat and are not supplementing. • What are complementary proteins, and what are their function? Complement proteins are proteins that are found in plant foods. Their function is to meet the complete protein amount without having to eat complete proteins from animal products. • What are limiting amino acids, and how does a diet avoid this effect? Proteins that are incomplete proteins are called limiting amino acids because it reduced the value of protein In the food. A diet is restrictive and can lead to deficiency because not all the EAA;s are being consumed. Those who eat normally, should not have to worry about this deficiency because they should eat enough complete and incomplete. Discuss how protein is digested, is absorbed as amino acids, and becomes available to cells. • What is Nitrogen Balance, and what populations may be in a positive nitrogen balance? Nitrogen is essential in proteins so the nitrogen balance studies can be used to determine the body’s use of proteins through the amount of nitrogen that enters the body and leaves the body. Nitrogen (+): When more nitrogen is in the body than excreted. This occurs in growing children and pregnant women who require more protein intake. Additionally, in those recovering from illness or injury as the body heals can be positive too. • Differentiate the processes of anabolism, catabolism, deamination, and hypermetabolism. Anabolism: Protein synthesis Catabolism: Protein breakdown Hypermetabolism: Elevated resting energy expenditure. Deamination: Breaking off an amino acid group (NH2) from an amino acid molecule, resulting in one molecule of ammonia (NH3) and a keto acid. • What are the benefits and drawbacks of vegetarianism? B: Reduce risk for obesity, diabetes type 2, CVD, hypertension, GI disorders, and some cancers like lung or colorectal. Lower costs (economic approach), spiritual approach (non-harming to animals)

D: Vitamin deficiencies especially vitamin D. Others are B12, calcium, and omega fatty acids, iron deficiency, social health (vegetarians often must explain themselves to others about their diet. • What are strategies that vegetarians can take to maintain essential nutrient intake? Read vegetarian cookbooks with nutrition information in it, MyPlate has resources for vegetarians. List the functions of protein. • What is an appropriate portion size of grains, vegetables, fruit, dairy, and protein based on MyPlate? Grains= 2 oz, vegetables = 4 cups, fruit = 1/2 cups, dairy = 1 cup (low or fat free) Protein= 3 0z meat and beans. • What is meant as Chaining? o What are the dangers of chaining (ex. Eating wings and watching football)? Link the two actions together and whenever that action takes place the other action needs to happen. So when you watch football you need to eat wings. o What are some ways that chaining can be used to improve eating habits? Linking healthy food to eating other foods. Eating a sandwich, you eat a fruit too. Links those actions together. Weighing foods, have certain foods like milk to increase calcium at your miday meal. • How does protein relate to these functions or substances? o Collagen o Wound Healing o Insulin o Blood Clotting o Fluid Balance o Buffering o Transportation of vital substances Describe the differences between water-soluble and fat-soluble vitamins. • List the main functions, recommended intake/sources, and consequences/causes of deficiency/excess? o Water Soluble Vitamins ▪ Thiamin (B1) : main functions: Serve as a coenzyme. A substance that activate an enzyme in energy metabolism, nerve function related to muscle actions too.

Recommended intake/sources: 1.2 mg (men), 1.1 mg (women) Lean pork, whole grains, legumes, seeds, nuts consequences/causes of deficiency/excess: Alters the muscular, nervous, GI, CV systems. S/S: ataxia (muscle weakness and loss of coordination, pain, anorexia, mental disorientation, and tachycardia. ▪ Riboflavin (B2) (sensitive to ultraviolet light) Main functions: Coenzyme in the release of energy from nutrients in every cell of the body. recommended intake/sources: 1. 3 (men), 1.1 (women) Plant and animal foods, in the US milk, grains, broccoli, asparagus, dark leafy greens, whole grains, enriched breads, and cereals. consequences/causes of deficiency/excess: Ariboflavinosis (swollen lips), Cheilosis (cracks in lip corners, glottis( swollen tongue), ▪ Niacin (B3) main functions: Coenzyme for energy metabolism. Critical for glycolysis, and TCA cycle recommended intake/sources: 16 mg (Men) 14 mg (women). Protein containing food (meat, poultry, etc) consequences/causes of deficiency/excess: Pellagra and the 3 D’s. (Dermatitis, Dementia, Diarrhea) ▪ B6. main functions: Metabolism of amino acids, proteins, carbohydrates, and fatty acids. Proper function of the nervous system, hemoglobin synthesis, tryptophan into niacin. recommended intake/sources: 1.3 mg (men and women). Whole grains, cereals, legumes, chicken, fish, pork, and eggs. consequences/causes of deficiency/excess: Dermatitis, altered nerve function, weakness, poor growth, convulsions, microcytic anemia ▪ Folate main functions: Coenzyme in reaction involving the transfer of one-carbon units during metabolism> Required for synthesis of amino acids, DNA and RNA synthesis, blood synthesis (heme group), fetal neural tube deficits (spine abifida). recommended intake/sources: 400 mg (men and women) (600 mg for pregnant). leafy greens, vegetables, legumes, cereals, fruits, and juices. consequences/causes of deficiency/excess: Spine abifida, (etc) ▪ Cobalamin (B12)

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main functions: Folate metabolism, support RNA and DNA synthesis. Intrinsic factor must be present. recommended intake/sources: 2.4 mg (men and women). Meat, fish, poultry, eggs, dairy. consequences/causes of deficiency/excess: pernicious anemia, megaloblastic anemia. Older adults are more likely to be deficient due to the intrinsic factor. ▪ Vitamin C main functions: antioxidant and coenzyme. Provides the cement that holds structures together (teeth, cartilage, bone matrix, etc). recommended intake/sources: 90 mg (men), 75 mg (women) Minimum to prevent scurvy (10 mg/day) Fruits and vegetables. consequences/causes of deficiency/excess: Scurvy. o Fat-Soluble Vitamins ▪ Vitamin A main functions: Maintain skin and mucous membranes throughout the body. Vision, bone growth, immune system, normal reproduction. recommended intake/sources: 900 mg (men), 700 mg (women). Fat in animal related foods (whole milk, butter, liver, egg yolk, fatty fish. Yellow orange vegetables (sweet potatos, etc). consequences/causes of deficiency/excess: night blindness, keratomalacia (hard dry cornea). Toxic: weakness, anorexia, vomiting, etc. ▪ Vitamin D main functions: Absorption of calcium and phosphorus. Bone mineralization, growth and CV function. recommended intake/sources: 20 mg for adults (800 IU). Fat of animal products. ( not milk) consequences/causes of deficiency/excess: Rickets, and osteomalacia, osteroporosis (bad bones). Toxic: hypercalcemia (kidney damage) ▪ Vitamin K main functions: Cofactor in blood clotting like prothrombin, protein formation for bone, kidney and plasma. recommended intake/sources: 120 mg (men), 90 mg (women). Dark leafy greens! consequences/causes of deficiency/excess: Inhibits blood coagulation.

▪ Vitamin E main functions: Antioxidant that protects polyunsaturated fatty acids and vitamin A from oxidative damage. Important for lungs and RBC membranes. recommended intake/sources: 15 mg (men and women). Vegetable oils, and maragine. Whole grains, seeds, nuts, wheat germ, green leafy vegetables. consequences/causes of deficiency/excess: Secondary defiencys only (CF, blocked bile duct) liver problems, hemolytic anemia. • What are some of the benefits of phytochemicals? They have disease fighting properties. (reduce risk of CVD, block tumor growth, anti- inflammatory effects.) • What are some advantages and disadvantages to vitamin supplements? Improves the nutritional status of at-risk groups. Too much vitamins can be dangerous. Chapter 20 – Nutrition in Cancer and HIV/AIDS Describe common characteristics of cancer and HIV/AIDS in terms of their effects on the GI tract, on which nutrition therapy focuses. • What is considered unexplained weight loss and what can this indicate? Weight loss greater than 10 percent in 6 months and can indicate malnutrition. • What is cachexia and what are some common treatments? Severe body wasting with lean body mass and weight loss from anorexia associated with cancer. Discuss the individualized nature of nutrition support in the management of cancer. • What are the goals of nutrition during cancer treatment? Decrease risk of surgical complications, patient meets increased energy and protein requirements, helps repair and rebuild normal tissues, promote increased tolerance, assist in quality of life. • What are the nutritional side effects of cancer surgery? Malnutrition is often a side effect. (table 20.2) • What are some nutritional approaches to nutrition-related problems in cancer therapy? PG-SGA screening, eat foods that are tart and spicy, early education for anorexia (small and frequent meals wit high calories content, cold foods (N/V), diets rich in fiber, avoid smoked meats, etc.) Explain the basis of interventions to achieve the goals of HIV nutrition therapy. • What is AIDS-related wasting syndrome?

Involuntary weight loss of greater than 10 percent in 1 month with S/S of diarrhea, weakness, of fever. • What are some ways to maximize food intake in HIV/AIDS patients? Use nutrient dense foods, offer five or six small meals, high calories condiments, diet to tolerance of pt, offer supplements, drink lots of liquids, no caffeine, use a straw for beverages. • What is steatorrhea and what are some interventions that can improve malabsorption? Too much fat in your stool. Restriction of fat and lactose is common. • What are Cryptosporidium infections, and how can HIV/AIDS patients attain safe water? Drink only filtered water or boiled for 1 min water. NO PUBLIC Water or taps. Identify indicators that are key to effective nutrition support and related medical therapies for cancer and HIV/AIDS. • What are the nutritional implications for the immunocompromised patient? Wasting and malnutrition. • What are some important points to make when educating about food safety for immunocompromised patients Prevent dehydration and monitor intake and output. Must avoid public foods especially waters from public places or foods washed with water from public places. Chapter 13 - Nutrition for Disorders of the Gastrointestinal Tract Anti-Inflammatory Diets • What are some common anti-inflammatory diets? Traditional Mediterranean and DASH diet. Nutritional Concerns and Therapies for Esophageal, Stomach, and Intestinal Disorders: • Dysphagia o What issues are related to swallowing difficulties? Regurgitation, choking, etc. o What approaches do nurses use to maintain nutrition and hydration? Thickening agents, record I and O strictly, consult with dietitian, monitor food intake. • Heartburn and Gastroesophageal Reflux Disorder o What type of meals are best to avoid GERD? Foods like chocolate, alcohol, peppermint, caffeine, vinegar based foods will irritate the lining of the stomach.

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o What are some ways the nurse can educate the patient on reducing symptoms? Straining to defecate needs to be limited, preventing, and managing constipation. • Esophagitis and Hiatal Hernia o What are some factors that may decrease sphincter pressure? Smoking, alcohol, chocolate, caffeine and some medications. o What foods can these patients avoid to minimize symptoms? Foods high in fat. • Vomiting o What disorders may lead to excessive vomiting? Virus or toxin has entered the GI tract, motion sickness, pregnancy, cancer, eating disorders. o What damage can occur with excessive vomiting? Wear tooth enamel and damage the esophagus. o What are some strategies to maintain hydration with vomiting? Small cold meals, no fried, hot, or spicy foods. Broth based foods will be beneficial for these patients. Offer Zofran 30-60 mins before meals too. • Peptic Ulcer Disease o What nutritional strategies can be used to help meet the treatment goals? Some avoid red and black pepper, and caffeine and alcohol. Encourage patients to take prescribed meds and triple therapy for H. Pylori is often required more than one round to treat. • Dumping Syndrome o What are some important nursing interventions to prevent this syndrome? Discuss foods to avoid, ensure the patients are consuming adequate fluids between meals to prevent dehydration and record I and O. • Intestinal Gas (Flatus) o What are common foods to avoid preventing gas? Increase the fiber gradually. Omit alcohol, and products that contain fructose as needed. Potentially milk if lactose causes problems. • Diarrhea o What are some strategies to maintain hydration with diarrhea? Give electrolytes or carbohydrates via IV. Enteral therapy 1-2 days ad low fat, low fiber, low lactose diet.

• Constipation o What nutritional strategies can be used to avoid constipation? Increase physical activity, and fluid intake. 8-10 glasses per day. Fiber rish products. o What are some pharmacological and non-pharm strategies to treat constipation? Bulking agents, stool softeners, laxatives and probiotics may work. Increasing activity and fluid intake 8- 10 glasses per day. • Celiac Disease and Gluten Sensitivity o What are some foods to include and avoid for these conditions? Grains, breads, flour, etc. Anything wih gluten in it. • Irritable Bowel Syndrome & Inflammatory Bowel Disease o What is a low-FODMAP diet? The diet limits fermentable oligosaccharides, disaccharides, monosaccharides, polyols. So it limits sugar intake because it increases the osmolarity. ( foods with fructose, sucrose, and polyls sorbitol and mannitol and those related carbohydrates are avoided. o What benefits do high protein and fiber have in IBD, and when are they each effective? During the acute stage of IBD to help with deficits and nutrition diets high in protein and fiber help. • Ileostomies and Colostomies o What are the functional differences between these concerning fluid loss? Ileostomy: fluid and electrolyte replace it important because the effluent is more liquid and those are lost to the effluent in the ileostomy. Colostomy: the effluent is more proportional. Chapter 14 - Nutrition for Disorders of the Liver, Gallbladder, and Pancreas Hepatitis • What are the most important nutritional strategies for a patient with hepatitis? IV fluids, and oral feedings should be initiated as soon as possible. With frequent feeding high in energy and high quality protein to minimize muscle loss and body weight. Don’t limit fat intake unless not tolerated well. NO ALCOHOL!!! • What is the importance of protein while dealing with a poor appetite? To minimize muscle loss and body weight. Additionally, it promotes faster and better healing. Cirrhosis • How do you promote a positive nitrogen balance for these patients?

By administering neomycin which kills off the bacteria that make urea. More protein can be absorbed which promotes a higher nitrogen balance because protein is high in nitrogen. • What are some important nursing interventions? Fluids with I and O, Daily weights, electrolytes monitoring, fluid restrictions 1500 mL per day. Give suggestions on how to cope with the thirst. Gallbladder Disorders • What is the connection between very low-calorie diets (VLCDs) and gallstones? The diet too low in fat disabled the gall bladder from contracting and it won’t empty out the bile which the gallstones will then form. • What is the role of omega-3 polyunsaturated fatty acids (PUFAs) in Cholecystitis? It influences bile composition which decreases biliary cholesterol saturation. Pancreatitis • What are the complications of bowel rest, and what nutritional strategy can avoid them? Bowel rest can lead to atrophy of the intestinal mucosa and bacterial translocation. Nutritional strategies that can be used to avoid them are Early enteral feedings. • How do enteral and parenteral feeding work concerning nutritional support? Enteral feedings should be used for those on it for longer than 30 days. The paternal feedings should only be used for those where enteral feedings is contraindicated.

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