NUTRI LEC

BSN2C | MIDTERMS
NUTRITION IN PREGNANCY AND LACTATION 2. Blood Volume and Composition
Nutritional needs during pregnancy and lactation: o Bld. Vol. > Blood Components=
• Iodine Anemia
• Vitamin D, A, and C
• Protein 3. The Circulatory System
• Iron o Left Cardiac hypertrophy, leading to
PREGNANCY tachycardia and palpitations
• Usually from 38 to 42 weeks o Bradycardia- after delivery
• A non-pregnant woman needs 1500-2000 o Pregnancy Induced Hypertension.
calories, but if pregnant she needs additional
300 calories during the 2nd and 3rd trimesters. 4. Respiration
o changes to estrogen and growing
The basic principles of healthy eating that apply to fetus
healthy people are also appropriate before, during, 5. Renal function
and after pregnancy: o malnutrition and DHN (dehydration)
• eat plenty of fruits and vegetables of various
kinds and colors; 6. GIT function
• whole-grain bread and cereals; o due to hormones progesterone,
• lean protein foods estrogen, human chorionic
• low-fat or fat-free milk and dairy products gonadotropin.
• and healthy fats in moderation.
7. Weight gain
NOTE: As with the general public, sodium, solid fats, o weight before and during pregnancy
added sugars, and refined grains should be limited. should be documented.
"Low sodium intake should be observed
SOURCES OF FOLIC ACID by pregnant women"
• 100% fortified ready-to-eat breakfast cereals: White • Should be 2 to 4 Ibs by the end of 1st trimester
bread, rolls, pasta, and crackers (In the United States and approximately 1 lb a week
and Canada, enriched flour is required to be fortified • Thereafter
with folic acid.) o *Average weight gain (25-35lbs)
o Weight gain during pregnancy is
SOURCES OF NATURALLY OCCURRING FOLATE primarily water- up to 7 to 10 liters!
• Leafy green vegetables, o Weight before and after pregnancy
• spinach should be checked.
• Citrus fruits o 2 IMPORTANT Hormone during
• Dried peas and beans, such as lentils, pregnancy ESTROGEN &
soybeans, pinto beans PROGESTERONE
o low sodium intake should be
HEALTHY SUPPORT TISSUES observed
▪ high intake = water retention
Estrogen
• helps support the baby and the placenta, the
development of the organs of the baby
• Estrogen is also the key component of
menstruations, nataas ksai it helps to
regulates the menstrual cycle.

Progesterone
o creates a healthy uterine lining to support a
fertilized egg, embryo and fetus. If progesterone
levels are too low during pregnancy, it could
cause complications such as bleeding or
PHYSIOLOGICAL BASIS
miscarriage.
1. Brought by the three stages of pregnancy
a) Implantation
b) ORGANOGENESIS- Malnutrition
c) Growth
 3. Constipation
• Can result from relaxation of the cardiac
sphincter and smooth muscles related to
progesterone, may lead to haemorrhoids
o Can be relieved by eating high-fiber
foods, getting daily exercise, drinking
at least 13 glasses of liquid each day,
and responding immediately to the
urge of defecating
o DO NOT USE LAXATIVE.
▪ When laxative is used during
pregnancy, there will be a
contraction in the uterus.

4. Edema
• mild and PHYSIOLOGIC in the 3rd trimester,
PATHOLOGIC if accompanied with toxemia of
pregnancy.

5. Leg Cramps
• usually at night, manifested by sudden
contraction of the GASTROCNEMIUS
MUSCLE.
o may be due to Calcium-Phosphorous
imbalance

6. Rapid Weight Gain

• defined as an increase on weight of 3kg or
more during 2nd and 3rd trimester.

7. Weight Loss
• < 500 grams/mon (1st trimester)
• < 250 grams/mon (2nd trimester)
• “AT RISK”
PROBLEMS DURING PREGNANCY o Preterm deliveries, abortion, and
1. Nausea and Vomiting mental retardation.
• also known "morning sickness" 8. Pregnancy- Induced Hypertension (PIH)
o Eat dry crackers or dry toast before A. Pre- eclampsia-
rising H- Hypertension
o Ice chips E- Edema
o Eat small, frequent meals L- low platelet
o Avoid foods with offensive odors P- Proteinuria
o Avoid liquids at mealtime
o Hyperemesis gravidarum B. Eclampsia
(extreme/severe morning sickness)- • all plus "C" – Coma
life threatening – REQUIRE
HOSPITALIZATION 9. Anemia
• KETONURIA • Condition caused by an insufficiency of red
• NOT NORMAL > 3 TIMES blood cells, haemoglobin or blood volume
• Iron deficiency is the most common form
2. Heartburn • Folate deficiency can result in a form of
o Burning sensation beneath the chest megaloblastic anemia.
o May be relieved by eating small frequent
meals, avoid spicy of greasy foods, avoid 10. PICA
liquids with meals, waiting at least an hour • It is the craving for non-food substances such
after eating before lying down and waiting at as starch, clay (soil), or ice.
least 2 hours before exercising.
Gestational Diabetes Mellitus
• due to "STRESS". Close monitoring by health
care provider.
Nursing alert: CONTROL OF SUGAR!!!
CAN CAUSE:
1. IUFD- intra uterine fetal demise
2. Premature delivery
3. Macrosomia

Dietary Guidelines Key Recommendations For Who

Are Capable Of Becoming Pregnant And
Breastfeeding
Women of Childbearing Age Who May Become
Pregnant
• Choose foods that supply heme iron, which is
more readily absorbed by the body, additional
iron sources, and enhancers of iron
absorption such as vitamin G-rich foods.
• Consume 400 micrograms (g) per day of
synthetic folic acid (from fortified foods
and/or supplements) in addition to food
Best food for baby
forms of folate from a varied diet.
Reduce allergy
• Achieve and maintain a healthy weight
Economical
before becoming pregnant. This may reduce
Always Available
the risk of complications during pregnancy,
Safe
increase the chances of a healthy infant birth
Temperature is right
weight, and improve the long-term health of
both mother and infant.
Fresh
• Do not drink alcohol because alcohol can
Encourage maternal bonding
cause negative behavioural or neurologic
Ensure means of contraception
consequences in the offspring when
Digestible
consumed during pregnancy, especially
Immunity
during the first few months. A safe level of
Nutritious
alcohol intake during pregnancy has not
Good tooth and jaw
been established.

Women Who Are Pregnant or Breastfeeding
(Including Adolescent Girls)
• Consume 8 to 12 oz of seafood per week from
a variety of seafood types.
• Due to their high methylmercury content,
limit white (albacore) tuna to 6 oz per week
and do not eat the following four types of fish:
tilefish, shark, swordfish, and king mackerel.
• If pregnant, take an iron supplement, as
recommended by an obstetrician or other
health-care provider.
• If pregnant, consume 600 g/day of dietary
folate equivalents from all sources (natural
and synthetic)
• Pregnant women are encouraged to gain
weight. Maternal weight gain during
pregnancy outside the recommended range
is associated with increased risks for maternal
and child health.
• Pregnant women are advised to not drink
alcohol because a safe level of intake has not
been established. If breastfeeding women
choose to drink, they should wait until the
infant is at least 3 months of age and
consume only one drink, waiting at least 4
hours before breastfeeding.
Calorie Requirement
• 85 calorie required to produce 100ml milk
• Average daily milk production 750ml
(640calories)
• 6 mos. =600ml = 510 extra calories
• FNB=500 calories a day during lactation
• 1 ounce of human milk = 20 calories
• Lactation Specialist
• Experts on breastfeeding and help new
mothers who may be having problems such
as the baby not latching on properly.
Breastmilk
Room Temperature (66- 8-10 hours
72 degree F)
Refrigerator 8 days
Refrigerator freezer 3-4 months
Deep freezer 12 months
LESSON 2: NUTRITION IN INFANCY AND
CHILDHOOD
What is the best practice to feed an infant?
- breast milk is the perfect food for a baby's
digestive system. It has the nutrients that a
newborn need, and all of its components —
lactose, protein (whey and casein), and fat — are
easily digested.
- The first year of life is a time of phenomenal
growth and development. After the first year, a
 child continues to grow and change, but more 2) there is normal growth
slowly. Sound nutrition throughout infancy and 3) there is one or two mustard colored bowel
childhood promotes normal growth and movements a day
development; facilitates academic and physical 4) breast becomes less full during nursing
performance; and help prevent various diseases
in adulthood. This lesson examines the special Recommended Dietary Intake for Infant
nutrient needs of infants and children. • High protein and high calorie diet
Nutrient Needs during Infancy • Caloric intake should be 98-108 kcal/kg of
- An infant grows faster during the first year than body weight
ever again. Guidelines in Infant Nutrition
- The growth of infants and children directly • BREAST MILK is the best food during the first 12
reflects their nutrition status. months of life
- Healthcare professionals use growth charts to • A newborn can hold approximately 30 ml (2
evaluate the growth and development of children tablespoons)
from birth to 20 years of age. • Infant feeding should not exceed 240 ml (1 cup)
• Soy milk may be given if there is milk allergy
WHO Growth Standards Are Recommended for Use • Commercial iron-fortified formula may be given if
in the U.S. for Infants and Children 0 to 2 Years of not breastfeeding
Age • Vitamin C and iron should be given if taking cow’s
- The World Health Organization (WHO) released a milk before 1 year of age
new international growth standard statistical • Breast-fed infants gain less weight than those
distribution in 2006, which describes the growth who are formula fed
of children ages 0 to 59 months living in Developmental Considerations
environments believed to support what WHO • A normal full-term infant can thrive on breast milk
researchers view as optimal growth of children in or iron-fortified formula exclusively until 4-6
six countries throughout the world, including the months
U.S. The distribution shows how infants and • May be given complex carbohydrates at 2-3
young children grow under these conditions, months
rather than how they grow in environments that • Biting movements begin at approximately 3
may not support optimal growth. months
Growth Parameter Development • Chewing begins at 7-9 months
Weight - Average birth
• Extrusion reflex fades at 3-4 months
weight – 3500
grams Indicators of readiness to Introduction
- First 6 months of Solid Foods
- Average weight • Physical ability to pull food in the mouth rather
gain is 2 lbs/month than always pushing the tongue and food out of
- Doubles birth the mouth
weight at 6 months
• Willingness to participate in the process
- Second 6 months
- Average weight • Ability to sit with support
gain is 1 lb/month • Having head and neck control
- Triples birth weight • Dissatisfaction to intake of more than 32 oz of
at 12 months formula a day
Height - Average birth • Dissatisfaction to every 3-4 hours of nursing
length – 20 inches
- First 6 months -
Techniques For Feeding Solid Foods
increases by 1
inch/month • Introduce one food at a time
- 12 months – • Wait 5-7 days before introducing new item
Increases by 50% • Introduce the food before formula or
breastfeeding
Caloric Requirement • Introduce only small amount of new food (1-2 tsp)
- 1st year of life- 98-108 calories per kilogram of body at a time
weight • Respect food preferences
- Feeding ON DEMAND • Minimize additives like salt or sugar
Age Protein Requirement • Do not initiate feeding until the infant is already
0-6 months 2.2 g per kg per day
4-6 months old
6-12 months 1.56 g per kg per day
• Do not place food in bottles with formula
• Introduce food with a positive attitude
Infant is getting sufficient calories from
• Use dish in feeding commercial baby food
breastfeeding if:
• Baby food jars should be refrigerated once
1) there are 6 or more wet diapers a day
opened
• Do not use food opened 48 hours ago • Begins to
Infant Development and Recommended Foods drink from
cup.
Age (mo) Feeding Skills Foods Introduced 6-10 • Begins to • Begin breads
Into the Diet hold own and cereals
bottle. from table.
0-4 • Turns head • Feed breast
• Reaches for • Begin yogurt.
toward any milk or infant
and grabs • Begin pieces
object that formula.
food and of soft,
brushes
spoon. cooked
cheek.
• Sits vegetables
• Initially
unsupported. and fruit from
swallows
table.
using back of
tongue; • Gradually
gradually begin finely
begins to cut meats,
swallow fish,
using front of casseroles,
tongue as cheese, eggs,
well. and mashed
legumes.
• Strong reflex
(extrusion) to 10-12 • 10 Begins to • Add variety.
push food master • Gradually
out during spoon but increase
first 2-3 still spills portion sizes.
months some.
4-6 • Extrusion • begin iron- Solid Foods to be Introduced
reflex fortified
diminishes, cereal mixed
and the with breast
ability to milk, formula,
swallow or water.
nonliquid • Begin pureed
foods meats,
develops. legumes,
• Indicates vegetables,
desire for and fruits.
food by
opening
mouth and
leaning
forward.
• Indicates
satiety or
disinterest by
turning away
and leaning
back.
• Sit erect with
support at 6 Foods Likely to Cause Allergies
months
• Wheat
• Begins
• Tomatoes
chewing
action. • Orange
• Brings hand • Fish
to mouth. • Egg whites
• Grasp objects
with palm of Foods to Omit
hand.
• Sweets
6-8 • Able to self- • begin
feed finger textured • Canned vegetables
foods. vegetables • Honey and Corn syrup
• Develops and fruits. • gum, hard or gel-type candies
pincher • Begin • Hotdog or sausage slices
(finger to unsweetened, • Large raw apple slices
thumb) diluted fruit
• Marshmallows, nuts, popcorn, raw carrots,
grasp. juices from
cup. raw
 • celery, whole beans, whole cherries, whole • Size
grapes • Metabolism
Weaning • Health
• the process of switching an infant's diet from
breastmilk or formula to other foods and fluids. Guideline for Fat Intake
• May be started at 9 months Age Requirement
• Indicators of Readiness 2-3 years old 30-35%
• Infants drink from cup effectively at 9 months 4-18 25-35%
• Sucking reflex diminishes in intensity from 6-9
months Recommended Dietary Intake for Toddler
• Guidelines • 1,300 kcal/day
o Should be done when infant is not • fats are restricted until age 2
irritable • fats should be 30% of total daily calories after
o Difficult to start during summer age 2
Common Problems During Infancy • increase calcium and phosphorus
• Premature Infants • whole milk until age 2
• Cystic Fibrosis
• Failure to Thrive Guidelines to Prevent Choking
• Galactosemia Do not give children under 4 years old
• Phenylketonuria • Peanuts
• Maple syrup Urine Disease • Grapes
• Hotdogs
Summary • Raw carrots
• The primary food for infants during the first 12 • Hard candy
months is either breast milk or iron-fortified • Thick peanut butter
formula.
• Breastmilk offers immunological protection Parent’s Primary Responsibility
• At about 4-6 months, infants should gradually • To provide nutritious food in a pleasant
begin eating solid foods. setting, and the child’s responsibility is to
• The addition of foods to an infant’s diet should be decide how much food to eat or whether to
governed by three considerations: the infant’s eat
nutrient needs, the infant’s physical readiness to Calorie and Nutrient Needs
handle different forms of foods, and the need to • 6 months = 54 calories per pound of weight
detect and control allergic reactions. • 10 yr. old = 35 calories per pound of weight
• By the time infants are 1 year old, they are • Nutrient need 6 mos.-10 years nutrient needs
drinking from a cup and eating many of the same increases bec. Of the increase in body size.
foods as the rest of the family.
Nutrition during • 1 ml of water for each calorie
Childhood • Fiber needs
TODDLER • After 3 fiber needs “age +5 grams”
Growth Parameter Development • and no more than “age + 10 grams”
Weight • Weight gain – 4-5 FEEDING GUIDELINES
lbs/year • Never provide food for comfort or reward.
• 2 ½ years old – • Eat only at the table and at designated times.
quadruples birth • Give water to drink rather than calorie laden
weight
fruit juice
Height • height increase – 3
inches/year • Eat slowly
• 2 years old- height is • Use the 20 minutes technique if your child
half the expected wants a caloriedense snack.
adult height • Learn to determine whether your child is
really hungry or just bored, tired or lonely.
CHILDHOOD • Make sure your child gets enough sleep (8-10
• Weight gain at 2 y.o. 5 lbs. hours per night).
• Toddler - Language “No” • Change any unhealthy habits you may
• Rule of Thumb –(preschool) 1 tablespoon for each possess.
year of age • Discourage unacceptable behavior (such as
• Snack every 2-3 hours standing at the table or throwing food).
Child calorie needs depends on: • Let young children explore and enjoy food.
• Rate of growth • Don’t force food on children.
• Activity level
 • Provide nutritious foods, and let children
choose which ones, and how much, they will Anorexia nervosa
eat. • It is a psychological disorder more common in
• Limit sweets. women than in men. Irrational fear of being fat
• Don’t turn the dining table into a • It causes the client to drastically reduce calories,
battleground. causing altered metabolism, which results to:
• Never tell a child he cannot have a food o Hair loss
because “he is too fat” o Low blood pressure
• Learn correct portions, even if this means o Weakness
weighing and measuring o Amenorrhea
• Remember, there is nothing a child cannot o Brain damage
eat; its is just how often and how much will be o Even death
consumed of a particular food. • Some may want to resemble slim fashion models
and have a distorted body image
Common Problems During Childhood • These young women usually set a maximum
• Obesity weight for themselves
• Childhood Type 2 Diabetes • and become expert at “counting calories” to
• Osteoporosis maintain their chosen weight
• Cardiovascular Disease • They often exercise excessively to control or
reduce their weight
LESSON 3: TEEN, ADULT, AGING
DIET IN ADOLESCENCE Treatment requires:
• 13-20 YEARS OLD 1. Development of a strong and trusting
• Period of rapid growth relationship between the client and the
• Growth rate 3 inches a year for girl healthcare professionals involved in the case.
• 4 inches for boys 2. That the client learns and accept that weight
• Secondary Sexual Characteristics Development gain and a change in body contours are
Division of Adolescence normal during adolescence.
• Early – 13- 14 years 3. Nutritional therapy so the client will
• Middle – 15-16 years understand the need for both nutrients and
• Late – 17-20 years calories and how best to obtain them.
4. Individual and family counselling so the
Food Habits problem is understood by everyone.
• Boys- enormous appetites 5. Close supervision by the healthcare
professional.
• Prefer to imitate their peers and do what is
6. Time and patience from all involved
popular
Bulimia
• Adolescents’ eating habits can be seriously
• Syndrome in which the client alternately
affected by:
binges and purges by inducing vomiting and
o Busy schedules
using laxatives and diuretics to get rid of
o part time jobs
ingested food they know their binge-purge
o Athletics
syndrome is abnormal but also fear of being
o social activities
overweight
• Lack of an available adult prepare nutritious food
• Bulimic usually binges on “forbidden foods”.
• RECOMMENDED DIETARY INTAKE
• It can irritate the esophagus and cause
o High calories
electrolyte imbalances, malnutrition,
o High-IRON, High-CALCIUM, High-Zinc
dehydration and dental carries
o Glycogen Loading (for athletes)
Treatment:
• FOOD PREFERENCES/PATTERNS
1. Limiting eating to mealtimes
o Prefers fast foods and fad diets
2. Portion control
o Low-Calorie and Starvation Diets
3. Close supervision after meals
COMMON PROBLEMS DURING
4. Teach the client about basic nutritional facts
ADOLESCENT
5. Psychological counselling
• Anorexia Nervosa
Overweight
• Bulimia
• Self-esteem is affected
• Overweight
• Makes an individual prone to overweight as an
• Fast Foods
adult
• Alcohol and other Addictive drugs
• Heredity is believed to play a role
• The health care provider can play an important
role by offering guidance on changing eating
 habits, increasing exercise, and adopting a Side Effects of Nicotine
healthier lifestyle

Fast foods
• These are restaurant foods that are ready to
serve before orders are taken
• It is excessively high in fat and sodium, as well
as calories, and contain only limited amounts
of vitamins and minerals and little fiber.
Alcohol
• Sugars and starches can be changed to
alcohol in a process called fermentation
• It provides 7 calories per gram
• Alcohol initially causes the drinker feel
“happy” but ultimately it is depressant;
continued drinking leads to sleepiness, loss of
consciousness, or death
• Alcoholism – abuse of alcohol
• It affects absorption and normal metabolism
of glucose, fats, proteins, and vitamins
• Leads to cirrhosis, high blood pressure, cancer
of the throat and esophagus, and can damage
the reproductive organs
• It can cause severe economic and family
problems, as well as addiction, disease, and
death

Marijuana (grass, weed, pot, Mary Jane, reefer, bud

ganja and dope)

• Approximately 23% of high school teens uses

marijuana
• Increases appetite, especially for sweets
• 1 marijuana cigarette : 4 or 5 tobacco cigarettes
• Delta-9-tetrahydrocannabinol (THC) – fat soluble
ingredient
• Can lead to the use of other drug such as cocaine

Cocaine
• Highly addictive and extremely harmful
• Crack – smokable form of cocaine
• Causes restlessness, heightened self-confidence,
euphoria, irritability, insomnia, depression,
confusion, hallucinations, loss of appetite,
• Can cause cardiac irregularities, heart attacks,
and cardiac arrest resulting in death

Tobacco
• Cigarette smoking is addictive.
• Teenager smoke to be “cool”, to look older,
because they think it will help them lose weight, Other Addictive Drug
or because of peer pressure. • Methamphetamine – potent form of
• It can influence appetite, nutrition status, and amphetamine
weight • Crank, speed, crystal, meth, zip and ice
• Nicotine the dangerous substance presents in • Causes heart, breathing and blood pressure rates
tobacco to increase
• They need the DRI for Vitamin C plus 35 mg, • The mouth is usually dry, and swallowing is
because smoking alters metabolism. difficult. Urination is also difficult.
• Appetite is depressed
• Pupils are dilated and reflexes speed up
• As the drug wears off, feeling of fatigue or
depression are experienced.
• Inhalants – chemicals whose fumes are inhaled
into the body and produce mind altering effects.
Physically and psychologically addictive.
• Gasoline, lighter fluid, tool cleaning solvents,
model airplane glue, typewriter correction fluid,
permanent ink in felt-tip pens.
• They are at risk for depression and apathy, nose
bleeds, headaches, eye pain, chronic fatigue,
heart failure, loss of muscle control and death

Energy Drink
• Contains stimulant usually caffeine
• Has 80mg of caffeine per 8 oz serving
• Can cause transient rise in blood pressure
• Cause to lose small amount of calcium and
magnesium

DIET DURING YOUNG AND MIDDLE

ADULTHOOD
• Growth is completed at the age of 25 years old
• The iron requirement of female throughout child
bearing years is higher than male
• Protein needs 0.8 gram per kilogram of body
weight
• Ca = 19-50 years old is 1,000mg per day
• Vitamin D = 5 microgram per day
• Calorie requirements begins to diminish after age
25
• The onset of rheumatoid arthritis (RA) usually
occurs between the ages of 30 to 50 and will
affect approximately 1% of the population
women outnumbering men three to one.
• Affects the joints of the fingers, hips, knees,
ankles, elbows, shoulders, and neck
Special considerations
• It is especially important to maintain good eating
habits during young and middle adulthood.
• Women, who may be concerned about weight,
cost of food, or time, can easily develop nutrient
deficiencies.
Protein Requirement after age 65 y.o.
• By far the most effective method of weight loss is
• 1 gram per kilogram of body weight
increased exercise combined with reduced
• Decreased secretion of Hcl and enzymes thus
calories.
decreases intrinsic factor that leads to deficiency
Nutrition in Aging
of vitamin B12
• Gerontology- the study of aging
• Decreased need for iron especially in women
• FACTORS THAT AFFECT AGING
• Caloric requirement decreases by 2-3%
o Heredity
o Nutrition • A client that consumed less than 1,500 calories a
o Lifestyle day needs multivitamin and mineral supplement
o Working conditions Nutrition-related Concerns in older adults:
o Attitudes toward life 1) Alzheimer’s disease
• Can impact nutrition due to impaired
cognition
2) Malnutrition
3) Obesity
• Can be due to buying processed foods
over whole foods due to income level
 4) Frailty
• Diminished strength, endurance, &
physiologic function that increase an
individual’s function that increase an
individual’s vulnerability for developing
dependency
• Leads to negative psychological &
physical outcomes
5) Sarcopenia
• Defined as “loss of muscle mass &
strength”
• Estimated to affect 30% of ppl >60 & affect
more than 50% of those ≥
• i. Related to sedentary lifestyle; less
than optimal diet
• ii. Protein intake can be helpful →
reduce muscle mass loss
• Muscle mass → longevity of life a. Pad
the organs, more mobility, healthy
• the BMR = have adequate proteins
6) Osteopenia
• Lower bone mass → diagnosed prior to
osteoporosis
7) Osteoporosis
• BMD is low → skeleton can’t sustain
ordinary strains
Risk factors:
• Low body weight, petite frame
• Women are more at risk than men

Nutritional therapy
• Calcium & Vitamin D supplementation
o Other bones minerals & collagen
• Adequate protein intake
• Nutrition screening for older adults: - Older
adults at greater risk of consuming an
inadequate are those who are - Less educated
/ low literacy - Live alone
• Residents tend to be frail elderly w/ multiple
diseases & conditions