NCLEX Review

1. NCLEX Review Nutrition

2. Fat Soluble Vitamins • Vitamin A (Retinol) occuvite • Needed for: Vision, skin, immune system and mucous membranes • Stored in liver • Foods: • Vegetables: Dark green, yellow, orange • Fruits: Apricots, Cantaloupe • Beef liver • Deficiency causes night blindness to total blindness • Vitamin D (Cholecalciferol) • Aids in absorption of calcium • Naturally occurring: Human body and Fish liver oil • Foods: Cream, Butter, Egg Yolks, Milk • Severe deficiency causes Rickets

3. Fat-Soluble Vitamins • Vitamin E (tocopherol) • Strong Antioxidant needed for cell wall structure • Premature infants lack this causing Hemolytic Anemia • Deficiency: Disrupts synthesis of myelin • Foods: Raw avocado and mango, Almonds, hazelnuts and peanuts and oils • Vitamin K (-quinone) • Needed for blood-clotting and bone development • ½ of our Vit K is supplied by intestinal bacteria • Foods: Leafy greens

4. Water Soluble Vitamins • Vitamin C (ascorbic acid) • Needed for antioxidant, connective tissue, iron absorption • Deficiency: Scurvy • Foods: Citric fruits • Vitamin B1 (thiamin) • Needed for energy production and storage • Deficiency: beriberi (“I can’t I can’t”) In the US Alcoholics are at risk • Foods: Wheat germ, grains, lean pork, beef, liver, and legumes

5. Water Soluble Vitamins • Vitamin B2 (riboflavin) • Needed for energy production and tissue health and growth. Also an antioxidant • Deficiency: cracked lips, swollen, red tongue, burning, itching, or tearing eyes and scaly greasy dermatitis • Foods: Milk (keep from light) and liver • Vitamin B3 (niacin) • Needed for energy production, high doses can reduce LDL and Triglycerides • Deficiency: Pellagra: Dermatitis, diarrhea, dementia, death • Foods: Meat, avocado, bread products

6. Water Soluble Vitamins • Vitamin B6 (pyridoxine) • Needed for metabolism, hemoglobin synthesis, neurotransmitter synthesis • Deficiency: CNS dysfunction and certain anemias • Foods: Grains and meats • Folate (folic acid) • Needed for DNA synthesis and hemoglobin formation • Deficiency: Megaloblastic anemia during pregnancy and diet deficiencies, Neural Tube Defects: spina bifida and anencephaly • Foods: Chicken and beef liver, spinach, yeast and beans

7. Water Soluble Vitamins • Vitamin B12 (cobalamin) • Needed for blood formation and nervous system function • Deficiency: Anemia, seen in intrinsic factor deficiency (Pernicious Anemia) and vegans • Foods: Beef and Chicken liver, clams, crab, oysters and mussels

8. Minerals • Calcium • Needed for Bone and tooth formation, blood clotting, muscle and nerve action • Deficiency: (Common in postmenopause and chronic renal failure) Osteoporosis, Tetany (muscle spasm) and hyperreflexia, and hyperphosphatemia • Foods: Milk and milk products, dried figs, and sardines • Phosphorus • Needed for calcium regulation, energy metabolism, and acid-base balance • Deficiency: Hypercalcemia (confusion, lethargy, dysrhythmias) • Foods: High protein foods usually have high phosphorus, and carbonated drinks

9. Minerals • Sodium • Needed for fluid balance, acid-base balance and muscle action • Deficiency: Usually caused by excessive sweating or diarrhea, can lead to: weakness, drowsiness, or seizures • Foods: Table salt, meat/animal products, and processed foods • Potassium • Needed for fluid balance, conversion of blood glucose to stored glycogen, muscle action, and release of insulin from pancreatic cells • Deficiency: Seen in vomiting/diarrhea, non-K sparing diuretics, severe malnutrition, or surgery. Leads to muscle (all) weakness • Foods: Unprocessed fruits and vegetables: Avocado, dried figs, pinto beans and soybeans

10. Minerals • Magnesium • Deficiency seen in alcoholics, and leads to muscle weakness • Iron • Needed for hemoglobin synthesis and metabolism • Deficiency leads to anemia and primarily caused by deficient diet • Foods: Beef (esp. liver), black-eyed peas, oysters and clams, and Cream of Wheat • Iodine • Deficiency leads to hypothyroidism (goiter) • Foods: Most processed foods and table salt is iodized

11. Protein • Complete proteins • Animal origin • Incomplete proteins • Plant origin • Vegetarians/Vegans • Teach complementary proteins • Grains and lentils or beans • Peanut butter and bread • Rice and dal • Tofu and rice • Legumes and seeds • Soybeans and pumpkin seeds • Grains and Dairy • Pasta and cheese • Cereal and milk

12. Gastroesophageal Reflux Diseaseaka GERD • Severe reflux (heartburn) 30-60 minutes after eating • Pain may mimic cardiac chest pain (radiation to arm, neck, jaws) • Causes • Hiatal Hernia • Pregnancy • Obesity • Aggressive Vomiting • NG Tubes

13. Acid Stimulating Agents • Food intake • Stimulates acid production • Avoid constant snacking during the day • Large meals • Distend the stomach leaving the esophageal sphincter slightly open • Milk • Stimulates more acid than it can buffer • Seasonings • Peppermint and Spearmint • Hot chili peppers, Black pepper, Chili powder

14. Acid Stimulating Agents • Coffee, Tea, Soda, Chocolate • Individual tolerance • Regular anddecaf • Citric Acid Juices and Tomato Juice • Alcohol • Concentrated 40% (80 proof) • Beer • Smoking • Affects acid production, ulcer healing, and the effectiveness of drug therapy

15. General Care of GERD • Increase protein and decrease fat • Decrease size of meals and increase number of meals • Drink between meals and sip liquids during meal • Sit upright for 2 hours after eating • Elevate HOB at night • Avoid constipation • Stop smoking • Avoid NSAIDs and Anticholinergics when possible • Decrease stress • Avoid tight fitting clothing

16. Diarrhea • DEHYDRATION • Orthostatic hypotension • Decrease BP, increase HR, dizziness • Replace fluids (not just water) • Electrolyte loss • Sodium and Potassium • May cause weakness, drowsiness • Extremely low sodium levels may cause seizure • Metabolic Acidosis • Bicarbonate loss • Modified BRAT Diet • Only until regular diet tolerated

17. Upper GI Loss • Caused by: Vomiting or NG suction • Vomiting: Aspiration Risk • Fluid Loss • Electrolyte Loss • Sodium, Chlorine (which will affect other electrolytes) • NG Flushing to be done with NS • Metabolic Alkalosis • Hydrogen loss (Gastric Acid: HCl)

18. Absorption Disorders • Celiac Disease or Sprue • Ingestion of gluten (found in grains) causes damaging changes in the GI tract and malabsorption of vitamins, minerals, and calories • Diet • Replace Grain products with corn or rice products • Increase calories (protein) • Decrease fats • Carbs should be simple (fruits) • Supplements • Vitamins: A, B, C, D, and E • Minerals: Iron (if anemic)

19. Absorption Disorders • Cystic Fibrosis • Genetic Disorder causing increased secretions and decreased pancreatic enzymes • Nutrition defecits • Malabsorption • Sodium loss through perspiration • Diet • Higher calorie: Protein • Vitamin Supplements: Fat soluble • Pancreatic Enzyme Replacement: Pancrease

20. Bowel Disorders • Ulcerative Colitis and Crohn’s Disease • High protein and calorie • Vitamin and mineral supplements • Avoid gas producing foods • Bulk-forming agents • Diverticular Disease • Increase fiber as tolerated, but avoid indigestible roughage • Avoid seeds, nuts, popcorn, dried fruit (raisins) • IBS • Increase fiber, decrease fat • Smaller meals • Avoid carbonated beverages and gum chewing • Pay attention to triggering foods • Constipation • Increase activity, fiber, and maintain hydration

21. Liver Disorders • Hepatitis • High protein, carbs, calories • Moderate fats • Cirrhosis • High protein • Low sodium, fluid restriction as ordered • Diets for PUD and varices • See GERD slides • Soft texture • B-VITAMINS!!!!! and folate • NO ALCOHOL

22. Gallbladder/Pancreatic Diseases • Cholecystitis and Cholelithiasis • Low Fat diets (even the good fats) • Pancreatitis • Acute- IV nutrition • Chronic- • Low-fat, small meals, may need supplements • Avoid: alcohol, caffeine and nicotine • Pancreatic Enzymes • Insulin?

23. Kidney Diseases • Acute Renal Failure • Increase carbs • Decrease sodium and potassium • End-Stage Renal Disease • As above, add low phosphorus • Moderate protein (just enough) • Nephrotic Syndrome or Nephrosis • Low sodium , Moderate protein (just enough) • Acute Glomerulonephritis • Increase carbs, high calorie • Protein, sodium and fluid restriction • Chronic Glomerulonephritis • Same as above • Polycystic Kidney Disease • Increase sodium

24. Stones • Calcium phosphate • Decrease dietary calcium, avoid excess Vit. D • Calcium Oxalate • Avoid oxalate rich foods • Tea, almonds, cashews, chocolate, cocoa, beans, spinach, rhubarb • Struvite • Limit high phosphorus foods (dairy, red/organ meats, and whole grains) • Uric Acid • Limit purines (organ meat, gravy, red wine, sardines • Cystine • Limit methionine (meat, cheese, eggs, and milk) • Increase fluid intake to 3L/day

25. Ash Diets • Alkaline Ash Diet (Uric Acid Stones) • Increases pH (reduces acidity of urine) • Milk, fruits (except cranberries, plums, prunes), rhubarb, vegetables, small amounts of meats: Beef, halibut, veal, trout, and salmon • Acid Ash Diet (?) • Decreases pH (increases acidity of urine) • Cheese, eggs, meat, fish, oysters, poultry, bread, cereal, whole grains, pastries, cranberries, prunes, plums, tomatoes, corn and legumes

26. Burn/Thermal Injuries • Stage 1- Up to 48 hours • Hypovolemia • Replace fluid and electrolytes • Stage 2- 48-72 hours • Fluid overload a concern • Possible electrolyte toxicity • Stage 3- Over 72 hours • Increase in metabolism • Increase urine output

27. Burn/Thermal Injuries • Stage 4- Healing • Increase protein (2) and calories (2-3) • 25% Protein, 50% Carbs, 25% Fat • Vitamins: A (immune), B (energy and protein metabolism), C (tissue rebuilding) • Minerals: Iron (anemia), Zinc (immune), Calcium/Phosphorus Balance • Curling’s Ulcer

28. Endocrine • Diabetes • Carbs (low simple sugars), 1 exchange = 15 carbs 3-4 exchanges/meal 1 exchange for snacks • Protein • Thyroid • Hyper- increase calories • Hypo- decrease calories • Parathyroid • Hyper- decrease calcium • Hypo- increase calcium

29. Cardiac • Atherosclerosis • Low fat, low cholesterol • CHF • Low sodium, fluid restriction • Watch potassium • Anemia • Iron, folic acid, B12 • Z-track Iron injections

30. Hypertension and CHF • Sodium-Restricted Diet • Mild • 2-3 g sodium per day • Moderate • 1 g sodium per day • Strict • 500 mg sodium per day

31. Hypertension • DASH Diet • Dietary Approaches to Stop Hypertension • 4-6 servings of fruits per day • 4-6 servings of vegetables per day • 2-3 servings of low fat dairy foods per day • Lean meats and high fiber grains

32. Cardiovascular Disease

33. Modifying Risk Factors • TLC Diet (Therapeutic Lifestyle Changes) • Calories taken in should equal calories used in a day • Reduce total fat intake to less than 30% of calorie intake • Reduce saturated fats to 7%, polyunsaturated fat to 10%, and monounsaturated fat to 20% of total fat intake • Reduce cholesterol to 200 mg/day • Complex carbohydrates should make up about 50% of calorie intake • Increase soluble fiber to 10-25g • Protein should account for 15% of calorie intake • Diet rich in vegetables, fruits, whole grains, low in trans fats and saturated fats

34. Peri-operative • Pre-op • Protein • Vitamin K • Post-op • Protein • Iron (with vitamin C) • Vitamin A, B, C • Potassium • ADAT in 24-48 hours • AMBULATE

35. Pediatrics • Food Progression (one at a time) • Iron fortified cereal, fruits/vegetables (cooked/mashed), meats (strained), toast • Non-reduced fat milk- end of first year • Hydrocephalus • Small feedings • Pyloric Stenosis • After feeding • HOB up 60 degrees • Position on Right side

36. Miscellaneous • Anorexia • Attractive food • Neutropenic Precautions • Peeled fruits and veggies only • Rheumatoid Arthritis • Increase protein during acute attacks • Dumping Syndrome • Decrease fluids with meals • Lithium (salt) • Increase fluids • COPD • Carbs