NCLEX: Physiological Integrity: Basic Care and Comfort—Nutrition

Contents

Physiological Integrity: Basic Care and Comfort—Nutrition: POPULATION SPECIFIC NUTRITIONAL NEEDS

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

Physiological Integrity: Basic Care and Comfort—Nutrition: Nutrition During Pregnancy and Lactation

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

Nutrient Needs During Pregnancy gives a summary of nutrient needs (maternal and fetal) during pregnancy.

I. MILK GROUPimportant for calcium, protein of high biological value, and other vitamins and minerals.

  • Pregnancy —three to four servings (four to five for adolescents).
  • Lactation—four to five servings.
  • Count as one serving—1 cup milk; 1/2 cup undiluted evaporated milk; 1/4 cup dry milk; 11/4 cups cottage cheese; 2 cups low-fat cottage cheese;
    11/2 oz cheddar or Swiss cheese; or 11/2 cups ice cream.

II. MEAT, POULTRY, FISH, DRY BEANS, NUTS, AND EGGS GROUPimportant for protein, iron, and many B vitamins.

  • Pregnancy—three servings.
  • Lactation—three servings.
  • Count as one serving—1/2 cup cooked dry beans, 1 egg, or 11/2 tbsp peanut butter is equivalent to 1 oz meat; use peanut butter or nuts rarely to avoid excessive fat intake; limit eggs to reduce cholesterol intake; trim fat from meat, and remove skin from poultry.

 

Physiological Integrity: Basic Care and Comfort—Nutrition

 

III. VEGETABLE AND FRUIT GROUPvitamins and minerals (especially vitamins A and C) and roughage.

  • Vegetables:
    1. Pregnancy—three to four servings.
    2. Lactation—three to five servings.
    3. Count as one serving—1 cup raw leafy greens, 1/2 cup of others.
  • Fruits:
    1. Pregnancy—two to four servings.
    2. Lactation—two to four servings.
    3. Count as one serving—1/2 medium grapefruit; 1 medium apple, banana, or orange; 3/4 cup fruit juice.
  • Good sources of vitamin C—citrus, cantaloupe, mango, papaya, strawberries, broccoli, and green and red bell peppers. D. Fair sources of vitamin C—tomatoes, honeydew melon, asparagus tips, raw cabbage, collards, kale, mustard greens, potatoes (white and sweet), spinach, and turnip greens.
  • Good sources of vitamin A—dark-green or deep yellow vegetables and a few fruits (apricots, broccoli, pumpkin, sweet potato, spinach, cantaloupe, carrots, and winter squash).
  • Good sources of folic acid—dark-green foliage-type vegetables.

IV. BREAD AND CEREAL GROUPgood for thiamine, iron, niacin, and other vitamins and minerals.

  • Pregnancy—6 to 11 servings.
  • Lactation—6 to 11 servings.
  • Count as one serving—1 slice bread, 1 oz ready-to eat cereal, 1/2 to 3/4 cup cooked cereal, cornmeal, grits, macaroni, noodles, rice, or spaghetti.

V. NOTE: use dark-green leafy and deep-yellow vegetables often; eat dry beans and peas often; count 1/2 cup cooked dry beans or peas as a serving of vegetables or 1 oz from meat group.

Physiological Integrity: Basic Care and Comfort—Nutrition: Nutritional Needs of the Newborn

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

I. CALORIES—108 kcal/kg/day.

II. PROTEIN—2.2 gm/kg/day (1 gm protein = 1 oz milk).

III. FLUIDS—3.5 oz/kg/day.

IV. VITAMIN D—400 IU daily for infants who are bottle-fed after week 2.

V. FLUORIDE—0.25 mg daily up to 3 years old when local water supply has less than 0.3 ppm content.

Physiological Integrity: Basic Care and Comfort—Nutrition: Nutritional Needs of the Geriatric Client

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

I. CALORIES—1,500 to 2,000 kcal/day to maintain ideal weight; 12% of calories from protein sources; 50% to 60% of calories from carbohydrates; 20% to
30% of calories from fats.

II. HIGH FIBER—prevent or alleviate constipation and dependence on laxatives.

III. SODIUM—3 to 4 gm/day according to cardiac and renal status.

IV. FATS—limit to help retard the development of cancer, atherosclerosis, obesity, and other diseases.

V. FLUIDS—6 to 8 glasses/day.

VI. COMMON DEFICIENCIES: calories; calcium; folic acid; iron; thiamine; vitamins A, B12, C, and D; niacin; zinc.

VII. FACTORS CONTRIBUTING TO FOOD PREFERENCES:

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Physical ability to prepare, shop for, and eat food.
  • Income.
  • Availability of food if dependent on others.
  • Food intolerances.

VIII. COMMON EATING PROBLEMS: Eating Problems of the Geriatric Client and Ways to Improve Nutrition provides interventions for common eating problems of the geriatric client.

Physiological Integrity: Basic Care and Comfort—Nutrition: CULTURAL FOOD PATTERNS

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

Cultural Food Patterns gives a summary of the cultural food patterns of various ethnic groups, and Hot-Cold Theory of Disease Treatment* details the “hot” versus “cold” theory of disease treatment.

Physiological Integrity: Basic Care and Comfort—Nutrition: RELIGIOUS CONSIDERATIONS IN MEAL PLANNING

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

I. ORTHODOX JEWS:

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Kosher meat and poultry.
  • No shellfish, eels, or pork products.
  • Milk and dairy products cannot be consumed with meat or poultry; requires separate utensils.
  • No eggs with a blood spot may be eaten. Eggs may be used with either meat or dairy meals.

II. CONSERVATIVE AND REFORM JEWS: dietary practices may vary from religious laws.

III. MUSLIMS: no pork or alcohol.

IV. HINDUS: vegetarianism (cows are sacred).

 

Physiological Integrity: Basic Care and Comfort—Nutrition

Physiological Integrity: Basic Care and Comfort—Nutrition

Physiological Integrity: Basic Care and Comfort—Nutrition

Physiological Integrity: Basic Care and Comfort—Nutrition

Physiological Integrity: Basic Care and Comfort—Nutrition

 

V. SEVENTH-DAY ADVENTISTS:

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Vegetarianism is common (lacto-ovo).
  • No shellfish or pork products.
  • Avoid stimulants (coffee, tea, other caffeine sources).
  • No alcohol.

VI. MORMONS (LATTER-DAY SAINTS [LDS]): no coffee, tea, or alcohol.

VII. CATHOLICS: some still adhere to meatless Fridays and fasting during Lent.

Physiological Integrity: Basic Care and Comfort—Nutrition: COMMON VITAMINS AND NUTRIENTS AND RELATED DEFICIENCIES

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

Physiological Functions of Common Vitamins and Related Deficiencies gives a summary of the physiological functions of common vitamins and the results of deficiencies. Essential Nutrients and Potential Deficiencies gives a similar summary of essential nutrients.

Physiological Integrity: Basic Care and Comfort—Nutrition: MEDICAL CONDITIONS WITH DIETARY MANAGEMENT

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

The dietary management of various medical conditions is detailed in Medical Conditions with Dietary Management.

Physiological Integrity: Basic Care and Comfort—Nutrition: SPECIAL DIETS

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

I. LOW-CARBOHYDRATE DIET—ketogenic: low carbohydrate, high fat; dumping syndrome: low carbohydrate, high fat, high protein.

II. GLUTEN-FREE DIET—elimination of all foods made from oats, barley, wheat, and rye; may have corn and rice. Used for celiac disease.

III. HIGH-PROTEIN DIET—lean meat, cheese, and green vegetables.

  • Nephrotic syndrome (may also be on low-sodium diet).
  • Acute leukemia (combined with high-calorie and soft food diets).
  • Neoplastic disease.

IV. LOW-PROTEIN DIET:

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Usually accompanied by high-carbohydrate diet and normal fats and calories.
  • Renal failure, uremia, anuria, acute glomerulonephritis.

V. LOW-SODIUM DIET:

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Heart failure.
  • Nephrotic syndrome.
  • Acute glomerulonephritis (varies with degree of oliguria).

 

Physiological Integrity: Basic Care and Comfort—Nutrition

Physiological Integrity: Basic Care and Comfort—Nutrition

 

Physiological Integrity: Basic Care and Comfort—Nutrition

Physiological Integrity: Basic Care and Comfort—Nutrition

 

Physiological Integrity: Basic Care and Comfort—Nutrition

 

Physiological Integrity: Basic Care and Comfort—Nutrition

Physiological Integrity: Basic Care and Comfort—Nutrition

 

Physiological Integrity: Basic Care and Comfort—Nutrition

 

VI. HIGH-PHOSPHORUS DIET:

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Use when serum phosphorus level is less than 2.7 mg/dL due to:
    1. Insufficient intake (e.g., malnutrition, starvation).
    2. Increased phosphorus excretion due to:
    a. Renal failure.
    b. Hyperparathyroidism.
    c. Malignancy.
    d. Antacids that are aluminum hydroxide–based or magnesium-based.
  • Sources of phosphorus: beef, chicken, fish, organ meats, pork, nuts, legumes, whole-grain breads and cereals, milk, egg, cheese, ice cream, carbonated beverages.

Physiological Integrity: Basic Care and Comfort—Nutrition: COMMON THERAPEUTIC DIETS

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

I. CLEAR LIQUID DIET

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Purpose: relieve thirst and help maintain fluid balance.
  • Use: postsurgically and following acute vomiting or diarrhea.
  • Foods allowed: carbonated beverages; coffee (caffeinated and decaffeinated); tea; fruit-flavored drinks; strained fruit juices; clear, flavored gelatins;
    broth, consommé; sugar; popsicles; commercially prepared clear liquids; and hard candy.
  • Foods avoided: milk and milk products, fruit juices with pulp, and fruit.

II. FULL LIQUID DIET

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Purpose: provide an adequately nutritious diet for clients who cannot chew or who are too ill to do so.
  • Use: acute infection with fever, gastrointestinal upsets, after surgery as a progression from clear liquids.
  • Foods allowed: clear liquids, milk drinks, cooked cereals, custards, ice cream, sherbets, eggnog, all strained fruit juices, vegetable juices, creamed
    vegetable soups, puddings, mashed potatoes, instant breakfast drinks, yogurt, mild cheese sauce or pureed meat, and seasonings.
  • Foods avoided: nuts, seeds, coconut, fruit, jam, and marmalade.

III. SOFT DIET

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Purpose: provide adequate nutrition for those who have trouble chewing.
  • Use: clients with no teeth or ill-fitting dentures; transition from full liquid to general diet; and for those who cannot tolerate highly seasoned, fried,
    or raw foods following acute infections or gastrointestinal disturbances, such as gastric ulcer or cholelithiasis.
  • Foods allowed: very tender minced, ground, baked, broiled, roasted, stewed, or creamed beef, lamb, veal, liver, poultry, or fish; crisp bacon or sweetbreads;
    cooked vegetables; pasta; all fruit juices; soft raw fruits; soft breads and cereals; all desserts that are soft; and cheeses.
  • Foods avoided: coarse whole-grain cereals and breads; nuts; raisins; coconut; fruits with small seeds; fried foods; high-fat gravies or sauces; spicy salad dressings; pickled meat, fish, or poultry; strong cheeses; brown or wild rice; raw vegetables, as well as lima beans and corn; spices such as horseradish, mustard, and catsup; and popcorn.

IV. SODIUM-RESTRICTED DIET

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Purpose: reduce sodium content in the tissues and promote excretion of water.
  • Use: heart failure, hypertension, renal disease, cirrhosis, toxemia of pregnancy, and cortisone therapy.
  • Modifications: mildly restrictive 2-gm sodium diet to extremely restricted 200-mg sodium diet.
  • Foods avoided: table salt; all commercial soups, including bouillon; gravy, catsup, mustard, meat sauces, and soy sauce; buttermilk, ice cream, and sherbet; sodas; beet greens, carrots, celery, chard, sauerkraut, and spinach; all canned vegetables; frozen peas; all baked products containing salt, baking powder, or baking soda; potato chips and popcorn; fresh or canned shellfish; all cheeses; smoked or commercially prepared meats; salted butter or margarine; bacon; olives; and commercially prepared salad dressings.

V. RENAL DIET

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Purpose: control protein, potassium, sodium, and fluid levels in body.
  • Use: acute and chronic renal failure, hemodialysis.
  • Foods allowed: high-biological proteins such as meat, fowl, fish, cheese, and dairy products—range between 20 and 60 mg/day. Potassium is usually limited to 1,500 mg/day. Vegetables such as cabbage, cucumber, and peas are lowest in potassium. Sodium is restricted to 500 mg/day. Fluid intake is restricted to the daily urine volume plus 500 mL, which represents insensible water loss. Fluid intake measures water in fruit, vegetables, milk, and meat.
  • Foods avoided: cereals, bread, macaroni, noodles, spaghetti, avocados, kidney beans, potato chips, raw fruit, yams, soybeans, nuts, gingerbread, apricots, bananas, figs, grapefruit, oranges, percolated coffee, Coca-Cola, Orange Crush, sport drinks, and breakfast drinks such as Tang or Awake.

VI. HIGH-PROTEIN, HIGH-CARBOHYDRATE DIET

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Purpose: corrects large protein losses and raises the level of blood albumin. May be modified to include low-fat, low-sodium, and low-cholesterol diets.
  • Use: burns, hepatitis, cirrhosis, pregnancy, hyperthyroidism, mononucleosis, protein deficiency due to poor eating habits, geriatric clients with poor
    food intake, nephritis, nephrosis, and liver and gallbladder disorders.
  • Foods allowed: general diet with added protein. In adults, high-protein diets usually contain 135 to 150 gm protein.
  • Foods avoided: restrictions depend on modifications added to the diet. These modifications are determined by the client’s condition.

VII. PURINE-RESTRICTED DIET

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Purpose: designed to reduce intake of uric acid–producing foods.
  • Use: high uric acid retention, uric acid renal stones, and gout.
  • Foods allowed: general diet plus 2 to 3 quarts of liquid daily.
  • Foods avoided: cheese containing spices or nuts, fried eggs, meat, liver, seafood, lentils, dried peas and beans, broth, bouillon, gravies, oatmeal and whole wheats, pasta, noodles, and alcoholic beverages. Limited quantities of meat, fish, and seafood allowed.

VIII. BLAND DIET

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Purpose: provision of a diet low in fiber, roughage, mechanical irritants, and chemical stimulants.
  • Use: gastritis, hyperchlorhydria, functional GI disorders, gastric atony, diarrhea, spastic constipation, biliary indigestion, and hiatus hernia.
  • Foods allowed: varied to meet individual needs and food tolerances.
  • Foods avoided: fried foods, including eggs, meat, fish, and seafood; cheese with added nuts or spices; commercially prepared luncheon meats; cured meats such as ham; gravies and sauces; raw vegetables; potato skins; fruit juices with pulp; figs; raisins; fresh fruits; whole wheats; rye bread; bran cereals; rich pastries; pies; chocolate; jams with seeds; nuts; seasoned dressings; caffeinated coffee; strong tea; cocoa; alcoholic and carbonated beverages; and pepper.

IX. LOW-FAT, CHOLESTEROL-RESTRICTED DIET

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Purpose: reduce hyperlipidemia, provide dietary treatment for malabsorption syndromes and clients having acute intolerance for fats.
  • Use: hyperlipidemia, atherosclerosis, pancreatitis, cystic fibrosis, sprue, gastrectomy, massive resection of the small intestine, and cholecystitis.
  • Foods allowed: nonfat milk; low-carbohydrate, low fat vegetables; most fruits; breads; pastas; cornmeal; lean meats; unsaturated fats such as corn oil; desserts made without whole milk; and unsweetened carbonated beverages.
  • Foods avoided: remember to avoid the “5 Cs” of cholesterol—cookies, cream, cake, coconut, chocolate; whole milk and whole-milk or cream products, avocados, olives, commercially prepared baked goods such as donuts and muffins, poultry skin, highly marbled meats, shellfish, fish canned in oil, nuts, coconut, commercially prepared meats, butter, ordinary margarines, olive oil, lard, pudding made with whole milk, ice cream, candies with chocolate, cream, sauces, gravies, and commercially fried foods.

X. DIABETIC DIET

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Purpose: maintain blood glucose as near normal as possible; prevent or delay onset of diabetic complications.
  • Use: diabetes mellitus.
  • Foods allowed: choose foods with low glycemic index; composed of 45% to 55% carbohydrates, 30% to 35% fats, and 10% to 25% protein. Foods are divided into groups from which exchanges can be made. Coffee, tea, broth, bouillon, spices, and flavorings can be used as desired. Exchange groups include: milk, vegetables, fruit, starch/bread (includes starchy vegetables), meat (divided into lean, medium fat, and high fat), and fat exchanges. The number of exchanges allowed from each group is dependent on the total number of calories allowed. Non-nutritive sweeteners (aspartame) if desired. Nutritive sweeteners (sorbitol) in moderation for those who have controlled diabetes and have normal weight.
  • Foods avoided: concentrated sweets or regular soft drinks.

XI. ACID-ASH AND ALKALI-ASH DIETS

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Purpose: furnish a well-balanced diet in which the total acid ash is greater than the total alkali ash each day.
  • Use: retard the formation of renal calculi. The type of diet chosen depends on laboratory analysis of the stones.
  • Acid-ash and alkali-ash food groups:
    1. Acid ash: meat, whole grains, eggs, cheese, cranberries, prunes, plums.
    2. Alkali ash: milk, vegetables, fruit (except cranberries, prunes, and plums).
    3. Neutral: sugars, fats, beverages (coffee and tea).
  • Foods allowed: all the client wants of the following:
    1. Breads: any, preferably whole grain; crackers; rolls.
    2. Cereals: any, preferably whole grain.
    3. Desserts: angel food or sunshine cake; cookies made without baking powder or soda; cornstarch pudding, cranberry desserts, custards, gelatin
    desserts, ice cream, sherbet, plum or prune desserts; rice or tapioca pudding.
    4. Fats: any, such as butter, margarine, salad dressings, Crisco, Spry, lard, salad oils, olive oil, etc.                                                                                                  5. Fruits: cranberries, plums, prunes.
    6. Meat, eggs, cheese: any meat, fish, or fowl, two servings daily; at least one egg daily.
    7. Potato substitutes: corn, hominy, lentils, macaroni, noodles, rice, spaghetti, vermicelli.
    8. Soup: broth as desired; other soups from foods allowed.
    9. Sweets: cranberry or plum jelly; sugar; plain sugar candy.
    10. Miscellaneous: cream sauce, gravy, peanut butter, peanuts, popcorn, salt, spices, vinegar, walnuts.
  • Restricted foods: no more than the amount allowed each day.
    1. Milk: 1 pint daily (may be used in other ways than as beverage).
    2. Cream: 1/3 cup or less daily.
    3. Fruits: one serving of fruit daily (in addition to the prunes, plums, and cranberries); certain fruits listed under Foods avoided (following) are not allowed at any time.
    4. Vegetables, including potatoes: two servings daily; certain vegetables listed under Foods avoided (following) are not allowed at any time.
  • Foods avoided:
    1. Carbonated beverages, such as ginger ale, cola, root beer.
    2. Cakes or cookies made with baking powder or soda.
    3. Fruits: dried apricots, bananas, dates, figs, raisins, rhubarb.
    4. Vegetables: dried beans, beet greens, dandelion greens, carrots, chard, lima beans.
    5. Sweets; chocolate or candies other than those listed under Foods allowed (preceding); syrups.
    6. Miscellaneous: other nuts, olives, pickles.

XII. HIGH-FIBER DIET

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Purpose: soften stool; exercise digestive tract muscles; speed passage of food through digestive tract to prevent exposure to cancer-causing agents in
    food; lower blood lipids; prevent sharp rise in blood glucose after eating.
  • Use: diabetes, hyperlipidemia, constipation, diverticulosis, anticarcinogenic (colon).
  • Foods allowed: recommended intake about 6 gm crude fiber daily: all bran cereals; watermelon, prunes, dried peaches, apple with skin; parsnips, peas, brussel sprouts; sunflower seeds.

XIII. LOW-RESIDUE (LOW-FIBER) DIET

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Purpose: reduce stool bulk and slow transit time.
  • Use: bowel inflammation during acute diverticulitis or ulcerative colitis, preparation for bowel surgery, esophageal and intestinal stenosis.
  • Foods allowed: eggs; ground or well-cooked tender meat, fish, poultry; milk; mild cheeses; strained fruit juice (except prune); cooked or canned apples, apricots,
    peaches, pears; ripe bananas; strained vegetable juice; canned, cooked, or strained asparagus, beets, green beans, pumpkin, acorn squash, spinach; white bread; refined cereals (Cream of Wheat).

XIV. LACTOSE-FREE DIET

  • Purpose: decrease symptoms that occur after having milk products: diarrhea, cramps, abdominal pain, increased flatus.
  • Use: in lactose intolerance, where there is an inability to tolerate lactose because of absence or deficiency of lactase, an enzyme found in the secretions of the small intestine required for digestion of lactose.
  • Foods avoided: milk products.
  • Foods allowed: soy-based milk foods; hard cheese, cottage cheese, yogurt (contains inactive lactose enzyme).

Physiological Integrity: Basic Care and Comfort—Nutrition: ANTICANCER NUTRIENTS AND NON-NUTRITIVE COMPOUNDS

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

I. USE: To enhance immune function, promote wellness as an anti-inflammatory agent; to reduce risk of chronic diseases, including cancer.

II. SOURCE FOODS:

  • Berries.
    1. Rich in: vitamin C, fiber, potassium, phytochemicals (flavonoids).
    2. Effect:
    a. Antioxidants: protect against cell damage.
    b. Anti-inflammatory.
    c. Antiulcerative.
    d. Antiviral.
    e. May help to inhibit tumor formation in: liver, colon, esophageal, and oral cancer.
    3. Servings: daily.
  • Citrus fruits.
    1. Rich in: vitamin C, folic acid, phytochemicals (e.g., beta-carotene, limonoids, monoterpenes, phenols).
    2. Effect:
    a. Inhibit activation of cancer cells; detoxify cancer promoters.
    b. Aid protective enzymes.
    c. Stimulate cancer-killing immune cells.
    d. May reduce risk of: breast, skin, colon cancers.
    3. Servings: daily.
  • Cruciferous vegetable family.
    1. Rich in: antioxidants (e.g., beta-carotene and vitamin C); also isothiocyanates; including sulforaphane.
    2. Group includes: broccoli, kale, cauliflower, cabbage, bok choy, brussels sprouts.                                                                                                                          3. Effect:
    a. Isothiocyanates: interfere with tumor growth.
    b. Neutralize cancer-causing chemicals.
    c. Stimulate enzymes (e.g., glutathione S-transferase) that inactivate carcinogens.
    d. May help reduce risk of hormone-related cancers (e.g., breast, prostate, and thyroid).
    e. May help reduce risk of: lung, GI, oral, pharyngeal, and esophageal cancers.
    4. Servings: 3 servings/week.
  • Fatty fish (salmon, trout, herring, bluefish, sardines).
    1. Rich in: omega-3 fatty acids, iron, B vitamins, selenium, vitamin D.
    2. Effect:
    a. Inhibit growth of cancer cells.
    b. Stimulate the immune system.
    c. Help prevent or reduce muscle wasting.
    d. May reduce the risk of cancers of: breast, prostate, endometrium, colon.
    3. Servings: twice/week or more often.
  • Flaxseed.
    1. Rich in: omega-3 fatty acids, lignans, fiber, protein, calcium, potassium, vitamin B, iron.
    2. Effect:
    a. Block tumor growth.
    b. Inhibit angiogenesis.
    c. Enhance immune system.
    d. Anti-inflammatory.
    3. Caution: Not to be used by clients with hormone-sensitive breast cancer and/or if using tamoxifen or other antiestrogenic drugs.
  • Garlic and onions.
    1. Effect:
    a. Increase detoxification of enzymes.
    b. Stimulate cancer-fighting immune cells.
    c. May decrease risk of: prostate, breast, gastric, and colon cancer.
    d. May also have antiasthma and cardioprotective effects.
    2. Servings: use in any recipe.
  • Green tea.
    1. Rich in: polyphenols (antioxidants that prevent DNA damage).
    2. Effect:
    a. Catechins (a type of polyphenol) may help to rid body of carcinogens.
    b. May neutralize cell-damaging free radicals.
    c. Stimulates immune response.
    d. May suppress the growth of cancer cells.
    e. May reduce the risk of: colorectal, prostate, breast, bladder, gastric, esophageal, liver, lung, skin, and head and neck cancers.
    3. Servings: 2 to 4 cups daily.
  • Herbs and spices.
    1. Rosemary: rich in carnosol and ursolic acid with strong antioxidant activity.
    2. Turmeric and cumin: rich in curcumin that may reduce risk of leukemia, skin, and liver cancers.
    3. Chili peppers: rich in capsaicin that helps to prevent formation of nitrosamines; may reduce risk of colon, gastric and rectal cancers.
  • Legumes/beans.
    1. Rich in: low-fat source of protein and dietary fiber, iron, folic acid, calcium, zinc, phytochemicals (e.g., phytosterols, saponins, phytic acid,
    isoflavones).
    2. Effect: prevent DNA damage → provide anticancer activity.
    3. Servings: 3 to 4/week.
  • Nuts.
    1. Rich in: dietary fiber, vitamin E, healthy fats. a. Brazil nuts: high amount of selenium.
    b. Walnuts: high in omega-3 fatty acids.
    2. Effect: encourage “suicide” (apoptosis) of cancer cells.
    3. Servings: 2 Brazil nuts daily; 2 tbsp of walnuts daily.
  • Olive oil (extra virgin).
    1. Rich in: monounsaturated fats, polyphenols.
    2. Effect:
    a. Inhibit oxidative stress.
    b. Arrest cell proliferation.
    c. Induce cell death (apoptosis).
    3. May reduce risk of: breast, prostate, and colorectal cancers.
  • Vegetables/fruitsorange-colored (carrots, sweet potatoes, winter squash, mangoes, papayas).
    1. Rich in: vitamin C, folic acid, other B vitamins, fiber and beta-carotene.
    2. Effect: carotenoids strengthen immune system.
    3. May reduce risk of: lung, colorectal, uterine, prostate, and breast cancers.
    4. Servings: daily servings of dark-orange and green foods.
  • Soy foods.
    1. Rich in: protein, fiber, calcium, variety of vitamins and minerals; phytoestrogens (e.g., isoflavones, lignans).
    2. Dietary sources: soybeans (edamame), tofu, tempeh, miso, soy nuts, soy milk.
    3. Caution: Those with breast cancer are advised to limit soy consumption to 3 to 4 servings/ week.
    4. May reduce risk of cancers: breast, prostate, thyroid, and colon.
    5. Servings: 1 to 2 daily soy servings (10 to 30 gm soy protein and 30 to 90 mg isoflavones). Avoid excesses of more than 200 mg isoflavones daily.
  • Tomatoes.
    1. Rich in: lycopene, vitamin C, beta-carotene, potassium.

2. Effect:
a. Antioxidants that scavenge free radicals.
b. Reduce tissue damage.
c. Protect cell membranes.
d. Prevent formation of nitrosamines.
3. Have been shown to inhibit growth of: prostate, colon, bladder, cervical, stomach, esophageal, and lung cancers.
4. Servings: 4 or more daily.

  • Whole grains.
    1. Rich in: fiber, vitamins, trace minerals, antioxidants, plant sterols, phytoestrogens, phytases, tocotrienols, lignans, ellagic acid, saponins.
    2. Dietary sources: oats, barley, mullet, brown rice, bulgur.
    3. Effect: may reduce risk of various cancers, as well as hypertension, heart disease, obesity, and diabetes.
    4. Servings: 3 times daily.
  • Yogurt with live, active cultures.
    1. Rich in: protein, calcium, and probiotics.
    2. Effect:
    a. Boost immunity.
    b. Inhibit cell proliferation.
    c. Induce cell death.
    3. May protect against colorectal cancer.
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Physiological Integrity: Basic Care and Comfort—Nutrition: FOOD LIST FOR MENU PLANNING

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

I. HIGH-CHOLESTEROL FOODS—over 50 mg/ 100-gm portion: beef, butter, cheese, egg yolks, shellfish, kidney, liver, pork, veal.

II. HIGH-SODIUM FOODS—over 500 mg/100-gm portion: bacon (cured, Canadian); beef (corned, cooked, canned, dried, creamed); biscuits, baking powder; bouillon cubes; bran, added sugar and malt; bran flakes with thiamine; breads (wheat, French, rye, white, whole wheat); butter, cheese (cheddar, Parmesan, Swiss, pasteurized American); cocoa; cookies, gingersnaps; cornflakes; cornbread; crackers (graham, saltines); margarine; milk (dry, skim); mustard; oat products; olives (green, ripe); peanut butter; pickles, dill; popcorn with oil and salt; raisins; salad dressing (blue cheese, Roquefort, French, Thousand Island); sausages (bologna, frankfurters); soy sauce; tomato catsup; tuna in oil.

III. HIGH-POTASSIUM FOODS—more than 400 mg/100-gm portion: almonds; bacon, Canadian; baking powder, low sodium; beans (white, lima); beef, hamburger; bran with sugar and malt; cake (fruitcake, gingerbread); cashew nuts; chicken, light meat; cocoa; coffee, instant; cookies, gingersnaps; dates; fruits, fruit juices; garlic; milk (skim, powdered); peanuts, roasted; peanut butter; peas; pecans; potatoes, boiled in skin; scallops; tea, instant; tomato puree; turkey, light meat; veal; walnuts, black; yeast, brewer’s.

IV. FOODS HIGH IN B VITAMINS

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Thiamine: pork, dried beans, dried peas, liver, lamb, veal, nuts, peas.
  • Riboflavin: liver, poultry, milk, yogurt, whole-grain cereals, beef, oysters, tongue, fish, cottage cheese, veal.
  • Niacin: liver, fish, poultry, peanut butter, whole grains and enriched breads, lamb, veal, beef, pork.

V. FOODS HIGH IN VITAMIN C: oranges, strawberries, dark-green leafy vegetables, potatoes, grapefruit, tomato, cabbage, broccoli, melon, liver.

VI. FOODS HIGH IN IRON, CALCIUM, AND RESIDUE

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Iron: breads (brown, corn, ginger); fish (tuna); poultry; organ meats; whole-grain cereals; shellfish; egg yolk; fruits (apples, berries); dried fruits (dates,
    prunes, apricots, peaches, raisins); vegetables (dark green leafy, potatoes, tomatoes, rhubarb, squash); molasses; dried beans and peas; peanut butter;
    brown sugar; noodles; rice.
  • Calcium: milk (dry, skim, whole, evaporated, buttermilk); cheese (American, Swiss, hard); dark green leafy vegetables (kale, turnip greens, mustard greens,
    collards); black-eyed peas; tofu; canned fish with bones; figs.
  • Residue: whole-grain cereals (oatmeal, bran, shredded wheat); breads (whole wheat, cracked wheat, rye, bran muffins); vegetables (lettuce, spinach, Swiss
    chard, raw carrots, raw celery, corn, cauliflower, eggplant, sauerkraut, cabbage); fruits (bananas, figs, apricots, oranges).

VII. FOODS TO BE USED IN LOW-PROTEIN AND LOW-CARBOHYDRATE DIETS

Focus topic: Physiological Integrity: Basic Care and Comfort—Nutrition

  • Low protein (these proteins are allowed in various amounts in controlled-protein diets for renal decompensation): milk (buttermilk, reconstituted evaporated, low sodium, skim, powdered); meat (chicken, lamb, turkey, beef [lean], veal); fish (sole, flounder, haddock, perch); cheese (cheddar, American, Swiss, cottage); eggs; fruits (apples, grapes, pears, pineapple); vegetables (cabbage, cucumbers, lettuce, tomatoes); cereals (cornflakes, puffed rice, puffed wheat, farina, rolled oats).
  • Low carbohydrate: all meats; cheese (hard, soft, cottage); eggs; shellfish (oysters, shrimp); fats (bacon, butter, French dressing, salad oil, mayonnaise, margarine); vegetables (asparagus, green beans, beet greens, broccoli, brussels sprouts, cabbage, celery, cauliflower, cucumber, lettuce, green pepper, spinach, squash, tomatoes); fruits (avocados, strawberries, cantaloupe, lemons, rhubarb).

VIII. DIETARY GUIDE—My Plate has replaced the Food Pyramid as a guide to daily food selection (My Plate—guide to daily food choices.)

  • Balance calories:
    1. Enjoy food, but eat less.
    2. Avoid oversized portions.
  • B. Increase the following foods:
    1. Half the plate should be fruits and vegetables.
    2. Grains should be whole grains (e.g., whole wheat, oatmeal, brown rice).
    3. Switch to fat-free or low-fat milk.
  • Reduce the following foods:
    1. Sodium—read the label.
    2. Soda—drink water instead of sugary drinks.

 

Physiological Integrity: Basic Care and Comfort—Nutrition

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