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), Tolerable
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.

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 Topics (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 Highlights Learning Activities
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 countries.
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 Box, 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 past 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

Chapter 1-3
TEACHING STRATEGIES
Content Focus Content Highlights Learning Activities
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 past several years claiming to
have additional health benefits. Bring some
specific examples to class.
Invite a nutrigeneticist 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 Highlights Learning Activities
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 Highlights Learning Activities
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 risk 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 cooking 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 those presented in Giddens, J. R. (2017). Concepts for nursing practice (2nd ed.). St.
Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically 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
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 questions 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 involved.
5. Describe four mechanisms of nutrient absorption from the small intestine.
6. Describe the function of the large intestine.
7. Identify accessory organs to the digestive system and state their secretions and the functions of the secretions.
8. Describe the role of the nervous system in the digestive process.
9. Relate the gastrointestinal (GI) circulation of fluid to total water balance in the body.
10. State the hormonal stimuli for the various secretions of the GI tract.
11. Discuss the roles of prebiotics and probiotics in GI health.
12. Describe how the body controls blood glucose levels.
13. Describe the body metabolism interrelationships of protein, fat, and carbohydrate.
14. Describe the problem of lactose intolerance and other common digestive problems.
STUDENT RESOURCES
understand  Textbook Chapter 2
 Animations (Evolve website)
o DG001 Overview of the Digestive Tract
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 Highlights Learning Activities
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: Ask students to imagine that they have swallowed a
bead and ask them 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 psychological 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 Highlights Learning Activities
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 Highlights Learning Activities
Esophagus
Entry into 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
INTESTINE): FINAL
ABSORPTION 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 Highlights Learning Activities
Role in Absorption
Role of Colon Microflora
absorption of food. (Refer to Box 2-2.) information about probiotics from reputable Internet 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. Many
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 absorbed.
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 day,
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 gas 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 pylori: Risk Factor for African Americans and Hispanics
NURSING CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2017). Concepts for nursing practice (2nd ed.). St.
Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically 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 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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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 insulin levels.
13. List natural food sources of dietary fiber.
14. Describe the health benefits of functional foods and phytochemicals.
15. Give an overview of digestion, absorption, and metabolism of carbohydrates.
STUDENT 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 Highlights Learning Activities
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 diabetes 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 Highlights Learning Activities
Polysaccharides
alternative sugar options used in foods marketed
for diabetic patients. 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
nonnutritive sweeteners (NNSs). The text
mentions two recently approved NNSs, lo han guo
and stevia. Discuss the available information
about these new NNS options.
 Group Activity: Many consumers are concerned about the health 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 Highlights Learning Activities
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-carbohydrate diets. Discuss how the
reduction of one nutrient may affect the
absorption of 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 website,
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 Highlights Learning Activities
DIGESTION-ABSORPTION-
METABOLISM REVIEW
Digestion
Absorption and
Metabolism
Review the importance of the pancreas and the
small 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 those presented in Giddens, J. R. (2017). Concepts for nursing practice (2nd ed.). St.
Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically 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.

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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 Exemplar: 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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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 Composition Table
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 Highlights Learning Activities
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 items 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 Highlights Learning Activities
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 Versus 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 Box, 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 website 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 Box, 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 Highlights Learning Activities
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 him
maintain a healthy weight, but he’s now almost 40 and his weight has gradually crept up 40 lb in the past 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 gained
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 Culture 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 those presented in Giddens, J. R. (2017). Concepts for nursing practice (2nd ed.). St.
Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically 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 Versus 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 Care Policy, Finance, and Regulatory Environments
o Cis Versus 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 questions 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 Range 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 Highlights Learning Activities
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.
Review 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 Building,
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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