Clinical Nutrition Oral Questions Cmt Nta Level 4

Clinical Nutrition Oral Questions Cmt Nta Level 4

Clinical Nutrition Oral Questions Cmt Nta Level 4

1. Food: is what is eaten or taken into the body by oral or parenteral routes for the purpose of nourishing the body. That is, supply of energy and building up of the tissues.

2. Nutrients Food: is what is eaten or taken into the body by oral or parenteral routes for the purpose of nourishing the body. That is, supply of energy and building up of the tissues.

3. Nutrition: is the term standing for the sum of all processes involved in food intakedigestion, assimilation and utilization by the body

4. Nutritional status: is the result of the body’s nutrient intake and utilization, which may be good or bad.

5. Under-nutrition: Conditions arising from deficiency of nutrients.

6. Over-nutrition or even toxicity: Conditions arising from excess of nutrients

7. There are five 5 food groups which are:

Ø Cereals, Green Bananas, Roots and Tubers

Ø  Pulses, Nuts and Foods of Animal Origin

Ø Fruits

Ø Vegetables

Ø Fats and Oils, Sugars, Honey

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8. Dietary fibre is a food component that cannot be fully broken down by digestive enzymes. Food high in dietary fibre helps to enhance bowel function and as a result it can prevent and sometimes treat constipation.

9. Balanced meal is a meal which contains a mixture of foods from all food groups

10. Digestion: is the process by which food is broken down into simple chemical compounds that can be absorbed and used as nutrients

11. Absorption: Is the process of liquid, gas  or other substance (final products of digestion) being taken into the blood stream through villi in the small intestine

12. Carbohydrates: is any of a large group of organic compounds occurring in foods and living tissues and including sugars, starch, and cellulose. They contain compounds of carbon, hydrogen and oxygen atoms

13. Fat/Lipids: is a substance such as oil or wax dissolved in alcohol but not in water  

14. Villi: are the smallest finger like projection which are found all over the mucous layer of small intestine. Their functions are to absorb the amino acid, glucose, fatty acid and glycerol, water, mineral salts and vitamins after digestion has been completed

15. Anaemia: deficiency/reduction of number of red blood cells in the body which decreases oxygen capacity of the blood.

16. Ant-nutrients: Substances in food that are natural poisons or toxins e.g. (the poison in bitter cassava) or that interfere with digestion, absorption or use of nutrients in the body

17. Antioxidants: Molecules, which can either be nutrients or enzymes and sometimes both, which mop up damaging fundamental nature in our bodies.

18. Balanced Diet: A diet which provides adequate amount of all nutrients required by the body.

19. Bio-availability: The degree to which a nutrient is absorbed or becomes available at the site of physiological activity after intake.

20. Body Mass Index: Weight (kg) divided by height (m2). 

21. Calorie: A measure of energy content in foods.

22. Complementary Feeding: The child receives solid (or semi-solid) foods in addition to breast milk or suitable breast milk substitute after six months of age.

23. Complementary Foods: Foods or liquids whether manufactured or locally prepared, given to a baby in addition to breast milk or infant formula after six months to satisfy their nutritional requirements.

24. Dietary Fibres:The non-digestible carbohydrates and lignin found intact in plants. It facilitates the emptying of the bowel.

25. Enzymes:These are chemical substances proteins in nature found in the body that speed up the rate of chemical reactions but are not changed in the process 

26. Essential Nutrient: A nutrient which is necessary for life and cannot be synthesized by the body therefore it must be included in the diet. 

27. Exclusive Breastfeeding:Giving a baby only breast milk but no other food or drink not even water (with the exception of medicines and vitamin or mineral drops prescribed by doctor; suckling directly from the breast, expressed breast milk is also permitted

28. Exclusive Replacement Feeding: Breastfeeding is completely replaced with suitable breast milk substitute and no other foods, liquids or solids, not even water (with the exception of medicines and vitamins or mineral drops or syrups prescribed by a medical personnel).

29. Fermented Foods: Foods that have been subjected to processing, involving the action of yeasts or bacteria for example, yoghurt (mtindi), togwa and fermented porridge.  

30. Germinated Foods: Foods made from seeds that have started to sprout for example kimea. It can be from millet, maize, beans or legumes.

31. Health Diet: A diet with appropriate types and adequate amounts of foods and drinks to supply nutrient for maintenance of body cells, tissues, and organs, and to support normal growth and development

32. Healthy Eating: Eating patterns, which involve a variety of culturally acceptable foods, balanced by a moderation intake of each food from all food groups, to provide sufficient nutrients that are required for growth, development, physical activity as well as for the maintenance and restoration of health.

33. Healthy Lifestyle: A way an individual or a community, practices good social, physical, mental, spiritual health, and in harmony with internal and external environment.

34. Lactation: The process of synthesizing and secreting breast milk.

35. Malnutrition: An abnormal physiological condition caused by deficiencies, excesses or imbalance of energy and nutrients in the body.

36. Metabolism: A chemical process within cells whereby energy is produced enabling the body to maintain life.

37. Mother-to-Child Transmission (MTCT): Transmission of HIV from mother to her child during pregnancy; at the time of labour and birth or through breastfeeding.

38. Nutrients: Substances found in foods that provide energy, enhance growth, help repair body tissues and regulate body functions.

39. Nutrition: The way our bodies take in and use food 

40. Nutritional Assessment: The measurement of nutritional status. It is based on anthropometric (scientific study of measurement) and biochemical data, and a dietary history. 

41. Nutrition Status:Is the state (Grade) of health produced by the balance between requirement and intake of nutrients.

42. Nutritional Supplements: These are the products taken in by mouth and contain dietary ingredients, which may include vitamins, minerals or amino acids, as well as other substances such as enzymes

43. Obesity: A condition of being ‘too fat’. In adults it means having a BMI of 30 and above.

44. Overweight: A condition of having a weight that is ‘too high’ in relation to a person’s height. In adults it means having a BMI of 25 – 29.9. When a person is overweight, usually energy intake by the body is higher than energy expenditure.

45. Replacement Feeding: Feeding infants (who are receiving no breast milk) with a diet that provide all the nutrients the child need until the child can be fully fed on family foods. During the first six months of life, replacement feeding should be a suitable breast milk substitute.

46. Osteoporosis: A condition characterised by progressive decrease in bone density. The bones become fragile and more likely to break. If left untreated, osteoporosis can progress painlessly until a bone breaks.

47. Under nutrition, occurs when nutrients intake does not meet nutrients needs.Stores are then used up and health declines.

48. Over nutrition, is a prolonged consumption of more nutrients than the body needs, can lead to over nutrition. In the short run, for instance a week or two, over nutrition may cause a few symptoms such as GI tract distress from excess dietary fibre or iron intake. But if kept up some nutrients may increase to toxic amount which can lead to serious disease.

49. Common micro-nutrient deficiencies

Ø Nutritional anaemia

Ø Iodine Deficiency Disorders (IDD)

Ø Vitamin A deficiency

 

· Causes of malnutrition including severe malnutrition causes can be described into three categories

Ø Immediate causes

Ø Underlying causes

Ø  Basic causes

 

· Metabolism: Is a term used to describe all the changes which are concerned with the use of food once it is absorbed in the alimentary canal

· Catabolism: Is the breakdown of complex molecules in living organisms to form simpler ones, together with the release of energy.

· Anabolism: is a process in which the liver creates new proteins from digested nutrients.

· Carbohydrate metabolism: A general term for any metabolic activity—e.g., breakdown of starches and sugars into smaller units—to be used for energy, or the storage. E.g. glycogen storage in the liver.

· Once the glucose reaches the liver the following may occur:

Ø It can be used to provide energy to the liver itself

Ø The liver may give back the glucose to the blood stream to maintain the level of blood sugar

Ø Can be converted into glycogen then stored in the liver for later use

Ø It can be converted into fats

Ø If the glucose needed for energy and heat production it is first changed into a form which is called: LACTIC ACID (is a compound produced when glucose is broken down and oxidized

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· Polysaccharides: are called complex carbohydrates, are chemically the most complicated carbohydrates. It contains large number of monosaccharides, are combined

· Disaccharides: Is a type of simple sugar formed, when two monosaccharides are joined.

· Monosaccharides: These are the simplest form (unit) of sugar.

· Glycolysis: is the process that allows the simple sugar glucose, which comes from your food, to be broken down into usable energy.

· Gluconeogenesis: Is the formation of glucose, especially by the liver, from non-carbohydrate sources, such as amino acids and the glycerol portion of fats

· Pentose phosphate pathway Is a series of biochemical reactions in which glucose is converted into other molecules such as those needed to synthesize nucleic acids

· Pentose: is carbohydrate with five-carbon sugar

· Protein metabolism: is the process whereby protein foods are used by the body to make tissue proteins, together with the process of breakdown of tissue protein in the production of energy.

· The nitrogen cycle describes how nitrogen moves between plants, animals, bacteria, the atmosphere (the air), and soil in the ground.

· Nitrogen is found in the amino acids and it plays a role in the nucleic acids. These acids make proteins that we need in our body. Nitrogen is an important element to all life on Earth

· Amino acid is subdivided into main groups;

Ø Essential amino acid and

Ø Non-essential amino acid

· Fats deposits are:

Ø Greater omentum

Ø Around the kidney

Ø In the breast

Ø Buttocks and

Ø Hips

· Anaemia is classified according to causes and mechanism of its development:

Ø Haemorrhagic anaemia

Ø Haemolytic anaemia

Ø Hypo plastic/Aplastic anaemia

Ø Nutritional anaemia

· Signs and Symptoms of Iron Deficiency Anaemia (IDA)

Ø Tiredness and fatigue

Ø Dizziness and/or headaches

Ø Palpitations     

Ø Difficulty in breathing on exertion

Ø Inadequate temperature regulations

Ø Mild degree of splenomegaly

Ø Pallor of the mucous membrane and beneath the nail.

Ø Brittle finger nail (sometimes spoon shaped-koilonychias)

 

· The following are the major complications of anaemia.

Ø Heart failure

Ø Reduced mental capacity.

Ø Anaemia negatively affects school performance

Ø Reduced immune competence, leading to high incidences of diseases

Ø Poor pregnancy outcomes (low birth weight, spontaneous abortion, premature delivery)

Ø Failure of mothers to withstand blood loss at delivery and hence increased risk of maternal deaths

· Groups with High Risk for Anaemia are:

Ø Women, especially during pregnancy or soon after delivery

Ø Babies who are low birth weight or not breast fed

Ø Premature babies

Ø Young children especially if they are malnourished

Ø Sickle cell disease patients

Ø Adolescents, who are growing fast, especially girls

Ø Older men and women, especially if they are poor

 

· Strategies for prevention and control of anaemia

Ø Promotion of consumption of iron- and vitamin-rich foods

Ø Prevention and treatment of anaemia-related diseases (malaria, worm infestation)

Ø Iron and folic acid supplementation to the most at risk groups (children, pregnant women, sickle cell disease patients)

Ø Building up of foods with relevant nutrients (iron, folic acid)

 

 

· Iodine Deficiency Disorders (IDD);isdeficiency of iodine in the body.

· Hyperthyroidism:Is an increased production of thyroid hormone,

· Hypothyroidism:is a deficiency of thyroid activities (which is low production of thyroid hormone)

· How to examine and classify goitre

Ø Stand or sit facing the person

Ø Place your two thumbs on either side of the person’s trachea, several centimetres below the larynx (voice box)

Ø Roll your thumbs gently over the thyroid (which lies next to the trachea). This is called palpation.

Ø If each lobe of the thyroid is smaller than the end joint of the person’s thumb, there is no goitre.

Ø If one or both lobes are larger than the end joint of the person’s thumb, then there is goitre.

Ø Ask the person to bend their head back and look upward. Try to see the goitreAsk the person to look straight forward, and try to see the goitre again.

 

 

· Iodine classification;

 

Ø Grade 0 No goitre lobes smaller than

end joint of thumb

Ø Grade 1A Thyroid lobes larger than ends

of thumbs

Ø Grade 1B Thyroid gland visible with

head bent back

Ø Grade 2 Thyroid gland visible with head

in normal position

Ø Grade 3 Thyroid gland visible from

about ten meters 

 

· A person who is hypothyroid:

Ø Feels cold easily

Ø Moves slowly and lacks energy

Ø Think slowly and appear unconcerned

Ø May be sleepy

Ø Has a dry skin

Ø May be constipated

· Women who are hypothyroid during pregnancy may also have;

Ø Miscarriage or still birth

Ø Low birth weight babies

Ø Babies with congenital deformities,

Ø Babies with cretinism

 

· Cretinism: poor physical & mental development, there are two types of cretinism;

Ø Neurological cretinism

Ø  Hypothyroid cretinism

 

· The effect of Neurological cretinism;

Ø Squint (eyes are not held straight)

Ø Weakness and stiffness especially of the legs

Ø Severe mental handicap (defect)

Ø Deafness and mutism (the child cannot speak)

 

· Various medicinal preparations are administeredfor control of iodine deficiency, such as:

Ø Injectable iodized oil

Ø Iodinated oil capsules

Salt iodation’s

· VITAMINS. Are essential organic substances needed in small amounts in the diet for normal function, growth, and maintenance of body tissues

· Vitamins are classified into two groups:

Ø water-soluble

Ø fat-soluble.

 

· Fat soluble vitamins have the following general properties:

Ø They consist only carbon, hydrogen and oxygen

Ø  They are soluble in fats

Ø   They are relatively stable (compared to water soluble vitamins during processing, preservation and preparation of foods

· There are a total of ninewater-soluble vitamins:

Ø Thiamine (vitamin B1)

Ø Riboflavin (vitamin B2)

Ø Niacin or Nicotinic acid (vitamin B3)

Ø Biotin (Vitamin B7)

Ø Pantothenic acid (Vitamin B5)

Ø Focalin (folic acid) (Vitamin B9)

Ø Cobalamin (vitamin B12)

Ø Pyridoxine (vitamin B6) – which functions as co-enzyme in the synthesis and breakdown of amino acids. It is therefore important in the metabolism of protein

Ø Ascorbic acid (vitamin C) – involved in the formation of collagen. Also enhances absorption of iron in the gut. 

 

 

· Vitamin A It plays important roles in the body including;

Ø Vision

Ø Maintenance of epithelial tissue

Ø Synthesis of mucous secretion

Ø Formation of bones

Ø Growth and development,

Ø Immune function and

Ø Reproduction

Ø Also works as an antioxidant and fighting cell damage

 

 

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· The common symptoms and signs Vitamin A deficiency include:

Ø Night blindness: Reduced ability to see in dim light.

Ø Conjunctival neurosis: Drying of the conjunctival, patches of neurosis give the appearance of sandbanks at receding tide. The conjunctiva loses its bright and shiny and often becomes thickened, wrinkled and sometimes pigmented.

Ø Bigot’s spot: Triangular-shaped, raised whitish plaques that occur in both eyes

Ø Corneal neurosis: Drying of the cornea surface, appears unclear and then rough on simple examination

Ø Exophthalmic fundus: Sometimes seen early in the disease, the retina has white dots around the periphery of fundus. They disappear following treatment.

 

 

 

· Complications of Vitamin A deficiency include:

Ø Corneal ulceration: Following cornea neurosis, the cornea is softening with ulceration, and areas of necrosis

Ø Keratomalacia: Perforation of the cornea prolapsed of the iris, loss of ocular contents and perhaps destruction of the eye. Total blindness often occurs following keratomalacia.

Ø Corneal scar: Occurs when treatment is introduced, when a corneal ulcer is still small and it is healed.

· VitaminsB; Are a class of water-soluble vitamins that play important roles in cell metabolism

· Roles of Vitamin B1;

 

Ø All B vitamins help the body change food (carbohydrates) into fuel (glucose), which the body uses to produce energy

Ø  Also help the body metabolize fats and protein.

 

 

 

 

· Complications of vitamin B1 (thiamine) deficiency;

Ø Thiamine deficiency causes beriberi.

Ø It occurs when people consume highly milled polished rice or maize, and starchy roots such as cassava, which are removal of thiamine content.

 

· Classification of beriberi;

Ø Wet beriberi: the cardiac form.

Ø Dry beriberi: the neurological form.

Ø Infantile beriberi

 

 

· Signs and symptoms of wet beriberi;

Ø Heart palpitation, chest pain.

Ø Dyspnoea (breathlessness), a rapid, sometimes irregular pulse and distended neck veins with visible pulsations

Ø The heart is found to be enlarged

Ø Cyanosis

Ø Increased oedema

Ø Severe dyspnoea

Ø Acute circulatory failure and death

 

· Dry beriberi; Is a condition which affecting chiefly the peripheral nerves

· Signs and symptoms of infantile beriberi;

Ø In the acute form, the infant develops dyspnoea and cyanosis and soon dies of cardiac failure.

Ø Aphonia may occur in more chronic types of beriberi

Ø Wasting, thinness

Ø Vomiting and diarrhoea, and eventually the child becomes marasmic because of deficiency of energy and protein

Ø Oedema occasionally

Ø Convulsion in the terminal stage

· Signs and symptoms in vitamin B2 deficiency ;

Ø Dry scaly skin

Ø  Mouth inflammation and sores

Ø  Sore throat

Ø Eyes Itchy

Ø Light sensitivity

 

· Early Symptoms of Pellagra;

Ø A person appears poorly malnourished, often weak and underweight

Ø A person may also have diminished sensitivity to gentle touch and sometimes some muscular weakness and tremor

Ø Untreated cases of pellagra may die of the disease

 

· Features of the skin with Dermatitis are;

Ø Deepening of the pigmentation

Ø Dry skin, scaly and eventual cracked

Ø Desquamation

Ø Rarely the skin may blister

Ø The tongue and other parts of the mouth are often sore, red and smooth

 

 

 

· Symptoms and Signs of Dementia;

Ø Irritability

Ø Loss of memory

Ø Anxiety

Ø Insomnia

 

 

· Protein energy malnutrition (PEM): is a series of pathological conditions arising from a deficiency of energy and protein foods.

· PEMcan be classified into three categories;

Ø Gomez classification: Based on weight deficit for age but not the type or duration of the condition.

Ø Wellcome classification: Based on presence or absent of oedema and a minimum body weight above or below 60 percent of the Harvard standard weight for age (fiftieth percentile).

Ø Waterlow: Based on duration of malnutrition.

 

· Main clinical conditions in classification of malnutrition;

Ø Underweight ;is the mildest form of PEM and can be detected only by checking the weight of the child and by plotting it on the special weight for age chart.

Ø Marasmus;is a form of protein energy malnutrition, due to severe caloric deficit.

Ø Kwashiorkor;is a form of protein energy malnutrition, produced by severe protein deficiency.

Ø Miasmic kwashiorkor;Is the worst form of PEM – it has the combination of severe wasting (like in marasmus) and oedema (like in kwashiorkor).  

 

· Signs and Symptoms of Kwashiorkor

Ø There is failure of growth but the child is not as severely wasted, as in marasmus

Ø The body weight is 60-80 percentof the standard

Ø The abdomen is swollen (liver enlargement due to fatty infiltration)

Ø The child shows hair changes (hair becomes brown, straight and soft)

Ø Skin rashes (called ‘flaky paint dermatitis’)

Ø The child becomes inactive, apathetic (unconcerned), irritable and is difficult to feed

Ø The child has oedema of lower limbs and other parts of the body

Ø Moonfaced shape 

 

 

 

· Signs and Symptoms of Marasmus:

Ø Remarkable failure of growth –which can be considered the deterioration of the underweight condition

Ø The body weight is less than 60 percent of the standard

Ø Severe muscle wasting with flaccid, wrinkled skin and bony prominence

Ø The child looks awake and hungry and displays what is referred to as ‘old person’s face.’

Ø  Oedema is absent. 

· There are several complications of severe malnutrition, which can make treatment difficult.

Ø Hypoglycaemia (low blood sugar)

Ø Hypothermia (low body temperature)

Ø Diarrhoea

Ø Dehydration

Ø Anaemia

Ø Infections

· Wasting: Weight for age and weight for height are low. It is a rapid decline of weight while height has remained unchanged.

· Stunting: Low height for age. The child has failed to gain height that would correspond with his age. Stunting is caused by chronic under-nutrition (long illness and/or semi-starvation) – that being a reflection of adverse socio-economic condition.

· Body Mass Index (kg/m2)

 

Ø Below 16.0-     Severe under-nutrition

Ø 16.0 – 17.0-     Moderate under-nutrition

Ø 17.1 – 18.4-     Mild under-nutrition

Ø 18.5 – 24.9-     Good nutritional status

Ø 25.0 – 29.9-     Overweight

Ø 30.0 and above-    Obesity

 

· General causes of (PEM);

Ø Diseases (Diarrhoea, Malaria, Worm infestation)

Ø Inadequate food intake

Ø Poor socio-economic status

Ø Poor mother education on maternal and child health

Ø Poor health facilities

 

 

 

 

 

· Different strategies may includecontrol of PEM;

Ø Incorporate nutrition objectives into development of policies and programmes e.g. RCH, HBC, PMTCT, IMAI and IMCI.

Ø Improving household food security

Ø Protection and promotion of good health

Ø Improving the quality and safety of foods

Ø Protect and promote breastfeeding and complementary feeding

Ø Early treatment of common diseases

Ø Immunization

Ø Growth monitoring

Ø Promoting appropriate diets and healthy lifestyles

· Obesity is a condition which is characterized by the accumulation of excess fat in the body.

· Causes of Obesity;

Ø Sedentary lifestyle; Tendency to take less exercise and do less energetic physical work.

Ø Lack of information or knowledge on healthy eating habits

Ø Ill health and disability; Energy expenditure is reduced by physical incapacity (e.g. back injury).

Ø Psychological factors;Many people tend to eat a lot when they are lonely, worried or depressed.

Ø Social pressure and behavioural factors; Slight changes in behaviour, such as an increase in the number of snacks between meals or change of employment which leads to more eating in a social setting.

Ø Endocrine disorders

Ø Certain drug treatments

Ø Genetic makeup

· There are two ways of classifying obesity;

Ø By fat distribution

Ø Using body weight

· Limitations of BMI

Ø Muscles

Ø Ethnic Groups

Ø Pregnancy

Ø Body Shape

 

 

 

 

 

 

 

· How To Achieve A Healthy Weight Healthy Eating

Ø Starchy foods

Ø Fruits and vegetables

Ø Dairy foods

Ø Meat, fish and other non-dairy sources of protein (such as beans)

Ø Fat and sugar

Ø Remember to eat meals containing plenty of fibres, and not too much fat or sugar. Eat snacks which are not energy-rich.

Ø Regular ExerciseKeeping physically active is an important way of staying healthy and maintaining a healthy weight.

· Assessment Of Nutritional Status Is Divided Into Four Groups

Ø Dietary history

Ø Anthropometry (the study of human body measurements)

Ø Physical examination

Ø Laboratory tests

· Main Indicators to Assess dietary intake

Ø Amount and type of food eaten

Ø Eating frequency

Ø Food preferences and food dislikes

Ø Food taboos

Ø Eating problems (e.g., lack of appetite, nausea)

Ø Food availability, including indigenous (original) foods

Ø Hygiene in food preparation

Ø Food storage

Ø Where the patient eats

Ø Who prepares meals for the patient

Ø Resources used in food preparation

Ø How the patient acquires food, presence of financial problems

Ø Use of food/nutritional supplements

Ø Do you watch what you eat? Are you on any particular diet?

· MUAC is the circumference of the left upper arm, measured at the midpoint between the tip of the shoulder and the tip of the elbow using measuring or MUAC tape.

· The basic anthropometric measurements are:

Ø Height or length

Ø Weight

Ø Calculation of the body mass index (BMI)

Ø Mid Upper Arm Circumference (MUAC)

 

 

· Direct measurement of the concentrations of a nutrient or a metabolite in the body fluid, usually in the serum or urine.

· Indirect Measurement The best way to measure levels of nutrients is to measure its stores because: A decrease in the dietary intake of a nutrient leads to the mobilization of that nutrient from its stores to maintain a normal plasma concentration.

· How to Measure Weight;

Ø Make sure the scale pointer is at zero

Ø Ask the person to take off shoes, hat, and scarves so that they are wearing minimum clothing

Ø Ask the person to stand straight on the center of the balance platform (if the person cannot stand without help, take MUAC)

Ø Record the weight to the nearest 0.1 kg

· How to Measure Height;

Ø Ask the person to remove shoes and headgear, stand erect, and look straight ahead with feet together and knees straight. The heels, buttocks, shoulder blades, and back of the head should touch the wall. (If the person cannot stand without help, MUAC should be taken instead)

Ø Record height to the nearest 0.5 cm.

· How to Measure MUAC for Adults;

Ø Remove clothing that may cover the client’s left arm. If possible, the client should stand erect and sideways to the measurer.

Ø Calculate the midpoint of the left upper arm by first locating the tip of the shoulder with your fingertips. Bend the client’s elbow to make a right angle

Ø Place the tape at zero, which is indicated by two arrows, on the tip of the shoulder and pull the tape straight down past the tip of the elbow. Read the number at the tip of the elbow to the nearest centimeter.

Ø Divide this number by two to estimate the midpoint. A piece of string bent in middle can also be used for this purpose; it is more convenient and avoids damage to the tape. Mark the midpoint with a pen on the arm.

Ø Straighten the client’s arm and wrap the tape around the arm at the midpoint. Make sure the numbers are right side up. Make sure the tape is flat around the skin.

Ø Inspect the tension of the tape on the client’s arm. Make sure the tape has the proper tension and is not too tight or too loose. Repeat any step as necessary

Ø When the tape is in the correct position on the arm with correct tension, read and call out the measurement to the nearest 0.1cm

Ø Immediately record the measurement

· How to Measure MUAC for Children;

Ø Keep your work at eye level. Sit down when possible. Very young children can be held by their mother during this procedure. Ask the mother to remove clothing that may cover the child’s left arm.

Ø Calculate the midpoint of the child’s left upper arm by first locating the tip of the child’s shoulder (arrows 1 and 2) with your fingertips. Bend the child’s elbow to make a right angle (arrow 3). Place the tape at zero, which is indicated by two arrows, on the tip of the shoulder (arrow 4) and pull the tape straight down past the tip of the elbow (arrow 5). Read the number at the tip of the elbow to the nearest centimeter. Divide this number by two to estimate the midpoint. As an alternative, bend the tape up to the middle length to estimate the midpoint. A piece of string can also be used for this purpose. Mark the midpoint with a pen on the arm (arrow 6).

 

· Recommendations for Healthy Eating During Pregnancy;

 

Ø Eat starchy foods, such as maize, rice, wheat, millet, sorghum, yams, potatoes and potato products. These foods items should form the main part of the meal.

Ø Pulses, nuts, fish, meat, poultry, milk or eggs, should accompany these foods.

Ø In addition, fruits and vegetables should be available for every meal.

Ø Drink enough safe and clean water at least two liters a day.

Ø Eat frequently

Ø Eating five meals a day is recommended (three main meals plus two snacks).

· Other contributing factors are for children death;

Ø Malaria

Ø Diarrhea

Ø Measles

Ø Neonatal sepsis

Ø Upper respiratory tract infection/acute respiratory tract infection (ARI)

· Feeding Children Ages 2-5 Years;

Ø Offer a variety of foods, taking into consideration the five food groups

Ø Feed family foods for three meals per day

Ø Feed a healthy snack in between meals twice a day (e.g. porridge, milk and boiled or sweet potatoes)

Ø Do not force a child to eat. Make sure children are adequately fed

Ø Care must be taken to ensure that there is no contamination of foods

Ø The child should be taken to the clinic for growth monitoring, supplementation and de-worming

· Feeding of The Sick Child;

Ø Increase intake of nutrient dense foods

Ø Increase feeding frequency

Ø Provide soft foods which are easy to swallow

Ø Increase intake of fluid to prevent dehydration

· Teenagers need additional:

Ø Calories: More energy is needed because they are highly active

Ø Calcium: Calcium is essential for development of strong and dense bones.

Ø Iron: Iron is an essential nutrient needed to help new muscle cells to obtain oxygen for energy production. Deficiency of iron causes anemia which leads to fatigue, confusion, and weakness.

· Nutritional and Health Problems Facing Adolescents;

Ø Undesirable food habits (less fruits, vegetables, depend too much on snacks/junk foods and sweetened colored drinks)

Ø Alcohol abuse and drug use

Ø High morbidity and mortality due to HIV/AIDS

Ø High incidences of diseases, and anemia due to worms

Ø Early adolescent pregnancies increase maternal deaths

· Adults Aged 20-59 Years Recommendation;

Ø Promote nutrition education among adults on health and lifestyle

Ø Supplementation with iron and folic acid

Ø Promote use of reproductive and child health (RCH) services for reproductive age groups

Ø Monitor dietary habits and physical activity due to risk of nutrition-related chronic diseases (NCDs)

Ø Discourage alcohol consumption and smoking 

· Elderly Adults, Aged 60 Years and Above Recommendation;

Ø Foods rich in calcium and vitamin B

Ø Care and support for the elderly

Ø Accessibility of quality health services for the elderly

Ø Monitor- dietary habits, physical active

· Exclusive Breastfeeding: Exclusive breastfeeding means giving a baby breast milk only and no other food or drink, including water, (except prescribed medicines and vitamin or mineral drops).

· Predominant Breastfeeding: Predominant breastfeeding means breastfeeding baby but also giving small amounts of water or non-nutritive drinks.

· Full Breastfeeding: Full breastfeeding means breastfeeding either exclusively or predominantly.

· Bottle Feeding: Bottle feeding means feeding a baby from a bottle, regardless of what is in the bottle. This may include expressed breast milk.

· Artificial Feeding: Artificial feeding means feeding a baby on artificial feeds, and not breastfeeding at all.

· Partial Breastfeeding: Partial breastfeeding means giving a baby some breastfeeds, and some artificial feeds, either milk or cereal, or other food

· Timely Complementary Feeding: Timely complementary feeding means giving a baby other food and fluids in addition to breastfeeding, when it is appropriate, at six months of age.

· Replacement Feeding:  The process of feeding a child, who is not receiving any breast-milk, with a diet that provides all the nutrients the child needs until the child is fully fed on family food.

· Importance of Breastfeeding;

Ø Breastfeeding is important for the short and long term health, survival, growth and development of children.

Ø Both the action of breastfeeding and the composition of breast milk are important.

Ø The action of breastfeeding helps the child’s jaw to develop as well as muscles such as the tongue and muscles of the Eustachian tube.

· Colostrum: is thick and yellowish or clear in color. It is the special breast milk that women produce in the first few days after delivery. After a few days, colostrum changes into mature milk. Mature milk contains foremilk and hind milk.

· Foremilk: is the bluish milk that is produced early in a feed. It contains plenty of protein, lactose, vitamins and minerals and plenty of water but not much fat.

· Hind milk: is the whiter milk that is produced later in a feed. It is rich in fat, which provide about half of the energy of a feed. It is important for the baby to have hind milk, to get enough energy.

· Advantages of Colostrum;

Ø It contains more antibodies and other anti-infective proteins than mature milk. This is part of the reason why colostrum contains more protein than mature milk.

Ø Colostrum has a mild purgative effect, which helps to clear the baby's gut of meconium (the first rather dark stools). This clears bilirubin from the gut, and helps to prevent jaundice.

Ø Colostrum contains growth factors, which help a baby's immature intestine to develop after birth. This helps to prevent the baby from developing allergies and intolerance to other foods.

Ø Colostrum is richer than mature milk in some vitamins - especially vitamin A. Vitamin A helps to reduce the severity of any infections the baby might have.

Ø It is very important for babies to have colostrum for their first few feeds. Colostrum is ready in the breasts when a baby is born. It is all that most babies need before the mature milk comes in.

· Advantages of Breastfeeding;

Ø It costs less than artificial feeding

Ø It helps a mother and baby to bond and develop a close, loving relationship

Ø It helps a baby's development

Ø It can help to delay a new pregnancy

Ø Helps the uterus to return to its previous size. This helps to reduce bleeding, and may help to prevent anemia

Ø Reduces the risk of ovarian cancer, and possibly breast cancer, in the mother.

Ø Provides warmth, closeness and contact, which can help physical and emotional development of the child.

Ø Mothers who breastfed are less likely abandon or abuse their babies.Is environmentally friendly

· Disadvantages of Artificial Feeding;

Ø Artificial feeding may interfere with bonding. The mother and baby may not develop such a close, loving relationship.

Ø An artificially fed baby is more likely to become ill with diarrheal, respiratory, ear, and other infections.

Ø Diarrhea may become persistent

Ø They may get too little milk and may become malnourished, because they get too few feeds, or because they are too diluted. They are more likely to suffer from vitamin A deficiency

Ø An artificially fed baby is more likely to die from infections and malnutrition than a breastfed baby.

Ø They are more likely to develop allergic conditions such as eczema and possibly asthma

Ø They may become intolerant of animal milk, so that the milk causes diarrhea, rashes and other symptoms

Ø A baby may get too much artificial milk, and become obese

Ø  Also a baby may risk of some chronic diseases in the child, such as diabetes, is increased

Ø They may not develop as well mentally, and may score lower on intelligence tests.

Ø A mother who does not breastfeed is more likely to become fertile again and can become pregnant more quickly.

Ø A mother who does not breastfeed is more likely to become anemic after childbirth.

Ø She is more likely later on to develop cancer of the ovary and possibly of the breast.

Ø Artificial feeding may be harmful for children and their mothers.

Ø Breastfeeding is fundamental to child health and survival, and important for the health of women

· A poor suckling position is a cause of many breastfeeding problems including:

Ø Sore and cracked nipples

Ø Unsatisfied babies, who want to feed very often or for a very long time

Ø Frustrated babies who fuss at the breast or refuse to breastfeed

Ø Mothers who believe that they do not have enough milk

· Effect of HIV On Nutrition;

Ø Reduced food intake

Ø Poor absorption of nutrients

Ø Changes in metabolism

Ø Those which cause household food insecurity

Ø Weight loss, muscle wasting and weakened immune system

· Improving Diet Quality for PLHIV;

Ø Use fermented and germinated or sprouted foods. Fermented foods include: Sour milk (mtindi) and togwa

Ø Grains such as maize, millet and sorghum can be germinated

Ø Pulses such as beans and peas can be sprouted

Ø Fermented and germinated/sprouted foods can be easily digested and absorbed

Ø They facilitate digestion and the absorption of other foods

Ø Use spices such as cinnamon, garlic, cardamom, and ginger

Ø It stimulate appetite

Ø Facilitates digestion and absorption of nutrients

Ø Mash or grind food, facilitates swallowing and digestion

Ø Steam food such as leafy vegetables, carrots, sweet-pepper, and eggplant,

Ø helps retain some nutrients

Ø Cook leafy vegetables promptly

Ø Cook immediately after cutting

Ø Cook for a short time and not more than necessary

Ø Eat immediately after cooking to preserve nutrients

· Healthy Lifestyles For PLHIV;

Ø Eat a variety of foods: Whenever possible it is advisable to use locally available foods in preparing balanced meals as they are cheaper and people are used to them. Such foods can include indigenous vegetables, wild fruits and edible insects.

Ø Eat small meals frequently: People living with HIV and AIDS may experience difficulties with food intake, digestion and absorption due to various complications such as oral thrush, nausea, vomiting and diarrhoea.  It is important for PLHIV to eat nutritious smaller portions more frequently throughout the day to meet their nutrient requirement.

Ø Choose food rationally: Foods differ in their nutrient contents.  Choose foods that will provide adequate nutrients. For example, it will be wise to buy and eat nutritious foods such as oranges, groundnuts, eggs or milk instead of a bottle of soda, or other coloured drinks, which will provide only sugar (energy) without other nutrients.

· Important micronutrients for the immune system particularly for HIV include:

Ø Zinc

Ø Iron

Ø Selenium

Ø Vitamin A, C, E and B.

· HIV infected individual needs to:

Ø Increase the amount of energy intake

Ø Maintain dietary intake during illness

Ø Increase nutrient intake for recovery and weight gain

Ø Manage conditions that affect food intake

Ø Maintain food safety and hygiene

Ø Seek medical attention immediately

Ø Manage food and nutrition implications, if on ART

Ø Observe healthy lifestyles

Ø Have enough rest to reduce energy expenditure.

 

 

 

 

 

· Scurfy in Infants

Ø Painful limbs

Ø Beading of the ribs

Ø Skin bruising

Ø Suborbital haemorrhage

Ø If teeth have erupted, gingival changes are also seen

· Common symptoms of Rickets in children include:

Ø Child tends to be miserable

Ø Flabby toneless state of muscles that causes a pot-belly

Ø Impairment of normal development i.e. late in reaching all the milestones of early life

Ø Gastro-intestinal upset and excessive sweating of the head

Ø The main signs of the disease are bone deformation including the following features:

Ø A swelling at the growing ends (epiphyses) of the long bones, or a swell at the junction of the ribs with the costal cartilage (‘rickety rosary’)

Ø In infants, the anterior fontanelle closes late

Ø In older children, bossing of the frontal bone, bow-legs

· Complications of Rickets

Ø Deformities of the spine

Ø Changes in the pelvis

Ø May lead to difficulty in childbirth in women who have had rickets in childhood.

· Osteomalacia;is characterized by pain (sometimes severe) in bones, particularly in the pelvis, lower back, and legs.

Ø Spontaneous fractures may be a feature.

Ø Muscle weakness, hypotonia, tetany and convulsion due to hypocalcaemia may occur.

Ø Osteomalacia should not be confused with osteoporosis, a disease of aging, in which decalcification is also a feature.

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