Table of Contents

 

 

 

PART I

WELLNESS, NUTRITION, AND THE NURSING ROLE

 

1

Wellness Nutrition

2

 

Role in Wellness

2

 

Definition of Health

3

 

Role of Nutrition

4

 

Health Promotion

4

 

Role of Nutrition

5

 

Nutrition Monitoring

5

 

Definition of Wellness

6

 

Role of Nutrition

6

 

Disease Prevention through Nutrition

6

 

Overview of Nutrients within the Body

8

 

Nutrient Categories

8

 

Food, Energy, and Nutrients

8

 

Energy

9

 

Carbohydrates

9

 

Proteins

9

 

Lipids (Fats)

9

 

Vitamins

10

 

Minerals

10

 

Water

10

 

Dietary Standards

10

 

Dietary Reference Intakes

11

 

Additional Standards

12

 

Adequate Eating Patterns

12

 

Nutritional Assessment

12

 

Assessment of Dietary Intake

14

 

Portraits of Malnutrition

15

 

Diet Evaluation

15

 

Assessment of Nutritional Status

15

 

The Nutrition Specialist

16

 

Toward A Positive Nutrition Lifestyle: Self-Efficacy

17

2

Personal and Community Nutrition

20

 

Role in Wellness

20

 

Personal Nutrition

20

 

Food Selection

21

 

Community Nutrition

21

 

Dietary Guidelines for Americans

22

 

Food Guides

23

 

MyPyramid Food Guidance System

24

 

Other Food Guides

24

 

Fruits & Veggies—More Matters

28

 

Exchange Lists

28

 

Criteria for Future Recommendations

29

 

Consumer Food Decision Making

30

 

Food Selection Patterns

30

 

Consumer Information and Wellness

31

 

Food Labeling

32

 

Health Claims

35

 

Food Safety

36

 

Risk Analysis and Food Safety

36

 

Biotechnology: Consumer Risk or Benefit?

36

 

Food Safety and Manufactured Products

37

 

Foodborne Illness

37

 

Food Preparation Strategies

40

 

Toward A Positive Nutrition Lifestyle: Locus of Control

43

PART II

NUTRIENTS, FOOD, AND HEALTH

 

3

Digestion, Absorption, and Metabolism

49

 

Role in Wellness

49

 

Digestion

49

 

The Mouth

49

 

The Esophagus

50

 

The Stomach

51

 

The Small Intestine

53

 

The Large Intestine

54

 

Absorption

54

 

Elimination

55

 

Digestive Process Across the Life Span

56

 

Metabolism

57

 

Metabolism Across the Life Span

57

 

Overcoming Barriers

57

 

Heartburn

57

 

Vomiting

58

 

Intestinal Gas

59

 

Constipation

59

 

Diarrhea

59

 

Toward a Positive Nutrition Lifestyle: Contracting

60

4

Carbohydrates

63

 

Role in Wellness

63

 

Food Sources

63

 

Carbohydrate as a Nutrient within the Body

65

 

Function

65

 

Digestion and Absorption

66

 

Glycogen: Storing Carbohydrates

67

 

Metabolism

67

 

Glycemic Index and Glycemic Load

68

 

Simple Carbohydrates

69

 

Monosaccharides

69

 

Disaccharides

70

 

Complex Carbohydrates: Polysaccharides

74

 

Starch

74

 

Fiber

76

 

Overcoming Barriers

79

 

Hypoglycemia

80

 

Diabetes Mellitus

80

 

Toward a Positive Nutrition Lifestyle: Tailoring

82

5

Fats

85

 

Role in Wellness

85

 

Functions

85

 

Food Functions

85

 

Physiologic Functions

86

 

Functions of Phospholipids and Sterols

87

 

Structure and Sources of Lipids

87

 

Fats: Saturated and Unsaturated

87

 

Phospholipids

90

 

Sterols

90

 

Fats as a Nutrient in the Body

90

 

Digestion

90

 

Absorption

91

 

Metabolism

92

 

Fat Intake and Issues

92

 

Fat Content of Foods

92

 

Detecting Dietary Fat

93

 

Fast but High-Fat Foods

93

 

Preserving Fats in Food

94

 

Food Cholesterol versus Blood Cholesterol

96

 

Synthetic Fats and Fat Replacers

98

 

Overcoming Barriers

99

 

Energy Intake

99

 

Extreme Dietary Fat Restrictions

99

 

Reduced Intake of Other Nutrients

100

 

Dietary Fat Intake and Diet-Related Diseases

100

 

Type 2 Diabetes Mellitus and Hypertension

102

 

Toward a Positive Nutrition Lifestyle: Gradual Reduction

102

6

Protein

105

 

Role in Wellness

105

 

Structure of Protein

105

 

Protein Composition

106

 

Protein as a Nutrient in the Body

108

 

Digestion and Absorption

108

 

Metabolism

109

 

Nitrogen Balance

110

 

Functions

111

 

Growth and Maintenance

111

 

Creation of Communicators and Catalysts

111

 

Immune System Response

111

 

Fluid and Electrolyte Regulation

111

 

Acid-Base Balance

111

 

Transportation

111

 

Food Sources

111

 

Quality of Protein Foods

111

 

Complementary Proteins

112

 

Measures of Food Protein Quality

113

 

Protein RDA

113

 

Vegetarianism

114

 

The Benefits of Vegetarianism

114

 

The Drawbacks of Vegetarianism

115

 

Contemporary Vegetarianism

115

 

Dietary Patterns of Protein

116

 

Restructuring the Dinner Plate

117

 

Overcoming Barriers

117

 

Malnutrition

117

 

Toward a Positive Nutrition Lifestyle: Chaining

121

7

Vitamins

124

 

Role in Wellness

124

 

Vitamin Categories

127

 

Food Sources

127

 

Water-Soluble Vitamins

127

 

Thiamine (B,)

127

 

Riboflavin (B2)

130

 

Niacin (B3)

131

 

Pyridoxine (B6)

132

 

Folate

132

 

Cobalamin (BI2)

135

 

Biotin

135

 

Pantothenic Acid

136

 

Choline

136

 

Vitamin C

136

 

Fat-Soluble Vitamins

138

 

Vitamin A

138

 

Vitamin D

141

 

Vitamin E

143

 

Vitamin K

144

 

Overcoming Barriers

145

 

Just Swallowing a Pill

145

 

Rethinking Vitamin Supplementation

146

 

Role of the Health Practitioner

146

 

Toward a Positive Nutrition Lifestyle: Social Support

146

8

Water and Minerals

150

 

Role in Wellness

150

 

Water

150

 

Food Sources

150

 

Water Quality

151

 

Water as a Nutrient in the Body

152

 

Fluid and Electrolytes

155

 

Minerals

156

 

Mineral Categories

156

 

Minerals as Nutrients in the Body

159

 

Major Minerals

160

 

Calcium

160

 

Phosphorus

166

 

Magnesium

166

 

Sulfur

166

 

Electrolytes: Sodium, Potassium, and Chloride

167

 

Sodium

167

 

Potassium

168

 

Chloride

169

 

Trace Minerals

169

 

Iron

169

 

Zinc

173

 

Iodine

174

 

Fluoride

175

 

Selenium

175

 

Copper

175

 

Chromium

177

 

Other Trace Minerals

177

 

Overcoming Barriers

177

 

Hypertension

177

 

Toward a Positive Nutrition Lifestyle: Projecting

179

PART III

HEALTH PROMOTION THROUGH NUTRITION AND NURSING PRACTICE

 

9

Energy Supply and Fitness

183

 

Role in Wellness

183

 

Energy

183

 

Energy Pathways

185

 

Carbohydrate as a Source of Energy

185

 

Fat as a Source of Energy

185

 

Protein as a Source of Energy

185

 

Anaerobic and Aerobic Pathways

185

 

Energy Balance

187

 

Estimating Daily Energy Needs

187

 

Components of Total Energy Expenditure

187

 

Adaptive Thermogenesis

189

 

Fitness

189

 

Health Benefits of Physical Exercise

190

 

Sedentary Individuals

191

 

Moderately Active Individuals

191

 

Vigorously Active Individuals

191

 

Special Populations

191

 

Strength Training

192

 

Bodybuilding

193

 

Food and Athletic- Performance

193

 

Kcal Requirements

194

 

Water: The Essential Ingredient

194

 

Carbohydrate: The Energy Food

195

 

Carbohydrate Loading

195

 

Protein

196

 

Protein and Amino Acid Supplements

196

 

Fat

197

 

Vitamins and Minerals

197

 

Ergogenic Aids

197

 

Overcoming Barriers

198

 

American “Couch Potatoes”

198

 

Psychosocial Dimensions of Fitness

198

 

Exercise Makes You Hungrier: Myth or Fact?

199

 

Toward A Positive Nutrition Lifestyle: Modeling

199

10

Management of Body Composition

203

 

Role in Wellness

203

 

Body Composition, Body Image, and Culture

203

 

Body Image

203

 

Body Perception

203

 

Body Image: Illusions versus Reality

204

 

Body Preferences: Gender Concerns

204

 

Body Acceptance: A Key to Wellness

204

 

Management of Body Fat Composition

205

 

Association of Body Fatness with Health

205

 

Healthy Body Fat

210

 

Functions of Fat

210

 

Measuring Body Fatness

212

 

Regulation of Body Fat Level

213

 

Changes in Body Fatness

213

 

Genetic Influences on Body Size and Shape

213

 

Set Point and Body Fatness

215

 

When Body Fatness Deviates from Usual

217

 

Time for Some New Approaches

219

 

Developing A Personal Approach

219

 

Gain, Lose, or Maintain: A Wellness Approach

219

 

Adopting an Active Lifestyle

222

 

Overcoming Barriers

223

 

Prospects for the Future

223

 

Toward A Positive Nutrition Lifestyle: Explanatory Style

225

11

Life Span Health Promotion: Pregnancy, Lactation, and Infancy

228

 

Role in Wellness

228

 

Nutrition during Pregnancy

228

 

Body Composition Changes during Pregnancy

229

 

Energy and Nutrient Needs during Pregnancy

230

 

Nutrition-Related Concerns

235

 

Overcoming Barriers: Relief from Common Discomforts during Pregnancy

239

 

Nutrition during Lactation

240

 

Anatomy and Physiology of Lactation

240

 

Promoting Breastfeeding

241

 

Energy and Nutrient Needs during Lactation

242

 

Contraindications to Breastfeeding

243

 

Nutrition during Infancy

243

 

Energy and Nutrient Needs during Infancy

243

 

Special Nutritional Needs

247

 

Toward A Positive Nutrition Lifestyle: Refraining

249

12

Life Span Health Promotion: Childhood and Adolescence

253

 

Role in Wellness

253

 

Life Span Health Promotion

253

 

Stages of Development

253

 

Childhood (1 to 12 Years)

253

 

Childhood Health Promotion (1 to 12 Years)

258

 

Techniques

258

 

Adolescence (13 to 19 Years)

260

 

Adolescence Health Promotion (13 to 19 Years)

262

 

Overcoming Barriers

262

 

Food Asphyxiation

262

 

Lead Poisoning

263

 

Obesity

263

 

Iron Deficiency Anemia

265

 

Role of Nurses

266

 

Food Allergies and Food Intolerances

266

 

Eating Disorders

268

 

Toward A Positive Nutrition Lifestyle: Psychosocial Development

272

13

Life Span Health Promotion: Adulthood

277

 

Role in Wellness

277

 

Aging and Nutrition

277

 

Productive Aging

278

 

Stages of Adulthood

278

 

The Early Years (20s and 30s)

278

 

The Middle Years (40s and 50s)

279

 

The Older Years (60s, 70s, and 80s)

280

 

The Oldest Years (80s and 90s)

281

 

Adult Health Promotion

284

 

Knowledge

284

 

Techniques

284

 

Overcoming Barriers

287

 

Food Asphyxiation

287

 

Stress

288

 

Women’s Health Issues

288

 

Men’s Health Issues

289

 

Toward a Positive Nutrition Lifestyle: Rationalizing

290

PART IV

OVERVIEW OF MEDICAL NUTRITION THERAPY

 

14

Nutrition in Patient Care

295

 

Role in Wellness

295

 

Nutrition and Illness

295

 

Hospital Setting

296

 

Bed Rest

297

 

Malnutrition

297

 

Nutrition Intervention

298

 

Screening

298

 

Nutritional Risk

306

 

Nutritional Theory

307

 

Food Service Delivery Systems

307

 

Enteral Nutrition

310

 

Parenteral Nutrition

318

 

Transitional Feedings

322

15

Nutrition and Metabolic Stress

326

 

Role in Wellness

326

 

Immune System

326

 

Role of Nutrition

326

 

The Stress Response

327

 

Starvation

328

 

Severe Stress

329

 

Effects of Stress on Nutrient Metabolism

331

 

Protein-Energy Malnutrition

334

 

Multiple Organ Dysfunction Syndrome

336

 

Surgery

336

 

Burns (Thermal Injury)

336

16

Interactions: Complementary and Alternative Medicine, Dietary Supplements, and Medications

342

 

Role in Wellness

342

 

Complementary and Alternative Medicine

342

 

Alternative Medical Systems

343

 

Mind-Body Interventions

344

 

Biologically Based Therapies

344

 

Manipulative and Body-Based Methods

345

 

Energy Therapies

346

 

Application to Nursing

346

 

Dietary Supplements

346

 

Regulation and Labeling

346

 

Supplement Use

347

 

looking to the Future

348

 

Application to Nursing

348

 

Medications

348

 

Drug-Nutrient Interactions

348

 

Risk Factors of Drug-Nutrient Interactions

352

 

Prescription and Over-the-Counter Medications

352

 

Effects of Drugs on Food and Nutrients

354

 

Effects of Food and Nutrients on Drugs

357

 

Effects of Herbs on Food, Nutrients, and Drugs

358

 

Application to Nursing

358

17

Nutrition for Disorders of the Gastrointestinal Tract

371

 

Role in Wellness

371

 

Dysphagia

371

 

Nutrition Therapy

372

 

Gastroesophageal Reflux Disease, Hiatal Hernia, and Esophagitis

375

 

Nutrition Therapy

376

 

Peptic Ulcer Disease

376

 

Nutrition Therapy

378

 

Dumping Syndrome

378

 

Nutrition Therapy

378

 

Celiac Disease (Gluten-Sensitive Enteropathy)

378

 

Nutrition Therapy

380

 

Lactose Intolerance

380

 

Nutrition Therapy

381

 

Inflammatory Bowel Disease

381

 

Nutrition Therapy

381

 

Ileostomies and Colostomies

381

 

Short Bowel Syndrome

384

 

Nutrition Therapy

384

 

Diverticular Diseases

384

 

Nutrition Therapy

385

 

Intestinal Gas and Flatulence

385

 

Nutrition Therapy

385

 

Constipation

385

 

Nutrition Therapy

386

 

Diarrhea

386

 

Nutrition Therapy

386

18

Nutrition for Disorders of the Liver, Gallbladder and Pancreas

390

 

Role in Wellness

390

 

Liver Disorders

390

 

Fatty Liver

390

 

Viral Hepatitis

390

 

Cirrhosis

394

 

Liver Transplantation

396

 

Nutrition Therapy

396

 

Gallbladder Disorders

397

 

Nutrition Therapy

398

 

Pancreatitis

398

 

Nutrition Therapy

399

 

Cystic Fibrosis

399

 

Nutrition Therapy

399

19

Nutrition for Diabetes Mellitus

405

 

Role in Wellness

405

 

Diabetes Mellitus

405

 

Type 1 Diabetes Mellitus

406

 

Insulin

411

 

Exercise

412

 

Type 2 Diabetes Mellitus

413

 

Oral Glucose-Lowering Medications

414

 

Blood Glucose Monitoring

414

 

Hypoglycemia

417

 

Diabetic Ketoacidosis

417

 

Hyperglycemic Hyperosmolar Syndrome

417

 

Nutrition Therapy

417

 

Role of the Nurse

420

 

Special Considerations

421

 

Illness

421

 

Gastroparesis

422

 

Diabetes Management through the Life Span

422

20

Nutrition for Cardiovascular and Respiratory Diseases

432

 

Role in Wellness

432

 

Coronary Artery Disease

433

 

Nonlipid Risk Factors

435

 

Nutrition Therapy

435

 

Hypertension

438

 

Nutrition Therapy

438

 

Myocardial Infarction

440

 

Nutrition Therapy

440

 

Cardiac Failure

442

 

Nutrition Therapy

442

 

Life Span Implications

443

 

Overcoming Barriers

443

 

Demystifying Labels

443

 

Respiratory Diseases

445

 

Chronic Obstructive Pulmonary Disease

445

 

Acute Respiratory Failure and Respiratory Distress Syndrome

447

21

Nutrition for Diseases of the Kidneys

452

 

Role in Wellness

452

 

Kidney Function

452

 

Nephrotic Syndrome

452

 

Nutrition Therapy

454

 

Acute Renal Failure

454

 

Nutrition Therapy

455

 

Chronic Renal Failure

455

 

Nutrition Therapy

455

 

Hemodialysis

457

 

Nutrition Therapy

457

 

Phosphorus and Calcium

458

 

Peritoneal Dialysis

459

 

Intermittent Peritoneal Dialysis

459

 

Continuous Ambulatory Peritoneal Dialysis

460

 

Continuous Cycling Peritoneal Dialysis

460

 

Nutrition Therapy

460

 

Renal Transplantation

460

 

Pretransplantation

461

 

Immediate and Long-Term Posttransplantation

461

 

Renal Calculi

461

 

Calcium Stones

462

 

Oxalate Stones

464

 

Uric Acid Stones

464

 

Cystine Stones

465

 

Struvite Stones

465

22

Nutrition in Cancer, AIDs, and Other Special Problems

470

 

Role in Wellness

470

 

Cancer

470

 

Nutrition and the Diagnosis of Cancer

471

 

Benefits of Nutritional Adequacy

471

 

Nutritional Effects of Cancer Treatments

473

 

Nutrition Therapy

476

 

Anorexia Caused by Cancer or Its Treatment

477

 

Nausea and Vomiting

480

 

Taste Abnormalities

480

 

Principles of Nutritional Care

480

 

Acquired Immunodeficiency Syndrome (AIDS)

481

 

Malnutrition in HIV/AIDS

482

 

Altered Nutrient Intake

482

 

Weight Loss and Body Composition Changes

483

 

Physical Impairment

483

 

Endocrine and Metabolic Disorders

483

 

Cycle of Malnutrition and Wasting

483

 

Nutrition Assessment in Cancer and HIV/AIDS

484

 

Nutrition Therapy

484

 

Prevention ofFoodborne Illness

485

 

Exercise Recommendations

485

 

Multidisciplinary Approach

485

 

APPENDIXES

 

A

Exchange Lists for Meal Planning

491

 

Common Measurements

491

 

Starch List

491

 

Nutrition Tips

491

 

Selection Tips

491

 

Fruit List

493

 

Nutrition Tips

493

 

Selection Tips

493

 

Milk List

493

 

Nutrition Tips

494

 

Selection Tips

494

 

Sweets, Desserts, and Other Carbohydrates List

494

 

Nutrition Tips

494

 

Selection Tips

494

 

Nonstarchy Vegetable List

496

 

Nutrition Tips

496

 

Selection Tips

496

 

Foods

496

 

Meat and Meat Substitutes List

496

 

Nutrition Tips

496

 

Selection Tips

497

 

Meal Planning Tips

497

 

Very Lean Meat and Substitutes List

497

 

Lean Meat and Substitutes List

497

 

Medium-Fat Meat and Substitutes List

498

 

High-Fat Meat and Substitutes List

498

 

Fat List

498

 

Nutrition Tips

498

 

Selection Tips

498

 

Monounsaturated Fats List

499

 

Polyunsaturated Fats List

499

 

Saturated Fats List

499

 

Free Foods List

499

 

Fat-Free or Reduced-Fat Foods

500

 

Sugar-Free Foods

500

 

Drinks

500

 

Condiments

500

 

Seasonings

500

 

Combination Foods List

500

 

Fast Foods List

502

 

Planning Individualized Diets Using Exchange Lists

503

Step 1

Conduct Nutrition History

503

Step 2

Calculate Daily Kibcalorie Requirements

504

Step 3

Determine Distribution of Carbohydrate, Protein, and Fat Kilocalories

504

Step 4

Determine Servings from Each Exchange List

504

B

Eating Well with Canada’s Food Guide to Healthy Eating

506

C

Body Mass Index Table: Obesity Values (2nd BMI table)

509

D

Kilocalorie-Restricted Dietary Patterns

510

 

Comparison of Weight Loss Programs

510

 

Moderate Restriction ofKcal

513

 

Very-Low-Calorie Diets (VLCD)

513

 

Formula Diets

513

 

Pharmacotherapy

513

E

Foods Recommended for Hospital Diet Progression

514

F

National Renal Diet

516

G

Foods High in Lactose, Purines, and Oxalates

520

 

Lactose Content of Foods

520

 

High-Lactose Foods

520

 

Low-Lactose Foods

520

 

Purine Content of Foods

520

 

High-Purine Foods: Content 150 to 825 mg/100 g

520

 

Moderate-Purine Foods: Content 50 to 150 mg/100 g

520

 

Low-Purine Foods: Content 0 to 50 mg/100 g

521

 

Oxalate Content of Foods

521

 

High-Oxalate Foods: >10 mg/Serving

521

H

Cultural and Religious Dietary Patterns

522

 

Glossary

527

 

Index

534