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

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    Chapter 1 - 1 TEACH FOR NURSES LESSON PLAN Chapter 1: Nutrition and Health CHAPTER OBJECTIVES 1. Describe the effects of obesity, the aging population, the growth in ethnic and racial diversity, new food products, and genetics on nutritional 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), Tolerab le Upper Intake Level (UL), Estimated Average Requirement (EAR), and Acceptable Macronutrient Distribution Range (AMDR). 7. List the key recommendations of the 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 - 2 STUDENT RESOURCES understand  Textbook Chapter 1  Food Composition Table apply  Review Questions (Evolve) synthesize  Nutritrac Nutrition Analysis Software 5.0 INSTRUCTOR RESOURCES before class  Nursing Curriculum Standards (below) in class  PowerPoint Presentations (Evolve)  Image Collection (Evolve)  Learning Activities (below)  Discussion T opics (below)  In - Class/Online Case Study (below)  TEACH for Nurses Lesson Plans after class  Test Bank (Evolve)  Download by Resource Type * Sold separately from textbook. TEACHING STRATEGIES Content Focus Content H ighlights Learning A ctivities NEW CHALLENGES FOR HEALTH PROFESSIONALS Rise in Chronic Disease Population Diversity and Chronic Disease Lifestyle Intervention and Education Offer a comparison of US chronic disease statistics to those of several European cou ntries. Discuss reasons for the differences , from food consumption to national health care to activity levels. Take a moment to recognize the ethnic diversity in your own classroom. Discuss the Focus on Culture B ox, How Did Our Food Patterns Become  Activity /Online Activity : Choose a chronic disease listed in this section and research the increase in the number of chronic patients in the p ast 25 years. Present some prevention information that might be helpful for patients dealing with these chronic diseases.  Online Activity: Assign the students to investigate a new product claiming to have health benefits. Have them look at both the vitamins these products provide and other chemicals that are touted to improve health.  Research Activity: Have students research scholarly journals for an

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    Chapter 1 - 3 TEACHING STRATEGIES Content Focus Content H ighlights Learning A ctivities New Directions in Nutrition Genes in Nutrition and Health Disseminating Nutrition Information So Diverse ? Ask students if they identify with a particular religious or ethnic food pattern or if their eating habits include a mixture of different patterns. Discuss some of the new products that have appeared in the p ast several years claiming to have additional health benefits. Bring some specific examples to class. Invite a nutr i geneticist to speak to the students about the field of study and the current research. Evaluate two different Internet sites that discuss nutrition information: one from a government agency and one from a company that sells nutrition products. article about nutrigenomics or nutrigenetics and share their findings with the class.  Online Activity: Have students investigate two websites that post nutritional information. Focus on a few claims on those websites and research whether these claims have been corroborated by a reputable source. THE SCIENCE OF NUTRITON Working Definitions Functions of Foods and Nutrients Nutrient Interrelationships Nutritional Status Review the important nutrition definitions found in this section. Make sure the students understand the differences among them. Invite a nutritionist to speak to the class about the challenges in the profession. Review the functions that macronutrients and micronutrients play in nutrition. Emphasize the importance of sufficient water intake. Give some specific examples of nutrient interrelationships. Evaluate how people with optimal nutrition status are not only physically healthy but also mentally healthy and are more able to combat stress and fight infection.  Group Activity: Provide groups of students with week - long menus that 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 menus closer to optimal nutrition.  Activity: Ask students to clip newspaper or magazine articles relating to nutrition and bring them to class. This is a good way to increase awareness.

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    Chapter 1 - 4 TEACHING STRATEGIES Content Focus Content H ighlights Learning A ctivities NUTRITION POLICY AND NATIONAL HEALTH PROBLEMS Diet, Health, and Public Policy Development of Nutrition Policy Healthy People 2020 Examine the progression of health care policies and programs from the 1920s to the present. Discuss the economic and social reasons for changes in policy (e.g., better living conditions, rise of the middle class) Bring part of the Surgeon General’s Report on Nutrition and Health from 1988 for the class to read. Discuss some of the studies that were reviewed and cited for this report. Compare the nutrition goals and objectives for Healthy People 2020 with the same information for the initiatives in 2000 and 2010. Discuss how the goals have changed for the newest version.  Discussion Topic: Discuss health care policy bills that may currently be in debate in the US House or Senate. Examine what issues are of concern at the present time.  Activity: Assign students or groups to poll friends and relatives to ask them about the types of preventive health practices they use. Discuss which of these practices could be taught to patients struggling to lead healthy lives. NUTRITION GUIDES FOR FOOD SELECTION Nutrition Standards Dietary Guidelines Current Dietary Status of the US Population Dietary Guidelines for 2015 – 2020 Strategies for Implementation Food Guides Discuss more about the EAR and for what groups it might be used. Evaluate what prompted the revisions and additions of the DRIs from 1997 through 2010. Discuss how nurses, as vested community members, can join with community leaders to promote good nutrition and physical well - being. Compare and contrast the three eating patterns suggested by the 2015 Dietary Guidelines. Examine how the main cultural groups in your area could change their diets to accommodate these patterns. Bring up the MyPlate food guide website in class and review the options shown there. Have the students write down what they had for dinner last night and turn it in anonymously. Review  Discussion Topic: As a class, discuss local or national media or community - based campaigns to improve dietary habits. Are they aware of any such programs? Do they believe they have influenced their food choices or activity levels in any way?  Community Activity: Have students visit a community facility where food is served (e.g., school, senior center) and see what health promotion material is available there or posted for the consumers to see.  Discussion Topic: Discuss what changes in your home food environment would have to occur in order to adopt a healthier lifestyle.  Research Activity: Have students compare the differences between US nutrient standards as set out in the DRIs and United Nations standards for developing countries. Discuss findings in class.

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    Chapter 1 - 5 TEACHING STRATEGIES Content Focus Content H ighlights Learning A ctivities several of the papers in class and discuss whether the meals reflect good choices and what adjustments, if any, could be made for a healthier meal. A SAFE AND HEALTHY FOOD SUPPLY Discuss the most common foodborne illness reported 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 the general public.  Activity: Ask the students to rate several restaurants that they frequent on their cleanliness, food handling procedures, and menu choices. Discuss the restaurants’ reputations for offering nutritional foods and any reports of foodborne illnesses. PERSONAL PERCEPTIONS OF FOOD What Do I Usually Eat? Nutritional Analysis by Nutrients and Energy Values Discuss with the students their typical weekend food pattern. Evaluate food choices and how they were influenced by the social and physical environment and the people present. Give a brief review of the nutritional analysis found on the Evolve website.  Activity: Have the students use the nutritional analysis on the Evolve site to review the dietary intake of a family member. Evaluate your findings and present them to the class along with a plan of correction. Discuss the plan of correction with the family member and discuss his or her reaction with the class. IN - CLASS / ONLINE CASE STUDY Abdul grew up in India and has come to America for college. He lived with an Indian family during his freshman year, but then he moved into an apartment with three other students, all from different countries. They all study very hard and do not want to take time to cook, so he eats mostly convenience food. He has found some Indian convenience foods; they aren’t as good as home cooking , but he does enjoy the familiar taste. He is acquiring a taste for American food and pizza and often eats fast food for lunch because 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 - 6 Traditional Indian dishes are high in grains, legumes, and vegetables. As Abdul eats more convenience foods and American fast foods, his intake of grains, legumes, and vegetables will decrease and his intake of fat and sodium will increase. He is at r isk for becoming overweight and developing high blood pressure , and he may have inadequate intakes of micronutrients. Cognitive Level: Application 2. What practical changes could Abdul make to make his eating habits more consistent with the Dietary Guidelines for Americans? He and his roommates could take turns cook ing dinners for each other; they could each cook one or two different meals from their country 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 that are made with grains, legumes, and vegetables and are lower in fat. When he does eat fast food, he could choose sandwiches or salads 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: Application NURSING CURRICULUM STANDARDS QSEN / NLN COMPETENCIES  Patient - Centered Care/Human Flourishing o Personal Perceptions of Food  Evidence - Based Practice/ Spirit of Inquiry o Evidence - Based Practice Box: How Do I Use It? NURSING CONCEPTS

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    Chapter 1 - 7 The following conceptual themes and specific concepts match tho se presented in Giddens, J. R. (201 7 ). Concepts for nursing practice (2 nd ed.) . St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspon d to the Schlenker textbook. A full Concept - Based Curriculum Map covering the entire book can be found in the “ Download by Resource Type ” folder on Evolve. Health Care Recipient Concepts THEME: Personal Preferences  Concept: Culture o Exemplar: Population Density and Chronic Disease o Exemplar: Personal Perceptions of Food Health and Illness Concepts THEME: Homeostasis and Regulation  Concept: Nutrition o Exemplar: New Directions in Nutrition o Exemplar: The Science of Nutrition o Exemplar: Nutrition Policy and National Health Problems Professional Nursing and Health Care Concepts THEME: Care Competencies  Concept: Evidence o Exemplar: Evidence - Based Practice Box: How Do I Use It? BSN ESSENTIALS  Essential III: Scholarship for Evidence - Based Practice o Evidence - Based Practice Box: How Do I Use It? ANSWERS TO QUESTIONS IN THE BOOK Note: Answers to these question s can be found on Evolve site. Click here .

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    Chapter 2 - 1 TEACH FOR NURSES LESSON PLAN Chapter 2 : Digestion, Absorption, and Metabolism CHAPTER OBJECTIVES 1. 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 invol ved. 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 RESOURCES understand  Textbook Chapter 2  Animations (Evolve website) o DG001 Overview of the Digestive T ract o DG002 Bile and Pancreatic Ducts  Food Composition Table apply  Review Questions (Evolve) synthesize  Nutritrac Nutrition Analysis Software 5.0

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    Chapter 2 - 2 INSTRUCTOR RESOURCES before 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 Plans after class  Test Bank (Evolve)  Download by Resource Type TEACHING STRATEGIES Content Focus Content H ighlights Learning A ctivities HUMAN BODY: THE ROLE OF NUTRITION FOOD: CHANGE AND TRANSFORMATION IMPORTANCE FOR HEALTH AND NUTRITION Show a short video of the connections in the digestive system and the breakdown of foods as they travel through the system. Obtain from your anatomy department a human body model with dissectible parts and allow students to locate organs of the digestive system. Discuss how proper nutritional status of the body affects both health and disease. Provide several examples and encourage the students to interject some examples of their own .  Activity: A sk students to imagine that they have swallowed a bead and ask th em to state in correct sequence the organs it would pass through on its route through the body .  Online Activity: Have the students choose a food occurring in nature (e.g., fruits or vegetables), a healthy food made from natural substances (e.g., bread or butter), and a food with more than one chemical (e.g., circus peanut candy); break them down into nutrients, vitamins, and chemicals; and draw a diagram of how the body absorbs each food. Connect diseases that might affect the absorption of these foods. THE GASTROINTESTINAL TRACT Component Parts General Functions Sensory Stimulation and Review the parts of the GI tract. Request student input and analyze some physiologic and psychologic al influences that can stimulate or repress the desire for food.  Activity: Have the students interview a patient whose eating habits have changed because of a physical illness, condition, or disorder. Questions could include what foods they cannot tolerate, 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 - 3 TEACHING STRATEGIES Content Focus Content H ighlights Learning A ctivities Gastrointestinal Function PRINCIPLES OF DIGESTION Gastrointestinal Secretions Gastrointestinal Motility: Muscles and Movement Nervous System Control Discuss what happens to the body when the GI secretions are not produced in sufficient amounts or when they do not work properly. Give the class a demonstration of the types of movements the GI muscles make to break down the food and move it forward through the GI tract.  Online Activity/ Discussion Topic: Investigate the points at which the 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 FOOD THROUGH THE DIGESTIVE TRACT MOUTH AND ESOPHAGUS: PREPARATION AND DELIVERY Taste and Smell Mastication Chemical Digestion Swallowing Review the fifth sensation of taste and discuss in detail how it influences the acceptance and liking of certain foods. Emphasize the ways dysgeusia and hypogeusia can be a sign of approaching health problems. Invite a former smoker to speak to the class about the difference in taste sensations when they smoked and after they quit. Discuss ways in which smell affects the taste of foods. Consider how mouth pain can restrict food intake and discuss what types of diseases or problems can cause mouth pain. Have students volunteer to demonstrate how much more difficult it is to swallow correctly when in the supine position.  Discussion Topic: Ask for student input about their experiences with patients who are not interested in eating. Have them discuss the cause of the issue and what the nursing staff did to encourage the patient to eat.  Activity: After the anatomic parts are learned, move onto the physiologic aspect of digestion and absorption. Describe a meal containing the three major nutrients, and ask students to describe the digestive events, starting in the mouth. To keep the exercise manageable, they can concentrate on one nutrient or one organ at a time .

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    Chapter 2 - 4 TEACHING STRATEGIES Content Focus Content H ighlights Learning A ctivities Esophagus Entry i nto the Stomach Ask them to describe the difficulties in detail. Invite a physician who has been in practice for more than 10 years to discuss the number of gastroesophageal reflux disease ( GERD ) diagnoses today compared with 10 years ago. Have them discuss what they recommend to reduce instances of GERD. STOMACH: STOAGE AND INITIAL DIGESTION Motility Chemical Digestion Discuss what happens in the stomach when the pH is too high or too low and how the pH levels are affected by both nerve and hormonal stimuli. Review what senses can increase stimuli. Examine the GI secretions that affect digestion.  Small - Group Activity: Divide students into small groups of four or five and have them come up with a list of things that they think cause interference with the release of their own gastric secretions. Compare lists and discuss possible coping mechanisms.  Activity: Have the students consider the Perspectives in Practice box and identify which items they, as educated people, do not follow and how they could change their eating habits to better adhere to these recommendations. SMALL INTESTINE: MAJOR DIGESTION, ABSORPTION, AND TRANSPORT Motility Chemical Digestion End Products of Digestion Absorption Review the types of secretions that are a vital part of the digestive process within the small intestine. Discuss the adverse health effects when one secretion is not produced in ample supply. Discuss the transport mechanisms in more detail and give examples of particular nutrients that are transported by each mechanism. Generate discussion about absorption of long - chain fatty acids and their route through the lymphatic system. Consider the dangers to the lymphatic system of excessive fat intake. COLON (LARGE INTESTIN E ): FINAL ABSOR P TION AND WASTE ELIMINATION Provide examples (besides those listed in the text) of minerals and vitamins that may not be properly absorbed. Discuss what can be done to assist in proper absorption. Examine the role of colonic bacteria in the digestion and  Small - Group Activity: Have student groups make presentations on topics related to common digestive disturbances, such as constipation, flatus, heartburn, lactose intolerance, diarrhea, and nausea.  Online Activity/Discussion Topic: Ask the students to find

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    Chapter 2 - 5 TEACHING STRATEGIES Content Focus Content H ighlights Learning A ctivities Role in Absorption Role of Colon Microflora absorption of food. (Refer to Box 2 - 2 . ) information about probiotics from reputable I nternet sources. Ask them to share their own experiences with probiotics and whether they use them on a regular basis. IN - CLASS / ONLINE CASE STUDY IN - CLASS / ONLINE CASE STUDY Brooke has decided to follow a vegetarian diet. She has been experimenting with various plant proteins, especially legumes. M any days she has a veggie burger on a whole - grain bun and salad for lunch; bean, pea, soup for dinner; and snacks of fruit, vegetables , and hummus. She is enjoying the taste of these foods but is experiencing a lot of uncomfortable intestinal gas. She is concerned that this could 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 absor bed. She is also eating a lot of whole grains, fruits, and vegetables , which contain starches and fibrous materials that are resistant to digestion by pancreatic amylase. In the colon, these undigested materials are digested by bacteria to produce gas. Cognitive Level: Knowledge 2. 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 of fruits, vegetables, and legumes and gradually switch from refined to whole grains. She could start by changing one meal per d ay, then adding a second meal, then a snack, etc. Over time, her intestinal microflora may adjust to her new diet. Also, she may find that certain types of legumes, fruits, and vegetables create more problems than others. She may be able to reduce the problem of gas 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 - 6 be in social situations. Eating slowly, chewing food carefully, and relaxing during meals may also help decrease intestinal g as and discomfort. She could try over - the - counter products to reduce gas formation, but she should check with her doctor first. Cognitive Level: Application NURSING CURRICULUM STANDARDS QSEN / NLN COMPETENCIES  Patient - Centered Care/Human Flourishing o Complementary and Alternative Medicine Box: Bismuth and Certain Herbs: A Dangerous Combination o Focus on Culture Box: Helicobacter py l ori : Risk Factor for African Americans and Hispanics NURSING CONCEPTS The following conceptual themes and specific concepts match tho se presented in Giddens, J. R. (201 7 ). Concepts for nursing practice (2 nd ed.) . St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspon d to the Schlenker textbook. A full Concept - Based Curriculum Map covering the entire book can be found in the “ Download by Resource Type ” folder on Evolve. Health and Illness Concepts THEME: Homeostasis and Regulation  Concept: Nutrition o Exemplar: Human Body: The Role of Nutrition  Concept: Elimination o Exemplar: Colon (Large Intestine): Final Absorption and Waste Elimination THEME: Protection and Movement  Concept: Sensory Perception o Exemplar: Sensory Stimulation and Gastrointestinal Function BSN ESSENTIALS  Essential IX: Baccalaureate Generalist Nursing Practice

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    Chapter 2 - 7 o Complementary and Alternative Medicine Box: Bismuth and Certain Herbs: A Dangerous Combination o Focus on Culture Box: Helicobacter py l ori : Risk Factor for African Americans and Hispanics ANSWERS TO QUESTIONS IN THE BOOK Note: Answers to these question s can be found on Evolve site. Click here .

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    TEACH FOR NURSES LESSON PLAN Chapter 3 : Carbohydrates CHAPTER OBJECTIVES 1. 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 in sulin 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 RESOURCES understand  Textbook Chapter 3  Animations: o Insulin Function  Food Composition Table apply  Review Questions (Evolve) synthesize  Nutritrac Nutrition Analysis Software 5.0

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    INSTRUCTOR RESOURCES before 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 plans after class  Test Bank (Evolve)  Download by Resource Type TEACHING STRATEGIES Content Focus Content H ighlights Learning A ctivities THE NATURE OF CARBOHYDRATE Basic Fuels: Sugars and Starch Dietary Importance Review the process of photosynthesis illustrated in Figure 3 - 1. Discuss how both plants and humans use carbohydrates for energy needs. Compare the rate of carbohydrate energy to that of other energy sources. Examine whether modern processing that can extend the shelf life of carbohydrates affects the nutritional value of the product.  Discussion Topic: Discuss where most of your carbohydrates come from in your diet: fruits, vegetables, or grains. Review the optimal ratio and how your diet compares with that.  Research Activity: Ask students to bring various food labels to class and then look for the ingredient “sugar” on each label. Also note its position in the listed ingredients, which indicates the quantity of sugar in the product compared with other ingredients. Help students identify different forms of sugar from the ingredient listing. The students may be surprised to see which products contain sugar. Include breakfast cereals; many are very high in sugar. Compare 100% fruit juice and soda; students may be surprised by the amount of sugar in juice and energy or sports drinks. CLASSIFICATION OF CARBOHYDRATES Monosaccharides Disaccharides Sugar Alcohols Give examples of the foods in which glucose is naturally found. Discuss the ongoing debate and concerns over high - fructose corn syrup. Review information about some products that surprisingly have added sugar. Have a diabet es nurse come in to speak about  Discussion Topic: Have students give some examples of products they have chosen 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 one product with added sugar that they could eliminate and replace with something healthier.  Discussion Topic: Discuss the popular low - carb and no - carb diets, evaluating both their benefits and their dangers.

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    TEACHING STRATEGIES Content Focus Content H ighlights Learning A ctivities Polysaccharides alternative sugar options used in foods marketed for diabetic patient s. Discuss any warnings that should be noted when consuming these products. Have the nurse also address the importance of diabetic patient understanding of the glycemic index. Analyze the available information about resistant starch. With student input, make a comparison list of the benefits of resistant starch and dietary fiber. IMPORTANCE OF CARBOHYDRATES Emphasize the major sources of complex carbohydrate forms, such as cereal grains, legumes, potatoes, and other vegetables. Discuss foods that supply these in the diet. Refer to the Perspectives in Practice Box, Cutting Down on Sugar.  Presentation Activity: Assign various topics concerning carbohydrates to students and ask them to prepare short reports for class presentation. Examples of topics of current interest and importance include comparison of breakfast cereals, NNS , sugar and hyperactivity, sugar and dental caries, fiber and heart disease, and phytochemicals and cancer. FUNCTIONS OF CARBOHYDRATES Energy Special Functions Discuss how protein is needed not only for energy demands but also for tissue building and repair and urgent muscle responses to immediate demands of the body. Review Table 3 - 4.  Discussion Topic: Discuss the importance of having a good breakfast in the morning to provide the brain with an adequate amount of glucose to function properly. Discuss whether students notice an appreciable decline in their mental capabilities when they skip breakfast. Discuss how important it is for patients with dementia or memory problems to have a balanced breakfast. RECOMMENDED INTAKE OF CARBOHYDRATE Dietary Reference Intakes Acceptable Macronutrient Distribution Range Nonnutritive Sweeteners Review Box 3 - 4 and discuss the Acceptable Macronutrient Distribution Range (AMDR ) . Estimate how closely the average consumer comes to following the AMDR in their diet. Review Table 3 - 5, which compares the properties of Food and Drug Administration ( FDA ) - approved n onnutritive s weet e ners (NNSs ) . The text mentions two recently approved NNS s , l o h an g uo and stevia. Discuss the available information about these new NNS options.  Group Activity: Many consumers are concerned about the h ealth effects of NNS. Assign students to small groups and have each group investigate the dangers of a particular NNS. Are there valid objections to NNS , and if so, what studies support them? CARBOHYDRATES AND Show a video of how dental caries breaks down  Activity: Ask students to evaluate their carbohydrate sources according to

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    TEACHING STRATEGIES Content Focus Content H ighlights Learning A ctivities ORAL HEALTH tooth enamel. MyPlate. IMBALANCES IN CARBOHYDRATE INTAKE High - Carbohydrate Diets Low Carbohydrate Diets High - carbohydrate diets put a heavy demand on the pancreas for insulin production and release. Explain why this is concerning and what it means in terms of overall health and body function. Examine both the positive and negative effects of low - carb ohydrate diets. Discuss how the reduction of one nutrient may affect the absorption o f another.  Research Activity: Have students choose a popular high - carb or low - carb diet to investigate. What claims do the proponents of the diets make in terms of weight loss, overall health, and general nutrition? Are these claims supportable by serious, valid research studies? FIBER: THE NONDIGESTIBLE CARBOHYDRATE Types of Fiber Dietary Fiber Functional Fiber Discuss the importance of each type of dietary fiber and the consequences of inadequate intake. Take a survey of the class to find out if the students regularly use flaxseed in their cooking to increase fiber intake and improve colon health. Have students make a class list of products that have added functional fiber.  Discussion Topic: Have students review Box 3 - 5 and Table 3 - 6 and evaluate their recent fiber intake based on the foods listed.  Activity: Using the Food Composition Table located on the student web site, ask students to evaluate their own carbohydrate and fiber intake for 1 to 3 days. Evaluate the diet in the following manner:  Determine total grams of carbohydrates and percentage of kcalories from carbohydrates.  Determine total grams of fiber.  Determine whether carbohydrate kcalories were from simple or complex sources.  Determine grams of sugar eaten  Determine food sources of dietary fiber. HEALTH PROMOTION Health Benefits of Fiber Recommended Fiber Intake One of the major benefits of fiber is its ability to bind to cholesterol in the small intestine and prevent its absorption. Discuss as a class how eating high - fiber foods with high - cholesterol foods should help control blood cholesterol. Review the recommended fiber intake for both men and women and discuss why Americans seldom ingest the recommended amount.  Class Activity: Have students bring in two types of snacks to share with the class: one snack that is high in fiber and requires intensive chewing and another snack that is lower in fiber and easier to eat. Have them discuss the differences in texture and in hunger satiety. Discuss what personal recommendations they could make to their patients about high - fiber products that taste good and eliminate hunger. FUNCTIONAL FOODS: SPECIAL CARBOHYDRATE FOODS Discuss the importance of eating unprocessed, raw foods in order to obtain the nutrients functional foods offer.  Online Activity: Research advertising about functional foods, find a specific claim about a certain food, research its validity, and share this information with the class.

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    TEACHING STRATEGIES Content Focus Content H ighlights Learning A ctivities DIGESTION - ABSORPTION - METABOLISM REVIEW Digestion Absorption and Metabolism Review the importance of the pancreas and the sma ll intestines in the digestion, breakdown, and absorption of carbohydrates. Start in the mouth and discuss events as you progress through the gastrointestinal tract. IN - CLASS / ONLINE CASE STUDY Christina was a cheerleader and prom queen in high school. She is now married with three children and is about 40 lb heavier than when 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 a low - carbohydrate diet book , and she has been following it for about a week, eating mostly meat, chicken, fish, cheese, eggs, salad, and vegetables. She has found that she feels quite satisfied and has already lost 6 lb. But she is also noticing that she feels weak and lethargic. 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 make glucose for her brain and other body tissues to function. Her muscles are also using more fatty acids for energy. This is metabolically inefficient and causes tiredness. Cognitive Level: Knowledge 2. Why is it potentially dangerous for Christina to continue this diet plan? Correct Answer: Christina is not getting enough servings of vegetables, fruits, and grains to get all the nutrients her body needs. Plus, her extreme carbohydrate restriction could cause accumulation of ketones from fat breakdown, which could be dangerous if she develops

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    ketoacidosis. This can result in loss of water and dehydration, which may account for most of her weight loss so far. Her relatively high protein intake may place a strain on her kidneys because deamination of excess amino acids creates more waste to be excreted. And her relatively high fat intake may increase cardiovascular risk. Cognitive Level: Knowledge 3. 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 using MyPlate guidelines to design a well - balanced and varied eating plan. Controlling portion sizes, limiting added sugars and fats, and getting regular exercise would help her stay healthy and look her best. NURSING CURRICULUM STANDARDS QSEN / NLN COMPETENCIES  Patient - Centered Care/Human Flourishing o Focus on Culture Box : Who Eats More Fiber?  Evidence - Based Practice/ Spirit of Inquiry o Evidence - Based Practice Box: Do Nonnutritive Sweeteners Help You Lose Weight?  Safety/Nursing Judgment o Focus on Food Safety: Honey NURSING CONCEPTS The following conceptual themes and specific concepts match tho se presented in Giddens, J. R. (201 7 ). Concepts for nursing practice (2 nd ed.) . St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspon d to the Schlenker textbook. A full Concept - Based Curriculum Map covering the entire book can be found in the “ Download by Resource Type ” folder on Evolve.

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    Health Care Recipient Concepts THEME: Personal Preferences  Concept: Culture o Exemplar: Dietary Importance o Exemplar: Recommended Fiber Intake o Exemplar: Focus on Culture Box : Who Eats More Fiber? Health and Illness Concepts THEME: Homeostasis and Regulation  Concept: Glucose Regulation o Exemplar: The Nature of Carbohydrate  Concept: Elimination o Exemplar: Functional Fiber THEME: Protection and Movement  Concept: Inflammation o Exemplar: Carbohydrates and Oral Health  Concept: Infection o Exemplar: Carbohydrates and Oral Health  Concept: Tissue Integrity o Exemplar: Functional Foods: Special Carbohydrate Foods Professional Nursing and Health Care Concepts THEME: Care Competencies  Concept: Evidence o Exemplar: Nonnutritive Sweeteners  Concept: Safety o Exem plar: Focus on Food Safety: Honey BSN ESSENTIALS  Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety o Focus on Food Safety: Honey  Essential III: Scholarship for Evidence - Based Practice o Evidence - Based Practice Box: Do Nonnutritive Sweeteners Help You Lose Weight?

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     Essential IX: Baccalaureate Generalist Nursing Practice o Focus on Culture Box : Who Eats More Fiber? ANSWERS TO QUESTIONS IN THE BOOK Note: Answers to these question s can be found on Evolve site. Click here .

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    Chapter 04 - 1 TEACH FOR NURSES LESSON PLAN Chapter 4 : Lipids CHAPTER OBJECTIVES 1. 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; cis versus trans fats ; 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 the adequate 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 RESOURCES understand  Textbook Chapter 4  Animations: o CV016 Coronary Artery Disease  Food C omposition T able apply  Review Questions (Evolve)

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    Chapter 04 - 2 synthesize  Nutritrac Nutrition Analysis Software 5.0 INSTRUCTOR RESOURCES before 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 plans after class  Test Bank (Evolve) TEACHING STRATEGIES Content Focus Content H ighlights Learning A ctivities LIPIDS IN NUTRITION AND HEALTH Health Issues and Lipids Functions of Lipids Discuss the differences between the good fats (polyunsaturated and monounsaturated fatty acids) and bad fats (saturated and trans fats). Examine where these fats can be 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 lipids and how those lipids enhance the taste and texture of those foods.  Online Activity: Have students search the Internet for articles about good fats and the importance of ingesting proper amounts. PHYSICAL AND CHEMICAL NATURE OF LIPIDS Physical Characteristics Chemical Characteristics Bring in several i tems that most consumers think are mainly carbohydrates and have the students read the labels to discover how much fat these items actually contain. Display a picture of the molecular structure of both a carbohydrate molecule and a lipid molecule. Discuss the differences between them. • Community Activity: Have students take an inventory of the snack items in their cabinets at home and bring a list to class to discuss. Examine how many items have a high fat content. Discuss whether there are similar snacks that are healthier. FATTY ACIDS AND TRIGLYCERIDES Discuss what type of helpers long - chain fatty acids need to enter the lymph and then the blood.  Research Activity: Have students find a scholarly article about medium - chain triglyceride oil and discuss its primary consumers and its uses.

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    Chapter 04 - 3 TEACHING STRATEGIES Content Focus Content H ighlights Learning A ctivities Characteristics of Fatty Acids: Chain Length Characteristics of Fatty Acids: Saturation Essential Fatty Acids Discuss and display the molecular composition of saturated, monounsaturated, and polyunsaturated fats while reviewing their sources and their contribution to bodily functioning. Review the roles of linoleic and α - linolenic acid. Define the term essential as a nutritionist uses it. Differentiate between essential and nonessential . Be sure to explain why linoleic fatty acid is the true essential fatty acid.  Research Activity: Have students read about the possible link between high levels of fish oil and the increased risk for prostate cancer. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3145396/ FOOD LIPIDS AND HEALTH Degree of Saturation Cis V ersus Trans Fats Visible and Hidden Fat Acceptable Macronutrient Distribution Range Appropriate Intakes of Fat and Carbohydrate Use Figure 4 - 2 to show the spectrum of food fats from saturated to unsaturated. Refer to Table 4 - 1 for a summary of the health effects of fatty acids. Ask students to list visible fats and invisible fats. Emphasize that it is not always obvious when foods have a high fat content. Refer to Box 4 - 4. Use the Focus on Culture B ox, Developing a Food Frequency Questionnaire for Culturally Diverse Groups, to discuss the difficulty of identifying hidden fats, especially in ethnic foods, which may be unfamiliar. Discuss how appropriate dieting should be addressed with patients so that they understand the need for particular nutrients in the proper quantities. Explain that cutting down on the excessive intake in one area can lead to increased intake in another area. A proper balance is the key to a healthy diet.  Group Activity: Provide each of the student groups with a diet plan that is lacking in some area. Have them discuss how to adjust the diet so that it includes all the proper nutrients at acceptable levels. Present them to the class and discuss any additional adjustments.  Online Activity: Write out a typical lunch from a fast - food restaurant and a typical brown bag lunch. Use the Food Composition Table located on the student w e b site to calculate (1) the total grams of fat and (2) the percent of total kcalories that come from the fat in the two meals. What makes the difference between these two meals? LIPID - RELATED COMPOUNDS Cholesterol Lipoproteins Cholesterol, Lipoproteins, Review the functions of cholesterol, emphasizing that it has many important functions and is found in products with other essential nutrients. See the Evidence - Based Practice B ox, Plant Sterols: Weapon for Lowering Blood Cholesterol Levels, for more information about plant sterols.  Activity: Have students bring in food products that have the following terms on their labels: hydrogenated, polyunsaturated, no trans fatty acids. Have them classify the type of fat/oil in the food product according to degree of saturation. Bring in shortenings, coffee creamers, margarine, crackers, frozen desserts, whipped toppings, egg substitutes, milks, and oils.

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    Chapter 04 - 4 TEACHING STRATEGIES Content Focus Content H ighlights Learning A ctivities and Cardiovascular Risk Show a picture or a video of lipid conversion and transport. Evaluate how both fat intake and genetic factors affect a person’s cholesterol level and risk for cardiovascular disease. HEALTH PROMOTION Lowering Fat Intake Fat Replacers Discuss the use of fat replacers , such as fruit purees , and examine those approved by the Food and Drug Administration ( FDA ) . Explain how fruit, whole grains, and low - fat dairy snacks are better than items made with fat replacers. Compare the nutrients in a pear, a whole grain bagel, a serving of low - fat yogurt, and a serving of an item made with a fat replacer.  Activity: Have students bring in food advertisements that emphasize low - fat and reduced - fat products and discuss the claims made for them, if any.  Activity: Have students calculate the amount of fat in their own diet and identify major sources of saturated and unsaturated fats. Students may also identify major sources of visible and hidden fat in their diets. Many students will be surprised at their findings. DIGESTION - ABSORPTION - METABOLISM REVIEW Digestion Absorption Metabolism Discuss how important the secretions of the small intestines are in preparing lipids for digestion and absorption. Review the three stages of lipid absorption. See Figure 4 - 5 for clarification and visual assistance. IN - CLASS / ONLINE CASE STUDY Most of Damon’ s relatives have developed type 2 diabetes by the time they are in the 60s. Damon is determined that this will not happen to him , so he has always avoided sweets and kept his carbohydrate intake low. He eats mostly meats, cheese, fruits, and vegetables and only small amounts of bread, tortillas, rice, and baked goods. He assumed that this way of eating would help h im maintain a healthy weight, but he’s now almost 40 and his weight has gradually crept up 40 lb in the p ast 10 years. 1. Why do you think Damon is gradually gaining weight? Correct Answer: Damon’s diet is low in carbohydrate but is relatively high in fat, which adds significant extra energy. Cognitive Level: Knowledge

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    Chapter 04 - 5 2. What changes could Damon make to reverse his gradual weight gain as well as decreasing his risk for developing type 2 diabetes. Correct Answer: Damon could decrease his portions of meats, poultry, and cheese and eat more legumes and grains, focusing especially on whole grains such as whole wheat bread, brown rice, wholegrain pasta, and wholegrain tortillas. This will decrease the fat content and energy content of his diet without increasing his risk for developing type 2 diabetes. The extra fiber will further help decrease his risk for type 2 diabetes as well as helping to reduce his LDL - cholesterol level. Damon could visit www.ChooseMyPlate.gov to help him design a food plan that includes appropriate amounts of foods from all the food groups. Losing the weight he has gai ned will, in itself, reduce his risk for type 2 diabetes. Cognitive Level: Application NURSING CURRICULUM STANDARDS QSEN / NLN COMPETENCIES  Patient - Centered Care/Human Flourishing o Health Issues and Lipids o Focus on Cultur e Box: Sources of Fat in the Diets of Culturally Diverse Groups  Evidence - Based Practice/ Spirit of Inquiry o Evidence - Based Practice Box: Plant Sterols: Weapon for Lowering Blood Cholesterol Levels NURSING CONCEPTS The following conceptual themes and specific concepts match tho se presented in Giddens, J. R. (201 7 ). Concepts for nursing practice (2 nd ed.) . St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored spe cifically to correspond to the Schlenker textbook. A full Concept - Based Curriculum Map covering the entire book can be found in the “ Download by Resource Type ” folder on Evolve. Health Care Recipient Concepts

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    Chapter 04 - 6 THEME: Personal Preferences  Concept: Culture o Exemplar: Focus on Culture Box: Sources of Fat in the Diets of Culturally Diverse Groups Health and Illness Concepts THEME: Homeostasis and Regulation  Concept: Nutrition o Exemplar: Lipids in Nutrition and Health Professional Nursing and Health Care Concepts THEME: Health Care Infrastructures  Concept: Health Policy o Exemplar: Cis V ersus Trans Fats BSN ESSENTIALS  Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice o Focus on Culture Box: Sources of Fat in the Diets of Culturally Diverse Groups  Essential III: Scholarship for Evidence - Based Practice o Evidence - Based Practice Box: Plant Sterols: Weapon for Lowering Blood Cholesterol Levels  Essential V: Health C are Policy, Finance, and Regulatory Environments o Cis V ersus Trans Fats  Essential IX: Baccalaureate Generalist Nursing Practice o Focus on Culture Box: Develop Food Frequency Questionnaires for Culturally Diverse Groups ANSWERS TO QUESTIONS IN THE BOOK Note: Answers to these question s can be found on Evolve site. Click here .

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    Chapter 05 - 1 TEACH FOR NURSES LESSON PLAN Chapter 5 : Proteins CHAPTER OBJECTIVES 1. 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 terms anabolism and catabolism and 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 R ange for protein. 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 RESOURCES understand  Textbook Chapter 5  Food Composition Table apply  Review Questions (Evolve) synthesize  Nutritrac Nutrition Analysis Software 5.0 INSTRUCTOR RESOURCES

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    Chapter 05 - 2 before 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 plans after class  Test Bank (Evolve) TEACHING STRATEGIES Content Focus Content H ighlights Learning A ctivities PHYSICAL AND CHEMICAL NATURE OF PROTEINS General Definition Chemical Nature General Pattern and Structure Essential Amino Acids On the board, compare the structures of the amino acids listed in the text with each other and also with the structures of carbohydrates and fats. Discuss the dual nature of amino acids and how it responds to the body’s pH. Rev iew Box 5 - 1 for the categories of amino acids. Examine what acids are found in food and which are produced by the body.  Activity: Have the students draw out the structure of a simple amino acid and explain in their own words how these connect to build body proteins. THE BUILDING OF PROTEINS Protein Structure Types of Proteins Discuss the structure of body proteins and what researchers look for when trying to develop medications. Review the types of proteins listed, discussing how each protein’s structure makes it perfect for the job it needs to do.  Research Activity: Have students find a scholarly research article about proteins and their function within the body. Discuss what new information about proteins is the subject of discussion in the medical world. FUNCTIONS OF PROTEIN Growth, Tissue Bu ilding, and Maintenance Specific Physiologic Roles Discuss the importance of protein during the adolescent period, when bone and tissue are expanding rapidly. Examine what types of protein are best during this period. Review the physiologic roles of amino acids. Discuss whether proper ingestion of protein can prevent certain diseases such as Parkinson disease or glaucoma.  Discussion Topic: Have the students discuss their experiences with patients who needed specific types of amino acids to advance their recovery.  Interview Activity: Have students interview several people at a local gym about their protein ingestion. Do they pay special attention to their protein intake in regular meals and do they use protein drinks and other supplements?

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