Study Guide for Final NUR 242 (McCullough)

Comprehensive section of the final test has about 3 questions from each chapter.

Ch1 Overview
AMDR; essential nutrients; kcal/g of pro-cho-fat; key recommendations of Dietary Guidelines
for Americans 2010, health habits of Seventh Day Adventists (slides—not in textbook)
● carbohydrates 45-65%- 4kcal
● fat 20-35%- 9kcal
● protein 10-35%- 4kcal
● essential nutrients- nutrients that the body cannot make, we must eat them
● key dietary guidelines for 2010:
○ have a healthy eating pattern within appropriate kcals, limit added sugars,
saturated fats, and sodium intake, limit alcohol, exercise
● health habits of seventh day adventist-
○ vegetarianism, regular exercise, avoid alcohol, smoking, caffeine

Ch2 Digestion and Absorption

lipoproteins—composition, function; GI organs and their functions; peristalsis and
segmentation
● 4 lipoproteins: chylomicrons, HDL, LDL, VLDL
○ chylomicrons- carry lipids from intestinal cells to body
○ HDL- carry cholesterol from body to liver
○ LDL- carry cholesterol from liver to body
○ VLDL- carry triglycerides from liver to body
● peristalsis vs. segmentation
○ peristalsis is successive waves of involuntary muscle contractions that push stuff
along in GI
○ segmentation is periodic squeezing of the intestine by circular muscles that both
mixes and slowly pushes contents along

Ch3 Carbohydrates
mono, di and polysaccharides; actions insulin and glucagon, soluble and insoluble fibers—
sources, functions in body; Health Effects of Starch, Dietary Fibers, pg 77-79
● insulin- brings glucose from the bloodstream into cells
● glucagon- promotes breakdown of glycogen to glucose and bring glucose to bloodstream
● soluble fibers- lowers risk of chronic diseases
○ barley, legumes, fruits, oats, veggies
● insoluble fibers- ease elimination
○ fruits, veggies, grain
● health benefits of starch-
○ reduced risks of obesity, cancer, CVD, diabetes, dental caries, GI disorders,
malnutrition

Ch4 Lipids
sources of omega-3 fatty acids; Mediteranean diet and olive oil; effects of saturated, trans,
PUFA, MUFA on LDLs; sources of saturated fats in US diet; what oils to recommend to patients
for cooking; fats bring which important nutrients with them in the diet?
● sources of omega 3 fatty acid
○ mediterranean diet, olive oil, fatty fish, flax and chia seed, nuts, oils (canola),
yeast
● effects of saturated and trans fats on LDL
○ raises LDL
● effects of polyunsaturated and monounsaturated fats on LDL
○ lowers LDL
● Top sources of saturated fats in the US?
○ grain-based desserts, pizza, cheese, sausage, bacon, franks, ribes
● what oils for cooking
○ robust olive oil
● fats bring
○ fat-soluble vitamins and minerals (D, E, A, K)

Ch5 Proteins
Be able to define (and recognize meals w) complementary proteins; kwashiorkor and marasmus
—distinguishing characteristics; RDA for protein for adults; roles of protein in the body, pg 127,
what is a protein sparing diet, give examples high quality protein
● complimentary protein
○ two or more proteins that together provide essential amino acids
○ combo of at least two: legumes, seeds, grains, dairy
● kwashiorkor
○ edema, bloated bellies, red hair
● marasmus
○ “skin and bones” loss of body fat and muscles
● RDA for protein- 0.8 kg/day
● role of protein
○ structure, enzymes, transportes, fluid and electrolyte balance, acid-base balance,
antibodies, hormones, energy, glucose
● protein sparing diet
○ eating diet high enough in carbs and fat to keep protein from being used for
energy
○ high-quality protein: meat, seafood, eggs, dairy

Ch6 Energy Balance and Body Composition

Feasting and fasting diagrams—esp. what happens if no carbohydrates; ketone bodies come
from ___________ when there is no ___________; central obesity—waist measurements; BMIs
for healthy, overweight, obesity; factors influencing BMR; Figure 6-4 Components of energy
expenditure
● feasting- all excess energy is stored as fat
● early stages of fasting
○ glycogen stores fuel for one day. nervous system uses exclusively glucose
● late stages of fasting
 ○ amino acids converted to glucose to fuel brain, ketone bodies produced, some
brain cells adapt to using ketone bodies
● where do ketone bodies come from and when are they made
○ liver from fat breakdown, made when carbs are not available
● waist measurements for central obesity
○ > 40 in for men, >35 in for women
● BMI for healthy, overweight, obese
○ 18.5-24.9, 25-29.9, 30+
● what are the factors that influence BMR
○ body build, height, gender, nutritional status, age, illness, prolonged stress,
smoking, caffeine, hypothyroidism, sleep
● what are the three components of energy expenditure
○ physical activity, basal metabolism, thermic effect of food

Ch7 Weight Management

Table 7-3; Table 7-4; appetite vs hunger; benefits of physical activity pg 178; behavior
modification pg 181; weight maintenance habits p 181.
● what are daily amounts from each food group for 1800 kcal diet
○ 1.5 c fruit, 2.5 c veggies, 6 oz grains, 5oz protein, 3c milk, 5tsp oils
● appetite and hunger
○ hunger is the physiological need to eat, appetite is the desire to eat
● benefits of physical activity
○ improved body composition, lower disease risks, short-term increase in energy
expenditure, long-term increase in BMR, appetite control, stress reduction,
control of stress-eating, physical and psychological well-being, improved self-
esteem
● What are behavior modifications for losing weight?
○ keep a food and activity diary, make small changes, use positive self-talk, have a
good attitude, reward yourself
● weight maintenance habits?

Ch8 Vitamins
Vitamin B12 absorption, deficiency symptoms, sources, who is at risk for deficiency?
Vitamin A deficiency symptoms, sources,
Vitamin D role in bones, deficiency, toxicity, sources
Vitamin C role in collagen, wound healing, sources
Thiamine and alcoholics, glucose absorption and Wernicke-Korsakoff syndrome
What group of vitamins are necessary for energy metabolism?
● What are 4 things necessary for vitamin B12 absorption?
○ intake of animal products, low stomach pH, intrinsic factor, functional ileum
● symptoms of B12 deficiency
○ large RBC, weakness, SOB, pale skin (anemia), fatigue, smooth and red tongue,
numbness, tingling in hands/feet, GI problems, weight loss, difficulty walking,
cognitive problems
 ● sources of B12- animal products
● Who is at risk for B12 deficiency?
○ vegans, people who take meds to raise stomach pH, people who’ve stopped
making intrinsic factor, people without a working ileum, long-term users
metformin
● symptoms of vitamin A-
○ infectious diseases, night blindness, blindness, keratinization
● what are sources of vitamin A
○ milk, eggs, spinach, dark leafy greens
● what is vitamin D function
○ mineralization of bones
● what are the symptoms of vitamin D deficiency
○ rickets, osteomalacia
● what are the symptoms of vitamin D toxicity
○ excess blood calcium, calcification
● what are the sources of vitamin D
○ fortified milk, made in body with help of sunshine
● what is vitamin C’s function
○ synthesis of collagen, wound healing
● what are the sources of vitamin C
○ citrus fruits, sweet red peppers, green peppers, brussel sprouts, broccoli
● what vitamin might alcoholics be deficient in
○ thiamin
● What is wernicke-korsakoff syndrome, and how does it affect glucose absorption?
○ severe thiamine deficiency, thiamine necessary for glucose to enter CNS cells
● what group of vitamins are necessary for energy metabolism
○ vitamin B

Ch9 Minerals
Renin-aldosterone-ADH
Calcium-Magnesium-Phosphorous and bone health
Iron—deficiency (who at risk, how to assess), sources
Sodium—sources, function in body
Potassium—sources, function in body
Iodine—thyroid, cretinism, BMR
● function of renin
○ eventually leads to water retention and increased BP
● what is the function of aldosterone
○ causes sodium retention which leads to water retention
● what is the function of ADH
○ causes kidneys to retain water
● how do calcium, magnesium, and phosphorus promote bone health
○ calcium forms bone structure, and magnesium and phosphorus are also part of
bones
 ● who is at risk for iron-deficiency
○ toddlers, teenage girls, women of child-bearing age
● how can we assess for iron deficiency
○ check conjunctiva for color, check for pallor, weakness, fatigue, reduced work
productivity, inability to concentrate, apathy, lowered cold tolerance
● what are the sources of iron
○ meat, poultry, fish, plant foods
● what are the sources of sodium
○ cold cuts, pizza, soups, restaurant/processed foods, breads
● what is sodium’s function in the body
○ primary regulator of ECF volume, principal electrolyte in ECF
● what are the sources of potassium
○ fresh fruit and vegetables
● what is potassium’s function in the body
○ maintain F&E balance and cell integrity, principal positive ion in ICF
● what does iodine have to do with the thyroid
○ forms an integral part of thyroid
● what is cretinism
○ iodine deficiency in pregnancy leads to mental retardation of child
● how does iodine impact BMR
○ iodine affects metabolism because it forms an integral part of thyroid hormones,
which regulate metabolism

Ch10 Pregnancy and Infancy

Birthwt related to pre-pregnancy wt; RDAs for kcals for pregnancy/lactation; appropriate wt gain
in pregnancy; folate in pregnancy—RDA, what does it prevent?; iron recommendations for
pregnancy; American Academy of Pediatrics recs for breast feeding and food introduction;
benefits of breastfeeding
● american academy of pediatrics for breast feeding and food introduction
○ breastfeed exclusively for first 6 months, then add complementary foods one at a
time
● benefits of breastfeeding
○ good nutrition for infant antibodies, hormones, improves cognitive development,
protects against food allergies, reduces risk of SIDS, contracts uterus, delays
return of regular ovulation, conserves iron stores, saves time and money
● how is pre-pregnancy weight important to birth weight
○ birthweight correlates with pre-pregnancy weight and weight gain
● What is the RDA for folate in pregnancy and what does folate prevent?
○ 600 mcg/day; prevents neural tube defects
● What are the iron recommendations for pregnancy?
○ eat foods that supple heme-iron and are iron-rich; take supplements

Ch11 Childhood
Recommendations to prevent childhood obesity (Table 11-5); iron deficiency and behavior; iron-
rich food (Table 11-1); lead toxicity—effects, how to prevent, recommendations from Mealtimes
at Home; nutrients likely to be deficient in teen years
● recommendations to prevent childhood obesity
○ create permanent healthy lifestyle habits, regular scheduled meals and snacks,
take time to have conversations while eating, model healthy eating, show
enjoyment of healthy foods
● how does iron deficiency affect behaviors
○ iron deficiency impairs attention span and learning ability and affects intellectual
performance
● iron-rich foods
○ cream of wheat, snow peas, plums, raisins, meats
● what are the effects of lead toxicity
○ early: diarrhea, irritability, fatigue
○ later: learning disabilities and behavior problems, mental retardation, death
● how can we prevent lead toxicity
○ feed kids balanced timely meals with ample iron and calcium, wash floors, do not
use contaminated water with formula, test water with for lead, keep old painted
objects away
● what are some recommendations from mealtimes at home
○ provide variety of foods, avoid power struggles, prevent choking, allow kids to
help plan and prepare meals, have healthy snacks, prevent dental caries, role
model
● for which nutrients are teens likely to develop a deficiency
○ vitamin D, iron, calcium

Ch12 Later Adulthood

Nutrition recs for rheumatoid and osteo arthritis; nutrition recs to prevent cataracts and macular
degeneration; nutrition recs for brain health (pg 357-359); treatment for sarcopenia, nutrients of
concern (vit D/Ca, B12, iron)
● what nutrition recommendations for rheumatoid arthritis
○ omega-3 fatty acids in fish oil to reduce inflammation
● what are nutrition recommendations for osteoarthritis
○ weight loss
● what are the nutrition recommendations to prevent cataracts or macular degeneration
○ antioxidants, vitamin C & E
● What are the nutrition recommendations for brain health?
○ Whole grain ≥3x/day, green leafies ≥6x/week, berries
≥2x/week, fish ≥1x/week, poultry ≥2x/week, beans ≥3x/week,
nuts ≥5x/week, red meats <4x/week, fast/fried foods
<1x/week, butter <1tbsp/day, cheese <1x/week,
pastries/sweets <5x/week, alcohol no more than 1x/day
● treatment for sarcopenia
○ physical activity and high protein diet
● what nutrients are of concern for elederly people
○ vitamin D, calcium, B12, iron, folate
Ch13 Nutrition Care and Assessment
Identifying risk of malnutrition (esp 6 signs from Consensus Malnutrition Characteristics—from
slides); clinical signs of nutrient deficiencies (pg 395); Table 13-8 Involuntary Wt Loss; edema
masking weight loss, is albumin useful for measuring malnutrition?
● risk for malnutrition
○ weight loss, appetite change
● what are the 6 signs of malnutrition from consensus malnutrition characteristics
○ unintentional weight loss, inadequate intake, loss of muscle mass, loss of
subcutaneous fat, edema, reduced hand grip strength
● clinical signs of vitamin C deficiency
○ bleeding gums, poor wound healing, bruising or bleeding
● clinical signs of iron deficiency
○ pale membranes, pale skin, spoon-shaped pale nails
● clinical signs of vitamin A deficiency
○ dryness, night blindness, lack of fat under skin
● clinical signs of b vitamin deficiency
○ redness at corners of eyes, dry lips, sores in corners of lips, smooth or magenta
tongue, dry/rough skin, dementia, peripheral neuropathy
● clinical signs of zinc deficiency
○ poor taste sensation, poor wound healing
● clinical signs of vitamin K
○ bruising or bleeding under skin
● clinical signs of iodine deficiency
○ swollen glands at neck
● clinical signs of vitamin D deficiency
○ bowed legs
● what rates of involuntary weight loss are associated with nutritional risk
○ >2% in 1 week, >5% in 1 month, >7.5% in 3 months, >10% in 6 months
● how does edema mask weight loss
○ fluid accumulation in interstitial spaces in increased weight
● is albumin useful for measuring malnutrition
○ no

Ch14 Nutrition Intervention and Diet/Drug Interactions

Modified diets—clear liquid, full liquid, blenderized, dysphagia, mechanically altered, high and
low fiber, low sodium, fat-restricted, high-kcal/high protein. Be able to recognize menu items
that don’t belong on a particular modified diet.
Methotrexate and folate
Warfarin (Coumadin) and Vitamin K
MAO inhibitors and tyramine sources
● what is a clear liquid diet
○ clear and liquid at room temp: water, tea, coffee, broth, juice
● what is full liquid
○ all liquids including milk, custard, pudding, creamed soups, icecream
● what is a blenderized diet
 ○ anything blended
● what is dysphagia diet
○ can be pureed, mechanically altered, advanced
● what is a low fiber
○ no whole grains, nuts, fruits, dried beans/peas, or most veggies
● what is a low-sodium diet
○ less than 1500 mg a day
● what is a fat-restricted diet
○ for reducing symptoms of fat malabsorption, avoid whole milk dairy, gravies,
creams, fatty meat, nuts, chocolate, oils
● what is a high kcal/high protein diet
○ increased kcal and protein: peanut butter, eggnog, nutritional shakes
● how do methotrexate and folate interact
○ methotrexate is similar to folate and deprives cancer cells of folate to stop growth,
lead to folate deficiency
● how do warfarin and vitamin K interact
○ warfarin and vitamin k are structurally similar, Warfarin blocks enzymes that
activate vitamin K, so vitamin K intake needs to be steady, so Warfarin activity is
stable
● how do MAO inhibitors and tyramine sources interact
○ combination of these two can lead to hypertennsive crisis

Ch15 Enteral and Parenteral Nutrition

Choosing between enteral and parenteral
Candidates for TPN and tube feeding. Which disease states indicate which method.
Types of formulas—standard, hydrolyzed…
Recommendations for transitioning to table food or from TPN to GI tract
How to respond to hyperglycemia, hypertriglyceridemia for TPN pts
● how to choose between enteral and parenteral
○ if GI tract is functional use enteral, if not parenteral
● who are candidates for PN
○ Patients with intestinal obstructions or fistulas, paralytic ileus, short bowel
syndrome, intractable vomiting or diarrhea, severe GI bleeding, severe
malabsorption, bone marrow transplants, or severe malnutrition with intolerance
to enteral nutrition
● who are candidates for tube feeding
○ Patient has a severe swallowing disorder, gastroparesis, mental incapacitation, GI
obstructions and fistulas that can be bypassed by tube, certain types of intestinal
surgeries, little or no appetite for extended periods, extremely high nutrient
requirements, mechanical ventilation
● what is standard formula
○ contains whole proteins for patients who can digest and absorb whole nutrients
● what is hydrolyzed formula
○ Protein and carbs partially or fully broken down, fats are medium-chain
triglycerides
● what are recommendations for transitioning to table food or from TPN to GI tract
 ○ oral should supply ⅔ before switching
● how do we respond to hyperglycemia for TPN patients
○ Provide insulin with parenteral solutions, avoid overfeeding or overly fast
infusion rates, restrict amounts of dextrose in solution
● How do we respond to hypertriglyceridemia for TPN patients?
○ Reduce or stop lipid infusions if blood triglyceride levels >400 mg/dL, avoid
overly fast lipid infusions and dextrose overfeeding

Ch 16 Metabolic and Respiratory Stress

Conditions that result in high metabolic stress
General results of metabolic stress (increase BMR…..)
Protein and energy needs during acute metabolic stress
Initial concerns for acute metabolic stress pts
COPD pts and problems with excessive kcals.
Tube feedings for COPD pts have a bit more ___________ than standard formulas.
● What are some conditions that result in high metabolic stress?
○ Disease or injury such as uncontrolled infections or extensive tissue damage
(burns, severe wounds)
● What are the general results of metabolic stress?
○ Increased BMR, glycogen to glucose, amino acids to glucose, fat tissue to
triglycerides, increased HR and RR, rise in BP
● How much protein and energy does a patient need during acute metabolic stress?
○ 25-30 kcal/kg (obese 22-25 kcal/kg of IBW); 1.2-2.0 g/kg (obese 2.0-2.5 g/kg of
IBW)
● What are the initial concerns for acute metabolic stress patients?
○ Restore lost fluids and electrolytes, remove underlying stressors
● Why are excess kcalories a problem for COPD patients?
○ Too many carbs cause excess CO2 production
● Tube feedings for COPD pts have a bit more fat than standard formulas.
Ch17 Upper GI
Nutrition therapy for: Dysphagia, GERD, PUD, Gastrectomy/Dumping syndrome
H. pylori involved in which disorders?
● Nutrition therapy for dysphagia
○ National dysphagia diet (pureed, mechanically altered, or advanced food; thin,
nectar-like, honey-like, or spoon-thick liquids)
● Nutrition therapy for GERD
○ Avoid eating large meals, wait 3 hours after eating before lying down, maintain
healthy weight, and avoid alcohol, caffeine, smoking, peppermint, and spearmint
● Nutrition therapy for PUD
○ Avoid alcohol, coffee, caffeine, chocolate, and pepper
● Nutrition therapy for gastrectomy
○ Initially NPO, then liquids, soft foods, avoid fried or chewy foods, high fiber,
sugars, caffeine, and alcohol; prevent dumping syndrome
● Nutrition therapy for dumping syndrome
○ Restrict fluids during meals, limit meal size, restrict sugar, lay down after eating,
restrict fiber
 ○ H. pylori involved in which disorders?
Ch18 Lower GI
long term results of fat malabsorption
nutrition therapy for lactose intolerance, celiac, irritable bowel syndrome, acute pancreatitis,
Crohn’s, diverticulosis

● What are the 4 long-term results of fat malabsorption?

○ Weight loss and malnutrition, essential fatty acid deficiencies, increased risk of
bone loss, increased risk of oxalate stone formation
● Nutrition therapy for lactose intolerance
○ Avoid milk, ice cream, pudding, cream soups, and soft cheeses; can have yogurt
and hard/aged cheeses
● Nutrition therapy for celiac
○ Life-long adherence to gluten-free diet, avoid lactose during exacerbations,
dietary supplements
● Nutrition therapy for irritable bowel syndrome
○ Increase fiber intake to relieve constipation, eat small and frequent meals, avoid
FODMAPS foods
● Nutrition therapy for acute pancreatitis
○ Initially NPO to reduce pancreatic stimulation, progress to regular diet or fat-
restricted diet if showing symptoms of fat malabsorption
● Nutrition therapy for Crohn's
○ Aggressive dietary management, high protein and kcal diets for patients with
malnutrition, tube feedings, low fat and low fiber diets, and avoiding lactose,
fructose, and sorbitol
● Nutrition therapy for diverticulosis
○ Severe flare-up: NPO and IV fluids, then clear liquids, then low-fiber diet
○ After recovery: gradually increase fiber intakes until RDA met