Week 9 Adverse Childhood Experiences

Question 1

What is ACEs?

Answer 1

Adverse Childhood Experiences

• ACEs is defined as any types of abuse, neglect, and/or traumatic experience that occurred before the age of 18 years old
• A child raised in an environment that lacks sense of safety, stability, and bonding is also considered ACEs
• ACEs is a generational, family, and community centered public health issue
• It is common among all populations; however, some populations are more vulnerable

Question 2

Why are ACEs relevant

Answer 2

• Covid-19 will have an impact on ACEs scores
• ACEs will affect the planning, management, and compliance of client care interventions
• all adult patients were once children and the events of their childhoods may manifest in adulthood
• no matter what nursing specialty you choose, ACEs may have an influence on client outcomes

Question 3

What are the different specialties that ACEs can prevent itself in

Answer 3

• adult med surg: chronic conditions like hypertension, diabetes, cancer
• L&D: high risk pregnancies leading to prematurity, birth complications or post partum depression
• ED: high risk behaviors leading to injuries or a dependency to utilize EDs to meet basic care needs or addiction crisis
• ICU: chronic life threatening effects of ACEs
• Mental health: depression, anxiety, PTSD, addictions, suicide, etc.

Question 4

What do you consider when creating a plan of care for you client based on the social ecological model

Answer 4

• the client as an individual: age, education, income, social history and background
• relationship: the people closely involved with the client influences his/her behavior, life experiences, and choices
• Community: the quality, safety, and accessibility within a neighborhood
• Societal parameters: determinants of health are influenced by health, economic, economic, educations, and social policies

Question 5

IN RED What is the relationship between ACEs and nutrition

Answer 5

• food insecurity
• access to fresh foods
• family food options, preparation, and eating habits
• finances for food

Question 6

Explain the sources of nutrition information

Answer 6

1. Dietary reference intakes: encompass types of nutrient reference values fo males and females in different age groups including:
   - recommended dietary allowance (RDA): the average daily dietary intake of a nutrient that is sufficient to meet the nutritional requirements of approximately 98% of healthy people
2. USDA dietary guidelines:
   - intended as a primary source of health information for nutrition educators, policy makers, and health care providers
   - based on scientific evidence
   - provide info about choosing a nutritious diet, maintaining a healthy weight, achieving adequate exercise, and food safety
   - updated every 5 years

Question 7

What are the definitions for macronutrients and micronutrients

Answer 7

Macro: supply the body with energy (kilocalories); the body needs large amounts

Micro: help manufacture, repair, and maintain cells; the body needs small amounts (vitamins and minerals)

Question 8

Explain the 3 classes of nutrients that provide the body with energy

Answer 8

Carbohydrates:
- primary energy source for muscle and organ function

Proteins;

• complex molecules made up of amino acids
• essential amino acids must be supplied in the daily diet because they cannot be manufactured by the human body
• nonessential amino acids can be synthesized in the body, so they do not need to be obtained from dietary sources

Lipids:

• fats are solid at room temp; oils are liquid at room temp
• you will hear the terms lipids and fats used interchangeably
• fat is an essential nutrient, but certain types, when consumed in excess, can also be a health hazard

Question 9

Explain why the micronutrient vitamins are essential

Answer 9

• because the body cannot make vitamins, they must be supplied by the foods we eat
• vitamins are critical in building and maintaining body tissues, supporting our immune system so we can fight disease, and ensuring healthy vision
• they also help our bodies to break down and use the energy found in carbs, proteins, and lipids
• vitamins are especially critical during periods of rapid growth, pregnancy, lactation, and healing
• some evidence supports the claim that certain vitamins prevent chronic illness
• vitamins are either far soluble (stay in the body longer) or water soluble (need to be replaced more frequently)

Question 10

What are the major minerals

Answer 10

• Calcium; in the US, calcium deficiency is one of the most common mineral deficiencies because the recommended daily intake is difficult to achieve by diet alone
• magnesium
• phosphorus
• potassium
• sodium

Question 11

What are the important trace minerals

Answer 11

• copper
• fluoride
• iodine
• iron
• zinc

Question 12

Explain the important facts about water as a nutrient

Answer 12

• make up large percentage of body weight
• transports substances: circulating as a component of blood, water serves as a medium for transporting oxygen, nutrients, and metabolic wastes
• water “fills in the spaces” in body tissues (muscle)
• maintains body temperature: when body temp rises, evaporation of sweat helps cool the body

Question 13

Explain how developmental stage is a factor that affects nutrition

Answer 13

1. from infants to elders: At specific developmental stages, nutritional needs and eating patterns vary according to physiological growth, activity level, metabolic processes, disease prevention, and other factors
2. includes lactating women
   - nutritional requirements increase dramatically during pregnancy as the mother provides for the nutritional needs of the fetus
   - folic acid intake is critical in the first trimester of pregnancy to prevent neural tube defects; a daily supplement of 0.6 to 0.8 mg is recommended during pregnancy
   - adequate protein and calcium are important for growing muscle, brain, and bone tissues
   - iron is essential to maintain maternal and fetal blood supplies and stores

Question 14

Explain the lifestyle factors that affect nutrition

Answer 14

• Dietary patterns; the type of food consumed is as important as the amount of food to a person’s overall health
• work environment: physically demanding work can cause fatigue and affect the quantity and quality of food consumed; when time pressure makes it difficult to prepare and eat healthy food during a short lunch break, some workers may rely on convenience foods to save time
• Cooking methods: up to half of the water soluble vitamin content (vit B and C) is lost in the cooking water of boiled veggies; keeping foods hot longer than 2 hours results in even further loss
• Oral contraceptive use: this method of family planning lowers the serum level of vit C and several B vitamins; women with marginal nutrient intake may need supplements
• Food to relieve stress: food is commonly used to cope with stress, depression loneliness, or boredom; skipping meals, binge eating, or consuming too much of a single food can result in poor nutrition, obesity and low self esteem
• Tobacco use: use vitamin C, an antioxidant fast than nonsmokers.

Question 15

What are the other diets modified for diease mentioned in the slides

Answer 15

• calorie-restricted: for clients requiring weight reduction
• protein controlled diet: to manage liver and kidney disease
• ketogenic diet: to treat difficult to control epilepsy, effective for weight loss, insulin control and may have role intreating cancer and neurologic disorders
• antigen avoidance diets: for client allergic to or intolerance of certain foods, such as gluten free diet for clients with celiac disease
• Calorie protein push: used when there is need to heal wounds, maintain or increase weight, or promote growth

Question 16

When screening for nutritional problems, what can be included in a dietary history

Answer 16

• 24 hour food recall
• food frequency questionnaire
• food record is the most accurate food diary

Question 17

What is included in a complete physical exam when identifying nutritional imbalances

Answer 17

• general survey
• alterations in vital signs
• poor skin turgor, wound healing
• concave/flat abdomen versus ascites
• change in muscle mass - if you don’t eat right your body has trouble putting on and maintaining muscle mass

Question 18

What are the lab results helpful in identifying nutritional imbalances

Answer 18

• blood glucose: indicates amount of fuel available for cellular energy
• hypoglycemia: <50 mg/dL; sx range from weakness to coma
• hyperglyemia: >109 mg/dL fasting or >127 mg/dL at random; may be a sign of DM
• serum albumin (prealbumin = most accurately reflects a patient’s nutritional status)
• creatinine: indicator of renal function
• hemoglobin: low hemoglobin may indicate inadequate iron intake or chronic blood loss

Question 19

What are the BMIs for overweight, class 1, 2, and 3 obesity

Answer 19

Overweight: 25.0 - 29.9

Class I: 30.0 - 34.9

Class II: 35.0 - 39.9

Class III: 40.0 or higher

Question 20

Explain underweight/undernutrition when discussing alterations in nutrition

Answer 20

• the causes of underweight status may be psychological, social economic, or physiological (e.g. hospitalization, self care deficits, illness, eating disorders)
• a person can also be malnourished with regard to specific nutrients without being underweight
• insufficient intake of protein, fat, vitamins, minerals
• consuming fewer calories than needed according to activity, gender, heigh and weight

Question 21

What are examples of etiologies for undernutrition

Answer 21

• difficulty chewing/swallowing
• alcoholism
• metabolic disorders: chronic diseases (DM, GI disorders) can alter nutrition intake

Question 22

What are the various subsidized programs are available to assist qualified people

Answer 22

• supplemental nutrition assistance program (SNAP)
• commodity supplemental food program
• Women, infants, and children (WIC)
• national school lunch and breakfast programs

Question 23

Explain the SNAP and WIC programs

Answer 23

SNAP:
- for low income households, this program issues coupons that can be used to buy food to cover the household’s needs

WIC:
- This federal program aims to safeguard the health of low income women who are pregnant or breastfeeding and to infants and children younger than age 5 who are at nutritional risk; WIC provides nutritious food to supplemental diets, offers information on healthy eating, provides support for breastfeeding, and makes referrals to health care as needed

Question 24

What are the alternative feeding methods you can use if a client cannot meet his/her nutritional needs

Answer 24

through the intestinal tract or IV as parenteral nutrition

Question 25

Explain enteral nutrtition

Answer 25

refers to the delivery of liquid nutrition into the upper intestinal tract via a tube

• tube feeding may be used in addition to or instead of oral intake
• tube feeding may be a short or long term therapy
• enteral nutrition is the preferred method of feeding for a client who has a functioning intestinal tract but needs nutritional support

Question 26

What are the risks associated with enteral feedings

Answer 26

• aspiration: this can lead to pneumonia, ARDS, or death
• bacterial growth
• other complications: diarrhea, nausea and vomiting, nasopharyngeal trauma, alterations in drug absorption and metabolism, and various metabolic disturbances

Question 27

What is a key point to remember with enteric tubes

Answer 27

Radiographic (x-ray) verification is the most reliable method for confirming tube placement and must be performed before the first feeding is administered

Question 28

Explain the regular diet, mechanical soft diet, and clear liquid diet

Answer 28

Regular diet:

• Also referred to as a general or normal diet
• Purpose is to provide a well-balanced diet and ensure that individuals who do not require dietary modifications receive adequate nutrition
• based on the dietary guidelines and the food guide pyramid, it incorporates a wide variety of foods and adequate caloric intake

Mechanical Soft Diet:

• consists of foods soft in texture, moderately low in fiber (clients at risk for constipation) and processed by chopping, grinding or pureeing to be easier to chew
• most milk products, tender meats, mashed potatoes, tender veggies, and fruits and their juices are included in the diet
• most raw fruits and veggies, seeds, nuts, and dried fruits are excluded

Clear liquid diet:

• leaves little residue in the GI tract
• this short term diet provides clear liquids that supply fluid and calories without residue
• it is often used with acute illness, before and after surgery, and other procedures such as x-ray or CT scan
• it includes coffee, tea, clear juices, gelatin and clear broth

Question 29

Explain the full liquid diet, GI soft diet, low residue/low fiber diet, and salt restricted (low sodium) diet

Answer 29

Full liquid diet:

• as a transition between clear liquid and a soft or regular diet, this plan provides easily tolerated foods
• the diet includes milk, strained and creamed soups, grits, creamed cereal, and fruit and vegetable juices

GI soft diet:

• can serve as a transition between a full liquid and a regular diet by providing foods low in fiber and soft in texture
• most raw fruits and veggies, nuts, seeds, coarse breads, and certain cereals are avoided
• milk, lean meats, fish, most forms of potatoes, and white breads are served on this diet plan

Low residue/low fiber diet:

• limits intake around ten grams of fiber daily
• designed to minimize the frequency and volume of residue in the intestinal tract

Salt Restricted (low sodium) diet:

• usually prescribed for patients with HTN and for those with excess fluid accumulations
• intake of commercially prepared foods such as cured or smoke meats, canned veggies, and regular soups as well as buttermilk, salt and salty foods are limited or avoided
• white milk, fresh or frozen meats, unsalted veggies, fruits and low sodium foods are included

Question 30

Explain the fat restricted, cholesterol restricted and vegetarian diets

Answer 30

Fat Restricted Diet:

• often prescribed for patients with GI disorders or excessive body weight
• limits the intake of fatty food such as margarine, mayonnaise, dressings, oils and gravies
• usually includes whole wheat breads, lean cuts of meat, skim milk, low fat cheese products, eggs, veggies, and other food items prepared without extra fat

Cholesterol restricted diet:

• lowering blood cholesterol can reduce the risk of heart disease
• cholesterol is found only in foods of animal origin
• certain oats, beans, and fruits are actually effective at lowering cholesterol levels in the body
• A cholesterol restricted diet limits the intake of meats, poultry, fried foods, egg yolks and whole milk products
• food high in saturated fat and trans fatty acids such as palm kernel oil, coconut oil, margarine, and shortening are also limited
• diet includes skim milk, lean meats, fruits, vegetable, and whole grain products

Vegetarian diet:

• varies widely depending on personal choice
• some variations designed to be lower in cholesterol and saturated fat and higher in dietary fiber; hence, it may be helpful in the prevention of heart disease and cancer risk

Question 31

Explain the consistent carbohydrate (diabetic) diet and the renal diet

Answer 31

Consistent Carbohydrate Diet:

• diet varies from client to client depending on the type and intensity of the diabetes, the patients’ personal history, and individual nutrient needs
• the exchange list for meal planning established the serving size amount of carbs per meal based on calorie recommendations
• meals are basically like those found on a regular menu, but carbs servings are carefully controlled and small snacks may be included in the meal plan
• carbs are starches, starchy veggies, juice, fruit, milk, and sugars

Renal Diet:

• is carefully planned with special consideration of nutrients, and it is often adjusted as kidney disease progresses
• a renal diet may serve the purpose of attempting to slow down the process of renal dysfunction
• if dialysis treatments are not being taken, the provider may restrict protein intake of foods such as potatoes, tomatoes, oranges, and bananas
• a phosphorous restriction may limit the intake of milk and dairy products, dried beans and peas, while grain breads and cereals coffee, tea and dark colored soda beverages

Question 32

Explain the other health conditions that require modification of dietary intake

Answer 32

• calorie-restricted: for clients requiring weight reduction
• protein-controlled diet: to manage liver and kidney disease
• ketogenic diet: to treat difficult to control epilepsy; effective for weight loss, insulin control and may have role in treating cancer and neurologic disorders (migraines, Alzheimer’s)
• antigen avoidance diets: for clients allergic to or intolerant of certain foods, such as gluten free diet for clients with celiac disease
• calorie protein push: used when there is a need to heal wounds, maintain or increase weight, or promote growth; if the person cannot consume enough kcal by adding fats and proteins to his/her regular diet, high calorie, high protein supplements may be used