Lecture Notes for Williams' Essentials of Nutrition and Diet Therapy, 12th Edition

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Chapter 1-1TEACH FOR NURSES LESSON PLANChapter 1: Nutrition and HealthCHAPTEROBJECTIVES1.Describe the effects of obesity, the aging population, the growth in ethnic and racial diversity,new food products, and genetics onnutritional needs of the population.2.Define nutrition, dietetics, registered dietitian, public health nutritionist, macronutrient, and micronutrient.3.State the physical characteristics of optimal nutrition.4.State factors that contribute to undernutrition, overt malnutrition, and overnutrition.5.Explain why public nutrition policies are needed.6.Explain the meaning of Dietary Reference Intakes (DRIs), Recommended Dietary Allowances (RDAs), Adequate Intake (AI), TolerableUpper Intake Level (UL), Estimated Average Requirement (EAR), and Acceptable Macronutrient Distribution Range (AMDR).7.List the key recommendationsofthe Dietary Guidelines for Americans 2010.8.Explain how to use the ChooseMyPlate.gov food guidance system.9.Identify the food groups in the Exchange Lists for Meal Planning and the types of foods found in each.10.Describe factors that affect safety of the food supply.11.Describe how individuals can assess their food intake using MyPlate or using computer-assisted nutrient analysis software.

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Chapter 1-2STUDENT RESOURCESunderstandTextbookChapter 1Food Composition TableapplyReview Questions(Evolve)synthesizeNutritrac Nutrition Analysis Software 5.0INSTRUCTORRESOURCESbefore classNursing Curriculum Standards (below)in classPowerPoint Presentations (Evolve)Image Collection(Evolve)Learning Activities (below)Discussion Topics (below)In-Class/Online Case Study (below)TEACH for Nurses Lesson Plansafter classTest Bank (Evolve)Download by Resource Type* Sold separately from textbook.TEACHING STRATEGIESContent FocusContent HighlightsLearning ActivitiesNEW CHALLENGES FOR HEALTHPROFESSIONALSRise in Chronic DiseasePopulation Diversity and ChronicDiseaseLifestyle Intervention and EducationOffer a comparison of USchronic diseasestatisticsto those of several European countries.Discuss reasons for thedifferences, from foodconsumption to national health care to activitylevels.Take a moment to recognize the ethnic diversityin your own classroom. Discuss the Focus onCultureBox, How Did Our Food Patterns BecomeActivity/Online Activity:Choose a chronic disease listed in thissection and research the increase in the number of chronic patientsin thepast 25 years. Present some prevention information thatmight be helpful for patients dealing with these chronic diseases.Online Activity:Assign the students to investigate a new productclaiming to have health benefits. Have them look at both thevitamins these products provideandother chemicals that are toutedto improve health.Research Activity:Have students research scholarly journals for an

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Chapter 1-3TEACHING STRATEGIESContent FocusContent HighlightsLearning ActivitiesNew Directions in NutritionGenes in Nutrition and HealthDisseminating Nutrition InformationSo Diverse?Ask students if they identify with aparticular religious or ethnic food pattern or iftheir eating habits include a mixture of differentpatterns.Discuss some of the new products that haveappeared in thepast several years claiming tohave additional health benefits. Bring somespecific examples to class.Invite a nutrigeneticist to speak to the studentsabout the field of study and the current research.Evaluate two different Internet sites that discussnutrition information: one from a governmentagency and one from a company that sellsnutrition products.article about nutrigenomics or nutrigenetics and share their findingswith the class.Online Activity:Have students investigate two websites that postnutritional information. Focus on a few claims on those websites andresearch whether these claims have been corroborated by areputable source.THE SCIENCE OF NUTRITONWorking DefinitionsFunctions of Foods and NutrientsNutrient InterrelationshipsNutritional StatusReview the important nutrition definitions foundin this section. Make sure the studentsunderstand the differences among them. Invite anutritionist to speak to the class about thechallenges in the profession.Review the functions that macronutrients andmicronutrients play in nutrition. Emphasize theimportance of sufficient water intake.Give some specific examples of nutrientinterrelationships.Evaluate how people with optimal nutritionstatus are not only physically healthy but alsomentally healthy and are more able to combatstress and fight infection.GroupActivity:Provide groups of students with week-long menusthat each reflect a different type of nutritional status (e.g.,overnutrition, malnutrition). Have the students evaluate the menu,identify the status, and propose simple solutions to move the menuscloser to optimal nutrition.Activity:Ask students to clip newspaper or magazine articles relatingto nutrition and bring them to class. This is a good way to increaseawareness.

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Chapter 1-4TEACHING STRATEGIESContent FocusContent HighlightsLearning ActivitiesNUTRITION POLICY AND NATIONALHEALTH PROBLEMSDiet, Health, and Public PolicyDevelopment of Nutrition PolicyHealthy People 2020Examine the progression of health care policiesand programs from the 1920s to the present.Discuss the economic and social reasons forchanges in policy (e.g., better living conditions,rise of the middle class)Bring part of theSurgeon General’s Report onNutrition and Healthfrom 1988 for the class toread. Discuss some of the studies that werereviewed and cited for this report.Compare the nutrition goals and objectives forHealthy People 2020with the same informationfor the initiatives in 2000 and 2010. Discuss howthe goals have changed for the newest version.Discussion Topic:Discuss health care policy bills that may currentlybe in debate in the US House or Senate. Examine what issues are ofconcern at the present time.Activity:Assign students or groups to poll friends and relatives to askthem about the types of preventive health practices they use.Discuss which of these practices could be taught to patientsstruggling to lead healthy lives.NUTRITION GUIDES FOR FOODSELECTIONNutrition StandardsDietary GuidelinesCurrent Dietary Status of the USPopulationDietary Guidelines for 2015–2020Strategies for ImplementationFood GuidesDiscuss more about the EAR and for what groupsit might be used. Evaluate what prompted therevisions and additions of the DRIs from 1997through 2010.Discuss how nurses, as vested communitymembers, can join with community leaders topromote good nutrition and physical well-being.Compare and contrast the three eating patternssuggested by the 2015 Dietary Guidelines.Examine how the main cultural groups in yourarea could change their diets to accommodatethese patterns.Bring up the MyPlate food guide website in classand review the options shown there. Have thestudents write down what they had for dinnerlast night and turn it in anonymously. ReviewDiscussion Topic:As a class, discuss local or national media orcommunity-based campaigns to improve dietary habits.Are theyaware of any such programs?Do they believe they haveinfluencedtheir food choices or activity levels in any way?Community Activity:Have students visit a community facility wherefood is served (e.g., school, senior center) and see what healthpromotion material is available there or posted for the consumers tosee.Discussion Topic:Discuss what changes in your home foodenvironment would have to occur in order to adopt a healthierlifestyle.Research Activity:Have students compare the differences betweenUS nutrient standards as set out in theDRIsandUnited Nationsstandards for developing countries.Discuss findings in class.

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Chapter 1-5TEACHING STRATEGIESContent FocusContent HighlightsLearning Activitiesseveral of the papers in class and discusswhether the meals reflect good choices and whatadjustments, if any, could be made for ahealthier meal.A SAFE AND HEALTHY FOOD SUPPLYDiscuss the most common foodborne illnessreported in the United States, its usual origin,and its signs, symptoms, and treatments.Online Activity:Have students access the Nutrition Evidence Library(NEL) and choose a nutrition research study to evaluate. Write a one-page summary about the article and your opinion of its worth to thegeneral public.Activity:Ask the students to rate several restaurantsthattheyfrequent on their cleanliness, food handling procedures, and menuchoices. Discuss the restaurants’ reputations for offering nutritionalfoods and any reports of foodborne illnesses.PERSONAL PERCEPTIONS OF FOODWhat Do I Usually Eat?Nutritional Analysis by Nutrientsand Energy ValuesDiscuss with the students their typical weekendfood pattern. Evaluate food choices and howthey were influenced by the social and physicalenvironment and the people present.Give a brief review of the nutritional analysisfound on the Evolve website.Activity:Have the students use the nutritional analysis on the Evolvesite to review the dietary intake of a family member. Evaluate yourfindings and present them to the class along with a plan ofcorrection. Discuss the plan of correction with the family memberand discuss his or her reaction with the class.IN-CLASS / ONLINE CASE STUDYAbdul grew up in Indiaand has come to America for college. He lived with an Indian family during his freshman year, but then hemoved into an apartment with three other students, all from different countries. They all study very hard and do not want totaketime to cook, so he eats mostly convenience food. He has found some Indian convenience foods; they aren’t as good as homecooking,but he does enjoy the familiar taste. He is acquiring a taste for American food and pizza and often eats fast food for lunchbecause it is inexpensive and quick to eat.1.What concerns would you have about Abdul’s eating habits?Correct Answer:

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Chapter 1-6Traditional Indian dishes are high in grains, legumes, and vegetables. As Abdul eats more convenience foods and American fastfoods, his intake of grains, legumes, and vegetables will decrease and his intake of fat and sodium will increase. He is at risk forbecoming overweight and developing high blood pressure,and he may have inadequate intakes of micronutrients.Cognitive Level: Application2.What practical changes could Abdul make to make his eating habits more consistent with the Dietary Guidelines forAmericans?He and his roommates could take turns cookingdinners for each other; they could each cook one or two different meals from theircountry of origin,which would increase the variety of foods that they eat without each of them having to cook every evening.They could freeze portions of leftovers for convenient meals on other days. Abdul could look for pre-prepared Indian meals thatare made with grains, legumes, and vegetables and are lower in fat. When he does eat fast food, he could choose sandwiches orsalads rather than fried foods. And he could keep a supply of easy-to-eat fruits and vegetables such as apples, bananas, tangerines,and mini carrots to help him feel satisfied with smaller portions of pre-prepared foods.Cognitive Level: ApplicationNURSING CURRICULUM STANDARDSQSEN / NLN COMPETENCIESPatient-Centered Care/Human FlourishingoPersonal Perceptions of FoodEvidence-Based Practice/Spirit of InquiryoEvidence-Based Practice Box: How Do I Use It?NURSING CONCEPTS

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Chapter 1-7The following conceptual themes and specific concepts match those presented in Giddens, J. R.(2017).Concepts fornursing practice(2nded.).St.Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to theSchlenkertextbook.A fullConcept-Based Curriculum Mapcovering the entire bookcan be foundin the“Download by Resource Type”folder on Evolve.Health Care Recipient ConceptsTHEME:Personal PreferencesConcept:CultureoExemplar:Population Density and Chronic DiseaseoExemplar:Personal Perceptions of FoodHealth and Illness ConceptsTHEME: Homeostasis and RegulationConcept:NutritionoExemplar:New Directions in NutritionoExemplar:The Science of NutritionoExemplar: Nutrition Policy and National Health ProblemsProfessional Nursing and Health Care ConceptsTHEME: Care CompetenciesConcept:EvidenceoExemplar:Evidence-Based Practice Box: How Do I Use It?BSN ESSENTIALSEssential III: Scholarship for Evidence-Based PracticeoEvidence-Based Practice Box: How Do I Use It?ANSWERS TO QUESTIONS IN THE BOOKNote:Answers to these questions can be found on Evolve site.Clickhere.

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Chapter 2-1TEACH FOR NURSES LESSON PLANChapter 2:Digestion, Absorption, and MetabolismCHAPTEROBJECTIVES1.Identify the anatomy of the digestive tract and state the major functions of each organ.2.Describe the mechanical and chemical digestion that occurs in the mouth, including the enzymes and substrates involved.3.Describe the mechanical and chemical digestion that occurs in the stomach, including the enzymes and substrates involved.4.Describe the mechanical and chemical digestion that occurs in the small intestine, including the enzymes and substrates involved.5.Describe four mechanisms of nutrient absorption from the small intestine.6.Describe the function of the large intestine.7.Identify accessory organs to the digestive system and state their secretions and the functions of the secretions.8.Describe the role of the nervous system in the digestive process.9.Relate the gastrointestinal (GI) circulation of fluid to total water balance in the body.10.State the hormonal stimuli for the various secretions of the GI tract.11.Discuss the roles of prebiotics and probiotics in GI health.12.Describe how the body controls blood glucose levels.13.Describe the body metabolism interrelationships of protein, fat, and carbohydrate.14.Describe the problem of lactose intolerance and other common digestive problems.STUDENT RESOURCESunderstandTextbookChapter 2Animations (Evolve website)oDG001 Overview of the DigestiveTractoDG002 Bile and Pancreatic DuctsFood Composition TableapplyReview Questions(Evolve)synthesizeNutritrac Nutrition Analysis Software 5.0

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Chapter 2-2INSTRUCTORRESOURCESbefore classNursing Curriculum Standards (below)in classPowerPoint Presentations (Evolve)Image Collection(Evolve)Learning Activities (below)Discussion Topics (below)In-Class/Online Case Study (below)TEACH for Nurses Lesson Plansafter classTest Bank (Evolve)Download by Resource TypeTEACHING STRATEGIESContent FocusContent HighlightsLearning ActivitiesHUMAN BODY: THE ROLEOF NUTRITIONFOOD: CHANGE ANDTRANSFORMATIONIMPORTANCE FORHEALTH AND NUTRITIONShow a short video of the connections in the digestive systemand the breakdown of foods as they travel through thesystem.Obtain from your anatomy department a human body modelwith dissectible parts and allow students to locate organs ofthe digestive system.Discuss how proper nutritional status of the body affects bothhealth and disease.Provideseveral examples and encouragethe students to interject some examples of their own.Activity:Ask students to imagine that they have swallowed abead and ask them to state in correct sequence the organs itwould pass through on its route through the body.Online Activity:Have the students choose a food occurring innature(e.g., fruits or vegetables), a healthy food made fromnatural substances (e.g., bread or butter), and a food with morethan one chemical (e.g., circus peanut candy); break them downinto nutrients, vitamins, and chemicals; and draw a diagram ofhow the body absorbs each food. Connect diseases that mightaffect the absorption of these foods.THE GASTROINTESTINALTRACTComponent PartsGeneral FunctionsSensory Stimulation andReview the parts of theGItract. Request student input andanalyze some physiologic and psychologicalinfluences thatcan stimulate or repress the desire for food.Activity:Have the students interview a patient whose eatinghabits have changed because of a physical illness, condition, ordisorder. Questions could include what foods they cannottolerate, foods they crave, factors that affect their desire to eat,etc. Discuss in class the results of the interviews.

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Chapter 2-3TEACHING STRATEGIESContent FocusContent HighlightsLearning ActivitiesGastrointestinal FunctionPRINCIPLES OF DIGESTIONGastrointestinalSecretionsGastrointestinal Motility:Muscles and MovementNervous System ControlDiscuss what happens to the body when theGIsecretions arenot produced in sufficient amounts or when they do not workproperly.Give the class a demonstration of the types of movements theGImuscles make to break down the food and move it forwardthrough theGItract.Online Activity/Discussion Topic:Investigate the points at whichthe sphincter muscles act as valves—pyloric, ileocecal, and anal—and discuss what happens when these valves malfunction.Examine how to improve the functioning at these points.MOVEMENT OF FOODTHROUGH THE DIGESTIVETRACTMOUTH ANDESOPHAGUS:PREPARATION ANDDELIVERYTaste and SmellMasticationChemical DigestionSwallowingReview the fifth sensation of taste and discuss in detail how itinfluences the acceptance and likingofcertain foods.Emphasize the ways dysgeusia and hypogeusia can be a signof approaching health problems.Invite a former smoker to speak to the class about thedifference in taste sensations when they smoked and afterthey quit.Discuss ways in which smell affects the taste of foods.Consider how mouth pain can restrict food intake and discusswhat types of diseases or problems can cause mouth pain.Have students volunteer to demonstrate how much moredifficult it is to swallow correctly when in the supine position.Discussion Topic:Ask for student input about their experienceswith patients who are not interested in eating. Have them discussthe cause of the issue and what the nursing staff did toencourage the patient to eat.Activity:Afterthe anatomic parts are learned, move onto thephysiologic aspect of digestion and absorption. Describe a mealcontaining the three major nutrients, and ask students todescribe the digestive events, starting in the mouth. To keep theexercise manageable, they can concentrate on one nutrient orone organ at a time.

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Chapter 2-4TEACHING STRATEGIESContent FocusContent HighlightsLearning ActivitiesEsophagusEntryinto the StomachAsk them to describe the difficulties in detail.Invite a physician who has been in practice formore than10years to discuss the number ofgastroesophageal refluxdisease (GERD)diagnoses today comparedwith10 years ago.Have them discuss what they recommend to reduce instancesof GERD.STOMACH: STOAGE ANDINITIAL DIGESTIONMotilityChemical DigestionDiscuss what happens in the stomach when the pH is too highor too low and how the pH levels are affected by both nerveand hormonal stimuli. Review what senses can increasestimuli.Examine theGIsecretions that affect digestion.Small-Group Activity:Divide students into small groups offour orfiveand have them come up with a list of things that they thinkcause interference with the release of their own gastricsecretions. Compare lists and discuss possible copingmechanisms.Activity:Have the students consider the Perspectives in Practicebox and identify which items they, as educated people, do notfollow and how they could change their eating habits to betteradhere to these recommendations.SMALL INTESTINE: MAJORDIGESTION, ABSORPTION,AND TRANSPORTMotilityChemical DigestionEnd Products of DigestionAbsorptionReview the types of secretions that are a vital part of thedigestive process within the small intestine. Discuss theadverse health effects when one secretion is not produced inample supply.Discuss the transport mechanisms in more detail and giveexamples of particular nutrients that are transported by eachmechanism.Generate discussion about absorption of long-chain fatty acidsand their route through the lymphatic system. Consider thedangers to the lymphatic system of excessive fat intake.COLON (LARGEINTESTINE): FINALABSORPTION AND WASTEELIMINATIONProvide examples (besides those listed in the text) of mineralsand vitamins that may not be properly absorbed. Discuss whatcan be done to assist in proper absorption.Examine the role of colonic bacteria in the digestion andSmall-Group Activity:Have student groups make presentationson topics related to common digestive disturbances, such asconstipation, flatus, heartburn, lactose intolerance, diarrhea, andnausea.Online Activity/Discussion Topic:Ask the students to find

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Chapter 2-5TEACHING STRATEGIESContent FocusContent HighlightsLearning ActivitiesRole in AbsorptionRole of Colon Microfloraabsorption of food. (Refer to Box 2-2.)information about probiotics from reputableInternet sources.Ask them to share their own experiences with probiotics andwhether they use them on a regular basis.IN-CLASS / ONLINE CASE STUDYIN-CLASS / ONLINE CASE STUDYBrooke has decided to follow a vegetarian diet. She has been experimenting with various plant proteins, especially legumes. Manydays she has a veggie burger on a whole-grain bun and salad for lunch; bean, pea, soup for dinner; and snacksoffruit, vegetables,andhummus. She is enjoying the taste of these foods but is experiencing a lot of uncomfortable intestinal gas. She is concernedthat thiscould become embarrassing.1.Why do you think Brooke is experiencing so much gas?Correct Answer:Legumes contain large amounts of oligosaccharides, such as raffinose and stachyose, that are not completely digested or absorbed.She is also eating a lot of whole grains, fruits, and vegetables,whichcontain starches and fibrous materials that are resistant todigestion by pancreatic amylase. In the colon, these undigested materials are digested by bacteria to produce gas.Cognitive Level: Knowledge2.How could Brooke minimize her discomfort and potential embarrassment due to intestinal gas?Correct Answer:Brooke would probably experience less gas if she changed her diet more gradually. She could gradually increase her intake offruits, vegetables, and legumes and gradually switch from refined to whole grains. She could start by changing one meal per day,then adding a second meal, then a snack, etc. Over time, her intestinal microflora may adjust to her new diet. Also, she mayfindthat certain types of legumes, fruits, and vegetables create more problems than others. She may be able to reduce the problemofgas odor by avoiding certain vegetables (e.g.,the cruciferous vegetables: broccoli, cabbage, and cauliflower) when she is likely to

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Chapter 2-6be in social situations. Eating slowly, chewing food carefully, and relaxing during meals may also help decrease intestinal gas anddiscomfort. She could try over-the-counter products to reduce gas formation, but she should check with her doctor first.Cognitive Level: ApplicationNURSING CURRICULUM STANDARDSQSEN / NLN COMPETENCIESPatient-Centered Care/Human FlourishingoComplementary and Alternative Medicine Box: Bismuth and Certain Herbs: A Dangerous CombinationoFocus on Culture Box:Helicobacter pylori: Risk Factor for African Americans and HispanicsNURSING CONCEPTSThe following conceptual themes and specific concepts match those presented in Giddens, J. R.(2017).Concepts fornursing practice(2nded.).St.Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to theSchlenkertextbook.A fullConcept-Based Curriculum Mapcovering the entire bookcan be foundin the“Download by Resource Type”folder on Evolve.Health and Illness ConceptsTHEME:Homeostasis and RegulationConcept:NutritionoExemplar:Human Body: The Role of NutritionConcept: EliminationoExemplar: Colon (Large Intestine): Final Absorption and Waste EliminationTHEME: Protection and MovementConcept:Sensory PerceptionoExemplar:Sensory Stimulation and Gastrointestinal FunctionBSN ESSENTIALSEssential IX:Baccalaureate Generalist Nursing Practice

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Chapter 2-7oComplementary and Alternative Medicine Box: Bismuth and Certain Herbs: A Dangerous CombinationoFocus on Culture Box:Helicobacter pylori: Risk Factor for African Americans and HispanicsANSWERS TO QUESTIONS IN THE BOOKNote:Answers to these questions can be found on Evolve site.Clickhere.

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TEACH FOR NURSES LESSON PLANChapter 3:CarbohydratesCHAPTEROBJECTIVES1.State the significance of carbohydrates as a major nutrient.2.Identify the three monosaccharides.3.Identify the three disaccharides and state their respective simple sugar components.4.Explain uses of sugar alcohols.5.Describe polysaccharides, including starch and resistant starch, glycogen, dextrins, and oligosaccharides.6.Identify the major functions of carbohydrates in body metabolism.7.Give values for recommended intakes of carbohydrates and fiber.8.List six nonnutritive sweeteners.9.Describe the role of carbohydrates in oral health.10.Describe the dangers of excessively high-carbohydrate and low-carbohydrate diets.11.Differentiate between dietary and functional fiber.12.Identify the physiologic effects of fiber on fecal mass, bile acids and cholesterol, gut microflora, and blood glucose and insulin levels.13.List natural food sources of dietary fiber.14.Describe the health benefits of functional foods and phytochemicals.15.Give an overview of digestion, absorption, and metabolism of carbohydrates.STUDENT RESOURCESunderstandTextbookChapter 3Animations:oInsulin FunctionFood Composition TableapplyReview Questions(Evolve)synthesizeNutritrac Nutrition Analysis Software 5.0

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INSTRUCTORRESOURCESbefore classNursing Curriculum Standards (below)in classPowerPoint Presentations (Evolve)Image Collection(Evolve)Learning Activities (below)Discussion Topics (below)In-Class/Online Case Study (below)TEACH for Nurses lesson plansafter classTest Bank (Evolve)Download by Resource TypeTEACHING STRATEGIESContent FocusContent HighlightsLearning ActivitiesTHE NATURE OFCARBOHYDRATEBasic Fuels: Sugars andStarchDietary ImportanceReview the process of photosynthesis illustratedin Figure 3-1. Discuss how both plants andhumans use carbohydrates for energy needs.Compare the rate of carbohydrate energy to thatof other energy sources.Examine whether modern processing that canextend the shelf life of carbohydrates affects thenutritional value of the product.Discussion Topic:Discuss where most of your carbohydrates come from inyour diet: fruits, vegetables, or grains. Review the optimal ratio and how yourdiet compareswiththat.Research Activity:Ask students to bring various food labels to class and thenlook for the ingredient “sugar”on each label. Also note its position in thelisted ingredients, which indicates the quantity of sugar in the productcompared with other ingredients. Help students identify different forms ofsugar from the ingredient listing. The students may be surprised to see whichproducts contain sugar. Include breakfast cereals; many are very high in sugar.Compare 100% fruit juice and soda; students may be surprised by the amountof sugar in juice and energy or sports drinks.CLASSIFICATION OFCARBOHYDRATESMonosaccharidesDisaccharidesSugar AlcoholsGive examples of the foods in which glucose isnaturally found. Discuss the ongoing debate andconcerns over high-fructose corn syrup.Review information about some products thatsurprisingly have added sugar.Have a diabetesnurse come in to speak aboutDiscussion Topic:Have students give some examples of products they havechosen to eliminate from their diets because of a high content of high-fructose corn syrup.Activity:Have students look at their diet and present information on oneproduct with added sugar that they could eliminate and replace withsomething healthier.Discussion Topic:Discuss the popular low-carb and no-carb diets, evaluatingboth their benefits and their dangers.

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TEACHING STRATEGIESContent FocusContent HighlightsLearning ActivitiesPolysaccharidesalternative sugar options used in foods marketedfor diabeticpatients. Discuss any warnings thatshould be noted when consuming these products.Have the nurse also address the importance ofdiabeticpatientunderstanding of the glycemicindex.Analyze the available information about resistantstarch. With student input, make a comparisonlist of the benefits of resistant starch and dietaryfiber.IMPORTANCE OFCARBOHYDRATESEmphasize the major sources of complexcarbohydrate forms, such ascereal grains,legumes, potatoes, and other vegetables. Discussfoods that supply these in the diet. Refer to thePerspectives in Practice Box, Cutting Down onSugar.Presentation Activity:Assign various topics concerning carbohydrates tostudents and ask them to prepare short reports for class presentation.Examples of topics of current interest and importance include comparison ofbreakfast cereals,NNS, sugar and hyperactivity, sugar and dental caries, fiberand heart disease, and phytochemicals and cancer.FUNCTIONS OFCARBOHYDRATESEnergySpecial FunctionsDiscuss how protein is needed not only for energydemands but also for tissue building and repairand urgent muscle responses to immediatedemands of the body. Review Table 3-4.Discussion Topic:Discuss the importance of having a good breakfast in themorning to provide the brain with an adequate amount of glucose to functionproperly. Discuss whether students notice an appreciable decline in theirmental capabilities when they skip breakfast.Discuss how important it is forpatients with dementia or memory problems to have a balanced breakfast.RECOMMENDED INTAKEOF CARBOHYDRATEDietary Reference IntakesAcceptable MacronutrientDistributionRangeNonnutritive SweetenersReview Box 3-4 and discuss theAcceptableMacronutrient Distribution Range(AMDR).Estimate how closely the average consumercomes to following the AMDR in their diet.Review Table 3-5, which compares the propertiesofFood and Drug Administration (FDA)-approvednonnutritivesweeteners(NNSs). The textmentions two recently approved NNSs,lohanguoand stevia. Discuss the available informationabout these new NNS options.Group Activity:Many consumers are concerned about the health effects ofNNS. Assign students to small groups and have each group investigate thedangers of a particular NNS. Are there valid objections to NNS,andif so,whatstudies support them?CARBOHYDRATES ANDShow a video of how dental caries breaks downActivity:Ask students to evaluate their carbohydrate sources according to

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TEACHING STRATEGIESContent FocusContent HighlightsLearning ActivitiesORAL HEALTHtooth enamel.MyPlate.IMBALANCES INCARBOHYDRATE INTAKEHigh-Carbohydrate DietsLow Carbohydrate DietsHigh-carbohydrate dietsput a heavy demand onthe pancreas for insulin production and release.Explain why this is concerning and what it meansin terms of overall health and body function.Examine both the positive and negative effects oflow-carbohydratediets. Discuss how thereduction of one nutrient may affect theabsorptionof another.Research Activity:Have students choose a popular high-carb or low-carb dietto investigate. What claims do the proponents of the diets make in terms ofweight loss, overall health, and general nutrition? Are these claimssupportable by serious, valid research studies?FIBER: THENONDIGESTIBLECARBOHYDRATETypes of FiberDietary FiberFunctional FiberDiscuss the importance of each type of dietaryfiber and the consequences of inadequate intake.Take a survey of the class to find out if thestudents regularly use flaxseed in their cooking toincrease fiber intake and improve colon health.Have students make a class list of products thathave added functional fiber.Discussion Topic:Have students review Box 3-5 and Table 3-6 and evaluatetheir recent fiber intake based on the foods listed.Activity:Using the Food Composition Table located on the studentwebsite,ask students to evaluate their own carbohydrate and fiber intake for 1 to 3days. Evaluate the diet in the following manner:Determine total grams of carbohydrates and percentage of kcaloriesfrom carbohydrates.Determine total grams of fiber.Determine whether carbohydrate kcalories were from simple orcomplex sources.Determine grams of sugar eatenDetermine food sources of dietary fiber.HEALTH PROMOTIONHealth Benefits of FiberRecommended FiberIntakeOne of the major benefits of fiber is its ability tobind to cholesterol in the small intestine andprevent its absorption. Discuss as a class howeating high-fiber foods with high-cholesterolfoods should help control blood cholesterol.Review the recommended fiber intake for bothmen and women and discuss why Americansseldom ingest the recommended amount.Class Activity:Have students bring in two types of snacks to share with theclass: one snack that is highinfiber and requires intensive chewing andanother snack that is lower in fiber and easier to eat. Have them discuss thedifferences in texture and in hunger satiety.Discuss what personalrecommendations they could make to their patients about high-fiber productsthat taste good and eliminate hunger.FUNCTIONAL FOODS:SPECIAL CARBOHYDRATEFOODSDiscuss the importance of eating unprocessed,raw foods in order to obtain the nutrientsfunctional foods offer.Online Activity:Research advertising about functional foods, find a specificclaim about a certain food, research its validity, and share this informationwith the class.

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TEACHING STRATEGIESContent FocusContent HighlightsLearning ActivitiesDIGESTION-ABSORPTION-METABOLISM REVIEWDigestionAbsorption andMetabolismReview the importance of the pancreas and thesmall intestines in the digestion, breakdown, andabsorption of carbohydrates.Start in the mouthand discuss events as you progress through thegastrointestinaltract.IN-CLASS / ONLINE CASE STUDYChristina was a cheerleader and prom queen in high school.She is now married with three children and is about 40 lb heavier thanwhen she graduated.She would like to try to lose most of the extra weight before her 15-year reunion in 6 months.A friend gave her alow-carbohydrate diet book,and she has been following it for about a week, eating mostly meat, chicken, fish, cheese, eggs, salad, andvegetables.She has found that she feels quite satisfied and has already lost 6 lb.But she is also noticing that she feels weak andlethargic.1.Why do you think Christina feels weak and lethargic?Correct Answer:Christina’s low carbohydrate intake means that her body has to convert amino acids from protein and glycerol from fat to makeglucose for her brain and other body tissues to function.Her muscles are also using more fatty acids for energy.This ismetabolically inefficient and causes tiredness.Cognitive Level: Knowledge2.Why is it potentially dangerous for Christina to continue this diet plan?Correct Answer:Christina is not getting enough servings ofvegetables, fruits, and grains to get all the nutrients her body needs.Plus, her extremecarbohydrate restriction could cause accumulation of ketones from fat breakdown, which could be dangerous if she develops

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Lecture Notes for Williams' Essentials of Nutrition and Diet Therapy, 12th Edition - Page 21 preview image

ketoacidosis.This can result in loss of water and dehydration, which may account for most of her weight loss so far.Her relativelyhigh protein intake may place a strain on her kidneys because deamination of excess amino acids creates more waste to beexcreted.And her relatively high fat intake may increase cardiovascular risk.Cognitive Level: Knowledge3.What suggestions would you make to Christina to help her to achieve her goals in a healthy and safe way?Correct Answer:Christina still has 6 months until the reunion.She could safely lose 1 to 2 lb a week and achieve her weight loss goal by usingMyPlate guidelines to design a well-balanced and varied eating plan.Controlling portion sizes, limiting added sugars and fats, andgettingregular exercise would help her stay healthy and look her best.NURSING CURRICULUM STANDARDSQSEN / NLN COMPETENCIESPatient-Centered Care/Human FlourishingoFocus on CultureBox: Who Eats More Fiber?Evidence-Based Practice/Spirit of InquiryoEvidence-Based Practice Box: Do Nonnutritive Sweeteners Help You Lose Weight?Safety/Nursing JudgmentoFocus on Food Safety: HoneyNURSING CONCEPTSThe following conceptual themes and specific concepts match those presented in Giddens, J. R.(2017).Concepts fornursing practice(2nded.).St.Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to theSchlenkertextbook.A fullConcept-Based Curriculum Mapcovering the entire bookcan be foundin the“Download by Resource Type”folder on Evolve.

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Health Care Recipient ConceptsTHEME: Personal PreferencesConcept: CultureoExemplar: Dietary ImportanceoExemplar: Recommended Fiber IntakeoExemplar: Focus on CultureBox: Who Eats More Fiber?Health and Illness ConceptsTHEME:Homeostasis and RegulationConcept: Glucose RegulationoExemplar: The Nature of CarbohydrateConcept: EliminationoExemplar: Functional FiberTHEME: Protection and MovementConcept: InflammationoExemplar: Carbohydrates and Oral HealthConcept: InfectionoExemplar: Carbohydrates and Oral HealthConcept: Tissue IntegrityoExemplar: Functional Foods: Special Carbohydrate FoodsProfessional Nursing and Health Care ConceptsTHEME: Care CompetenciesConcept: EvidenceoExemplar: Nonnutritive SweetenersConcept: SafetyoExemplar: Focus on Food Safety: HoneyBSN ESSENTIALSEssential II: Basic Organizational and Systems Leadership for Quality Care and Patient SafetyoFocus on Food Safety: HoneyEssential III: Scholarship for Evidence-Based PracticeoEvidence-Based Practice Box: Do Nonnutritive Sweeteners Help You Lose Weight?

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Essential IX: Baccalaureate Generalist Nursing PracticeoFocus on CultureBox: Who Eats More Fiber?ANSWERS TO QUESTIONS IN THE BOOKNote:Answers to these questions can be found on Evolve site.Clickhere.

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Chapter 04-1TEACH FOR NURSES LESSON PLANChapter 4:LipidsCHAPTEROBJECTIVES1.Identify the chemical composition of lipids.2.Identify the physical and chemical characteristics of lipids, including chain length.3.Differentiate between saturated, monounsaturated, and polyunsaturated fatty acids;cisversustransfats;and visible versus hidden fat.4.Explain the importance of essential fatty acids.5.State the important physiologic functions of lipids in the body.6.State the types and amounts of fats necessary in the diet.7.Differentiate between a fatty acid and a triglyceride.8.State the Acceptable Macronutrient Distribution Range (AMDR) for fat and theadequate intake (AI)for essential fatty acids.9.Explain the importance of lowering fat intake in the general population.10.List the pros and cons of use of fat replacers in foods.11.Define cholesterol; state the functions, food sources, and health concerns associated with it.12.Describe lipid digestion, both physical and chemical, starting in the mouth and going through the stomach and intestines.13.State the end products of lipid digestion.14.State the mechanisms by which lipids are absorbed into the bloodstream.15.Describe the effect of plant sterols on blood cholesterol levels.16.Identify the main sites of lipid metabolism.17.Identify the five types of lipoproteins and the function of each.18.Identify the hormones associated with lipid metabolism and the general effect of each.STUDENT RESOURCESunderstandTextbookChapter 4Animations:oCV016 Coronary Artery DiseaseFoodCompositionTableapplyReview Questions(Evolve)

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Chapter 04-2synthesizeNutritrac Nutrition Analysis Software 5.0INSTRUCTORRESOURCESbefore classNursing Curriculum Standards (below)in classPowerPoint Presentations (Evolve)Image Collection(Evolve)Learning Activities (below)Discussion Topics (below)In-Class/Online Case Study (below)TEACH for Nurses lesson plansafter classTest Bank (Evolve)TEACHING STRATEGIESContent FocusContent HighlightsLearning ActivitiesLIPIDS IN NUTRITION ANDHEALTHHealth Issues and LipidsFunctions of LipidsDiscuss the differences between the good fats(polyunsaturated and monounsaturated fatty acids) and badfats (saturated and trans fats). Examine where these fats canbe found.Review the important tasks that adipose tissue performs.Discuss what happens when the body ingests too few lipids.Give an example of several foods that contain important lipidsand how those lipids enhance the taste and texture of thosefoods.Online Activity:Have students search the Internet for articlesabout good fats and the importance of ingesting properamounts.PHYSICAL AND CHEMICALNATURE OF LIPIDSPhysical CharacteristicsChemical CharacteristicsBring in several items that most consumers think are mainlycarbohydrates and have the students read the labels todiscover how much fat these items actually contain.Display a picture of the molecular structure of both acarbohydrate molecule and a lipid molecule. Discuss thedifferences between them.•CommunityActivity:Have students take an inventory of thesnackitems in their cabinets at homeand bring a list to class todiscuss. Examine how many items have a high fat content.Discuss whether there are similar snacks that arehealthier.FATTY ACIDS ANDTRIGLYCERIDESDiscuss what type of helpers long-chain fatty acids need toenter the lymph and then the blood.Research Activity:Have students find a scholarly article aboutmedium-chain triglyceride oil and discuss its primary consumersand its uses.

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Chapter 04-3TEACHING STRATEGIESContent FocusContent HighlightsLearning ActivitiesCharacteristics of FattyAcids: Chain LengthCharacteristics of FattyAcids: SaturationEssential Fatty AcidsDiscuss and display the molecular composition of saturated,monounsaturated, and polyunsaturated fats while reviewingtheir sources and their contribution to bodily functioning.Review the roles of linoleic andα-linolenicacid.Define the termessentialas a nutritionist uses it. Differentiatebetweenessentialandnonessential. Be sure to explain whylinoleic fatty acid is the true essential fatty acid.Research Activity:Have students read about the possible linkbetween high levels of fish oil and the increased riskforprostatecancer.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3145396/FOOD LIPIDS AND HEALTHDegree of SaturationCisVersusTransFatsVisible and Hidden FatAcceptable MacronutrientDistribution RangeAppropriate Intakes of Fatand CarbohydrateUse Figure 4-2 to show the spectrum of food fats fromsaturated to unsaturated. Refer to Table 4-1 for a summary ofthe health effects of fatty acids.Ask students to list visible fats and invisible fats. Emphasizethat it is not always obviouswhenfoods have a high fatcontent. Refer to Box 4-4.Use the Focus on CultureBox, Developing a Food FrequencyQuestionnaire for Culturally Diverse Groups, to discuss thedifficulty of identifying hidden fats, especially in ethnic foods,which may be unfamiliar.Discuss how appropriate dieting should be addressed withpatients sothatthey understand the need for particularnutrients in the proper quantities. Explain that cutting down onthe excessive intake in one area can lead to increased intake inanother area. A proper balance is the key to a healthy diet.Group Activity:Provide each of the student groups with a dietplan that is lacking in some area. Have them discuss how toadjust the diet so that it includes all the proper nutrients atacceptable levels. Present them to the class and discuss anyadditional adjustments.Online Activity:Write out a typical lunch from a fast-foodrestaurant and a typical brown bag lunch. Use the FoodComposition Table located on the studentwebsite to calculate(1) the total grams of fat and (2) the percent of total kcaloriesthat come from the fat in the two meals. What makes thedifference between these two meals?LIPID-RELATEDCOMPOUNDSCholesterolLipoproteinsCholesterol, Lipoproteins,Review the functions of cholesterol, emphasizing that it hasmany important functions and is found in products with otheressential nutrients.See theEvidence-Based PracticeBox, Plant Sterols: Weapon forLowering Blood Cholesterol Levels, for more information aboutplant sterols.Activity:Have students bring in food products that have thefollowing terms on their labels:hydrogenated,polyunsaturated,no trans fatty acids.Have them classify the type of fat/oil in thefood product according to degree of saturation. Bring inshortenings, coffee creamers, margarine, crackers, frozendesserts, whipped toppings, egg substitutes, milks, and oils.

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Chapter 04-4TEACHING STRATEGIESContent FocusContent HighlightsLearning Activitiesand Cardiovascular RiskShow a picture or a video of lipid conversion and transport.Evaluate how both fat intake and genetic factors affect aperson’s cholesterol level and riskforcardiovascular disease.HEALTH PROMOTIONLowering Fat IntakeFat ReplacersDiscuss the use of fat replacers,such as fruit purees,andexaminethose approved by theFood and Drug Administration(FDA). Explain how fruit, whole grains, and low-fat dairy snacksare better than items made with fat replacers. Compare thenutrients in a pear, a whole grain bagel, a serving of low-fatyogurt, and a serving of an item made with a fat replacer.Activity:Have students bring in food advertisements thatemphasize low-fat and reduced-fat products and discuss theclaims made for them, if any.Activity:Have students calculate the amount of fat in their owndiet and identify major sources of saturated and unsaturatedfats. Students may also identify major sources of visible andhidden fat in their diets. Many students will be surprised at theirfindings.DIGESTION-ABSORPTION-METABOLISM REVIEWDigestionAbsorptionMetabolismDiscuss how important the secretions of the small intestinesare in preparing lipids for digestion and absorption.Review the three stages of lipid absorption. See Figure 4-5 forclarification and visual assistance.IN-CLASS / ONLINE CASE STUDYMost of Damon’s relatives have developed type 2 diabetes by the time they are in the 60s. Damon is determined that this will nothappen to him,so he has always avoided sweets and kept his carbohydrate intake low. He eats mostly meats, cheese, fruits, andvegetables and only small amounts of bread, tortillas, rice, and baked goods. He assumed that this way of eating would help himmaintain a healthy weight, but he’s now almost 40 and his weight has gradually crept up 40 lb in thepast 10 years.1.Why do you think Damon is gradually gaining weight?Correct Answer:Damon’s diet is low in carbohydrate butisrelatively high in fat, which adds significant extra energy.Cognitive Level: Knowledge

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Chapter 04-52.What changes could Damon make to reverse his gradual weight gain as well as decreasing his riskfordeveloping type 2diabetes.Correct Answer:Damon could decrease his portions of meats, poultry, and cheese and eat more legumes and grains, focusing especially on wholegrains such as whole wheat bread, brown rice, wholegrain pasta, and wholegrain tortillas. This will decrease the fat contentandenergy content of his diet without increasing his riskfordeveloping type 2 diabetes. The extra fiber will further help decrease hisriskfortype 2 diabetes as well as helping to reduce his LDL-cholesterol level. Damon could visitwww.ChooseMyPlate.govtohelp him design a food plan that includes appropriate amounts of foods from all the food groups. Losing the weight he has gainedwill, in itself, reduce his risk for type 2 diabetes.Cognitive Level: ApplicationNURSING CURRICULUM STANDARDSQSEN / NLN COMPETENCIESPatient-Centered Care/Human FlourishingoHealth Issues and LipidsoFocus on Culture Box: Sources of Fat in the Diets of Culturally Diverse GroupsEvidence-Based Practice/Spirit of InquiryoEvidence-Based Practice Box: Plant Sterols: Weapon for Lowering Blood Cholesterol LevelsNURSING CONCEPTSThe following conceptual themes and specific concepts match those presented in Giddens, J. R.(2017).Concepts fornursing practice(2nded.).St.Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Schlenkertextbook.A fullConcept-Based Curriculum Mapcovering the entire bookcan be foundin the“Download by Resource Type”folder on Evolve.Health Care Recipient Concepts

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Chapter 04-6THEME: Personal PreferencesConcept: CultureoExemplar: Focus on Culture Box: Sources of Fat in the Diets of Culturally Diverse GroupsHealth and Illness ConceptsTHEME: Homeostasis and RegulationConcept: NutritionoExemplar: Lipids in Nutrition and HealthProfessional Nursing and Health Care ConceptsTHEME: Health Care InfrastructuresConcept: Health PolicyoExemplar:CisVersusTransFatsBSN ESSENTIALSEssential I: Liberal Education for Baccalaureate Generalist Nursing PracticeoFocus on Culture Box: Sources of Fat in the Diets of Culturally Diverse GroupsEssential III: Scholarship for Evidence-Based PracticeoEvidence-Based Practice Box: Plant Sterols: Weapon for Lowering Blood Cholesterol LevelsEssential V: HealthCare Policy, Finance, and Regulatory EnvironmentsoCisVersusTransFatsEssential IX: Baccalaureate Generalist Nursing PracticeoFocus on Culture Box: Develop Food Frequency Questionnaires for Culturally Diverse GroupsANSWERS TO QUESTIONS IN THE BOOKNote:Answers to these questions can be found on Evolve site.Clickhere.

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Chapter 05-1TEACH FOR NURSES LESSON PLANChapter 5:ProteinsCHAPTEROBJECTIVES1.Describe the chemical structure of amino acids and proteins.2.Give examples of different types of proteins.3.Differentiate between indispensable, dispensable, and conditionally indispensable amino acids and give examples of each group.4.State the general functions of protein.5.Describe nitrogen balance and the conditions that may result in positive and negative nitrogen balance.6.Recognize the termsanabolismandcatabolismand give examples of protein anabolism and catabolism.7.Identify food items high in protein content.8.Compare complete versus incomplete proteins and give examples of each.9.Explain why quantity and quality of protein are important in the diet.10.Describe different types of vegetarian diet and factors that are important in planning each one.11.Identify factors that affect dietary protein needs.12.Explain protein-energy malnutrition, kwashiorkor, and marasmus.13.Discuss the Dietary Reference Intake for protein for various ages and genders and the Acceptable Macronutrient Distribution Range forprotein.14.Describe methods to evaluate protein quality.15.Starting in the mouth, describe the events of protein digestion and absorption, including the enzymes and hormones involved.STUDENT RESOURCESunderstandTextbookChapter 5Food Composition TableapplyReview Questions(Evolve)synthesizeNutritrac Nutrition Analysis Software 5.0INSTRUCTORRESOURCES

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Chapter 05-2before classNursing Curriculum Standards (below)in classPowerPoint Presentations (Evolve)Image Collection(Evolve)Learning Activities (below)Discussion Topics (below)In-Class/Online Case Study (below)TEACH for Nurses lesson plansafter classTest Bank (Evolve)TEACHING STRATEGIESContent FocusContent HighlightsLearning ActivitiesPHYSICAL AND CHEMICALNATURE OF PROTEINSGeneral DefinitionChemical NatureGeneral Pattern andStructureEssential Amino AcidsOn the board, compare the structures of the amino acids listed inthe text with each other and also with the structures ofcarbohydrates and fats.Discuss the dual nature of amino acids and how it responds to thebody’s pH.Review Box 5-1 for the categories of amino acids. Examine whatacids are found in food and which are produced by the body.Activity:Have the students draw out the structure of asimple amino acid and explain in their own words howthese connect to build body proteins.THE BUILDING OFPROTEINSProtein StructureTypes of ProteinsDiscuss the structure of body proteins and what researchers look forwhen trying to develop medications.Review the types of proteins listed, discussing how each protein’sstructure makes it perfect for the job it needs to do.Research Activity:Have students find a scholarly researcharticle about proteins and their function within the body.Discuss what new information about proteins is the subjectof discussion in the medical world.FUNCTIONS OF PROTEINGrowth, Tissue Building,and MaintenanceSpecific Physiologic RolesDiscuss the importance of protein during the adolescent period,when bone and tissue are expanding rapidly. Examine what types ofprotein are best during this period.Review the physiologic roles of amino acids. Discuss whether properingestion of protein can prevent certain diseases such as Parkinsondiseaseor glaucoma.Discussion Topic:Have the students discuss theirexperiences with patients who needed specific types ofamino acids to advance their recovery.Interview Activity:Have students interview several peopleat a local gym about their protein ingestion. Do they payspecial attention to their protein intake in regular mealsand do they use protein drinks and other supplements?

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