Health Promotion



Health Promotion


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http://evolve.elsevier.com/Wong/clinical





Patient and Family Teaching Guides


• Administering digoxin at home


• Applying a topical anesthetic


• Asthma medicine plan


• Blood glucose monitoring


• Caring for a central venous catheter


• Caring for an implanted port


• Caring for an intermittent infusion device


• Caring for the child in a cast


• Caring for the child with a colostomy


• Caring for the child with a tracheostomy


• Caring for the choking child


• Caring for the choking infant


• Caring for your child’s teeth


• Child cardiopulmonary resuscitation for the layperson


• Giving aerosolized medications (nebulizer treatments)


• Giving an enema


• Giving ear medications


• Giving eye medications


• Giving gastrostomy feedings


• Giving inhaled medications


• Giving intramuscular (IM) injections


• Giving medications to children


• Giving nasogastric tube feedings


• Giving nose drops


• Giving oral medications


• Giving rectal medications—suppositories


• Giving subcutaneous (Sub Q) injections


• Infant cardiopulmonary resuscitation for the layperson


• Interpreting peak expiratory flow rates


• Measuring oxygen saturation with pulse oximetry


• Measuring your child’s temperature


• Minimizing pain of blood glucose monitoring


• Monitoring peak expiratory flow


• Obtaining a stool sample


• Obtaining a urine sample


• Oral rehydration guidelines


• Performing clean intermittent bladder catheterization


• Preventing eye injuries


• Preventing spread of HIV and hepatitis B virus infections


• Safe disposal of needles and lancets


• Suctioning the nose and mouth


• Toilet training readiness



Nutrition


Dietary Reference Intakes


The Institute of Medicine (IOM) has developed guidelines for nutritional intake that encompass the Recommended Dietary Allowances (RDAs) yet extend their scope to include additional parameters related to nutritional intake. The Dietary Reference Intakes (DRIs)* are composed of four categories. These include estimated average requirements (EARs) for age and gender categories, tolerable upper-limit (UL) nutrient intakes that are associated with a low risk of adverse effects, adequate intakes (AIs) of nutrients, and new standard RDAs. The new guidelines present information about lifestyle factors that may affect nutrient function, such as caffeine intake and exercise, and about how the nutrient may be related to chronic disease (Table 2-1).



TABLE 2-1


Dietary Reference Intakes (DRIs)











































DRI Populations and Life Stage Groups Recommended Dietary Allowance (RDA) Estimated Average Requirements (EARS) Adequate Intake (AI) Tolerable Upper Intake Level (UL)

Average daily dietary intake level sufficient to meet the nutrient requirement of most healthy individuals in a given life stage or gender group. May be used to evaluate nutrient intake of a given population (e.g., vegetarian). Daily nutrient intake value estimated to meet the requirement of half the healthy persons in a given life stage or gender group (used to assess dietary adequacy and is the basis for RDAs). Recommended intake value based on observed or experimentally determined approximations of nutrient intake by a group of healthy persons, which are assumed to be adequate when an RDA cannot be determined. In healthy breastfed infants (0-6 mo), AI is the mean intake. Highest level of daily nutrient intake likely to pose no risk of adverse effects for most individuals in the general population. Risk increases as intake above the UL increases. May be used to set limits on nutrient supplementation, especially for vitamins and minerals that could be harmful.
Clinical Applications
Folate

 600 mcg/d 520 mcg/d 400 mcg/d* 1000 mcg/d
Iron

 10 mg/d 4.1 mg/d 10 mg/d 40 mg/d
Vitamin C

 65 mg/d 56 mg/d 65 mg/d 1800 mg/d


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See also Unit 1 for select DRI values.


*Women of childbearing age and with expectation of becoming pregnant should consume 400 mcg/d from supplements or fortified foods, or both, in addition to intake of folate from a varied diet.


Portions adapted from Dietary Reference Intakes (DRIs): Food and Nutrition Board, Institute of Medicine, National Academy of Sciences, 2004. Available at www.nap.edu; and Dietary Reference Intakes: An Update, International Food Information Council Foundation, 2005. Available at http://ific.org.




Dietary Guidelines for Children (American Heart Association)


The American Heart Association dietary guidelines (Table 2-2) may also be used to encourage healthy dietary intakes designed to decrease obesity and cardiovascular risk factors and subsequent cardiovascular disease, which is now known to occur in young children as well as adults. For more information on healthy dietary habits and child nutrition, visit the American Heart Association website, available at http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Dietary-Recommendations-for-Healthy-Children_UCM_303886_Article.jsp.



TABLE 2-2


Daily Estimated Calories and Recommended Servings for Grains, Fruits, Vegetables, and Dairy Products by Age and Gender






























































































































  1 Year 2-3 Years 4-8 Years 9-13 Years 14-18 Years
Kilocalories*
 Female 900 kcal 1000 kcal 1200 kcal 1600 kcal 1800 kcal
 Male 900 kcal 1000 kcal 1400 kcal 1800 kcal 2200 kcal
Fat (% of total kcal) 30%-40% 30%-35% 25%-35% 25%-35% 25%-35%
Milk or dairy† 2 cups‡ 2 cups 2 cups 3 cups 3 cups
Lean meat or beans          
 Female image oz 2 oz 3 oz 5 oz 5 oz
 Male image oz 2 oz 4 oz 5 oz 6 oz
Fruits§          
 Female 1 cup 1 cup image cups image cups image cups
 Male 1 cup 1 cup image cups image cups 2 cups
Vegetables§          
 Female image cup 1 cup 1 cup 2 cups image cups
 Male image cup 1 cup image cups image cups 3 cups
Grains          
 Female 2 oz 3 oz 4 oz 5 oz 6 oz
 Male 2 oz 3 oz 5 oz 6 oz 7 oz


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Estimates are based on sedentary lifestyle. Increased physical activity requires additional calories by 0-200 kcal/day for moderately active children and 200-400 kcal/day for very physically active children.


*For children age 2 years and older. Nutrient and energy contributions from each group are calculated according to the nutrient-dense forms of food in each group (e.g., lean meats and fat-free milk).


†Milk listed is fat-free except for children younger than age 2 years. If 1%, 2%, or whole-fat milk is substituted, this will use, for each cup, 19, 39, or 63 kcal, respectively, of discretionary calories and add 2.6, 5.1, or 9 g, respectively of fat, of which 1.3, 2.6, or 4.6 g, respectively are saturated fat.


‡For 1-year-old children, calculations are based on 2%-fat milk. If 2 cups of whole milk are substituted, 48 kcal of discretionary calories will be used. The American Academy of Pediatrics recommends that low-fat or reduced-fat milk not be started before age 2 years.


§Serving sizes are image cup for age 1 year, image cup for ages 2 to 3 years, and image cup for age 4 years and older. A variety of vegetables should be selected from each subgroup over the week.


Half of all grains should be whole grains.


Data from American Heart Association. Available at www.americanheart.org/presenter.jhtml?identifier53033999; and American Heart Association, Giddings SS, Dennison BA, and others: Dietary recommendations for children and adolescents: A guide for practitioners, Pediatrics 117(2):544-559, 2006. Reprinted with permission www.heart.org. Copyright 2011 American Heart Association, Inc.



MyPlate for Kids


In 2011 the United States Department of Agriculture replaced the Food Guide Pyramid (MyPyramid) with MyPlate (http://www.choosemyplate.gov/) (Figure 2-1). This colorful plate shows the 5 main food groups—fruits, grains, vegetables, protein, and dairy—with the intended purpose to involve children and their families in making appropriate food choices for meals and decrease the incidence of overweight and obesity in the United States. MyPlate provides an online interactive feature that allows the individual to select (click on) an individual food group and see choices for foods in that group. Approximate serving sizes are suggested and vegetarian substitutions are also provided.


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FIGURE 2-1 MyPlate. MyPlate advocates building a healthy plate by making half of your plate fruits and vegetables and the other half grains and protein. Avoiding oversized portions, making half your grains whole grains, and drinking fat-free or low-fat (1%) milk are additional recommendations for a healthy diet. (From U.S. Department of Agriculture: MyPlate, Washington, DC, June 2011, The Service, available online at www.choosemyplate.gov.)


imageCommunity Focus


Fluoride Supplementation*





imageCommunity Focus


Nutrition: Iron Absorption


To ensure that children receive an adequate supply of iron from foods, consider the following factors that may increase or decrease iron absorption:





Normal and Special Infant and Child Formulas*





































































Formula (Manufacturer) Comments and Nutritional Considerations†
Full-Term Infant Nutrition
 Similac Advance (Abbott) Contains prebiotics (galactooligosaccharides), antioxidants, DHA, AA, and nucleotides
 Enfamil Premium Newborn (Mead Johnson); Premium Infant Contains sources of DHA and AA; iron fortified; prebiotics added; contains vitamin D (400 IU in 27 fl oz)
 Enfamil AR for Spit Up with Lipil (Mead Johnson) For mild gastroesophageal reflux; contains rice starch; iron fortified; contains AA and DHA
 Gerber® Good Start Gentle Plus (Nestlé) & Gerber® Good Start Protect Plus Contains sources of DHA and AA; Protect Plus contains Bifidus BL™
 Similac PM 60/40 (Abbott) Powder only; low solute load; for infants with impaired renal, digestive, and cardiovascular function; lower calcium, potassium, and phosphorus content
 Enfamil Gentlease (Mead Johnson) Added DHA, ARA; decreased lactose content (20%)
 Enfamil RestFull (Mead Johnson) Rice carbohydrate (not rice cereal)
 Similac Sensitive for Spit Up (Abbott) Contains rice starch; Decreased lactose content; contains prebiotics, antioxidants, and nucleotides
Formulas for Cow’s Milk Protein–Sensitive and Lactose-Intolerant Infants*
 Similac Soy Isomil (Abbott) Soy protein; for infants with lactose intolerance and galactosemia; contains prebiotics, antioxidants, and nucleotides
 Enfamil ProSobee for Sensitive Tummy (Mead Johnson) Soy protein; lactose-free and sucrose-free formula for infants with lactose intolerance and galactosemia; contains AA and DHA
 Similac (Abbott) Expert Care for Diarrhea Soy based, lactose–free; for diarrhea in infants >6 mo; lessens amount and duration of watery stools
 Gerber® Good Start Soy PLUS (Nestlé) Milk–free and lactose free formula with DHA and AA
Protein Hydrolysate–Based and Amino Acid–Based Formulas
 Similac Expert Care Alimentum (Abbott) Liquid; hydrolyzed casein; hypoallergenic; lactose free; nutritionally complete; for infants with gastrointestinal malabsorption and colic
 Nutramigen AA Lipil (Mead Johnson) Powder; amino acid based for infants with severe protein allergy; lactose and sucrose free; nutritionally complete; contains AA and DHA
 Nutramigen Lipil for Colic (Mead Johnson) Extensively hydrolyzed; for colic
 Enfamil Pregestimil Lipil (Mead Johnson) Powder; hydrolyzed casein; lactose and sucrose free; easily digestible; for infants with postoperative bowel resection and malabsorption conditions
 Neocate (Nutricia North America) Powder; amino acid–based formula; for children sensitive to soy, cow’s milk protein, and hydrolyzed formula; nutritionally complete; high cost is a factor
 EleCare (Abbott) Unflavored (for less than 1 year of age) Powder; amino acid–based formula; hypoallergenic; nutritionally complete; iron fortified; for children sensitive to soy, cow’s milk protein, and hydrolyzed formula; high cost is a factor


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Jan 16, 2017 | Posted by in NURSING | Comments Off on Health Promotion

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