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Instructor’s Guide to Accompany Nutrition & Diet Therapy, 10th Edition, by Ruth
A. Roth

Chapter 1: The Relationship of Nutrition and Health

Key Terms

anthropometric measurements
atherosclerosis
biochemical tests
caliper
carbohydrates (CHO)
circulation
clinical examination
cumulative effects
deficiency diseases
dietary-social history
dietitian
digestion
elimination
essential nutrients
fats (lipids)
food diary
goiter
iron deficiency
malnutrition
minerals
nourishing
nutrient density
nutrients
nutrition
nutrition assessment
nutritional status
nutritious
obesity
osteomalacia
osteoporosis
peer pressure
proteins
respiration
rickets
24-hour recall
vitamins
water
wellness
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Objectives

After studying this chapter, you should be able to:

• Name the six classes of nutrients and their primary functions

• Recognize common characteristics of well-nourished people
• Recognize symptoms of malnutrition
• Describe ways in which food and health are related
• List the four basic steps in nutrition assessment

Learning and Teaching Strategies

1.  Assign each student a partner. Have them assess each other for the physical
characteristics of good nutrition (hair, skin, eyes, etc.) and for elimination and sleep
patterns, followed by a discussion with the partner to correlate the findings with the
dietary habits of the person. What conclusions can be deduced about the nutritional habits
of each other?

2.  Have the students search the web for a variety of sites that have computer analysis
capabilities to evaluate their nutritional intake.

3.  Have each student keep a five-day food diary and use the previously researched web sites
to perform a computer analysis of the foods consumed. Evaluate the results for
consumption of adequate nutrient intake. (Remind students to keep the diary as it may be
used later, at the instructor’s discretion. References to it are in the Discussion Questions).

4.  Have students complete a 24-hour recall. In groups of four or five, have them compare
and discuss their nutritional intake. Each group should summarize results and present to
the class examples of optimal nutritional intake and examples of a diet with inadequate
nutrient intake.

5. Invite a dietitian or a physician to discuss the relationship between biochemical test

results and the results of other blood tests, including nutritional status and the indication
of any disease processes that may be the result of poor nutritional intake.

Discussion Question 1

The author of the text notes that, “Nutrition and diet choice is a logical starting point for
preventive health care measures and education to improve quality of life.” Have students explore
community agencies that offer preventive health care programs that deal with nutrition. Have
them differentiate which are community funded, state funded, or federally funded. Describe the
services provided, the age groups it serves, and the disease or health problem it serves. These can
be presented in class as a discussion group.
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Discussion Question 2

Have students determine community projects that offer any type of preventive health programs
for community members. There are a multitude of projects available to residents, but the
community members may not be aware of the resources.

1. Have students determine what community resources are available that focus on
preventive health.

2. What methods do they use to let the public know what is available?

Help the students become advocates for preventive health care during a group discussion focused
on “the help is there, but the message may not have gotten out.”

Answers to Review Questions

1. c
2. d
3. b
4. b
5. a
6. c
7. b
8. c
9. c
10. b
11. d
12. b
13. d
14. a
15. d

Case in Point—Gary: Fending for himself

Gary, a 7-year-old Caucasian boy, was discovered searching a garbage can by a police officer.
The officer noticed that Gary was dirty, unkempt, and thin. His skin was pale.
Gary was taken to the police station, where he was turned over to social services.
Gary told social services that his mother had been sick and was taken to the hospital; he had not
seen her for many months. He did not know what hospital she was in, and he had been alone all
this time. He told the social worker that he had run out of food immediately after she left; he had
been able to survive by searching for food behind restaurants and in garbage bins. Social services
brought Gary to the local hospital, and upon examination, it was found that Gary had a distended
abdomen, serosanguinous sores on his body, and swollen and painful lower limbs. Gary limped
and found walking very tiring.
ASSESSMENT
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1. Identify three distinguishing signs of malnutrition.

a. Swollen and painful lower limbs
b. Distended abdomen
c. Body sores
2. What would you introduce first into Gary’s diet?
a. Essential nutrients
3. How frequently would you offer nutrition and how large a portion?
a. Small meals frequently throughout the day
4. What other signs of malnutrition would you expect to find?
a. Spindly arms
b. Poor hair quality
c. Dull expression
DIAGNOSIS
5. Write a nursing diagnosis for Gary.
a. Altered nutrition related to inadequate intake of balanced diet and water-
soluble vitamins (thiamine, folic acid, and pyridoxine) in subnormal living
conditions
PLAN/GOAL
6. What two changes can you predict will occur with the introduction of a good,
nutritionally sound diet?
a. Improved skin conditions
b. Abdominal bloating to decrease
7. Whom can you refer to for assistance?
a. Social services
b. Possible family members
IMPLEMENTATION
8. Name at least three methods that could be employed to improve Gary’s nutrition.
a. Offer small amounts of nutritious foods frequently
b. Identify the foods Gary likes
c. Prepare the foods in an appetizing way
9. Could a food diary be helpful?
a. In this case no because of Gary’s age and possible fear of admitting what he
ate
10. Would a home visit be beneficial for Gary and a caregiver?
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a. Yes, for reassurance that Gary is thriving

EVALUATION/OUTCOME CRITERIA
11. What could the doctor measure at the next appointment to see if the plan is working?
a. Weight
b. Blood labs for albumin
c. Overall appearance
12. What observations could the caregiver offer about the success of the plan?
a. Change in Gary’s appearance
b. Mental status changes
c. Gary’s contentment
13. What could be an important piece of information from Gary?
a. Gary stating that he feels stronger and is gaining weight
THINKING FURTHER
14. How could the Internet be of benefit to the caregiver?
a. Research ways to help Gary adjust to the new home situation
15. Who would also benefit from this information?
a. Gary

RATE THIS PLATE

Gary has been through a lot of heartache for a child his age. Gary is placed in a foster home, and
his foster mother asks him what he would like to eat for his first dinner with them. He thought
and thought and finally decided on the following plate. Rate this plate. Take into consideration
that Gary is malnourished, has not eaten much lately, and is lacking many nutrients.
Fried chicken—leg and thigh
1/2 cup mashed potatoes and 2 Tbsp gravy
1/2 cup corn with butter
Biscuit with butter
2% milk—8 oz
Can Gary eat all of this, and should he? Does this plate need to be changed, and how would you
change it?

ANSWERS TO RATE THIS PLATE FOR GARY

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Gary has not eaten much, and so this plate is too much food. Gary should be started on a vitamin
and mineral supplement in the form of a one-a-day vitamin with no more than 100% for each
nutrient.
Calories are given first in the form of carbohydrates, simple sugars, and fats. Proteins are started
after other caloric sources have already provided the necessary energy.
The caloric density of the plate is too high. At first, small amounts of food need to be offered.
Gary may have thought this was what he wanted, but his body would not be able to handle the
volume.
Many malnourished children develop lactose intolerance and will have to drink milk with the
enzyme lactase added to it to break down the lactose (the milk sugar).

Case in Point—Shannon: Making That Prom Dress Fit

Shannon was a healthy 16-year-old Asian girl who was so happy to return to school this year.
This is her junior year of high school, and she has been looking forward to attending the junior-
senior prom with Mike.
Shannon is very active in cheerleading, Photo Club, gymnastics, and swimming. She has decided
to join the Prom Committee this year so she can help plan the best prom that Wayne High has
ever seen. Shannon has begun to look for prom dresses knowing that she will need to be saving
every cent she can to afford the most perfect dress. Shannon has decided that she would like to
lose a few extra pounds before the prom and decides to go on a strict diet.
Shannon’s friends have noticed that the once perky, playful superstar of the swimming team has
been losing her “shine.” She has dull limp hair, which is a total change from the full head of
shiny, bouncy black hair. Shannon has developed a complexion problem and has started using all
kinds of acne products. Her skin is very oily and feels dirty all the time. Shannon’s friends also
noticed that she is not as pleasant as before, and Shannon has started to lose lots of her friends.
Shannon’s friend Ruth contacted Shannon’s mother and told her of her concerns. Shannon’s
mother agreed that she had also noticed the changes and would take Shannon to the doctor.
ASSESSMENT
1. Identify three changes in Shannon to suggest that she was getting into trouble.
a. Less energetic, lost her “shine”
b. Complexion problems
c. Attitude changes
2. What information would be important to share with the physician?
a. Shannon’s diet history
b. Her change in attitude and her unpleasantness
c. Her complexion changes
3. In which category of nutritional assessment would you list Shannon’s observations?
a. Anthropometric and biochemical assessments
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4. Which observation would you consider significant to cause concern?

a. Attitude changes
b. Lack of energy
c. Complexion changes
5. Is there any other information that you could have that would help identify Shannon’s
problem?
a. Is she showing signs of bulimia or anorexia?
DIAGNOSIS
6. Write a nursing diagnosis that most likely applies to Shannon’s problem.
a. Altered nutrition related to inadequate intake of balanced diet and water-
soluble vitamins or nausea and vomiting characteristic of anorexia or
bulimia
7. What contributed to the development of the problems?
a. Lack of confidence in her appearance
b. Desire to be like other girls
c. National obsession for weight
PLAN/GOAL
8. Who can help with the plan?
a. Parents
b. Friends
c. Dietitian
d. Physician
9. What two changes are most significant for Shannon?
a. Change in attitude
b. Change in appearance
IMPLEMENTATION
10. Name three methods that could be used to improve Shannon’s nutrition.
a. Add good, nutritious foods that do not allow for high calorie intake
b. Make mealtimes fun
c. Prepare meals that Shannon likes
11. How could friends and family help?
a. Provide encouragement that Shannon is working toward better health
b. Invite Shannon to dinner at her favorite restaurant
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c. Support Shannon’s efforts

12. How could a food diary help?
a. Identify quantity of foods, frequency of intake, and types of foods eaten
EVALUATION/OUTCOME CRITERIA
13. What can the doctor measure at the next appointment to see if the plan is working?
a. Shannon’s physical appearance
b. Shannon’s weight
14. What observations could Shannon’s mother offer about the success of the plan?
a. Shannon’s attitude toward family and friends
b. Shannon’s willingness to participate in the program
c. Shannon’s physical appearance
15. What information from Shannon would benefit the success of the plan?
a. How she feels about her appearance
b. How she feels about herself
c. How she cooperates with the plan
THINKING FURTHER
16. Who else could be at risk for the same or a similar problem?
a. Teenage girls
b. Young girls
c. All women with low self-esteem
d. People in need of being accepted
17. How could information from the Internet be useful?
a. Identify early signs and symptoms of anorexia and bulimia
b. Give information on where to get help
c. Identify the need for recognition of types of people who may fall under the
category of bulimic or anorexic

RATE THIS PLATE

Read this case study about Shannon again. Here is Shannon’s plate. Rate this plate.
For lunch Shannon has fixed herself:
1/2 peanut butter and jelly sandwich on white bread (1 Tbsp peanut butter and 1 Tbsp jelly)
Cup of tea with 1 tsp sugar
That was all she wanted. Answer the following questions about this plate:
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1. Was the amount of peanut butter sufficient? If not, why not? How would you change the
serving size?
2. Was the amount of jelly sufficient? If not, why not? How would you change the serving
size?
3. Was the bread the best choice? Why or why not?
4. Is there any other food or foods that you would like to add to this lunch and why?
5. Why do you think Shannon is experiencing changes in appearance and demeanor?

ANSWERS TO RATE THIS PLATE FOR SHANNON

1. Change the serving size of the peanut butter to 2 tablespoons.
2. The jelly should also be changed to 2 tablespoons. Jelly is full of sugar and should be
used sparingly, but Shannon can use the calories right now. A whole sandwich would be
ideal.
3. The bread would be more nutritious were it a multigrained bread with at least 3 grams of
fiber per slice. This bread provides more nutty taste with the peanut butter and jelly.
4. Add to the lunch three or four miniature carrots, a cup of vegetable beef soup, ½-cup
serving of fruit, and a glass of milk.
5. Poor nutrition can result in lost stamina, unhealthy skin, dull hair, and altered emotional
status.

Resource Guide

1. http://www.ajcn.org

The American Journal of Clinical Nutrition. This site is sponsored by the U.S.
government, and the reliable health information is selected by the U.S. Department of
Health and Human Services. Topics include: food safety, nutrition, obesity, osteoporosis,
and diabetes.

2. http://www.nutriwatch.org

Nutriwatch provides comprehensive information about nutrition and food safety. It

analyzes health claims made for nutrition-related products, warns about inappropriate
claims, and reports illegal claims for products to regulatory agencies.

3. http://www.nutrition.org

American Society for Nutrition. This site is sponsored by the American Society for
Nutrition. Icons are on the home page for MyPyramid, Dietary Reference Intakes (DRIs),
and Dietary Guidelines for Americans. Detailed research is provided for each nutrient,
vitamin and coenzyme, and mineral.
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