Discussion Response total 4

1. After analyzing Sarah’s typical daily intake I choose her evening crave for chips and salsa.

Tracing Sarah recommended weight during pregnancy there should be a gain between 25 to 35 pounds for her second and third trimester 1lb/week.  Sarah is still within the normal  limits of  weight gain; she only gain 24 pounds. Analyzing the  macronutrient and micronutrients that may contribute to  Sarah’s excess weight gain example serving size1 basket of  chips and salsa  has 430 calories; Fat 22g daily value 46%; total Carbohydrates 52g daily value 46%; Protein 5g and Sodium 460mg. RDA for pregnancy is Carbohydrate 50%, Protein 20% and Fat 30% and Sodium 2300 mg. Sarah’s Carbohydrate and Fat intake in one serving is high and is a  factor in her weight gain. Factor that can contribute to Sarah having a high-risk pregnancy is developing  gestational diabetes it is diabetes diagnosed for the first time during pregnancy (gestation). Like other types of diabetes, gestational diabetes affects how cells use glucose.  Gestational diabetes causes high blood sugar that can affect Sarah’s pregnancy and her baby’s health (Mayoclinic, 2020). An example of gestational diabetes complication is excessive birth weight. Higher than normal blood sugar in mothers can cause their babies to grow too large. A very large babies  who weigh nine pounds or more are more likely to become wedged in the birth canal, have birth injuries or need a C-section birth.
Early (preterm) birth. High blood sugar may increase women’s risk of early labor and delivery before the due date. Or early delivery may be recommended because the baby is large (Mayoclinic, 2020).
 
Develop a nutritional plan to help Sarah reduce heartburn would include vegetable which is  low in fat and sugar and can help reduce stomach acid. Non-citrus food e.g. banana, melons, apple, and pear, are less likely to trigger reflux symptoms than acidic fruit. Healthy fats include avocado, walnuts, flaxseed, and olive oil. Lean meat and seafood such as chicken, turkey, and fish (Healthline, 2020).

2. The meal that I chose to analyze based on Sarah’s typical daily intake is ice cream. I chose this because ice-cream is one of my weaknesses and I wanted to research it for my own benefit too. Any nutrition gained from ice cream should be balanced against the downside. One cup of regular vanilla ice cream has 273 calories, 15 grams of total fat and 28 grams of sugar. The American Heart Association recommends that women should limit sugar intake to 20 grams a day, men should stop at 36 grams and children shouldn’t have more than 12 grams daily. The biggest problem with the fat content is that 70 percent of the total fat consists of saturated fats that can contribute to cardiovascular disease (Busch, 2018). Ice cream can easily make you gain weight especially if you are eating it on a daily basis and not staying active to burn off those extra calories and fat.

In order to prevent heart burn it would be helpful to eat little meals often throughout the day rather than 3 large meals. I would also advise her to eat slowly. It would also be important to avoid late night eating. Acidic foods. Watch out for other heartburn triggers like citrus fruits and juices, tomatoes, and tomato sauces. Foods that increase stomach acid Sugary, heavy, greasy, and fatty foods are harder to digest, which means your stomach needs to make more acid to break them down. Lying down Lying in a horizontal position can make it easier for acid to creep up out of your stomach into your esophagus. Eating too close to bedtime can also trigger heartburn if your body is still digesting a lot of food when you lie down. Stress can make heartburn worse, as well as make you reach for triggers like cigarettes, alcohol, or greasy comfort food. Making changes to your lifestyle and diet can make a big difference in managing heartburn. Notice which things you suspect may be causing your heartburn. You may even want to keep a heartburn diary for a while. The goal is to get better at making choices, not to totally eliminate triggers (What Causes Heartburn, n.d).
Some risk factors of high risk pregnancy are, advanced maternal age, life style choices, maternal health problems such as high blood pressure, pregnancy complications such as an abnormal placenta position, multiple pregnancies, and pregnancy history. Sometimes a high-risk pregnancy is the result of a medical condition present before pregnancy. In other cases, a medical condition that develops during pregnancy for either you or your baby causes a pregnancy to become high risk.
Prompt 1

3. Micronutrients such as carbohydrates, fat, protein, vitamins and minerals are all components of one’s diet (Panoff,2020).An infant needs the following requirements; Vitamin A, Vitamin C, Calcium, Iron ,Vitamin D, Vitamin E Thiamin, Riboflavin, Niacin , Folate, Vitamin B12,Biotin, Pantothenic Acid, Phosphorus, Iodine, Magnesium, Zinc , and Copper. Nutritionist Lauren Panoff suggests that the best source for an infant to obtain the adequate amount of micronutrients would be via breast milk. Infant formula will also provide the infant its nutritional needs of breast milk is not available.  The potential health consequences of such high intakes of some of these micronutrients can cause skeletal abnormalities (Amaro-Rivera, López-Cepero, Diaz, Lee, & Palacios, 2018).  Important health consequences associated with deficiencies in some of these micronutrients for infants include rickets (vitamin D and calcium), anemia (iron), growth retardation (zinc), and impaired immune function (zinc and vitamin E) (Amaro-Rivera, López-Cepero, Diaz, Lee, & Palacios, 2018).

     Encouraging kids to eat their veggies can be difficult. Nutrition for kids is based on the same principles as nutrition for adults (Hensrud,2020). Proteins, fruits, vegetables, grains, and dairy are a few of these components. An excess of sugar and poor diet in children can cause type 2 diabetes, coronary heart disease, and cancer in the long run (Haimi & Lerner, 2014). For example, instead of giving children canned fruits, or fruit cups, fresh or frozen fruits would be a better option since there is no added sugar or preservatives (Hensrud,2020). If a child has an insufficiency of Vitamin and minerals their immune system can become compromised. They would be more susceptible to viral infections. The most common nutrient deficiencies among school children are calcium, fiber, folate, iron, magnesium potassium, and vitamin E. A deficiency in Iron can cause a child to develop Anemia (Haimi & Lerner, 2014).
     Nutrition is important no matter at what age.  As we get older our bodies have different needs so there are certain nutrients that become important, for example eating the right amount of potassium may lower the risk of high blood pressure. If an older adult is not ingestion enough fiber, they can develop constipation. As we get older everything slows down including mobility in our gut (Klemm,2020).
 

4. Balanced nutrition is essential for all age groups. For infants, it is recommended that mothers breastfeed. However, if the mother is unable to, cow milk based formulas are recommended (Nutritionist Resource, n.d.). Breastfeeding has numerous health benefits, including lower risk for respiratory tract infections, asthma, diabetes, certain leukemias and sudden infant death syndrome (Dudek, 2018). The american Academy of Pediatrics recommends that infants be exclusively breastfed for the first 6 months. Solid foods can be introduced, however, mothers should still continue to breastfeed for 12 months to provide the infant with adequate nutrient intake.

 
 Children need adequate nutrients to aid their growing bodies. Their diets should include carbohydrates, fruits and vegetables, milk and dairy foods, protein and quality fats. Other than these food groups, a child also needs specific nutrients such as vitamins A, C, iron and zinc (Nutritionist Resource, n.d.). Calorie levels depend on the child’s age and gender. For females, calories needed are between 1600 and 2000, as for males it is 1600 to 2800 (Dudek, 2018). 
 
When entering adulthood, most of the body’s growth and development is done and the need for a nutritious diet changes. As people age, there is a decline in physical activity and a lower metabolic rate. Due to this, calories needed decrease by 5% every 10 years. Older adults tend to have progressive loss of lean body mass. To prevent this, older adults should increase protein intake to 1 to 1.6 g/kg/day (younger adults need 0.8 g/kg/day). Water intake is essential for older adults, as the risk for dehydration increases due to impaired mobility, impaired sensation of thirst, alteration in mental status and adverse effects of medications. Most older adults do not meet the recommended daily intake of 2.7 L/day for women and 3.7 L per day for men. As for vitamins and minerals, older adults need more calcium and vitamin D and women need to increase their daily intake of iron (Dudek, 2018). 
 
 
 
 
 
 

1. Discuss the micronutrient requirements for infants, children, and older adults. What health disparities will occur if there is an excess or deficiency in micronutrients for each age group? Use evidence from one scholarly source other than your textbook or ATI book to support your answer. Use APA Style to cite your source.
2. Review the following case study and answer the questions below. Use evidence from one scholarly source other than your textbook or ATI book to support your answer. Use APA Style to cite your source.

Sarah
Sarah is 28 years old and 7 months pregnant with her third child. Her other children are 2-1⁄2 and 1-1⁄2 years old. She had uncomplicated pregnancies and deliveries. Sarah is 5′ 6″ tall; she weighed 142 pounds at the beginning of this pregnancy, which made her prepregnancy BMI 23. She has gained 24 pounds so far. Prior to her first pregnancy, her BMI was 20 (124 pounds). She is unhappy about her weight gain, but the stress of having two young children and being a stay-at-home mom made losing weight impossible.
She went online for her MyPlate plan, which recommends she consume 2,400 calories per day. She doesn’t think she eats that much because she seems to have constant heartburn. She takes a prenatal supplement, so she feels confident that even if her intake is not perfect, she is getting all the nutrients she needs through her supplement.
 

• Based on Sarah’s typical daily intake, pick one meal and analyze the macronutrient and micronutrients that may contribute to excess weight gain.
• Develop a nutritional plan to help Sarah reduce heartburn.
• Discuss the factors that may contribute to a high-risk pregnancy.

 
Below typical day’s intake for Sarah.   
 
 
You must use an outside scholarly resource in addition to your text or ATI book when formulating the posts. All information from any source must be cited in APA format!! If you take information from a source without giving credit that is considered plagiarism. I am attaching an APA resource to help you format your resources.
Please contact me with any questions or concerns regarding about the discussion.
Example of an initial post
Hello Class,
Sarah’s attitude is not appropriate towards supplements. Supplements to help people meet their nutritional requirements, but it is still important to eat foods that will offer nutrients for her and the baby. They should not be taken instead of eating the foods that are recommended. Since she is pregnant, her caloric needs have increased. If she were to meet those caloric requirements, it will increase the absorption and efficiency of the supplements that she takes (Dudek, 2018). Supplements do not have any calories and will not contribute to the 2400 calories that she needs (Dudek, 2018). It is good that she is taking supplements, but she needs to try and consume healthy foods that will not agitate her heartburn
 
I would inform Sarah that her weight gain is within the normal range. With her BMI, her total pregnancy weight gain should be between 25-35 pounds (Dudek, 2018). I would tell Sarah that she should start eating healthy now, and incorporate foods that offer a high nutritional value to continue that habit after pregnancy. In order for her to lose weight, she should implement weight loss strategies in the early postpartum period in order for it to be the most effective (Dudek, 2018). She should start slowly and include exercise into her weight loss plan (Mayo Clinic, 2018). Breast feeding burns many calories and can aid with the reduction of weight after giving birth because it uses the fat that was stored during pregnancy to produce the milk to feed the baby (Mayo Clinic, 2018). If she is breastfeeding, she should remember that it is important to drink a lot of water especially if she is exercising to reduce the risk of dehydration. If she is having trouble finding ways to exercise because she has two younger children as well, she could join a group for mom’s for exercising (Mayo Clinic, 2018). There are several ways that she can regain her healthy weight, and it all starts with her willingness to improve and a healthy and balanced diet.
References
Dudek, S. (2018). Nutrition essentials for nursing (Eighth ed.). Philadelphia: Wolters Kluwer.
Mayo Clinic. (2018, July 13). How to get back in your pre-pregnancy jeans. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/weight-loss-after-pregnancy/art-20047813
 
 

Discussion Question 1
The COVID-19 Pandemic has presented the nation and health care organizations with an unforeseen emergency. This type of situation requires all health professionals to be leaders in their communities.
·  Review this article https://gacc.nifc.gov/cism/documents/leadership.pdf (ATTACHED)
·  Review the ANA statement calling for a collaborative effort to respond to COVID-19 at this link https://www.nursingworld.org/news/news-releases/2020/american-nurses-association-calls-for-collaborative-effort-to-respond-to-the-coronavirus/
Answer these questions:
1. In your present health care organization how well prepared is the organization and the staff to respond to the pandemic?
2. What was the nursing leaders’ response to the crisis?
3. Relate the response to the theories you learned in this course and the Crisis Leadership article.
4. What else should be done to improve the response? What is the leader’s role in this improvement?
5. How are you responding to the pandemic as a health care professional and leader?
As in all assignments, cite your sources in your work and provide references for the citations in APA format. Support your work, using your course lectures and textbook readings. Helpful APA guides and resources are available in the  University Online Library. Below are guides that are located in the library and can be accessed and downloaded via the  University Online Citation Resources: APA Style page. The American Psychological Association website also provides detailed guidance on formatting, citations, and references at APA Style.
 
June 2017 Page 1
questions:
Crisis Leadership
D
“The demonstration of caring is more
important than all other leadership traits
combined…..Caring during crisis response
is not a feeling. Caring is a set of corporate
and personal behaviors that elicit the
perception that you and your organization
truly care.”
“People tend to be resilient and have
coping mechanisms that allow them to
return to a state of balance that is much
the same as prior to the crisis situation or
event. This is not to say that those who
experience devastating events will not
experience difficult adjustments. They will.
But we know from experience that human
beings in crisis are adaptable.
Most people will recover and the recovery
process can be accelerated when leaders
and managers offer and provide support.”
Bruce T. Blythe
Author of Blindsided, a Manager’s Guide to
Crisis Leadership
Interagency Critical Incident Stress Management Program
Crisis Leadership: is more about who you are than what you
know. Effective leaders connect deeply with their people,
nowhere more than during a crisis. No set of preparedness
strategies, or leadership techniques, will overcome a lack of
character, ethics or integrity.
Communication: is the single most important action you can
take. The process involves not only how you listen in order to
obtain the facts but also how well you speak openly and clearly
with those impacted, their families, cooperators, upper level
management and the public.
Anticipation: Good crisis leaders look out the windshield of the
crisis to identify what is on the horizon and balance their
perspectives on immediate and short-term focus; keeping in mind
where they and the organization may be headed.
Delegate: The only way to manage rapidly emerging issues
following a critical event is to utilize resources available to you.
Assess priority issues and enlist available persons to take action
on the delegated tasks. Doing so puts you in a position to
continue addressing the crisis.
Reactions: Ultimately, strategic crisis management is about
managing the reactions of people. Whether the crisis involves
multiple deaths or injuries, a suicide or other incident, the steps
you take will be to manage the reactions of people.
Be visible, open, and available: Highly visible leaders who
communicate directly with employees tend to be more effective
than those who are not accessible and communicate through
email rather than in person.
Leadership is always an opportunity to reinforce and build trust,
confidence, and workplace cohesiveness. When done well,
employees will feel cared about, supported, and secure in the
knowledge that leadership is both compassionate and competent.
Feeling cared about and supported in the immediate aftermath of
a traumatic event is hugely important in the healing and recovery
process.
Confidence in Leadership, Their Mission
and Hope for the Future
June 2017 Page 2
Safety:
 Ensure physical safety: remove people from the
incident site and treat their physical injuries.
 Avoid unnecessary exposure of other staff,
media, and the public.
The Single Most Important Action is Calm Effective
Communication:
 Don’t be afraid to say, “I don’t know.”
Particularly in the first few hours after a
tragedy, information will be scarce and likely
inaccurate.
 Keep staff informed and prevent the spread of
rumors. Provide information about the status of
the event, any ongoing emergency support,
and the health status of anyone who has been
injured.
 Avoid statements like “it will be alright” or “I
know how you feel.” Phrases such as these
may cause an individual to think their feelings
are not understood.
Connectedness with Peers, the Organization,
Family
 Don’t send people home or put them on leave if
at all possible. It is far better (i.e. less likely
post traumatic illness symptoms will follow) if
they get on with a routine and are with “the
team.”
 Immediate support is best provided by being
with and sharing experiences with work
colleagues and friends, rather than separating
them.
 Wherever possible, re-establish normal working
routines as soon as possible, albeit gently and
flexibly, and enable people to talk about what
has happened as they work, thereby avoiding
any onset of denial.
 If leave is required find out what employees are
planning to do with their time once they leave
work and check in with them by phone.
Encourage them to spend time with friends or
family members.
The Skills and Resources to Cope
 Ask employees and managers to be on the
lookout for those who are in obvious need of
help and bring them to your attention.
 Consider professional crisis intervention.
 Employees who have experienced trauma
respond best to information, structure, and
instructions on what to expect next.
Support after a Critical Incident
Managers who have experienced a critical incident offer
these insights on what they experienced after the
incident.
Effects on Managers
 “I was surrounded by people, but felt all alone.”
 Others have been through similar things like
this, but no one has been through this (my
situation and the loss, injury or other events
involving this organization and these
individuals.)
 “After the death, I recognized responsibilities
that I didn’t even know I had.”
 The difficulty of losing an employee who is also
a dear friend and how to address the multiple
facets that the loss represents.
 The feeling that, as a manager, you must “be
the things to all people” and the effects that has
on personal and professional life.
 The difficulty and importance of seeking and
accepting help.
 How a critical incident affects the manager’s
family, especially the spousal relationship.
 A critical incident, especially a line of duty death
often affects the way managers feel about the
work they have always loved. “I used to look
forward to fighting fires. Now I dread it when I
get the call.”
 Some managers felt relief that they pushed
hard for safety before the incident. Others felt
frustrated that they had done everything right
and still experienced severe injury or lost
someone.
 Feelings of guilt and responsibility. “Could I
have done more?”
 There is no way around feeling guilt after a
critical incident not matter what the
circumstances. But you can’t let it consume
you or play the “what if game.”
 “The experience forced me to learn. “
What Happens to Managers after a
Critical Incident?
D

#1.  The mother of a 10-year-old girl has brought her to the clinic based on concerns expressed by the school nurse.  The teacher has noted times when the girl appears to be daydreaming; however, after the nurse witnessed a few of these incidents, she has recommended the child be evaluated for absence seizures.  The mother is not totally convinced that is true, however, is willing to find out.
A.  How would you respond to this mother?
B.  What patient centered care will be appropriate here?
C.  What safety measures should the parents be encouraged to follow?
#2. You are assessing a child’s vision and notice the child is unable to correctly answer her questions when shown the Ishihara color plates.  When questioning the mother, you discover that the child has not understood the colors but the mother has just assumed the child was slow.
A.  How would you proceed?
B.  What care would you provide in this case?
C.  How will you know the nursing care plan was effective for this child?
#3.  The parents have brought their 3-year-old son to the clinic for an evaluation.  They are concerned something is wrong because he cannot seem to move like he used to and is having difficulty climbing up and down the stairs.
A.  How would you respond?
B.  What patient-centered care should you develop?
C.  You recognize that this patient will need assistance from other departments.  Which additional team members will be able to assist this patient and his family?
#4.  A mother has brought her 4-year-old daughter to the emergency department.  She didn’t realize her husband had sprayed the lawn with a pesticide and allowed their daughter to play in the yard.  She now comes in with complaints of nausea, vomiting, difficulty breathing, and confusion.
A.  How would you respond?  What are you initial interventions?
B.  How can you help the family?
C.  What are some nursing diagnoses that would be appropriate for this situation?
#5.  The parents are in denial demanding a second opinion.  The physician has just informed them their 2-year-old son has a glioblastoma.  Devastated, they ask the nurse, “How can this happen to us?”
A.  How would you respond?
B.  What are some nursing diagnoses you would identify in this situation (more than 1 please)
C.  What are some expected outcomes related to your nursing diagnoses? (should have an outcome for every diagnoses)