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914582MODULE 112: PATIENT ASSESMENT: CARDIO-PULMONARY
AND GASTROENTEROLOGY
CHAPTER 27: INFECTION CONTROL

INTRODUCTION
 Every procedure must begin and end with hand
hygiene practices
 Reduce transmission of disease organisms and
lessen severity of disease
DISEASE
 Any sustained, harmful alteration of the normal
structure, function, or metabolism of an
organism or cell
- Genetic, drug-induced, autoimmune,
degenerative, communicable, or infectious
 An unaffected person (carrier) can transmit
infection to another person
THE CHAIN OF INFECTION

 Antibiotics are unable to destroy viral invaders
that enter a normal cell and multiply within the
cell
...
)
BACTERIA
 Tiny, simple cells that produce disease in a
variety of ways
 Classified according to their shape, or
morphology
- Cocci: spherical, round
- Diplococci: grows in pairs, cause
pneumonia, gonorrhea
- Streptococci: grows in chains, cause strep
throat, scarlet fever pneumonia
- Staphylococci: grows in cluster, boils,
pimples, abscesses, food poisoning
- Bacilli: rod shaped, causes botulism,
tetanus, typhoid fever, pertussis, TB
- Spirilla: spiral shaped, may have 1-3 fixed
curves, one curve causes cholera
DIPLOCOCCI

STREPTOCOCCI

VIRUSES
 Intracellular parasites that take over DNA or
RNA of invaded cell
 Incorporate into the cell's reproductive material
(genetic material)
 Treatment is palliative (relief of symptoms)

BACILLI

ANTIBIOTIC RESISTANCE
 One of the world’s most significant public health
problems
 Resistance occurs when an antibiotic is used
inappropriately to treat an infection
- Prescribe antibiotic therapy only when it
will benefit the patient
- Treat the patient with an antibiotic that is
specific to the infecting pathogen
- Prescribe the recommended dose and
treatment duration of the medication
PROTOZOA
 Unicellular parasites that can replicate and
multiply rapidly once inside host
 Frequently are seen in tropical climates
FUNGI
 Include such organisms as mushrooms, molds,
and yeasts
 Grow best in warm, moist environments
 Treatment with antifungal agents
RICKETTSIAE
 Microorganisms that have characteristics of both
bacteria and viruses
 Obligate parasites that must live within a host
cell for growth
 Larger than viruses, so they can be viewed with
a microscope
 Can be treated with antibiotics
RESERVOIRS
 Second link in chain of infection
 May be people, insects, animals, water, food, or
contaminated instruments
 Must gain entrance into a host or else they will
die
 Reservoir host supplies nutrition for organism,
allowing it to multiply

PORTAL OF EXIT
 How pathogen escapes reservoir host
 Exits include mouth, nose, eyes, ears, intestines,
urinary tract, reproductive tract, and open
wounds
TRANSMISSION
 Direct transmission occurs from contact with
infected person or discharges from infected
person
 Indirect transmission occurs from:
- Droplets in air expelled by coughing,
speaking, or sneezing
- Vectors that harbor pathogens
- Contaminated food or drink
- Contact with contaminated objects (called
fomites)
PORTAL OF ENTRY
 How transmitted pathogen gains entry into a
new host
 May be mouth, nose, eyes, intestines, urinary
tract, reproductive system, or an open wound
 Anatomic defenses include integumentary
system, tears, cilia, mucous membranes, and pH
of body fluids
 Second line of defense is immune system and
inflammatory process
- Humoral immunity
- Cell-mediated immunity
ACUTE INFECTION
Rapid onset of symptoms but lasts a relatively
short time
Prodromal period is time when patient first shows
vague, nonspecific symptoms of disease
Symptoms appear after the tissue damage begins
CHRONIC INFECTION
 Persists for a long period, sometimes for life
 Some chronic infections are asymptomatic, but
virus is transmissible
LATENT INFECTION
 Persistent infection in which symptoms cycle
through periods of relapse and remission
- Examples include cold sores, genital
herpes, and varicella
OPPORTUNISTIC INFECTIONS
 Caused by organisms not typically pathogenic
but occur in hosts with an impaired immune
system response

OSHA STANDARDS FOR
THE HEALTHCARE SETTING
 Universal Precautions: all blood and certain
body fluids must be treated as if known to be
infectious for blood-borne pathogens
- Precautions must be implemented for all
patients, regardless of the information
available about person’s individual health
history
EXPOSURE CONTROL PLAN
 Identify job classifications and/or specific workrelated tasks in which an employee potentially
may be exposed to blood and/or body fluids
 Describe how an employer will use a
combination of safety controls
 Review and update at least annually to
incorporate the use of safer medical devices
 Available to all employees for review and
training
OSHA’S BLOODBORNE
PATHOGENS STANDARD
 Needlestick Safety and Prevention Act:
employers must keep a confidential sharps
injury log that describes the device involved and
details of how and where incident occurred
 Parenteral exposure includes accidental
needlesticks, occupation-related human bites,
and exposure of nonintact skin
 Engineering Controls – needleless systems, and
resheathing syringes
CDC’S HAND HYGIENE RECOMMENDATIONS
 Hands should be washed a minimum of 15
seconds with antimicrobial soap and warm
running water
 Alcohol hand rubs should be used before and
after contact with each patient, and also after
removing gloves
 Healthcare workers with artificial nails have
more pathogenic microbes under their nails
 Natural nail tips should be no longer than ¼ inch
BARRIER PROTECTION
 Barrier protection, or PPE (personal protective
equipment), includes specialized clothing or
equipment that prevents the healthcare worker
from coming in contact with blood or other
potentially infectious material
- Disposable gloves, face masks, face
shields, protective glasses, shoe covers,
laboratory coats, barrier gowns,
mouthpieces, and resuscitation bags

WHEN GLOVES MUST BE WORN
 Touching a patient’s blood, body fluids, mucous
membranes, or skin that is not intact
 Handling items and surfaces contaminated with
blood and body fluids
 Performing venipuncture, finger sticks,
injections, and other vascular procedures
 Assisting with any surgical procedure
 Handling, processing, and disposing of all
specimens of blood and body fluids
 Cleaning and decontaminating spills of blood or
other body fluids
ENVIRONMENTAL PROTECTION
 If any body surface is exposed to potentially
infectious material, scrub area with
antimicrobial soap and warm running water as
soon as possible after exposure
 If your eyes come in contact with body fluids,
continuously flush them with water as soon as
possible for a minimum of 15 minutes using an
eye wash unit
 Contaminated needles and other sharps should
never be recapped, bent, broken, or resheathed
 Reusable sharps that are contaminated should
not be processed in a way that requires
employees to reach into containers to grasp
them
 Immediately after use, dispose of syringes and
needles, scalpel blades, and other sharp items in
a labeled, leak-proof, puncture-resistant
biohazard container
 All specimens must be placed in a container that
prevents leakage during collection, handling,
processing, storage, transport, and shipping
HOUSEKEEPING CONTROLS
 Work surfaces must be immediately
decontaminated with a disinfectant after
accidental spills of blood or body fluids, at end of
each procedure, and at end of each shift
 If there is accidental blood spill
...

 Two largest cartilages are the epiglottis and the
thyroid cartilage
TRACHEA
 Also called the windpipe is a tough flexible tube
about 2
...
) in diameter and 11 cm (4
...
) long
...

 The diameter of the trachea is adjusted by the
ANS, which controls contractions of smooth
muscle in the walls
...

 Pneumonia can be caused by bacteria, viruses, or
other pathogens; it affects preschoolers and the
elderly most often
...

 If the organism is viral, the patient is given
supportive care, such as antipyretics, fluids, and
oxygen, until the immune system can control the
spread of the virus
...
g
...
Positive PPD indicates that he person
is exposed to Tuberculosis
PULSE OXIMETRY
 Noninvasive method of evaluating the pulse rate
and oxygen saturation of hemoglobin in arterial
blood
 Identifies percentage of the hemoglobin that is
oxygenated in comparison with the total amount
of hemoglobin available
 Nebulizer
 Metered Dose Inhaler
 Meter Dose with Spacer
 Peak Flow Meter
PULSE OXIMETRY PROCEDURE

OBTAINING SPUTUM FOR CULTURE
 Requested when the signs and symptoms are
accompanied by physical evidence of
pneumonia, TB, or other infectious diseases of
lower respiratory tract
 Sample is cultured and incubated, and the
pathogenic organism grown in the culture
medium is identified
 Sample may also be sent to the laboratory for
cytologic analysis
METHODS OF SPUTUM COLLECTION
 Expectoration is most common
- Instruct patient: first thing in morning ,
cough deeply, and collect 1 teaspoon into
specimen cup
- Return to the office or lab as soon as
possible
 Other methods include tracheal suctioning and a
bronchoscopy in the office

THE HEART

LAYERS OF THE HEART

PATIENT EDUCATION
 You play a vital role in allaying patients' fears by
explaining tests, making sure patient
understands how to prepare for the exam, and
what will be expected during procedure
 Give handouts or brochures to take home

CHAPTER 47: ASSISTING IN CARDIOLOGY
ANATOMY OF THE HEART

LAYERS OF THE HEART
 Acting as a double pump, its structure is divided into the right and left heart by the septum
...
They are surrounded by three layers:
 Endocardium - inner lining of the heart
 Myocardium-muscular, middle layer
 Pericardium-outer membranous sac
- Parietal: lines the outer surface of the pericardial cavity
- Visceral (epicardium): covers the heart’s outer surface

HEART CHAMBERS
 The upper chambers are the atria:
 Right atrium receives deoxygenated blood from
all body parts except the lungs through the
superior and inferior vena cava as the SA node
contracts
...

HEART CHAMBERS
 Right ventricle receives deoxygenated blood
from the right atrium through the tricuspid
valve or AV valve and pumps it though a
semilunar valve to the lungs to drop off waste
product and get oxygenated
...


MAJOR VALVES OF THE HEART
 Tricuspid valve: also known as the AV valve
(cusps are flaps of the valves): between right
atrium and right ventricle
...

 Bicuspid or mitral valve: between left atrium
and the left ventricle; allows blood to flow to the
left ventricle
 Aortic semilunar valve: between left atrium and
aorta where blood exits out to the body; blood
leaving the left ventricle passes through the
aortic semilunar valve and into the systemic
circuit by way of the ascending aorta
...
Take blood away from the heart
...
They move deoxygenated blood toward the heart
from the tissues; they have valves that prevent the backflow of blood (back to heart)
...
They have singled cell walls that connect arterioles with venules and
form the point of exchange for oxygen and nutrients into body cells and waste products coming from body
cells
...


PATIENT EDUCATION
 Provide encouragement and support and by
using community resources to help the patient
find assistance with these changes
 Provide pictures, brochures, and pamphlets to
help patients learn
 Document patient education intervention

THE CARDIAC CYCLE
 Includes all events that occur in the heart during
one single heartbeat
 2 phases of cardiac cycle:
- Systole: atria and ventricles contract and
empty of blood
- Diastole: relaxation phase of heart,
chambers refill with blood
ELECTRICAL CONDUCTION
SYSTEM OF THE HEART

POLARIZATION, DEPOLARIZATION,
AND REPOLARIZATION
 Polarization is the resting state of the
myocardial wall; no electrical activity occurs in
this phase
- Recorded on ECG strip as a straight line
 Depolarization occurs, resulting in the
contraction of stimulated heart muscle
 Repolarization occurs when the heart muscle
cells must return to a resting state
 Electrocardiograph records a series of waves, or
deflections, corresponding to part of cardiac
cycle
PQRST COMPLEX
 P wave occurs during a contraction of the atria
and shows beginning of cardiac depolarization
- First deflection from the baseline,
typically smooth and rounded, and occur
before each QRS complex
 Atrial repolarization is not recorded on an ECG
strip
 PR segment is the return to the baseline after
atrial contraction
 PR interval is time from the beginning of atrial
contraction to beginning of ventricular
contraction
 QRS complex shows contraction of the ventricles
and reflects the completion of cardiac
depolarization
 QRS complex is recorded as a much more
significant electrical activity than a P wave
 ST segment reflects the time between the end of
ventricular contraction and the beginning of
ventricular recovery
 T wave represents ventricular recovery
 QT interval is the time between the beginning of
QRS complex through T wave
TYPES OF ECG MACHINES

ELECTROCARDIOGRAPH PAPER

ELECTRODES AND LEADS
 Ten sensors, or electrodes, are placed on the
patient’s arms (two), legs (two), and chest (six)
to pick up electrical activity of the heart
 Must be applied to specific locations to record
the heart’s electrical activity from different
angles and planes
 The leads to the electrocardiograph carry
cardiac electrical impulses into the machine,
where they are magnified by an amplifier
STANDARD LEADS

AUGMENTED LEADS

CHEST LEAD LOCATIONS

COLOR CODES
PRECORDIAL LEADS

PREPARATION OF THE ROOM AND PATIENT
 Warm, adjustable lighting, and far away from
noise and other electrical equipment
 Position treatment table so it is comfortable for
the patient and for you to stand on one side
 Offer a pillow for under the head and knees
 Have the patient disrobe to waist and put on the
gown with the opening in front
 Place the patient in supine position after the
bladder is emptied, and the patient is rested for
10 minutes

RECORDING THE ELECTROCARDIOGRAM
 Most electrocardiographs perform
standardization functions and labeling
automatically
 Follow office protocol when performing the
procedure
 Remind patient to lie still and press appropriate
key to run ECG strip
 Review printout for clarity and give to physician
STANDARDIZATION
 Standardization is determined by an
international agreement so that an ECG can be
interpreted in the same way anywhere in the
world
- Make sure the machine is correctly
standardized
- Stylus should deflect exactly 10 mm when
standardization button is depressed
- Recording of standardization would be 2
mm wide and rectangular

SENSITIVITY AND SPEED
 Most machines have three sensitivity standards
that can be selected
- Adjust so QRS complex fits properly onto
ECG paper
 Usual speed for an ECG recording is 25 mm/sec
LABELING THE ECG
 Patient’s full name
 Gender
 Age
 Date and time of ECG
 List of all medications and/or supplements the
patient takes
 Variations from normal sensitivity and normal
speed
TELEPHONE TRANSMISSION
 Electrocardiograph can transmit a recording
over a telephone to an ECG data interpretation
center
 Recording is interpreted by a computer at data
center and verified by a cardiologist
INTERPRETIVE ELECTROCARDIOGRAPHS
 Equipped with a computer that analyzes the
recording as it is being run
 Immediate information on the heart’s activity is
available
 Patient baseline data must be entered into the
computer before ECG is recorded
ARTIFACTS
 Unwanted, erratic movement of the stylus on
paper caused by outside interference
 Electrocardiograph is extremely sensitive to any
kind of nearby electrical activity
- Wandering baseline is usually due to
moving the patient or poor electrode
attachment
- Somatic tremor is caused by muscle
movement
- Alternating current (AC) interference
from other electrical devices
- Interrupted baseline occurs when the
electrical connection has been
interrupted
NORMAL APPEARANCE OF ECG COMPLEXES
 Are the P waves, QRS complexes, and T waves
clearly present?
 Do they have a consistent appearance and do
they occur at regular intervals?

 Are any odd beats present that do not fit in with
the others?
 Is the rate normal, fast, or slow?
 Is the rhythm regular or irregular?
RATE
 To calculate heart rate from ECG recording:
- Count number of P waves in a 6-second
strip (30 large squares) and multiply by
10
- Count number of P waves in a 3-second
strip (15 large squares) and multiply by
20
- 300/ the # of big boxes between R wave
- 1500/ the # small boxes
 To get ventricular contraction rate:
- Count number of complete QRS
complexes that occur within 6 seconds
and multiply by 10 to get number of
ventricular contractions in 1 minute
RHYTHM
 Rhythm of a patient’s heartbeat is either regular
or irregular
 If patient’s heart is beating in a regular rhythm,
each cardiac cycle occurs within same time
frame, and individual cardiac cycles occur
exactly same length of time apart
- Measure distance between two
consecutive RR intervals for ventricular
rhythm
- Measure distance between two
consecutive PP intervals for atrial rhythm
ANALYZING AN ECG STRIP
 Rate
 Rhythm
 P waves: There should be one P wave before
each QRS complex; each is a positive deflection
and similar in size and shape
...

 Appearance of the segments and waveforms: Are
rhythmic PQRST cycles present? Are there any
abnormalities, such as more than one P wave,
QRS segments without a previous P wave, or an
elevated ST segment? All of these abnormalities
should be brought to the physician’s attention
immediately
...

The problem list of the identified patient
problems is kept in the front of the
patient's chart
...
)

SOAPE
 S for subjective data
 O for objective data
 A for assessment of the problem
 P for the plan of care
 E for evaluation
- Subjective data include the purpose of the

-

-

visit, with the patient's words in
quotation marks, or a summary of the
patient's statement about the chief
complaint
...

Evaluation is the assessment of the
patient's understanding of the treatment
or of the person's ability to comply with
the treatment plan
...

What is the primary disadvantage of the
SOMR system? (It can be very timeconsuming to find a back entry about a
particular problem or treatment
...


 Large Intestine
- Approximately 5 feet (1
...

The GI system digests and absorbs
nutrients for the entire body; if it
becomes diseased, all other systems are
affected
...
798 to see
characteristics of common
gastrointestinal complaints
...
g
...


o

o

o

The location of the hernia determines the
term by which the protrusion is
identified
...

The first sign of a peptic ulcer may be
iron-deficiency anemia or a positive stool
test for occult blood, which results from
erosion of blood vessels in the organ wall
...

HIATAL HERNIA AND PEPTIC ULCER

DIAGNOSIS
 Fiberoptic endoscopy of the stomach

o
DISEASES OF THE LIVER AND GALLBLADDER
 Cirrhosis
- Asymptomatic in early stages
 Hepatitis
- Viral hepatitis
 Cholelithiasis (gallstones)
 Cholecystitis: inflammation of gallbladder
o Cirrhosis: a chronic liver disease in
which the lobes of the liver become
fibrous and hard, and liver cells
degenerate, causing deterioration of
liver function
...

HEPATITIS
 Caused by localized infection, systemic infection,
chemical exposure, or complication of drug
metabolism
 Viral hepatitis (A, B, C, D, E, and G) causes
sudden hepatocyte inflammation
- Transmitted through different means
- Can cause lifelong liver damage and
increased risk of liver cancer
 Medical workers should be vaccinated
 First line of defense: frequent hand sanitization
and gloves
o Hepatitis A is spread through

o

o

o

What is the best form of treatment for
hepatitis B? (Prevention through
vaccination)
The Occupational Safety and Health
Administration (OSHA) requires
healthcare employers to make the vaccine
available to employees free of charge
...


GALLSTONES/CHOLELITHIASIS
 Signs and symptoms
- Most asymptomatic
- Pain occurs when stones obstruct cystic
or common bile ducts
- Nausea and vomiting may occur
 Diagnosis and treatment
- Based on symptoms; blood tests may be
done; abdominal sonogram
- CT scan and magnetic resonance
cholangiography may be ordered
- Surgical removal of gallbladder
o The pain is felt in the epigastric region

and the right upper quadrant, often
radiating into the right upper back area,
and is worse after a high-fat meal
...

Hepatitis B is spread through contact
with body fluids
...

Some parts of the world are endemic for
the disease
...


GROUPS AT RISK FOR HEPATITIS
THE MEDICAL ASSISTANT'S
ROLE IN THE GI EXAMINATION
 Assisting with the examination
 Carefully question the patient for a precise
description of problem
 Liaison between the patient and physician
 Abdominal pain is often referred pain from
another region
 Adjust drape to expose area that the physician is
examining

COMMON ABDOMINAL PAIN SITES

PROCTOLOGIC EXAMINATION
 Diagnose disorders of colon, rectum, and anus
 Proctologist: physician specialize in study of
colon, rectum, and anus
 Anal area examined with proctoscope
 Rectum and sigmoid colon examined with
sigmoidoscope
 Remaining colon examined with colonoscopy
JACKKNIFE POSITION

DIAGNOSTIC PROCEDURES
 Barium swallow
 Upper gastrointestinal (UGI) and small bowel
series; air-contrast UGI
 Barium enema; air-contrast barium enema
(ACBE)
 Ultrasonography
 Sigmoidoscopy
 Colonoscopy
 Endoscopy
COLON FIBERSCOPES

CLOSING COMMENTS
 Patient education
- Listen to patient concerns and record
them in the chart
- Report to the physician or note in the
medical record
 Legal and ethical issues
- Responsibility is to assist the physician
and act as the patient's advocate
- All information exchanged between the
patient and physician is private

CHAPTER 30: ASSISTING IN NUTRITION
AND HEALTH PROMOTION

OCCULT BLOOD SCREENING
 Fecal examination is one means of evaluating
patients with GI bleeding, obstruction, parasites,
dysentery, colitis, or increased fat excretion
 Blood is not found in the stool of healthy
individuals
 Pt should avoid eating red meat before test
 If occult blood test is +ve further test is needed

HEALTH PROBLEMS RELATED TO
POOR NUTRITION AND LIFESTYLE FACTORS
 Anemia – low on red blood cells, iron deficiency
or Vitamin B deficiency
 Cancer
 Constipation
 Diabetes Mellitus Type 2
 Hypercholesterolemia
 Atherosclerosis – hardening of blood vessels due
to buildup of cholesterol
 Hypertension – high blood pressure
 Osteoporosis – weakening of the bones
 Stroke – CVA
WHY WE EAT THE WAY WE DO
 Be sensitive to personal reasons
 Background
 Culture

 Religion
- Food means celebration
 Psychological components
NUTRITION AND DIETETICS
 Nutrition – nutrient intake and use
 Phase of metabolism
- Anabolism (building)
- Catabolism (breaking down)
 Digestion
- Mouth, stomach, small intestine
- Nutrient absorption
 Small intestine
 Dietetics: practical application of nutritional
science to individuals
o Metabolism is the process in which nutrients
o

are used at the cellular level for growth and
energy production and excretion of waste
Nutrients are the organic and inorganic
chemicals in food that supply the energy and
raw materials for cellular activities

 Basal Metabolic Rate (BMR) – the energy needed
at rest
 1800-2200 kcal/day – adult age 20-40
 Energy requirement increase depending on how
active we are: less energy if not active
- Excess energy will be stored in the form
of fat in the adipose tissue
- Lead to overweight and obesity
- Lack of exercise – bone weakness, high
blood pressure and diabetes
 18-25 – normal weight
 25-29 – overweight
 30 and above – obese

NUTRIENTS
 Functions
- Provide source of energy or fuel
- Supply material to build and repair body
tissue
- Regulate metabolic processes
 Categories
- Essential: cannot be manufactures by the
body and therefore must be included in
the diet
- Nonessential: can be created in the body
and therefore does not need to be
included in the diet
NUTRIENT COMPONENTS
 Carbohydrates
Can give
 Fats
energy

 Proteins
 Vitamins
 Minerals
 Water
 Fiber (roughage) – portion of a plant that cannot
be digested or absorbed
- Promotes regular bowel movements
CARBOHYDRATES
 Provides energy
...
Toxicity
can occur when consumed in large quantities
VITAMIN A
 Carotene – yellow or orange fruits and
vegetables, liver, dairy products
 Formation and maintenance of skin, mucous,
membrane and aids in vision in dim lights
 Deficiency – dry skin, night blindness
VITAMIN B
 Whole grain, milk, eggs

(thiamine) = nerve disorder, mental
confusion

(riboflavin) = rash, anemia, cracks in the
corners of the mouth

(pyridoxine) = dermatitis, convulsion

(cobalamin) = anemia, neuritis, brain
degeneration

VITAMIN C
 Citrus fruits, berries and peppers
 Deficiency – scurvy (gum) bleeding, slow wound
healing
VITAMIN D
 Dairy products (has Calcium), eggs, sunlight
 Deficiency – rickets, calcium loss in adult
VITAMIN K
 Vegetables, fruits, dairy, grain
 Deficiency – bleeding disorders
MINERALS
 Minerals are non-organic elements and compose
5% of the body
 No calorie value, help bones and teeth develop
 Water – most important item in diet, about 5060% of the body weight is water
- Na (sodium) – high sodium can lead to
hypertension
- Electrolytes imbalance can lead to heart
problem (example: potassium, calcium)
- Thirteen needed to be healthy
- Water-electrolyte balance
- Acid-base balance
- Regulate muscular and nervous activity
- Help in blood clotting
- Regulate heart rhythm
WATER
 Body is 60% water
- Can go longer without food than water
 Involved in all body processes
 Electrolyte losses
- Life-threatening imbalances
 Eight glasses a day
ANTIOXIDANTS
 Protect against oxidizing free radicals
 Must have sufficient amount in the body
 Found in vitamins C, E and beta carotene
 Protect against some cancers and macular
degeneration
WHEN VITAMIN
SUPPLEMENTS ARE NEEDED
 Vitamin or mineral deficiency
 Iron and folate for pregnant women
 Calcium for the lactose intolerant
 Vitamins for the elderly
 Postsurgical or burn patients
 Strict vegetarians – may need Vitamin B
along with iron and zinc

and D,

 Gastric bypass recipients – may require multiple
nutrients, including Vitamin B , protein and
iron
 Antioxidant vitamins (Vitamin C, E and A) may
prevent cell membrane damage that leads to
cancer and heart disease
 Vitamin C and E also appear to protect against
the development of cataract
...

 Vitamin B may help lower LDL levels, and folic
acid is recommended for women planning a
pregnancy to prevent neural tube defects
VEGETARIAN AND ADEQUATE PROTEIN
 Vegans must have many vegetable proteins
 Build meals around protein
 Try soy-based beverages
 Try meat substitutes
CHOOSE MYPLATE
 Replace food pyramid
 Build healthy plate meals
 Five basic food groups

NUTRITION STATUS ASSESSMENT
 Body fat measurement
- Fat stored at hips and abdomen
- Skin fold
- Waist to hip ratio
 Measured with calipers,
DEXA scan
- Body Mass Index (BMI) weight to height
ratio
 Measured with monograms
o Fat at the hips is more common in women
and is stored for special purposes such as
during pregnancy
...
75 in
women and 0
...
95 in men

MEASURING BODY MASS INDEX

THERAPEUTIC NUTRITION:
MODIFYING A DIET
 Consistency
 Calorie Level
 Amount of nutrients
 Degree of bulk or fiber
 Spiciness
 Level of specific foods
TYPES OF DIET
 Liquid
- Clear Liquid: only includes transparent
or translucent liquids, such as broth
soups, tea and gelatin
- Full Liquid: includes all foods allowed
on a clear liquid diet plus milk, custards,
strained cream soups, refined cereals,
eggnog, milkshakes and all juices
...

 High or low fiber
 Diabetic – have a daily serving of nuts or seeds,
five dark fruits, reduce salt intake, and choose
fish over poultry or other meats
- Based on individual health needs
- Basic goal of controlling blood glucose
level
- Other factors must be considered
 Heart healthy
- Reduce cholesterol levels and LDL
- Increase HDL through exercise and
alcohol

READING FOOD LABELS
 Valuable source of nutritional information
 Must include:
- Serving size and calories
-

Totals of fat
 Saturated, unsaturated, trans
- Percent daily values (percent of Vitamin
C, calcium and iron)
 Nutrient amounts
- Weight per serving
- Percent daily value
 Ingredients in descending order by weight
 Carbohydrates = 4 calories per gram
 Protein = 4 calories per gram
 Fat = 9 calories per gram
 Alcohol = 7 calories per gram
NUTRITIONAL FACTS LABEL

ORGANIC FOOD PRODUCTION ACT
 Producing and labeling regulations
 No exposure to:
- Pesticides
- Chemical fertilizers
- Sewage sludge
Food-Borne Diseases
 Result from eating contaminated food and water
 Be aware of gastrointestinal symptoms
- Fever greater than 101

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